Sattar 2014

There is a peculiar phenomenon that is increasing in frequency as more and more Americans gain more weight: the appearance of “ectopic” fat—essentially fat found in odd places where it doesn’t belong.

The appearance of ectopic fat appears to be the body’s response when it runs out of places to store excess fat. It stores it in the abdomen, where nearly all health problems related to weight originate. It also stores it in “subcutaneous” locations, i.e., beneath the skin in the buttocks, thighs, calves, arms, neck, chest. Imaging studies, however, are also identifying fat stores in the most improbable locations, such as:

  • Heart—Fat accumulates in the sack around the heart (pericardium), on the outside of heart muscle (epicardium), and in the heart muscle itself, especially around the coronary arteries. These fat locations are inflammatory and amplify risk for cardiovascular events such as heart attack.
  • Joints—You can actually see globules of fat floating in the lubricating synovial fluid in knees, hips, and other joints. There’s also an accumulation of fat in the knee as the infrapatellar fat pad. While fat in the abdomen increases joint inflammation, fat in the joint itself is worse, causing local inflammation to increase and damage cartilage.
  • Liver—Of course, the familiar fatty liver is another example of ectopic fat.
  • Muscle—Muscle can also be infiltrated by ectopic fat and is believed to result in loss of strength, further impairing the decline in strength and muscle mass that occurs with aging.
  • Pancreas—The pancreas is, of course, in the abdominal cavity, but fat accumulating here appears to have special implications that include pancreatic inflammation and damage to the β-cells that produce insulin, a phenomenon that can convert a type-2 diabetic to a type-1 diabetic, dependent on insulin injections for a lifetime.
  • Kidney—-The kidney is in a separate abdominal compartment, the retroperitoneal space, but is nonetheless a location that ectopic fat can also accumulate and reduce kidney function.

It is becoming clearer and clearer that minimizing both abdominal visceral and ectopic fat reverses these situations. Problem: conventional methods of weight loss—reducing calories, pharmaceuticals, and bariatric procedures—favor loss of subcutaneous fat over visceral or ectopic fat. Conventional weight loss methods also inevitably lead to signifiant loss of muscle that, in turn, reduces basal metabolic rate. Loss of muscle, reduction in basal metabolic rate then cause weight regain, even if a reduced calorie intake is maintained. In short, such conventional methods are only temporary fixes that lead to long-term downturns in health. This includes the current GLP-1 agonist craze, the hype over drugs such as semaglutide (Ozempic, Wegovy). Say you take the weekly injections of Wegovy and tolerate the nausea, vomiting, and diarrhea. Over a year, you lose 30 pounds at a cost of $15,000, of which 10 pounds is muscle. You can’t afford to do this indefinitely, so you stop the drug. You regain 24-27 pounds, nearly all of which is fat. You are now more insulin resistant than at the start, your risk for heart disease, breast cancer and other cancers, stroke, and cognitive decline are GREATER than your risk prior to weight loss—and you are $15,000 poorer (a huge wealth transfer, by the way, from the pockets of the public to that of the pharmaceutical industry).

Is there a way to circumvent all the problems associated with conventional weight loss “solutions”? Yes, absolutely. But it requires some unconventional insights and methods. To lose weight but specifically favor loss of abdominal visceral and ectopic fat, maintain or increase lean muscle mass and thereby basal metabolic rate, and maintain the lost weight without regain, we need to:

  • Reverse insulin resistance—achieved through a diet that does not raise blood glucose nor provoke insulin; address common nutrient deficiencies that drive insulin resistance (vitamin D, magnesium, omega-3 fatty acids, iodine) that, when combined, synergize to minimize insulin resistance
  • Banish appetite-stimulating opioid peptides that derive from the gliadin protein of wheat and related grains
  • Gain control over inflammatory mediators—also achieved through the diet and addressing common nutrient deficiencies
  • Address small intestinal bacterial overgrowth (SIBO) and associated endotoxemia—since they are major drivers of insulin resistance and inflammation
  • Restore lost keystone microbial species from the GI microbiomeL. reuteri is the champion here since it both provokes oxytocin from the brain that restores youthful muscle mass, thereby preserving or increasing basal metabolic rate, while also colonizing the small intestine and producing bacteriocins, natural antibiotics effective against the species of SIBO. Next in line is L. gasseri, the BNR-17 and 2055 strains.

This combination of strategies is superior to any conventional strategy: You favor loss of abdominal visceral and ectopic fat while preserving or increasing lean muscle mass. You can take your efforts even further by addressing two additional components missing from the lifestyles of most modern people that, when restored, add further to the specific loss of abdominal visceral and ectopic fat and increase lean muscle mass: collagen peptides and hyaluronic acid. And, compared to the thousands of dollars that pharmaceuticals and bariatric procedures cost, these methods cost almost nothing. Because there is no pot of gold at the end of this rainbow, don’t expect your doctor to one day experience an epiphany and help you gain control over weight and body composition—there’s nothing in it for him or her.