The Foundation:
Fat Does More Than
You Think
So what is fat exactly? We all agree that fat, in its simplest form,
land, New Jersey, in the 1990s. Her days were filled with school,
sports, friends, and a newly developing interest in boys. But just as
Christina entered puberty, something strange happened. Her body
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T H E S E C R E T L I F E OF FAT
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T H E S E C R E T L I F E OF FAT
Christina
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hypothesized that extra body fluids such as leftover milk from lactation and unused semen were converted into fat, the latter leading to
the belief that overweight men were sterile. Hippocrates wrote about
fat as moistness in the body that could lead to sexual dysfunction
if not addressed.
This idea that fat was made from body fluids lived on for many
years, though some early scientists and physicians also made the
connection between fat, food, and energy. Galen, the Greek physician, touted his ability to use exercise to reduce a huge fat fellow to
a moderate size. King Henry VIIIs physician, Dr. Andrew Boorde,
blamed sweet wines for the kings fat. Premodern theories about fat
focused on food and exercise, a relationship that could be observed
with the unaided eye. But it was the development of the microscope
in the mid-1600s that deepened our understanding of fat.
In the 1670s, Antonie van Leeuwenhoek successfully produced a
lens that could magnify objects over two hundred times their original
size. European scientists used van Leeuwenhoeks lenses to examine
body fluids, plant elements, pieces of animal organs, and anything else
they could fit under the lens. Much to their surprise, they found that
plants and animals were composed of small vesicles. These structures came to be called cells and, it was theorized, were the smallest living components of organisms. Scientists learned that cells were
self-sustaining bodies that were connected to each other and served as
the building blocks of structured organs. When fat was studied under
the microscope, it too was found to consist of cells.
What was unique about fat cells, however, was that they had the
distinct ability to store fatlots of it. Fat cells (also called adipocytes) could expand their volume more than one thousand times
normal size by pushing other cell contents off to the side.
Cell theory of the seventeenth century was further refined by
molecular theory in the nineteenth century. In 1874, Theodore Gobley elucidated the molecular structure of a fat molecule, showing
that it is simply a long chain of carbon atoms. Different types of fat
molecules were identified and collectively came to be called lipids.
Piecing these findings together, the scientific community was able
to classify the structure of body fat. It is a body part made of fat
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T H E S E C R E T L I F E OF FAT
tissue (also called adipose), composed of fat cells, which store millions of fat molecules that can be used for energy.
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Fat as an
organ
Over time, it became clear that fat tissue isnt just made of fat.
The soft layer that surrounds our bodies was found to be, on average,
only three-quarters fat, with the rest composed of collagen fibers
that hold it in place; veins and nerves; as well as blood, muscle, and
stem and immune cells. When we pinch an inch, we are really not
pinching that much fat.
By the twentieth century, scientists were deciphering the process by
which our bodies make and use fat. In , Rudolph Schoenheimer
and David Rittenberg at Columbia University were able to trace how
carbohydrates from food got shuttled to the liver, where a portion
was converted into fat molecules. These carbohydrates-turned-fat were
then distributed via the bloodstream to fat tissue and deposited there
as triglycerides (a triplet form of fat molecules), for long-term storage.
After Schoenheimer and Rittenbergs discovery, researchers believed
that the liver made all of the fat in the body. But a decade later, Benyamin Shapiro and Haim Ernst Wertheimer at the Hebrew University
of Jerusalem revealed that adipocytes could also make their own fat.
Until this time, researchers still believed fat to be mere passive storage
with no metabolic capabilities. Shapiro and Wertheimer had discovered that fat possessed the power to produce itself.
A Fat Primer
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Fat molecule
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Glucose
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CH2OH
Glycogen
(chains of glucose)
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Triglyceride
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T H E S E C R E T L I F E OF FAT
Fat is altogether different. Unlike glycogen, fat is not simply glucose stacked away and available for use. Fat molecules (also called
fatty acids) are chains of fourteen to twenty carbon atoms that are
linked together. These molecules are joined in threes to form triglycerides, which are long, lithe, and malleable so they can be packed
tightly together in our fat cells. When the body is low on glucose
and glycogen, it reaches for fat and converts it into the energy it
needs. Fat is the certificate of deposit: not easy to get to, but it can
safely hold a lot of energy in reserve.
The scientific term for the process by which our bodies make fat
is lipogenesis, while the breakdown of fat to release fatty acids into
circulation is called lipolysis. Lipogenesis occurs most notably after
we eat and have excess nutrients to store.
As we digest food, insulin is released from the pancreas and signals cells throughout the body that nourishment is coming, so they
should be ready to accept it and either convert it into energy for
immediate use or store it. After a meal, our glucose levels climb
(cash is abundant), then our glycogen levels rise (checking account
is stocked), a portion of dietary fat gets stored in fat tissue, and then
the excess carbohydrates, sugar, fat, and protein go to the liver, where
they are converted through lipogenesis into fat.
From the liver, fat molecules travel in the bloodstream and are
deposited in our body cells, most obviously into our fat cells. Fat
molecules repel water and pack together so efficiently that 40,000
calories weighs just ten pounds in our bodies. If we had to store the
same amount of energy in glycogen or glucose, with water mixed in,
we would weigh more than twice as much as we do. Thank nature
for body fat.
You may be surprised to know that our active brains use as much
energy as our muscles. The liver is a close second to the brain, with
the heart, gastrointestinal system, and kidneys coming in close
behind. Once the fatty acids get into the cells, chemical processes
tear apart the carbon bonds. The breakdown of the fatty acids produces chemical energy that our bodies can use. When glucose and
glycogen stores are low, the body reaches for fat, its certificate of
deposit, for energy.
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T H E S E C R E T L I F E OF FAT
normal and the numbers were great. She never required another
plasmapheresis.
As she ate less, Christinas circulating glucose and triglyceride
levels reduced dramatically, leading to the remission of her diabetes. Fat deposits in her liver dissolved and its size reduced by
40 percent. The painful pockets of fat beneath her skin also went
away. The experimental treatment enabled her body to metabolize glucose and fats more effectively, so that they no longer circulated in her bloodstream or collected in vital organs. Not only did
Christinas health improve, but the child who was once slated for
an early death went on to college, got a job, got married, and is
living a fulfilling life.
The story of Christina and others with lipodystrophy offers a startling example of the importance that fat has in maintaining good
health. Without it, other organs cant properly function. Strictly
controlling intake and preventing excess fats in the blood could help
manage the symptoms of lipodystrophy, though it would be virtually impossible to precisely match energy consumption and expenditure every minute of the day. But thats what life without fat would
require us to do. Body fat allows us to absorb energy from food now
and retrieve it as needed later, so that we can think of other things
than eating.
We also use it for producing heat, insulating our organs, and serving
as a messenger to our immune system. Our fat plays different roles
because our bodies contain more than one type. The type of fat that
stores energy is called white fat, and white fat is what we want to
lose when were overweight. There is also brown fat, which is found
in the neck, back, and heart regions. Its color comes from the high
density of organelles called mitochondria.
The difference between these two types of fat is more than color.
While the white kind stores energy, the brown kind actually burns
energy for heat. Brown fat accomplishes this through a special protein called thermogenin. Infants have a higher proportion of brown
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fat than adults, although the latter have more beige fat. Beige fat
was discovered in 2012 by Dr. Bruce Spiegelman, a researcher at the
Joslin Diabetes Center in Boston. He found that during exercise our
muscles produce a hormone called irisin, which sends a message to
this beige fat and ultimately converts it to brown. It is not certain
why the body grows more brown fat in response to exercise, but for
the sake of weight loss, beige is the new brown!
The idea of manipulating white fatinjecting it with brown fat
or converting it to beigeis now an active area of research for obesity treatment. In addition to exercise, exposure to cold has also been
shown to increase activity of brown or beige fat in adults. Brown fat
has potential to reduce white fat, scientists now believe.
Brown fat sounds like the holy grail of dietingfat that burns
energy so we can keep eating more. But even something this good
can turn bad. Consider the unique case of Jocelyn Rhees.
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T H E S E C R E T L I F E OF FAT
Hussain did a number of metabolic and endocrine tests on Jocelyn to investigate her failure to thrive. Her blood sugar was low so
he started her on continuous glucose infusion and increased caloric
intake. Her insulin levels were low and her adrenaline, noradrenaline, cortisol, and growth hormone levels were fine. But when Hussain measured Jocelyns resting energy expenditure, it was much
higher than normal.
Unsure of what the problem might be, Hussain enlisted the help
of other medical teams at the hospital. Geneticists tested for gene
mutations associated with metabolic disturbances, the general
pediatric group checked Jocelyn for unusual childhood diseases,
the gastrointestinal team checked her digestive system. Tests were
run for cystic fibrosis and infections. Every examination indicated
that Jocelyn should be gaining weight normally. Feeling lost, Hussain also reached out to experts outside the hospital, but no one
could say why a child who consumed six times as many calories as
other children her age would not gain weight.
Hussain had been monitoring the child for a year, giving her continuous feeding and care, still she weighed only six pounds. Hussain
recalls, As a clinician I was very frustrated because I couldnt get a
diagnosis. And for me it was also quite emotional because this child
that had come to me wasnt gaining weight, despite everything wed
done. Not even after every clinician, every consultant who had an
interest in weight gain had seen her. It was also frustrating for the
family because they all wanted to go home, and I couldnt send her
home because she needed IV glucose.
Finally, after a year of searching, a hint emerged. The doctor
had ordered biopsies of Jocelyns liver, muscle, and adipose tissue.
Her liver and muscle biopsies were normal, but her adipose sample
showed extraordinarily high amounts of brown fat. It was the first
time during his entire investigation that he had found something
insightful. Excessive levels of brown fat would explain everything,
Hussain says. It seemed that the brown fat was burning the calories
and the glucose was being sucked into oxidative phosphorylation
and not being deposited into the tissues for storage. Indeed, Jocelyns brown fat was shooting her metabolism through the roof, caus-
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ing her to immediately utilize all the glucose she consumed. Brown
fat also increases sensitivity to insulin, which explained her low level
of the hormone. But too much brown fat was preventing Jocelyn
from developing normally.
At three years old, Jocelyn still only weighed six pounds. Despite
the involvement of doctors and scientists all over the world, no treatment was ever found for her condition. Six months after her third
birthday, Jocelyn Rhees passed away.
Even something as beneficial as brown fat can harm us if it is out
of proportion. Jocelyns life is a reminder of the importance of having healthy, balanced body fat.
Body fats role is not confined solely to energy storage and heat. In
Fat as a Messenger
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and sores. Replacing this fatty acid enabled signaling within the
immune system to resume, reduced inflammation, and allowed the
rats to live.
George Burr published these findings, but the bias against fat was
so strong that he received a letter of condolence for concluding that
dietary fat was important. Since the Burrs experiments, however,
other scientists have shown that linoleic acid gives rise to a number of fatty acids called eicosanoids. These are fat molecules in the
body that derive from the lipids in the cell membrane. Instead of
providing energy, however, they serve as short-distance messengers
that can affect nearby organs and fat itself. Problems with this type
of fatty acid have been linked not just to inflammation but also to
cancer, arthritis, and other disorders.
One of the most studied groups of eicosanoids is prostaglandins,
which are involved in sensitizing our bodies to pain. Prostaglandins
also play a key role in pregnancy and are capable of inducing labor.
Whod have thought fat was so important for procreation?
ust like the scientists whom the Burrs consulted in the 1930s,
people still assume that all fat is bad. But researchers from van Leeuwenhoek onward have showed us that fat is involved in the management of our energy stores, thermal regulation, keeping our cells
intact, and, surprisingly, in sending signals within our bodies.
As profound as the early research on fat was between the discovery of the fat cell and the isolation of fatty acids, what researchers
found in the 1970s through the 1990s was even more startling. Fat,
it was revealed, could actually talk.
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