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Metabolic syndrome: A game of consequences?
The Economist ^ | Mar 11th 2010 | NA

Posted on 03/27/2010 1:01:34 AM PDT by neverdem

One of the scourges of modern life may have been profoundly misunderstood

BEING fat is bad for you. On that, almost everyone agrees. It is just possible, though, that almost everyone is wrong. In fact, getting fat may be a mechanism that protects the body. The health problems associated with fatness may not be caused by it but be another consequence, another symptom, of overeating.

That is the heretical proposal of Roger Unger and Philipp Scherer. Dr Unger and Dr Scherer, who work at the University of Texas, in Dallas, have been reviewing the science of what has come to be known as metabolic syndrome. This is a cluster of symptoms such as high blood pressure, insulin resistance and fatness that seem to increase the risk of heart disease and strokes, late-onset diabetes and liver disease. Metabolic syndrome is found in a sixth of the American population.

“Syndrome” is the medical term for a collection of symptoms whose common cause is not properly understood. The symptom of metabolic syndrome that appears first is usually obesity, so this is generally regarded as the underlying cause.

Dr Unger and Dr Scherer, however, turn this logic on its head. They point out that there is usually a period of many years between a person becoming overweight and his developing the other symptoms. If the growth of adipose tissue (the body cells in which fat is stored) were directly harmful, that would not be the case. This is one of the lines of evidence that has led them to the conclusion that, in addition to its role in storing energy as a hedge against future famine, getting fat is a protective mechanism against metabolic syndrome.

Their thesis is that lipids (the group of molecules that includes fats), which are needed in small amounts to make cell membranes, are toxic in larger quantities. Absorbing them into adipose tissue is one of the body’s ways of dealing with that toxicity. But are lipids toxic? In one sense, it is obvious that they are. The build up of fatty plaques in blood vessels, which results in atherosclerosis, is a result of the inability of the cells lining the walls of these vessels to cope with too much fat.

Fat, and proud of it More subtly, though, the two researchers have dug up evidence that an excess of lipids damages heart-muscle cells, and even destroys pancreatic cells in rodents. This could help explain the fact that the form of diabetes that follows metabolic syndrome can involve damage to pancreatic cells.

It is generally thought that the growth of adipose tissue causes cells in the liver, muscle and fat tissue to become resistant to insulin (a hormone produced in the pancreas) and thus unable to absorb glucose from the blood. How this happens has been the subject of a lot of hand waving, though the tendency of adipose tissue to produce chemicals that encourage inflammation is often mentioned.

Dr Unger and Dr Scherer attack this whole notion. In a paper in Trends in Endocrinology and Metabolism they argue that insulin resistance is another side-effect of metabolic syndrome whose cause is lipid molecules poisoning tissues in which they are not supposed to be present in large quantities. The problem of lipid damage, they believe, is linked to hormones produced not by the pancreas, but by adipose tissue itself. These hormones are called leptin and adiponectin.

Leptin has several roles, but one is to encourage cells to oxidise lipids and thus destroy them. For example, in the cases of the heart-muscle cells and pancreatic cells mentioned above, dosing them with leptin keeps them healthy. Adiponectin, meanwhile, encourages the body’s adipose tissue to absorb lipids.

As adipose tissue grows, however, its production of adiponectin falls. The ability of the tissue to absorb lipids and keep the rest of the body safe thus drops. Leptin production, meanwhile, grows along with the mass of the adipose tissue. In what is, admittedly, the least-tested part of their thesis, Dr Unger and Dr Scherer argue that other cells react to this increase in leptin concentration by becoming resistant to the hormone’s effects. That, in turn, stops them oxidising lipids and opens those cells to lipids’ toxic effects.

Dr Unger and Dr Scherer suggest that this failure of the leptin mechanism, particularly its role in oxidising lipids, is crucial to the development of metabolic syndrome, and that it is a pathology of adipose tissue that has become overloaded.

In light of all this, they suggest that insulin resistance, like obesity, should be viewed not as a pathology but as an adaptive response by the body to an excess of circulating lipids. To save themselves when they are threatened with being overwhelmed by lipids, cells become insulin-resistant, which stops them taking up extra glucose which would then be converted into lipids.

In support of this hypothesis, the researchers point to studies on mice whose leptin receptors have been broken by genetic mutations. In a healthy mouse (one with working leptin receptors) even a diet that is 60% fat does not cause a build-up of lipids anywhere except in the adipose tissue. In one with broken receptors, a mere 6% is enough to overload other tissues to the point where lipids would be toxic. Such experiments cannot, of course, be done on people, but something similar occurs naturally. A few unfortunates are born without adipose tissue. These people rapidly develop the symptoms of metabolic syndrome.

Sadly for self-indulgent humans, none of this affects the basic message about staying healthy, which remains to eat less and exercise more. It does, though, raise important questions about how metabolic syndrome is treated. The focus that many doctors have on controlling diabetes may be mistaken, possibly counterproductive, if insulin resistance is actually a protective mechanism. Even if it is not, the destruction of pancreatic cells that comes with diabetes may be unrelated to the development of insulin resistance. And liposuction (not, admittedly, something that most doctors would recommend) would be expected to make things worse, since it would get rid of the source of the hormones that regulate lipids.

Dr Unger and Dr Scherer, then, have attempted to apply some new thinking to a disease that affects more people as the world gets richer. Even if they are wrong, a little lateral thinking may help shake up the field. If they are right, a lot of people may thank them in the future.

TOPICS: Culture/Society; News/Current Events
KEYWORDS: diabetes; metabolicsyndrome; syndromex; type2diabetes
Symptoms are subjective complaints. Signs can be observed.

Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity

1 posted on 03/27/2010 1:01:35 AM PDT by neverdem
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To: austinmark; FreedomCalls; IslandJeff; JRochelle; MarMema; Txsleuth; Newtoidaho; texas booster; ...
FReepmail me if you want on or off the diabetes ping list.
2 posted on 03/27/2010 1:04:20 AM PDT by neverdem (Xin loi minh oi)
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To: neverdem
If we look at the relics and artwork left by our ancestors, we see that they actually worshipped the fattest.

Being fat was a sign of individual wealth.

3 posted on 03/27/2010 1:32:41 AM PDT by UCANSEE2 (The Last Boy Scout)
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To: neverdem

......getting fat may be a mechanism that protects the body.....

Some thoughts on health, evolution and the religious implications..........

Of course it is. That is a common sense statement. Getting fat is not the problem. Staying fat is the problem. The article essentially says that obscured in a plethora of medical mechanisms. The ritual fasting has been abandoned and diabetes, heart and vascular disease are the result.

If you think Darwinian, of natural selection of traits, you can see that in the development of our species from time to time there is famine. As a matter of fact, in the northern areas it can come every winter. Fat enables wintering over.

The Problem in modern societies is that we have developed methods and processes for maintaining an abundance of food and a dearth of famine. We experience no periods of low food supply, it is always abundant. We celebrate the feasts at the onset of winter and then just keep eating. The pounds keep accumulating.

Our ancestors recognized the problem and developed fasting as a remedy. Ramadan, Lent, Fish on Friday and others are programmed fasting built in to religious rituals.

4 posted on 03/27/2010 5:05:27 AM PDT by bert (K.E. N.P. +12 . Ostracize Democrats. There can be no Democrat friends.)
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To: neverdem
Great article. Bet my endocrinologist cringes when I bring this one in.
5 posted on 03/27/2010 5:30:55 AM PDT by texas booster (Join FreeRepublic's Folding@Home team (Team # 36120) Cure Alzheimer's!)
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To: bert

You know the obesity epidemic could have been divine providence preparing the US for the coming 0bama famine. ;)

6 posted on 03/27/2010 5:32:47 AM PDT by CajunConservative (Shut Up Mary!)
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To: CajunConservative


7 posted on 03/27/2010 5:35:41 AM PDT by bert (K.E. N.P. +12 . Ostracize Democrats. There can be no Democrat friends.)
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To: neverdem


8 posted on 03/27/2010 6:15:53 AM PDT by metmom (Welfare was never meant to be a career choice.)
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To: texas booster

You’ll probably get lectured about not believing everything you read on the internet, just like I do when I ask about something I read.

Until they hear about it, it’s just hogwash. There’s hardly a doctor around who will listen to a serious question about something you read, no matter what the credentials of the researcher.

9 posted on 03/27/2010 6:17:53 AM PDT by metmom (Welfare was never meant to be a career choice.)
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To: Tunehead54

Read later ... need a snack ... ;-)

10 posted on 03/27/2010 7:28:23 AM PDT by Tunehead54 (Nothing funny here ;-)
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To: neverdem

I know I’m going to sound like a broken record, but here I go again...

Why do these researchers ignore normal-weight T2 diabetics? Why do they ignore thin runners who eat low-fat diets and go on to develop T2 diabetes and heart disease?

They ignore it because we’re a stupid, superstitious society peopled with human beings who like to think that bad things only happen to bad people who bring down the wrath of the gods onto themselves. They ignore these uncomfortable facts because the medical community is largely peopled with human beings who don’t want to admit that the diet they’ve been prescribing may, in fact, be the *cause* of disease, not the cure.

Metabolic syndrome does NOT only affect fat, lazy people. Until doctors can acknowledge that fact, they’re never going to cure it.

11 posted on 03/27/2010 12:01:48 PM PDT by Marie (Obama seems to think that Jerusalem has been the capital of Israel since Camp David, not King David)
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To: Marie

Amen! They do this because it is acceptable to say to someone, “You are unhealthy!”, but not “I don’t like the way you look.”

Most of what is written concerning health these days is based on prejudice and on “what everybody knows is true”. People want to believe that if they achieve some magic weight and “normal” numbers, they will never get sick and die. Americans are adherents of the religion of healthism, so anything that defies conventional wisdom is heresy.

For more health info from a different perspective, you might enjoy Nortin Hadler’s books (The Last Well Person and Worried Sick). Also there is a great blog, junkfoodscience@blogspot. com.

There is a very old book called The Wisdom of the Body that very clearly demonstrates that our bodies are not passive containers. In other words, there is a reason for everything our bodies “do”. Bodies will defend the status quo, sometimes in ways we do not understand or may not perceive to be helpful - such as gaining fat.

The more we find out; the more we discover how little we understand about our bodies and about health. Question everything the experts say.

12 posted on 03/28/2010 8:23:12 PM PDT by Pining_4_TX
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To: neverdem

Oddly enough (or perhaps not, given this information) the very fattest among the Pima Indians who have diabetes, generally are the healthiest. Perhaps the good doctors are right. Gaining weight helps the body cope with whatever it is that causes type 2 diabetes. After all, some of the drugs used to treat type 2 cause weight gain.

As Alice said, “Curiouser and curiouser.”

13 posted on 03/28/2010 8:35:40 PM PDT by Pining_4_TX
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To: neverdem
Well, so long as we now understand that it is because of Syndrome...


14 posted on 03/28/2010 8:40:06 PM PDT by 70times7 (Serving Free Republics' warped and obscure humor needs since 1999!)
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