Your Fat (no, not YOU'RE Fat)

While attending medical school at the University of Cincinnati back in the 1970s, the faculty would occasionally warn us that “…about half of what we’re teaching you will be proven wrong in five years.” In hindsight, although that was a bit of an exaggeration, they were making an important point: knowledge grows, insights multiply, and soon science and medicine evolve to new understandings and practices. In other words they were saying, never be complacent and think that the answer has been found. Science is a process, not a religion.

One particularly good example of a changing scientific landscape is our knowledge and understanding of body fat (also know as adipose tissue). Three decades ago we were taught that fat was a dumb tissue unlike those making up sophisticated organs like the kidney, brain or heart, and it merely served as a depot for energy storage. The cells making up this tissue are called adipocytes and we now know they are far from dumb, and further, when enough of them gather together in certain places in your body this fat can actually control your destiny...no foolin'!

Please see illustration below:

Graphic from hypericum.com

The midsection fat (slang terms abound, e.g., jelly belly, beer gut, front porch, muffin top, bay window, love handles) is actually composed of two very different types of fat: the subcutaneous fat that lies just below the skin and pictured as light blue and the visceral fat which lies underneath the abdominal wall (which includes the muscle layer) and is pictured in dark blue. The subQ fat is the soft material that you can easily grab and hold--that is, unless you have a near-perfect six-pack or "washboard" set of abdominal muscles.

Below you can see two abdomens...the guy above has essentially NO subQ abdominal fat whereas the guy below looks like he put a few pounds on since college.


The image above is from here, and the one below is from here.

What has been learned in the past two decades is that the visceral fat, that is, the adipose tissue within your abdominal cavity actually acts as an endocrine organ and can have a significant effect on your metabolism. This intra-abdominal fat significantly increases the risk for cardiovascular disease, hypertension and diabetes.

One reason that the visceral fat has such a profound effect on our metabolism and disease risk is that the blood from this visceral fat drains directly into the liver, our master metabolic organ. Through the hormones that this fat secretes, it controls--among other functions--how our body reacts to the insulin that our pancreas puts out. Increased visceral fat increases the cell's resistance to the action of insulin; the pancreas senses this, and then ratchets up the amount of insulin it secretes. When the pancreas cannot keep up with the increased demand for insulin caused by this insulin resistance, type 2 diabetes develops.

The distribution of body fat is dependent on several variables including genetics, metabolism, hormonal balance, the presence of certain diseases, aging and sex. For example, when women go through menopause their fat distribution shifts from the periphery to the center, and they often get belly fat similar to that of overweight men.

Ok...so what does this all mean?

• First, understand that sit-ups will not give you a spot-burn and get rid of belly fat; you cannot tighten up what you can grab above the muscle layer--you must lose it through negative calorie balance


• If you distribute excess fat more or less evenly over your body and do not concentrate it in your abdomen you are less at risk for diabetes and cardiovascular disease


• You will lose fat in the order that you put it on--last on, first off


• If you have a family history of diabetes, hypertension, heart attacks or other cardiovascular disease, reducing abdominal fat should become a serious personal goal

© Copyright 2009 Doctor's Weekly Commentary

May not be reproduced whole or in part without citation and/or link to this site

The Wrath of Grapes

The Bible warned about it in Isaiah and Homer wrote of its most unfortunate effect, accidental death. It is the hangover, that acute post-alcohol morning-after illness that many of us first experience as undergraduates. The hangover differs, of course, from the effects of acute alcohol intoxication ("I promise...God...if you stop the room from spinning I'll never drink this much again") in that it occurs later on when your blood alcohol is zero and would pass a sobriety test. It also differs from the infamous post-red wine headache that is not related to the morning-after alcohol effect discussed here.

It is likely that the hangover is older than recorded time, in that it was first experienced in prehistory many times amongst peoples on different continents when they independently discovered (by accident) that fermented carbohydrates produced a substance that made you feel...how shall we say...unusual.


Moving from the Neolithic to the present, my good friend Donna N. asked me to try and separate out truth from fiction regarding this phenomenon. And the fact that Donna asked me about this subject does not indicate that she repeatedly drinks herself into a sorry state only to awaken the next morning feeling miserable; Donna is a modest drinker who nonetheless suffers these symptoms.


This illustrates an important point that will often run through these columns, namely that we all have highly individual reactions to environmental determinants of both our short- and long-term health. That's right, although "we're all different" sounds trite, it is certainly true when it comes to health and disease. So, while some of us will be "hungover" after two glasses of wine the night before, others can bolt out of bed at 6:30 the next morning--after having had three shots of tequila, two scotches and a brandy nightcap the night before--and get to the gym with no problem. On the other hand, there is evidence that the more one drinks, the more likely the occurrence of a hangover (what pharmacologists call a dose response), but this rule does not work for everyone.

The Symptoms

About 2/3 of sufferers will have a headache and just feel lousy overall ("poor sense of general well-being"). One-third will have diarrhea, whereas one in five individuals will have either loss of appetite, tremulousness or fatigue (though these symptoms can occur together). Ten per cent also complain of nausea (this seems a bit low to me!). These numbers come from a table in an article in the Annals of Internal Medicine that forms the main basis for this column.

Where do the Symptoms Come From?

One long-standing theory has been that the acute alcohol hangover is the first stage of alcohol withdrawal; that is, the syndrome alcoholics suffer when they abruptly stop drinking. While the hangover and withdrawal do share some symptoms (e.g., headache, fatigue and feeling lousy) this theory has been discounted; however, this hypothesis has likely contributed to the legendary "hair of the dog" treatment for hangovers (that is, having some alcohol the morning after) that should not be tried!

Alcohol ingestion decreases the secretion of an important hormone that helps control our body's water content, namely antidiuretic hormone. Therefore, if levels of this hormone decrease, water is lost through the kidneys since unopposed diuresis now occurs and dehydration results--with resulting symptoms.

Acetaldehyde, a product of alcohol metabolism, may also be responsible for some of the symptoms. Individually, we all produce varying rates of acetaldehyde depending on the genetically-programmed levels of the necessary enzyme that we possess. Another possible cause of hangover symptoms are compounds related to alcohol called congeners, and these are specific to the process whereby individual spirits are produced. Since "see-through" spirits (gin, vodka and rum) have less than the dark liquors and wine, it is thought that the former are better than the latter for avoiding hangovers.

Further suspects for the hangover symptoms are hormonal derangements, altered glucose metabolism and neurologic dysfunction. We likely will never know for sure what the most important cause(s) is (are) since this is not a high research priority of the NIH or the pharmaceutical industry.

What to Do

First, do not drink to excess; but, if a long night of festivities cannot be avoided, make sure you eat! Food in ones' stomach during times of ethanol ingestion has been associated with less in the way of hangover symptoms. Second, drink plenty of water (the water mixed in with the Scotch does not count) during your drinking, or at least before you go to bed that night. This will help offset the morning headache that is likely the result of the aforementioned dehydration. This should be especially adhered to whenever the drinking environment is independently associated with water loss (a long flight, a hot afternoon at the company picnic or a day at the beach).

Propranolol, a beta-blocker, has been tested to no avail for the treatment of hangover; glucose solutions have also shown no effect. Positive effects have been shown for certain NSAIDS (drugs in the ibuprofen/Advil class) and B-vitamins.

Recommendations

All right: you've awoken with a dreadful hangover. What to do?

• Have 8 ounces of water
• 20 minutes later, have another 8 ounces of water, this time accompanied by an NSAID (Advil or equivalent ibuprofen or the longer-acting Aleve; dose of ibuprofen 400 to 600 mg; be sure to take with at least 8 oz water for stomach protection)
• Do not take Tylenol or equivalent; not good for liver with the alcohol in the rear view mirror
• Take a multi-vitamin or B-complex (there is a small study that showed a positive effect here; at any rate, as my grandma would say: "It couldn't hurt")
• As soon as you feel up to it, have a banana, cereal or eggs over easy and some toast
• Continue to rehydrate with water

Here's to ya!

© Copyright 2009 Doctor's Weekly Commentary
May not be reproduced whole or in part without citation and/or link to this site