Dr. Manickam Palaniappan
Appearances
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Thank you.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
If your waist circumference is more than 102 centimeters in men, and if your waist circumference is more than 88 centimeters in women, you are at increased risk of heart disease. So people who are listening to this podcast, they can do this simple test by themselves in the morning. They can just measure the waist circumference around their belly button.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
If it is more than 100 to 102 centimeters in men, Then it is a wake up call for you. It is an indication that the adipose tissue overflow is happening. And adipose tissue is not bad. You need adipose tissue. Adipose tissue releases a hormone called adiponectin.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And what this does is similar to what we talked about in starvation, it releases a lot of hormonal regulations where all the fat tissues are getting broken down into energy and you can use them for when you are not having enough food, similar to our ancestors during fasting and hunting time.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
But what is happening is and that adipose tissue, adiponectin hormone regulation happens very well if it is subcutaneous fat. when it is flowing into visceral fat, the adiponectin goes down. And when adiponectin goes down, the transmembrane fatty acid reflux is the problem with this metabolic profile that I talked about with increased triglycerides and increased LDL and decreased HDL.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And when that goes up, and that is where the underlying problem of your plaque formation and the blood vessels supplying the heart and that increases the risk of hypertension and heart disease and everything. So it is bottom line, it is very clear that visceral fat increases the risk of heart disease. This is what I explain to all my patients on the clinical level. Okay.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
But I go a step beyond that. And then I say that, yes, it's good that, you know, we found your diabetes. We found your hypertension. Now, you know, that visceral fat is at increased risk of heart disease. And now we can treat you from diabetes to developing into heart attack. Okay. But I am more interested in how a normal person don't develop diabetes or hypertension to start with.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Okay, so there is a normal person, subclinical level, clinical level and the outcome. Okay, so clinical level is your diagnosis of diabetes, hypertension, obesity and everything. So I think the key, which is the most important thing in the world is to target preventive medicine right at the subclinical level where everything is happening before the disease happens. Right.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Actually, I didn't know about this as a medical doctor myself until there was a health care to me person. So I think I'll just tell you my journey. Please. And then I can say how I learned about all this. So similar to all Indian immigrant, we're all hardworking and we work so hard to settle in our career. And we build our career so much to a point that we forgot to build our muscle.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
during the young days. And so I entered medical school in 2000, and then 2000 to 2006 was my MBBS. And I came here, I did my MPH, Master's in Public Health, MD, General Medicine, DM, Gastro, AB, Gastro, Advanced as well. So from 2000 to 2015, if you look at it, it says Dr. Palaniyapan Manikam, MBBS, MD, AB, Gastro, there are like eight letters right after my name.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
But at the same time, there was eight inches of belly hanging around my belly button.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
right so i was similar to every hard-working person out there i abused my body as well in the in the name of settling down and my career was more important than my health so i had a scare while i was seeing a patient in my office in my gastroenterology office after being in attending where i suddenly had a palpitation dizziness and chest pain
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And then they found out that I had an angina and then, you know, treatment was done. And while I was sitting in that hospital bed, and that was the time where I was actually looking at what am I doing to my body?
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And that opened up so many mistakes that is happening to every immigrant, not only Indians, every immigrant who comes to United States for better life, better financial status and better work profile and all those things.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
At the same time, and everybody can relate to this, that we are the last person in the list to focus on our health and we are the first person in our list to focus on our education and career. And statistics says that Indian immigrants are the most successful immigrant population over here in US.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Of course, of course. And in the hospital, if you look at it, all the patients in the ICU unit with the cardiovascular disease We are seeing so many young people, you know, like 35 to 45 years old, working so hard in the software industry. I come from nearby area and it is pretty common. It is very common. And they say all these big names, you know, all these giant tech companies where
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
On paper, it looks great. But when they are admitted as a patient, that's where they are realizing that, okay, no, we are going too far. I think it is high time that we dial back down and then see what happened to me where I was pretty normal. I was not obese. And I just recently had a physical exam just before the attack and my body mass index was 24.7. But that is where the problem started.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
I think that, you know, I went to a primary care physician here in US and then BMI is good. Your LDL was slightly high and HDL was slightly low. Triglycerides was slightly high. Okay. So I want audience to focus on this three parameters, high triglycerides, low HDL and increased LDL. That's exactly what happened to me. And that was exactly one week prior to this heart attack that I had.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And this is a very common lipid profile among all Indian immigrants, especially Indians in India as well. And if you look at me, my BMI was normal at 24.7 according to the US standards. But that is not the problem for the Asians and Indians, South Asians mainly. So I didn't realize that BMI should be 23 and not 24.9 for South Asians because all the studies were done in Caucasian population.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
That's number one. Number two, if you look at me, I look very skinny. I look very skinny when you look from the front. But the moment I turn to the side, that's where the belly fat comes into play.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Correct. Toffee.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Trophy. And I still remember that I wear this t-shirt with a mission impossible. Okay. Mission impossible would be, when you look at straight, it'll be perfect. When you turn on the side, mission will be here. Impossible will be over here. I still remember that t-shirt.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
So then I realized that my waist circumference, which is the measurement around your belly button when you take an inch tape, was 101 centimeters. Okay, and I have read in multiple studies that waist circumference more than 100 centimeters puts you at an increased risk of heart disease. I didn't know. I didn't realize the importance of that at that time.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And now I realize that, okay, maybe that is what is happening. And that is where I belong to this category of skinny fat. After realizing this, I kind of looked around all my friends and family and everything. Everybody had this, most of them, most of them had this problem of skinny fat. They look skinny from out, fat from inside, and mainly they have this tendency to form along the truncal area.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Yes. So when we eat more, right, when we eat more than what we need, the energy is getting converted into fat, thinking that we will need that energy sometime later in the future. when we don't have food. But unfortunately, that situation never happens. Because when I put a video on intermittent fasting, the ad comes for Uber Eats in between. So we are in a situation where there is no
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
there is no problem with the food availability. So when there is excess of calories that get converted into fat, usually what happens is just beneath the skin, there is a fat accumulation called subcutaneous fat. And beneath the subcutaneous fat is your muscle.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And beneath your muscle is your fat deposition around the organs that includes your liver, pancreas, retroplatonial space and the momentum. These are all like fancy terms, but basically bottom line is the fat is getting accumulated behind the muscle inside your body, which you are not able to see right away. and that is what is called visceral fat.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Being a gastroenterologist, I see a lot of patients with fatty liver and the number one reason is visceral fat being deposited around the liver.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Of course, and on the top of it, we are genetically predisposed as well because of this theory called adipocyte overflow hypothesis. What that means is, you know, there is some school of thought where it says that we talked about the subcutaneous fat just beneath the skin and there is a muscle and the fat beneath the muscle around the organs, visceral fat.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
When there is no space to accumulate in the subcutaneous fat, that's where the adipose tissue overflows into the visceral fat. And there is a school of thought saying that among Indians and South Asians mainly, the compartment of the subcutaneous fat is significantly smaller compared to the Western counterparts.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
So what happens is, let's say it's a box, and you can fill like 100 lipid particles inside the box of the subcutaneous fat in a Caucasian counterpart. Unfortunately, we can only fill 50 lipid particles in that subcutaneous fat in a South Asian counterpart. So what happens for the remaining 50? It spills over into the visceral fat. And this hypothesis is very visible even in babies.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And you could track down how the fat is being formed in the babies. So there is this thing called thin fat Indian baby hypothesis. Thin fat Indian baby. What that means is, let's say you take two babies. One is a Caucasian baby and the other one is an Indian baby. So Indian babies are thinner, lighter and shorter compared to the Caucasian counterparts. That is a pretty known fact.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
But the unknown fact is the subcutaneous fat is almost equal compared to the Caucasian counterpart even at birth. So there is something called subscapular fat. It is a marker of a central fat where you measure the fat just beneath the shoulder bone. And that was pretty high or equal in the Indian babies, even though they are normal weight.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And that is even more predominant in low birth weight babies. Let's say the baby has low birth weight. Even in low birth weight babies, they don't have lean muscle mass. Every other area, the mass is lower except for the truncal fat.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
And this is absolutely mind blowing that even in low birth weight babies, Indian babies, they have this fat sparing capacity of just localizing storage of adipose tissue right around the truncal area in the belly, buttocks and the thigh area.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
so this is what is fascinating is they study this in a longer population all right in uh in atherosclerotic vascular disease study in uk where they took like okay 450 000 of european patients and 8 500 patients of indian uh immigrants uh asian south asians they followed them up for 11 years okay They followed them for 11 years.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
At the end of 11 years, they found out that there was an 8% increase in risk of heart attack in the South Asian people compared to only 4% increased risk of heart attack in the European counterparts.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
No, I think that I'm not saying at all that genetic is the main reason. That is not the point. Major point is people think that you are healthy. Indians, if you are healthy, doesn't mean that you are completely healthy. You need to be on top of your health. Yeah, you have to be more on top. More on the top of your head. Yeah.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
Given the genetic problem, that is what the point that I always tell my patients is that, yes, you're doing great, okay? Your LDL is only slightly high. Your triglycerides are only slightly high. Your HDL is only slightly low. But that slightly low is significantly higher to you compared to a Caucasian patient that I have.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
So I drilled that point every time to my patient when they walk into my office. And I said that, unfortunately, you know, when you play cricket, you know that we as Indians and South Asians, we start the innings with the wicket down. you need to put more effort to be healthy compared to a Caucasian counterpart.
Dhru Purohit Show
Why Visceral Fat Is So Dangerous and 3 Strategies To Tackle It For Good
On the top of it, unfortunately, as we talked about initially, we are the last community to focus on health on the top of this genetic problem.