Shall we take a look at fat, as a noun and not as an adjective? What is fat? Unfortunately, we are witness to more people, especially kids and young adults, who carry much fat. We also know that these beings are at a much higher risk for many preventable diseases. Diabetes is primarily related to too much fat. So why is this? If fat is simply more bulk, then shouldn’t one who carries this mass suffer primarily from muscular-skeletal issues? In fact, they do but it becomes the least of their problems. What do fat cells do that is so harmful?

Fat tissue is mainly composed of fat cells. Imagine multiple clusters of grapes hanging on a vine, held together by thin fibers (connective tissue) and throw in small nerves and blood vessels. Fat cells would be the juicy grapes. Fat tissue is one of the largest organs in the body. For men, it makes up 15 to 20% of body weight and for women, 20 to 25%. While most of the fat is visible, that is, close to the skin, a good amount also is present internally around various organs.

A fat cell can be seen as an energy storage tank composed of triglycerides. When there are more calories taken in then expended, triglycerides are formed and stored in the fat cell. When energy output exceeds caloric intake, triglycerides are released into the blood stream for energy consumption. This part of the equation is relatively simple and easy to comprehend.

When we look at a chubby kid or an obese adult, do they have more fat cells than a lean person or do they have larger fat cells or perhaps both? This becomes an important issue for the following reason. During early infancy, a large number of fat cells are formed only to decrease to a static number around the first birthday. Hence many infants are cherubic and so huggable. If the caretakers unknowingly overfeed the infant (and there may be genetic and other predisposing factors), additional fat cells are added and they also enlarge in size. This is the key point: the increased number of cells don’t go away, they remain the same or even multiply throughout childhood and adolescent life. The lean child, on the other hand, maintains the same cell count until adolescence when there is another growth spurt with the possibility of adding additional fat cells. For the obese child or the adolescent, with proper diet, the volume of the fat cells will shrink, but the numbers don’t change. This probably explains why, for these individuals, it is so easy to gain weight and so much effort needs to go into losing weight.

Just imagine, parents having this information. They could spare their children enormous amounts of future grief not to mention the cost our society pays for lost wages and health expenditures for many chronic diseases associated with obesity.

75% of obese children grow up to be obese whereas only 10% of lean kids grow up to be obese. Fat cells, much like many other cells in our body, have a certain life expectancy. Each year, there is an 8% turn over of fat cells. That is, about 8% die off, being replenished by newly formed 8%. This rule also applies equally to obese folks, which explains their weight maintenance.

To return to the original point, what is it about these fat cells which cause so much harm? Fat cells aren’t just warehousing triglycerides. Fat tissue happens to be an endocrine organ. That is, it manufactures hormones. Hormones, specifically coming from fat cells are called adipokines. Fat cells are active participants in regulating physiologic and pathologic processes, including immunity and inflammation. From an evolutionary biological view, fat cell turnover would have been designed as an on going peak and trough event (eat as much as you can now and store fat because you never know when you will eat again). Our body was not designed to carry a large amount of fat, all the time. The hormones coming out of our fat cells are many in number. They not only do direct damage to various tissues through their inflammatory actions but also recruit certain immune mediated cells which also cause harm. For example, insulin resistance develops causing diabetes. Diabetes in turn, affects virtually all the organ systems in the body since it alters the blood vessels which bring nourishments to every cell. We are only beginning to realize the vast array of chemicals spewing out of our fat cells, their actions on other cells, on genetics, other hormones, lipids and metabolism. That is, obesity is the cause of various endocrine and metabolic abnormalities rather than the victim of these abnormalities. Fat cells don’t just hang out, they play and they play rough because they were designed to store fat, then destroy or clean up the surrounding tissues during lean times.

Take home message: 1) please, keep your kids lean. The number of fat cells they create will never decrease throughout their life time; and 2) carrying much fat isn’t a cosmetic issue; these cells do much harm.

Eat consciously and move more.
Dr. Philip Bhark M.D., FACC

Also of interest… Dr Bhark will be blogging on www.ExpatNewsletter.net | Thailand’s Fastest Growing Community Website…


How about some good news on drinking coffee? It’s about time. Coffee is consumed in abundance world wide. Folks often associate coffee with caffeine, which is true, but in addition, it contains a large number of antioxidants and other bioactive compounds. Caffeine, in coffee, has given it a negative health image, since caffeine is a stimulant. Health conscious people often claim with some amount of pride and self righteousness that they “don’t do caffeine”. Modern day medical mystics such as Edgar Cayce and Rudolph Steiner both claimed the health benefits of coffee but this information has not been widely publicized. They both asserted that coffee was good for us, especially when it was freshly brewed and drunk without milk or sugar added. No large scientific proof was available until recently. A large study, undertaken by the National Institute of Health, National Cancer Institute and the Division of Cancer Epidemiology and Genetics and published in The New England Journal of Medicine, May 17, 2012, has shown that coffee consumption was inversely related to total mortality. The study involved over 400,000 participants between 1995 and 2008, giving it a robust statistical power.

Before this large investigation, there were multiple smaller reports suggesting a negative link between coffee and heart disease given the possibility of a change in the lipid profile and blood pressure. These studies, in retrospect, have involved small numbers of people and were poorly designed. Tobacco use, previously not looked at in association with coffee consumption, turns out to be an important determinant as well. Coffee drinkers were more likely to smoke cigarettes, consume more alcohol and red meat and exercise less. They also tended to eat less fruits and vegetables and white meat. Therefore, it made sense to discover that coffee drinkers had an increased mortality over nondrinkers, both men and women. However, this large study cited above, was able to tease out the various confounders, looking specifically at coffee consumption alone. This is what they found out. There were less deaths among coffee drinkers from heart disease, respiratory disease, stroke, injuries and accidents, diabetes (especially among women), and infections. There were no differences among women regarding deaths from cancer. For men, who drank more than six cups of coffee daily, there was a slight increase in cancer related deaths.

About two-thirds of the participants drank regular coffee while the remainder drank castrated (decaffeinated) coffee. There was no mention of the type of coffee or the brewing methods nor whether milk or sugar was added. Coffee consumption varied from 1 cup daily to more than 6 cups. Women benefited more than men from coffee drinking. The benefits were also slightly dose dependent, with 4 to 5 cups being the “optimal” daily dosing.

Given the popularity of this beverage, I think this study is very helpful for many. Of course, if caffeine bothers you (extra heart beats, upset stomach, nervousness, insomnia and so on) you need to avoid the caffeine. Decaffeinated coffee, made naturally by water processing rather than industrial strength chemicals, can also offer a delicious brew with attendant health providing antioxidants such as polyphenols. There is some controversy that milk may nullify some of the beneficial effects of coffee.

It goes without saying that tea, especially green tea, is extremely beneficial for us. Two to three cups of green tea daily would also keep the doctor away.

Cheers. To your health! Dr. Philip Bhark M.D., FACC

Also of interest… Dr Bhark will be blogging on www.ExpatNewsletter.net | Thailand’s Fastest Growing Community Website…


Dr Philip Bhark - CholesterolDoes the word cholesterol evoke a yucky feeling in you? Similar to an uninvited relative who shows up at your doorstep with an inappropriate grin? Or perhaps a tax collector who you definitely don’t like to be friends with but nevertheless have to learn to get along with? TV commercials capitalize on this unhappy relationship by portraying cholesterol as a bothersome character, dressed in a yellow skin-tight garb including a hood (a la Woody Allen’s “sperm cells”) who lurks around your kitchen taking all the fun away from your enjoyment of food.

To be fair, we wouldn’t be alive without cholesterol. It forms the foundation for all our sex hormones, is an essential unit of our cellular structure and function, forms bile and vitamin D, just to name a few. It is made endogenously (internal origin) by the liver and other organs, the amount depending on your exogenous cholesterol intake. Our current problem with food arises from too much availability rather than too little, as it was for our ancestors many millennia ago. Cholesterol production, absorption, transportation, uptake by cells, its journey back to the liver, degradation, elimination are more complicated than we wish to know or to understand. Therefore, we have taken short cuts and have labelled two primary cholesterol carriers as HDL (so called good cholesterol transporter) and LDL (aka “bad” cholesterol carrier). In fact, most of the beneficial aspects of cholesterol is carried out by LDL. The problem comes when we have excess amounts of LDL or when we do other harmful things to ourselves (such as smoking cigarettes, building up large amounts of free radicals through unhealthy foods, poor intake of vitamins and other nutrients, stress, etc.) whereby the LDL becomes oxidized or unstable, which in turn makes it easier to enter into blood vessel walls. Once inside the wall, it can attract many other agents, eventually forming a fatty plaque, known medically as atherosclerosis or more commonly in the streets as “clogging of the arteries”.



For those of you who exercise, we can safely assume that you are looking for certain benefits such as increased strength, flexibility, energy and enhanced mood, not to mention good looks. So why is it that many of us donʼt feel the same way about our brain? Why do we assume that the brain requires no enhancement or in the least, some amount of attention? Scientific data clearly document the many benefits of exercising our brain. Henceforth, I will call it “brain gym” for lack of a better term (please let me know if you have an alternative phrase). For this article, we shall remain focused on what is going on inside the skull and the rest of our body. We wonʼt speculate on the connection between the brain and the mind or of any spiritual or religious matters.

The brain, similar to many organs in the body, adheres to the “use it or lose it” dictum. The brain either improves its functions or when left alone, steadily deteriorates over time. Toxins, poor circulation, high blood pressure, diabetes, infections, inflammations and the normal again process cause functional or structural deterioration. So does lack of use. The brain loves to be stimulated with activities such as playing music, problem solving, learning a new language (anyone speak Thai)? Through a process called “neuroplasticity” the brain cells, with repeated stimulation for a specific function, will grow in numbers in certain regions, enhancing performance. London cab drivers have large hippocampus (a primary memory area) due to their extensive memorization of city streets and famous landmarks; violinists have larger brain mass involving the area of brain that deals with hand movements; senior citizens who meditate regularly (45 minutes or more daily) actually add brain tissue in the area of the brain which deals with “executive functions” while non-mediators steadily lose brain tissue in the same area due to the normal “aging” process.

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