0:00 there's studies showing that like you can take, you know, a dozen healthy young men and you could put them on a very caloric dense. So they're consuming between 1,200 or 1,500 calories more a day, primarily of processed foods. So this is like refined carbohydrates. This is like high saturated fat, you know, this is like the combo of the saturated fat, sugar, like processed foods. They will gain visceral fat, particularly fat around the liver, but they don't actually gain weight. When you take these healthy young men and you're giving them these processed foods, you cause the brain to become insulin resistant in 5 days. 5 days. >> It's not. Dr. Rhonda Patrick, I want to talk visceral fat and really just get into the weeds with it. But I want to
0:46 open with a question that a lot of people wonder, if you don't have access to a DEXA scan to go get an actual image of how much visceral fat you have, how do people know that they have it? So there's there's I would say the the number one way that even most physicians will measure visceral fat is by measuring your waistline, your waist circumference. And that's something that people can do at home. So typically women that have a waist circumference of 35 in or more, that's a sign that they're they have a high amount of visceral fat, higher than they should. For men, it would be 40 in or above for their waistline. But it's also important to realize that the visceral fat is the kind of fat that
1:33 is it's known as belly fat. It's the it's the midsection fat. It's this fat that's deep inside your body that's lining your organs. It's it's lining your your liver, your intestines, you know, your pancreas. And it's not the kind of fat that you can just like pinch. Let me find fat. That you can't pinch it and feel it. Like this is subcutaneous fat. This is a different type of fat. And so people with visceral fat typically have that apple shape body, right? Where the fat is in the midsection. So their body kind of looks a little bit more apple shaped versus perhaps a pear shape body where people are storing their fat more in maybe their hips and their thighs. That's that's not the visceral fat, right? It's the visceral fat is here in
2:19 that midsection. So that would be I would say the easiest way for someone to know if they have visceral fat. Again, definitely if you've got like the the the the the gut, right? The the belly, I mean that's that's a big sign, but measuring your waist circumference is probably the best thing that you could do aside from going and getting a DEXA scan. Can people be relatively lean appearing and still have because 40 in might be hard to achieve if you're you know, leaner, but if someone's lean, you could probably get to 36 38 and still be having high amounts of this or moderate amounts of visceral fat. So do you see that people can actually have that? They were Absolutely. Now, this
3:05 isn't something that I personally see, but I've seen it in the literature and I have been part participating in clinical trials and these individuals, what we refer to them as is lean but metabolically unhealthy. So they are individuals that actually you really you look at them and you would think that they do not have a lot of fat or visceral fat and yet they actually do have visceral fat and it may not be a ton of it, but it's enough to be metabolically unhealthy. So that is a great question. It's not necessarily and we can get into the causes of visceral fat and that'll help people also identify, but but it's not that you're necessarily going to have a huge waistline. I think that's the the biggest indicator of it, but you can be lean and have visceral fat and not really know it and and that's a problem,
3:51 right? Because then you're basically didn't have all these negative effects of visceral fat, things that we'll talk about, but you won't even really know that you have it. So you're not going to really take any you're not going to take have any motivation to improve your lifestyle to try to decrease visceral fat if you don't even know you have it in the first place right? >> Totally. So visceral fat is by nature very inflammatory. So what do people feel if they have that? And that's why it can be kind of sneaky because it's like you could be oh, maybe I'm just fatigued or like what what do people feel since it's so metabolically active? I put a link down below for some other minerals that are important just for everyday life like sodium, potassium, and magnesium and you can find those in element. So that is a link for a free
4:39 sample variety pack of element electrolytes with any purchase. So you can get their chocolate salt flavor, you can get their lemon lime, you can get their regular lemonade flavor. All this stuff is amazing and they have ready to drink sparkling cans as well. So this stuff is epic and it's getting you pretty much a zero calorie or five calorie way to get your minerals in, curb your appetite, and just have something that tastes good. So that link is down below. This stuff has been such a game changer for me for the years. Like when it comes down to just being able to like go through the day without feeling like I need to munch on stuff all the time. Plus my brain feels sharper because salt is so critical for that neurological function, for those neuronal signaling. So that link is down below. Yeah, so let's talk about the difference between visceral fat and just regular subcutaneous fat. As you
5:25 mentioned, visceral fat is metabolically active. It is a type of fat that is constantly breaking down triglycerides into free fatty acids. And these because of the nature of where visceral fat is, I you know, it's in the midsection. It's sort of deep in there. It's surrounding the liver, surrounding organs. It's really close to something called the portal vein, which is delivering circulation to other organs, right? Including the liver. And so what happens is visceral fat can essentially it's breaking down these fatty acids and these fatty acids are then going straight back to the liver. And the problem is is that um they're also
6:11 antagonizing insulin receptors. And so it's a big problem because the visceral fat doesn't respond to insulin like subcutaneous fat does. So subcutaneous fat also can break down and form free fatty acids, but once you have a meal, when you eat a meal and insulin is released, the subcutaneous fat, it's a stop signal. Okay, stop breaking down fatty acids. We're going to now deal with this new energy coming in. The visceral fat doesn't do that. It just continues to break down the fatty acids. And so what happens is is that new energy coming in, these fatty acids are antagonizing the insulin receptors on the liver, on the muscle. And so the new energy, the glucose that's coming in stays in your circulation. It's not going into the liver. It's not getting
6:58 taken up into the muscle. And so what happens is this acute, you know, state of insulin resistance, so to speak. And so your body then tries to overcompensate. Hey, we got to get this glucose, you know, taken up into our liver, into our muscles, right? Let's let's release more insulin. So then your body releases more insulin to overcompensate. And what happens is that your blood glucose then goes takes a sharp drop cuz you just released a ton of insulin, right? And so you get this energy crash because your blood glucose level really dips low after that overcompensation of insulin. And so what happens is people that have a lot of visceral fat will experience like they'll eat their food and then they'll experience this crash
7:43 afterwards. And then when you get that crash, that's a signal to the brain, I need energy, right? Like blood glucose level is too low. I need energy. And so your brain is then telling your body, hey, you need to eat and it's pri- prioritizing this energy dense, you know, quick energy foods, right? Processed foods, refined sugars, things like that. And so then you get these cravings for those foods. And it's like this vicious cycle. And you mentioned fatigue and that's really kind of in this mix as well because the visceral fat, we talked all about how it causes acute insulin resistance and we can definitely get into the actual insulin resistance like, you know, not just like cute after a meal, but it actually causing insulin resistance in a minute, but um I want to
8:30 talk about fatigue because you mentioned it and it's really important because this visceral fat is also producing inflammatory cytokines. It's producing inflammatory molecules. And so it's activating your immune system at like this low level. So if you think about like anytime you're sick, if you're fighting off a pathogen, whether it's a virus or a bacterial infection, like what's the first thing that you notice? Well, you're fatigued, you're tired, you have no energy. Why is that? One of the reasons is because it takes an enormous amount of energy to activate your immune system. And so your body has this way of triaging energy to your immune system when it needs to be active, right? Because you want to fight off this, you know, viral virus or bacterial, you know, infection, right?
9:16 Um that's that's something that evolution wants us to do, right? Survive. So it requires a lot of energy and takes that energy away from everything else like your brain, right? So you're you're basically taking energy away from everything else to prioritize the activation of immune system. And that's why low level chronic inflammation is a drain on your energy system because it takes all that energy away from everything else. And so that is you know, these are some of the I would say like the acute problems of visceral fat. This is something that people that have more visceral fat would probably notice on a day-to-day basis versus some of the longer term problems we can talk about like cancer, right? You can't really feel cancer, but you can feel fatigued,
10:02 you can feel an energy dip, and you can feel cravings, right? So, these are I would say some of the common problems of this role fat, and it's a cycle, too, because the visceral fat itself is you know, causing the inflammation, and it's like causing this acute insulin resistance, and making you where you're basically going to overcompensate, make more insulin, have the energy crash, but then you're going to like refeed with the very kinds of foods that are increasing visceral fat, and you're going to overfeed, right? Like you're going to eat you're going to consume more calories, and so it's just this vicious cycle of, you know, terrible eating, energy crashes, not feeling good, and then like, you know, gaining more visceral fat. Is there an argument to be had that visceral fat is almost a precursor to insulin resistance, or is it a two-way
10:48 street? Cuz I know that insulin resistance can definitely seemingly, if you look at the literature, seems like it contributes to visceral fat, but hearing you say this, it's almost like, which came first, the chicken or the egg? >> Yeah, it definitely is a a a cycle, for sure. Um the the uh visceral fat causes insulin resistance, like we do know that, because of the free fatty acids that I was mentioning, you know, the the visceral fat is making these free fatty acids constantly breaking down triglycerides with no stop signal. It's not responding to insulin. And so, your your fatty acids that are being made, they do, and there's all kinds of like you can get into all the molecular mechanisms without talking about all those pathways. It's a very it's it's a pretty much scientific fact that free
11:35 fatty acids do basically cause insulin resistance. They are antagonizing those insulin receptors, and so, your your organs are not responding to insulin like they should. Um so, it's definitely a cause of insulin resistance, and then it's a vicious cycle, as well. So um I would say both, for sure. For sure. Um if that answers your question, but, you know, the insulin resistance is the beginning of type 2 diabetes, right? So, we're talking what we're talking about with insulin resistance is that you're basically your body's not responding to a normal amount of insulin, and so your pancreas kind of dumps out, like I said, it overcompensates and dumps out more insulin to try to force the body to
12:21 respond, right? Force your liver and your muscles and your tissues to respond to the insulin to take the glucose up, because you don't want glucose sitting around in your your bloodstream and your vascular system. It's very reactive. It reacts with proteins through the Maillard reaction, and it forms something called advanced glycation end products, and these things are damaging everything. They're damaging the collagen that lines your blood vessels, causing hypertension. They're damaging the collagen that that lines your heart, the myocardium and the pericardium. It stiffens it, and it's like the major cause of the stiffening of the heart with age, and this is a huge increase for cardiovascular disease. And so, your body like wants to take the glucose up into your your tissues, like that's that's important, right? For health.
13:06 And so, um the problem is is that eventually the pancreas can't keep up. It can't keep overcompensating. Like at some point, this system this you run out of gas, right? Like you can't keep you can't it just can't keep up, and that's when you kind of tip into that type 2 diabetes, you know, realm, where it's like, okay, I'm not no longer just insulin resistant. It's you know, at some point it's like, now I now my pancreas can't even overcompensate. It's just like there's there's there's not enough in there to do it. So um the type 2 diabetes is like, you know, that's like when you really have reached like a problem, right? Where you're you've really like the visceral fat and the whole inflammatory cycle has gotten to that point where um it's gotten really, really bad. And then there's there's the the problem with the fatty
13:52 liver, right? So, you're you're constantly releasing these fatty acids, and as I mentioned, you know, the portal vein, it's going right to the liver, and the visceral fat is it's all in this same area. And so, what happens is, typically, you know, when you're giving fatty acids to the liver, it prioritizes those fats, right? So, the new energy coming in, the new glucose, whatever coming in, it's not going to be prioritizing that. It's it's got these fatty acids. What happens with the visceral fat is it's just constantly churning it out, and so the liver's like, what do you do with it? Like there's too much fat. Especially when it's in tandem with another meal, then you have this huge surplus right? >> Exactly. Exactly. And so, it starts to accumulate it around the liver,
14:38 and that is what we probably all have heard of. This is the non-alcoholic fatty liver disease, and this is also a really big problem, because, you know, over time, what happens is the liver starts to get inflamed as it accumulates that fat, and it starts to get, you know, fibrosis. And so, it's just like this vicious cycle of, you know, when you have an inflamed liver and a fibrotic liver, you're going to become even more insulin resistant. You're going to become even more less responsive to the glucose and the insulin, right? And so, it's just this terrible, terrible cycle, and really all coming down to stemming from this visceral fat. Visceral fat is really at the core of it. And it is a cycle, as you mentioned, right? It's not
15:23 it's not a one-way street. It's definitely a two-way street. They're feeding back to each other. Do we find that visceral fat is really just a proxy for liver fat, or vice versa? Or I guess what I'm asking is, can you have high amounts of visceral fat and not extraordinarily fatty liver, right? Like can you have this fat that starts to deposit without really being fatty liver, or is there like a kind of a quintessential sort of like, no, it's usually this ratio, like it starts in the liver, kind of spreads outward? Cuz I know we even have like myocardial fat, right? We have these things that can like kind of spread everywhere. Um is there any link there, or is it all pretty much epicenter at the liver? I I do think there, you know, li- at liver is the epicenter, for sure.
16:10 Um but yeah, it does start to spread around other organs through that portal vein, right? I mean, the portal vein is delivering the these fatty acids to to other organs, as well. Um the intestines, the the pancreas, but but the liver's really the epicenter of it, where that's like the the the start of it. And um you know, there there's studies showing that like you can take a healthy, so, you know, a dozen healthy young men. I mean, these are people that are young, they don't they're not, you know, they don't have visceral fat much visceral fat, they're not overweight, and you can put them on a this was a recent publication in Nature. You can put them on a very caloric dense, so they're consuming between 1,200 to 1,500 calories more a day,
16:56 primarily of processed foods. So, this is like refined carbohydrates, this is like high saturated fat, you know, this is like the combo of the saturated fat, sugar, like processed foods. After 5 days of eating this calorically dense, you know, very, very um energetic, you know, dense food, they will gain visceral fat, and particularly fat around the liver. So, their their livers start to get fatty, but they don't actually gain weight. Interesting. So, like they gain like a pound of weight. So, you wouldn't really know >> Yeah. that you're gaining that visceral fat, but, you know, unless you're doing, you know, DEXA scan or something like that. That's a no. And and and even at that point, the waist circumference won't work, cuz they didn't really gain
17:42 weight, but you are but they did gain the the visceral fat. And so, it just shows you that visceral fat is very responsive to dietary changes, particularly if you're talking about excess calories, and particularly if we're talking about excess calories in the form of refined high fatty foods. So, processed foods. >> is this a situation where calories matter, but we start to actually pay attention to macronutrient composition, or combinations of nutrients? You know, cuz it's like, yes, calories matter, but maybe there's a situation where hey, this is actually the composition of the food that you eat in also with some kind of caloric uh surplus really makes a difference here.
18:28 Yes, absolutely. Um the combination of the the refined sugars, so like sugar-sweetened beverage, you know, these these like really, really like high glycemic foods without a fiber matrix, I mean, it's just it's hitting the glucose is hitting the bloodstream so quick, and it's causing a pretty massive insulin spike, as well. Um and the thing about this is that and this kind of like segues into brain insulin resistance. Have you heard of this? >> Yes. Yeah. And it this, you know, people usually think about insulin resistance with respect to the liver, or they think about it with muscles. Um you know, they're not thinking about the brain. Well, the brain is also can become insulin resistant.
19:14 And that is terrible. So, typically, like the the brain responds to insulin for a variety of reasons, okay? And I'm going to answer your question, but that the it basically um when there's an insulin response, when insulin gets gets to the brain, it's a signal to the brain to, for one, stop eating. It's a satiety signal, right? It's like, okay, I I'm I'm full, right? And the other thing it does is that it is basically directing the rest of the body how to store the energy they just consumed, right? So, are we going to store it as subcutaneous fat, you know, this kind of fat that we can pinch, are we going to store it as this midsection fat, this like deeper belly fat, the
20:00 visceral fat? And the brain plays a really important role in like, you know, basically being the conductor, telling the body how to store that fat. So, um when the brain becomes insulin resistant, those signals go away, particularly in the hypothalamus part of the brain. You're no longer satiated after a meal, and even after a high-energy meal, you'll just keep overeating. You'll keep eating more. And the body doesn't know how to store the fat, store the energy, or use it. And so, what happens is you end up storing more visceral fat. And this is like this is known that people that are more insulin resistant in their brain, they they tend to to have more visceral fat. Well, it turns out that high sugar, high
20:49 sugary foods, obviously calorie, you know, dense as well, cause this insulin resistance in the brain. And this is also a new study. Actually, this is the study I was talking about is that they're they became insulin resistant in their brain. These were the healthy young men that ate the 1,200 to 1,300 calories a day, and it was refined refined foods. Um their brain became insulin resistant. And they accumulated, you know, fat around the liver, but they didn't really didn't gain much weight, like 1 lb. So, um you can actually cause your brain to become insulin resistant pretty acutely. And it does come down to those like really high-energy, like high-caloric, high-sugar foods that do that. Um you're not going to really see that if you're eating a plate of vegetables, you know, versus like a
21:35 bunch of cookies and cake and like high-fat, high-sugary foods. >> Yeah. And if the conductor is sending a distorted signal, then it really doesn't matter how many calories you're eating. It matters where it's going. Yeah, where it's going. And and we know it's going to that midsection, which is so bad. So, um I think I think it becomes this vicious cycle, too, because then you basically don't have that satiety signal. And so, people tend to start overeating more. Whether when And what are they going to overeat? They're going to overeat, you know, refined carbs and and Right, exactly. Because again, it all comes down to that again, you have these energy crashes, and then you get the cravings, right? And and you're craving the foods that are more going to give you the quick energy, because that's
22:20 what your body thinks it needs. It's like, I'm having a crisis right now, right? I am my blood glucose has gone too low, I'm crashing. I'm having a crisis. I need to replenish immediately. And so, you crave those those quick energy foods, processed foods. When it starts having that crisis, does that sort of tie into like the glucocorticoid receptors and the response with sort of stress and visceral fat? Like, does your body just sense you in this almost high-stress situation? Is that going to influence more storage into the visceral region? >> I'm sure it does. I mean, you know, stress itself, cortisol, does cause the body to store more fat viscerally as well. So, you So, basically, like if you're in a chronically stressed state, your body will tend to store more
23:09 uh visceral fat. And I don't know exactly why that is. I mean, there's some evolutionary hypotheses as to why visceral fat exist in the first place. And it's kind of I mean, again, this is hard to prove, right? But it makes sense. It's thought that um the reason that we store visceral fat, it's it's a stress response, because your your body's trying to protect you from like a puncture wound or something, you know, like some some terrible animal's going to come bite you or something, and it's protecting your organs. It's like a fat lining your organs, so it's protecting you. And it's some kind of protective response. Um which probably ties into to why when you're really stressed and your cortisol
23:56 cortisol goes high, it's like, oh, it's that time. We got to, you know, we got to store the fat around >> You're stressed and weak and vulnerable and prone to attack. We need to protect ourselves. We need to protect our internal organs. Um and this is super interesting, and I don't, you know, like I said, it's a hypothesis, but it kind of makes sense. No, it does. There's some other stuff They also talk a little bit about it potentially protecting against lipopolysaccharides, right? Like potentially from uh you know, inflammatory or pathogenic material coming out of the out of the gut, right? I don't know if that's Again, that's hard to prove, too. That's another discussion that people have on it, which it seems maybe to a small degree that would make sense, but I have a personally have a hard time imagining that like visceral fat would like diffuse a, you know, a major inflammatory storm that's coming out of the gut, but it's it's possible. I know
24:43 I know lipopolysaccharides do bind to um L- LDL particles. And that's through through um They they they're basically binding to like the apoB part of it, and that's partly thought to um negate some of that inflammatory response, which is >> Makes sense. Which Yeah, it makes sense, and that's why when you have inflammation, your LDL goes up really high. >> Ah, I didn't even know that. That makes sense. >> Yeah, your body starts to increase more VLDL, and then LDL goes up. Lipopolysaccharides binds to the LDL. Um unfortunately, because it because it's attracted to that apoB apoB protein on LDL is how your body recycles LDL through the liver. And it obscures the apoB, and so you end up not being able to recycle the um LDL
25:31 as well, which is why in the combination of inflammation and like high saturated >> going to say, cuz that's that whole cycle of you have to recycle the saturated fat and all that. Interesting. That opens up a Yeah, because it's that's a whole separate discussion, but it's uh it sometimes it's hard to have these discussions with the the the almost like two dogmatic diet tribes, where you still have to say even to the, you know, carb-insulin model people that like, hey, like high saturated fat is still problematic, like independent of itself. I mean, even like, you know, the new food pyramid still is actually addressing the fact that like high amounts of saturated fat probably not the best thing. Um that makes a lot more sense. >> Yeah. The the the storm is the saturated fat plus the sugar, because the sugar is causing that inflammation.
26:16 >> Yeah. And and then you've got the the the saturated fat increasing your lipopoly your your um lipoproteins, your LDL. And so, it's essentially like the perfect storm. And that's that's the the problem as well. Um But since we're talking about the, you know, the inflammation and the visceral fat, I mean, imagine it. So, if you have the visceral fat, you're getting you're getting this constant inflammatory signal as well. So, again, then you're taking in more saturated fat. Yeah. You've got the inflammation that's being generated. It's not good. What's also interesting is this inflammation, you know, it's it's not only having this acute effect on like your energy levels, right? Yes, it's an energy sink, because it's activating the immune system. It's also linked to cancer. And this has
27:03 been shown. So, people that have high amounts of visceral fat are 44% more likely to have a variety of different types of cancer, like the main ones, you know, colon cancer, pancreatic cancer, liver cancer. Um it goes on and on. And and that is because And even even when waist circumference is is considered, so even after correcting for waist circumference, the visceral fat itself increases cancer incidence. And you know, that's obviously human studies that have linked that, but there have been animal studies that have mechanistically looked at that and said, okay, what what what happens when we have an animal with visceral fat? Well, it turns out that the the inflammatory molecules, and they're
27:50 they're making quite a bit of them. They're actually transforming normal cells into cancer cells. They're actually causing normal cells to become cancerous. They're damaging They're damaging the cells. Um so, that is you know, over time, when you get enough damage, eventually you're going to get it in in a part of the cell that's going to lead to an oncogenic mutation. So, yeah, it's bad. Um cancer incidence, and then, you know, obviously just all-cause mortality is higher. So, people with visceral fat There's a variety of studies that have looked at this, and usually the studies are measuring waist circumference, which again, is a proxy for visceral fat. Not always, cuz you can have visceral fat, as you mentioned, and not have a large waist circumference.
28:36 But generally, if you do have a large waist circumference, then you're like, we're talking high levels of visceral fat, right? Um those individuals have a they're at any given point, they're twice as likely to die from like an early cause of death than people without this like a high waist circumference or visceral fat, right? So, you know, visceral fat, it's it's linked to all kinds of problems, you know, problems in in the way we feel on a day-to-day basis, but also like long-term disease risk, you know? So, it's it's something really important to focus on. I mean, I think I think it's something that people really need to be aware of, like how bad it is. It's not just a cosmetic thing, you know, we're so concerned with looking good and not having And and people are with their subcutaneous fat, that's what they're
29:23 kind of focused on. It's It's that belly fat. It's that visceral fat that's deep, and not not even necessarily showing as belly fat in some people, right? For sure. That's the problem. Um so, it's good to have these conversations and um to educate people about that, because, you know, it's not It's not something that people really know about. No, and the the good news is, I mean, I know we and we can talk about this, is that yes, it stores fast, but from the literature I've seen, it also goes away fast when you do the right things. You know, it's I think sometimes like you're looking at the actual like cubic volume of this visceral fat. And granted, you absolutely can have a large volume of it, but as a mean so in terms of volume compared to the overall adiposity we carry throughout our body, there's not a whole lot of it compared
30:08 to that, right? So, it's easier to lose it, easier to lose it, right? With the right sort of lifestyle intervention. So, I definitely want to get into that now. Like what are some ways that we can start kicking this stuff down? Yes. Visceral fat, the good news is is that you can lose it, you can reduce it, you can reverse insulin resistance in the brain, you can reverse insulin resistance in the body, you can you can reverse fatty liver, right? So, that's the good news. Um how do you do that? The number one way is exercise. Exercise will help you lose visceral fat. What type of exercise? That would be cardiovascular exercise to in the moderate to vigorous intensity
30:54 range, high intensity interval training at the top. I mean, there are tons of studies out there looking at people that do dietary changes or exercise, comparing the two, and you can you can make a dietary change. In other words, like you can start to eat a little bit healthier, but that's not necessarily going to make you lose visceral fat, particularly if you're not reducing your calorie intake, if you're still kind of consuming the same amount of calories. Exercise is the one that's going to do that. I mean, even even people that don't lose weight can lose visceral fat. Like there's studies out there, multiple studies showing that. Like if you you're engaging in routine aerobic exercise, we're talking jogging, running,
31:39 swimming, cycling, and then I as I mentioned, high intensity interval training, we can dive more into that, but those people will lose visceral fat even without losing weight, right? And you lose the most amount of visceral fat early on any sort of exercise program or even weight loss program, something that would be a calorie restricting type of program. And I don't that will be next on my list on how to lose visceral fat. But um there have been a variety of studies looking at the types of exercise and what's best and what's the frequency and what's the dose, right? Like what what are all these parameters that you need to consider to really lose the visceral fat. And I think it's pretty clear to me after reading, you know, the the exercise literature, looking at, you know, visceral fat loss, that you you
32:25 really need to, if you're doing more of a moderate to vigorous type of continuous exercise, so that would be like the jogging, the running, the cycling, the swimming, probably need to do about 3 hours a week. That's that's that's like a good dose that if you look at the literature and combine sort of like multiple studies, 3 hours a week of that often times like three sessions a week, so in some cases people will be doing an hour. Now, you can break that up ever you know, you could do 5 days a week, right? Do like like shorter sessions. But it does seem like if you're in that moderate to vigorous exercise zone, like 3 hours a week. And then if you're wanting to do if you're doing more of the the vigorous, high intensity interval training in the
33:11 vigorous, you know, you can pretty much cut that in half. So, you know, an hour and a half. But even even study there are even studies showing that high intensity interval training, so we're talking about the kind of exercise where there's a lot of protocols out there. I mean, you can do um you know, the a minute a minute on minute off where you're going as hard as you can for that minute. Obviously, you're not going to be going all out. Um you can do like Tabata, 20 second on 10 second off. You can do even circuit training. Circuit training is a type of interval training, right? CrossFit training. It doesn't you can whatever works best for you. High intensity interval training, it's been shown that you can even do 30 minutes or less than 30 minutes three times a week and lose visceral fat. And high intensity interval training, when you
33:56 compare it head on to even moderate getting into that moderate to vigorous intensity continuous training zone, high intensity interval training wins. When when with respect to losing visceral fat. The best of both worlds is you do both. Like you combine, right? Like you do some hit and you do some of this like moderate to vigorous or running cycling swimming whatever whatever's your jam. You got to make it consistent, that's the key because um you you have to be consistent about the exercise that if you stop exercising, you'll stop you'll you'll, you know, you won't continue to lose visceral fat. Um and that's really important because people that are trying to actively lose it because they have it, you really have to stay on that program. So, make it a part of your personal hygiene.
34:42 Do whatever is like that appeals to you and and make sure you're consistent with it. Resistance training is a big question people have. That's another type of exercise. It's important. You want to gain muscle mass, you want to maintain muscle mass, you have to engage in resistance training to do that. Very important for longevity, right? I mean, you've talked about it, you know, >> For sure. Yeah. Yeah, I've talked about my podcast. It's a very very important for healthy aging. However, when it comes to visceral fat loss, it's a little bit um there's some nuance there. So, what I've seen in the literature is that, you know, people that are younger, they're not going to lose visceral fat on a resistance training program alone. And that has been a head-to-head comparison with aerobic training. So,
35:29 people that were doing aerobic exercise versus resistance training, I'm talking younger adults, they only lose the visceral fat if they're on the aerobic exercise program. The resistance training alone didn't didn't And we've all we've all been to the gym and seen the gym rats, great muscles, they're they're yolked, they got the belly fat, man. And it's like, you know, um you have to add in that aerobic exercise. Where I've seen positive effects with resistance training and losing visceral fat is with middle-aged adults, particularly postmenopausal women. And that to me makes sense because when we get into the causes, we can talk about some of the causes of visceral fat. We've kind of touched on it, but there is an age-related cause, particularly with the when it comes to
36:15 hormones. So, women before they're perimenopausal, before they're postmenopausal, they have a lot of estrogen that they're making throughout their cycle. Estrogen does tell the body to store fat subcutaneously. So, women that are, you know, premenopausal will have more subcutaneous fat than visceral fat. As soon as they hit perimenopause, as soon and then and then eventually menopause, where does it start to hit? Belly, right? And any woman that's gone through this knows it, you know, that's that's the thing, right? Um because you you no longer have that estrogen signal there telling your body to to store the fat subcutaneously rather than viscerally, right? Rather than than around your organs in the midsection.
37:01 And so, um where this comes in is resistance training. Testosterone also does Testosterone actually causes the body to burn visceral fat at a higher rate. And so, men don't have as much of an issue with visceral fat. Although as they get older and start to their testosterone does decline, they do start to more easily gain visceral fat. And this is probably why you'll see the statistics out there, 50% of men over the age of 50 have a high amount of visceral fat, 70% of women over the age of 50 have a high amount of visceral fat. Um getting back to the resistance training, I think there's a hormonal component in there as well. And that's why postmenopausal women are more responsive to it, right? Like you are
37:47 increasing testosterone when you're when you're working out. When you're young and you have a lot of testosterone already, like the amount that you're increasing probably isn't making much of a difference with what you're already making. So, Yeah, that makes sense. And I'm sure androgen receptor density plays a role, too. Like what's what's actually able to bind, right? And actually have a binding site versus just like circulating and converting to DHT and making you bald and, you know, it's there's all those other The other thing that's kind of interesting is that I feel like resistance training it might be hard to get like a cohort on this entirely because I bet you there is a play where resistance training helps as a glucose sink for sort of the downstream effects of visceral fat. It might I would imagine, if I could guess, you probably hit a little bit more of a
38:32 ceiling if you have some muscle mass on you with visceral fat. Like it's probably a little bit harder to get to an extreme amount of visceral fat because you at least have a sink for excess glucose to stop that sort of spiral or at least attenuate it a little bit. >> Exactly. And that's where the key is combining them. Like if you're doing some sort of aerobic and or high intensity interval training and resistance training, I it's going to amplify it, for sure. Like you mentioned, you are you are making your muscles more responsive to glucose, you are making them more sensitive to insulin with resistance training as well. And so, it's going to it's going to amplify that as well. So, there's definitely a role, I think, for resistance training in a visceral fat loss program. I just think that like really making sure you're hitting some of that more vigorous intensity aerobic
39:19 exercise, high intensity interval training is really important there. And like you said, circuit training, too, right? Like you can do you can Yeah, incorporate it. Right, like with CrossFit, right? So, that like you are getting you're getting that aerobic as well as you're activating your muscles and getting that resistance training as well. Have you heard I'll just interrupt you for one second. Like I got the cuz this is I know we both kind of are we enjoy that style of training. There's this Have you heard of the the interference theory? Like where they They used to think that if you were to combine cardio and resistance training that they would like impede one another. Like they would actually And there was some I can't remember where it was published. It was I think in 2023. It was like completely debunked the interference theory where essentially if you are if you're trying to get to like total like submaximal lift, it's a different
40:05 story. But for the most part, intertwining cardio with your actual resistance training doesn't seem to reduce your output that much on your resistance training. Not to any measurable degree. So I think sometimes we I'm just going to call a spade a spade. I think people like endurance cardio because it's kind of easy. Sometimes, you know, it's just easy to hop on there like you can just do it. And I think I can speak for a lot of men same with resistance training. Honestly, like if conventional resistance training if you're training like Dorian Yates or something like that, it's a different story. But if you're, you know, going to the gym and you're a gym bro and you're resistance training, look me in the eyes and tell me that you're it's really, really hard. You know, it's Trust me, I've been there like it's That's not the hard part. The hard part is the consistency.
40:50 But you ask them to do some kind of high-intensity interval training, that's hard, right? So being able to like intertwine that with resistance training, it would make sense in your mind. You think, "Well, this is going to prohibit me from being able to do my maximal lifts." And that might be the case psychologically. But hopefully this clip right here is enough satisfactory people to say like, "No, it actually doesn't impede." Like if you have adequate recovery. If you say, "I'm going to go do a sprint session and then I'm going to recover for a couple of minutes and then I'm going to go bench press." Like you should be able to bench press within like, you know, 10% of your max. Yeah. I have Yeah, I've talked to you Brett Show and followed about that. Yeah. And it's yeah, for sure
41:36 I think I think that myth has been debunked. Like you said, you're not Maybe maybe if you're if if you're like some elite athlete that's trying to like powerlift or something. Right. Different story. But different story. >> Yeah. And and and for for if anything, you know, the aerobic exercise actually helps improve the recovery. It's bringing It's bringing, you know, all the goodies to the muscle which is important for recovery, right? Blood flow. So Um Not to mention combining You said you're doing the high-intensity interval training and then also doing your lower moderate aerobic work. That allows you by building that base of you know, zone two, zone three sometimes. It actually allows you to get more of that post-exercise oxygen consumption fat burning that you get from your hit. So you actually help yourself out with your hit. It makes your hit more effective for fat loss because you're actually able to go into,
42:23 you know, oxidative phosphorylation in a little bit better after a workout. So all the reason to combine them. I mean there's there's there's no reason not to. Um I would say the second major um way to lose this role fat, that was like the first and we definitely went on went on for that. I would you know, in in my opinion from reading the literature, this the the next major lever to pull would be calories, calorie intake. And so pretty much any weight loss program will help you lose visceral fat. Like I said, the most amount of visceral fat is actually lost early in a weight loss program. So anything that's going to restrict calories, whether it is
43:08 counting calories or it's intermittent fasting, time-restricted eating, even pharmacological treatments we have now like GLP-1 receptor agonists, Ozempic for example. Anything that's going to reduce your calorie intake will also reduce visceral fat. And in fact, you know, it does Food composition's important. Like you do want to eat healthy during that period of of eating if you're intermittent fasting for example, because as I mentioned, the brain insulin resistance can happen pre-acutely and certainly when you start to eat a lot of like high glycemic foods without the fiber matrix that are refined and fatty, that is essentially, you know, blunting the insulin response in the brain. And
43:54 so you're basically going to start over-consuming more, right? Um But there's this interesting study that was done. It's called the Carb-F UNC trial, Carb-F UNC trial. And this trial was looking at the different types of diets. If you calorically restrict, so they're isocaloric. In other words, all three of the diets in this trial had the same amount of calories and these calories were, you know, restricted. So they're basically like eating fewer calories than they would, right? So it was a calorie deficit that they were in. But the different diets were the first diet was more of a refined carbohydrate diet, although I would say the refined carbohydrates were like grains, not cake and sugar. So different kind of refined in a way.
44:42 The second diet was also a higher carb diet, but it was more of whole food type of carbs like vegetables and fruits. And then the third diet was a low-carb, high-fat diet. And again, all three diets, they were isocaloric. So they were all people eating these different diets were consuming the same amount of calories. The key was they were in a calorie deficit. And guess what? All three diets caused loss in visceral fat. There was no big differences that were statistically significant between the three, which was a bit surprising. You think, "Oh, maybe the higher grain diet would, you know, you wouldn't lose as much visceral fat because it's like more refined." But it was really the calorie deficit that was the most important. And the fact that they were in that calorie deficit
45:27 was was the key to losing visceral fat. So I think that the crux of the story here is that whatever way you like to reduce your calories, for me, I like to do intermittent fasting. Um I like to skip one meal. Um that that works for me. So if I skip one of the meals of the day, that that is how I reduce my calories. As long as I can make sure I'm eating a good, healthy, balanced, you know, diet when I am eating my meals, then I'm good. Um some people like to just like count their calories. Like I know like, you know, some people like to do that. Whatever works well for you, that's what you should do. And if you can be in that calorie deficit, that's going to help you lose the visceral fat.
46:14 Um that's the next I think biggest lever that you can pull. Now, when it comes to diet composition, it's not like it doesn't matter. Because you will if you are eating the refined carbohydrates as I mentioned, 5 days of eating a high high carb, high saturated fat. And when I say that, that's essentially processed foods. Processed Any You go and go to any like processed food package, you know, it's high in fat and it's high in in refined sugars. Like that's that's that's the the selling combo. It tastes good. Um that that is going to cause insulin resistance in your brain after just 5 days. And that's basically going to make you overeat. You're going to overeat because you're not going to have the satiety signal. You're going to start to store visceral fat because your
47:01 your your hypothalamus part of your brain isn't responding to insulin. So it's not communicating to your body how to store the fat, right? Or how to store the energy that you're consuming. So it's it's it's it's kind of a a What I'm trying to say here is that diet plays a big role in Diet composition does play a big role in the cause the accumulation of visceral fat um versus losing it. You do have to be in a calorie deficit. You can't just take, you know, change the composition of your diet. Now maybe you'll stop gaining more of it. So it stops that cycle of gaining more of it. But like to lose what you already have, you have to be in a deficit. Right. Like that makes sense right? >> Yeah. I'm trying I hope I'm explaining this well because it's a little nuanced, right? Yes. Diet composition plays a
47:47 role in the ability to produce and accumulate visceral fat. It's sort of a cycle, but Yes, it's a cycle. Right. But if you only change diet composition and not your calorie intake, it's going to be hard to lose that visceral fat. You need the exercise. You need to be in that calorie deficit as well. Um and then there's some other factors that play a role. I would say sleep is up there. Believe it or not, there've been some studies looking at sleep deprivation in the in the form of restriction and how it affects visceral fat accumulation. So um Most of the studies are done with college students. They're always like healthy young men. Yeah, it's like the standard um participant that you're going to get, right? Is a healthy young men. So healthy young men that were
48:34 um this was an interesting study. I think it was like published in 2022. It was a small study, not not like a huge number of of men that were in the study. But it was about 21-day study. And for two of those weeks, the two two weeks, these these men were put on a sleep-restricted, you know, schedule. So they were only allowed to sleep for 4 hours a night versus like 9 hours a night. And this was 2 weeks. And after those 2 weeks, the these men had gained like 11% visceral fat. And they essentially gained like no weight. Like you you wouldn't Nothing reflected on the scale. Maybe like a pound. Again, you know, it's like the pound. But like I I gained a pound in a day. I'm like, you know, Yeah. So so really no weight gain, but they
49:19 gained visceral fat. And then when they were put back on a normal sleep schedule, 9 hours, they still were accumulating visceral fat for the short term. It like took a while for the body to like recalibrate. Now it wasn't that they lost the visceral fat. It's just that they stopped gaining it eventually. So, sleep plays a really important role in the accumulation and like your body's ability to actually accumulate visceral fat. So, you can imagine it as an amplifier. I like to imagine it as an amplifier along with your diet and your exercise routine, right? So, making sure you're getting good quality sleep is important. If you're constantly sleep deprived, I mean, think of people that are shift workers, firefighters, for
50:05 example. I mean, they're going through these periods that where they're absolutely getting no sleep for days, right? And so, they're very prone to this visceral fat accumulation. So, they have to have the exercise dialed in, they have to have the diet dialed in as well because it's it's it's they're definitely more susceptible to it. So, I say sleep um sleep alone, getting good sleep isn't going to make you lose the fat. What I'm what I'm getting at is that if you're chronically sleep deprived, you're going to be more prone to gaining visceral fat and that's an important distinguishing factor here, right? >> Do you Do you think it's more to do with the If we get into the mechanisms, is it more to do with the stress or is it the fact that there is a cuz we do know from the literature pretty concretely that you can have even acute insulin resistance that comes as the result of
50:50 even one night of poor sleep. Yes. I think it has to do with both. I think the biggest factor here, and this is a great question, Thomas. You can have, you know, acute insulin resistance happen after even one night of like like like sleeping 4 hours. So, that is because your body, you know, there's a variety of factors going on, but you do become less sensitive to insulin from sleep deprivation. You're also um going to eat You're going to overeat. And this is These studies have been done as well. People that are even, you know, again, one night and then you extend that to three nights and it's exacerbated, right? Three nights of like getting 4 hours of asleep 4 hours of sleep a night. Um it's pretty
51:35 detrimental because you become acutely insulin resistant and you start to have these cravings for high energy foods. And so, people start to overeat and and they tend to overconsume calories as well. Without They normally wouldn't do that. It's just It's the sleep deprivation that's doing it. So, it's this It's that cycle where you're acutely becoming insulin resistant, right? And you're consuming more food. So, it's kind of starting that cycle of the visceral fat accumulation. And then you have the stress response and the cortisol as well, right? So, that's like they're all It's just this perfect storm of factors. But um yeah, great question and I I'm so glad you you touched on that. For me, I wore a continuous glucose monitors for
52:21 for years and and when I was a a young new parent, um actually I wasn't that young, but when I was a new parent, I immediately noticed my my blood glucose regulation was crazy off. And if I had done an insulin resistance test, I'm sure I would have acutely been insulin resistant. And I had to do high-intensity interval training to like negate that. And it really really almost completely negated it almost. I mean, it was it was insane. You know, cuz like the first month or so like for a woman, like you're not really exercising much. You can't. Like you're recovering from like a very traumatic event in your body. So, um that's when I noticed it the most, you know, when I wasn't exercising. And so, um sleep is so so
53:08 important for glucose regulation, for insulin sensitivity, and for the accumulation of visceral fat because that at the end of the day plays into it, right? It You will start to accumulate fat when you become insulin resistant. Again, coming back to that question of yours, the chicken or the egg. It is a two-way street. They're they're they're both doing the same thing. Visceral fat causes insulin resistance, insulin resistance causes you to accumulate more visceral fat. So, it's this vicious cycle you have to break free from. And how do you break free from? Exercise, vigorous intensity, hit, you know, getting good sleep, getting in a caloric deficit. You have to do that, you know, if you're really trying to lose it if you have it and you're trying to lose it. Diet composition. And then again, these other levers like stress, you know, whatever For me, um I like to exercise that helps
53:55 me with my my cortisol, my stress response. A lot of people have I mean, we live in a stressful time. You go on social media and it's like like that's the algorithm. It's designed to stress you out, right? It's designed to like alarm you. So, we're you know, whatever you can do, whether that's meditation, whether it's prayer, whether it's exercise, whatever routine that you can stick to that helps you, going out in walks in nature, exercising in nature. Like all these things can help lower cortisol. And um that's another lever to kind of like amplify all these other effects, right? That we're talking about in terms of lowering >> Totally. lowering our visceral fat and decreasing our visceral fat. I mean, this is really important for people that do have visceral fat. Like you have to get rid of it. For those of us that are like
54:42 we're already we're already doing these things, you know, we have to keep doing them so we don't gain it. And especially as we get older, you know, for me, I'm a middle-aged woman. As as like, you know, you start to approach middle age, again, it's going to be easier and easier for your body to start to store that that visceral fat. So, and that's again because of the hormonal changes that are happening. People also get more sedentary as they get older. You know, there's all all sorts of things. You also have I mean, flat out just more damage associated molecular patterns as you get older. You have just more just, you know, age-related inflammation that's just circulating, right? For for most people. And I think that's a contributing factor. Cuz when you look at insulin resistance, you look at brain insulin resistance, you look at any kind of mitochondrial dysfunction or syndrome X or any of that, they're all
55:27 inflammatory conditions, right? of the day. It's like I I always encourage people when they're looking at insulin resistance, I'm like, this is not a problem with eating too many carbohydrates. This is an inflammatory problem and your response to carbohydrates is just a side effect of it. The carbohydrates may have been part of the cause, but it's the end of the day, this is a big overarching inflammatory issue. And it sounds like, you know, visceral fat kind of ropes right back into that. It's like we need to get this inflammation under control, which I think it would help if people understand maybe what some of the causes uh visceral fat. We can also talk about causes of of inflammation, too, cuz I feel like that's something that might be interesting to kind of tie in together. Yeah. You know, and with respect to the causes of visceral fat, and we've been discussing some of them already. When I
56:15 obviously obesity, overweight, like all those things, insulin resistance, like those those things do feed into to causing more visceral fat. But the diet composition does play a role here as well as I would say the diet composition it's it feeds into the excess calorie intake, too. Because when and I I like to go back to that nature study. When you take these healthy young men and you're giving them these processed foods, which are calorically dense, right? So, you know, they're they're eating they're eating more of a calorically dense, but very high-fat, high-sugar diet, you cause the brain to become insulin resistant in 5 days. Yeah. That's nuts. It's nuts. And what happens is without even actual weight gain other
57:00 than a pound, you're accumulating visceral fat and fat around the liver. This was This was in healthy young men, right? So, I do think diet composition, if we're thinking about causes of of visceral fat, we have to take up and think about the brain and the role of the brain in this because, you know, the brain at the end of the day is really important for satiety signals. And if you are not getting those signals, then you're going to overeat. When you're you're supposed to be full, you're not going to be full. And your body's then going to store that energy in the wrong place, right? It's going to store it as visceral fat versus the subcutaneous fat. So, I think that um diet composition is important there. And then you have to
57:46 also realize that when we're talking about brain insulin resistance, yes, it it it it's it it causes your body to accumulate visceral fat, but it also is associated with inflammation in the brain. It's associated with, you know, insulin is an important signal to the to the neurons in your brain to grow. It's anabolic, you know, like just like in muscle, right? It can be anabolic. And it's also important for neurotransmitter signaling in neurons. And when you take that away in the in the case of insulin resistance, when the the neurons aren't responding to insulin, so it's like the insulin's not there, your your neurons, they don't have that purpose, right? They they start to
58:31 atrophy and die. >> Yep. And it plays a role in neurodegenerative diseases like Alzheimer's disease. Um it plays a role in the accumulation of some of the pathological features of Alzheimer's disease like amyloid beta plaques. So, I know I went on a tangent here, but it all becomes it all comes down to because uh you can acutely cause insulin resistance in the brain in such a short period of time from diet composition and calorie intake, you know? And they're kind of intertwined because if you're eating refined processed foods, these ultra-processed foods, you are going to consume more calories. Yeah. For one, because they're calorically dense. For two, because it's completely disrupting the satiety signals in your brain. And so, you want to eat more. And that study was done by Kevin Hall, right? Where you
59:17 you basically like give people like free access to the food and if it's processed foods, they will consume 500 more calories on average a day than people that are given whole foods, right? And that's because you're not getting those satiety signals. >> Which is crazy. That's a pound of fat a week right there. 500 calories a day. But but but like it I think I don't remember. Is that how much weight they gained in that study? Well, I'm just it's like if you were to consistently do that, 500 extra calories per day, you know. >> but think about the visceral fat. It's more. It's more. Like I just mentioned that study, they were consuming they were consuming almost 1,200 calories a day and they only gained a pound of weight after 5 days. This is like This is we're talking visceral fat gain is happening before that weight gain. It's happening and you don't know it's happening and
1:00:03 it's not that you can't ever cheat, especially if you exercise because that's like the that's going to help negate everything, the exercise, right? It's going to help make you insulin sensitive. It's going to help you take up the glucose. It helps with the satiety hormone signaling, all that stuff. It's like the it's like the the cure, the panacea, truly. So, it's not like you can't cheat and have some like, you know, processed foods. It's that you can't eat them every day and you certainly shouldn't be eating them if you're sedentary. If you're sedentary, my goodness, like that's that's that's like the worst combination ever. But even people that are like sedentary, but they're like, I don't eat, you know, I I try to follow a whole foods. Well, that's great.
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