January 30, 2020
The other day I was perusing some popular health and fitness pages on Facebook . One discussion was from a person asking a question about targeting stubborn fat.
The page administrator answered the question this way: "You can't target certain areas of the body. It's simply impossible. The body burns fat from all over. Spot reduction has been proven a myth."
And the truth is? The page administrator is wrong on both accounts. First, you can certainly target stubborn fat, and spot reduction has been proven to occur.
Spot reduction refers to the idea that you can burn fat from a particular area of the body by exercising that area directly. This idea brings back memories of late night infomercials with people bouncing up and down on ab loungers or adducting away with thigh toners.
Ridiculous, right? But you may be surprised to know that in 2007, a study published in the American Journal of Physiology, Endocrinology and Metabolism by Dr. Bente Stallnecht confirmed that spot reduction does indeed occur. In the study, intense localized exercise in one leg burned significantly more fat than in the non-exercised leg.
So, this study answered the question once and for all. Yes, spot reduction does occur. Only one problem: it occurs on such an insignificant scale as to be useless. The amount of extra fat burned from the working leg in this study was like taking a few drops of water out of a lake.
The take home? Spot reduction technically does occur, but at such a marginal level that it's essentially insignificant. I like to say that trying to spot reduce fat with targeted exercise is like trying to change a tire with a pencil. It's practically impossible.
Attacking stubborn fat and spot reduction are two different things. I brought up spot reduction first because it's important to define what we're talking about here. We are not talking about spot reduction. Spot reduction is about exercise alone.
Targeting stubborn fat is about diet, exercise, and supplementation. Spot reduction is essentially impossible. Targeting stubborn fat is not only possible, but probable, if you understand what you're doing.
The first thing to know about stubborn fat is that it is physiologically different than other fat. Stubborn fat has a high density of alpha-receptors compared to betas, is more insulin sensitive, and receives less blood flow than regular fat.
Subcutaneous fat (fat below the skin) is more stubborn than visceral fat (the fat around your organs) or intramuscular fat (the fat in your muscle). The most stubborn areas of fat are the hips, butt, thighs of women, and the love handles on men.
To burn fat you have to release it from a fat cell. That is called lipolysis. That fat then has to be brought to another cell to be burned. This is where blood supply to and from tissues is important. Finally the fat has to get inside a cell and be burned. This last step is called lipid oxidation.
Stubborn fat releases its fat more slowly the non-stubborn fat. This is due to two different types of receptors in fat cells. Your major fat releasing hormones are the catecholamines – norepinephrine and epinephrine to Americans, and noradrenaline and adrenaline to most of the rest of the world.
These hormones bind receptors in fat tissue that send the signal to speed fat release or slow fat release. These receptors are known as alpha and beta-receptors. The betas speed fat release. Think B for beta and burn. The alphas slow fat release. Think A for alpha and anti-burn.
These receptors have this effect largely because they turn on intracellular signaling that either speeds or decreases the activity of hormone sensitive lipase (HSL), the major fat releasing enzyme in the body.
This is all mediated by cyclic AMP (cAMP). So, to beat stubborn fat you'll need to do things that increase the activity of beta-receptors and decrease the activity of alpha-receptors.
The vast majority of fitness and health professionals misunderstand insulin resistance. Most think insulin resistance is all one thing. In reality, insulin sensitivity and resistance is tissue specific. If you're used to thinking about insulin resistance in the typical way you will not understand stubborn fat.
Stubborn fat is more insulin sensitive, meaning it's less insulin resistant than regular fat. The normal action of insulin on fat cells is to decrease the activity of HSL, the major fat releasing enzyme, and increase the activity LPL, the major fat storing enzyme.
So a fat cell that's more insulin resistant stores less fat and releases more of it. A fat cell that's more insulin sensitive stores more fat and releases less of it. Stubborn fat is more insulin sensitive than other fat.
Not only that, but insulin has an effect on the activity of alpha and beta-receptors as well, increasing the relative expression of the alphas compared to the betas. When it comes to stubborn fat, insulin is not your friend for multiple reasons.
Other hormones get in on the action too. Thyroid activity ramps up beta-receptor activity and turns down alpha-receptor activity. Anything that disrupts thyroid function isn't helpful for stubborn fat.
Estrogen increases the activity of alpha-receptors. High estrogen states such as the late follicular phase and the early luteal phase of the female cycle are times during the month when female stubborn body fat is more stubborn.
Another piece to this story is that stubborn fat gets less blood flow, which means even if the fat is released it doesn't get moved out of the area to be burned elsewhere very easily. First off, alpha-receptors impact blood flow too. More alpha-receptors in an area mean less blood supply to that area.
Next, stubborn fat is in areas that are harder for the body to heat up. Saddlebags and love handles are further away from the center of the body and tend to be "colder."
The practicality of this information is limited of course. There are few ways to heat local areas of the body up, but using sauna, hyperthermia baths, massage, high temp workout areas or even those old neoprene ab belts may not have been such a silly idea when looked through this lens.
Whether they can make a real difference I'm not sure, but people have done stranger things in pursuit of stubborn fat loss.
Now that you understand many of the angles involved with stubborn fat, let's talk about the fix. There are three simple steps that are easier said than done:
The more I study the metabolism the more convinced I become that dieting by eating less and exercising more is by far one of the major blocks to permanent change. This is especially true of stubborn fat.
When you follow this method the body engages in severe metabolic compensation. Adaptive thermogenesis is one aspect of this. You eat less and exercise more and your body will make you more hungry, give you less energy, induce insatiable cravings and decrease your resting metabolic rate around 300 calories per day on average.
In other words, your body has primed itself to resist further losses in body fat as well as made it far more likely you'll soon engage in a three month doughnut binge.
And guess where you're more likely to store all the regained fat. You guessed it, the stubborn fat areas you were trying to burn in the first place! So, not only does dieting make you fatter, but it makes stubborn fat more stubborn.
Two of the main ways it does this is through increased insulin sensitivity in stubborn fat tissue and decreased thyroid output which tilts things even more in favor of alpha receptor activity versus beta.
Dieting in the traditional way is a recipe for making stubborn fat more greedy and stingy. Dieting may be making your fat parts fatter.
To stop dieting you simply do one of two things. You either eat less and exercise less (ELEL) or you eat more and exercise more (EMEM). What you don't do is continue eating less and exercising more.
ELEL is an approach where low intensity exercise like walking dominates and only a few sessions of weight training are done during the week. This allows a very low calorie or low carb diet without the compensations created by eating less and exercising more.
A good way to think of this approach is as a 3:2:1 for diet and exercise. Three meals per day, two of them are protein and veggies based, and only one contains starch. This is matched with three rest and recovery activities (like massage, yoga, naps), two traditional weight training workouts, and one hour or more of slow walking on all or most days.
The opposite of ELEL is EMEM. In this approach calories and carb intake are high to fuel lots of intense daily activity through the week.
This is a 3:2:2 approach. Three meals per day, plus two protein based snacks, and two times the starch intake at the first meal after an intense workout. This is matched by three weight workouts, two metabolic conditioning sessions, and two traditional cardio workouts per week.
Both the ELEL and EMEM approach will decrease metabolic compensation, but the EMEM approach is probably the better approach to keep the metabolism humming and stubborn fat burning.
You can't get comfortable with any one system either. The metabolism is highly reactive and adaptive, so while it will compensate much less with an ELEL or EMEM approach, it'll compensate none-the-less.
To circumvent this compensation it's a good idea to cycle the diet in a way that keeps the metabolism guessing. This once again keeps the thyroid activity elevated, keeps leptin levels from dropping too low and keeps insulin sensitivity at a manageable level.
When it comes to calories, hormones, and stubborn fat, you're looking for the Goldilocks effect. Not too much, not too little, but just right. One to two weeks in an ELEL approach followed by one to weeks in an EMEM approach works great.
Women can also time this with their menstrual cycle. The week before and during menses will be the lowest estrogen times, making those pesky alpha-receptors far easier to circumvent.
This would be the time you'd want to alter diet, exercise and lifestyle towards fat loss efforts. This is also a time of increased cravings and hunger for women due to altered brain chemistry that accompanies the hormone changes.
One clinical pearl I can give that almost completely negates this effect is the use of unsweetened baking cocoa powder in water. Cocoa raises dopamine and serotonin, the same brain chemicals that drop around menses.
When we talk about targeting the area we're not talking about exercise, we're talking about timing diet, exercise, and supplementation correctly. When you burn fat, you burn it from all over your body, including your stubborn fat.
It's just that under normal circumstances the stubborn fat burns much more slowly. This is why you can have people getting lean but noticing their lower body fat (women) or love handles (men) seem to not be responding... or even appearing fatter.
This is of course not the case as fat loss is likely occurring in the stubborn zones too. But when the rest of the body is reducing so much faster it creates the illusion that the stubborn areas are worse off.
The first step is to remember that fat loss is about reducing calories and balancing hormones.
You'll need to choose which part of your cycle will put you in the most deficit. You'll use one part of the cycle, I suggest the ELEL, to "starve the fat." Then you'll use the other part of the cycle, I suggest EMEM, to "feed the lean" and protect against metabolic compensation and hormonal changes that make stubborn fat more stubborn.
In addition there are supplements that can help. My two favorites are green tea extract and coleus forskohlii or forskolin (sold as Carbolin-19®). Both of these supplements work on the same cellular messengers that are activated by the catecholamines, only they don't do it by binding alpha and beta-receptors.
This goes a long way to taking the brakes off of stubborn body fat. Keep in mind these work best in lower insulin states.
There are also ways to directly block alpha-receptor activation. This can be done by the use of yohimbine HCL (as contained in Hot-Rox® Extreme), synephrine, and berberine. Yohimbine HCL is probably the best here, but it's best used under fasted exercise conditions and you can develop tolerance to it. It also can be very stimulating. Berberine is an underappreciated insulin reducer and has some weak alpha-receptor blocking effects.
Finally, you certainly can use the ephedrine/caffeine combination with or without aspirin, or clenbuterol if you can find it. As a natural healthcare provider, my bias is against the use of these approaches for safety reasons.
With limited space and complicated mechanisms, here are the main points:
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