Exactly Why Belly Fat Is Less About Calories + More About Your Hormone Health

Hormonal Belly Fat: What It Is and How to Lose It Dr. Will Cole

What is it about the modern world that has spurred an epidemic of weight gain? The problem is getting more serious by the day; with nearly two-thirds of Americans considered either obese or overweight, our society’s weight problems account for almost 21 percent (1) of all health care costs in the United States. Many people have tried to blame this unfortunate situation on any number of things, from trans fats to high fructose corn syrup to pollution. The real answer is probably “all these things and much more,” but in the meantime, millions of people struggle to lose weight throughout their entire lives, often with little to no success.

We can see evidence of this struggle in the ever-increasing number of fad diets claiming to be the magic solution for all our weight loss troubles. Unfortunately, contrary to what conventional medicine may tell you, weight loss is more than just a matter of “calories in, calories out,” or some other simple trick, and restricting your food intake is not necessarily the key to losing weight. For the majority of people, sustainable weight loss is anything but a simple formula, and there is a reason for that: The human body is complex, and each person is unique.


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Body weight, weight gain, and weight loss are all way more complex than we thought.

Traditionally, it has been a generally accepted belief that weight gain causes health problems, but in my years of clinical experience as a functional medicine practitioner, I have come to believe that weight gain, as well as an inability to lose weight, is often a symptom of an underlying health problem that has yet to be addressed. In other words, a health problem could be causing your weight problems, rather than the other way around. It could be a side effect!

In some ways this is good news because if weight loss doesn’t work, we can come at it from a different angle – the angle of health first. To put it simply: We must get healthy to lose weight, not lose weight to get healthy. With increasing health comes a balanced body, and that is when weight loss may happen on its own, or with just a little help.

The bane of hormonal belly fat

When it comes to stubborn weight loss, one of the biggest complaints I hear about is the expanding waistline, pot belly, beer belly…in short, belly fat. For many people, this is the first area of the body where weight gain shows, and the last place it wants to leave. Unlike subcutaneous fat, which is stored just under the skin (the kind you can pinch), belly fat is most often visceral, located around your midsection all the way inside the abdominal cavity. It feels harder because it is beneath the muscle, rather than on top.

Because of visceral fat’s location closer to (sometimes surrounding) the vital organs of your body, this type of fat greatly increases your risk for serious health problems. Since visceral fat cells are released directly into your blood, they end up making their way into your liver, pancreas, heart, and other vital organs – which is a problem considering these fat cells contain triglycerides that can pump harmful free fatty acids into cells that are not designed to store fat. This can trigger a cascade of health problems, so it’s vitally important to reduce this type of fat as much as possible.

But how do you do lose hormonal belly fat? As I mentioned before, losing weight (especially this type of fat) takes more than just eating like a rabbit and restricting how much food you consume. Remember: With increased health comes a balanced body. Weight gain and the presence of visceral fat are a sign that your system is out of balance, and that can greatly affect how well your body burns fat, specifically hormonal belly fat. One imbalance that is likely to be part of this problem may be hormone imbalance.

Adrenal Stress: Belly Fat’s Root Cause

Your hormones are your body’s chemical messengers, sending instructions from one area to another, to direct metabolic functions. Hormones instruct the organs of the endocrine system – such as your thyroid and adrenal glands – to release more hormones in a complex symphony of metabolic balance. This is why, when one hormone or hormone-producing organ goes awry, it can inhibit the whole process, and since metabolism is directly linked to your body’s ability to use food for fuel, this can send your fat-burning ability into a tailspin. But when it comes to belly fat and visceral fat in particular, after years of studying and clinical experience I have seen one hormone imbalance that is most often to blame: cortisol.

Cortisol is your body’s primary stress hormone. It’s released by your adrenal glands and rises or falls throughout the day, according to your energy needs. It typically starts out high in the morning to help wake you up, and slowly tapers off throughout the day. Your “sleepy time” hormone, melatonin, is inversely proportional to cortisol, starting off low in the morning and increasing in the evening to help you fall asleep. Cortisol imbalances are common and can quickly throw off this natural daily rhythm, so that cortisol is high when it should be low, low when it should be high, or always low, or always high.

Can cortisol give you belly fat? Studies have looked at this relationship between cortisol and weight extensively and have found a significant link between cortisol levels and increased weight, specifically that stubborn hormonal belly fat in both men (2) and women. (3) In fact, one study looked at the cortisol levels of 41 women (4) and found that those with high levels of visceral fat had significantly greater cortisol spikes during times of stress as well as for a full hour after the stressful event had passed. Yikes!

How do I lose my adrenal stress belly fat?

Now that you see why its overall health, and cortisol specifically, that we have to target in order to free our bodies from excess hormonal belly fat, let’s look at the actionable steps we can take to finally achieve health, balance, and sustainable long-term weight loss. Here’s how to get rid of cortisol belly fat.

1. Look into lab tests

Knowledge is power, so the first step I recommend in tackling any sort of health problem is to know where you are, what’s working, and exactly what isn’t. This is the best way to determine the best course of action for you. In my clinic, I run a urine and salivary adrenal fatigue test on patients with weight problems. This test looks at your brain-adrenal function and cortisol patterns throughout the day, so you can see if your cortisol is behaving normally, or not.

2. Tap into the power of adaptogens

Adaptogens are plant and herbal medicines that are rock stars at restoring balance to various areas of the body, especially when stress is causing the imbalances. Some of my favorites for rebalancing your cortisol belly and easing dysfunction of the HPA-axis (the interactions between the hypothalamic, pituitary, and adrenal glands of your endocrine system – key hormone producing organs) are licorice root, (5) ashwagandha, schisandra, (6) and cordyceps. Find these in powdered form and add to your teas, smoothies, or coffee.

3. Give keto a go

This popular diet focuses on a high-fat, moderate-protein, low-carb ratio of macronutrients, with the goal of reaching a state of ketosis. In ketosis, the body uses ketones (by-products of fat burning) instead of glucose for energy. When your body is starved of a glucose source, it turns to fat to produce ketones, and an increasing number of provocative studies are showing that a ketogenic diet can help manage blood sugar, keep metabolism stable, and alleviate HPA-axis dysfunction to help regulate cortisol. If you decide to go keto, I suggest a clean, plant-centric ketogenic diet (rather than one with loads of meat and dairy like the typical conventional keto diet you may have seen on social media). Focus on healthy fats like coconut oil, avocados, and olives, and lots of low-glycemic green vegetables.

4. Manage adrenal stress belly fat’s panic button

You can eat the cleanest, purest, most perfect keto diet and take adaptogens all day long, but if you’re not managing your stress, you cannot manage your stress hormones. A study published in Biological Psychiatry found that chronic stress alone can spike cortisol, (7) slow your metabolism, and increase cravings enough to make you gain up to 11 pounds every year – even without overeating! When you’re stressed, your body holds on to fat as an emergency resource, which can make weight loss feel nearly impossible. Manage the stress, and your body will understand that it’s finally okay to burn that fat for fuel and release you from excess weight for good.

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  1. Cornell University. (2012, April 9). Obesity accounts for 21 percent of U.S. health care costs, study finds. ScienceDaily. Retrieved June 24, 2020 from www.sciencedaily.com/releases/2012/04/120409103247.htm
  2. Wallerius S, Rosmond R, Ljung T, Holm G, Björntorp P. Rise in morning saliva cortisol is associated with abdominal obesity in men: a preliminary report. J Endocrinol Invest. 2003;26(7):616-619. doi:10.1007/BF03347017
  3. Duclos M, Marquez Pereira P, Barat P, Gatta B, Roger P. Increased cortisol bioavailability, abdominal obesity, and the metabolic syndrome in obese women. Obes Res. 2005;13(7):1157-1166. doi:10.1038/oby.2005.137
  4. Moyer AE, Rodin J, Grilo CM, Cummings N, Larson LM, Rebuffé-Scrive M. Stress-induced cortisol response and fat distribution in women. Obes Res. 1994;2(3):255-262. doi:10.1002/j.1550-8528.1994.tb00055.x
  5. Al-Dujaili EA, Kenyon CJ, Nicol MR, Mason JI. Liquorice and glycyrrhetinic acid increase DHEA and deoxycorticosterone levels in vivo and in vitro by inhibiting adrenal SULT2A1 activity. Mol Cell Endocrinol. 2011;336(1-2):102-109. doi:10.1016/j.mce.2010.12.011
  6. Panossian A, Hambardzumyan M, Hovhanissyan A, Wikman G. The adaptogens rhodiola and schizandra modify the response to immobilization stress in rabbits by suppressing the increase of phosphorylated stress-activated protein kinase, nitric oxide and cortisol. Drug Target Insights. 2007;2:39-54.
  7. Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry. 2013;73(9):827-835. doi:10.1016/j.biopsych.2013.01.032

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Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.

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