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Scot: We had a whole episode about Scot's fatness, and this is an update to the fatness because I decided to take a different route to losing the weight than I had in the past.

So we had Thunder Jalili on, and in order to lose the 15 pounds, I normally would put myself in a calorie deficit. I would figure out what my base metabolic rate is. And this gets a little complicated, but your base metabolic rate is basically the amount of calories your body would burn just to survive. And you eat less than that, and you do some exercising, and that puts you in a deficit, which then would encourage your body theoretically to burn fat.

Thunder told me not to do that, which was totally different. So this is a little update on what's going on.

You're listening to "Who Cares About Men's Health," providing inspiration, information, and a different interpretation on men and men's health. We've got a good crew here today. It's the core crew, as I like to call it. The MD to my BS, Dr. Troy Madsen.

Troy: Hey, Scot. I'm part of the core, and I'm proud of it.

Scot: All right. My name is Scot Singpiel, and we've got producer Mitch over here. He brings the microphones and so much more.

Mitch: So much more. Hoo-gah.

Scot: Mitch just got promoted.

Mitch: I know.

Scot: Mitch got a promotion.

Mitch: Love it. Yeah. Core, I'm in the core.

Troy: You're in the core.

Scot: Thunder encouraged me to just stop eating the stuff that got me there, which was Reese's peanut butter cups and probably drinking too much beer, to go back to time-restricted eating, which is this concept that you stop eating for a prolonged period of time. It could be 10, 12 hours, whatever. So you might stop eating at 6:00 at night, not eat until 6:00 the next morning. And get some activity. And remember that I had a fun time and it took me a while to get to where I was, and it might take me a little while to get back.

So I've got a little update. I'm down five pounds. Yeah, I've gotten rid of 5 of the 15.

Troy: That's pretty good.

Scot: Yeah. I mean, I don't know. We'll see if this continues. The win for me was I went on a weeklong vacation and I just didn't eat sweets.

Troy: Wow.

Scot: But you can't necessarily control what you eat as well when you're on vacation. And when I came back, I was at the same spot. So that makes me happy.

Troy: Oh, so that was the win. Okay. I was going to say, "You lost weight on vacation?" But you're just saying you were able to maintain.

Scot: I was able to maintain. I didn't think about it too much and I didn't probably have as much activity as I would.

Mitch: Did you road trip?

Scot: Yeah.

Mitch: Do you not get fun snacks every time you fill up the gas?

Scot: Normally, yes. This trip, no.

Mitch: Okay. Not this time? No?

Scot: No.

Mitch: All right.

Troy: It doesn't sound like a fun road trip.

Scot: No. The snacks . . .

Mitch: That's what I was about to say. That's a part of it.

Scot: Yeah. Well, we did have snacks. I mean, it was Triscuits and cheese, and it was trail mix, but not with chocolate in it. So it was a lot of nuts and some dried fruit. So kind of healthier stuff, I guess.

Mitch: Sure.

Scot: Yeah, Mitch does not look enthusiastic.

Mitch: No. I'm about to go on a road trip myself and highlight, day one, going and filling the tires, topping off at the gas station, and getting a big old sack . . .

Scot: That's right.

Mitch: . . . of every bit of junk food.

Scot: I mean, I guess . . .

Mitch: Maybe I won't do it this time.

Scot: No. I think every once in a while, you might be able to do that, right? I mean, if you're in a position. It just kind of worked out for me that way.

Mitch: Okay. That's good.

Scot: So anyway, down five pounds. I've been doing some reading and I'm a little scared, because I'm afraid that five pounds is just kind of those five easy pounds, right? Like, just maybe some water weight, some salt weight. I don't know.

So I started doing some reading because I was interested in this base metabolic rate and the different exercise levels. So you've got your base metabolic, which is your body. If you just sat around, did nothing, this is how many calories your body needs to function.

And then you've got some of these other levels, right? You've got sedentary. Sedentary, that's how you pronounce it. What is sedentary, do you think? And that bumps you up a couple. You get to eat a couple hundred more calories if you're sedentary. What do you think that is?

Troy: I mean, you're a couch potato. Those are couch potato calories. Those are like just lifting your arm to use the remote and turn on the TV and reach for your soda. Those are your sedentary.

Scot: This is, I think, where some people might run into problems. That's not the case.

Troy: Sedentary?

Scot: Sedentary, according to a couple places I looked, includes activities of daily living. So doing the kinds of things like going out and raking, vacuuming, and even they included walking the dog.

Troy: No. I think of sedentary as . . . Someone who's sedentary in my opinion, in medical terms, in my practice, if I describe someone as sedentary, they're not walking a dog. They're able to take care of themselves, so they're getting up, walking to the kitchen, and walking to the restroom, but they're not doing a whole lot beyond that. I don't see them as out raking leaves and walking dogs. I don't know.

Scot: Yeah. I think that's where this problem is. I think the problem could be as an individual that you're trying to figure out what your activity level is so you can go, "This is how much I should be eating." Well, I'm not sedentary because I go out and I do stuff. I clean the house. I rake leaves. I mow the lawn. In the definitions I've seen, all those things are included in sedentary. The difference is that you do not do 30 minutes of intentional exercise a day.

Troy: So that's the next step up? So to not be sedentary, you have to do 30 minutes of intentional exercise a day?

Scot: Yep, and that's called low active. And low active is daily . . .

Troy: No. Low active is 30 minutes?

Scot: Yeah. Low active is exercise equal to walking 30 minutes at four miles an hour, which burns anywhere from 135 to 165 calories for the average-weight person.

Troy: Four miles an hour is a pretty brisk walk.

Scot: That is an incredibly brisk walk. I have long legs and I can walk fast. I'm probably doing 3.7, 3.8 max. So that seemed a little weird.

Troy: That's fast. I don't know who made the scale up.

Mitch: Let me tell you. It is the FDA and the NCBI. [Crosstalk 00:06:08] this group is the front for public health. It was published back in 2018 when they decided that this is what sedentary meant.

Scot: So this is all going someplace that hopefully will be helpful to listeners and also is going to inform my thinking, and I wanted to throw this out to you guys.

So then the difference between low active to active is it's kind of the same. Your daily activities of living, except for you're doing an hour and 45 minutes of intentional exercise. So that's walking at four miles an hour.

Troy: A day?

Scot: Yeah, a day.

Mitch: A day.

Scot: And then very active is daily exercise walking four hours and 15 minutes at four miles an hour, or you could jog for two hours a day. And that burns anywhere from 1,100 to 1,400 calories.

Troy: This is an interesting scale.

Scot: It is. I mean, think about the individuals we've had on the show in the past who have struggled with losing weight, right? We're saying, "Well, if you get out and get those 30 minutes of activity, that should be pretty good." But I'm starting to kind of wonder if those 30 minutes is good for your cardiovascular health, it's good for your health in general, but if you're trying to lose some weight, you're going to have to go beyond that.

Troy: See, the problem with this scale, though, is there are just so many studies that show if you can just do 30 minutes of activity three times a week, there are very clear health benefits from it, where this scale is implying that those people are just low active, and even they're less than low active.

Scot: I'm going to say there's a differentiation. There's a fine differentiation here.

Troy: Thirty minutes?

Scot: Thirty minutes a day has health benefits for cardiovascular and those other things, but if you're trying to lose body mass, fat, you need to do more.

Troy: But do you think that's sustainable? We're talking 30 minutes of brisk walking at four miles an hour every day. For the average person, it's . . . I feel like you have to have a routine that's sustainable for you. And on the activity side, it sounds like they're recommending high activity, where I'm sure you could balance that with just some decreased caloric intake or adjustment in whatever your dietary intake is, and you're going to accomplish the same thing,

I don't know. I guess I'm trying to figure out where they're going with this, just because that activity level they're putting for active and very active is really active. And maybe I'm kind of taking it a little bit personally here, because I feel like I'm pretty active. I'm pretty active, but I'm not meeting their definition of very active.

I mean, maybe over the course of a week, if you added it all up, I would meet that definition. But over the course of a week, I get about 11 hours, 10 to 11 hours of . . . I don't want to call it jogging because I don't want to be called a jogger.

Scot: I mean, you're running.

Troy: It's running, but still it's . . . Yeah, that's really active what they're getting at there. Two hours a day of what they're describing as jogging.

Mitch: Well, again, this is just how you do your calculations. So when you look up base metabolic rates and things like that and try to get your diet clued in . . .

Scot: Yeah, and you're trying to figure out how many calories you need to sustain. But it could also be used for, "How many calories can I eat, and then what do I have to do to put myself in a bit of a calorie deficit so I can lose that weight?"

Troy: So maybe that's the flip side, just saying, "If you really want to eat this many calories, you're going to have to exercise a ton." Maybe that's what they're trying to say.

Scot: Yeah, I think so.

There was a "Time" magazine article, and I need to send this to you because they quote a lot of research. This is the next part of my thinking, because this was the next thing that I read.

So they cited many studies that exercising at a moderate level for 30 minutes, which is good for health, results according to these studies in little weight loss. So it's good for maintaining, but for losing it's not.

And then they cited some other studies. A combination of diet and exercise generated no greater weight loss than diet alone after six months. At 12 months, the diet and exercise combo showed an advantage, but it was slight, about four pounds on average.

So, in this, the conclusion that they came to based on the research . . . And there was another study. It said exercise results in weight loss when 400 to 500 calories are burned per session at least five times a week.

Troy: So I see what you're getting at here, Scot. What you're saying is if you want to lose weight, don't focus on exercise. Focus on diet. There are clear health benefits from exercise, but it's not going to accomplish the weight loss you need.

Scot: Yeah. Exercise is not going to accomplish the weight loss you need, diet and exercise. But then beyond that, you have to put in a certain amount of exercise, which they're saying is something that can burn 400 to 500 calories per session, 5 times a week, which they equated to 90 minutes of brisk walking or 30 minutes of running 8-minute miles.

Troy: Yeah.

Mitch: Geez.

Scot: I mean, 400 to 500 calories, that's a lot, right? Ninety minutes of brisk walking? Or if you get on a cardio machine and you're not pushing yourself super hard, 90 minutes, that's a lot.

Troy: It is a lot. And how many calories are in just a large soda?

Scot: Right?

Mitch: Too many.

Scot: Too many.

Troy: Yeah, you get a large soda for your road trip and right there you're at 400 calories.

Mitch: This is something that I'm really excited . . . We have a guest coming on in a couple weeks who is part of the weight management program here at The U. And she was talking a lot about in our little pre-interview . . . She was like, "Yeah, losing weight is a lot more than just diet and exercise," and I'm excited to kind of talk to her about all this.

Scot: Yeah. So, for some people, diet and exercise might work, but there are some people that it does not work. And she's going to hopefully tell us some of the things that could happen or some of the things that could be going on that could be preventing somebody from losing.

But I just feel like there's a huge disconnect in the information that I've received. And again, you know what? There are a lot of studies out there. Who knows? But if in order to get some weight loss I have to be doing 400 to 500 calories burned per session, that's a lot more than what I'm currently doing. So maybe that's where my frustration is that in the past I haven't lost weight, or where other people have frustration. So I feel like that needs to get figured out.

Troy: Yeah. I mean, again, it just seems like . . . Like you said, Mitch, maybe we'll have someone on here who talks about all the other factors besides diet and exercise. But my takeaway from this is that you can't just sweat off the calories. You've got to focus on the caloric intake if you really want to lose weight.

Scot: Yeah. You've got to focus on both.

Troy: Yeah. I mean, you've got to do both, but it's going to come down a lot to caloric intake. You can't just say, "I'm going to burn it off by going out and walking the dog," or something. It's a lot of exercise to burn off 400 to 500 calories.

Scot: Yeah. Like you said, what's an average soda have? And if you are doing 30 minutes, according to the scale, which is low active, that burns 135 to 165 calories. So a soda is probably what, 220? I'm guessing.

Mitch: It's 180 per 12 ounces.

Troy: A 12-ounce can.

Mitch: If you get a Big Gulp . . .

Scot: Yeah. So you can either walk for 30 minutes at four miles an hour to burn that or just not drink that, right? So that really kind of shows the importance of watching some of that stuff.

Anyway, here's what I'm thinking. And again, it comes back to sustainability on a couple of levels. One, time. I don't have 90 minutes a day. Two, I'm not in that great of shape anymore.

Troy: Oh, no.

Scot: And I don't know if I could sustain five sessions of 400 to 500 calorie burning and not be completely drained. So I don't know. Part of me wants to try to start to burn some more calories so I can get . . .

Here's the deal on the road trip. This time, instead of the punishment pants, I just sat and played with my fat to remind myself how miserable it is.

Troy: So you were just . . . Is this as you're driving? You're just holding your fat rolls and kind of bouncing them and jiggling them?

Scot: Yeah, exactly.

Troy: What are you doing?

Scot: You drive with one hand and you kind of bounce it and you kind of grab it.

Mitch: For the listeners, he's cupping underneath his lower abdomen and kind of making a flipping, squishing motion. I'm so glad I'm back in studio.

Troy: Yeah, that's wonderful.

Scot: I want not to have to do that anymore.

Troy: So was this what you did just to keep yourself from going in every gas station and getting a large soda and a big thing of candy or something?

Scot: Top of mind, man. Top of mind.

So I don't know what to do with this information other than to say it was kind of eye-opening to me the amount of activity that it kind of takes to burn fat. There are two things. There's the amount of activity that takes to be healthy and reduce the risk of disease. But if you're trying to get rid of body fat, that number has got to go up quite a bit. And then once you get rid of it, maybe your daily exercise goes down again because maintaining is easy. I don't know. But anyway . . .

Troy: I totally get it now. At first, I just thought, "Wow, where is this going?" But I get the point of it, that you have to exercise a lot to burn calories. I mean, that's the simple reality. You've got your basal metabolic rate and that burns quite a few calories, just the thing that keeps you alive. But then beyond that, it's not like you can tell yourself, "Hey, I just went and did a brisk walk with the dog for 30 minutes, and I'm going to reward myself now for that exercise by having a soda or taking in some extra calories." Yeah, you did not burn that many calories.

Scot: Yeah. Even if you don't take in those extra calories, you're probably not going to be losing much fat from just walking the dog.

Troy: Yeah. It takes a lot to burn. Yeah, it really does.

Scot: So that's my update. Those are the things I'm kind of struggling with and I'm trying to figure out. So I'll keep you up to date. Mitch, you have an update too.

Troy: Well, I was going to say, though, Scot, you made progress. I thought that was the best point. I mean, Thunder made a lot of great points, but the one that I think really made sense is it takes you a long time to put that weight on. Think how long it took. It's not going to come off in a month. It's a process. So you're a month out from that discussion with Thunder and you've already lost a third of the weight. That's great.

Scot: Yeah. We'll see if that keeps going down.

Mitch brought up that he felt like he had a different situation, that he has struggled his whole life to try to lose those extra pounds. What's your update?

Mitch: So I was weighing around 230 a little over a month ago, and I am just under 210 pounds as of this morning. So in a month I've lost over 20 pounds.

Troy: Wow. That's crazy. You've lost almost 10% of your body weight in a month.

Scot: Yeah. You want to ask him what he's done, Troy? Do you have any guesses what the difference is? For you, Mitch, this is crazy.

Troy: Let me guess. Did you just stop eating or what?

Mitch: No. I'm eating red meat and sunlight.

Troy: Eating red meat and sunlight. You just go outside and open your mouth.

Scot: Yeah. Any other guesses as to why? Like Mitch said, this is just kind of unheard of that it would be this easy.

Troy: Wow, I'm trying to think what you could have done. I'm guessing you went back to time-restricted eating. I'm sure that was part of it.

Mitch: I was doing that before. I'm still doing it.

Troy: Oh, you were doing it before. That's right. You were doing it before, and you had already really focused on cutting down on sodas and sweets and all that kind of stuff.

Scot: Yeah. He was doing all the right things, remember, and then he was just getting frustrated because it wasn't happening.

Troy: Yeah. I know you were talking more about the carbs. Have you focused more on carbs?

Mitch: I'm eating the same I've always eaten.

Troy: Did you get a different scale? I'm kidding. "This scale makes me look great."

Scot: The best way to lose weight is get that little dial underneath the scale and calibrate it differently.

Troy: Just change the dial. Wow. I really want to figure out how you've done this. Are you exercising more? I know you were trying to . . . You were already doing some exercising.

Scot: I mean, I'm doing it maybe once more a week, once more than I used to, but no, not really.

Troy: Okay. This is huge. You've lost almost 10% of your body weight in a month, and you were struggling before and you were doing everything right. So I don't know the answer. What have you done?

Mitch: So I got my hormones figured out.

Troy: That's right.

Mitch: So I've been working with Dr. John Smith, and he identified that I had really low testosterone. And now that the hormones are . . . I've been three, four weeks on this medication that we'll probably talk about in a future episode that just helps up my testosterone a little bit, and suddenly, I have tons more energy, and I'm losing weight like crazy, and I haven't changed anything.

I've been working out the same I've always been and struggled. I'm eating the same 1,800 to 2,000 calories every day that I've been doing forever and watching the macros and blah, blah, blah, sleeping all the time, etc. But all it took was getting my hormones in check and suddenly I'm starting to get to a healthy weight.

Troy: Wow. That's impressive. Are you putting on muscle mass too?

Mitch: We'll find out when I get in the BOD POD. I don't know if I trust my scale, but maybe. Hopefully. I don't know.

Scot: He just pulled out the guns.

Mitch: Scot, how are my guns?

Troy: He's flexing.

Scot: Does your scale give you a body fat percentage?

Mitch: It does.

Scot: And has that been dropping too?

Mitch: Yes.

Scot: My scale did not match up at all with the BOD POD, so it'll be interesting to see how accurate yours is.

Mitch: That's what I'm curious about too, yeah.

Troy: But it seems like on the scale it was all about relative change. Like, the number itself isn't as meaningful. How much has your body fat percent changed on your scale?

Scot: He's looking that up.

Mitch: It says 4%.

Troy: So you're a 4% body fat change. Like we've talked about before, the actual number maybe isn't super accurate on those home scales, but the relative change is . . . Again, that's significant.

Scot: It is significant. So it was all hormones. How does that make you feel?

Mitch: Well, it's a little strange because I do not want to be the guy that is like, "Testosterone solves everything. It's the magic bullet. You'll lose weight. You'll get your libido back," all the stuff you see on those irritating ads on the internet.

But if you legitimately have a hormonal imbalance, you should go talk to your doctor and you should probably get it fixed, right? It's not the magic bullet for people who are just a little low or something like that. But for me, I was well below the acceptable range when I did my follow-up test with John Smith, and it's night and day for me.

Troy: What was your level?

Mitch: I was in the lower 200s when I got it tested.

Scot: Because the low range is like 180, right?

Mitch: Three hundred.

Troy: He said if you're less than 300, you're low and you were . . . what did you say again? Low 200s?

Mitch: Yeah, 226 I think was the average between the two tests.

Troy: Yeah. So it wasn't like you were going in there and just being like, "Oh, I'm 330 and I need to get on testosterone." You were definitely below the level that he said he really kind of uses as a cutoff. And you'll get your levels rechecked here, it sounds like, in the next couple of weeks.

Mitch: Yeah. And we'll have him back on, and we'll kind of talk about what's going on. Yeah, there was something about, "No, this isn't 'optimizing T levels.'" I had a hormonal deficiency, and it was impacting metabolism, energy levels, etc. And it took some meds to get back to where I needed to be.

Scot: Wow. I think that's awesome.

Troy: It is.

Mitch: I think it's awesome too.

Scot: I keep looking for the thing that's wrong with me, Troy. I keep hoping . . .

Troy: What's yours, Scot?

Scot: I keep looking. Is it testosterone? No. I keep looking for that test that's going to just shine a light on why I have struggled in the past to put on muscle or to lose . . . Even when I was at my lower weight, I still had a good percentage of body fat because I just don't have a lot of lean mass. So I'm still looking for my thing.

Troy: The magic bullet.

Scot: Yeah. It's a magic bullet, right? What's the difference between a magic bullet and what Mitch experienced?

Troy: There's not. That is a magic bullet. That's a dramatic change. You want to talk about a magic bullet? Yeah. I mean, 4% body fat reduction, almost 10% weight loss in a month, that's impressive. And I've known very few people who could ever say they had that sort of experience while really not making any other changes. It sounds like you said you're exercising maybe one more day a week, but . . .

Mitch: Yeah. It's not huge changes. It's tracking a little closer on my calories. I'm working out a little bit more. It's not anything huge. It really is this medical thing that needed to get fixed before anything else could work.

Scot: And I think it's worth, if you are curious about testosterone, going back to our episode on testosterone. I think the thing to really keep in mind for everybody is it is not a magic bullet.

I can't remember what Dr. Smith said that range was. Like much beyond 600? You're not getting much return on that. So if you're around 500 or 600, you're probably fine, right? That's probably not what the problem is. Does that sound familiar to you, Troy?

Troy: I can't remember the exact numbers. I wish I did. Yeah, again, we should probably look at that just to give the exact numbers, but I do remember him saying the 300 number and if you're under that, you definitely need to be on some sort of hormonal therapy.

That episode, I was kind of skeptical throughout it, like, "Really? Do we really need testosterone? Does it really make that big of a difference?" But, Mitch, your experience, and clearly you met the criteria he talked about, and it's made a difference, no doubt.

Mitch: So I was having a conversation with one family member who had been experiencing some hormonal issues themselves. And it was really interesting because from the female perspective, hormones are a huge part of everything from energy levels to how your skin looks, to how much energy you have, how well you sleep, etc. And I think a lot of times as guys we just assume it's a yes or no, like an "Am I low on oil?" kind of approach to your car. Am I low on testosterone? Better put some more in me if it's going to work.

But talking with the doctor and stuff like that, testosterone has everything to do with estradiol levels, with all these other pieces and parts floating in your soup of juices all through your body. And it has a holistic impact on everything.

Troy: Yeah. That's cool.

Scot: Troy, do you have an update for us? Now, you don't have a weight problem. Actually, you'll be gaining about 8 to 10 pounds here in a few months in the form of a new life, a new Madsen.

Troy: I know. I've got a baby carrier that I'm going to be carrying on my . . . I looked at it. So, for the first several months, I carry the baby on my front side and then I can transfer the baby to my backside. I guess my back, not my backside. It's going to be another 8 to 10 pounds I'll be carrying around.

Scot: Are you going to go running with the newborn?

Troy: Oh, you know it. This is so funny. So Laura shared the news with me as I got home from work from a late shift. That next morning, I was reading all about running strollers, reviews, what's the best thing, all that stuff.

Scot: Good for you.

Troy: I know. This is embarrassing. I spent more money on a running stroller than I would ever care to admit. But I asked around. I talked to people. Yeah, I will be taking her running, and this is what some good runners I know recommended and said, "If you really are serious about going on long runs with a child, get this." So yeah, I'll be taking her running.

Scot: That's good. We learned that exercise is super important even for the dads when the child first comes along to counteract any potential . . . I mean, it's a massive lifestyle change, and you're trying to mitigate that as much as possible. Anything else going on? Any other new updates?

Troy: No, things are good. And it's a good point you made too, Scot, because I think it can be a massive lifestyle change. But I was talking to my brother about it. He was just visiting here a week or two ago, and he has three kids and he said that's what people always said to him too. It's a massive lifestyle change, but he said, "Hey, we're just going to do the same things we've always done. We're going to bring our kids." And his kids now are early teens down to about 9 years old. And the kids are crazy active. They love running.

My little 9-year-old niece, we just did a run. She ran a half marathon with me, just went out and busted out a half marathon trail run with me. They're just super active. And so I'm hoping that's how this can be. I'm hoping running can be something that we share as a family and that we're all out doing things together.

So I don't want it to be a massive lifestyle change, because I kind of have had that thought as I'm continuing to run. Not necessarily, "Why am I doing this?" but kind of the back of my mind thinking, "Wow, I'm not going to be able to do this as much in about two months." But then I tell myself, "Well, it doesn't have to change. We can keep doing this, we can stay active, we can keep running and doing all these things." So that's what I'm hoping for, and that's our plan.

Scot: Have to come up with some creative solutions and just have to be dedicated to it, I guess.

Troy: Yeah, I think so. Yeah, you come up with some creative solutions. You have to spend some money on some gear. Like I said, it's a whole lot more money than I ever expected to spend on a stroller, but it should be a stroller that lasts us for many, many years and hopefully running marathons together and doing lots of long runs with her. That's the hope, so we'll see how it all works out. I'll report back in about three months, Scot, and tell you where things are.

Scot: All right. Well, I guess that's that. This is going to be kind of an ongoing thing. We're really excited about some of the upcoming episodes talking about body weight control, losing some body weight, some fat if you have to.

Mitch: And having some people on to talk about testosterone again, and a little bit more about how all that connects and . . .

Scot: Yeah. And I'm just going to keep on keeping on and we'll see if I can catch up to Mitch. He's a Troy Madsen distance ahead of me in the marathon.

Mitch: Oh, no.

Troy: Mitch is smoking you, Scot.

Scot: He really is.

Troy: He's far beyond where I would be right now if this were a marathon. That's impressive.

Scot: I'm going to keep investigating just the amount of activity that you need and keep reading on that. I'll send you some of that information, Troy. You can see what your take is.

Troy: But give yourself credit though, Scot. You didn't lose 10% of your body weight, but you're down 33% of your weight gain. That's great.

Scot: No, I'm cool with it.

Troy: Yeah, you're making progress.

Scot: I just want to get to a point where I'm not playing with it anymore.

Mitch: You've got to quit doing that. I will leave the studio if you keep doing that.

Troy: Well, you can't play with it on a road trip, because you're sitting down. You're kind of hunched down. It's naturally just going to kind of bunch up there. So it's like, "Oh, feel all this fat here." I'm sure it's not as bad as you're saying it is.

Scot: All right. Well, gentlemen, as always, great conversation. Thanks for listening. And if you have any questions, you can reach out to us. It's super easy to do. You can just email us at hello@thescoperadio.com if you have any questions or stories you want to share. Thanks for listening, and thanks for caring about men's health.

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Scot: Not only does body fat impact how we look and feel about ourselves, excess body fat has been associated with a lot of diseases that can significantly impact our health. And one of the organs, I didn't even know this, that's particularly susceptible to becoming damaged by excess body fat is the liver. And today on "Who Cares About Men's Health, what to know and what to do if you've been diagnosed with fatty liver disease.

Got a big crew here today. This is going to be a lot of fun. The MD to my BS, it's emergency room physician Dr. Troy Madsen.

Troy: Hey, Scot.

Scot: All right. And we also have Dr. Susan Pohl, who is in family medicine. And she's also very passionate about wellness for disease prevention. So you're in the exact right place. Welcome, Dr. Pohl.

Dr. Pohl: Thank you. Good to be here.

Scot: And the star of this week's show . . . What do you think of that, Listener Brett? You're the star. You're the reason we're all here today.

Brett: Oh, I'm so excited. Thank you.

Scot: Yeah. So Brett wrote an email to us that I'll get to here in a second. But essentially, he was diagnosed with fatty liver disease during his last physical. So first thing, Brett, when your provider told you that, what was your reaction, being told that you had a fat liver? That kind of doesn't sound like a fun thing to be told.

Brett: It was a little scary because, "Do I need a liver transplant? Am I going to die soon? Or is this just because I am overweight?" That's the question.

Scot: We talk about the core four on this podcast, which is to be healthy today and in the future, you should watch your activity, your nutrition, your sleep, your emotional health, and then you've also got to know that plus one more, which is your genetics. I have a feeling we're going to be delving into a lot of those today.

So here is the email. "I've been listening for a while and thought I'd ask a question after my last physical. Diagnosed with fatty liver disease, but my physician didn't explain it too well. And I've been searching for more answers on what it is, why I should worry about it, and what I should do to treat it. I've Googled a lot of stuff, but I'm unsure what to do. My doctor recommended I avoid fatty, greasy, fried foods. But I wasn't sure if I should consult a dietitian or do anything else."

So that is Brett's condition. I want to ask you, when you searched on the web, what did you find about fatty liver disease? I'm kind of curious what's out there.

Brett: I found actually a couple of previous interviews that The Scope did for fatty liver disease. And I found pretty much the . . . Healthline, I think there was an article for it, and basically it said, "Take it seriously and lose weight," is the main thing, which is good, but easier said than done also.

Scot: So is the concern, actually, how to accomplish what it suggested to do? Or did you really truly find that you didn't find a lot of information that explained what this condition was, why you should be concerned, that sort of thing?

Brett: A bit of both. I wasn't really sure how I got it. Am I drinking too much soda? Am I eating the wrong foods? And then should I be exercising differently? These are things . . . Then what's the long-term prognosis? I was really scared that, "Am I going to need a liver transplant in 10,15 years? Or is this more like something that will eventually kill me when I'm 90 and that's okay?"

Troy: I'm curious, Brett, how did your healthcare provider diagnose you with fatty liver disease?

Brett: Well, there were a couple of ways. First, the blood work said that that indicated it. But then there . . . he sent me downstairs in his clinic. They had this thing called a FibroScan. It was essentially an ultrasound that looked at my liver and found the tissue was consistent with that diagnosis.

Troy: Okay, interesting. Obviously, we're all kind of spread out everywhere recording, so I haven't met you in person. But if you wouldn't mind sharing with us a little bit more about your health. Do you consider yourself overweight? Do you exercise, or did this come as a surprise to you to hear, "Wow, I've got a fatty liver and this doesn't make any sense"? I'm just a little curious about kind of where things came from there.

Brett: Effects of weight gain were definitely not a surprise to me. I've been a stay-at-home dad for the past three years, and it's been a more sedentary lifestyle than it was when I was working. I do work out, especially in the past year and a half, four to six days a week. Mostly a lot of cardio, but also weightlifting and things like that. I do it at night because as a stay-at-home dad, I don't have a lot of time in the day to run to the gym, and there's no daycare there.

So I've gained probably 25 to 30 pounds over these past three years. I've not been happy with it, but I've also thought that some of that could be from not just diet but also exercise. My body mass index is about 32 right now. So it's in the obese range, but it's on the lower range.

Going back to the episode a few weeks ago, when you had Scott on, the listener, I believe that was his name, I'm bit more average in my eating and exercise, average American, than he is. So growing up liking the normal food groups, which includes some of the fattier and sweeter foods. But also, I like to cook. I like to make meals that are healthy. I also have kids who are picky eaters, so sometimes I have to sacrifice good food for what they will actually eat. So it's a balancing act always.

Troy: Yeah, for sure. Like you said, though, you are exercising regularly. You have put on some weight just in the last few years. But again, it sounds like this kind of blindsided you to hear this, like, "I've got fatty liver disease." Like you said, you're searching all over trying to get answers. What does this mean? What are the implications of this?

Brett: Yeah. I mean, I expected things like higher cholesterol and things like that. Those things I've actually seen over the past few years of physicals. But this was kind of more surprising. Moving from heart to liver was more surprising.

Scot: Dr. Pohl, let's have you jump in right here. I want to ask a question, but I also just kind of want to let you go with what it is you would want to know at this point. I think Brett's main concern is, "Is this something he needs to worry about? And what can he do about it?" That's what he wants to ultimately walk away from. But we could also learn more about this condition. So, Dr. Pohl, where do we go from here?

Dr. Pohl: Thank you so much for having me on the show. Just as a clarification, I am a family physician. So I work at University of Utah, and I'm board certified in family medicine. I'm also board certified in obesity medicine, so I treat people who are having complications from weight. I'm not a hepatologist. A hepatologist would be someone that just specializes in liver disease.

Scot: So let me jump in for a second. Is that ultimately who Brett should go see at this point, or . . .

Dr. Pohl: So one of the things to think about . . . I'm just going to start from a big 10,000-foot informational view, and I think Brett can then get some more information from his doctor.

First of all, when we think about the liver, the liver has hundreds of functions, including clotting and digestion and regulating your blood sugar. The liver itself also stores fat, and everybody has fat in their liver. So fat in the liver is normal, but when the amount goes up, that's considered abnormal.

Again, from a 10,000-foot view, the liver can become diseased. The two main classifications of liver disease are related to alcohol or non-alcoholic liver disease.

So the first thing I would want to know is how much alcohol you drink, because that in and of itself can be a toxin and is one of the most common causes that can progress liver disease. Brett, do you mind if I ask how much alcohol you drink?

Brett: I don't drink at all. The most I do is I throw some wine or something into a recipe for . . . But I don't drink any alcohol.

Dr. Pohl: Okay, so that makes it easy. We can classify this as non-alcoholic liver disease. So as we branch into the non-alcoholic liver disease, there are some interesting terms. I don't want to get too much into the weeds, but the term non-alcoholic fatty liver disease, or NAFLD, actually means that you just have more fat than is generally considered "normal."

Normal fat content would be somewhere around 5% to 10% of the liver content is fat. And so you've been diagnosed with a little bit more than that, and I don't know what your level is.

Now, excess fat in the liver, actually the body can tolerate that in a lot of people. And NAFLD, or non-alcoholic fatty liver disease, is actually incredibly common. One out of every four adults in the US is considered to have some level of NAFLD, or higher than what we consider normal fat in the liver. But only some of those patients will then progress to some level of fibrosis.

So fibrosis is where the fat is actually more inflammatory and there's starting to be a little bit of scarring in the liver. Scarring in the liver is fibrosis, and we can pick that up on scans, like the FibroScan that you talked about or MRI.

What we want to avoid is this becoming very progressive and it leading to cirrhosis and liver failure. And I think that's what you were concerned about, Brett.

So it's important that you had the FibroScan and that they did look for some fibrosis. Now, if we're starting to see some fibrosis, then we're talking about NASH, which is non-alcoholic steatohepatitis. Only a few people with fatty liver are starting to get some inflammation and fibrosis in their liver.

But the good news is that the liver is incredibly resilient. The liver is an organ that is just an incredibly resilient organ. So the fact that you've been found to have this, this is one of those things that you are in control of, and you can be the captain of your ship and help your liver recover and heal from this.

Troy: So hearing all that, Dr. Pohl, where do you think Brett falls on that? I know it's probably hard to tell without actually seeing results, but you think he kind of falls maybe in that fibrosis phase or maybe just a little bit more fat than the average person in the liver?

Dr. Pohl: Well, I would have to see the result of his FibroScan. I mean, verbally, that story that he's telling me . . . the fact that your doctor was concerned about it makes me think . . . I'm playing Sherlock here. But from that story, there was enough fibrosis that the doctor was concerned and would classify you more in the NASH.

Now, I'm not sure if that's true, so I would contact your doctor and say, "What level of fibrosis . . ." We score that with numbers. "What level of fibrosis do I have? And do I have NASH?" And so just ask your doctor, "Do I have NASH, non-alcoholic steatohepatitis?"

Brett: Non-alcoholic steatohepatitis.

Brett: Yeah, or N-A-S-H. You can do a lot with this. And that's the good news, is that lifestyle medicine is the way, really, to approach this. It's the best way to improve the fat distribution that you have. Everyone needs fat, but the way your body is distributing its fat is causing some issues for you.

So I'm just going to segue into some lifestyle things you can do. You mentioned things like soda and sugar. Your doctor had mentioned things like fat, and obviously excess fried foods are going to be calorically rich, and so that can lead to weight gain in general. But tell me about the sugar that you eat regularly, including sugary sodas and drinks.

Scot: They always go after the good stuff, don't they, Brett?

Brett: Yeah. Well, it's true. I think I'm a little better than average in terms of soda intake. I probably have one or two a week, maybe. My post-workout drink, because it's at night, is a cup of chocolate milk. I looked online and it says eat chicken breasts and things like that. But when I get home from the gym at 11:00, that's not exactly appetizing. So that's my main sugar intake.

I feel like I'm pretty normal on things like candy and things like that. Not a lot, but like I said, I'm also around kids, so sometimes they make me eat. "Make me." Yeah.

Troy: Dr. Pohl, do you think that for Brett it's just flat out you've got to get your BMI down and this is all going to reverse? Or maybe he continues on at a BMI of 32 but drops the sugar, and then that's the key to reversing this.

Dr. Pohl: Most people with a BMI of 32 that have fatty liver or NASH will benefit most easily from weight loss. So unless there's a profound transformation of fat to muscle, most people need weight loss.

Scot: It sounds like really it's just a matter you're decreasing your total body fat and, in turn, you're decreasing the fat in the liver, and that's really what you're trying to do here.

Dr. Pohl: Yes, exactly. And sugar does tend to be very toxic to the liver. When we get big spikes of sugar, that's very inflammatory and actually produces inflammation in the liver.

I never say no to . . . I like chocolate cake, and I never say no to those things, and an occasional soda. I mean, all those things are part of my diet. But just realize that those should be kind of the peak of your pyramid. So if you really need that piece of pumpkin pie around Thanksgiving, have that piece of pumpkin pie. I mean, that's important to you. Have that piece of pumpkin pie. But don't have rolls and pasta and pumpkin pie and a Coke and chocolate milk after your workout. That is five servings of carbohydrates that your body is going to turn into sugar.

So think about what's important to you. Just don't waste those calories on things that . . . waste those sugar grams. If you want to get really technical, talk to your doctor about monitoring the sugar and actual grams of sugar in your diet. Most people do well by keeping it under 50. A lot of people do really well if they keep it . . . Getting it under 25 would be awesome, but that's hard to do, because it hides in so many things like ketchup and salad dressing and those kind of things. So decreasing your sugar is really important.

And then there is some data that shows that increasing the good foods in your diet will also help. So the nice thing about this is it's the same diet that we talk about for heart health. So we're not talking about a different liver diet than heart health. The Mediterranean diet is what tends to promote weight loss. It tends to decrease inflammation.

I'm sure you've talked about the Mediterranean diet before, but that's a diet that's high in foods like salmon and cod and fatty fish, and then high in dark vegetables like greens and kale, and adding some nuts.

Now, the key with nuts is measure those nuts because they're very calorically dense, but nuts are a good part of your diet. And by decreasing the empty carbs and adding some of these good nutritious foods to your diet usually you can heal that liver.

Brett: I do think that's something that I haven't done too much, is doing a detailed monitoring of the food that I've eaten, looking at the . . . That's good to know the level for the sugar content to have in a day, because I haven't really tried to measure that. And I think that's a good idea to get started.

I've really struggled about how to start approaching this, whether to start cutting out 20% of my portion size of my meal or whether to just cut out certain foods entirely or whether to do certain things.

One of the questions I had to my doctor, and he was kind of saying, "Yeah, maybe, but you could try these other things," is should I look at going to a dietician to help me get started on this? Or should I start with some more basic steps?

Dr. Pohl: I think consulting with a dietitian is fine. And I think you can talk to your insurance about whether they'd pay for it. I think if you've got inflammation in the liver, they likely will, but sometimes that becomes a barrier. Sometimes insurance doesn't want to pay for that. But investing in that or accessing your insurance for that is a great tool.

One of the things to start with, though, is to start with just the easy things. I'm not getting paid by MyFitnessPal, I promise, but I'm a big fan and I recommend it all the time. Just for three days, if you enter in all the foods that you eat, it'll actually show you how many sugar grams you're eating. Just for three days, enter in all your foods and see at the end of the . . . Don't modify anything. Just enter it in and see how many sugar grams you end up with at the end of the day.

Then you can start thinking about, "Oh, goodness, maybe some of those empty calories that . . . Do I really need the barbecue sauce with the sugar or can I substitute some Tabasco sauce or something else?" So there are some easy substitutes, if you start looking at that.

My suggestion for most people is start monitoring with one of those easy online apps, and MyFitnessPal is pretty easy to use. Just put your information in. You can take that information to your dietician, and then they can help you with some easy substitutions as well.

Scot: Dr. Pohl, it sounds like really the place that you recommend Brett to start is just those added sugars. That's what we're talking about, right? So monitor what you're eating for three or four days and find out what those added sugars are and see if you can get rid of some of those with something else. Is that accurate?

Dr. Pohl: Yes. Get rid of those easy, added sugars. Yes, that's a good summary.

Scot: Yeah. And I will tell you a soda, I think, has like 50 grams of added sugar. And you said you want to try to keep it at 50 grams a day?

Dr. Pohl: Yeah, exactly. So even that one soda is a lot for your day. Now, I don't like to tell people you can never have a soda, but just realize that you're spending those grams of sugar on a drink. Do you really want to do that? If we talk about it as a cost, it's an expensive cost to have all of your sugar in one can of soda.

Scot: We had an episode called "Hidden Sugar." It's really shocking where sugar hides. Like Dr. Pohl said, in barbecue sauce, in salad dressings. We talked about you think you're eating a fruit-flavored yogurt and that's healthy, but there's a lot of added sugar in that. The little packets of instant oatmeal that you get, half of that is added sugar. So it really kind of hides in very insidious ways.

You might be surprised after looking at packages and monitoring just how much added sugar you're actually getting. Even I used MyFitnessPal and I eat pretty clean, and my added sugar was higher than I ever would have expected. So I think that is good advice.

Dr. Pohl: I want to admit that I had been advising people about diet and exercise, and then I looked at my low-fat yogurt and found the exact same thing. It was 24 grams of sugar. So it was a day's supply of sugar in my low-fat, healthy yogurt.

These things that are sold to you in packages, make sure you look at those packages, because a lot of the things in the health food aisle like granola and low-fat yogurt and things that have the word "fruit" on it, fruit snacks, fruit juice, all those things, they're in the health food aisle, so we feel like, "Oh, these must be great." But check those sugar grams because they hide in these "healthy foods."

Scot: Especially low-fat food, because when you take the fat out, you've got to add something back in to make it taste good. And sugar is what they do. They add sugar back in.

Troy: Yeah, I saw something about a junior high that has their healthy foods vending machine, and they would sell applesauce in there. And the applesauce was just selling out like crazy, and they're so excited, like, "The kids are eating applesauce. Yay." Each little thing of applesauce has like 15 grams of added sugar or something ridiculous. It's amazing.

But I went through that same process with yogurt as well. I was thinking I was eating healthy. We had Thunder on here, Thunder Jalili, who talked about hidden sugars. I looked at the yogurt I was eating, same thing, just tons of added sugar. It's just amazing.

Brett: Yeah, I do try and monitor some of that, and I try and not do as many processed meals and things like that, try to make meals from scratch. Even things like pancakes and waffles, I make from scratch so I can see what exactly I'm putting in there, and not relying on a box mix or something like that. I like to make even macaroni and cheese from scratch, but sometimes my kids aren't fooled by the difference between the colors.

But that's the thing. I do like to try and control those hidden sugars after . . . I did listen to that episode, and that's one of the things I tried to control through the recipes that I've gotten. But I'm absolutely not perfect in that way, and I'm eating plenty of things I know are sugary, too, though.

Scot: I'm really trying to make this simple for any guy that's listening, and sometimes it can get really complex and it can get confusing as to "What should I really, really do?"

So I think we've established to really critically look at those sugars. You might think you're doing well, but after a three- or four-day examination, you might discover, "Not doing as well as I thought." So if you can maybe replace some of those calories with healthier choices, limited seeds and nuts and some vegetables, that's another strategy to try.

I think a lot of people don't realize how many calories are in the foods they eat. I think it's really easy to eat way too many calories. So perhaps monitoring those through MyFitnessPal will give you some insight into that.

And maybe really having two or three meetings with a nutritionist also have just a separate set of eyes on what's going on might be advantageous too.

Dr. Pohl, what do you think of that advice? Brett, do you think that's . . . is that a little bit more straightforward of a plan that you think you could follow?

Dr. Pohl: I love that summary. I think it's a great, actionable summary. Brett, what do you think you could do?

Brett: Yeah, that sounds like a very good idea to start monitoring, start there. It's the easiest thing to do for me personally, and it gives me some data to go to the nutritionist and see what to move forward from there.

Dr. Pohl: And the biggest thing is also just talk to your doctor about it and just find out what your level of fibrosis is and what kind of weight loss plan you should be on.

The caution I want to give you at the very end is that dramatic weight loss, which would be something more in the line of two to four pounds a week, we would recommend . . . If you're going for dramatic weight loss quickly, that can actually worsen fatty liver because of the stress that you're putting your body under. So slow and steady weight loss, something in about the range of one to two pounds per week, is kind of that sweet spot of sort of detoxifying your body.

Troy: And how long do you think Brett should give it before he really goes back to his doctor and says, "Hey, I'd really like you to take a look at my liver again and see where things are"? I mean, are we talking a few months, six months, a year?

Dr. Pohl: Well, talk to your doctor about what level of fibrosis you have. And then the goal would be if you're starting to see some changes on the scale, and you've made some changes consistently for at least three months, then go talk to your doctor about whether you should be rescanned and see whether that level of fibrosis is less. Three to six months.

It's interesting to see . . . the studies show that even small amounts of weight loss, like 5 to 10 pounds, which is only a couple of percentage points, can actually make big changes on the inflammatory properties of the liver.

So set a goal of a certain amount of weight loss. But if you've had some success with 5 or 10 pounds, definitely talk to your doctor about if it's time to look.

Scot: I hear Troy's voice in my head right now, Brett. So I'm going to share some additional thoughts here. And I'd like to get both Troy and Dr. Pohl's thoughts on this.

So it doesn't have to be all at once. Don't expect you're going to change overnight what you eat, or you're going to go from one person to another. It doesn't have to be radical changes. You don't have to all of a sudden go to eating chicken breasts and a plateful of vegetables. The nutrition can still be good. Just start making some minor changes.

Is there one thing that you could do in the first week? Maybe that's to eliminate one soda, or maybe that's to eat an extra serving of vegetables. Give yourself a little bit of time, I think, to go through this process.

I think a lot of times we think, "Oh, I've got to eat healthy now." And then that comes with a lot of baggage of what it is you're going to eat, and sometimes then you get miserable and it's not sustainable.

Troy always says just make those little, small changes one at a time.

Troy: Yeah, that's the key too. I think you have to give yourself credit for what you're doing as well. You're exercising a lot. I think that's great. You're doing more exercise, far more, than the average person does. So you really need to give yourself credit there.

Dr. Pohl has given some great advice just in terms of maybe dropping some sugars here and there. I'm sure you'll start to see that weight loss. Again, one pound a week sounds like that's the goal. And as you see that, again, give yourself credit for it. Say, "Hey, I'm making progress. This is where I need to go." It's not a dramatic change. It's going to be something over several weeks and months.

Scot: And that weight fluctuates from week to week, right? So if all of a sudden you gain a pound, don't worry about that. Sometimes it's just the time of day you've weighed yourself on that scale. Dr. Pohl, a half-pound would be fine, right? This is a long-term game right now. He's got time.

Dr. Pohl: Oh, yeah. In fact, if there's no weight loss, but you're making those dietary changes . . . Like I said, if you're exercising and making dietary changes and you're weight-neutral, that's fine. But I just don't want you to go for dramatic weight loss because that can be harmful as well.

Brett: Well, thank you so much. I really appreciate you doing this and for giving me all the congratulations for actually caring about my health. I'll take all the praise I can get, and hopefully I don't die from this soon. No, just kidding. This was very reassuring. Thank you.

Scot: Brett, thank you very much. Appreciate having you on the show. Hope you have a great rest of your day.

Brett: Thank you.

Scot: Awesome. Dr. Pohl, thank you as always. I appreciate your time.

Dr. Pohl: Thank you for inviting me. It's so much fun to talk about health and helping people become more healthy and reach their fitness goals and their health goals.

Scot: Hey, it's me, Scot. You made it to the end. Good for you. That must make you a super fan. Just wanted to throw this out there. If you found this podcast helpful, or if you've enjoyed "Who Cares About Men's Health" episodes, and you know somebody else that could get benefit out of it, please let them know. That's the way we can grow the show.

We'd also love to hear from you at any time. Listener Brett reached out to us so we could answer his question. You can email us at hello@thescoperadio.com. You can also go to our Facebook page. It's facebook.com/whocaresmenshealth. And you can also call and leave a message on our listener line at 601-55SCOPE.

Would love to hear from you. Love it if you'd recommend the show to somebody. Thanks for listening, and thanks for caring about men's health.

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Interviewer: Your fat tends to get a bad rap but there is good fat, it's called brown fat and not only does it help you stay thin it has amazing healing powers that you might not know about. Dr. A Patel, director of clinical regenerative medicine at the University of Utah, Tell me about brown fat and how fantastic it is.

Dr. Patel: It's a great question, everyone thinks fat is fat, and really there's two types of fat, there's white fat and there's brown fat. White fat is the big cells that make you gain weight give you heart disease, diabetes, metabolic syndrome, all these bad things. But if you think of little kids, they can eat thousands of calories and until they start getting older they don't lose that, everyone thinks their metabolism is slowing down but what it is, is they're losing their brown fat. When you're really young you have what's called brown fat and brown fat is very unique, it's very metabolically active so that's a fancy term that means it has a lot of horsepower in it,. It's having a little car with basically a big v8 engine, where white fat is a really big car with basically a 2 cylinder engine.

Interviewer: Yeah, it takes up a lot of space but moves real slowly.

Dr. Patel: And that's how most people feel when they get to fat, so what we've done is we've been able to identified a brown fat stem cell in actual patients. And everyone believes it's in kids but we found actually that you could find this even in patients who are 80 years old. The problem is as you get older you get fewer and fewer cells, these cells start dying off. So our goal was how do we one; identify these cells because then we can say can we look at this brown fat stem cell as a potential target for new drugs or new therapies where we can take grown ups who actually have diabetes, metabolic syndrome, all these bad things that can make you die from heart disease and look at a drug that could actually make you increase your own brown fat stem cells or can we grow these brown fat stem cells outside your own body and put them back into you and use them as a target for the diabetes, the weight gain.

Interviewer: So just to be clear, up until just recently it was believed that brown fat existed really in adult humans

Dr. Patel: Yeah, and that surprising, it's one of things that just because no one was able to identify it no one believed that you could actually find it or did it exist. This is incredible because this is something where obesity is an epidemic in the U.S. and there are millions of drugs, medications, fad diets and everything there but there's so little science to support it. This is where science is finally starting to catch up in saying what are we missing? Or what was there when we were younger; or what do bears have that lets them hibernate, and that's brown fat, that's what they have too? So, how do we harness the power of brown fat and not just say well we need more of it but how do we actually develop this in a safe reproducible manner that potentially may actually become not only a cell therapy but also a drug therapy to increase your body's own ability to produce more brown fat as you get older.

Interviewer: What's the biggest challenge that you're facing? You said this is in very early stages.

Dr. Patel: The biggest challenge with brown fat stem cell is that there's so few of them so how do you safely grow them in a large enough, make billions of these so we can study them better and actually make them potentially available for therapy because the goal would be you'd need trillions of cells to start looking at how could you use this as a therapeutic model or basically how would you treat patients with this. So growing them we've been able to identify them now how do you scale up to do the experiments to say does this really work in patients

Interviewer: So children have a lot of brown fat, as you grow older it decreases so your body is getting rid of it for some reason apparently.
Dr. Patel: Well one of the reasons the brown fat originally is what's called a thermal regulator, basically regulates heat, so when you have a shiver response when your young and you don't have a lot of fat, it generates heat. That's even in small animals and things like that. That's what brown fat is used for is to generate heat, regulate body temperature, and as you get older because you get more white fat you basically form your own insulation and you don't need , so it's a natural way of the body to say well if i don't need this cell I'm going to start getting rid of it. the problem is when your own body starts decreasing the amount of brown fat it's thinking I don't need it to produce heat, but we lose the ability to regulate a lot of other things such as fat, sugars, and all that so it's sort of a bad side effect of getting the white fat on board. So the more insulation you have the less metabolically functional or the less efficient you are. You become energy inefficient by having too much insulation.

Interviewer: So if I was to stay very lean and thin and keep the white fat off, would I be more likely to have more brown fat then?

Dr. Patel: You would be, the thinner you are the potential to more brown fat as you get older is much higher.

Interviewer: What's your final thought on this?

Dr. Patel: So brown fat has huge potential both for therapy, for diabetes but also just studying how the body works so we can find better ways to safely develop therapies to treat obesity, type II diabetes, and heart disease which is the number one killer of patients in the U.S.

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