Do You Have Excess Belly Fat? Why It’s A Problem And What You Can Do About It with Dr. Elizabeth Boham

Coming up on this episode of the Doctor's Pharmacy.

The visceral adiposity, that belly fat, is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn't listening to its insulin as well as it used to. And so that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight.

Hey everyone, it's Dr. Mark. I recently found a new drink that.

Fits into my Pegan diet and it's.

Honestly something I always look forward to.

When I need a nourishing pick-me-up. It's the Sun Goddess Matcha Green Tea from Peak and it's the best tasting and smoothest mixing matcha I've ever tried. I'm sure you heard me talk a lot about using food as medicine and matcha is a great example of this. It's full of polyphenols which are especially helpful for our good gut bugs and other antioxidants support better aging, a balanced blood sugar, and a strong immune system. I love blending the Sun Goddess matcha powder with some hemp or oat milk in a creamy latte as part of my morning ritual. I've also used it in recipes like my matcha poppy bread or very smoothies and it works great every time. It's also the only matcha that's 100% organic, ceremonial grade, and quadruple toxin tested for purity. Matcha makes a great alternative to coffee because it provides sustained energy without the jitters. L-theanine is a powerful amino acid in matcha that helps you feel calm, focused and clear so you get a boost without the crash. Peak Sun Goddess matcha actually contains more theanine because they shade their matcha plants 35% longer than other brands. I really do feel awake, focused and balanced after enjoying my matcha every morning. Right now, Peak Tea has a special offer for my listeners. Just head over to peaktea.com/hymen and use the code hymen That's P-I-Q-U-E-T-E-A.com slash hymen with the code hymen to get 5% off site wide and free shipping when you purchase a bundle.

Starting the morning off right has a huge effect on the rest of the day. Personally, I love having a super nutrient dense gut healing smoothie for breakfast so I can feel energized, focused and balanced all day long. I like to use a ton of green leafy veggies. healthy fats like avocados, nuts and seeds, a handful of antioxidant rich berries, and then some good gut foods like prebiotic fibers and collagen peptides. Now you might have noticed that collagen has gotten a lot of hype lately, and I know a lot of nutrition trends come and go without the science to back them up. But collagen is one we can all actually get excited about. It's great for supporting healthy bones, nails, skin and joints. and as we get older, collagen production slows down. So I love using collagen peptides to support connective tissue and my gut health. But quality is key. My favorite collagen is from Primal Kitchen because it's grass fed and it doesn't have any fillers, artificial ingredients, dairy, wheat or soy. I get Primal Kitchen collagen peptides at an amazing discount through Thrive. Thrive Market members save an average of $32 on every order when compared to other retailers and they have a huge selection of natural and organic and even regenerative foods. They make it easy to shop by diet type, get frozen bulk grass-fed meats, wild caught fish, or even skincare products and cleaning products shipped right to your door all at a huge discount. And right now, Thrive is offering all Doctors Pharmacy listeners a great deal. You'll get an extra 25% off your first purchase plus a free gift when you become a Thrive Market member. anytime you spend more than $49 you'll get free carbon neutral shipping just head over to thrivemarket.com forward slash Hyman to use the offer that's thrivemarket.com Hyman and now let's get back to this week's episode of the doctor's Pharmacy.

That'S Pharmacy with an F I won't spell it out because I got reprimanded for doing that too many times on the podcast so it's just doctors pharmacy, a place for conversations that matter. And if you have belly fat, it matters. This conversation will matter because we're all struggling with it. And today we're going to talk on our special house call episode with Dr. Elizabeth Boham, my colleague at the Ultra Wellness Center, who's the medical director. She's a world-renowned physician, teaches all over the world. She's helped thousands of people achieve optimal health, and she focuses on nutrition or practice every day. She's an RD, she's an exercise physiology, she's an MD, she's contributes to all sorts of national media and educates physicians all around the world. She's just the bomb. So anyway, welcome Liz.

We're going to talk about belly fat. Thank you, Mark. It's great to be with you and.

To talk about belly fat. Oh yeah, my favorite topic. I've written all these books on belly fat. That's the problem, right? Well, the thing about it, it's a huge problem and it's so easy to fix. And it's not through the ab roller or the Time Master, whatever, infomercial tool you can figure out to get your abs right. I mean, you can't get good abs through exercise. I mean, eventually you have to do exercise, but if you just focus on exercise, you won't get it straight. So let's talk about this problem because for those of you listening, you know, we are in a staggering health crisis, not just COVID, but the whole pandemic of chronic disease that's driven by poor metabolic health and this phenomena of being over fat. you can be overweight or you can be over fat or you can be both. We're going to talk about that today and why it's so important to think about for our own health, for our longevity, for preventing disease and just for feeling good and actually even just getting our own lives together and managing our appetite and our metabolism and our energy and all the things that affect us. So I'm so excited to talk to you about this. This is my favorite topic.

Oh, yeah. Mine too. Mine too. And we know, we know that where your fat is in your body makes a huge impact. You know, we used to so always worry about pinching an inch, right? When we were growing up, can you pinch an inch? But now we realize that that fat that's deep inside the belly, the visceral adiposity, that belly fat deep inside the abdomen is really concerning in terms of overall health. And like you mentioned, it's a huge issue. It is a huge pandemic. In just the United States, we know that 70% of Americans are overweight or obese. But 86% are over fat, meaning that they have too much fat. And especially, you know, that concerning visceral fat is a real concern. And over half of our kids also are over fat. And so, you know, it's staggering. That's staggering. Half of our children are creating so much. It's staggering. It's sad. It's sad, you know, and it's creating so many health problems from Just feeling crummy to tired to causing cancer, increasing our risk of cancer like breast cancer and prostate and colon and lung cancer, of course increases our risk of diabetes and cardiovascular disease, increases our risk of Alzheimer's disease and cognitive decline. It increases our risk of stroke and blood clots and high blood pressure and infections. As you were mentioning earlier with COVID we realize that people with too much fat, people who are over fat, people with too much visceral adiposity, have an increased risk of COVID-19. They have lower immune systems, they have increased risk of erectile dysfunction and infertility and PCOS and hair loss in the wrong places and they make it harder to lose weight. So it's just connected to so many things and it's unfortunately so common. And so that's why we like to talk about it so often, because sometimes it takes us talking about a subject more than one time for people to really kind of put all the pieces together for themselves.

It almost seems too good to be true that all these problems are related to one phenomena. And while there are often many causes for many of these things, the majority of these problems that you mentioned, from infertility to heart disease, cancer, diabetes, Alzheimer's are all related to this weird fat that's very different. And you know what you mentioned, pinch an inch, it's not, that's the subcutaneous fat. It's the fat around your organs that really matters. And I remember this one study I read, you probably saw years ago where they, it was the New England Journal of Medicine, and they, they did a liposuction on this very obese woman who were really was very, very big, and they sucked out 40 pounds of fat from her subcutaneous tissue. So basically she lost 40 pounds just by sucking out all the fat. But when they did a CAT scan to look at the fat inside, that didn't change at all. And what also didn't change was all of her biology. In other words, if you change your diet, you can change the quality of the fat and the messages that make very, very quickly within days to weeks. but for her, even though she lost 40 pounds of subcutaneous fat, there was no change in her blood pressure, blood sugar, cholesterol, any of the markers of poor metabolic health. She was just as sick as she was before, even though she was 40 pounds lighter because they took out the subcutaneous fat. So this belly fat is really different than the fat on your body, your arms, or into your gin or whatever. It's very different fat. So talk about this fat particularly. We call it VAT or visceral adipose tissue or belly fat or organ fat or whatever you want to call it, but it's fat around your organs, your liver, your kidneys, your intestines. it's in that organ compartment. What's it doing that's different than regular fat?

Yeah, you know, I was also so blown away when that study came out all those years ago and it just really was an eye-opener for me to say, you know, and I use that example for patients all the time. Like, you can't, we can't just liposuction this away and your blood pressure is not gonna come down. Like, you think, oh, if I can just liposuction it away, then my diabetes will go away. But it doesn't work like that, right? 'Cause you're not getting to that deep adiposity and that deep belly fat. And that deep belly fat is really inflammatory. What we realized is that deep belly fat produces all sorts of inflammatory markers, interleukin-6 and tumor necrosis factor. So it actually results in increased inflammation in the body and it is associated with increased insulin resistance. And that high level of insulin and the high level of inflammation those two things, and I'm sure there's more, are really drivers for all of these processes to get out of whack in the body, for the cholesterol to get out of whack, for your inflammation in your arteries to get out of whack, for cancer to like to grow.

And so, it's inflammation drives all these things.

And that deep fat, that's absolutely, absolutely. And so, and that deep fat is not just hanging out, it is metabolically active as we've talked about before and you always like to talk about it's metabolically active. It's not just sort of sitting there. It's really doing something. It's not just holding up your pants. It's an endocrine organ that's doing... No, right? It's actually doing things. It's and it's producing all these chemicals and hormones and it's increasing the inflammation in your body. And so if there's one thing that people can focus on, like if you're, you know, you kind of sometimes people get overwhelmed with all these messages in in health, right? Like, oh my goodness, what do I do? What diet do I follow? What should I work on? Where do I focus? And sometimes people get overwhelmed and they almost give up. We see that all the time. And this is like the basic thing that everybody can focus on. You know, even for myself, like I'm like, you know, I do a lot of these self-care things right. I try to all the time, right? But, you know, this is an area that we can all focus on that can improve our health. if we just pay attention to what's our waist circumference and what's our waist to hip ratio, because that's telling us how much belly fat we have.

Yeah, so I think that's right. I often joke and say there's a simple test you can do to figure out if you have this problem. It's called the mirror test. You take off your shirt, you look in the mirror, you jump up and down, and if your stomach jiggles, you probably have it. And the truth is 88% of Americans have it. They're metabolically unhealthy. That's because they have this visceral fat. it's making them unhealthy and causing all these other problems that we see as separate, right? Oh, I have high blood pressure. Oh, I have high cholesterol. Oh, I have high blood sugar. But they're all the same problem. Or I have low sex drive or low testosterone, or I have, you know, pimples and poor periods and sleep apnea and whatever the things are that we're suffering from. We see them as all separate, but they're all connected by this and. with COVID now, the vulnerability of this population with visceral fat has just been highlighted. 63% of hospitalizations could have been prevented if people had better metabolic health and ate better food. So the real question is, we're going to talk about what causes it and how we start to diagnose it. But what are the ways we can diagnose it properly? You mentioned the waist-to-hip ratio. That's a simple test. Tell us about that, and then let's talk talk about some of the blood tests that you see. It may seem like other stuff, but are clues to you having bigger belly fat.

Yeah. The waist to hip ratio is a great measurement that we can all do and repeat on our own. So what you do is you get your waist circumference and to find the right place for your waist circumference, it's in between, you find your lowest rib and you find your upper hip bone. and then you put the tape measure in between and that's considered your waist circumference. So if you find that lowest, your last rib and your hip bone and go in between the two, that's considered your waist circumference.

It's like your belly button.

And then your hip. Yeah, you know, some people's belly button hangs down or is in a different place. So it's not always the belly button, but it is around that area. Yeah. And then their hip circumference is, you know, know, it's considered over the greater trochanter. But if you don't know where that is, I always say to people, go over the largest part of your hip because that just makes your number look better. So you want to, you know, get the biggest hip circumference as you can have. Not that you want it, you know, you want to be, you know, way overweight, but it's, you pick the biggest hip circumference to, to determine your waist hip ratio. If you can't figure out where that greater trochanter is.

Yeah.

So for, for the, the goal, for Caucasian people, for Caucasians is to have a waist circumference less than 35 inches for women and less than 40 inches for men. For Asian and Indian ethnicities, it's stricter, less than 31 inches for women and less than 37 inches for men. And that waist to hip ratio is a great measurement to do. So for women, you want to be less than 0.8 and for men less than 0.9 is the waist to hip ratio you want to have. So you want, you know, a smaller waist than hip, of course. And, and the neat thing, this is a really simple test you can do and something you can check every month. You know, you can redo your waist tip ratio every month and watch your progress and say, okay, what am I doing? What do I need to do? And it's a really inexpensive way to figure out, is this problem for me.

Yeah, that's really huge. And I think it's also important what you said in that people of Indian or Asian descent can have significant visceral fat and all the complications from it at much lower weights. So if you look at their weight, weight might be perfect. It might be less than 25, 23 in their body mass index, which is 25 or more is overweight. But they may be full of this visceral fat and they can be diabetic, they can be thin and they look thin, we'll call them skinny fat. So they have the same issues as someone who is overweight, but they're just over fat.

Yes, or toffee, right? Thin on the outside fat on the inside. So, you know, if you are a smaller person, then that's where also that waist to hip ratio can be really helpful. And you're right, you're right. No test is ever perfect. So for some people, the waist circumference or the the waist to hip ratio isn't giving us all of the information. There's a lot of other biomarkers that of course tell us that somebody has too much visceral adiposity, that somebody is carrying too much weight around the belly. If we see a high C-reactive protein or marker for inflammation, it makes us wonder, okay, do they have metabolic syndrome, insulin resistance, visceral adiposity? If we see that fasting insulin greater than five, that's when we say, okay, this is something we have to pay attention to. If we see too many small dense LDL cholesterol particles, we've spoken about that before, that's a sign that somebody has insulin resistance or visceral adiposity.

If.

We also check for things like oxidative stress, too many free radicals being produced, that's a sign. If their liver function tests are high or they have signs of fatty liver, that can also be because of this visceral adiposity or gout, high uric acid, that can also be because of this. Or that pattern in cholesterol, the high triglycerides, low HDL, all of these things can give us a sign, give us information and say, okay, this person is struggling with metabolic syndrome, insulin resistance, or probably because of visceral adiposity.

And you often notice all these things at normal at the same time. Right? So you see a pattern and it's really pretty easy to diagnose when you know what to look for. So you get inflammation, you get abdominal cholesterol, you get high blood sugar, high insulin, lots of oxidative stress, your liver. I mean, these are all things that seemingly are treated like separate problems, but.

They'Re all connected to this visceral fat. And what's amazing is to watch them improve when we make shifts or changes in somebody's lifestyle, you know, or you know, there's lots of things that can contribute to this, from toxins in the environment to shifts in the microbiome to poor diet, you know, having a nutrient-poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor sleep, too much stress can all contribute to it. But when we shift somebody's lifestyle and when we make shifts in these issues that they're dealing with, We see these, these markers, these biomarkers improve significantly. So it's really fun to watch. We see it improve all the time.

Yeah. So, so I'm gonna get into, you know, the causes a little more deeply in a minute, but there is another test that we often do, which I like a lot. And it's sort of the gold standard. It's called the DEXA body composition test. And it's like a x-ray, very low dose x-ray. I mean, you have to basically take 50 of these to equal one flight across the country from New York. California in terms of radiation. And it measures the compartments of your body, your arms, your legs, your belly, and can tell you what the fat is, where it is. And, and it's pretty compelling. There's also MRI technology that does a CT technology, liver fat measurements. So there's a lot of ways to look at this, but it is, it is really the central problem of our time. And, and there are many causes, but the major cause is our ultra processed high starch sugar diet. That's the biggest cause because that drives insulin and insulin drives all the available fuel that you've eaten into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis of your fat, and it produces all these inflammatory compounds, and it screws up your hormones, and it makes you hungry all the time, and it slows your metabolism. So it's the worst possible thing. and it's really driven predominantly by that. So we know that a high carbohydrate in the sense of starch and sugar diet, because vegetables are carbohydrates, so you can eat as much of those you want, is the biggest driver of this. But there are other causes, right? And you mentioned a few of them. So let's kind of go through some of the unusual things that might be driving this, whether it's the microbiome, toxins, and other things that drive inflammation.

You know, I always, just in terms of the most common cause, right? I get so concerned when I see a young child, maybe like eight or nine, and their parents are buying them a muffin and a sugary coffee drink or sugary beverage for breakfast. And I'm like, oh no, it's just a setup. It's a setup for them to have problems for their whole life. And I think that it's important that people take care of those basics like you mentioned. But we always look for, you know, sometimes people are doing, or they feel like they're doing everything right, and there's hidden reasons for why they start to develop visceral adiposity and that belly fat when they're really doing a lot of things correctly. And one of the things that I find that people don't realize is what happens when they start to lose lean muscle mass as they get older. So, you know, we might be exercising a good amount every day, but if we're not working really hard to maintain that good lean muscle mass, what happens after the age of 25 is we slowly lose lean muscle mass. And then it's just so much easier for the body to put on excessive fat. And we know that having good lean muscle mass and exercising really keeps our insulin sensitive. and so that's one thing that people, that slowly catches up with people and they become more insulin resistant over time. And, and you mentioned toxins. You know, unfortunately, there's been multiple, multiple toxins associated with this visceral adiposity.

So, I want to underscore what you just said. I want, Liz, I want to, I want to underscore what you just said. Yeah. Because you basically said something really important. Absolutely. Around muscle loss when you get older. And, and muscle loss is really could be thought of as replacing muscle with fat. So you could be the same weight at 65, then you are 25, it'd be twice as fat. And that fat in your muscles, it's not just in your belly, is also this poor metabolic fat. And it leads to this increasing phenomena with all the consequences that we see of disease. So I feel like this is a really important thing that people understand. So exercise basically strength training, building muscle and aerobic exercise, even interval training will help improve metabolic function and help keep this insulin resistance at bay as we age. Because it is something that affects almost everybody as you age unless you do something actively about it. So let's talk about toxins.

You do have to work really hard at it, you know? I mean, it's like so easy to maintain. Well, I don't know if it's so easy, but it's so much easier when you're younger to maintain your lean muscle mass. And as you get older, it's really work. You know, people are like, I do go for a walk every day. And I'm like, you know, it's just, it's not enough for you right now. And getting in two days a week where you really are working on resistance type exercise, there's so many ways you can do that. That, you know, that really can make a big difference. So, yes, so toxins. You know, BPA is a toxin that's been unfortunately associated with with visceral adiposity, fatty liver metabolic syndrome. And BPA, bisphenol A, is that hard plastic that is pervasive, unfortunately, in our environment and has been associated with breast cancer, but it's also been associated with insulin resistance. So I think it's important that we recognize that there are a lot of toxins out there that are impacting our insulin sensitivity and possibly through how it damages our mitochondria and you know, it's just really, there's more to it sometimes than just our food intake. And we always really have to dig and look for that when we're working with our patients.

For sure. We call these things obesogens. You know, they're petrochemical toxins. They're even heavy metals I've seen. So we really have to be alert to people are not losing weight and they're not successful doing the basics stuff of diet and lifestyle change. What else is there? And there are other things like the microbiome. So maybe we can share a little.

Bit about that and what we're learning. Dr. The microbiome, I think, is so fascinating, right? I mean, there's so much information there that we're learning, and there's going to be so much more that we're going to learn over time. And I don't think we have it obviously all figured out, but we know that there's certain bacteria in our digestive system that are associated with less inflammation and a healthier weight. And there's certain bacteria in our digestive system that are associated with more inflammation in the body, and having an easier time with weight gain. So it's fascinating, the association between the microbiome and this whole process of insulin resistance. And so, you know, when somebody comes in and we're trying to figure out what's going on with them, we want to work on all angles here. And, you know, we want to ask those questions of what's going on in your digestive system. is, you know, how are your bowel movements and how do you feel after you eat? And are there foods that you're not tolerating? Because we can work to manipulate that to help improve somebody's metabolism.

Yeah. And also, you know, anything that causes inflammation, right, could cause weight gain. So people might be having food sensitivities that are causing it, or they're exposed to mold in their environment. or they have latent infections. Yes. Because anytime there's inflammation, it drives insulin resistance independent of the cause. So the biggest cause, just, you know, not to get too down on that rabbit hole of these things, the biggest cause, obviously, is sugar and starch. Those are the two biggest things that are driving inflammation. But there are a lot of other things that people need to think about that also do it. Now, people listening might be going, okay, yada, yada, yada. Okay. All this great science about belly fat, what it does and why it's bad and how to test for it and, you know, what causes it, but. how do I get rid of it? Is the big question. How do you actually get rid of it? And, and I think it's, it's so, it's, it's so gratifying practicing functional medicine and, and at the Ultra Wellness Center where we work, it's so, it's so gratifying seeing this because this is one of those kind of slam dunk, idiot proof things for most people. And it happens so quickly and it's so striking because people are always struggling with this. I'm well, if you understand biology and how the body works and how it functions, which is really the foundation of functional medicine, which is understanding how to work with the body rather than against it, you can drive these biological changes really quickly and, and really change the quality of the fat dramatically. And the, and the fat, and just give you a quick example, and then we'll go into what to do about it. This is one of my favorite studies that I've read recently is a study looking at gastric bypass surgery. basically they said, well, you know, gastric bypass works because it causes all these, you know, amazing changes in hormones and appetite and blah, blah, blah, blah, blah, blah. So there's all these theories about why it works. Well, somebody decided maybe we should test this theory. So they took a bunch of people who are really overweight and they gave them gastric bypass on half of them. The other half just ate the diet that the gastric bypass people ate after they had the surgery. And there was no difference. But very quickly, within days of changing their diet, the quality of their fat changed. And it went from being inflammatory fat that's driving all these problems to really shifting that. And so it can happen pretty quick, even if you're still a little overweight, you can still have the metabolic and health benefits. And, of course, you still need to get the weight down. But I think it's just an interesting phenomenon. So I kind of love that study. so let's talk about, you know, what, what do you do and some case studies that you've had that really sort of illustrate the ways in which we can use this strategy of, of function and science, functional medicine, the science to drive real change for these patients in their, not only their, their belly fat, but all the other biomarkers and health issues and consequences that come from having this belly fat.

Absolutely. Like we were talking about the visceral adiposity, that belly fat is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn't listening to its insulin as well as it used to. And so that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight. It makes us more hungry, but it also makes it much harder to lose weight. So one of the things we really, when you were talking about, okay, how do we we really work with our physiology is we want to prevent insulin spikes because we know that higher levels of insulin are what's really driving us to gain this visceral adiposity. And so, as you mentioned, it's those refined carbohydrates and sugars that drive up insulin levels in the body. And we know that if we just ate just fat, we wouldn't secrete a lot of insulin. and protein, we secrete some insulin, but not as much as with carbohydrates. So what's really important is bringing down the percentage of calories that somebody's getting from carbohydrates, especially the refined and processed carbohydrates that cause that insulin spike. And so I always talk to people about that, having that balance of the, you know, good healthy fat and some, and lots of fiber and some protein at every meal and just pulling away the simple sugars and refined carbohydrates because that brings the insulin down and makes us less likely to hold on to that weight around our belly. So that's really the first area we always work on. And, you know, we can dive into a couple cases as examples.

So this is really a great point. So basically the key to this is keeping your insulin levels low because as long as your insulin levels are high, the body really has a one-way street of fuel into your fat cells. So basically insulin locks the fat cells in your belly and prevents the breakdown, we call it lipolysis, they're the breakdown of this belly fat. So like you said, how do you cut insulin levels? Well, you've got to cut out the starch and sugar, especially if you're in an extreme case. If you have a lot of belly fat, you really need to be more strict, like no sugar, grains, beans, even some fruit. And then as you start to become more metabolically healthy and resilient, you can add things back. But it's really key to be really religious about it. And also, there are other factors like artificial sweeteners that are driving this and there are other carbohydrates we might think are okay, like we're eating whole grains or eating whole wheat bread or eating, but they may not for people who are really insulin resistant.

Be helpful.

And what you also said was so important about fat. Fat doesn't cause any spike in insulin. And you see this phenomenon. This is just a great story I learned from David Ludwig, who's a professor at Harvard, one of the greatest scientists in this field. And he said, Mark, if you would take a type 1 diabetic, and this is very different than type 2, which is basically from eating sugar and starch, type 1 diabetics have an autoimmune disease that damages their pancreas. They cannot make insulin. so the presenting symptoms, and every doctor learns this in first year medical school, are they're hungry all the time, they're peeing all the time, and they're losing weight. So they could be eating 10, 000 calories a day and lose weight. Why? Because there's no insulin. So that's really the key. And a ketogenic diet is the most extreme version. But there are a lot of other approaches to eating more fat, less starch and, and the continuum of all that. So I think this really important. And protein is really important too, but if you eat too much protein, you can also get insulin spike.

Absolutely.

Right.

So the first patient that we're going to talk about is a woman who, she was in her mid-50s and she came to see me because she had just been diagnosed with an estrogen receptor, progesterone receptor positive breast cancer. And it was stage one. So she was, you know, she was lucky in that sense or, you know, she found it early in that sense, so that was great. she had surgery and, and radiation, and she was placed on aromatase inhibitor. But she said, you know, I, I want to do whatever I can to prevent this from coming back. And so we gathered all of her information, her whole history, and she noted in her, in her history that she had gained, like, 30 pounds since she had her children. And it just came on slowly over the years. She became more tired over time and really just had a harder time with losing that weight. So she came in about 30 pounds overweight and when we checked her waist to hip ratio, it was 0.88. And remember we said for women we want that waist to hip ratio to be less than 0.8. So hers was high at 0.88. And not crazy off the charts overweight, but 30 pounds higher than she needed to be. And so we said, okay, I explained to her, this is where we really want to focus because there's so much research here showing the connection between insulin resistance and belly fat and breast cancer. So we really want to focus on lowering your waist-to-hip ratio, and we want to focus on lowering your insulin levels because we know that will lower inflammation in the body, and it will decrease your risk of getting a reoccurrence or another cancer for that matter. So she was really motivated and we put her on the Pegan diet. You know, we really worked to lower her percentage of carbohydrates in her diet. She was, you know, she was a pretty healthy eater, but getting in some, you know, her coffee drink that had added sugar in it and, you know, needed to really make some shifts. So we started to tighten up her diet. We gave her a lot more phytonutrients. We gave her a lot more fiber. We worked to increase her omega-3 fats. And we also did, we really tried to increase her green tea intake. There's some really interesting research with green tea. You know, we've always talked about it from a breast cancer prevention strategy because it's got anti-angiogenic properties. It's can, it's a tumor, it can impact the tumor suppressor gene. in a healthy way and decrease risk of cancer that way. And it's an antioxidant, but it also has been shown to lower insulin and help with lowering body weight. So when people drink four cups of green tea a day for eight weeks, they had improvement in their metabolism and their weight and their BMI. And so that was helping her on both angles. We also gave her more omega-3 fats to help improve her triglyceride HDL ratio. So we added in 2 to 4 grams of fish oil. And, you know, there has been some really interesting research on kimchi as well at helping to improve somebody's insulin sensitivity. And so we had her start to incorporate lots of phytonutrients in her diet, lots of vegetables, but also kimchi to help with improving her microbiome. And she did really well. She was able to lower her weight. It took a few months to get the weight down, six months or so, but she even got that waist-hip ratio to less than or right around 0.8, which we were happy with. So she's doing great.

That's amazing. So you see this happen over and over with our patients and you sort of just dial in the simple recommendations. It seems are obvious, but for some it's a little different. And, you know, I just to share a few cases of mine. I remember one who had, for example, severe diabetes and sugars were 250, couldn't get in control. We changed his diet, even put him on a ketogenic diet. It helped a lot. But what was fascinating is we couldn't get that last mile until it was by accident, really. He was complained to me of his gut and his bloating and all kinds of issues and gas. And I was like, so let's just try and experiment. Let's just try charcoal. Now, diabetes is not treated by taking charcoal pills. But by understanding functional medicine and interrelationship of the microbiome and inflammation and how it affects, for example, the toll receptors causes increases in TNF alpha, which is a, basically an inflammatory cytokine when these cytokine storm things, it causes insulin resistance. And I said, well, let's just try it. He says, wow, I took this charcoal and my blood sugar went to normal for the first time. And I was like, wow, that's fascinating. Or another, another patient had, was a trainer and a fitness trainer and, you know, ate healthy and she struggled and her, she had high mercury and we got rid of the mercury and she was able to lose weight. so I think, you know, most of the time it is really about the diet. And then, you know, I think adding the exercise, too, we didn't really talk about that. But adding the exercise, even though you can't exercise your way out of a bad diet, you can exercise your way into better health and fitness and increased metabolism. So it's really important to actually, as you're losing the belly fat, to maintain your muscle. That's where you talk about the strength training and exercise. What about the next case you were going to share about who was a guy who had high blood pressure and bad cholesterol and tired all the time. Yeah.

I mean, this is, yeah, we see this all the time. You know, somebody comes to us because they, he had just gone to his physician. He's 47 and he had just gone in for his routine physical, and all of a sudden, his doctor wanted to put him on blood pressure medication, and he wanted to put him on cholesterol medication. And, you know, so he he was like, oh, no, this is not, this is not what I want to do. And he, it sort of woke him up a little bit and he said, let me just explore this a little bit and, and look into it and look at this a little differently. I don't want to just treat all my symptoms with a medication. I want to see what's going on here. So, you know, I mean, he, he was, he was just struggling with his energy. So he's feeling a little bit lower in energy he would put on some weight. And, and, and, but otherwise, he, you know, he was just kind of doing fine. He didn't have a lot of other complaints. And when we did his waist to hip ratio, his waist to hip ratio was at one. So again, remember, with men, we want their waist to hip ratio to be less than nine. And he was at one. And so this was assigned to me right away that I knew I had to work on insulin resistance and this visceral adiposity. I knew that this belly fat, this too much weight in his abdomen was triggering this high blood pressure, was triggering an unhealthy cholesterol pattern. And when we looked, when we did that particle size test on his cholesterol, we saw that his small dense LDLs were too high and his HDL were too low and his oxidized LDL were too high as well, which we know when LDL cholesterol gets oxidized, that's when it can get damaging to the artery lining. So that's when we said, okay, you know, we're going to really focus on your insulin levels here. And again, we pulled away all the refined and simple sugars. He needed to get rid of some extra beer that he was drinking. We got in a lot more vegetables in his diet. We worked to increase his omega-3 fats in his diet. you know, he didn't want to take a lot of pills, but he was really, he was good at making shifts in his diet. He really got motivated. He also got motivated because we talked about how that increase in waist circumference increases erectile dysfunction. And so he said, you know, that's really interesting. I really want to lose this weight around my belly. And so that really got him motivated to get right on the diet. really worked to increase his exercise. We had him get some strength training in three days a week. He ended up working with a trainer, which was really helpful for him to stay motivated. And he started to add in a little bit more interval training on those other days. But that really helped him. And within three months or so, we saw that waist-to-hip ratio come down significantly. And in like six months, he was at at 0.9 of waist-to-hip ratio, his blood pressure improved, his cholesterol pattern improved, his energy improved, and he never needed to start medication. And he's doing really well.

That's amazing. And then, you know, just so many stories like that. It just kind of reminds me of this patient I had who was, wasn't typical. And so sometimes you think it was typical, but she looked like the Michelin woman, I guess. She's, or, you know, total Apple, like you just round, you've seen these people, it's around and the skinny legs. big belly. And I thought, oh, man, her tests are going to be so bad and her blood sugar is going to be high and it's going to be terrible. And what was fast in her A1C, which is her average blood sugar, what was fascinating with her. And this is just sort of speaks to what really happens to people, is her, her blood sugar was perfect. In fact, we even did a glucose tolerance test where you look for diabetes, and we gave her the equivalent of two Coca-Colas and watched whether her blood sugar went up or not. And it never went up. I mean, her blood sugar was under 100 fasting. It never went up over 110, even after all that. But what was really different, and this is the thing people should listen to, and we're going to put in the show notes, the tests that you should think about doing and asking your doctor for. And I've written a lot about it, and in fact, at the end, there's a great descriptions of actually how to diagnose this. But what she had was very high fasting insulin, like 50, which should be under five. and after she took a sugar drink, should be under 30, hers was like 200 or 300. And so her insulin was so high, she could lose weight. And within a very short time, she lost like 50 pounds of belly fat just like that by shifting her diet and reducing the inflammation and dealing with this sort of starch and carbohydrate intake that she took.

Yeah, it's amazing.

It's amazing. It's pretty amazing. And it's really, it's, you know, it's a really gratifying area. And I think, you know, when you look at aging, when you look at fertility, when you look at chronic disease, when you look at productivity, when you look at your brain function, all those things are related to this belly fat. And, and it's really the, the sort of the drum beat that I, and we have been sharing for decades at the Ultra Wellness Center, which is, it's really about the quality of the food you eat, the quality of your diet. And it's why I spend so much time writing books like the blood sugar solution, the 10-day detox diet, fat get thin, Pegan diet, food was next to eight because if we can get this straight, we're going to solve so many of our global issues around health and chronic disease, the economy and everything else. So it's kind of an exciting moment where I think this is becoming more and more recognized. I literally just got off a call with a senator, really, and his team about how we begin to address this true policy. So I'm kind of optimistic. I'm always a little bit optimistic no matter what. Anyway, I think I'm more optimistic than ever that we actually have a moment to start to change the tide on this. Any last thoughts, Liz, on belly fat before we wrap up our podcast?

Yeah, I agree, I agree, Mark. There's so much we can do and simple changes in your diet make a huge impact on how easy it is to maintain a good healthy weight and to prevent this from happening. And when you make those changes and cut out that extra sugar and cut out those refined carbs, you're also not only having an easier time with maintaining your weight and keeping that weight off your belly, but also preventing all those diseases like we spoke about.

That's so great.

Thanks for all the great work you do, Mark. It's really exciting.

Yeah. Well, thank you, Liz. And thanks for being on this week's House Call. I love sharing this information to all of you. If you love this mini episode of the Doctor's Pharmacy, share with your friends and family. Subscriber, you get your podcast, leave a comment, how have you addressed your belly fat? We'd love to hear from you. And also, you know, I've got this new incredible content opportunity which is called Dr. Hyman Plus. And, you can go to my website, drhyman.com, learn more about it. And, it's, you know, ad-free podcast, access to all our documentary series, and ask me anything with me where every month I answer questions through video and personally as well as Dr. Bollom and others are from our team are doing deep dives into functional medicine. so it's a really wonderful way to access a lot more content if you're a little geeky like us. So Dr. Hyman Plus, check it out. And of course, we'll see you next time on the Doctor's Pharmacy.

Thank you, Mark. Hey, everybody, it's Dr. Hyman.

Thanks for tuning in to the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts.

That I know and I love and.

That I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements to gadgets to tools to enhance your health. It's all the cool stuff that I use and that my team uses to optimize and enhance our health. And I'd love you to sign up for the weekly newsletter. I'll only send it to you once a week on Fridays. Nothing else, I promise. and all you have to do is go to drhyman.com/picks to sign up. That's drhyman.com/picks, P-I-C-K-S, and sign up for the newsletter and I'll share with you my favorite stuff that I use to enhance my health and get healthier and better and live younger longer.

Hi everyone. I hope you enjoyed this week's episode. Just a reminder that this podcast is for educational purposes only. this podcast is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided on the understanding that it does not constitute medical or other professional advice or services. If you're looking for help in your journey, seek out a qualified medical practitioner. If you're looking for a functional medicine practitioner, you can visit ifm.org and search their find a practitioner database. It's important that you have someone in your corner who's trained, who's licensed healthcare practitioner and can help you make changes, especially when it comes to your health.

Don't forget, there's a way to listen completely ad free with Hyman Plus on Apple podcasts. You can enjoy every episode without any breaks. Just open Apple podcasts and tap try free to start your seven day free trial.