Health Report - 9July2007 - The obesity epidemic
http://www.abc.net.au/rn/healthrepo...007/1969924.htm
EXCERPT......
Robert Lustig: 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.