Thread by @ElieJarrougeMD

Visceral fat has a job.

Your body didn’t put it there by accident.

As a doctor who reverses metabolic disease daily, I see this constantly: here’s what it actually does, when it turns against you, and why your doctor is probably measuring the wrong thing.

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Visceral fat is the fat stored deep inside your abdomen around organs like the liver, pancreas, and intestines.

Unlike the fat under your skin, visceral fat is metabolically active.

And despite its bad reputation, it serves important functions.

Normal function of visceral fat:

• Cushions and protects organs
• Provides a quick-access energy reserve
• Produces hormones involved in appetite (leptin) and metabolism (adiponectin)
• Helps coordinate immune function

In healthy amounts, it’s part of healthy physiology.

Many people think excess visceral fat causes metabolic disease.

Reality is more complicated.

A strong argument can be made that chronic hyperinsulinemia and metabolic dysfunction often come first.

Visceral fat expands as a consequence of metabolic dysfunction.

As visceral fat expands, it becomes inflamed and releases inflammatory cytokines and free fatty acids directly into the liver through the portal circulation.

This contributes more to:

• Fatty liver
• Insulin resistance
• Chronic inflammation
• Hypertension

Now the system starts feeding itself.

Here’s what happens next:

Your body needs more and more insulin to keep blood sugar normal.

For years, glucose may look “fine” on routine labs while insulin works overtime behind the scenes.

Most doctors never measure fasting insulin, so they miss this stage completely.

This is why some people develop Type 2 diabetes seemingly out of nowhere.

It didn’t happen overnight.

The process was often brewing silently for years or even decades before blood sugar finally rose enough to trigger a diagnosis.

The biggest mistake in medicine is focusing more on BMI.

I’ve seen overweight patients with excellent metabolic health.

I’ve also seen “normal-weight” patients with severe insulin resistance, fatty liver, and sky-high fasting insulin.

The scale doesn’t tell the whole story.

Better markers include:

• Waist circumference
• Fasting insulin
• Triglyceride-to-HDL ratio
• Liver enzymes
• hs-CRP
• DEXA or MRI when necessary

The question isn’t:

“How much do you weigh?”

It’s:

“How metabolically healthy are you?”

The good news?

Visceral fat is highly responsive to lifestyle change.

In my practice, improving nutrition, increasing protein intake, reducing ultra-processed foods, fasting, strength training, improving sleep, and managing stress routinely melt visceral fat and improve metabolic health.

Bottom line:

Some visceral fat = normal and protective.

Too much = fuel for insulin resistance and metabolic collapse.

Address the cause with real food and lifestyle. The body knows what to do.

What’s your fasting insulin?

Has your doctor ever checked it?