In my book, THE BROWN FAT REVOLUTION, I divide the diet and exercise programs into two categories:  pre and post menopause.  Why?  The distribution of fat, fat metabolism, and amount of lean muscle are dramatically affected by menopause (estrogen levels).  It has always intrigued me that diets and exercise programs fail to consider this baseline fact when formulating their programs.  As a plastic surgeon, I am consistently aware of the difference in the quality of the skin, fat and muscle in each decade.  In fact this knowledge determines the nuances of a surgical plan because my result is only as good as the “ingredients” that I start with.  The same holds true for a woman who is planning the most effective exercise and nutrition program seeking a flat belly.

A  WOMAN’S ABDOMEN can be flat at any age but we start by recognizing what lifestyle, genetics, sports history, nutrition, pregnancy history and overall health bring to the table.  Left me distill these multiple factors and generalize per decade.  As I do this, woman will find “aha!” moments in their decade that may allow them to pivot to a more efficient way to achieve that universally desired:  FLAT BELLY!

30’s: In this decade xs fat is more commonly seen in the hips.  I am a strong proponent of CORE training:  Pilates, Yoga, Ball routines and varied core routines can build the PILLAR of the entire body…tight, strong but not bulky and fit.  For those women who desire that “cut” look a cleaner diet is necessary…low carbs….this look is achieved in the kitchen…not only the gym per se….

Of course, if pregnancy occurs, the program should be intensified and occasionally there may be some excess skin once optimal shape and fat volume is achieved..then and only then should a “tuck” be entertained….but this is a rare need if diet and exercise are usednsynergistically after pregnancy…of course, a young woman who comes into pregnancy with a fit abdomen will have a quicker recovery…

40’s: The fat distribution changes to preferentially deposit fat in the flanks (muffin top) and lower abdomen. (below the umbilicus)….exercise should continue as in the 20’s but now focus on more attention to the lower abdomen: the transverses abdomens muscle.  The diet need to be cleaner with less carbs….

50’s: The fat distribution continues to be more prominent in the lower abdomen and flanks…the muscle wall weakness becomes more of an issue in creating that ” middle age” bulge…decreased overall metabolism encourages an increase in visceral fat ( inside the abdomen) causing the bulge below the umbilicus to expand and become more of an issue….so manynwoman know this shape and recognize it as looking matronly….solution:  core routine as previous decades but add intense lower abdominal routine to ab workout and concomitantly take a close look at the carbs and alcohol in the diet…..these calories seem to go directly to the belly in this decade!

60’s: The same changes as the 50’s, but more of a challenge to control visceral fat…so, attention to diet and control of carbs, alcohol, artificial sweeteners, coffee very important….these will all bloat the belly.  Exercise the same as in the previous decade.  I find that women who find fun things to love like ballroom dancing, ballet, tennis….will get a total body workout, core training, improvement in posture and metabolic boost while enjoying themselves while they create youthful, fit, tight bodies with youthful fat distribution ….flat belly, beautiful posture, arms, legs, breasts, neck look better because the HUB of the body is firm….it is a great look….and best achieved proactively….not surgically!


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Have you ever noticed that the same throngs of people are on the cardio deck every day, sweating and working so hard, but that no one’s body looks any different than it did last year?  Why?  Most people engage in robotic cardio. The focus is on duration of time on the machine and not on the choice of machines/resistances/intensities of movement.  What is the goal of cardio:  to lose white fat (and expose their abdominal contour) , build lean muscle (and increase metabolism 24/7 not just right after cardio), change the shape of their bodies (butts, legs  and core) and increase their 1.cardiopulmonary stamina.    Here is how you can use cardio to really work  quickly and efficiently:

1. Most importantly, do your cardio first thing in the morning BEFORE you eat at   least 3 times a week.   Be consistent!

2. Choose a machine that allows you to connect with your body in a non-robotic manner (so that you feel the movement):  treadmill with a sharp incline, bike with high resistance, stairs with resistance….a flat treadmill where you are running is almost ineffectual since your body will just go into automatic pilot and your muscles do not read this as “work.”  Sprint:   go as intensely as you can for as long as you can then go into a cool down pace then repeat the intense run.  Studies have shown a 20 percent increase in fat loss with sprinting.

3. If you do sprint, you can limit cardio to a 20 to 25 minute experience per session.  That is enough!

4. While you are doing the exercise, visualize your tight butt, firm thighs, and firm abdomen and transfer your energy into these parts to consciously work them in the movement.

5. Keep your abdomen tight while doing the exercises, assuming an erect posture with shoulders back. Remember CORE, CORE, CORE and MORE!

6. Use music (an Ipod) to get into a zone of feeling your body and what the muscles are doing with every movement

7.Your post cardio shack should be high in protein….low in carbohydrates

Go ahead and watch the white fat shred off of your body with this regimen!

A Valentine’s Day No Guilt CHOCOLATE: CACAO

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VALENTINE’S DAY is the day set aside, in many countries around the world, to celebrate love, often through the exchange of cards, flowers and, of course, chocolate. How could this feast of CHOCOLATE happen now, only six weeks after all those New Year’s resolutions have just begun to settle in?  A huge day for truffles, and chocolate in the shapes of hearts & kisses, more chocolate is consumed during the Valentine’s Day holiday than at any other time of the year… and most of it the processed kind.  Let me tell you how to keep your New Year’s resolution by eating a healthier kind of chocolate!

I walked into my favorite food museum yesterday, Whole Foods, and was greeted by a cheerful woman standing by a display that featured raw chocolate powder, cacao powder.  Interested in what she had to say, I listened as she extolled the virtues of this delicate Mayan Superfood.  She featured recipes made from this magical powder, one being a chocolate sauce for desserts.  I happily sampled the contents of the little paper cup she handed me, which contained a slice of banana, drizzled with this delectable.  Knowing the benefits of cacao, the chocoholic that I am, I of course, made the purchase.

In my book, THE BROWN FAT REVOLUTION, I recommend to those of us who are true “chocoholics” to take the plunge and just “be done” with the craving.  Get rid of any guilt and celebrate with chocolate, good chocolate.  A holiday level chocolate treat contains about 250 calories, certainly, not enough to throw everything off kilter.  I assure you, there will be no metabolic catastrophe and you will continue to shed that soft, yellow fat, once you resume your diet and exercise program. I always kept a stash of dark chocolate in my freezer as the “grab of choice” in a pinch.  I now consume an even smarter choice,  a more pure kind of chocolate, which is made with raw cacao powder.

 Unlike popular commercial chocolate, which is processed, raw cacao consists of an abundance of healthy antioxidants that are preserved through the benefit of the cacao not being heated.  Many of the health beneficial flavinoids are not compromised by the process of cooking  the chocolate.  Pure raw cacao will not cause insulin spikes that are sometimes cited as a cause of overeating and weight gain.

In my book THE BROWN FAT REVOLUTION, I explain how “sugars and sweets produce, as you know, a rapid elevation of glucose into the blood.  Insulin then spikes to normalize your blood sugar and move the glucose into your tissues.  IF the glycogen stores there are already full, it’s already on its way to becoming yellow fat.  The most effective approach is to avoid sugars …”.  Further, “if there’s no sugar there, there is no glucose to shunt to your tissues.  Instead, because there’s an insulin spike but no real sugar to manage, your body will tip into hypoglycemia (low blood sugar).  In fact, after the high peak is reached, your insulin usually drops lower than what it was prior to the spike.  This makes you very hungry.  It’s a gain-weight situation.”

Good chocolate has a lot going for it, and for you! Studies have shown that it does not cause acne, nor does it increase dental cavities or cause diabetes.  It is a super antioxidant. It is actually touted as having 2X the antioxidants of red wine, 3X the antioxidants of green tea.

Heart Health: It dilates the blood vessels, improves circulation, helps to regulate blood pressure, and lowers LDL, or the bad cholesterol.  It contains oleic acid a heart-healthy  monounsaturated fat that is said to raise HDL, or the good cholesterol.

Mood Health:   It raises the level of Serotonin, thus acting as an anti-depressant. It helps reduce symptoms of PMS. It simulates the secretion of endorphins, giving way to the feeling of pleasure and well being

Skin Health: It is rich antioxidant properties laden with vitamins and minerals, such as magnesium, Vitamins B1, B2, C,D & E

The TAKE AWAY is to dig in and enjoy!  Choose unsweetened dark chocolate or cacao.  Either way, it will be a healthy treat, helpful to your well-being.  Eat good chocolate and have just a little bit more of it!

Brown fat in the news

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Brown fat is becoming a hot topic in the news. Check out these articles:

“Brown Fat, Triggered by Cold or Exercise, May Yield a Key to Weight Control.” The New York Times, 01/24/12 Read

“Brown Fat Furnishes Physiological Furnace.” Scientific American (podcast), 1/25/12  Read/Listen

“How Now, Brown Fat? Scientist Are Onto a New Way to Lose Weight.” TIME, 01/26/12  Read

“Brown Fat – Keeps You Warm And Keeps You Slim.” Medical News Today, 01/25/12 Read

“Brown fat could explain why some stay toasty in the cold.” CTV Edmonton, 01/24/12  Read

“Swimming with Brown Fat,” SwimmingWorld, 01/25/12 Read

“How does brown fat differ from the other fat in your body?  ShareCare, answered by Dr. Michael Roizen  Read 

Thanksgiving Traditions

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I remember Thanksgiving, 15 years  ago as a pivotal holiday in the usual conflict of how to handle food when you are trying to lose weight.   I was eating very cleanly to lose fat and gain muscle:  small portions, multiple well-spaced  meals  which were  high in protein and low in carbs, no sugar, no desserts, and no alcohol.  I had been on this regimen for about 3 months.   On that Thanksgiving Day, I thought, “Make it your ‘cheat day.” Turkey, stuffing, white potatoes smothered in gravy, sweet potatoes, turnips, cranberry sauce, string beans, apple pie, pumpkin pie, and mince pie filled my plate as it had on every Thanksgiving.  About 2 hours after my meal, I had abdominal cramps, felt dizzy, cold sweats… like I had been poisoned.  Actually, I had poisoned myself by the volume of fatty food and sugar . I did not realize that  my body was in a delicate nutritional balance after  only  3 months of eating healthfully.  The large volume of carbs and sugar cause a monumental insulin spike which precipitated a rebound hypoglycemia which occasioned my symptoms. That said, Thanksgiving is defined by food, tradition and family. This is not the day to deprive yourself.  My advice for all of you who are on the Brown Fat Diet or eating well:  enjoy the holiday.  But take care to go slowly and eat small portions.

McDonald’s, Government, or Parents?

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I have spent 30 years studying the habits that allow people to over eat, become fat, stay fat, and falter at repeated diets.  The present issue of the government controlling the McDonald’s happy meals is ridiculous at several levels.  First,  why should the government get involved in this?  We have a free enterprise system and last I noticed Americans were still allowed to make their own decisions as to what they want to eat.   So, politically, I see legal control of human behavior  as a very dangerous step…. a slippery slope that  feels “socialistic.”   The responsibility of teaching children about nutrition is NOT that of McDonald”s nor the government but of the parent(s).  Children cannot drive to McDonald’s.  They do not have the money to pay for a meal.  The parents do!   The subliminal messages they absorb from watching their parents’ behavior is much stronger than that of an occasional commercial on TV.

I agree that these meals and most fast food is unhealthy (from a “fat” perspective) and may be a major contributor to the obesity problem in America.  However, if parents took the time to have healthy choices available,  to teach good nutrition habits by their own behavior, this would be a non-issue.  The operative word here is time.   Time to plan, shop and prepare food.  Since the key to a healthy body is good nutrition, it is definitely worth it to invest this time. BTW an occasional treat of a Happy Meal in a child who knows good nutrition with a toy is perfectly OK!    In my books, THE BROWN FAT REVOLUTION and LOSE THE FAT LOSE THE YEARS, I recommend an occasional “cheat” meal so that a sense of deprivation is avoided.

The government cannot dictate what our choices are.  It is the parental responsibility to teach “body respect”  and the importance of nutrition.   Ironically, like alcohol and drugs, creating a forbidden McDonald’s Happy Meal might make it more inviting…. what a paradox!  Michelle Obama has declared “Childhood Obesity”as the centerpiece of her First Lady platform.  I wonder how /if this dictum to control McD’s little meal is connected.   It appears to me that the PR buzz of laws to control the little box is more enticing to a publicist than a McDonald’s Happy Meal is to a child!

Plastic Surgery Then and Now

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I have been in practice for 28 years and have seen a 180 degree change in the specialty of Plastic Surgery.    In 2010,  the term “Plastic Surgery” clearly misrepresents the specialty.   A better umbrella to cover all of the techniques now available to rejuvenate the face and body would be “cosmetic medicine.”    Not “cosmetic surgery”  but  “cosmetic medicine”  I  prefer the use of the term medicine. It underscores the multilayered approach that a good plastic surgeon takes to a patients chief complaint.  My first consideration after good general health is the nutritional investment each patient has in themselves.  Proactive involvement in the process of looking better/younger is mandatory! Are they overweight?  Have they made a commitment to their body by  eating what is natural and healthy.   Do they exercise regularly?  Are they psychologically stable?  Are the expectations appropriate for the selected procedure?  Can they  really afford the procedure without undue financial stress?   Only after considering all of these issues, should the “cosmetic medical” plan be “prescribed.”  It might be Botox in one patient, laser lipo in another  and a facelift in another, but at the end of the day, each case is customized.

The Brain and Body Image

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You might find this hard to believe but after 28 years of morphing my patients bodies with plastic surgical procedures and 20 years of an avid interest in body building, I continue to be perplexed on how people perceive their physical appearance, their body image.  I continue to study neurobiology since it is clear to me that the answer to most issues that seem so illogical is found in the uncontrollable and unpredictable chemical reactions in the brain.    The study of Neurobiology has  clearly improved my understanding of body image more than all of my experience in dealing with patients and friends who are devoted to “controlling” their images/bodies.  Basically, our brains are  hard-wired to see  shapes and contours.  These are stored in our brains.   Once registered , it is difficult to change  neural “impressions” or brain memory  despite a change in appearance that is clearly seen with the eyes.  Basically, the objective reality of the body is only processed by the eyes, and delivered to the brain for perception.  This is a pivotal mechanism in understanding the lack of positive feedback in some people who have lost significant weight,  or had extensive plastic surgery, or  dramatically changed their bodies with exercise/diet regimens.  I  now understand the genesis of the problem.  Modifying the brain is another issue!


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It may seem evident to most that losing weight and looking younger are complimentary.  This is not usually the case in folks who lose weight with non-nutritional restrictive diets.  In The Brown Fat Revolution and Lose the Fat/Lose the Years, I make the case for eating well AND losing weight so that all tissues are rejuvenated.   Once  nutritional discipline sets in, why not seize the opportunity to not only achieve optimal weight but to restore your skin, muscles, bones and fat to look, feel and act younger?  All it takes is  attention to the  “natural” quality of what you eat.  So simple, yet so rewarding!  Your body needs fat  “on it” to look young.  It is the fat that creates the “volumes” of youth that we see in a young woman’s body and face.  But it must be high quality, well nourished fat that hugs the underlying bones and supports the overlying skin creating the three dimensional contours of youth.  Just as you can change your skin to look younger with stress control, diet, exercise and topical care….you can modify the quality of your fat with nutrition and exercise and look younger!

People ask me what I eat to maintain consistently low body fat. I refer them to The Brown Fat Revolution diet section. I have been eating according to this plan for 9 years and my total body fat varies from 7 to 9 percent. For me, it is not about cardio but diet. ABS are made in the kitchen!