In my day to day endocrinology practice one of the first complaints I hear from people, no matter what the medical problem, is about weight. Almost always, it is either because they are gaining or unable to lose it. When I began my medical practice 40 years ago, this was also the case. What is it about weight that prevents more progress from being made? Could it be because in nature having adequate amounts of stored fat on the body eg belly fat, is essential for survival in the same way having gasoline in the fuel tank of a car is needed to keep it going? Not to mention the role of fat as an insulator against the cold. Imagine trying to live through a winter without clothes, the way primitive humans did? Being covered in fat was literally a lifesaver. The more we know about the role of fat (adipose) in our lives the better we are equipped to live with (and without) it.
It’s tempting to think that all fat is built the same, but this is not true.
There are actually three types of fat; white, brown, and beige fat, and they are distributed in different parts of the body in different proportions, as either visceral fat (inside the body and organs) or subcutaneous fat (under the skin).
White fat is the fat most people are familiar with – over 73.2% of all Americans carry too much and are classed as either overweight or obese (CDC, 2017 to 2018). While some white fat is absolutely essential for a healthy metabolism, every body has its limits.
Brown fat is found mainly in babies and plays a key role in providing energy and keeping us warm. Adults retain a small percentage of brown fat around their necks and shoulders.
Beige, or brite fat, is similar to brown fat and is optimized for burning fat rather than storing it, unlike white fat.
As we can see, white fat is the ‘bad stuff,’ and is the type of fat that many of us worry about.
Visceral and Subcutaneous Fat
Fat is distributed as either visceral or subcutaneous fat, and there is a big difference between the two.
Subcutaneous Fat
Subcutaneous fat is stored under the skin in the limbs and extremities; arms, belly, thighs, and buttocks. When you pinch your arm or leg, you’re likely feeling a layer of subcutaneous fat distributed under the skin. Made up of mostly white fat, some subcutaneous fat is essential for hormonal function, as well as keeping warm.
While people with different body compositions will likely carry different percentages of subcutaneous fat, everyone has their limits. Subcutaneous fat is not totally harmless, but it poses fewer risks than visceral fat.
Visceral Fat
Visceral fat is stored primarily around and inside the abdomen. Yes – fat is more than skin deep and is stored inside of us as well as under our skin.
Whilst excess subcutaneous fat is still unhealthy, many recent and reputable studies such as this large-scale meta-analysis of 2.5 million participants suggest that visceral fat poses a much greater health risk than subcutaneous fat.
The increased health risk of visceral fat is linked to its proximity to the vital organs.
The closer fat is to the stomach and abdomen, the greater the chance is that it penetrates under the skin, wrapping itself around the liver, heart, kidneys, pancreas, and other organs. A study conducted by the University of Chicago and published in 2016 also found that visceral fat behaves differently from subcutaneous fat and resists fat burning (lipolysis). This also explains why abdominal fat is seen as ‘stubborn fat’ that is hard to lose.
Around 59% of all US adults were abdominally obese in 2015 to 2016, representing a massive increase from around 47% in 1999 to 2000 (CDC, 2016).
Visceral fat poses a much greater risk than subcutaneous fat in developing in the following conditions:
Heart disease
Type 2 diabetes
Insulin resistance
High blood pressure
High cholesterol
Certain types of cancer, such as stomach cancer, bowel cancer, pancreatic cancer and liver cancer
How to Measure Visceral Fat
Traditionally, BMI (body mass index) has been the go-to yardstick for measuring body fat. Today, many health authorities encourage the use of both BMI and abdominal fat measurements. The measurement of waist circumference is a popular method to assess abdominal fat. It’s possible to have a healthy BMI and high waist measurement, and vice-versa.
Take your shoes off and stand with your feet together.
With a bare stomach, relax and exhale all air from your diaphragm.
Use a fabric tape measure to measure your waist circumference at the naval.
Record the measurement.
Be aware that this measurement is likely not the same as what many consider to be their ‘waist’ measure (i.e. the measurement they use to fit trousers).
Men
Women
Low Risk
37 inches and below
31.5 inches and below
Medium Risk
37.1 to 39.9 inches
31.6 to 34.9 inches
High Risk
40 inches and above
35 inches and above
Does Abdominal or Visceral Fat Increase With Age?
The short answer is yes, it does. The plight of the so-called beer belly or middle-age spread is real!
This study published in the International Journal of Body Composition Research found that visceral fat increased by over 200% in men and 400% in women between the age of 30 and 70.
Why?
As we age, our metabolism changes and slows down, but the ‘middle-age spread’ is also linked to changes in behavior and diet.
To briefly summarize, aging reduces our percentage of lean muscle mass, which lowers our metabolic rate. Additionally, whilst it’s perhaps natural to indulge a little more as we get older, it’s easy to eat more and exercise less. That gives your body every excuse to pile on that abdominal fat!
Abdominal Fat and Menopause
Studies have shown that estrogen plays a major role in body fat distribution, hence why women experience a much greater change in visceral fat with age due to menopause accompanied by the loss of estrogen (400% vs 200% in men between the ages of 30 and 70).
Multiple studies, including this one published in the Journal of Menopausal Medicine, have also found that estrogen replacement therapy (ERT) can mitigate some of this weight gain. However, estrogen replacement is not without its risks and is unsuitable for many.
Namely, ERT can increase the risk of blood clots leading to strokes and embolisms and cause headaches, swelling, or edema. ERT is also often linked to an increased risk of breast and ovarian cancer. It is worth mentioning however, studies reviewed by Breastcancer.org show that the risk is only significant after using ERT 10 years or more (in the case of estrogen-only therapy). Combination HRT which includes both estrogen and progesterone poses a much greater risk.
As such, ERT is certainly not a ‘silver bullet’ for treating menopause-related abdominal weight gain.
Part 2 of this article will be published in 2 weeks at this website www.metabolism.com
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Dael is taking a lonely path as a confirmed smoker. So far the benefits seem to out weigh the risks, but we all know what the end of this road will look like. I am posting Dael’s comments to see if the community at metabolism.com can make a positive impact on Dael’s rebellious attitude.
Dael writes:
hey guys and gals just to let you know,
am down to 130lbs and feeling fit as a fiddle. have the 6 pack and abs i dreamed of and am fitter than i have ever been.. it really is odd cos i hate smoking but here i am having lost 42 lbs and loving every second of it apart from the smoking. what can i say – maybe rather die skinny and liking myself, than a fatty with some self righteous notion of how wonderful i am for not smoking… i hated myself with the extra weight, sorry but true…. i really can’t give a f***k for what anyone thinks on here but at least i can bear to look at myself in a mirror and like what i see, not loathe what i look like and try to bullshit myself into believing that i am sooooo happy cos i gave up the cigs….. but next is the NRT – lets see what happens there, and b4 anyone says it, yes i lost two of my best friends to cancer, of the spine and brain, but all i can say is like james dean , i’d rather live fast and furious, that be fat and dumb til 101, you can all choose, but in the end what do you all want? i do not advocate smoking !!!
Metabolism.com is pleased to share the following article provided by our guest contributor, Tom Hines. **********************************************************
In some ways, your body is like a machine — it works best when it’s properly maintained and tuned up. Food is your fuel and when you fill your tank with lousy fuel, your engine sputters and stalls. If your body’s engine is sluggish and needs a jumpstart, spirulina and other green superfoods can help deliver the energy necessary to keep the machine running smoothly, avoiding a breakdown.
Spirulina is a ‘green superfood,’ a term used to describe various nutrient-rich natural supplements, which include Chlorella, Wheat Grass, Barley Grass, Alfalfa and Kelp. Unlike most store-bought supplements, the concentrated vitamins and minerals they provide are not synthetic. Green superfoods are whole foods harvested directly from nature and are exactly what your body needs to offset stress and to clear away toxins.
SAD is very sad indeed
S.A.D. stands for Standard American Diet – there was never a more apt acronym. The majority of U.S. citizens today subsist on processed fast food laden with refined carbohydrates and saturated fats. Meats are frequently tainted with growth hormones, antibiotics and pathogens. For people who manage to work the recommended five to nine daily servings of fruit and vegetables into their diet, modern agricultural techniques have stripped crops of many vitamins and minerals.
Processed and cooked foods, which are the cornerstones of the S.A.D, and beverages such as coffee, tea, soft drinks and alcohol create an acidic blood pH, encouraging the growth of bacteria, fungus and mold. In an overly acidic environment, the body literally begins to compost. Illnesses such as heart disease and diabetes are often the result of the composting process. Green superfoods have an alkalizing effect, counteracting the acidity caused by poor diet, stress and toxic overload and setting the stage for a return to good health.
Spirulina and Chlorella, the most super of the green superfoods
Spirulina is a blue-green algae whose name comes from its spiral coil shape. High quality spirulina thrives in both salt and fresh water in tropical climates and it is known to have nourished the Aztecs, who harvested the algae from Lake Texcoco. Some of the benefits of Spirulina are:
Contains all of the essential amino acids vital to human health
An excellent protein source for all vegetarians, including vegans
Balances blood sugar by boosting glycogen, which offsets insulin
Rich in GLA (gamma linolenic acid) and other essential fatty acids Delivers an array of vitamins, including the all-important folic acid
High in potassium and a dozen other minerals
Improves focus and mental clarity
Chlorella is a single-celled green algae whose name is derived from Greek and Latin words that translate to “little green.†In the 1940’s and 1950’s, intensive research was done on little green algae’s potential role in solving world hunger, due to its high protein content and its bounty of beneficial vitamins and minerals. The natural health community, meanwhile, has always touted Chlorella’s health-imparting properties, particularly in the area of detoxification. In addition to being the very best source of chlorophyll, here are some more of Chlorella supplement benefits:
Rids the body of toxins and stored waste
Tones and cleanses the blood
Reduces body odor, acting as an internal deodorant
Improves bowel health and reduces flatulence
Naturally freshens the breath
Clears the skin
Cereal grasses and seaweed
Wheat grass is a popular juicing ingredient due to its superior nutrition, which it delivers without raising blood sugar. It also helps to lower blood pressure.
Barley grass alkalizes the blood and strengthens the digestive system.
Alfalfa helps reduce LDL (low-density lipoprotein) or bad cholesterol, without affecting levels of HDL (high-density lipoprotein) or good cholesterol and studies are underway to determine its effectiveness at lowering blood sugar levels and its ability to invigorate the immune system.
Kelp is a brown-algae seaweed, which grows in abundant kelp forests in shallow oceans all around the world. Kelp is rich in iodine and therefore beneficial to overall thyroid health. Its high vitamin and mineral content promotes pituitary and adrenal gland health as well. It’s renowned for its contribution to lustrous hair and skin. Taken shortly after exposure, it can also mitigate the negative ramifications of heavy metals and irradiation.
Making the most of green superfoods
Incorporating Spirulina, Chlorella and other green superfoods into the diet is easy, since they are all available in powdered form. Simply mix the desired amount into salad dressing, or add it to soup, juice or water. The taste is fresh and green and the active enzymes of living food add a healthy dimension even to a less than healthy meal. Of course, pregnant or breastfeeding women and people taking medications should consult with their doctors before incorporating any new food into their diets.
Many people who regularly incorporate green superfoods into their daily regimen have reported increased energy, mental clarity and an overall healthy glow. When stress, toxic thoughts and an imperfect diet have left your body’s engine sluggish, green superfoods are a quick and easy way to put yourself back on the road to health. Long may you run!
About the Author Tom Hines, co-owner of NutritionGeeks.com (MN #1 Now Foods herbal provider), has been working in the nutrition industry since 1997, is a competitive powerlifter, lives with his wife Netti and three boys TJ, Grady and Brock on the prairie in west central Minnesota, spends his leisure time coaching youth wrestling, working with his horses and being play toy #1 for his boys.
A member of metabolism.com, Louise Infante, is a great enthusiast of the vegetarian life style. Louise submitted this blog to metabolism.com so we could help her get the word out. I found the article extremely informative and hope you do too. Thanks Louise for your effort.
Give me five minutes and I’ll give you 1 very good reason for being vegetarian.
While fish is the most important dietary way to obtain the long-chain omega-3s eicosapentaenoic acid and docosahexaenoic acid, which has been shown to be essential in supporting brain health, low intake of eicosapentaenoic acid and docosahexaenoic acid in vegetarians does not adversely affect mood, reported by a new study (Nutr J. 2010;9:26. DOI:10.1186/1475-2891-9-26).
A research team from Arizona State University conducted a cross-sectional study to compare the mood of vegetarians who never eat fish with the mood of healthy omnivorous adults.
An overall total of 138 healthy Seventh Day Adventist adults residing in Arizona and California (64 vegetarians and 79 non-vegetarians) were enrolled in the study and completed a health history questionnaire, food frequency questionnaire and 2 psychometric tests, the Depression Anxiety Stress Scale and also the Profile of Mood States..
Vegetarians had significantly lower mean intakes of eicosapentaenoic acid, docosahexaenoic acid and the omega-6 arachidonic acid; they had higher intakes of the omega-3 alpha-linolenic acid and the omega-6 linoleic acid.
“Seed oils are the richest sources of α-linolenic acid, notably those of rapeseed (canola), soybeans, walnuts, flaxseed (Linseed oil), clary sage seeds, perilla, chia, and hemp.”
However, the vegetarians also reported significantly less negative emotion than omnivores in both psychometric tests. Mean total psychometric scores were positively linked to the mean intakes of eicosapentaenoic acid, docosahexaenoic acid and arachidonic acid , and inversely related to alpha-linolenic acid and linolenic acid intake.
The study team noted there is also the possibility that vegetarians may make better dietary choices and could generally be healthier and happier.
If you want to give it a try, here is an example of vegetarian recipe based on Italian cuisine
Italian Spaghetti with Zucchini
Ingredients: * 17 oz. Spaghetti * 24 oz. Of thin sliced zucchini * 1 / 2 cup walnuts oil * A few basil leaves * 2 tablespoons of yeast flakes * Salt and pepper
Zucchini contain fewer calories and possess no fat. But they are a good source of potassium, e vitamin, ascorbic acid, folate, lutein and zeaxanthin.
These types of nutrients are extremely sensitive to heat and to enjoy their benefits you should find a quick solution to cook or even eat raw in salads.
From the therapeutic perspective, zucchini have laxative, refreshing, anti-inflammatory, diuretic and detoxifying action.
About the Author – Louise Infante writes for vegetarian menu blog, her personal hobby blog centered on vegetarian cooking tips to help people live better.
What exactly is a Nutrition Consultation? That is Question Number One from the public! Well, a nutrition consultation is something that takes into account someone’s medical and weight history; blood work/laboratory values; activity; habits; Calorie, protein, carbohydrate, fat and fluid needs; nutrition support needs and personal goals. A good nutrition assessment will take all of this into account in order to get a full picture of a client and what their specific needs and recommendations are.
A very common issue is that people think they are eating way too much at night and want to cut down on their intake a night. Most of the time, these folks aren’t eating enough during the day and find themselves so hungry at night that they make up for missed meals and more! In this case, I teach that food is the best appetite suppressant around! If you eat good, solid, healthy meals and snacks, you won’t feel so hungry later on in the night.
Of course, sometimes people experience “emotional eating” where they are counting on food to meet an emotional need that they have. At first it may feel like the need is fulfilled. Food is comforting, nurturing, it can seem like a “companion”. HOWEVER, food is fuel, not emotional support. When we mistake food for emotional support, we stop looking for the real, underlying emotional issues that need our attention. That is when food becomes a distraction, a past time, even an addiction. I urge clients to look at food as food and not an emotional crutch or distraction. On the other end of the spectrum are the folks who need to gain weight and can’t seem to gain no matter what they do. A nutrition consultation will provide an assessment of exactly how many Calories they need to maintain and to gain weight. It will provide guidance for consuming healthy foods and not empty Calories, as well as recommendations for maintaining lean body mass.
Some folks need nutrition support, especially if they are on medications that deplete nutrients. My professional opinion is that the majority of people in this country do not even meet the RDA’s for many nutrients and I believe that the RDA’s need to be updated to reflect current knowledge and research in the science of nutrition.
A Nutrition Consultation will also help dispel the numerous misleading concept about nutrition that are out there floating around on the internet and in the media. I teach people some very basic concepts so that when they look at the latest headlines or listen to what other people have to say about nutrition, they will be armed with knowledge that will help them to judge what it truly best for themselves. So that is a Nutrition Consultation in a NUTshell. And as always, Consider having an individualized consultation!
Beth Ellen DiLuglio, MS, RD, CNSD, CCN, LD/N In regards to this reply please read the our terms of service at:https://www.metabolism.com/legal_disclaimer/
The mission of the The Thyroid Project is to encourage sharing of information and experience between the public and the medical community about the treatment of hypothyroidism (low thyroid function). For at least the past few decades there is a growing awareness of “something missing†in the way suffers of hypothyroidism are treated for their disease.
Too many patients, as documented in an on-line study of 12,000 individuals conducted by the American Thyroid Association published in June 2018, (https://doi.org/10.1089/thy.2017.0681) , complain of persistent symptoms of hypothyroidism despite what their doctors believe is successful treatment with levothyroxine (brands include Synthroid, Unithroid, Tirosent, Levoxl). We believe something needs to be done to resolve this conflict between patients and their doctors.
By Gary M. Pepper, M.D. Ozempic, Rybelsus, Trulicity, Wegovy, Saxenda are the central players in the weight loss craze sweeping across the globe. Metabolisim.com has been monitoring this phenomenon from its beginnings in 2008 with its report “Lizard Spit Reduces Blood Sugar and Appetite”, regarding the first drug in this class, Byetta (exenatide). Caught In the middle of the current chaos are the medical experts who treat diabetes and have been prescribing these medications for more than a decade. Here is a brief commentary from one such board certified endocrinologist; “I started treating Type 2 diabetics with GLP-1 agonists more than 10 years ago. In some respects, these medications have revolutionized the treatment of diabetes by lowering blood sugar effectively and promoting weight loss at the same time, a unique combination of benefits. Not everyone benefits from these drugs to the same degree unfortunately, and I have seen lots of patients experience unacceptable side effects from them. Nothing though, has prepared me for what is happening now. Too often, I find myself confronting someone who expects me to prescribe one of these drugs just so they can lose weight. Sadly, one extreme example was someone who, despite battling a life threatening medical condition, was insistent on getting a prescription. At the same time my diabetic patients are scrambling to find a place to buy their medications if they can even afford it. It is disheartening, to say the least, and I dread the negative interactions with some of my patients I now face almost daily.”
Off- Label Use
The FDA is the U.S. government’s department tasked with evaluating and approving drugs for specific medical conditions. When a new medication is approved for treating a medical condition by the FDA the agency will, at the same time, set strict guidelines for exactly which patients may use the newly approved drug. When a medication is used “off-label” it means that these limitations are being overridden by the provider for a potential benefit which outweighs the drugs risks. It is a general misconception that off-label means illegal; it does not. This practice has been going on for ages and more than 20% of prescriptions in the United States are prescribed off-label. A common example is the use of beta-blockers (approved for heart problems) for the treatment of performance anxiety.
GLP-1 agonist drugs, as discussed recently by metabolism.com. were originally approved for the treatment of Type 2 diabetes in adults. In the past few years most of these same medications have gained unprecedented popularity for their “off-label” weight loss benefit. Of the 5 GLP-1 agents presently in U.S. pharmacies only Wegovy (semaglutide) and Saxenda (liraglutide) are FDA approved for treating obesity. Of these two, Wegovy is the newer and had been much more popular that its sister drug Saxenda, probably due to being dosed only once weekly compared to daily for Saxenda and less likely to cause side effects. Due to Wegovy’s soaring popularity, its manufacturer, Novo Nordisk, increased the price of Wegovy two times since its initial release.
by Gary M. Pepper, M.D. and Sam Jeans, MSc The global anti-obesity drug market, in 2021was valued at over $2 billion. Within one year this figure had skyrocketed to $8 billion and is expected to climb to nearly $ 20 billion by 2027. This astounding growth is a reflection of soaring obesity rates, and the arrival of a new class of weight loss medication fueling a craze both in the USA and across the world.
The FDA and global health regulators, until very recently, had maintained a very tight ship when it comes to treating obesity with medication, placing the emphasis on diet and exercise rather than weight loss drugs. Since the 80s, anti-obesity drugs continued to be controversial, and a more stringent FDA implemented ongoing safety trials along with other precautions. There is some speculation that a shift in attitude toward approval of weight loss medication by the FDA , is underway
Weight loss drug controversies are far from over and, in fact, may soon rival the amphetamine crisis of the 70’s. For that reason, metabolism.com has felt it important to provide our guide to weight loss drug issues, past and present.
Anti-Obesity Drugs Timeline
Prescription drugs for lifestyle diseases such as obesity were marketed heavily throughout the 1950s to the 1970s. Amphetamines entered the public domain after the Second World War where they were used extensively in the military.
In the 50s, walk-in clinics prescribed diet pills with other medications almost at random, with or without genuine concern for one’s weight. These brightly colored pills became known as “rainbow pills”.
In the 1960s and 1970s, the so-called “rainbow pill diet” of pills was finally coming to an end as the FDA began to systematically ban many of the drugs involved. A high-profile expose by investigative journalist Susanna Mcbee, published in Life magazine, brought attention to this new modern public health crisis.
The rainbow pill diet combined amphetamines, laxatives, thyroid hormones, and even diuretics to produce extreme weight loss, combined with benzodiazepines, barbiturates, and steroids to reduce side effects, and antidepressants to suppress medication-induced insomnia and anxiety.
In 1968, rainbow pills were linked to over 60 deaths, with numerous accounts of their devastating impact surfacing in the news and media. Within just two months, 48 million pills were seized and destroyed. Nevertheless, amphetamine-based diet pills remained extremely popular throughout the 1970s. In 1978, some 3.3 million prescriptions for amphetamines were written each year, with some 50 million pills a year ending up in the black market.
In 1979, the FDA banned amphetamines as a weight loss aid, but that is hardly the end of the USA’s love affair with obesity medication.
Here’s a brief timeline of recent anti-obesity drugs:
Lack of energy and inability to lose weight are constant challenges for many people and are every day complaints encountered in the doctor’s office. Almost anyone can find some relief from these problems by accessing the healing properties of physical activity. Mentioning to a patient the need for ‘more exercise’ often causes rolling of the eyes, sighing, shrugging, snorting or worse yet, the hundred-yard stare. We all know exercise is important but who has the energy for that? It seems like a vicious cycle. Surprisingly, when done correctly, exercise can improve energy with the additional advantage of promoting weight loss and restoring tone and stamina. It is helpful to remember that the human body was designed for a lot more physical activity and a lot less food than we are privileged to experience in present day life. It therefore takes will power and knowledge to maintain the environment required for optimal health. Here are eight steps to get in the swing of regular exercise. Some suggestions may surprise you.
