HealthyGamerGG - What New Fat Research Actually Says

Episode Date: March 24, 2022

Today Doctor K does a deep dive into fat tissue, blood pressure, hormones, and more, teaching you all about the monolith that is fat and cardiac health. Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

The first thing that we're going to talk about today is fat. And mainly the role of fat within the body. And in order to talk about this, we're going to have to embark on a couple of basic physiologic kind of things. Okay, so we're going to explain a couple of systems and basic physiologic concepts with the body. So the reason that I personally got interested in this is because a lot of times when it comes to helping people, like even when I think that. about my patients. I've been astonished by how much exercise or weight loss can help improve

people's mood and like overall well-being. So we know that the body and mind are like very, very closely connected, right? So there's a mind-body connection. The interesting thing that I'm excited about more recently is that this mind-body connection has been historically sort of like propagated by people like people who are into yoga or Tai Chi or, or meditation. And that's totally fine. There's nothing wrong with any of those things. We're big believers in the value of yoga, Tai Chi meditation, because there's been science about that. And that's what actually gets me pretty excited is that there have been lots of clinical trials now on yoga, for example, to reduce the effects of osteoarthritis or rheumatoid arthritis, Tai Chi and osteoarthritis. So there are a lot of

inflammatory conditions that can get positively affected by these sorts of things, as well as like mental health conditions. So we know that, for example, like doing yoga and meditation and stuff like that can have positive effects on mood and even clinically reduced symptoms of things like generalized anxiety disorder or major depressive disorder. So we know that there's a mind-body connection. So now what I'm super excited about is like as science progresses, what we're sort of discovering is like what is specifically the nature of the mind-body connection. So what is happening in our body and what are like the chemical compounds, hormones, paracrine, autocrine factors. So those are different things in the hormonal

system, which we'll explain in a second, that sort of relate to an effect, our mind and other parts of our physiology. And one of the biggest discoveries over the last, I want to say decade, but maybe even closer to 15 years, because remember, all science moves slow, right? So this hasn't really, even in a sense hit the mainstream yet, even though there's been like 10 or 15 years of research on it, is that fat is not energy storage. So there's been a perception that we have these things called adipocytes and that adipocytes are our fat storage cells. And we've sort of believed that basically as you eat, for example, more carbohydrates, so carbohydrates really stimulate adipocytes. And as our fat cells, as we make more fat cells and as our fat cells grow

and fill up with fat, we've sort of assumed physiologically that, like, that's what they are. It's just like your fat is just kind of sitting there, right? So your belly fat, other parts of your fat are just like they're just storage. And so as we exercise more, as we eat healthier, as we start to enter a negative caloric state, that like we start to burn more calories than we use. And so that's, then we get rid of the fat. So it's just storage. It's kind of we're filling up our vaults with fat and energy, and as we stop making deposits and start making withdrawals, we like burn out that fat. But the really interesting thing recently is that adipocytes are actually very endocrinologically active. And what does that mean? So in terms of our body, we have something

called the endocrine system. So the endocrine system is the system of hormones, generally speaking. and what is a hormone? So a hormone is a chemical compound that travels through the bloodstream and affects distant organs, right? So if we think about our adrenal glands, which are sort of situated like right here, like kind of in the back,

they sit above our kidneys, our adrenalins will secrete adrenaline, right? So if we get like some kind of, let's say we're driving down the street and someone like swerves in front of us, we'll get a burst of adrenaline. So that's a chemical compound that's released from here, travels through our bloodstream

and starts to have all kinds of different effects. So I think of hormones is essentially like body-wide signals. It's almost like stances in like gaming. So there's like tank stance, there's DPS stance, there's going into stealth. So it's sort of like a kind of a body-wide, like let's get all of our organ systems in line. Let's get our skeletal muscle, our heart rate, our digestive system, our brain, all kind of

focused in the same direction. So a good example of this is that adrenaline will increase our heart rate, will increase our blood pressure, will reduce blood flow to our digestive system. Because when adrenaline is active, we don't need to be metabolizing nutrients. Like, we're not worried about, like, digesting things and, you know, storing things away for later. We're worried about survival. So it'll constrict blood vessels to our stomach and our intestines and our colon, and it'll dilate blood vessels to our skeletal muscles, to our arms and legs. So what we're basically doing is rerouting blood flow from our GI system to our muscles. Other examples of adrenaline, they also affect your brain. So when adrenaline is in the brain, we start to make, we start to see the world as more black and white, and we start to see, like, more danger in things.

and we tend to start to make like very, very, like, rapid decisions, right? Because when we're, if we're being attacked by a tiger, for example, like, we don't want to sit there and, like, think philosophically about whether, you know, whether the tiger is friendly or hungry or what. Like, we need to act. So hormones act bodywide. So the interesting thing here is that they're, like, we understand a lot of, you know, hormonal actions and stuff.

There's thyroid hormone, adrenaline, insulin, glucagon, all that kind of good stuff. We understand how these things work. But one of the most interesting recent discoveries, and once again, recent is like 10 to 15 years, is that adipocytes are endocrinologically active. And so what that means is they secrete all kinds of stuff that has different kinds of effects on different parts of our body. So rather than being like inert, what this sort of means is that a lot of what people may experience if they are overweight or they do have central adiposity. So there's even data that shows that central adiposity is worse than peripheral adiposity. And what does this mean? So basically, like, when the majority

of your fat, or if you have more fat that's around your belly, that tissue seems to act differently, not all adipocytes are the same than fat that, let's say, is around your thighs or your arms or your back or whatever. So it's kind of interesting because not all adipocytes, because remember that fat is sort of distributed throughout your body, like, well, have sort of belly fat, we'll have visceral fat, which is the fat that surrounds our organs, we'll have peripheral fat, we'll have some fat like around our thighs and things like that. And it seems that central adiposity is like worse for health outcomes than peripheral adiposity. So I'm a little bit rusty on this stuff, but for example, I think central adiposity has

worse cardiovascular outcomes. So if you have this, you know, two people with the same grams of fat on their body. The person who has all of their fat sort of located around their belly region is more likely to have worse cardiovascular outcomes, which includes things like heart attacks, than people who have fat that's like evenly distributed through their body. And so that sort of suggests that not all adipocytes are the same, which in turn sort of, and as people started to explore that, what they sort of discovered is that adipocytes are endocrinologically active. So let's take a quick look at some of the measures of what fat actually. does. Okay, so I'm going to go to a quick review article, but this is white fat. So if we look,

let me see if there's a better diagram here. Yeah, here we go. This is going to be easier to understand. So this is, if we look at white fat, so what people have sort of discovered is that there are all kinds of effects from white fat. So we're going to kind of zero in on a couple. So the first that we're going to talk about is appetite regulation and nutritional intake. So what this sort of means is that the amount of fat you have will actually affect things like how hungry you feel. Okay? The second thing that we're going to talk a little bit about is insulin. So glucose and lipid metabolism, this is really, really important. So for example, like diabetes, so one of the things that has been shown to clinically improve diabetes and insulin resistance and healthier

blood sugar metabolism is actually losing weight. So this is another example of something that's kind of like not really a clinical treatment, right? So exercise is not a clinical treatment. Like, it's not a medicine that's prescribed. But as part of something that you can do to clinically improve a illness. So glucose and lipid metabolism are affected, body weight homeostasis is affected by the amount of fat you have. But there's also all kinds of stuff that we didn't sort of realize. One is vascular tone control. This means blood pressure. It affects our coagulation cascade and fibrinolosis. So what this sort of means is like clotting. So the risk factors of stroke or developing a deep vein thrombosis, having things like a pulmonary embolism,

like these are all things where coagulation sort of affects our ability to, for example, coagulate if we get a cut. But it also does things like if we're too coagulant, what that means is that we can develop a blockage within our blood vessels. And a stroke is essentially like, let me just explain this. so why is coagulation important? So if you're in a pro-coagulatory state, I've got a blood vessel that's going to my brain.

And if my coagulation proteins are all messed up, what they're going to do is they're going to coagulate and they're going to stop blood flow. And then once I stop blood flow, what this means is that like the brain over here is like not receiving blood, and then I end up with something called an ischemic stroke. Okay?

So remember that coagulation proteins are there to stop blood flow. So if I get a cut on my arm, it starts to bleed and then my coagulation proteins like show up and then they'll like block the cut and then they'll you know then you'll scab over and then you get that little like blood scab right which is hard and is blood and it's not really skin you can pick it off and it'll start bleeding again so that's the coagulation process the really interesting thing here is that it seems like coagulation balance is actually affected by like the amount of fat that you have other really important things are just in general immunity, angiogenesis reproduction.

So what this sort of means is that, for example, we also know that sometimes if people have difficulty getting pregnant, that affecting their body weight can actually like increase their chances of pregnancy. And there are even some medications that you can take if you are overweight and trying to get pregnant that will help you sort of get pregnant. And some of those medications will do things like affect glucose and lipid metabolism, are also used. as treatments for diabetes. So the key thing here is that fat affects like all kinds of different things in your body. And the reason that I think this is important for like our community is because I've sort of seen this as a mental health professional where like sometimes fixing a

clinical issue or improving a clinical issue can involve like non-clinical things. So there are, you know, all kinds of patients that I've worked with who will start exercising, for example. And what we see is that their experience of a depressive episode gets substantially better. And so we know some of these mechanisms pretty well. So for example, like we know that sunlight has a protective mechanism against depression. And part of the reason for that is because vitamin D deficiency is a risk factor for major depressive disorder. So when I see a patient, oftentimes what I'll do is I'll order a vitamin D test. And if their level is low, then what we'll do is supplement vitamin D test. Then what will do is supplement vitamin D or I'll tell them to get into the sun more. And it's really

interesting because it seems to help. There's data that shows that vitamin D supplementation can actually improve clinical depression. So the point about fat is that like this is the kind of thing where if you start exercising and you reduce the amount of white fat that you have, that you may have benefits in all kinds of different parts of your life that you're not really aware of, right? it could help you potentially get pregnant. It could help you with appetite regulation. It could help you with autoimmune diseases. So we're not really sure. There's like different clinical trials depending on what you're talking to. And that's why you should absolutely like, if you're concerned about this and you do have a medical condition, bring it up with your doctor and sort of get their

guidance. So let's dive into what some of these things are and why I think they're important. Okay. So the first thing is nutritional intake. There are two things that we're going to talk about. two things that, two hormones or chemical signals that adipocytes produce. The first is leptin. So this gives us a sense of satiety. So we tend to have two hormones that will make us feel hungry or make us feel full. The really interesting thing is that generally speaking, leptin is what makes us feel full and ghrelin is what makes us feel hungry. But it appears that something happens when you have sort of dysregulated adipotis. metabolism that causes leptin to be released and can sometimes have paradoxical effects. So something about the amount of fat that you have, and we'll kind of get into other mechanisms,

seems to affect how hungry you feel. And if the body was simple, it would be as simple as, oh, leptin makes you feel full. Fat produces leptin, therefore fat should make you feel full. But the body's complicated, right? We have dozens and dozens or hundreds of signals, having different effects on different organs. And what we sort of find is that leptin metabolism seems to be messed up and can actually, like, affect people's sense of satiety and how hungry they feel. What precise effect does it have? We actually don't know because it's complicated and we haven't entirely figured it out yet.

The second hormone I want to talk about is angiotensin. So angiotensin also affects essentially, like our salt intake. So it's a hormone that will really, really affect how much you crave salt. NGiotensin is also very important for blood pressure because our blood pressure is maintained heavily by the sodium concentration of our blood. And so, for example, if someone has high blood pressure, we'll give them a medication, or we can give them a medication called an ARB, which is an angiotensin receptor blocker. So what happens is when you block the action of angiotensin, it reduces your blood pressure.

So the other thing here that's important is that it affects salt intake, right? And also, like, we know that, for example, reducing weight can have beneficial effects on blood pressure. Blood pressure, having high blood pressure is one of the slowest and most dangerous diseases you can have. Part of the reason it's so dangerous is because you'll never feel it. So our body is very, very good at if we have a blood pressure of 120 over 80, we'll feel potentially exactly the same as if we're 160 over 100.

The problem is if you sit at 160 over 100 for many, many, many years, it can do a lot of damage to your different organs, like kidneys, brain, etc. And since our body is so good at adapting to blood pressure, you won't sort of feel it. So one of the trickiest things about being a doctor is getting like, patients to take their blood pressure medication, because if they skip five days, they don't feel a difference. But if they do take it, they'll sort of experience potentially side effects. So sometimes it can be really hard for patients to, like, take blood pressure medication, because you don't see a benefit, right? It's not like taking like an anti-inflammatory or

antipyretic medication, like ibuprofen or acetaminopin when you have a fever. It's like you feel instantly better. It's not like taking antinausea medication. It's like you, you know, you don't feel it. Key thing here is that it seems like fat cells will actually secrete leptin and angiotensin. So what we're sort of discovering is that like fat cells will are endocrinologically active and will affect like blood pressure and your kidneys. So the next thing that we're going to talk a little bit about is insulin sensitivity. So just to give you all a little bit of background, when we have blood, when we eat a candy bar and we have glucose in our blood, bloodstream. This travels to our pancreas. Our pancreas detects it and secretes insulin,

specifically from the beta cells of the pancreas. Insulin then goes to different cells and tells them, hey, we've got a bunch of sugar in our blood. Take that sugar in and stick it in your cell. and so then that ends up reducing the concentration of sugar in our blood. So this is basically how our body signals. Insulin is the signal to our body that we just ate a meal. So what happens when we eat a meal, we digest it in our stomach, we absorb it in our intestines. It gets absorbed into our bloodstream. Insulin gets triggered and then all of that nutrients, all of those nutrients will get absorbed by our cells.

So they get taken up by our brain, they get taken up by liver, they get taken up by liver, they get taken up by skeletal muscle and they get taken up by adipocytes. So one of the things that we've sort of discovered is that adipocytes lead to insulin resistance. And what does that mean? What does that do? So this sort of makes sense physiologically, right? If you want to think about this from a bird's eye view, remember everything that we're talking about is somewhat of an oversimplification. But the more fat storage you have, the less likely to make fat, because this is what happens over here, you need to be. So our body has something called a weight set point. So a set point for how much we want to weigh, and it's kind of tightly regulated around that set point. And so this is the kind of thing

where, like, if we have a bunch of fat, like it's sort of telling our body, hey, we don't need to store more fat. That's sort of like the general, like, physiologic logic behind it. Physiologic logic. You guys like that? So the tricky thing here is that even though adipocytes cause insulin resistance, like, isn't that a good thing? Well, not really, because when we have a bunch of blood sugar floating around in our bloodstream and it doesn't get absorbed, this is how we end up with diabetes. And the reason that diabetes is bad is because it turns out that having high concentrations of blood sugar in your bloodstream is damaging to your cells. So, for example, when we have high blood sugar, for prolonged periods of time, we're talking like years or decades.

right, for like 10 years, what that does is cause peripheral nerve damage, for example, worsens cardiovascular outcomes. Okay? So what this sort of means is that our bloodstream is not designed to have a bunch of blood sugar there. And so like, it's supposed to, like,

blood sugar is supposed to be, like, relatively transient and or keeps at a certain level. So it's tightly regulated. If it's way higher than that, it starts to cause, like, damage to, to ourselves, you can sort of think of it like a sewer pipe that gets clogged with stuff, right? Like the sewer pipe is supposed to be like free flowing. And it's supposed to transport stuff, right? Like, we want it to be like moving particular things and move from point A to point B. But we don't

want to like clog up our sewer pipe, even with the stuff that it's supposed to carry. And that can lead to bad outcomes. So the other thing about adipocytes is that they tend to lead to insulin resistance, worsen our blood sugar, and can contribute to things like diabetes. These functions are basically like people sort of get, right? We know that fat has something to do with nutritional intake, insulin sensitivity, metabolism, et cetera. So this is what gets to be really, really interesting, inflammatory markers. So fat appears to be a pro-influ-I shouldn't say pro, high levels of fat can lead to a pro-inflammatory state. So there are two markers we're going to talk about TNF Alpha and Interleukin 6. So TNF Alpha and Interleukin 6 are two cytokines. So these are like

immunological signals. So in our bloodstream, we have like white blood cells. Okay. We also have things like macrophages, which eat other cells. I mean, they eat things like bacteria. And they're flowing around in our bloodstream. When we have high levels of TNF alpha and interleukin 6, both of these guys go into high alert. So they're like, oh, this means that there's like, let's attack something. It's like go time. And what happens when we enter a high inflammatory state, which can be healthy, right? There's a reason why we create inflammation. Inflammation can be part of the process of healing. It can also be part of the process that we use to fight an infection. So when you get, like, let's say I get a cut that gets infected, it gets warm and inflamed and hurts. And why is that?

it's because there's vasodilation, so our capillaries are kind of like leaking stuff. And what they're leaking is like white blood cells. So they're leaking like immune system stuff. And then all of our white blood cells are going to the site of battle in conducting a war against the bacteria that are that are building there. So that inflammation can be a healthy part of our body. The challenge is that when we have a bunch of adipocytes that are kind of like not regulated properly, they can increase the level of TNF alpha in interleukis. and six, and this in turn will lead to pro-inflammatory states.

And the problem with pro-inflammatory states is that a lot of the problems that we face medically are like diseases of inflammation. So there are even inflammatory hypotheses for clinical depression. Those seem to be like not great, to be honest. So people have even done clinical trials where can you treat a depressive episode with anti-inflammatory agents? And the answer is like, it doesn't seem like there's great. evidence for that, but we do know that there's low levels of inflammation in the brain when

people are clinically depressed. So, you know, question mark for clinical depression. But then there are all kinds of other diseases that people suffer from, right? So like arthritis, eczema, IBS, which is inflammatory bowel syndrome, all sorts of autoimmune diseases. So like things like lupus, right? So if you all watch house, like the lupus is always, always on the differential. So there are all kinds of conditions like psoriasis is another one. So like skin conditions, like different kinds of inflammation, like gastric inflammation, gastritis, like all this stuff gets worse by like, you know, all these pro-inflammatory cytokines. And remember that like the pro-inflammatory cytokines aren't by themselves bad, right? It's just that our body wants

them to be active at a particular time and wants them to be like not active at other times. A couple of other things to remember is that I think TNF Alpha and IL-6 are the strongest predictors in terms of cytokines, that is, of COVID mortality. Right. So this is just like a simple example of how we've looked at, okay, if people are more likely to die of COVID, what's going on in their immune system. seems like they're dumping high levels of TNF Alpha and IL-6. The other reason that this is important is not just because of autoimmune stuff, but IL-6 has been linked to aging. So this is another example of, like, data that is very preliminary,

so we don't know necessarily that, like, IL-6 makes you older. But if we look at the processes of cellular aging, and we look at the effects of IL-6 on those, processes, what we find is that they tend to accelerate those processes. So there may be some links that having, and there's also some, you know, epidemiological evidence that, for example, like having a low inflammatory state leads to longer lifespan. So this is one of those situations where you have to be really careful about connecting the dots. This does not necessarily mean that having a bunch of adipocytes will mean you age faster, right? So I don't want you all to draw that

conclusion. This is how science works where like what's something like you know, we know this piece, which is that aisle 6 accelerates, you know, certain cellular processes. Let's just call this process A. The other thing that we know is we'll look at aging and what we find is, oh, aging also seems to be mediated by process A. So what this sort of, what some people will want to do is they'll say, oh, that means that IL-6 definitively causes you to get older faster, which I don't think is fair to say.

We haven't really linked those. But it seems that, I mean, we haven't sort of made that conclusion, but it does seem that there's some linkage. Another good example of this is that, you know, we look at cancer, which essentially ages ourselves very rapidly, and IL-6 is sort of correlated

with that rapid aging within cancer. Also, our immune system is all over the place when we have cancer. So this is where, once again, like just to be aware that there's all kinds of effects that adipocytes could be having on your body, including potentially accelerating the aging process, which is actually like kind of scary, right? That's why we're sort of sharing it with you.

Okay? So there are a couple of other things that we've sort of already talked about, but I'll just kind of mention. So PAI1 is a plasminogen activating something. So this is like the clotting stuff, fibrenelysis. So, Fibron is essentially something that can form like a clot. And so what we want to do is break down the clot. You're right? So over time, we don't want to, we don't have a clot forever. So when I get a cut, I want it to clot over.

And then I want to build skin underneath. And then we want to break down essentially like the dam, which is what a fibrin clot is. It's a dam that prevents flow. And then like, then we want to break it down because we want flow to go back there. Right. So on my hand, eventually I want blood flow to be back there. So the key thing here is that. It's just another example of, you know, a chemical signal that's released by adipocytes.

So we'll kind of review those that sort of affects this kind of stuff. So if we look at here's an example of all of the actual compounds. We didn't go into all of them that are released by adipocytes and will sort of affect different organ systems. The last thing is that it does seem to affect steroid metabolism. So like we mentioned already, like even things like libido or the ability to get pregnant may be related to the level of edipocytes you have in your body. So we can see that it affects sex steroids, glucocorticoids, are things like stress hormones.

So glucocorticoids like cortisol is like the primary glucose glucose corticoid. So when we are in a high stress state, it does all kinds of stuff, right? It messes with our mental, it messes with our physical, it can mess with our stomach, effects like muscle development, affects our rest, all of those kinds of things. So glucocorticoids will sometimes activate the reticular activating formation, which is a part of our brain that causes us to sleep lightly. So when we're in a high stress state, we don't get as restful sleep, which is originally designed to be an adaptive mechanism.

Because if we think about the way that we used to experience stress, if I see a tiger footprint, like when I go to bed that night, I want to be a light sleeper because there's a tiger in the neighborhood. our body was not really designed to experience long-term stress. So if we think about the way that monkeys get stressed out, they don't worry about like paying rent at the end of the month, right? So they don't experience 29 days of constant stress about things at the end of the month. As our society has changed, as we worry about things like,

how am I going to pay for this or how am I going to pay rent or will I be alone forever or I didn't get any Tinder matches today, it boosts our stress hormones. And then that sort of like wreaks havoc on all kinds of different. different parts of our body, including our ability to sleep. So we talked, we're not going to go into all of these, but, you know, we talked about IL-6 and TNF Alpha, which are in- October fests, birthday fests, finally, raked vests. Whatever fest they're celebrating this fall, give them gifts that they'll actually want, like drinks, and get them all from Drizzly, an app for alcohol delivery. With Drizley, you can compare prices on bountiful cornucopias of beer, wine, and spirits,

then get them all delivered to their door, or the pile of leaves are sitting in. So download the Drsley app or go to drizzle.com. That's D-R-I-Z-L-Y.com and get gifting today. Flammatory markers, and we talked a little bit about leptin. We talked about NGO-Tensin. These are the clotting factors. So this, once again, is just kind of like a, I thought it was really interesting because, like, it turns out that fat actually has a very profound effect

on all kinds of our different systems. And sometimes it's really, really surprising because when I've worked with patients in the past who will have something like IBS, you know, it's really interesting what kinds of lifestyle changes can have a clinical impact. So this is also where if you all have any of these conditions or you're concerned about this stuff, you should absolutely go talk to your doctor about it, right? Say, you know, hey, I have IBS. Like, are there any recommendations that you have for, like, reducing my body's like inflammatory state? And see what your doctor says. I think it's a very, very good question to ask your doctor. So let me just see if there's anything else in this.

Yeah, so this just kind of goes into more detail. So just to kind of summarize, we're going to talk a little bit more. But it turns out that adipose tissue is not just fat storage, but is actually a complicated endocrine organ. The next thing that I want to talk a little bit about is when people sort of discover this, what they tend to do is talk a lot about different kinds of like herbs. and supplements or food ingredients that will change white fat into brown fat.

So just this is where, let's take a step back. So we have two kinds of fat. We have white fat. And we have brown fat. Okay? And the difference is that white fat we used to think of as storage. And brown fat is used for thermogenesis. So human beings have a very small,

level of brown fat, whereas bears who hibernate in the winter will have high levels of brown fat. And so what happens is like thermogenesis essentially maintains body temperature. So there are a couple of other interesting things. People in northern climates, generally speaking, have higher levels of brown fat. People with high levels of thyroid hormone also have high levels of brown fat, or sorry, not T-S-H-T-4. Very important distinction. okay and this may be meat like this these two could be related right so as it gets colder maybe our thyroid hormone goes up and we stimulate thermogenesis the key thing about brown fat is that it actually burns calories so the more brown fat we have like the more calories we burn at like

basal metabolic level so is without activity so this is like the amount like you know we maintain a temperature of 98.6 how do we maintain that temperature all the time by burning energy right what's the cell that burns energy? It can be brown fat. So what a lot of people will do is as people sort of discover, oh, fat is an endocrine organ. Like, what are all of the things that reduce brown fat? And this is where I think you'll need to be extra careful about like media, because oftentimes what we'll see is like an article that sort of says, oh, there's a new study that found that green tea reduces, like, increases is fat burning, which could be true. But I think as we're going to look at this next paper,

I'm going to invite y'all to be a little bit careful about that kind of stuff, because oftentimes the media articles won't go into the detail of what kind of study was done and like specifically what they found. This is also where if y'all are thinking about starting something like a supplement or whatever, like absolutely go talk to your doctor about it. It's totally fine to, you know, talk to them because there may be more to the issue than you realize. The other thing to remember, there's a lot of detail about this in Dr. Kay's Guide to Mental Health. So we have a video about the safety of using herbal supplements, which I highly, highly recommend y'all check out.

It goes into a lot of detail about how you can get liver toxicity and just how to approach supplements and some of the cautions around like supplements, which tend to be pretty unregulated. It doesn't mean that they can't help. There are a lot of clinical trials, which we'll kind of talk about, that have shown that herbs and supplements and things like that can have positive impacts for health, but you have to be, there are a lot of cautionary things to be concerned about, okay? So what we're going to do is talk, take a look at a couple of different herbs or chemical

compounds, like food compounds, that will sometimes get advertised as converting white fat to brown fat, right? And the reason we're sharing this is because a lot of people like watching this are like, oh, okay, so I need to reduce my amount of white fat. How do I do that? Well, if you, if you do a Google search for reducing white fat, which you may find is like articles, right, from like Healthline or WebMD, about here are five things that you can take that have been shown to reduce white fat or to convert white fat to brown fat. So let's take a look. Okay? So the first thing that we're going to talk about is capsaicin, or capsinoid. So these are essentially like the spicy ingredient from peppers. And capsaicin is a good example of actually like a pretty well-studied

thing, and I'm going to tunnel down into this. So here's one study. So Snitker published a paper in 2009 where oral treatment with capcinoids in overweight or obese subjects was associated with abdominal fat loss and increase in fat oxidation compared with the placebo group. So this was a study that had a sample size of 80 people, but there are a couple of important things about it. So it's double-blind, placebo-controlled, has a sample size of 80, and is in humans. Okay? So this, I think, like, there's decent evidence that capsaicin actually does, like, reduce

the amount of white fat you have and may stimulate brown fat. Okay? There are a lot of other studies that they sort of talk about, but we're going to compare this with a couple of other studies. So here's a compound that people loved talking about recently, not recently, like maybe 20 years ago, resveratrol. So resveratrol is a compound that's, it's a natural polyphenol that has, that has, has been found in red wine in grapes, peanuts,

uh, grapes, peanuts, et cetera. So the key thing about resveratrol is that like people started talking about the health benefits of wine with resveratrol. And what they were sort of doing is citing studies. And then people were sort of saying like drinking a glass of red wine is like good for your heart. And so a lot of people who really enjoyed red wine who had been told for their entire lives that like, hey, maybe you're drinking a little bit too much.

Maybe you should cut back. Wine is expensive. Alcohol is bad for you. They're like, see, see. like resveratrol is good. So here's another example of like, you'll see articles about this where people will say like, oh, resveratrol has actually been shown

to like reduce white fat. But let's take a closer look at the actual studies. Okay. So the administration of resveratrol in mice fed with a high fat diet has been shown to reduce the visceral fat pads and suppress adipogenesis. Okay?

So like this is very, different from the SNITKer paper. Because the SNTker paper is actually giving human beings like capsenoids and measuring what happens. Whereas like what's this is like giving mice 400 milligrams per KG per day for 10 weeks. Like I have no idea like look at the I mean this this may not be a one to one fair comparison because maybe resveratrol is like less concentrated than

Capsaicin, right? Because you need just a little bit of pepper. But generally speaking with mice, studies, sometimes they'll give these mice like very, very high dosages of stuff because they're trying to detect an effect, right? And it's kind of like mice. So you're not worried about compliance. You're not worried about like, you know, like the mice is having side effects and things like that. You'll just give them a bunch of stuff. So then you'll also have, you know, like gene studies or like, like cellular studies. So these are studies that, for example, we'll just take a cell culture and they'll

measure like how does gene expression change when I when I have a bunch of cells sitting in a petri dish and I squirt some resveratrol like what do the cells start doing differently so this also is like not even I mean they're living cells but it's not even within a human organism I mean it's not even within a mice a mouse organism right so like the studies for risveratrol tend to be in mice so feeding my standard diet plus resveratrol induced expression of CERT 1 and UCP genes. So there could be something here. And this is how science progresses. We start by studying things in mice and then we may move on to studying things in primates and eventually we'll move on to studying things in humans. But, you know, this is where we have to be super,

super careful because like if there's an article that says, oh, resveratrol, did you know resveratrol or drinking a glass of red wine can help you lose weight? And like that could be true, but just be a little bit careful about the level of, of, you know, evidence that people are talking about. So curcumin is another really good example. So curcumin has gotten a lot of, you know, interest recently. So curcumin is the active ingredient in turmeric, or one of the active ingredients in turmeric, has been used in Indian and Ayurbedic medicine for many, many, many years. And so what people will do is, like, they'll say, like, oh, did you know that using turmeric can help you lose weight. So, so turmeric is a good example. It does have some human studies, right?

So it looks like in this study, I think this is a small population size. Recent clinical trial assessed the safety and efficacy of 30-day treatment with curcumin, combined with phosphatidyl syrin in overweight subjects undergoing weight loss by diet and lifestyle intervention. In this study, curcumin administration increased weight loss, enhanced fat mass loss, and induced reduction in waist to hip circumference. But keep in mind, this is the other thing that you have to be careful about, right? because in this study, they also administered phosphatidyl syrin with it. So what effect does that have?

Does that mean that I can go to a health food store by curcumin tablets and lose weight if I just take it? Right? So the answer is we don't know, right? Because in this study, like, they added this additional compound. What is the effect of that additional compound? We don't know. This is also where some of the study involves intragastric administration of curcumin, 50 milligrams to 100 milligrams per KG daily in mice, right?

So the intragastric is really, really important. So that means they're not even feeding it. They're like putting it directly into the GI system. And this is important, especially for curcumin, because there are some concerns about absorption of curcumin through the GI system of especially humans. So at some of the doses that you may need to create this kind of decreased fat pad or whatever.

Humans may not like actually absorb that level. So the point here is that, you know, just be careful because there are all kinds of like caveats when it comes to things like herbal medicine. Green tea is another thing that has been touted for weight loss for a long time. So be a little bit careful about that too. You know, so we know that there are beneficial compounds in tea like catacons. So the other thing that we have. have to be careful about in green tea is like how much of the benefits of green tea are due to

caffeine versus the catacans. So we know that caffeine has thermogenic properties. And so once again, like we've got some rat studies here and we've got some human studies, right? So with regard to human studies demonstrated that green tea enhances, I think, EE, what is that? Enhanced oxidation. I think it improves fatty acid oxidation. I don't know, fat oxidation. Let's lower, I'm blanking on what he is. Oh,

enhanced energy expenditure. So what this sort of refers to is our baseline, like energy expenditure. Yeah, so like, like green tea may have a benefit. So in terms of, so this is good.

So the role of green tea in tackling obesity seem controversial in human trials. So like, you know, there are all kinds of confounding factors, which sort of, I don't know that popular meat,

will like go into. So the key takeaway here is that oftentimes, you know, especially with things on the frontier of medicine, like, you know, adipose tissue is an endocrine organ, it can be like really, really exciting and very informational. So do I advocate for having a healthy level, like a healthy body weight? Like absolutely. Is this, you know, just a disclaimer, I'm not commenting, hopefully people are not interpreting this as like having anything to do with body positivity. I'm not saying this has anything to do with health, I mean, beauty standards or anything like that. I'm not saying that we should, you know, lose weight for the sake of being more attractive or fulfilling a society body standard, societal body standard. What we're talking about

today is the literal biochemical effects of adipose tissue. And so whether you're overweight, underweight, whatever, like that's not sort of what we're talking about. We're sort of zeroing in on adipose tissue is a potential contributor to all kinds of physiologic problems. And so, problems and health benefits. The key takeaway here is that, you know, if you are overweight or you do have a very central, like, fat deposition, and you suffer from any of these issues, this is something that you should be thinking about. And especially if you have, like, a clinical diagnosis, absolutely something you should be talking to your doctor about. The last thing to keep in mind is that oftentimes on the frontier of medicine, what people will do is, like, they'll make studies,

right? So it's good that people are studying this stuff. Oh, green tea can help me lose weight. tea can promote thermogenesis, green tea can do all these kinds of things. They'll make all these kinds of claims. And those claims are scientifically valid, but they're not really like valid at the level of like human trials, right? So this is where you all have to be really careful about health-related compounds, right? I know that a lot of people are very interested in neurotropics. So these are things that are sort of good for our brain. We just be a little bit careful because oftentimes, especially as we sort of, you know, look at popular dissemination of scientific concepts, they're not really like digging down into, you know, what is the dosage

that we're administering to mice? Are these human trials or mice trials? What's the sample size for the human trials? In this case, it's 80 if memory serves. I don't think it's listed here, but, and so just be a little bit careful about that stuff. So I think, you know, sometimes I run across things that I think are really, really interesting. This is something that I personally monitor very, very closely because I am really curious about what we're going to learn about, like, the endocrine impact of fat and potentially using like weight loss or reducing our central adiposity or even adjusting, you know, the genetic activation of particular fat cells. So there's some studies that kind of go into that. So if we look at like these compounds, right,

This is, Resveratrol is talking about altering the genetic expression of fat cells. And that will in turn adjust all kinds of things. So keep this stuff in mind, be a little bit careful. You know, be critical of stuff that you all come across. And if you all have an actual, like, health condition, please go see a doctor about it. Okay? Questions. Looks like we have time for a couple other posts.

What did I have for breakfast this morning? I had half of banana, a cup of tea, and then a bowl of oatmeal. with blueberries. Is stress in an inflammatory state? Absolutely. So stress, psychological stress, so we can talk about this for a second. This is also, I think there's a video that goes into a lot of detail about this in Dr. Kay's guide. So when we have a physiologic state of stress, this causes the release of different compounds. So let's talk about glucocorticoids, like cortisol. And cortisol does all kinds of things. So, I think, let me just make sure I understood the question, but okay, whatever.

So when we go to cortisol, cortisol will have all kinds of different effects. So it'll increase blood sugar. It'll cause breakdown of fat and muscle. Why? Because we want a lot of available energy. Right? It'll also do things like activate our immune system. And why is that?

Well, let's think about it. When do we want cortisol active? It's like when we see a tiger in the wilderness, right? So what's likely to happen if we see a tiger in the wilderness? Maybe we'll get scratched. Maybe we'll get bitten. All those, you know, the tiger's fangs have all that juicy, juicy bacteria, which loves getting past your dermis and into your bloodstream.

So we want our immune system on high alert, right? it'll also have effects on your brain, right? So it'll make you a light sleeper. And this in turn will lead to less restable sleep. And so like cortisol will wreak havoc on your body. Cortisol is a hormone that is designed to sacrifice long-term health for short-term survival. That's what our adrenaline system is there for. Right. Like we can break down fat and muscle, but we need that we need like as much sugar as we can get in our bloodstream so that our muscles when we start to run and fight, have an endless supply of energy. The challenge is that when we're in this state for a long period of time, we end up actually like, you know, because there's no short-term

threat, right? We're not actually getting attacked by a tiger. And so over time, that long-term stress will actually negatively affect us quite profoundly. There's another really interesting thing about a cortisol tumor, which is that one of the features of a cortisol tumor is something called a buffalo hump. And so we develop fat pads with cortisol tumors. And why is that? So generally speaking, remember what we're trying to do is we're taking muscle and fat and we're breaking them down into blood sugar. And back in the good old evolutionary days, we would then use that blood sugar to run or fight. So what happens nowadays? Do we run? Do we run? or fight when we're stressed out, when we don't make rent, when we're worried about making rent

at the end of the month, are we running around and being very active? Sometimes, but usually not. Usually we're just stressed. And then the body gets confused. So when we don't use it to run or fight, what happens? Blood sugar starts insulin. And then insulin forms, creates fat. And so essentially what we're doing in high stress states is we're converting muscle to fat. So I'll just show you all a quick picture. This is where, so this is where like, this is literally what happens. You get a fat deposition. And then let's look at cushinggoid habitus. So this is what happens. Oh, this is from Facebook, but wherever. So this is what a cushinggoid habitus looks like. So for someone who has high levels of glucocorticoid hormones, this is what happens to them. Oh, can y'all not see any of this?

Shit. Okay, Gigi. Let me switch over. Okay. Let's start from the top. Okay. I'm going to show you all, Gigi. Okay. First thing. Hopefully you all caught that, but let's start from the top. So stress causes the release of glucocorticoids. Cortisol is one example. Cortisol increases blood sugar. Oh yeah, there was absolutely a diagram. We'll go through it right now. this causes a breakdown of fat and muscle in order to stimulate our blood sugar, activates our immune system, makes us light sleepers, so we get less restful sleep. And this is why like stress is bad for you physiologically, right? So over time, your blood sugar is going to be high, your immune system is going to be overly active, but there's no infection to fight. Thus, we've got all these soldiers, our white blood cells, which with itchy trigger fingers

that are like in a high alert state and there's nothing to fight. So what they end up doing is causing autoimmune problems. So we know that stress worsens autoimmune disease. Also causes us to be light sleepers, which means we don't get deep, restful sleep.

Last thing that we're going to talk a little bit about in terms of the metabolism, I think this is super interesting. So if you have a cortisol tumor or Cushing's disease, you can get something called buffalo hump. And what happens here, remember that when we recrete cortisol, what we're doing is we're breaking down muscle and fat to stimulate blood sugar. And once we have high levels of blood sugar, we normally want those so that we can

run or fight, right? So we want as much energy available to our calves and our thighs and our arms as possible. And generally speaking, when we see a tiger, let's say 10 million years ago, if we saw a tiger, what we would do is like hike eight miles, right? Like we want to just get the hell away from the tiger. So we need a lot of energy for our skeletal muscles. But nowadays when we get stressed, we're not running or fighting. So then we have a bunch of blood sugar in our bloodstream. And then like after a while, the cortisol starts to wear off. Because there's an antagonistic relationship between cortisol and insulin in some ways.

And then we secrete insulin. And what does insulin do? Stores all that blood sugar is fat. So when we're in a stress state, we are literally converting muscle into fat. And what that results in is something called a cushinggoid habitus. Okay? So this is where, like, this is literally what happens to people's bodies. You'll see wasting of the arms and legs like muscles, and you'll see fat deposition.

So this is a buffalo hump. Okay? Good question. So we should exercise when stressed? Absolutely. You should absolutely exercise when you're stressed. So there's something really cool about exercise. One key thing about exercise, which is why it's so good for all this blood sugar stuff.

when you exercise your muscles will absorb blood sugar without insulin i mean yeah without insulin right so generally speaking so what that means is that you are getting you are lowering your blood sugar without insulin and so remember insulin is going to activate your body's physiology to store that sugar as fat and so when you exercise it makes so the insulin resistance that you get with high levels of adiposity, exercise counteracts that like almost directly. Because what it, because remember with insulin resistance, you're not going to be absorbing blood sugar from the, from the bloodstream, right? And so when you exercise, it actually bypasses that whole mechanism. It recruits a completely different physiologic mechanism where it's

like, because you're exercising now, right? So we don't care about like, you're using your muscles. So your body's like, well, if you're, if my muscles are active, like they need energy. So let's absorb this stuff. Let's pull blood sugar out of the bloodstream. As the blood sugar gets pulled out of the bloodstream and your blood sugar levels drop, then your body's like, oh, like we have low blood sugar. So let's break down fat. Let's break down liver glycogen.

Let's break down different things so that we can add more blood sugar to the bloodstream. So a lot of like, you know, I don't know if you guys have seen this, but the actual caloric change from exercise is quite small, right? Like I think if you run a mile or something, you'll burn like 50 calories. It's very small. I don't know exactly what the number is. The key thing, though, is that all these benefits from exercise are not about the direct energy expenditure.

They're about adjustments to your body's metabolism. The basic way your body is operating. And when we have, like, a sedentary life when we're just sort of sitting in our chair all day, like all those effects get, like, they're in the wrong direction. Those numbers are really off. Let's see. How many calories?

Does running a mile burn? Okay, so it looks like, so it looks like it's 100 calories. So according to a chart from the American Council on Exercise, a 120-pound person burns about 11.4 calories per minute while running. So if you run a 10-minute mile, you'll burn 114 calories. Right? So one mile will burn 100 calories. It's not that bad.

My point is that there's, so if we, the key thing there is that like when you, run that mile, it's not just the calories that you burn. It's the fact that like you're activating your whole body's like metabolism. And so then over the next 24 hours, you will like burn even more calories because your body is like doing stuff, right? So when you run, for example, presumably your leg muscles will get stronger. So when you hypertrophy your your leg muscles, what's going to end up happening is like that hypertrophy, the building up of the leg muscle will require energy. It's not just about protein, right?

It's like the metabolism involved. Right? So remember that like even when we're sitting around doing absolutely nothing, we tend to burn about 2,000 calories a day. That's just the maintenance of your body requires 2,000 calories, like respiration, heartbeat, all that kind of stuff. Yeah, so, I mean, you may not get too much hypertrophy. Yeah, so anandamide is originally a compound that I'm not too familiar

in a bunch of details. But my understanding of anandamide is it's the compound that is in marijuana, right? Like, so I think the original person who coined anandamide was, I think they were Indian and they were studying marijuana. Isn't the brain the most consuming of our energy if you look at the weight energy ratio? I'm not sure. I would. So it's definitely one of the highest consumers of glucose for sure.

So we, you know, at some point we may have to do like a very very very. very in-depth discussion about marijuana because I think it's like one of these topics where people will make like, so someone's asking a question, is weed good for stress? So that implies that like there's a binary effect, right? So like either I say yes or I say no. But the truth is like hopefully if you all have been paying attention, like the key takeaway when it comes to like physiology as well as like psychology is that it's complicated. Right. It's not it's not. It's not like absolutely good and it's not absolutely bad. The other thing to remember is that any time you're talking about an intervention for a problem, it's a risk-benefit analysis. Whether you're

talking about a medication or a substance or even exercise, there's like a risk-benefit analysis, right? So running, for example, is very good for your cardiovascular health, but like can be very hard on the knees. So we can talk about it. The answer is, in my opinion, it's complicated. So So, like, that's where, you know, there's an individual discussion that it all oftentimes have with patients about whether, like, marijuana is, like, appropriate for them or not. Generally speaking, I don't advocate for regular marijuana use for most people. I think there's some absolute exceptions to that, like, in terms of, like, I've seen very, very good effects for marijuana use and people who are undergoing chemotherapy.

Like, I even saw a study recently that marijuana may have some positive impact on COVID, related stuff. But like that that also is like these studies are, you know, they're like very initial. So a lot of times people who want to use marijuana and are looking for a justification will jump on these studies. Whereas and then similarly you'll have people on the other end of the spectrum who are like all drugs are bad and will like be like, oh, never use marijuana. All these studies like they can't be trusted. But the truth is like just like any other, anything else we put in our body, like chances are, you know, herbs, that is like. So, comprehensive. compounds that are supposed to be in our body, right? We're not talking about like, like,

clearly toxic stuff. But, you know, when we talk about things that human beings will ingest or inhale, like there's a variety of different effects.