Belly Fat and CRP
By Alice R. Laule,
M.D.
One of my long time patients just had a huge
breakthrough, and suggested I write the next newsletter about it. That sounded
like a good idea to me — so here goes.
Her breakthrough had to do with belly fat and CRP. It
turns out the whole issue of having a fat belly is not as simple as it might
appear on the surface. There has been a lot of discussion in the medical
literature in the last 5-6 years about the importance of a laboratory test
called the CRP (C-Reactive Protein). CRP is an indicator of inflammation.
Historically, before the 20th century brought us the fear of cholesterol, the
cause of heart attacks and arteriosclerosis was postulated by a Dr. Virchow to be
the product of inflammation in the body. Basically, Dr. Virchow thought the
linings of the arteries got inflamed, and that caused them to thicken and get
blocked.
The twentieth century then brought to light the whole
issue of cholesterol, and an elevated cholesterol became the focus of all heart
disease prevention. In fact, cholesterol got demonized, and many people,
including too many physicians, forgot that cholesterol is a good guy.
Cholesterol is the precursor to all our adrenal hormones, Vitamin D, and a lot
of brain cells, as well as doing repairs in the body. Without it we don’t
thrive. A cholesterol below 120 is, in fact, associated with an increased risk
of death and increased risk of cancer. If heart disease is all about the
cholesterol, and nothing else, why is it that 50% of people having their first
heart attack have normal cholesterol?
Therefore a more modern, 21st century approach is now
including an extended array of risk factors, including homocysteine, fibrinogen
and its products, a couple of other markers of clotting tendencies, and the
above-mentioned CRP. We seem to be coming full-circle, back to understanding
that Virchow was correct, there is an inflammatory component. When inflammation
causes damage to the endothelial lining of blood vessels, it is cholesterol
that comes in to make the repair and starts the process of thickening and
eventually blocking the artery.
We can discuss the other risk factors in subsequent
newsletters, but for now, let’s discuss the associations with elevations of
CRP. If a person has a terrifically high CRP, it is probably worth looking for
underlying infections, the most common being Chlamydia, Herpes, and
Cytomegalomvirus. However, by far and away the largest cause of a CRP elevation
is belly fat. And not just any old belly fat. The kind that
causes the CRP to go up is the fat that surrounds the organs, inside the
abdomen. This visceral adipose tissue (VAT) is not just a benign storage pool
of fat. It acts
more like a big hormone secreting organ, and the hormones it secretes are
not pleasant ones. They come by many
names — tumor necrosis factor alpha, leukotrienes, cytokines, pro-inflammatory
eicosanoids. The names don’t matter. What does matter is these hormones get
into the blood stream, and cause tremendous inflammatory disease. In the
process, they damage artery linings, cause signaling for cholesterol to
increase and become oxidized (the worst kind) trying to make repairs. The blood
test that is the marker of this kind of inflammation is the CRP. A person can be quite thin appearing
and have VAT, visible on an MRI. Another person with a big saggy belly that
will allow you to grab fat by the handfuls on the outside of the abdominal wall
may have only subcutaneous fat, which does not cause the CRP to be
elevated. It is not always easy to tell
the difference. An excellent indicator is simply the triglyceride level. If the
triglycerides are high, the belly fat is probably VAT, at least in part.
Without having a blood test, you can get some ideas for yourself, however. Are
you under a great deal of stress, and taking no time for relaxation,
meditation, prayer and quietude? Then you may have an elevated cortisol level,
which causes VAT. Do you crave sugar and starchy foods, have hypoglycemia, and
a family history of diabetes? Do you seem to gain weight on almost no quantity
of food at all? Then you probably have at least occasional elevations of your
serum insulin level, and your belly fat is likely to be VAT. On the other hand,
if you eat very sensibly, maybe just too many calories, handle your stresses
wisely, but can grab a handful of fat on the outside of your abdomen, that is
probably just subcutaneous fat.
It is
these kinds of variables that make our Weight Loss Clinic so valuable, because
the weight loss program for people with different sorts of fat has to be
tailored to the individual. Whatever you may still hear about weight loss being
as simple as “calories in calories out,” that is not the truth. The food we eat
becomes information to our body, directing it to behave in certain ways. A
whole lot goes on in the way of energy biochemistry when we eat. Complex
carbohydrates cause the body to behave in very different ways from simple
carbohydrates. Eating patterns matter
also. A classic study done with rats, each group of rats being fed exactly the
same number of daily calories, demonstrates this fact. One group of rats was
fed 700 calories a day but allowed access to their food all day long. The other
group was trained by food removal to eat all 700 calories at one sitting. After
a period of time of feeding in this pattern, the rats that ate only once a day
were significantly more obese than the rats that ate throughout the day.
Therefore, it cannot be just calories in, calories out, not even for rats.
Triglyceride and CRP testing can
help you determine what kind of belly fat you have, and how much mischief it is
causing. There is no doubt that VAT is far worse that subcutaneous fat. In
fact, subcutaneous fat actually produces a compound called adiponectin which is
anti-inflammatory. Interestingly,
people with anorexia nervosa usually have a very high percentage of body fat,
and most of it is VAT. They also make very little adiponectin. This is not to
say that having huge amounts of subcutaneous fat is a good thing. Elevated
estrogens deposit in the fat, causing increased cancer risk, and there are
numerous other things that get out of balance metabolically. There is still an
overall health risk, as a recent study showed, busting the myth of the “healthy
obese” person, who just has subcutaneous fat, is athletic and active, and
therefore was supposed to be not at risk.
To complete the story of the person
who suggested I write on this topic, over the past 12-18 months she has lost
her VAT, and the CRP which was chronically and stubbornly in the 30’s (for
years!), now has dropped to between 2 and 3. That is still slightly high –-
below one is best — but an almost miraculous improvement that left us both
smiling.
Meanwhile,
keep smiling, and stay healthy,
Alice
R. Laule, M.D.