Visceral and Ectopic Fat, the hidden drivers of metabolic disease.

Not all fat is created equal. While subcutaneous fat (the layer under your skin) is relatively harmless, visceral and ectopic fat represent the true metabolic threat, driving inflammation, hormonal disruption, and chronic disease. These two forms of silent fat storage have a significant effect on your health. Visceral fat is deep, organ-surrounding fat, and Ectopic fat is typical fat that accumulates within organs such as the liver, pancreas, heart, muscle and kidneys.

These forms of fat accummulation are the reason why most people struggle to lose weight and is associated with most chronic diseases. The body will always prioritise visceral fat loss and ectopic fat loss over adipose loss which is why most middle aged people try to lose weight and see no difference for many months, if at all.

Let’s take a deep dive into why visceral fat/extopic fat loss is absolutely critical for health (especially in relation to inflammation and chronic disease), and how a well-designed strategy can not only help you lose weight, but also prevent most of the chronic diseases as we age.

Understanding Visceral Fat

Visceral fat refers to the fat stored deep inside the abdominal cavity, surrounding vital organs like the liver, pancreas, and intestines.It’s metabolically active, meaning it constantly releases inflammatory cytokines (like IL-6 and TNF-α) and free fatty acids directly into the portal circulation — the blood flow that leads straight to the liver.

When visceral fat levels rise, insulin resistance accelerates, liver fat accumulates, and metabolic control begins to unravel.

2. Ectopic Fat — Fat Where It Doesn’t Belong

When the body’s primary fat storage sites (subcutaneous adipose tissue) reach capacity, the overflow spills into organs and tissues that were never designed to store fat — this is known as ectopic fat.

Common sites include:

Liver → hepatic steatosis (“fatty liver”)
Pancreas → reduced insulin production
Heart & pericardium → cardiac dysfunction
Kidneys & skeletal muscle → insulin resistance and vascular stress

This misplaced fat interferes with normal cellular signaling, mitochondrial function, and organ performance.

3. How Visceral and Ectopic Fat Interconnect

Visceral fat acts as the “gateway” to ectopic fat accumulation:

Chronic insulin elevation and energy surplus expand visceral stores.
As visceral fat capacity maxes out, fatty acids spill over into the bloodstream.
The liver and other organs absorb this excess, forming ectopic fat deposits.
The liver then becomes insulin-resistant, producing more glucose and triglycerides — perpetuating the cycle.

This is the core loop of metabolic dysfunction: visceral fat → ectopic fat → systemic inflammation → worsening visceral fat.

4. Consequences of Elevated Visceral & Ectopic Fat

Inability to lose weight
Insulin resistance and glucose instability
Elevated triglycerides and LDL cholesterol
Low testosterone and disrupted sex hormones
Fatty liver and elevated liver enzymes
Mitochondrial dysfunction and low energy output
Increased risk of type 2 diabetes, cardiovascular disease, and dementia

5. How the Body Prioritises Fat Loss

When metabolic health improves, through fasting, exercise, supplements and peptides, the body prioritises visceral and ectopic fat clearance first. These stores are highly vascular, hormonally responsive, and energy-rich, meaning they’re easier to mobilise than subcutaneous fat. Once these invisible fats start to mobilise due to the correction of the metabolic imbalances, then finally adipose fat starts to drop. But not before.

6. Reversing Visceral & Ectopic Fat

Both visceral and ectopic fat are highly reversible. Key strategies include:

Strategy	Mechanism
Fasting / Time-Restricted Eating	Lowers insulin, increases hepatic fat oxidation
Zone 2 + Resistance Exercise	Improves mitochondrial efficiency and insulin sensitivity
Correct balance of unprocessed macros. ie protein, carbohydrates and fats.	Reduces lipogenesis and gut inflammation
Berberine, Chromium, Milk Thistle, Apple cider vinegar	Support liver detoxification and insulin signaling. Happy Liver
Peptides	Reduce appetite, improve fat oxidation, and reverse hepatic steatosis
CoQ10, NAC, Alpha-Lipoic Acid, Medicinal Mushrooms, Beetroot powder	Mitochrondrial optimisation
Hormone Optimisation	Men's Plus, Boost and Happy Hormones/Period

The strategy: Optimise health...don't just waste money on Band-Aids

Weight management is a nice side effect of correcting internal metabolic imbalances. My approach has changed from a shorter-term results focus, which was driven by what people wanted, to a health optimisation approach that addresses these deeper metabolic imbalances. This does take time and real dedication, however to be honest it is the only way. Everything else is temporary and explains why people always gain back the weight and more from mainstream fast results apporaches.

Step 1

Diet: anti-inflammatory, nutrient dense, visceral/ectopic fat reducing

Diet is central. For visceral/ectopic fat reduction and inflammation mitigation, the following principles apply:

Emphasise whole-foods: vegetables, fruits, legumes, whole grains, lean proteins, healthy fats. These provide anti-inflammatory nutrients and support metabolic health.
Minimise processed foods, refined sugars, high-glycaemic carbs, excess saturated fats as they drive insulin spikes, lipogenesis, visceral fat deposition and inflammatory signalling.
Target a moderate calorie deficit if weight loss is indicated; visceral/ectopic fat is often responsive to energy balance improvements and dietary quality.
Consider functional foods: For example, incorporating kelp (a seaweed) may provide additional support as part of a whole-food platform.
Maintain protein intake and adequate fibre: Protein helps preserve lean mass (important during fat loss) and fibre supports gut health, satiety, and metabolic regulation.

Step 2

Exercise: Long Zone 2 cardio + strength

Movement is non-negotiable. In an optimisation protocol focused on visceral fat and metabolic health. What I find is that most people do not focus on LONG and slow exercise. Our bodies were designed to move often and for a long time.

Zone 2 aerobic training (moderate intensity, e.g., 60-70% of max heart rate, sustainable for 60 minutes or more) helps enhance mitochondrial function, fat oxidation, vascular health, and may preferentially mobilise visceral fat under the right conditions (especially when paired with diet).
Mix in resistance/strength training: Important to maintain muscle mass, boost resting metabolic rate, and improve insulin sensitivity.
Add NEAT (non-exercise activity thermogenesis) and lifestyle movement: standing, walking, incidental movement all contribute to improving the overall energy balance and reducing the sedentary burden, which favours visceral fat accumulation.
Consistency matters more than intensity alone. The long runs of Zone 2 create a metabolic environment favourable for fat loss and vascular/mitochondrial resilience.

Step 3

Hormone optimisation

Hormone optimisation sits at the centre of true metabolic health. Every key process in the body, how we burn fat, build muscle, regulate blood sugar, and even how efficiently our mitochondria produce energy, is influenced by hormonal balance.

When hormones such as insulin, cortisol, thyroid, testosterone, oestrogen and growth hormone are in sync, metabolism runs smoothly and energy feels stable and effortless. When they drift out of balance, the result is fatigue, weight gain, inflammation and poor recovery.

Optimising hormones is not about boosting one in isolation but about restoring communication between the brain, the glands, and the cells. This involves improving sleep, managing stress, training intelligently, and providing the right nutritional signals through protein, healthy fats, micronutrients, and targeted supplementation. The goal is to create harmony across all systems so the body naturally shifts toward fat burning, stable energy, mental clarity and long-term resilience.

For men we have Men's Plus and for women Happy Hormones/Happy Period

Step 4

Therapeutic interventions

Peptides

Visceral fat loss: Emerging pharmacotherapy now offers adjuncts to lifestyle. Retatrutide is a next-generation triple-agonist (GLP-1, GIP, glucagon), which recent trials show strong reductions in body fat, particularly visceral adiposity.

In a fat-mass substudy, android visceral fat mass decreased by up to ~31% with a 12 mg dose over ~36-48 weeks.
Liver fat, abdominal fat, and metabolic parameters improved.
It is not yet widely approved everywhere it must be used under medical supervision and as part of an overall strategy.

Mitochondrial Recovery

Our mitochrondria produce our energy. Without efficient energy production and mitochondrial our bodies can feel like they are spinning their wheels. Lots of effort and little results. When mitochrondria are optimised the body essentially wakes up, becomes more efficient and these metabolic processes can start to clear.

Several peptides have shown strong potential to improve mitochondrial function, including MOTS-c, Humanin, SS-31 (Elamipretide), BPC-157, and Epitalon. These peptides act at the cellular level to enhance energy production, reduce oxidative stress, and support mitochondrial biogenesis.

Mitochondria are the body’s energy factories, converting nutrients into ATP, the fuel that powers every cell. When mitochondrial performance declines, metabolism slows, inflammation rises, and energy levels drop. Optimising mitochondrial function is therefore central to metabolic health. Peptides like MOTS-c and Humanin, which are naturally produced within mitochondria, help improve glucose utilisation, support insulin sensitivity, and protect cells from metabolic stress. SS-31 stabilises mitochondrial membranes and improves energy efficiency, while BPC-157 and Epitalon support cellular repair and longevity pathways.

By restoring mitochondrial efficiency, these peptides, along with supplements like CoQ10, Lipioc Acid, NAC and medicinal mushrooms can help the body burn fat more effectively, maintain lean muscle, improve recovery, and sustain energy levels throughout the day. In essence, mitochondrial health is metabolic health. When the mitochondria thrive, the entire system becomes more resilient, youthful, and efficient. This phase needs to come after the metabolic factors of insulin resistance are addressed.

Peptides are not yet approved for use; however are available for research purposes and should be used under the guidance of a practitioner.

Supplements

Kelp

Kelp (and other seaweed/macro-algae) can act as a useful adjunct in the visceral-fat/inflammation strategy. Evidence:

A randomized controlled trial of iodine-reduced kelp powder in overweight Japanese men found a significant reduction in body fat percentage over 8 weeks.
Reviews of seaweed-derived components (e.g., alginates, fucoidans) indicate potential benefits in lipid metabolism, gut microbiota modulation, and reduction of metabolic-syndrome risks.
Kelp is nutrient-rich (minerals, iodine, fibre) and low in calories, supporting a nutrient-dense diet. Boost 3 contains Kelp and Irish Moss.

Berberine and Chromium

Berberine and chromium are two powerful natural compounds that work synergistically to support visceral fat reduction and overall metabolic health. Berberine, an alkaloid derived from plants such as barberry, activates the AMPK pathway, often referred to as the body’s metabolic master switch, which enhances fat burning, improves insulin sensitivity, and reduces the storage of fat around the organs.

It also helps stabilise blood sugar and lower inflammation, two key drivers of visceral fat accumulation. Chromium complements these effects by improving the way cells respond to insulin, supporting stable energy levels and reducing cravings that often lead to central fat gain.

Together, they create a metabolic environment that encourages the body to use fat as a primary fuel source rather than storing it. For individuals focused on reducing visceral fat, the combination of berberine and chromium offers a natural, evidence-based way to improve glucose metabolism, lower inflammation, and restore a leaner, healthier metabolic state.

Mitochrondrial supplements

Supporting mitochondrial function is central to energy, resilience, and longevity. Four cornerstone compounds, CoQ10, N-acetyl cysteine (NAC), alpha-lipoic acid, and medicinal mushrooms, work synergistically to restore cellular vitality and defend against oxidative stress.

CoQ10 (Ubiquinol) is a vital coenzyme embedded within the mitochondrial membrane, acting as both an energy carrier and antioxidant. It facilitates electron transfer in the respiratory chain — the process that generates ATP, the cell’s energy currency. As natural CoQ10 production declines with age or statin use, supplementation restores mitochondrial efficiency, improves cardiac output, and enhances overall cellular resilience. It’s particularly valuable in men with declining energy and hormonal balance, as it supports both metabolic and cardiovascular performance.

N-acetyl cysteine (NAC) replenishes intracellular glutathione, the body’s master antioxidant. By maintaining optimal glutathione levels, NAC helps neutralize free radicals generated during ATP production and protects delicate mitochondrial membranes from oxidative injury. It also supports detoxification in the liver, helping to clear reactive metabolites that otherwise damage mitochondria — making it a key tool for anyone dealing with inflammation, toxin exposure, or metabolic stress.

Alpha-lipoic acid (ALA) plays a dual role as a cofactor in mitochondrial enzyme complexes and as a powerful redox modulator. It bridges fat- and water-soluble antioxidant systems, regenerating vitamins C, E, and glutathione while improving insulin sensitivity and glucose utilization in muscle tissue. Together with NAC, ALA enhances mitochondrial biogenesis and supports the recycling of cellular energy substrates, effectively “tuning up” the metabolic engine.

Medicinal mushrooms — particularly Cordyceps, Reishi, and Lion’s Mane — add a powerful adaptogenic layer. Cordyceps boosts ATP synthesis and oxygen utilization, improving stamina and recovery; Reishi supports immune-mitochondrial communication and lowers inflammatory cytokines; and Lion’s Mane promotes neurogenesis and mitochondrial protection within the nervous system. Their beta-glucans and polysaccharides also modulate the gut-immune axis, indirectly improving mitochondrial efficiency through reduced systemic inflammation.

When combined, these nutrients form a mitochondrial synergy: CoQ10 powers the electron flow, NAC protects the redox environment, ALA optimizes metabolic turnover, and medicinal mushrooms fortify the body’s adaptive capacity. The result is deeper energy, improved cellular recovery, and protection against the oxidative decline that underlies aging and metabolic dysfunction.

Putting it all together

The Butterworth Health Optimisation Program

In my vision of the Butterworth Health Optimisation Program, the approach to visceral fat looks something like this:

Baseline assessment: visceral/ectopic fat quantification (via waist circumference, imaging if available), metabolic panel (insulin, lipids, liver enzymes, CRP), inflammation markers, fitness assessment (VO₂, baseline Zone 2 capacity).
Goal-setting: Establish visceral/ectopic-fat reduction target (for example, reduce waist circumference, visceral fat area, and lower inflammatory markers).
Lifestyle pillar integration: Diet overhaul (anti-inflammatory, nutrient-dense), structured exercise protocol (Zone 2 + strength), sleep optimisation, stress management (since stress drives cortisol, which shifts fat to visceral stores), mindful movement.
Adjuncts: Consider medical/therapeutic tools (like Retatrutide under supervision) when lifestyle alone is insufficient or when risk profile is elevated (metabolic syndrome, NAFLD, high cardiovascular risk). Functional food add-ons such as kelp supplementation, gut-health support (prebiotics/probiotics), and minimising toxins and environmental stressors.
Progress tracking & adjustment: Monitor changes in visceral fat proxies, inflammation markers, metabolic performance, fitness metrics. Adjust diet, exercise intensity/volume, and adjunct use accordingly.
Longevity & resilience orientation: The program is not just about “losing belly fat” but about shifting the body into a lower-inflammation, higher-metabolic-flexibility, higher mitochondrial-function state, thereby reducing the risk of chronic disease, improving vascular health, enhancing lifespan and healthspan. This is not a quick fix....it is an approach for health optimisation for the rest of your life.
Community: A large component of the program is online mentoring from Jeff in a community environment where others can share their experiences and support each other on the journey.

Summary

Visceral/ectopic fat is probably the most important marker for health and longevity. It is a representation of metabolic disease and mitochrondrial dysfunction which underpins all chronic disease.

Hence why it makes up a core component of the Health Optimisation Program. I also do a deep dive into other metabolic processes such as oxidative stress, digestive capacity, inflammation, essential fatty acid profiling, and consider biometrics such as resting heart rate, heart rate variability and VO2 max.

This is a serious program for people serious about optimising their health. Less about symptoms and more about correcting the underlying metabolic defects which are causing your symptoms.

If you wish to apply for the program, please email us at support@butterworthhealth.com to see if you meet the inclusion criteria and eligibility.