Medicosnext
Dr. Sanjaya Kumar Shrestha
He is a professor of Cardiology who began his medical journey with an MBBS from Mymensingh Medical College, Dhaka University, in 1996. He completed primary and secondary level school education from St. Xavier’s and Budhanilkantha School. After MBBS he pursued an MD in Medical Microbiology at Kasturba Medical College, Manipal University, in 2000. He became the first Nepali doctor to pass the FCPS-Part 1(Fellow of College of Physicians and Surgeons of Pakistan) exam in Medicine in 2001 and completed two years of Internal Medicine training from National Academy of Medical Sciences (NAMS, Bir Hospital) and one year of Cardiology training from Shahid Gangalal National Heart Centre (SGNHC). He then completed his MD in Cardiology in 2007 from the First Affiliated Hospital of Zhengzhou University, China, known to be the largest hospital of the world. Finally, he did his Fellowship in Interventional Cardiology from the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, in 2018. He currently serves as a Professor of Cardiology at Kathmandu Medical College (Kathmandu University). His research spans cholesterol’s role in heart disease, where he challenges conventional thinking, asserting that cholesterol is not the true cause of coronary heart disease.
Belly fat is not just about looking bad, it is a dangerous type of fat that increases the risk of serious diseases like diabetes, heart attack, and paralysis. These are called cardiovascular diseases, and according to the World Health Organization, the leading cause of death worldwide is cardiovascular disease.
Many people believe that eating fatty foods like oil, ghee, and cholesterol-rich foods directly causes weight gain and belly fat. This idea is only partially true, not the complete truth. Similarly, many people believe that eating less (dieting) and exercising alone will reduce weight.
This is also not entirely true. You might be surprised to hear this. So, what is the real truth?
Understanding Energy Storage in the Body
To understand this, we must first understand how the body stores and uses energy. Our body has about 30 trillion cells, and each cell needs energy to survive and function, just like a factory needs fuel. This energy is stored in three energy tanks in our body:
Tank 1: Blood Sugar (Glucose)
This is the first fuel the body uses. It comes from sugar and carbohydrate-rich foods and lasts for about 4–6 hours. Excess glucose is stored in the liver and muscles as glycogen.
Tank 2: Glycogen (Stored in Liver and Muscles)
After Tank 1 is empty, the body uses this fuel. It lasts for about 6–10 hours.
Tank 3: Belly Fat (Visceral Fat) – The Main Energy Store
If Tanks 1 and 2 are full, excess energy is stored in the third tank, visceral fat around the abdominal organs, in the form of triglycerides. This is the largest energy reserve and can supply energy for many days. But here is the key point: This fuel is used only after Tanks 1 and 2 are empty.
Evolutionary Insight
Thousands of years ago, humans depended on hunting for food. Hunting was not always successful. When successful, all 3 tanks were full. When unsuccessful, survival depended on belly fat (Tank 3). Because of this, excessive belly fat did not accumulate in early humans. But in the last 200 years, things have changed. High intake of sugar and processed foods, and frequent eating throughout the day. As a result, Tanks 1 and 2 never get empty and Tank 3 (belly fat) keeps increasing
The Real Problem: Insulin Resistance
Belly fat is not just a cosmetic issue. When it increases, it leads to a condition called Insulin resistance. Insulin is a hormone produced by the pancreas that helps cells use glucose as fuel. In insulin resistance, the body needs more insulin than normal, the pancreas produces excess insulin, and blood insulin levels rise. High insulin levels prevent the body from using fat (triglycerides) as energy, and cause further increase in belly fat. So, a vicious cycle develops:
Belly fat → Insulin resistance → Insulin → More belly fat
Eventually, this leads to type 2 diabetes, chronic inflammation in blood vessels, and damage to arteries of the heart, brain, and kidneys, resulting in heart attack, paralysis (stroke) and kidney failure.
How to Reduce Belly Fat (Scientific Approach)
First, if you suspect increased belly fat, check for insulin resistance. This can be done easily by measuring fasting blood sugar (FBS), and fasting insulin (FI). Then calculate HOMA-IR:
HOMA-IR = (FBS x FI) / 405
If your HOMA-IR is above 2, insulin resistance has already started.
Key Concept: Use Energy from Tank 3
Now you understand, to reduce belly fat, the body must use Tank 3 (fat storage). But for that to happen Tanks 1 and 2 must be emptied first.
How to Do This: 16-Hour Intermittent Fasting
Let’s say, you eat dinner at 8 PM in the evening. By the next morning, at 8 AM it becomes 12 hours of fasting and by 12 noon it will be 16 hours of fasting. Now, if your first meal (breakfast) is at 12 noon, you complete 16 hours of fasting. This is called Intermittent fasting if you do this daily.
What happens during this fasting?
- First 4–6 hours → Tank 1 (glucose) is used
- Next 6–10 hours → Tank 2 (glycogen) is used
- After ~12 hours → Body starts using Tank 3 (fat)
If you add morning exercise, fat burning increases further and fat burning becomes more efficient.
Important Mistake
If you eat breakfast at 8–9 AM:
- Tanks 1 and 2 get refilled again
- Tank 3 (fat) is never used
So belly fat never reduces.
Final Advice
If you want to reduce belly fat, prevent insulin resistance and avoid diabetes, heart attack, stroke, and kidney failure, start 16-hour intermittent fasting and do morning physical exercise.
Track Your Progress
- Check HOMA-IR before starting
- Repeat after 3 months
If it decreases or comes below 2, that is a major achievement
If you have any questions, please write them in my email (sanjayakumar70@gmail.com) or call me at my mobile number (9841433303). I will try to answer them.
