Visceral Fat - a Toxic Asset

There is now substantial evidence that the metabolic diseases associated with obesity, such as hypertension, type 2 diabetes and atherosclerosis are caused in part by toxic substances released by visceral fat. All trials of drugs for these lifestyle diseases, such as the recent JUPITER study, have been done in subjects with preventable excess visceral fat. Trialist doctors love people with excess visceral fat and recruit them into their drug trials because viscerally obese people have lots of “events” like heart attacks and strokes.So if you don’t want to have events, then lose that excess visceral fat. The rule of thumb is that your waist circumference at the level of your umbilicus should be less than half your height.

Visceral fat cells (adipocytes) are different from subcutaneous fat cells in that visceral fat cells are insulin resistant, can develop inflammation and their blood flow is part of the portal circulation, draining directly through the liver.

You have dangerous excess visceral fat if your waist circumference at the level of the umbilicus is more than half your height.

The Portal Circulation

Blood passing through the intesines and its associated fat tissue does not return directly to the heart but passes first through the liver where the absorbed food is metabolized. The system works well in lean people but when the visceral adipocytes become enlarged they produce toxic substances which damage the liver and cause it to release other substances which damage other organs. So, just losing subcutaneous fat by liposuction will not eliminate the metabolic consequences of obesity.

Enlarged adipocytes are toxic

When adipocytes become enlarged, for unknown reasons, they secrete factors which attract inflammatory cells, called macrophages which in turn release toxic factors such as the interleukins responsible for damage to the liver and other organs including the arteries and promote the insulin resistance causing type 2 diabetes.

Individuals vary in the tendency to store excess calories in subcutaneous vs visceral fat deposits. For example, some women tend to store fat around the hips instead of around the viscera and maintain a small waist circumference. Men seem to more susceptible to visceral accumulation. Subcutaneous fat is more insulin sensitive than visceral fat so it does not cause insulin resistance and Type 2 diabetes. Removing subcutaneous fat by liposuction is only cosmetic is potentially deadly and has no effect on prevention of Type 2 diabetes.

At any rate, fat accumulation in any depot is caused by excess calories over what is burned.

Multiple benefits to losing visceral fat

Become a connoisseur of ectopic fat distributions!

Visceral and subcutaneous fat deposition.

An extreme example of subcutaneous fat deposition on the buttocks. While unsightly this fat will not cause Type 2 diabetes.

Pure visceral obesity, typically in males. Those guys look like twins with identical ectopic fat distribution. 

Mostly visceral obesity in a woman

Abdominal obesity is a state of chronic visceral inflammation. Any person with abdominal obestiy is sick regardless of any other measurement such as blood pressure, blood cholesterol or blood glucose because they are at high risk for many lifestyle diseases. So, eliminating visceral fat must take priority over drugs in preventing these disease of lifestyle.