Saturday, November 16, 2013
There’s a difference between ugly fat and dangerous fat. In general, the ugly stuff, by social convention is a view from the rear.
The worrisome kind of fat bulges under your belt and is best seen from the side. Waist size provides a clue that there is bad fat inside the abdomen. It’s called visceral fat. Some of that is stored in your liver and it’s especially problematic.
There are also some other kinds of fat. Brown fat is associated with body temperature control. The thing to understand is that different kinds of fat have different metabolic consequences and waist size predicts your risk of serious illness better than your bathroom scale does.
Recent scientific interest has spotlighted the metabolic syndrome. That work may give us the best way to understand the aging process. For nonscientists, I’ll to start with some definitions.
“Metabolic” focuses on chemistry and the ways our bodies use energy. We’ve learned that fat cells are more than empty sacs that store reserves until we need them. Some fat cells create byproducts that play a role in the risk of developing diabetes, cancer and other components of the syndrome.
A “syndrome” is a cluster of diseases that occur together more often than we would expect from chance. If two or more diseases occur together they may, or may not, have a single cause.
Let’s say that a doctor sees 10 patients from Touchet. All are 15 to 30 years old. They all have a fever, itchy red spots and larger than average head sizes. When a similar outbreak occurs in Las Vegas, another doctor begins calling it “Touchet syndrome.” When an underlying cause is found, it may be renamed “Touchet disease.”
We might discover, for example, that a virus selectively attacks a particular age group and it results in an allergic response. It’s likely that the head size will prove to be a statistical anomaly, but that won’t keep some hucksters from trying to make a buck from the idea. They may try to sell tight fitting hats or special vitamins for everyone with an oversized dome.
I include these health issues as part of the metabolic syndrome: diabetes, heart and vascular disease, cancer, dementia, a decrease in muscle mass and depletion of some hormones.
Since the syndrome is an interactive network of diseases, we could start with any one of them to study its connections. Let’s begin with fat distribution.
Juvenile obesity is a special concern, but before that became a new epidemic the pattern was for humans to gain weight from about age 30 to about age 70. After that, some begin to lose pounds, but the pattern varies. What seems constant is the shift of fat stores.
They decrease beneath the skin and they’re replaced with bad fat. Think of bad, visceral fat as an unwanted endocrine organ in your body. Reducing it lowers blood pressure in hypertensive patients. Liposuction or other methods of removing the fat beneath the skin has no beneficial effect on blood pressure.
Fat cells, adipocytes, produce a long list of chemicals. I mentioned leptin and ghrelin in an earlier article. Others may play an important role in aging. Visceral fat is also associated with inflammation and with insulin resistance, which is the defect in Type 2 diabetes, a central player in the metabolic syndrome and aging.
While studying visceral fat products that promote disease, researchers found a unique protein that combats vascular disease. This agent, adiponectin, isn’t made by visceral fat cells. However, visceral fat promotes disease by removing adiponectin.
Sadly, visceral fat is hard to measure and maintaining weight control is difficult. Remember to follow waist size and the waist to hip ratio. (There are multiple sites on line explaining the measuring technique and some offer calculators.) Opinions differ, but the ratio should be less than 0.8 in women and 0.9 in men. Sorry, ladies.
In rats, we can show that reducing visceral fat promotes longevity, but they are on starvation-level diets. Exercise helps to reduce visceral fat — possibly only in conjunction with weight loss — but exercise has other benefits as well.
There are studies on drugs that may help, assuming they are released. You can buy adiponectin, the protective agent that is partially blocked by visceral fat. I can’t encourage using it, because of uncertain efficacy and unknown long-term risks.
In short, we have the old standards of dietary moderation and vigorous exercise as useful tools. Aspirin, statins and other medications can protect against specific diseases.
Research offers some promise of finding the basic underpinnings of the metabolic syndrome, and the newly released information on statins indicates they have a broader and more important effect than simply lowering cholesterol.
The claims that modern society is killing us should raise awareness and lead to research, but we are living longer than most of our grandparents.
Studies on mummies show that ancient societies suffered from the diseases that make up the metabolic syndrome. There appears to have been a genetic link, and that shouldn’t surprise you. Like our fat cells, we metabolize things differently one from another.
See you at the “Y.”
Dr. Larry Mulkerin is a retired clinical professor and oncologist who lives in Walla Walla. A former U.S. Army Green Berets medical officer with experience in the Middle East, he also is the author of “The Ayatollah’s Suitcase,” a novel available at amazon.com and other online book retailers. He can be reached at firstname.lastname@example.org.