A Primary Driver of Chronic Disease

Disclaimer: Not Medical Advice. Opinions are my own.

In partnership with Sisu

Today's Newsletter at a Glance:

• Not all fat is equal

• Why is visceral fat dangerous?

• How can you measure visceral adipose tissue (VAT)?

• How can you lose it?

It will come as no surprise that obesity has exploded in the past 20 years.

I see firsthand the negative impacts of overnutrition on heart health in the operating room weekly.

The truth is stepping on the scale doesn't tell the whole story.

Where your muscle, fat, and ultimately the weight is distributed matters.

The human body has many different types of fat, including brown, subcutaneous, and essential fat. However, the most problematic type is visceral fat.

What is Visceral Fat?

Visceral adipose tissue (VAT) is stored under the abdominal wall and surrounds internal organs such as the liver, intestines, and pancreas.

Unlike subcutaneous fat, which sits under the skin and can be easily seen and touched, visceral fat isn't visible.

When the storage capacity in the subcutaneous reaches its limit, fat spills over into the intra-abdominal space.

What's the limit before fat starts to spill?

It depends.

The tricky part is that body composition differs between individuals.

This means some may store more or less subcutaneous fat before the body starts storing visceral fat.

However, the chronic disease engine directly correlates with the visceral fat stored around the organs.

Why is Visceral Fat so dangerous?

What makes visceral fat different from the rest?
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Visceral fat is metabolically active.

• It secretes various pro-inflammatory cytokines such as IL-6 and TNF alpha.
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• Visceral fat releases free fatty acids, affecting insulin sensitivity, increasing your chances of Type-2 diabetes.
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• Visceral adipose tissue (VAT) can disrupt hormone balance like leptin, which regulates appetite and hunger.

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The higher volume of VAT surrounding your organs, the more fat you accumulate within your organs.

This is how non-alcoholic fatty liver disease (NAFLD) can occur.

All in all, visceral fat is directly correlated with an increased risk of cardiovascular disease, type 2 diabetes, autoimmune disease, and neurodegenerative diseases.

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How to Measure your Visceral Fat?

As we discussed, every individual will have a different threshold of subcutaneous storage before visceral fat starts to accrue.

How much visceral fat do you have?

To answer that confidently, a DEXA scan is required.

What amount of visceral fat is a problem?

​A study by Meredith-Jones et al. identified the following VAT mass cutoffs associated with increased cardio-metabolic risk: 700 g in women under 40 years, 800 g in women 40 years and older, 1000 g in men under 40 years, and 1200 g in men 40 years and older.

If you want to assess your VAT levels from home, I recommend a Smart Scale or Waist-to-Hip ratio.

Many smart scales on the market can give you a rough baseline of your visceral fat level but won't have the accuracy of a DEXA scan.

Finally, the most convenient but least accurate is the Waist-to-Hip ratio.​

Measure your waist, above the belly button, and then measure the widest part of your hips.

WHR = Waist Circumference / Hip Circumference

You are at higher risk as a man with WHR >0.90 and a woman with WHR > 0.85.
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​Further research worth a look:

1. ​Evaluation of visceral adipose tissue thresholds for elevated metabolic syndrome risk across diverse populations: A systematic review​
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2. ​Optimal cutoff values for visceral fat volume to predict metabolic syndrome in a Korean population​​
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3. ​Visceral adipose tissue cutoffs associated with metabolic risk factors for coronary heart disease in women​

How to reduce Visceral Fat?

The good news is that you can significantly reduce your visceral fat through lifestyle choices.

Unlike stubborn subcutaneous fat, visceral fat is generally the first type of fat to be eliminated when weight loss begins.
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​How to start losing visceral fat today:

• Eat in a calorie deficit—consume fewer calories than you burn at rest + exercise. To keep you feeling full, try increasing protein and fiber.
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• Find an exercise program that works for you, such as classes, daily walks, running, swimming, resistance training, etc. Stay consistent. The small wins compound.
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• Prioritize sleep. Adequate recovery is crucial for success.
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The path to progress is simple but not easy.

Your health is too important to overlook.

Take the first step today.​
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​Only the best,

Jeremy London, MD