By Dr. Frank Sabatino

All too often, weight loss programs and weight loss drug approaches mistakenly focus on body weight, and overlook excess body fat as the most significant health risk. In fact, landmark research in Finland demonstrated that you can have normal, healthy body weight and still have a dangerous excess of body fat. (1) Obesity is a significant risk factors in the four most profound causes of death in the Western world: heart disease, cancer, stroke, and type 2 diabetes. (2)(3)(4) But all body fat is not equal. The bulk of body fat is soft fat that you can pinch just below the skin (subcutaneous fat). However, the most highly metabolically active fat is deep visceral fat in the protective apron of belly fat (the greater momentum) underneath the muscle layer of the body, that is also packed and wrapped around a variety of internal organs including the heart, intestines, kidney, liver and pancreas. Increased visceral fat is associated with hard, expanded belly fat and a protruding belly, and is also referred to as visceral or abdominal obesity.

The adipocytes (fat cells) in visceral fat function like an additional organ of your endocrine system, releasing a variety of hormones and proteins involved in regulating appetite, food intake, immune system response, and metabolism. The hormones and proteins they release establish important signals and communication with other endocrine organs as well as with the brain and nervous system. This helps ensure a balance of the creation, accumulation, and movement of fat in adipose tissue in response to changes in nutrient intake and calorie demands. (5)

As a result, excess visceral fat can also promote chronic inflammation, chronic disease and metabolic disorders. Similar to the immune system itself, fat cells synthesize a class of proteins called cytokines, unique chemical messengers that influence and modulate the inflammation response of the immune system. Several of these fat-generated cytokines (referred to as adipokines), including adiponectin, resistin, tumor necrosis factor-alpha, and interleukins, along with macrophage colony-stimulation factor, can stimulate the immune system and increase inflammation. (6)

Increased visceral obesity is significantly linked to impaired glucose metabolism, insulin resistance, metabolic syndrome (high blood pressure, high blood sugar, elevated cholesterol), and predisposition to colon, breast, and prostate cancer. (7-10) It is also associated with prolonged hospital stays, increased incidence of infections, and increased mortality in hospital. (11) The hormone estrogen is typically involved in regulating sexuality and reproduction. Fat cells produce and store estrogen. As you gain visceral fat, fat cells increase the activity of the enzyme aromatase that converts testosterone to estrogen. This increase of estrogen can provoke the abnormal growth of cells in the reproductive system, promoting estrogen sensitive tumor and cancer growth in the breast. (8) This can also account for the increase in estrogen, and breast development, in overweight men with excessive visceral fat. 

The accumulation of visceral fat can alter the amount of the hormone adiponectin to increase the risk and susceptibility to a variety of pathological conditions including certain malignancies. (12)(13) The hormone adiponectin released by fat cells reduces inflammation, protects the endothelial lining of blood vessels, and reduces the risk of atherosclerosis. An increase in visceral fat reduces this hormone and is associated with heart disease, hypertension, and insulin resistance. As insulin resistance develops, insulin cannot attach effectively to receptors on the surface (membranes) of cells, blocking the effective entry of sugar. Glucose (sugar) levels in the blood will then continue to increase, posing a potentially toxic threat to the body. When the body is consistently confronted with elevated blood sugar, it converts this toxic threat into the most energy-efficient material -fat- that it can possibly create and stores it in your fat cells increasing the accumulation of visceral fat. (14) 

Elevated blood sugar can be very damaging to the body, and is a form of toxic, chemical stress. It is important to recognize the impact of all chronic stress and sleep deficiency on the dangerous increase of abdominal/visceral fat. Any form of stress provokes the glands of stress, the adrenal glands, to elicit a fight-or-flight stress response and release the hormone cortisol to mediate this response. Cortisol has an affinity, a love affair, with visceral fat cells in your abdominal region and can promote the accumulation of risky belly fat when stress becomes chronic and relentless. Cortisol has a direct impact on the fat-making enzyme lipoprotein lipase. This enzyme is located in small blood vessels in the vicinity of visceral fat cells. In response to chronic stress, fat cells are exposed to consistent high levels of cortisol, and heightened levels of sugar and fatty acids released in the chronic stress response. Fat cells can then convert the sugar and fatty acids into fat and dramatically increase the deposition of visceral fat.

Not only does cortisol directly increase the activity of this fat-making enzyme, but it also directly stimulates the genetic production of this enzyme to promote fat production in fat cells around your belly. This lends credence to the important role of stress management in general, and toxic stress reduction in particular, in fat and weight gain. In addition, chronic sleep deficiency is a major stress that directly promotes excessive cortisol release and insulin resistance to promote a dangerous increase of visceral fat (belly fat).

So increased visceral fat is directly associated with an increase in abdominal weight gain, a bigger belly and waist size. Measuring the size ratio of your waist and hips can indicate abdominal obesity. Using a tape measure, measure your waist, and then measure the widest part of your hips. If you divide the size of your waist by the size of your hips (waist/hip ratio), and the number is greater than 0.85 in women and 0.90 in men, it indicates excessive visceral fat (abdominal obesity). 

The great news is that the accumulation of visceral fat can be prevented and reduced by a variety of healthy lifestyle modifications. A low-fat, low calorie-dense whole plant exclusive diet, without added salt, oil and sugar, provides all the nutrients you need while supporting metabolic function for the best reduction and regulation of body fat. It is essential that you participate in an activity program with 30 minutes of walking, or any endurance activity you enjoy, 5 times a week, and resistance training of major muscle groups to maintain muscle mass 2-3 times a week. Supporting your restorative sleep, and performing mindful stress reduction techniques (breath work, meditation, yoga, tai-chi etc.) are important for metabolic balance and effective weight and fat loss. 

Keep in mind that if you have experienced difficulty in achieving healthy body fat, and have fueled your frustration with programs that produce a recurring roller coaster of weight loss and weight gain, you may want to jump start better success with water-only fasting. Fasting has been shown to significantly reduce visceral fat that is effectively maintained with re-feeding, especially with SOS-free whole plant food.

REFERENCES

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