Can low carb cause central adiposity?

This is mostly a post of a personal nature, but I thought I would put it here on the science side of things because I'll try to tie observations and anecdotes in with some scientific backing/references.

Personal background for my interest in this:  

As a child I had a rather boyish body until around age 12 or so.  At that age my shape (butt and thighs) started coming out (not fat though), but I was a rather late bloomer.  I didn't gain my "puberty weight" until I was 16 or so -- perhaps 20 lbs -- again mostly in my butt/thighs.  Anyone remember Tracey Gold from Growing Pains?  That would be pretty close (pre-anorexia) to my shape.  I lost the weight then yo-yo'd most of my 20's on various diet plans (none of which were low carb).  Although cycling as high as the 200-210 range and as low as 145 during that time, my general body type did not change.  I would always gain or lose weight mostly in my butt/thighs only getting the back and belly bulges at top weights.  My midriff was always  one of my better assets at the bottom of weight swings.  Probably TMI, but my breast size pretty much went up and down about 1.5 cupsize with weight/size.  In 1997 my weight hit up against an all time high and I was wearing 16's.  Well dressed at my high weight I was Delta Burke-ish.

It was then I discovered Atkins and, coupled with a very active job, I lost 40 lbs in a few months getting down to size 8 jeans.  This was the beginning of my body shape transformation.  I lost proportionally more weight in my thighs this time, but not in my waist.  This time tummy weight either remained or perhaps even shifted.  When I went off LC I regained weight rapidly and blew right on through my former upper limit.  I gained it everywhere, but most prominently in the belly like I never had before.  One more cycle of loss and regain a few years later and let's just say that my belly stuck out considerably more than my 40/42D+'s!!  You know, all my life I had difficulty finding clothing that fit at any weight -- my waist was disproportionately small compared to my thighs.  Pants that fit my thighs gapped at the waist.  And when I was heavier, it got worse as larger sizes, especially true plus sizes, tended to just get bigger in the waist.   But since that first low carb weight LOSS, pants have fit me better at every size.  Sometimes I even had extra room in the seat!

This body type was not only foreign to me, but in the past I could always write my weight off as not particularly unhealthy b/c I carried most of it well below the waist.  Now, I carried it around the middle and upper arms and less so proportionally in legs and backside.  Today, after losing the weight I fit (even too big) pants I wore 15 years ago when I weighed some 40 lbs less.  My chest size has gone down from the 40-42 mark to a 36, but I still must shop the "full cut" lines for D cups.  Fifteen years ago when I wore the aforementioned pants I was a 34C in a regular cut.

So, why am I telling you all this info?  Because this is one of my root causes for concern over the healthfulness of LC eating.  Today, the largest remaining fat "depots" are my belly, breasts, and upper arms (although that seems to be more skin).  I wonder over the hormonal implications of having larger breasts when I'm now officially menopausal.  And I worry over my central "obesity" although somewhat comforted that it appears to still be sub-Q vs. visceral.  I don't know if I'm some sort of odd-ball in this regard, but even if so, is this seemingly permanent shift in my fat distribution dangerous, benign or even beneficial?  

In this regard, I've looked to some of the women in the low carb community.  How are they looking after years of low carbing?  I was not encouraged.  Back in early 2009 I came across some pictures of Laura Dolson, Dr. Mary Vernon and Dana Carpender.  All overweight or downright obese.  Although I've never seen the pictures, in their recent book,  MD Eades developed a belly despite low carbing requiring a 6 Week "Cure".  A cruise through various LC forums and blogs will unearth numerous success stories with either stalling out 20+ lbs north of goal and/or weight regain.

Recently I came across some more recent pics of Dana from Jimmy Moore's 2010 Low Carb Cruise, and thought to myself that these were comforting.  I chanced by her blog, read back a bit, and noted that she's now at a low weight for herself and wearing size 10/12's.  Her book was about a 40 lb weight loss on low carb, but she's blogged over the years about weight fluctuations.  In any case, I was flabbergasted when she posted some gymsuit pictures of herself on her new blog:  My Total Gym Transformation.  Kudos to Dana for her honesty in posting these.  But yikes!  If this is the result of 15 years of "fighting the low fat lie" and eating low carb, am I the only one for whom the side pics registered cause for concern?

And then I look at Jimmy Moore.  Obviously not a woman, but a long term low carber who has been steadily gaining weight (and having only short-term success to date at losing it) for almost 3 years now.  One can look at pictures from Jan 2010 here and here.  Now it is difficult w/o seeing pics of his original weight loss progression, but when I look at the before/afters, on his various websites, at over 400 lbs Jimmy seemed to distribute his weight fairly well around his body.  Sure, he had a belly, but in this pic of Jimmy +30 from low weight at 260 lbs, despite remaining rather consistently low carb, one can see where he's gaining ... and the 2010 pics seem to indicate most of it is going to the worst place from a health perspective.

Now I've hesitated making this post as I don't want to be seen as picking on or criticizing these nice folks, but if we can't scrutinize LC "celebs" and look to them for long term prospects, who can we look to?  In the end my thinking is that they "put it out there" so I'm not out of line commenting here in my little ol' blog.

Considering all of the information I've gathered on the etiology of insulin resistance, I think the above may well be two examples of how long term low carbing can increase insulin resistance and perhaps body fat distribution that may be influenced by whatever few carbs one might consume.  I also consider that the extreme carnivore wing of the LC community tends to be the only ones that get truly lean.  My thoughts on this are that they are probably very insulin resistant but it doesn't lead to overt problems because they eat essentially no carbs so their body's inability to handle them normally is not challenged.  It is also very difficult to overconsume on meats, especially when dairy is omitted or extremely limited.

From a recently referenced article:

VAT may influence central SCAT
Mauriege et al found that adrenoreceptor sensitivity was increased in SCAT cells of individuals who have a higher VAT accumulation compared to those with a low VAT deposition [112]. SCAT adipocytes from women with visceral obesity exhibit higher lipolysis rates in vitro than those obtained from women with little VAT [113]. Mauriege et al also demonstrated that among men with high levels of VAT, SCAT adipocytes are more sensitive to β-adrenergic lipolysis which may further exacerbate an impaired insulin action, a potentially important factor in the etiology of metabolic syndrome associated with visceral obesity [112]. Moreover, an increased truncal SCAT mass and an increased amount of VAT mass can independently predict insulin resistance [114]. Together, these findings support that VAT may enhance central SCAT lipolysis and accelerate release of peripheral FFAs.
So the fact that at least a goodly portion of my trunk fat appears to be SCAT, this may indicate excess VAT. The measurements in the Eades recent book offer me little insight into the matter.  Another way to read this is that the trunk fat is an indicator of a degree of IR independent of whether or not my VAT is out of whack.
Later in this same article estrogen is discussed:
Estrogen promotes the accumulation of peripheral gluteo-femoral SCAT, which may be protective [131]. The abundant presence of peripheral fat mass in generally obese women is associated with increased plasma adiponectin, and the loss of estrogen with menopause is associated with an increase in central fat [132]. This accounts for the progression in many overweight women after menopause from a predominantly pear-shape or "gynoid" habitus to the apple or "android" shape. Contrary to popular belief, menopause does not seem to independently cause a gain in total body weight; the increases in BMI that often accompany menopause are usually consistent with normal aging [133]. However, even without weight gain, body fat distribution changes; postmenopausal obese women tend to accumulate abdominal fat along with deterioration of risk factors, even if total body weight and BMI do not change during menopause transition.
After menopause, when ovarian function declines, adipocytes become the primary source of endogenous estrogens [134], and compared to "gynoid" or pear-shaped women, those with central obesity (apple- or "android-" shaped) have lower plasma SHBG and higher estradiol [125,135]. This suggests regional differences in the enzymatic conversion of steroid hormones in VAT versus SCAT [125,136-138]. In ovarian hormone-deficient women, SCAT adipocyte size, lipoprotein lipase (LPL) activity, and basal lipolysis were not found to be significantly greater compared to regularly cycling premenopausal women. However, in the ovarian hormone-deficient women, omental (VAT) adipocyte size was significantly higher, and the omental/SCAT LPL activity ratio and VAT lipolysis were also significantly higher [139]. 
Perhaps my belly is now the inevitable result of my "change of life".  But I am a bit young to have gone through all of this.   I wonder sometimes if LC didn't perhaps accelerate this by influencing estrogen rather than vice versa?  I suppose I'll never know.  But it is worth repeating that the first shift in fat distribution occurred in my early 30's during weight LOSS through low carb.

I would appreciate any input from other (particularly female) low carbers if they have experienced similar as well as any thoughts on whether or not I should be concerned by this as much as I am.


James Krieger said…
Here's a relevant animal study that was just published:

Of course, I don't know if rat models are the best models for looking at long-term effects of LC diets, but the results do fall in line with your thinking...insulin resistance over the long term, and greater hepatic lipid content
James Krieger said…
In the clinic that I used to do research for, we had so many people come in that had used Atkins in the past and lost a lot of weight...only to regain it ALL and gain more on top of that. This would match up with some of your anecdotal observations here.
James Krieger said…
Here's a relevant paper that was just published:

While I'm not sure rat models are the best models for looking at the long-term effects of LC dieting, the results do confirm your speculation here.
CarbSane said…
Harumph! Maybe I'm a Sprague Dawley rat :)

Interesting study, thanks for the link James!

The regain bounce was the reason I had to find a different way this time. Whether or not I ever lose another pound, I REFUSE to regain. Massive weight swings are not healthy for anyone, but I'm convinced that LC rollercoastering is more unhealthy because of the insulin resistance "hangover".
Layla said…
I know that this is an old article, but I recently discovered your blog and I found this article particularly interesting.

Now, I am no one to talk, since I've been on the Atkins diet for just 1 year now, but I have really only lost weight around my waist and boobs (boobs go on any diet)

measurements before Atkins:
184 lbs
waist: 33 inches
Hips: 40 inches
chest (w/o boobs): 37 inches

Now, after 1 year on Atkins:
152 - 155 lbs (I seem to retain some water nowadays)
waist: 28 inches
Hips: 39 inches
Chest (w/o boobs): 33 inches

So, i have definitely lost the most around my waist, which is a first for me, because my waist has always been the last part of my body to drop inches. My calves shrunk about 1 inch and my thighs have always been rather thin, maybe I lost 1 inch there as well, if not less.

So, I can't say that your theory applies to me personally, although I'm only 25, that probably also counts for something.

As for eating carbs: Sometimes I eat a potato or two, I have even had a slice of baguette and immediately my previous problems returned: extreme thirst, bloaty hands and feet, stomach/intestinal pains and an overall feeling of extreme discomfort. But I really can't say they are worse than before Atkins, just more noticeable because I'm not used to feeling like that anymore.

I hope this is helpful, somehow :)