 Welcome to the Dr. Gundry podcast. Belly fat is something many Americans have struggled with at one point or another, but carrying that extra weight around your midsection is doing so much more than standing in the way of you and your health goals. It's seriously harmful. In fact, my guests today say that excessive belly fat is one of the leading causes of cardiovascular and metabolic disease and that many of us are at risk no matter how thin we might look. After a quick break, we'll hear from Dr. Paul Hahn and Hank Kim, the CEO and CSO of Bello, the world's first portable belly fat scanner. Bello is scientifically designed to directly measure lipids under the skin and provide an accurate measure of belly fat in a matter of seconds. It's been globally recognized for excellence in innovation and quality and has won the CES 2020 Innovation Awards Honoree and the IF 2020 Design Award. And in just a minute, we're going to talk all about it. We will reveal why so many of us struggle with belly fat, what it may indicate about our health and why simply stepping on the scale is not enough. We'll also share how the Bello device could help you decode your belly fat and better manage your health. Many of the listeners may not know this, but there are actually multiple types of belly fat. Can you explain the difference between visceral and subcutaneous fat is one more concerning the other and why would that be? Subcutaneous fat is located right under the skin. It regulates the body temperature and protects the body from external shocks. Think of a distended belly fat protrude above the one's bell trine. The kind people often thinks about when they call someone fat or obese. On the other hand, visceral fat refers to a fat attached to the organs of the human body, not the skin. Generally, it refers to fat that adheres to the bodily organs, such as the liver, large intestine and small intestine. It may not always be obvious that someone has an issue with visceral fat because it may not always show the way subcutaneous fat does. In the United States, we have this expression of having love handles. Those are the fat that sometimes just protrudes above your belt, but that's not visceral fat. That's what you're saying. I think one of the striking things, before I was a heart surgeon and I was a general surgeon, so I was in the belly quite a bit and you're right, there's a tremendous amount of fat that occurs inside of our belly that really has nothing to do with what's sitting on the outside. I've actually written about the fact that this visceral fat is also on the arteries of the heart and interestingly enough, the more fat that's on the outside of the heart, the more likely that somebody is going to develop heart disease. This is also visceral fat. I think knowing the difference between subcutaneous fat or maybe love handles and what's really inside I think is actually really important. How does the weight visceral fat accumulate in the first place? Can you share what the underlying mechanisms are? I've written about this, but I want to hear your take as well. Before we go further, I would like to explain a little more about the why this fat is more dangerous. Yes, basically the subcutaneous fat and visceral fat neither are great. However, while subcutaneous fat acts as an energy source located under the skin, visceral fat does not stay in one place. This is the fat that travels throughout the body in once a bloodstream. So as it moves, it accumulates in various bodily organs such as the liver and heart and so on. In addition, excess visceral fat is particularly dangerous because it relays as chemicals that cause various cardiovascular diseases and even cancer. To summarize all of this, the subcutaneous fat is the cause of externally messing up your body or damaging your external aesthetics, and visceral fat is the cause of internally messing up your health. If I explain more about this, there are many reasons why the midsection is more the bigger and fatter and accumulated more fast. However, one major reason is because our weight is very closely related to our eating habit. The main cause of this is excessive calorie intake. For example, excessive intake of carbs turns into fat, especially as people get older, since the enzyme that synthesizes fat is activated in the abdomen rather than the limbs. More fat accumulates in the abdomen than in any other part of the body, and hormonal changes are also an important factor in midsection weight gain. This is especially so in the case of a woman because they experience a rapid decrease in female hormones as they reach middle to late ages. These hormonal changes interfere with the breakdown of fat and creating an environment in which visceral fat is accumulated more easily. Alcohol also contributes to this. It does not cause accumulation of fat, but it is very high in calories and does not make you feel full, so leading to overeating. Therefore, it is recommended to avoid excessive snagging while drinking. A lack of exercise is also one of the main causes of weight gain. If you do an exercise, you will gradually lose muscle and your body will begin to easily accumulate fat. But other than these reasons, the body naturally accumulates a lot of fat in the abdomen. There are tens of thousands of reasons why the abdomen is vulnerable to fat accumulation. In the United States, liposuction is very popular for aesthetics, but a lot of people don't realize that liposuction is just getting rid of subcutaneous fat. It's not actually getting rid of visceral fat, is that right? When people go and have liposuction and they see their fat disappear, I've actually had a lot of patients come back and tell me that they had all their fat removed so they don't have any fat anymore. But liposuction doesn't remove visceral fat. That's a misnomer. I could remove visceral fat and take it out of your abdomen, but I don't recommend it as a surgical procedure. So, I think your point is well taken. People can have an aesthetically pleasing result with liposuction, but be unaware that there's actually a silent killer still inside their belly. Is that a good way of saying that? Yes, right. And I like your point. Many people are, I think, aware of what we call a beer belly, and that's actually visceral fat that's accumulating from excessive carbohydrate and alcohol intake. So, it's a real thing, correct? Okay. You know what? In general, if the lower abdomen is convex or there is a lot of fat in thighs or buttocks, you know, it can be considered as a circuitaneous fat type. And of course, this is difficult to get rid of easily with just nutrition and exercise plan, especially in women. After childbirth or menopause, a lot of fat accumulates in the abdomen under the influence of hormones. These cases are more difficult to eliminate as they are deeply associated with circulatory disorders. In this case, you know, through aerobic exercise or core exercise, you might need to burn fat cells and promote blood circulation to create muscle to replace fat. On the other hand, you know, if the upper abdomen is convex, there are many cases of visceral fat again. This visceral fat is also not easy to remove. The best way to reduce it is to use that fat as an energy source through a proper exercise and diet. However, you know, there are people who have experienced the cases where their belly fat remains the same even after losing weight through good management. There also will be some people who have high body fat measurement despite their slim figure. This is usually called the lean obesity or skinny obesity. Even in this case, you know, visceral fat types become more prominent. In order to get rid of visceral fat, it is important to not only diet and exercise, but also combine various methods such as lowering your blood sugar and insulin through, for example, fasting for more than 12 hours and allowing your fat to be more efficiently broken down. Obviously, you know, according to the advice of your paramedic doctor. Yeah, I think that's a really important point. And I emphasize that in a lot of my books, like The Energy Paradox, that one of the best ways, particularly when diet and exercise don't necessarily address visceral fat, that intermittent fasting or time restricted eating really is where this really attacks the underlying problem. And you know, I think you're right. There is such a thing as, you know, a skinny obesity that is actually more common than people might know. And I think that's one of the things I really like about your device is that people think about, well, I get on the scale and my weight is normal, or I even I look at my body mass index, BMI, and my body mass index is normal. But then when we start with very almost invasive means looking at body fat and where it's located, many of these people are shocked that even though they're skinny, they're actually obese in their abdomen, in their visceral fat, where it shouldn't be. Now I think one of the exciting things is, as many of our listeners know, there are ways to measure visceral fat that frequently involve rather invasive procedures, whether they're x-rays or whether they're whole body immersion. I want to, the reason I'm excited about the Bella device is because you guys have figured out how to make this measurement, how to have people see what their visceral fat is in an easy handheld device. So let's talk about your device, Bella. It's intended to help users understand and support their metabolic health. So first of all, we use this term a lot, and I think most of my viewers and listeners understand the importance of metabolic health, but I'd like to hear it from you. How do you, what is metabolic health in your idea? You know, metabolism refers to the overall chemical reaction that coordinates every cell in the body to function properly, to store or produce energy. Metabolic function manages energy for basic life support activities and controls the production and consumption of energy that is necessary for various human activities. If your metabolism slows down, it can result in your body operating inefficiently and increases your chances of causing health problems in the long run. So what does that have to do with belly fat in particular? Is that just a good way of assessing overall metabolic health? There are many risk factors for developing metabolic syndrome. Some well-known factors include insulin and blood sugar. Abdominal obesity and visceral fat are known to cause high blood sugar by interfering with normal activity of insulin. As a result, uric acid may increase and lipid metabolism may suffer. These symptoms eventually lead to other complications and chronic disease. So abdominal fat is deeply linked to diseases such as diabetes, high blood pressure and cardiovascular disease. It can also cause problems with your blood vessels. Visceral fat travels throughout the body and accumulates along the walls of blood vessels. The accumulated fat pops out from these walls as the lump grows and turns into the blood clot, which as you know well causes heart attack or stroke. In short, visceral fat is a time bomb. You're absolutely right. In fact, years ago, I was actually going to write a book and I even drew the cover of a fat belly and there was a time bomb in there. And the book was going to be called Time Bomb. You couldn't have said it better. It literally is a time bomb. So everybody's going to go, well, wait a minute. Why can't I just hop on the scale every now and then? Doesn't my weight give a good indication of my health? As you know, it's true that weight is the easiest indicator of our health status. Of course, we need to control weight well. However, it's difficult to determine abdominal obesity, especially visceral fat, with just numbers on a scale. So there are people who have visceral fat despite their lean body type and there are others who have visceral fat and metabolic disease due to genetic factors or harmful habits such as drinking alcohol and smoking, even despite regular diet and exercise. And I mentioned before and you probably would agree with me. So even if I get my BMI checked and there's a lot of scales that check BMI or I can look at a chart and look at my BMI, why isn't that enough? What are the problems with just measuring body mass index? OK, BMI or body mass index is weight divided by height squared. It presumes that most overweight people are also fat while, you know, and while it's often true, there are many exceptions. Men and women with greater than average muscle mass will weigh more and have higher BMI, but maybe more well than others with lower BMI. And conversely, there may be individuals who weigh less than average but have lower than average muscle mass and are more fat without appearing to be obese. And nowadays it has become very common to measure body composition as well as weight using a smart BIA scales that measure body composition. But if I strictly speaking, you know, the measurement provided by these smart scales are not true measurement but predictions. The BIA technology measures the impedance of the torso, arms, and elects by sending a minute electrical signal through the body to estimate the amount of water contained in the body. So it is just the technology that predicts body composition by formulations based on the measured water content. It is a technology that continues to evolve but has some major gaps. So a chip among them is its technological limitations that measure only the moisture content. Since the amount of water in the body composition is taken as a muscle mass, people with a lot of water in their apidose tissue may be mistaken for having a lot of muscle mass. Thus, there can be big changes in their composition according to their hydration status such as diet, water intake, and urination. So the best way to overcome these limitations and to measure how much visceral fat is actually accumulated is through a radiographic method such as Cascan or DEXA. However, if you have to be exposed to radiation every single time you measure your belly fat, other problems may arise. Because of this, we use a near-infrared technology, in other words, a NERS technology instead of radiation to measure visceral fat. So since our NERS technology directly measures a total hemoglobin concentration, oxygen saturation in capillaries and water and lipid and the tissue of interest, it overcomes the limitation of VIA technology and analyzes body composition more accurately by minimizing other interference. So I can say that consistent quantitative measurement is the most optimal technique for standardizing health indicators. Yeah, I'd echo that. I have one of these impedance scales, and I actually have several of them, and I have them in my office. But you can fool these scales actually very easily. Many people retain about two pounds of water during the day, and since the conductance of electricity depends on saltwater transmission and fat as a good insulator, many of my patients are shocked when at the end of the day they may weigh more, but it says they've lost significant amount of body fat. And I use that as an example to show my patients that this technology can be fooled very easily. You're right, depending on your hydration status. So it's okay, but what I really wanted to have you on the program is that you've taken this to a much more accurate level. So let's talk about this near-infrared spectroscopy, NERS. How long has this technology been around? NERS technology has been used for several decades and used in various fields since the 1990s. In the meantime, optical devices such as light sources and detectors have developed it rapidly, and the method of implementing technologies and computational models have also made a variety of developments, and even now, you know, research is continuing in various fields, and it is a trend to apply the appropriate technology implementation method according to its measurement purpose and commercializing. So how has this system been used in the past? Where was it, its applications before Bella? Okay. It is used in various fields, but I will briefly talk about it only in the medical and healthcare field. Yeah, if you look at the research field, it is typically used in advancing brain hemodynamics research and functional imaging research of soft tissue cancer, such as breast cancer diagnosis. Of course, it is not limited there, too, and there are various research cases regarding this. In terms of commercialized product, there are multiple oximetry devices for measuring oxygen saturation, such as pulse oximeter and brain oximeter. In addition, sports-related wearable devices and imaging devices for functional neuroimaging or perfusion in extremity tissues are also being developed. So many people, when they use a device of any sort, they want to know, well, is it safe? If it sounds like you're going to beam beams through my belly, and what's that going to do? Okay, so you're asking about safeness, right? Right. It definitely is safe. In general, for accurate quantitative body composition measurement, radiation-based equipment, such as CAT scan or DEXA, must be used. However, an IR has a longer wavelength, which means it has a weaker energy than data-visible and newly ultraviolet wavelengths. So our devices use a very safe technology that raises no concerns about radiation exposure. In addition to safety, if I say, it is very simple to use and only takes a few seconds to scan by contacting the device with the scan. Yeah. One of the things I was impressed with your device, your technology, the accuracy, has been compared to the gold standard of DEXA and CAT scans. Can you tell me about what those studies found comparing bellow to the gold standards? Okay. Since the field of nurse technology is a field with so many different studies, it is difficult to mention all of them. So the evaluation of accuracy varies depending on the purpose of use. However, among many studies, it can be said that the study of the optical properties of absorption and scaring for objects applied to bellow, our product, has already achieved considerable results. Even research results on the accuracy of nurse technology have been reported quite frequently. And it can be said that the accuracy has already been proven through a measurement comparison with existing diagnostic documents such as CAT scan, DEXA and MRI. Even now, many related researches are in progress and our company is also conducting research for further development of the technology. So I think this area will become more sophisticated in the future. And bellow, our device is also a product that has been validated for its accuracy through clinical research. In addition, a coming product such as a next-gen bellow and the muscle-measuring device called FEDAL, which you are about to release, are also being developed through conducting clinical research correlating with CAT scan and DEXA in Korea and United States. In this study, our product shows around at least 92% and up to 97% of measurement accuracy depending on items compared to those reference equipment. Now I know you develop bellow to look for visceral fat and to have a quick and portable and rapid assessment of visceral fat. But do you see potential for this whole technology to be a way of early disease detection? For instance, how do you see this comparing to ultrasound MRI or to CT scans? Okay, doctors often rely on visible data such as endoscopy, x-rays, and MRI just to set to make a diagnosis. In the past, doctors depended heavily on experience and intuition, but now with the development of diagnostic devices, they have the technology to look into a patient's body without incision. It is true that possibility of early detection of a disease has dramatically increased, but there are cases in which the general public still misses the diagnosis or refuses to diagnosis due to their concern about radiation exposure. Compared to x-rays and ultrasound that see and interpret the structure or shape of tissues, this technology provides functional images to see and interpret physiological changes. So bellow measures the quantitative values of hemoglobin, fat, and water in the subcutaneous tissues by irradiating several near-empharet arrays based on the values that are analyzed by putting those data into a specific algorithm, and it finds out what changes are occurring in our body and predicts of which diseases or risk factors at high levels. So do you see this technology dominating the diagnostic market in the future? I mean, it sounds like it has tremendous potential. At this moment, it cannot be said that nurse technology will replace the existing diagnostic technology. However, it's now in the stage of conforming its scalability through clinical trials. The best example is the early detection of breast cancer. For example, when cancerous tissues formed in the breast, new blood vessels are created because sugar and oxygen are consumed, repeat drops, and hydrolytic enzymes increase. By measuring the quantitative values of these changes, a malignancy index can be calculated and compared with the patient's current physical conditions. Will you be initiating or are there clinical studies that are going to start using this for that purpose? Yes. We are conducting clinical studies in Korea. All right. So would you recommend bellow users share their data with their doctors? And I might add that the bellow device is available. It's fully approved. People can purchase the device. Would you recommend the bellow users share their data with their doctors? Or how do you best make sense of the data for themselves? Okay. You know, definitely I recommend it. We initially developed this product as a personal device, but we are working to expand it to business-to-business platforms, such as clinics and medical institutions. Doctors and other medical professionals have indicated the value of being able to monitor a patient, a metabolic risk factor, without having to conduct more invasive diagnostics but having a tool to measure and encourage patients to continue on their wellness journey. So the best way is to use this device is, you know, using consistently. So I think that the starting point to understanding your own data is by measuring your fat regularly every day or once every two, three days and tracking and managing how the major data moves. And you know, if you put this device on your desk or in a drawer, it is just a cool-looking gadget. However, if you use it on a daily basis and see how your condition is changing over time, it's like, you know, having a personal trainer in the palm of your hands. Yeah, I agree. It is a cool-looking device. And it is incredibly lightweight and ergonomic, and I was shocked personally with how easy it is to use and actually what a sophisticated device it is, despite looking small and user-friendly. So congratulations on that. Now, OK, so what if I'm a pretty healthy person? Is using a bella still beneficial? I don't want to say that a bella isn't necessary for everyone. If you are, if you are a paragon of health and fitness and you have all the tools to maintain that kind of status, you know, then perhaps you can do without bella. However, as we have discussed, you know, just because you look healthy, it does not always mean you are. So if you are someone who cares not only about aesthetics, but your overall metabolic health, and when a simple and reliable way to measure and improve it, you should check out bella. Just place bella on your belly and with the press of a button, then figure out what's happening in your body. Yeah, I don't suppose either one of you has a bella device handy to hold up to the camera. Yes, right here. Ah, there they are. Yeah, I mean, these are... It's just pump size. Yeah, they're very small, and like I say, the information that you get is sent to an app on your phone, and I think it's kind of fun. I've purposely tried to gain weight, and the bella detected it, and it detected it going into my visceral fat, and then I purposely lost that weight, and I can do that at will, and the bella tracked it very well. So it was not fooled despite me, I guess, trying to fool it. So, you know, it's a great device. Well, this has been great. So where can listeners learn more about bella and your work? Your listeners can find out more about bella and purchase the device on our website, but also from many other online shops, including Amazon, Walmart, CBS, Lifetime Fitness Marketplace in New Ag, and Brookstone, and more places. So bella has just returned with more powerful functions and enhanced services, which is a next-gen bella. We are currently crowdfunding on Indiegogo. In addition, a product called FEDO that can measure and grade the mass and quality of muscles by area of interest, which has already won the Innovation Award at CES 2020-22. We'll be at lunch next year. You can find out more about our new products by visiting our online store at shop.olivehc.com. Great, and we'll put that up for our viewers to see. Well, you know, congratulations on this technology. You've really, I think, brought another aspect to those of us who are interested in our personal fitness, our personal health, and it's really easy to use. I think it gives some important information that, you know, Heretofore was only available with a CAT scan or a DEXA scan. And you're right. Most people don't want to do that, nor should they, I think I should add. All right, well, both of you, thanks very much for coming on the podcast and we'll keep in touch and looking forward to the next innovation from you. It's a really exciting work. Okay, thanks for having us. All right, thank you. All right, it's time for our audience question. This week's question comes from Mohammed Bellatar, who says, thank you, sir, for all this good information. I have a question, please. What do you think about apple cider vinegar? Well, I think apple cider vinegar is actually wonderful and actually I think vinegars in general are some of the best health promoting tools that you should use, whether you use them as shots, whether you use them in salad dressings. In my upcoming book, Unlocking the Keto Code, you're going to see why vinegars are so important to get into your diet and get into your body and the reason why they work, I think, is going to really surprise you. So that's a great question. Please enjoy your apple cider vinegar. If any of you watched my interview with Orlando Bloom, we toasted each other with shots of apple cider vinegar. He's a big fan as well. Review of the Week, this week's review comes from Wanda McLaughlin, who says, you saved my life. I came across your plant paradox book three years ago. I have read it four times, as well as your longevity book. They are always out highlighted in color flags because I am constantly referring to them and I also have your cookbooks. Thank you, Dr. Gundry. You truly did save my life. Well, Wanda, thank you for writing about that. Again, this is why I do this. This is why I continue to see patients. This is why I continue to write. And this is why I do the Dr. Gundry podcast for people like you and all my viewers and listeners because I'm Dr. Gundry and I'm always looking out for you. We'll see you next week. Before you go, I just wanted to remind you that you can find the show on iTunes, Google Play, Stitcher, or wherever you get your podcasts because I'm Dr. Gundry and I'm always looking out for you.