Fat cells weigh in with more bad news

By KAREN UHLENHUTH

The Kansas City Star

http://www.kansascity.com/mld/kansascity/living/9415849.htm?1c

If fat cells, those glistening globules packed into our ever-swelling
buttocks and bellies, would only spend their days in idle repose
like
good
couch potatoes, they wouldn't be such a worry.

But it's turning out that those blobs of blubber are industrious.
That's not
to say they burn a lot of calories. They don't. What researchers are
discovering is that fat cells are busy manufacturing and secreting
all
manner of hormones and other chemicals that seem to fuel chronic
ailments
such as heart disease and hypertension.

"The hormonal story is fascinating because there are so many things
that fat
cells make that could be impacting our health," said Michael Jensen,
a
professor of medicine at the Mayo College of Medicine in Rochester,
Minn.
Indeed, many people in the booming field of fat-cell research now
think
of
fat as an endocrine tissue, much like adrenal glands and ovaries.

For years it has been known that fat tissue, along with the ovaries,
produces the female hormone estrogen. But that's just the start.
About
10
years ago, the science of fat went slip-sliding into a new paradigm
when a
researcher discovered that fat cells make leptin, a hormone closely
tied
with appetite and the growth of fat tissue. Many more compounds — 25
or
30,
according to one researcher — have been added to the list since then.

Two that have been getting attention in medical research circles are
adiponectin and resistin. Resistin is thought to impair the body's
ability
to use insulin, the hormone that helps the body keep a fairly
constant
blood
sugar level. As people get fatter, they tend to have higher levels of
resistin. The other one is adiponectin, which appears to have the
opposite
effect, making it a "good" hormone. Naturally, people with more fat
tend to
have less adiponectin.

In addition, fat cells churn out a whole array of cytokines, which
are
compounds that encourage cells to grow and that are associated with
inflammation. Inflammation of the blood vessels is now thought to be
the
cause of many heart attacks, and some experts suspect that
inflammation
is a
factor in the development of diabetes and cancer.

The hormonal fallout from being overweight makes the body behave as
if
it
were inflamed, said George Bray, chief of obesity and metabolic
diseases at
the Louisiana State University Medical Center in Baton Rouge.

Obese people tend to have high levels of C-reactive protein, or CRP,
according to William Haynes, a professor of internal medicine at the
University of Iowa. Haynes studies how obesity raises blood pressure
and
damages blood vessels. Some medical people think that C-reactive
protein is
a better indicator of heart disease than cholesterol levels.

"It could be that fat cells make (the compounds) that cause the
liver
to
make CRP," Haynes said.

And that's not all the trouble that fat cells are causing. Blood
pressure is
controlled by a group of compounds that, for example, tell the body
to
take
in and retain more salt and water. More of the compounds in the body
translate roughly into higher blood pressure.

"It's clear that fat cells can produce some of the components of
this
system
" Haynes said. The bottom line: Fat people are more likely to
develop
high
blood pressure.

Unfortunately, there's still more to the story. It turns out that
fat
cells
produce a compound whose nickname is PAI1. People with lots of PAI1
are
at
increased risk of developing blood clots.

All of the above is why Bray calls overweight "a chronic, relapsing
neurochemical disease."

And while health problems tend to increase along with the amount of
fat
tissue in the body, scientists suspect that what matters more than
the
quantity of fat is the size of the fat cells. A person of healthy
weight
might on average have about 22 pounds of fat containing 14 billion
fat
cells
according to Jensen's calculations.

As we age, our fat-cell count can change. It may decrease and can
certainly
increase. At the same time, the cells themselves can shrink or (more
often)
swell with every hot-fudge brownie sundae.

As Americans pack on the pounds, fat cells get bigger, until they
reach
their limit. Then a new fat cell is created.

The job of the fat cells is to release just as much fat into the
bloodstream
as the body needs for fuel. When you consider that even a slim
person
has
enough fat to keep her going for three months, it's apparent that
those
14
billion cells need release only a fraction of their contents, Jensen
said.

If those 14 billion cells release even a little bit more fat than is
needed,
the effect is higher blood sugar levels, insulin resistance and on
and
on,
Jensen said.

And bigger fat cells seem to be less well-controlled than smaller
ones.

"Obesity is a disease in its own right because it has big fat
cells,"
Bray
said. "The big fat cell is the pathology. If you don't change the
size,
you
don't change the disease."

Researchers at Washington University investigated that issue in a
study
that
was published in June in the New England Journal of Medicine. They
recruited
15 obese women. Seven had Type 2 diabetes and eight had slightly
impaired
insulin sensitivity.

"When people are on a diet and lose 5 to 10 percent of their fat,
their
cholesterol and blood pressure improve, (along with) their response
to
insulin," said Selma Mohammed, a physician and research instructor
at
the
university's Center for Human Nutrition. "We figured if people can
lose
weight by dieting and have beneficial effects, we would try it by
just
sucking out the fat."

They used liposuction to remove about 20 pounds of abdominal fat
from
each
woman, resulting in about a 10 percent overall weight loss. A few
months
later, they evaluated the women's health and found that their insulin
sensitivity had not improved. Reduced insulin sensitivity is
important
because generally it is a precursor to Type 2 diabetes. Furthermore,
the
researchers found no reductions in their subjects' levels of
inflammatory
compounds, nor any improvement in their lipid levels or blood
pressure.

The bottom line: There's no painless way for people to shed their
excess
weight. It seems that eating fewer calories than you burn "may be
what
triggers cells and enzymes in our body to lead to improved
metabolism,"
Mohammed said. In other words, fat cells don't ratchet down the
hormones and
other proteins they pump into the bloodstream until they've gone to
bed
hungry a few nights.

To reach Karen Uhlenhuth,

features reporter, call

816) 234-4783 or send e-mail to kuhlenhuth@....
Fat facts


• A person of healthy weight has, on average, about 22 pounds of fat.

• Those 22 pounds contain roughly 14 billion fat cells.

• About 320,000 people in the United States had

liposuction in 2003

• Fat deep within the

abdomen causes the most health problems
http://www.kansascity.com/mld/kansascity/living/9415849.htm?1c
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