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23 Shevat 5765 - February 2, 2005 | Mordecai Plaut, director Published Weekly
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The Fat Inside: The Concealed Consequences of Obesity!
by Dr. Reuven Bruner, Ph.D.

People who are obese probably already know that they're more likely than lean people to develop heart disease and diabetes. But they may not realize that they are also at increased risk for a range of gastrointestinal (GI) diseases, including fatty liver disease, gastroesophageal reflux disease (GERD), gallbladder disease, severe pancreatitis and some GI cancers.

Having excess body fat means not just having excess fat inside fat tissue, but also having excess fat in organs, including the gastrointestinal organs, particularly the liver. Having excess fat in the liver causes liver dysfunction and even can lead to serious long-term liver disease. For example, if you're obese and have diabetes and hypertension, you have about a 75 percent chance of having fatty liver disease.

Normally, nutrient-rich blood passing from the stomach and intestines through the liver is converted into energy when carbohydrates, protein, fats and minerals are processed. But the metabolism of excess fat and the subsequent increase in fatty acids can damage the liver, impairing its functions such as regulating blood sugar levels by storing glucose for later use. Fat in the liver can begin as nonalcoholic fatty liver disease, which resembles the damage to the liver done by alcohol abuse, and progress to cirrhosis of the liver, in which liver cells are replaced by scar tissue. As a result, liver disease due to obesity is a leading cause of liver transplantation in the United States.

Obesity is also a risk factor for GERD, a condition that affects the lower esophageal sphincter, which is a muscle that acts as valve between the esophagus and stomach. In GERD, this valve doesn't close, so contents from the stomach slip back up into the esophagus, causing heartburn and acid indigestion. Losing weight, especially if people improve their diets in the process, can ease GERD symptoms.

The relationship between weight and gallbladder disease is a more complex one. Gallbladder disease is characterized by the development of gallstones, which are balls of solid material — usually mostly cholesterol — that form in the gallbladder when it cannot dissolve all of the cholesterol in bile, or when the gallbladder is not emptying properly.

People who are obese, particularly obese women, have a much higher risk of gallstones than non-obese women. But losing weight initially increases your risk of having gallstones because weight loss itself changes the composition of bile. Gradual weight loss, as well as exercise, is thought to result in lower gallstone risk. And after someone has maintained weight loss, their risk of gallstones goes down.

While obese people are not more likely to get pancreatitis, or inflammation of the pancreas, they are more likely to have a severe form of it. The reason for that is unknown. It might be due to excess fat around the pancreas that gets digested by leaky pancreatic enzyme, releasing fatty acids and toxic products around the pancreas.

Additionally, colon and rectal cancer have been found to occur more often in people who are obese than in leaner people. And a recent study found a link between liver cancer and obesity. Although its not understood how obesity increases cancer risk, it's thought to be due to a genetic predisposition combined with a poor diet.

Specialists recommend screening for GI conditions for all people who are obese, particularly if they also have high cholesterol, high blood pressure and/or diabetes. It's important to recognize that, in addition to the diseases we associate with obesity — diabetes, hypertension and heart disease — being overweight can also increase risk of GI disease. These diseases need to be on the radar screen.

2004 Dr. Reuven Bruner. All Rights Reserved.

For more information contact him at: POB 1903, Jerusalem, 91314, Israel; Tel: (02) 652-7684; Mobile: 052 2865-821; Fax: (02) 652-7227; Email: dr_bruner@hotmail.com

 

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