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2007-07-16 15:07:02
A researcher in the United States claims that the reason for the obesity
epidemic is more than just the calories we eat and the lack of exercise. It's a
substance that food manufacturers are widely using.
Show Transcript | Hide Transcript
Transcript
This transcript was typed from a recording of the program. The ABC cannot
guarantee its complete accuracy because of the possibility of mishearing and
occasional difficulty in identifying speakers.
Norman Swan: Good morning and welcome to the program. Today on the Health
Report a theory with scientific evidence behind it as to why the obesity
epidemic is perhaps worse than it should be. The food industry, especially in
the United States, hates the message you're about to hear and while certain
manufacturing practices mentioned don't happen in Australia, as you'll hear,
some in fact do.
The question is whether there's stuff in our food which makes us even fatter
than our calorie excess would suggest. It's about how a carbohydrate may be
behaving like a dietary fat. One of the key people pushing this idea is Dr
Robert Lustig who's Professor of Pediatric Endocrinology at the University of
California, San Francisco.
Robert Lustig: I'm very interested in what's happened over the last 30 years
that has fomented this obesity epidemic. And of course everyone says well,
that's because you're eating too much, and you're exercising too little and of
course that's true. But the question is what about our physiology allows this
to happen, we have some built-in negative feedback mechanisms that are supposed
to stop us from gaining too much weight but clearly they are not working. The
question I've been interested in now for the last ten years is what is actually
blocking that signal to the brain to tell our bodies to eat less and exercise
more? Clearly something is getting in its way.
Over the course of those ten years I've done numerous experiments in people and
have come up with the notion that this is actually one of the main functions of
the hormone insulin. Insulin's job is to store energy, insulin's job is to make
you gain weight.
Norman Swan: Transports sugar from the blood into cells.
Robert Lustig: Exactly, that's insulin's job. Let's take a diabetic off the
street, blood sugar is 300 -- in Australian terms that would probably be
something in the order of 15. We give them a shot of insulin, the blood sugar
goes down to 100, that would be something like 4 or 5, the question is where
did the sugar go? It went to the fat for storage. That's insulin's job,
insulin's job is to take sugar from the blood and put it into fat for storage,
more insulin -- more fat. Well all these kids who are walking around who are
massively obese now have extraordinarily high insulins. The question is when
your insulin is high and you're storing energy you make another hormone, and
that hormone is called leptin, and leptin is supposed to go to your brain and
tell your brain that you've eaten enough.
Norman Swan: It's produced by fat cells in fact.
Robert Lustig: That's right, it's produced by fat cells, it circulates in the
bloodstream, binds to specific receptors in the hypothalamus, the area of the
brain that controls energy balance and it's supposed to turn eating off. In
addition it also raises the tone of an area of your brain called the
sympathetic nervous system which is designed to actually help you burn energy.
So by reducing food intake and by increasing the burning of energy you're
supposed to stay in balance -- but clearly these kids are not in balance.
So the question is, could insulin actually be interfering with that leptin
signal, and that's what we've ultimately shown by actually suppressing insulin
with a drug.
Norman Swan: So what have you done?
Robert Lustig: We took these kids who developed massive obesity after brain
tumours; these kids have a tumour in the area of the brain which controls
energy balance, the most common of which is called a cranial pharyngioma, and
once these kids are treated, that area of the brain is now dead, it cannot see
leptin. When you can't see leptin your brain is starving, and so what it does
is it increases your food intake because you need to eat more -- even though
there's plenty of leptin, you can't see it, so it's like it wasn't there -- and
it also reduces your sympathetic nervous system in order to actually make you
feel lousy and to burn less energy.
Because energy expenditure, energy burning and quality of life are the same
thing, anything that raises your energy expenditure makes you feel good; for
instance coffee, for two hours, and then you need another one. Anything that
reduces your energy expenditure, like for instance hypo thyroidism as an
example, makes you feel lousy. So when you can't see your leptin your brain
thinks you're starving, you feel crappy, you certainly don't want to exercise
and you're going to eat more.
So we see these children with brain tumours who can't see their leptin and we
asked the question -- could we somehow influence this disastrous feedback
cycle? What we did is we gave a drug called Octreotide and we knocked down
their insulin levels with this medicine and all of a sudden, not only did these
kids stop eating, they started exercising spontaneously, they just did it. Two
kids started lifting weights at home, one kid became a competitive swimmer, one
kid became a manager of his high school basketball team, running around
collecting all the basket balls.
Norman Swan: So you're postulating that insulin was having an influence on the
brain itself.
Robert Lustig: Right, by getting the insulin down instead of the energy that
they were eating being forced to fat, the energy that they were eating could
now be burned by muscle, could now be burned by the rest of the body, made them
feel better.
Norman Swan: It could help to explain why leptin has been such a disappointing
hormone, that in fact it's much more complicated than leptin, if only it was
just leptin but in fact leptin's pretty lousy at controlling appetite itself,
even when you've got it.
Robert Lustig: That's right, all the studies giving leptin to obese people have
basically been failures, and the reason is because you have this thing called
leptin-resistance, you can't see your leptin. If you could see your leptin you
wouldn't be fat, in fact leptin resistance and obesity are actually the same
thing. So the question is, what causes the leptin resistance, what causes you
to not be able to see your leptin? Well these brain tumour kids, we know what
it is, they've got death of that area of the brain. The question is what's
wrong with the rest of us?
What we did was we actually dropped insulin in otherwise normal, healthy obese
people, using the same mechanism.
Norman Swan: Adults or children?
Robert Lustig: This was adults, and we ended up with the same answer, we were
able to get them to stop eating, in fact they stopped eating carbohydrate on a
dime, they went from 900 calories a day in carbohydrate intake to 350 calories
a day in carbohydrate intake, they stopped snacking between meals, they stopped
drinking soft drinks. We didn't tell them to do this, they just did it, they
didn't need to do it. Their insulins went down, they felt better, they started
exercising and they lost weight and continued and kept losing weight.
If you look at all of the drugs that are out on the market today, they all
cause some weight loss and then at the four month time point that's it, you
can't lose any more, you hit the negative plateau and you can't go any further.
And the reason that you hit this negative plateau is because your leptin has
finally gotten down to a point where your brain is now starving. When we got
the insulin down not only did the leptin keep going down but it kept going down
even further. They kept losing more weight, they kept feeling better, they kept
exercising and we were able to not have a negative plateau, we lost even more
weight over the course of the year.
Norman Swan: So how come anti-diabetic drugs which effectively do that, they
reduce insulin resistance, get your insulin levels down -- how come they don't
universally cause weight loss, in fact some of them can cause weight gain?
Robert Lustig: It depends on which one, in fact Metformin is an insulin
sensitiser, it does get insulin levels down and we've shown that it's actually
a very good promoter of weight loss, especially in insulin-resistant children.
If you look at the adult data it's a relatively mediocre respons. The question
is why does it work in some patients to cause weight loss and not in others,
and that's a very complicated answer. I think it has to do with how insulin
resistant you are when you take the medicine.
It is true that there are some anti-diabetic drugs that cause you to gain
weight, they are called the glitazones one is called rosiglitazone or
piaglitazone.
Norman Swan: They are the new generation of anti-diabetic drugs?
Robert Lustig: That's right and the reason they cause weight gain is because
they actually cause pre-adipocytes, that is fibroblasts that are not adipocytes
themselves yet...
Norman Swan: So actually these are the cells that become fat cells?
Robert Lustig: Yes, almost adipocyte stem cells if you will, and they actually
cause them to differentiate into adipocytes giving you a larger tank to store
energy, and when you do that you actually can clear energy better and that
makes you insulin-sensitive for a time. But only at the expense of increasing
the size of the tank.
Norman Swan: So why are people still searching for weight-loss drugs if what
you're saying is all you need to do is to depress insulin and the technology
exists to do that?
Robert Lustig: Well it's not that easy. It's actually quite difficult. Not
everybody has a disorder that's amenable to an insulin antagonist. Only about
20% of adults have the disorder called insulin hyper secretion that is
responsive to this drug called Octreotide. 80% are insulin-resistant and
Octreotide does not work in them at all. Metformin will work in them but only
to a certain point because it's not the perfect drug either and it has other
side effects.
Norman Swan: There's a non drug that does it which is exercise, particularly
resistance exercise, building up your muscles.
Robert Lustig: Exactly, in fact exercise is the best treatment. The question is
why does exercise work in obesity? Because it burns calories? That's
ridiculous. Twenty minutes of jogging is one chocolate chip cookie, I mean you
can't do it. One Big Mac requires three hours of vigorous exercise to work that
off, that's not the reason that exercise is important, exercise is important
for three reasons exclusive of the fact that it burns calories.
The first is it increases skeletal muscle insulin sensitivity, in other words
it makes your muscle more insulin sensitive, therefore your pancreas can make
less, therefore your levels can drop, therefore there's less insulin in your
blood to shunt sugar to fat. That's probably the main reason that exercise is
important and I'm totally for it.
The second reason that exercise is important is because it's the single best
treatment to get your cortisol down. Cortisol is your stress hormone, it's the
hormone that goes up when you are mega-stressed, it's the hormone that
basically causes visceral fat deposition which is the bad fat and it has been
tied to the metabolic syndrome. So by getting your cortisol down you're
actually reducing the amount of fat deposited and it also reduces food intake.
People think that somehow exercise increases food intake, it does not, it
reduces food intake.
And then the third reason that exercise is important, which is somewhat not
well known, but I'm trying to evaluate this at the present time, is that it
actually helps detoxify the sugar fructose. Fructose actually is a
hepato-toxin; now fructose is fruit sugar but we were never designed to take in
so much fructose. Our consumption of fructose has gone from less than half a
pound per year in 1970 to 56 pounds per year in 2003.
Norman Swan: It's the dominant sugar in these so-called sugar free jams for
example that you buy, these sort of natural fruit jams.
Robert Lustig: Right, originally it was used because since it's not regulated
by insulin it was thought to be the perfect sugar for diabetics and so it got
introduced as that. Then of course high fructose corn syrup came on the market
after it was invented in Japan in 1966, and started finding its way into
American foods in 1975. In 1980 the soft drink companies started introducing it
into soft drinks and you can actually trace the prevalence of childhood
obesity, and the rise, to 1980 when this change was made.
Norman Swan: What is it about this, it's got more calories than ordinary sugar
weight for weight hasn't it?
Robert Lustig: No, actually it's not the calories that are different it's the
fact that the only organ in your body that can take up fructose is your liver.
Glucose, the standard sugar, can be taken up by every organ in the body, only
20% of glucose load ends up at your liver. So let's take 120 calories of
glucose, that's two slices of white bread as an example, only 24 of those 120
calories will be metabolised by the liver, the rest of it will be metabolised
by your muscles, by your brain, by your kidneys, by your heart etc. directly
with no interference. Now let's take 120 calories of orange juice. Same 120
calories but now 60 of those calories are going to be fructose because fructose
is half of sucrose and sucrose is what's in orange juice. So it's going to be
all the fructose, that's 60 calories, plus 20% of the glucose, so that's
another 12 out of 60 -- so in other words 72 out of the 120 calories will hit
the liver, three times the substrate as when it was just glucose alone.
That bolus of extra substrate to your liver does some very bad things to it.
Norman Swan: Dr Robert Lustig who's Professor of Pediatric Endocrinology at the
University of California, San Francisco. And you're listening to a Health
Report special here on ABC Radio National on how food manufacturers by adding
fructose to our foods, either from corn syrup as in the United States or added
sucrose as in Australia, may actually be making the obesity epidemic even
worse, starting with damage to our liver cells, the hepatocytes.
Robert Lustig: The first thing it does is it increases the phosphate depletion
of the hepatocyte which ultimately causes an increase in uric acid. Uric acid
is an inhibitor of nitric oxide, nitric oxide is your naturally occurring blood
pressure lowerer. And so fructose is famous for causing hypertension.
Norman Swan: High blood pressure. And what you're saying here is that the liver
cell itself gets depleted of this phosphate and then you've got this downstream
reaction.
Robert Lustig: That's right. And so when you have excess uric acid you're going
to end up with increased blood pressure and we actually have data from the
NHANES study in America, the National Health and Nutritional Examination Survey
in America which actually shows that the most obese hypertensive kids are
making more uric acid and have an increased percentage of their calories coming
from fructose.
Norman Swan: Are they getting gout as well?
Robert Lustig: Well not yet. They will.
Norman Swan: So what you're saying in fact is that whilst we are clearly eating
too much, we're passively eating too much of the wrong thing, that the food
manufacturing industry is putting stuff in which is fuelling the epidemic?
Robert Lustig: Absolutely, we're being poisoned to death, that's a very strong
statement but I think we can back it up with very clear scientific evidence.
Norman Swan: There's clear scientific evidence on this fructose pathway in the
liver?
Robert Lustig: There's clear scientific evidence on the fructose doing three
things that are particularly bad in the liver. The first is this uric acid
pathway that I just mentioned, the second is that fructose initiates what's
known as de novo lipogenesis.
Norman Swan: Which is fat production.
Robert Lustig: Excess fat production and so VLDL, very low density lipoproteins
end up being manufactured when you consume this large bolus of fructose in a
way that glucose does not, and so that leads to dyslipidaemia.
Norman Swan: And that's the bad form of cholesterol.
Robert Lustig: That's correct. And then the last thing that fructose does in
the liver is it initiates an enzyme called Junk one, and Junk one has been
shown by investigators at Harvard Medical School basically is the inflammation
pathway and when you initiate Junk one what happens is that your insulin
receptor in your liver stops working. It's phosphorylated in a way that
basically inactivates it, serum phosphorylation it's called and when your
insulin receptor doesn't work in your liver that means your insulin levels all
over your body have to rise. And when that happens basically you're going to
interfere with normal brain metabolism of the insulin signal which is part of
this leptin phenomenon I mentioned before. It's also going to increase the
amount of insulin at the adipocyte storing more energy. And you put all of this
together and basically you've got a feed forward system of increased insulin,
increased liver fat, liver deposition of fat, increased inflammation -- you end
up with non-alcoholic fatty liver disease. You end up with your inability to
see your leptin and so you consume more fructose and you've now got a viscious
cycle out of control.
In fact fructose, because of the way it's metabolised, is actually damaging
your liver the same way alcohol is. In fact it's the exact same pathway, in
fact fructose is alcohol without the buzz.
Norman Swan: So this is the obesity related fatty liver disease that people
talk about?
Robert Lustig: Exactly.
Norman Swan: Some people say, I've heard obesity experts say, well it's
surprising that will all the ready availability of food that we're not fatter.
In other words that we are actually controlling our appetite pretty well given
that we've probably been evolutionary designed to eat anything that goes, and
there's anything that goes all around us, so why aren't we actually fatter?
It's not so much why is there an obesity epidemic, why isn't is worse, is what
people say and therefore you don't need to postulate fructose, it's just the
fact that we've evolved in the Savannah to eat in times of plenty.
Robert Lustig: I've heard those same concerns you know, why, if we have so many
calories why aren't we fatter. Well there are a few reasons why that might be.
I do want to mention that the American food industry produces 3,900 calories
per capita per day. We can only eat 1,800 calories per capita per day. In other
words the American food industry makes double the amount of food that we can
actually use. Who eats the rest? We do, through this mechanism, they actually
know that by putting fructose into the foods that we eat, for instance pretzels
-- why do you need fructose in pretzels, why do we need fructose in hamburger
buns?
Norman Swan: Are you postulating here a fructose conspiracy, the way the
tobacco industry had a nicotine conspiracy?
Robert Lustig: Well I can't call it a conspiracy per se. I certainly know, and
they certainly know that they sell more of it when they add the fructose to it.
That's why it's in there, otherwise why would it be in there? Do they know that
this is actually harmful? That's what I don't know. There's no smoking gun,
ultimately we found the smoking gun for smoking, you know we found the
documents. I'm not prepared to say that about the food companies. I do not know
that they know that they are hurting us. However, they definitely know they
sell more, and it temporarily coincides with the advent of fructose being added
to our diet.
Norman Swan: And of course you could argue that it's going up because they are
responding to the market and they've got sugar-free, fat-free etc. etc.
Robert Lustig: Well in fact fat-free doesn't help, if anything as the fat
content of our foods has gone down, and it has gone down, it's gone from 40% to
30%, in fact our obesity prevalence has gone way up. So that's not the answer.
Norman Swan: This is because they're adding carbohydrates and sugars to it to
replace the fat.
Robert Lustig: Absolutely, in fact fat does not raise your insulin but
certainly sugar does. And fructose has been bandied about...because after all
it doesn't raise your insulin directly because there's no fructose receptor on
your beta cell in your pancreas. So people say well it doesn't raise your
insulin, but in fact it does because it's a chronic effect not an acute effect.
This has nothing to do with one fructose meal, this has to do with a year's
worth of fructose meals, or a lifetime's worth of fructose meals, because as
you become insulin resistant, which fructose clearly does and has been shown by
many investigators not just me -- that interferes with that leptin signal which
causes you to eat more.
Norman Swan: Insulin-resistance increases your insulin levels because your
pancreas pumps out more to get the insulin working.
Robert Lustig: Exactly, especially since your liver is not responding to it
because of that effect on the serum phosphorylation of the insulin receptor. So
that's going to cause you to make a whole lot more insulin, that's going to
interfere with your leptin, that's going to make you eat more so the whole
thing just keeps going out of control.
Norman Swan: One way of proving this would be to put you on a fructose free
diet, has anybody done that?
Robert Lustig: Well no one's done it yet. In fact we're trying to do that, in
fact we're actually going to be working with the Atkins Foundation here in
America to actually do a fructose withdrawal experiment to try to actually
answer that question directly.
Norman Swan: Well given that you're not going to come to harm by reducing the
fructose in your diet -- somebody who's listening to this -- what's the
ingredient on the packet, or the jar, or the back of the tin that tells you
there's fructose in there because it won't always say fructose will it?
Robert Lustig: Well high fructose corn syrup, it should say that, now in
Australia for instance the sodas don't have high fructose corn syrup they have
sucrose. Well sucrose is half fructose. You know a lot has been made over this
high fructose corn syrup being particularly evil. In fact high fructose corn
syrup is either 42% or 55% fructose, the rest is glucose. Well sucrose is 50%
fructose the rest is glucose. In fact high fructose corn syrup and sucrose are
equally problematic.
Norman Swan: Basically table sugar.
Robert Lustig: Table sugar -- that's right. We were not designed to eat all of
this sugar, we're supposed to be eating our carbohydrate, particularly our
fructose, with high fibre. Well the fact is we have 100 pound bags of sugar
that go into the cakes, and the donuts.
Norman Swan: So we don't need to get obsessed on fruit sugars, it's sugar
itself, sucrose.
Robert Lustig: Absolutely, it's sugar in general. So people say oh does that
mean I can't eat fruit? No, let's take an orange -- an orange has 20 calories,
10 of which are fructose and has high fibre. A glass of orange juice has 120
calories, it takes 6 oranges to make that glass of orange juice and there's no
fibre. You tell me which is better for you, so by all means eat the fruit, just
don't drink the juice. Juice is part of the problem and there's plenty of data,
not just mine. Miles Faith had an article in Pediatrics, December 2006 showing
that in toddlers, in inner city Harlem in New York, in toddlers the number of
juice servings correlated with the degree of BMI increase.
Norman Swan: Where does this fit, I mean people at the University of Sydney
who've pioneered the glycaemic index, the idea that you get some foods which
actually boost your blood sugar very quickly and some which are slow. They kind
of argue that it doesn't actually matter terribly much what kind of sugar it
is, it just depends on how fast your insulin is going to go up. Where does what
you're saying fit into the glycaemic index story?
Robert Lustig: In fact glycaemic index is half the story, the other half of the
story is the fibre. Here's the way it works -- carrots, let's talk about
carrots for a minute. Carrots are very high glycaemic index, what is the
definition of glycaemic index? It's how high your blood sugar goes if you eat
50 grams of carbohydrate in that food, that's what glycaemic index is. So if
you eat 50 grams of carbohydrate in carrots your blood sugar goes up very high
and so that would be a high glycaemic index food. Fructose is a low glycaemic
index food because fructose does not stimulate insulin, it's all of these
calories but it doesn't stimulate insulin. So in fact a soda has a glycaemic
index of 53 which is low. So you'd say oh wait a second, carrots are bad for
you and a soda is good for you? Because glycaemic index is not the whole story,
in fact what you really want to talk about is a related concept called
glycaemic load.
Glycaemic load is glycaemic index times the amount of food you'd actually have
to eat to get the 50 grams of carbohydrate, so in carrots you'd have to eat the
entire truck in order to get that. Well you can't do that, you wouldn't do
that, so in fact carrots, even though they are high glycaemic index are
actually low glycaemic load. Carrots are fine, there's nothing wrong with
carrots. On the other hand fructose, I mean a soda, there's a lot wrong with it
but you wouldn't see it in just looking at glycaemic index.
Norman Swan: So glycaemic index plus common sense?
Robert Lustig: Well it's glycaemic index plus fibre. Fibre turns any food into
a low glycaemic load food. In fact we are supposed to eat our carbohydrate with
fibre, that's the key. Processed wheat is white, when you go out into the field
it's brown but by the time it gets to your bakery it's white. What happened?
Well the bran was stripped off, well the bran is the good part, the bran is
what we're supposed to be eating.
Norman Swan: I've often wondered, I've heard of some processed stuff and the
evil of the food industry etc. but explain to me a conundrum -- why Asians are
thin, or have been traditionally thin and for centuries they've eaten processed
rice, they've eaten white rice, they don't like brown rice and I don't blame
them.
Robert Lustig: Not a problem, I can explain it very simply. If you look at the
Atkins diet, the Atkins diet was no-carb, high-fat, no-carb and it worked. We
look at the Japanese diet, high-carb, no-fat, it also worked. When you put them
together you get something called McDonalds and clearly that doesn't work. So
the question is what is it about the Japanese diet, even though they eat all of
this white rice, that still allows this phenomenon to be OK? And the answer is
very simple -- it's called fructose, because fructose is really not a
carbohydrate. If you look at the metabolism, the liver metabolism of fructose
it is just like a fat, it doesn't stimulate insulin, just like fat. It causes
all this de novo lipogenesis.
Norman Swan: Fat production
Robert Lustig: Fat production within the liver, it causes deposition of fat
within the liver, it's actually like alcohol and alcohol is like a fat. So
here's a carbohydrate that's acting like a fat. So outside of the Japanese
diet, when you eat a low fat diet what are you eating? Snackwell -- and what
did they do? They added sugar because otherwise it would be unpalatable. So in
fact a low fat diet's not really a low fat diet, a low fat diet containing
fructose is really a high fat diet and that explains what's going on. So a
Japanese diet yes, they're eating a lot of white rice but they are also eating
a lot of fibre in all of their vegetables and they are not consuming any
fructose. There is no fructose in the Japanese diet whatsoever, but there is
now, and childhood obesity has doubled in Japan in the last ten years whereas
adult obesity hasn't moved.
Norman Swan: And the reasons?
Robert Lustig: Because the adults are eating like they used to and the children
are eating like we do in America.
Norman Swan: So do you check your home garage floor for brake fluid every
morning, I mean you can't be the most popular person with the food industry?
Robert Lustig: Well I'm not, I am not, very much so. The Corn Refiners
Association and the Juice Products Association have been on my tail, but the
fact of the matter is the science is clear, the science is there and the
science has to drive the policy.
Norman Swan: So what about the regulators?
Robert Lustig: Well we're trying to work with them, we are trying to do
something about it. They are not moving very fast. In fact you may be aware of
the International Obesity Task Force that met at the Sydney meeting in October
and they came out with something which they called the Sydney principles. The
Sydney principles involved marketing and advertising to children and trying to
get rid of that, and they basically said that you have to do something about
this and it has to be statutory in nature, it has to be regulated, it has to be
a law. In fact in Europe 52 health ministers from the World Health Organisation
from all the different European countries got together in Istanbul in August
and agreed that marketing to children had to stop. Well in fact that is not
happening in America.
Norman Swan: Nor is it in Australia.
Robert Llustig: Well probably not, but I just met with the commissioner of the
Federal Communications Commission, Miss Deborah Taylor Tait, and she mentioned
that she expected that the food companies would police themselves, that
regulation would not be necessary. In fact I said, excuse me but I disagree. In
fact in 1978 the US Federal Trade Commission had an entire congressional
hearings on marketing and advertising to children and the food companies
actually lobbied congress to actually have that killed. And they knew why, they
knew what they were doing then, and they are going to do it again because it's
not in their best interest. They couldn't increase their profits by 5% a year
if they didn't advertise and market to children.
Norman Swan: Dr Robert Lustig is Professor of Pediatric Endocrinology at the
University of California, San Francisco.
References:
Robert H Lustig Childhood obesity: behavioral aberration or biochemical drive?
Reinerpreting the First Law of Thermodynamics. Nature Clinical Practice,
Endocrinology & Metabolism Review,August 2006;2;8:447-457
Robert H Lustig, MD The 'Skinny' on Childhood Obesity: How Our Western
Environment Starves Kids' Brains. Pediatric Annals, December 2006;35;12:899-907
Elvira Isganaitis,Robert H. Lustig Fast Food, Central Nervous System Insulin
Resistance, and Obesity. Arterioscler Thromb Vasc Biol. 2005;25:2451-2462
Guests
Dr Robert Lustig
Professor of Pediatric Endocrinology
University of California
San Francisco
Presenter
Norman Swan
um no
(Score:5, Insightful)
by eneville (745111) on Sunday July 15, @05:41AM (#19865617)
(http://www.s5h.net/)
I hate articles like this. The reader should not be blaming a single food as a
CAUSE for obesity. The cause is that the consumer should not be eating large
quantities of anything. Personally if anything is to blame then its the
consumer for not getting off their ass and actually preparing food, going for a
bike ride, or doing some running. Simple exercise like washing up has now been
replaced with a dish washer, we mow lawns with electric/petrol mowers, and we
don't even write letters by hand either, soon voice recognition will replace
keyboard work. When will the world learn that as physical creatures we depend
on a good, fresh diet and plenty of exercise.
(HE IS NOT BLAMING A SINGLE FOOD ! CONSUMERS DONT KNOW ABOUT FRUCTOSE IN ALL
FOOD, Dr Robert Lustig said lack of exercise is not the only reason)
Somewhat related to a number of the comments....
A book was published about a year ago, "Mindless Eating". It discussed the
various factors that cause us to overeat and undereat. (The latter is a serious
problem in combat situations in the military. It's one thing for a civilian to
lose 20 pounds of fat, it's another thing for a fighting soldier to lose 20
pounds of muscle.)
It's easy to say "eat less/eat healthier", but that requires far more attention
than you realize. Marketers are NOT trying to get you to eat poorly, they just
want you to buy from them instead of the competitor. If everyone wanted
broccoli, there would be broccoli stands on every corner.
Most people want something fast, cheap and filling. Chains have tried
introducing healthier fare periodically (e.g., Taco Bell had 'lite' choices for
awhile), but they weren't popular enough to be economically viable. But offer a
larger standard drink or more fries and your sales climb, so you get a downward
spiral that results in a pound of french fries and people drinking 64 ounces of
soda.
Worse, this "renormalizes" what people expect. Did you know that coke bottles
were originally 8 fl oz? Then pepsi introduced a standard 10 fl oz bottle as a
marketing gimmick. Vending machines stabilized things at 12 oz for a while
(since you had to stay at the standard size to be sold in the machine), but
fast food restaurants competed with each other with larger and larger cups,
free refills, etc. You could always buy a smaller size but that's
psychologically hard when you get half as much drink but pay nearly the same
price.
Ditto coffee. It used to be a cup or two in the morning, perhaps with a bit of
cream. Then Starbucks came into the market and the sizes have not only
increased, the amount of fat and sugar has exploded. People who would never
consider drinking a milk shake every day (or even twice a day!) do this without
thinking twice when it's a fancy Starbucks drink. If you want a cup (8 oz) of
black coffee... good luck!
I think the most telling story was some guy at a yard sale(?) who asked if the
seller had any more dinner plates in a set from the 40s. He was holding a
serving platter. Historically dinner plates were around 8", but now they're
usually 12" (iirc), or over twice as much area. People tend to fill their
plates so we're eating a lot more food without thinking about it. Now look at
sit-down restaurant chains (Chili's, Olive Garden, etc.) They're selling
presentation so they use larger plates than you have at home, and they fill
those plates. It's not an exaggeration to say that they serve 3 or 4 solid
servings, nutritionally speaking.
This is gradual enough that most people aren't aware that it's happening, but
we are eating a lot more food and finding it harder to eat the correct
portions. How often have you seen a 6'+ adult order from the child's menu?
Does this excuse people from TRYING? No, of course not. But arrogant "people
should know better" tirades don't help since changes requires us to be aware of
the subtle changes that have lead us to the current selections and portion
sizes.
Re:from the "no shit" dept.
(Score:5, Insightful)
by Optikschmoptik (971793) on Sunday July 15, @05:08AM (#19865495)
(http://djdanique.com/)
How long have nutritionists been telling us this?
At least as long as Fat Land [amazon.com] has been out, but probably a bit
longer than that. The story of American obesity is the story of American corn
subsidies, which is therefore the story of high-fructose corn syrup and
omnipresent, cheaper-than-water soda; and the story of vending machines and
fast-food restaurants, 'family-style' Applebee's-like chains that exist solely
to help burn off the excess corn stock by selling almost nothing but corn and
its byproducts.
Don't tell the presidential candidates though, they have to win in Iowa!
[ Reply to This | Parent ]
Re:from the "no shit" dept.
(Score:5, Interesting)
by JanneM (7445) on Sunday July 15, @05:32AM (#19865581)
(http://www.lucs.lu.s...ren/log/current.html)
and the story of vending machines and fast-food restaurants,
There is something to what you write. But, here in Japan vending machines are
absolutely everywhere - really, it's crazy; I walked about 3km every morning to
my previous job, in a partly rural area and I realized that there was not a
single spot along the route where I could not see at least one vending machine.
And there has always been lots and lots of fast-food here as well as takeout
meals; many traditional Japanese dishes like soba, onigiri, oden and so on are
meant to eat quickly from a counter or street vendor cart, or while going from
place to place, and the bento meal is ubiquitous. A traditional Japanese meal,
furthermore, is an orgy in "grazing" behavior, with dozens of small dishes to
eat in turn.
No, while "fast-food" style serving may contribute to creating bad habits, the
main culprit is still what people eat, and how much of it, not how you eat it.
Most Japanese meals just aren't very fattening; while you often have some part
of the meal that is fatty or calorie-rich, you don't get much of it, while you
often do get large amounts of vegetables, pickles and other lean stuff. A
steak, for instance, may be 100 grams or so, and be just one dish of a dozen
you get for your meal.
[ Reply to This | Parent ]
o
Re:from the "no shit" dept.
(Score:5, Funny)
by superdude72 (322167) on Sunday July 15, @07:17AM (#19865953)
The Japanese meal you describe sounds somewhat healthier than the American fast
food diet of:
Two beef patties slathered with carbohydrate-rich condiments sandwiched between
carbohydrate-rich bread, served with a side of carbohydrate-rich french fries
and a 32 oz. cup of high fructose corn syrup. All super-sized because the
marginal cost of the ingredients is so low, it is profitable for the
restaurants to offer extra portions for a premium.
The innocuous-seeming bun, even, is so loaded with refined carbohydrates that
you might as well be eating your hamburger in the middle of a donut sliced in
half.
[ Reply to This | Parent ]
+ 9 replies beneath your current threshold.
o
Re:from the "no shit" dept.
(Score:5, Interesting)
by TheRaven64 (641858) on Sunday July 15, @07:18AM (#19865959)
(http://theravensnest.org/ | Last Journal: Thursday May 31, @07:12AM)
There's probably some truth in that. I spent some time in a Japanese town
slightly smaller than the one I grew up near in the UK. When I got on the bus,
I was given something that looked like a raffle ticket, with a number
indicating where I got on. At the front was a big board explaining how much
people with each numbered ticket had to pay to get of at each stop. When I got
off, I was expected to just drop the ticket and the money down a hole by the
driver. The driver had no way of telling exactly how much I'd paid.
When I asked what happens if people don't have enough change on them, I was
told that generally they pay a bit more the next time they ride. I'd love to
have a system like that here, since it would save a lot of time with people
buying bus tickets when they got on at each stop, but I can't imagine it
working with the average British person, who would just see it as a way to
avoid paying for the service. It seems to be not so much an issue of how
law-abiding the Japanese are as the culture of respect.
[ Reply to This | Parent ]
+
Re:from the "no shit" dept.
(Score:5, Informative)
by DDLKermit007 (911046) on Sunday July 15, @08:20AM (#19866183)
Less about respect, and more about fear of being ostracized. Sure you'll get
away with it a few times, but not too many times. People have eyes, and you
really never get to hear what other people say about you in Japan. Pretty
important stuff when you generally end up getting to know your community better
since your on foot allot more, and on public transportation. Once you are
caught, and have a black mark for doing something bad, you'll spend a damn long
time clawing your way outa that hole if you ever can. It's easy to sluff off
personal guilt in other countries, but in one thats so entrenched with the idea
of personal guilt...it's hard to have it not rub off on you after a while.
Theres others, but thats a big one I've noticed.
Re:Nasty aftertaste
(Score:5, Funny)
by steve86-ed (469774) on Sunday July 15, @05:15AM (#19865521)
Personally, I can't stand all the corn syrup the Americans seem to have in
everything they eat. Maybe this is my body's way of saying "get the hell out of
this silly country before you become one of them!"?
If you don't like it, you can leave. We don't need no whinny Euro-cans telling
us not to devour copious amounts of corn syrup and sugars. And stop calling me
an American. America is huge, I just live in the best part of it, the USA. That
makes me a Citizen of the United States of America, but you can shorten that
down to a CUSA. From now on when you want to badmouth the best nation on Earth,
you can address us as Cusans. It's about time we had our own identity.
I think all the corn syrup has gone to my head...
[ Reply to This | Parent ]
Re:Nasty aftertaste
(Score:5, Insightful)
by Eli Gottlieb (917758) on Sunday July 15, @11:10AM (#19867367)
(https://sourceforge.net/projects/glider-kernel | Last Journal: Wednesday May
23, @10:48AM)
Most people who smugly criticize America from abroad are European. If they
angrily criticize America for what it did to their country, they're from South
America or the Middle East. If they laugh at how much money they make off
stupid Americans, they're from Asia.
The one exception is that Britons seem to have some understanding that their
food is scarcely better than ours.
Re:And in other news.........
(Score:5, Informative)
by Rosyna (80334) on Sunday July 15, @06:01AM (#19865677)
(http://www.unsanity.org/)
Don't drink Soda Pop and always check the labels for High Fructose Corn Syrup.
It is says it has it, don't buy it. That shit should be illegalized in most
foods.
Why? HFCS and Sugar breaks down to the same things in the body. Every study
I've seen shows that HFCS is no more dangerous than Sugar. Studies that only
look at the Fructose show that high amounts of Fructose is dangerous. The HFCS
in soft drinks and sport drinks is not high in Fructose. The "High Fructose"
part of "High Fructose Corn Syrup" means it has a high content of fructose
compared to corn syrup itself (which has next to no fructose).
In fact, a happy paper [nih.gov] at the NIH says pretty much this.
[ Reply to This | Parent ]
Re:And in other news.........
(Score:5, Informative)
by the grace of R'hllor (530051) on Sunday July 15, @09:30AM (#19866521)
From my read of TFA, fructose breaks down in the body the way alcohol does. The
liver has to do all the work (glucose is mainly broken down directly in muscles
and organs, where it is useful), and turns it to fat, while not raising insulin
levels. Not raising insulin levels means the body doesn't know it has enough
sugar already, which means apetite doesn't decrease in the amount it should.
Now, fruits have the exact same fructose in it. Why are fruits better? For one,
they come with other nutrients. For another, to consume the amount of fructose
in a glass of coke, you'd have to eat a whole bushel of apples. The logistics
prevent you from overindulging in fruits, while soda's are all about
overindulging.