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

Episode Date: May 3, 2021

Do You Have Excess Belly Fat? Why It’s A Problem And What You Can Do About It | This episode is sponsored by Pique Tea and Thrive Market You might be surprised to learn that not all body fat is created equal; where the fat is on your body makes a big difference when it comes to your overall health. The fat inside your belly is called “VAT” or visceral adipose tissue and this type of fat is particularly dangerous. When you begin to put on weight, especially this lethal belly fat, your biology shifts out of balance, veering into the unstable and unhealthy territory of disease—which in turn often leads to more weight gain. In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to explain how belly fat contributes to other health issues. They also discuss the numerous factors that contribute to belly fat, including but not limited to diet, and how they work with patients to eliminate excess visceral fat.  Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well. This episode is sponsored by Pique Tea and Thrive Market. Head over to piquetea.com/hyman and use code HYMAN to get 5% off sitewide AND free shipping when you purchase a bundle. Thrive is offering all Doctor's Farmacy listeners an amazing deal. You will receive an extra 25% off your first purchase and a free gift when you sign up for Thrive Market at thrivemarket.com/Hyman.  In this conversation, Dr. Hyman and Dr. Boham discuss: Why visceral fat, or belly fat, is so concerning Learnings from liposuction and bariatric surgery How visceral fat drives inflammation and insulin resistance Tests to determine if visceral fat is an issue for you, including your waist circumference, waist-to-hip ratio, DEXA body composition, liver fat measurement, LDL cholesterol particle size, C-reactive protein test, oxidative stress, uric acid, glucose tolerance test, and fasting insulin level Symptoms of too much visceral fat including inflammation, abnormal cholesterol, high blood sugar, high insulin, high oxidative stress, and more Foods that drive inflammation and insulin sensitivity and belly fat Hidden drivers of excess visceral fat including loss of lean muscle mass, environmental toxins, imbalances in the gut microbiome Patients they have worked with to decrease belly fat Additional Resources: Dr. Hyman has written several books on this topic; learn more here https://drhyman.com/about/#section-6 7 Ways to Permanently Banish Belly Fat https://drhyman.com/blog/2015/01/29/7-ways-permanently-banish-belly-fat/ How Out of Control Blood Sugar Can Cause Belly Fat, Brain Fog, and Chronic Disease https://drhyman.com/blog/2020/11/19/bb-ep170/ Fatty Liver is More Dangerous than You Might Realize. Here’s How to Heal It https://drhyman.com/blog/2016/05/05/fatty-liver-is-more-dangerous-than-you-might-realize-heres-how-to-heal-it/ 8 Strategies to Reverse Skinny-Fat Syndrome https://drhyman.com/blog/2015/12/11/8-strategies-to-reverse-skinny-fat-syndrome/

Coming up on this episode of The Doctor's Pharmacy. The visceral adiposity, that belly fat, is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn't listening to its insulin as well as it used to. And so that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight. Hey everyone, it's Dr. Mark. I recently found a new drink that fits into my vegan diet and it's honestly something I always look forward to when I need a nourishing pick-me-up. It's the Sun Goddess Matcha Green Tea from Peak and it's the best tasting and smoothest mixing matcha I've ever tried. I'm sure you heard me talk a lot about using food as medicine and matcha is a great example of this. It's full of polyphenols, which are especially

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It's Dr. Mark Hyman. Welcome back to The Doctor's's pharmacy. That's pharmacy with an F. I won't spell it out because I got reprimanded for doing that too many times on the podcast. So it's just doctor's pharmacy, a place for conversations that matter. And if you have belly fat, it matters. This conversation will matter because we're all struggling with it. And today we're going to talk on our special house call episode with Dr. Elizabeth Boham, my colleague at the Ultra Wellness Center, who's the medical director. She's a world-renowned physician, teaches all over the world. She's helped thousands

of people achieve optimal health, and she focuses on nutrition and her practice every day. She's an RD. She's an exercise physiologist. She's an MD. She contributes to all sorts of national media and educates physicians all around the world. She's just the bomb. She's an MD. She contributes to all sorts of national media and educates physicians all around the world. She's just the bomb. So anyway, welcome, Liz. We're going to talk about belly fat. Thank you, Mark. It's great to be with you and to talk about belly fat.

Oh, yeah, my favorite topic. I've written all these books on belly fat. It's a problem, right? Well, the thing about it, it's a huge problem, and it's so easy to fix. And it's not through the ab roller or the time master, whatever infomercial tool you can figure out to get your abs right. I mean, you can't get good abs through exercise. I mean, eventually you have to do exercise, but if you just focus on exercise, you won't get it straight. So let's talk about this problem because for those of you listening, you listening, we are in a staggering

health crisis, not just COVID, but the whole pandemic of chronic disease that's driven by poor metabolic health and this phenomenon of being over fat. You can be overweight or you can be over fat or you can be both. We're going to talk about that today and why it's so important to think about for our own health, for our longevity, for preventing disease, and just for feeling good and actually even just getting our own lives together and managing our appetite and our metabolism and our energy and all the things that affect us. So I'm so excited to talk to you about this because it's my favorite topic. Oh yeah, mine too, mine too. And we know that where your fat is in your body makes a huge impact. You know, we used to so always worry

about pinching an inch, right? When we were growing up, you know, can you pinch an inch? But now we realize that that fat that's deep with inside the belly, the visceral adiposity, that belly fat deep inside the abdomen is really concerning in terms of overall health. And like you mentioned, it's a huge issue. It is a huge pandemic. In just the United States, we know that 70% of Americans are overweight or obese, but 86% are over fat, meaning that they have too much fat. And especially, you know, that concerning visceral fat is a real concern. And over half of our kids also are over fat. And so, you know, it's staggering. It's staggering. It's sad. It's sad, you know. And it's creating so many health problems from just feeling crummy to tired to causing cancer, increasing our risk of cancer like breast cancer and prostate and colon and

lung cancer. Of course, increases our risk of diabetes and cardiovascular disease, increases our risk of Alzheimer's disease and cognitive decline. It increases our risk of stroke and blood clots and high blood pressure and infections. As you were mentioning earlier with COVID, we realized that people with too much fat, people who are over fat, people with too much visceral adiposity have an increased risk of COVID-19. They have lower immune systems. They have increased risk of rectal dysfunction and infertility and PCOS and hair loss in the wrong places. And they make it harder to lose weight. So it's just connected to so many things. And it's unfortunately so common. And so that's why we like to talk about it so often. Because

sometimes it takes us talking about a subject more than one time for people to really kind of put all the pieces together for themselves. It almost seems too good to be true that of these problems that you mentioned from infertility to heart disease, cancer, diabetes, Alzheimer's, are all related to this weird fat that's very different. And when you mentioned pinch and inch, it's not, that's the subcutaneous fat. It's the fat around your organs that really matters. And I remember this one study I read, you probably saw years ago, where they, it was the New England Journal of Medicine. And they did a liposuction on this very obese woman who were really was very, very big. And they sucked out 40 pounds of fat from her subcutaneous tissue. So basically she lost 40 pounds just by sucking out all the fat. But when they did a CAT scan to look at the fat inside, that didn't change at all.

And what also didn't change was all of her biology. In other words, if you change your diet, you can change the quality of the fat and the messages that make very, very quickly within days to weeks. But for her, even though she lost 40 pounds of subcutaneous fat, there was no change in her blood pressure, blood sugar, cholesterol, any of the markers of poor metabolic health. She was just as sick as she was before, even though she was 40 pounds lighter because they took out the subcutaneous fat. So this belly fat is really different than the fat on your body, your arms, or under your chin or whatever. It's very different fat. So talk about this fat particularly, we call it VAT or

visceral adipose tissue or belly fat or organ fat or whatever you want to call it, but it's fat around your organs, your liver, your kidneys, your intestines. It's in that organ compartment. What's it doing that's different than regular fat? Yeah. I was also so blown away when that study came out all those years ago. And it just really was an eye-opener for me to say, and I use that example for patients all the time, like we can't just liposuction this away and your blood pressure is not going to come down. You think, oh, if I can just liposuction it away, then my diabetes will go away. But it doesn't work like that, right? Because you're not getting to that deep adiposity and that deep belly fat.

And that deep belly fat is really inflammatory. What we realized is that deep belly fat produces all sorts of inflammatory markers, interleukin-6 and tumor necrosis factor. So it actually results in increased inflammation in the body. And it is associated with increased insulin resistance and that high level of insulin and the high level of inflammation, those two things, and there's, I'm sure there's more are really drivers for all of these processes to get out of whack in the body for the cholesterol to get out of whack, for your inflammation in your arteries

to get out of whack, for cancer to like to grow. And so it's that deep fat that's absolutely, absolutely. And that deep fat is not just hanging out. It is metabolically active, as we've talked about before. And if you always like to talk about it, it's metabolically active. It's not just sort of sitting there. It's really doing- Not just holding up your pants? It's an endocrine organ that's doing it. No, right? It's actually doing things. And it's producing all these chemicals and hormones, and it's increasing the inflammation in your body.

And so if there's one thing that people can focus on, like if you're, you know, you kind of, sometimes people get overwhelmed with all these messages in, in health, right? Like, oh my goodness, what do I do? What diet do I follow? What, what should I work on? Where do I focus? And sometimes people get overwhelmed and they almost give up. We see that all the time. And this is like the basic thing that everybody can focus on. You know, I, even for myself, like I'm like, you know, I do, I do a lot of these self-care things, right? I try to all the time. Right. But, you know, this is an area that we can all focus on that can improve our health. If we just pay attention to

what's our waist circumference and what's our waist to hip ratio, because that's telling us how much belly fat we have. Yeah. So I think that's right. I often joke and say there's a simple test you can do to figure out if you have this problem. It's called the mirror test. You take off your shirt, you look in the mirror, you jump up and down. And if your stomach jiggles, you probably have it. And the truth is 88% of Americans have it.

They're metabolically unhealthy. It's our metabolic unhealthy. That's because they have this visceral fat. It's making them unhealthy and causing all these other problems that we see as separate, right? Oh, I have high blood pressure. Oh, I have high cholesterol. Oh, I have high blood sugar. But they're all the same problem.

Or I have low sex drive or low testosterone, or I have, you know, pimples and poor periods and sleep apnea and whatever the things are that we're suffering from, we see them as all separate, but they're all connected by this. And with COVID now, the vulnerability of this population with visceral fat is just, it's just been highlighted. You know, 63% of hospitalizations could have been prevented if people had better amount of metabolic health and ate better food. So the real question is, one, you know, we're going to talk to them about what causes it and how we start to diagnose it. But what are the ways we can diagnose it properly? You mentioned the waist to hip ratio.

That's a simple test. Tell us about that. And then let's talk about some of the blood tests that you see. It may seem like other stuff, but are clues to you having bigger belly fat. Yeah. You know, the waist to hip ratio is a great measurement that we can all do and repeat on our own. So what you do is you get your waist circumference.

And to find the right place for your waist circumference, it's in between, you know, you find your lowest rib and you find your upper hip bone. And then you put this, you put the tape measure in between, and that's considered your waist circumference. So if you find that lowest, your last rib and your hip bone and go in between the two, that's considered your waist circumference. It's like your belly button pretty much, right? Yeah. Some people's belly button hangs down or is in a different place. So it's not always the belly button, but it is around that area. Yeah. And then their hip circumference is considered over the greater trochanter. But if you don't know where that is, I always say to people go over the largest part of your hip, because that just makes your number look better. So you want to, you know,

get the biggest hip circumference as you can have, not that you want to, you know, you want to be, you know, way overweight, but it's, you pick the biggest hip circumference to, to determine your waist hip ratio. If you can't figure out where that greater trochanter is. So the goal for Caucasians is to have a waist circumference less than 35 inches for women and less than 40 inches for men. For Asian and Indian ethnicities, it's stricter, less than 31 inches for women and less than 37 inches for men. And that waist to hip ratio is a great measurement to do. So for women, you want to be less than 0.8. And for men, less than 0.9 is the waist to hip ratio you want to have. So you want a smaller waist than hip, of course. And, and the neat thing,

this is a really simple test you can do and something you can check every month. You know, you can redo your waist hip ratio every month and watch your progress and say, okay, what am I doing? What do I need to do? And it's a really inexpensive way to figure out, is this a problem for me? Yeah, that's really huge. And I think, I think it's also important what you said in that people who are of Indian or Asian descent can have significant visceral fat and all the complications from it at much lower weights. So they may, if you look at their weight, they might, weight might be perfect. It might be less than 25, 23 in their body mass index, which 25 or more is overweight. But they may be

full of this visceral fat. And they can be diabetic. They can be thin. And they look thin. We'll call them skinny fat. So they have the same issues as someone who is overweight, but they're just over fat. Yes, or toffee, right? Thin on the outside, fat on the inside. So, so, you know, if you are a smaller person, um, then, then that's where also that waist to hip ratio can be really helpful. Um, and, and you're right, you're right. None, no test is ever perfect for us. So for some people, the waist circumference or the waist to hip ratio, isn't, isn't giving us all of the information. There's a lot of other biomarkers that of course tell us that somebody has too much visceral adiposity,

that somebody is carrying too much weight around the belly. If we see a high C-reactive protein or marker for inflammation, it makes us wonder, okay, do they have metabolic syndrome, insulin resistance, visceral adiposity? If we see that fasting insulin greater than five, that's when we say, okay, this is something we have to pay attention to. If we see too many small, dense LDL cholesterol particles, we've spoken about that before, that's a sign that somebody has insulin resistance or visceral adiposity. If we see, we also check for things like oxidative stress, too many free radicals being produced, that's a sign. If their liver function tests are high, or they have signs of fatty liver, that can also be because of this visceral adiposity or

gout, high uric acid, that can also be because of this. Or that pattern in cholesterol, the high triglycerides, low HDL, all of these things can give us a sign, give us information and say, okay, this person is struggling with metabolic syndrome, insulin resistance, or probably because of visceral adiposity. And you often notice all these things abnormal at the same time, right? So you see a pattern and it's really pretty easy to diagnose when you know what to look for. So you get inflammation, you get abnormal cholesterol, you get high blood sugar, high insulin, lots of oxidative stress, your liver. I mean, these are all things that seemingly are treated like separate problems, but they're all connected to this visceral fat. And what's amazing is to watch them improve when we make shifts or changes in somebody's lifestyle, you know, or, you know, there's lots of things that can contribute to this from toxins in the environment to shifts in the microbiome to poor diet, you know, having a nutrient poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor sleep, too much stress

can all contribute to it. But when we shift somebody's lifestyle and when we make shifts in these issues that they're dealing with, we see these markers, these biomarkers improve significantly. So it's really fun to watch. We see it improve all the time. Yeah. So I'm going to get into the causes a little more deeply in a minute, but there is another test that we often do, which I like a lot, and it's sort of the gold standard. It's called the DEXA body composition test. And it's like a x-ray, a very low dose x-ray. I mean, you have to basically take 50 of these to equal one flight across the country from New York to California in terms of radiation.

And it measures the compartments of your body, your arms, your legs, your belly, and can tell you what the fat is, where it is. And it's pretty compelling. There's also MRI technology that does this, CT technology, liver fat measurements. So there's a lot of ways to look at this. But it is really the central problem of our time. And there are many causes, but the major cause is our ultra-processed high-salt sugar diet. That's the biggest cause because that drives insulin, and insulin drives all the available fuel that you've eaten into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis of your fat,

and it produces all these inflammatory compounds, and it screws up your hormones, and it makes you hungry all the time, and it slows your metabolism. So it's the worst possible thing. And it's really driven predominantly by that. So we know that a high carbohydrate in the sense of starch and sugar diet, because vegetables

are carbohydrates, so you can eat as much of those as you want, is the biggest driver of this. But there are other causes, right? And you mentioned a few of them. So let's kind of go through some of the unusual things that might be driving this, whether it's the microbiome, toxins, and other things that drive inflammation. You know, I always, just in the terms of the, the, the most common cause, right. I get so concerned when I see, you know, a, a, a young child, maybe like eight or nine and their parents are buying them a, you know, a muffin and a sugary coffee drink or sugary, you know, beverage for breakfast. And I'm like, Oh no, you know, it's just a setup. It's a setup for them to have problems for their whole life, you know, beverage for breakfast. And I'm like, Oh, no, you know, it's just a setup.

It's a setup for them to have problems for their whole life. You know, and I think that it's important that people take care of those basics, like you mentioned, but we always look for, you know, sometimes, sometimes people are doing, or they feel like they're doing everything right. And there's, there's hidden reasons for why they start to develop visceral adiposity and that belly fat when they're really doing a lot of things correctly. And one of the things that I find that people don't realize is what happens when they start to lose lean muscle mass as they get older., we might be exercising a good amount every day, but if we're not working really hard to maintain that good lean muscle mass, what happens after the age of 25 is we slowly lose lean muscle mass. And, and then it's just

so much easier for the body to put on excessive fat. And we know that having good lean muscle mass and exercising really keeps our insulin sensitive. And so that's one thing that people, that slowly catches up with people and they become more insulin resistant over time. And you mentioned toxins, you know, unfortunately, there's been multiple toxins associated with this visceral adiposity. So I want to underscore what you just said. I want Liz, I want to, I want to underscore what you just said, because you basically said something really important around muscle loss when you get older and, and muscle loss is really, um,

could be a thought of as replacing muscle with fat. So you could be the same weight at 65, then you are 25, it'd be twice as fat. And that fat in your muscles, it's not just in your belly, it's also this poor metabolic fat. And it leads to this increasing phenomena with all the consequences that we see of disease. So I feel like this is a really important thing that people understand. So exercise, basically strength training, building muscle and aerobic exercise, even interval training will help improve metabolic function and help keep this insulin resistance at bay as we age. Because it is something that affects almost everybody as you age, unless you do something actively about it. So let's talk about toxins. You do have to work really hard at it. I mean, it's like so easy to maintain. Well, I don't know if it's so easy, but it's so much easier when

you're younger to maintain your lean muscle mass. And as you get mean, it's like so easy to maintain. Well, I don't know if it's so easy, but it's so much easier when you're younger to maintain your lean muscle mass. And as you get older, it's really work, you know, and people are like, I do go for a walk every day. And I'm like, you know, it's just, it's not, it's not enough for you right now. And getting in two days a week where you really are working on resistance type exercise, there's so many ways you can do that, that, you know, you know, That really can make a big difference. So yes, so toxins. BPA is a toxin that's been unfortunately associated with visceral adiposity, fatty liver, metabolic syndrome. And BPA, bisphenol A, is that hard plastic that is pervasive, unfortunately, in our environment and has been

associated with breast cancer, but it's also been associated with insulin resistance. So I think it's important that we recognize that there are a lot of toxins out there that are impacting our insulin sensitivity and possibly through how it damages our mitochondria. And it's just really, there's more to it sometimes than just our mitochondria. And, you know, it's just really, there's more to it sometimes than just our food intake. And we always really have to dig and look for that when we're working with our patients. For sure.

We call these things obesogens. You know, they're petrochemical toxins. They're even heavy metals I've seen. So we really have to be alert to people are not losing weight and they're not successful doing the basics, stuff of diet and lifestyle change. What else is there? And there are other things like the microbiome. So maybe you can share a little bit about that and what we're learning. Oh, the microbiome, I think is so fascinating, right? I mean, there's so much

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

weight gain. So people might be having, uh, absolutely activities that are causing it, or they're exposed to mold in their environment or they have latent infections because anytime there's inflammation, it drives insulin resistance independent of the cause. So the biggest cause, just, you know, not to get too down on that rabbit hole of these things, the biggest cause obviously is sugar and starch. Those are the two biggest things that are driving inflammation. But there

are a lot of other things that people need to think about that also do it. Now, people listening might be going, okay, yada, yada, yada. Okay, all this great science about belly fat and what it does and why it's bad and how to test for it and what causes it. But how do I get rid of it is the big question. How do you actually get rid of it? And, and I think it's, it's so, it's, it's so gratifying practicing functional medicine and at the Ultra Wellness Center where we work. It's so, it's so gratifying seeing this because this is one of those kind of slam dunk, idiot proof things for most people. And it happens so quickly. And it's so striking because people are always struggling with this. I'm like, well, if you understand biology and how the body works and how it functions, which is really the foundation

of functional medicine, which is understanding how to work with the body rather than against it, you can drive these biological changes really quickly and really change the quality of the fat dramatically. And just give you a quick example, and then we'll go into what to do about it. This is one of my favorite studies that I've read recently is a study looking at gastric bypass surgery. Basically, they said, well, gastric bypass works because it causes all these amazing changes in hormones and appetite, blah, blah, blah, blah, blah, blah, blah. So there's all these theories about why it works. Well, somebody decided maybe we should test this theory. So they took a bunch of people who are really overweight and they gave a gastric bypass

on half of them. The other half just ate the diet that the gastric bypass people ate after they had the surgery. And there was no difference, but quickly, within days of changing their diet, the quality of their fat changed. And it went from being inflammatory fat that's driving all these problems to really shifting that. And so it can happen pretty quick. Even if you're still a little overweight, you can still have the metabolic and health benefits. And of course, you still need to get the weight down. But I think it's just an interesting phenomenon. So I kind of love that study. So let's talk about, you know, what do you do and some case studies that you've had that really sort of illustrate the ways in which we can use this strategy of functional medicine and the science to drive real change for these patients in their,

not only their belly fat, but all the other biomarkers and health issues and consequences that come from having this belly fat. Absolutely. Like we were talking about the visceral adiposity, that belly fat is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn't listening to its insulin as well as it used to. And so that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight. It makes us more hungry, but it also makes it much harder to lose weight. So one of the things we really, when you were talking about, okay, how do we really work with our physiology, is we want to

prevent insulin spikes because we know that higher levels of insulin are what's really driving us to gain this visceral adiposity. And so as you mentioned, it's those refined carbohydrates and sugars that drive up insulin levels in the body. And we know that if we just ate just fat, we wouldn't secrete a lot of insulin. And protein, we secrete some insulin, but not as much as with carbohydrates. So what's really important is bringing down the percentage of calories that somebody is getting from carbohydrates, especially the refined and processed carbohydrates that cause that insulin spike. And so I always talk to people about that, having that balance of the good, healthy fat and lots of fiber and some protein at every meal, and just pulling away the simple sugars and refined

carbohydrates, because that brings the insulin down and makes us less likely to hold on to that weight around our belly. So that's really the first area we always work on. And, you know, we can dive into a couple of cases as examples. So this is really a great point. So basically the key to this is keeping your insulin levels low, because as long as your insulin levels are high the body really has a one-way street of fuel into your fat cells so basically insulin locks the fat cells in your belly and prevents the breakdown we call it like policies

they're the breakdown of this belly fat so like you said how do how do you cut insulin levels? Well, you've got to cut out the starch and sugar, especially if you're in an extreme case. If you have a lot of belly fat, you really need to be more strict, like no sugar, grains, beans, even some fruit. And then as you start to become more metabolically healthy and resilient, you can add things back. But it's really key to be really religious about it. And also there are other factors like artificial sweeteners that are driving this. And there are other carbohydrates we might think are okay, like we're eating whole grains or eating whole wheat bread or eating, but they may not for people who are really insulin resistant be helpful.

And what you also said was so important about fat. Fat doesn't cause any spike in insulin. And you see this phenomenon. This is just a great story I learned from David Littowick, who's a professor at Harvard, one of the greatest scientists in this field. And he said, Mark, if you would take a type 1 diabetic, and this is very different than type 2, which is basically for meeting sugar and starch. Type 1 diabetics have an autoimmune disease that damages their pancreas. They cannot make insulin. So the presenting symptoms, and every doctor learns this in first year medical school,

are they're hungry all the time, they're peeing all the time, and they're losing weight. So they could be eating 10,000 calories a day and lose weight. Why? Because there's no insulin. So that's really the key. And a ketogenic diet is the most extreme version, but there are a lot of other approaches to eating more fat, less starch, and the continuum of all that. So I think that's really important. And protein is really important too. But if you eat too much protein, you can also get insulin spike. Absolutely. Right. So the first patient that we're going to talk about is a woman who, she was in her mid fifties and she came to see me because she had just been diagnosed with an estrogen receptor, progesterone receptor positive breast cancer. And it was stage one. So she was, you know, she was lucky in that sense, or, you know, she found it early in that sense.

So that was great. She had a surgery and, and radiation, and she was placed on aromatase inhibitor, but she said, you know, I want to do whatever I can to prevent this from coming back. And so we gathered all of her information, her whole history. And she noted in her history that she had gained like 30 pounds since she had her children. And it just came on slowly over the years. She became more tired over time and really just had a harder time with losing that weight. So she came in about 30 pounds overweight. And when we checked her waist to hip ratio, it was 0.88. And remember we said for women, we want that waist to hip ratio to be less than 0.8. So hers was high at 0.88 and, you know, not crazy off the

charts overweight, you know, but 30 pounds higher than she needed to be. And so we said, okay, you know, I explained to her, this is where we really want to focus because there's so much research here showing the connection between insulin resistance and belly fat and breast cancer. So we really want to focus on lowering your waist to hip ratio. And we want to focus on lowering your insulin levels because we know that will lower inflammation in the body and it will decrease your risk of getting a reoccurrence or another cancer for that matter. So she was really motivated and we put her on the Pegan diet. You know, we really worked to lower her percentage of carbohydrates in her diet. She was, you know, she was, she was a pretty healthy eater, but getting in some, you know, her,

her, you know, coffee drink that had added sugar in it and, you know, needed to really make some shifts. So we, we started to tighten up her diet. We gave her a lot more phytonutrients. We gave her a lot more fiber. We worked to increase her omega-3 fats. And we also did, we really tried to increase her green tea intake. There's some really interesting research with green tea. We've always talked about it from a breast cancer prevention strategy because it's got anti-angiogenic properties. It can impact the tumor suppressor gene in a healthy way and decrease risk of cancer that way. And it's an antioxidant, but it also has been shown to lower insulin and help with lowering body weight. So when people drink four cups of green tea a day

for eight weeks, they had improvement in their metabolism and their weight and their, and their BMI. And, um, and so, so that was, that was, that was helping her on both angles. We also gave her more omega-3 fats to help improve her, her, uh, her, her triglyceride HDL ratio. So we added in two to four grams of fish oil. And there has been some really interesting research on kimchi as well at helping to improve somebody's insulin sensitivity. And so we had her start to incorporate lots of phytonutrients in her diet, lots of vegetables, but also kimchi to help with improving her microbiome. And, and she did really well, you know, she was able to, to lower her weight, it took a few months to get the weight

down, you know, six months or so. But she even got that waist hip ratio to that, you know, to less than or right around point eight, which we were happy with. So she's doing great. That's amazing. So you see this happen over and over with our patients. And you sort of just dial in the simple recommendations. It seems they're obvious. But for some, it's a little different.

And just to share a few cases of mine, I remember one who had, for example, severe diabetes. His sugars were 250, couldn't get it in control. We changed his diet, even put him on a ketogenic diet. It helped a lot. But what was fascinating is we couldn't get that last mile until it was by accident, really. He was complaining to me of his gut and his bloating and all kinds of issues and gas. And I was like, hmm, so let's just try an experiment. Let's just try charcoal. Now, diabetes is not treated by taking charcoal pills, but by understanding functional medicine and interrelationship of the microbiome and

inflammation and how it affects, for example, the toll receptors and causes increases in TNF-alpha, which is basically an inflammatory cytokine, one of the cytokine storm things, it causes insulin resistance. And I said, well, let's just try it. He says, wow, I took this charcoal and my blood sugar went to normal for the first time. And I was like, wow, that's fascinating. Or another patient was a trainer and a fitness trainer and ate healthy and she struggled. And she had high mercury. And we got rid of the mercury and she was able to lose weight. So I think most of the time it is really about the diet.

And then I think adding the exercise too. We didn't really talk about that. But adding the exercise, even though you can't exercise your way out of a bad diet, you can exercise your way into better health and fitness and increase metabolism. So it's really important to actually, as you're losing the belly fat to maintain your muscle, that's where you talk about the strength training and exercise. What about the next case you were going to share about who was a guy who had high blood pressure and bad cholesterol and tired all the time? Yeah. I mean, this is, yeah, we see this all the time. You know, somebody comes to us because they, they, he had just gone to his physician, he's 47

and he had just gone in for his routine physical. And all of a sudden his doctor wanted to put him on blood pressure medication and he wanted to put him on cholesterol medication. And, you know, so he was, he was like, oh no, this is not, this is not what I want to do. And he, it sort of woke him up a little bit. And he said, let me just explore this a little bit and look into it and look at this a little differently. I don't want to just treat all my symptoms with a medication. I want to see what's going on here. So, you know, I mean, he, he was, um, he was just struggling with his energy. So he's feeling a little bit lower in energy. He would put on

some weight and, um, and, and, but otherwise he, you know, he was just kind of doing fine. He didn't have a lot of other complaints. And when we did his waist to hip ratio, his waist to hip ratio was at one. So again, remember with men, we want their waist to hip ratio, his waist to hip ratio was at one. So again, remember with men, we want their waist to hip ratio to be less than nine and he was at one. And so this was a sign to me right away that I knew I had to work on insulin resistance and this visceral adiposity. I knew that this belly fat, this too much weight in his abdomen was triggering this high blood pressure, was triggering an unhealthy cholesterol pattern. And when we looked, when we did that particle size test on his cholesterol, we saw that his small dense LDLs were too high and his HDL were too low

and his oxidized LDL were too high as well, which we know when LDL cholesterol gets oxidized, that's when it can get damaging to the artery lining. So that's when we said, okay, we're going to really focus on your insulin levels here. And again, we pulled away all the refined and simple sugars. He needed to get rid of some extra beer that he was drinking. We got in a lot more vegetables in his diet. We worked to increase his omega-3 fats in his diet. He didn't want to take a lot of pills, but he was good at making shifts in his diet. He really got motivated. He also got motivated because we talked about how that increase in waist circumference increases erectile dysfunction. And so he said, you know, that's really interesting. I really

want to lose this weight around my belly. And so that really got him motivated to get right on the diet and really worked to increase his exercise. We had him get some strength training in three days a week. He ended up working with a trainer, which was really helpful for him to stay motivated. And he started to add in a little bit more interval training on those other days. But that really helped him. And within three months or so, we saw that waist-hip ratio come down significantly. And in like six months, he was at that 0.9 of waist-hip ratio. His blood pressure improved.

His cholesterol pattern improved. His energy improved. And he never needed to start medication. And he's doing really well. That's amazing. And, you know, just so many stories like that. It just kind of reminds me of this patient I had who wasn't a typical. And so sometimes you think it was typical, but she looked like the Michelin woman, I guess.

She, you know, total apple. Like you just round, you've seen these people, just round and their skinny legs and big belly. And I thought, oh man, her tests are going to be so bad and her blood sugar is going to be high and it's going to be terrible. And what was fascinating, her A1C, which is her average blood sugar, what was fascinating with her, and this is just that it speaks to what really happens to people, is her blood sugar was perfect. In fact, we even did a glucose tolerance test where you look for diabetes. And we gave her the equivalent of two Coca-Colas

and watched whether her blood sugar went up or not. And it never went up. I mean, her blood sugar was under 100 fasting. It never went up over 110, even after all that. But what was really different, and this is the thing people should listen to, and we're going to put in the show notes the tests that you should think about doing and asking your doctor for. I've written a lot about it, and you can get in.

There's great descriptions of actually how to diagnose this. But what she had was very high fasting insulin, like 50, which should be under five. And after she took a sugar drink, it should be under 30. Hers was like 200 or 300. And so her insulin was so high, she couldn't lose weight. And within a very short time, she lost like 50 pounds of belly fat, just like that by shifting her diet and reducing the inflammation and dealing with this sort of starch and carbohydrate intake that she took. Yeah, it's amazing. It's amazing. It's pretty amazing. And it's really, it's, you know, it's a really gratifying area. And I think, you know, when you look at aging, when you look at fertility, when you look at chronic disease,

when you look at productivity, when you look at your brain function, all those things are related to this belly fat. And it's really the sort of the drumbeat that i and we have been sharing for decades at the ultra wellness center which is it's really about the quality of the food you eat the quad of your diet and it's why i spent so much time writing books like the blood sugar solution the tend to detox diet eat fat get thin pegan diet food wasn't actually because if we can get this straight uh we're going to solve so many of our global issues around health and chronic disease, the economy and everything else. So it's kind of an exciting moment where

I think this is becoming more and more recognized. I literally just got off a call with a senator really in his team about how we begin to address history policy. So I'm kind of optimistic. I'm always a little bit optimistic no matter what anyway, but I think I'm more optimistic than ever that we actually have a moment to start to change the tide on this. Any last thoughts, Liz, on belly fat before we wrap up our podcast? Yeah, I agree. I agree, Mark. You know, it is really, there's so much we can do and simple changes in your diet make

a huge impact on how easy it is to maintain a good, healthy weight and to prevent this from happening. And when you make those changes and cut out that extra sugar and cut out those refined carbs, you're also not only having an easier time with maintaining your weight and keeping that weight off your belly, but also preventing all those diseases like we spoke about. So thanks for all the great work you do, Mark. It's really exciting. Yeah. Well, thank you, Liz. And thanks for being on this week's House Call. I love sharing this information to all of you. If you love this mini episode of The Doctor's Pharmacy, share with your friends and family. Subscribe, read your podcast, leave a comment. How have you addressed your belly fat? We'd love to hear from you. And also, you know, I've got this new incredible content opportunity, which is called Dr. Hyman Plus. And you can go to my website,

drhyman.com, learn more about it. And it's, you know, ad free podcast, access to our documentary series, and ask me anything with me where every month I answer questions through video and personally, as well as Dr. Bohm and others are from our team are doing deep dives into functional medicine so it's a really wonderful way to access a lot more content if you're a little geeky like us so Dr. Hyman Plus check it out and of course we'll see you next time on The Doctors Pharmacy. Thank you Mark. Hey everybody it's Dr. Hyman thanks for tuning The Doctor's Pharmacy. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love and that I've learned so much from. And I want to tell you about something else I'm doing, which is called Mark's Picks. It's my weekly newsletter. And in it, I share my favorite stuff from foods to supplements

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

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