by Dr C.S. Foo
Men turn into apples and women become pears. The twin factors of sedentary lifestyle and one meal too many lead to an expanding waistline, facilitated by male hormones. Females put on weight around the hips, buttocks and thighs. Interestingly, when the ovarian door closes in menopause, the distribution of fat becomes concentrated in the abdomen, once again auguring well for sexual equality.
The body mass index (BMI) is popularly used to gauge obesity, but one can have normal BMI and yet carry unseen excess fat. Why all this fuss about fats? Obesity is obviously linked to a host of maladies but it is the dangers of hidden fat that needs to be urgently unmasked.
There are an estimated 40 billion fat cells (adipocytes) in the adult body, soaring to thrice that level in some cases. Each fat cell contains essentially a large droplet of fat, much like a balloon filled with liquid. It was thought that fat (adipose tissue) is merely a passive storage depot, but we now know that fat cells are active in producing some good stuff and some really nasty stuff, depending on the type of fat and its distribution.
A crucial and beneficiary regulatory hormone produced by the fat cells, known as leptin, is instrumental in controlling appetite and determining the rate of energy expenditure. With increase in adiposity, the blood levels of leptin rises and provides the brain with a feedback sensation of fullness (satiety) so that one stops eating.
In mice and humans, a defective gene labeled the 'obesity gene' has been isolated. This leads to lack of leptin, and the brain does not get the message that the stomach is full, thereby contributing to a voracious appetite. Fortunately such morbid obesity genetic defects are rare, so we have no grounds to blame our parents.
The root cause of 40% of adults being overweight lie in the vagaries of our modern lifestyles, which has a strong emphasis on convenience (fast foods and remote controls) and inertia (for physical activity).
It is well documented that cardiovascular conditions have an underlying inflammatory pathway. Fats, in particular those residing in the abdominal cavity, sends out dangerously potent and inflammatory proteins which cause blood vessel damage and constriction, leading to a tendency towards heart disease, diabetes, hypertension and stroke.
Types of Fats
When a sumo wrestler stamps his feet, the tsunami of lard sets off undulating ripples across the body. This subcutaneous fat is that cushion lying just beneath the skin. Getting rid of such fats has given rise to the multi-billion dollar business of wraps, massages, fad diets, drugs, invasive procedures, surgery, and so on. However, what is the point of looking good on the outside when you are dilapidated on the inside?
Fortunately, subcutaneous fat is less sinister than the fat hidden in the belly, that which envelopes the gut, infiltrates the liver and strangles the heart. This is called visceral fat. The young sumo champion gobbles pots of 'chanko', a vegetable and meat broth, which in moderation is actually a healthy stew. A well built rishiki (sumo wrestler) consumes 20,000 calories per day and naps after meals. Of course he spends hours in training.
Surprisingly, the blood pressure and cholesterol levels are generally normal during the winning years. The pendulum swings the opposite direction upon retirement. The metabolic rate reduces with less activity while eating patterns remain in excess, resulting in redistribution of fat from the subcutaneous depot to visceral fat.
Many sumo retirees suffer from hypertension, diabetes, heart disease and stroke. To top that off, all that stamping and stomping plus carrying the massive weight ushers painful osteoarthritis of the knees.
The lifespan of a professional sumo wrestler is shorter than the general population by 10 to 15 years.
Fats That Kill
Accurate measurements of visceral fat requires advanced and expensive imaging techniques, which is not feasible on a large scale, and is unnecessary. An abdominal girth of 90cm for women and 100cm for men, measured with a tape around the tummy, just below the belly button (navel), alerts the owner of a serious malady.
Visceral fat is like a selfish patron, first to get in, last to leave. Being a troublemaker, it is metabolically active and quietly releases disturbing susbstances called adipokines like IL-6 (interlukein -6) and C-reactive protein. These covert radicals cause progressive widespread inflammation and organ damage which is unfelt until ... wham! The door bursts open and spews out a squad of assailants.
Cause of Visceral Fat
When we were in our teens, we wore waist size 25; in our 20s, size 30; and it shot up to 34 or more after that. What we gained in pounds, we lost in health. If one could see inflammation, it would be like a cauldron on a fire, slowly boiling.
Middle age seems to be the period that the midsection makes its announcement of arrival. Many people attribute it to a slower metabolic rate with increasing age. The underlying reason is that we incessantly pamper our palate and live to eat, rather than eat to live. Aren't we always making a beeline for our favourite sea-food restaurant or other?
A new tagline for some is "see food, eat", even when not hungry.
When we were younger, we had more activities and our metabolism was all about churning up energy. One calorie in was one calorie out. Come adulthood, we become overstressed, overworked, and underpaid and spend more time trying to chase the dollar, neglecting the most important pillar of health - exercise.
Most outings revolve around food and the calories begin to pile up. Since the body is not utilising the energy, the excess calories are channelled to fat, notably visceral fat. Now a calorie in is no longer a calorie out.
The fat cells lining the intestines begin to fill up and like a wet cloth 'drips' into the circulation, known as the portal system, which brings the excess fats to the liver to be converted into a much misunderstood player called cholesterol.
Fatty liver is an extremely common finding, but despite its hazards, has been given a cursory glance only. For connoisseurs of French food, foie gras is derived from inhumanely forced-fed baby geese. The delicacy melts in the mouth like butter because it is essentially a diseased fatty liver.
Similarly, if we overeat, our liver becomes infiltrated by fat as well, paving the way for liver inflammation and potential development of cirrhosis later.
Many, including health professionals, thought that the root cause of obesity is due to high fat intake. This is certainly not the case if our daily calories from fats do not exceed 30%. The body needs good fats for many metabolic functions.
The bigger culprit is bad carbs (carbohydrates), especially those highly processed like white jasmine rice, white bread, noodles, kueh teow, frosted cereals, doughnuts, etc, and starchy fruits and tubers like banana and potato.
One Bad Apple Spoils the Family
Anyone 'privileged' to have eaten a rotten apple knows that the fruit may look good on the outside but can harbour a little worm inside. In the male predominant apple-shaped profile of central obesity, there is more than one slimy worm.
Many people undergo an annual medical check-up, but fail to realise the impact of the results, especially those who try to save on professional advice by 'going direct' (to the laboratory).
An increase in blood fats (triglyceride), often accompanied by raised cholesterol, is an important indicator of risk. Inflammation of the liver may show up as raised liver enzymes. The blood sugar may be just sitting on the fence. C-reactive protein is a marker for underlying inflammation. The blood pressure may be just touching the upper limit.
Train of Destruction
Something is not quite right but there are no symptoms of being unwell. The train of destruction has left the station as :
* Metabolic syndrome (Syndrome X) takes root.
* High fats floating around the circulation can lead to toxicity (lipotoxicity). Notable organs that succumb are the pancreas and liver, heralding diabetes and liver disease.
* Nasty inflammatory proteins sets up blood vessel damage, leading to high blood pressure, heart disease and stroke.
* Sleep apnoea is a common disorder of nocturnal disturbance to self and people in the same room. Loud snoring, disruptive breathing due to a thick neck, increased density of fatty tissue around the roof of the mouth (soft palate), throat and tongue is evidence of airway obstruction. There is a definite link between visceral obesity and sleep apnoea.
Some studies link the development of visceral fat to dementia or Alzheimer's disease. Big belly, smaller brain, less self control – amazingly, we know that even without medical evidence.
Releasing the Fat
Visceral fat is like a prison, once in, hard to get out. Metaphorically, obesity is like an incarcerated prisoner serving time. It could be a life sentence, but the fat can be released after rehabilitation.
To secure its emancipation, a little alteration (or major change for some) in lifestyle and diet is without a doubt a prerequisite. Selecting the right exercises, which includes aerobics, is essential. Doing a couple of sit-ups or spot abdominal exercises can tone the muscles but would not reduce visceral fat.
Cutting down highly processed carbohydrates, fatty foods and reduced total calorie intake is an integral component of weight management. There has to be a workable programme to reverse the trend in central obesity. Find a plan that works and work the plan, not just for a fixed duration – make it a lifelong practice.
There are no miracle pills, creams, teas, fad diets or massages that can effectively release the entrapped fats. Even accepted cosmetic surgical procedures like liposuction only tackle subcutaneous abdominal fat, and do not kill the fat within.
More info on VISCERAL FAT here.