The Facts on Leptin: FAQ

The truth about the hormone leptin and obesity.

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By Katherine Kam WebMD Feature Re ie!ed by Laura ". Martin# MD

$t%s been called the &obesity hormone& or &'at hormone& (( but also the &star ation hormone.& When scientists disco ered leptin in )**+# e,citement arose about its potential as a bloc-buster !ei.ht loss treatment. / en today# the $nternet is loaded !ith sites that sell leptin supplements. Any truth to those pitches0 And !hat e,actly is leptin0 WebMD as-ed t!o e,perts on leptin to discuss ho! this hormone a''ects !ei.ht and appetite# as !ell as other aspects o' health. Q. What is leptin? &Leptin is not our obesity hormone. Leptin is our star ation hormone#& says Robert 1. Lusti.# MD# pro'essor o' pediatrics at the 2ni ersity o' 3ali'ornia# 4an Francisco and a member o' the /ndocrine 4ociety%s 5besity TasForce. Leptin is a protein that%s made in the 'at cells# circulates in the bloodstream# and .oes to the brain. &Leptin is the !ay your 'at cells tell your brain that your ener.y thermostat is set ri.ht#& Lusti. says. &Leptin tells your brain that you ha e enou.h ener.y stored in your 'at cells to en.a.e in normal# relati ely e,pensi e metabolic processes#& he says. &$n other !ords# !hen leptin le els are at a certain threshold (( 'or each person# it%s probably .enetically set (( !hen your leptin le el is abo e that threshold# your brain senses that you ha e ener.y su''iciency# !hich means you can burn ener.y at a normal rate# eat 'ood at a normal amount# en.a.e in e,ercise at a normal rate# and you can en.a.e in e,pensi e processes# li-e puberty and pre.nancy&. But !hen people diet# they eat less and their 'at cells lose some 'at# !hich then decreases the amount o' leptin produced. &Let%s say you star e# let%s say you ha e decreased ener.y inta-e# let%s say

you lose !ei.ht#& Lusti. says. &6o! your leptin le el .oes belo! your personal leptin threshold. When it does that# your brain senses star ation. That can occur at any leptin le el# dependin. on !hat your leptin threshold is.& &7our brain senses that and says# 81ey# $ don%t ha e the ener.y onboard that $ used to. $ am no! in a star ation state#%& Lusti. says. Then se eral processes be.in !ithin the body to dri e leptin le els bacup. 5ne includes stimulation o' the a.us ner e# !hich runs bet!een the brain and the abdomen. &The a.us ner e is your ener.y stora.e ner e#& Lusti. says. &6o! the a.us ner e is turned on# so you .et hun.rier. / ery sin.le thin. the a.us ner e does9:is; desi.ned to ma-e you ta-e up e,tra ener.y and store it in your 'at. Why0 To .enerate more leptin so that your leptin can re(establish its personal leptin threshold... $t causes you to eat and it causes you to .et your leptin bac- to !here it belon.s.& Q. How does leptin affect weight &1ere%s the <uestion: $' this thin. !or-s li-e a thermostat (( an adipostat (( !hy do !e -eep .ainin. !ei.ht0& Lusti. says. The problem is that o er!ei.ht people ha e lar.e amounts o' leptin# but their brains aren%t .ettin. the important si.nal to stop eatin.. &1o! come the brain doesn%t .et it0 That phenomenon is called 8leptin resistance#%& says Lusti.# !ho has done research on the sub=ect. Leptin resistance is similar to insulin resistance in type > diabetes# in !hich the pancreas produces lar.e amounts o' insulin# but the body doesn%t respond to it properly. Leptin le els can -eep .oin. hi.her as people .et 'atter. &We all ha e a leptin 'loor? the problem is# !e don%t ha e a leptin ceilin.#& Lusti. says. &$n leptin resistance# your leptin is hi.h# !hich means you%re 'at# but your brain can%t see it. $n other !ords# your brain is star ed# !hile your body is obese. And that%s !hat obesity is: it%s brain star ation.& 6ot only is leptin part o' the hun.er system# it%s also part o' the re!ard system# Lusti. says. &When your leptin le els are lo!# 'ood is e en more re!ardin.. When your leptin le els are hi.h# that%s supposed to e,tin.uish the re!ard system so that you don%t need to eat so much# and 'ood doesn%t loo- nearly as .ood.&

But in leptin(resistant people# the re!ard system doesn%t cue a person to stop eatin. !hen leptin le els rise# Lusti. says. &The leptin is bein. made by the 'at cells# the 'at cells are tryin. to tell the brain# 81ey# $ don%t need to eat so much#% but the brain can%t .et the si.nal. 7ou 'eel hun.rier and the re!ard doesn%t .et e,tin.uished. $t only .ets 'ostered# and so you eat more and you -eep .oin. and it becomes a icious cycle. $' your brain can%t see the leptin si.nal# you%re .oin. to .et obese.& Q. Can leptin work as an obesity treatment? That !as the .reat hope a'ter leptin%s disco ery in )**+# says Richard At-inson# MD# an endocrinolo.ist# obesity e,pert# and clinical pro'essor o' patholo.y at @ir.inia 3ommon!ealth 2ni ersity. Accordin. to At-inson# mouse e,periments that be.an in the early )*ABs pointed to &some sort o' a hormone that a''ected 'ood inta-e and body 'at# but :scientists; didn%t -no! !hat it !as.& When researchers 'inally disco ered leptin in )**+# it helped &put obesity on the map because it su..ested9obesity may ha e some physiolo.ical basis# instead o' =ust bein.# &'at people can%t -eep their mouth shut#%& At-inson says. &For those o' us in the 'ield o' obesity# it !as a !atershed moment. 4uddenly# e erybody =umped on the band!a.on. This became a 'rantic obsession !ith the obesity community# at least.& Many scientists e,plored leptin as a possible treatment 'or obesity? they belie ed that i' people !ere leptin(de'icient# .i in. them leptin !ould raise le els# !hich !ould si.nal them to stop o ereatin.. &But !hen you started .i in. it to people# it didn%t !or- so !ell#& At-inson says. &This stu'' is made by 'at tissue# and as you .et 'atter# you ma-e more o' it. That !as <uite a shoc- because e erybody thou.ht that obese people !ere .oin. to be de'icient in leptin#& he says. With the more recent understandin. o' leptin resistance# it ma-es no sense to .i e people leptin i' they ha e an impaired response# Lusti. says. &The resistance is still there. 6o amount o' leptin is .oin. to o ercome that resistance.& Ci in. leptin only helps in a 'e! e,tremely rare cases in the !orld in !hich people ma-e no leptin at all# !hich causes them to o ereat and become obese. When those people recei ed leptin by in=ection# they stopped o ereatin. and lost !ei.ht. But 'or the ast ma=ority o' people# the

treatment !on%t !or-# nor is leptin appro ed as a medical treatment 'or !ei.ht loss. &Leptin is still sort o' e,perimental. There%s no real need to ta-e leptin no!# unless you%re one o' those ery small (( probably )BB people in the !orld (( !ho doesn%t ma-e leptin#& At-inson says. Q. What about leptin supplements, such as those sold on the Internet? Because leptin is a di.estible protein that doesnDt enter the bloodstream# it canDt be ta-en in supplement 'orm# At-inson says. E$' you !ere to ta-e it as a pill# itDs =ust li-e eatin. chic-en or bee'. $tDs a protein and your body !ould =ust brea- it up# so you !ouldnDt absorb it 'rom a pill.F 4o those Eleptin supplementsF sold on the $nternet donDt actually contain leptin# e en thou.h their name can be misleadin.. $nstead# these supplements contain in.redients that are purported to help impro e leptin 'unctionin. or 'eelin.s o' 'ullness. EA ariety o' these supplements may be more aimed at total !ellness (( thin.s li-e helpin. balance other hormones# thyroid hormones (( =ust optimiGin. health so that the body be.ins to respond to leptin more appropriately and allo!s the person to 'eel 'ull#F says Du''y MacKay# 6D# a licensed naturopathic doctor !ho ser es as ice president o' scienti'ic and re.ulatory a''airs at the 3ouncil 'or Responsible 6utrition# a trade .roup 'or the supplements industry. E4ome o' !hat youDre seein. is tried(and(true in.redients that are -no!n to cause satiety# thin.s li-e soluble 'ibers that ha e been -no!n 'or a lon. time to help ma-e people 'ull#F MacKay says. As 'or supplementsD e''ects on leptin 'unctionin.# the picture is less clear# he says. EThe leptin science has only been unra elin. since )**+# so there are a lot o' unans!ered <uestions.F E6o ma.ic bullets are bein. disco ered#F MacKay says. E:But; !e shouldnDt !rite this path!ay o'' as somethin. that !e shouldnDt continue to e,plore.F Rather than ta-in. supplements that ha enDt been 'ully pro en to help# o er!ei.ht people ha e other options to aid leptin 'unctionin.# e,perts say. Lusti. ad ises them to reduce resistance to insulin Ha hormone that controls blood su.arI and to brin. do!n hi.h le els o' tri.lycerides Ha blood lipidI.

E$nsulin resistance .enerates leptin resistance. The practical ad ice is: Cet your insulin do!n#F Lusti. says. E1o! do you .et insulin do!n0 The best !ay is donDt let it .o up. 4u.ar ma-es insulin .o up. We are o erdosed on su.ar in this country. $ thin- that i' !e .ot the su.ar do!n# our insulin resistance !ould impro e and that !ould help !ith the !ei.ht loss.F Reducin. hi.h tri.lyceride le els helps# too# Lusti. says. Too much tri.lyceride inter'eres !ith leptinDs =ourney 'rom the blood to the brain ia a leptin transporter that allo!s the hormone into the brain. EWhen youDre insulin(resistant# you ha e hi.h tri.lyceride :le els;. ThatDs one o' the hallmar-s#F Lusti. says. ETri.lyceride seems to bloc- leptin transport into the brain. $n order to ma-e your leptin !or-# you ha e to let the si.nalin. occur. The only !ay to let the si.nalin. occur is to .et your tri.lyceride do!n.F Q. Does leptin affect other parts of the body? Leptin appears to ha e many 'unctions that scientists are still e,plorin.. &$t didn%t !or- as a !ei.ht loss a.ent# but there%s no! startin. to be some other thin.s that are really interestin. about it#& At-inson says. The hormone plays a role in heart and bone health# Lusti. says. &We -no! that leptin is ery important in -eepin. the immune system happy and that chronic in'lammation occurs in the 'ace o' inade<uate leptin si.nalin.# and that%s part o' cardio ascular disease.& &We also -no! that leptin has direct e''ects on bone to increase bone health and bone mineral density# so !hen your leptin%s !or-in. ri.ht# your bones are healthier and they accrue more calcium#& he says. 4cientists are also 'indin. some associations bet!een leptin and certain cancers# At-inson says. For e,ample# some recent research su..ests that leptin can promote the .ro!th o' melanoma# a type o' s-in cancer. Accordin. to At-inson# leptin may e en a''ect !omen%s 'ertility. &$' the brain doesn%t sense leptin# you !on%t be 'ertile. $' you thin- bac- to our ca eman days# !hen there !ere lots o' 'amines# i' you didn%t ha e enou.h 'at to sur i e a pre.nancy# then you%re better o'' not .ettin. pre.nant in the 'irst place. 4ome people ha e thou.ht that the leptin 'eeds bac- on the hypothalamus to -eep the reproducti e hormones !or-in. !ell# too.&