Re: Biochemistry of the obesity epidemic; interview with pediatric endocrinologist
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The obesity epidemic
Listen Now - 09072007 |Download Audio - 09072007
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.
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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
Producer
Brigitte Seega
Mon 8.30am
repeated Mon 8pm
Presented by Norman Swan
I think one of the reasons the Atkins Diet is so succesful is because it
also eliminate fructose from the diet, whether planned or not.
http://lowcarbdiets.about.com/od/nutrition/a/fructosedangers.htm
Jimmie
.
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