Subcutaneous vs visceral fat. Which do you carry?

We all store body fat in slightly different ways, leading to a multitude of body shapes and sizes. Some of us store it on our thighs and buttocks, others more on their upper arms and chest. Some of us have a more even spread while others will have body fat concentrated in specific areas. While fat in certain places may concern us, a bulging waist-line is the biggest cause for health concerns and this relates to the different types and volumes of fat stores we have in our bodies.

The two main types of fat stores in our bodies are subcutaneous and visceral fat:

Subcutaneous fat is the body fat which is found directly under your skin and is normally pinchable and can be measured with body fat/skin fold callipers.

Visceral fat (also known as abdominal fat) is found within the abdominal cavity, between the stomach, intestines, liver, kidneys etc., making it much trickier to measure.

What’s the difference?

Both subcutaneous and visceral fat, as well as being energy stores, also have endocrine functions. They release hormones and proteins such as leptin, adiponectin, IL-6, TNF-α and angiotensin, which help regulate other organs and processes in our bodies. However, the hormones and proteins secreted by visceral fat are thought to be more pro-inflammatory than subcutaneous fat.

This is one of the reasons why excess visceral fat is more strongly associated with metabolic disease (i.e. – insulin resistance & type 2 diabetes) and cardiovascular disease, than excess subcutaneous fat. The proximity of visceral fat to the portal vein (a vein that carries blood directly to the liver) is another hypothesis why excess visceral fat has greater negative effects on health.

So how do I know if I have excess unhealthy visceral fat?

For a start, men are much more likely to store fat as visceral fat whereas women are more likely to store it as subcutaneous fat. This is mainly due to sex hormone differences, but once women reach menopause, it is slowly reversed and they become more inclined to store it as visceral fat.

Like with BMI and obesity, your genetics are another factor that could predispose you to having excess or unhealthy visceral fat. Where you store your fat has been shown to be heritable. In the Quebec Family Study, heritability was estimated to be 56% for visceral fat and 42% for subcutaneous fat1. Other studies have given heritability estimates of over 70% suggesting a very strong genetic influence on fat distribution2.

Recent scientific research has uncovered some of the genetic variations which might impact fat distribution. In overweight (BMI >25) Korean women, the G allele of PPARG was significantly associated with greater amounts of both subcutaneous and visceral fat compared to those who were CC, although the effect on subcutaneous fat seemed larger3. Another study showed that while G allele carriers had a higher BMI they had a similar waist circumference. This suggested that G allele carriers might be carrying less visceral fat.

Many other genes and their variants have also been associated with fat distribution. Recently a multi-national research consortium published a paper identifying 7 new genetic variations associated with fat distribution traits such as the volume of visceral and subcutaneous fat and the ratio of visceral to subcutaneous fat5.

There are numerous types of scans (at various price points) that can identify your ratio and volume of subcutaneous and visceral fat. However, an easy and free estimate can be obtained via the simple tape measure. Although it's not going to give you exact numbers on the quantity of the different types of fat, simply measuring your waist circumference (WC) can be very informative. Men with a WC of >40 inches (102 cm) and women >35 inches (88cm) will likely have excess visceral fat and should be taking immediate action to reduce it. Measuring your hip circumference (around the widest portion of your buttocks) is another good measure as it can be combined with your WC to give your waist-to-hip ratio. A ratio of >0.9 for men and >0.85 for women is an indicator of serious central obesity and an excess of visceral fat. Although these measures are far from perfect, they are easy and convenient for almost everyone to do, and tracking these over time will let you see if your dropping weight and fat from the abdominal area.

What can you do if you suspect you are carrying a lot of visceral fat?

Well it's no different to losing body fat from anywhere else on your body. The only difference is that losing visceral fat can improve metabolic and inflammatory health markers more than losing subcutaneous fat, evidenced by liposuction (which only removes subcutaneous fat) not having much effect on these health parameters.

Leading an active lifestyle along with a healthy, well-balanced diet is the best way to reduce all types of body fat. Some studies have shown that high-intensity exercise is particularly beneficial for fat loss and specifically visceral fat. So get sprinting hard and lifting heavy!

How to start shifting the fat

If you do happen to be carrying a lot of fat around your abdomen (or elsewhere) and can't sprint on a treadmill or struggle to work at a high intensity generally, try the following:

Instead of running intervals on the treadmill by increasing the speed, select a comfortable walking pace while the incline/gradient on the treadmill is flat and spend 5 minutes warming up. Then to increase the intensity, ramp up the incline/gradient (between 8-15%) for 30-60 seconds before returning it to its flat position for 1-2 minutes of active rest. If in the beginning you need to stop completely to catch your breath, that's ok. Do this for 10-20 repetitions, depending on how you feel. As you get fitter and start dropping body fat, gradually either increase the pace, the gradient, the time at higher intensity, the number of repetitions or reduce the time of the active rest periods.

This is great for people who carry a lot of weight as it can be much kinder on their joints than trying to sprint or even jog. If you do have problems with your joints (i.e. – knees or hips) and even walking is too much stress then getting in the pool will probably be best thing for you. You don't necessarily need to use the pool to swim in a traditional horizontal manner (e.g. doing lengths of front crawl or breast stroke etc.) if this is too taxing. You could exercise in a more vertical manner, such as running on the spot, jumping jacks, squat or lunge jumps or variations and combinations of any of these movements. The same principle applies in regards to intervals, rest periods and repetitions.

Blueprint now provides comprehensive medical weight-loss that range from non-prescription meal replacement, to the prescription hCG Diet. Contact your Blueprint Health Care Representative for more information. 

Having problems losing weight? It could be a vitamin K deficiency

Vitamin K is a group of structurally similar, fat-soluble vitamins that the human body needs for post translational modification of certain proteins required for blood coagulation, and in metabolic pathways in bone and other tissue.

The primary function of vitamin K is to aid in the formation of clotting factors and bone proteins. It serves as a cofactor in the production of six proteins that regulate blood clotting, including prothrombin. In addition, it helps to form osteocalcin, a protein necessary for the mineralization of bone. Vitamin K also aids in the formation of glucose into glycogen for storage in the liver. In addition, it promotes the prevention and reversal of arterial calcification, plague progression and lipid peroxidation. Deficiency may increase the risk of calcification of arterial walls, particularly in individuals on vitamin D supplementation (Vitamin D promotes calcium absorption). Vitamin K exists in three forms: K1, a natural form found in plants (phylloquinone); K2, which is synthesized in the intestine (menaquinone); and K3, a synthetic form that must be activated in the liver (menadione). Vitamin K is absorbed in the upper small intestines and transported throughout the body in chylomicrons. 

Deficiency Symptoms:

Excessive bleeding, a history of bruising, appearance of ruptured capillaries or menorrhagia (heavy periods) are the most common clinical symptoms of overt vitamin K deficiency, although subclinical deficiency may not affect clotting mechanisms.

Due to its critical role in bone formation, long-term vitamin K deficiency may impair bone integrity and growth, eventually predisposing a person to osteoporosis. Antibiotic usage can induce vitamin K deficiency since it upsets the balance of normal intestinal flora. Anticoagulants such as Coumadin and warfarin can also deplete vitamin K by blocking the activation of prothrombin. However, patients on warfarin or other blood anticoagulants should not supplement with vitamin K unless specifically recommended and approved by their physician. Other causes of deficiency include celiac disease, liver disease, certain medications (i.e. aspirin, Dilantin), very high doses of vitamins A and E (over 600 IU) and gastrointestinal disorders associated with the malabsorption of fats, such as bile duct obstruction, pancreatitis or inflammatory bowel disease. 

WHAT MEN NEED TO KNOW ABOUT TESTOSTERONE REPLACEMENT THERAPY

Testosterone replacement therapy (TRT) is a great treatment option for men with hypogonadism – a condition in which the body fails to produce enough of the hormone testosterone.

Hypogonadism can be a result of either illness or as part of normal aging.

Whether or not men with hypogonadism should receive TRT remains debatable. This is mainly because hypogonadism is still not fully understood and also because TRT may lead to other health risks in some cases. Nevertheless, TRT is considered a revolutionary treatment for men having suboptimal levels of a very important male hormone.

What does it mean to have low testosterone?

According to Abraham Morgentaler, MD, the Director of Men’s Health Boston with over 20 years of experience in treating male hypogonadism, The Endocrine Society considers low testosterone levels to be a total of testosterone (T) below 300ng/dl.

However, he also warns that there is no definitive agreement on what constitutes normal T levels. The situation is further complicated by the fact that half of the circulating T is not available to the cells due to testosterone binding to a glycoprotein called sex hormone–binding globulin (SHBG).

Luckily, we’re now able to measure total free testosterone levels which is a precise indicator of the biologically available levels of T in a man’s blood. Other than testing for blood testosterone levels, doctors also look for symptoms of hypogonadism because some men don’t develop problems from having low T levels and treatment may not be needed in such cases.

Is TRT successful?

Just a little over 15 years ago, TRT was not as successful as it is today because the available formulations were not efficient in reproducing the pattern at which T is naturally secreted by the body. These therapies have resulted in either too low or too high T levels the following administration.

Nowadays, the situation is quite different as TRT is efficient enough to provide men with ideal levels of T similar to those naturally produces by the testes according to an article published in the Current Pharmaceutical Design.

Today’s TRT involves either injection, topical gels, and patches with the latter being the best treatment option for achieving a uniform level of blood T for men receiving treatment for low testosterone. Because of the hypothalamus and the pituitary gland release hormones that stimulate the testes to produce T at daily intervals, it’s always best to mimic the natural way T is released in the human body.

Which men are candidates for TRT?

Men who present with the symptoms of male hypogonadism such as a low sex drive, erectile dysfunction, infertility, central obesity, osteoporosis, loss of muscle mass, and who are tested for low testosterone levels are usually candidates for TRT.

The reason why men develop TRT are many, and the underlying causes should also be looked into before suggesting TRT. For instance, some men may develop hypogonadism due to pituitary tumors and treatment of these tumors usually result in the improvement of T levels.

On the other hand, older men usually have lower T levels than they did in their youth and whether or not T would benefit them is a matter of debate. These men also worry that TRT may put them at risk of developing prostate cancer. Although this idea may seem logically plausible, Dr. Morgentaler states that there is no real evidence to support such claims.

What are the benefits of TRT?

Just like estrogen provides a protective effect on women’s general health status, so does testosterone on men. Dr. Morgentaler believes that the therapeutic effect of TRT will be recognized in the near future not for just improving the patient’s well-being but also in protecting the patient against heart disease and all-cause mortality.

Men receiving TRT may see improvements in their overall functioning and feelings of well-being. Their energy levels may improve, their sex drive may rise, and their body composition may also improve. These benefits are best achieved by consulting a medical professional licensed to treat men with hypogonadism, but there are also claims that natural nutraceuticals may also do the trick. However, men should be aware that these products are not regulated and pose a health hazard in some cases according to a recent study published in the Journal of Dietary Supplements.

Conclusion

Most men will experience a decline in their T levels with age, and although this decline is completely normal, it can and does cause uncomfortable symptoms in some men.

Furthermore, men with illnesses that affect the functioning of their reproductive system and testosterone production may greatly benefit from TRT. Most treatment options today are both safe and effective in restoring normal T levels when administered by a certified physician.

On the other hand, men wishing to boost their T levels with alternative methods may find herbal supplements beneficial as some studies found that herbs and other plants have the potential to stimulate sex hormone production in some cases.