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_Dr. Robert Lustig_ Dr. Robret Lustig begins with the question, “What do the Atkins diet and the Japanese diet have in common?” The two diets seem diametrically opposed. The Atkins diet is all fat, no carb. And the Japanese diet is all carb, no fat. They both work. So, what do they have in common? They both eliminate the sugar fructose. According to Dr. Lustig, the obese are getting obeser, but the BMI (Body Mass Index) curve is shifting. We all weigh 25 more pounds today than we did 30 years ago. All of us. Our genetic pool hasn’t changed in the last 30 years, but our environment most certainly has. In order to talk about the environment, we need to talk about what is obesity. Of course, we’re all familiar with the concept of the first law of thermodynamics which states, in human terms, that “if you eat it, you better burn it, or you’re going to store it”. Calories in, calories out. Dr. Lustig used to believe that, but not anymore. He thinks it’s the biggest mistake. It’s this phenomenon that he will attempt to debunk because there’s another way to state the law, which is much more relevant and more to the point. “Calories in calories out” means two behaviors, gluttony and sloth. If that were the case why are all these countries who have adopted our diet all suffering now from the same problem? There’s another way to state this first law. If you’re going to store it, and you expect to burn it (normal energy expenditure for normal quality of life) then you’re going to have to eat it. Now all of a sudden, gluttony and sloth are actually secondary to a biochemical process which is primary. It’s a different way to think about the process and it also alleviates the obese person from being the perpetrator but being the victim. Obesity: No one chooses to be obese. In fact, we have an epidemic of obese 6 month olds. If you want to say it’s all about diet and exercise, then you have to explain this! So any hypothesis proffered to explain the obesity epidemic must all explain this too. And it’s not just in America, but around the world now. No question, we’re all eating more. The question is “why”? We’re all eating more because our leptin isn’t working properly. Leptin is a hormone that comes from our fat cells and tells our brain “I’ve had enough. I don’t need to eat anymore and I can burn energy properly”. Something is wrong with our energy balance. If we’re eating more calories now than we were 30 years ago, our leptin isn’t working. It makes no difference whether or not the food is there. There’s something wrong with our biochemical negative feedback system that normally controls energy balance and we have to figure out what caused it and how to reverse it.
Thomas Irwan Kristanto
So where are all the extra calories from? It’s all in the carbohydrate. We eat more carbs now, especially since we’ve been told since 1982 to reduce our fat consumption from 40 to 30 percent. So what happened? We did it. We reduced our fat consumption from 40% to 30% and look what’s happened to obesity, Metabolic Syndrome, non-alcoholic fatty liver disease, Cardiovascular Disease and stroke prevalence? They’ve all skyrocketed as our fat consumption has gone down. It’s not the fat, it’s the carbohydrate. Which carbohydrate? Our beverage intake has increased. There has been a 41% increase in soft drinks and a 35% increase in fruit drinks. Just remember that one soda per day added to your diet calculates to a 15.5 lb/yr weight gain. Soft Drinks: How come we can’t stay energy stable? How come leptin doesn’t work? Dr. Lustig calls this The Coca Cola Conspiracy. Caffeine is the main ingredient in Coke. It’s also a mild stimulant and diuretic, which makes you pee. There are 55 milligrams of sodium added per can of coke, which makes you thirstier. So why is there so much sugar in Coke? To hide the salt. Anyone remember New Coke in 1985? More salt, more caffeine. They knew what they were doing. That’s the smoking gun. They know. That’s why it’s called the Coca Cola Conspiracy. Are soft drinks the cause of obesity? It depends on who you ask. If you ask scientists from the National Soft Drink Association, they’ll say no. However, Dr. David Ludwig did a prospective study which found that each additional sugared drink increase over a 19 month follow up period in kids increased their odds risk ratio for obesity by 60%. If you look at Meta Analyses (conglomeration of numerous studies subjected to rigorous statistical analysis) 88 studies all showed significant associations. What if you take the soft drinks away? There’s a Fizzy Drink study from Christchurch, England where they went into schools and took out the soda machines for a year. Prevalence of obesity stayed constant over the year whereas the prevalence of obesity in the control schools (where nothing changed) continued to rise over the year. High Fructose Corn Syrop: So what’s in soft drinks? High Fructose Corn Syrup (HFCS). We were never exposed to HFCS before 1975. Today it’s in everything. We are exposed to 63 lbs of HFCS per person per year in America. So what is HFCS? One reason we use it is because it’s sweeter. HFCS is sweeter than table sugar (120 Index in sweetness vs 100). Pure fructose (lab fructose) is 173. You should be able to use less? Right? Wrong! We use just as much, in fact, we use more. Even lab (crystalline) fructose is being added to soft drinks (without cutting back on it) and they’re advertising it as a good thing. We use HFCS because it’s sweeter but also because it’s cheaper. HFCS is one glucose and one fructose. Glucose and fructose are NOT the same. HFCS contains 42-55% fructose and sucrose contains 50% fructose. Sucrose and HFCS ARE the same. There is no difference between them. They are equally bad. They are both dangerous. They are both poison. It’s not about the calories. Fructose is a poison by itself.
Thomas Irwan Kristanto
Before food processing, we used to get our fructose from fruits and vegetables, which would be about 15 grams/day of fructose. Not sugar. It would be double (30 grams). More and more of our caloric intake is being accounted for by sugar every year so it’s not just that we’re eating more, we’re eating more sugar! For adolescents today, we’re up to almost 75 grams (12% of total caloric intake). Twenty five percent of adolescents consume at least 15% of their calories from fructose alone. Compared to the 16-24 gr/day pre-WWII, this is a disaster. The fat’s going down, the sugar’s going up and we’re all getting sick. Now to the Biochemistry. Fructose is NOT glucose, that what the liver does to fructose is really unique. Fructose is 7 times more likely than glucose to do that browning reaction, the advanced glycosylation end products. Fructose does not suppress the hunger hormone from your stomach, called Grehlin. Acute fructose ingestion does not stimulate insulin because there is no receptor for fructose on the beta cell that makes insulin so the insulin doesn’t go up. If insulin doesn’t go up, then leptin doesn’t go up and if leptin doesn’t go up, your brain doesn’t see that you ate something. Therefore, you eat more. Liver Hepatic fructose metabolism is completely different between fructose and glucose. They are NOT the same. I am going to show you that chronic fructose alone causes Metabolic Syndrome (cluster of obesity, Type 2 Diabetes, lipid problems, hypertension and CVD). Dr. Lustig goes on to explain glucose, ethanol and fructose and how they are each metabolized. Glucose: When Glucose enters the body, most of it is used up by cells and organs before it reaches the liver. What does enter the liver is easily stored there as Glycogen. When this happens the liver releases chemicals to signal to the brain that it should stop eating. Fructose: When Fructose enters the body, all of it reaches the liver where 30% of it gets turned into fat. Harmful chemicals are generated in the process. These chemicals can cause Gout and Hypertension, increase bloodpressure and suppress the signal to the brain that you should stop eating. (This part is hugely simplified. In the talk this is a long drawn-out discussion about the biochemistry of metabolizing Fructose) Fructose metabolized in much the same way as alcohol, only it doesn’t affect the brain directly. Ethanol: Ethanol is a carbohydrate and a toxin. We know that ethanol is not good for us. The brain doesn’t metabolize fructose, but since ethanol affects the brain, it is an acute toxin. Therefore, it is controlled and taxed to limit consumption of ethanol…. because it’s a toxin and we know it.
Thomas Irwan Kristanto
A vicious cycle of consumption and disease: hypertension inflammation hepatic insulin resistance hyperinsulinemia dyslipodemia muscle insulin resistance obesity continued consumption Clinical intervention. 1. Get rid of all sugared liquids, including juice (there is no such thing as a good sugared beverage) – only water and milk allowed 2. Eat your carbs with fiber. Fiber is an essential 3. nutrient even though the government doesn’t want it to be. Otherwise, they couldn’t sell food abroad. 4. Wait 20 min for 2nd portions for satiety signals to take effect 5. Buy your screen time minute for minute with physical activity. This is the hardest one to do. Exercise: So why is exercise so important in obesity? Because it burns calories? Come on! Twenty minutes of jogging is one chocolate chip cookie. “Are you jokin’ me?” So why is exercise important? 1. Exercise is important because it improves skeletal muscle insulin sensitivity because the insulin actually works better at your muscle, which brings your insulin levels down, which is good for you. 2. Exercise is also your endogenous stress reducer. It’s the single thing that actually stress. The resulting cortisol release decreases appetite. 3. Exercise makes the TCA cycle run faster and detoxifies fructose, which improves hepatic insulin sensitivity. Exercise allows you to burn the fructose off before you make the fat. That means a higher metabolism, but it has nothing to do with burning calories. You simply can’t burn off all the calories you consume through exercise. Fiber: So why is fiber important in obesity? This his my motto. “When God made the poison, he packaged it with the antidote”. Fructose is a poison, but whenever there’s fructose in nature, there’s way more fiber. Sugar cane is a perfect example. It’s a stick! Consequently, you need to eat carbs with fiber. That’s why fruit’s okay because first, it limits the amount of fructose you’re going to take in and second, it gives you an essential nutrient, which you needed in the first place. And you get some micro-nutrients along with it so that your liver works healthier. What fiber does: 1. Fiber reduces the rate of intestinal carb absorption, reducing insulin response.
Thomas Irwan Kristanto
2. It increases the speed of transit of intestinal contents to the ileum to raise PYY and induce satiety, which means you get your satiety signals sooner. 3. Fiber inhibits absorption of some free fatty acids to the colon, which are metabolized by colonic bacteria to short chain fatty acids (SCFA), which suppresses insulin. Final Points The earlier you expose children to sweets, the more they will crave sugar later in life. This also goes for pregnant women and their unborn babies. So why doesn’t the FDA regulate Fructose if it is this harmful? Apparently they only regulate toxins that have a harmful effect in a single dose, not those that need chronic exposure. So sugar is excluded.
Thomas Irwan Kristanto