By Dr. Alan C. Logan, ND, FRSH

French physician Jean Vague is generally credited with being the first scientist to make strong connections between abdominal obesity and the risk of chronic diseases. Since his original work some 50 years ago, the research has piled up and now there are some clear relationships between abdominal fat and chronic disease. The risk of type 2 diabetes and cardiovascular disease are now known to be significantly greater in those with a large waist circumference. In fact, waist circumference is now being recognized as a much more accurate means to establish risk of chronic disease in those carrying excess weight. Study after study shows that waist circumference is more closely related to cardiovascular disease and diabetes than is body mass index (BMI = weight in Kg divided by height in meters²). Neurodegenerative diseases such as Alzheimer’s and other dementias and even psychiatric conditions such as depression, schizophrenia and anxiety disorders are associated with a greater waist circumference. Waist circumference is also associated with various types of cancer.

Why is the location of fat so important when it comes to its relationship to disease? Although multiple factors are involved, the stress hormone cortisol may be a key player. Animal and human studies show that excessive levels of blood cortisol promote insulin resistance and a propensity to gain weight in the abdominal region. When patients with high cortisol undergo interventions to reduce cortisol, there is generally a significant decrease in intra-abdominal fat stores. Cortisol increases the activity of an enzyme responsible for laying down fat. The enzyme in question - lipoprotein lipase has the potential to significantly promote abdominal weight gain because the enzyme activity is 2 - 4 times more concentrated within abdominal fat stores vs. other areas. Abdominal fat cells themselves secrete inflammatory chemicals called cytokines and generate free radicals. The combination of inflammation and oxidative stress is likely the main reason why elevated abdominal fat storage is connected to many chronic diseases. Higher waist circumference is associated with lower blood levels of antioxidants, not because the diet is any different, likely because antioxidants are used up more readily to combat the increased free radical production.

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Stress management, mind-body medicine and healthy dietary habits are critically important in keeping abdominal fat in check. Stress promotes unhealthy dietary choices which include high fat and high sugar items. This combination of saturated fat and sugar is a recipe for disaster when it comes to abdominal fat. Remember that saturated fats as found in butter, cream, milk, ice cream, and meats are preferentially stored in the abdominal region, and once there, they are difficult to mobilize. In contrast, fish, canola, and olive oils are more likely to be stored within lean muscle areas, and are more readily mobilized for use as energy.

Don’t look for the infomercial supplement products to keep cortisol in check - there is no scientific evidence that these over-the-counter “cortisol-blocking” remedies are of value in obesity. Only 2 ingredients have been shown to have significant value in decreasing waist circumference in human weight loss studies – green tea (particularly the EGCG catechin within green tea) and conjugated linoleic acid (CLA). Human research in the American Journal of Clinical Nutrition showed that green tea rich in catechins (natural plant chemicals in the polyphenol family) reduced abdominal fat by 26cm² in overweight adults. This supports other human research showing that green tea increases the use of fat as an energy source and decreases waist circumference. CLA has also been shown to decrease waist circumference in overweight males. The doses used in the clinical studies are often not reflected in commercially available products, abs+ made by Genuine Health is an exception. Recently abs+ was the subject of a successful human weight loss study at the University of Toronto.

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