Fireside Chats with a (student) DPT: FAT: Friend AND Foe

Aren't you lucky? You get the inside scoop on weird body functions, esoteric muscle length-tension relationships, and need-to-know health and fitness tidbits!! From a real, bonafide, enthusiastic pie-in-the-sky first year student doctor of physical therapy!!!! Lucky you!!!!!


Also, Jesse is starting to glaze over from my frequent interjections concerning fat, obesity, hormones, and insulin resistance, so I'm going to share it all with you instead.

Hence . . .the official inauguration of the much acclaimed segment: "Fireside Chats with a (student) DPT" Our first edition is entitled: FAT: Friend AND Foe.

Let the learning commence . . . .

(Also, Jesse is now pointing out the fact that I am not actually sitting next to a fire while I write this post - USE YOUR IMAGINATIONS PEOPLE!)

SO . . .

I was being a good DPT student and reading the latest publication of Physical Therapy: Journal of the American Physical Therapy Association. Yes, I am a card-carrying member of the APTA. This was the Diabetes Special Issue. Diabetes is a huge concern for PT's because of its high prevalence in the patients we see. Follow my train of thought here: there are two kinds of Diabetes, Type I (where pancreas doesn't make insulin, which helps move glucose around in your body so it can be used for fuel) and Type II (where your body's cells are resistant to insulin and the insulin then can't move blood glucose). Type I gets a lot of hype because of the insulin injections needed to regulate blood glucose, but Type II is becoming more of a problem because it is mainly caused by a sedentary lifestyle and poor diet habits - both of which have increased in the general population and -frighteningly - even more so in kids!

I could 'chat' for hours about this stuff, but I'll try to keep to a few key points in regards to the link between fat and insulin resistance.

First of all, fat is not just a storage site for excess calories (ie a passive mass). That's right, folks, it doesn't just sit there taking up space. In healthy, lean people, fat is your FRIEND - it releases hormones that tell the brain when you're full, regulate your bloodpressure, and play an active role in your immune system! Fat also cushions stuff like your kidneys and reproductive organs to protect them!

In overweight and obese people, excess fat becomes your FOE. I think this is so wild - fat cells release hormones that have a DIRECT ROLE in promoting diseases like diabetes and problems with the cardiovascular system. Some fat hormones stimulate inflammation in the fat cells themselves and in other tissues like your liver or your skeletal muscles. While inflammation is a natural part of your immune system when it wants to hunt down and clean up bad stuff in your body, chronic inflammation leads to a lot of cell breakdown and toxic substances staying in tissues. These toxic substances cause insulin resistance (were you paying attention to this term before???) and general damage to your healthy cells.

Ok - because - again - this could go on forever, I'll try to use bullet points now! These are some factoids that I thought were really cool, ie PAY ATTENTION!

• fat cells release hormones that promote inflammatory factors that interrupt insulin's ability to regulate blood glucose

• some fat hormones actually fight against obesity (too low levels = obesity)

• abdominal fat is much more dangerous than subcutaneous or thigh fat (yay for me!)

• women are more likely than men to distribute their fat intake to their thighs rather than their abdominals (yay again! sorry jess . . )

• some fat hormones respond to exercise alone - some to weight loss alone - some to both! (aka you need to exercise for fitness AND actually lose fat mass to keep normal fat cell hormone levels)

• this means it is technically very difficult to be "healthy and fit" and overweight at the same time (sorry)

• obesity causes fat (lipids) to be not only in actual fat cells (adipocytes) but also in your organ and muscle tissues

• in athletes, these lipid droplets are used as quick sources of energy, but in sedentary, obese people the lipid droplets just sit there and actually cause damage (ie cell death!) to the tissues they are in

So the bottom line is: in people who are overweight, fat is not just a passive glob of stuff that weighs you down, puts undue pressure on your joints, and displaces your organs to weird places - it actually releases hormones that WILL actively damage your body's cells! Both REGULAR exercise and weight loss are needed to put these hormones at a healthy level, at which point fat will actually promote health and wellness.

If anyone has any questions - please ask! I tried to keep things simple yet accurate. For better or worse, as a DPT student, it is now part of my professional duty to promote health and wellness for everyone. You can look forward to many more obnoxious rantings in the future - rantings with love!

Again, not that many pictures - I'll have to wrangle up some more for the next installment of 'Fireside Chats with a (student) DPT" - stay tuned!

References

Stehno-Bittel L. Intricasies of fat. Physical Therapy. 2008;88:1265-1278.

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