Fire­fighter try­ing to lose ex­cess pounds in chest and stom­ach

Sherbrooke Record - - LOCAL SPORTS - ASK THE DOC­TORS By Robert Ash­ley, M.D.

I’m a fire­fighter and in pretty good phys­i­cal shape, even though I have Type 1 di­a­betes — but my body doesn’t show it. Specif­i­cally, I have flabby abs and man boobs. I walk, run, do push-ups and crunches, and I think I eat pretty well. What else can I do?

First, I have some ques­tions for you: How long has this been go­ing on? Is the fat around the belly some­thing new or some­thing grad­ual over many years? Is the gy­neco­mas­tia (“man boobs”) some­thing you have been deal­ing with since ado­les­cence, or is it some­thing you have only no­ticed re­cently?

Let us be­gin with gy­neco­mas­tia. Gy­neco­mas­tia oc­curs in ado­les­cence due to a rel­a­tive im­bal­ance of es­tro­gen and testos­terone. The rel­a­tively el­e­vated lev­els of es­tro­gen com­pared to testos­terone stim­u­late breast tis­sue in ado­les­cent boys, lead­ing to breast en­large­ment. The ma­jor­ity of ado­les­cent boys will lose this breast tis­sue, but in 20 per­cent the en­larged breast tis­sue will per­sist into adult­hood. In adult men, some es­tro­gen is pro­duced di­rectly by the testes, but most is pro­duced from the break­down of testos­terone and the adrenal hor­mone an­drostene­dione. As in ado­les­cent boys, adult men can de­velop gy­neco­mas­tia if there is an im­bal­ance be­tween es­tro­gen and testos­terone lev­els.

Then, of course, there’s obe­sity, which leads to in­creased fat in breast tis­sue. This can give the ap­pear­ance of in­creased breast tis­sue, which is termed pseudo-gy­neco­mas­tia. Be­cause the fat in the breast tis­sue car­ries the en­zyme that con­verts testos­terone and an­drostene­dione to es­tro­gen, breast fat may ac­tu­ally in­crease es­tro­gen lev­els and stim­u­late the for­ma­tion of breast glands.

Be­cause breast fat and the fat in your ab­domen are re­lated, the fun­da­men­tal ques­tion is likely: Why are you stor­ing fat?

First, blame the di­a­betes — and the con­nec­tion be­tween the dis­ease and your diet. As a Type 1 di­a­betic, you’ve prob­a­bly been on in­sulin for many years. In­sulin in­hibits the break­down of fat, but also stim­u­lates the cre­ation of fat. The higher your body’s in­sulin level, the more your body will store fat. The more in­sulin you in­ject, the more fat you will store.

The higher your calo­rie in­take and the higher your car­bo­hy­drate in­take, the more in­sulin you will re­quire to keep your blood sugar low. This will lead to a greater stor­age of fat. Look for foods that are low in glycemic in­dex, mean­ing low in the food’s abil­ity to raise the blood sugar. Avoid high-sugar foods such as cook­ies, can­dies, cakes, so­das, ice cream and juices. These foods may no longer be part of your diet. But if they still are, and if your sin­cere de­sire is to re­move the fat from your body, then elim­i­nat­ing these foods will help. I would also rec­om­mend lim­it­ing the amount of high-glycemic car­bo­hy­drates, such as bread, pasta, rice, corn and pota­toes. In­creas­ing fiber in your diet will also de­crease your in­sulin re­quire­ments.

Then there’s aer­o­bic ex­er­cise. Walk­ing, run­ning, bik­ing, rollerblad­ing, hik­ing, swim­ming, us­ing an el­lip­ti­cal ma­chine — all of these will help you lose and main­tain a lower weight.

Of course, even with a good diet and ex­er­cise, you may have difficulty to­tally los­ing this un­wanted fat. The im­por­tant point is to be pa­tient, dili­gent and more ob­ses­sive about your diet. This will de­crease your in­sulin re­quire­ments, help con­trol your di­a­betes and help you lose the fat.

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