How To Lose Belly Fat

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

Sugar and starch and this belly fat is the number one cause of aging and age-related diseases. So if you want to die early, get a belly fat. Hey everyone, it's Dr. Hyman. One of the most important tools I have for helping my patients to optimize their health is testing. And that's why I love Rupa Health. and what they're doing. Functional medicine testing can require placing orders with lots of different labs and it can get kind of complicated for me and my patients to easily access results and keep track of everything. But Rupa Health has totally streamlined that process. Looking at hormones, organic acids, nutrient levels, inflammatory factors, gut bacteria, and so many other internal variables that can help us find the most effective path to health and healing. I'm really excited now that I can finally take advantage of these tests without the hassle and confusion of going through multiple labs. Rupa is a place for functional medicine practitioners to access more than 2,000 specialty tests from over 20 labs like Dutch, Vibrant America, Genova, Great Plains and lots more. It's 90% faster letting you simplify the process of getting the functional tests you need and giving you more time to focus on your patients. This is really a much needed option in functional medicine and in this whole space and it means better service for you and your patients. You can check out a live free demo with a Q&A or create an account@rupahelp.com that's R-U-P-A www.pahelp.com Now, I'm all about using health tools that have stood the test of time as part of different medical traditions. So, I was really excited to learn about Paleovalley's Apple Cider Vinegar Complex. Apple Cider Vinegar has actually been around for millennia used both for cooking and wellness. I mean, Hippocrates was even known to prescribe it for different ailments. So, it's easy to see why it stuck with us for so long and we found benefits and using it for things like blood sugar regulation, supporting a healthy weight, and improved digestion. It might sound surprising that many of us lack sufficient stomach acid, which is pretty key for extracting nutrients from food. Apple cider vinegar counteracts that problem and supports the right environment on our stomachs for optimal nutrient absorption. Considering that more than 90% of us are nutrient deficient, it's a good thing to think about. But drinking vinegar doesn't appeal to most people, and I get it, and it can actually even damage the enamel of our teeth. and that's where paleo Valley's apple cider vinegar complex comes in, a convenient capsule that combines apple cider vinegar with other health supporting ingredients like lemon, cinnamon, ginger and turmeric, all of my favorites. Right now, paleo Valley is offering my listeners 15 off their entire first order. Just go to paleovalley.com forward slash hymen to check out all their clean paleo products and take advantage of this deal. That's paleovalley p a l e o v a l l e y.com hymen Now let's get back to this week's episode of the Doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Welcome to the Doctor's Pharmacy and a new series we're doing called Masterclass, where we dive deep into popular health topics, including inflammation, autoimmune disease, brain health, and lots more. And today I'm joined by my guest host, my good friend, my business partner and host of the Drew Prout podcast, Drew Prout himself. And we're going to be talking about the foods you need to stop eating to lose belly fat and what you should start eating that actually will help you lose belly fat and feel better. Well, welcome, Drew.

Thanks, Mark. Great to be here. And, you know, it's a little bit of a click baity topic, but I figured you're great at giving the people what they think they want, but then really you end up giving them what they need. So we're gonna meet the people where they're at. and we're gonna talk about this because a lot of people are very interested. And we're gonna jump right in with two, two of the top foods or food categories that we can stop eating or be more mindful around or limit or minimize when it comes to their role of increasing belly fat. So Mark, what are these two categories and what do you wanna say about them?

Well, we're gonna learn a lot about belly fat on this podcast. But the truth is it's the most dangerous thing in your body. If you have belly fat, it is a risk factor for every single age related disease, period. So it is, forget about smoking. This is the killer. One of the two things that are the worst, one is liquid calories. Well, liquid calories, I don't mean like a protein smoothie. what I mean is soda, juices, even nut milks, which you think are healthy, can be spiking your sugar. Sweetened coffee, sweetened teas, energy drinks. You know, we are living in a sea of liquid sugar, and it's different. It's really different than regular sugar. I mean, regular sugar is bad enough, but this seems to just accelerate the development of belly fat by being quickly absorbed, spiking blood sugar, spiking insulin, and that just leads to this whole cascaded belly fat. It's really bad. So if you can do a single thing to dramatically improve your health is get rid of liquid sugar calories. The second is flour, which is everywhere. And it turns out that flour is worse than table sugar when it comes to raising your blood sugar, which when you raise your blood sugar, you raise insulin, when you raise insulin, you, you sweep all the fuel out of your bloodstream and throw it into your belly fat cells. It's basically what happens. So it's like insulin basically opens the gates, all the fuel, fat, sugar, carbs, everything goes flooding into your fat cells. And then the gate closes like a one-way turnstile in the subway. You can't get back out. So it's really, it's really bad. So flour and sugar. Now, do I eat flour occasionally? Yes. Do I try to eat flowers that are better? Yes. I'll have. coarsely grain flour or I'll have flowers that are full of extra fiber lignans. I'll have buckwheat flour, Himalayan buckwheat flour, which is actually full of phytochemicals and low glycemic load and high protein, high minerals and microbiome enriching fiber. So there's ways to hack it, coconut flour, almond flour, those are all fine. I'm talking about wheat flour or grain flours, even brown rice flour, all these healthy, quote, and gluten-free snacks. They're actually often worse than regular flour because they're just so highly processed and it quickly absorbs. So those are also huge things. And, you know, it's different eating a whole grain versus whole grain flour. Even if you eat whole wheat bread, it's still a problem. So I would stay away from flour and sugar, except on occasion as a treat, and make sure you have a meal that includes protein and fat and.

Fiber so you actually can mitigate the effects of the flour on your blood sugar. So Mark, let's break down the basics. What is belly fat and what are.

We learning about why it's so problematic?

So, you know, most of us were.

Taught that, you know, oh, fat is just fat. It's like this inert thing. You know, it's just there holding up your pants. It doesn't really do much. Not good to be fat or have fat on your body too much, but it's not a thing, really. That's how it was when I was in medical school. But now we've learned that the fat cells in the belly we call visceral fat or belly fat. It's essentially the fat around your organs, right? Your liver, kidneys, intestines, all this fat is very different qualitatively. and when you see someone with a big belly or even who's skinny with a little belly, that is a sign that they're accumulating this belly fat. And what these cells are, are a whole another organ. They produce cytokines. You've heard of the cytokine storm. Why is it that people with obesity are at the highest risk of hospitalization and death? Because their belly fat cells produce what we call adipocytokines, one in particular called interleukin-6 or IL-6. is one of the key cytokines that's driving the cytokine storm in COVID. So that's why we're seeing this problem is because of belly fat. Why people are dying from COVID is because of belly fat. That is important to understand. If everybody in America was thin and had no belly fat really to speak of, COVID would be like a non-issue, right? Unless you're really old or have a chronic disease or something terrible. But 88% of us have some degree of belly fat. that's driving this problem. So that's one issue. They also produce all kinds of hormones. So you see all kinds of changes in people's bodies. For example, women, when they have a lot of belly fat, will get acne, they'll get facial hair, they'll lose the hair on their heads. Men will, the opposite will happen. They'll get high estrogen levels because the fat converts testosterone to estrogen. They'll get breasts, they'll lose all the hair on their body. they'll get soft skin, you know, like a woman. So these are real things that happen. They also change your brain chemistry and they affect your hormones and your mood and your appetite. There's literally hundreds of molecules that are being produced by these fat cells. They're not just storage units for extra calories. They're literally organs that are dangerous organs that are producing inflammation, screwing up your hormones, screwing up your brain chemistry and making you sick. and causing all the diseases of aging.

So, Mark, talk about how actually belly fat and fat as a whole, but specifically belly fat might have been used as a survival mechanism, but now it's kind of gotten completely out of whack in the way that it's around with this 24/7.

Yeah, well, you know, Drew, we evolved in a sea of scarcity. Now we live in a sea of abundance and our genes are adapted to scarcity very well. So we are very good at accumulating and storing any excess calories. So I remember going to Alaska a few years ago with my daughter and we were watching this grizzly bears hunt the salmon in the early part of the summer. And we were told by the guide that, you know, they eat the salmon, they do fine, but they don't really gain a lot of weight. And then they go up into the mountains in the end of the summer and they eat berries and they will gain 500 pounds. by eating sugar essentially. And they gain all that weight. And then what do they do? Then they hibernate. So they lose all the way through the winter. That's why they don't get high blood pressure and diabetes and just continue to have problems. We just keep eating all winter as the problem. And I think the challenge with our modern diet is the absolute excess of calories, the absolute excess of sugar and starch in our diet. and the endless ability to overeat. We were producing between 500 and 700 more calories a day per person in America than we did when I was born. So I think we have to really take a good serious look at the way our bodies are adapted, which is to store as much fat as possible, as quickly as possible, when we have an excess of calories or we have an excess of sugar calories. That's a good thing in the context of these feast famine events that happened throughout human history. The problem now, we just keep eating. So we have to actually stop this process of overeating and eating the wrong foods that's driving this belly fat because it is the single biggest thing that's driving disease. So at one point it was an adaptive mechanism, now it's a maladaptive mechanism. Yeah, there's a great new book out.

And you're doing an Instagram live with the author and I believe the book is called Nature Wants Us to Be Fat and it's Dr. Richard Johnson, and he's one of the top researchers in the space of uric acid and belly fat. And he, through his investigations in hypertension, discovered that, you know, the theory is that millions of years ago, human beings developed this ability to basically use fruit, high amounts of fruits, just like you're talking about other animals like bears to pack on all that fat and survive the winter. It's a fascinating Instagram live, you know, we're going to tune in to, to watch it. And the book is really interesting as well.

Well, think about it. Fruit trees all come in at the same time. So what are you going to do? I mean, they didn't have canning. They didn't have, like, freeze drying. Like, they just had to eat as much as they could while they could get it. And that's basically what we're designed to do. And then the more you want, the more you eat it, the more you want it. So that's how it works. So your body is triggered into overeating when there's an abundance of sugar. It's just how your body's set up and designed.

It's not a design flaw.

It's actually a good thing, except it's only a flaw when we have highly processed industrial food system.

Talk a little bit more about liquid sugar. Why is it that liquid calories, specifically liquid sugars, again, sodas, large amounts and frequent use of fruit juices, especially on an empty stomach first thing in the day, like the classic American orange juice, energy drinks, over-sweetened and highly sweetened, you know, coffees, and lattes that people are getting from places like Starbucks. Why are they so problematic and how is it that they produce so much more belly fat than other foods that people are consuming? So, as I said earlier, sugar calories.

Are bad and liquid sugar calories are worse. And the reason is they're unpacked from the matrix of food that they're in. They're not in a matrix of fiber or protein or fat. They're just pure sugar. And often it's pure fructose, which is, you know, when you eat fruit juice or if we have for example, high fructose corn syrup, that's up to 75% fructose in the sodas. What those liquid calories do is they get quickly absorbed because there's not anything buffering their absorption. They spike your blood sugar, that creates a spike in insulin, and that creates the flood of all the available fuel that's in your bloodstream into your cells. So it goes right into your belly fat cells. It doesn't go into your butt or arm or your earlobe. It goes right into your belly fat. And that is why the liquid sugar calories are the single biggest correlate with obesity in America. If you look at one of the things that people do that are most linked to obesity is liquid sugar calories. And people are clueless about the amount of sugar they're consuming. Most people don't know that, for example, they have their Starbucks mocha frappuccino latte or whatever. It's got up to twice as many sugar calories as a cola, as a can of soda. So, and you think, oh, I'm eating something healthy or it's got milk or it's got whatever. It's definitely bad news. So I think there's a single biggest thing you can do to improve the quality of your health is get rid of liquid sugar calories. Occasionally a glass of wine is fine. Beer not so much. I mean, occasional beer is fine, but not a staple. Shot of alcohol like tequila, okay. But more and more research is coming out that alcohol may not be really that great for us. So I think we have to really be cautious about it.

But those tend to be less of a problem, but they're still bad. So I'm going to pull one of the studies that our team member Melanie listed for us that are on this topic. And I'll just ask you to maybe expand on, you know, what the connection might be there. So here's a study out of the European Journal of Preventive Cardiology, Coronary Heart Disease Incidence in Women by Waist Circumference Within Categories of Body Mass Index. And the study, which looked at hundreds of thousands of women, found that waist circumference, which is part of belly fat, increased the risk of coronary heart disease looked at over a period of 20 years. How could that be possible? How is that your waist circumference and belly fat could be connected to heart disease?

Oh, that's easy. So this is what I've been spending my whole life doing. So thank you for that easy question. You know, people say, how do I know if I have this or not? What do I do? Well, I always joke, I say you could do the mirror test is where you jump up and down in front of a mirror without your shirt on. If your stomach jiggles, you have it. Okay? It's basically that. You can take a tape measure and you can measure around your belly button, around the widest point in your hips, and you divide your waist by your hip. And if it's over 0.9, if you're a man over 0.8, if you're a woman, you're in trouble. If your waist is bigger than your hips, that's bad. If your hips are bigger than your waist, that's good. It's just obvious. Now, why is it a problem? Well, as I said, when you have this belly fat, it's driving insulin resistance, inflammation in the body, and also what we call atherogenic dyslipidemia, which is a medical word for really crappy lipid or cholesterol profile that's causing heart disease. What causes this profile? What is this profile? It's small cholesterol particles, it's small HDL, small LDL, a lot of particles, and a large fluffy triglycerides that are full of fat, which is not good, and it leads to this horrible problem of high triglycerides, low HDL, small particles, which is the big driver of heart disease. If your cholesterol is 300, and your HDL is 100, and your LDL is 70, or let's say your LDL is 150, I'm not that worried. And your triglycerides are normal. If your cholesterol is 150 and your triglycerides are 300 and your HDL is 30, that's terrible. I'm really worried about you. Even though one cholesterol is 150, one is 300, I'm much more worried about the 150. So you have to look at the quality of the cholesterol. You talked about your NMR profile, your lipid profile. This is really key. So we have to look at the right type of cholesterol. And when you have this belly fat, it causes the wrong type of cholesterol. The second thing is that it drives inflammation. which we know is that the root cause of heart disease. And without inflammation, you don't get heart disease. The third thing it does is it makes your blood clot. So if you have too much sugar and starch, it makes your blood thick and it leads to this increased clotting risk. And the heart attack is a blood clot in the heart. A stroke is a blood clot in the brain. So basically that's why you don't want to have belly fat. And it's why It's so bad to eat these liquid sugar calories or anything that's gonna cause belly fat. And by the way, it's a linear correlation. So it's like this, the more your waist to hip ratio goes up, the more your risk of heart attacks and death.

Powerful, powerful reminder. Let's take another category that people are familiar with, and that is dementia, cognitive decline. And there is a study that we'll link here in the show notes. And the title of the study in the Journal of Neurology is Central Obesity and Increased Risk of Dementia more than three decades later. And I'll read out the conclusion for you and you can expand on it. Central obesity in midlife increases risk of dementia independent of diabetes and cardiovascular comorbidities. 50% of adults have central obesity, therefore the mechanisms linking central obesity to dementia need to be unveiled. Why would something like belly fat be connected to dementia?

Well, basically the bottom line is bigger belly, smaller brain. The bigger your belly is, the smaller the hippocampus is. It literally shrinks, which is the memory center in the brain. And the reason this happens is you get a phenomenon we call diabetes of the brain, type 3 diabetes we're calling Alzheimer's now, or insulin resistance in the brain. And it's gonna happen independent of cardiovascular disease. so we know that as I said earlier, that sugar and starch and this belly fat is the number one cause of aging and age-related diseases. So if you want to die early, get a belly fat. If you want a heart attack, get belly fat. If you want a stroke, if you want cancer, if you want Alzheimer's, if you want high blood pressure, belly fat's your ticket. So you don't want that going on in your body because it leads to all these metabolic changes. So this is this whole phenomenon of insulin resistance or diabetes in the brain. is what's driving this problem. So it's not just about heart disease, it's not just about high blood pressure, it's not just about, you know, diabetes or being a little overweight. It's really about the quality of your life and what's going to happen to you as you grow older. And often people don't understand that this is a 100% reversible problem. 100%. Mark, I'd love you to talk about.

And you've been talking about this for years, but I'd love for you to talk about it in the context of this podcast. You know, you have a few articles on the internet saying that when it comes to belly fat, there are two aspects. Number one, we have to understand that it's not your fault. And for the people that are listening or watching on YouTube, I'd love you to explain what do you mean by that, that it's not your fault? And then along with that, there's so much that's in your control that you can do. Let's start with the first piece of it. Why is it not your fault if you are carrying a ton of belly fat or excess fat from a medical standpoint?

From a medical standpoint and from a scientific standpoint, from a nutrition standpoint, the dogma is really clear. Calories in, calories out. The reason you're overweight, the reason you have belly fat is because you eat too much and you don't exercise enough. Hashtag, you're a lazy glutton. Okay? That is just a bunch of malarkey. and here's why. We know that all calories are the same in a laboratory. So you say, oh, you say all calories are not, are not the same. Dr. Hyman, who are you to say that this is, you know, the first law of thermodynamics is all energy is conserved. And so calories in, calories out. This is the way it is. This is just science. And I'm like, well, yes, you're right. In a vacuum. So what, what the first law of thermodynamics says, for those of you who are not up and up on your physics, is it says that energy is conserved. quote, in a system, meaning a closed system, like a vacuum. When you drop a pound of feathers and a pound of lead off a bridge, the feathers float through the air and the lead goes crashing down. If you drop them in a vacuum, they drop at the same exact rate. Why? Well, they don't have to contend with air. The feathers have to contend with air. When you eat food, it has to go through your metabolic processes. It has to deal with your microbiome, it has to deal with your genetics, it has to deal with your hormones, it has to deal with your brain chemistry. It's interacting all with that all the time. So if you eat a thousand calories of broccoli or drink a thousand calories of soda, they're gonna have very different effects on your body versus if you burn them in a laboratory, they release the same amount of energy. I mean, a calorie is defined as basically the amount of energy required to raise the temperature of one liter of water, one degree centigrade. That's it, right? So yes, in a lab, they're the same. So the message that it's about eating less and exercising more misses the central science, which has overturned that theory that all calories are the same. And this is what we call the carbohydrate insulin hypothesis. And the key proponent of this has been Dr. David Ludwig, who's a colleague and friend of mine. who's one of the most published, researched and esteemed scientists in the field of nutrition today from Harvard Medical School. And he's written, you know, really in depth about this. You can read his articles on Medium. You can go to PubMed and find his work. He wrote a very extensive review of this called the Carbohydrate-Insulin Hypothesis and essentially shows through the science that when you eat a carbohydrate-rich diet, if you are genetically susceptible, which is most of us on the planet, okay, some aren't, but probably 80% of us are. You are carbohydrate intolerant. And when you eat X amount of carbohydrate in the form of sugar or starch, not talking broccoli carbohydrates here, it raises your insulin more than someone, for example, like me who doesn't have that problem. So it's really important to understand that if you are consuming starch and sugar in any form, that you are driving this pathway of weight gain, central weight gain, inflammation, oxidative stress, blood clotting, hormonal dysregulation, brain chemistry changes. And it's really based on the information in the food because food is not just calories, it's information, it's instructions, it's code. It can upregulate your genes or downregulate them. It changes your microbiome, it changes your immune system, it changes your hormones, your brain chemistry. we have tremendous power to understand now the quality of our food determines the quality of our health. The quality of the information, the food is what changes the messages that get turned on or off in your body that regulate everything, not just your weight. So it's so important people understand that when they're eating food, not only are they eating calories, but they're eating information. The second thing around it's not your fault, your fat, is we live in a toxic nutritional landscape. It's almost impossible to go out there and hunt and gather in America and find stuff that's not gonna kill you, right? I mean, I travel, I go to airports. I mean, they've gotten better for sure, but I never travel without my emergency food pack in my bag. I carry protein and fat in my bag for at least a day's worth of food, so I don't have to get stuck in a food emergency. But it's rough out there in America, and we are living in a toxic nutritional landscape where the easy choice is the wrong choice. and the hard choice is the good choice.

It's such an important reminder for everybody who's watching because I think there's so many individuals, and Mark, I'm sure you've had patients, and I'd love to talk about a case study. There's one that comes to mind, somebody who suffered tremendously with excess weight and specifically belly fat and what they did to get better, but there's so many people that carry around the guilt because they've been told their whole life through the media, maybe even their doctor, their well-intentioned doctor who's just repeating what they learned, that they need to finally get some willpower and get their life together. And so many of these people have tried so hard. They tried so hard and they tried so many different things, but because they are trying the standard advice, which is just eat less and exercise more, which is the same advice that they gave to the people on the show, the Biggest Loser. I'd love for you to talk about that and what we've found out from that experiment. They feel like it's not working. So talk a little bit about the biggest loser and then we'll go into a case study.

Well, the biggest loser was a problem because people were motivated by money. They were given extremely low calorie diets. They were pushed beyond their limits in exercise and they were able to achieve significant weight loss, which you will do. And the problem is when you do that, your body is in a state of crisis. and as soon as you stop, it's gonna rebound and you're gonna gain back that weight and often more. Because often when you lose fat, you lose fat and muscle. When you gain back, you just gain back fat. So you could be basically the same way as you were when you started your diet and actually burning less calories. That happens to people. And you see all the people who are really overweight or struggle with yo-yo dieting their whole life, they go, I don't really eat that much. I don't know what's going on. And they're right. They're right. Their metabolism has slowed down so much. because they've lost so much muscle and they've screwed up their metabolism. So, you know, if you lose weight, you have to work on your muscle mass, which is important, and it has to do with the quality of the food you're eating. But the, the whole idea that you can go on these crash diets and, I mean, I never put people on a calorie restricted diet. Never. I never say, count your calories, cut your calories, don't eat too many calories. I don't even say the word calories. Like, I don't, it's just so irrelevant. And I've had people lose hundreds of pounds. And it works because when you use science, not willpower, it's easy. People aren't hungry, they feel nourished, they feel satisfied, they don't feel deprived, it's sustainable, they want to continue it, they feel good. You've got to use science, not crazy, crazy amounts of external force or internal force like willpower to actually get you to do it.

So, Mark, let's get into that case study. And is there somebody in mind that you want to talk about and what they did to radically reduce the amount of belly fat, which then, besides looking better and everybody cares about looks, it actually reduced their risk of many of the chronic diseases that we talked about earlier.

Well, this is a great example, Drew, because it illustrates all the bad crap that can happen to you if you eat sugar and starch your whole life, really. And then it illustrates how quickly it turns around if you change. because, you know, think about it. We spend 40, 50 years getting sick. It can take a few months to get better, which people don't realize. It's really dramatic. So, you know, it takes a while for food to kind of screw you up, but it can take very quickly for you to get fixed by it. And this woman was named Janet. She came to see us at Cleveland Clinic. She was 65 years old, and she had every kind of chronic disease except cancer and dementia. I mean, she had high blood pressure. She had pretty bad heart disease with needing stents and all kinds of procedures. She had heart failure because her heart muscle was damaged. She had type 2 diabetes on insulin. Her kidneys were starting to fail. She was getting fatty liver. So pretty much her whole body was starting to shut down. And she came in pretty desperate and she was a fairly well-educated woman, but her family just had no food sense and they grew up on junk and she thought this is just what you eat. processed food. She never knew how to cook or do anything. And so within, within three days, and she was on insulin for 10 years, within three days of changing her diet to a whole foods, anti-inflammatory, phytonutrient rich, high fiber, high quality fat diet, essentially the 10 day detox diet, which I wrote a book about in 2014. Essentially, within three days, she was off insulin. In three months, she was off all her medication, her heart medication. her blood pressure medication, her diabetes medication, and her numbers normalized. Her blood sugar went from way out of control A1C of 11.4, I think, to 5.6. So just to put in perspective, if a drug causes a one-point drop, it's a blockbuster benefit. Like, wow, this is amazing. This drug, new drug, lowered A1C by one point. Like, that's how of a sensitive scale. It's what we call logarithmic scale. So it's not a linear scale. It's like exponential scale. She went down from 11 to 5.6. You don't see that with medication. There's no drug that can do that. Second, her blood pressure normalized. She got off her blood pressure pills. Her heart failure, which we measured on an echocardiogram, reversed, which you never see. You just don't see that in traditional medicine unless you get a heart transplant. Her kidneys got better, her liver got better, and she lost like 45 pounds in three months. And then she went on to lose 116 pounds and looks like a completely different person. and she was on her way to the graveyard by way of a heart transplant and a kidney transplant. And then she avoided all that and it's doing amazing. And back to being a powerful contributing member of her community. So that's the power of food when you understand that. And she had this giant massive belly and you could see her face before and after. It was just red and inflamed. And that inflammation is what's driving all the obesity and everything else.

And if anybody wants to see a photo of Janice with her approval and also how her numbers improved over time, we have the link to that inside of the show notes that Dr. Hyman has put together. So, Mark, let's go into the portion of the podcast where we take some audience questions, some questions from your community. Here's the first question. What about belly fat after menopause? Is there a difference and is it more dangerous?

I don't think it's different, but it gets more dangerous as you get older, for sure. So often women are in a hormonal chaos in that time of their life. They get thyroid dysfunction, adrenal dysfunction from too much stress. Their blood sugar and insulin are often more deranged because they're more stressed. They're in that sandwich generation between like getting their kids launched and their parents getting older and a very busy career time. And, it's just a disaster. And, you see this terrible triad of sex hormone dysregulation, insulin resistance, thyroid or four things, insulin resistance and adrenal dysfunction. And that leads to increased belly fat and metabolic issues. It's not inevitable. There are many 50 year old women or 55 year old women who manage it and who eat well and exercise and take care of themselves in ways that actually prevent this. But you have to be more Vigilant, you have to be more careful, and you'd be more on top of it. Like, I'm, you know, 62 years old, so I have to pay way more attention to my health than I didn't when I was 32 or 42. just to be able to do the same thing. So if I go for a couple weeks without exercising, it's a lot worse now than it was when I was 25. It takes me a little more time to get back to where I was. So really important to understand that you need more inputs as you get older, but you can still maintain vigorous health and strength. And they've shown that with the research that actually you can stay vital in health and helping fit very, very long into your later life.

All right, next question. What's the challenge with eating? late at night, regularly having dinner at 9:00 PM, 10:00 PM, or even eating late night snack at 11 or midnight, maybe even 30 minutes, 10 minutes before people go to bed.

One of my first books, Ultra Metabolism, I wrote about what we call the Sumo Wrestler Diet. And, basically, the Sumo Wrestlers, the way they gain weight because you've got these little Japanese people who are not genetically prone to being obese. And, how do they get them to be those huge Sumo wrestlers? Well, they basically wake them up, they do their routine of exercise and training, and then they eat a humongous meal called chanko nabe, which is basically like, it's really actually healthy stuff, but it's a massive amount of, of food and protein and fat and rice, and it's like this massive meal. It's, I love it, actually. I love to eat it, but. it just makes him gain a lot of weight. So they basically had this giant lunch and then they go to sleep and take a nap. And then they do the same thing. Afternoon, they may wake up a little exercise, big dinner, go to bed and sleep with a big full stomach. That will make you gain weight. Why? Because when you're sleeping, your body's in repair storage mode. So all these hormones change from day to night. And the hormones at night are storage hormones. so you're gonna store all that food as belly fat. So you don't wanna eat before bed. Three hours at least. I mean, occasionally if you go out to dinner or whatever, it's fine. But like if you're on a regular schedule, like I eat, you know, five, six o'clock bed, you know, nine, ten o'clock, give myself three hours to digest my meal and don't have snacks. It's, I mean, snacking first of all is the worst invention of humanity. It's, you know, we was like we all of a sudden got six, seven hundred extra calories a day per person and the food industry was, what are you gonna do with that? Well, let's make it all these fun snacks and convince America they need to snack and never be hungry. It's like it's the worst thing. So snacking is terrible and you should really eat in a shorter time window. You should definitely not eat before bed. And if you do, I promise you.

You'Re gonna gain weight. Yeah, one of the thing that the sumo wrestlers do is they drink a big pint of beer in addition to that meal. I was watching a documentary on sumo wrestlers. Oh, yeah, yeah. And I was talking about this with Dr. Richard Johnson we mentioned earlier. you're saying, yep, that flood of uric acid that comes in and that's sign to store up the belly fat. So, yep, don't live like a sumo wrestler is the moral story unless you wanna look like one.

That was basically from ultra metabolism way back when.

Here's another question from our community. If insulin drives weight, why are diabetics put on insulin?

Great friggin question. Here's the thing, most doctors know this, most average people don't know this. When you have a diabetic and you put them on insulin, what happens? Do you know?

They gain weight.

Their blood sugar goes down, but they gain weight, their blood pressure goes up and their cholesterol gets screwy. So it's like a whacK-A-Mole. Yes, it keeps the sugar down, but what you actually learned, and that this was a huge study, was called the ACCORD study of 10,000 diabetics. who are in aggressive blood pressure management. In other words, they like, let's get these people's sugar as close to normal as possible. Let's give them lots of insulin, lots of drugs. Let's drive their sugar down. And let's see how they do. And you think, oh, well, if sugar is the problem with diabetes, if they got their sugar normal, they'd be fine. Turned out the opposite was true. The lower their blood sugar, the worse they were. The more heart attacks, the more deaths. Why? Because they use a lot of insulin, and insulin makes you die, it makes you fat, it kills you. It's the worst thing when it's in excess. So, if you, and I often, by the way Drew, I see type 1 and type 1 diabetics often getting double diabetes. In other words, they have type 1, but then they get type 2. So here's how that works. Normally you should make about 20 units of insulin, 15-20 units of insulin a day to manage your blood sugar. That's the average person. what happens if you're a diabetic type one, if you, let's say you want to eat cake and ice cream and cookies and whatever, you can do it and you can keep your blood sugar normal, but you need to give yourself more insulin. And so they keep giving themselves more and more insulin and they get insulin resistant, which means they need more and more insulin just to keep their sugar normal. So they might be using 50, 60, 100 units of insulin. That's terrible. So you can get double diabetes by eating too much crap and using insulin to manage your blood sugar. so the key is to keep your blood sugar as low as possible. And, and, and a friend of mine is a type one diabetic, and she uses a ketogenic diet, and, and she basically uses one or two units of insulin a day, which is like ridiculously low, because if you, you fat, you eat fat, you don't need, you don't need insulin. And that's why ketogenic diet works so well for type two diabetes, where they cure 60 of people where 95 or 100 got off the main medication, over 90 get off their insulin or reduce it dramatically. It's, it leads to the most weight loss of any study I've ever seen, which is about 12, which doesn't sound like a lot, but. most studies, you get 5% everybody's jumping up and down and super happy. So it's more than double what you.

See with a normal weight loss study.

Right.

And there's a way to do cleaner versions of keto, there's ways to do dirty versions. We're obviously talking about the cleaner ones that are plant forward, plant rich at the base of it to get all that.

We don't want to just be eating.

Bacon all day and- no. Olive oil, avocados, nuts and seeds. Yeah, there's plenty ways to do keto in a clean way. All right, a couple more questions here before we wrap up today's podcast on belly fat. Why is it so important to practice stress management techniques to help with losing belly fat? Is there a connection between the mind and the body when it comes to belly fat?

Well, yes, stress makes you fat, relaxing makes you thin. Okay, it's that simple. Here's how. I actually, I had a patient, I learned this from her. She was a woman who had a daughter living in Israel. and it was during the time of, like, maybe 15 years ago, whenever they had the infant, it was really bad. And she was terrified for her daughter, and she was so stressed, and she could not lose weight. She was, like, 40 pounds overweight, and she struggled, struggled, struggled. Her daughter moved back to America. 40 pounds went away.

And.

And what happens when you're stressed, you make cortisol, and you send all sorts of signals through the vagus nerve and the sympathetic parasympathetic nervous system to your fat cells. So. So basically, every cell in your body is wired to your nervous system. so you're eating, you're trying to metabolize your food, your fat cells are listening to your signals from your brain and they're telling it what to do. And it turns out that the wiring that goes to your fat cells, when you're under stress, tells the fat cells to store fat. And that's, wow, okay, so you never wanna eat a meal if you're stressed. You wanna stop, take a breath, you know, why do people say grace, have a prayer, take a moment, it's to reset your nervous system. And I think there's a simple practice called take five that you can do before you eat, where you take five breaths, five seconds in, five seconds out, five times, just like that, you know, through your nose ideally, but just five deep breaths and you'll see your body will change, your physiologically will change, your pH will change, your brain chemistry will change, and your body will be more in a state of relaxation that receives eating. Also, you can actually absorb nutrients as well when you're stressed. So there's a lot of issues around stress. But between the innovation of the fat cells that makes them store fat and the high levels of cortisol, by the way, cortisol is a drug also that we use called prednisone or steroids. Your body makes it and you need it, it's there. But when it's in excess, when people are taking it, for example, what happens to them? So there's actually a word for it. It's called cushingoid. they get looking like Cushing's patients, which are people who have a tumor that's making too much cortisol. So they'll get really big bellies and belly fat, they'll get skinny arms and legs, they'll lose, they'll get high blood pressure, they'll get diabetes, they'll get all the things that we see from people who have too much sugar. But it's from the cortisol that raises blood sugar, raises insulin and all these secondary effects. 'Cause you want that, right? If you're running from a tiger, you.

Want your blood sugar to be as high as possible so you don't run out of gas if you're running from the tiger. All right, last question that we have here, Mark, and then we'll do a little bit of a recap for today's episode. What is the role of fasting or intermittent fasting when it comes to losing our belly fat? And are there techniques or resources that Dr. Hyman has to make it fasting easier or less scary is what I'm reading into the question?

Yeah, yeah, yeah, yeah, yeah. Okay. So, yes, so time-restricted eating, intermittent fasting, fasting, mimicking diets, ketogenic diets, they all do the same thing. They basically give your body a break, a period of non-eating or, or appearance of not eating, right? If you're, if you're eating keto, you're not eating carbs, but you're still eating, but the body doesn't register it as, as anything that's driving insulin. So, so if you could drink a liter of olive oil on empty stomach, your insulin will not rise one bit, even if it's a million calories, it just doesn't go up, right? But if you eat that pat with sugar, it's a problem. So the key to fixing the belly fat is to lower the insulin and to turn on all the other signals that make you burn fat. And the way to do that is, and there's a lot of ways to do that, but one of the ways to do that is to do time restricted eating. So you eat within an eight hour window. So let's say you eat dinner at six, you can eat the next morning at 10. It's not that terrible. I mean, if you eat at eight, you can't eat till 12, whatever. But you really need a break from eating. And if you really have a lot of belly fat, the eight hour window to eat is really effective. And it turns on all the signals that repair your body, reduce insulin resistance, get rid of belly fat, build muscle, reduce inflammation, increase your antioxidant enzymes, improve your brain function and cognitive awareness. So it's really beneficial. You can also do periodic fasts, like a day fast, 24 hours, 36 hours. you can also do other things like fasting mimicking diets where you restrict your calories for five days, like Valter Longo has talked about and it's been on the podcast talking about that. Or you can go on a ketogenic diet, which basically you can do with time restriction or not, but that also does the same thing. So when you think it's scary, it's 'cause you think you'll be hungry. But the truth is if you learn how to eat with the right composition and information, the food, it will make you feel full, satisfied, you won't be hungry. And there's hacks. You can drink a lot of fluids. You can sometimes use a MCT oil because that won't kick you out of ketosis. So you can really, you know, use a lot of techniques, but it's very safe. It's very effective. And it's actually not that scary because it's, it's not that hard for most of us. Now, if you're really underweight, if you've got cancer to something, you know, stuff like, stuff like that, you don't want to be doing the too much of, restricted eating. I mean, I know for me, I can do, I can do 16 hours. If I go more than that, I'm, I'm in trouble. Like I, I get in trouble. So I just, you know, I have very low body fat and I'm probably too stressed, but I don't really feel stressed, but I think my adrenals have beat up over my life. But I've been trying to recover from my life. But the truth is, you know, your body usually does really well if you have any visceral fat doing time-restricted eating, intermittent fasting or ketogenic diets.

All right, Mark, those are all the questions that we have for today. I'm gonna pass it over to you to a little bit of a recap. of what we covered, foods to avoid that are linked to belly fat, why it's important to bring our belly fat down, not just for looks, which often brings people in, but actually for chronic disease, and maybe a message of hope because a lot of people feel very stuck when it comes to this topic and feel like they tried everything.

Yeah, well, it's actually, to me, it's one of the most satisfying parts of my practice, Drew, because the power of changing the composition of your diet is so extreme and works so well that, and it's so relatively easy to do that it should give people a lot of hope. And so just to recap a little bit, we, you know, it's not rocket science, right? It's sugar and flour and particularly liquid calories. So any sugar, any flour, pretty much, unless it's like coconut almond or maybe the Himalayan Tardary Buckwheat flour, you want to really be careful about. the second thing is that when you get excess amounts of sugar and flour, it does a couple of key things. Just to recap, one, it spikes your blood sugar, and then that spikes your insulin, and then that puts all the fuel that's circulating in your bloodstream, both fat and sugar and everything, into your fat cells, and it locks them in there. And when it does that, it slows your metabolism, it creates inflammation, it makes you hungrier, it causes all kinds of brain issues in terms of depression, it leads to Alzheimer's, heart disease, cancer, diabetes, high blood pressure. I mean, it's basically the worst thing you can have. And yet, when you switch up the way you're eating and understand that food is information and change the quality of your diet and change the kinds of carbohydrates you're eating from starch and sugar to more vegetables and fruit, you literally will change this overnight. So It's about cutting down or out the sugar and starch, depending on where you are, and then increasing the proteins and the fats, particularly the fats, avocados, olive oil, nuts and seeds, all those really help cut appetite, regulate your metabolism better, speed up everything. And it's, it's really easy to fix. And I, I can't tell you how many thousands of patients I've had who've gotten so much better and fixed all their numbers. And then the millions who've read my books and done others. programs that we've done have seen so much amazing results. So it's not that hard. It's a little scary. And I think people are struggling. I encourage people to kind of fall back on the 10-day detox. It's 10 days highly structured that gives you exactly what to eat, when to eat what, and how to actually regulate your hormones and your brain chemistry so you're not hungry, you're not starving, you feel good, you minimize any of the withdrawal effects because a lot of stuff can happen. And if you stop eating sugar and starch, you start dumping sodium. and when you start dumping sodium, you dump water, and you get dehydrated, electrolyte, all kinds of issues happen from, you know, going from being really unhealthy to healthy. There's a doorway, and you have to know how to manage that. So all that's in the 10-day detox, I think we'll link to it. And if you've loved this podcast, please share with your friends and family on social media. Subscribe where you get your podcast. Leave a comment. We'd love to hear from you, and we'll see you next week on the doctor's Pharmacy. Hey everybody, it's Dr. Hyman. Thanks for tuning into the Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you to 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.

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