Episode 115 Summary


Let us tell you a little story about a very jolly man in a lovely red suit - He is particularly well known for his red suit trimmed with fluffy white fur. That’s right. We’re talking about Santa Claus. Santa Claus is very well known to the majority of the western world for his jolly temperament and his large round belly. In Australia, a physique such as Santa’s with a large, rounded abdomen is often referred to as having a “beer belly”.

So what IS a beer belly? How does it affect health and how is it related to diet? - Fat, or adipose tissue is more than a simple storage organ. It is a metabolically active tissue which interacts with our body via hormone signaling and other chemical messaging. Adipose tissue is really important and in fact essential for life and crucial to good health, however when our bodies become overwhelmed by long term excessive consumption of sugar and starch insulin resistance may develop and our adipose tissue can be a major player in this process. 


Let us explain more - It is important to understand that there are two different types of fat that we store.  Subcutaneous fat, which is the fat we store just under the skin, and visceral fat, the fat which wraps around our internal organs.  Visceral fat is the fat which accumulates to create the appearance of a “beer belly”.

Where you store your fat is dependent on many factors that are not within your control - These factors include genetics and your sex and even your age, but it can have enormous implications for your health. Subcutaneous fat, the fat which sits just under the skin is metabolically active but it is less involved in the development of insulin resistance and the cardiovascular implications of insulin resistance, however for those who have an accumulation of visceral fat, a beer belly, like Santa Claus, this is unhealthy. It is something you should address and change for the sake of your future well-being. 

Why is visceral fat so unhealthy? In visceral fat the individual fat cells or adipocytes tend to become quite enlarged. Visceral fat is an active immune organ with its own immune system. Visceral body fat is inflammatory. These enlarged fat cells begin to leak out cytokines and other immune mediators which attract more immune cells which creates a vicious cycle of inflammation all throughout the visceral body fat. The end result is that as a result of the cytokines, the TNF alpha (an inflammatory cytokine produced by white blood cells), and the macrophages all out of balance and over-firing, it impairs glucose metabolism, causes insulin resistance and triggers inflammation throughout the entire body. A sign of this inflammation can be an elevated CRP, which is a blood marker of inflammation.  This is a significant risk factor for heart disease.


The cytokines from fat (adipose tissue) are known as adipokines - Your visceral fat, your “beer belly” is like an inflammation factory. Pumping out adipokines that go all over your body, causing: 


  • Joint pains
  • Headaches
  • Difficulty sleeping


So how do we close down the inflammation factory? How do we get relief from these symptoms?

Mainstream advice recommends adopting a calorie deficit, and although short term this may be effective, it is the gateway to yo-yo dieting, and can have negative impacts on your metabolism and mental health. 


At Real Life Medicine we advocate for a much more sustainable way of eating - We want you to nourish your body and treat the upstream causes of the increased visceral fat, namely the high insulin levels. To reduce visceral fat and counter insulin resistance, eat a delicious low carb, real food diet. Move your beautiful body in sports and activities that you enjoy and once you are established and feeling well on a low carb real food diet and your woodshed is open, you can throw in some intermittent fasting. (Read more about the woodshed here).

When you reduce the excess quantities of sugar and the excess quantities of starch and excess quantities of processed food in your diet,  your amazing, clever, beautiful body will do the rest.

To help you on your journey we have written a free e-book. The Doctors' Guide to Real Health and Weight Loss which you can download below.


Get our free e-book, The Doctor's Guide to Real Health and Weight Loss

Show notes:

Episode 115 - What is a beer belly?

Dr Mary Barson: (0:11) Hello, my lovely listeners. I'm Dr. Mary Barson.


Dr Lucy Burns: (0:15) And I'm Dr. Lucy Burns. Welcome to this episode of Real Health and Weight Loss. Good morning, lovely listeners. And good morning to you gorgeous Dr. Mary. How are you this morning?


Dr Mary Barson: (0:31) I'm well, Dr. Lucy here this early morning. I love that we've got up early to do this. It's putting first things first, and prioritising the stuff that's important to us.


Dr Lucy Burns: (0:43) Absolutely.


Dr Mary Barson: (0:44) You've always got more time than you think. You have time to run a fabulous podcast, even when you're busy. That's what I'm learning more and more.


Dr Lucy Burns: (0:55)

Well, let's think it's a bit like a mantra, because your mantra could be, Oh my god, I'm so overwhelmed. I've got no time. And that then becomes your truth. Or your mantra can be, life is busy, but I prioritise the things that are important to me.


Dr Mary Barson: (1:09) Yes, yes. Hence why I'm here with you on this lovely morning talking to you, beautiful listeners.


Dr Lucy Burns: (1:17) Yes, pre the crack of dawn.


Dr Mary Barson: (1:18) Correct.


Dr Lucy Burns: (1:19) So gorgeous woman, two things. The first thing I'm just going to let our podcast listeners know in case they drift off this episode is that we have got a free resource that is super helpful and we are explaining a lot about this in this episode, which is called The Doctors’ guide to Real Health and Weight Loss. It's a downloadable eBook. And you can get it from our website, simply by going to rlmedicine.com and you'll see it under free resources. So as part of that, I wanted to tell a little story. And the little story is about a very jolly man who has a lovely red suit. He's probably the only person in the world that gets away with this red suit that is then trimmed with white fur. And he is well known to the majority of certainly the Western world. And I thought we'd talk a little bit about his health and maybe part of his diet. So we all know that for the majority of people Santa has visited already. And that night, he will have consumed a diet that largely consists of beer, shortbread, fruit-cake, glasses of milk, cookies, maybe mince tarts. What did you leave out for Santa, Dr. Mary?


Dr Mary Barson: (2:50) Yes. So there's a certain point where I feel your parental control kind of evaporates. So my daughter was in charge of this. So we left out for Santa, an array of fruit, berries and shortbread biscuits.


Dr Lucy Burns: (3:06) And if you could wave a wand and give Santa something perhaps a little more healthful?


Dr Mary Barson: (3:13) Yeah, of course.


Dr Lucy Burns: (3:15) Yeah. What would you give him?


Dr Mary Barson: (3:17) Oh, I definitely would have put out some beautiful salami and some delicious slices of hard cheese.


Dr Lucy Burns: (3:24) Yes. And maybe a glass of kombucha for his poor gut. 


Dr Mary Barson: (3:27)  Yeah, that's right. Chief protein bar. That would have been great.


Dr Lucy Burns: (3:33) Yes, absolutely. So we all know that the image of Santa is that of a jolly belly. So you know, in Australia, when people have Santa’s physique, we will often call it the beer belly and I thought today we'd talk a little bit about what that actually is. And there is no better person than you, Dr. Mary to talk about that, given your extensive knowledge of biochemistry.


Dr Mary Barson: (3:59) Thanks, Lucy, I'm a little bit excited. I first might say that fat is not just a simple, it's not just simple storage. Fat is way more than that. Our fat tissue or as it is more technically called - the adipose tissue - interacts with our entire body to maintain metabolic homeostasis. That is all of our metabolic processes in some way interact with our adipose tissue. And our fat tissue interacts with our body through hormones and other chemical messages. And it does lots of lots of really good stuff. It's actually completely crucial to good health. And when the system gets a bit overwhelmed by, in many cases, having too much sugar and starch over a too long a time, or the metabolic processes get a little awry and we develop insulin resistance. It is actually the fat cells that are a main player in the development of insulin resistance and our main player in many of the poor health outcomes that we can have from insulin resistance.


(5:18) So largely speaking we have two types of fat that we store. That's the subcutaneous fat, the fat that just goes under our skin, either elegantly or inelegantly, depending on how you feel. And then we've got the visceral fat. And the visceral fat is the fat that wraps around our organs, our internal organs, and that is the fat that you find in your belly. Where you store your fat depends on many things that you can't control, like your age and your genetics and your sex. And where you store your fat has huge implications for your health. If most of your fat is subcutaneous, the fat that sort of sits under the skin, it's actually not very bad for you, it doesn't have very many significant health consequences. It's metabolically active, absolutely. But it isn't involved that much in the development of insulin resistance, and all the whole suite of cardiovascular complications that come with that. If, like Santa Claus, your body fat is more visceral, then that is unhealthy. And that is something that you would like to address and to change. It's a lot to do with the size of the fat cells, the actual single adipocytes. In visceral fat, they tend to be quite enlarged, and in subcutaneous fat, they tend to be small. You know, the world is full of athletes out there. And there are some athletes like sumo wrestlers that are actually quite overweight, but they're not insulin resistant. They aren't, they're very fit, they're very active and their fit, active lifestyle probably plays a really significant role as to why there doesn't tend to be many insulin resistance sumo wrestlers despite their increased weight. However, they often develop insulin resistance after they stop being sumo wrestlers. Indeed, many athletes can develop insulin resistance after they stop being athletes and they stop exercising so much. And that is because there is a change in the way that their bodies store fat. I reckon it would be important to talk about inflammation here.


Dr Lucy Burns: (7:56) Excellent. I think that yes, inflammation is super important. And I would hazard a guess that Santa’s body is quite inflamed, and that he probably experiences reasonable amounts of joint pain, which sounds weird that his belly fat would be causing joint pain. But um, I would love to explore that either now or a bit later in the episode. But yes, let's talk about inflammation.


Dr Mary Barson: (8:27)

Yes, poor Santa. We feel for Santa. We really really do. his. This whole episode is like you know, wanting to help understand Santa and to help him help himself and to empower all of you beautiful people to help yourselves. Santa probably does have some joint pain and Santa might also have a bit of trouble sleeping, he might get headaches, there could be lots of things that are going on for poor Santa. And that could be largely due to the fact that visceral body fat is quite inflammatory. It's a very active immune organ. Our fat is an active immune organ, it has its own immune system. There are two main theories as to why visceral fat is so inflammatory, but it is. One theory is that the inflamed large fat cells recruit the immune system into them. And then once the immune system is there, they start leaking out all of these cytokines and other immune mediators that then attract more immune cells and you get this vicious cycle of inflammation all throughout the visceral belly fat. Poor Santa. Another theory is that the actual immune cells themselves the pre immune cells become these immune cells, it kind of doesn't matter. The end result is either way that we've got a whole host of immune processes that are firing away and misfiring inside that visceral body fat. And when you get localised inflammation like that, With the cytokines with TNF alpha, with the macrophages doing their thing, going a bit berserk is that it actually impairs glucose metabolism, and causes insulin resistance, as well as elevating inflammation throughout the whole body. So if we did blood tests on Santa, he would probably have an elevated CRP, which is a marker of inflammation within the body. And with that, just simply having elevated inflammation is a huge risk factor for heart disease, one of the most significant risk factors, in fact, as well as mediating a whole lot of other issues such as inflamed joints and headaches and just not feeling very good. All of this is happening within the fat within the visceral body fat and it seems like doom and gloom and, and bad news. However, there is a lot you can do to reduce that highly inflammatory, metabolically active, visceral fat within your body.


Dr Lucy Burns: (11:08) Absolutely. And you know, what's funny, I, when you were talking about fat being more than storage, I absolutely thought that. I thought, oh, yeah, that's just like a cupboard that you put your excess energy in. And, you know, it's like the never ending cupboard, you can always store more. But it wasn't until I heard this phrase adipokines, which is one of my favourite words, which is a combination of sort of adipocytes and cytokines that you were talking about. And I go, ah, and so actually, your fat is like an inflammation factory, it's just pumping out these adipokines that go all over. And as you said are then integrally involved in inflammation in in all parts of our body,


Dr Mary Barson: (11:51) Yeah, our fat cells interact with every part of our body through those chemical messengers. And they're not all bad. I mean, we have good adipokines, like adiponectin is something that we need that has multiple health benefits throughout our body. But when we get that increased visceral fat, when we have more visceral fat than is good for us, that is when the whole system is out of balance, and that can generate poor health.


Dr Lucy Burns: (12:19)

Absolutely. So if we wanted to close down the inflammation factory, how would we go about that?


Dr Mary Barson: (12:27) Great question. So I like to look at the science and there is some beautiful articles and research out there, looking at ways that reduce visceral fat, and it's a very important hot topic that the scientific community and medical community have been looking at for a long time, because we've understood for a long time that it is the visceral fat that can be so damaging to our health. There are a few ways. I'm going to say this, even though I don't like it. I will say that a calorie restricted diet has been shown to reduce visceral fat, at least in short term studies looking at periods of 12 weeks. So that does happen. But calorie restriction has got a whole lot of other problems for your health and metabolism and your mental health. And it's also just not a very sustainable way. It's the gateway to yo yo dieting, and we just don't like yo yo dieting and the diet rollercoaster. Another way to reduce the visceral body fat is to reduce the sugar and starches. And I like this way much more because it is sustainable. You can eat as much as you like, you're not hungry, you are nourishing your body. And the thing I particularly love about reducing your carbohydrate intake is that it treats some of the upstream causes of the increased visceral fat, namely, the high insulin.


Dr Lucy Burns: (14:04) It's so interesting, isn't it? Because you're right about low calorie diets. And this is the problem with many nutritional studies is they use short term interventions like 12 weeks. And the reason they do that it's you know, it would be incredibly expensive to do a long term controlled study. So then they do a 12 week study and try and extrapolate that out for a couple of years. Or instead of doing that, they will look at observational studies and then try and correlate that to causation. So, I mean, we absolutely know that you can lose weight by calorie counting and calorie restriction. But we also know that that is the root cause of yo yo dieting. It is the root cause of disordered eating, it is the root cause of so many metabolic and mental health problems related to basically not getting enough nutrition.


Dr Mary Barson: (15:03) Yes, yes, it's bad for your brain, bad for your metabolism and not a good long term solution. A study done in 2015 by I think was Gower and Goss looked at restricting dietary carbohydrates as they call it, so reducing the sugar and starches in the diet, and they found that you could reduce visceral fat. Even if people didn't lose weight overall, they still reduced their visceral fat, which I thought was really interesting. It is also important to note that they found that carbohydrate restriction reducing carbohydrates was superior to calorie restriction for fat loss overall. And the other thing you can do to reduce visceral fat is exercise. Moving your body, whatever kind of movement you like, it doesn't have to be a grueling gym regime, unless you like grueling gym regimes, then absolutely go for it. But moving your body is another way to reduce visceral body fat and to improve insulin sensitivity. And one of the ways in which you can treat that upstream cause of the insulin resistance and the poor, happy, large, inflamed, visceral fat cells. And then the third thing is intermittent fasting. That is also a really powerful way to reduce visceral fat. So it's eat a delicious low carb, real food diet. Move your beautiful body and throw in some intermittent fasting.


Dr Lucy Burns: (16:43) Mm hmm. So it's interesting because you and many of our listeners have heard us talk about the woodshed. So, I thought I might just quickly go through what the woodshed is.


Dr Mary Barson: (16:55) You are the analogy queen, Dr. Lucy,


Dr Lucy Burns: (16:57) I know! I do love a good analogy. So. So for those of you who haven't heard this analogy, and for those of you who have well just bear with me, I think you can never hear it enough. So we know that our body can use two forms of fuel, it can use carbohydrates, which is sugar. So sugar and starches, they’re the same thing. So you know, again, looking at Santa’s diet, it's you know, it's the shortbread, it's the beer, it's the mince tarts, it's the cookies. Interestingly, it's also bread and rice and potatoes and those sorts of things. They all count as carbohydrates. So you can use that as your fuel or you can use fat as your fuel. And for lots of us, particularly those of us who have been on a low fat diet, we don't have access to our fat stores very easily. So the analogy is, if your body is like a fireplace and using the two forms of fuel - kindling is the carbohydrates, it's the glucose, it burns quickly, but it dies down quickly. You have to keep replenishing it if you're using purely glucose as your fuel. Or, ideally, you should be able to put some logs on your fire. So the logs are your fat. Now for lots of us, particularly with insulin resistance, we don't have logs next to our fireplace. They're in the woodshed. So the woodshed is any of our fat stores, but in particular our visceral fat stores. 


(16:29) So you might toddle out to your woodshed to get a log. This is when your body is going yes we need more fuel. You toddle out to your woodshed. And you can see, perfect, all of these lovely logs all lined up ready to burn. And you go to open the door and the door is locked. And the lock is insulin. So it doesn't matter then what you're trying to do. If you can't get your fat stores, you will literally run out of fuel. And this is when you come back to your fireplace, which now just has a couple of embers burning. And it's really, you’re starting to get a bit cranky by now, you're tired, your brain is not working properly, you've got some brain fog, you might even start to get a bit hangry. And of course, you know there's plenty of processed food options that have been marketed to us for the three o'clock hangry period. And so our brain by this stage is really yelling out for some fuel and it will often get desperate and just get whatever it can because it really wants something. And so understanding this is part of this glucose roller coaster that we talk about which you can find more about in our ebook, but really getting clear on that. So with those three steps of reducing carbs, adding in some exercise and intermittent fasting, the first thing that needs to be done is to really open the shed because it becomes hard to do exercise if you've literally run out of fuel. And it's very hard to do intermittent fasting when you've run out of fuel. And so people get despondent because they're too tired or they're too hungry, and they think they're failures. So again, my love's in our ebook, it goes on about this, we talk about why reducing your insulin is really important. It doesn't take long, like it's not months, this is not a month long process, you can reduce your insulin, really in a matter of weeks. And we see this all the time. It's so amazing. People will say, you know, Dr. Lucy, Dr. Mary, I can't believe I hated exercise. And now I feel like I've got to move. And it's so exciting. It's so wonderful. And we just love it. And so again, my loves, I think, really important, just to be mindful that intermittent fasting is very, very powerful. But it can be hard, if you're not doing it with reducing carbohydrates as well.


Dr Mary Barson: (20:54) Oh, absolutely. When you get your insulin lower, and in a better balance, then you reduce so much of that vicious cycle of the inflammation throughout all of your visceral fat cells, your body is able to start burning those fat cells. Because if insulin is high, your fat cells really are essentially locked away. Get it down, you can access your fat cells and then you just have this beautiful steady supply of energy that can supply throughout the day. And then intermittent fasting becomes just natural, it just feels like no, I just don't feel like breakfast, or lunch, I feel great. And it's so much easier. And you're right about the exercise, it just feels natural, you just naturally want to exercise, you naturally want to do some intermittent fasting, your body is in a much better, beautiful balance.


Dr Lucy Burns: (22:01) Absolutely. It's so wonderful. As you said, it doesn't take long, you know, we see people's fatty liver reverse in a couple of weeks. The organs don't want the fat, any opportunity they can to release it, and they're happy as Larry. So you know, it is this wonderful opportunity that you have to give your body what it's really asking for. It's not deprivation, it's actually working with it, and allowing it to empty, you know, the organs to empty their fat stores. And then these beautiful organs can function better. And then we're back in balance, it's so wonderful.


Dr Mary Barson: (22:42) It's absolutely true. For every harmful pathway within our body, potentially harmful pathway, our bodies are so smart, we've got three or four or more redundant healthful pathways that would counteract that damage, we just need to remove the obstacles to good health. We need to remove the things that are stopping our bodies from naturally getting into that balance. And in the case of visceral fat, honestly, reducing the excess quantities of sugar and the excess quantities of starch, excess quantities of processed food. If you simply do that, your amazing, clever, beautiful body will basically do the rest.


Dr Lucy Burns: (23:27) Absolutely. And can I just spend maybe one minute, I just want to talk a bit about beer. You know, we have in Australia, the beer belly. And why do we call it that? And I think that the thing with beer is that it is a combination of both alcohol and carbohydrates. And that combination is really tricky for our liver. So the liver, you know, we love the liver, the lovely liver will process alcohol, it does a phenomenal job. It has to work pretty hard sometimes, but alcohol is converted to triglycerides, which are actually fat. So beer is essentially, the alcohol and carbohydrate combination is a bit like doing a high carb high fat diet. It's very hard for our body to process. It's like the double whammy. So you've got then the alcohol being processed in the liver, being converted to triglycerides, a lot of that is then stored as fat in the liver. So it is the cause of fatty liver. And then you combine it with the big slog of glucose that comes from beer, which is carbohydrate. And that's really the double whammy there. And so, you know, I think that it's really important for people to recognise that a beer belly, we use it all the time. It's not harmless. It's a really harmful state of health. And particularly men, if any blokes are listening to this, because it is, you know, beer is - I know both sexes drink beer, but it is predominantly marketed to men.  It is predominantly men that drink the majority of beer. So the beer belly, it's not solely a male problem. I mean, women have a beer belly too. It's just that we'll call it something else for them. But you know, it's really important to recognise that a beer belly’s not just harmless. It's not just a fun name for somebody who just happens to be having a larger abdomen. It's actually a state of poor metabolic health.


Dr Mary Barson: (25:30) It is, and it is a state of poor metabolic health that can be reversed


Dr Lucy Burns: (25:37) Absolutely. Absolutely. All right, Dr. Mary, I think we probably need to wrap it up now. But, lovely people, you know, this time of year for a lot of us is all about beer, alcohol, alcohol, high carbohydrate foods, all of those things and, you know, overtime, they do have long term consequences. So please go download our book. It's absolutely free. We think it's a great read. And you can have a look at that. Dr. Mary I feel like you've got something on the tip of your tongue.


Dr Mary Barson: (26:15) I do. I just wanted to give our beautiful listeners the website address. If you want to download our beautiful free ebook, head to our website and the address is https://www.rlmedicine.com/free. That is https://www.rlmedicine.com/free.


Dr Lucy Burns: (26:47) Excellent. So, lovely listeners. We will be back next week with another beautiful episode, all related to New Year. And of course the eternal New Year's resolution.


Dr Mary Barson: (27:01) Can’t wait! 


Dr Lucy Burns: (27:03) Bye for now lovelies.


Dr Mary Barson: (27:05) Bye lovely ones.


Dr Lucy Burns: (27:12) So my lovely listeners, that ends this episode of Real Health and Weight Loss. I'm Dr. Lucy Burns.


Dr Mary Barson: (27:19) And I'm Dr. Mary Barson. We’re from Real Life Medicine. To contact us, please visit our website rlmedicine.com


Dr Lucy Burns: (27:30) And until next time, thanks for listening. The information shared on the Real Health and Weight Loss podcast, including show notes and links provides general information only. It is not a substitute, nor is it intended to provide individualised medical advice, diagnosis or treatment, nor can it be construed as such. Please consult your doctor for any medical concerns.


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