Dr. Max Gulhane - 'Identifying & Eliminating Visceral Fat for Optimal Health'

[Music] [Applause] the topic of my talk is today is identifying and eliminating visceral fat for Optimal Health so what what's the purpose of of human optimization or or lifestyle medicine as I see it well it's to help my patients of the the longest uh most active and fulfilled lives possible and it's to help them to do that by identifying the most significant and modifiable biomarkers for improving health what this means is there needs to be something that we can tell you that you can improve on that we can measure easily and give you actionable uh advice to address and I think uh and this is obvious that uh lifestyle is always going to be the way that we address this uh most optimally for a life a disease caused by a lifestyle so again let's think about that ladder you're either dying you're surviving or you're thriving and I I really think that most people if they're eating a standard Australian diet and they're exposed to a standard Australian light environment they will definitely just be surviving but what we want to do is identify the biomarker that is keeping you there and preventing you from getting to the next level so what what we were used to well this was this is the Peak Performance this is what uh we we evolv doing and there was no hospital there was no um this guy didn't go see a GP at all but uh he was in Prime Health and again that's where we're at collectively so the question is what is appropriate for our based on our biology and what factors can we address uh particularly to identify why we're here instead of there I want to talk and this topic will be about visceral fat so what is it why it's so harmful why you might consider getting an MRI scan and what factors will be causing the deposition deposition of visceral fat and perhaps how can we get rid of it so I I want to start by explaining that not all fat is the same there subcutaneous fat which lives underneath your skin and it secretes a whole bunch of very important hormones and it's it's a a very hormonally active tissue but but its role in the body is is energy storage in a physiological way so it is uh very very uh useful and it's metabolically benign we also have some brown fat again this regresses as people get older and babies have a lot of it but the role of that is to to uh uh generate heat and a third type of fat uh which of which visceral fat is a prime example is a pathological type of fat and this lives deep inside the abdomen so you can see the subcutaneous fat is going to be under the skin visceral fat is is inside the abdomen and all these different types of fats have extremely different uh effects both on on inflammation metabolism and how the body is operating so visceral fat is a form of E what's known as ectopic fat so what is ectopic fat it's fat that occurring in an abnormal position or in an abnormal manner or form as I said it's a problem and it's secreting what are known as very pro-inflammatory cyto which are molecules that inflame the immune system and cause inflammation in the body it also secretes substances that increase the likelihood of of blood clotting the presence of ectopic fat represents a fundamental dysfunction in your body's ability uh to deal with energy and and Metabolism I likened it to a dumpster fire viseral fat is the dumpster fire inside your body or or the or the radioactive spill either or you can take your pick the the visceral fat is is not the only type of ectopic fat so it it is the the one that I'm going to be talking mostly about because it actually is aoxy for other sites of this of ectopic fat so we've got fat inside the liver which is uh known as hepatic steatosis we've got fat around the heart pericardial fat we've got fat inside the muscle uh known as myosteatosis and there's even ectopic fats in the upper Airway uh and and the tongue so what does this look like well the best way to understand and visualize different types of fat is through an MRI scan or a CT but MRI doesn't involve radiating you so what what what we can do is we can basically take a slice of your body at different levels and look at what's going on under the hood so you can see in this patient this is a incredibly healthy person so in the white is is the sub is fat it's subcutaneous and everywhere else you there's there's very little fat inside the abdomen visceral fat half a liter this is this is someone who has a subcutanous fat but look at all this white white stuff that white stuff is visceral fat that's the chemical spill that that's the dumpster fire going on inside this person's body what if we look at different levels well if we take that level up to the level of the heart what we can see something similar you you've got accumulation of fat around that heart that that's pericardial fat and if we take the a little bit lower this is at the level of the uh the upper uh lower leg this is a bone this is your these are your your Tibi and your fibula this is in a young healthy athlete there is no intramuscular fat in him he is incredibly fit and healthy this is a 65-year-old diabetic you can notice how there's intramuscular fat ectopic fat within that muscle and that's a problem why do we care about visceral fat and and other forms of e ectopic fat is isn't it just a bit of human marbling or or human Fara what's wrong with that these tast great well well I'm about to tell you even though it tastes good in animals this is a a massive problem if it's in humans the reason is because visceral fat hepatic fat and other forms of ectopic hatat go go hand inand with what's known as metabolic syndrome and insulin resistance what is metabolic syndrome well metabolic syndrome is the overlying path to chronic disease if you have a metabolic syndrome and the consequences of metabolic syndrome uh you are going to become ill you going to become uh debilitated before your time and you're going to be living very much at the bottom of of that ladder that I mentioned so what what I want you to appreciate is that there's massive individual in the variation in the location and the propensity to develop deposit visceral fat depending on who you are depending on on your genetics and depending on your environment but what I'm I'm going to talk to you about is how you can uh modify it with your lifestyle so metabolic syndrome there's basically five criteria and what they found is that people that had these five criteria were at high or more than three were at more high risk of developing cardiovascular disease and and a range of other chronic health conditions the moment you've got more than three out of five and I would I would argue you know E ending them indivi individually you're beginning your path to to chronic disease so how does this relate to visceral fat well the findings from epidemiological studies over the past 30 years have shown that visceral adapost tissue accurately measured by CT or MRI is an independent risk marker for cardiovascular and metabolic morbidity and mortality and it and they further states that ectopic fat deposition including the hepatic and epicardial fat might contribute to increase a artherosclerosis and cardio metabolic risk so this is later in the in the review paper and this is the list of conditions that is associated with visceral fat so the next when you think of visceral fat and you think of the dumpster fire inside the abdomen this is potentially the list of of conditions that uh you could develop uh over time as I mentioned insulin resistance is the overlying uh disease process at play and and all and we go down hypertension heart failure coronary disease uh respiratory disease sleep apnea and what do we talk about the fatty tongue the reason why sleep apnea occurs with ectopic fat deposition is because the tongue gets too fat um and that obstructs the upper Airway not only um cardiovascular but also uh dementia reduced cognitive function all these are CI of of excess ectopic fat and insulin resistance cancer is a big one every single uh almost every cancer uh has they we've they've done there's lots of evidence showing that the outcome of cancer patients who have more visceral fat is poorer compared to those who have less fat and for the for the ladies in the audience peos or polycystic ovy syndrome is insulin resistance uh and is associated with visceral fat and that's another example of of what we're dealing with here these are this is all uh a process is occurring with with excess visceral fat so what about what about BMI and the reason I want to talk about BMI is because that is what most people talk about we're either overweight we're underweight we're obese uh as per a BMI a body mass index which is your weight over your height squared and we've got a range of targets the problem with with BMI is that it doesn't offer any insight into the type of fat that you've actually got so do we know how much visceral fat or subcutaneous fat no we have no idea it doesn't give us that idea any insight and what matters is that viseral fat and it also matters the duration of that of that visceral fat and the longer someone has an abdomen full of visceral fat the more likely they are to develop the metabolic side effects that I mentioned previously so what what I want you to show here is another MRI scan and again this is all of different individuals what you can see again in the in the outside is their subcutaneous and inside a visceral fat this is our healthy athlete and down the bottom is our most unhealthy person look at the difference in in the amount of visceral fat in all their abdomen and the degree of that white inside that abdominal cavity is the amount of visceral fat and you can see that that person has got 3.6 L uh compared to this this gentleman that or person that only has 6.63 so the the surprising thing that I I want you to think about is these people all have the same BMI that's that's a normal BMI that's not overweight so if you went in and and got seen by your your your your doctor or someone else who measured your BMI they calculated it they'd say oh yeah that's okay you you're not you're not even overweight you don't even have uh a BMI that's overweight but if you're this guy this person you're you're in the danger zone so what what this means is that we can't rely on a normal BMI to reassure us that we don't have visceral fat let's look at some more uh ex examples of this so this is someone and we've got they've highlighted here in green is subcutaneous fat and the blue is visceral fat and and uh red as muscles so what what we can see in this patient is that they've got low low amount of visceral fat and they've got minimal subcutaneous fat this is a metabolically healthy person and they would they would also have a normal BMI but but they are healthy let's look at this person they've got a massive amount here of subcutaneous fat but they've also got very little visceral fat so this paradoxically or surprisingly is what we call a metabolically healthy obese so this person is not at the same risk as someone as a as someone who has the same BMI but uh is caked with visceral fat and finally this person again is probably similar to the one I mentioned at the end of my uh that uh previous slide they have not not a lot of subcutaneous fat but they've got a large amount of visceral fat and they are very metabolically sick and they they're going to be high risk so let let's let's think about a table here so you can be what's your BMI you what's your subcutaneous fat how much visceral fat do you have and how likely you to be insulin sensitive or insulin resistant so with low amount of visceral fat you're going to be um very insulin sensitive and you're going to have a low risk of long-term chronic disease what what's known as the tofi which is a thin on the outside fat on the inside they've got a normal BMI but they've got a large amount of visceral fat they're going to be instant resistant and they're going to be on their way to to chronic disease and you've got we've also got people who've got a raised BMI and they've both got a large amount of subcutaneous and viseral fat so they're also going to be high risk and finally we've got those metabolically healthy obese uh they they are insulin sensitive despite their large BMI and despite um a high amount of subcutaneous fat but because they have a low amount of visceral fat the point that I really want you to emphasize is that we need to know if you're a tofi and that is the that's key because these people are being classified as uh as low risk or they're not being informed about uh the amount of risk that they they currently have so what about my LDL cholesterol so and and if you notice when I when I brought up the slide about uh the the metabolic syndrome LDL or total cholesterol was not on that list we were talking about triglycerides and we're talking about htl so I thought this this study from 2009 was very interesting so what they did is they uh they looked at over 50,000 patients who had been hospitalized with heart attacks um with with uh a range of other diseases presentations of coronary artery disease and they took their blood lipids uh around 24 hours after admission what they found is that almost half the patients hospitalized with coronary artery disease have an admission LDL cholesterol that is essentially normal and they conclude a substantial proportion of patients present with their first or recurrent heart disease event well within the current guideline recommended targets for LDL so we're thinking about a biomarker for health optimization and we're thinking about how we can help you do the best thing by your health well this doesn't look very good if if half the people who came in with a heart attack had had a normal LDL so so the the elephant in the room really is visceral fat and that is the thing that is not being talked about and that is the factor that uh the risk factor that is really important that isn't being mentioned and what we can the those that that are insisting or myopically looking at LDL cholesterol without taking into consideration visceral fat insulin resistance metabolic syndrome I think are uh like the Blind Men feeling the elephant so really the the root of of the problem is visceral fat and identifying visceral fat is the 8020 of Health optimization let let's think about what's driving this problem there's four key areas that that I see uh that drive the accumulation of visceral fat so Cadian disruption processed foods and carbohydrates Alcohol and Other toxins and and chronic stress so circadian disruption the the a presence of artificial light at night is critical in disrupting our body's ability to regulate its metabolism that that light signal which reduces your body's ability to make melatonin elevates its cortisol in in instead and that is sending an incredibly confusing message to your body energy storage systems that artificial light at night will drive overeating it will drive what's called hyperphagia and it will force people to influence and to put more weight on than they would otherwise the absence of of sunlight exposure we need uh sunlight during the day during the morning to allow our bodies to remain what's called leptin sensitive which and and as I mentioned earlier leptin is one of the hormones that gets secreted by our our fat cells it tells the body how much energy there is on board when we we get our Cadian rhythm is disrupted our body becomes resistant to the effect of leptin it's unable to to understand how much energy it's got on board so it will drive overeating and it will drive um weight gain shift work is particularly problematic and it it's very clear to anyone who's worked in a hospital or a shift work uh situation when you see night shifts come on uh and and this particularly the people that are doing prolonged night shift they are almost invariably on average more overweight than than the dayshift staff and so cadan disruption is playing a critical role in this uh and and poor sleep and poor sleep is going is reflecting the fact that the body is is not able to it's not performing it its proper repair mechanisms um and that shows how important Cadian disruption and sleep is to Optimal Health so dietary drivers of visceral fat the one factor that is is possibly the most important of these I believe is polyunsaturate saturated seed oils and they're different they're not the same as the polyunsaturated uh fatty acids that we were talking about uh in the previous presentation they they these are plant derived Omega 6 fatty acids and they've got uh they're particularly enriched in in uh what's called linolic acid and linolic acid is problematic for a number of reasons but it breaks down into a whole bunch of Highly toxic uh chemical byproducts uh several of these are also going to be driving overeating they're going to be driving consumption of of uh hyperpalatable food because they act in the same way that your your brain's endorphin systems so you when you eat foods that contain seed oils your appetite and your satiety is being hijacked and they're going to very very much drive the accumulation of of visceral fat carbohydrates and refined grains sugar uh Ultra processed foods and and any F type of liquid calories uh that the contain sugar are going to be rocket fuel or for depositing visceral fat and fruit consumed out of season uh it becomes it turns from a uh it's no it's not a health food when it's consumed out of season and that's because uh it's it's in congruent with the amount the messaging that you're giving it through your solar exposure uh during during the winter eating bananas is is not a good idea so chronic stress stress is we were designed to have an intermittent amount of stress that was then resolving temporary and then rest that unrelenting and chronic stress which we we see today in so many of our modern environments is going to very very potently deposit visceral fat uh and those effects are mostly mediated through through cortisol alcohol so alcohol again is is possibly one of the easiest things to cut out if we want to address uh accumulation of visceral fat it it goes hand inand um and and what we know is that when you when cutting cutting out alcohol fatty liver particularly can can resolve very very quickly the there's other good evidence that endocine disrupting chemicals including BPA and other uh endocrine disruptors like phthalates which exist in plastic water bottles which it exist um in the environment they are when consumed can drive obesity and and visceral fat and we've Al there's also evidence particularly in in animal models that uh lowd dose or contamination of food with herbicide like Roundup drives fatty liver disease so uh additionally there's certain medications like long-term insulin and and steroids that will also cause the accumulation of visceral fat so the the point that I want to make is that these factors are all interlined and they're overlapping and there's it's never going to be one factor and the they all people who are uh as I mentioned are going to have a disrupted Cadian Rhythm are also the same people who are eating the bag of chips you know 2 a.m. on the on the night shift uh and and drinking from plastic bottle uh doing things like this so there's not only one factor and they all amplify each other again let's adopt an ancestral lens and what point that I want you to um take away and perhaps maybe the the most important point of my talk is that visceral fat will accumulate in proportion to the degree that your lifestyle is incompatible with your biology so how do we solve our visual fat how do we readjust our lifestyle to to minimize the Hood we we're dep depositing this very dangerous type of fat well we need an optimal light environment we need to see the morning sunlight because that is going to be critical in programming our circadian rhythm in making us making sure we're LEP and sensitive so our body knows how much energy is on board and we can get get to work um removing that visceral fat um when that soan rhythm is regulated exposing our skin throughout to the sun throughout the day is very incredibly important it doesn't take long ideally do what you can um and get get a little bit in blocking artificial light light at night will also um is a is a key part in preserving that circadian rhythm because when you are exposed to artificial light your body isn't making melatonin which is that key hormone of of repair and instead it's going to be um making uh cortisol and Ure consistent high quality sleep blue light blocking glasses or blue light blocking clipons uh is is very important so what what's a optimal human diet well I I believe that the adopting of very very low carbohydrate or Carnival diet is the most effective way of reducing visceral fat the reason for this is because it cultivates such a low insulin environment and it is really addressing insulin resistance right at at its root cause the implications of adopting uh carnivore or extremely low cop diet as well allows that gut to heal and so much of the dysfunction and that we see from a processed food diet particularly is involved in uh gut permeability and the inability of that of your gut lining to to to make an effective barrier against the intestinal contents so a a carnivore or animal-based Diet is really going to to effective there fermented vegetables and seasonable consumption of plant Foods might be appropriate uh in some meal timing and this is what what I what I want think people to think about is eating like a lion or a great white shark so rather than a cow that's grazing all day so Lions will eat one or two big meals and then they will just be resting and digesting so fewer meals less often is the strategy to to re taking back your metabolism and helping you heal and and deal with your visceral fat one or two meals a day is a great way approach and fasting so those who aren't medicated uh at with anti-hypertensive medications or heart failure medications or other types of medications particularly fasting is a great way to Kickstart the process of visceral fat loss and uh is very safe it's free so I would definitely consider that uh and eating during daylight hours again this is about sending our body the most appropriate circadian signals and eating uh throughout the day when the Sun is up is the most appropriate and not when the sun's gone down uh and it's 10 p.m. eliminate toxins so so greatly reduce alcohol eliminate it or or get rid of it because that is again driving your visceral fat accumulation water filtration uh for for endocrine disrupting chemicals avoiding plastic content contact with food foods and um avoid some synthetic fragrances and care products because they contain endocrine disrupting chemicals that might be that you might be fighting against uh in your effort to lose um lose this visceral fat and min minimize stress we want as as we said we want acute temporary stresses not chronic stress nature and yoga are a great approach and and think about ancestrally we would have had a uh exposure to a tiger we would have run away and then we' be resting wouldn't be having the tiger living next to us in our bedroom but that's the lifestyle that most people are living today and high intensity exercise so possibly the most important uh physical activity you can do to get rid of visceral fat is maximum intensity and uh certain uh Physicians that have also noted that chronic cardio cardio exercise can have the opposite effect in retaining visceral fat rather than eliminating it so for that reason I I encourage maximum intensity within your capability sprinting is uh is the best and work out outside and not under artificial light so the the loss of visceral fat can be as quick or as slow as you want based on stacking these type of Lifestyle interventions and the goal is eventually is to live a lifestyle that minimalizes viseral fat accumulation and and prevent it from coming back so in closing think about MRI scanning for visceral fat and once you realize that that the risk exists in your visceral fat then looking directly at the disease makes the most sense MRI scanning is going to be superior to the other modalities like CT again because it gives you the highest resolution images and it gives us uh does it without any ionizing R radiation and it's extremely motivating for people in terms of lifestyle change to be able to see that dumpster fire going on uh in inside their own abdomen and if not identify metabolic dysfunction so identify this this signs of metabolic uh metabolic dysfunction and metabolic syndrome including that waist circumference including that blood pressure um and particularly see a doctor who can understand met metabolic health and do specific blood tests that can identify the earliest signs of metabolic disease so in closing the accumulation of visceral fat is proportional to your lifestyle incompatibility with your biology consider an MRI scan uh to visualize visceral fat and eliminate visceral fat by adopting carnivore diet circadian regulation and ancestral lifestyle practices thank you very much thanks Max that was great just a um point on the waist circumference is it Point worth pointing out that the ratio between the height and the waist is what you yeah so so um the the the ratio of the waist to the height is is very sensitive it's it's less it's obviously not as useful as doing an MRI scan but in terms of what we can do in the clinic the waste to height ratio is very very good and you simply just involves measuring that waste and the height and getting a ratio what what yeah exactly so what I like to see is below half in in men and Below about 48 in women yeah yeah hey uh so with the uh BPA and plastic exposure and stuff do you have any tips on how to avoid that uh with meat for example so you know a lot of meat comes vacuum packed in plastic um and to avoid that is quite challenging um and keep it fresh at the same time yes so that's a very good question how how can we avoid plastic contact with meat so the highest risk of leeching of endocrine disruptors is through liquids so meat is is not as bad as say you know oil sitting in a plastic bottle but it's still something that we're working on I mean I've talked to Jake Wy about this and it's an ongoing problem because we need obviously to preserve the meat and at the moment we don't have anything better than plastic so uh yeah we need some smart people to to work on this problem and hopefully get get a solution and just to add I I heard that fat was um the plastic was fat soluble so if it's a fatty cut of meter for example like it can actually dissolve the plastic and absorb into the fat well Le less likely so yes these compounds are overwhelmingly fat lipophilic or but usually in the case of being at room temperature or being at at high temperatures so that's why the canola oil sitting on the Shelf in the supermarket is so harmful because it that that process of leeching is going to be occurring higher at at higher temperatures so I mean refrigerated or frozen meat um yeah I mean you we can only do our best and and I think that's okay right and you said water was the liquids was the worst so bottled water was yeah it's not ideal Yeah by any means ches any yeah so so great question so how can we access visal fat MRI in Australia so that it's not something that's being offered at the moment and it's it's quite challenging to get this because it's obviously not a Medicare refunded uh test but uh there's a there's physician in the US Dr sha omara who's doing this with his patients and it's going to involve uh people like you demanding something like this and demanding to to to have access to a test that can help you identify your risk of of developing chronic disease in this way so it's something that I'm working on um at in in alry and would we hope to be able to offer it um quite soon and again it would be an out-of pocket a test but we we what we do would we get uh window we get levels uh at at the different levels and then be able to show you those images and and use those to guide uh weight loss so yeah to to to be announced I was just wondering if you could um could you please put back up the slide on the LDL percentages or the measurement of that thank you it's not going to help you maybe in way so the the point about uh LDL and and I I want to emphasize that the context matters so so if we have a high LDL in the context of high triglycerides and low HDL that's that's a problem and it's going to reflect the fact that that LDL is going to be oxidized and the oxidation of the LDL is the problem is problematic in terms of developing uh aosc oric cardiovascular disease the the problem though is that it's nowhere near as reliable as a biomarker of predicting who's going to get a heart attack compared to say in insal resistance and and visceral fat visualization in the in the absence of the the fat MRI or until that comes out how useful is a dexa scan so it it is it will give you your proportions of subcutaneous versus visceral fat it it won't be as accurate in estimating them but it's going to be better than uh than using those tape measure measurements the the value of the MRI is really as behavioral change so it's really visualizing that that dumpster fire and it's just not the same when we just see a number on on the Dexter report so to to answer the question yes it's it's definitely better than nothing but um yeah not not as good thank you hi Ela yeah so I like I like in farm salmon to you know kfo confin fed pork so it's it's suboptimal for a whole bunch of reasons it it it has a a massive amount of inputs needed as you know sub therapeutic or therapeutic antibiotics and other kinds of mitsides that permit it to exist in that farmed environment so I I think it's it's going to be suboptimal compared to Wild Court definitely and I'm not surprised to hear that the fatty acid ratios are less favorable oh sorry eating hemp no I I I would suggest um I'd probably suggest trying to Source a better source of fish where possible but you probably still better eating farm salmon than occasionally than not eating it at all yeah definitely so fasting insulin again is going to be much more sensitive than even those metabolic uh syndrome criteria for developing early uh for emerging insulin resistance so fasting insulin uh I like to see it under five as a reference range um but it in many ways it's a proxy for visceral fat and it's a proxy for ectopic fat um in in the way that and it and it usually correlates quite well Ma so I was just going to make a comment last gentleman who said uh you mentioned should we should we use hemp I'm assuming mean hemp oil like omega-3 sort of Rich plants and things like that yeah so so the problem with that those sorts of Omega-3s is they're they're ala as opposed to DHA and EPA we we don't need ala we can't really use it so that's not really helpful kind of Omega-3 so gets put under the blanket in the ospice of Omega-3s and Omega-3s are good but it's not so you can convert a very small fractional amount of ala into DHA or EPA but it's it's minuscule so it's it's really not helpful you need DHA EPA and those only come from animal sources yeah thanks Anthony so Marine Source sources of omega omega uh 3s all right thank you so much Max guys we're going to take a break for lunch now give him a round of [Applause] [Music] applause

Channel: Low Carb Down Under

Views: 64,485

Keywords: Low Carb Down Under, LCDU, www.lowcarbdownunder.com.au, REGENERATE Health Summit, Max Gulhane, Visceral Fat, Circadian Health, Quantum Biology

Id: pa6Gg2P67yM

Length: 38min 11sec (2291 seconds)

Published: Sat Oct 14 2023