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Episode 54
The Doctor's Farmacy: House Call

Do You Have Excess Belly Fat? Why It’s A Problem And What You Can Do About It

Open the Podcasts app and search for The Doctor’s Farmacy. If you’re viewing this site on your phone, you can just tap on the

Tap the subscribe button and new shows will be added to your library.

If you’re using a different device, our show is available on the following platforms.

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You might be surprised to learn that not all body fat is created equal; where the fat is on your body makes a big difference when it comes to your overall health. The fat inside your belly is called “VAT” or visceral adipose tissue and this type of fat is particularly dangerous. When you begin to put on weight, especially this lethal belly fat, your biology shifts out of balance, veering into the unstable and unhealthy territory of disease—which in turn often leads to more weight gain.

In this episode, Dr. Hyman sits down with Dr. Elizabeth Boham to explain how belly fat contributes to other health issues. They also discuss the numerous factors that contribute to belly fat, including but not limited to diet, and how they work with patients to eliminate excess visceral fat.

Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing, she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. Dr. Boham has contributed to many articles and wrote the latest chapter on Obesity for the Rankel Textbook of Family Medicine. She is part of the faculty of the Institute for Functional Medicine and has been featured on the Dr. Oz show and in a variety of publications and media including Huffington Post, The Chalkboard Magazine, and Experience Life. Her DVD Breast Wellness: Tools to Prevent and Heal from Breast Cancer explores the Functional Medicine approach to keeping your breasts and whole body well.

This episode is sponsored by Pique Tea and Thrive Market.

Head over to piquetea.com/hyman and use code HYMAN to get 5% off sitewide AND free shipping when you purchase a bundle.

Thrive is offering all Doctor’s Farmacy listeners an amazing deal. You will receive an extra 25% off your first purchase and a free gift when you sign up for Thrive Market at thrivemarket.com/Hyman.

In this conversation, Dr. Hyman and Dr. Boham discuss:

  • Why visceral fat, or belly fat, is so concerning
  • Learnings from liposuction and bariatric surgery
  • How visceral fat drives inflammation and insulin resistance
  • Tests to determine if visceral fat is an issue for you, including your waist circumference, waist-to-hip ratio, DEXA body composition, liver fat measurement, LDL cholesterol particle size, C-reactive protein test, oxidative stress, uric acid, glucose tolerance test, and fasting insulin level
  • Symptoms of too much visceral fat including inflammation, abnormal cholesterol, high blood sugar, high insulin, high oxidative stress, and more
  • Foods that drive inflammation and insulin sensitivity and belly fat
  • Hidden drivers of excess visceral fat including loss of lean muscle mass, environmental toxins, imbalances in the gut microbiome
  • Patients they have worked with to decrease belly fat

I hope you enjoyed this conversation as much as I did. Wishing you health and happiness,
Mark Hyman, MD
Mark Hyman, MD

Guest

 
Mark Hyman, MD

Mark Hyman, MD is the Founder and Director of The UltraWellness Center, the Head of Strategy and Innovation of Cleveland Clinic's Center for Functional Medicine, and a 13-time New York Times Bestselling author.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

 
Dr. Elizabeth Boham

Dr. Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine.

Show Notes

  1. Dr. Hyman has written several books on this topic; learn more here
  2. 7 Ways to Permanently Banish Belly Fat
  3. How Out of Control Blood Sugar Can Cause Belly Fat, Brain Fog, and Chronic Disease
  4. Fatty Liver is More Dangerous than You Might Realize. Here’s How to Heal It
  5. 8 Strategies to Reverse Skinny-Fat Syndrome

Transcript

Dr. Elizabeth Boham:
The visceral adiposity, that belly fat is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn’t listening to its insulin as well as it used to. And so, that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight.

Dr. Mark Hyman:
Hello, everybody. It’s Dr. Mark Hyman. Welcome back to The Doctor’s Farmacy. That’s Farmacy with an F. I won’t spell it out because I got reprimanded for doing that too many times on the podcast. So, it’s just Doctor’s Farmacy, a place for conversations that matter. And if you have belly fat, it matters. This conversation will matter because we’re all struggling with it.

Dr. Mark Hyman:
And today we’re going to talk on our special house call episode with Dr. Elizabeth Boham, my colleague at The UltraWellness Center, who’s the medical director. She’s a world renowned physician. She’s all over the world. She’s helped thousands of people achieve optimal health, and she focuses on nutrition in her practice every day. She’s an RD. she’s an exercise physiology. She’s an MD. She contributes to all sorts of national media and educates physicians around the world. She’s just the bomb. So anyway, welcome, Liz. We’re going to talk about belly fat.

Dr. Elizabeth Boham:
Thank you, Mark. It’s great to be with you, and to talk about belly fat.

Dr. Mark Hyman:
Oh yeah, my favorite topic. I’ve written all these books on belly fat.

Dr. Elizabeth Boham:
Because it’s a problem, right?

Dr. Mark Hyman:
Well, the thing about it, it’s a huge problem and it’s so easy to fix. And it’s not through the Ab Roller or the Thighmaster, whatever infomercial tool you can figure out to get your abs right. I mean, you can’t get good abs through exercise. I mean, eventually you have to do exercise, but if you just focus on exercise, you won’t get it straight.

Dr. Mark Hyman:
So, let’s talk about this problem, because for those of you listening, we are in a staggering health crisis, not just COVID, but the whole pandemic of chronic disease that’s driven by poor metabolic health and this phenomena of being over-fat.

Dr. Mark Hyman:
You can be overweight or you can be over-fat, or you can be both. We’re going to talk about that today and why it’s so important to think about for our own health, for our longevity, for preventing disease and just for feeling good, and actually even just getting our own lives together and managing our appetite, and our metabolism, and our energy, and all the things that affect us. So, I’m so excited to talk to you about this because this is my favorite topic.

Dr. Elizabeth Boham:
Oh yeah, mine too. Mine too. And we know that where your fat is in your body makes a huge impact. We used to always worry about pinching an inch, right? When we were growing up. Can you pinch an inch? But now we realize that that fat that’s deep with inside the belly, the visceral adiposity, that belly fat deep inside the abdomen is really concerning in terms of overall health. And like you mentioned, it’s a huge issue. It is a huge pandemic.

Dr. Elizabeth Boham:
In just the United States, we know that 70% of Americans are overweight or obese, but 86% are over-fat. Meaning that they have too much fat, and especially that concerning visceral fat is a real concern. And over half of our kids also are over-fat. And so-

Dr. Mark Hyman:
That’s staggering. Half of our children. Half of our children.

Dr. Elizabeth Boham:
… it’s staggering and it’s creating so much… It’s staggering. It’s sad. It’s sad. And it’s creating so many health problems, from just feeling crummy to tired, to causing cancer, increasing our risk of cancer like breast cancer and prostate, and colon, and lung cancer. Of course, increases our risk of diabetes and cardiovascular disease, increases our risk of Alzheimer’s disease and cognitive decline. It increases our risk of stroke and blood clots, and high blood pressure, and infections.

Dr. Elizabeth Boham:
As you were mentioning earlier with COVID, we realize that people with too much fat, people who are over-fat, people with too much visceral adiposity have an increased risk of COVID-19. They have lower immune systems. They have increased risk of erectile dysfunction and infertility, and PCOS, and hair loss in the wrong places, and make it harder to lose weight.

Dr. Mark Hyman:
Wow.

Dr. Elizabeth Boham:
So, it’s just connected to so many things and it’s unfortunately so common. And so, that’s why we like to talk about it so often, because sometimes it takes us talking about a subject more than one time for people to really put all the pieces together for themselves.

Dr. Mark Hyman:
It almost seems too good to be true that all these problems are related to one phenomena. And while there are often many causes for many of these things, the majority of these problems that you mentioned from infertility to heart disease, cancer, diabetes, Alzheimer’s, are all related to this weird fat that’s very different. And once you mentioned pinch an inch, that’s the subcutaneous fat. It’s the fat around your organs that really matters.

Dr. Mark Hyman:
And I remember this one study I read, you probably saw it years ago, it was the New England Journal of Medicine. And they did a liposuction on this very obese woman, who really was very, very big and they sucked out 40 pounds of fat from her subcutaneous tissue. So basically, she lost 40 pounds just by sucking out all the fat. But when they did a CAT scan to look at the fat inside, that didn’t change at all.

Dr. Mark Hyman:
And what also didn’t change was all of her biology. In other words, if you change your diet, you can change the quality of the fat and the messages they make very, very quickly, within days to weeks. But for her, even though she lost 40 pounds of subcutaneous fat, there was no change in her blood pressure, blood sugar, cholesterol, any of the markers of poor metabolic health. She was just as sick as she was before, even though she was 40 pounds lighter because they took out the subcutaneous fat.

Dr. Mark Hyman:
So, this belly fat is really different than the fat on your body, your arms, or under your chin or whatever. It’s very different fat. So, talk about this fat, particularly, we call it VAT or visceral adipose tissue, or belly fat, or organ fat, or whatever you want to call it. But it’s fat around your organs, your liver, your kidneys, your intestines. It’s in that organ compartment. What’s it doing that’s different than regular fat?

Dr. Elizabeth Boham:
Yeah. I was also so blown away when that study came out all those years ago and it just really was an eye opener for me to say, and I use that example for patients all the time like, “We can’t just liposuction this away and your blood pressure is not going to come down.” You think, “Oh, if I can just liposuction it away then my diabetes will go away.” But it doesn’t work like that. Right? Because you’re not getting to that deep adiposity, that deep belly fat.

Dr. Elizabeth Boham:
And that deep belly fat is really inflammatory. What we realized is that deep belly fat produces all sorts of inflammatory markers, interleukin 6 and tumor necrosis factor. So, it actually results in increased inflammation in the body and it is associated with increased insulin resistance. And that high level of insulin and the high level of inflammation, those two things and I’m sure there’s more, are really drivers for all of these processes to get out of whack in the body, for the cholesterol to get out of whack, for your inflammation in your arteries to get out of whack, for cancer to grow.

Dr. Mark Hyman:
So, inflammation drives all these things, right?

Dr. Elizabeth Boham:
Absolutely. Absolutely. And that deep fat is not just hanging out, it is metabolically active as we’ve talked about before. And you always like to talk about, it’s metabolically active. It’s not just sitting there, it’s really doing all of that. It’s an endocrine organ, it’s doing-

Dr. Mark Hyman:
Not just holding up your pants.

Dr. Elizabeth Boham:
No. Right. It’s actually doing things and it’s producing all these chemicals and hormones, and it’s increasing the inflammation in your body. And so, if there’s one thing that people can focus on… Sometimes people get overwhelmed with all these messages in health, right? “Oh my goodness, what do I do? What diet do I follow? What should I work on? Where do I focus?” And sometimes people get overwhelmed and they almost give up. We see that all the time.

Dr. Elizabeth Boham:
And this is like the basic thing that everybody can focus on. Even for myself, I do a lot of these self-care things, right? I try to all the time, right? But this is an area that we can all focus on that can improve our health, if we just pay attention to what’s our waist circumference, and what’s our waist-to-hip ratio? Because that’s telling us how much belly fat we have.

Dr. Mark Hyman:
Yeah. So, I think that’s right. I often joke and say, there’s a simple test you can do to figure out if you have this problem, it’s called the mirror test. You take off your shirt, you look in the mirror, you jump up and down. And if your stomach jiggles, you probably have it. And the truth is, 88% of Americans have it, are metabolic not healthy. That’s because they have this visceral fat that’s making them unhealthy and causing all these other problems that we see as separate, right? “Oh, have I high blood pressure?” “Oh, have I high cholesterol?” “Oh, have I blood sugar?” But they’re all the same problem. Or, “I have low sex drive or low testosterone. Or, “I have pimples and poor periods, and sleep apnea.” And whatever the things are that we’re suffering from, we see them as all separate, but they’re all connected by this.

Dr. Mark Hyman:
And with COVID now, the vulnerability of these population with visceral fat is just been highlighted. 63% of hospitalizations could have been prevented if people had better metabolic health and ate better food.

Dr. Mark Hyman:
So, the real question is one, we’re going to talk to them about what causes it and how we start to diagnose it. But one of the ways we can diagnose it properly, you mentioned the waist-to-hip ratio. That’s a simple test. Tell us about that. And then let’s talk about some of the blood tests that when you’d see, that may seem like other stuff, but are clues to you having bigger belly fat.

Dr. Elizabeth Boham:
Yeah. The waste-to-hip ratio is a great measurement that we can all do and repeat on our own. So, what you do is you get your waist circumference. And to find the right place for your waist circumference, it’s in between, you find your lowest rib and you find your upper hip bone, and then you put the tape measure in between. And that’s considered your waist circumference. So, if you find that lowest, your last rib and your hipbone, and go in between the two, that’s considered your waist circumference. And then your hip circumference-

Dr. Mark Hyman:
It’s like your belly button pretty much, right?

Dr. Elizabeth Boham:
Yeah. Some people’s belly button hangs down or is in a different place. So, it’s not always the belly button, but it is around that area. Yeah. And then the hips circumference is, it’s considered over the greater trochanter. But if you don’t know where that is, I always say to people, go over the largest part of your hip because that just makes your number look a bit better. So, you want to get the biggest hips circumference as you can have. Not that you want to be overweight, but you pick the biggest hips circumference to determine your waist-to-hip ratio, if you can’t figure out where that greater trochanter is.

Dr. Elizabeth Boham:
So, the goal for Caucasians is to have a waist circumference less than 35 inches for women and less than 40 inches for men. For Asian and Indian ethnicities, it’s stricter, less than 31 inches for women and less than 37 inches for men.

Dr. Elizabeth Boham:
And that waist-to-hip ratio is a great measurement to do. So for women, you want to be less than 0.8. And for men, less than 0.9, is the waist-to-hip ratio you want to have. So, you want a smaller waist than hip, of course. And the neat thing, this is a really simple test you can do, and something you can check every month. You can redo your waist-to-hip ratio every month and watch your progress and say, “Okay, what am I doing? What do I need to do?” And it’s a really inexpensive way to figure out, “Is this a problem for me?”

Dr. Mark Hyman:
Yeah, that’s really huge. And I think it was also important when you said, and that people of Indian or Asian descent can have significant visceral fat and all the complications from it at much lower weights. So, if you look at their weight, it might be perfect, it might be less than 25, 23 of their body mass index, which 25 or more is overweight, but they may be full of this visceral fat and they can be diabetic. And they can be thin, and they look thin. We’ll call them skinny fat. So, they have the same issues as someone who is overweight, but they’re just over-fat.

Dr. Elizabeth Boham:
Yes. Or TOFI, right? Thin on the outside, fat on the inside. So, if you are a smaller person, then that’s where also that waist-to-hip ratio can be really helpful.

Dr. Elizabeth Boham:
And you’re right, you’re right, no test is ever perfect. So, for some people, the waist circumference or the waist-to-hip ratio isn’t giving us all of the information. There’s a lot of other biomarkers that of course tell us that somebody has too much visceral adiposity, that somebody is carrying too much weight around the belly. If we see a high C-reactive protein or marker for inflammation, it makes us wonder, “Okay, do they have metabolic syndrome, insulin resistance, visceral adiposity?” If we see that fasting insulin greater than five, that’s when we say, “Okay, this is something we have to pay attention to.”

Dr. Elizabeth Boham:
If we see too many small dense LDL cholesterol particles, we’ve spoken about that before, that’s a sign that somebody has insulin resistance or visceral adiposity. We also check for things like oxidative stress, too many free radicals being produced. That’s a sign. If their liver function tests are high or they have signs of fatty liver, that can also be because of this visceral adiposity or gout, high uric acid, that can also be because of this. Or that pattern in cholesterol, the high triglycerides, low HDL, all of these things can give us a sign, give us information and say, “Okay, this person is struggling with metabolic syndrome, insulin resistance or probably because of visceral adiposity.”

Dr. Mark Hyman:
And you often notice all these things abnormal at the same time, right? So, you see a pattern, and it’s really pretty easy to diagnose when you know what to look for. So, you get inflammation, you get abnormal cholesterol-

Dr. Elizabeth Boham:
Absolutely.

Dr. Mark Hyman:
… and you get high blood sugar, high insulin, lots of oxidative stress, your liver… I mean, these are all things that seemingly are treated like separate problems, but they’re all connected to this visceral fat.

Dr. Elizabeth Boham:
And what’s amazing is to watch them improve when we make shifts or changes in somebody’s lifestyle. Or there’s a lots of things that can contribute to this, from toxins in the environment to shifts in the microbiome, to poor diet, having a nutrient poor diet, eating too many refined carbohydrates and simple sugars, not getting enough exercise, poor sleep, too much stress, can all contribute to it. But when we shift somebody’s lifestyle and when we make shifts in these issues that they’re dealing with, we see these markers, these biomarkers improve significantly. So, it is really fun to watch, we see it improve all the time.

Dr. Mark Hyman:
Yeah. So, I want to get into the causes, a little more deeply in a minute. But there is another test that we often do, which I like a lot and it’s the gold standard. It’s called the DEXA body composition test. And it’s like a X-ray, a very low dose X-Ray. I mean, you have to basically take 50 of these to equal one flight across the country from New York to California in terms of radiation. And it measures the compartments of your body, your arms, your legs, your belly. And can tell you what the fat is, where it is. And it’s pretty compelling. There’s also MRI technology that does a CT technology liver fat measurements.

Dr. Mark Hyman:
So, there’s a lot of ways to look at this, but it is really the central problem of our time. And there are many causes, but the major cause is our ultra processed high starch sugar diet. That’s the biggest cause, because that drives insulin, and insulin drives all the available fuel that you’ve eaten into your fat cells in your belly. And then it keeps the fat there, prevents this breakdown process called lipolysis of your fat, and it produces all these inflammatory compounds, and it screws up your hormones, and it makes you hungry all the time, and it slows your metabolism. So, it’s the worst possible thing. And it’s really driven predominantly by that.

Dr. Mark Hyman:
So, we know that a high carbohydrate in the sense of starch and sugar diet, because vegetables are carbohydrates, so you can eat as much of those as you want, is the biggest driver of this. But there are other causes, right, Liz? And you mentioned a few of them. So, let’s go through some of the unusual things that might be driving this, whether it’s the microbiome, toxins and any other things that drive inflammation.

Dr. Elizabeth Boham:
I always, just in the terms of the most common cause, right? I get so concerned when I see a young child, maybe like eight or nine, and their parents are buying them a muffin and a sugary coffee drink or sugary beverage for breakfast. And I’m like, “Oh no.” It’s just a setup. It’s a setup for them to have problems for their whole. And I think that it’s important that people take care of those basics, like you mentioned. But we always look for, sometimes people are doing or they feel like they’re doing everything right, and there’s hidden reasons for why they start to develop visceral adiposity and that belly fat when they’re really doing a lot of things correctly.

Dr. Elizabeth Boham:
One of the things that I find that people don’t realize is, what happens when they start to lose lean muscle mass as they get older. So, we might be exercising a good amount every day, but if we’re not working really hard to maintain that good lean muscle mass, what happens after the age of 25, is we slowly lose lean muscle mass. And then it’s just so much easier for the body to put on excessive fat. And we know that having good lean muscle mass and exercising, really keeps our insulin sensitive. And so, that’s one thing that slowly catches up with people and they become more insulin resistant over time. And you mentioned toxins, unfortunately there’s been multiple toxins associated with this visceral adiposity [crosstalk 00:19:03].

Dr. Mark Hyman:
Sorry. I want to underscore what you just said. Liz, I want to underscore what you just said.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
Because you basically said something really important around muscle loss when you get older. And muscle loss is really, can be thought of as replacing muscle with fat. So, you can be the same weight at 65 than you were 25, maybe twice as fat. And that fat in your muscles it’s not just in your belly, it’s also this poor metabolic fat. And it leads to this increasing phenomenon with all the consequences that we see of disease. So, I feel like this is a really important thing that people don’t understand.

Dr. Mark Hyman:
So exercise, basically strength training, building muscle and aerobic exercise, even interval training, will help improve metabolic function and help keep this insulin resistance at bay as we age. Because it is something that affects almost everybody as you age, unless you do something actively about it. So, let’s talk about toxins.

Dr. Elizabeth Boham:
You do have to work really hard at it. I mean, it’s so easy to maintain… Well, I don’t know if it’s so easy, but it’s so much easier when you’re younger to maintain your lean muscle mass. And as you get older, it’s really work. People are like, “I do go for a walk every day.” And I’m like, “It’s not enough for you right now.” And getting in two days a week where you really are working on resistance type exercise, there’s so many ways you can do that, that really can make a big difference. So, yes, so toxins.

Dr. Elizabeth Boham:
BPA is a toxin that’s been unfortunately associated with visceral adiposity, fatty liver, metabolic syndrome. And BPA, bisphenol A is that hard plastic that is pervasive unfortunately in our environment. And has been associated with breast cancer, but it’s also been associated with insulin resistance.

Dr. Elizabeth Boham:
So, I think it’s important that we recognize that there are a lot of toxins out there that are impacting our insulin sensitivity and possibly through how it damages our mitochondria. And it’s just really, there’s more to it sometimes than just our food intake. And we always really have to dig and look for that when we’re working with our patients.

Dr. Mark Hyman:
For sure, we call these things obesogens. They’re petrochemical toxins. They’re even heavy metals, I’ve seen. So, we really have to be alert to, people are not losing weight, and they’re not successful doing the basic stuff of diet and lifestyle change. What else is there? And there are other things like the microbiome. So, maybe you can share a little bit about that and what we’re learning.

Dr. Elizabeth Boham:
Oh, the microbiome I think is so fascinating, right? I mean, there’s so much information there that we’re learning. And there’s going to be so much more that we’re going to learn over time. And I don’t think we have it obviously all figured out. But we know that there are certain bacteria in our digestive system that are associated with less inflammation and a healthier weight. And there’s certain bacteria in our digestive system that are associated with more inflammation in the body and having an easier time with weight gain.

Dr. Elizabeth Boham:
So, it’s fascinating the association between the microbiome and this whole process of insulin resistance. And so, when somebody comes in and we’re trying to figure out what’s going on with them? We want to work on all angles here. And we want to ask those questions of, “What’s going on in your digestive system? And how are your bowel movements? And how do you feel after you eat? And are there foods that you’re not tolerating?” Because we can work to manipulate that to help improve somebody’s metabolism.

Dr. Mark Hyman:
Yeah. And also, anything that causes inflammation, could cause weight gain. So, people might be having these sensitivities that are causing it. Or they’re exposed to mold in their environment. Or they have latent infections. Because anytime there’s inflammation, it drives in some resistance, independent of the cause.

Dr. Mark Hyman:
So, the biggest cause, not to get too down that rabbit hole, of these things, that the biggest cause obviously is sugar and starch. Those are the two biggest things that are driving inflammation. But there are a lot of other things that people need to think about that also do it.

Dr. Mark Hyman:
Now, people listening might be going, “Okay, yada, yada, yada. Okay, all this great science about belly fat and what it does and why it’s bad, and how to test for it, and what causes it, but how do I get rid of it?” Is the big question. How do you actually get rid of it?

Dr. Mark Hyman:
And I think it’s so gratifying practicing functional medicine and in The UltraWellness Center where we work. It’s so gratifying seeing this because this is one of those slam dunk, idiot proof things for most people. And it happens so quickly. And it’s so striking because people are always struggling with this. And I’m like, well, if you understand biology and how the body works, and how it functions, which is really the foundation of functional medicine is understanding how to work with the body rather than against it, you can drive these biological changes really quickly, and really change the quality of the fat dramatically.

Dr. Mark Hyman:
And just to give you a quick example, and then we’ll go into what to do about it. This is one of my favorite studies that I’ve read recently, is a study looking at gastric bypass surgery. Basically they say, well, gastric bypass works because it causes all these amazing changes in hormones and appetite, blah, blah, blah, blah, blah. So, there’s all these theories about why it works.

Dr. Mark Hyman:
Well, somebody decided maybe we should test this theory. So, they took a bunch of people who were really overweight and they gave them gastric bypass on half of them. The other half just ate the diet that the gastric bypass people ate after they had the surgery. And there was no difference.

Dr. Mark Hyman:
But very quickly within days of changing their diet, the quality of their fat changed. And it went from being inflammatory fat, just driving all these problems to really shifting that. And so, it can happen pretty quick. Even if you’re still a little overweight, you can still have the metabolic and health benefits. And of course, you still need to get the weight down, but I think it’s just an interesting phenomenon. That’s why I love that study. So, let’s talk about-

Dr. Elizabeth Boham:
They’re very good.

Dr. Mark Hyman:
… what do you do, and in some case studies that you’ve had, that really illustrate the ways in which we can use this strategy of functional medicine, the science to drive a real change for these patients in their, not only their belly fat, but all the other biomarkers and health issues, and consequences that come from having this belly fat?

Dr. Elizabeth Boham:
Absolutely. Like we were talking about the visceral adiposity, that belly fat is associated with high levels of insulin in the body and insulin resistance. And that means that the body isn’t listening to its insulin as well as it used to. And so, that high level of insulin, as you mentioned earlier, causes us to store calories and to just gain weight. It makes us more hungry, but it also makes it much harder to lose weight.

Dr. Elizabeth Boham:
So, one of the things, when you were talking about, okay, how do we really work with our physiology? Is we want to prevent insulin spikes because we know that higher levels of insulin are what’s really driving us to gain this visceral adiposity. And so, as you mentioned, it’s those refined carbohydrates and sugars that drive up insulin levels in the body.

Dr. Elizabeth Boham:
And we know that if we ate just fat, we wouldn’t secrete a lot of insulin. And protein, we secrete some insulin, but not as much as with carbohydrates. So, what’s really important is bringing down the percentage of calories that somebody’s getting from carbohydrates, especially the refined and processed carbohydrates that cause that insulin spike. And so, I always talk to people about having that balance of the good healthy fat and lots of fiber, and some protein at every meal, and just pulling away the simple sugars and refined carbohydrates, because that brings the insulin down and makes us less likely to hold on to that weight around our belly. So, that’s really the first area we always work on. And we can dive into a couple of cases as examples.

Dr. Mark Hyman:
So, this is really a great point. So, basically the key to this is keeping your insulin levels low, because as long as your insulin levels are high, the body really has a one way street of fuel into your fat cells. So, basically insulin locks the fat cells in your belly and prevents the breakdown. We call it policies, they’re the breakdown of this belly fat.

Dr. Mark Hyman:
So, like you said, how do you cut insulin levels? Well, you’ve got to cut out the starch and sugar, especially if you’re an extreme case. If you have a lot of belly fat, you really need to be more strict, like no sugar, grains, beans, even some fruit. And then as you start to become more metabolically healthy and resilient, you can add things back. But it’s really key to be really religious about it.

Dr. Mark Hyman:
And also, there are other factors like artificial sweeteners that are driving this, and there are other carbohydrates, we might think are okay, like eating whole grains or eating whole wheat bread or eating… But they may not, for people who are really insulin resistant be helpful.

Dr. Mark Hyman:
And what you also said, was so important about fat. Fat doesn’t cause any spike in insulin. And you see, this is phenomenon. And this is just a great story, I learned from David Ludwig, who’s a professor at Harvard, one of the greatest scientists in this field. And he said, “Mark, if you would take a type 1 diabetic, and this is very different than type 2, which is basically from eating sugar and starch.” Type 1 diabetics have an autoimmune disease that damages their pancreas. They cannot make insulin. So the presenting symptoms, and every doctor learns this in first year of medical school, are they’re hungry all the time. They’re peeing all the time and they’re losing weight. So, they could be eating 10,000 calories a day and lose weight. Why? Because there’s no insulin. So, that’s really the key. And a ketogenic diet is the most extreme version. But there are a lot of other approaches to eating more fat, less starch and in the continuum of all that. So, I think that’s really important. And protein is really important too, but if you eat too much protein, you can also get insulin spike.

Dr. Elizabeth Boham:
Absolutely. Right. So, the first patient that we’re going to talk about is a woman who, she was in her mid 50s. And she came to see me because she had just been diagnosed with an estrogen receptor, progesterone receptor positive breast cancer. And it was stage one. So, she was lucky in that sense of she found it early in that sense. So, that was great. She had a surgery and radiation. And she was placed on aromatase inhibitor. But she said, “I want to do whatever I can to prevent this from coming back.”

Dr. Elizabeth Boham:
And so, we gathered all of her information, her whole history. And she noted in her history that she had gained like 30 pounds since she had her children. And it just came on slowly over the years. She became more tired over time and really just had a harder time with losing that weight.

Dr. Elizabeth Boham:
So, she came in about 30 pounds overweight. And when we checked her waist-to-hip ratio, it was 0.88. And remember we said, for women, we want that waist-to-hip ratio to be less than 0.8. So, hers was high at 0.88, and not crazy off the charts overweight, but 30 pounds higher than she needed to be.

Dr. Elizabeth Boham:
And so, we said, okay. I explained to her, “This is where we really want to focus, because there’s so much research here showing the connection between insulin resistance and belly fat, and breast cancer. So, we really want to focus on lowering your waist-to-hip ratio. And we want to focus on lowering your insulin levels because we know that will lower inflammation in the body and it will decrease your risk of getting a reoccurance or another cancer for that matter.”

Dr. Elizabeth Boham:
So, she was really motivated and we put her on the pegan diet. We really worked to lower her percentage of carbohydrates in her diet. She was a pretty healthy eater, but getting in some, her coffee drink that had added sugar in it. And needed to really make some shifts.

Dr. Elizabeth Boham:
So, we started to tighten up her diet. We gave her a lot more phytonutrients. We give her a lot more fiber. We work to increase her omega-3 fats. And we also did, we really tried to increase her green tea intake. There’s some really interesting research with green tea. We’ve always talked about it from a breast cancer prevention strategy because it’s got anti-angiogenic properties. It can impact the tumor suppressor gene in a healthy way and decrease risk of cancer that way. And it’s an antioxidant, but it also has been shown to lower insulin and help with lowering body weight.

Dr. Elizabeth Boham:
So, when people drink four cups of green tea a day for eight weeks, they had improvement in their metabolism and their weight, and their BMI. And so, that was helping her on both angles.

Dr. Elizabeth Boham:
We also gave her more omega-3 fats to help improve her triglyceride HDL ratio. So, we added in two to four grams of fish oil. And there has been some really interesting research on kimchi as well at helping to improve somebody’s insulin sensitivity. And so, we had her start to incorporate lots of phytonutrients in her diet, lots of vegetables, but also kimchi to help with improving her microbiome.

Dr. Elizabeth Boham:
And she did really well. She was able to lower her weight. It took a few months to get the weight down, six months or so. But she even got that waist-to-hip ratio to less than right around 0.8, which we were happy with. So, she’s doing great.

Dr. Mark Hyman:
That’s amazing. So, you see this happen over and over with our patients, and you just dial in the simple recommendations that seems are obvious, but for some it’s a little different. And just to share a few cases of mine. I remember one who had, for example, severe diabetes and his sugars were 250. He couldn’t get it in control. We changed his diet, even put them on a ketogenic diet, helped a lot. But what was fascinating is we couldn’t get that last mile until it was by accident, really. He was complaining to me of his gut and his bloating, and all kinds of issues, and gas. And I was like, “So, let’s just try and experiment. Let’s just try charcoal.”

Dr. Mark Hyman:
Now, diabetes is not treated by taking charcoal pills. But by understanding functional medicine and interrelationship of the microbiome and inflammation, and how it affects, for example, the toll receptors and causes increases in TNF alpha, which is basically an inflammatory cytokine. When the cytokine storm things, it causes insulin resistance. And I said, “Well, let’s just try it.” And he says, “Wow, I took this charcoal and my blood sugar went to normal for the first time.” And I was like, “Wow, that’s fascinating.”

Dr. Mark Hyman:
Or another patient I had, was a trainer and a fitness trainer, and ate healthy. And she struggled, she had high mercury. And we got rid of the mercury and she was able to lose weight.

Dr. Mark Hyman:
So, I think most of the time it is really about the diet. And then I think adding the exercise too, we didn’t really talk about that. But adding the exercise, even though you can’t exercise your way out of a bad diet, you can’t exercise your way into better health and fitness, and increased metabolism. So, it’s really important to actually, as you’re losing the belly fat to maintain your muscle. That’s where you talked about the strength training and exercises. What about the next case you were going to share about, who was a guy who had high blood pressure and had cholesterol, tired all the time?

Dr. Elizabeth Boham:
I mean, we see this all the time. Somebody comes to us because he had just gone to his physician, he’s 47. And he had just gone in for his routine physical, and all of a sudden his doctor wanted to put him on blood pressure medication and he wanted to put him on cholesterol medication. And so, he was like, “Oh no, this is not what I want to do.” And it woke him up a little bit and he said, “Let me just explore this a little bit and look into it, and look at this a differently. I don’t want to just treat all my symptoms with the medication. I want to see what’s going on here.”

Dr. Elizabeth Boham:
So I mean, he was just struggling with his energy. So, he’s feeling a little bit lower in energy. He would put on some weights. But otherwise, he was just doing fine. He didn’t have a lot of other complaints.

Dr. Elizabeth Boham:
And when we did his waist-to-hip ratio, his waist-to-hip ratio was at one. So again, remember with men, we want their waist-to-hip to be less than nine. And he was at one. And so, this was assigned to me right away that I knew I had to work on insulin resistance and this visceral adiposity. I knew that this belly fat, this too much weight in his abdomen was triggering this high blood pressure, was triggering an unhealthy cholesterol pattern.

Dr. Elizabeth Boham:
And when we looked, when we did that particle size test on his cholesterol, we saw that his small dense LDLs were too high and his HDL were too low. And his oxidized LDL were too high as well, which we know, when LDL cholesterol gets oxidized, that’s when it can get damaging to the artery lining. So, that’s when we said, “Okay, we’re going to really focus on your insulin levels here.”

Dr. Elizabeth Boham:
And again, we pulled away all the refined simple sugars. He needed to get rid of some extra beer that he was drinking. We got in a lot more vegetables in his diet. We workED to increase his omega-3 fats in his diet. He didn’t want to take a lot of pills, but he was good at making shifts in his diet. He really got motivated.

Dr. Elizabeth Boham:
He also got motivated because we talked about how that increase in waist circumference increases erectile dysfunction. And so, he said, “That’s really interesting. I really want to lose this weight around my belly.” And so, that really got him motivated to get right on the diet and really worked to increase his exercise.

Dr. Elizabeth Boham:
We had him get some strength training in three days a week. He ended up working with a trainer, which was really helpful for him to stay motivated. And he started to add in a little bit more interval training on those other days. But that really helped him, and within three months or so, we saw that waist-to-hip ratio come down significantly. And in like six months, he was at that 0.9 of waist-to-hip ratio. His blood pressure improved. His cholesterol pattern improved. His energy improved. And he never needed to start medication. And he’s doing really well.

Dr. Mark Hyman:
That’s amazing. And then there are just so many stories like that, it just reminds me of this patient I had, who wasn’t a typical. So, sometimes you think that was typical, but she looked like the Michelin woman, I guess. She was total apple. You’re just round. I know you’ve seen these people, these around and the skinny legs, and big belly. And I thought, “Oh man, her tests are going to be so bad. And her blood sugar is going to be high, and that’s going to be terrible.”

Dr. Mark Hyman:
And what was fascinating, her A1C, which is your average blood sugar, what was fascinating with her, and this is just to speaks to what really happens to people, is her blood sugar was perfect. In fact, we even did a glucose tolerance test where you look for diabetes and we gave the equivalent of two Coca-Colas and watched whether her blood sugar went up or not. And it never went up. I mean, her blood sugar was under 100 fasting. It never went up over 110, even after all that.

Dr. Mark Hyman:
But what was really different, and this is the thing people should listen to. And we’re going to put in the show notes the tests that you should think about doing and asking your doctor for. I’ve written a lot about it, and in fact then, there’s a great description of actually how to diagnose this. But what she had was very high fasting insulin, like 50, which should be under five. And after she took a sugar drink, it should be under 30. Hers was like 200 or 300. And so, her insulin was so high, she couldn’t lose weight. And within a very short time, she lost like 50 pounds of belly fat just like that by shifting her diet and reducing inflammation, and dealing with this sort of starch and carbohydrate intake that she took.

Dr. Elizabeth Boham:
Yeah. It’s amazing. It’s amazing.

Dr. Mark Hyman:
It’s pretty amazing. And it’s a really gratifying area. And I think when you look at aging, when you look at fertility, when you look at chronic disease, when you look at productivity, when you look at your brain function, all those things are related to this belly fat. And it’s really the drum beat that I am, and we have been sharing for decades at The UltraWellness Center, which is really about the quality of the food you eat, the quality of your diet. And it’s why I spend so much time writing books like The Blood Sugar Solution: 10-Day Detox Diet, Eat Fat, Get Thin, The Pegan Diet, Food: What The Heck Should I Eat?

Dr. Mark Hyman:
Because if we can get this straight, we’re going to solve so many of our global issues around health and chronic disease, the economy and everything else. So, it’s an exciting moment where I think this is becoming more and more recognized. I literally just got off a call with a senator, riling his team about how we can begin to address this through policy.

Dr. Mark Hyman:
So, I’m optimistic. I’m always a little bit optimistic no matter what, anyway. I think I’m more optimistic than ever that we actually have a moment to start to change the tide on this.

Dr. Elizabeth Boham:
Yeah.

Dr. Mark Hyman:
Any last thoughts, Liz, on belly fat before we wrap up our podcast?

Dr. Elizabeth Boham:
Yeah. I agree, Mark, there’s so much we can do. And simple changes in your diet make a huge impact on how easy it is to maintain a good healthy weight and to prevent this from happening. And when you make those changes and cut out that extra sugar, and cut out those refined carbs, you’re also, not only having an easier time with maintaining your weight and keeping that weight off your belly, but also preventing all those diseases like we spoke about.

Dr. Mark Hyman:
That’s so great. Well, thank you for joining us.

Dr. Elizabeth Boham:
Thanks for all the great work you do, Mark. It’s really exciting.

Dr. Mark Hyman:
Yeah. Well, thank you, Liz. And thanks for being on this week’s house call. I loved sharing this information to all of you. If you love this mini episodes of The Doctor’s Farmacy, share with your friends and family. Subscribe where you get your podcast. Leave a comment on how you’ve addressed your belly fat. We’d love to hear from you.

Dr. Mark Hyman:
And also, I’ve got this new incredible content opportunity, which is called Dr. Hyman+. You can go to my website, drhyman.com, learn more about it. And it’s ad-free podcast, access to our documentary series. And Ask Me Anything with me, where every month I answer questions through video, and personally, as well as Dr. Boham, and others from our team are doing deep dives into functional medicine. So, it’s a really wonderful way to access a lot more content if you’re a little geeky like us. So, Dr. Hyman+, check it out. And of course, we’ll see you next time on The Doctor’s Farmacy.

Dr. Elizabeth Boham:
Thank you, Mark.

If you are looking for personalized medical support, we highly recommend contacting Dr. Hyman’s UltraWellness Center in Lenox, Massachusetts today.

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