Visceral fat
Hi Dr Attia I want to ask about the best methods of losing visceral fat. Despite losing weight, intermittent fasting, I find my abdomen bulging. My weight and build is towards lean. I’m 39 and what worries me is my risk of developing NAFLD and CAD. I look forward to your expertise.
Niacin
There has to be a subgroup of people for whom niacin is truly beneficial. Recent podcast left that burning question. Increase in Apo A1 plus lowering of Apo B and lp(a) certainly would seem to make it prudent. The more potent lowering of LDL with statins has made it difficult to show additional benefit but it has to be there in proper subgroup analysis. For now I still go to niacin if I need more Apo B reduction ( and who doesn’t right). But maybe having Apo E4 is as good a reason as any to want to add niacin even if Apo B looks good just to drive more Apo A1 protein to brain.
Insulin Resistance and Dietary Fat
How can dietary fat drive insulin resistance in the context of a very low carb diet that is energy balanced? Do IRS1, FTO, other genetics play a role? Besides reducing dietary fat and carbohydrates, are there other interventions that may help if fat is the driver?