Fat: Location, Location, Location Matters

Andrew Siegel, M.D.     Blog #74


We all have body fat; even elite athletes have a body composition that is a svelte 5-10% fat—this translates into roughly 10-20 pounds of fat for a 180-pound athlete.  What is important is that all fat is not created equal—where the fat accumulates in our bodies dramatically effects how that fat behaves.  So, the very location where your fat takes up residence has a tremendous influence on your health.

Fat on our body surface is much less problematic than fat deep within our body. Humans have two basic types of fat: subcutaneous fat and visceral fat. Subcutaneous fat—also known as “love handles,” “spare tires,” “muffin tops,” or “middle-age spread”—is present between the skin and the abdominal wall. When present in normal amounts, it gives us nice contours and makes us look less bony and skeletal and more smooth and curvy. When present in excessive amounts, it makes us look plump, roly-poly and pear-shaped. A moderate amount of subcutaneous fat is of little danger to our health and, in fact, provides us numerous advantages including padding and insulation to conserve heat and help with temperature regulation, a means of storage of fat-soluble vitamins, and a ready source of energy. Visceral fat—also referred to as a “pot belly,” “beer belly,” or “Buddha belly”—is internal fat deep within the abdominal cavity that can make us apple-shaped.  It wraps around our internal organs including our liver, kidneys, and pancreas. Visceral fat is always unhealthy fat that can have dire metabolic consequences. In general, waist circumference is a reasonably good measure of visceral fat. (Of course, morbid obesity due to either type of fat can prove extremely  dangerous to one’s health.)

It’s kind of like real estate, the value of which is predicated on location, location, location. Think of visceral fat as prime, expensive beachfront property on the gold coast with a short walk to the ocean, the ocean of metabolic disasters.  Think of subcutaneous fat as less expensive, inland property, quite removed from this ocean of metabolic disasters.  Clearly, visceral fat is fat that behaves badly and fat that is strongly desirable to avoid.

In many ways, the distinction between subcutaneous and visceral fat parallels the distinction between good fats and bad fats in our diet.    The not unhealthy one or two inches of subcutaneous fat that you can pinch around your waistline can be thought of as a good fat such as the fat in olive oil, avocados, or nuts.   On the other hand, the unhealthy visceral fat that causes a man to have a big protuberant abdomen—creating an appearance not unlike a very pregnant female—can be thought of as bad fats such as the partially hydrogenated fats present in vegetable shortening that are commonly used in fast foods and other processed baked goods.

Visceral fat storage is not static but dynamic, meaning that there is continuous mobilization of our fat (as fatty acids) and storage (as triglycerides).  Lipolysis is the chemical reaction in which the fat is broken down into fatty acids that the body can use as energy. This can occur very readily in visceral fat. Likewise, accumulation of visceral fat can occur in a very rapid fashion. Excessive intake of calories will be rapidly stored as visceral fat, whereas under circumstances of a reduced calorie intake, the visceral fat is broken down to provide fuel for our bodies’ metabolic processes, particularly muscle contraction.

Visceral fat is not just a bland collection of fatty tissue sitting inertly within your belly causing an oversized appearance to your abdomen.  It is an extremely metabolically active endocrine organ with a life of its own.  Fat is the largest endocrine organ in our bodies and it releases a myriad of pro-inflammatory factors, hormones and immune cells that can affect metabolism and other bodily functions. Fat has an abundance of the hormone aromatase, which converts testosterone to the female hormone estrogen.  One consequence of too much fat in men is excessive conversion of testosterone to estrogen. Men with plentiful visceral fat often will bear the consequences of lower testosterone and higher estrogen levels, including sexual issues and breast development as well as numerous other negative consequences of insufficient levels of testosterone.

Visceral fat is intimately connected to the inflammatory process and can result in insulin resistance, metabolic syndrome, cardiovascular disease and an entire array of negative health ramifications, including chronic diseases such as arthritis and cancer.  This is in contradistinction to subcutaneous fat, which produces far less inflammatory chemicals. Since men have a tendency towards visceral fat collection whereas women have a tendency towards subcutaneous fat collection, this might explain why women are less susceptible to cardiovascular disease then men are.

Insulin is the principal regulator of fat metabolism. After a sugar and carbohydrate load, insulin is released to get the fuel into our cells. When we go without food, as happens when we sleep, insulin levels decrease and fat is released to be used as fuel.  Insulin levels are determined primarily in response to our carbohydrate intake in order to keep our blood sugar regulated. Insulin has much to do with the way our bodies store or burn fat. You can think of insulin as our fat hormone—when insulin levels are elevated, we accumulate fat; when levels are low, we burn fat for fuel.  So if you have a substantial collection of visceral fat, it becomes highly desirable to reduce sugar and refined carbohydrate intake to decrease insulin and burn away that bad, pro-inflammatory fat as fuel. The good news is that by losing abdominal fat, the potentially bad health repercussions can be reversed. The dangerous visceral fat submits relatively easily to diet and exercise whereas the less harmful subcutaneous fat at the waist is more stubborn and resistant to reversal measures.

How To Burn Fat:

  • Eat in accordance with nature’s design—meaning whole foods.  Avoid processed foods.  The best diet is an “anti-processed-atarian” diet.
  • Avoid “naked” calories (stripped of fiber), so restrict sugar, simple white carbohydrates, and liquid calories. Specifically avoidsugared drinks, white pasta, white rice, white bread, doughnuts, bagels, potatoes, etc.  Aggressively steer clear of high fructose corn syrup.
  •  Eat high-quality, whole-grain, high-fiber carbohydrates (whole grain pasta, brown rice, whole grain breads, legumes, whole fruits and vegetables), lean protein sources (easy on meat and dairy) and healthy fats (vegetable and seafood-origin).
  • Avoid giant meals in which the caloric load will be stored as fat; substitute with multiple smaller meals in which the calories will be used for immediate energy.
  • Limit after dinner snacking since unnecessary calories at a time of minimal physical activity will be stored as fat.
  • You must incorporate exercise into your lifestyle, achieving balance between aerobic, resistance and core workouts.  Aerobic exercise has great potential in burning fat for fuel and interval training seems to really rev up our fat-burning capabilities.
  • Portion control is the name of the game: in order to burn fat, energy intake must be less than energy output.  Even if you eat only the healthiest of foods, if calories in exceed calories out, you will not burn fat for fuel.
  • Minimize stress; if you can’t eliminate it, work to manage it.
  • Get adequate amounts of quality sleep.  See my previous blog entitled “Sleep To Slim” to find details: https://healthdoc13.wordpress.com/2012/07/20/sleep-to-slim/

The bottom line is that while body fat in any excessive amount is unhealthy and unattractive, it becomes a potentially life-threatening issue depending on its location in our bodies.  An enormously protuberant belly can lead to processes that result in disease—and even death.

Andrew Siegel, M.D.

Author of Promiscuous Eating: Understanding and Ending Our Self-Destructive Relationship with Food


Now available on Amazon Kindle


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