Visceral Fat - The Root of All Metabolic Evil

October 22, 2023

Visceral Fat, The Source of All Metabolic Evil

"Eeewwww,......gross!" said my anatomy partner in medical school as she lifted out the heart of our cadaver. His heart was almost completely covered with fat.

"Is that why he died of heart disease?" she asked.

"Oh, no....that's just part of the accumulated fat," our anatomy instructor said.

He was wrong. Visceral fat, the extra fat wrapped around your organs is a different kind of fat. It spews out inflammatory cytokines. For example, if you take 66 folks with GERD who are suffering from all the vagaries of acid reflux, and measure their visceral fat, you will find that they universally have more visceral fat than the norm. They can be shown to have high levels of the inflammatory cytokines IL-6, IL-1β, and IL-8. We have dozens of inflammatory cytokines that all rise in various ranges in response to the aggravating stimuli, but visceral fat appears to take the cake.

It's not just acid reflux that is caused by visceral fat, it is just about any chronic condition that afflicts us as we age. Just type in coronary artery disease and visceral fat to Google. The very first article you will find will be from the journal, Obesity, which confirms a direct correlation with the quantity of visceral fat to the extent of coronary artery disease.

Not happy with that? How about osteoarthritis? You know, those nasty swollen, nobby knuckles you get as you get older. One of the most common questions I get is "How do I get rid of these?" and folks show me their hands and their big, puffy knuckles. They can't get rings on and off anymore. You know the drill. Type into Google Osteoarthritis and Visceral Fat and the first article you read will be from the American College of Rheumatology meetings that show a direct correlation with pain in hands and joints from visceral fat.

Ok, are you with me?  Want to get personal and serious?  Type in Visceral Fat and Alzheimer's. That is our number 1 dread as we age. Again, from the journal, Metabolites, we see a study correlating visceral fat with the risk of developing cognitive decline. Bummer.

On and on. You can type in diabetes, high, blood pressure, and cancer, and in each, you will find recent research showing the link.

Now, do you want to get personal? Type in Face Shape and Visceral Fat. Oh dear. One more time, you will find studies showing that our face gets puffy and droopy in relationship to our visceral fat.

Subcutaneous fat, that which makes up our natural energy storage so that we can make it through the starvation season (winter, dry season, famine) while pregnant is not inflammatory. It is what you can pinch and which you cover up with layers of obscuring clothing. It's harmless. No inflammatory cytokines.

Estrogen protects women from getting visceral fat. During women's reproduction years, women tend not to get visceral fat. Men have no such protection. So, women going through menopause will accumulate visceral fat and change their fat storage compartments. They will observe that their tummies get a little bulge under their waistline that just wasn't there before. Their faces will look a little puffier and saggy. Double bummer.

Where does visceral fat come from? Our modern diet of processed foods, particularly sugars, refined carbohydrates, trans fats, and saturated animal fats is to blame. Throw in lack of exercise, stress, and alcohol and you have a perfect storm to accumulate visceral fat. Suddenly, we understand the Brazilian research showing that eating ultra-processed foods correlates with all sorts of metabolic diseases.

How can we measure visceral fat? Well, that's what's changed. The old method of standing on a fancy scale and measuring total body fat and guessing what percent is visceral fat is not quite up to snuff. But the MRI scanner now does it just fine. As costs come down and MRI speed and accuracy improve, we can now calculate the volume of visceral fat, just like we can calculate the volume of our brain, by adding serial slices of the MRI and then making a sum of it all. Does insurance pay for it? Not yet. But it might be the smartest thing they do. Seeing your image of your visceral fat, and looking in the mirror and your puffy eyes and saggy cheeks, you might just be motivated to do something about that.

www.What will Work for me? Well, from one saggy-cheeked guy to another, this is a total bummer. When I look at myself in the mirror sideways, just before I hop in the shower, I realize why I take my glasses off before I go into the bathroom. Yuck. Getting old is not for the faint of heart. I want to learn more about this visceral fat stuff and how to get rid of it. Next week, how to get rid of it.

References: Cleveland Clinic, Jr Neurogastrointestinal Motility, Obesity, Amer Coll Rheum, Metabolites, Nutrients, Jr Ster Biochem,

Pop Quiz

1. What is visceral fat?                            Answer: The deep, internal fat inside your organs that is wrapped into the membranes that surround your organs.

2. What is the principal cause of it?                                Answer: Our modern, ultra-processed food diet. Sugar, white flour, trans fats, multiple ingredients of unknown origin, and artificial sweeteners all add up. 

3. Does it affect male pattern baldness too?                        Answer: Google any irritating condition you may have and there is research indicating trouble, some association.

4. How does visceral fat wreak its havoc?                     Answer: Uniquely, it puts out showers of inflammatory cytokines that put the whole body on edge.

5. Does visceral fat affect coronary arteries? Answer: There is anecdotal evidence, aside from the well-documented clinical evidence, of segments of coronary arteries that dip out of the visceral fat around the heart into the heart muscle. The artery segments inside the fat were severely atherosclerotic. The artery segment inside the heart muscle was clean.