Koo 2022

I recently posted a DrDavisInfiniteHealth blog post on the issue of ectopic fat, i.e., fat now appearing in peculiar body locations such as the heart, knee, and kidney with health implications beyond that of obesity alone. Accumulation of fat on the surface of the heart and enveloping the coronary arteries, so-called “epicardial fat,” for instance, increases risk for heart attack, congestive heart failure, and heart rhythm problems. Excess kidney fat impairs kidney function, often irreversibly.

I’ve also recently discussed the importance of not thinking about weight loss per se but about achieving beneficial effects on body composition that avoid the problems caused by weight loss while amplifying the health benefits and preventing weight regain. One of the pivotal issues here is preserving or increasing lean muscle mass. I don’t mean bodybuilder or Arnold Schwarzenegger-levels of muscle, but a restoration of the degree of musculature you had when you were 25 or 30 years old. Recall that, as we age, we lose about 30-35% of muscle, a phenomenon that impairs numerous areas of health. Preserving muscle, for example, during a weight loss effort prevents regain of weight.

In other words, muscle takes center stage in importance in crafting your healthy and attractive body composition. You want bulges in the right place, not the wrong places. Muscle is also subject to ectopic fat, “myosteatosis,” fat that infiltrates the muscle itself. The greater your degree of overweight, the larger your waist circumference, the more likely muscle becomes infiltrated with fat. This reduces strength and adds to unhealthy effects such as insulin resistance that underlies increased risk for type 2 diabetes, heart disease, cognitive impairment and dementia, risk for breast cancer, etc.

Abdominal visceral and ectopic fat respond to the strategies we follow in my programs, strategies that include:

  • Elimination of wheat, grains, and sugar
  • Restoration of important nutrients lacking in modern lives that, when combined, favorably impact insulin resistance and inflammation: omega-3 fatty acids, magnesium, iodine, vitamin D
  • Addressing dysbiosis, SIBO, and endotoxemia, phenomena that also add to insulin resistance and inflammation
  • Restoration of Lactobacillus reuteri that, via oxytocin, provokes increased muscle mass and reduction of abdominal visceral and ectopic fat
  • Restoration of Lactobacillus gasseri that reduces abdominal visceral fat (likely via reduction in endotoxemia)
  • Increased intake of collagen that adds to increased muscle and reduced abdominal visceral fat

Exercise, on the other hand, is only modestly helpful in reducing abdominal visceral and ectopic fat. But there is an important exception: myosteatosis or muscle fat. This fat is not very responsive to the above strategies, but is exquisitely sensitive to exercise. Here is a graph of some of the results from the Lifestyle Interventions and Independence for Elders pilot (LIFE-P) study conducted at the University of Pittsburgh:


Goodpaster 2008

The level of exercise was mild to moderate, consisting mostly of walking and home exercises such as pushups and squats with occasional group sessions. Over one year, as you can see, intermuscular adipose tissue (IMAT) increased in the non-exercising control group, with no additional increase (but also no decrease) in IMAT with these modest efforts. Would a more intensive or prolonged exercise effort have reversed fat infiltration in muscle? Do our added strategies such as L. reuteri and oxytocin, L. gasseri, and collagen peptides stack the odds further in favor of reversing any excess muscle fat? I’ll bet they do, but no one has yet looked at this question formally to my knowledge.

In the meantime, know that, by engaging in my programs and strategies, you are achieving results in improving body composition and likely minimizing or eliminating the excess risk from both abdominal visceral and ectopic fats. But staying physically active by walking, biking, swimming, and some strength work address any myosteatosis you may have developed in previous years.