Fever, heart, and atypical gratitude

Overlooked considerations during our Thanksgiving feast

Tomorrow is Thanksgiving here in the states. Millions of us are cooking already. I’m seeing 20 patients today, and so I am spared a good deal of the preparation, though I’ll be exhausted nonetheless. I have three ideas to explore briefly before I see my first patient:

• Can Thanksgiving gluttony cause a fever?

• Can it trigger a heart attack?

• Is it OK to be thankful for “the ability to accept disturbing symptoms in our bodies” rather than simply “our good health?”

A fever

My daughter came home yesterday from school with an interesting story that stumped her primary care father. Her school had their annual Thanksgiving feast in which massive amounts of lasagna are prepared, cooked, and eaten. One of her classmates was “going for the new record” and ate 11 servings of lasagna. This equaled a whole tray. The boy ended up “not feeling so well” immediately afterwards. Nausea, but short of vomiting. He went to the school nurse. He reportedly had "a low grade fever,” but no other symptoms such as sore throat, headache, runny nose, or cough. After holding his belly for an hour in discomfort, with nurse supervision and a provisional diagnosis of “eating too much,” his temperature normalized and he returned to class — with the new school record for lasagna gluttony.

Can pigging out really cause a fever?

The best answer I could find (quickly) on this came from a study using rodents. Meal thermogenesis, the increase in body temperature following food consumption, appears to be a well-regulated physiological response that occurs after eating. Rodent studies, including the comprehensive work by Perry et al., show increases of approximately 1°C (1.8°F) after carbohydrate or protein-rich meals; human studies demonstrate more modest increases of 0.2-0.5°C (0.4-0.9°F), typically peaking 60-90 minutes after eating. This difference in magnitude likely reflects fundamental metabolic and physiological differences between species, including variations in body size, metabolic rate, and brown adipose tissue activity. However, we both dissipate some energy as heat after meals.

The mechanism underlying this temperature increase appears to work through a leptin-brain-adrenal medulla-adipose tissue axis, where eating triggers increased leptin levels, leading to catecholamine release and subsequent temperature elevation. Interestingly, both human and rodent studies show that this response is blunted in obesity but can be restored with weight loss, and that the response varies based on meal composition, with carbohydrate and protein meals producing greater temperature increases than high-fat meals.

Anyone up for a Thanksgiving Day experiment? I’m going to measure my temperature before eating dinner, and then 30/60/90/120 minutes later. I’m not promising I’ll do this, as it might be weird. But I’m curious. Are you?

And I hope it truly was the 11 servings of lasagna that caused our school hero to develop a fever, and not his being patient zero in a superspreader event.

Heart considerations

A patient asked me yesterday about the risks of pigging out in terms of his gallstones. Clearly this is not a good idea, but this also triggered a memory about heart attack risk after a gluttonous meal.

According to a study presented at the American Heart Association's Scientific Sessions, consuming an unusually heavy meal could quadruple the risk of heart attack within two hours after eating, similar to how extreme physical exertion or anger can trigger cardiac events. The research at Brigham and Women's Hospital studied nearly 2,000 heart attack patients and found that heavy meals can affect the heart through multiple mechanisms: they trigger the release of hormones that increase heart rate and blood pressure, may promote blood clot formation, can impair arterial function through high fat content, and cause insulin spikes that affect coronary artery relaxation. This discovery marked the first time that overeating alone was identified as a potential heart attack trigger, particularly dangerous for those with existing heart disease.

Now granted this was not a randomized trial but rather based on a recall questionnaire. But I definitely feel my heart pumping hard like I’m on a treadmill after overeating. I know my digestive system is working out, so maybe this is another reason to take it easy on Thanksgiving. Pace yourself.

Atypical gratitude

Many blessings and sayings of grace will be offered tomorrow, gathered around Thanksgiving tables, perhaps with political minefields and unspoken resentments burbling under the surface. We might keep the blessings generic, with something like “We give thanks for the precious gift of health that allows us to gather here today.” And while I agree with this sentiment, odds are each and every person over age 40 gathered at the table has an expanding list of medical stuff that increasingly undermines any notion of perfect health.

I plan to give thanks for the health I have, and for the miraculous, merciful ability of the body and mind to accept and adapt to its own imperfections and maladies.

When a new problem arises, or we lose a functionality, it is natural to be upset. And yet we learn to accept aches and pains, floaters in our vision, feelings of ants crawling on our lower extremities, angina, muscles cramping and twitching, headaches, heartburn, memory lapses, and even a rage felt at the way the world is going.

May we accept the new normal in our bodies, the degradation of what was once better in our lives, even as we extend a genuine compassion towards our imperfect selves and fellow beings on this journey together.

Happy Thanksgiving!