Question – What is the best approach for me to reduce belly fat for good, considering I have knee pain?

Answer – Three things to clarify first:

  1. Losing belly fat is about changing your diet and reducing stress.
  2. Knee mobility varies a lot, so the solution for activity varies widely.
  3. To be successful in the long run you’ll need to educate yourself.


Physical activity and exercise will do little to remove belly fat (subcutaneous fat, the stuff you can pinch). They are important for health in other ways, and they can help with fat loss by reducing visceral fat, making your muscles more insulin sensitive, improving your mood, and reducing hunger (if done for shorter periods at higher intensity).

Do everything you can NOT to lose your mobility. That means trying different suggestions, trying them again, never giving up. Losing mobility is a downward spiral. So walk, row, swim every week if you can. Strength train 2–3 times each week. If you can’t lunge or squat, work your upper body heavy anyway using seated positions. Try modified leg work.

I have clients with knee problems, but what works is different for each. One can walk but not row. Another can row. None can lunge but one can squat. I’m sure you’ve seen these inspiring memes about guys who’ve lost their legs, but they’re buff and doing pull ups. And any exercise can be modified, so don’t simply give up on it all.

Here’s an introductory all-around work out to do every other day. I suggest this as a baseline on which to build later:

  • 400m run
  • 20 pull ups
  • 20 push ups
  • 20 squats
  • 400m run.

To modify this work out: walk the 800m, do back against the wall squats or tap squats with a bench behind you, do suspension pull ups (TRX) or pull downs with machine or do rows with dumbbells, do push ups from knees or on incline or against a wall. Add reps and distance when you can. Progress the exercises when you can.


But to lose the fat, you must change your eating.

Any plan where you cut calories across the board (calories-in-calories-out, CICO) will not work for two reasons:

  1. You’ll be reducing protein and fat intake along with the reduction in carbohydrates, and this ratio will keep your body preferentially using glucose from carbs for fuel, and when that runs out, your body will break down the amino acids from your muscles for fuel. Yes, maintaining a deficit in calories (which by the way is only a guess about how much you’re actually using each day) will drop weight, but some or even most of that will be lean body mass. That is bad on so many levels. If you’re fat, you already eat more grams of carbohydrates than grams other macronutrients, so your body has upregulated the enzymes to utilize them and store them. Your metabolism won’t, therefore, switch easily to converting the more complex fuel of fat.
  2. Calorie deficits when you rely on carbohydrates for fuel are impossible to maintain. You will be fighting hunger all the time. Carbs stimulate your endorphins. You will be hungry and have cravings. Your body will be malnourished. Deficit diets have only a 5% success rate after a year. Almost all gain back any weight they lost PLUS more (likely since their body has an even lower metabolism with less muscle).

However, if you first train your metabolism to prefer fat as fuel, losing that belly and even maintaining a calorie deficit will be easy. The only way to do this is to reduce carbohydrates (LOW CARB). And by “low carb” I mean you need to eat more grams of fat and protein than carbs EVERY SINGLE DAY. The actual grams of carbs that will upregulate enzymes for fat burning varies by person, so if you’re currently eating 300+ grams daily like many westerners, any dip in that will help. Most who go low carb that I’ve known reduce over time. I’m now eating under 20g daily but started with a target of staying under 100g carbs.

So the actual diet to follow is low-carb. This comes in different forms: ketogenic, paleo, primal, LCHF, carnivore. You can buy a book, join an online menu service, or do it yourself. I did it myself and recommend it because it’s simple: grains and sweet things are not food.

  • Eat only meats, organs, vegetables, nuts, and some fruits.
  • Eat whole foods.
  • Don’t buy premade meals.
  • At restaurants eat only salads, but add meat to it.
  • You may be able to eat dairy, but it’s problematic for many of us—stimulates cravings because it raises a higher insulin response than other kinds of protein.
  • Plenty of water, tea, and coffee.
  • I’ve at times found bulletproof coffee and fat bombs helpful.

Educate yourself

You must read those who have been successful and those who do the science. The forces of business and the government agencies beholden to them are arrayed against you. The low fat, CICO model is based in politics not science, but proponents carry tremendous weight with online resources like Webmd, Livestrong, Mayo, Harvard, and any place with a .gov site. My certifying agency is firmly in the low-fat camp and despite their railing against “extreme” diets and “leaving out whole food groups” like grains as “unhealthy”, their recent nutrition summit is stacked with vegans and vegetarians.

My story is not unique. I did what many have done who went paleo. I lost the fat and then I built the muscle. Started 9 years ago and have never backtracked. It’s not willpower. It’s feeding your body what it needs. There are a few hurdles, but after 3 months, I cleared them (carb “flu”, convenience, peer pressure). The best single source I found to start you is Mark Sisson’s blog Mark’s Daily Apple. He posts everything you need — including the science resources — to achieve success. And you’ll find his forum full of success stories.

One final point: sleep

I have some clients doing everything right but they still have a gut. This is likely related to chronic cortisol release. The mechanism is complex, but suffice to say that if you’re not getting enough sleep, your body will be packing your gut. Sleep is not a time when your body does nothing. It doesn’t move but hormonally it’s very active. It needs sleep to perform functions that will keep you lean!

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