Obesity. The Scourge of Modern Society

I must be cruel only to be kind, thus bad begins and worse remains behind. – Hamlet, William Shakespeare.

The afternoon had been brutal; temperatures melting the thermometers. A brownish glazed haze hung over like a limp dirty rag. The sky was obscured and the sun barged through with a bright circular, blinding orb; a view from a glaucoma eye. The streets were bare as the shimmering pavement cast its vistas of watery mirages.  I walked into a bar/cafe for a cold drink.

The bar was bustling with patrons. What caught my eye was the number of people draped over the stools on which they sat. Not a single seat fit the size of the seat. There were unambiguous folded-over curls of fat barely concealed by the clothes that were stretched at the seams.

Currently 73 million Americans are classified as obese and national spending on obesity related illnesses dwarfs illnesses related to alcohol and tobacco (the other civilization curses). It is estimated to cost $344 Billion by 2018 (ncbi data)

Obesity Data Adults and Children:

My mind goes ballistic when faced with these facts. No wonder we are where we are. The decline in health, the cost of healthcare not withstanding, we are doing it to ourselves. We indulge and want a pill. In fact a physician friend of mine remarked the other day, “I have a party to go to. It is at a such-and-such restaurant, you know the one where they have the delicious desserts with cheesecakes and truffles…” He paused and then said, “You know, I am going to take an extra Statin before I go.” Now granted he is a urologist and not quite that adept with issues of cardiology but also he does tip the scales when he drives his empty car through the highway weighing stations. He dresses in the extra-large and consumes the extra-large. There is very little, that has the smell of food, that passes him by without tickling his olfaction or gastric grumble.

I do remember him a decade ago though when he was the spitting image of a daytime TV star. But all that has been folded over and blanketed around by layers and layers of consumables.

What of this? My friend, an intelligent physician, never the less a human being at his basest, is also a victim of his own making. He blames it on stress, anxiety, divorce, work and family. He doesn’t ask my opinion, because I would say the same thing. “Too much food and too many excuses, buddy!”

Obesity Epidemic!

You pay a great deal too dear for what’s given freely. –A Winter’s Tale, William Shakespeare

Obesity is an epidemic. Yes! When 30% of the population is draping over their chairs, taking a pocketful of medications to keep themselves moving and wearing vertical stripes to streamline the misshapen body, then something is terribly wrong. One can easily blame the excess on excess. Wealth transgresses all elements of health until we reach the uber-rich where skinny is the name-of-the-game. And that “skinny” is not acquired from starving but from uber-neuro-stimulants, that only the elite can afford. But the addictive factor is the same. What struck me dumb was the chart that showed the Maltese were heavier then Americans. Say What? They are not wealthy, so what gives?

Le me not digress here too much. Let us look at the vile mechanistic prongs of desire; consumption and obesity.

Childhood Obesity:

This bodes dangerously on our society as a whole. Children are the Future. Preserve and Protect them!

Human Paleontology:

In the ancient days when Jean Auel’s Mammoth Hunters were still in the hunter-gatherer mode, only two fact-lets of life existed: Feast or Famine.

The human body had evolved though the virtues of its plastic genetics into allowing the (human) vessel to consume large quantities of food and store it in the form of “fat” for the lean days of “famine.” Not only was this mechanism true then, it is true today as well in the animal world. For instance the hibernating bears that forage during the seal-stalking season and then lie for months dormant while their bodies consume the fat slowly in their sleep. 

They are lean again after hibernation for more kills for survival. Now lets just imagine that in this land of bears if we were to have a “mega-seal-grocery store” open 24/7 for the bears to visit and satiate themselves. We would have… Obese bears barely able to carry their own weight of thousand pounds and they would probably not be able to stand on their hind-legs to scare anyone, except with their growl. (And then maybe we can spend on their health care also).

So from the metaphorical sublimity of thought to the facts on the physical ground today, one can see the obvious. We have 24/7 food available and there is no famine in at least the near-future, so the act of consumption has taken on a whole new direction. We have changed from “eat to live,” to “live to eat.”  We are devising more mechanisms to enjoy the abundant food in newer and newer ways. There are TV Chefs propounding one recipe after another making mountains out of butter and tall buildings out of chocolates. The constant barrage of this advertising campaign, out pours the juices of desire and lust into a mind filled with “wants.” One should ask, “Why does not the body not stop the consumption once it is satiated?”

Energy for the Organs: Glucose

Ah! here lies the rub of biological trappings in altered semantics. Food that is consumed is converted to glucose. As the liver does its wonderful and steady-paced work in this conversion called “Glucogenesis,” the glucose is liberated into the blood to reach its various destinations throughout the body for use. Remembering that the cells derive energy from glucose to commit to their functions: Liver; Assimilates and reprocesses food along with Glucogenesis, forming various clotting factors and creating enzymes, etc, Heart: Needs its energy requirements for pumping blood continuously for the human life-time with it’s over 2 Billion beats, Brain: In electrical transmission, dissemination of information within and storage of information, Muscles; to keep us moving, Bone; modulation to keep us from fracturing into a heap, Kidneys; for filtering the blood, good from the bad  and the Lungs; Work by exchanging gases: oxygen for carbon dioxide. So yes the glucose has all those places to visit to keep this wonderful organs to keep doing what they are supposed to do. The hormone responsible for delivering glucose to the cell and the muscles is Insulin. Once that process has been completed, the leftover glucose is converted into free fatty acids by the liver and stored as fat. Insulin is also instrumental in that lipid deliverance.

Energy for the Organs: Fatty Acids

It becomes obvious for all to see that excess of unutilized glucose would result in excess of stored fat. (Lipogenesis) That is exactly what happens. Additionally trans-fat consumption leads to a triglyceride blood-load, which flows through the liver and is converted into Fatty Acids for use as energy. Excess amounts return to the liver to be stored as fat. As more and more fat is stored in the liver and cause degeneration, free fatty acids roam the arborized jungle of the blood vessels. Excess of unconverted free fatty acids are also metabolized into LDL and VLDL. It is important to remember that fatty acids by themselves have very important functions in restoration of energy and since all the cellular walls are composed of phospholipids there is direct need for a constant supply of fatty acids for new-forming cells in the body and the brain.  (Thus removing the lipids artificially is also fraught with some concern: Some of the “Statin” side effects of muscle cramps, pain (Rhabdomyolysis) and memory loss are a result of this withdrawal.) A balance is needed.

“Fatty acids synthesized by the liver are converted to triglyceride and transported to the blood as VLDL In peripheral tissues, lipoprotein lipase digests part of the VLDL into LDL and free fatty acids, which are taken up for metabolism. This is done by the removal of the triglycerides contained in the VLDL. What is left of the VLDL absorbs cholesterol from other circulating lipoproteins, becoming LDLs. LDL is absorbed via LDL receptors. This provides a mechanism for absorption of LDL into the cell, and for its conversion into free fatty acids, cholesterol, and other components of LDL. The liver controls the concentration of cholesterol in the blood by removing LDL.”

Fatty Acids and Gene Control:

These are the fatty acids that my urologist friend was trying to minimize in his bloodstream.  Fatty acids are saturated  (if they have a double Hydrogen bond) or unsaturated and they too display Cis or Trans moiety (Left, Right tendencies) The proper fit for each fatty acid is needed for  function. (If the glove fits…) Fatty Acids store more than 6 times energy as compared to glycogen and the energy they release is via transportation into the mitochondria, where by beta oxidation and electron transport, energy is released and used by the cell. If my friend thought through the mechanistic triangle, he would easily see the irony of his actions.  And speaking of genetic mediation of the fatty acids, there is some data that suggests that about 12 SNPs (Single Nucleotide Polymorphism) on the ATGL (Adipose Triglyceride Lipase) gene is associated with the Free Fatty Acids, Triglycerides and Type 2 Diabetes. Any mutations will lead to disease probability outcomes. And we are not talking about the Apo gene collage which also play a part in the LDL management. (Time for your individual research, otherwise this Blog will reach gigantic proportions.)

Insulin Resistance:

What is interesting is that excess Insulin in the blood stream is among the signal generators transmitted by the brain for the need for glucose. Remembering that the software of the body resides in the brain. All things sensory and motor are driven by this three-pound marvel. So when the brain senses the excess relative/absolute Insulin it sends hunger pangs and borborygmias (growling stomach) and other alerts for hunter-gatherer mission. In obese people the system of alerts are falsely spiked. Here lies the conundrum; when there is excess free-fatty acids floating around and excess fat larding over in the various cellular compartments of the body, the brain is “blinded” to the insulin levels in the blood (which are trying to satisfy the cellular entry “deliverance”) but unable to send the “satiety” signals and therefore the constant hunger pangs continue even after a “Half-Pound cheeseburger, fries, milkshake and a piece of pie, have been consumed.

Organ Effects from Excess:

Excess free-fatty acids and glucose, all conspire to create damage to the various organs. The kidney filtration system suffers forcing dialysis, the blood vessels layered with clogging fat choke the delivery of blood, forcing the heart to beat extra hard and that tires the poor organ into congestive heart failure if not outright a heart-attack from the clogged arteries. The lung’s ventilatory volume is reduced due to the excess belly-fat that prevents full expansion leading to atelectasis. The eye suffers in vision due to retinal artery clogging and damage to the Rods and Cones within it. The brain suffers greatly because of diminished blood flow from the clogged arteries and also from the inactivity that commonly foreshadows obesity, thus names, places and memories get commingled and the thoughts are discombobulated. The liver gets laden with fat and ultimately scar tissue slides in to cause cirrhosis and even liver cancer, while the muscles of the body suffer from disuse and atrophy. So this majestic quintessence of dust, this like an angel turns into a disuse blubbering mass of protoplasm. (I am cruel only to be kind.)

High Fructose Corn Syrup (The devil in its details):

One more thing while I have the hacksaw with me. This High Fructose Corn Syrup, a chemical construct of such great harm, present in every soda, fast food dessert and drink, making all things taste sweet and addictive, is the devil in disguise. We should all take notice when a package states its presence and avoid the package. High Fructose Corn Syrup is pure fructose and pure unadulterated evil. The fructose has to be converted into glucose by the liver and weight for weight it delivers a significant punch. In fact there is data emerging that this “Syrup” has, because of its constant loading of the glucose in the bloodstream causes constant stimulation of the pancreas to liberate Insulin. This constancy leads to fatigue of the organ and ultimately dysfunction. Lab studies also show that High fructose corn syrup causes pancreas cells to proliferate and transform into cancer cells (By inducing Transketolase Flux) .  Quoting Dr. Liu:

“Carbohydrate metabolism via glycolysis and the tricarboxylic acid cycle is pivotal for cancer growth, and increased refined carbohydrate consumption adversely affects cancer survival.”

 And:

“Importantly, fructose and glucose metabolism are quite different; in comparison with glucose, fructose induces thiamine-dependent transketolase flux and is preferentially metabolized via the nonoxidative pentose phosphate pathway to synthesize nucleic acids and increase uric acid production. These findings show that cancer cells can readily metabolize fructose to increase proliferation.”

Insulin Growth Factor and Cancer:

One more thing while I am at it; Excess stimulatory influence of Insulin also stimulates the IGF (Insulin Growth Factor) The receptors for the IGF line themselves up on the surface of various cancer cells and coalesce with Insulin to stimulate the interior of the nucleus (of the cancer cell) to start manufacturing data for fattening, growth and proliferation. The stimulatory influences can be in the form of glucose, corn syrup or Free fatty acids. All three mentioned promoters have an effect on the pancreas to release Immuno-Reactive-Insulin (IRI) to counter the barrage.

Seyffert  et al.state unequivocally:

“Studies indicate that long-chain FFA, in physiological concentrations, can markedly stimulate insulin secretion by a direct effect on the pancreas. The results lend support to the concept of insulin as a hormone that is importantly involved in regulating the metabolism of all three principal classes of metabolic substrates and whose release is in turn regulated by all of them.”

The Pill & Blame Society:

Pills, pills and more pills! In this world where we are inclined to “fix” everything with a pill, There are an overabundance of “snake-oil” pills for you to consider. But consider does not mean consider for use. It means simply that they are harmful and lend themselves to you to perpetrate a fraud on your senses to achieve the desired goal without imposing limitation. No amount of blame on senses will rectify the problem. It is you and you are it, alone, against this beast called obesity. Please note and even though at the risk of repeating myself. No pill designed for weight reduction, will give you health. Period! There are no magic bullets, no potions, no apothecary concoctions that will minister to your need against obesity. There is but one and only one solution and that is limiting caloric intake. Simply: Eat Less!

Simple Dietary Math:

About 3000-3500 calories equate to ONE pound of excess weight. So if one reduces 300 calories a day (One less Twinkie) one would lose ONE pound of weight in 10 days. Simple math, not subject to conditions, questions or scrutiny!

Healthy 2000 Calorie Diet:

The average HEALTHY diet is one composed of 2000 calories a day. In fact data from rats and humans (if you insist) suggest that a 25% reduction in caloric intake leads to a 30% increase in lifespan. So what gives? Why are we trying to circumvent our lives by overeating? And there is very little but laughter that emerges from the Authors who have written countless books on “Special Diets.” They are literally laughing their way to the bank, while you contemplate. Remember it is the Intake (stored energy as in food) – (minus) Output  (Exercise/ work) = Weight Stability Loss or Gain.

Now that I may have set you on the path of research to confirm this truth, let me also say that the 2000 calorie diet that will drive you into the healthy 80s and 90s does not constitute bad foods. One cannot consider a 2000 calorie diet of “cookies and cream” and survive the hammer. Here some modicum of reasonableness needs to be addressed. Eat healthy and add “food-stuff” that is beneficial to you, for instance; broccoli, spinach, carrots, fish, some chicken, some fruit and sparingly (if you cannot give up red meats) a small steak. Limiting alcohol (Alcohol is a sugar and is metabolized into glucose rapidly) and EXERCISE. Ugh! You say now, but not when you are playing tennis, golf or skiing the Rockies, climbing mountain Kilimanjaro or for that matter swimming the English Channel in your 60s, 70s 80s or even 90s!

Obesity and Chronic Illnesses:

So no stones are left gathering moss; I’ll make this simple and direct: Cancer is directly linked to obesity! Obese people who are inactive and have slow colon-transit rates have a higher risk of colon cancer. Obesity is also linked to breast cancer, Prostate cancer and if one really thinks it through most chronic illnesses.

Speaking of Chronic Illness: The morbidity that ensues from obesity includes simple but crippling problems like Arthritis. The cause effect is simple. The joints were not designed by nature to bear ever increasing weights. The wear and tear leads to the canes, walkers and wheelchairs. Obesity is now being recognized as a “Metabolic Syndrome” that has dire consequences.

Metabolic Syndrome:

Emergence of the Metabolic Syndrome classified (ncbi):

“Metabolic syndrome is associated with many conditions and risk factors. The two most important risk factors are:

Extra weight around the middle of the body (central obesity). The body may be described as "apple-shaped."

Insulin resistance, in which the body cannot use insulin effectively. Insulin is needed to help control the amount of sugar in the body.

The disease-complex of Metabolic Syndrome is associated with atherosclerosis, Type II Diabetes, High Blood Pressure, Stroke, Heart Attack, fatty degeneration of the liver and Kidney disease.  New data from the National Cancer Institute suggest a higher risk of liver cancer related to Metabolic Syndrome.

Diabetes Type II. There is enough literature if reviewed would put a person into a state of starvation. Diabetes is a scourge of “advanced civilization” The over-abundance of glucose, stored fat and the inability of the pancreas to keep up with the demands leads to diabetes. Besides an overtaxed pancreas, there is true “blindness” to the circulating insulin by the free-fatty-acids in the blood stream which furthers the cause of having more glucose in the circulation and more unusable insulin that cannot optimally deliver glucose or FFAs within the cell for utility.

Once there was a hope, now vanished, to eradicate obesity with a “pill” called Leptin. No, Nada, Never going to happen! The only hope is that you give yourself a chance to live a healthy life.

There is only one hope if you wish to contemplate on the subject; If you wish to continue consuming large amounts of food: wait for the evolution to genetically modify us humans so we can concurrently metabolize excess – that could take another thousand years, or simply try to “push away from the table” method with “just a little hunger left in your stomach.”

Let me define Obesity once again: Any excess weight that elicits such complications as have hitherto been elucidated. Or for more practical matters: BMI below 30. Weight based on Actuarial Tables (the most accurate since they are associated with morbidity and mortality and the insurance companies assigns risk of capital based on that. The higher the risk the greater the premiums) is probably the most accurate for your own personal health-risk definition. If you can pinch an inch of your waist-line…

Excuses, excuses:

Life is full of excuses. We live under the stress of living. We live under the foreboding of death. We live in the dissonance of thought, of conflicts and upheavals. We live in the pejorative world where humans conspire to advance climbing to the top by “stepping-on” other humans. These are the travails of modern society. Ours is a future that can only be made better by knowing and taking responsibility for our own selves!

He that is good for making excuses is seldom good for anything else. -Benjamin Franklin

Eat Less! Exercise More! Laugh Often!

In nature there is no blemish but the mind: none can be called deformed but the unkind. – William Shakespeare.

References:

Liu, H et al. Fructose Induces Transketolase Flux to Promote Pancreatic Cancer Growth Cancer Res August 1, 2010 70; 6368

Groop, CL, et al. Glucose and Free Fatty Acid Metabolism in Non-insulin-dependent Diabetes Mellitus J. Clin. Invest. Volume 84, July 1989, 205-213

Ellsworth, D. L., et al. (1999) Coronary heart disease: at the interface of molecular genetics and preventive medicine. Am J Prev Med, 15(2), 122-133.

Felber JP, Ferrannini E, Golay A, Meyer HU, Theibaud D, Curchod B, Maeder E, Jequier E, DeFronzo RA. Role of lipid oxidation in pathogenesis of insulin resistance of obesity and type II diabetes. Diabetes. 1987 Nov;36(11):1341–1350

Seyffert WA, Jr, Madison LL. Physiologic effects of metabolic fuels on carbohydrate metabolism. I. Acute effect of elevation of plasma free fatty acids on hepatic glucose output, peripheral glucose utilization, serum insulin, and plasma glucagon levels. Diabetes. 1967 Nov;16(11):765–776

Lakka T, Laaksonen DE. Physical activity in prevention and treatment of the metabolic syndrome. Appl Physiol Nutr Metab. 2007;32(1):76-88

Tania M. Welzel et al. Metabolic syndrome increases the risk of primary liver cancer in the United States: A study in the SEER-medicare database. Hepatology  Volume 54, Issue 2, pages 463–471, August 2011

The ATGL gene is associated with free fatty acids, triglycerides, and type 2 diabetes. Diabetes. 2006 May ;55(5):1270-5.