The fat cell flux explained


By John Ditraglia - Contributing Columnist



I just listened to Peter Attia’s latest ask-me-anything podcast (AMA#22 April 12, 2021) where together with superhero assistant Bob (I can’t find his last name) they analyze how fat gets into and out of fat cells. This flux is the crux of the issue for fat science aficionados but for these guys it is a sidelight of their main interest in studying how to live longer and better. You can’t listen to the entire podcast without a very modest subscription but you can read my commentary.

The podcast starts out with the very basic physics construct of boundary analysis. That is starting out with the fat cell as a black box or a room and you just watch what goes in and comes out. This devolves quickly into complications that is catnip for obsessed nerds like me but might induce many normal people into looking for the bottom line with glazed eyes. That bottom line accounting is not different from the even bigger simplification that it doesn’t matter what you eat and we haven’t beaten obesity yet. It’s still hard to argue with the common presumption of the cause of obesity since before James Boswell’s quote of Samuel Johnson’s, “Whatever may be the quantity that a man eats, it is plain that if he is too fat, he has eaten more than he should have done.” But the truth is closer to what H. L. Mencken said, “For every complex problem there is an answer that is clear, simple, and wrong.”

Along the way, we meet insulin as the conductor of anabolism. Anabolism is a big new word that means storing energy. In my unoriginal words, insulin is the fed hormone. They also cite a report in The New England Journal of Medicine from 2004 that I missed or forgot or have in a pile here somewhere, that shows that just cutting out 19% of total body fat by abdominal liposuction does not have the same metabolic benefit of losing weight by not eating. (1,2,3) It reminds me of the olden days and the words of Homer Simpson, “I’m not fat. It’s glandular.”

But then Peter and Bob devolve into a delicious philosophical discussion of the science of science. That is something we have all been dwelling on these long days in the Trump swamp. Bob has a revision of Ronald Regan’s “trust, but verify” to “don’t trust, and verify.” To which I would add my personal rule of thumb, “if most people think something then that is invariably wrong.” And to primum non nocere – first, do no harm, the logical corollary is primum nihil facere – first, do nothing.

But how is that fundamentally different from what anti-vaxers or climate change deniers are doing? Maybe it’s like pornography – you can’t define it but you know it when you see it. Maybe we are missing the point.(4) Maybe if there ever comes the day (soon I predict) when obesity has a real fix, most people are going to make reasonable choices without understanding all the science. Maybe all this fake science and lie mongering isn’t a new phenomenon but rather a figment of in your Facebook.

1. Klein S et al. Absence of an Effect of Liposuction on Insulin Action and Risk Factors for Coronary Heart Disease. N Engl J Med 2004; 350:2549-2557

DOI: 10.1056/NEJMoa033179

2. Kelley KE, Thermodynamics, Liposuction, and Metabolism. N Engl J Med 2004; 350:2542-2544

DOI: 10.1056/NEJMp048115

3. letters to the editor about 1. https://www.nejm.org/doi/full/10.1056/NEJM200409233511320?query=recirc_curatedRelated_article

Metabolic Effects of Liposuction — Yes or No? | NEJM

To the Editor: Klein and colleagues (June 17 issue)1 report an absence of effects of abdominal liposuction on cardiovascular risk factors, inflammatory markers, and insulin resistance in obese wome…

www.nejm.org

4. Rosenbaum L No cure without care – soothing science skepticism. N Engl J Med. April 15, 2021; 384;15:1462-65.

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.

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By John Ditraglia

Contributing Columnist

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.

This writer’s opinion is their own and not the opinion of this newspaper

John DiTraglia M.D. is a Pediatrician in Portsmouth. He can be reached by e-mail- jditrag@zoomnet.net or phone-354-6605.