Latest / Rebellious Aging Podcast / Fat: Friend or Foe?
Transcript
- Bob Peterson: Dr. Robert Peterson and today we're going to be talking about fat in the continuation of our rebellious aging series and with me today is Mina and she's going to help try and keep me on track and keep me talking in not so technical terms. digestible information. So Mina, fat, friend or foe? Personally I've had a very complicated long Okay, so now that we have a little bit more of like a baseline and our fundamentals down, I kind of wanted to ask you the difference, right, between the two types of fat that we talked about earlier that I think it's really important to just solidify this distinction between these two types of fat, which is visceral and subcutaneous fat and what that means. Yeah, well, the subcutaneous fat, as I said, is the fat that's under your skin. Yes. And interestingly, So, Dr. P, for all of us wondering out there, you know, we know a lot about fat. We've heard a lot about it, but how does it actually work and what does it do? Yeah, that's amazing actually. So let me tell you what it's designed to do and what it has done all through evolution that got us to this point. Fat is a phenomenal energy storage device. It's like the best battery ever because slightly negative relationship with fat, personally. It's not for everybody, but I would love to know more about it and educate myself so that maybe it can evolve. Okay. Well, I think fat is very much misunderstood. So we'll get into that a little bit, but fat for many, many, many, years, millions of years has been our really good friend. But now in an age of abundance, fat's kind of become a little bit of a fall. ⁓ When you have extra calories, when there's abundant food, you can eat them. And then you want to have reserves. You want to build up extra energy because in the old days, you know, you never knew where your next meal was coming from and it may not be coming. So in times when you had enough, you would want to pack on a little extra to send you through the lean times such as winter. We talked about how fat is a reserve and it's a phenomenally efficient system. And it's amazing because if you have extra calories, you want to carry them around. what's the best way to carry them? It turns out that fat is because carbohydrates and proteins will only generate a few kilocalories per gram. So a few calories per unit, whereas fat generates nine calories per gram. And so we need to talk about why that is and how we can turn fat back into our friend and make it do nice things for us. So let's start out with some terminology because everybody knows about fat, but there's some words that we're going to have to be talking about during the course of the discussion today that people may not be familiar with. So let's start with the fat cell itself. So a fat cell is called an adipocyte and the adipocytes or famine or anything like that that would interfere with your ability to continue to get the energy stores that you need to live and move and do all those things. So fat isn't just really like just there. It has some merit and it has some ⁓ historical background, right, as to our evolution and why we developed fat to be these kind of energy deposits you're saying. Yeah, that's right. So how did nature design this? So it's a much easier way to carry it around. So if you need to carry around 9,000 extra calories just for a rainy day, that's only a kilogram of fat. Whereas that would be several kilograms of muscle mass or glycogen or something like that. So fat's a really nice way of carrying fat around. It's more condensed and your body can just basically easierly carry it. That's right. Okay. Yeah. are three different kinds. There's white, brown, and beige, which are kind of in between. So white adipocytes are white fat. That's the fat that you're familiar with. That's chicken fat. That's the fat on the meat. And that's a really interesting thing because it's a cell that is just full of the lipids, which is oil. When you have extra calories, the body then processes this in the liver and turns it into fatty things like ⁓ cholesterol and LDL, HDL, all that stuff. And those travel through the body. And if you have extra, the insulin tells the body, okay, fat, take up some of this extra and store it. So it's like storage tanks for gasoline. ⁓ And if you think about it, where is the easiest place to carry fat around if you need extra calories? The best place to put it is by your waist, right? Yeah. Like a fanny pack. A fanny pack of fat. A fanny pack of fat. And that's why the femoral gluteal fat that women store, they store fat in this area by the hips because if you have fat there, it's easy to carry it around. So it's basically a balloon filled with oil. Like when you melt down like cooking oils in the form of what looks like a solid block of fat. That's basically oil. That's right. So now if you imagine taking that fat, that lard or something and packaging it into little teeny tiny bubbles, little teeny tiny balloons, that's basically what white fat is. And the interesting thing is that if you look at it under the microscope, you see the If it's on your back or your arms or someplace like that. It's inconvenient. It's a lot more work for the same amount of fat. ⁓ Similarly, if it was lower down, if it was by your knees or your ankles, every time you move your leg, you'd have to be lifting that fat up. But if it's right here by your hips, ⁓ then that's a good place. So for women in particular, women frequently in the old days and still yet will have a period of time And then when you need more, I mean, excuse me, when you need energy because you don't have enough food, then the signals are the reverse. And the body sends out the glucagon and other signals like that and says, okay, body, we need some of the reserves. We need to take some out of our bank account and pay off the things that we need to pay this week. We need to pay for food and shelter and clothing. so the body will then mobilize that fat. the cellular stuff, the cell part, the cell nucleus, all of the cell apparatus, is this thin rim around this lake of fat in the middle. So that's a white fat cell. Now, the issue with that is that the fat in the middle is far from the cell membranes, and that's where it exchanges back and forth with the blood. ⁓ There's also two other kinds of fat. where they need a lot of extra calories for about nine months. And so when women get pregnant, they have this additional added-on energy requirement. So for women, it's helpful to have, especially in evolutionary terms, a lot of extra calories available for pregnancy, and especially if they're pregnant during the winter or something. and send it back into the bloodstream in HDL, LDL, all those things. And the liver will take that and other cells will take that up and they will then burn that fat, which has been stored in the meantime. And when they burn that fat, then that makes the ATP and the energy that we use for doing all the things that we do. Now, as we talked about earlier, brown fat will then actually just burn the fat right off and make And this was a surprise. isn't something... I didn't know there was more than one type of fat. I didn't know that either. And we didn't know that when I was in medical school. Wow. Yeah. This is new information. This is something that has come into our consciousness since I was in medical school. And so there's brown fat. Now, when I was in medical school, we knew that brown fat existed, but we thought it was only in newborn babies. where there's really not enough calories even for them and they also need calories for the baby. So in having a lot of extra is really useful. That's why the fat is in constant communication with the rest of the body. And it's a very powerful endocrine system that tells the woman in adipose tying speak using a low 600 biologically active heat. So it doesn't go through a pathway of making energy producing things that are useful for other cells. It just makes heat, which is kind of wasteful, but it's also useful when you're cold. ⁓ And it's metabolically favorable if you have a lot of extra that you need to burn off. the fat is stored in these tanks, these balloons full of fatty And it was only to keep the newer babies warm because newer babies, you know, they need the fat. They need the fat. They need to burn fat. They need to generate heat. Yes. And brown fat's job is to generate heat. And we thought, OK, fair enough. Babies are little and they're, you know, they have a lot of surface area and it's easy for them to cool down. So they need a way of generating heat. But we didn't realize is that brown fat is actually present in everybody. ⁓ chemicals that this would be a good time or a bad time to have a baby. If the fat cells are depleted and there's not enough, they send a signal that tells the woman, don't have a baby now because this might not work. We may not have enough energy to have the baby. And in fact, ⁓ in times during war and things like that where there's widespread famine, ⁓ tissue and because they're a sphere, the fat in the middle isn't close to the edge. You kind of have to use up the fat on the edges first before the fat in the middle can get out to be used up. So this has a few important ramifications. One is that because it's like a balloon, if you have a situation where you have a prolonged period where there is extra, it keeps blowing up the balloon. and it's present in sort of the areas around the central trunk and spinal cord and stuff. And it makes sense that in a cold environment, you would want to generate heat for the important parts. Yes. And by doing PET scans, know, the positron emission tomography, they discovered relatively recently that adults all have brown fat. And in fact, brown fat is really important. women will stop having periods because the fat is telling the woman's reproductive system that this is not going to work. That the body isn't ready and that environment is not good enough to be carrying a child. That's right. And that's part of the reason also women need to have an extra surplus of calories in reserve more so than men. without the balloon inflating and deflating, inflating and deflating, inflating and deflating, which was kind of what it was designed for, inflating, deflating, inflating, deflating. It just keeps inflating, inflating, inflating. Stretched out. Stretched out. And so just like your leotard, once it gets stretched out to a larger size, it wants to stay that size. And it took a lot of energy to build the extra membrane and all of the stuff. And the more brown fat you have, faster you burn calories and it's metabolically healthy to have more brown fat. So the way that you're phrasing it sounds like brown fat is not to be framed in like a negative way, but more so in that a positive and that we need this kind of fat. Yeah, the brown fat. Now it's interesting because brown fat burns the fat right into heat. which is why women have bigger fat deposits typically in those areas. And that's what gives them that hourglass figure, the wider hip waist area, the wider hip area, because that's the easiest place to carry the extra stored energy. ⁓ they know that there's a high likelihood during times of fertility ⁓ that that extra calorie is going to be needed. And so once it gets to a certain size, it does not want to get smaller because it was a lot of work to get there and it doesn't want to undo it. So just like your leotard has a hard time on stretching and fitting you back. you lose weight, the fat cells don't like to shrink down because they've got all this surface area and it will fold up. The net effect of that is that fat fights back. Right. And Energy. Yes, just the heat. Normal fat is a storehouse for energy that's converted into ATP and things that the muscles use and that all the cells in the body, it's converted into the ATP and other molecules, NAD and ADPH that the body uses in its normal ⁓ energy utilization, but not so much heat. Heat is a byproduct of some of the burning of the ATP and so forth. So the body puts away extra there to use in a rainy day. And then ⁓ what happens is that menopause, the estrogen goes down and the estrogens was causing the body to store the fat in those regions. The estrogen goes down and the body says, well, we don't need as much extra energy reserves in those regions now. And so there's a shift of that The fat doesn't want to shrink down. And so it sends out some of those 600 biologically active materials and tells the brain, the gut, the other things, hey, we're shrinking here. Send us more food. We want to stretch back out. And that's why it's so really hard to lose weight, because the fat is telling you it doesn't want to shrink back. But the brown fat is designed specifically for making heat and warming you up if you're in a cold environment. And so it has an enzyme that makes it burn the fat directly into heat, which other other cells in the body don't have. Yeah. So that's very interesting. So let's get back to our our white fat cells for a minute. They're just a big balloon full of fat. Right. The brown that energy is no longer as important. And so the body will kind of diminish that. And guess what it does with the extra calories? It puts them into the adipose, the visceral adipose. So at menopause, it's really important to be aware of that and to avoid that shift. Yes, your diet and your lifestyle accordingly. That's right. Because the ⁓ If we think about evolution and we even think about today, the fat cells are inside. They don't know what's going on when they shrink down. That means you haven't had enough to eat and they don't know that because you've had famine or you were sick. know, why didn't we get our food today? You know, something wrong up there. Yeah. So if the fat cells are shrinking down, they're sending signals that say, hey, we're shrinking. You know, if there's food around, please. fat cells have little teeny pockets of fat, little balloons full of fat inside the cell and a lot of mitochondria. Now mitochondria are a little bit dark and guess what? That's why the fat is brown. I see. That's what gives it the brown color because of the mitochondria. And you also mentioned that there was in between, right? That's right. A beige fat. Right. So not quite brown, not quite white. That's exactly right. Yes. The visceral fat is different from the subcutaneous fat. Subcutaneous fat is more or less good for you because... It's more okay to have, That's right. Because it doesn't... The visceral, the subcutaneous fat, the baby fat, the woman distribution fat, that fat ⁓ is there for padding against bumping things. It helps keep the skin strong and healthy. ⁓ It's a way of thermoregulation and... take some. Yes. And then when there is food, the fat is going, ⁓ OK, let's fill us back up because they think that you've been sick and everybody has the experience of having the flu or some, you know, something where they've lost a little bit of weight due to the illness. And as soon as you get better, how long does it take you to gain the weight back? A few days. It's immediate. Yeah. Yeah. So beige fat is exactly what you just said. It's in between. so it's thermogenic. can be induced by cold exposure to convert more towards brown phenotype, it can drift towards the white fat. Oh, so it can swing both ways basically. Whatever your body needs, it can convert itself to. That's exactly right. Oh, good. Yeah. Depending on what the body signaling tells it to do. Yes. giving you insulation from the cold. And it's not, it doesn't produce so many bad cytokines. The visceral fat on the other hand is right inside. And all of the cytokines and things that it produces will then go to the liver directly through the portal vein. So all of the stuff inside your abdomen, all drains through the liver. you lose weight for two weeks because you're sick and as soon as you're better, boom, you gain it right back. Similarly, if you lose weight from dieting, you can lose weight over, you know, four months. And that's how long it takes too. Oh, it takes a long time because the fat's fighting you every step of the way. And then as soon as you stop paying attention, boom, you're back up and the fat cells are now happy because they've filled back up. So the liver gets a first look at everything that's coming through and that's good. The liver is going to be processing the fats and things. if those things that it's releasing are inflammatory molecules, then that causes the liver to have problems. And that isn't the case with the subcutaneous fat as much. And so if there's extra calories and they're being shunted into the visceral fat, that visceral fat is not so good for you. Right. The brown fat is mostly central. The beige fat is brownish, beigeish fat that's sprinkled throughout the white fat. so ⁓ it's all around and it can convert back and forth a little bit depending on the body's needs. the fat cells are called adipocytes. ⁓ That's the medical term for fat cell. And as we just talked about, there's brown, beige, and white. Now the interesting thing is, let's say you weigh 150 pounds. You're going a lot of 150 pounds and you lose 10 pounds. Great, you're 140. Again, your body doesn't know, were you sick? Was there a problem getting food? And then, if food then is available, the fat cells are going, me back up, fill me back up. And so you will... And that's why the all liver recommendations are try to reduce the amount of visceral fat. And that's why if you measure your waistline, that's going to give you an indication for most people of what their visceral fat is, the inside, the abdomen fat, the unfavorable, the bad fat. And, uh, and then especially you want that on a man to be less than 40 on a woman to be less than 35 inches. Um, and. That's how types right now. The next word that we need to talk about is adipokines. Adipokines. Right. Yes. Explain to me please in layman's terms. Right. Because it's not obvious what that is. And in fact, this is another thing that has been discovered since I was in medical school. And so most physicians are unaware of the fact that fat is incredibly active and is constantly talking. rapidly gained back to 150. So in a few days, you'll gain back 10 pounds. But then when you hit 150 again, you'll stop and you don't keep going. You don't. You'll gain 10 pounds in a week. But then when you get to 150, you don't keep gaining 10 pounds every week after that. Right. Because wouldn't it make sense that you just keep increasing and increasing? You just keep growing up. Right. But they're just getting back to where they were stretched out to is what you're saying. That's exactly right. The fat cells are getting back to what they think is the right amount. or 100 centimeters and you know the metric equivalent. And then you want the abdomen to be smaller than the waist. Right. Because remember the waist has first of all the hip width, the bones doesn't change. your bone structure is not going to care whether or not you lose or gain fat. It's going to stay the same. to all the other parts of the body. It's not just a bag of lard sitting there, which is what we used to think. That's what I still thought up until this point was that fat was just lazy and did nothing. Right. And that's what we all thought. And you're telling me otherwise. Absolutely. Fat is a very highly ⁓ active communicant with all of the other parts of the body. And in fact, there are over 600 It might not be what you want to be the right amount, but it's what they think is the right amount. think that is your, they think that's your healthy weight. Your baseline. That's right. So they're getting back up to that. And then when you get to there, they're saying, okay, we're cool. We're back to. They stop stressing out about it. Right. And so the fat cells are keeping track of what's going on with you over a period of time. And they're giving signals to the brain, to the gut, to the liver. And if you're big person, the bones are going to be wider and if you're small, the bones are going to be smaller. But the ratio should be favorable. then so you want on a man, you want the waist hip ratio to be less than 90 percent. Yes. Point nine. And on a woman, you want it to be less than point eight five because women, as we said earlier, have a little extra fat in addition to the bones ⁓ there. And so you want on a woman, you want that ratio to be less than point eight five or eighty five. Yeah. ⁓ bioactive chemicals that are released by fat. fat is in an active conversation with the brain, with the heart, with the liver, with all of the other parts of the body. And this is a conversation that we were really not aware of as recently as when I was in medical school, which wasn't all that long ago. So, adipokines are really important. There are so many of them that even people that are working a lot with fat like me. of what they think your normal weight is. Now from a fat cells perspective, your normal weight is the heaviest weight you have ever been. That is so rude. They think that I'm fat. My cells, they think I'm fat? No. Whatever the highest weight you ever were, that's what your fat cells think. don't know all their names. 600 is too many. That's incredible. That's crazy. Yeah, that's more people than were in my high school class. I didn't know all their names either. So the next word that we're going to be talking about that's really important is called senolytics. Senolytics. Right. Yes. Now, what is a senolytic? Senolytic means something that lysis, which is breaks down So the visceral fat is the not good fat and subcutaneous fat is by and large pretty good fat. And so it's not just a question of how much fat you have, how much you weigh, what your BMI is, but in addition, how much good fat you have versus how much bad fat you have. And ideally, of course, you want less of the bad fat and more of good fat. and then this will also carry over this conversation, I'm guessing, into your That's now full. That's what you mean by fat fights back, right? I do. Your fat is actively fighting against you, no matter your dietary goals or your weight or anything. They're they're working against you to stay at your heaviest weight. That's right. Because you're they're trying to get you back to the weight you were when the fat cells were stretched out. And when you get there, they're happy. They're fine with that. The moral of the story is your day-to-day life with your patients, right? When you see patients in the office, they come to you with the concerns of, my fat is gathering in places that I don't want. How do we fix it? Or what treatments can you provide to help me get to where I want to be? Right? That's absolutely right. This is a conversation we have daily, almost daily, because it's not just a matter. If somebody is overweight, diffusely, their whole body is overweight. senescent cells, now so senolytic. And that means medications or processes that get rid of aged cells that are no longer functional. So it selects them out and ⁓ they're targeted for destruction so that they no longer take up space and are causing trouble. And you think, well, you know, that's kind of mean. ⁓ But actually it's not because Try to never exceed your maximum weight, whatever that was, or your target weight. So when you're graduating from college or high school, or actually, yes, graduating from high school, that freshman 15, that everybody gets extra weight when you go off to college, that's stretching those fat cells out. And they think that's your new baseline weight. And whatever you gain on top of that, or they have a lot of intra-abdominal fat, then the best thing to do is diet and exercise is lose weight. On the other hand, if their fat is in a specific place that they don't like, because it doesn't look good, it bothers them. just carry weight more in one place than they do the others and they're just kind of wanting to maybe shift some things around. Is that what you're talking about? Yeah. That it turns out that everybody's skeletons kind of look the same. It's not just that the cells have gotten older and sort of aren't really capable of doing as much as they did when they The purpose, right. But actually they senescent factors. And the senescent factors are a part of the causing of the aging of not just those cells, but neighboring cells and in fact the whole body. So senescent cells release inflammatory mediators, which cause That's your new baseline weight. And that's why for the rest of your life or know, pretty much whenever you lose weight, it's very easy to gain back to the highest weight you ever were. So you're talking about over the period of my entire life, right? These cells in me are remembering what my heaviest was and always trying to get me back there. So even if I am 40 something now, Um, it, know, the bone structured varies, you know, some people are taller, some people are a little bit wider, but if you, if you look at a skeleton, it's kind of hard to know who it was apart from the height. Yes. Fat distribution of their hand varies enormously from person to person. And that's a lot of what makes us look different. some fat distributions are just not considered attractive. Um, inflammation throughout the whole body and they're actually dysfunctional. So we really, we don't need those at all. That's actually harming us. That's right. First of all, that's exactly right. We don't need them because they're not doing anything useful. And second of all, they're causing harm, not just locally, but all through the whole body. So, senolytics, medications and processes that will reduce the number of these senescent cells are actually a very promising ⁓ And then in my 20s, was my heaviest, I was like 200, say. You're telling me that in my 40s, my body's gonna keep trying to get me back to 200 pounds? Yep. Pretty much. That's crazy. Now, it's of course, ⁓ it's a little bit not quite as bad as that. But if you think of it that way, that whatever the heaviest you ever were, that's what your body is gonna try to get you back to. It's a constant battle. by society and by the person themselves. And of course that's culturally dependent. know, fat used to be considered very attractive because I you were healthy and you didn't have tuberculosis. So plump in the days of Rubens, yes, it was a great thing. But nowadays we favor a thin aesthetic. And as we talked about having thin, know, intra-abdominal fat is very, very helpful. But if there's fat... avenue for anti-aging and for keeping young and fighting the inflammation aging process. Yeah, anything that we can do to eliminate inflammation in the body, that's going to really, really help, I think. Because I mean, you can feel a difference, right? Physically. That's absolutely right. So ⁓ the next thing we're going to be talking about, which is something that people are pretty familiar with, is steroids. ⁓ I see. Hot topic. Yes. Hot topic nowadays for all the droiders out there. to stay under there, the moral of that story is try not to ever make that higher. Prevent, prevent it, right? Prevent it. So when you're in your twenties and you're healthy and you're not at a high weight yet, put a red line on a weight chart and say, I am never gonna exceed this line. And if I find that on the scale, I'm getting close to that line, in one place, say for example, under your chin or your love handles or something like that, and you want to get rid of that specific fat, it's really hard to get rid of that fat by diet or exercise. Right. Because diet and exercise is going to reduce fat everywhere. You can't spot target with diet and exercise where you're going to reduce your fat, right? It's just going to be pretty all over evenly spread throughout the body. Well, cortisol is the body's best hormone and it's a steroid hormone. cortisol ⁓ is important because it really impacts on fat metabolism a lot. And in fact, cortisol changes the fat metabolism to favor adipose fat as opposed to subcutaneous fat. So let's talk about that. Yeah. Subcutaneous fat is the fat under your skin. Yes. And visceral fat, the abdominal fat. no eating for that day, even if it's Christmas or Thanksgiving. Now that's really hard. It takes a lot of self discipline, but your body will thank you for it later on. And especially, like I said, it's a one way street. whatever, whatever the top weight you were, that's the way it's going to try to be. And that's what I mean by the fat fights back. That is incredible. I had no idea. Yeah. So And then, you're talking about if there's pockets of fat that just kind of sit there in our, what we call like the stubborn fat that won't move no matter what you do, then I guess patients would come to you seeking your advice. That's exactly right. Yeah. So, you can't spot reduce that. In fact, if you lose weight frequently, not only will you not lose the fat where you, where you don't like the fat, you will quite possibly lose fat where you is right. That's right. It's inside. Yes. Around the organs. Yes. In the inside underneath your abdominal muscle. bad fat. That's the bad fat. the subcutaneous fat is baby fat. baby fat is good fat. ⁓ And when you lose your baby fat and you gain your beer belly, ⁓ that's actually unfavorable metabolically as well as not what you want. So those things are really important. So let's break for a minute. don't want to lose it. there are fat pads in the cheeks and in the jaw area. And if those fat pads get smaller, they hollow your face out. You look tired. You look gaunt. Yeah. And then you look older. That's right. So losing weight may not actually make you look better, which is maybe your goal. And that's actually an issue with the weight loss from the GLP-1 drugs. There's what they call GLP-1 face where So let's ⁓ pause for sec. you lose weight, which is great. You know, that's what you're trying to do. And that's probably metabolically healthy. But then you, you hollow out in the face because the face fat tends to disappear and it tends to show up, you know, further south. And that's something that you really weren't hoping to achieve. Now, if you do have extra fat in one place, we can target that by a variety of different treatments that we have. We have ways of dissolving fat, of melting it with radio frequency energy, with ultrasound energy, with laser energy. And then of course we have liposuction, which is actually just removing it. ⁓ And liposuction is a very effective way of doing that. And it's fantastic for spot reduction, which ⁓ is difficult to achieve by diet and exercise. On the other hand, if you... need to lose weight and be more fit metabolically, liposuction is not going to help you with that. Right. Because it's only that one spot and it doesn't help overall. And in particular, most importantly, we cannot affect the visceral intra-abdominal fat by liposuction. Yes. That's going to be diet and exercise. And that's when you go to your primary care physician and you say, how do I look better? How do I lose this weight? they're going to tell you that it's only through diet and exercise, right? You can't, there's no cheat code for that one. You, you don't have fat deposits like you would be able to go in there with a, you know, with some liposuction and then just easily fix it. Right. That's right. So there's different types then, right? Of, treatments, everybody's personalized. You see people in for consultations and then they might vary drastically, right? Based on the individual themselves. That's absolutely right. Okay. So we not infrequently see people for abdominal fat that they don't like, their tummy's too big. And some of them, I always imagine the umpire and the manager of the baseball team and the manager of them poking the umpire in the tummy and the umpire's tummy is this big tummy, but it's firm. It's a big firm tummy. It's not like when you poke it and it goes in and it's fat on the outside. It's firm. It's hard. And it's firm because the fat is all intra-abdominal. Yeah. There's only a small amount of subcutaneous fat. With liposuction, we can only remove the subcutaneous fat. So for patients like that, tell them, I'm sorry, liposuction is not going to help you. Yes. And for you, diet and exercise, the traditional the traditional, uh, know, tandem. But of course now the GLP one drugs are actually really amazing for helping people lose fat and they lose the, the, uh, adipose intra abdominal fat as well. And so that's kind of a new thing. then game changer is absolutely a game changer. And those drugs are phenomenal. And there's other drugs on the offing there's, ⁓ the SGLP drugs, there's ⁓ new stenolytic drugs. So there are things that over the next 10 years are going to be additional things that we can do in addition to diet and exercise. Diet and exercise is good because it's under your control and it's cheap. Dieting can be free. exactly. Or it can be expensive depending on how you do it. Yeah. But an exercise is not expensive and doesn't have to be at least. You can spend more on exercise, but those are a good place to start and then add on with other things. Now, ⁓ interestingly on the liposuction, as I said, a lot of times we'll have to tell people, I'm sorry, we can't help you with your intra-abdominal fat. It's not amenable to liposuction. Yes, you can't go in there with... the liposuction tools and go and try and navigate your way around all those organs that are important, right? That sounds dangerous. It would be very dangerous. my gosh. Yeah. So, so we can't help them with that. Now, on the other hand, there are, so there's some people come in, they have fat in places they don't want it. Typically the abdomen is a common one. ⁓ the, hips, thighs, the neck, the arms, ⁓ bra roll. ⁓ and so for them, we've discussed the possibility of liposuction as a way of spot reducing that area. ⁓ people, as we've talked about earlier, people vary tremendously from person to person. Some people's subcutaneous fat in the abdominal region can be this thick and they have very little visceral fat, which is good. ⁓ but they don't like the, you know, they don't like the fact they can't see their six pack. that they've been working so hard to get because they've got a pillow in front of them. And we can take away that extra fat that they don't like. Conversely, there are people who have not enough fat in certain places. So over the past 30 years, we've gotten really good at rearranging the fat and taking fat from places where it's more than is desired and putting it into places where they want to have a little bit more. So where would somebody want more? The face right here, especially is a place that we commonly put fat. And then people also will hollow out in the temples along the jaw line, things like that. And then sometimes people want extra in their breasts and then in Florida in particular in their butts. And so we can take the fat, we can remove it and then we put it back in. Now, when we take the fat out, It's interesting because the fat has no blood flow when we removed it. Yes. So when we put the fat back in, right when we put it in, it also has no blood flow. ⁓ huh. So in order for the fat to survive, it has to hook up with blood flow in the area where we put it. ⁓ interesting. And so, yeah. So if we put in a lot of fat, then all of that fat won't be able to hook up to the blood flow. It's sort of first come first serve and ⁓ they don't share. And so the fat that doesn't get hooked up to the blood flow will die. So if you put in too much, you'll have a bunch of dead fat and then the dead fat can turn into cysts or can get infected or can make lumps and things like that. problematic. Yeah. So about 20, 25 years ago, we used to put in too much because the idea was if 30 % of the fat would take or 40 % or 50%. Say half the fat takes. If you just put in twice as much, you'll end up with what you want. But what happens to the rest of Well, that's the problem is that the reason 50 % takes is that some of it gets blood flow, some of it doesn't, and a dozen dies. So if you say, okay, fine, say we want to put 10 cc's. We want 10 cc's of volume, which is a ⁓ good amount. mean, 10 cc's is a lot for the face. Say we want 10 cc's to take. Okay. And if 50 % of it's going to die, we put in 20 cc's, then we'll end up with 10 cc's and idea is that, perfect. But maybe say, well, we need more than 10 cc's. Let's put in 40 cc's. So we'll end up with 20. Well, then actually you don't end up with 10. You don't end up with 20. You end up with three because the fat... all strangles each other in the competition for the blood flow and you end up with a lot of dead fat and end up with lumpiness, which was a common thing 25 years ago. But now we've learned that the important thing is what we call recipient site limitation, that you can't put more in than it will take. Yes. So there's a technique to it. You can't just go in and deposit all of that fat that you just harvested. You need to carefully methodically reinsert it back into the body. That's exactly right. Yeah, you need to be very, very careful about how you put it, where you put it, how much you put it, how you distribute it in order for it to take and not get lumpy and have a good take rate and so forth. But a lot of us went through that period of putting in too much fat, myself included. ⁓ And ⁓ we've learned better. Yeah, and we know, obviously. Now we know better. Yeah. Progress. So I think that those are the main things we wanted to cover in this introductory episode. So just to recap these things, we talked about the different kinds of fat cells, the adipocytes, the brown, white, beige. That's right. Yes. The brown, white and beige and why they're different. We talked about the chemicals that they secrete that can affect everything in the body. 600 different adipokines. the chemical signals. All that communication. Right. We talked about the old cells, the senolytic cells that are releasing the senolytic factors and the senolytic phenotype, which is the old non-functioning fat cells that are now releasing inflammatory factors. talked about cortisol and how that affects your fat cells and tends towards truncal obesity and favors adipocyte deposition in the abdomen. And we talked about visceral versus subcutaneous fat. And we talked about most importantly, why it's so darn hard to lose weight because the fat bites back. Constantly. Constantly. And it's always trying to get you back to where you once were, even if where you once were is where you want to be now. Yeah, that's, that's, I think a good arsenal of information that I think is the foundation is the basis of what we need to know to change the way we view that basically. Absolutely. So maybe in our next episode, we can talk more about the nitty gritty of what's going on actually inside for the people that are really interested. that would be interesting too. I like that. OK. All right. Until next time. tuned and we'll see you next time. Thank you.