Section 8: Metabolic Syndrome

Fat in tummy what we call as abdominal obesity has something different than rest of our body fat, in terms of metabolism. This fat is abnormal in the sense of metabolism and leads to a complicated metabolic situation called METABOLIC SYNDROME. This essentially is comprised of type 2 Diabetes, high BP, high cholesterol, increase chance of having heart problem and stroke, etc.

Although fat is fat, all are not the same, the metabolism differs. Two main types of fat, one is called white and the other is brown. Brown fat was initially given by nature to store energy what we know is important during hibernation of some animals like frog in the winter time.

This fat is mainly the storehouse for energy for the periods of non-availability of food and used to be required hundreds of years back in humans also for winter or rainy season. We have lost most of them because we are clever enough now to know how to keep the food supply constants for day in and out, only some has been left in the tummy.

In some adverse situation like physical inactivity, stress, eating more than we need (don’t we love to eat!) and certainly genetic predisposition. We, as Indians, for some reason or other are more predisposed to accumulate fat in the tummy and its’ associated problems.

Stress is in a unique position to enhance this abdominal obesity. Stressed out individuals – sleepless nights, no appetite, fears for infertility, and women with period problems add typical stressful situations of the day. Stress has its main effect in one place of the brain called hypothalamus, the highest point for controlling all hormonal changes in the body.

Hypothalamus secretes a hormone called CRH (Corticotrophin Releasing Hormone) in stressful situation which is considered to be in the center of stress reaction. The stressful situations would include physical stress like fever, surgery, burn, low sugar, fall of blood pressure as well as acute psychological stress like anxiety or depression.

What we are facing in both the developed and developing countries is the change in lifestyle and continued pressure from workplaces because of more and more demand in a shorter timeframe (not to forget the stress of unemployment and frustration).

This CRH stimulates the Pituitary gland to release Corticotrophin which then stimulates the Adrenal glands to secrete Cortisol, the stress hormone. This is the main reason, we think today, is responsible to start the ball rolling for accumulation of excess fat in the odd area like the tummy.

Other hormone like adrenaline and noradrelanine (together called catecholamine – the fight or flight hormone) also comes from Adrenal glands, Growth Hormone from Pituitary gland along with several tissue products called cytokines have role for abdominal obesity in chronic stressful situation.

Cortisol and Catecholamine causes lipolysis (breaking down of fat) making fat products like free fatty acid available in the blood in excessive amount, which take shelter in less active area of fat store in the tummy. Invariable is to find Insulin resistance in similar situation of abdominal obesity.

Insulin is a hormone that comes from Pancreas gland in the tummy and the only hormone in the body to lower blood sugar. Other than its’ effect on sugar metabolism Insulin causes lipogenesis (that is accumulation of fat).

We do not know exactly why Insulin chooses tummy for the fat accumulation but probable reason is the proximity of the pancreas to abdominal viscera where the level of Insulin in the portal circulation (the circulation of the abdomen) is higher than other parts of the body.

It is not sure whether Insulin resistance is secondary to abdominal obesity or causes it but one thing is clear Insulin resistance takes the centre stage in continuation of abdominal obesity and its’ dreadful allies like Diabetes, BP, heart problem, etc.

Most important however is to realize the consequences of abdominal obesity. The solution has to be manifold. Stress relieve is one important aspect for which understanding the cause of the stress and a clear discussion with an expert is very important. Then starts change of lifestyle that is practical to the particular person in the defined situation.

We obviously need to check time and again BP, blood sugar, blood cholesterol, etc and take necessity action.

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