How to Reduce Visceral Fat, Insulin Resistance - Dr. Sean O'Mara

Food cravings are multifactorial and may be triggered by sensory cues (smell, sound) reminiscent of childhood foods, and people's mindset about dietary change (viewing it as deprivation vs. empowerment) influences whether sensory triggers activate actual consumption or are resisted.

“we have five senses and some maybe sometimes the smell or the sound like some sound some song reminds you of like a treat you used to eat while you were young or the smell of cert some something reminds you of your childhood days where you used to eat these foods and if people believe that they're giving up these foods rather than i'm empowering myself and eating more meats and i choose to eat that way then that trigger that cue can then become a well i feel sad for myself maybe i should eat that because that reminds me of mom”

Carbohydrate elimination can cause 'keto flu' symptoms, but these are generally benign and temporary, though some people have negative experiences and quit prematurely

“you want to go ahead and do that now unlike uh unlike exercise you can go head first and cut out you know processed carbs i think you still have to be uh cautious about you know carbohydrate elimination and uh the fact that you're dependent on carbs and you get some of this flu but you know keto flu and some of the kind of symptoms that you can find that are associated with people studying cards are fairly benign and people can get through it except for the ones who go through it and have a bad experience and give up”

A 68-year-old executive eliminated processed carbohydrates and developed a six-pack abdomen while losing significant visceral fat over 35 weeks without exercising even one minute

“this gentleman has and also the deposition of fat within the oblique muscles so these dark structures on the side of the muscles... in two weeks what's interesting at least to me that in the untrained eye so people who are watching this right now can see themselves that the visceral fat has been diminished... and then we go a little further down 15 weeks 25 weeks and now at week 35 you can see he's diminished his visceral fat significantly... he actually developed a judy a six-pack and what center's team is that he developed this six-pack and lost all this visceral fat from just doing the one thing cutting out processed carbs and he did not exercise one minute”

An Israeli study found that specific microbiome species protected certain individuals from blood sugar spikes after consuming chocolate brownies with icing, suggesting microbiota composition determines carbohydrate tolerance

“there's an interesting study out of israel that gave people chocolate brownies with icing and they tested people for their blood sugars and not surprisingly most people's blood sugars went up and one in some cases individuals blood sugars did not go up they did not have a glucogenic blood sugar response or response in their their insulin um that could be measured and so what they found was they decided it was a microbiome study they looked at they sequenced the gut microbiome and they found common to those individuals that didn't raise their blood sugar certain specific microbes”

Processed carbohydrates cause rapid visceral fat deposition, with some patients accumulating measurable visceral fat in just over a weekend of consuming processed carbs

“we were able to see in some cases just in just over a weekend uh the deposition of visceral fat from processed carbs”

Distance running (marathoning) accumulates fat around the heart (pericardial fat) and in the abdomen (visceral fat) despite the runner's lean appearance, with a 34-year-old marathoner running 8-10 marathons annually showing significant visceral and pericardial fat

“all this red is visceral fat and he had very little subcutaneous fat around this is a marathoner who was running eight to ten marathons uh a year so you can see he's had a fair amount of visceral visceral fat in there but what was also significant is how much uh subcu pericardial fat he had so this is the right lung and the left lung here and the middle is the heart and we can quantify that fat a large chunk of fat around his heart so he was a young marathoner 34 years old and had a significant amount of visceral fat”

Exercise generates reactive oxygen species (ROS) molecules that cause oxidative damage; there is an optimal "sweet spot" for exercise quantity, and excessive exercise creates more oxidative damage than benefit

“when you exercise you generate a reactive oxygen species or oss and these ros molecules go through the body and they cause hap they wreak havoc so there is a sweep spot for exercise nobody really knows exactly what that is but when you exercise too much and now we you know more and more we're finding that you can't exercise too much there is you know the capacity for humans to over exercise you stress your body and all this oxidative damage comes as a result of that”

Cardiologist Dr. James O'Keefe has published videos, YouTube content, and TED talks warning about the harm of durational (distance) exercise, particularly distance running, based on cardiovascular pathology he has observed

“somebody else is a doctor uh o'keefe i think his first name is james o'keefe who's a cardiologist and he was recently on with dr peter attia peter ortiz the drive and uh dr keith has done youtube videos and uh ted talks and so he's a cardiologist who's warning about durational exercise particularly distance running and the harm that he's seen in hearts”

O'Mara emphasizes that diet must be the priority before exercise for health optimization; attempting to exercise away weight and health problems while still eating processed foods is ineffective—analogous to 'shoveling sand against the tide'—because diet is the primary lever for health change.

“that the priority is eating healthy and not exercise and that they're diluting themselves into thinking that by just exercising they're really going to solve the problem i i tell them it's like shoveling sand against the tide if you think that you're going to eliminate those health concerns just by exercising”

Sarcopenia (muscle loss) is accompanied by osteoporosis due to bone resorption from the inside out, creating fragile bones prone to femur fractures with approximately 90% mortality within one year in elderly patients

“as uh this is osteoporosis so as the bone gets resorbed and you start losing your bone becomes thin the it thins from the inside out so the middle of the bone gets thin and it's replaced with bone marrow until it's so thin and brittle that you get a female fracture and then 90 percent mortality from a femur fracture after the age of i think 85 within one year”

Alcohol consumption is a primary driver of persistent or accumulating visceral fat even in people following low-carbohydrate diets and good sleeping habits

“people that have persistent high visceral fat or accumulating visceral fat even in the absence of eating processed uh carbs oftentimes it's from alcohol so i'll ask them if they're they're consuming alcohol and usually it's a you know a serious um alcohol user and they simply need to cut it out”

Meat sources should be examined; grass-fed meat and wild game are healthier than grain-fed CAFO (confined animal feeding operation) meat because of the source animal's diet

“if you're eating an animal you want to be eating an animal that ate healthy food so you gotta get an animal that ate a species-specific diet that's why i like wild game feed because they typically you know eat a healthy diet unless they get into a farmer's field and start eating a bunch of corn uh oftentimes wild game is is really healthy”

Fat infiltrates develop within muscle tissue (visible on MRI as marbling) and correspond to visceral fat levels, representing intramuscular lipid deposition that impairs muscle function

“fat that invades your muscle tissue sort of like what you might go to a butcher shop and you see marbling in steak that's really unhealthy fat and that corresponds to visceral fat we see it in humans”

Sugar cravings are not primarily due to addiction but rather due to infection with obesogenic microbes that are dependent on simple carbohydrates as an essential nutrient; these microbes signal the host to seek the foods they require, and eliminating these microbes by changing diet breaks the craving cycle.

“here's here's what i think happens with people that continue to do it there's this fun is for for sugar and and uh you know some people say it's addiction some some studies show its addiction some studies challenge that it's really not addiction here's what i think is going on that we don't have good analysis of good radar i think it's the microbiome...they are infected they are infected with the species of microbes that are completely dependent upon that particular food that this person continues to crave and keeps eating and so that particular species or species of microbes have simple carbohydrates as an essential macronutrient for their survival”

Processing food by grinding or exposing it to air increases surface area and inflammatory capacity, causing higher blood sugar spikes and greater insulin response compared to whole food

“processing is just so ubiquitous even cauliflower rice you know taking cauliflower and grinding it up you know causes it to to raise your blood sugars yeah faster and higher than if you eat cauliflower and whole form so you know processing is is something as as easy as just grinding something up and it's exposed to air as a consequence and so it it just it has a higher capacity for being more inflammatory and to spike your blood sugars higher and have a higher insulinogenic response higher levels of insulin”

Sprinting eliminates visceral fat more effectively than distance running (jogging), making it superior for visceral fat reduction

“springing sprinting really gets rid of visceral fat uh as a a better form of exercise than jogging”

US life expectancy has dropped for three consecutive years, and this decline began 1-2 years before COVID-19, indicating it is driven by disease burden rather than pandemic effects alone

“our life expectancy continues to drop for the first time i think for the past three years it's dropped and it's not just coveted it really dropped uh one or two years before kovitz showed up and it's because of our level of disease just how unhealthy we are”

Constantly doing high-intensity exercise (like CrossFit) seven days a week is not ideal for optimal health because human bodies are not wired for consistent high-intensity training

“it's not ideal to do that type of exercise as well in the book and it's has ramifications for optimal health so i completely agree with you super interesting”

Marathoners tend to have more health issues compared to non-runners, and their immune systems become taxed through marathon training, often resulting in illness immediately after races

“marathoners tend to have more health issues i know that i think in the book i mentioned that their immune system gets really taxed through the whole marathon process and so right after oftentimes they get sick”

High-intensity exercise should be very brief (5-10 minutes per session, once every 3 days on average), not frequent or long-duration, and intense enough to barely breathe and feel near-death, to optimize visceral fat reduction with minimal time investment.

“between these photographs my exercise was averaged about um five to ten minutes once every three days i barely exercised and uh to this day i hardly exercised very long it's very high intensity exercise so if you want to save time you know uh do high intensity exercise don't do a lot of durational exercise”

Jim Fixx, an early marathoner in the 1970s, suddenly died from a heart attack, providing historical evidence of cardiovascular harm from marathon running

“we've all had experiences where we've heard about people that are you know marathoners that suddenly dropped out of a heart attack jim fix was one of the first back in the 70s when uh where marathon running was just at its infancy”

The follow-up phase of the Israeli microbiome study attempting to transfer protective microbes to glucose-sensitive individuals has not worked, likely because these microbes are too delicate to survive outside the live gut environment

“from this study i have heard it's not working and the reason is these microbes are so delicate right that it they cannot get this to to work it's only in vivo that these microbes to live within the gut so nature is best it doesn't look like we're going to anytime soon get a probiotic of made of those particular microbes that's going to provide a protective benefit from glucose”

Sagittal abdominal diameter (measured while lying flat using a ruler or caliper) is a 'poor man's MRI' that can reliably infer visceral fat levels without expensive imaging

“i like to tell people judy that's a poor man's mri i mean you can infer visceral fat from doing that measurement so an example of how that measurement can be done is if you lay down on a flat surface and you take yardsticks some cases you have to do yardsticks some cases you can just use a ruler but you and you do flat across on the abdomen you can track what that diameter of the abdomen is laying down”

A 58-year-old client who ate healthy whole foods, didn't drink alcohol, wasn't stressed, and slept well but ran 50 miles per week (10 miles on 5 days) was unable to reduce visceral fat until he replaced distance running with sprinting, demonstrating that distance running actively prevents visceral fat loss.

“he was running more than i was actually he was running 10 miles a day or five days a week so 50 miles of running and that's a good healthy amount about distance running on a weekly basis so we finally persuaded him look you're in a study for the national science foundation and and we really need you to stop running because it's part of the protocol that we look at high intensity the the impact of high intensity exercise when a low low carbohydrate diet and so he agreed to so he stopped running here and then in two months it was even less than two months he came back and what he did was sprinted between here and here he stopped running and he only sprinted”

MRI visualization of visceral fat creates profound psychological motivation for change in ways that numerical lab values cannot, with patients often becoming emotionally activated upon seeing their scans

“it's extraordinary the motivation that comes from a visceral fat scan so when you look at it in cross-section and and that's the reason why dexa scan i think is basically almost a waste of money because the dexa scan doesn't really allow you to visualize your visceral fat it gives you a number so it's just like a lab study but when you can see the amount of visceral fat that you have in you it it engages your your cerebral cortex your brain in such a profound way that it helps you to overcome you know the the resistance to change”

White rice and processed potatoes are problematic carbohydrates that spike blood sugar, while wild rice is also problematic despite its reputation, making all processed grains and starch-based carbs suboptimal for metabolic health

“rice is processed because oftentimes they remove the skin the outer surface of rice to make it white and even wild rice is still problematic and and still bumps blood sugar so i i basically especially the whites potatoes and things like that and rice um i tell i tell them to cut it out”

O'Mara's body composition change was achieved primarily through diet and minimal high-intensity exercise (5-10 minutes once every three days), not through intensive strength training

“between these photographs my exercise was averaged about um five to ten minutes once every three days i barely exercised and uh to this day i hardly exercised very long it's very high intensity exercise”

The carnivore diet produces measurable improvements in voice quality in older clients, as reduced fatty infiltrates in laryngeal tissues and tongue improve speech enunciation and articulation

“i have a client that i've got carnivore and he's older and his voice is changing you know it's very interesting that you know that the fatty infantries i went through with your your with you earlier about those fatty infantries and muscles those invade the the voice you know the laryngeal tissues in the tongue so you you probably have all had experience for to talk to somebody that gets heavy and that as they get heavy over a period of time they get more heavy and pretty soon you know my name is chilly you know they just get this thick and tongue from the deposition of fat”

Obesogenic microbes can be reacquired through environmental exposure (touching contaminated surfaces) even after dietary change has eliminated them; continuous consumption of probiotic fermented foods is necessary to maintain a healthy microbiome and prevent yo-yo weight gain.

“they have to continue it's been my experience they have to continue to eat this otherwise they're going to yo-yo so if they people lots of people lose weight they change their microbiome and then one day they shop at walmart or target or they go to the airport and they touch a door they touch their face those obesogenic microbes from somebody else go back into their gut and then they get those cravings again so you got to keep eating good probiotic food”

O'Mara takes photographs of his face and his clients' faces to track changes in inflammation, noting that facial changes are visible after visceral fat reduction due to reduced inflammatory cytokines

“i take a lot of pictures um i have clients take pictures of their faces because this is an interesting phenomenon that people should be aware of it's a modality that you know besides tracking visceral fat on an mri scan or a ct what i notice after doing 5000 mris is i pay attention these people's faces and they come back and their faces were changed right”

O'Mara felt fraudulent and professionally dissonant upon realizing that dietary change had solved his health crises, prompting him to become a researcher to understand the mechanisms

“i felt like a fraud i felt like such a fake individual you know thinking myself as a professional with a doctoral degree and yet not one minute had i spent in my medical training or my medical career advocating what had the single most dramatic impact on my health in my lifetime just cutting out processed foods and basically eating clean so i was so dismayed over this experience that i decided that i had to become a researcher”

O'Mara and Judy discuss the importance of not teaching children that sweet foods and cake are celebrations, instead modeling healthy food choices and positive associations

“if anybody's listening today and you're pregnant and you're going to have a baby or you have a very young baby and you're thinking about your hopefully you're breastfeeding um but you're thinking about starting solid foods when that baby becomes one years old most people put this you know cupcake in front of her slice a cake with colorful icing and candles clap and sing and you know create this you know very positive experience don't do that”

Continuous glucose monitors (CGMs) are useful tools for patients to see how specific foods affect their blood sugar, helping them make dietary decisions

“if for those that you know are currently listening you can get a cgm and you can talk to your doctor about prescribing you one i prescribe them for my clients and that will give them helpful insights about processed foods”

Insurance companies deliberately avoid promoting visceral fat awareness because eliminating chronic disease would dramatically reduce healthcare spending and insurance company revenue

“insurance companies are not at all interested in imaging visceral fat in fact they don't want uh at the highest levels it won't won't be discussed with low levels but at the highest levels they're not going to do anything that promotes awareness of visceral fat because all so we every form of chronic disease we ever saw in 5 000 people went away or got better when visceral fat was eliminated do you know how much money we're talking to the healthcare industry the largest part of our economy right if we were able to eliminate chronic disease”

Keeping elderly people healthy and young-appearing extends their ability to influence and be relevant to their grandchildren, motivating elderly health optimization for relational reasons

“if you're an older person and you've got grand kids or you're about to have grandkids you want to stay relevant in their lives you want to do that you want to be healthy so get yourself healthy make these lifestyle choices you'll have a younger sounding voice for a much longer period of time you'll have a more or more favorable appearance so that you can speak into their lives and be a better influencer to them”

If someone has had an abdominal CT scan previously, they can request the imaging and report to review their own visceral fat levels, as visceral fat is visible on CT (appearing as black fat in the abdomen)

“so here's so in this scan you know for your viewers and i really this is so exciting i really want them to go back and and see if they've ever had donald ct because you can see at least at that point in time in your life what your visceral fat was at at that time so on a ct abdominal ct visceral fat shows up as black so all this black judy is visceral fat”

Getting health and lifestyle advice from physicians who appear unhealthy or perform poorly is counterproductive; credibility on health matters should come from people who demonstrably look and perform well, as their appearance and performance are the results of their own practices.

“you know i remember taking my kid to an orthopedic surgeon this listening the guy make noises trying to get out of the out of his chair i'm like god he can't even get out of a chair right and i'm supposed to be listening to him about health advice...so yeah we you know pay attention to you know people that look good and perform well get health advice lifestyle advice uh from then if i need surgery yeah uh you know because i'm getting a car wreck or something”

Dr. O'Mara personally experienced complete elimination of food cravings for sweets, ice cream, pasta, and bread after changing to a meat-based diet, transforming from a child conditioned by learning fudge-making (at age 6) into an adult with zero cravings for processed foods.

“i was one of those people i learned to make fudge my mom taught me to make fudge when i was six years old with the candy thermometer i mean what a wicked thing to do to a kid it's amazing to have teeth i do i haven't lost any of my teeth um except for wisdom teeth but that that had such a powerful influence on me i became addicted to sweet things and ice cream and pasta and bread and now i have no cravings i have zero cravings”

People attempting carbohydrate elimination need community support and involvement with others doing the same to avoid discouragement and premature quit, as the stakes for health optimization are high

“i like to throw some caution on people make sure they they get support from other people get involved in other communities that that are doing that to help them uh derive support because uh yeah there's so much at stake with health optimization you know getting yourself healthy that we don't want to lose um through a discouraging experience somebody who would otherwise become healthy and they just give up because oftentimes when they give up they try a little bit they end up being way worse than if they've never tried it's really a sad sad situation”

Distance runners sometimes show passionate resistance to the idea that they should sprint instead, similar to how vegans resist arguments about eating meat, suggesting group identity can interfere with openness to evidence

“what it seems to be is that when you exercise you generate a reactive oxygen species or oss and these ros molecules go through the body and they cause hap they wreak havoc so there is a sweep spot for exercise nobody really knows exactly what that is but when you exercise too much and now we you know more and more we're finding that you can't exercise too much there is you know the capacity for humans to over exercise you stress your body and all this oxidative damage comes as a result of that and when you sprint you don't generate as much roses because it's a shorter duration so the exact mechanism for this to happen has not been uh well established by studies so i just issued that as a caveat that we don't really know but it's it's probably related to roses and then somebody else is a doctor uh o'keefe i think his first name is james o'keefe who's a cardiologist”

Older people are biologically programmed to dismiss unhealthy-appearing elderly people as irrelevant and not worth listening to, creating a generational discontinuity in wisdom transfer

“when i was younger we revered the elderly but when i was a young man the elderly was were way healthier than they are today so biologically the younger people today it's not their fault they don't pay attention the elderly because it's biology the the elderly sulfide disease their brains at a very primitive level are wired to say this older person is not relevant and doesn't have that much to offer me because they look so bad in disease”

Judy Cho's mother adopted a carnivore diet at age 64-65 and has reversed aging, now appearing to be in her 50s at age 70, and has maintained her weight while her friends gained weight during COVID through stress eating of processed carbohydrates, demonstrating the transformative effects of dietary change in older individuals.

“it's true my mother she went carnivore at like 65 i think maybe 64. and she is reversing in age now she looks younger and younger and when she dyes her hair people think she's in her 50s and now she's 70. and oh that's great yes and it's incredible because she looks really young and through covid while all her friends you know were stressed out and eating a lot of carbohydrates and processed foods at home she just maintained her weight”

Health is best defined by how one appears and how one performs physically; this definition captures the integration of visceral fat reduction, muscle development, and physiological optimization

“my definition of health is how you appear and how you perform is are the best is the best definition i have come up with as a health optimizing physician”

Not all members of the carnivore community agree on organ consumption; some people do well limiting organs (primarily skeletal muscle), while others benefit from organ meat

“i challenge because i have clients that i work with one-on-one where eating more liver was not an ideal thing and so i think for every single person the answer to what exactly works for their diet will differ and we should be open because that's how we'll progress in science and finding avenues and ways for people to heal”

O'Mara wants to develop an AI/machine learning model using facial photography to predict optimal personalized health interventions, as human pattern recognition suggests this is possible at scale

“if anybody from google or amazon is listening what i want to do is use a an artificial intelligence machine learning model to study the facial changes in humans if a dumb human like myself can pick up these changes we can teach a machine a computer to pick up these changes and large quantities of people map it to data on diet and lifestyle and you know go through structured data on on websites facebook and where people put their diets out there and we can start educating the machine on this and one day you're going to open up your cell phone and it's going to do biometrics and tell you yes you can open this because you're who you are but it's also going to say today judy you need to sprint this long you need to eat this you need to fast this amount of hours”

O'Mara personally experienced a three-minute fight for his life as a police officer, describing it as unlike anything else in his life and noting that ancestors experienced such intense struggles for 4 million years

“i can't recommend to people to go out and get in a bar fight but you can exercise very intensely kind of emulating what a fight might like be like and it's it's really high highly intense in a very short period of time and uh you know mma fighters and boxers kind of know this but you know i i was a former police officer and i once had a fight for my life for the bad guy that i i really thought i was dying i was gonna die and it was only about three minutes but that was unlike anything in my life those three minutes and i've realized that we just don't exercise like that but that judy was the life of our ancestors for four million years those kind of struggles”

Historically, human parents avoided the 'taste pleasure' training of children that modern parents do, suggesting that childhood food preference formation has changed due to cultural shifts rather than biological inevitability

“i think that can be avoided a lot by parents they're just simply educated and i think that's how we raised our kids in the past slowly but surely we went off on the defensivity on a lot of stuff and that's why i think we're in the state that we're in today”

Dr. Andrew Caffey (and possibly another Caffey) on Instagram notes that Inuit peoples who follow an all-meat diet do not consume organs, instead eating only skeletal muscle and discarding organs to their animals

“i just the other day i was listening to dr uh chaffey and uh chaffey and andrew caffey and d um he's on instagram and he was giving a talk about you know this very point you know consuming too many uh animal organs he just eats really skeletal muscle and and meat and and doesn't need uh organs quite a few people in the carnivore community uh eat a lot of organs but dr chaffey made this interesting point about the anyway because they live basically an all meat diet and they don't there's no plants up there for them to eat um but they apparently do not eat any organs they just eat they just eat the the the muscle and they throw the organs to their huskies”

O'Mara and Dr. Zhang's research strategy examined wild animals (species with absence of chronic disease) to understand their diet, exercise, and living patterns as a model for human health

“when we set out we decided we would look at where there was an absence of chronic disease among species and that's in animals in the wild and we we asked ourselves what did they eat and how did they exercise how did they live to try to figure out interventions to reverse chronic disease”

At age 48, O'Mara was mildly obese, pre-diabetic, had clogged arteries, restless leg syndrome, a large prostate, obstructive sleep apnea, eczema, and Barrett's esophagus (requiring 3-month monitoring)

“about 10 years ago was a pretty unhealthy middle-aged 48 year old physician you know i would say mildly obese pre-diabetic clogged arteries restless leg syndrome and large prostate waking up four to five times a night to to pee i had obstructive sleep apnea eczema and barrett's esophagus which is for those who aren't familiar it's a very severe form of gastroesophageal reflux disease so it's having to be scoped every three months to follow my pre-cancerous lesions”