Good fat, bad fat

No, this is not a discussion of monounsaturated versus hydroxgenated fat. This is about the relatively benign fat that accumulates on your hips, rear end, or arms--the "good"--versus the deep visceral fat that encircles your intestines, kidneys, liver, pancreas, and heart--the "bad."

And I'm not talking about what looks good or bad. We've all seen the unsightly flabby upper arms of an overweight woman or the cellulite on her bulging thighs. It might look awful but, metabolically speaking, it is benign.

It's that muffin top, love handle, or wheat belly that encircles the waist, a marker for underlying deep visceral fat, that:

--Increases release of inflammatory mediators/markers like tumor necrosis factor, leptin, interleukins, and c-reactive protein
--Is itself inflamed. When examined under a microscope, visceral fat is riddled with inflammatory white blood cells.
--Stops producing the protective hormone, adiponectin.
--Traffics in fatty acids that enter the bloodstream, resulting in greater resistance to insulin, fat deposition in the liver (fatty liver), and increases blood levels of triglycerides
--Predicts greater cardiovascular risk. A flood of recent studies (here's one) has demonstrated that larger quantities of pericardial fat (i.e., visceral fat encircling the heart, visible on a CT scan or echocardiogram) are associated with increased likelihood of coronary disease and cardiovascular risk.

You can even have excessive quantities of bad visceral fat without much in the way of fat elsewhere. You know the body shape: skinny face, skinny arms, skinny legs . . . protuberant, flaccid belly, the so-called "skinny obese" person.

Nobody knows why fat in visceral stores is so much more evil and disease-related than, say, wheat on your backside. While you may struggle to pull your spreading backside into your jeans, it's waist girth that is the problem. You need to lose it.

Comments (11) -

  • john

    8/27/2011 8:03:14 PM |

    Did you know the VDR-knockout mice have miniscule amounts of visceral fat?  They're hyperphagic and also have low SC fat, very high UCP1, and poor general health--a very high Ca diet helps some.  I'm not really sure how to extract any useful information from the studies on those mice though.

  • Might-o'chondri-AL

    8/27/2011 8:46:31 PM |

    10 days ago in journal Radiology 2011, 260(3): "The association of pericardial fat with coronary artery plaque index at MRI imaging...":
    (quote) "... this is the first study to determine the association of pericardial fat on coronary artery plaque burden in asymptomatic individuals."
    (quote) "The coronary artery eccentricity (ratio of maximal to minimal coronary artery wall thickness) was determined by using magnetic resonance (MR) imaging and served as an index of plaque burden. The pericardial fat volume was determined by using computed tomography."
    Pericardial fat refers to fat around the heart in case wording confuses anyone.

  • Joe

    8/29/2011 10:16:37 PM |

    I've lost ~65 pounds in the last 7 months, but that doggone visceral fat is still hanging on for dear life, unfortunately, even with my internal organs trying hard to evict it, too.
    I'm determined to get rid of it all, plus the few remaining pounds of subcutaneous fat I have left, mostly in the form of "love handles," come hell or high water.


    PS: UPS just delivered my copy of your new book, Wheat Belly, a few minutes ago, Dr. Davis, that I ordered mostly for my brother-in-law, who still eats massive amounts of cereals, bread, pasta, etc. (and who has an ever increasing "wheat belly").  Maybe it'll offer a few tips on how to lose VF specifically...

  • wheat lover

    8/29/2011 10:18:40 PM |

    Is wheat driven small LDL dose dependant?
    If I eat one sandwich a day, do I get no benefit from reduced wheat at all?
    How long must one be wheat free to get a reduction in small LDL?
    Thank you

  • Joe

    8/29/2011 10:21:29 PM |

    I'm making this post in this thread because the vitamin D thread appears to be shut down:

    Dr. Davis:
    Stenosis is when the valve fails to fully open, and insufficiency is when the valve fails to fully close (as I understand it). Presumably, both result in decreased blood flow from the heart.

    On that assumption, anything that can be done to strengthen the heart muscle itself would seem appropriate, including participating in vigorous exercise, taking various heart-beneficial supplements, like magnesium and vitamin D ("contractility"), CoQ-10, fish oils (may affect "palpitations, fibrillation and arrhythmias"), etc. And losing weight, of course.

    Which has been my chosen course of action. I'm 68 years old. I've lost ~65 pounds over the past 7 months, I now run 5K+ 3-4 times per week (I feel great!), I do some upper-body weight-lifting to conserve muscle mass during weight loss, I take the above supplements (including 6000 IUs of vitamin D, plus I get almost daily sun exposure during my runs, walks, etc.), and I pray a lot. The only symptom(s) I appear to be experiencing are some mild palpitations from time to time. Other than that, nada.

    I've been unable to find in the literature any specific ways to treat insufficiency other than valve replacement or repair, both of which require open-heart surgery - and which just ain't gonna happen.  No way, Jose.  My plan is to "keep on keeping on" (as described above)  for as long as I can, and hope for the best.

    Eventually, I will succumb to heart failure, I presume, but I'm hoping to push that eventuality as far into the future as I possibly can. My second echo stress test is scheduled for next March, and I'm hoping that the numbers will show some progress, but I'll settle for no slippage. I feel like I'm "in training" for the event, and I'm a competitive guy. I also hope that my aggressive approach is the right one, but I have no way of knowing if it is or not because of a lack of information in the literature. My cardiologist gave me a "no restrictions" edict regarding exercise, but didn't have much more to add. I've taken those words literally; I have taken my MHR up to 165bpm, but I am hesitant to take it any higher at this point, for obvious reasons. But I think I've still got more in the tank, so to speak. I now have a RHR in the 50s. My BP now averages ~115/62. With numbers like that, I have to keep reminding myself that I have "heart disease."

    Dr. Davis, what is the longest that any of your insufficiency patients have been able to put off the inevitable (inevitable in this case should be considered to be heart failure or valve replacement/repair)? What other supplements might help me out? Is it feasible that I could get another 10 years out this regimen, or am I just kidding myself?

    How's that for putting you on the spot, Doc?


  • michael goroncy

    8/29/2011 11:46:50 PM |

    Joe...I don't understand your aversion or fear of surgery. You have an 'easy' fix solution. Most people with CAD would trade places with you.

    Your valve problem is mechanical and not in the same category as arteries being occluded.
    No amount of exercise or supplementation and nutrition will correct your current situation, albeit a great protocol for CHD prevention.

    That's my 2 cents...while you await Bill Davis to respond to your concerns...good luck.

  • Lorak

    8/30/2011 2:22:53 AM |


    My 2 year old daughter had her aortic stenosis fixed via a valvuplasty.
    I am not a doc but thought I'd throw that out there. Regarding my daughter she is 25 years old living a normal healthy life. Her initial assessment by another cardiac surgeon was open hear surgery to repair the stenosis along with a life with no child birth and drugs for her lifetime.  Good luck to you!

  • Dr. William Davis

    8/30/2011 6:38:15 PM |

    Hi, Joe--

    While I have been seeing incredible effects in aortic valve stenosis patients (essentially stopping progression in most, reversing a few, a few continuing to progress), the handful of people with aortic valve insufficiency don't really add up to a real experience. Nonetheless, I have indeed seen several stop progressing, a couple actually improve. My colleagues will dispute this, calling it quackery, since I have not yet published any of this.

    That said, vitamin D is wonderful for overall health. Vitamin K2 is also proving to be a fascinating nutrient with potential for substantial bone and artery/valve effects, also. Neither are harmful. So I believe nothing is lost except a few dollars by giving it a try.

  • Dr. William Davis

    8/30/2011 6:40:32 PM |

    Great, Joe! 65 pounds over 7 months is absolutely spectacular!

  • Ned Kock

    9/8/2011 9:52:47 PM |

    For those interested, here is a way to tell the difference between subcutaneous and visceral fat:

  • robert

    9/9/2011 11:32:49 PM |

    Nice topic. I think not everyone know the difference between these 2 kind of fats. And the difference is really important.