BUTTS, NOT GUTS--that's
As researchers investigate the epidemic that is threatening our modern civilization, they are finding that fat is not the inert substance we once thought it was. It is an active part of our endocrine system, and fat in different locations has radically different metabolic effects.
You're probably sick of hearing about the epidemic of obesity. But the fact is, the industrialized world appears to be eating itself to death. Adult obesity has doubled and childhood obesity has tripled in the last 30 years, to the point where children born today have a shorter life expectancy than their parents.
You probably know that being too fat is associated with high blood pressure, heart disease, high cholesterol, osteoarthritis, asthma, sleep apnea, gall bladder disease, certain kinds of cancers--and various psychosocial and lesser ailments. Most significant is the association with diabetes, which leads to a host of disorders of the blood vessels and nerves, the end stage of which can culminate in blindness, heart attacks, strokes, amputation of the feet and renal failure.
So this is not good. But medical science is populated with ambitious and curious folks who love a challenge, and they have turned their attention to this mass of blubber that threatens to annihilate our overfed society. Their investigations reveal that fat is a very active part of our endocrine system--so much so that some regard it as the largest endocrine organ of the body. (The conventional endocrine system is the series of glands like the pituitary and the thyroid that control so much of the body's metabolism and other functions, through the hormones they release.)
Fat's impact on metabolism depends on its location.
The visceral fat in your belly that surrounds your abdominal organs, and gives your body an apple shape, is bad. It is associated with a particularly pernicious derangement of sugar and fat metabolism called metabolic syndrome, which puts people at increased risk for heart disease.
By contrast, gluteal fat ("gluteal" being the genteel medical term for your butt), which gives people a pear shape, does not have this association. It actually can be beneficial, acting as a metabolic sink and clearing fatty acids out of your blood stream after you eat a fatty meal.
So, the mantra is "butts, not guts," or pears, not apples.
Even before the endocrine function of fat was known, it was noted that apple-shape obesity was bad, and a waist measurement of more than 40 inches in men and more than 38 inches in women was a risk factor for metabolic syndrome.
There's another advantage to butt fat. The endocrine function of fat is related to hormones it produces called adipokines. These tend to do bad things to your blood vessels, and the fatter you are, the more of them you produce, with one exception: adiponectin.
This hormone has generated a lot of interest as potential therapy. It appears to have a protective effect on the inner lining of blood vessels and is found in higher quantities in thin people and people who exercise. And--here's the butt advantage again--it is produced only by gluteal fat.
The cannabis effectOne other fiendish twist that Mother Nature has built into our metabolisms is that fat cells also have a controlling effect on how much we eat, through so-called "cannabinoid receptors."
The whole concept of our bodies and our brains having cannabinoid receptors intrigues me. They are so named because they are stimulated by cannabis. There are different subgroups of these receptors, but it is the CB1 receptors that are involved here.
These CB1 receptors are found in fat cells and various other places--amazingly, they are the most ubiquitous receptors in the central nervous system. And the limbic system (the part of the brain that controls our pleasurable emotions) is absolutely loaded with them. This makes it sound as if we're wired to be heavy cannabis users, which is not what I'm suggesting, of course!
Stimulation of the CB1 receptors--by other hormones the body produces--turns on a whole host of mechanisms that lead to fat deposition. But perversely, it also leads to an inhibition of the satiety reflex, so we go on eating even when we're full. And the more fat you have, the more of these receptors you have.
All fascinating stuff, but "So what?" I hear you ask.
I guess exploring the basic science is a necessary preliminary to finding solutions.
I'm sure much of the research into this is being funded by drug companies, in the hope of finding some salable drug. The mind boggles at the market that would be opened up for the first company to come up with a truly effective treatment for obesity.
There are some glimmers on the horizon. There's a drug, rimonabant, which is already available in Europe but not yet in the U.S. It's a CB1 receptor blocker.
There is also Meridia, already available in the U.S., which is a centrally acting appetite suppressant--though it certainly hasn't been the panacea everyone is looking for.
But there's something daft about having to take pills to control ourselves. The real problem is that we have developed a terrible diet, combined with a culture of sloth--or inactivity, at least.
Make the effortWe should be eating whole- grain everything (flour especially), fruit and vegetables. Instead, we are eating refined or white flour and other grains, which are rapidly digested and lead to an extreme spike in our blood sugar and deposition of fat. We combine these refined grains with meat, dairy, eggs, other fats and masses of sugar to create an incredibly calorie-dense diet.
Think about what you eat from day to day, and how much of it fits these categories. Compare that with eating fruits, vegetables and unrefined grains, such as whole-wheat flour and beans. The fruits and veggies fill you up with far fewer calories. And the grains take time to digest, so they don't cause the spike in glucose.
We are, of course, dealing with the evil of a huge food industry that has developed all sorts of goodies using refined flour and sugar. Most calamitous of all, our kids are being taught to like (or dare I say crave) junk food--it's even become the norm in schools.
I look forward to the day when carrot sticks are advertised on "Sesame Street."
Another problem is that our splendid technological ingenuity has produced a host of labor-saving devices, so the only exercise we get is when we have the chutzpah to get off our butts and exercise. There's also such insanity as schools cutting down on recess to try to comply with No Child Left Behind and the like.
It all plays into the culture of "Don't make the effort, just take a pill."
I sometimes think the obesity epidemic is Mother Nature's cunning scheme to be rid of a species that is doing its best to destroy her planet. She's just letting us eat ourselves into oblivion.
But if you have to be oversupplied with this flubbery mess, at least hope that it sticks to your butt, and not your waistline.
The bad news is that there's no way you can control where your fat gets deposited. It's just that if you're an apple, you need to work harder on losing it.
DR. PATRICK NEUSTATTER is a family practitioner with Pratt Medical Center in North Stafford. He can be reached at pneustatter@prattmed