Healthcast 651 - If you have a big belly, you may be at risk for Alzheimer’s.

See all the Healthcasts at https://www.biobalancehealth.com/healthcast-blog

That is a strong statement, however I am confident in saying that belly fat can put you at risk for Alzheimer’s disease, because it is a fact supported by medical research. These studies reveal that obesity, especially abdominal obesity (Beer belly, Gut, “Dunlap’s disease”…..), increases the onset and rate of Alzheimer’s dementia! Another reason to change your lifestyle to benefit your longevity.

Abdominal obesity can come from fat accumulation right underneath your skin (the fat you can pinch between 2 fingers) OR the fat that grows inside your abdomen like an apron draped over the intestines. It is called “visceral fat”, and this type of fat is what places you in the crosshairs for several diseases of aging including Alzheimer’s Disease, heart disease, stroke, diabetes, and rapid aging.  A large belly is more common in men, but it is still a risk for women if they develop an apple shaped body.

Below is a picture of visceral fat, and a diagram of what it looks like in an artist’s sketch of a normal weight person. When the yellow fat doubles and triples in thickness the abdomen pushes out to look like a “beer belly”.  

Visceral fat extends from your stomach over the transverse colon and your small intestines like an apron.  This fat pad thickens with alcohol abuse (beer belly), high carbohydrate diet, overeating, junk food, under exercise and creates a large pad of fat that secretes inflammatory cells.  The resulting inflammation is the vehicle that damages your brain leading to Alzheimer’s disease and damages your arteries leading to heart disease and stroke.

In my office we use INBODY machines that measure your Visceral fat, BMI, and percent body fat.  Normal visceral fat is below #10 on our machine, BMI less than or equal to 25, and fat % for men < 19% and for women < 26%.

The Research: A recent study correlated the size of patient’s belly (visceral belly fat), and obesity with the amount of amyloid plaque (the cause of Alzheimer’s disease) in their brain. This was measured by MRI in the study subjects’ brains.  The age of the patients studied was between 40-60.

The study found that the amount of visceral fat (fat inside your abdomen) is directly correlated with the amount of amyloid plaque and inflammation in the brain!  That causes Alzheimer’s Disease.

If that doesn’t motivate you to lose your belly fat, then you are making a choice to eventually suffer from Alzheimer’s disease, a heart attack, a stroke or arthritis.  If you are thinking that you will just wait for “something to happen”, then not making a decision to change your lifestyle is making a decision to take on illness in the future.

We have new medications to help you lose that belly fat and they really work. You should ask your doctor to help you and if they don’t understand the importance of arriving at ideal weight then look for a different doctor who will help you.

Even with medication you will have to put in the work and self-control to turn down unhealthy foods when others are being unhealthy.  You will also have to add daily exercise to your schedule if you really want to avoid Alzheimer’s Disease, heart attack, stroke and early death.

The possible meds and habits that can help you lose your “belly”:

·     Limit calories and or carbohydrates

·     Increase daily exercise

·     Diet pills (amphetamines that older patients usually can’t take)

·     Xenical (Orlistat)-Side effect is fatty diarrhea

·     Qsymia (topiramate/Phentermine) can increase BP

·     Contrave for craving (naltrexone/bupropion) can decrease sex-drive

·     Semelanotide (Imcivree-new), darkens the skin, expensive

·     Metformin ER an oral, effective medication to treat insulin resistance, and promote weight-loss

·     Victoza and Saxenda injections are diabetic treatments, that can cause GI reflux, however they work well for patients who have Type II Diabetes who need to lose weight.

Even though many patients lost weight with these medications, many could not tolerate the drugs listed above because of the side effects.  These side effects limited our ability to help all patients lose weight…until now!

Now, for the first time we have an effective way to help most people lose their dangerous visceral (belly fat). If you have a big belly you are at high risk for inflammatory diseases like Alzheimer’s dementia, obesity, heart disease, diabetes, cancer and stroke.

The new weight loss drug’s generic name is Semaglutide, and has been marketed under several names: Wegovy, Ozempic, and Rybelsus. A second generic drug that is in the same family of drugs is called Tirzepetide, includes Mounjaro (for diabetics) and Zepbound (for weight loss). All of these drug’s work for weight loss, pre-diabetes and Type 2 Diabetes.  Most insurance companies do not cover weight loss and they require a precertification for you to get the medication covered by insurance.  This precertification process is time consuming for the doctor and her staff, which costs the doctor an increase in her overhead to employ a nurse to provide this service for the patient. In general people with a BMI under 30 will not be covered for Semaglutide or Tirzapeptide, however if their BMI is over 30, there is a chance insurance will pay for one of these drugs for a period of time.

The market price at the pharmacy is between $900/$1200 per month if you pay out of pocket to your pharmacy. Because of this fact and because we have so many patients whose pellets are not paid for by insurance, we provide access to the generic form of these drugs through a compounding pharmacy. The cost is a fraction of the normal out of pocket cost, about $560 for 3 months supply. In this way we have been able to treat many people who cannot afford to pay the exorbitant going rate for this medication.

Because it is costly for a patient to receive the medication no matter how they are able to get it, It is very important for weight loss patients to be compliant and follow a low carbohydrate diet, exercise daily and to refrain from alcohol consumption while they are taking weight loss medications.  We require our patients who request these drugs to be seen at least every 2 months by one of our NPs or our weight loss specialist to help them get the best results possible.

These drugs work for weight loss and diabetes by multitasking.  The ways the medication actually works are listed below: Semaglutide and Terzapeptide,

·      decrease hunger between meals  

·     you feel full faster than normal so you eat less

·     decrease sugar and alcohol-craving

·     decrease the release of sugar from the liver when you are fasting, which turns into fat

·     Prevent hypoglycemia which causes hunger and fat gain

·     Makes patients more insulin sensitive.

Obesity is not just a lifestyle problem; it is a disease that should be treated with medicine PLUS lifestyle changes. These drug actions take place in the brain, stomach hormones, pancreas and liver, as well as in all the cells in your body.

At Bio Balance Health® have years of experience in treating patients with bio-identical testosterone pellets and we have observed that weight loss plus testosterone pellets for patients over 40 allows patients to lose fat without losing muscle. Now we add these weight loss medications to T pellets, and we have the perfect combo for safe weight-loss (really fat loss).

The biggest worry for patients is that they may not be able to get off this drug after they achieve ideal weight.  I have found that the longer you have been overweight and the more overweight you are, the higher the risk of needing maintenance medications to maintain your ideal weight. We try to wean our patients off injectable meds by switching them to Metformin ER, a drug that insurance will pay for.

With these effective meds we finally, we have an effective preventive treatment to add to our testosterone and estradiol pellets for those people who view Alzheimer’s as their worst nightmare, and for those patients who are worried about heart disease, diabetes and stroke  we can prevent the diseases that can ruin our “golden years”.  

KCM

Research:

People with large amounts of visceral fat as they age may have higher risk of Alzheimer’s disease.

NBC News (11/20, Carroll) reports, “People who have large amounts of” visceral fat “as they age may be at higher risk of developing Alzheimer’s disease, a new study suggests.” The findings were presented at the Radiological Society of North America’s annual meeting.

HealthDay (11/20, Thompson) reports that investigators “compared brain scans of 54 people between the ages of 40 and 60 with their levels of belly fat, BMI, obesity and insulin resistance.” The investigators “found that people who had more visceral fat compared with fat found just under their skin tended to have higher amyloid levels in the precuneus cortex.” The “relationship was worse in men than in women, and higher visceral fat measurements also were related to increased inflammation in the brain.”