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Societal Control of Sugar Essential to Ease Public Health Burden

April 28, 2012 By Leave a Comment

Robert H. Lustig, MD, and a team of the University of California, San Francisco (UCSF) researchers argue that sugar should be controlled like alcohol and tobacco to protect public health. In a new report, they maintain that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer. 

 

 

Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.

Robert Lustig, MD

In the Feb. 2 issue of Nature, Robert Lustig, MD, Laura Schmidt, PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at UCSF, argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet, make it a primary culprit of this worldwide health crisis.

This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.

Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver – the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome — the key metabolic changes that lead to diabetes, heart disease and cancer — are not clinically obese.

“As long as the public thinks that sugar is just ‘empty calories,’ we have no chance in solving this,” said Lustig, a professor of pediatrics, in the division of endocrinology at the UCSF Benioff Children’s Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

“There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,” Lustig said. “But sugar is toxic beyond its calories.”

Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. “We recognize that there are cultural and celebratory aspects of sugar,” said Brindis, director of UCSF’s Philip R. Lee Institute for Health Policy Studies (IHPS). “Changing these patterns is very complicated.”

According to Brindis, effective interventions can’t rely solely on individual change, but instead on environmental and community-wide solutions, similar to what has occurred with alcohol and tobacco, that increase the likelihood of success.

Laura Schmidt, PhD, MSW, MPH

The authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar.

“There is an enormous gap between what we know from science and what we practice in reality,” said Schmidt, professor of health policy at UCSF’s IHPS and co-chair of UCSF’s Clinical and Translational Science Institute’s (CTSI) Community Engagement and Health Policy Program, which focuses on bridging academic research, health policy, and community practice to improve public health. In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level,” she said.

The paper was made possible with funding from UCSF’s CTSI, UCSF’s National Institutes of Health-funded program that helps accelerate clinical and translational research through interdisciplinary, interprofessional and transdisciplinary work.

Claire Brindis, DPH

Many of the interventions that have reduced alcohol and tobacco consumption can be models for addressing the sugar problem, such as levying special sales taxes, controlling access, and tightening licensing requirements on vending machines and snack bars that sell high sugar products in schools and workplaces.

“We’re not talking prohibition,” Schmidt said. “We’re not advocating a major imposition of the government into people’s lives. We’re talking about gentle ways to make sugar consumption slightly less convenient, thereby moving people away from the concentrated dose. What we want is to actually increase people’s choices by making foods that aren’t loaded with sugar comparatively easier and cheaper to get.”

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For more information, please visit http://www.ucsf.edu.

Photos by Susan Merrell

 

Reference 

Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature 2012; 482 (7383): 27-9.

 

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Is Sugar Toxic?

April 20, 2012 By Leave a Comment

If you are what you eat, then what does it mean that the average American consumes 130 pounds of sugar a year? Dr. Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. Some physicians go so far as to call sugar a toxin (CBS News, 2012).

 

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To Ditch Dessert, Feed The Brain

September 20, 2011 By Leave a Comment

Brain reward regions are activated when glucose falls below normal levels (blue). In lean people -- but not obese people -- the prefrontal cortex which is involved in decision making and regulating impulses is activated (red) when glucose levels are normal.

If the brain goes hungry, Twinkies look a lot better, a study led by researchers at Yale University and the University of Southern California has found.

Brain imaging scans show that when glucose levels drop, an area of the brain known to regulate emotions and impulses loses the ability to dampen desire for high-calorie food, according to the study published online September 19 in The Journal of Clinical Investigation.

“Our prefrontal cortex is a sucker for glucose,” said Rajita Sinha, the Foundations Fund Professor of Psychiatry, and professor in the Department of Neurobiology and the Yale Child Study Center, one of the senior authors of the research.

The Yale team manipulated glucose levels intravenously and monitored changes in blood sugar levels while subjects were shown pictures of high-calorie food, low-calorie food and non-food as they underwent fMRI scans.

When glucose levels drop, an area of the brain called the hypothalamus senses the change. Other regions called the insula and striatum associated with reward are activated, inducing a desire to eat, the study found. The most pronounced reaction to reduced glucose levels was seen in the prefrontal cortex. When glucose is lowered, the prefrontal cortex seemed to lose its ability to put the brakes upon increasingly urgent signals to eat generated in the striatum. This weakened response was particularly striking in the obese when shown high-calorie foods.

“This response was quite specific and more dramatic in the presence of high-calorie foods,” Sinha said.

“Our results suggest that obese individuals may have a limited ability to inhibit the impulsive drive to eat, especially when glucose levels drop below normal,” commented Kathleen Page, assistant professor of medicine at the University of Southern California and one of the lead authors of the paper.

A similarly robust response to high-calorie food was also seen in the striatum, which became hyperactive when glucose was reduced. However, the levels of the stress hormone cortisol seemed to play a more significant role than glucose in activating the brain’s reward centers, note the researchers. Sinha suggests that the stress associated with glucose drops may play a key role in activating the striatum.

“The key seems to be eating healthy foods that maintain glucose levels,” Sinha said. “The brain needs its food.”

 

Reference

Page KA, Seo D, Belfort-Deaguiar R, Lacadie C, Dzuira J, Naik S, Amarnath S et al. Circulating glucose levels modulate neural control of desire for high-calorie foods in humans. J Clin Invest 2011 Sep 19. [Epub ahead of print]

 

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Big Sugar

September 3, 2011 By Leave a Comment

 Big Sugar (CBC, 2005) explores the dark history and modern power of the world’s reining sugar cartels. Using dramatic re-enactments, it reveals how sugar was at the heart of slavery in the West Indies in the 18th century, while showing how present-day consumers are slaves to a sugar-based diet. Going undercover, Big Sugar witnesses the appalling working conditions on plantations in the Dominican Republic, where Haitian cane cutters live like slaves. Workers who live on Central Romano, a Fanjul-owned plantation, go hungry while working 12-hour days to earn 2 USD.

 

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Nutrition and Behavior (Lecture)

August 25, 2011 By Leave a Comment

In this lecture, Dr. Russell Blaylock explains one of the most important connections between nutrition and our health, how nutrition affects our behavior. Citing a series of important studies, he shows that good nutrition can powerfully enhance our memory, mood, and behavior in a socially desirable way. Likewise he shows us that poor nutrition can lead our youth into a world of violence, crime, depression and suicide. By using an impressive array of studies on both juvenile and adult prisoners, Dr. Blaylock demonstrates these principals and outlines specific measures you can take to protect your children from these detrimental effects. Most importantly, he shows us that it is never too late to make these nutritional changes.

 

 

Filed Under: Mental Disorders, Mental Disorders, Nutrition (videos), Sugar, Sugar & Sweeteners, Sugar and Sweeteners, Sugar Videos, Videos Tagged With: , ,

The Dangers of Energy Drinks

August 14, 2011 By Leave a Comment


Energy drinks have become increasingly popular in recent years. There are many brands on the market. Each contain caffeine and some have added stimulants such as guarana, an herbal form of more caffeine, as well as ginseng. Most of these drinks, in moderation, are probably relatively harmless for healthy people. However, when consumed to excess or by those with certain medical conditions, they may have harmful effects. 

 

 

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Sugar: The Bitter Truth (Lecture)

August 4, 2011 By Leave a Comment

Robert H. Lustig, MD is Professor of Clinical Pediatrics, at the University of California, San Francisco (UCSF). He is nationally recognized in the field of neuroendocrinology, with an emphasis on the regulation of energy balance by the central nervous system. Dr. Lustig has a special interest in childhood obesity. He has become publicly notable through his efforts to draw attention to the effects that the natural sugar fructose can have on human and especially children’s health if consumed in large amounts. On May 26, 2009, Robert Lustig gave this lecture called “Sugar: The Bitter Truth” which was posted on YouTube the following July and has become a viral success with over a million viewings. In this lecture, Lustig notably calls fructose a “poison” and compares its metabolic effects with those of ethanol. He is particularly critical of the widespread use of High Fructose Corn Syrup in the United States.

Sugar: The Bitter Truth. Series: UCSF Mini Medical School for the Public [7/2009] [Health and Medicine] [Show ID: 16717].

 

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Fructose Consumption Increases Risk Factors for Heart Disease

July 29, 2011 By Leave a Comment

Study suggests U.S. Dietary Guideline for Upper Limit of Sugar Consumption is too High:

A recent study accepted for publication in The Endocrine Society’s Journal of Clinical Endocrinology & Metabolism (JCEM) found that adults who consumed high fructose corn syrup for two weeks as 25 percent of their daily calorie requirement had increased blood levels of cholesterol and triglycerides, which have been shown to be indicators of increased risk for heart disease.

The American Heart Association recommends that people consume only five percent of calories as added sugar. The Dietary Guidelines for Americans 2010 suggest an upper limit of 25 percent or less of daily calories consumed as added sugar. To address this discrepancy in recommended consumption levels, researchers examined what happened when young overweight and normal weight adults consumed fructose, high fructose corn syrup or glucose at the 25 percent upper limit.

“While there is evidence that people who consume sugar are more likely to have heart disease or diabetes, it is controversial as to whether high sugar diets may actually promote these diseases, and dietary guidelines are conflicting,” said the study’s senior author, Kimber Stanhope, PhD, of the University of California, Davis. “Our findings demonstrate that several factors associated with an elevated risk for cardiovascular disease were increased in individuals consuming 25 percent of their calories as fructose or high fructose corn syrup, but consumption of glucose did not have this effect.”

In this study, researchers examined 48 adults between the ages of 18 and 40 years and compared the effects of consuming 25 percent of one’s daily calorie requirement as glucose, fructose or high fructose corn syrup on risk factors for cardiovascular disease. They found that within two weeks, study participants consuming fructose or high fructose corn syrup, but not glucose, exhibited increased concentrations of LDL cholesterol, triglycerides and apolipoprotein-B (a protein which can lead to plaques that cause vascular disease).

“These results suggest that consumption of sugar may promote heart disease,” said Stanhope. “Additionally our findings provide evidence that the upper limit of 25 percent of daily calories consumed as added sugar as suggested by The Dietary Guidelines for American 2010 may need to be re-evaluated.”

Also working on the study were: Andrew Bremer, Guoxia Chen, Tak Hou Fong, Vivien Lee, Roseanne Menorca, Valentia Medici, Peter Havel and Nancy Keim of the University of California, Davis; Katsuyuki Nakajima and Takamitsu Nakano of Otsuka Pharmaceutical Co. in Tokyo, Japan; and Yasuki Ito of Denka Seiken Co. in Tokyo, Japan.

The article, “Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women,” appears in the October 2011 issue of JCEM.

 

Filed Under: Cardiovascular Disease, Health Conditions, Sugar, Sugar and Sweeteners Tagged With: ,

Treating Obesity Via Brain Glucose Sensing

July 23, 2011 By Leave a Comment

Photo: FREEIMAGES.co.uk

The past two decades have witnessed an epidemic spread of obesity-related diseases in Western countries. Elucidating the biological mechanism that links overnutrition to obesity could prove crucial in reducing obesity levels. In the July 26 issue of PLoS Biology, Dr. Dongsheng Cai and his research team at Albert Einstein College of Medicine describe a pathway that directs the brain to sense the body’s glucose dynamics, and they find that a defect of this glucose sensing process contributes to the development of obesity and related disease. Importantly, the team also found that correction of this defect can normalize the whole-body energy balance and treat obesity.

The hypothalamus in the brain plays a key role in controlling energy and body weight balance. To maintain balance between energy intake and energy expenditure, the hypothalamus constantly gauges the whole-body’s energy levels by sampling circulating hormones (e.g. insulin and leptin) as well as nutrients (e.g., glucose). Although we know quite a bit about the hormonal pathways in the hypothalamic regulation of feeding, the mechanisms for hypothalamic nutrient sensing are much less clear. Moreover, a causal link between a nutrient sensing defect and obesity remains to be established. The team led by Dr. Cai discovered a novel role of a protein complex, hypoxia-inducible factor (HIF), in hypothalamic glucose sensing and whole-body energy balance in mice.

HIF is a nuclear transcription factor which induces hypoxia response. When tissue oxygen level is low, HIF is activated to promote cellular metabolic adaption and survival. Recent research has appreciated the involvement of HIF in the metabolism of tumor cells. “However, an intriguing but unexplored question is whether HIF can be important for the regulation of whole-organism metabolism, and if so, which tissue and cells are responsible.” says Cai, who is an expert in neuroendocrinology and metabolism.

Cai and his group examined HIF in the hypothalamus and, surprisingly, found that it can be activated by glucose and that this regulation was associated with appetite control in mice. In identifying the cellular and molecular basis, the team found that in response to glucose, HIF acts in a unique group of hypothalamic nutrient-sensing neurons to induce expression of POMC gene – a gene which has been known to play a key part in hypothalamic control of feeding and body weight. Most excitingly, the team demonstrated the therapeutic potential of targeting hypothalamic HIF to control obesity. By enhancing the hypothalamic HIF activity via gene delivery, mice become resistant to obesity despite the condition of nutritional excess.

“It was an exciting discovery,” explains Cai, “Our study is the first to show that beyond its classical oxygen-sensing function in many cells, HIF in the hypothalamic neurons can sense glucose to control the whole-body balance of energy intake and expenditure which is critical for body weight homeostasis.” Overall, this study reveals a crucial role for neuronal HIF in bridging the brain’s glucose sensing with the brain’s regulation of body weight and metabolic physiology. These findings also highlight a potential implication for developing neuronal HIF activators in treating and preventing obesity and related diseases.

 

Reference

Zhang H, Zhang G, Gonzalez FJ, Park S-m, Cai D.  Hypoxia-Inducible Factor Directs POMC Gene to Mediate Hypothalamic Glucose Sensing and Energy Balance Regulation. PLoS Biol 2011; 9 (7):  e1001112. doi:10.1371/journal.pbio.1001112

 

 

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Too Much Sugar Is Bad, But Which Sugar Is Worse: Fructose Or Glucose?

July 3, 2011 By Leave a Comment

In 2005, the average American consumed 64 kg of added sugar, a sizeable proportion of which came through drinking soft drinks. Now, in a 10-week study, Peter Havel and colleagues, at the University of California at Davis, Davis, have provided evidence that human consumption of fructose-sweetened but not glucose-sweetened beverages can adversely affect both sensitivity to the hormone insulin and how the body handles fats, creating medical conditions that increase susceptibility to heart attack and stroke.

In the study, overweight and obese individuals consumed glucose- or fructose-sweetened beverages that provided 25% of their energy requirements for 10 weeks. During this period, individuals in both groups put on about the same amount of weight, but only those consuming fructose-sweetened beverages exhibited an increase in intraabdominal fat. Further, only these individuals became less sensitive to the hormone insulin (which controls glucose levels in the blood) and showed signs of dyslipidemia (increased levels of fat-soluble molecules known as lipids in the blood). As discussed in an accompanying commentary by Susanna Hofmann and Matthias Tschöp, although these are signs of the metabolic syndrome, which increases an individual’s risk of heart attack, the long-term affects of fructose over-consumption on susceptibility to heart attack remain unknown.

 

Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119 (5): 1322-34.

Comment:
Hofmann SM, Tschöp MH. Dietary sugars: a fat difference. J Clin Invest. 2009;119 (5): 1089-92.

 

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