The book Growing Better Not Older by Dr. Sean O’Mara caught my eye, given my interests on this blog. He is an M.D. who in his late 40s was himself sedentary and not very healthy. He found out about the importance of visceral fat, which is the fat packed around our organs, as opposed to subcutaneous fat (“under the skin”). Cosmetically we normally worry about subcutaneous, as in trying to lose your “love handles” or “beer belly”, but it is the visceral that has worse health consequences. Dr. O’Mara found that this is often routinely seen in MRI scans, but not often noted by physicians, because the scan is usually taken to diagnose something else. In his case is was for back issues. After finding out he had excess visceral fat and learning about the importance, he modified his own lifestyle, including getting active and cleaning up his diet. This led to a large decrease in visceral fat and becoming healthier. Dr. O’Mara was so excited about the results that he modified his own practice to focus on this, and has since helped many clients get healthier. He goes over a list of 10 lifestyle changes, with exercise and diet being prominent. For exercise he feels short intense sessions are more effective than long cardio sessions. For his own diet he cut out most overly processed foods, and went on a low-carb version of the Paleo diet. Since that worked so well for him it is what he recommends (or something similar). I’ll go into more detail whether that specific diet is necessary, but regardless I recommend Dr. O’Mara’s book, both for inspiration and the 10 useful lifestyle tips.
I wanted to find out more on the exercise and diet recommendations. Specifically for me, short intense exercise like HIIT is not recommended because of my leaky heart valve. So I wanted to find out what alternatives target visceral fat well. For diet, I wondered if low-carb was really a key factor or if just getting rid of processed foods would do the trick. This was a good candidate for deep research on Gemini AI so I asked the question “what is the latest evidence on diet and exercise to reduce visceral fat?”. The resulting chat is here, and the report generated is here. The report starts with confirming the negative health implications of visceral fat. It goes on to show that Dr. O’Mara’s recommendations are spot on, although there are some diet alternatives.
For exercise it generated this chart for effectiveness in reducing visceral fat based on evidence in the literature:
Sucra stands for “Surface Under the Cumulative Ranking curve”, the higher this number the better, it indicates the effectiveness of various treatments. I looked into exercise with my limitations below. It turns out the 10×1 higher intensity intervals I’m allowed to do on my bike are enough to tick the “high intensity” box so should be effective. As far as diet goes there is this chart:
VAT stands for visceral adipose tissue, same as visceral fat. So the type of diet Dr. O’Mara recommends scores well. I was concerned that Plant-based Diet was too vague without specifying “whole food”, So I asked:
I have a follow-up question on the section “Comparative Efficacy of Dietary Patterns on Visceral Fat”. I think the plant-based diet (ppbd) result may be misleading. plant-based diet can include highly processed food and food laden with sugar or refined carbs. whole-food plant-based (wfpb) is better because it eliminates these low quality foods. Are there any research results for VAT reduction specifically for wfpb.
The response is at the bottom of the chat here. The answer is whole food plant based also works well, although I didn’t have a head-to-head comparison to see it’s relative effectiveness vs. low-carb. I should point out you should never directly trust the results of these chats. I chased down the references to confirm the important points, which I recommend doing.
Just to be certain I read a second book on this topic:
This author also recommended short intense exercise, and as for diet he mostly emphasized getting rid of highly processed foods.
My take away is that exercise is important, especially at higher intensities. For diet, everyone seems to agree on cutting out processed foods. If you want to pursue this more aggressively you could take the further step of a more restricted diet, such as low-carb or wfpb.
I was curious how the medical understanding of visceral fat has evolved over time, so I did another Gemini query “History of medical understanding of the role of Visceral fat”, which led to this chat. It seems our understanding has improved a lot since about the 1990s to the present. One of the confusions that has been cleared up is that some people are overweight and metabolically unhealthy, and some have lower BMI but are not healthy. This would make sense if the former had more subcutaneous fat and less visceral fat. Here is a summary chart:
Read the chat if you’re interested in more detail. The finding about draining into the liver is significant and fascinating.
Gemini asked me this follow-up question “Would you like me to find a specific “masters athlete” cycling protocol that balances steady-state and intervals for optimal metabolic health?” and I said “yes. however I have moderate aortic paravalvular leakage so it must also be safe for that“. The result is in that same chat, and it confirmed pretty much what I’m already doing. My 10×1 intervals should be effective, as well as longer less intense “zone 2” rides.
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