#1 Thing Stopping You From Losing Belly Fat - How To Lose It Effectively | Dr. Mark Hyman

Belly fat is one of the biggest drivers of having heart attacks. So the question then is what's driving belly fat? Well, two things. Excess sugar and refined carbs and ultra processed food and excess calorie consumption. So basically sugar, carbs and processed food and just too many calories. Welcome to Doctor's Pharmacy. I'm Dr. Mark Hyman and welcome to our special edition of Health Bites. And let me ask you something. Do you carry excess weight around your midsection, even though you feel like you Eat healthy. Do you exercise regularly, but your waistline keeps growing? If that sounds like you, know that you're not alone. Millions of people around the world struggle with obesity and maintaining a healthy weight. And the truth is, it's not your fault. Let me say that again. It's not your fault, despite what the food industry might have you think. Now, our modern day lifestyles stack the odds against us, and today's world doesn't really lend itself to a healthy and happy population either. We live in a toxic nutritional landscape. In fact, it's really the opposite. Many of us are sick, unhealthy, and depressed. First, you have to understand that belly fat isn't just there to keep up your pants. And what we call a dad bod is so much more. Belly fat is an active endocrine organ that secretes hormones and creates whole body inflammation and all the chronic diseases that come with it. So whether or not you've heard of the term visceral adipose tissue or VAT or visceral fat or belly fat, I'm sure you heard of, we're gonna discuss it today. And we're gonna dive deep into what it is, what contributes to it, and how to get rid of it. using the principles of functional medicine. All right, let's get right into it. What is visceral fat? Visceral fat, or VAT as opposed to FAT, or visceral adipose tissue, is your intra-abdominal fat. It's the fat around all your organs, your liver, your pancreas, your intestines, and all the organs in the abdomen. And it's commonly referred to as belly fat, and it's the number one driver of aging. Why? Because unlike subcutaneous fat, that fat located just underneath your skin that you can pinch with your fingers, visceral fat is not visible on the outside. Subcutaneous fat sometimes is a good proxy for how much visceral fat you have, but not always. Visceral fat is not just a storage site for excess energy. It's a metabolically active organ that secretes molecules that impact your hormones and your brain chemistry and your immune system and so much more. Visceral fat has been strongly linked to insulin resistance or prediabetes. We've talked about that forever on the podcast, in other words, diet and obesity and very high levels of inflammation. Now a lot of hormones are affected by or produced by visceral fat. Some of them are called adipocytokines. Cytokines are inflammatory messenger molecules that are made by adipocytes, otherwise known as your fat cells. Leptin, often called the satiety hormone because it helps regulate energy balance and inhibits hunger, right? It's the feel full hormone that's affected. Leptin levels are often directly proportional to the amount of body fat we have. The more visceral fat we have, the more body produces leptin, which seems like a good thing, right? 'Cause then you're not gonna feel hungry, but it's the opposite because you get leptin resistance. So leptin resistance occurs when your leptin levels are consistently high, just like an insulin resistance. So in leptin resistance, the brain doesn't respond to leptin signals effectively, and it leads to continued eating and fat accumulation, especially around the belly, despite adequate or even excess fat stores. So it's like your body feels like it's starving in the midst of plenty. Another hormone that's important in regulating body fat is something called adiponectin. Now, this is a good thing because it enhances the body's ability to break down glucose and has an anti-inflammatory and insulin sensitizing effect. But the bigger your belly fat, the lower your adiponectin levels. So it's kind of not there helping you when you've got extra belly fat and adiponectin levels go down as your belly fat goes up. High adiponectin levels are also good and they're associated with a lower risk of type two diabetes and and heart disease. Lower levels of this important hormone adiponectin are associated with an increased amount of visceral fat and it makes insulin resistance worse, which is a hallmark of metabolic or pre-diabetes or diabetes or type 2 diabetes or whatever you want to call it, it's all the same thing. The next set of hormones that are regulated and backed by your belly fat are probably surprising to you. It's your sex hormones. Yep, your sex hormones. You see, visceral fat, particularly in men, well in women too, but in men it's really acting badly. It contains an enzyme called aromatase and that converts testosterone or the androgens, the male hormones, into estrogens and that results in high estrogen levels for men, which is not good, and it leads to low testosterone levels, which which affects fertility, it affects energy, brain function, sexual function, and lots more. It can contribute to erectile dysfunction, loss of lean body mass and muscle, and increased risk for heart disease. So it's not good. Now, in women, and particularly in premenopausal women, high levels of belly fat or visceral fat cause the opposite. They cause a high level of androgens or testosterone, which then increases the risk for something called PCOS, which is a common cause of infertility and acne and weight gain and irregular or heavy menstrual bleeding in women. It's really common and it's really annoying and it affects a lot of women. And it's primarily related to this excess belly fat, not for all women, but for most. Now in peri and postmenopausal women, high levels of visceral fat increase aromatase and estrogen levels, and that leads to the risk for estrogen related cancers like breast, uterine and ovarian cancer. So as your body fat goes up, your estrogen production goes up and the risk of estrogen related cancers goes up. Now, the other thing that's produced by belly fat is something called cytokines. You might have heard the cytokine storm with COVID and these are things that are not bad or good. They're basically designed to regulate your immunity and fight infection, and they can be good. But when they're overactive all the time, they just drive this chronic sterile inflammation. And this belly fat that you have, or hopefully you don't have it, is driving an enormous amount of these inflammatory cytokines because the fat cells themselves become cytokine producing factories, particularly something called IL-6 and TNF Alpha. These are extremely triggering for chronic inflammation throughout the body, and essentially it's like a fire in the belly. Think of it that way. It's driving fire everywhere in your body. And this contributes to this sterile, chronic low-grade inflammation. And that leads to all these other issues and even things like high leptin and low adiponectin. Inflammatory cytokines are really the problem. In fact, that's why so many people with obesity had high risk of COVID serious infections and death because they were already pre-inflamed. So high leptin, low adiponectin and these pro-inflammatory cytokines are a recipe for disaster. It contributes to systemic inflammation, to insulin resistance, which are really critical factors in developing type and heart disease, even certain cancers and even dementia. All of it's related to the same thing, which is this pre-diabetes, belly fat, inflammation, insulin resistance, it's all one problem. It also causes a lot of others, right? It causes abnormal cholesterol, really bad types of cholesterol, not the kind of just you get on your regular panel, but ones we check with a special test looking at lipid particle number and size. And when you have atherogenic dyslipidemia, which is a big medical word for you have high triglycerides, low HDL, small particles, lots of particles, it's caused by the belly fat. Now, when you have high levels of belly fat or visceral fat, it causes high levels of something called free fatty acids. These are the basically fuels from fat in your blood, especially in the presence of insulin resistance. Now, normally insulin inhibits the breakdown of lipids or we call lipolysis. So insulin, the higher it is, it breaks the ability of the body to burn fat. It basically stops your body from burning fat, which is not a good thing. And now when insulin resistance is high, when your body's resistant to the effects of insulin, you keep making more and more insulin, you're actually not able to burn the fat. It's almost like the fat gets in the cells by can't get out. It's like a one-way turnstile at the subway. And this leads to the mobilization and release of triglycerides, which are shuttled to the liver by the portal vein, and that creates, you know, more, more, more, and more trouble. And that combined with inflammatory cytokines and other bad cholesterol particles, high triglycerides, small dense LDL, low levels of HDL, all this dramatically increases the risk of developing heart disease. In fact, belly fat is one of the biggest drivers of having heart attacks. So the question then is what's driving belly fat? Well, two things, excess sugar and refined carbs and ultra processed food and excess calorie consumption. So basically sugar, carbs and processed food and just too many calories. So what are the main sources of these excess calories in the American diet? Well, the main source of all calories and any calorie in the American diet is ultra processed food. It's basically science projects made by the food industry from deconstructed ingredients that they get from a farm originally as soy, corn and wheat, but turned into all kinds of molecularly deranged chemically extruded, colorful, food-like substances that don't even meet the definition of food. If you look at the definition of food in the dictionary, which is something that supports growth and health of a living organism, which it doesn't. And what is it? It's refined sugar, it's starch, processed fats. And when we looked at the data, and I'm just going to share some studies, all the links are going to be in the show notes so you can dig into it yourself. In a study called the PREDIMED study, a very big trial, 1500 participants, randomized controlled trial, people 55 to 75 who are overweight or obese, for every 10% of their diet, that was ultra processed food, they had a significantly greater accumulation of belly fat. And even worse than another study, the Global Burden Disease, 195 countries, they looked at their diet and they found that for every 10% of your diet, it's ultra processed food, your risk of death increases by 14%. And guess what, folks? Our American diet is 60 to 70% ultra processed food. More than two thirds of our diet is this junk, which isn't actually food. And it's driving this epidemic of chronic disease, which we're seeing all across America and increasingly the globe. Here's the other kicker. It's way easier to overeat ultra processed food. I mean, who binges on a bag of avocados? Bag of potato chips, bag of cookies, no problem, right? These are hedonic foods. They're high in sugar, salt and fat. They're designed to make you overeat. They're designed to activate the addiction centers in your brain. And this is not an accident, my friends. If you want to read about this, read Salt, Sugar and Fat by Michael Moss. He talks about the very pernicious way in which the food industry has actively created taste institutes where they hire craving experts to create, quote, the Bliss point of food to create heavy users. I'm not making these terms up. This is literally their own internal corporate terms. Craving experts, taste institutes, Bliss point of food, heavy users like addicts. They understand the biology of this and they are after it. And what's even worse, I'm sorry, I'm just gonna get a little rant tangent here, but they are putting little kids as young as two years old in MRI scanners and showing them images to see which images will most activate the reward center in the brain. How do we addict little kids? This is criminal, my friends. What this does is when you eat ultra processed food, it doesn't actually make you feel full and it then makes you eat more. And the data is really clear. We'll share it in a minute. But when you eat more, obviously you're going to gain weight. This is a landmark trial by NIH scientist called Kevin Hall and his colleagues published in the journal Cell Metabolism. and they did a very elegant study. They took 20 healthy weight adults and they randomly assigned them to eat either an ultra processed diet or whole foods for two weeks. Now, the meals in each diets were identical in terms of calories, macronutrients, protein, fat, carbs, sugar, sodium, fiber. But on average, the people assigned to eat the ultra processed food ate 500 calories more a day than the individuals assigned to eat the whole food diet. Think about that. When you are given food to eat, you're going to eat more if it's ultra processed food. and most of the calorie surplus came from carbs and refined carbs and refined oils, not protein because you can't overeat protein. I mean, who's going to eat a 20 ounce steak? It's really hard to do, but you could easily eat a whole bowl of pasta or two or three or four. Now, carbs and fat are high in ultra processed food and carbs that we're eating are refined grains, flour and sugar. I'm not talking about broccoli, which is a carb, or asparagus, which is a carb, or blueberries, which are carbs. Those are all fine. I'm talking about the industrial carbs that we consume. also the industrial oils, the refined oils we have, which are ubiquitous in our food supply and add extra calories and oxidative stress. And the other thing is, ultra processed foods are typically low in protein. And so protein makes you feel full. And if you have low protein in the food, it's going to make you want to keep eating until you can find the protein, because it's the only macronutrient we need in gram amounts. Think about that. There's no biological need for carbohydrates, fatty acids. We have some essential fatty acids, but they're really needed in milligram amounts, right? Whereas protein, you need in large, large amounts. It's the only macronutrient that you need. And if you don't get it, you're going to keep the ultra processed food group in this study also gained significantly more weight than the whole food group, which lost weight over the two week intervention period. What else is causing us to gain weight and belly fat besides ultra processed food? Well, all the added sugar. All that's coming out, obviously partly from ultra processed food, but also sugar sweetened beverages. In this country, the average American consumes about 22 teaspoons of added sugar or about 152 pounds a year. Now, I'm not having that much, my friends. some of you out there eating a little bit more. The average kid consumes about 34 teaspoons a day. Think about that. That's a lot of sugar. I mean, you wouldn't put 34 teaspoons in your coffee, would you? But we get that every day for our kids. So liquid calories and liquid sugar calories are the worst. From sodas, fruit juices, sweetened nut milks, sweetened coffees, energy drinks, teas, sports drinks, all this stuff is just poison. Do not drink sugar sweetened beverages, period. You will dramatically change your life. And sugar sweetened beverages and sweetened coffees and teas basically contribute to about 40% of the intake of added sugar. So if you just cut those out, you're going to be doing yourself a big favor. Now, why are liquid sugar calories so bad? Well, they're consumed in isolation from their food matrix, right? So their fructose and glucose and who knows what else, sometimes other sugars, they're just pure sugar and they don't contain fiber, they don't contain protein, and they don't contain fat, which all slow down the absorption. So once they're quickly absorbed, it spikes your blood sugar and your insulin, and high insulin drives excess as fuel into your fat cells. Now, what does insulin do? It basically opens a gate and lets the fuel sugar and fats into your fat cells, making them grow and grow, especially belly fat. Insulin makes belly fat. Just remember that insulin makes belly fat. It's the fat storage hormone. High insulin leads to more cravings and an increase in hunger because you're getting high insulin and you get a sugar dip and then you're going to be in a life-threatening situation. You think you're dying because you're not getting enough sugar, hypoglycemic. You have more sugar cravings. more carb cravings, and it's a huge problem. This is called the carbohydrate insulin model of weight gain. There's other theories around weight, like energy balance and obesogens and redox models. We've talked about those at length on the podcast, Doctor's Pharmacy with Robert Lustig. It's complicated, but basically this is a big, I think probably the number one driver of weight issues, which is refined starches and sugars. And the other thing besides sugar is flour. We eat so much flour and refined grains, according to the USDA. consumption data. The average American consumes about 152 pounds of sugar and 133 pounds of flour per person per year. Now, in a cross-sectional analysis, the participants from the Framingham Heart Study, one of the biggest studies ever done, when they had three more servings of whole grains per day, they were 10% likely to have belly fat than those who consumed no whole grains. Now, what are whole grains? Whole grain oats, brown rice, bulgur, things like that. Wheat germ. Refined grains were what? English muffins, bagels, muffins, biscuits, white rice, rice, pasta, pancakes, waffles, crackers, pizza. You get it. Now, the refined grains were positively associated with subcutaneous fat and fat or visceral adipose tissue. So you both got subcutaneous fat, but also you got the dangerous belly fat. And that's because refined grains just are high glycemic. In fact, they have a higher glycemic index than sugar. They spike insulin and they promote fat storage. Also, refined grains don't have any fiber, which slows the absorption of sugar. And the fiber, which is present in whole grains, promotes all kinds of good things like incretin hormones. You might have heard of those. Probably don't know what I'm talking about, but you do because it's a GLP-1 hormone, or otherwise known as Ozempic, which your body makes, and that delays gastric emptying and prevents overeating. So basically fiber is like a natural GLP-1 agonist. And I've had patients who was 40 pounds just taking extra fiber supplements before meals. A lot safer than taking Ozempic. Also being sedentary, we're incredibly sedentary society. And a cross-sectional study of the Ann Haines data, this is a National Health and Nutrition Examination Survey, which is this big national government study. It's going on for decades. decades and decades. They looked at 10, 000 adults over over who are 20 years old, older, who are inactive and sat more than eight hours a day. They had the highest total and trunk body fat. In other words, belly fat compared to those who were more active and sitting less than four hours a day. So being physically active for at least 150 minutes a day helped offset the effects. What else causes belly fat? Not sleeping, lack of quality sleep. Not getting enough sleep is linked to an increased calorie intake the next day. I can tell you that's true because if I don't sleep, I'm craving the carbs. looking for the bagels, I'm looking for the sugar, I get it. And even though I know all this stuff, my brain is hijacked and if I don't get enough sleep, I want to eat all the bad stuff. And when you do that, you get higher visceral fat. So if you don't sleep, you're gonna get belly fat. A small trial of 12 healthy non-obese adults found that when people were restricted from sleep for 21 days, in other words, they weren't allowed to sleep a full eight hours, they consumed on average 300 more calories than the control group who were sleeping nine hours a night, which sounds like heaven. And the one who didn't sleep also gained significantly more weight. Now, according to the CAT scans, the excess calories consumed were converted into visceral fat. So when they looked at actually imaging studies in this group, they found that they just converted all those extra calories into belly fat. What else causes belly fat? Alcohol. Now, in a population-based study of nearly a thousand Japanese men, those who had higher weekly alcohol it was strongly associated and significantly associated with higher abdominal fat or visceral adipose tissue. They had a higher waist circumference, a higher waist to hip ratio, we're going to talk about what that is, which are both independent variables and are concerning to me as a doctor because that's what's linked to mortality. Another study showed that men who drank more than three drinks a day, which is a lot of people, I think, were 80% more likely to have belly fat than those who didn't drink as much. you've heard of beer belly? Well, that's it. And that is what's going on here. The beer belly is driven by this extra visceral fat, which then creates more estrogens and more fat. It's just a vicious cycle. But it's probably, you know, alcohol's calorie content, its impact on appetite, fat burning, hormones, sleep, insulin sensitivity, a lot of things. And maybe some other factors too. But we definitely know that when you consume a lot of alcohol, it does increase estrogens in the body for sure. And that, it makes you gain weight. and it's just a vicious cycle. Now, maybe there's other factors. Maybe unhealthy user bias. Maybe those who drank were more likely to smoke or more likely to be sedentary, be unhealthy. So maybe that was part of it. But for sure, it's not just that. What else makes you gain belly fat? Stress. Literally stress makes you fat. I wrote about this in my one of my first books, Ultra Metabolism. Higher levels of stress are linked to greater belly fat accumulation and also makes it harder to lose fat. In fact, it's really cool. Every single fat cell is innervated by a nerve from your vagus nerve, from your sympathetic nervous system. Your nervous system is literally wired into your fat cells. And when you're stressed, they're listening and it's danger zone. And you don't want to lose fat when you're in danger because you might need it. That's why stress makes you gain weight. It also makes higher cortisol levels, which is a basically makes you gain weight and have belly fat and diabetes and high blood pressure. And basically in human and animal studies, if you've been exposed to cortisol at a high amount over your lifetime, it definitely leads to more fat deposition and more belly fat. And then you get this vicious cycle because more belly fat leads to more cortisol secretion and then poor stress, a stressful task, and it's just a vicious cycle. That's a lot of things that cause belly fat. And there's more. Obesogens. What are obesogens? Obesogens are environmental toxins that make you gain weight. And I've written a lot about this in my book. Many of my books, actually, the environmental toxins by many mechanisms are driving obesity through a whole series of things that that lead to insulin resistance, that lead to thyroid dysfunction, that affects your metabolism, poison your energy production and the ability to burn calories is a whole series of reasons. But these endocrine disrupting chemicals promote obesity by increasing the number and size of the fat cells. They alter your basal metabolic rate. They affect your gut microbiome. They affect your hormones and your hunger hormones. And there's many of these things out there and they're everywhere. PFAS, which are the forever chemicals, which are like in Teflon and other things. BPA in lining cans. phthalates, plastic bottles, parabens and skincare, pesticides, glyphosate, they're everywhere. Now, why is visceral fat so problematic? Visceral fat increases with age and it's related to reduced life expectancy and chronic disease. It's just bad news. The bigger your belly, the shorter your life. The bigger your belly, the smaller your brain. We'll get to that. Now, one of the most predictive metrics that determines your risk of death is the size of your waist, your belly fat. Now, this fat leaks inflammatory cytokines. We talked about those. that drive inflammation throughout your body and they make insulin resistance worse and they negatively affect your heart, your brain, your liver and your gut. And then what happens? Well, you get type 2 diabetes, you get heart disease, you get pre-diabetes, you get certain cancers like colon, breast, pancreatic and prostate cancer and you get fatty liver which is affecting I think 90 million Americans now. It's so common. PCOS, which is a hormonal condition affects women, autoimmune diseases, depression is linked to poor metabolic health. In fact, many psychiatrists are now calling depression and mental health as a metabolic disorder of the brain. Even Alzheimer's is called type 3 diabetes, bigger belly, smaller brain. So just remember that if you want to keep your mind as you get older, you got to shrink your belly. And research shows that people with larger stomachs in their early 40s have nearly three times the risk of developing dementia in the Alzheimer's when they reach their 70s. And if you're diabetic, the risk of Alzheimer's is four times the rate of someone who doesn't have Alzheimer's. So where does conventional medicine miss the mark. I mean everywhere. It doesn't take a proactive approach. A yearly lab testing is kind of so superficial and your results often come back, quote, normal despite serious underlying metabolic dysfunction. Basically rely on your weight and your height, which is kind of not very helpful because your BMI, which is the metric we use, it looks at your height and weight as a way of regulating your obesity metric. It doesn't take into account muscle mass, doesn't take about muscle loss. So you someone will misdiagnose obesity. Let's say someone who's a bodybuilder will have a BMI that's high and they can actually be not obese and not fat. And someone who's very thin, who's like a 65 year old lady who looks skinny, could be skinny fat because they look thin on the outside but have high levels of visceral fat on the inside. It's estimated that much of a third of the population is skinny fat. The problem with BMI is it doesn't look at what's an important metric, which is the waist to hip ratio or your waist circumference. conferences because if you have a giant belly, well, that's a bad thing, right? And that's really what we're looking at here. And also, the conventional approach just looks at calories. All calories are the same. It doesn't matter if it's soda, doesn't matter if it's broccoli, as long as you're not eating more than you're burning, you're fine. And that's just not how it works because calories and food is information. And information regulates your biology in many ways. It affects your microbiome, it affects your immune system, it affects your hormones, your brain chemistry. So it's not just as simple as calories in, calories out. And the energy balance model, you know, has some Merit, but it isn't the whole story. And we need to look much deeper than that. This whole cultural meme of eat less and exercise more is the answer to weight loss. I mean, how's that working out for you all there? Not so good, right? Not so good. Because it doesn't work. Because if you worry about what you eat, you don't have to worry about how much you eat because your hormonal signals will correct and you'll actually self-regulate your appetite and you won't be craving like we saw in the ultra processed food study. When you look at just energy balance, it doesn't really address the hormonal impact of food. And doctors really, on the other hand, also can't blame them because they have no training in nutrition. Like zilch, nada, zip. I learned about like rare nutritional deficiency diseases that I've never seen like rickets and scurvy. So like that was my nutrition training. And they don't know how or they don't have the time to talk to their patients about nutrition. And sadly, less than 25% of medical schools receive the minimum amount of nutrition training. We're not talking about what's in the training, just that they get any training at all, right? And they often advise low-fat diets based on outdated ideas that, and then you eat more carbs and you gain more weight and, and they blame the patient when it doesn't work. It's just kind of a vicious cycle. So conventional medicine doesn't get it right. So what's a functional medicine approach to assessing and addressing visceral fat? Well, you got to check things. You got to test things. So you have to look at the body with some simple measurements. It's not that hard. You can probably do it at home. Right? Right. So you need tape measure. It's one of the most important medical diagnostic tools. Simply put it around your waist and your belly button at the widest part of your belly button and the widest part of your hips. So in the widest part of your belly button, that's your waist circumference. It's highly correlated with visceral fat. If it's greater than 40 inches in men or 102 centimeters, you're in trouble. And if it's over 35 inches in women or 88 centimeters, you're in trouble. And when they looked at large study men with a waist circumference of over 102 had a 225% higher risk of having heart attack. And if your waist circumference was over 88 as a woman, you had a 275% higher risk of having a heart attack. Another study of European women aged 45 to 79 found that those with the biggest waists had more than double the risk of developing heart disease after adjusting for all other risk factors. This is like a direct correlation. I would say causation actually. every additional waist size increase raise the risk for cardiovascular disease by 10%. Now, the other thing you need to know is your waist to hip ratio. If your waist is bigger than your hips, that's a sign of more belly fat. It should be greater than 0.9. And in men, if that's higher than that, you're in trouble. And if it's over 0.8 in women, you're in trouble. And that means belly fat. Now, your body mass index is, you know, says over 25 is overweight, over 30 is obese, you know, and so forth. But again, it doesn't take into account where the fat is. So it's just one metric and not the most important indicator of those, for example, who are skinny fat. Like I said, you could have a 65er woman who's basically got sarcopenia, lost most of her muscle, has got marble fat and basically looks skinny but is actually fat. We call that toffee or thin on the outside, fat on the inside, or metabolically obese, normal weight. On the other hand, a muscular, physically fit body builder type may look overweight on a BMI, but he just has large muscles. The next thing you want to is do the proper lab testing. Visceral fat is located within the body's trunk, making it hard to see with the naked eye. So you kind of have to just look, right? And if you look in the mirror and you got belly fat, pretty good indicator you have high visceral fat below the surface. But if you want to look at those particularly lean on the outside and have high visceral fat or marbling with skeletal muscle, you need some different kinds of tests. So we're going to get into what those are in a minute. Also, by the way, this is really common in kids. Studies suggest that five to 10% of children fatty liver or NAFLD. Now, this is something we used to see in alcoholics, never in kids. I mean, I remember going to an obesity conference and I saw this hepatic surgeon there and it was a childhood obesity conference. I'm like, what are you doing here? Why is a liver surgeon at a childhood obesity conference? He says, well, Mark, the truth is we're now doing liver transplants in kids as young as 15 years old from liver failure from drinking soda and sugar and processed food. This is terrifying to me. It should be a national emergency. Also, lab testing also so can be really helpful. Now, in functional medicine, we do a lot of tests that look at your metabolic health, your lipid health, your hormone health. And I co-founded a company called Function Health so that everyone can have affordable access to the right test to know what's going on in their bodies. Now, you can learn more, you can sign up and bypass the wait list, which is quite large, no pun intended, by going to functionhealth.com/mark. And what should you get tested? Well, you should get your fasting insulin tested, your fasting glucose, your A1C, hemoglobin A1C, your leptin level, adiponectin, cortisol, c-reactive protein, which measures inflammation, a comprehensive lipid panel, not just a regular one you get at the checkup with your doctor, but we call lipo protein fractionation, which looks at the number of particles. You have small, dense particles and the size of the particles. You also want to check your hormones, right? Testosterone, estrogen, sex hormone binding globulin because it affects your sex hormones. And you might want to do additional testing, like body composition. You can use an in-body scan, which is something many doctors offices have, a DEXA scan. The most accurate is a CT or full body MRI, but not everybody's going to get that. It's kind of expensive. The DEXA and the other other scans help you see the amount of organ fat and the amount of muscle and where it is. So it's really important to do and I recommend all my patients get a DEXA scan. Now many gyms, fitness centers, health centers have an in-body so you can start there, but you want to go check it out and you can find out the nearest location near you by going to inbodyusa.com so what's the functional medicine approach to get rid of visceral fat? you gotta get to the root cause of it. And you know what it is? It's diet, diet, diet. You cannot exercise your way out of visceral fat. You just can't, because food is what's driving most of it. And you have to handle your diet. So the first thing is avoid all the things that make you gain visceral fat, right? Ultra processed food, refined flour, sugars. We talked about all that. Trans fats, added sugar, liquid sugar, all the sugar, sweetened beverages, juices, not your snacking. We should not be snacking, right? They just contribute to calorie surplus. If you're gonna snack, make it high in protein or fiber. I like macadamia nuts. If you're gonna eat food, which you're gonna have to do, eat the right food. If you eat whole foods that are low in starch and sugar, low glycemic, it definitely helps you lose that belly fat. Now, I don't recommend this for everybody, but ketogenic diets are more effective than low-fat diets for losing visceral fat when you do them properly. There was one study that took overweight participants with or without insulin resistance and put them on a low carb high fat diet, about 5% carbs, 30% protein, 65% fat, or a low fat high carb diet, about 63% carbs, 13 to 23% protein and 20 to 25% fat, which isn't actually even that low fat. They did it for 15 weeks. The low fat group restricted calories, right? Because basically when you eat low fat diets, you're hungry all the time and you have to restore calories. But the high fat group did not restrict calories. Think about that. The low carb high fat group, even though they didn't restrict calories, lost twice as much body fat. They also lost significantly more visceral fat than the low fat group, about 18% versus 5%. So basically eating a lower carb higher fat diet worked for weight loss and belly fat loss. Now the insulin resistant individuals in the low carb high fat group, people who are already like pre-diabetic, lost significantly more visceral low fat than the insulin resistant individuals who are in the low fat group. So if you low fat and you're insulin resistant, it's not a good idea. Low carb diets promote belly fat loss. They do. And a controlled feeding trial of 69 healthy overweight men and women, they were randomly assigned to a low or high glycemic low calorie diet for eight weeks after, you know, washout period. And they were provided with all these different foods in both phases. And basically they were given their food. They knew what they were eating. The low glycemic the ones who had the low starch sugar, had 11% less intra-abdominal fat than the high glycemic group at the end of the trial despite losing the same amount of weight. Now think about that. When you eat low starch and sugar, you lose the belly fat even if you're losing weight everywhere, you're losing it more from your belly. The low glycemic group lost more abdominal and body fat and the high glycemic group lost more lean muscle mass, which is not what you want to have happened. So the people had more starch and sugar, lost more muscle, which is critical for your metabolism. Also, what else do you want to do? You want to eat protein at every meal because it makes you feel full, about 30 grams. And people who have higher protein tend to have less visceral fat. It makes you feel full. It increases all the fullness hormones. We call the satiety hormones. You might have heard of one of them, GLP-1, otherwise known as Ozempic, PYY, and CCK, all of which helps you reduce cravings and hunger. So you want to eat about 0.7 to 1 gram of per pound of ideal body weight. I'm about 175 pounds, so about 150 to 170 or so grams of protein for me. Focus on quality, right? Wild caught, small fish, grass-fed, organic, regeneratively raised meats if possible. I love force of nature, which is a great source of meats. Pasture raised chicken and eggs. Eat lots of fiber. Fiber slows the absorption of starch and sugar and also makes you feel full. And eat lots of phytochemicals because they have all kinds of beneficial things that help regulate blood sugar and insulin. So, make yourself a plate of about 75% of your plate being veggies, non-starchy colorful veggies, all colors. And also eat a lot of green veggies like chard, spinach, broccoli, kale, cauliflower, dandelion. Well, cauliflower is not green, but anyway, it's part of the broccoli family. Dandelion greens, Brussels sprouts, asparagus, cabbage, bok choy, broccoli rabe. I'm having that tonight. Having it in my fridge, collard greens and so forth. You can have those in unlimited amounts. Eat some fruit, but eat the lower glycemic fruit like blueberries, cherries, blackberries, raspberries, cranberries. Had some of that in my smoothie this morning. Some stone fruit, apples, pears, all that's fine. Watch out for the tropical fruit. It has a big effect on blood sugar and also fat. Fat is your friend. Fat, you want high quality fat. Avocados, olive oil, nuts, seeds like almonds, walnuts, chia seeds, flax seeds. I wrote a whole book on this called Eat Fat, Get Thin. It works. One guy wrote me back after doing it, he lost 200 pounds. You can eat grass-fed meats that are fatty, wild caught seafood like sardines, herring, mackerel, anchovies. Maybe you don't like those, but I do. They're fatty and good. What about your lifestyle choices? Well, don't eat out at fast food restaurants and chains. You don't know what you're getting. You don't know what's in the food. There's mystery oils, added sugar, just not great. Sleep. You want to prioritize sleep, seven to eight hours a night so you don't get those carb cravings. You also want to deal with stress, active relaxation, really important. so meditation, yoga, journaling, walking in nature, exercise, you know, really important. Also, don't eat when you're stressed. If you take five deep breaths before you sit down to eat, you're going to change your metabolism. Literally, say a prayer, maybe grace, take a moment to relax your nervous system. Just breathe. It's really important. Exercise, obviously, is a really important way to reduce visceral fat, but you can't exercise your way out of a bad diet. But you do want exercise. So at least about 150 minutes a week can help mitigate the effects of being sedentary. So aerobic exercise like walking, jogging, swimming, cycling, do moderate intensity exercise as well, like so you can do it over several days. Basically, moderate intensity means being able to talk but not sing during the activity. Well, it's zone two training. Strength training, critical. Building muscle is key. That's where metabolism is. Body weight exercises, resistance bands, free weights, machines, whatever works for you. At least two to three days a week. Focus on major muscle groups. Sprint training, we call it HIIT training, also increases your metabolism. It may be the most effective way to reduce or fat according to the research, maybe one to three times a week, where basically you go to 89% of your maximum heart rate followed by rest or low intensity training. Time-restricted eating can also be helpful, so try to eat most of your meals within a window where you're giving yourself a 12-hour break overnight or 14-hour break, so you're eating within a 10-hour window or 12-hour window is better than eating all the time and eating when you go to bed and eating when you wake up definitely will help your metabolism work better. Also, hormesis is great. Hormesis is essentially where you do stuff that doesn't kill you that makes you stronger. And you can actually increase the burning of visceral fat through hormesis and the browning of visceral fat, which is a really cool idea. So the browning of your belly fat means you turn white fat into brown fat. Now, why should we care? Because brown fat is also known to be very metabolically active. It's full of mitochondria, which is what makes it more metabolically active. It has higher metabolic rate and it burns more calories. So how do you activate your brown fat and how do you even turn your white fat into brown fat? Well, cold therapy really works. Jumping in a cold plunge, cold bath. I was recently in Iceland and I did three minutes in a 35 degree ice bath every day. And holy cow, that was cold. There was even ice cubes in it one day. Of course, I was in a sauna beforehand, but still, very important to do cold therapy. It can be very helpful for you. You don't have to do long, just a minute, three minutes. Sauna, very helpful also. Maybe 15-20 minutes, about 170 degrees, activates a lot of metabolic pathways that are great for you. Phytochemicals, which are another kind of stress 'cause they're the plant's defense mechanism can be really helpful in metabolic health. Green tea is great. Resveratrols and blueberries, cranberries, grapes, capsicin, hot peppers, genistein and diosgenin, which are in non-GMO sources of soy like tofu, tempeh. Lots of spices are great like turmeric, cinnamon, berberine. Also you wanna avoid environmental toxins as best you can, like pesticides, buy organic when you can. I use the Clean 15 Dirty Dozen Guide from the Environmental Working Group. Just go to ewg.org. Don't drink from plastic bottles. Get rid of BPA and plastics if you can from your life. Drink from stainless steel or glass containers. Don't eat food in plastic containers. Watch out for your skincare stuff full of phthalates. So you can use a Skin Deep database from the Environmental Working Group to check your products and find ones that aren't full of these nasty compounds. PFAS also is everywhere. It's these forever chemicals. You just make sure you get a high quality water filter for your house. so that brings us to the end of our conversation around visceral fat, which is far more than unwanted weight around your midsection. It's an active endocrine organ. It's secreting cytokines and hormones and neurotransmitters that have a horrible impact on our health, that makes us age faster, increase risk for all chronic diseases. But it's something that you can do something about. It's totally fixable. It's within our control. But it is the single biggest crisis of our time. So I I hope this episode helped shine a light on the dangers of visceral fat. And I know that there's many things that you can do that are within your control that you can do to help reduce it. So get on it. If you love that last video, you're gonna love the next one. Check it out here.