1How Inflammation Makes Us Sick, Bloated, and Unhappy
The Big Bang theory of your belly fat, and why this turning point marks a major change in your life, your health, and your future.
Imagine you’ve just eaten a filling and delicious meal. You compliment the chef, push back a bit from the table, and place your hand on your belly.
You’ll notice that your hand rests comfortably atop your abdomen, right below your chest, a few inches north of your belly button. That resting place is hard, almost ledge-like, with plenty of softer tissue surrounding it.
It may be difficult to remember a time when that swollen lumpiness wasn’t there, but your belly is a relatively recent development; you weren’t born with it. Your body formed it over time, in response to a slowly smoldering, ongoing health issue you probably have heard about but don’t fully understand. That issue is called chronic inflammation. And the center of its universe is your belly. A round gut is the equivalent of a check engine light on your dashboard.
Let’s take a look under the hood, and discover exactly what the issue is.
WHAT IS A “LEAKY GUT,” EXACTLY?
It seems weird that we can gain weight just because a few trillion microscopic organisms move in one direction or the other. But the balance within your gut can be so delicate that, once it’s out of whack (the technical term is “gut dysbiosis”), an extraordinary amount of trouble can occur. Obesity, diabetes, and other disorders are often the result of an inflammation-based issue that doctors call “leaky gut syndrome.”
What’s that?
Have you ever brushed your teeth and noticed some blood leaking from your gums? That’s inflammation—it’s caused by a buildup of unhealthy bacteria in and around the space where your teeth meet your gums. As the gums become inflamed, they pull away from the teeth—a condition known as “receding gums”—and more and more of the tooth becomes visible. As the problem gets worse, bacteria and other compounds can enter your bloodstream through these little leaks in your gums, ratcheting up your inflammation levels. People with gum disease have two to three times the risk of heart attack and stroke as those with healthy gums, and the same bacteria that’s found in oral plaque has been found in arterial plaque as well.
What Americans’ Finances Tell Us About Fat, Inflammation, and the Calorie Myth
Pop quiz: Which of the following is the best indicator of how much you weigh?
A. Your education level
B. The town you live in
C. The number of cheeseburgers you eat per annum
D. Your hourly pay rate
According to reams of recent research, the answer is All of the Above—except C.
In America, one of the most significant predictors of your weight is your income. In states where median household incomes are below $45,000 a year, more than 35 percent of the population is obese; in states where incomes average more than $65,000 annually, the obesity rate is less than 25 percent. (The same phenomenon is found in Europe, where individuals with lower incomes are up to 20 percent more likely to be obese.)
And this disparity is a pretty recent phenomenon: Researchers at the University of Tennessee, looking at data compiled by the Centers for Disease Control and Food Access Research Atlas project, found that as recently as 1990 there was no discernable connection between income status and obesity. But by 2015, that correlation was undeniable.
I have seen this phenomenon with my own eyes, whenever I drive from New York City to my hometown of Rensselaer, New York, just outside of Albany. It is not what one would call a wildly prosperous community:
Median 2020 Property Value, Rensselaer County: $197,100
Median 2020 Property Value, New York County: $1,020,000
Source: Data USA
Motoring up the Thruway with young daughters in tow, I’d have to stop frequently for bathroom breaks, snack breaks, and (for me) coffee breaks. The farther north I got, the heavier the people at the rest stops would be. And when I drove back to the Big Apple, I’d see the phenomenon reverse itself.
Let’s stop a minute and think about this. Food costs money. So why does having less money make you gain weight?
One very popular viewpoint is that people with less money are destined to eat the dollar menus at fast-food restaurants, and hence load up on calories. It’s a perspective that reached its apogee in the early 2000s, when two teenagers attempted to sue McDonald’s for making them obese—just a few short years before the hit film Super Size Me landed in theaters. So many, many fast-food calories!
Except when you actually look at the calories fast-food patrons consume, that theory just doesn’t hold water:
McDonald’s Big Mac, medium fries, and a Coke: 1,040 calories
Outback Steakhouse cheeseburger, one-half order Aussie fries, and a Coke: 2,290 calories
In fact, while a study of 123 restaurants of every type found that the average meal contained 1,205 calories, Tufts researchers found that the average fast-food meal weighed in at just 809 calories, a remarkable 33 percent less than full-service restaurants.
The anomaly reaches beyond restaurant culture. Researchers at the University of Minnesota surveyed ninety households within their local community and found that households with higher incomes spent significantly more money both on food served at home and food from restaurants. And they spent more than twice as much money on sweets and snacks than people from lower-income families!
If calories are indeed the driving force in weight gain, then from a purely statistical standpoint, the financially challenged person eating cheap, lower-calorie fast food and saving money on sweets and snacks ought to weigh less than the average well-off American who dines at a wide array of fine eating establishments and doubles down on the Ding Dongs.
Perhaps, then, there’s something else at work here.
One clue: According to the Minnesota study, while high-income families spent more on junk food, they also spent more than twice as much as poorer families on fresh fruits and vegetables.
That’s the disparity. The challenges of fast-food and convenience-food culture don’t come from calories; they come from a lack of nutrients, a resulting lack of diversity in the microbiome, and the obesity-promoting inflammation that results. One 2020 study analyzed blood samples from more than 17,000 people and found that, even when accounting for lifestyle factors such as smoking, alcohol use, and BMI, those with lower education levels tended to have higher levels of three markers of inflammation. And in a 2022 study, Harvard researchers found that living in a high-status, high-income neighborhood is associated with lower inflammation.
How strong is the link between financial health, inflammation, and fat? Consider this: Also in 2022, a separate report tracked the increases in visceral fat percentage in the American public between the years 2011 and 2018. Unlike other studies, the researchers in this project sought to look not just at the ongoing increase in people who were overweight or obese, but at the amount of visceral fat that people were carrying around. They found that, as expected, visceral fat as a percent of body weight continually increased—until 2016. At that moment, the tide seems to have turned, and visceral fat percentage—which is tied directly to inflammation—began to inch downward.
Why? How?
“We had a lot of discussion over why there would be such an inflection point,” Jacob E. Earp, PhD, told me. As an assistant professor in the Department of Kinesiology at the University of Connecticut and research associate at UConn’s Human Performance Laboratory, Earp was part of the team that conducted the visceral fat study. While they arrived at no definitive explanations, researchers note that this development happens to coincide with two significant changes in American society: a marked downturn in the national poverty rate and widespread enrollment in the Affordable Care Act, leading to a significant reduction in the number of people who were uninsured.
In other words, less poverty + more available health care = less inflammation + less obesity.
But why is a lower income associated with greater fat and higher inflammation? “There’s a lot of speculation,” Earp told me. “There’s discussion about inability to access fruits and vegetables, more reliance on cheaper sources of food—processed food. There’s less financial freedom to use recreational facilities. There could be cultural issues as well.
“A lot of it could be the freedom that you have when you don’t have as many financial constraints. How much you can spend on produce, how much time you have to go grocery shopping, to cook your own food? If you’re working overtime, well, that’s time you might have invested into healthy activities.” And financial stress, like any other type of stress, is closely linked to rising inflammation. (See Chapter 5: Listening in on the Conversation Between Your Belly and Your Brain.)
But what the evidence tells us is that stress and a lack of dietary variety are significant drivers of obesity. That’s why this program isn’t about cutting calories and fretting about your weight; it’s about kicking back and eating your way lean.
Well, what you’re seeing in the bathroom mirror when your gums bleed is not unlike what’s happening in your gut when your microbiome becomes unbalanced. The lining of your gut becomes inflamed, much like the tissues of your gums. Imagine your gut lining as like a fine mesh, one that allows water and nutrients to flow through, but keeps everything else in its place. As it becomes irritated, the lining swells, and those fine flow points get stretched, creating gaps. At that point, bacteria and their various compounds begin to enter the bloodstream.
One of these compounds, called lipopolysaccharides (LPS), is found in the cell walls of certain bacteria. A healthy gut prevents the flow of LPS into the bloodstream, but a leaky gut lets this compound through. Higher levels of LPS in the bloodstream have been linked to obesity, metabolic syndrome, and inflammation in fatty tissue. In one study, people who were injected with LPS showed an increase in insulin resistance.
This leakage alerts the immune system, which goes into overdrive trying to respond to these unwanted invaders. Meanwhile, the various microorganisms and metabolites begin to collect in the liver, creating damage there, while inflammation grows throughout the body, turning the powerful artillery of the immune system against our own healthy cells, increasing the risk of everything from obesity to diabetes, from heart disease to arthritis.
The good news is that the gut lining is, like most of the rest of our bodies, constantly being regenerated. With a thoughtful, anti-inflammatory, nutrient-packed diet and other lifestyle changes, the gut lining can quickly heal itself—and set you on the path to rapid weight loss.
ANATOMY OF A POTBELLY
Fat is supposed to be our friend.
We may think of the mass in and around our belly as just a collection of unsightly fat cells—also known as adipose cells—but fat is a far more complicated structure. Among those adipose cells are immune cells, which help to clear away pathogens; endothelial cells, which line the blood vessels and help to ensure the flow of nutrients; and nerve cells, which help you feel all the feels. Working together, this collection of cells that form our fatty tissue is the single largest endocrine organ in the body. Every year, about 8 percent of this tissue dies off and is replaced, which means that you get an entirely new set of fat every thirteen years.
And when our fat is healthy, these cells all work together to keep us in top shape. The fat cells themselves, teeny-tiny things, secrete a hormone called adiponectin, which does a lot of good stuff: It reduces inflammation, discourages the formation of fatty deposits in the arteries, and enhances the response of cells to insulin, helping to keep blood sugar under control. The immune cells embedded in the fatty tissue contribute to this effort by issuing forth anti-inflammatory compounds of their own. And fatty tissue plays a role in hormonal regulation as well, including estrogen and leptin, the “satiety” hormone that helps to keep hunger at bay.
But when the microbiome becomes disrupted, or when too much fat begins to accumulate, inflammation sets in, and this entire system starts to fall apart. Friend becomes foe. Neighbor turns on neighbor. Fat begets fat.
And the fire begins.
HOW INFLAMMATION CREATES FAT
You may assume that weight gain means more fat cells, but that’s not exactly how it works. Instead, when we take in more calories than we burn, the cells we already have start to swell with stored energy, in the form of triglycerides. This is the kind of weight gain that we might see in early adulthood—a few extra pounds that start to form around our midsection. And it’s pretty easy to reverse: If we just eat a little less and exercise a little more, those triglycerides can be burned off, and our fat cells—and our pants—can return to their original size.
A little extra fat is no big deal; indeed, it’s natural and maybe even healthy. Studies show that those who gain weight in midlife, but never become obese, live just as long or longer than those who stay lean their whole lives. Remember, fat’s job is to protect us.
But there is a tipping point. Researchers writing in the European Journal of Immunology called it “the Big Bang”: the point at which our fat flips from being a healthy, immune-regulating organ to becoming dysfunctional and dangerous. Whether or not you hit that tipping point depends on the amount of weight you gain, as well as your age, your physique, your level of inflammation, the health of your microbiome, and other aspects of your overall health. But once you do hit it, this additional weight begins to take on a life of its own.
As the adipose cells grow larger—reaching as much as ten times their original volume—they become stressed and produce less of the healthy adiponectin that protects us. Instead, they begin to secrete more pro-inflammatory factors, compounds with ominous, Bond villain–style names like resistin and tumor necrosis factor-a. The endothelial cells become stressed as well, impairing the flow of oxygen and becoming gummed up with cholesterol. This is a red alert for the body, which senses real danger as the cells in the fatty tissue struggle for oxygen and nutrients.
As a response, more immune cells—white blood cells called macrophages—begin to form in the fatty tissue. (The heavier you are, the greater percentage of your fat is made up of immune cells. In healthy fat tissue, macrophages make up about 10 percent of the total cells, but as the tissue becomes inflamed, that number can grow to as much as 40 percent. That’s right—nearly half of your fat isn’t even fat anymore.)
At first, these additional immune cells remain benign. But as the fat mass grows, the immune system panics. The anti-inflammatory cells become outnumbered as more and more inflammatory cells gain purchase, releasing their own Bond-villain compounds. Other cells switch allegiance, like double agents: Invariant-chain natural killer T cells, which work on your behalf to control inflammation when you’re lean, suddenly turn on you, flipping into inflammation-promoting mode. The bastards!
Copyright © 2024 by Stephen Perrine