so when people look at belly fat they think okay this person's overweight belly fat is problematic because they are overweight and have excess fat but there's other things that belly fat is doing excess fat specifically belly fat Beyond just the extra weight or the extra fat that we're carrying what uh what are some things that really are concerning with belly fat specifically great question yeah so belly fat is probably one of the most concerning types of fats so we have so many different types of fats on our body body and not all the fat is bad per se you know we have like subcutaneous fat which is under our skin and some of that can be you know protected for our body provides a cushion it keeps us warm there's also Brown fat which helps keep us warm as well but belly fat is of of concern because it implies there's an underlying metabolic and hormonal problem and the main thing is that belly fat is not always just subcutaneous fat which is the fat you can pinch that's under the skin but it implies that there's visceral fat which is the fat surrounding the internal organs so the problem is that is usually a sign the person has a big metabolic problem and hormonal problem called insulin resistance so what's happening and this is actually affecting half of our country right now is that the visceral fat that's accumulating around the organs is blocking the insulin receptors so our pancreas makes insulin and insulin's job is to tell our cells to take up blood sugar but the visceral fat is just blocking those receptors and that's causing the pancreas to pour out more insulin and so that's what we call insulin resistance and the high levels of insulin are very inflammatory so high insulin basically this is the physiology that can lead to diabetes um but even if you don't have diabetes if you just have insulin resistance we know that high insulin levels are inflammatory on pretty much every organ in our body so in the brain you know has having higher insulin levels is associated with a higher risk of dementia and Alzheimer's disease in fact that's why they call it type type three diabetes and a higher risk of inflammation in the heart leading to cardiovascular disease heart attack as well as stroke um so basically it's a signal it's actually a sign that your body is in this chronic inflammatory state so obesity is actually a state of chronic inflammation and what is that these cells these visceral fat cells um which we call adipocytes they actually pour out inflammatory cycin which we call adipokines so they're like inter lucans and tnf Alpha but we can actually measure this on patients blood work so I like to use a test called the high sensitivity C-reactive protein or the hscrp to see what's their overall level of inflammation and one thing that's amazing is that when p patients start eating better and actually lose weight we can actually see that inflammation marker go down on their blood work so after today's video I put a link down below for an 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Barrel sauna so use that code down below Del 15 for the barn charge sauna blanket interesting so what are some of these other things that these adipic kinds can can do I mean they're obviously they're signaling molecules so like what's their purpose like why um you know they clearly have a purpose that's probably a good purpose outside of just the overabundance of it being a bad purpose like what are what are they designed to do great question so I think that you know our rest store fat to really save energy for when there's going to be a time of famine but you know here in the United States there never is a time of famine so the problem is this overabundance actually creates kind of like an inflammatory Cascade where the body doesn't know what to do with the excess calories and so it stores it and now you get blood vessels that are growing through the fat and it becomes like its own endocrine org and what's interesting is it even has enzymes that can convert hormones so in men for example it'll convert testosterone to estrogen um so these fat cells actually produce an enzyme called aromatase so a lot of times in um obese men or overweight overweight men will see that they have lower testosterone levels and higher estradi which is estrogen on their under blood work interesting yeah so with uh you know when it becomes sort of its own in organ MH like what kind of disruption that can that potentially cause for for women not just not just men from the aroma taste side of things like what what other things is the excess fat doing aside from being like hey it's making my heart have to work harder it's you know it's creating obviously more vasculature which everything has to work harder and it's creating this you know inflammatory state is it having hormone likee effects with women too can it influence that absolutely um in women it can even affect fertility so again it can affect their menstrual hormone levels we know in women that high insulin can actually tell the ovaries to make testosterone and so that's what we see in um PCOS polycystic ovary syndrome we one thing I noticed on my patients um is when we help them with their diet and reduce their carbohydrate intake and get their insulin levels under control I noticed that their insulin levels come down but their testosterone level also comes down interesting what are uh what happens with high testosterone in women yeah so in women higher testosterone can present with um we call it heroism which is like facial hair it can also present with like acne um and and even hair growth in other parts of the body like the chest things like that yeah any other like Downstream effects uh you know as far as like even PCOS and things like that like what how does that interplay happen there yeah so in PCOS um the testosterone is there and I mean it can be very like inconvenient again because of the acne and the facial hair but again it can impact the whole fertility as well we notice when um testosterone levels come down they're more likely to be ovulating and we see more balance between the estrogen and the progesterone levels so the main problem in PCOS is that the women are not ovulating and so they have estrogen but they have like no progesterone at all and the high testosterone is an indicator again that the the ovaries are making the wrong hormone they're making testosterone and that's being driven by high insulin so it all kind of ties together that's very interesting so it's interesting that in men it's essentially driving up estral but in women it's doing the opposite isn't that interesting yeah yeah so um I mean it's almost as though it's protecting the body just because there's this energy toxicity and it's kind of just disregulation all over the place um what about as far as as mood I mean does some of these can these adipokines cross the bloodb brain barrier do they impact do they do they influence anything in the brain I think absolutely absolutely so when people are in this chronic inflammatory State because of high insulin high blood sugar there that can definitely cross the bloodb brain barrier we know that blood glucose affects the brain and that's why people come down with brain fog they can be um have more mood swings um again reflecting that unstable blood sugar and that high insulin is also driving hunger so these people always are feeling hungry and if they don't get a carb fix then they can get very irritable and these are all symptoms of just the high insulin um that's really kind of hijacked their cravings and their mood as well so you look at the the sort of quintessential like skinny fat person someone that's you know skinny arms and legs skinny everywhere else but then has belly fat you know mainstream will almost have us think that's like okay well that's just genetically where they store it and that could be part of the equation it seems like sure I'm sure there is a genetic predisposition to where you store fat I mean obviously but but then it makes me wonder I mean there has to be other influence too like I mean if you look at women for example they store more gluto Emeral fat right so clearly there's like a hormonal reason why we store fat in specific places it's not purely genetic you know like I'd say like when you look at women I this would be a random number to say but I mean it's almost as though like six or seven out of 10 women tend to start storing fat like around the hips and buttocks and much less you know apple shape whereas men you see much more apple shape right right and so again it's like okay I don't necessarily think that it's just a genetic factor I think like there's there is external and environmental influence on that so with that what are some things that people can maybe do to potentially reduce belly fat accumulation absolutely yeah so along the lines I was going to say that the liver is the other big organ where people are storing fat and that is the thing I'm seeing in what you're describing as the skinny fat person yeah which is really shocking because you know fatty liver disease we think of it as a disease we see in people overweight or obese but lately I've been seeing a lot of people that have a completely normal body habitus but we're seeing consistently elevated liver enzymes on their blood work and we have liver ultrasounds documenting that they have fatty liver but you would never guess that because they look normal normal on the outside they're normal body weight but what it's telling me is that they have the insulin resistance and that's again what I see on their blood work they have high insulin they have high liver enzymes they have high triglycerides so I call that the metabolic Trifecta and it's all being driven by a carbohydrate diet so it actually has nothing to do with the fat in the diet it's the carbohydrates and the sugar that's triggering the insulin release and then the insulin is telling the liver to store fat and make high triglyceride so it's all kind of intertwined but the nice thing is the treatment for all of this is like the same treatment so the treatment is to really get the insulin down and we can do that by with diet and exercise but the diet is probably one of the main things because you can't really out exercise the belly fat yeah in other words if you don't change your diet and you just exercise it's probably not going to fix your fatty liver disease yeah so diet is huge and that's why I love putting patients on a Paleo diet so the paleo diet kind of gets rid of all the grains in the diet so again cutting out bread rice pasta cereals that can make a huge difference because that grains are really feeding that cycle of hunger because that every time they eat like a bread or pasta that's just spiking their insulin levels so we kind of stabilize their insulin and their blood sugar levels and that can make a huge difference I see it all the time on their blood work like I see Improvement in their metabolic parameters their hemoglobin A1c which is like the average sugar number for 3 months they're fasting glucose their insulin their liver enzymes and we see them lose inches off their waistline so in addition to uh their weight they'll tell me that their pants fit so much better yeah not to mention I mean you're by nature of a paleo diet you're eliminating the hyper palatable processed stuff and you're probably ultimately eating less too just because by very nature ofly I'm left with this piece of steak and some fruit and you know it's right just simply eating less of that to begin with so you've got kind of a double whammy effect the most amazing thing that I hear from patients is that they're just not as hungry yeah that's the most amazing thing they don't feel deprived so like when I see them at 3 months they've you know they lost 10 pounds but they're like I'm satisfied I'm not even hungry that much so that's the amazing part I think if people started looking at like belly fat abdominal that as sort of a Cascade that happens as a result of energy toxicity I think that it would make a lot more sense for people I feel like we we we cram this calories in calories out thought process which clearly isn't getting across to people right like it's still making it's still hard for them to reduce their calories and you're as other experts have mentioned I mean you're pitting yourself against hunger which you're never going to win right you're never going to win against the power of your mind and hunger and energy toxicity is such a powerful term that I think people like and I try to encourage people to say like okay like you just have too much energy coming in at once right like it's just in that maybe calories but it's also like okay in the way of carbohydrates that's going to go to the front of the line in terms of wanting to be used so if you're consistently piling on carbohydrates then you're consistently putting something in front of burning anything else yeah so you're much more likely to stay in that state of energy toxicity and right yeah no I completely agree and I love that term energy toxicity and I think that's why they've all these studies showing that Cal calorie restriction actually promotes longevity yeah you know which is so fascinating and the trick is how do you get to caloric restriction without consciously thinking about caloric restriction every second of every day you know because then you're just thinking about starving yourself all the time and you're thinking about restricting and a that's not exactly a healthy mindset to feel restrictive all the time but it's also once the other shoe drops and the crap hits the fan with something in life you're just going to go right back to what's comfortable because you're not you know you're you're not consciously having this in your for you know your for brand you're just you're you're going to default to Old Habits the other thing is the other big hormone that plays a role with belly fat is the cortisol and I think that's a good point you make about when people are under stress and then they resort to the Comfort Foods yeah that cortisol you know especially people who are chronically stressed or they're not sleeping well at night they have insomnia that's going to raise their cortisol levels that's the stress hormone from the adrenal glands and the high cortisol also triggers belly fat yeah and so um it also ties in and triggers more insulin release so the cortisol and Insulin kind of go hand inand yeah so um that's why part of weight loss is also making sure you're getting a good night's sleep um I think people who are not sleeping I see sometimes their weight does creep up as well um and then exercise is also I think a big part I think you know so many people are just sedentary and that's such a big problem so incorporating you know cardio exercise like 30 to 45 minutes a day and then some weight training too if they can do that that can make a huge difference at opening up those insulin receptors yeah and then my other favorite is to use berberine are you familiar with burine Bin's awesome oh yeah so berberine is one of my favorites it's um you know from the root of the bourine plant and very anti-inflammatory and just kind of opens up those insulin receptors so we see really good results um using berberine to help patients with the insulin resistance who are struggling with the belly fat as well yeah any particular you consume that along with your meal or just after a high carb meal or what's your take with berberine there yeah so berberine usually I have patients take one one capsule after every meal okay so that's like 1,000 milligrams per day and again that's just opening up those inin receptors um the nice thing is in people with normal blood sugar it doesn't cause low blood sugar and it's also really great for the gut microbiome so it's antimicrobial and kills like bad bacteria and yeast in the gut microbiome as well yeah interesting about berberine too is I know it it's a the literature seems shows it seems to be more effective the more insulin resistant you are so it has has an effect where if a like a healthy person were to take berberine it's actually it's a moderate effect it's not lifechanging but it's one of those things where it's like okay well you have to ask yourself if you're normal healthy functioning then do you need to take it U if you have a healthy insulin response and a glute for transcation but if you're getting to a point where okay yes I have a problem then it seems to be more effective at least in the rodent model research that's what it it's pretty clear that it's like hey like this works better the further on up the line that you get which is and even seen it used in adjunct with metformin and it's it's it's quite promising there no absolutely I think yeah I use it a lot for my diabetic patients um it really helps them a lot but I think in my practice it overlaps so much for the gut health as well yeah totally yeah well uh doc where can everyone find you oh yeah so I have a practice in Fullerton it's called OC integrated medicine and then I also I'm on online as well I have a YouTube channel it's Raj nupad MD awesome well thank you so much for coming up here thank you so much Thomas Thomas thank you yeah