The Nourisher - Editor’s Blog

In Monday’s Health Report on ABC radio Norman Swan interviewed Dr Robert Lustig, Professor of Pediatric Endocrinology at the University of California, San Francisco

Lustig began the conversation by talking about the his study of the obesity epidemic in America and around the world. He said, “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.” It is natural for the human body to stop when it needs no more food and to desire exercise.

Insulin’s job is to transport energy into cells, store energy, gain weight and Leptin’s job to tell your brain you’ve eaten enough. Hi studies on children who has survived brain tumors in the area of the brain which govern balance of energy show that after treatment and surgery, they go on to become obese. The damaged brain can no longer see Leptin. It continually thinks it is starving. The children no longer knew when they were full and almost every bit of energy they ate became fat cells.

He began to use drugs to “knock down” the children’s insulin levels which worked, “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..” No longer was all the energy they ate going to fat, it was able to be used by the body.

Why then can’t we use these drugs on all obese people?

“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. 80% are insulin-resistant and (it) 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” says Lustig.

Norman Swan and the good doctor then began to talk sense:

Norman Swan: There’s a non drug that (helps obesity) which is exercise, particularly resistance exercise building up your muscles.

Robert Lustig: Exactly, in fact exercise is the best treatment…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…

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 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… 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…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.

…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.

Briefly, Lustig recounts the cost of High Fructose diets:

1. 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. (data from … the National Health and Nutritional Examination Survey in America … shows that the most obese hypertensive kids are making more uric acid and have an increased percentage of their calories coming from fructose.)
2. Initiates what’s known as the de novo lipogenesis… 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..the bad form of cholesterol
3. Initiates an enzyme called Junk one (your insulin receptor in your liver stops working). Insulin levels all over your body have to rise interfering 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.

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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.

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I do want to mention that the American food industry produces 3900 calories per capita per day. We can only eat 1800 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.

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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.

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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 (it) 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 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 have 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 or 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.

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What does this say about the current ‘health’ trend to down a wheat grass shot with a watermelon and pineapple juice chaser? 

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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 Communication’s 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, who’s Professor of Pediatric Endocrinology at the University of California, San Francisco.

To help put an end to advertising to children  join the Pull the Plug on Food Advertising Campaign

To check for sneaky names for refined sugar in manufactured food, read Nancy Appleton’s article: 124 Ways Sugar Ruins Your Health 

About the Author...

A Super Hero and one of many who have realised their true calling as saviors of humanity, healers of our connection with Nature and creators of Heaven on Earth. The Nourisher's gift is the re-spiritualisation of the 'process of recreation' we call eating. Mother of three Super Heroes in training and wife to her God incarnate, The Nourisher hails from the place of feminine healing, Byron Bay, Australia. She gathers together Life Creators from all over the globe at NourishedMagazine.com.au