비만의 원인….인슐린 – 호르몬성 미만 (3) I Can Make You Fat…Insulin – Hormonal Obesity

by Jason Fung, 한국어 정리 Dr. Hayun Lee

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비만에게 1977년은 분명한 전환점이었습니다. 그 이유가 무엇이었을까요? 아마도 자동차의 사용 증가가 비만의 근본 원인이었을 것입니다. 점점 앉아있는 생활과 운동 부족도 비만의 원인입니다. 운동 속설은 다음 시리즈에서 다룰 것입니다.
In the current epidemic of obesity, there is a clear turning point in 1977.  What was the reason? Perhaps the increased use of cars is the underlying cause of obesity.  The increasingly sedentary lives and lack of exercise then led to obesity.  We will address the myth of exercise in an upcoming series.

하지만 자세히 살펴보면, 이 '자동차' 가설은 밑 빠진 독과 같습니다. 운전 행위에 관한 미국공공이익그룹(US Public Interest Group)의 보고서를 보면, 차량 마일 수와 1인당 숫자는 1946년부터 2007년까지 지속적으로 증가했지만, 1977년 부터의 급격한 증가는 없었습니다. 자동차가 운전 비만의 주요 원인이라면 1977년에 갑자기 자동차 운전이 늘었습니까? 증가하지 않았습니다. 이 이론은 광대 없는 서커스처럼 불완전합니다. 무섭게도. 이것은 패스트푸드 식당의 증가가 비만에 책임이 있다고 생각하는 것과 같습니다. 고도로 가공 처리된 살찌게 만드는 탄수화물로 가득한 패스트푸드가 비만의 원인이라는 사실을 부인하지는 않지만, 1977년에 레스토랑 수가 급격히 늘지는 않았습니다. 수십 년 동안 점진적으로 늘었을 뿐입니다. 자동차 사용과 패스트푸드 증가가 비만율의 완만한 기본 상승에 기여했겠지만, 1977년의 급격한 비만 증가의 원인은 무엇입니까? 

최고의 추측은 나쁜 미국 식이조언 1977(odious Dietary Guidelines for Americans 1977)이라고 생각합니다. 

노점상에게 주요 기업을 경영하도록 하는 등의 부조리 움직임 속에서, 갑자기 엄마의 식이 지침이 미국 정부의 식이 조언으로 바뀌었습니다. 

이 조언은 과학적 합의로 결정되지 않았습니다. 의학적 합의도 없었습니다. 대신 정치인이 며칠에 걸쳐 결정했습니다. 그런데 그 조언은 무엇이었습니까? 

탄수화물을 더 많이 먹어라! 
지방과 포화지방을 덜 먹어라!

결과는? 비만 전염병. 

정치인의 식이 조언을 들었을 때 다른 무엇을 기대했습니까? 그럼 비만의 원인은 무엇입니까? 병인은 무엇입니까? Charles Banting과 같은 전통적 견해에 따르면 비만의 원인은 설탕과 녹말 식품 이었습니다. 칼로리가 원인이라는 관점이 나오기 전에, 주로 독일과 유럽의 사상가들은 다른 생각을 갖고 있었습니다. 제2차 세계대전은 핵심적으로 사상가들을 몰아냈고, 결함이 있는 칼로리 해석이 영양 정통이 되었습니다. 

비만은 체지방(fat mass)의 호르몬 조절장애(dysregulation)라고 가정했습니다. 

즉, 몸에는 체지방을 제어하는 호르몬 신호가 있습니다. 예를 들면, 갑상선자극호르몬 (TSH)이 갑상선을 제어합니다. 성장호르몬(GH)이 세포 성장을 제어합니다. 성 호르몬(테스토스테론, 에스트로겐)이 성적 성숙을 제어합니다. 이것을 내분비선 호출이라 하는데 이것을 제어하는 물질이 호르몬입니다. 이것이 호르몬비만이론 (HOT) 입니다.
On closer examination, this ‘Cars’ hypothesis holds water like a straw basket.  Look at this recent report by the US Public Interest Group on driving behavior. The number of vehicle miles and the per capita numbers increase continuously from 1946 to 2007. There is no sharp upward spike starting in 1977. If the increase in cars is the major factor driving obesity – how does that explain the sudden turn in 1977? It doesn’t. This theory is as incomplete as a circus without clowns. Scary…. It is a similar story for those who would consider that the increase in fast food restaurants is responsible for obesity.  While I do not deny that fast food, which is highly processed and full of fattening carbohydrates, is fattening, there is no sharp upward spike in the number of restaurants in 1977.  There is just a gradual increase over the decades. The increasing use of cars and fast food may contribute to the underlying slow rise in obesity rate but what caused the sudden increase in 1977?  My best guess is the odious Dietary Guidelines for Americans 1977. In a move as absurd as hiring a street vendor to run a major corporation, we suddenly shifted from Mom-based dietary advice to US government sanctioned dietary advice. This advice was not decided by scientific consensus. There was no medical consensus. It was instead decided over several days by a politician. And what was that advice?  Eat more carbohydrates.  Eat less fat and saturated fat. Result? The obesity epidemic.  What else did we expect when you take dietary advice from a politician? So what causes obesity? What is the aetiology? According to traditional views like Charles Banting – it was the sugars and the starchy foods that cause obesity. Before the caloric view became popular, there was another school of thought – predominantly German and European thinkers. World War II essentially wiped out most of the European thinkers and the flawed caloric interpretation became nutritional orthodoxy. Obesity was hypothesized to be a hormonal dysregulation of fat mass. That is, there is a hormonal signal from the body that controls fat mass.  For example, thyroid stimulating hormone (TSH) controls the thyroid.  Growth hormone (GH) controls growth of cells.  Sex hormones (testosterone and estrogen) control sexual maturation.  These are called endocrine glands and the substances that control them are hormones.  This is the hormonal Obesity Theory (HOT).

체지방(fat mass)도 호르몬으로 컨트롤 됩니다. 

지방세포를 살찌게 하는(비만) 주요 자극은 아마도 인슐린입니다. 

코르티솔도 작은 역할을 합니다. 호르몬은 몸이 살찌는 신호입니다. 따라서, 이 신호에 따라, 몸은 살찌는 동작을 하는데 - 더 먹거나 운동을 덜 하거나 또는 총에너지지출(TEE)을 줄이는 것입니다. 이 이론의 장점은 다음과 같습니다. 첫째, 몸의 다른 시스템처럼 지방세포도 호르몬 제어 하에 있습니다. 즉, 먹을지 안 먹을지에 대한 결정은 의식 있는 뇌가 하는 것이 아니고, 자동으로 제어됩니다. 자동 제어는 배고픔과 기초 신진대사 속도를 모두 고려합니다. 또한, 이것은 칼로리의 입출입이 불가분 하게 서로 연결되어 있음을 의미합니다. 그들은 호르몬 신호에 따라 비만을 늘리거나 줄이기 위해 함께 작동합니다. 이전 시리즈 칼로리에서 보았듯이, 칼로리 섭취량과 지출은 완전히 일치됩니다.
Fat mass should also be under hormonal control. The major stimulus to gain fat cells (obesity) is likely insulin. To a lesser extent, cortisol plays a role. Hormones are the signal for the body to become obese.  Therefore, under this signal, we undertake behaviors to become obese – that is we eat more or exercise less or decrease total energy expenditure. There are several advantages to this theory.  First, the fat cells, like all other systems in the body are under hormonal control.  That is, it is not simply up to our conscious brain to decide whether to eat or not, but under automatic control.  This takes into account both hunger and basal metabolic rate. Also, this means that calories in and calories out are inextricably linked to each other.  They will work together to either increase or decrease obesity based on the hormonal signals.  As we have seen in the previous Calories series, caloric intake and expenditure are tightly syncronized.

이 이론이 맞는다면 증명 또는 반증하기 매우 쉬운 가설이어야 합니다. 인슐린이 비만을 일으킨다면(병인이라면), 인슐린을 많이 주고 살이 찌는지 여부를 살펴볼 수 있습니다. 인슐린은 토론토대학의 Banting과 Best가 1921년에 발견했습니다. 제1형 당뇨병은 췌장의 인슐린 생성세포의 자가면역(autoimmune) 파괴로 생기는 질병입니다. 제1형 당뇨병은 인슐린 레벨을 극도로 낮추어서 인슐린 주사가 이 질병의 기적적 치료에 이르게 합니다. 하지만 인슐린은 다른 용도를 갖고 있었습니다. 1923년까지 만성저체중 아동의 성장제로 사용되었습니다. 여기 백만 달러짜리 질문이 있습니다. 인슐린이 살찌게 만든다면 인슐린을 주면 체중이 늘까요? 인슐린을 늘리면 살이 찝니까? 한마디로 YES 입니다. 제1형 또는 제2형 당뇨병 환자에게 인슐린을 처방하는 대부분의 의사들은 이미 이 사실을 알고 있습니다. 인슐린 복용 환자들도 이것을 잘 알고 있습니다. 인슐린이 비만의 원인입니다! 인슐린이 많아지면, 비만이 더 심해집니다. 이것은 단순히 부정할 수 없는 인생의 현실입니다.
If this theory is true, then this should be an extremely easy hypothesis to prove or disprove.  If insulin causes obesity (its aetiology), then we can simply give more insulin and watch to see if people become obese. Insulin was discovered in 1921 by Banting and Best at the University of Toronto.  Type I diabetes is a disease that results from the autoimmune destruction of the insulin producing cells in the pancreas. This results in extremely low levels of insulin and insulin injections led to the miraculous cure of this disease.  But it also had other uses. By 1923, it was being used as a fattening agent for chronically underweight children. So here’s the million dollar question. If insulin causes obesity, then giving insulin should cause weight gain.  If I give somebody insulin, will it make them fat?  The short answer is YES. In fact, almost any physician who prescribes insulin to patients with type I or type II diabetes already knows this to be a fact.  Patients taking insulin are also more than well aware of this. Insulin causes obesity!  The more insulin you give, the more obesity you get.  This is simply an undeniable fact of life.

제1형 당뇨병 환자에 대한 초기 연구를 살펴봅시다. 
“당뇨 제어와 합병증 실험에서 제1형 당뇨병을 가진 성인의 체중과 구성에 대한 집중적인 당뇨 치료의 효과" 
제1형 당뇨병 환자는 생존하려면 인슐린이 필요합니다. 이 실험에서, 환자를 무작위로 2그룹으로 나누었습니다. 한그룹은 인슐린을 최소로 얻습니다. 다른 그룹은 엄격한 제어 하에 당을 유지하기 위한 보다 많은 인슐린을 복용합니다. 입증된 이 생각은, 당에 대한 엄격한 제어가 당뇨 합병증을 줄이는데 도움이 되었다는 점입니다. 하지만 체중증가의 원인은 무엇일까요? 위 그래프에서 볼 수 있듯이, 9년 동안 인슐린을 많이 복용한 그룹(빈 막대기)은 적게 복용한 그룹 (그림자 막대기) 보다 많은 체중증가로 여러 문제들이 심각하게 발생되었습니다.
Let’s look at an early study in type I diabetics. “Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial”

Type I diabetics require insulin in order to survive.  In this trial, they randomized 2 groups of patients.  One group would get a minimal amount of insulin. The other group would get larger doses to keep the sugars under tight control. The idea, which was proven, was that tight control of sugars helped to reduce complications of diabetes. However, what happened to weight gain? You can see from the graph above that the group with larger doses of insulin (open bars) over a 9 year period developed significantly more problems with major weight gain than did the group with lower doses (shaded).

놀랍게도! 그 후 9년까지, 30% 이상의 환자가 체중이 "상당하게" 늘었습니다! 과체중. 이 환자들은 의지력이 부족했습니까? 이전보다 게을렀습니까? 먹을 걸 더 탐했습니까? 아닙니다. 그들은 인슐린을 취했습니다. 인슐린이 살찌게 만든 것입니다. 사실, 인슐린 투여량과 평균 혈청 인슐린 그리고 체중증가 사이에는 직접적인 상관관계가 있습니다. 복용량-반응 관계가 있습니다. 
Yowzers!  By 9 years of follow up, over 30% of patients had “major” weight gain! Hefty hefty. Were these patients lacking in willpower? Were they lazier than before? Were they more gluttonous? No No and No. They got insulin. It made them fat. In fact, there is a direct correlation between both the total insulin dose and the mean serum insulin and weight gain.  There is a dose-response relationship.

 

인슐린 복용량이 많을수록 체중이 늘었습니다. 인슐린의 혈중 레벨이 높을수록 체중이 더 늘었습니다. 
The higher the dose of insulin, the more weight gained.  The higher the blood levels of insulin, the more weight gained.

 

제2형 당뇨병은 어떻습니까? 때때로 제2형 당뇨병은 인슐린을 취합니다. 이 정확한 문제를 해결하기 위한 연구 제목은 다음과 같습니다.
"제2형 당뇨병 위험을 가진 환자에 대한 sulphonylureas 또는 인슐린 집중 혈당 조절의 기존 치료 및 합병증 위험과의 비교" Lancet 1998.9 12;352 (9131):837-53
What about type 2 diabetics? Sometimes these patients also take insulin.  A study to address this exact issue was entitled.
“Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes” Lancet 1998 Sep 12;352(9131):837-53

제2형 당뇨병에서도 인슐린 복용이 늘면 살이 찝니다. 연구 초기에, 두그룹의 체중은 동일합니다. 그들을 무작위로 많거나 적은 인슐린이 포함된 치료를 했습니다. 인슐린을 많이 복용한 사람들의 체중이 더 늘었습니다. 이 모든 것에서 “인슐린이 비만을 야기한다”라는 불가피한 결론이 나왔습니다. 인슐린을 많이 취한 사람들이 적게 취한 사람들보다 평균 10.5파운드 체중이 늘었습니다. 
In type 2 diabetes increased insulin dosage causes obesity.  At the beginning of the study, the weight is the same in both groups.  They are randomized to treatment containing more or less insulin.  Those with higher doses of insulin gained more weight. All this leads to the inescapable conclusion from this study that Insulin causes Obesity. Those who took more insulin gained an extra 10.5 pounds on average compared to those that took less insulin.

 

즉 - 당신을 살찌게 만들 수 있습니다. 누구도 살찌게 만들 수 있습니다. 그냥 충분한 인슐린만 주면 됩니다.
In other words – I can make you fat.  I can make anybody fat.  I just need to give enough insulin.

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