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  #1   ^
Old Tue, Mar-09-10, 02:59
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Demi Demi is offline
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Default Obesity as Protection Against Metabolic Syndrome, Not Its Cause

Quote:
Obesity as Protection Against Metabolic Syndrome, Not Its Cause

ScienceDaily (Mar. 9, 2010) — The collection of symptoms that is the metabolic syndrome -- insulin resistance, high cholesterol, fatty liver, and a greater risk for diabetes, heart disease, and stroke -- are all related to obesity, but, according to a review in the March 9th issue of Trends in Endocrinology and Metabolism, not in the way you probably think they are.

In fact, says Roger Unger of the University of Texas Southwestern at Dallas, obesity is the body's way of storing lipids where they belong, in fat tissue, in an effort to protect our other organs from lipids' toxic effects. It's when the surplus of calories coming in gets to be too much for our fat tissue to handle that those lipids wind up in other places they shouldn't be, and the cascade of symptoms known as metabolic syndrome sets in.

It comes down to simple facts that all of us know on some level or another: Americans since the 1950s eat too much high-calorie food loaded with carbs and fat (what Unger calls "potent adipogenic nutrient mixtures") and, thanks to modern technology, we move far too little. Until that changes, Unger doesn't see any end to the growing epidemic of metabolic syndrome. Still, our metabolisms aren't broken; the pathways that squirrel fat away as an energy source for use in lean times are just completely overwhelmed. "We are pushing our homeostatic capability to the maximum," says Unger, who coined the term "lipotoxicity" in 1994. "Overnutrition used to be rare -- reserved for those in the castle. Today, it's just the opposite. Bad calories are so cheap that anyone can afford to get overweight."

Unger cites plenty of evidence in support of a protective role for obesity. Genetic manipulations in mice that increase or decrease fat formation have provided evidence that adipogenesis, meaning the generation of fat cells, delays other metabolic consequences of overeating. The reverse is also true, he writes. Obesity-resistant mice have in some cases been found to develop severe diabetes upon eating too much, as a result of lipid accumulation in tissues other than fat.

There is some disagreement in the field about whether insulin resistance is a primary cause of metabolic syndrome or just one of its features, Unger notes. But on this, too, he has a clear view. Insulin resistance is not the cause of metabolic syndrome, he says, it is a "passive byproduct" of fat deposition in the liver and muscle once storage in fat cells begins to fail.

It also makes sense in Unger's estimation that cells that have already taken on too much fat would begin to exclude glucose, causing its levels in blood and urine to rise. Once in cells, glucose becomes a substrate for the production of more fat. "The body is doing what we should have done -- keep excess calories out -- and it may be protective," Unger says.

At the center of the transition from protective obesity to metabolic syndrome is resistance to the fat hormone leptin, well known for its appetite-suppressing effects, Unger says. The hormone is also responsible for partitioning fat in the body. The rise of leptin as fat stores grow is therefore an adaptive response, but that can only go so far before resistance sets in.

Based on the genes they carry, some people will be better able to sustain lipid storage in fat and can get away with being overweight, even obese, without the other symptoms. Eventually, though, the need to cut calories is something all of us will face.

"Once you reach a certain age, almost everybody is leptin resistant," he says. "Nature stops protecting you once you pass the reproductive years," requiring all of us to watch our diets and do exercise.

Unger's perspective comes from the research he does at UT Southwestern's Touchstone Center for Diabetes Research and a thorough understanding of the scientific literature, but it also stems from his own memories in childhood when one only saw fat ladies at the circus. "That's how unusual it was," he says. "The younger you are, the more skewed your perception is of an epidemic that surrounds you."

Unger concludes his review article this way: "Based on evidence reviewed here, it seems that prevalent forms of metabolic syndrome and T2DM [type 2 diabetes mellitus] result from unremitting caloric surplus complicated by failure of adipocytes to maintain protection against lipotoxicity. If one imagines the USA population to be unwitting volunteers in the largest (300 million subjects) and longest (50 years) clinical research project in history, the specific aim of which was to determine if the deleterious effects of sustained caloric surplus in rodents also can occur in humans, the outcome of the project becomes clear -- after 50 years of exposure to an inexpensive calorie-dense diet high in fat and carbohydrates, 200 million subjects are overweight and >50 million have metabolic syndrome. The failure of healthcare providers and pharmaceutical industries to contain the pandemic suggests that elimination of 'bargain basement' calories will be required to 'price obesity out of the market.' Unfortunately, this would have profound socioeconomic implications: How do we tax excessive calories while at the same time guaranteeing sufficient access to high-quality foods for the underprivileged?"

Journal Reference:

Scherer et al. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity. Trends in Endocrinology and Metabolism, March 9, 2010
http://www.sciencedaily.com/release...00308122023.htm
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  #2   ^
Old Tue, Mar-09-10, 04:58
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  #3   ^
Old Tue, Mar-09-10, 19:12
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Quote:
The failure of healthcare providers and pharmaceutical industries to contain the pandemic suggests that elimination of 'bargain basement' calories will be required to 'price obesity out of the market.' Unfortunately, this would have profound socioeconomic implications: How do we tax excessive calories while at the same time guaranteeing sufficient access to high-quality foods for the underprivileged?"

By making meat, eggs and cheese more affordable than carby junk? Of course they won't because these things contain (gasp!) saturated fat, cholesterol and (highly nutritious) calories.
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Old Wed, Mar-10-10, 08:19
renegadiab renegadiab is offline
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Quote:
Originally Posted by Zei
By making meat, eggs and cheese more affordable than carby junk? Of course they won't because these things contain (gasp!) saturated fat, cholesterol and (highly nutritious) calories.


Yep, they mention "fat and carbohydrates" as the culprits. It's the carbs that raise triglycerides, which have to be stored. We know the truth, but the rest of the world can't get away from demonizing fat.
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  #5   ^
Old Thu, Mar-11-10, 04:36
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Quote:
From The New Scientist
March 10, 2010


Obesity: Food kills, flab protects

by Andy Coghlan

OBESITY kills, everyone knows that. But is it possible that we've been looking at the problem in the wrong way? It seems getting fatter may be part of your body's defence against the worst effects of unhealthy eating, rather than their direct cause.

This curious insight comes at the same time as several studies distancing obesity itself from a host of diseases it has long been blamed for, including heart disease and diabetes.

Instead, these studies point the finger at excess fat in the bloodstream, either when the fat cells of obese people finally get overloaded or when lean people who can't store a lot of fat eat too much. This seems to have a destructive effect by provoking the body's immune response.

None of this changes the fact that too much rich food and too little exercise is bad for you. But viewing obesity as a symptom of an unhealthy diet, rather than the direct cause of disease and death, plus a better appreciation of the immune system's reaction to fat, should radically change our understanding of what is shaping up to be one of modern society's biggest health scourges. The findings also point to new ways to treat diabetes, heart disease and other diet-linked conditions.

In recent years, most rich countries, and some poorer ones, have seen a massive rise in so-called "metabolic syndrome", whose symptoms can include insulin resistance, high blood cholesterol and an increased risk of diabetes, heart disease and stroke. That the syndrome goes hand in hand with obesity is well known, but exactly how all these conditions are linked is unclear.

In an attempt to determine the effects of obesity itself, diabetes researchers Roger Unger and Philipp Scherer, both at the University of Texas Southwestern Medical Center in Dallas, reviewed several recent studies of the role of fat cells in humans and mice.

In particular, the pair looked at the fates of people with a genetic condition that means they can't make their own fat cells and mice genetically engineered to have low supplies of these cells and fed a diet that would make normal mice obese. They found that, despite not being obese, both tend to develop metabolic syndrome earlier on in life than their overweight, overfed counterparts.

This led Unger and Scherer to conclude that obesity protects the body from the effects of overeating by providing somewhere safe to deposit the dietary deluge of fat and sugar, which in excess is toxic to many body tissues (Trends in Endocrinology and Metabolism, DOI: 10.1016/j.tem.2010.01.009).

Only when the body's fat cells, or adipocytes, are crammed to capacity do the problems of metabolic syndrome begin. The fully engorged adipocytes begin to die and leak their contents into the bloodstream, including saturated fatty acids such as palmitic acid. Such fats then accumulate in tissues such as the liver, pancreas and heart, where they may prompt the symptoms of metabolic syndrome.

The theory is certainly plausible, says Gökhan Hotamisligil, a diabetes and obesity researcher at the Harvard School of Public Health, Boston, who was not involved in the study. "When fat cells break, it's like an oil tanker being hit," he says. "It unloads this toxic cargo, almost like an oil slick."

It also fits with what we know about age-related obesity. Leptin, a hormone produced by fat cells, directs surplus dietary fat into adipocytes and orders other cells to burn off any fat. Unger and Scherer point to rodent studies showing that leptin's ability to do this drops off with age. The researchers conclude that fats locked safely away in adipocytes get released as we age, and that this could explain why older people who are obese are more at risk of metabolic syndrome.

By shifting the blame from fat to food, Unger and Scherer's hypothesis also helps to explain why not all overweight people develop metabolic syndrome and some lean people do. In 2008, a study found that half of overweight and a third of obese Americans had healthy metabolic profiles, whereas a quarter of "lean" people had signs of metabolic syndrome (Archives of Internal Medicine, vol 168, p 1617).

So why is fat a problem when it breaks free of the protective adipocytes? The answer, it seems, lies with the immune system.

Preeti Kishore and her colleagues at the Albert Einstein College of Medicine in New York, injected the amount of fat typically found in a large beefburger into the blood of 30 volunteers. The volunteers' bodies responded by producing 3 to 5 times as much as normal of a hormone called plasminogen activator inhibitor-1.

"We were surprised by the magnitude of the rise in PAI-1," says Kishore. The researchers suggest that this increase in PAI-1 leads to metabolic syndrome. This makes sense as we already know that PAI-1 aggravates the symptoms of diabetes by making cells less responsive to insulin, which regulates blood concentrations of glucose. It is also involved in blood clotting, and blood clots can lead to strokes and heart attacks.

Kishore's team was equally surprised to discover that PAI-1 was not produced by fat cells, as had been assumed, but immune cells called macrophages lodged in fat tissue. Fatty acids and fat cells both needed to be present to trigger the production by macrophages of PAI-1 (Science Translational Medicine, DOI: 10.1126/scitranslmed.3000292). Kishore says drugs that block PAI-1 or mop up free fatty acids might help prevent metabolic syndrome.

Meanwhile, the link between metabolic syndrome and the immune system has been further confirmed by Hotamisligil and his colleagues. When they fed mice a fat-rich diet, the animals rapidly became obese, insulin-resistant and developed other symptoms of metabolic syndrome. But mice lacking a gene called PKR stayed lean and healthy on the same diet (Cell, DOI: 10.1016/j.cell.2010.01.001).

It seems that PKR activates a "gang" of other genes responsible for inflammation, insulin resistance and metabolic dysfunction. "PKR is a high-ranking officer in this destruction," says Hotamisligil, who adds that blocking the activation of PKR might be a way to fight both obesity and metabolic syndrome.

Unger stresses that the best way to prevent metabolic syndrome is eating less and exercising more. Still, drugs based on a greater understanding of the immune system's role in the condition could be a useful last resort.

How dangerous are the worst foods?

That fatty foods, not body fat per se, are harmful is becoming clearer (see main story). But just how bad are the worst culprits and how do we best reduce their consumption?

Eating too much fatty food is well known to raise the risk of diabetes and heart disease. But consumption of sugary soft drinks, which has soared over recent decades (see graph), can also be harmful. That's because insulin converts any excess sugar into fats called triglycerides, which get dumped in fat cells.

To find out how harmful these drinks are, Litsa Lambrakos of the University of California, San Francisco, and her colleagues analysed data from several major US studies. They estimate that between 1990 and 2000, sugary drinks contributed to 130,000 new cases of diabetes, 14,000 new cases of coronary heart disease, a total of 50,000 years of incapacitation due to coronary disease, and 6000 extra deaths overall. Lambrakos presented the results at a recent Cardiovascular Disease Epidemiology and Prevention conference in San Francisco. "The impact is substantial," she says.

Lambrakos is now investigating whether a calorie tax would discourage consumption of sugary drinks, and there is already evidence that this might work.

Assessing the impact of price hikes on junk food is tough as such food has tended to become less and less expensive in real terms. However, Barry Popkin's team at the University of North Carolina in Chapel Hill used the eating habits of 5115 young adults over 20 years to determine a relationship between the price of various foods and consumption, which they then applied to hypothetical price hikes.

They conclude that an 18 per cent tax on soda drinks would reduce the weight of the average US citizen aged 18 to 30 by 2.25 kilograms per year (Archives of Internal Medicine, vol 170, p 420). A 10 per cent increase in the cost of soda would decrease consumption by 7 per cent, while a similar tax on pizza would reduce consumption by 11 per cent.
http://www.newscientist.com/article...b-protects.html


Quote:
The New Scientist
March 10, 2010

Editorial: Learn to love your fat

AS PEOPLE in rich countries know very well, eating too much food and burning too few calories is why a substantial number of us are overweight or obese. Now, however, a remarkable change in perspective has come from the discovery that obesity actually provides people with temporary protection from the harmful effects of fat.

The insight has come from re-examining the common assumption that fatness itself drives the development of metabolic syndrome, which is what causes so much of the actual damage. The syndrome comes with a mixture of life-threatening effects, with cardiovascular disease and type 2 diabetes being among the most serious.

In fact, it now seems that body fat may be a barrier that stops millions of Americans and portly citizens elsewhere from going on to develop the syndrome.

As we report on page 8, the real damage is caused by the inflammatory effect of high levels of fat in the bloodstream. And ironically, it's fat cells that protect us from this by serving as toxic dumps, locking away the real villains of the modern diet.

The problem is that this protection only lasts so long, until there is simply no more room inside the fat cells. That's when they start to break down, leading to a toxic spill into the bloodstream. This sets off an inflammatory response that causes various kinds of damage to body tissues. In this way, every excess calorie takes people closer to metabolic syndrome.

So what can we do to stop a superabundance of fat triggering the syndrome? Of course there's no substitute for a healthy diet and exercise, but exhortations to this effect seem to be of limited use. As with cigarettes and alcohol, a tax on calories - pricing foods by their energy content - is increasingly seen as another "lever" to change behaviour by making obesity too costly.

The new research may even suggest treatments to combat metabolic syndrome, such as anti-inflammatory drugs. One promising candidate is salsalate, an arthritis drug related to aspirin, and the Joslin Diabetes Center in Boston is now considering large-scale trials.

What might be more helpful, though, is simply a wider recognition that fatty and sugary foods are more directly toxic than we had assumed. Ideally, people should be as well informed about the harmful effects of what they eat as, for example, pregnant women are about drinking and smoking.

There is a consolation - you have your fat tissue to protect you when you consume that extra burger or sweetened soda. But now you know the perils of pushing your friendly fat cells beyond their natural limits.
http://www.newscientist.com/article...e-your-fat.html
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  #6   ^
Old Mon, Mar-15-10, 01:45
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rightnow rightnow is offline
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I've thought several times there must be something to this idea. I mean, my stepmother, same height as me, weighed about 130, was diabetic. I weighed 500# and was not, although I was *very* insulin resistant (although I still am, this has improved enormously from an improved diet and some weight loss). But the point is that quite obviously, just being fat does not 'cause' diabetes or disease as many people seem to think, or I would already be dead 15+ years ago.

The fact that fats store toxins etc. plus now it's starting to seem they have their own effects and operate as a distributed organ, a bit like skin does... does make it seem that fat may even be part of a sort of 'adaptive' element in the body, maybe (given the toxin storing) even related in part to immunity. I dunno, if the body has chronic 'inflammation' how many particles are not healthy, how many are stored in fat cells to 'protect' the body from them, along with other things? I have no idea. I just think there's probably something to this concept that fat may be, functionally, protective in certain regards.
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Old Mon, Mar-15-10, 16:39
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Hutchinson Hutchinson is offline
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Getting fat is good: Official Hyperlipid Petro's take on the paper
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Old Mon, Mar-15-10, 17:06
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Nancy LC Nancy LC is offline
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Scherer et al. Gluttony, sloth and the metabolic syndrome: a roadmap to lipotoxicity.

Not much biblical judgement in that title, eh?
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Old Mon, Mar-15-10, 17:31
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Valtor Valtor is offline
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Originally Posted by Nancy LC
Not much biblical judgement in that title, eh?

I'm reading the full text of this study and I think I actually agree with it.

http://download.cell.com/trends/end...ermediate=true+
Quote:
The pathway to metabolic syndrome: a unifying hypothesis
Role of caloric surplus
The sine qua non of the metabolic syndrome is chronic
caloric surplus. The development of the syndrome is expedited
if the caloric excess is rich in fat plus glucose and/or
other carbohydrates. In the United States, potent adipogenic
nutrient mixtures are provided in the form of
sucrose-containing drinks and carbohydrate-rich fatty
foods. These nutrients potentiate the secretory response
of insulin, producing the hyperinsulinemia that upregulates
expression of the lipogenic transcription factor
SREBP-1c and its target enzymes. In addition, glucose
provides substrate for de novo lipogenesis. This system
allows the surplus calories to be stored as triacylglycerol,
whether derived from dietary fat containing ‘‘prefabricated’’
fatty acids, or produced from surplus dietary glucose...
etc...

Good text so far.

Patrick
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Old Mon, Mar-15-10, 18:23
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rightnow rightnow is offline
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So does that suggest that if you eat intense sugary foods and gluten foods, but do not 'exceed' calories, that there is no damage from this? Metabolic syndrome only happens if someone gets fat? How would that touch the reality of Syndrome X and tons and tons of often thin women who can't conceive and have a variety of other symptoms?

And what is EVER the point of going on about calories when everything from oxygen usage to gut bacteria to metabolic processing is so dramatically different between people -- particularly in combination -- that it nearly ceases to have any meaning? When 700 calories a day for an already super obese woman becomes "too many" to lose weight (ref: Dr. Jeff Freidman's work with post gastric surgery patients), and so ridiculously low numbers of calories can cause actual weight gain in some people -- to me it becomes utter nonsense to even look at this like any intelligent approach to anything. "Too many calories" is a pointless quantifier when that number becomes literally less than any normal person can be expected to live on without actual malnutrition (never mind hunger).

Besides, as Taubes and others explained, everything we eat, sans a little bit at the moment perhaps, basically gets stored as fat. It's simply that normal bodies 'release' that as energy. The same fat cells fill and release. It does not say anywhere in this that what you eat only gets stored as fat if it's "too many calories" over some arbitrary-if-not-magical number; it does not say that what you eat only gets stored if it's bon-bons instead of carrot sticks; it says that food is energy and energy intake stores in the fat cells, period. The issue is its release, not its storage. So the suggestion that obesity is caused by 'too many calories' may have merit, sure, but is clearly not the ONLY cause of 'stored fat'. A metabolic issue can cause the storage of incredibly low calories not because they're "too many" but because *nearly-all* incoming energy -- in any quantity -- is stored and resists release.

I think the way the above is written sounds like it could have come from 30 years ago. That's not a good thing.
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Old Mon, Mar-15-10, 18:51
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I agree that if you ignore the parts about gluttony and sloth, it's not a bad article. Lipotoxicity is worth investigating.
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Old Mon, Mar-15-10, 19:00
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Valtor Valtor is offline
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Quote:
Originally Posted by rightnow
So does that suggest that if you eat intense sugary foods and gluten foods, but do not 'exceed' calories, that there is no damage from this?

No it does not mean that.

Quote:
Originally Posted by rightnow
Metabolic syndrome only happens if someone gets fat?

No, but getting fat protects you from the metabolic syndrome for a while. In theory, you could still develop the metabolic syndrome without getting obese.

Quote:
Originally Posted by rightnow
How would that touch the reality of Syndrome X and tons and tons of often thin women who can't conceive and have a variety of other symptoms?

I don't think this paper touches this.

Quote:
Originally Posted by rightnow
And what is EVER the point of going on about calories when everything from oxygen usage to gut bacteria to metabolic processing is so dramatically different between people -- particularly in combination -- that it nearly ceases to have any meaning? When 700 calories a day for an already super obese woman becomes "too many" to lose weight (ref: Dr. Jeff Freidman's work with post gastric surgery patients), and so ridiculously low numbers of calories can cause actual weight gain in some people -- to me it becomes utter nonsense to even look at this like any intelligent approach to anything. "Too many calories" is a pointless quantifier when that number becomes literally less than any normal person can be expected to live on without actual malnutrition (never mind hunger).

IMHO This paper does not try to properly explain why people overeat, other than mentioning that it is very easy to get an excess of calories from carby foods.

Quote:
Originally Posted by rightnow
Besides, as Taubes and others explained, everything we eat, sans a little bit at the moment perhaps, basically gets stored as fat. It's simply that normal bodies 'release' that as energy. The same fat cells fill and release. It does not say anywhere in this that what you eat only gets stored as fat if it's "too many calories" over some arbitrary-if-not-magical number; it does not say that what you eat only gets stored if it's bon-bons instead of carrot sticks; it says that food is energy and energy intake stores in the fat cells, period.

As far as I'm aware, a surplus of calories (whatever that means) can only go to creating more lean mass and/or stored as glycogen and/or stored as fat. Of course the actual macronutrients consumed affects what happens to the extra energy.

They are saying that any sustained calorie surplus would culminate to metabolic syndrome. Even on an all meat diet. Of course, we both know that a sustained calorie surplus would be hard to accomplish on an all meat diet.

Quote:
Originally Posted by rightnow
The issue is its release, not its storage. So the suggestion that obesity is caused by 'too many calories' may have merit, sure, but is clearly not the ONLY cause of 'stored fat'. A metabolic issue can cause the storage of incredibly low calories not because they're "too many" but because *nearly-all* incoming energy -- in any quantity -- is stored and resists release.

I think the way the above is written sounds like it could have come from 30 years ago. That's not a good thing.

Here is their explanation.

Quote:
(a) Proposed pathway to the metabolic syndrome. Chronic caloric surplus
is here proposed to be the sine qua non for all subsequent events. It differs from
more conventional views of the etiology of this disorder in three main respects: (1)
obesity, commonly considered a ‘‘disease’’ that causes metabolic syndrome, is
depicted here as a normal physiological response to caloric surplus that actually
protects, at least temporarily, by sequestering toxic fatty acids in adipocytes that
would otherwise damage organs. (2) Insulin resistance is also taken out of the
etiologic mainstream to become a consequence, rather than cause, of the ectopic
lipid deposition. (3) Leptin resistance is placed in a key causal role to explain why the
hyperleptinemia of chronic overnutrition ultimately loses its ability to prevent ectopic
lipid accumulation in target organs, at which point the metabolic syndrome is
present.
(b) Role of obesity-induced hyperleptinemia. Hyperleptinemia lowers fat
content in peripheral organs. As adipocytes expand with triglycerides, leptin
secretion increases proportionately. Because leptin stimulates fatty acid oxidation,
adipocytes would be oxidizing, rather than storing, fat if the endogenous leptin they
secrete were to act on them. Such an autocrine/paracrine relationship between the
secretory product, leptin, and the secreting cells, is prevented by a progressive
decline of leptin receptor expression. This physiologic leptin resistance is essential to
permit accumulation of surplus calories into adipocytes. Meanwhile, the lipooxidative
action of leptin is fully operative on peripheral organs, which minimizes
ectopic lipid accumulation, at least temporarily. However, later in life peripheral
organs also become leptin resistant. Leptin action on the hypothalamus limits the
level of overnutrition, whereas lipo-oxidative action of leptin on the peripheral
tissues keeps them free of ectopic lipid accumulation resulting from adipocyte
spillover. If the disappearance of the leptin receptor during overnutrition is prevented
by transgenic overexpression, obesity is prevented.

Patrick
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Old Mon, Mar-15-10, 22:32
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rightnow rightnow is offline
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Ah, I see. more info = clearer. Thanks Patrick.
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Old Tue, Mar-16-10, 13:14
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Nancy LC Nancy LC is offline
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Quote:
Originally Posted by Hutchinson
Getting fat is good: Official Hyperlipid Petro's take on the paper

Heh! This is worth reading...
Quote:
This is ABSOLUTELY crucial. These people have finally gotten the message! And they are idiots! When a concept is so clear cut that even morons can see it, there really is hope for the world.
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Old Tue, Mar-16-10, 17:42
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Valtor Valtor is offline
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Quote:
Originally Posted by Nancy LC
Heh! This is worth reading...

I like reading Peter's blog. But in this case I really think he fell to his own bias. He said it himself that he did not fully read the study. I still think that there is good info from it. Note that they do not even try to explain why we overeat so much, so there is nothing in it that contradicts Taubes et al.

Patrick
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