Dhru Purohit Show - Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good

Episode Date: December 23, 2024

This episode is brought to you by Fatty15, Lifeforce, and Levels,  As we age, signs like swollen joints, puffiness, lethargy, and reduced sharpness may indicate chronic inflammation tied to visceral fat, the “hidden fat” deep in our organs. Focusing solely on visible subcutaneous fat can overlook metabolic dysfunction in lean individuals. Addressing visceral fat reveals key drivers of health, paving the way for longevity and optimal well-being. Today on The Dhru Purohit Show, we bring you a special compilation episode featuring Dhru's conversations with experts on the dangers of visceral fat. Dr. Sean O’Mara delves into the risks associated with visceral fat, the foods and lifestyle factors that contribute to its production, and actionable steps to lower visceral fat levels to prevent chronic disease and extend lifespan. Dr. Ana Claudia Rosa highlights the lifestyle factors that increase visceral fat and offers strategies to reverse its percentage in the body. Dr. Manickam Palaniappan (Dr. Pal) discusses the unique challenges of belly fat and visceral fat within the South Asian population, explaining why individuals in this group should be cautious—even if they have a "normal" lipid profile and are not classified as obese by traditional standards. If you're seeking a deep dive into visceral fat and practical ways to reduce your risk of chronic disease, this episode is for you. Dr. Sean O’Mara works with business executives, professional performers, and athletes who are motivated to optimize their biology through innovative performance-enhancement techniques.  Dr. Ana Claudia Rosa is a physician, radiologist, and medical doctor affiliated with the VA healthcare system. Dr. Rosa is an expert on visceral fat, emphasizing its significance in detection and detailed reporting.  Dr. Manickam Palaniappan is a renowned gastroenterologist recognized for his expertise in digestive health and innovative treatment approaches. Dr. Palaniappan is highly respected for his skill in managing complex gastrointestinal disorders, including inflammatory bowel disease, liver diseases, and colorectal cancer. In this episode, Dhru and his guests dive into: What is visceral fat, and why it's dangerous (1:12) Top drivers of visceral fat and why there is such an explosion (9:37) How subcutaneous fat differs from visceral fat (24:37) Accumulation of excess levels of visceral fat (32:37) How Dr. Ana implements these strategies in her own life (37:53) Tracking visceral fat and optimal testing (43:53) How belly fat translates to chronic disease (50:50) Dr. Pal's personal story (53:33) Why visceral fat develops (59:17) Lifestyle vs Genetics or both (1:04:33) Also mentioned: Full episode with Dr. Sean O'Mara Full episode with Dr. Ana Claudia Rosa Full episode with Dr. Pal This episode is brought to you by Fatty15, Lifeforce, and Levels. Fatty15 is offering an additional 15% off its 90-day subscription Starter Kit. Go to fatty15.com/dhru and use code DHRU to replenish your C15 levels for long-term health. Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress; go to mylifeforce.com/dhru!  Right now, Levels is offering my listeners an additional 2 FREE months of the Levels annual Membership when you use my link, levels.link/DHRU. Make moves on your metabolic health with Levels today.  Learn more about your ad choices. Visit megaphone.fm/adchoices

When we think about fat, we tend to focus on the visible fat that we can see in the mirror. But there's another type of fat, an often overlooked type of fat, that exist internally, even in leaner individuals. Hi, everyone, Drew Prode here. And today we have a fantastic episode with you with three guests that we've had in the past who are talking to us about the dangers of visceral fat. Yes, visceral fat. It's wreaking havoc on our health. It's acting as a silent killer. behind the surface. And as mentioned in today's episode, we have three fantastic educators who are

talking to us about this subject and the dangers of visceral fat. We have Dr. Sean Omarra, Dr. Anna Claudia Rosa, and Dr. Powell. And they're here to talk to us about how identifying and lowering visceral fat levels could be a canary in the coal mine for reducing inflammation and promoting overall health and longevity. Now, let's tune into my conversation with Dr. Sean Amara as he explains what visceral fat is and shares what he believes to be the top five causes of visceral fat. I want to talk about visceral fat. Help us understand what is it and give us a few reasons why it's so dangerous inside

the body. Yeah. So a good name because people hear about visceral fat. It's often described other ways like deep belly fat, but some cool names that I like to refer to it as invisible obesity because it's. It's kind of fat that you don't know about. So it's invisible. It's deep in your abdomen.

Another term that I've heard that I'll give credit to is Carl Lenore's superhuman radio. He calls it radioactive fat. And so it's this fat, you know, from the concept that it actually has inflammatory properties. It's not really radioactive, but it's the notion that it has the ability to influence tissues outside of itself. And the way it does that, Drew, is through inflammatory molecules, that it's constantly leaking and producing and sending throughout the body. So it's a proximity to the vascular system that allows it to be distributed throughout the body. And then it has this untoward inflammatory effect and all the tissues. So keep in mind, chronic disease, we hear about the common pathway of chronic disease is inflammation.

And it's my clinical experience that visceral fat is behind all of that. I mean, it's got this association or causality yet to be proven in many cases to virtually every form of chronic disease. So one of the interesting things I like to let people think about when it comes to visceral fat is if you have a malady, a certain form of chronic disease, just go on Google or AI, and go, you know, put in the search term, whatever you have, comma, and then list visceral fat. The other technical term for it is visceral adipose tissue. Adipose means fat.

So a variety of terms are used to describe visceral fat, but it is a really bad player because of its influence throughout your body. So I think that's a pretty good introduction to its association with chronic disease. and then anecdotally, I would like to share that I studied it for seven years for the National Science Foundation, a grant that we received. And during that time, we looked at in 6,000 people, their chronic disease, things that they identified as forms of chronic disease they were suffering. And as we focused on eliminating visceral fat in those individuals, all of their forms of chronic disease either got better or completely. It was amazing as they got rid of visceral fat and to the extent they did. So sentimentology and conditions reversed better if you eliminate more of that visceral fat and only partially prove if you if you just eliminate to a little bit.

So that was absolutely shocking to see that something as profoundly connected to pathology and disease was never shared with me in medical school. We only learned about it through this study. But, you know, there's a lot of studies. If you Google Viceralfat, and just like I invited people to go on Google or AI and look at its association with whatever condition they might be afflicted with, it's connected with so many conditions.

It's been very well researched. But the problem is I've never seen something so valuable in the research lane kept from practitioners. physicians. It's it's inexplicable how something as powerful as this biomarker is kept from medical schools.

The curriculums and medical schools are standardized. I went to both a law school. I'm an attorney as well as a physician. And I remember there are good law schools and bad law schools. But in the United States, there is no bad medical school. And that's because all the

curriculum is set and they're very, very good professional schools. The downside to that is because that curriculum is set and standardized, we don't have really good curriculum and not so good curriculum. So it's all kind of cookie cutter. And ubiquitous in all these medical schools is a lack of awareness about visceral fat and some of the other biomarkers that we learned out in our study for the National Science Foundation in addition to visceral fat. Let's talk about the basics. What are the top drivers of visceral fat? And why is it such an explosion of visceral fat in our modern day society? Yeah. So the big five things that we have found that contribute the most to visceral fat, based on our experience with the National

Science Foundation and using this MRI to evaluate it, is first and foremost, processed foods. So when you eat a lot of processed foods, and maybe I'll just pull up this image here to support that, that you contribute to visceral fat. So let's demonstrate for those watching here, the elimination of processed foods. If you simply only eliminated processed foods

and you didn't do anything else. So you want to limit your confounders. In other words, we didn't do medications, we didn't do exercise, we didn't have this individual do a sauna, we didn't have them fast or anything else other than simply eliminate processed foods, processed carbohydrates in particular. And just to be clear, we're talking about ultra-process foods or we're talking about, because, you know, processed foods is a term can be kind of confusing to people. Some people will say guacamole is processed, right?

But you're talking about first and foremost, ultra-process foods. Yeah. But then also it sounds like you're talking about some minimally processed foods, especially when it comes to certain carbohydrates, right? Like are you talking about like pastas and other things like that? Yeah, that would be included. So anything that really changes the form if it's not a natural process. So if you simply take an avocado and squash it and turn to guacamole, that's a pretty natural process. but if you were to take something like wheat, grind it up, add some oils, and cook it, that would be a lot more processing.

So our guidance to individuals during the National Science Foundation was to only use natural kind of processed foods, you know, squashing, changing the form with some kind of mechanical event as opposed to cooking or adding other ingredients into it. So we instructed this individual to eat food in whole form. So it would be meat and vegetables in non-processed form that he was allowed to eat. And he did that. And he had this amount of visceral fat on his baseline, meaning when he first got started. Yeah. And so you, just to describe again for the people that are listening on the podcast, you have basically a series of six images. And they go from week zero all the way to week 30.

So this is a sequential imagery. And the visceral fat here is this sort of yellow, whitish imaging that's there. And you go week by week. You go week zero to two to five to 15 to 25 and 35. So you sequentially see. And then next to it, you talk about how much the amount of visceral fat is. And is that in the total body or is that in the abdomen region? Like week zero, it says 5.6 pounds.

Is that the total body or is that just in that area? Just in the abdominal cavity. So the visceral fat would roughly correspond, include fat outside the abdomen around the heart. So that's organ fat too. But it's quantified in this particular image through software that was captured and limited just within the adamant. So this pinkish red color in the middle is your visceral fat. Your subcue fat is the yellow. We tracked and paid attention to.

the visceral fat because that is the more harmful substance. And yeah, sorry about that. I got it wrong. The pinkish was the visceral fat. Yeah. My apologies. Yeah, just adding some clarity to it. So you can see from in just two weeks, even though you are not a radiologist and many who are

watching this and able to see that, they can visualize that the visceral fat, the pinkish substance has been reduced. And so that's an important observation to be aware of. And that happened just by this individual cutting out processed foods. But as you rightfully point out, over 35 weeks, this guy goes from having a dad body, he's 68 years old, and he also has muscle with fat infiltrating the muscle. We call that adverse muscle composition or myosteotosis, the technical term for it, where fat starts depositing within the muscle of your body.

And by a time, 35 weeks are up, this guy goes from a dad bod to looking like a collegiate swimmer. Look, he looks like somebody in his 20s. He reduces visceral fat that much. And he actually improved his musculature, and he did so without any exercise. So the elimination of visceral fat was profoundly facilitated by the elimination of processed carbohydrates and food. So you ask what, you know, what causes visceral fat? That's a big one. And then I don't have an image of it, but a second one we get into is alcohol.

So somebody that drinks, the more you drink, and you could, I could throw, have you start pounding, become, you know, this heavy, heavy drinker. We're not going to see visceral fat for a while. But the more you drink, the more your metabolism is burdened and your capacity. to have a healthy response to the caloric intake becomes compromised. And is that generally because people who are drinking more are sort of also drinking their calories, right? So they're also getting just total excess extra calories and that's contributing to visceral fat?

Well, the calories do make a contribution, but it's really more of its metabolic impact. Alcohol, when it's ingested, behaves differently because of its biochemical. composition than any other forms of calories. So if you're ingesting fruit or rice or protein or meat or some other form, it's not going to have as much impact on your metabolism as alcohol. So we have our clients eliminate. We recommend that they either cut back, scale back on alcohol or completely eliminated. And those that eliminated completely have better results in eliminating

of visceral fat than those that continue to drink. And to the extent that you continue to drink, you become more resistant to the elimination of visceral fat. So somebody who comes back and has disappointing results between their scans, we will ask them about alcohol use. But for the most point, what's really interesting is people, when they get scanned, really are very, like I said earlier, very open to changing their lives more than any other time. Because they see it firsthand. They do. And they say, you know, I've never thought about giving up

alcohol, but now I see that stuff inside of me. And they give up alcohol. They give up processed foods. And the third thing that causes visceral fat is impaired sleeping. So if they have a sleeping disorder, if they have obstructed sleep apnea or they are apic at night time, we bring this to attention their visceral fat, suddenly they get a lot more serious about using maybe their CPAP machine or going in and getting evaluated for CPAT or obstruct a sleep apnea, or they work on improving their sleep hygiene, becoming more attentive to how they may be impairing the sleep. A lot of people don't value sleep. They see this huge amount of visceral fat that they have inside, of them. And so with that awareness, suddenly they start going to bed earlier. They start

cutting out all the stimulation and other things. And that we could do, you know, months of shows on sleep. But, you know, suffice it to say that impaired sleeping has a major contribution to visceral fat. The fourth one surprises people. And it was a very, it was a very interesting conversation that you had with Dr. Lustick is about stress. So stress causes through the mediation of cortisol, the contribution and composition and deposition of visceral fat within the abdomen. And so individuals who unknowingly have stress in their lives or who have stress in their lives but simply tolerate or put up with it will be unfortunately accumulating, unnecessarily a visceral fat inside of them to the extent that they have it.

Now, everybody's body is a little bit different, and some people respond to stress a little bit different. But to the extent that you can eliminate stress, you will eliminate the composition or deposition of visceral fat inside of people. So it's really an important discussion for people to be aware of. And then the final point that we see is, believe it or not, and it came a surprise, is durational exercise, where we simply exercise too much. And so we see that people that are runners, and I'll pull up a nice scan of this, here's an MRI of somebody who's a marathoner who would run eight to ten marathons a year. He had a lot of this visceral fat within him and he had this very small amount of subcutaneous fat.

So we call these people with low subcutaneous fat on the outside tofies. So they're thin outside and fat inside. So this marathoner was filled with a lot of visceral fat. So we see, and it's probably two things. One, it contributes to visceral fat when you overexercise and the exact mechanism is not clear. But my theory is probably through elevated reactive oxygen species, ROSs that go around that are associated with exercise. If you exercise too long and too much, you enhance these ROSs from being produced.

And so another example of this happening is a really nice before and after scan and a 50-year-old executive a company who came in and he was having his repeat at Donald scan, his MRI. So this for the audience that's, you know, listening, you have a before and after. It looks like they're taking about two months apart, right? Correct. And so on the left-hand side for this individual that you mentioned, go ahead. Yeah. So on the left side is an MRI image of his abdomen and he's got a substantial amount of visceral

fat within his abdomen. His muscles look pretty good and he was a pretty healthy guy. He was doing a lot of healthy things, 58 year old executive. And this was a repeat itself. I don't have the MRI before it, but it was disappointing and alarming. So we asked him all the other contributions of visceral fat and he assured us and we were reassured by his answers that he didn't have any of those other contributions. And here he disclosed to us that he was. in his running, he was doing, wasn't doing marathons, he was doing 10-mile runs five days a week, so 50 miles a week, which is a lot of running. As a consequence of all the running, he had a substantial amount of visceral fat that was staying there.

And what visceral fat distance running appears to do is makes the elimination of visceral fat refractory. So not only does it seem to contribute to visceral fat, but when you start doing things like cutting out processed foods and sleeping better, cutting out alcohol, and then you get, you have a harder time still getting the benefits of eliminating that visceral fat. So your body is resistant, holds on to that visceral fat more tenaciously if you're going to be doing distance running. So what we advocated and asked this guy to do was to substitute in for his distance running springing.

And so this guy went from being a distance running. runner to a sprinter. And he did so in just two months. It was actually a little shy of two months. And look at the dramatic elimination of his visceral fat. So this image on the right now shows a lack of white and he has much more dark present within his adornal cavity. And then you can see the shape of his adjutorpegant appears to be more oval and he has a six-pack. And his muscles have increased. Nothing else changed in this direction. other than he simply substituted distance running for sprinting. And so we've seen this in numerous individuals who eliminate distance running and substitute

in sprinting. Distance running, long, like marathon runners, etc. They just stop running. They don't do any more jogging. We recommend that they just simply do sprinting. It's a completely different form of exercise. I mean, it's hard to do. I'm a former distance runner.

I ran cross country in school. I love distance running. I could not stop. I will admit to anybody in the audience say I was addicted, in my belief, I was addicted to running. I loved it. And I loved the endorphins that produced. And I would run 70 to 90 minutes every single day.

I could not stop doing this. And many people are like that. So for me, I stopped doing distance running. I start springing, I get my clients, patients that work with me to do the same thing, and dramatic improvement in the reduction of visceral fat when they start doing so. Next up on today's episode, I speak with Dr. Anna Claudia Rosa, who further breaks down how visceral fat is different from subcutaneous fat and how visceral fat drives the chronic diseases that we're seeing in our population today

based on her beliefs. Dr. Rosa also shares about her own efforts to reduce visceral fat, and make sustainable lifestyle changes. You know, understanding what visceral fat is and how it develops in the body is important. But I love how Dr. Rosa takes that information and has connected it to inform her on our own personal daily habits for overall health.

There's a lot of confusion about the different fats that are there and not all the fats are created equally, right? Visceral fat is the most dangerous. We're going to come back to that in a second. So the subcutaneous fat, which would be part of what would be included, if you've got an in-body scan or a dexas scan to look at your body composition, which we highly recommend that people get.

It's a good idea to tell you how much fat you have. And also, do you have appropriate amounts of muscle, which will come back to, and bone as well, right? People look at it often to measure their body composition, but also as individuals are aging, they might look at it to see if they're at risk of osteoporosis, if you're trying to make fitness goals. There could be a lot of reasons why you're doing. these imaging scans. So subcutaneous fat, that's the fat, as I understand, please correct

if I'm wrong, it's the fat that we can pinch and that we sort of see and that the fat that often when people look in the mirror, they're thinking like, this is the fat that I'm not excited about. And it's sort of like the vanity fat that's there, right? Can you share a little bit more about that? Most definitely. Subcutaneous fat is the fat that is between your skin and your muscles, the outside of your muscles, the musculature fascia. So subcutaneous fat is the fat that you can pinch. And it's also the love handles that we feel, unfortunately, when we are with excess of weight. And subcutaneous fat has two compartments. You have the superficial subcutaneous fat that is the fat that is in between the skin and a fascia called scarpus fascia.

and this is the fat, the superficial subcutaneous fat, is the fat that it's kind of beneficial, not in huge amounts, but it's kind of beneficial because it produces a substance called a diponecting which protects you from some kind of cardiovascular diseases. Then you have the fat that is beneath the scarpus fascia and goes up to the level of your muscles, the external portion of your muscles, and it is the de-carpidus fascia. and it is the deep subcutaneous fat. The deep subcutaneous fat is the fat that you also want to reverse and to decrease in your body together with the visceral fat that is within the abdominal cavity,

because both of them produce inflammation in your body from head to toe. So both of them are connected with chronic diseases, pre-diabetes, diabetes type 2, Alzheimer's, which is now considered diabetes-type-type-to-old. and lots of kinds of cancer and fatty liver and the fatty liver developing inflammation in the liver and the inflammation in the liver leading to cirrhosis and the cirrhosis leading to liver cancer which is hepatocelicarcinoma and it's becoming a huge health problem right now because the non-alcoholics teato hepatitis as cause of cirrhosis and as cause of liver cancer is increasing exponentially in incidence,

and it's almost becoming epidemic because of people being overweight and having lots of visceral fat. It's important to understand that this is much bigger than a conversation in just terms of how much fat we think we have on our body. It's about understanding that visceral fat in its own way is kind of like an organ that's gotten out of control,

and that's what you're here to talk to us about. It is an organ that got out of control because it has its metabolic active and it has its own life within your body again suffocating the life of everything else. And that's why I'm here. I want as a radiologist to be able to show images for each one of you that are listening to us. So then you are going to be able to see your own visceral fat and then take actions to on your health and really honor your body and fight not only to lose. weight, but mainly to lose weight in the areas that need to be corrected and reversed like visceral fat. You want to lose weight in a way that you are also burning the visceral fat and using that as a few to become the best version of yourself. This is a good opportunity here. Before we continue,

and we have so many incredible images that you've put together, there's a good opportunity here to talk about some of the basics. You know, we connected because of one of our mutual friends, who's also a colleague of yours, Dr. Sean Amara. Yeah. And, you know, we, we, We learned a lot about visceral fat from him. As you started to go down this journey and learning about visceral fat and also starting to make changes in your own lifestyle, which we'll talk about later on, what have you understood to be the top drivers in this modern world that we live in that are actually leading to excess levels of visceral fat accumulating to the degree that they become super dangerous for us

and promote a whole host of chronic diseases. What are the top drivers that are actually at the root and causing this accumulation of visceral fat? So I would say the top driver is processed food. So processed food is the top driver of building visceral fat in your body. Because when you remove processed food, as Sean Omera, our friend, was able to show in his research with 6,000 people from the National Science Foundation, when you remove processed foods, you already see a good impression. improvement in your visceral fat decrease by following with MRI, right? And the benefit of following with MRI is that it doesn't have radiation, ionizing radiation,

so you can repeat as much as you want, especially if you are on a research space. And you're not using intravenous contrast. So it's definitely safe and with no problem for individuals that would be afraid of ionizing radiation or IV contrast as well. No worry about allergies or anything like that. The other thing I would say is stress, which we are running around our lives and we are in a go, go, go, go, go mode and we don't sleep well. So stress is definitely one of the things that also are so not beneficial for our bodies.

And he talks so well about the strategies to, you know, work on stress, which is sauna, cold therapy, sunshine, sunrise, sunset, and walking. And I would add the soul, the soul portion, I would say journaling and gratitude and, you know, meditation and just grounding yourself in yourself. Just grounding yourself in your soul and all the tools you have inside of you that you just have to turn on the light and dig deep, right? Just like your t-shirt, which says gratitude. I love gratitude, gratitude. Which is amazing. Gratitude is the foundation of my life.

you know, my whole life. One thing that I wanted to say about muscle and visceral fat is the dietary strategy, I believe the dietary strategies are awesome for burning the visceral fat. And I love the term burning because I am a widow and grief also is a journey for me. And I've learned that I sit with my feelings, sit with my emotions and I let them be there and

I rise from the ashes. So I love to tell myself, I'm burning my visceral fat and I'm rising from from its ashes and becoming my own phoenix, you know, for my life. So what I wanted to say is I do believe that burning the visceral fat, the food strategies are awesome. And again, I agree with you. If you want to go to the extreme, go for it. But do what is comfortable for yourself.

if you eat a piece of pizza or you eat a piece of bread, it's not something that you should beat yourself up or think that you're not doing the strategies correctly. You are doing in a way that it's sustainable and manageable and you're going to be accountable for yourself. But for muscle, I am 100% with you. You are not, I don't believe you're going to change the marbling on your muscles just by the dietary.

you have to build these muscles again. And for you to build these muscles again, you have to put them to micro-tares and by the exercising, and then it's going to renew and it's going to, you know, build new cells. And that's how you build muscles. Use it or lose it. Use it or lose it. Exactly.

So strength training, high-intensity exercise training, sprinting, you have to put your muscles to a certain degree of stress that it's going to hurt the muscles, quote on quote, a little bit for the muscles to rebuild. And again, like Dr. Gabriel and Sean talk so well, both of them, the muscles are part of your brain. The muscles are the health of your brain as well. Yeah, that's well said.

You know, first of all, obviously, this is the first time we're meeting in person. had mentioned to me before that you had lost your husband. And I want to just acknowledge that and say, I'm very sorry to hear about that. Thank you. And, you know, there's plenty of times in our life that we're dealing with all sorts of different things that are happening. The loss of somebody, we're getting back on track.

Maybe we just discovered some information. You had shared with me when we had a pre-phone call in talking about this podcast that, you know, through the work of Sean and getting a chance to meet him a little bit and digging into this, for the first time you started to really pay attention. to your own life and your own health and start to implement some of these things. Yes. And because you also know that different aspects of life can influence us, like losing somebody. That's the hardest thing that I could imagine anybody going through in the world is losing

somebody that they love. There has to be a sense of gentleness that's there and realizing that, hey, listen, this is about slow and steady progress. And even sometimes the most beneficial thing that you could do for yourself is even sometimes taking a little bit of a break and slowing down a little bit. Yes. And then getting back on track when you feel a little bit more grounded. You have more love in your life, community, support, you feel there.

So how has it been for you implementing some of these strategies in your life? And what have you noticed on your journey of not just a radiologist who wants to educate people, but an individual and a medical doctor and a human being who wants to get healthy herself? So in my own journey with Shan's strategies, one thing that really hit me, hard was my father was a surgeon and he died in 2021 and he was like the perfect doctor, right? Sedentary and very brilliant and very smart and very knowledgeable and amazing as a doctor and as a person, but two others, not to himself. He took care of everybody else.

Yes, he took care of everybody else and was a workaholic and really didn't take care of himself. So he died in 2021. and I saw him, his body failing. He had barely no muscles. I saw his CT exam. He had barely no muscles and he had lots, like lots, lots of visceral fat. His body was almost completely fat. And when I came back home to the United States because I'm from Brazil,

so when I came back home to the United States, I realized I am going to do everything and anything in my power for me to not die. that way. You know, I'm not saying that I'm not going to get sick later in my life. That's the plan of my soul. But everything and anything I could do that I am in control and I could own my health, I'm going to do it. So I started walking and I walked more than 10,000 steps daily and I started, he died in August. I started in September and I just started 10,000 steps and I've never stopped again in December, December 21st, 2021. And I want to say commitment and consistency, I have been doing more than 10,000 steps daily and I've never missed one day. But again, with compassion

and kindness to me, knowing that the days that I had a cold, I walked slower. The days that I felt more energy, I walked more and I walked better. So I have been implementing Sean's strength. I met in 2020. I did not start the strategies in 2020. There was too much going on in the world, and I had lots of stress in my life. So last year when I was living in Omaha, he came for a summit that was great talking about Kiro and strategies. It was Dr. James Seaman from the Fit and Fabulous doctor that she organized the summit. And it was a very good one. And he invited me, hey, come, I would like to see you again and we could talk. So I've started doing the strategies. I am kind of a client of his, but I am also a friend. And I have seen noticeable improvement for me. I had dealt

with asthma and rosacea and brain fog because I am, I had to take my uterus and over is out. so I am in menopause as well. So I had noticed a huge improvement in my muscles, and I'm doing sprinting, and I'm doing the strength training. And I am also so proud of myself and so happy and so joyful. And I am part of the community of his clients, and I see daily improvement from everybody. It's a slow process, but it happens and it's noticeable,

and it's so worth it because you feel your body healing from inside out. Muscle building and better energy and better memory and lose of weight and lose of measurements. And I see people from his group that are dealing with cancer that it's kind of controlling the cancer so far because you are not feeding sugar, you are not feeding carbs for cancer cells and you are doing fasting, it could also help with cancer. I'm not saying again that you shouldn't be doing

your conventional treatments, but I'm saying that these are additional tools that might help. That getting fit and improving their metabolic health seems to be, you know, supporting their cancer journey. Yes, multiple sclerosis, all these autoimmune diseases

that are related to inflammation and inflammation has the root cause of visceral fat. So if you are decreasing your visceral fat, you are decreasing the inflammation. So you are decreasing the flares that you would have from, you know, multiple sclerosis or any other kind of rheumatoid arthritis or any kind of disease that is autoimmune in nature. If you are controlling the inflammation, you are making your body better, right?

So again, I'm not saying that you shouldn't go to your doctor or you shouldn't take medication if needed, but I'm saying that reversing visceral fat helps with controlling and reversing and getting better with these diseases as well. And so on this journey that you're on and with all the information that you know, and we still have a few more slides that we're going to go through in a minute, but you know, it's always nice for people to hear the human side of somebody who's an expert in this field, especially when it comes to describing and highlighting the dangers of it. So with how much you know about visceral fat and your access to MRI and imaging, how often are you tracking your own visceral

fat as part of this? And do you have a target number that you're trying to get to? You know, we've shared earlier that it's just important to reduce our overall level of visceral fat, but how do you know, you know, what you're shooting towards? So do you track your visceral fat as an individual? And is there some sort of target that you're trying to reach as you are working on your own health journey? So I do, I have my bioimpedance and access scan and it showed the 44% of fat. I had 44% of fat like three months ago. That was your body composition. That was my body composition. Then I did the MRI and I do have a severe amount of visceral fat like three months ago. That was three months ago.

That was your first MRI that you did? That was not my first MRI. I had my first MRI in 2020. So it was a little better when I saw Sean for the first time. But then, like I said, I didn't act on anything. You weren't implementing a lot of the strategies that were there. Yeah. But then I...

The world was upside down. Yes. Yes. Yes. There's a lot of things that are going on. Yes. But before I started, before I started, I had my MRI and I still have a significant amount of visceral fat. But I've started implementing the strategies.

and I plan on repeating the MRI, like maybe in nine months, because like I said, I still have lots of visceral fat and I know that I'm doing the strategies. So it's not that I have to repeat it right now to see how I'm doing. Right, you're doing the work. Because I'm doing the work and I know it needs time, right, for my body to heal progressively because it's a journey.

I do not have a target goal in numbers. I do have a target goal in my heart. I want to get to be a person with minimal visceral fat or no visceral fat. But the point is, I want my body to be functional better and better with better balance, with better strength, with my bone mass is normal, but I want to keep my bone mass as normal. I want to improve my musculature, you know, with strength. Because before I started the strategies, I had so much subcutaneous fat and things. fat in my muscles that I could barely, like if I would try to contract my thigh muscles,

my quadriceps, I could barely feel them. And now I can feel them again, you know, so I'm happy because I am in the progress of becoming better. And that's my target. Yeah. I want to keep in this journey. I want to keep getting better and better every day in every way. And I can see the improvement in my levels of energy.

I can feel the improvement in my brain, in my memory. in my, you know, fast thinking and things coming better and easier, flowing better, work. I have, I feel more joy in my life, which I tell myself to, happy is like, oh, I'm happy because I have this fit bit and, you know, but joy is like, I'm happy, I'm feeling joy. It comes from me taking care of myself. And that's why I'm saying connect with your cause, with your why, because then you're not going to give up. That's so important. You know, we're recording this podcast at the beginning of the year.

And it's around this time of year that, you know, late, mid to late January, that so many people are starting to feel like they're letting go of any kind of maybe intentions that they set. And a lot of that comes from people being so hard on themselves. Yes. You know, there's this old quote, I don't know who it's attributed to. Maybe we'll look at it afterwards. It says, you know, we tend to overestimate what we can get done in a year and underestimate what we can get done in 10. So many times in this fast-paced culture, we want everything now. Why haven't I lost, let's say somebody's trying to lose weight?

Why haven't I lost the 10 pounds that I want to lose now? Or how do I look for that quick fix to do it today or the next 24 hours? Yes. Or what is going to be the solution to flatten my stomach or this, the eight-minute abs that are there? But when we and the research around habit change and actually long-term change of habits, you know, a friend of mine, Dr. B.J. Fogg, who's at Stanford's Behavioral Lab, he is the author of a book called Tiny Habits and the Tiny Habits Methodology. And he talks about how simple, tiny habits that we can sustain over a period of time

and integrate into our life through things like Habit Stacking, those are the ways that we permanently end up getting much faster to those bigger goals because there are tiny things that we implement that can become now the foundation of how we're showing up in the day. I love that. And that's how we make progress. I'm all for total transformation for people, but it's that showing up every single day one degree of improvement from manageable strategies that get us excited that we can sustain

that lead to us looking back a year, two years, three years, four years down the line and saying, wow, look at how much change has occurred. I tell myself this all the time. I love what you're talking about because I call it my box of tools to keep going in everything in my life because of grief and everything, right? So I tell myself, I have my mantras or incantations and I love reading. So 1% I get better every day. I'm going to get 365% better in a year.

So I don't need to aim for 365% in a year. So I can even have less than 1% improvement every day because I will be improving. And I tell myself to that being compassionate to me, like, I love the book, The Four Agreements that says, take off in person and do your best. So do my best. I do my best. It's not going to be the same every day, but I'm doing my best. My next guest, Dr. Powell, also shares how a health scare served as a personal wake-up call and discusses how visceral fat can drive heart disease and poor metabolic health. Dr. Powell also shares why South Asians, that's the background that I come from from India,

are particularly predisposed to accumulate more visceral fat. Let's tune in. Why is belly fat so dangerous to our overall health? If your waist circumference is more than 102 centimeters in men, and if your base circumference is more than 88 centimeters in women, you are at increased risk of heart disease. So people who are listening to this podcast, they can do this a simple test by themselves in the morning. They can just measure the waist circumference around their belly button.

If it is more than 100 to 102 centimeters in men, then it is a wake-up call for you. It is an indication that the adipose tissue overflow is happening. It's happening. And adipose tissue is not bad. You need adipose tissue. Adipose tissue releases a hormone called adiponectin. And what this does is, similar to what we talked about in starvation,

it releases a lot of hormonal regulations where all the fat tissues are getting broken down into energy. you can use them for when you are not having enough foot, similar to our ancestors during fasting and hunting time. But what is happening is, and that adipose tissue, adiponectin hormone regulation, happens very well if it is subcutaneous fat. When it is flowing into visceral fat,

the adiponectin goes down. And when adiponectin goes down, the transmembrane fatty acid reflex is the problem with this metabolic profile that I talked about with increased triglycerides and increase LDL and decrease HDL. And when that goes up, and that is where the underlying problem of your, you know, plaque formation and the blood vessels are playing the heart,

and that increases the risk of, you know, hypertension and heart disease and everything. So it is bottom line, it is very clear that visceral fat increases the risk of heart disease. This is what I explained to all my patients on the clinical level. But I go a step beyond that. And then I say that, yes, it's good that, you know, we found your diabetes, we found your hypertension. Now you know that visceral fat is at increased risk of heart disease. And now we can treat you from diabetes to developing into heart attack. Okay.

But I am more interested in how a normal person don't develop diabetes or hypertension to start with. Okay. So that is a normal person, subclinical level, clinical level. and the outcome. Okay. So clinical level is your diagnose of diabetes, hypertension, obesity and everything. So I think the key,

which is the most important thing in the world, is to target preventive medicine right at the subclinical level where everything is happening before the disease happens. Right. Actually, I didn't know about this as a medical doctor myself

until there was a healthcare to me person. So I think I'll just tell me my journey. Please. And then I can say how I learned about all this. So similar to all Indian immigrant, we're all hardworking,

and we work so hard to settle in our career. And we build our career so much to a point that we forgot to build our muscle during the young days. And so I was enter medical school in 2000, and then 2000 and 2006 was my MBBS. And I came here, I did my MPH Masters in Public Health, MD General Medicine, DM Gastro, AB Gastro, Advanced, as well. So from 2000 to 2015, if you look at it, it says Dr. Palineap and Manicum, Mb, S, Mb, M-D, A, B, Gastrothal, like eight letters right after my name. But the same time, there was eight inches of belly hanging around my belly button.

Right. So I was similar to every hardworking person out there. I abused my body as well in the name of settling down and my career was more important than my health. So I had a scare while I was seeing a patient. in my office in my gastronology to office after being an attending where I suddenly had a palpitation, disinous and chest pain. And then they found out that I had an angina and then, you know, treatment was done. And while I was sitting in that hospital bed. And that was the time where I was actually looking at what am I doing to my body. And that opened up so many mistakes that is happening to every immigrant,

and not only Indian, every immigrant who comes to United States for better life, better financial status, and better work profile and all those things. At the same time, and everybody can relate to this, that we are the last person in the list to focus on our health, and we are the first person in our list to focus on our education and career. And statistics says that Indian immigrants are the most successful immigrant population over here in US. Yeah, they have the highest average income per capita, any ethnic minority. And along with that, they have the highest risk of heart disease amongst any ethnic group in here in America. Of course, of course.

And in the hospital, if you look at it, all the patients in the, you know, I see unit with the cardiovascular disease, we are seeing so many young people, you know, like 35 to 45 years old, working so hard in the software industry. I come from near Bay Area. And it is pretty common. It is very common. And they say all these big names, you know, all these giant tech companies where on paper it looks great. But when they're admitted as a patient, that's where they're realizing that, okay, no, we are going too far. I think it is high time that we dial back down and then see what happened to me where I was pretty normal. I was not obese.

And I just recently had a physical exam just before the attack. and my body mass index was 24.7. But that is where the problem started. I think that, you know, I went to a primary care physician here in US and then, you know, BMI is good. Your LDL was slightly high and, you know, HDL was slightly low, triglycerates was slightly high. Okay, so I want audience to focus on this three parameters. High triglycerides, low HDL, and increased LDL.

That's exactly what happened to me. And there was exactly one week prior to this heart attack that I had. And this is a very common lipid profile among all Indian immigrants, especially Indians in India as well. And if you look at me, my BMI was normal at 24.7 according to the US standards. But that is not the problem for the Asians and Indian, South Asians mainly. So I didn't realize that BMA should be 23 and not 24.9 for, South Asians because all the studies were done in Caucasian population. That's number one.

Number two, if you look at me, I look very skinny. I look very skinny when you look from the front. But the moment I turn to the side, that's where the belly fat comes into play. Yeah, you were thin on the outside, fat on the inside. Correct. Toffee. Toffee.

Toffee. And I still remember I wear this T-shirt with a mission. Impossible. Mission impossible would be, when you look at straight, it'll be perfect. When you learn on the side, mission will be here. Impossible will be over here. I still remember that teacher.

So then I realized that my base circumference, which is the measurement around your belly button when you take an inch tape, was one zero one centimeters. Okay, and I have read in multiple studies that waist circumference more than 100 centimeters puts you at an increased risk of our disease. I didn't know.

I didn't realize the importance of that at that time. And now I realized that, okay, maybe that is what is happening. And that is where I belong to this category of skinny fat. After realizing this, I kind of looked around all my friends and family and everything. Everybody had this, most of them, most of them had this problem of skinny fat. They look skinny from out, fat from inside. And mainly they have this tendency to form along the trunk area. Yeah.

So that is also a lot of visceral fat. Can you take a moment to just explain visceral fat to the audience if they're just not familiar with it? Yes. So when we eat more, right? When we eat more than what we need, the energy is getting converted into fat, thinking that we will need that energy sometime later in the future when we don't have food. But unfortunately, that situation never happens. because when I put a video on intermittent fasting,

the ad comes for Uber Eats in between. So we are in a situation where there is no problem with the food availability. So when there is excess of calories that get it converted into fat, usually what happens is just beneath the skin, there is a fat accumulation called subcutaneous fat. And beneath the subcutaneous fat is your muscle. and beneath your muscle is your fat deposition around the organs that includes your liver, pancreas, retropratonial space and the momentum.

These are all like fancy terms but basically bottom line is the fat is getting accumulated behind the muscle inside your body which you are not able to see right away and that is what is called visceral fat. Being a gastroenterologist I see a lot of patients with fatty liver and the number one reason is visceral fat being deposited around the liver. So you combine the visceral fat along with the blood profile that you're talking about, which is essentially you're talking about high triglycerides,

low HDL and elevated LDL, all signs. And if you add maybe some fasting insulin in there or fasting glucose, a sign of a metabolically unhealthy individual. Exactly. And a lot of Indians, immigrants, South Asians, many people that, that went from eating a more traditional diet and that are now maybe immigrated somewhere and are eating more of a processed food diet

are now suffering and are in that profile range, which makes them at risk for a whole host of diseases, including a lot of belly fat around their waist. Of course, and on the top of it, we are genetically predisposed as well because of this theory called adiposite overflow hypothesis. What that means is, you know, there is some school of thought

where it says that we talked about the subcutaneous fat just beneath the skin and there is a muscle and the fat beneath the muscle around the organs, visceral fat. When there is no space to accumulate in the subcutaneous fat, that's where the adipose tissue overflows into the visceral fat. And there is a school of thought saying that among Indians and South Asians mainly the compartment of the subcutaneous fat is significantly smaller compared to the western counterparts.

So what happens is, let's say it's a box, okay, and you can fill like, you know, 100 lipid particles inside the box of the subcutaneous fat in a Caucasian counterpart. Unfortunately, we can only fill 50 lipid particles in that subcutaneous fat in a South Asian counterpart. So what happens for the remaining 50? It spills over into the visceral fat. And this hypothesis is very visible even in babies. And you could track down how babies are being formed. So I'm sorry, how the fat is being formed on the babies.

So there is this thing called thin fat Indian baby hypothesis. Thin fat Indian baby. What does mean, what that means is let's say you take two babies. One is a Caucasian baby and the other one is an Indian baby. So Indian babies are thinner, lighter and shorter. compared to the Caucasian counterpart that is a pretty known fact. But the unknown fact is

the subcutaneous fat is almost equal compared to the Caucasian counterpart even at birth. So, if you... There is something called a sub-scapular fat. It is a marker of a central fat

where you measure the fat just beneath the shoulder bone. And that was pretty high or equal in the Indian babies even though they are normal weight. And it is even more predominant in low birth weight babies.

Let's say the baby has low weight, birth weight. Even in low birth weight babies, they don't have lean muscle mass. Every other area, the mass is lower. Except for the trunkal fat. And this is absolutely mind-blowing

that even in low birth-weight babies, Indian babies, they have this fat sparing capacity of just local. localizing storage of adipose tissue right around the truncle area in the belly buttocks and the thigh area. So this is what is fascinating is they study this in a longer population, all right? In atherosclerotic vascular disease study in UK where they took like, okay, 450,000 of European patients and 8,500 patients of Indian immigrants, South Asians. They followed them up for 11 years.

They follow them for 11 years. At the end of 11 years, they found out that there was a 8% increase in risk of heart attack in the Indian South Asian people compared to only 4% increased risk of heart attack in the European counterparts. How much do you think, and the idea that it's genetically driven, is it fair to say that that's a little bit debated, that how much of it that is the lifestyle of the individuals, like a lot of Indian population, they tend to be eating less protein,

they're less active. We're going to get into a lot of these things here in a minute. And how much of it is pure genetic? Is it fair to say that it could be a little bit of both? No, I'm not saying at all that genetic is the main reason. That is not the point. Major point is people think that you are healthy. Indians, if you are healthy,

doesn't mean that you are completely healthy. You need to be on top of your health. Yeah, you have to be more on top. More on the top of your health. Given the genetic problem, that is what the point that I always tell my patients is that, yes, you're doing great, okay? Your LDL is only slightly high.

Your triglycerase is only slightly high. Your HDL is only slightly low, but that's slightly low, significantly higher to you compared to a Caucasian patient that I have. So I drill that point every time to my patient when they walk into my office and I said that unfortunately, you know, when you play cricket, you know that we as Indians and South Asians,

we start the innings with the wicket down. You need to put more effort to be healthy compared to a Caucasian country. On the top of it, unfortunately, we are the, as we talked about initially, we are the last community to focus on health on the top of this genetic problem. Yeah, because all the emphasis goes into, education, career, for all good reasons. And that's led to a lot of return on investment, right? Indians, if you look at like a lot of the top companies in Silicon Valley, the CEOs, how well they've done as a, you know, a society here, being in an incredible country like America

and some of these other countries that they've immigrated to and being able to take advantage of capitalism. Yes. Right. For a long time in India, like capitalism wasn't capitalism. It was more like nepotism, you couldn't get a job unless you knew somebody. So it's great to be able to be in these countries that you can flourish. And I think people are waking up and saying that we have a big problem, even though we come from this country of turmeric and all these incredible health trends and yoga and breathing, we're actually dying earlier and we're living sicker longer than many other parts of the world. And that's a big problem. We need help for everybody. but we need health in particular for the society that's completely ignored it.

Yes, yes. While some individuals are at increased risk for experiencing its cascading effects, visceral fat is a danger to all of us and something that we want to be paying attention to. And it's important to also mention that visceral fat can be more of a threat at various points in our life. In fact, women going through perimenopause and menopause can see a massive uptick in visceral fat. A perimenopausal woman has about 8% visceral fat, but after menopause, that number can triple due to the drop in estrogen levels, which keeps inflammation at bay in paramedopausal women. You can hear more about visceral fat and how to protect yourself from it in my full conversations with Dr. Sean Amara, Dr. Anna Claudia Rosa and Dr. Powell.

The links to those episodes are in the show notes below. And as always, if you like this episode, if you love this episode, consider sharing it with a friend. You can take a screenshot and just text it to them. Or you can grab the link if you're a little bit more sophisticated from Apple or Spotify and send it over to them. You might make somebody's day with this information and help them on their health journey. What could be better than that? Until next time, thanks for tuning in.

Drew Perraud, signing off.