Dhru Purohit Show - Why Visceral Fat is So Dangerous and What You Can Do About It with Dr. Ana Claudia Rosa

Episode Date: January 24, 2024

This episode is brought to you by Cozy Earth and Sweetgreen.  In the pursuit of optimal health, physicians and individuals must broaden their perspective beyond the visible, subcutaneous fat. Often fixated on this outer layer, doctors might overlook signs of metabolic dysfunction in leaner individuals and miss the silent killer beneath the surface. Addressing visceral fat levels can unlock the secrets to longevity and redefine the well-being standards for all. Today on The Dhru Purohit Podcast, Dhru sits down with Dr. Ana Claudia Rosa to discuss visceral fat as the silent killer behind inflammation in our body, which ultimately leads to most chronic diseases. Dr. Rosa shares MRI images to show how individuals with the same body mass index can have varying degrees of visceral fat that can significantly impact their health. Dr. Rosa also shares the lifestyle factors that increase visceral fat and the factors we can hone in on to reverse the percentage of visceral fat in our body. If you are looking to deep dive into visceral fat, this episode is for you!  Dr. Ana Claudia Rosa is a physician, radiologist, and medical doctor affiliated with the VA healthcare system. She holds the position of assistant professor at the University of Minnesota. Dr. Rosa is an expert on visceral fat, emphasizing its significance in detection and detailed reporting. She guides both patients and ordering providers through cross-section imaging, particularly MRI scans. In this episode, Dhru and Dr. Rosa dive into (audio version / Apple Subscriber version): Why visceral fat is so dangerous to our body and what it can do in your body (1:53 / 1:53) Different types of fat (7:11 / 7:11) How body mass index is not a factor in determining visceral fat (14:37 / 13:15)  Ectopic fat and the damage it causes to our organs (21:40 / 20:10)  The drivers of visceral fat (26:10 / 24:50)  The impact of visceral fat on longevity (40:25 / 38:45)  The role stress, sleep, and diet play in reducing visceral fat (52:04 / 48:44)  Why the body produces visceral fat (1:14:45 / 1:11:25) Specific lifestyle advice to reduce visceral fat (1:18:30 / 1:16:30)  A finding of normal on the MRI versus cause for concern (1:25:12 / 1:22:22) The importance of muscle (1:34:50 /1:32:39) Dr. Rosa’s health journey in losing visceral fat and becoming stronger (1:51:50 / 1:48:36)  Health as an investment in your life (2:09:24 / 2:06:06) Distinguishing visceral fat on your MRI (2:12:55 / 2:10:55) Also mentioned in this episode: Watch this episode on YouTube Dr. Rosa’s Presentation Slides  Dhru’s episode with Dr. Sean O’Mara  Right now, get 40% off your Cozy Earth sheets. Just head over to cozyearth.com and use code DHRUP. Find out more about Sweetgreen and their newest protein plates at www.sweetgreen.com. New Users of the sweet green app can use the code "Dhru5" for $5 off. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit megaphone.fm/adchoices

Viceral fat is a biomarker that shows your body suffering from inflammation, and visceral fat is reversible with lifestyle strategies. If you start the strategies, you're going to see a noticeable improvement in your health and in your life. Today, we're deep diving into the topic of visceral fat, one of the top silent killers that hardly anyone is talking about. Hi, everyone, Drew Prod here, and on today's episode, we have Dr. Anna Claudia Rosa here to talk to us about the dangers of visceral fat, why it's so problematic, how to spot it, and most importantly, the lifestyle

changes that help us get to the root of it. Now, a little bit more about Dr. Rosa. She's a distinguished physician, radiologist, and medical doctor affiliated with the VA healthcare systems. In addition to being a medical doctor and a PhD, she holds the position of assistant professor at the University of Minnesota. Dr. Rosa generously shares her profound knowledge on visceral fat, emphasizing its significance in detection and in detailed reporting. Her expertise guides both patients and ordering providers through cross-sectional imaging, particularly MRI scans. Her mission is to help everyone recognizing the subtle yet impactful presence of visceral fat

so that they can take proactive measures to optimize their health and challenge the existing status quo. On today's episode, Dr. Anna Claudia Rosa has a fantastic presentation, which we've linked to in the show notes that you can watch and download to follow along or check out our interview on YouTube if you would want to see the presentation in the actual podcast. Stay tuned for a fantastic episode with Dr. Anna Claudia Rosa. Dr. Anna Rosa, welcome to the podcast. We're here today to talk about a silent killer, visceral fat, and you have a fantastic presentation you're going to walk through. But first, let's start at the top. Remind our audience why visceral fat, a name that so many people are hearing

these days is so dangerous to the body. Hi, Drew, thank you so much for having me in your podcast. And visceral fat is so dangerous to our bodies because it produces lots of molecules that release inflammation and produce inflammation throughout all our bodies, right? So from the brain that it could lead to dementia, from the pancreas, that it could lead to diabetes and prediabetes and fatty liver. So visceral fat, is a silent killer that we haven't learned to deal with it in medical school because it's not in the curriculum of medical school. However, it's something that it's the root and the cause of the majority of not all chronic diseases that are like really killing ourselves every day.

And we are walking around not knowing that we are so unhealthy. And we are just like one step away from dying because of visceral fat. It's scary to think when you really look at how big of problem it is. And as a medical doctor and a radiologist, you're here to sound the alarm about visceral fat. You look at imaging all day, helping patients to understand the problem when their visceral fat builds up, what's driving the cause of it, which we're going to get into a second, and most importantly, things, tips, suggestions that they can do to get to the root of addressing it. So let's go into some of that imagery here that you've prepared for us. We have slide number 10 from your presentation. Tell us what we're looking at here on the image. So on slide number 10,

I have on the right left side of the image, you see a bioimpedance and dexas scan study, where the amount of visceral fat says that it's 44%. So it's just a number and you go home and you are surprised that you have 44% of fat in your body. However, when you look at the image of the MRI, which is an axial slice through your body at the, the level of the vertebral body L3 or at the level of your umbilical button, you can see that all this white, all this white is visceral fat. And it's really like encasing, embracing. And now that I know how important visceral fat is in killing ourselves daily as a silent killer, I would say suffocating. Visceral fat is suffocating your organs within the abdomen. You're literally getting suffocated

from the inside out. You are getting suffocating from the inside out. And visceral fat is suffocating your life. Visceral fat is suffocating your soul. Visceral fat is suffocating the chances you have to be the best version of yourself. So on the right side, it's an image, MRI, which we're going to talk about a little bit more. Yes. And it's imaging of the abdomen.

Yes. Right? So this is somebody's abdomen. They're like waistline sort of region. Yes. Right. And on the left-hand side, you mentioned this is a breakdown of individual's body composition. Now, just one question for you.

The body fat says 44%. Is that the same thing as visceral fat? Like there's body fat and there's also visceral fat is a part of body fat. So is the 44% fully visceral fat? Or is there also some non-visceral fat inside the mind? No. And that's the point that the MRI is so much better to evaluate the real differentiation of fat in your body because the 44% that you see in the,

the dexia or bioimpedance is the fat that you have in your body, which will include the subcutaneous fat, the superficial, which already learned that is a beneficial fat if you don't have it in huge amounts. And the deep subcutaneous fat, which is also as bad as visceral fat because it's also metabolic active releasing molecules that lead to inflammation, and the visceral fat, which is the fat that you have within your abdominal cavity, again, suffocating your organs, like an ocean of visceral fat that your organs are all immersed on it. You know, that's worth repeating because 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 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 from 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 scarpa's fascia and goes up to the level of your muscles, the external portion of your muscles, 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 3, and lots of kinds of things. 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 hepatocelicar carcinoma. 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, right? So there is the subcutaneous fat, superficial and deep,

and then you have the visceral fat, which is the one within the abdominal cavity, encompassing your organs, and then the same kind of visceral fat when it's in your chest, encasing your vessels, the aorta, or in case, in your heart, we call it medial steino fat, epicardial fat, pericardio fat. This episode is brought to you by cozy earth. You know, something I've been really thinking about lately is the fabrics I bring into my home. If you've been watching the headlines or looking on social media, PFAs, plastics, and other toxic chemicals are freaking ubiquitous in our clothing and everyday household materials. That's why I do my best to limit my exposure whenever I can,

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Right now, Cozy Earth is offering my listeners 40% off sitewide with the code D-H-R-U-P. That's my first lame and my last initial at checkout. Just head over to CozyEarth.com and use the code Drew P at checkout. That's CozyEarth.com slash D-H-R-U-P for 40% off. You know, this is so important to break down because while everybody wants to, you know, improve their body composition generally and while individuals who might have excess subcutaneous fat feel like oh you know it'd be great to lose 10 pounds or whatever and and that's fine you know I want to celebrate anything that people want to do right I think the most important thing is to

truly be healthy and as a byproduct of living a healthy lifestyle generally speaking and staying away from ultra processed foods and not having an abundance of alcohol and processed calories that are there your body will start to naturally head in the right direction. Right? So, you know, weight loss, great, if that's what people want. But I like to start off with health first. So no shame on anybody who wants to lose weight. But most importantly, even bigger than whether or not people want to lose weight or not, is that we're sounding alarm and you in particular are talking about visceral fat because

even if you are somebody who might seem like you are thinner or normal weight, you could have a high amount of visceral fat in your body. Even if you're somebody that thinks that you look normal, depending on your body composition and your lifestyle, including how you eat, your level of stress that's there, your activity level, especially, you could have dangerous amounts of visceral fat that are there that could be connected to a whole host of chronic disease.

So 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, it's 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. And I would say for the people you are telling that you believe you are healthy, there is no other way to see if you are really healthy and ask your question, how unhealthy I am or how healthy I am if you don't have a cross-sectional study,

an MRI or a CT. There is no way because, as I'm going to show in the images, most the people who think that they are healthy that have normal BMIs, they could be the tofu, which is thin outside and fat inside, and you believe you're healthy and you have all this huge amount of visceral fat killing you silently inside of your body. So this is a perfect time to tee up an image that's part of your presentation. We have a bunch of fantastic images that are really put together so well here. Thank you for that.

Thank you. To drive the message home of visceral fat. So in this image here, you are highlighting at the title of this image, it says, all have the same BMI. these are nine different people who all have the same body mass index of 24, but they are vastly different in their health. And you are looking at that from a combination of visceral fat. So first, describe the image from a standpoint of the audience that's looking at this, especially on YouTube. And if you're following long on audio, you can click on the presentation show notes below to go to slide number six. Can you describe what part of the body is muscle that they're looking?

at or healthy tissue and what part of the body or abdomen is visceral fat. Okay. So this is very important because you're not going to know that if you do not have an MRI. If you have a Dexscan, probably you're going to believe, you're still going to believe that you are normal and you're not. You are the thin outside, fat inside. So if you look at the last image, which is on the bottom right, it's easier on this one. So every. everything that is white. You look at the subcutaneous fat, it's white, and then you look inside the abdomen. Since it's the same, since it's fat as well, the visceral fat is also white. Then if you look at the gray images here, these are the muscles. So here you have the

erector spinal muscle, which is the muscle responsible for keeping us standing up. And then you have the soas muscle and you have the vertebral body. And this is at the level of your umbilical button. So it's what we call the level of the vertebral body L3, which is your lumbar spine, L3. We have five lumber type vertebral bodies. And this is at the level of L3 or at the level of your belly button. And all the gray here are muscles, all the gray here are muscles, vertebral body and then you have organs like bowel loops here and all the white, all the white is fat. So like I have said before, the fat in between your skin and the muscles is the subcutaneous fat. And we have two different types of subcutaneous fat, the deep and the superficial.

And the fat within your abdominal cavity, it is the visceral fat. So if you go to the first image here on the top left, you're going to see a healthy, metabolic healthy individual. An individual that barely has white within the abdominal cavity does not have a lot of subcutaneous fat as well and has a very good muscle bulk. See how the SOA's muscle is very bulky and how the erector spinal muscle is very bulky and you have a good abdominal musculature as well. If you progress from the left top to the right bottom, you will see that the amount of

or white inside your abdomen is increasing. So the people here are progressively getting metabolic unhealthy, progressively getting sicker and sicker from the silent killer inside of their abdomen, which is the visceral fat. As you can see all this white is visceral fat. So this is the visceral fat of a thin outside fat inside person. This person doesn't seem to have lots of subcutaneous fat. fat. This person believes he or she is a normal healthy individual with a BMI of 24.

They go to the doctor's office and the doctor says, hey, keep doing what you're doing. Exactly. You're in the normal BMI range and you seem to look pretty good. Absolutely. And your blood work is normal. Nothing seems crazy. Normal, which means that if the entire population is unhealthy, you're also normal. You're probably unhealthy too just like them. But you're within the reference ranges that are there. Exactly. And the doctor's not notifying them of visceral fat because they're not getting an MRI

done to see it. Yeah, exactly. They're not getting an MRI that would show the real situation of how unhealthy they are. They are metabolic unhealthy. And these are the individuals that suddenly die from a heart attack. They are young and they are healthy and look healthy, right? And suddenly die from a heart attack. And these are the individuals that are getting older and are developing pre-diabetes, diabetes.

And, you know, visceral fat is a biomarker that shows your body suffering from inflammation. And visceral fat is reversible with lifestyle strategies. And you, if you start the strategies, you're going to see a noticeable improvement in your health and in your life. And as you can see to from the top left, which is the health. metabolic health person to the bottom right, see the difference in the musculature. You can see how bulky these soas and erector spinal muscle are, how bulky the six-pack muskulature of the abdomen is, and you can see how thin these muscles are. So this is what you mean by visceral fat suffocating your body, is your muscles don't actually have

room to develop in the way that they're meant to be. But it's not just because the visceral fat. It's also because most likely this individual has a lifestyle. Again, excess calories from ultra-processed foods or highly refined carbohydrates as too much of a concentration. And there probably is some element of super sedentary lifestyle. Yeah. Or the intense or the intense long endurance training.

Yeah. Long duration of cardiovascular training. like running or jogging, which has been proven to not be beneficial for the fast-to-itch musculature that you want. And so then you have muscles replaced by fat and the muscles became atrophic. And that's the sarcophonia that when these people age, they are aging and they are less strong, less functional, not able to stand up, not able to walk very well because they believe they are healthy and they are not taking action while they can take action and get better.

Such an important message. And, you know, something else that you mentioned, you said, these are the type of individuals that just one day, they're at the gym or they wake up on a Monday morning and then they just all of a sudden, you know, have a heart attack. I think what I'm hearing you say and you correct me if I'm wrong is that, you know, visceral fat is, again, we're looking at an abdomen, but it's not just in our abdomen. It's in all of our organ systems. It can be in and sort of weaved into our heart? It can be in and weaved in other organs. What are some other organs where you sort of have visceral fat sort of in between organs? So the visceral fat is the fat within your abdominal cavity, period. That's the visceral fat. And the visceral fat is the

fat that it's metabolic unhealthy, producing inflammation in your whole body. So that's how the visceral fat affects all, everywhere else in your body, right? But then you have the fat that it's called ectopic fat, and that ectopic fat is linked and runs together with visceral fat because it's the inflammation fat. It's the fat that it's unhealthy for your body. So that's the fat that gets deposited around the vessels in your chest, which is the midiastino fat. That's the fat that gets deposited surrounding your heart, which is the pericardial and the epicardial fat. That's the fat that gets deposited in your liver, leading to fatty liver and inflammation in the liver. That's the fat that gets deposited in your pancreas

with pancreas, fatty replacement and developing diabetes. That's the fat that gets deposited in your muscles of your ties and everywhere else in your skeletal muscle, in your body, the heart, and everywhere else that has skeletal muscle, which is called the marbling of the muscles. You don't want to see white streaks within your muscle. You want to see a muscle bulk that is muscle, lean muscle. And that's the fat that gets deposited in the wall of your arteries, leading to peripheral arterial disease and cardiovascular issues and heart attacks and strokes. And also the deposition that will most likely lead to memory loss and dementia and Alzheimer as well. So visceral fat is involved in all this.

Got it. So that's a great, you know, for me, I'm learning here because I'm not the expert you are. So it's not the visceral fat that's actually in our heart. It's the byproducts that vitigal fat encourages. And then you get still these other unhealthy fats in your organ systems. And fatty liver is a perfect example of that. And it's still the poor lifestyle drivers that are driving this explosion of the silent killer in our body. But it's not exactly the visceral fat that's there. It's the byproduct. of the visceral fat. Yes, and that's why we have to reverse visceral fat, because when we reverse visceral fat, we take away the inflammation that visceral fat causes in our body, and we can get to a healthier state where we can heal our bodies. We can heal our liver. We can heal our brain. That's why the brain fog gets better when you start, you know, healing from visceral fat. That's why the memory and the sharp thinking gets better when you start healing from visceral fat. That's like the strength in your legs and when you start doing the strategies of sprinting and the energy

and many people with mental issues like depression, bipolar, anxiety, when they start reversing visceral fat, they also start getting better from mental issues. So visceral fat and the inflammation it causes affect definitely, affect your body from head to toe and it's killing you slowly and it's killing you silently, and there is nothing in the medical school curriculum that talks about visceral fat, that teaches about visceral fat. So fortunately, we are in an era right now that becoming healthy and health optimization protocols are really being a movement and a cause, and I am just inviting all of us to fight for this cause. Be an advocate for yourself, work in your own health, be a role model of health optimization, and then you're going to touch the lives of

other people around you. That's such an important message, is that we all have agency. We can make decisions and start heading in the right direction. Yes. And there's never too late of a time to start making those changes, right? 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 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 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 portion. I would say journaling and gratitude and, you know, meditation and just grounding yourself in yourself, just grounding yourself 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. Which is amazing. Gratitude is the foundation of my life, you know, my whole life. Well, I want to just take a moment here before we go down these other causes that are there and some commentary that I have. I'm so grateful that you came out here to talk about the subject with our audience. You know, you have a unique perspective because literally your job is to share your expertise and give perspective in imaging. As a radiologist and a medical doctor, your job is to look at imaging and help people understand that this image, not only to get a proper diagnosis for a doctor, but there's something so powerful about seeing an image. When you see an image as a patient that something is actually physically happening in your body, all of a sudden it goes from being kind of imaginatory to real.

And you have a great slide about this that we're going to get into in a second. But I just want to say that for you to take your expertise, put together this super thoughtful presentation that we're going to walk through on the topic of visceral fat, there's such a deep sense of gratitude because this is how, the world changes. One step at a time, one long format podcast at a time. They're not talking about this on the evening news, right? They're not sounding the alarm about visceral fat. And all the while, all the chronic diseases are getting worse every single year. Cancer, brain disorders like Alzheimer's disease, dementia, heart disease, the number one killer that's out there, you know, of both men and women, you know. And there's so many problems. And we change this by

helping people have access to more data, democratizing data, and also encouraging them that there are solutions out there that they can seek out to help them get healthier. So you're making that possible and I want to share that gratitude with you. Thank you. I'm grateful for you having me here and I am grateful for you being so active in really fighting to bring health topics for your audience. You know, you are always bringing people who bring light and I always tell myself When you are in a dark room like visceral fat and diseases and chronic diseases and, you know, all the big pharma and all the things monopolizing and dominating us, when you are in a dark place like that, if one person, one person only,

lights a flicker of light, like, you know, it illuminates everything and darkness is not there anymore, right? Yeah, that's so well said. So I would say, you are the light that you are bringing for your audience. and it's amazing. So I'm really grateful to be here and be of help to help to you and to others. This episode is brought to you by Sweet Green. You know, if you're a fan of this podcast,

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Visit your nearest Sweet Green. There's a ton of them out there or find out more information about Sweetgreen by going to Sweetgreen.com. And new users of the Sweet Green app, yes, they have their own app, by the way. You can order pickup or delivery through it. You can use the code Drew Five for $5 off. D-H-R-U-5 for $5 off your next order to the Sweet Green app. Well, a lot of gratitude for us and a lot of gratitude for each other and gratitude for the audience

who's listening in. So going back to your presentation and the power of imaging and how powerful images are, I would love for you to share slide number four on your image. You know, this is an x-ray, right? Yes. Not an MRI. No. But there's a reason why you put this image in the presentation that you've,

put together. Can you talk about that? Yes, I put this chest x-rays here because although they are not MRI and although they have nothing to do with visceral fat, I just want to engage your senses. So then you understand how much when we engage our senses, vision and hearing and it's completely different because you are turning off your brain and you are connecting with your heart. So that's what I ask from each one of you today, to connect with your heart for each image we are going to discuss because when you connect to your heart, you connect to a deeper cause, a deeper reason, and you're going to make changes that are going to be unbelievable for your life. So here on the left side, we have a normal chest x-ray and we see the lungs that are black because they are filled with

air. On the right side, we have this white area in your chest, in your right lung on the bottom, and the left lung is normal filled with air. And what I want to say is, if you are this person and you come to my office or to the emergency department and you say, I have a fever, I have chills, I have a cough, productive cough, my body hurts, my joint hurts. And the doctor orders a chest x-ray but doesn't show you the image. And the doctor runs your white blood cells that are elevated. And the doctor just tells you, you have a pneumonia.

your white blood cells are elevated, go home and take the medication and come back later, eight weeks later for us to see if you are better. It's one thing. You're going to go home and you're going to have in the back of your brain, oh, I have pneumonia. I just have to take care of myself and get better. But if the doctor pulls up your chest x-ray and shows you this wide, huge white area in your right lung, lower lobe, and the doctor tells you, you have pneumonia,

and that's the pneumonia area. That's where all the secretion and inflammation and infection is collected in your lung. You will have this memory picture in your brain, and you are going to bring this memory picture to your house. And you're going to lay down and remember of this memory picture while you are laying down taking your antibiotic. And you will figure out, I have to take my antibiotic and get better because I want that white area to go away, because I want my lungs to be like... You can't unsee the image. Once you see that and you're seeing where the pneumonia is,

you can't unsee it especially if the doctor said, hey, here's a normal chest x-ray. And here's yours, just as you've outlined it. Now it's in your visual. It's in your brain. You're going to be taking it much more seriously and you're actually going to want to take action that will lead to leading to you recovering.

And that's the power of imagery that's here, which tees us up perfectly. If we could go to slide number seven that you have, this teases up perfectly for this image that's here. You know, the title of this is intramuscular fat on an MRI. And this image really drives home a point that you mentioned previously, which is that, well, I'll let you talk about what this image is. Yeah. So this is a normal individual. This is a slice, a T2 axial slice, which is a transverse slice.

at the level of your thigh or of your mid thigh. And this is how you see a normal bulk muscle that you want. Very little subcutaneous fat. And the muscle is all gray. So these darker areas are the fascia separating. On the left side? On the left side of the image. Yes, on the left side of the image.

This dark line here is the fascia separating the muscles. And you can see that all the muscles are gray because they are only muscle lean muscle. If you go to the right side, you're going to see that you have a little bit more of subcutaneous fat, but look at these muscles comparing to the other side. They have all these white streaks within and interspersed the musculature. And again, for you that are in the audience right now learning, always look at the subcutaneous fat. The subcutaneous fat is white. So it's fat, white.

So anywhere else that might have white within the muscles is also fat. So you have fat within your muscles, like Sean says so well, the marbling of your musculature. So this will progress to musculature atrophy or sarcopenia, which is when you don't have enough muscles to sustain your body. So how do you want, that's my question. How do you want to age? Do you want to age with muscles that you're going to be walking on your two legs as a miracle walking person and, you know, being able to stand up, being able to take a shower alone, being able to have fun and have and travel around whatever you want and play with your kids and grandkids? Or do you want to progressively have your muscles replaced by fat in a point that you might need a wheelchair?

you might need, you might be on a nursing home, you might need people to take a shower, to give you a shower, you might fall and break your bones. So, and that's when we attack visceral fat. When we attack visceral fat, we are also attacking the ectopic fat, like the fat in these muscles, and you are building a more functional body. So then it's not about longevity in increasing number of years in your life. It's about if you are increasing, number of years in your life or even if you're not, since our days might be numbered. But like, how do you want, what is the quality, not the quantity, but what is the quality of life that you want for you?

And that's the point that you have to fight visceral fat because do you want to be able to take care of yourself or do you want people taking care of yourself and you need an oxygen tank or you are spending lots of money with medication and you're not being able to get a shower and you are on your diapers because your musculature from your pelvic area is not strong enough and you are, you know, with incontinence, urinary or fecal incontinence. How do you want to age? How unhealthy you want to be. Right. Do you want normal aging, which is what's happening on the left, right? Truly normal aging as our species was designed to do. Yes. Outside of, you know, rare events and, you know, war and things like that.

You know, if we're eating largely a whole food diet, we have normal aging. We're not eating excess, you know, ultra-processed calories. Or do you want abnormal aging, which is what we see, you know, so many people, I'm surprised, so many people when you ask them, hey, do you want to live to 90 or 100, you know, or even in some cases beyond that? I've never heard so many individuals saying, no, I don't. and even young people, and you ask them why, why don't you want to live to that age? You said, I look around, whether it's my grandparents, my parents, whether it's friends' parents,

or I go and visit the nursing home or volunteer, I see people that are in their 60s, early 70s, mid-70s, 80s. And if they're lucky enough to still have their brain capacity and they don't have Alzheimer's or dementia, which is very scary and my heart goes out to everybody who has that, they don't seem like they have a healthy aging. A lot of people are afraid of aging because they think of somebody who's frail. You know, Dr. Gabriel Lyon, who's been on this podcast before, talks a lot about the importance of maintaining lean muscle mass, especially for women as they age.

And she shared a statistic in her book and on the podcast that was mind blowing. And I believe that statistic was of women above the age of 65 who end up falling, again, tying back to having a lot of intramuscular fat, osteoporosis, sarcopenia in the body, they end up falling because they don't have a strong body, right? Or they trip or something happens and they break their hip. Something like 50% of them will never end up walking again. Yep. Which is very scary to hear.

And a big part of that that I'm hearing you share is that how well your body is protected from that fall. whether or not you end up falling in the first place. And God forbid, you know, there's plenty of reasons that we could all fall, even if you are healthy. How protective your body is in making sure that it protects the bones from breaking. A lot of that is all connected to how much visceral fat and intramuscular fat you have inside of the body. Is that accurate? Yes.

And exactly, you are extremely accurate. and see this about falling and breaking your hips and the mortality rate if you would research that, the mortality rate after breaking a hip is extremely high. And see here, this is a CT, but again, I will teach you how to look at a CT too. So again, this is your skin. Beneath the skin, you have the subcutaneous fat. On the CT, the fat is gray. But again, if the subcutaneous fat is gray, everywhere else that has fat is going to be gray because it's fat, same fat, right?

Same product, fat. But see this muscle. Again, this is the erectory spinal muscle. You can see that this person barely has the erector spinal muscle. All this that is gray, it's fat, replacing the muscle. So how are you going to be able to walk and sustain your body? standing up, if the musculature that is supposed to be doing that is fat and wobbly, you're going to fall, you're going to break your bones.

And that's what Dr. Gabriel teaches so well, muscle mass. Muscle mass is important to keep your body functional and to keep your brain functional because there has been lots of research showing that the muscle, the muscle health is absolutely related to your brain health, as well as your gut muscle, your gut, your gut, your microbiome and your gut health is completely related to your brain health. So you have to fight visceral fat, improve your microbiome by fighting visceral fat, and improve your muscle and improve your brain. Because again, what is the purpose of living, like you were saying, what's the purpose of living until 90 or 100 or 80, but not even knowing who you are?

because you have dementia. And it's so sad for the person and it's so sad for the family. So how could we fight this by fighting visceral fat as well? You know, we took a little break in terms of talking about causes. And I want to come back to that a little bit, right? You know, you mentioned processed food. And I think when Dr. Sean Amaro was here on the podcast, one of the distinctions that we really wanted to share,

because processed food can mean a lot of different things, right? It can mean, you know, almonds that are ground up and now are almond butter. you know, that's a processing that's there. It could be, you know, whole avocados that are turned into guacamole. But really, to drive the message home, we're really talking about ultra processed food. Yes. Ultra processed foods, which are foods that have gone through multiple steps, are generally not a food that you could create that same level of processing in your house, right?

And often have a lot of chemicals, preservatives, additives, and are adulterated. in their normal whole food form to be hyper palatable. Yes. I mean, everybody knows the classic examples of potato chips, right? That's a perfect ultra processed food. You know, having a potato here and there,

and potatoes actually by themselves score very high on satiety, like they're very satiating. When you add a lot of other things on top of them, sour cream, butter, you know, processed different things like that, they become less satiating. But having a potato here and there, is one thing. And generally speaking, try to get somebody to eat, you know, two or three potatoes. But now take that potato, ultra-process it, not just processing, ultra-processed and make it a chip,

right? You can crush an entire bag of potato chips. And that's going to be, it could be, you know, thousands of calories inside of that, ultra-processed food. So what I really wanted to drive home, and please correct me, you know, if I'm missing any angle of it, it, it's the hyper-palatable, ultra-processed foods in our diet that are so pervasive from everything like, you know, potatoes are the number one consumed vegetables here in America, primarily because of chips and fries, right? It's not that people are eating, you know, straight potatoes. And tomatoes are also a highly consumed vegetable. Not because people are eating them on their, you know, patty at McDonald's or somewhere, but because people are using them in ketchup and tomato sauce

in pasta. So these types of hyper-processed vegetables, and of course, in some cases, meats too, that are engineered to be something that we cannot stop eating or have added levels of salt. The number one source of salt, you know, people who have high blood pressure and are dealing with hypertension, they go to their doctor and their doctor will say, well, we need to take out sodium from your diet. People forget that the number one source of, you know, of sodium and salt, not exactly the same thing, but generally correlated, is bread rolls and pastries and breads, processed breads, right? Not sourdough bread that you get from the local bakery. Processed pastries, breads, bread rolls, that's the number one source of sodium and salt

in our diet. So these are the ultra-processed foods that, unfortunately, by the latest statistics, you have as part of our diet here in America, you know, depending on the age group that you're looking at, it could be up to almost 70% of the total calories. Of course, sugar-sweetened beverages fall into this category. You can have thousands of calories just by having, you know, a few sugar-sweetened beverages throughout the day. And these are the things that are in turn because of the concentration of calories. it's a lot of calories very quickly. And generally, they're refined carbohydrates, right? So it's another form of just a massive dose of sugar in your body.

This combination and unhealthy fats, this is what's driving this explosion of visceral fat from a dietary perspective. Is that accurate? I would say so. I would say that all this huge amount of calories that you just mentioned are all wasted calories, calories that you could just throw in the garbage because none of them are going to bring any nourishment to your body, right? So, oils that are not beneficial to your body, like seeds and vegetable oils, canola oil, and the huge amount of sugar that is added to everything with

different names. So I would say, do your own research because sugar has lots of different names, right? and the pesticides from the vegetables that are in the vegetables and the additives and preservatives and things that give color and taste. So these are the foods that you definitely should avoid. Or greatly minimize? Yeah, or greatly minimize because these are the foods that are definitely feeding your visceral fat and damaging the microbiome of your gut too. So I would say that it's, I would say, implementation of strategies for health should be according to how you feel comfortable and how you are not going to feel overwhelmed.

Because if you feel overwhelmed, either you're going to give up or you're adding stress as well, right? And we don't want to add stress because stress is always a feeding source to visceral fat. So look at the strategies from optimizing your health. Choose the ones that are easier to be implemented. Implement one at a time and then stack another habit. Stack another habit. And fruits and vegetables, there are controversial information. There is controversial information regarding fruits and vegetables,

but I would say mainly because of having the preservatives and the pesticides, not preservative, the pesticides, and I have been doing the strategies from Sean that he advocates for fermented vegetables and fruits because either they are prebiotics, probiotics, and they are fiber for my microbiome, so they are making my gut healthier. But also because the process of fermentation ends up taking away the amount of sugar that would not be good for, that would not be proper or good for the body, right? Yeah, I know Dr. Sean, he's a big on, you know, fermented foods and we had a whole conversation about that.

Yes. And, you know, there could be a lot of different ways that people choose to eat. Yes. And I think that part of this podcast is helping people separate, you know, what matters and what doesn't. Yes. Also helping them understand that there's going to be a lot of variability. You know, some people don't do well with dairy, even though there might be types of dairy

that actually could be very good for people, especially things like fermented, you know, dairy like kefir. Kiefer. Even me, when I have fermented dairy and kefir, even if I have too much weight protein in a day, I get little tiny little blemishes and things. And probably that's because of my history of poor gut health as a kid, being on a lot of antibiotics for strep throat and other things. So there'll be a lot of different variation.

And I think the thing for people to understand and notice is that generally speaking, if you're moving towards a whole foods diet, which again, almost 70% of our foods here in America and increasingly in the Western world that's changing is coming from ultra-processed foods, just moving to a whole food diet and then finding your personalization within that is going to be helping you move in the right direction. The challenge is a lot of people think that they're eating very healthy, but when they actually look at it and when they actually do, let's say a full metabolic workup and they get an MRI like this to look at their visceral fat, they actually realized that what they thought was healthy

is not actually healthy or it's not taking them to a place that is optimal. And that's why we're doing today's episode. Now, just high level, we talked about the dietary side of things, ultra-processed foods, highly-processed foods, fast foods, Doritos. And by the way, just so everybody's aware, these ultra-processed foods, it's, I don't want to, you know, just go after fast food. There's plenty of ultra-processed foods that are sold at Whole Foods Market and Trader Joe's. Yep. Because there's a lot of, quote, unquote, healthy food that has been made hyper-palatable. So it's really up to us to start to separate, you know, what is actually genuinely healthy

and should make up the, or what, I don't like to use the word should, what can make up the base of our diet, whole foods that's out there. and then what other things are an occasional situation, right? I think sometimes when people hear podcasts and they hear about the dangers of refined carbohydrates and sugar, they think, okay, I can never eat those things. You can have them every so often. Now, just understand, they're extremely addictive. They were designed to be that way.

And the healthier you eat and the more that you monitor your metabolic health, you look at your fasting insulin, you look at your A1C, you look at your glucose, you look at your lipid breakdown and you look at your visceral fat as well, the more you're going to be encouraged because not only do you feel better, but you're going to see your blood work change and you're going to also see your body composition change and your visceral fat reduce over a period of time if you so happen to be lucky enough to get a scan done. Yes, I would say in the same line of thought that you are making your comments right now, everything is moderation, right? You have to find what it's comfortable for you in eating and exercising and walking in sleeping patterns. You have to find

what it's comfortable and start from there with moderation one change at a time, one step at a time because becoming healthier, becoming optimizing your health. It's really not a destination. It's a journey. So you have to walk, you have to do things that you are going to be able to sustain. with commitment, consistency as a journey. Because you're not going to say, oh, I got to where I want to be because there will always be room to be better and better and improve your health better and better. So that's what I would say.

Start with what is manageable. Start with what you believe it's sustainable. Start with, like I said, connect to your heart. What is the reason you want to become healthier? What is your why? What is your why? a deep, deep why. And when you connect to that, make a plan.

You know, I'm in, and commit to yourself. You have to be the person. We as humans, we need, we have basic needs. We need to feel loved. We need to feel seen, heard, valued, honored, respected. And who would be the best person to do this for you? You. Because you were born with you, you're going to die with you.

So you are the person who needs to get your back. So love yourself, commit to yourself, find your why. And have compassion, you know, do your best at each day. And one step at a time, no criticism, no judgment, just do your best and keep doing. Keep doing. Do not give up. Just keep doing. Commitment, consistency, compassion, get your back. Powerful message. You know, part of this show in helping people separate what matters and what doesn't is also helping them realize that diet is the foundation of so many things, right? We cannot, you know, optimize every other area of our life and not pay attention to anything in our diet. And that being said, diet is not the only thing that's there. So when you

were talking about visceral fat, we chatted a little bit about diet and the ultra-processed foods, high amounts of refined carbohydrates that are linked to all sorts of conditions. We just did an entire episode on fatty liver disease with the top doctor at the Cleveland Clinic who has demonstrated that he can reverse, you know, in most instances, except for super late stage, non-alcoholic fatty liver disease, that they can reverse fatty liver disease by primarily what? Removing ultra-processed foods, extremely cutting down on refined carbohydrates, getting in the right foods inside of the body and system, and improving the metabolic health. and then you see the liver heal.

Yes. It's magic, but that's what the body is designed to do. So diet is important, and you started to mention that it's not just diet, especially when it comes to visceral fat. So one area you mentioned was stress. Another area that you mentioned was sleep, the importance of getting high quality sleep on a regular basis. And if you have something interfering with your sleep, like an undiagnosed sleep apnea, or some

sort of other issue, if you have a lot of red light, sorry, a lot of blue light, in the evening that's disturbing your sleep. If you have a lot of stress that's impacting your sleep, giving your sleep the attention that it deserves because improving your sleep is not just going to cut down cravings the next day. Yes. Because when you don't sleep well, you crave carbohydrates. That's been well documented and you want to overeat as well.

But also your body is more rested and can go through the repair process. So you have stress. You have sleep. We talked about diet. Is there anything else that you really? really want to highlight that are the root causes that are out there that are driving an explosion of visceral fat inside of the body. I want to highlight something that you also said about the last podcast you have had with fatty liver disease and non-alcoholics,

the auto-hypotitis, and all the things that you could do to reverse that are probably the similar things that you would do to reverse visceral fat because they are both ectopic fat, inflammation fat, right? And how you said it was so awesome because the most advanced you let it be in your body, the most you are exposed chronically to the ectopic fat, visceral fat or fat in your liver and inflammation in your liver, the hardest it is to reverse and it might not be reversible in the fact that the liver could develop cirrhosis, fibrosis, and then you would have a liver cancer because of that.

So that's what it's so important, and that's where I get the anchor. That's what it's so important, that talking about visceral fat as the root cause of all these chronic diseases should be implemented in the medical school curriculum. And the people who are listening should research and really advocate for themselves with providers who would jump in and be their accountability partners, providers that they can trust, with guidance and wisdom and knowledge, Because you got to work in the beginning stages where you can reverse, where you can build health, where you can build performance in a functional body, instead of letting it grow, grow, grow,

and then you have cirrhosis and then you have dementia, and then you have diabetes, and then you have like all these other complications because of isrophat. I am not saying that if you have all these complications, you should not work on yourself because all these things can get better. But if you are like a tofu, thin outside, fat inside, or if you have not developed these later complications, that's the point.

That's the time for you to just take ownership of your health and follow the strategies and research and work on your body. Part of what I'm hearing you say is that visceral fat is also, you know, it could take decades for Alzheimer's to develop. Yes. But visceral fat as being something that's connected to many chronic diseases, it's almost like the canary in the coal mine. You could be in your late teens, early 20s, mid-20s, early 30s,

and you could start to see that you have a level of visceral fat that is abnormal. Everybody's going to have some visceral fat inside the body, but you're starting to get abnormal levels of visceral fat. And that could be the earliest almost smoke detector going off. D, D, D, D, D, D, D, an alarm saying, hey, something bad. is happening in the body. We don't know exactly which way the body is going to say, ouch.

You know, diabetes is one way that the body says, ouch. Type 2 diabetes primarily. I mean, type 1 is a little bit different, obviously, autoimmune condition. You know, heart disease is one way the body says, ouch. Alzheimer's disease is one way that the body says, ouch. But before all those things say, ouch, there is often, in most cases, the silent killer that's building decades ahead of time. which is visceral fat.

Yes. Let's continue down the imagery of some of the slides that you've prepared for our audience today to really drive home this narrative again of visceral fat. What slide would you like to go into next from your presentation? So I would like to say if any of you have done a CT or an MRI in the past, you go to your clinic where you had the scan and just ask for a call. copy in a CD and you can come home and open the CD in your computer and I'm going to teach you now how to see your own visceral fat. I'm not going to teach you how to be a radiologist because

you need training for that to be a doctor, but I'm going to teach you to see the visceral fat. It's simple, it's fast, it's easy, it's effective. I would tell you, sit down because you're going to be very not well surprised. I have been reading. scans for 30 years. I am a doctor for 30 years. I am a radiologist for 26 years. And since I got my attention on towards visceral fat, at least 95% of the reports I give daily are with lots of visceral fat, moderate to severe visceral fat. So do not be alarmed or do not be alarmed and also be alarmed. if you have lots of this.

Both pay attention, but also understand that your health journey is a byproduct of a larger societal issue. We live in unfortunately this society that is the perfect storm to fatten us up in the wrong way. Right? So you're not alone. It's not your fault. And yet you can do something about it. Exactly.

This is what you're here to share with people. Yes. Do not be alarmed because you have time to work on it. Yeah. So I'm going to start with a CT scan because lots of people might have had CT scans in the past, most likely and not really an MRI. But I'm going to start with a CT and then I'm going to go to the MRI. As you can see on slide 18, this is a healthy individual. The scout image is the image that we acquire. so then we can plan the next images from the scan.

And this person has very little subcutaneous fat, as you can see here. And when we go and do the CT slice at the axial slice at the level of the heart, so you see the heart, you see the lungs that are black, and there is no fat surrounding the heart. That's a healthy person, thin inside, right? Barely none subcutaneous fat, too, but I'm focusing on the viscerative. fat and the ectopic fat, so no fat surrounding the heart. Lower at the level of the upper abdomen, again, here are the bowel loops and you barely see fat. If you are looking at a CT,

always look at the subcutaneous fat. The color or the shade that the subcutaneous fat is going to show up is the same shade that the fat inside your belly is going to show up because they are fat material, right? So if you are looking at a CT, the subcutaneous fat just beneath your skin above the superficially to the musculature. It's gray on CT. So you can see that this person has almost zero visceral fat. There is a little bit here, but this is retropyretoneal fat, so it's considered a fat that could be beneficial as well.

And almost non-visceral fat, very little subcutaneous fat, so thin inside and thin outside. and this is what I want to catch your attention. That's a different person and also a scout image where we plan the next slices. And you see that this person doesn't have much subcutaneous fat as well, a little bit more, but really could be the person that is thinking, I'm healthy. I have a little bit of subcutaneous fat. You can pinch a little bit, but I'm healthy. But on slide 22, at the level of the heart, again, we are on a CT.

So the fat is gray subcutaneous fat. So the fat inside the abdomen and the fat in the lower portions of your chest are also gray. So you can see the heart here and you have this huge amount of ectopic fat surrounding the heart, suffocating your life, suffocating your heart. And it's gray and it's ectopic fat. You are not supposed to have this fat there. It's the same metabolic, unhealthy fat from visceral fat. So it's the medial-cardio-paracardial fat.

And here at the upper abdomen surrounding your spleen, you have the visceral fat, which is also a huge amount of visceral fat compared to the other person. So this is a thin outside and fat inside person. You can see that there is very little subcutaneous fat, but there are lots of fat surrounding the heart. There are lots of fats surrounding the spleen in your upper abdomen. So this is somebody who would traditionally be described, as skinny fat.

Yeah. Which is why, again, it's so important as people are paying attention here, you could be an individual that has a lot of fat on the inside, even if you have not that much, you know, BMI or subcutaneous fat that's there. Yep. Yeah. This individual most likely has a normal BMI and has all this huge amount of ectopic fats surrounding the heart and visceral fat in the abdomen.

And this is metabolic unhealthy. These are the people that are walking like tick-tock bones, right? They can have any kind of problem related to visceral fat, cardiovascular disease, peripheral disease, diabetes, and they are unfortunately believing they are healthy. And you're not going to know if you are seeing outside, fat inside or toffee person, unless you have a cross-sectional study like that, which I would say the MRI because doesn't have ionizing radiation, but or and, like I'm saying, I'm showing the CTs because if by any chance you have had a CT in your past, you can get the scan on a CD and look at your house and see, okay, let me see my own visceral fat.

I will say, I definitely hear you on that, but even as I'm looking at these images and have seen my CT scan and other stuff, I'm still trying to like kind of figure it out a little bit. Like, you know, okay, is this part dark gray? Is it a little bit lighter? So I know you make it sound a little bit more easier. And I love that enthusiasm, right? I love that enthusiasm. I wish for us all to get to there.

And I hope maybe one day there's AI tools or other stuff or people have access to an incredible doctor like yourself. But I will, I just want to go on record that if anybody's following along and they're still trying to figure it out, I am still trying to figure it out. And I say that in a humble way that it does take a little bit of time to start to get better at looking at what are the sort of themes that are there. But the more that you share, and after even your colleague, Dr. Sean O'Morrow was sharing, the more I can now start to like look at a few different things. And I'm starting, even with your presentation, I'm starting to get a

better handle of how to get a big picture sense, at least. And again, the MRI is way easier to see. I'm just showing some CT images because if someone has a CT that they could look from a recent past, which is, which city is usually more common for people to have for any reason, right? So then if you have it, you would be able to look at yourself, yourself. So slide 23, here is at the level of the upper abdomen. And again, this person does not have much subcutaneous fat. That's the outer rim. That's the outer rim. That's the outer rim where you can see that outer sort of super white rim. The super white, yeah, the super white rim is your skin.

Subcutaneous fat. Yeah. Oh, that's the skin, sorry. Yeah. And then the gray. The gray is the subcutaneous fat. And then you have another different kind of gray, which is your muscle. Right.

And then you are within the abdominal cavity. And all this gray here surrounding the organs is visceral fat. So this person is a thin outside fat inside. And this person is interesting because. as a radiologist, I can say there are grayish interspersed in, this is your pancreas, and there are grayish areas interspersed in your pancreas, which is the pancreas fatty replacement. So this is the intramuscular fat that you were describing earlier, the sort of marbling that ends up happening.

Yeah, so now we are having a marbling in our pancreas, which we don't want that because then you have pancreatic insufficiency that will lead to the diabetes type 2, right? pre-diabetes and diabetes type. Yeah, it's so funny because, you know, anybody who eats, you know, some form of red meat especially, or has at least seen it, even if you don't eat red meat,

you know that a lot of different stakes or cuts of beef for ribeye or this or that, you know that a lot of the ones that seem to be very prized are the ones that people are looking for with a lot of marbling in between. But, you know, really learning from yourself, Dr. Sean Amara, as well as more ethical raised farms like white oak pastures, which is like regenerative farming and animal agriculture that's there or sort of animal

raising. You know, they show and have shown slices of meat of the animals that are not fed grain and crazy things like Skittles. Have you heard about this? I heard about that. There was a Skittles truck in like Iowa that was driving and kind of tipped over and all the skittles fell out on the road. And a police officer drove up and said, where are you going?

Are you going to like a candy factory? And they said, no, no, we're just taking this to the feed lot. This is just another source of carbohydrates that the animals eat to make up for the fact that there's not grass in the, you know, winter and other things. Right? To gain weight, right? And fat. To gain fat. To gain fat. Yeah. And so our, you know, besides factory farming being like incredibly, you know, cruel of a process, and we want to move to a more, you know, humane process. And there's a lot of, you know, regenerative and grass-fed sort of places that are out there that are trying to set a new standard in animal welfare.

You also see that those cuts of meat have very little marbling that's there because the animals are eating what they're designed to eat, which is largely, you know, grass that's there instead of all the corn and other things, skittles, whatever is being tossed into the mix. So that was really interesting to see. And if you look at often truly grass-fed meats that are there, a lot of times people who are super-officionados of steaks or other things like that, they sometimes don't want to go for those meats because they're like, oh, no, no, I want the barbelling. It's like you're kind of eating like a diseased cow that's there. And yeah, it might taste better.

But is that actually good for you? Is that good for the animal? I don't really think so if I had to guess. And I would say that in all honesty, it doesn't taste better at all. I have been getting grass-fed, grass-finished meat. And it's very, very, like, tender. and it has a different, the different taste that it's, you can see that it's the meat taste, you know, and I am Brazilian, I am a steak person.

So I would say that it definitely tastes more real, to be honest. It has, and it's very tender. And we can see if we give grains to the animals, they get all marbled and fat, and that's what happens to us, right? if we get all these grains and ultra-processed foods, that's what's happening to us in increasing the visceral fat, in nourishing. We are feeding the visceral fat,

and we are replacing our muscles with fat, and we don't want that, because we don't want our muscles to be functional and strong. Let me ask you a question. If visceral fat is so dangerous, why does the body create it in the first place? You know, like that might sound like a very basic question, and maybe there's parts of that you know

or maybe you don't know, but what is the purpose of visceral fat inside of the body? I believe I have read a little bit about that. I don't have lots of foundational knowledge as a radiologist or as a doctor in this area of field. Because again, we never learned about this. I have never learned about visceral fat in the medical school curriculum, right? So everything is kind of new in this knowledge for me as well. but I believe it's a way of our body to just put the toxins that it can't handle.

You know, you can't eliminate that. Your liver gets exhausted and gets the liver on it as well and the inflammation on it as well. And your liver is your metabolic organ together with your kidneys, right? And your bowel. So then you have the leaky gut and the microbiome being damaged. And so you don't really have any other resource to put all this. toxins out because the intake is way higher than the, you know, the out, the person keeps eating that daily. The person keeps eating a lot of that daily and gets to a point that your organs don't

know what, don't have the, don't have the capability or the ability to keep excreting and taking it out of your body anymore. So then it puts out, put it puts it there because it's, like you said, a different organ. And it's a different organ. It's an organ that it's taking over. your whole body. It's almost like a survival mechanism of the body under severe stress. Yes. And of course, there's a lot of things that we don't know. But generally speaking, I've even seen, you know, even people that are in the plant-based

community that are, you know, physicians that understand that, you know, visceral fat is not healthy for you. We've had, you know, some of those individuals on the podcast like Dr. Joel Kahn. He's a cardiologist that's based out of Detroit, a really incredible, you know, very knowledgeable individual. And, you know, he tells people, listen, if people choose to have some animal food as part of their diet, can they be healthy? Sure. I choose not to. And he has this whole reasons why, you know, I respect anybody eating any way that they want to do. But as a cardiologist, he knows, you know, especially having his training in integrative and functional medicine,

he knows that visceral fat is not a good thing. Right. So even if people have different ideas about what exactly causes it. One thing I think that is very important to take away, both traditional medicine, even if they don't teach it to doctors who are in medical school, they acknowledge that visceral fat is dangerous. Yes. Right?

People that are on integrative or functional or sort of the health experts, whether they're plant-based or whether they are omnivore or carnivore, I haven't seen anybody say that, hey, visceral fat is good for you, right? Nobody's out there saying that. Yes. Now, there may be people that are undereducated about how bad it is for you, but anybody who knows about visceral fat is saying we need to significantly reduce it inside of the

body. So that should give solace to the people who are listening that everybody pretty much across the board agrees that visceral fat is extremely harmful. and even if they disagree about how it accumulates and what exactly causes it, they all agree that we should be severely reducing it inside of the body. Yes, because like when I was in med school or even after I started working as a radiologist, I have set in innumerable differences, multidisciplinary conferences, and we discuss everything that comes from visceral fat.

So we learn about the cancer, we learn about diabetes, prediabetes, Alzheimer, mental issues, and we learn about all that. And now it's bringing to the light that the root and the cause of all the things that we have been discussing is visceral fat and is linked to visceral fat. So that's what I'm here because I want to ask the radiologists, my colleagues, it's time for us to start reporting visceral fat, start giving some guidance for the providers who order the CT or the MRI. like we do guidance as radiologists. If I find a mass in your breasts, for example, in a woman's breast or male's breast, I say, hey, this is suspicious, let's do a breast biopsy or a breast MRI or a breast mammogram, a diagnostic study.

Or if I find abnormal wall thickening in in your column, I say, hey, this is suspicious, let's do a colonoscopy. So I think it's important that we say that there is visceral fat, mild, moderate, severe, most likely it's going to be moderate to severe from my own experience as reading studies, as reading scans every day. And just give some guidance. Make sure that you say that the consolation of findings, the fat in the liver, the fat in the pancreas, the fat in the muscle, the fat, the visceral fat, the fat,

surrounding your heart, your vessels, all of them are related to metabolic complications and that all of them could be reversible. And you could do like sprint, some kind of sprint activities, some kind of strength training, no processed foods, no, you know, sugar, low-carb foods and, you know, all this kind. I am having in my report now in my impression, whenever I see a significant amount, whenever I see visceral fat that needs to be focused and reversed, I put in my impression. I describe and I say, this is reversible. And with these and this and this and this, because radiologists are used to give guidance to the doctors.

I'm not your doctor. I am the doctor of your doctor. So you're sort of helping the doctor educate themselves and say, hey, listen, you know, first of all, high, right? Yes. Which you're saying severe, moderate, which most people in America are probably going to be at least moderate or severe because our obesity.

the epidemic is so bad. And the tofies are in the category. And the tofies are in the category, too, right? A lot of my Indian friends are in this category, thin on the outside, fat on the inside. It's a major problem. So what you're saying is that you're starting to include recommendations to the doctor to say, hey, listen, this patient needs to. They're in the category of severe or moderate or whatever. Yes. And they need to specifically start implementing some lifestyle strategies. and here's some collection of things that you might want to discuss with them. Instead of just sending the patient home and saying, hey, listen, I want you to lose 10 pounds. Yes.

Right? Which is typically associated with just exercise a little bit more. Cardiovascular intensive. Yep. Do some running. People often do that. And just eat a little bit less. And they're trying to eat less, which, yes, if people could stick to, if you could wave a magic wand or through a snap of fingers and you could just get a patient.

to cut their calories in half, let's say, if they're overeating, right, by 100%. Let's say you cut it in half and you get it back to their normal rate. And even if those calories were still primarily ultra-processed foods, they would see a difference. The challenge is that everybody's seen and so many clinicians like yourself have seen is that if they're still largely eating processed foods, those foods are so addictive that just telling them to cut their calories down is just, it's almost nearly impossible. And how do we know? Because an entire population of people here in America have been given that advice for years,

and it hasn't worked. Now, if they could do it, it would work. I think that's important to acknowledge that even if they were eating ultra-processed foods, if they were able to control their calories, it would work. It's just not a long-term strategy. The better strategy is moving more towards whole foods. foods that are more satiating, you know, things like protein, you know, having good quality protein in the diet, you know, regardless of where it comes from, lowering the amount of, you know,

refined carbohydrates, these are the things that start to bring satiety back into control and it make it easier to follow through with a diet. Yes, because again, if you are cutting your calories and you keep, you're going to lose weight because you're cutting your calories. But if you keep eating the ultra-processed foods, you are still feeding your visceral fat. Right. Your fat would still be feeding. It would be reduced because you're having less, right? It would decrease, but you're still feeding it. Now... And the magic about reversing visceral fat is that the strategies do not ask you to cut your calories because it's not about the calories. It's about what you are eating, what you are eating that you're putting in your

body that's going to be healthy, right? So it's about eat when you are hungry. It's when you were not anymore. Your body knows when you are hungry. Your body knows when you need food. It's not that you need food at 7 a.m. 11, um, or 3 p.m. Your body knows when you need food. Your body knows the amount of food you need. And fasting and to, you know, renew yourselves and do phagocytosis, which is like you are getting yourselves and you are, um, your body is getting rid of the cells that are unhealthy, the cells that are old, the cells that might develop cancer. So fasting helps with that too.

So it's eating what it's healthy for your body. And that's what I invite your audience, because they already do that with you and all the knowledge you bring. Keep researching. Keep researching for a provider that will work with you for optimizing your health. Keep researching the strategies to optimize your health. and then go out there and put everything you feel comfortable with into action. Yeah.

Let's continue with some of the slides that you have here for the audience. Okay, so I'm showing CTs, and I'm going to get done with the CTs. I am on slide 24 right now. Again, lots of visceral fat, which is gray because it's a CT. The fat is gray, the subcontentious fat is gray, the fat inside the body is gray. But now I'm going to go to the study, the imaging modality that it's easier and it's more proper because it has no ionizing radiation and you can repeat it when you are already implementing the strategies and follow your own improvement. So first I want to show this. This slide is slide number 25 and it is from Sean, Dr. Sean O'Mara, my friend.

I just want to say that as radiologists, we usually describe this as normal. But why do we describe, both of them would be described as normal? All the four of them would be described as normal. But why? Because we are not seeing a cancer. We are not seeing inflammation like acute cholacistitis or something. So that's what it needs to be brought to the attention. And for the doctors to do their own research as well and learn more.

about visceral fat. Yeah, so you're looking at these four images here. And because you're not seeing a tumor or cancer or an abscess, you traditionally have said, hey, this patient is good. Yes. Because you weren't trained to look at and describe visceral fat as one of the earliest indications that something is wrong. And again, like we said, it's the silent killer, the silent enemy, and the root cause

of all the chronic diseases that will show up later. So on the bottom left, you see a normal. individual. You see that there is very little visceral fat and all these muscles are bulky because it's a person that exercises that their muscles, his or her muscles correctly. They're fit. They're fit. Yeah. And if you go to the top left, you're going to see this image with lots of visceral fat, which is all the white. So again, like I told you for the CT, look beneath the skin. the fat is white. This is called the T2 sequence without fat saturation. You don't need to know that,

but I'm just giving you the information. But beneath the skin, the fat is white. So if the subcutaneous fat is white, the other fat is going to be white as well, because they are fat, right? So look inside your belly and you're going to see all this white, this ocean of fat, surrounding your organs, suffocating your life. So you have the bowel loops immersed here. in this huge amount of visceral fat that is white. And if you look at the muscle bulk, you will see that the muscles here are way atrophic, this person barely has the rectus abdominis muscle,

which is your six-pack muscle. And if you look at the images very closely, you're going to see these white streaks interspersed in the musculature, and this is the muscle marbling, which you could see better here in this thigh. Like the lower right is muscle bulk normal, and the upper right is the muscle with the marbling. All these white streaks within the musculature is ectopic fat deposition,

is musculature atrophy because of being sedentary and not really exercising your muscles. the way you need to be healthy in your brain and to be healthy in your body. The perfect storm of explosion of visceral fat. Sedentary lifestyle, too much of the wrong calories. Yep. And maybe some stress in there. We all have some stress.

Running, cardiovascular, long term. Let's talk about that for a second. This was something that was quite surprising when I was hearing. You know, generally you hear like, great, if somebody is fit, and they can run a really long time, they're probably somebody that's going to be healthier. You know, you look at a lot of runners, especially marathon runners,

they look pretty slim. And, you know, what Dr. Sean had brought up, Sean Amara on the podcast last time, is he was saying that those patients have come in. He scanned them. And because of their lifestyle, they tend to be higher carbohydrate diet to support their endurance over a period of time.

their metabolic health may not always be the best. You know, their triglycerides could be, you know, very high because of byproduct of how much, you know, refined carbohydrates of the eating. And then when he looks at their muscle because of how they are working out, which is this endurance training, marathon running, long balance of cardiovascular training, you know, not, you know, this sort of type of working out that, sort of hyper focuses on, you know, both like, there's nothing wrong with endurance, but it's not necessarily focusing on strength as well. Yes. What he sees is that he sees a lot of visceral fat in these individuals. Yes.

Right. And lots of marbling the muscles. And a lot of marbling in these muscles. So even if they might be healthy because they're long distance running, if you don't protect your muscle through strength training. and also optimize your diet, you could be in a place in a situation where you have a lot of visceral fat.

How much of that do you think, just from what you know, and it's okay to say you don't know if you don't. How much of that do you think is the training that they're doing and how much of that is the dietary component, would you say? What percentage is each? I do believe that the dietary component overseeds the exercise component. I do believe that changing the way you eat for,

healthier foods, whole foods, and no processed foods, you see the decrease in fat in your body, the visceral fat and the marbling in your muscles way better. So I would say at least like 70, maybe even more, but I would say 70 is dietary, 30% would be exercise. And I do believe that the type of exercise makes a huge difference too, like Shan said, because endurance exercises also, we also kind of exert some stress in your body, so you're also releasing cortisol at the same time you are doing the endurance exercise, and you are exercising a different kind of muscle too. So instead of doing the fast-stitch muscle that you would use for sprinting and building muscles like on slide 25, the thigh and also the abdominal musculature and paravirtebral musculature,

the sprinting releases, I forgot the name of the, I forgot the name of the molecule that the sprinting releases. And by releasing that molecule, it increases the growth of your muscle together with growth hormone and the lactate, lactate, growth hormone, and I forgot the other substance. but it enhances your musculature growth, you know, so you're producing muscle and you're becoming stronger and you're replacing the fat for bimusculature, while the endurance and the running does not do that because it exercises more the slow twitch muscles. So there's a difference there in what muscle you are exercising, and when you get one better, you have the other one weaker because your body just has, your body works on one or the other. So that's why sprinting is better for the, what Dr. Gabriel Lyon talks to.

The sprinting is better because it builds more muscular skeletal muscle, fast to each that is going to keep your body up and running and up, up and running. Now, I didn't say it right. Up and walking and up and, you know, being functional. Yeah. Yeah. And just to be clear, you know, just for everybody who might have missed that episode, we'll link to it in the show notes, but Dr. Sean Omarah came on and he was largely sharing his clinical experience and some of the results from this NIH funded study that he did, right, which I believe was 5,000 participants.

6,000 participants that he had come in and he was looking at how much visceral fat people had and how that correlated with certain dietary interventions. Is that accurate? Yeah. So this is based on, you know, it's one study and it's also his clinical experience. there probably needs to be some more research that's put out there and some more individuals that, who knows, you never know who's listening today might want to do some of that research in their laboratory or university that's there.

But it is, like, I don't think it is, it's still emerging research that a diet in, let's say two individuals are eating the same diet, right, in terms of, calories, right? Let's say it's two men and their, you know, base calories sort of just to operate sort of, you know, their daily sort of metabolic rate and an operating function, let's say it's like 2,700 calories or 2,500 calories, right? If you had one of those individuals eating what would be more ultra-refined, let's say in particular, sugar foods, carbohydrate foods, let's say like maybe like a typical marathoner might eat a lot more of those foods. And you have another individual eating more of a clean paleo diet, right, where they're getting

a lot more of their protein in, higher quality fats, and they've greatly minimized. Sean's clinical experience is that the person who is eating a cleaner paleo diet or clean omnivore diet and getting their appropriate levels of protein is going to have less visceral fat. That's his clinical experience. And there's no big, big study on this yet because visceral fat is still emerging in the science. It's a new movement. It's a new movement. But that would be something amazing to have done one day because that would really help people end a lot of the diet Wars. And I would suspect that, if that's the case, you know, I work out at a gym that's very popular here in Los Angeles. It's called Gold's Gym. It's kind of the mecca of bodybuilding. It's a really

cool place. A lot of really great people work out of there. And you'll see all sorts of different people. And they talk about their different dietary interventions. There's a lot of individuals there that are in the classic sort of bodybuilder type, you know, look. And they have a lot of muscle and they need to eat a lot of calories to sort of sustain how much their body needs to support that level. They're also getting a lot of protein. But they're, you know, and they have six-pack abs. Is my understanding in the way that you're sharing it and your understanding of where the research is so far, at least right now, which is largely people's clinical experience, if I would look at, you know, this typical individual who's very ripped and maybe competing in

competitions. Maybe they're not at the super low body fat percentage that they're in a competition, but they're an individual that's eating a lot of carbohydrates inside of their diet, right? They're still getting their protein, but they're eating a lot of carbohydrates. Are you suspecting that this person, even though they look very fit, is having a higher percentage of visceral fat than where we would want them to be because they're eating a lot of refined carbohydrates? Is that your idea? So like, like the classic bodybuilder type. Yes.

Right? Like think about Arnold Schwarzenegger. I would have, I would say that that would be very interesting to see what kind of carbohydrates they are eating. They're eating, I mean, because they might be eating like fruits and vegetables that are not really. No, no, you see a lot of oatmeal. Oh. You see a lot of, you know, when you're needing to eat the amount of calories that some of these guys are eating, they're eating like six, seven, seven, eight thousand. calories. Yes. But they looked incredibly ripped.

Yeah. I would suspect that they might not be in the category of severe visceral fat or high visceral fat. Because they have so much muscle. Because they have muscle and the muscle has its own metabolism that is burning some kind of fat in the body as well because the muscles are metabolic. They soak up the glucose. They are their own metabolism, right? Their own metabolism. So I would suspect that they don't have high. or moderate visceral fat, but I would suspect that they would still have some kind of visceral fat that you would not want in your body for a chronic exposure. Because the issue of visceral fat, it's not like the visceral fat, it's not only the visceral

fat you have, the amount of visceral fat you have, but how long you are being exposed to the inflammation that the visceral fat is producing in your body. So we're all just guessing here and kind of pontificating and imagining. And it would be great for somebody to do some of this research that's out there. But you're imagining that because they are normally used to eating a high percentage of their, you know, calories that they're getting in a total day, even though they're prioritizing protein, they're getting it from like a lot of refined, you know, carbohydrates simply to just get enough calories. You would imagine that, especially when they're not training for like a competition where they're super low body fat percentage, you know, some of these guys are like six, five, six. 4% body fat, when they're not training for a competition, you would imagine that if they're still getting a lot of their calories from refined, a lot of refined carbohydrates, a lot of sugars,

a lot of things like that, that they could be in a position where they're quickly developing visceral fat and they're being exposed to that over a period of time. Yes, which is what we kind of see if you look around, like people who were athletes like you're saying, bodybuilders, or military people who are so fit, and then they retire. And they're not exercising as much. And they are not being exercising that much anymore. And really fast, they build visceral fat. Right?

Because that's the dietary habit. And then you're not having the muscles working with you to burn some of the things that you are eating. Because again, if we are going with the theory that the visceral fat builds in your body, because your body is not being able to, doesn't have any other resource, to expel that visceral fat and the toxins that create the visceral fat, if you have lots of muscles and the muscles are consuming the fat, so you have less visceral fat because your muscles are metabolic, your metabolism is high because you have lots of muscles, and they are consuming

some kind of the fat and the toxins that you are using, right, that you are ingesting every day. But if you stop these muscles to being so metabolic active, suddenly you're, your body will not have this scape valve to release the toxin somehow, and you're going to start building more and more visceral fat. Yeah, it's a great thing to, you know, talk about because, you know, when, uh, that's a idea. It's an idea, right? It's an idea.

Yeah. You're a radiologist. You know your corner, but we're just sort of imagining. And, you know, besides obviously, uh, just wondering about this, part of the reason that I'm also asking, and I asked this to Dr. Sean Amarro when he was here as well, is that I, I actually, as I've tried to get more serious about strain training, you know, I turned 40 and Dr. Gabriel Lyon was a big influence on me and helping me realize that, you know, I was severely undermuscled, largely growing up eating a highly processed vegetarian diet, right?

And not prioritizing protein, which of course you can do even if you're vegetarian. But I wasn't doing either. I wasn't eating a clean vegetarian diet and I wasn't eating. a lot of protein either. I, and then not strain training because anytime I would go in strain train, I wouldn't really see a result. And nobody really told me. You know, I would hear things back in the day from, you know, sort of, I would, you know,

call this sort of like vegetarian vegan propaganda that I was kind of listening to and really believe. They would say, oh, you don't need protein. Look at a gorilla. A gorilla just eats like fruit and greens and other stuff. Yeah, it's true. But if you look at a gorilla or you. you look at a chimpanzee, they are eating all day long.

Yeah. Right? The amount of food that they're eating, they basically eat and poop and eat and poop and eat and eat and poop. And their bodies were created to eat that. And their bodies were designed to extract those nutrients in that same way. And, you know, so I didn't think that protein was an important thing. And then when I finally went in to get body composition done, I went to go do, you know,

in-body scan. and I was working with a great training team here in Los Angeles called Ultimate Performance, and they did caliber testing. And I was very surprised that even somebody who was quite thin, as I am, you know, this was about a year and a half ago, I was very surprised to see, yes, I did come back from, I just came back from a trip to Italy where I was drinking a lot of wine and eating a lot of pizza and other stuff and celebrating my 40th. But I came back and I was surprised to see that my body composition, I was 20.

26% body fat. And I thought, wow, you know, based on the literature that's out there, and this is well established in the medical literature, you know, a healthy male by age, you know, we want to be, you know, sub 15% body fat for a healthy male, right? Women, and ideally, the ideal situation would be somewhere around probably like 12, 13, 14%, you know, depending on, you know, a few different variables. And that was really a wake-up call. And it wasn't that I was, uh, you know, fat, it was that I was under muscled. Yes. And what I'm getting to hear is that what I saw is that when I started prioritizing adding,

which for me is a big deal over a period of that year, almost a year of working out with this training group and every two weeks measuring my body composition, I was able to slow and steady by prioritizing protein and working out is, you know, you can't just eat more protein and develop more muscle. It's got to be the working out if you're trying to add lean muscle. muscle mass. Yes. Eating protein that I've understood from Dr. Donald Lehman, one of the top researchers in

this space and a mentor of Dr. Gabriel Lyon is that if you're trying to add lean muscle, 75% is the working out and resistance training and strain training. And then 25% is the protein. Yes, for people who are older who are not doing a lot of strain training, it is important to make sure you don't under eat on protein because at least the protein you eat will help you maintain the muscle mass that you have. Most definitely. So I was trying to add lean muscle mass and over a period of about eight, nine months,

I added almost about nine, ten pounds of lean muscle mass. And what I saw and I was measuring my blood work all through this process, I didn't have my visceral fat MRI. I'm going for my first one soon, which is going to be very exciting. And I'm going to have either you or Sean or both of you back on the podcast and I'm going to share my results. see that with the audience. But what I did measure is I measured my metabolic health. Yep.

Right? Through getting all my blood work done through a company called Lifeforce, which I'm a huge fan of. And I saw that even though I was eating a little bit more what would be considered processed carbohydrates in the form of, let's say, white rice, occasionally having some steel-cut oats, especially before a workout because I saw it improve my performance. I actually saw that my entire metabolic health simply by adding muscle improved. So I'm eating more carbohydrates, right? I'm eating more refined carbohydrates, right? As part of my diet, measuring everything, right?

Making sure that I'm not, you know, eating too many calories as a whole, right? Because they wanted me to drop fat and add muscle the same time. And why I'm bringing this up is that I do think it's important to talk about the working out piece and that adding to lean muscle mass. because sometimes it's easy for somebody to listen to a podcast and think, oh, I just got to go whole foods and cut out all the refined carbohydrates that are there. And they will see improvements. But the only challenge that I have with that is that that's a very difficult thing if you're going to say I'm never going to eat a little bit of rice. I'm never going to eat some whole grain pasta here and there, right? Especially if you want to live your life, you know, the occasional slice of pizza.

Right. Yeah. Right. So I saw in myself, again, not having access to my visceral fat, but I would imagine, you know, just by tracking my metabolic health, that my visceral fat, because my body composition went from 12.6 to at its, you know, most optimal was about 12, 26 dropped down to 12.5 body fat percentage. I would imagine that my visceral fat would have greatly reduced. Yes.

Right? Just knowing that I added muscle. And I was working out more. there. So I do think there can be some flexibility that we can share. And this is what Sean and I were talking about. And I think you largely agree. Yes. But I'm just highlighting my own N of one situation for the audience that improving my muscle mass, my fasting insulin went from like covering around four to dropping to like, you know, three, even though I was eating more carbohydrates inside of my diet simply because I added more muscle that was there. So these are all part of the story in the

equation in addition to the other things that you were sharing, lowering your stress levels, getting better sleep that's there, and, you know, and all the dietary recommendations. Yes. So I would say, first of all, congratulations. Thank you. I'm still working on it. As you said, it's not a destination. You're going to be working forever.

Yeah. We're all working on it. But I feel stronger. It's a journey. Right? I feel stronger. I'm still very skinny. And that, yeah.

But I'm adding lean muscle mass. As I go along, I'm getting, I'm getting stronger in the gym. And look at you. smile from one year to the other because you're proud of yourself right I'm proud in any age and obviously I'm you know I'm young at even 41 and even people who are 51 or 61 or 71 you can do this at any age that's there but when you make progress you feel excited yes and that's what I said earlier like you are fulfilling or giving yourself what you need by being human you are seeing what you need, you are hearing your body talking to you, you are honoring, valuing,

respecting you in your body. So you are proud of yourself because you are getting your back. You are committed to you. You are consistent to improving. Yeah, it's amazing. You are, you know, irradiating this glow because you are getting your back. You are doing that for you. No, I appreciate that. Yeah, but one thing that I wanted to say about muscle, and visceral fat is 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 feelings. visceral fat and I'm rising 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 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, coat on coat, 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. You had mentioned a meeting 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. Yes. 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.

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 to others, not to himself. He took care of everybody else and kind of forgot about himself.

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 sea 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 in 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 walk more than 10,000 steps daily. And 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. I met Sean 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'm also a friend. And I have seen noticeable improvement for me. I had dealt with asthma and rosacea and brain fog because I had to take my uterus and over-resout, 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 like daily improvement from everybody. It's, 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 have doubt 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 in, 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 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, I'm not saying that you shouldn't go to your doctor or you shouldn't take your medication if needed, but I'm saying

that reversing visceral fat helps with controlling and reversing and getting better with this 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 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 the XS 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. like I said, I didn't act on anything. Right, you weren't implementing a lot of the strategies that were there. Yeah, but then I... The world was upside down.

Yes. Yes. There's a lot of things that are going on. Yes. But after 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 strategy, 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 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 of, um, um, um, you know, um, Fast thinking and things coming better and easier, flowing better, work. 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. You know, there's this old quote, I don't know who it's attributed to. Maybe we'll look at it up 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, if 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%. 65% 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. And I tell myself, good job, Anna. You did your best today. And I like really what Sean says, your body is your major asset. And I took myself because I am kind of a spiritual, mystic Brazilian, you call the name that you would like.

But I say, my body is my only real asset because my body is the only thing that's going to be with me my whole life. And nothing else that I have I'm going to bring with me whenever I release this body and become so. only so, right? So I tell myself, I'm doing that daily, choosing my heart because what I don't choose, what I don't change, I choose, right? So I choose my heart because I'm choosing the comfort level that I want from whenever I'm older. And doing what is difficult, now it's going to make it easier than. And like you said, a journey one day at a time, it's not really about a target because there is no target for me. The target is when I'm dying and I'm going home also. So up to the day I die and I'm going home also, I'm going to do my best to be the best

version of me. And the best version of me is the one that like Sean says, I will have a better appearance, but I will be having a better performance in my body, functional, being able to take care of myself. You know, I saw, I read, I heard someone saying in a podcast, when you are not taking care of your health, you are being selfish because you're stealing from your older soul, older version. Your future self. Your future self. Yeah. You're stealing from your future self, the chances of living better. And you are also still. stealing from your loved ones the chances of having a better you. Yeah.

Right? It's so true. Yeah. It's so true. You know, these are the motivations. And I love what you said earlier, which is it's all hard. And you have to choose your heart. You know, being sick is so hard.

Being sick is so hard. And anybody who's been a caretaker. It's definitely harder than doing strength training, right? It's definitely. Well, I've never been. I'm sorry. I've never. No, no, no.

Please cut me off. Anytime you want, please, cut me off. I've never been, you know, knock on wood. I've never been, you know, extremely sick, minus like, you know, having like a cold or flu or whatever, maybe being younger. But I can imagine and from having been a caretaker of my grandparents, specifically my grandfather, who had dementia and developed a very bad cancer, you know, being sick in the viewing of it, is so hard. You know, it's so tough to be in that situation. And, you know, it's just an important reminder for a lot of people that, you know,

only less than 5% of all diseases are, like, heavily genetic. Yes. Right? Even the World Health Organization admits this. 95% of all diseases are influenced by our lifestyle. Environment. Including our stress, our environment, the toxins were exposed to, you know, our dietary, the diet that we're eating or the diet that we're not eating.

So choosing your heart and stepping into something to prioritize it. And the best way to do that is by having more knowledge. When you have more knowledge and you know what's possible and you know what to look for, then you can start heading in the right direction, which is why we're doing this podcast all on the topic of visceral fat, because it's one of those things that is just not getting enough attention. While we have some more time here, you still have some fantastic images that are worthwhile, to touch on. I'd love to turn it back over to you. We kind of ended off where we were chatting

about slide 25 talking about how these images, MRI scans of four different people, are all considered normal, quote, unquote, by a radiologist and a doctor who's translating that information to the patient because there's no glaring thing that's wrong like a tumor or something else that's there. There's no cancer that's in the body. But there are plenty of of examples of some people here, like the lower left-hand corner, as you mentioned, is a very healthy individual because they have low visceral fat and they have a lot of muscle and bulk, as you've shared earlier. And in the upper left-hand corner, in the upper right-hand corner, you have a lot of marbling

and a higher percentage of visceral fat that's inside the body. So that's where we left off. What other images do you want to share here to drive home the message of visceral fat? So, first of all, I'm going to start showing some MRIs. But first of all, before I know that some people are thinking, I can't get this MRIs with my insurance and they are so expensive. So I want to bring some insight here. Please.

Health is your major wealth, right? If you don't spend money with your health, you're going to spend money with hospital bills. with nursing homes, with medications, with surgeries. And if you lose your health, you're going to be regretting that forever. You're going to be trying to recover it. And it's way easier to prevent than recover, right? So I would invite you to see your health as an investment and not as an expense. So if you go online, you can research for clinics that you could go and you would pay out of

pocket and you might be able to find MRIs of the upper abdomen without intravenous contrast for around $500 to $600 to $700 to $700. I've heard that from clients that from Sean and other people I know that they have researched and they found clinics that would charge them like $500 for an MRI. And I would ask you, what is really $500? If you don't have this money, save it slowly. But like, what would be really $500 if you are able to prevent from buying medications for everything, you know, or if you are.

$500 well spent. Exactly. If you are able to prevent your brain to lose the cognition and suddenly you don't even know who you are anymore, right? Can I ask a question about that? So, okay, so you research up maybe like an imaging center. You know, they're all over. Yes.

Right? And you're looking specifically for a place that would do an MRI. Upper abdomen, upper abdomen, without intravenous contrast. Without intravenous contrast, right? And then typically the output, so first of all, does a doctor have to order it if you're paying cash? No. Okay.

So you can still, as a consumer, order it. From what I've heard, you can just show up and say that you want to have an MRI, from what I heard from the clients and patients that I know. you show up and say that you want to have an MRI abdomen without intravenous contrast. Same as you kind of would do for pre-newval, for cancer screening. You don't have an order, but you go there and you pay out of pocket, right? Right, right. So then the second question I have is that once the imaging is done,

and then that imaging is typically still often put on a CD or sent via like some sort of telehealth website where you can download it, is it presented in a way where obviously you can load? look visually and try to get a little bit better at sort of seeing how much of that white, you know, visceral fat you have. But I've seen in some of the imaging that you have here, there actually is a readout. If you go to slide number six on your presentation, inside of there, you have an actual measurement that's been listed that says total body fat and then it says it in liters and it

says total visceral fat, and it says it in liters. Is that common to get a reading of how much total visceral fat you have in that area? No, and that's exactly why I'm inviting the radiologists who are listening to this podcast to start describing visceral fat in your reports, because we haven't learned about this, and these images are from a paper that was published in the nutritional review. So this is just, they measured the visceral fat in these images just to show that the BMI was not a good like reference value, you know. So it was part of a study. So they're being very specific about it. It's part of the paper. Yes. But most people, like if I go in order today, I'm not really going to get visceral fat in a way that's quantified. No, you are not. Right. So you're not even going to have a

report right now that would say that you have mild or moderate or high. visceral fat. So can I ask an honest question? Yes. For a lot of people who, and I consider myself to be a professional amateur, and by that I mean, I have no degree in anything medicine related at all, no formal education. I always tell my podcast listeners, I'm just a lay person who likes to ask questions. You are just an amazing person. But I don't have any training. And even for me who really studies and tries to prep and looks through these presentations, I can see the difference between very literal visceral fat and a lot, but it's that in between that I might have a little bit of a hard time sort of noticing because I'm not trained, right? I don't have that background.

So is it still worthwhile for the people that are listening today to go and order imaging on their own, right? What are your thoughts about that? I would say that, it would be worthwhile. I'm trying, I'm going to try to show some images. I'm going to work on showing some images here and hopefully whoever is looking at their own images will be able to see, oh yes, I have a good amount of visceral fat, right? Because technically you would want to be like the left side, right side of the image, like there is barely visceral fat. You see all the gray from the organs. You see the gray from the muscles. And then you see, see the white from the subcutaneous fat here, and then you barely see visceral fat.

If you are, like the images on the left, where you have the top image, you have lots of visceral fat, which is the white within the abdomen, and the lower, and you also can see the shape of the abdomen. It's more kind of a protuberant abdomen, like the belly button is standing up, out, up and out. While you look at the lower image is already. one of the patients who did these strategies and got better. So you can see that the visceral fat decreased, but there is still a good amount of visceral fat. And you can see that the abdominal shape is more kind of oval

and not really like protuberant. So on the left hand side, you have sort of a before is the top image, top left, and you kind of had a little bit of an after. Somebody who's implemented some of these strategies we talked about, you know, getting some resistance training, maybe some sprinting, slowly working your way up to sprinting. And working on the processed food removal.

So you see an improvement. And then what is the one on the right side, which is where is our goal? Is it the same person? No, it's not. Okay. So it's just a contrast. Yes, it's just a contrast to see what a normal person, what a healthier person would want to look like with lots of gray inside your belly and no, no, barely no white,

because barely no visceral fat. And then the left side shows the people who have a good amount of visceral fat, moderate to high, and you would like to implement the strategies in yourself if you have this amount of visceral fat. So I would say it would still be worth. It would still be good to have the MRI, to have a baseline, and to make sure that you are thin inside or in fat inside if you believe that you are health. because maybe you are believing that you are healthy and you are thin outside and fat inside.

And that's going to be a wake up call for you. The same that was the wake up call that you have with your bi-impedance study. And you're going to say, oh, there is improvement. There is room for improvement that I can decrease this visceral fat and decrease the inflammation in my body. That's great. A lot of people in our audience, they might be working with an integrative doctor or a functional doctor. Not all of them, but there is an awareness of visceral fat. And often if you would ask one of those doctors, they would probably have a friend, even if they're not used to imaging.

And maybe somebody that could hop on the phone with you and kind of review a little bit of a scan that's there. I in particular, one of my trainers at the last gym that I was working out with, because he was going through and getting his master's program. And he just had done a lot of reading on his own. He would talk to me a lot about visceral fat. And I would imagine I never had an MRI scan to be able to show him. I have other people in my world that I can go to, like yourself and Sean, my brain. brother-in-law Neil, who's a cardiologist, who knows a lot about this, even though he's not a trained radiologist. But he would often show me images that were there and say, like, this is

an example of somebody who's healthier, this is somebody who's not. So maybe with a little bit of digging, you might be able to find somebody if you need some assistance. Yes. And you have now a baseline. Then you could continue to clean up your diet, lower your stress, improve your sleep, implement resistance training, cut down on alcohol, which is another big one that's there when it comes to visceral fat, or at least that was the understanding from our episode with Dr. Sean Amara. And now you can measure your progress over a period of time. Yes.

And again, Sean, Sean O'Mara, he has so many videos on YouTube and his website and Instagram, like, research him and you're going to learn to look at your visceral fat and you're going to learn the strategies. And if you would like, even if you would like his opinion, you could schedule a consultation for just like an initial, if you don't want to be a formal client, you could schedule an initial consultation just to discuss your MRI, right? And outside of the medical system that you work in, because are you at, if I remember correctly, are you at the VA?

I am at the VA healthcare system. You have the VA healthcare system. Do you provide consultations to individuals for, you know, if they get imaging done? Do you provide consultations to individuals to, you know, kind of help them understand? Not yet. Not yet. Not yet. I hope.

Yeah. I hope maybe in the future, but not now. From my understanding is that, you know, obviously you are licensed and a trained radiologist. Yes. You cannot be somebody's doctor if they're not your patient. No, exactly. But you could do a wellness consult and have them sign a disclaimer that says, listen, I understand you're not my doctor. This is for educational purposes only.

I'm only showing you this to get sort of an. opinion on education of what I should be paying attention to or questions I can ask my doctor. I can imagine there's so many people that are listening today's podcast that would love to do that service and would be willing to pay you, especially because they're not going to get that information and advice from, you know, their local imaging center. So maybe one day I'm hearing that you might want to do that. For now, I would contact Sean. I would contact Sean. Okay. And he would be able to help you all. Yes. And I would love to be of service to help people in any way, because I do believe that we heal together, right? We walk together. Yeah, in a way,

it's almost no different than this podcast. You know, you're not people's doctors. Yes. Yes. We're not giving medical advice. We're just educating individuals. Exactly. Showing the images. I'm not teaching anyone to become a radiologist, but I'm teaching, I'm trying to show to you how you could see your own visceral fat. And then from there, with the MRI scan done, you could look for the best fit for you, right? The best provider. And that's why I'm inviting the doctors and the providers out there to search for Sean. You know, if they go to your podcast and they listen to the three-hour podcast you had with him. And if they go to the Genius Life podcast and listen to the two-hours podcast he had with Max Lugavir. Yeah. If you take five hours one morning, you're going to be way ahead

knowledge that you could help your patients and mainly you could help yourself because I do believe that doctors are so burnt out, so overwhelmed. There is a huge rate of suicide between doctors because of being workaholics and being sedentary, not having time, not having energy, not having life within their souls anymore. So the strategies from Sean would definitely bring you back to life and you would be fulfilling your oath of do no harm and help your patients better as well, right? But anyway. No, I agree with you.

100%. Amen. As they say, amen. While we have a few more minutes here and we're winding down to the latter part of the podcast, I believe we have about 15 minutes or so, 15, 20 minutes. I know. I would love for you to share anything you want to share and I promise not to talk. Oh, dear.

I love you talking. I love talking to you. You are amazing. You have this amazing energy. I feel the same way about you. You have this amazing energy. Anyway, so here we are. MRI, T2 sequence, axial. Axio means I'm cutting from up to down, transverse slices in your body. And here we are at the level of the lower chest. So you can see the heart. You can see the lungs, black here. And you can see all this white, all the white from the subcutaneous fat. all the white from the ectopic fat that is surrounding your heart. So pericardial fat surrounding your heart and suffocating your heart, suffocating your life, metabolic active, metabolic unhealthy. All this inflameaging.

You don't want, you just want aging. You don't want inflammation, right? And you can see the muscle here, all these white streaks in your muscles, in these muscles. so the marbling and the sarcopinia and the loss of musculature that you need to live your life. So this is an axial image. Again, we are cutting transverse from your head to your toe. And this is slide 13. You have a coronal image.

Also T2 sequence. So the coronal is almost as I'm looking to you and you are standing up in front of me. I'm cutting from anteriorly to posteriorly. And as you can see on slide 12, you see all this fat here anteriorly to the heart. On slide 13, we just had the cut exactly at the level of that fat, and you can see all this fat here in your chest. All this fat is ectopic fat. It's not supposed to be here.

Then you go to the lower level at the level of almost at the level of your umbilical button, and you can see all this visceral fat, all the white here, the ocean of white surrounding your bowel loops, all this is fat. You're not supposed to have this there. But the benefit of having a radiologist is that the radiologist is going to tell you that you have these ticks coming out from your bowel loop, and this is colonic diverticulosis. So you also want to attack your visceral fat because decreasing inflammation, you're going to decrease the possibility of having bowels of acute diverticulosis. colitis, which is inflammation in your bowel. I don't know there was that connection that was there. That's fascinating. The inflammation, the inflammation, right? And then here another slice, slide 16, and you can see

all this white is visceral fat surrounding your organs. So again, beneath the skin, the outer layer is your skin. And then beneath the skin, you have the subcutaneous fat, which is white because it's fat. And then you have the musculature, your six-pack ab that here does this person doesn't even have barely has musculature in his abdominal wall anymore and then you come within the abdominal cavity all this white is visceral fat that you do not want and here again the benefit of having a radiologist is have this vessel here is the aorta the aorta is the major artery of your body and it pumps blood through your whole body to all the organs in your body, and this is dilated, and it's greater than three centimeters.

When it's greater than three centimeters, we say that there is abdominal aorta aneurysmal dilation. So that's important because it's something that you need to follow up, right? It's an aneurysm of the aorta. And here is what I told you before on the same slide 16. All this beneath the skin up to the level of the muscles is your subcutaneous fat. So we have the superficial subcutaneous fat, which is beneath the skin up to the level of this line here, and this line is the scarpa fascia.

And this superficial subcutaneous fat is not maleficic. It produces substances that are beneficial for your health, but you don't want to have lots of subcutaneous fat. But then the deep one, which is deep below beneath the fat, scarpus fascia up to the level of the muscle, these are your love handles. And this is the deep subcutaneous fat. And the deep subcutaneous fat is not good for your body, similar to the visceral fat within your abdominal cavity, because both of them secret molecules that are prone to escalate inflammation in your body, right? So you don't want that. So one more slide, just to show the fatty liver. So there is a specific sequence on MRI that evaluates for fat in your liver,

and it's called a T1 sequence in and out of face. So in this upper image on slide 17, you can see that your liver is lighter. And when you do the in out of phase sequence, you can see that your liver became extremely dark. That means you have a high, a significant, a severe amount of fat in your liver. So you have a significant fatty liver that you have to take action in the things you are doing for your life to decrease the visceral fat and to decrease the fatty liver because, again, as you discussed in your later podcast, the fatty liver will evolve to, if not taking action, will evolve to steato hepatitis and will evolve to cirrhosis and will evolve to liver cancer. Another slide that I would like to show you is just to recap.

Slide 35. Slide 35 shows this subcutaneous fat again, white. So fat is white on T2 without fat saturation. So white visceral fat. And you can see that this person has a huge amount of visceral fat. And that's what I want for you to look at. at your study, at your scan, if you get your scan at your house in your computer. You don't need to look at your liver.

You don't need to look at your pancreas. You might not even know what is the liver and what is the pancreas. And that's all right because you're not a radiologist. What I want you to focus in is fat, visceral fat. So how do you see visceral fat? First of all, look at the fat beneath the skin. It's going to be white. So that's fat.

All fat are going to be white. So it doesn't matter if it's subcutaneous or within the muscle or within the abdominal cavity. So if the fat beneath the skin is white, jump inside your belly. And if you have all this white surrounding everything else that is gray and everything that is gray is your organs, if you have all this white, the white is the amount of visceral fat you have within your abdominal cavity. And that's the only thing I'm asking you and I'm trying to show. you today so you're going to be able to look at your own images. What is white within your abdominal cavity? Again, white subcutaneous fat, white visceral fat within your abdominal cavity,

it is visceral fat. And it's inflammatory and it's your silent killer and it's your enemy and you do not want that. You want to burn this visceral fat to be the best version of yourself. And again, like I said, be the light that will light others. It's light 38. If you light your light, you're going to bring light to others because people are going to see you improving. And let's be part of this movement of health optimization. And let's bring, let's be a voice, let's be the voice.

Let's fight for insurance to get health optimizing screening approval. because there are screening for lots of cancers, lung cancer, prostate cancer, colon cancer, breast cancer, skin cancer. There are screening for so many things, imaging scans for so many screenings. So why not step backwards and do the screen to find the visceral fat that is the cause of all the cancers that we are screening, right? A root cause. Yeah, it's one of the root cause.

Yeah, a root cause. Yeah, I wanted to correct me too. Yeah, it might not be the single cause, but it's one of the major root causes of all these diseases. So let's step backwards and let's fight with Congress, with the military, with corporations like Amazon, Google, LinkedIn, whatever. Let's step backwards and fight to get this approved for insurance, a health optimization MRI protocol.

because if we are better, if we are healthier, we are going to increase our productivity, we are going to increase our joy, we are going to increase our satisfaction in life, and we're going to be better of service to everybody. So the last slide is this chest x-ray. I started with a chest-x ray, and I'm finishing with a chest-x-ray.

This is slide number 37. This is slide number 37. And I don't know if you guys are able to see that, but as a radiologist, this hits my face. So this is a chest x-ray with no heart in it. There is no heart. The heart was removed from this image just to be a trick, right? And I want to use it as a treat.

Not a trick or treat, but a treat. I want to remind yourselves, connect to your heart. You have to connect to your cause. It's not about a New Year's resolution. It's about a long-life-term resolution. When you are fighting visceral fat, when you are fighting and working to become a better and healthier, optimized person, you are looking at the long term. It's not a short-term thing.

It's small steps. Every strategy that you are stacking one on top of the other may them be bricks in your journey of becoming healthy and optimized. You are doing that one step at a time. connect with your heart, turn off your brain, turn off your doubts, turn off your excuses, turn off your fears. Connect with your heart. The feeling that I want to be healthy, I want to live healthier, I want to be alive with quality of life. We are on borrowed time.

So let's make the now, the moment we have right now and be our best version. So then we can really enjoy the life we have. we can really be the vessel for our souls and we can really give the gifts that only us, unique us could give to the world. Such a powerful. Thank you so very much. Thank you. Dr. Anna Rosa, this has been fantastic.

And thank you for reminding us that even though this conversation started off with the focus on visceral fat, we're really talking about getting connected to our deep why. Why are we here? What is the purpose of health? The purpose of health is not just to be healthy. It's to have the health so you can give love, attention, and energy to the things that light you up in life. Yes.

And by you coming on this podcast today, sharing your presentation with us that you'd spent so much time to put together, sharing your knowledge with us, opening up and sharing your personal story with us, you have contributed to helping us all light our light so we can pass it on to everybody else. I want to thank you again for flying out here, being a part of the show. It's been incredible. if our audience wants to get a chance to stay in touch with you and follow along on the journey and hear more.

What's the best way to do that? Are you active on all on social media? Yes. I do have a Facebook account, Anna Claudia Rosa. We'll put the link in the show notes. Yes. I do have an LinkedIn account, Anna Rosa. And I do have an Instagram account that, since,

I am not a social media person. I just forgot. But Drew is going to put the link in the show notes as well. Yeah. Well, who knows? Maybe after this. I am a perfect radiologist, I guess. Well, who knows after this, people are going to want to reach out to you and at least say

hi. Of course, Dr. Anna Rosa cannot be your doctor. You know, she can't answer medical questions. But if you want to say hi and how much you love this podcast, I'd encourage you to, you to know, reach out to her and say hello. This has been fantastic. Yes.

My honor. My honor. It's been such a pleasure. I can't wait to have you back on the podcast and hopefully to discuss my own MRI images that I'd love to transparently share with the audience. Dr. Anna Rosa, thank you again for being on the Drew Prod Show. It's a pleasure. Thank you.

Hi, everyone. Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast. is share with a friend, share with a friend who would benefit from listening.

Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about. It's my weekly newsletter, and it's called Try This. Every Friday, yes, every Friday, 52 weeks a year, I send out an easy-to-digest protocol of simple steps that you or anyone you love can follow to optimize your own health. We cover everything from nutrition to mindset to metabolic health, sleep, community, longevity and so much more. If you want to get on this email list, which is by the way free and get my weekly step-by-step protocols for whole body health and optimization, click the

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