October 6, 2023 • 28 mins
Prepare yourself for a fascinating exploration into the depths of body fat and its varying health implications. We promise you'll walk away with a new comprehension of fat distribution and how it can impact your life. Not all fat is equal; differences abound between abdominal visceral, ectopic, and subcutaneous fat. We navigate these variations and their unique health implications, shedding light on why abdominal visceral fat can be particularly harmful.
What if you could reduce abdominal visceral fat and ectopic fat stores with simple dietary adjustments? And what if these changes could minimize your need for conventional health care? This episode is a treasure trove of vital information around this subject. We delve into the tragic health implications of weight and muscle loss due to calorie reduction and discuss the best ways to maintain a healthier balance. In a deep dive into ectopic fat, we examine how its accumulation in organs can cause severe health complications.
Brace yourself for a groundbreaking revelation: the key to controlling your health and appearance lies in the right combination of diet, nutrients, and supplements. We passionately share how a strategic blend of these can help you reduce abdominal visceral fat, subcutaneous fat, and increase lean muscle mass. Join us in our movement of self-empowerment and health to minimize your need for conventional health care. Get ready to revolutionize your understanding of body fat and its profound implications on your health.
For BiotiQuest probiotics including Sugar Shift, go here.
A 15% discount is available for Defiant Health podcast listeners by entering discount code UNDOC15 (case-sensitive) at checkout.*
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Get your 15% Paleovalley discount on fermented grass-fed beef sticks, Bone Broth Collagen, low-carb snack bars and other high-quality organic foods here.*
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*Dr. Davis and his staff are financially compensated for promoting BiotiQuest and Paleovalley products.
Books:
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
William Davis, MD (00:06):
It's a simple fact.
Not all body fat is the same,that is, there are differences
in the kinds of fat you have inyour body.
Of course, fat can be a goodthing, as it is a form of energy
storage that your body canaccess during periods of food
deprivation or extended physicalexertion.
The problem in the modern world, of course, is that most of us
(00:27):
have now developed excess fat.
The most problematic forms offat in the human body are
abdominal, visceral fat, that is, fat that encircles the
abdominal organs that you cannotsee from the outside, and, more
recently, ectopic fat Fat thatinvolves organs such as the
heart, knees, pancreas, withunique health implications
(00:49):
beyond that of abdominalvisceral fat.
This is in contrast toso-called subcutaneous fat or
the fat found in the buttocks,thighs, calves, arms, etc.
That it has little healthimplications beyond stress on
weight-bearing joints and, ofcourse, aesthetics.
So in this episode of DefiantHealth, let's focus on abdominal
(01:11):
, visceral and ectopic fat, thentalk about what you can do to
erase the excess health problemsassociated with these forms of
fat.
Later in the podcast, let'stalk about Defiant Health's
sponsors that include PaleoValley, who provides fermented
grass-fed beef sticks, bonebroth, protein rich in collagen,
organic supergreens andlow-carb superfood bars and now
(01:35):
100% grass-fed and finishedpastured meats.
And Biotiquest, who providesunique probiotics such as sugar
shift to support healthy bloodsugars and simple slumber to
assist in obtaining healthysleep probiotics crafted with
the unique property of combiningsynergistic microbes.
It's no news to anyone, butbeing overweight, increased
(02:00):
weight, has become a majorproblem both in the US as well
as worldwide, but it's alsotaught us some new lessons about
being overweight.
You've likely noticed thatdifferent people gain weight in
different ways.
This has led to such labels asthe apple shape or pear shape
apple being weight that isgained in the abdomen.
(02:20):
Pear shape weight being gainedin the buttocks and thighs.
That is, lower body.
Also, labels like Android, onceagain the abdominal fat type of
pattern and Gynoid fat in thebuttocks and thighs.
This suggests that men tend todevelop this Android type of fat
, while women tend to developthis Gynoid.
(02:40):
That's a generalization.
That's not always true, but itcan sometimes be true, the point
being different people gainweight in different ways,
storing fat in different bodyparts.
It's also become clear that fatin certain locations is far more
important for health than fatin other locations, specifically
, fat in the abdomen, that is,fat that surrounds the abdominal
(03:02):
organs such as the intestines,liver and pancreas, has greater
health implications than fatthat's in the so-called
subcutaneous area, that is, thefat just below the skin surface,
so-called subcutaneous fat,that's the fat you tend to
accumulate in your buttocks,thighs, calves, arms and chest.
That has far less healthimplications.
(03:23):
Yes, it's not an aestheticallyappealing location, perhaps, and
it does add to stress on weightbearing joints, but it doesn't
have the same metaboliccomplications that abdominal
visceral fat has.
Because abdominal visceral fatis unique, it's different.
It is inflamed itself.
That is, if you looked atabdominal visceral fat, you
would see it is itself inflamed.
(03:44):
It's filled with white bloodcells reflecting inflammation.
Abdominal visceral fat also isa factory, a producer of
inflammatory cytokines orinflammatory mediators that
enter the bloodstream, such asvarious interleukins and tumor
necrosis factor alpha.
These are inflammatorymediators that export
inflammation from the abdominalvisceral fat to other parts of
(04:06):
the body, and it has numerousimplications for increased risk
for heart disease, dementia andcognitive impairment, breast
cancer, hypertension, type 2diabetes and numerous other
conditions.
Abdominal visceral fat is alsothe source for insulin
resistance, that is, your body'sinability to respond to insulin
(04:27):
.
So muscle, brain, liver don'tproperly respond to insulin, so
your pancreas compensates byproducing massive amounts of
insulin 10 times more, 30 timesmore, 100 times more insulin.
That degree of insulinresistance causes weight gain.
So it's a vicious cycle.
Abdominal visceral fat leads toinsulin resistance.
(04:48):
Insulin resistance causes anexpansion of abdominal visceral
fat and the increase in insulin.
Insulin resistance also leadsto all those health conditions,
increased risk for all thosehealth conditions like heart
disease, dementia and breastcancer.
For many years the prevailingway to assess someone's weight
was to use body mass indexer, orBMI, that is, body surface area
(05:10):
divided by weight, andsemi-arbitrary cutoffs were
established, such as 25, a BMIof 25, or lower being normal, 25
to 30, being overweight, above30, obese, above 40, super obese
.
The problem with BMI is that itassumes that fat is distributed
uniformly throughout the body,which of course is not true.
(05:30):
So BMI is kind of falling awayas the leading way to assess the
implications of beingoverweight.
Various other measures haveemerged, such as waist hip ratio
or a simple waist circumference, but the same problem applies
here these measures cannotdistinguish subcutaneous from
visceral fat.
So if you were to measure yourwaistline, for instance, you
(05:51):
can't tell if your waistline islarge.
You can't tell that fat is inthe subcutaneous compartment
that is below the skin orwhether it's in the abdominal
cavity surrounding abdominalorgans, thereby causing
body-wide inflammation andinsulin resistance.
You just can't tell thedifference.
So some of the more importantinsights into fat distribution
(06:12):
subcutaneous versus subdominalvisceral has come from
cross-sectional CAT scans, ctscans and MRI, typically
performed at the fourth or fifthlumbar vertebra level, and then
the area of visceral fat can becalculated.
And the area of subcutaneouscan be calculated, because those
appear very distinctly indifferent locations, by
(06:33):
cross-sectional CT or MRI.
And these measurements havemade it crystal clear that the
source of health problems is notsubcutaneous fat but abdominal
visceral fat.
By the way, improvements havebeen made in so-called
bioimpedance devices.
These are scales that measureyour weight and then break down
fat weight, muscle weight, andsome devices have added a
(06:55):
visceral fat calculation.
Unfortunately we're stillwaiting for validation of those
measures.
It's not quite clear howaccurate they are, but know that
some devices are able to add avisceral fat calculation.
Another recent development thathas appeared on the scene
because of the increasing weightgain by Americans is the idea
of ectopic fat, that is, thebody essentially runs out of
(07:17):
places to store fat and so itstarts to deposit excess fat
into various organs that includethe heart, so-called
epichartial fat, the pancreas,kidney, liver and even joints,
and in each of these instancesthat fat deposited in those
specific organs carriesadditional health implications
beyond that of just abdominalvisceral fat.
(07:39):
For instance, epichartial fatis fat that occurs on the
surface of the heart, that canbe seen on an echocardiogram as
well as CT and MRI, and that fatinflames the coronary arteries
and that increases risk forheart attack even more so than
just abdominal visceral fat.
That epichartial fat alsoimpairs the heart muscle, the
(07:59):
left ventricle.
It can weaken and cause changesin the heart muscle and can
lead to something calledcardiomyopathy that is, impaired
heart muscle performance, whichis a very serious issue.
So that's epichartial fat,pancreatic fat, that is, fat and
pancreas damages the beta cellsthat produce insulin.
It can lead a type 2 diabeticto becoming a type 1 diabetic.
(08:19):
Fat in the kidney impairskidney function and can lead to
kidney disease.
Fat in the liver of courseleads to cirrhosis over time,
which is a very seriouscondition.
Fat in joints, especially theknee, can cause knee pain that
mimics arthritis and alsoaccelerates arthritis, because
that fat in the knee spaceamplifies inflammation that
damages joint cartilage andaccelerates the development of
(08:43):
arthritis.
Ectopic fat can also accumulatein muscle, where it impairs
strength and contraction and canaccelerate the path to such
things as frailty, weakness,falls and fractures and loss of
independence.
To understand all these issues,it helps to remind yourself
that fat consists oftriglycerides, that is, the fat
(09:03):
in fat cells are triglycerides.
But don't think that eating fatwill raise triglycerides.
It does so only transiently andonly to a modest degree.
The real source oftriglycerides, that is,
triglycerides that are in thebloodstream and then stored in
fat cells, is the liver.
The human liver has an enormouscapacity for producing
triglycerides, and it does sofrom carbohydrates,
(09:26):
carbohydrates and sugars.
So whenever you eat grains,wheat and grains that contain
the amylopectin A carbohydrate,or you consume sugars, whether
it's sucrose, glucose orfructose, the liver is very good
at converting thosecarbohydrates and sugars to
triglycerides.
Now, triglycerides cannot floatfreely in the bloodstream
(09:47):
because the blood is an aqueousor water-based environment, and
fats like triglycerides cannotfloat freely because they would
coalesce and occlude arteriesand cause damage.
And so the only way thattriglycerides can float in the
bloodstream is if they'reattached to a water-soluble
protein or a collection ofproteins.
That's why triglycerides occurin the bloodstream as
(10:10):
lipoproteins, fat-carryingproteins, but specifically very
low-density lipoproteins, orVLDL, recall that fat is very
low density and that's why oilfloats on top of water in your
salad dressing, and so whentriglycerides are in the
bloodstream, they occur as thevery low density lipoproteins.
Vldl particles then deliverthese triglycerides to fat cells
(10:32):
as well as, by the way, causingcoronary disease.
Vldl particles are a directcause for coronary disease, but
VLDL delivers triglycerides toyour fat cells.
Fat cells also delivertriglycerides into VLDL
particles and other lipoproteins, and so the triglyceride level
in your bloodstream is a veryhandy index of how much visceral
(10:52):
fat you have.
The higher your triglycerides,the more it reflects an increase
in visceral fat stores as wellas ectopic fat stores.
For this reason, someresearchers have suggested that
we label people with largerwaistlines hypertriglyceridemic
waist, and some people haveidentified an increase in waist
circumference of 33 inches ormore in females, 35 inches or
(11:15):
more in males.
That corresponds to fastingtriglycerides of 133 milligrams
per deciliter in females, 177 inmales.
I think this is wrong.
I think this dramaticallyunderestimates visceral fat and
it's implications.
So I would not use thosecutoffs because, for instance,
if you had a waist of 32 inchesas a female and a fasting
(11:39):
triglyceride level of 120, bothbelow those cutoffs, you can
still have tons of abdominalvisceral fat inflammation,
insulin resistance.
So I think those kinds ofmeasures are just too lax.
They underestimate the severityof abdominal fat and
implications.
As you can see, it's not an easything to really know how much
abdominal visceral fat you haveIf you use a bioimpedance device
(12:01):
.
Maybe it's accurate, maybe it'snot.
We need better validation.
No one's going to getcross-sectional CT or MRI and
most of the places that do thesetests do not have the software
to make these calculations.
So we're kind of left into darkwith crude measures such as
waist circumference and BMI, butwe don't have cutoffs to tell
us exactly where you're safe.
(12:22):
I can tell you, however, that ifwe subscribe to this idea that
fasting triglyceride bloodlevels are an easy and
accessible index of visceral fat, I would aim for a fasting
triglyceride level of 60milligrams per deciliter or less
, because that's the level atwhich virtually all the
phenomena of those who haveabdominal visceral fat are
(12:43):
minimized or completely gone,and you'll see this reflected in
addition to the lowtriglyceride level.
You'll see this as excellent.
Fasting glucose of no more than90 milligrams per deciliter.
Low fasting insulin of no morethan four micro units per liter.
Higher HDL typically above 60milligrams per deciliter,
minimization of small alleleparticles, lower blood pressure,
(13:06):
lower C-reactive protein andother measures.
In other words, use thattriglyceride level fasting
triglyceride level as your index.
That's the best way to trackthe implications of excess
abdominal visceral fat.
Now, maybe in future thosebio-impedance devices become
validated againstcross-sectional CT and MRI.
Maybe we can use the visceralfat calculation as a handy index
(13:26):
.
But until then, the bestmeasure of whether you have too
much abdominal visceral fat andthereby implications for your
health is to look at yourfasting triglyceride level.
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So we've established that thesource of most of the problems
in people who are overweight orobese is abdominal visceral fat
(16:41):
and ectopic fat.
Not so much subcutaneous fat,but something that occurs in
parallel is loss of muscle,insulin resistance and
inflammation that arisesprincipally from abdominal
visceral fat also degradesmuscle and reduces strength.
It's also not uncommon to havemuscle actually infiltrated by
(17:02):
fat, so-called myosteatosis.
People are often told, in orderto reduce fat, to cut their
calories, move more, eat less ortake a pharmacologic agent to
lose weight, like the GLP-1agonist, such as Wegovy or
Ozempic, or even undergo abariatric procedure, such as
LAPBand or other means ofreducing stomach volume, such as
(17:24):
gastric bypass.
These are all variations on thesame theme.
They're all reductions incalories and we know with good
evidence.
We know with confidence thatany method of weight loss or fat
loss that involves reducingcalories leads to muscle loss,
inevitable muscle loss.
About 25 to 30% of all weightlost is muscle.
(17:47):
So if you lost 30 pounds, say,maybe you paid $15,000 for one
of those drugs over a year'stime and lose 30 pounds.
Of those 30 pounds, about 10pounds is muscle and muscle is
the principal determinant ofyour basal metabolic rate, or
BMR.
That's the rate of calorie burn.
(18:07):
You have just to maintain thework of living, to breathe, to
digest foods, to walk about, tosleep, all the things that
require some amount of energy.
That contributes to your basalmetabolic rate.
Where your basal metabolic ratedrops 15, 20, 25% when you lose
weight by reducing calories,regardless of the method used to
(18:29):
reduce calories, that means,let's say, you stop the drug
after a year because most peoplecan't afford the 12 to $1,500
per month for that drug.
They stop the drug and theyregain 24 to 27 pounds.
Most of it is fat, much of it inthe abdomen, and you are more
insulin resistant, more inflamed, have higher blood sugars, have
(18:50):
greater insulin resistance.
You are higher at risk forheart disease, dementia,
cognitive impairment, breastcancer, type 2 diabetes,
hypertension and otherconditions driven by both
insulin resistance andinflammation.
You're worse off at the endthan you were at the beginning
and your abdominal visceral fatand perhaps ecopic fat have
(19:11):
expanded despite what you wentthrough.
So you can see that cuttingcalories, regardless of the
method, is an awful way to tryto gain control over this whole
process.
What's a better way?
Well, those of you who've beenfollowing these conversations
know that my programs are meantare designed to reduce abdominal
visceral fat.
Don't worry about thesubcutaneous fat, that will
(19:33):
follow, but it's the abdominalvisceral fat that drives insulin
resistance and inflammationthat when addressed first.
You reduce abdominal visceralfat and ectopic fat stores and
the subcutaneous fat will follow.
So focus on getting rid of theabdominal visceral fat.
We do that by avoiding the foods, eliminating the foods that
(19:55):
raise blood sugar and insulin,because when you raise blood
sugar and insulin, it causesinsulin resistance.
So the worst foods for raisingblood sugar and insulin wheat,
grains and sugar.
We take them out.
Now, a corollary to this is wealso reject the idea of
producing fat intake.
We take all the fat you wanthalf bacon, add butter to your
(20:16):
foods, use coconut milk, use allthe extra virgin olive oil you
want, buy fatty cuts of meat,eat the fat and, if you're so
inclined, buy organ meats.
The dietary changes alone arehuge.
We tend to gravitate towardsunprocessed foods rather than
processed foods.
Processed foods just have toomany landmines of additives like
(20:36):
food preservatives, coloringsand synthetic sweeteners that
also impact on weight anddisrupt your microbiome, and so
we go for unprocessed foods,foods in their natural state,
such as an avocado, an egg, asteak, a piece of salmon,
spinach, but not box dried,prepared, microwavable foods.
We also restore nutrients thatare lacking in modern life, that
(21:01):
, when restored, they synergizeto further reduce insulin
resistance and inflammation.
Very simply, vitamin D,magnesium, omega-3 fatty acids
that can only come from fish oil, not from any other source, and
iodine to address your thyroidstatus.
Lastly, we take basic steps tobring back order into your
(21:22):
disrupted microbiome,gastrointestinal microbiome.
Fortunately, everybody has hadmassive disruptions of their
gastrointestinal microbiome dueto such factors as repeated
exposure to antibiotics,glyphosate, the herbicide that
is also an antibiotic,preservatives, emulsifying
agents in ice cream, saladdressing, other common foods,
stomach acid blocking drugs,non-steroidal anti-inflammatory
(21:44):
drugs, other drugs.
In other words, many factorshave disrupted the
gastrointestinal microbiome andpart of the effect is weight
gain because a disruptedmicrobiome leads to insulin
resistance.
So we take basic steps torestore a healthier microbiome.
We avoid all those things thatdisrupted it.
Like we minimize our exposureto antibiotics.
(22:05):
We avoid foods that havepesticides and herbicides and
choose organic instead.
Filter our drinking water,avoid processed foods with all
those additives.
We also add back fermented foodsso easy and so delicious and so
much better for you, in thatfermentation of, say, vegetables
, mobilizes many of thenutrients and make them more
(22:27):
bioavailable to you, includingvitamin C and phytonutrients.
So we ferment tomatoes andcucumbers, we could call it
sauerkraut, we could call itkimchi, kefiers, yogurts or just
veggies.
You ferment on your kitchencounter, so easy to do.
If you don't know what I'mtalking about, see my other
podcast, see my DR DavisInfinite Health dot com blog, or
(22:49):
see the many recipes I'veposted in the inner circle
within the DR Davis InfiniteHealth dot com website.
Or, of course, see my super gutbook that has lots of recipes
on fermenting foods.
Or see my friend Donna Schwankswebsite, cultured Food for Life
, and she's got tons offermented food recipes.
Fermented foods are importantbecause the microbes that
(23:11):
ferment food don't actually takeup residence in the GI tract.
They support the proliferationof truly healthy species,
species like acrimacia andfecalobacterium.
So you eat fermented foods richin fermenting species like
pediacoccus and leuconostoc.
They don't take up residence.
They feed and encourage healthymicrobes like those ones I
(23:32):
mentioned acrimacia,fecalobacterium and plenty of
others.
We also ferment specifickeystone microbes like
lactobacillus reuteri andlactobacillus gasseri and others
, and we can also choose thosemicrobes to achieve specific
effects.
If you want smoother skin andbetter sleep, let's ferment
lactobacillus reuteri.
If you want to have a healthierchild at birth, let's ferment
(23:56):
bifidobacteria infantis.
The child has less bowelmovements, less diaper change
from mom and dad, more likely tosleep through the night and has
better neurological maturationand a higher IQ.
If you want to have betterimmunity, let's ferment
lactobacillus casei.
If you don't know what I'mtalking about, once again refer
to those resources, especiallythe SuperGut book, my
(24:17):
DrDavisInfiniteHealth.
com inner circle, for therecipes and how to restore those
keystone microbes.
Many people think that taking acommercial probiotic alone is
all you need to do.
That's not true.
Commercial probiotics can behelpful, especially if one has
collection microbes that aresynergistic, such as the
BioDiquest Sugar Shift product afull disclosure.
(24:38):
They're sponsor of this podcastbut I also do believe in their
products because they werecrafted by a microbiologist who
paid attention to metabolitesshared by various microbes in a
synergistic fashion.
So that's a good choice, butyou need to do more than that.
Now in my programs we go evenfarther.
So just the basic programs,that is, the diet, the nutrients
(25:00):
that synergize to minimizeinsulin resistance and
inflammation and your efforts torecultivate a healthy GI
microbiome.
Those alone are very powerful,but we can go even further.
We restore factors largely lostfrom modern diets.
So because we were told,wrongly, that we need to avoid
fat and saturated fat to reducecardiovascular risk which is
(25:21):
complete, utter nonsense therenever was any evidence to that
effect.
There was very poor studiesconducted in the 1950s and 1960s
before clinical trial designwas understood, and there since
have been other trials that showthat limiting saturated fat and
total fat does not reducecardiovascular risk.
In fact, it disrupts things.
It causes a rise intriglycerides, it causes a rise
(25:44):
in donovus or fat hypertension,c-reactive protein, all the
things you're seeing that peoplearound you.
This is largely a product ofmisguided dietary guidelines,
dietary advice.
So we're going to do theopposite.
We don't limit fat, we eat nowheat, grains or sugars, we
avoid processed foods and we addback factors lacking because
the mistaken notion of cuttingfat in the diet, two of the most
(26:06):
important collagen andhyaluronic acid.
Now, if you were to go back toold ways and when you killed an
animal and ate its brain, tongue, heart, liver, kidneys, stomach
, intestines, skin, etc.
You would get tons of collagenand hyaluronic acid, and both
collagen and hyaluronic acid addto the loss of abdominal
(26:30):
visceral fat and the increase inmuscle.
Now put all this together thediet nutrients, the efforts at
correcting your microbiomerestoration, especially
lactobacillus rotari andlactobacillus gasari.
Combined with these missingnutrients, collagen, peptides
and hyaluronic acid, thecombination is extremely
(26:52):
powerful for losing abdominalvisceral fat, followed of course
, by subcutaneous fat, and forincrease, restoration or
increase of lean muscle mass.
What this does is puts you incontrol over the way you look,
the way you feel, how young youlook and feel.
In other words, it doesn'tleave you unhealthy and helpless
(27:15):
like conventional efforts do,such as pharmaceuticals and
bariatric procedures or simplycutting calories in your diet.
Now, if you want to know thedetails on how to do all this
with dose of college, and whatform is best, what form of
hyaluronic acid, details of thediet, these are in all my books,
of course, from the wheat bellybooks, especially the revised
expanded edition, also in theSuper Gut book, as well as my
(27:38):
drdavisinfinitehealthcom website, especially the Inner Circle,
which isa membership website,where we have two-way
discussions, typically once aweek for a couple of hours.
There's also this podcast, ofcourse, and my blog that has
several thousand posts on it,several thousand articles.
I have drdavisinfinitehealthcomblog.
Now, if you learned somethingfrom this episode of the Defiant
(27:59):
Health podcast, I invite you totell your friends.
Post your review, join themovement of self-empowerment and
health to minimize your needfor the exploitative products
and services of conventionalhealth care.
Thanks for listening.
It's a simple fact.
Not all body fat is the same,that is, there are differences
in the kinds of fat you have inyour body.
Of course, fat can be a goodthing, as it is a form of energy
storage that your body canaccess during periods of food
deprivation or extended physicalexertion.
The problem in the modern world, of course, is that most of us
(00:27):
have now developed excess fat.
The most problematic forms offat in the human body are
abdominal, visceral fat, that is, fat that encircles the
abdominal organs that you cannotsee from the outside, and, more
recently, ectopic fat Fat thatinvolves organs such as the
heart, knees, pancreas, withunique health implications
(00:49):
beyond that of abdominalvisceral fat.
This is in contrast toso-called subcutaneous fat or
the fat found in the buttocks,thighs, calves, arms, etc.
That it has little healthimplications beyond stress on
weight-bearing joints and, ofcourse, aesthetics.
So in this episode of DefiantHealth, let's focus on abdominal
(01:11):
, visceral and ectopic fat, thentalk about what you can do to
erase the excess health problemsassociated with these forms of
fat.
Later in the podcast, let'stalk about Defiant Health's
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It's no news to anyone, butbeing overweight, increased
(02:00):
weight, has become a majorproblem both in the US as well
as worldwide, but it's alsotaught us some new lessons about
being overweight.
You've likely noticed thatdifferent people gain weight in
different ways.
This has led to such labels asthe apple shape or pear shape
apple being weight that isgained in the abdomen.
(02:20):
Pear shape weight being gainedin the buttocks and thighs.
That is, lower body.
Also, labels like Android, onceagain the abdominal fat type of
pattern and Gynoid fat in thebuttocks and thighs.
This suggests that men tend todevelop this Android type of fat
, while women tend to developthis Gynoid.
(02:40):
That's a generalization.
That's not always true, but itcan sometimes be true, the point
being different people gainweight in different ways,
storing fat in different bodyparts.
It's also become clear that fatin certain locations is far more
important for health than fatin other locations, specifically
, fat in the abdomen, that is,fat that surrounds the abdominal
(03:02):
organs such as the intestines,liver and pancreas, has greater
health implications than fatthat's in the so-called
subcutaneous area, that is, thefat just below the skin surface,
so-called subcutaneous fat,that's the fat you tend to
accumulate in your buttocks,thighs, calves, arms and chest.
That has far less healthimplications.
(03:23):
Yes, it's not an aestheticallyappealing location, perhaps, and
it does add to stress on weightbearing joints, but it doesn't
have the same metaboliccomplications that abdominal
visceral fat has.
Because abdominal visceral fatis unique, it's different.
It is inflamed itself.
That is, if you looked atabdominal visceral fat, you
would see it is itself inflamed.
(03:44):
It's filled with white bloodcells reflecting inflammation.
Abdominal visceral fat also isa factory, a producer of
inflammatory cytokines orinflammatory mediators that
enter the bloodstream, such asvarious interleukins and tumor
necrosis factor alpha.
These are inflammatorymediators that export
inflammation from the abdominalvisceral fat to other parts of
(04:06):
the body, and it has numerousimplications for increased risk
for heart disease, dementia andcognitive impairment, breast
cancer, hypertension, type 2diabetes and numerous other
conditions.
Abdominal visceral fat is alsothe source for insulin
resistance, that is, your body'sinability to respond to insulin
(04:27):
.
So muscle, brain, liver don'tproperly respond to insulin, so
your pancreas compensates byproducing massive amounts of
insulin 10 times more, 30 timesmore, 100 times more insulin.
That degree of insulinresistance causes weight gain.
So it's a vicious cycle.
Abdominal visceral fat leads toinsulin resistance.
(04:48):
Insulin resistance causes anexpansion of abdominal visceral
fat and the increase in insulin.
Insulin resistance also leadsto all those health conditions,
increased risk for all thosehealth conditions like heart
disease, dementia and breastcancer.
For many years the prevailingway to assess someone's weight
was to use body mass indexer, orBMI, that is, body surface area
(05:10):
divided by weight, andsemi-arbitrary cutoffs were
established, such as 25, a BMIof 25, or lower being normal, 25
to 30, being overweight, above30, obese, above 40, super obese
.
The problem with BMI is that itassumes that fat is distributed
uniformly throughout the body,which of course is not true.
(05:30):
So BMI is kind of falling awayas the leading way to assess the
implications of beingoverweight.
Various other measures haveemerged, such as waist hip ratio
or a simple waist circumference, but the same problem applies
here these measures cannotdistinguish subcutaneous from
visceral fat.
So if you were to measure yourwaistline, for instance, you
(05:51):
can't tell if your waistline islarge.
You can't tell that fat is inthe subcutaneous compartment
that is below the skin orwhether it's in the abdominal
cavity surrounding abdominalorgans, thereby causing
body-wide inflammation andinsulin resistance.
You just can't tell thedifference.
So some of the more importantinsights into fat distribution
(06:12):
subcutaneous versus subdominalvisceral has come from
cross-sectional CAT scans, ctscans and MRI, typically
performed at the fourth or fifthlumbar vertebra level, and then
the area of visceral fat can becalculated.
And the area of subcutaneouscan be calculated, because those
appear very distinctly indifferent locations, by
(06:33):
cross-sectional CT or MRI.
And these measurements havemade it crystal clear that the
source of health problems is notsubcutaneous fat but abdominal
visceral fat.
By the way, improvements havebeen made in so-called
bioimpedance devices.
These are scales that measureyour weight and then break down
fat weight, muscle weight, andsome devices have added a
(06:55):
visceral fat calculation.
Unfortunately we're stillwaiting for validation of those
measures.
It's not quite clear howaccurate they are, but know that
some devices are able to add avisceral fat calculation.
Another recent development thathas appeared on the scene
because of the increasing weightgain by Americans is the idea
of ectopic fat, that is, thebody essentially runs out of
(07:17):
places to store fat and so itstarts to deposit excess fat
into various organs that includethe heart, so-called
epichartial fat, the pancreas,kidney, liver and even joints,
and in each of these instancesthat fat deposited in those
specific organs carriesadditional health implications
beyond that of just abdominalvisceral fat.
(07:39):
For instance, epichartial fatis fat that occurs on the
surface of the heart, that canbe seen on an echocardiogram as
well as CT and MRI, and that fatinflames the coronary arteries
and that increases risk forheart attack even more so than
just abdominal visceral fat.
That epichartial fat alsoimpairs the heart muscle, the
(07:59):
left ventricle.
It can weaken and cause changesin the heart muscle and can
lead to something calledcardiomyopathy that is, impaired
heart muscle performance, whichis a very serious issue.
So that's epichartial fat,pancreatic fat, that is, fat and
pancreas damages the beta cellsthat produce insulin.
It can lead a type 2 diabeticto becoming a type 1 diabetic.
(08:19):
Fat in the kidney impairskidney function and can lead to
kidney disease.
Fat in the liver of courseleads to cirrhosis over time,
which is a very seriouscondition.
Fat in joints, especially theknee, can cause knee pain that
mimics arthritis and alsoaccelerates arthritis, because
that fat in the knee spaceamplifies inflammation that
damages joint cartilage andaccelerates the development of
(08:43):
arthritis.
Ectopic fat can also accumulatein muscle, where it impairs
strength and contraction and canaccelerate the path to such
things as frailty, weakness,falls and fractures and loss of
independence.
To understand all these issues,it helps to remind yourself
that fat consists oftriglycerides, that is, the fat
(09:03):
in fat cells are triglycerides.
But don't think that eating fatwill raise triglycerides.
It does so only transiently andonly to a modest degree.
The real source oftriglycerides, that is,
triglycerides that are in thebloodstream and then stored in
fat cells, is the liver.
The human liver has an enormouscapacity for producing
triglycerides, and it does sofrom carbohydrates,
(09:26):
carbohydrates and sugars.
So whenever you eat grains,wheat and grains that contain
the amylopectin A carbohydrate,or you consume sugars, whether
it's sucrose, glucose orfructose, the liver is very good
at converting thosecarbohydrates and sugars to
triglycerides.
Now, triglycerides cannot floatfreely in the bloodstream
(09:47):
because the blood is an aqueousor water-based environment, and
fats like triglycerides cannotfloat freely because they would
coalesce and occlude arteriesand cause damage.
And so the only way thattriglycerides can float in the
bloodstream is if they'reattached to a water-soluble
protein or a collection ofproteins.
That's why triglycerides occurin the bloodstream as
(10:10):
lipoproteins, fat-carryingproteins, but specifically very
low-density lipoproteins, orVLDL, recall that fat is very
low density and that's why oilfloats on top of water in your
salad dressing, and so whentriglycerides are in the
bloodstream, they occur as thevery low density lipoproteins.
Vldl particles then deliverthese triglycerides to fat cells
(10:32):
as well as, by the way, causingcoronary disease.
Vldl particles are a directcause for coronary disease, but
VLDL delivers triglycerides toyour fat cells.
Fat cells also delivertriglycerides into VLDL
particles and other lipoproteins, and so the triglyceride level
in your bloodstream is a veryhandy index of how much visceral
(10:52):
fat you have.
The higher your triglycerides,the more it reflects an increase
in visceral fat stores as wellas ectopic fat stores.
For this reason, someresearchers have suggested that
we label people with largerwaistlines hypertriglyceridemic
waist, and some people haveidentified an increase in waist
circumference of 33 inches ormore in females, 35 inches or
(11:15):
more in males.
That corresponds to fastingtriglycerides of 133 milligrams
per deciliter in females, 177 inmales.
I think this is wrong.
I think this dramaticallyunderestimates visceral fat and
it's implications.
So I would not use thosecutoffs because, for instance,
if you had a waist of 32 inchesas a female and a fasting
(11:39):
triglyceride level of 120, bothbelow those cutoffs, you can
still have tons of abdominalvisceral fat inflammation,
insulin resistance.
So I think those kinds ofmeasures are just too lax.
They underestimate the severityof abdominal fat and
implications.
As you can see, it's not an easything to really know how much
abdominal visceral fat you haveIf you use a bioimpedance device
(12:01):
.
Maybe it's accurate, maybe it'snot.
We need better validation.
No one's going to getcross-sectional CT or MRI and
most of the places that do thesetests do not have the software
to make these calculations.
So we're kind of left into darkwith crude measures such as
waist circumference and BMI, butwe don't have cutoffs to tell
us exactly where you're safe.
(12:22):
I can tell you, however, that ifwe subscribe to this idea that
fasting triglyceride bloodlevels are an easy and
accessible index of visceral fat, I would aim for a fasting
triglyceride level of 60milligrams per deciliter or less
, because that's the level atwhich virtually all the
phenomena of those who haveabdominal visceral fat are
(12:43):
minimized or completely gone,and you'll see this reflected in
addition to the lowtriglyceride level.
You'll see this as excellent.
Fasting glucose of no more than90 milligrams per deciliter.
Low fasting insulin of no morethan four micro units per liter.
Higher HDL typically above 60milligrams per deciliter,
minimization of small alleleparticles, lower blood pressure,
(13:06):
lower C-reactive protein andother measures.
In other words, use thattriglyceride level fasting
triglyceride level as your index.
That's the best way to trackthe implications of excess
abdominal visceral fat.
Now, maybe in future thosebio-impedance devices become
validated againstcross-sectional CT and MRI.
Maybe we can use the visceralfat calculation as a handy index
(13:26):
.
But until then, the bestmeasure of whether you have too
much abdominal visceral fat andthereby implications for your
health is to look at yourfasting triglyceride level.
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So we've established that thesource of most of the problems
in people who are overweight orobese is abdominal visceral fat
(16:41):
and ectopic fat.
Not so much subcutaneous fat,but something that occurs in
parallel is loss of muscle,insulin resistance and
inflammation that arisesprincipally from abdominal
visceral fat also degradesmuscle and reduces strength.
It's also not uncommon to havemuscle actually infiltrated by
(17:02):
fat, so-called myosteatosis.
People are often told, in orderto reduce fat, to cut their
calories, move more, eat less ortake a pharmacologic agent to
lose weight, like the GLP-1agonist, such as Wegovy or
Ozempic, or even undergo abariatric procedure, such as
LAPBand or other means ofreducing stomach volume, such as
(17:24):
gastric bypass.
These are all variations on thesame theme.
They're all reductions incalories and we know with good
evidence.
We know with confidence thatany method of weight loss or fat
loss that involves reducingcalories leads to muscle loss,
inevitable muscle loss.
About 25 to 30% of all weightlost is muscle.
(17:47):
So if you lost 30 pounds, say,maybe you paid $15,000 for one
of those drugs over a year'stime and lose 30 pounds.
Of those 30 pounds, about 10pounds is muscle and muscle is
the principal determinant ofyour basal metabolic rate, or
BMR.
That's the rate of calorie burn.
(18:07):
You have just to maintain thework of living, to breathe, to
digest foods, to walk about, tosleep, all the things that
require some amount of energy.
That contributes to your basalmetabolic rate.
Where your basal metabolic ratedrops 15, 20, 25% when you lose
weight by reducing calories,regardless of the method used to
(18:29):
reduce calories, that means,let's say, you stop the drug
after a year because most peoplecan't afford the 12 to $1,500
per month for that drug.
They stop the drug and theyregain 24 to 27 pounds.
Most of it is fat, much of it inthe abdomen, and you are more
insulin resistant, more inflamed, have higher blood sugars, have
(18:50):
greater insulin resistance.
You are higher at risk forheart disease, dementia,
cognitive impairment, breastcancer, type 2 diabetes,
hypertension and otherconditions driven by both
insulin resistance andinflammation.
You're worse off at the endthan you were at the beginning
and your abdominal visceral fatand perhaps ecopic fat have
(19:11):
expanded despite what you wentthrough.
So you can see that cuttingcalories, regardless of the
method, is an awful way to tryto gain control over this whole
process.
What's a better way?
Well, those of you who've beenfollowing these conversations
know that my programs are meantare designed to reduce abdominal
visceral fat.
Don't worry about thesubcutaneous fat, that will
(19:33):
follow, but it's the abdominalvisceral fat that drives insulin
resistance and inflammationthat when addressed first.
You reduce abdominal visceralfat and ectopic fat stores and
the subcutaneous fat will follow.
So focus on getting rid of theabdominal visceral fat.
We do that by avoiding the foods, eliminating the foods that
(19:55):
raise blood sugar and insulin,because when you raise blood
sugar and insulin, it causesinsulin resistance.
So the worst foods for raisingblood sugar and insulin wheat,
grains and sugar.
We take them out.
Now, a corollary to this is wealso reject the idea of
producing fat intake.
We take all the fat you wanthalf bacon, add butter to your
(20:16):
foods, use coconut milk, use allthe extra virgin olive oil you
want, buy fatty cuts of meat,eat the fat and, if you're so
inclined, buy organ meats.
The dietary changes alone arehuge.
We tend to gravitate towardsunprocessed foods rather than
processed foods.
Processed foods just have toomany landmines of additives like
(20:36):
food preservatives, coloringsand synthetic sweeteners that
also impact on weight anddisrupt your microbiome, and so
we go for unprocessed foods,foods in their natural state,
such as an avocado, an egg, asteak, a piece of salmon,
spinach, but not box dried,prepared, microwavable foods.
We also restore nutrients thatare lacking in modern life, that
(21:01):
, when restored, they synergizeto further reduce insulin
resistance and inflammation.
Very simply, vitamin D,magnesium, omega-3 fatty acids
that can only come from fish oil, not from any other source, and
iodine to address your thyroidstatus.
Lastly, we take basic steps tobring back order into your
(21:22):
disrupted microbiome,gastrointestinal microbiome.
Fortunately, everybody has hadmassive disruptions of their
gastrointestinal microbiome dueto such factors as repeated
exposure to antibiotics,glyphosate, the herbicide that
is also an antibiotic,preservatives, emulsifying
agents in ice cream, saladdressing, other common foods,
stomach acid blocking drugs,non-steroidal anti-inflammatory
(21:44):
drugs, other drugs.
In other words, many factorshave disrupted the
gastrointestinal microbiome andpart of the effect is weight
gain because a disruptedmicrobiome leads to insulin
resistance.
So we take basic steps torestore a healthier microbiome.
We avoid all those things thatdisrupted it.
Like we minimize our exposureto antibiotics.
(22:05):
We avoid foods that havepesticides and herbicides and
choose organic instead.
Filter our drinking water,avoid processed foods with all
those additives.
We also add back fermented foodsso easy and so delicious and so
much better for you, in thatfermentation of, say, vegetables
, mobilizes many of thenutrients and make them more
(22:27):
bioavailable to you, includingvitamin C and phytonutrients.
So we ferment tomatoes andcucumbers, we could call it
sauerkraut, we could call itkimchi, kefiers, yogurts or just
veggies.
You ferment on your kitchencounter, so easy to do.
If you don't know what I'mtalking about, see my other
podcast, see my DR DavisInfinite Health dot com blog, or
(22:49):
see the many recipes I'veposted in the inner circle
within the DR Davis InfiniteHealth dot com website.
Or, of course, see my super gutbook that has lots of recipes
on fermenting foods.
Or see my friend Donna Schwankswebsite, cultured Food for Life
, and she's got tons offermented food recipes.
Fermented foods are importantbecause the microbes that
(23:11):
ferment food don't actually takeup residence in the GI tract.
They support the proliferationof truly healthy species,
species like acrimacia andfecalobacterium.
So you eat fermented foods richin fermenting species like
pediacoccus and leuconostoc.
They don't take up residence.
They feed and encourage healthymicrobes like those ones I
(23:32):
mentioned acrimacia,fecalobacterium and plenty of
others.
We also ferment specifickeystone microbes like
lactobacillus reuteri andlactobacillus gasseri and others
, and we can also choose thosemicrobes to achieve specific
effects.
If you want smoother skin andbetter sleep, let's ferment
lactobacillus reuteri.
If you want to have a healthierchild at birth, let's ferment
(23:56):
bifidobacteria infantis.
The child has less bowelmovements, less diaper change
from mom and dad, more likely tosleep through the night and has
better neurological maturationand a higher IQ.
If you want to have betterimmunity, let's ferment
lactobacillus casei.
If you don't know what I'mtalking about, once again refer
to those resources, especiallythe SuperGut book, my
(24:17):
DrDavisInfiniteHealth.
com inner circle, for therecipes and how to restore those
keystone microbes.
Many people think that taking acommercial probiotic alone is
all you need to do.
That's not true.
Commercial probiotics can behelpful, especially if one has
collection microbes that aresynergistic, such as the
BioDiquest Sugar Shift product afull disclosure.
(24:38):
They're sponsor of this podcastbut I also do believe in their
products because they werecrafted by a microbiologist who
paid attention to metabolitesshared by various microbes in a
synergistic fashion.
So that's a good choice, butyou need to do more than that.
Now in my programs we go evenfarther.
So just the basic programs,that is, the diet, the nutrients
(25:00):
that synergize to minimizeinsulin resistance and
inflammation and your efforts torecultivate a healthy GI
microbiome.
Those alone are very powerful,but we can go even further.
We restore factors largely lostfrom modern diets.
So because we were told,wrongly, that we need to avoid
fat and saturated fat to reducecardiovascular risk which is
(25:21):
complete, utter nonsense therenever was any evidence to that
effect.
There was very poor studiesconducted in the 1950s and 1960s
before clinical trial designwas understood, and there since
have been other trials that showthat limiting saturated fat and
total fat does not reducecardiovascular risk.
In fact, it disrupts things.
It causes a rise intriglycerides, it causes a rise
(25:44):
in donovus or fat hypertension,c-reactive protein, all the
things you're seeing that peoplearound you.
This is largely a product ofmisguided dietary guidelines,
dietary advice.
So we're going to do theopposite.
We don't limit fat, we eat nowheat, grains or sugars, we
avoid processed foods and we addback factors lacking because
the mistaken notion of cuttingfat in the diet, two of the most
(26:06):
important collagen andhyaluronic acid.
Now, if you were to go back toold ways and when you killed an
animal and ate its brain, tongue, heart, liver, kidneys, stomach
, intestines, skin, etc.
You would get tons of collagenand hyaluronic acid, and both
collagen and hyaluronic acid addto the loss of abdominal
(26:30):
visceral fat and the increase inmuscle.
Now put all this together thediet nutrients, the efforts at
correcting your microbiomerestoration, especially
lactobacillus rotari andlactobacillus gasari.
Combined with these missingnutrients, collagen, peptides
and hyaluronic acid, thecombination is extremely
(26:52):
powerful for losing abdominalvisceral fat, followed of course
, by subcutaneous fat, and forincrease, restoration or
increase of lean muscle mass.
What this does is puts you incontrol over the way you look,
the way you feel, how young youlook and feel.
In other words, it doesn'tleave you unhealthy and helpless
(27:15):
like conventional efforts do,such as pharmaceuticals and
bariatric procedures or simplycutting calories in your diet.
Now, if you want to know thedetails on how to do all this
with dose of college, and whatform is best, what form of
hyaluronic acid, details of thediet, these are in all my books,
of course, from the wheat bellybooks, especially the revised
expanded edition, also in theSuper Gut book, as well as my
(27:38):
drdavisinfinitehealthcom website, especially the Inner Circle,
which isa membership website,where we have two-way
discussions, typically once aweek for a couple of hours.
There's also this podcast, ofcourse, and my blog that has
several thousand posts on it,several thousand articles.
I have drdavisinfinitehealthcomblog.
Now, if you learned somethingfrom this episode of the Defiant
(27:59):
Health podcast, I invite you totell your friends.
Post your review, join themovement of self-empowerment and
health to minimize your needfor the exploitative products
and services of conventionalhealth care.
Thanks for listening.
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