What 10,000 Body Scans Taught Me About Fat, Inflammation, and True Health
If I were to pick the Top 5 best moments I have as a physician, one of them would be when a new patient returns for their 2nd DEXA Body Composition Scan after our initial consult, and they have blown things off the Richter. They’ve lost 40-50 pounds of fat and gained 10-25 pounds of muscle (if male) or lost 20-25 pounds of fat and gained 5-10 pounds of muscle (if female); their transformation is tangible to everyone. (Yes, males do have a physiological edge here—not fair, I know, but reality.) Even more remarkable for me is seeing their new walk with renewed confidence, looking years younger and radiating vitality. It’s a testament to their commitment and the efficacy of following the unchanging rules that guide nutritional biochemistry. Essentially, they have gained education, not influence.
Since 2013, I’ve performed over 10,000 DEXA Body Composition Scans on patients; specific metrics always grab my attention. First, I assess their Android Fat—the fat stored deep inside, particularly in the liver. The lower this percentage, the lower their systemic inflammation and disease risk. A minimum goal is <20% Android Fat.
Next, I evaluate their Fat-to-Muscle Ratio. This helps determine whether they’ve reached their optimal physiologic state or need to “keep their foot on the gas pedal” in their 'Kitchen'.
Finally, their Muscle Mass relative to age, sex, and height reveals much about their overall vitality and hormonal health. Ultimately, these numbers reflect how someone is focused on their ‘Kitchen.’ Everyone who works with me knows that: “Physical Health always starts and ends in the ‘Kitchen,’ every single time.” But....Why?
Fat: Friend or Foe?
A cornerstone of BioFIT Medicine is the principle that “Nothing made by the body is either bad or good; it’s simply about balance.”
Fat exemplifies this balance. A healthy adult has 25-30 billion fat cells, but obese individuals may have over 100 billion fat cells. Fat cells are part of the hormone system; they cushion organs and serve as a storage vault for environmental toxins—a kind of safety deposit box. However, during fat loss, it becomes more like a garbage dump, releasing stored toxins into the bloodstream.
Understanding someone’s “Kitchen” also involves looking at their biomarkers. Surprisingly, <1% of providers nationwide check Fasting Insulin, according to Quest Labs, yet it’s my #1 biomarker because it’s the king of the metabolic chessboard. Here’s why:
When you consume excess sugars and starches (glucose, galactose, or fructose—found in fruit, alcohol, refined sugars, complex carbs, dairy, and legumes), the extra energy is stored as triglycerides. Meals high in these sugars/starches spike insulin levels, driving triglycerides into fat cells for storage. As fat cells enlarge, they do more than alter appearance; they interact with the immune system, fueling chronic inflammation.
Chronic inflammation is the root cause of 95% of diseases Americans face today. Addressing it could drastically reduce the burden of heart disease, dementia, stroke, and cancer—the four most common causes of death. Fat loss, therefore, isn’t just about aesthetics; it’s about reversing inflammation and reclaiming health.
The Garbage Truck Effect
During significant fat loss, biomarkers can initially worsen. Why? The U.S. food system contains over 10,000 chemicals, compared to <500 in Europe. Fat cells release the stored triglycerides as Free Fatty Acids as they shrink. Yet, fat cells also unleash stored toxins—akin to a garbage truck dumping its load into the bloodstream. This flood of toxins challenges the liver and kidney's detox pathway, requiring time and support.
As a Functional Medicine provider, I sometimes need to support patients through this process with supplements like glutathione, N-acetylcysteine (NAC), and milk thistle. I recommend eating organic foods, staying hydrated, and reminding them that the body is finding a new equilibrium. Over time, biomarkers—including cholesterol (ApoB), kidney function, and liver enzymes—will stabilize.
What Gets Measured, Gets Managed
Functional Medicine focuses on identifying and addressing the root causes of disease. It’s not just about running tests—it’s about testing to manage and heal. Here are a few key biomarkers to keep an eye on when reviewing your labs:
Fasting Insulin:
Optimal Goal: Less than 3.
Consider reducing your carb and starch intake at each meal if it's higher.
HDL:Triglyceride Ratio:
Goal: 1:1 Ratio.
If your ratio is off, lowering carb and starch consumption can help bring it into balance.
Leptin:
The lower, the better. High levels can signal early Insulin Resistance. (This is a test I usually check just once)
hs-CRP:
Goal: Less than 0.5.
This is a marker for chronic inflammation but can spike temporarily if you’re ill.
Understanding your biomarker report can help you take informed steps to manage your health and move closer to your optimal self. Remember: your body doesn’t care if it’s Christmas, Hanukkah, Thanksgiving, New Year’s, or any other special occasion. You only get one body. Joy comes not solely from food but from the community it brings together. A healthier community fosters healthier interactions.
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