Dr. Wilson reports from the floor of the hospital where he works as a hospitalist in Gloucester, Mass.
This morning at our regular team meeting where all the healthcare professionals gather to discuss the patients I noticed that there was a jar of gum drops on the table with the label “Take one for brain dysfunction”. At least the nurses have a good sense of humor! Shortly thereafter one of the nurses rushing into the room to give her report and grabbed a handful of gum drops stating she skipped breakfast and needed to eat something before she became “hypoglycemic”.
I have treated her father who has classic end-stage CARB syndrome with morbid obesity, type II diabetes, depression and a long list of associated medical problems. She is an excellent nurse and I enjoy working with her. At the end of the day I noticed that she was having a heated discussion with the nurse manager. Apparently she needed to work overtime to finish her charting and the nurse manager wasn’t happy about shelling out more money for work that should be completed during her regular shift. As I approached them the nurse broke down crying. This surprised me because I know her as an experienced and hardened professional. In my experience, it is very unusual for such a person to openly cry in the workplace.
To me it is now clear that she has sugar-brain, the gateway condition to much more serious CARB syndrome. I printed a copy of Dr. Robert Lustig’s article “The Diet Debacle” and gave it to her. Hopefully she will read it before it’s too late. I would hate to lose such an outstanding nurse.
Just in case you missed it here’s Lustig’s article for you to review. Could you have sugar-brain?
You can make your own diagnosis
The Diet Debacle
by Dr. Robert Lustig
Robert Lustig is Professor of Clinical Pediatrics in the Division of Endocrinology and Director of the Weight Assessment for Teen and Child Health Program at the University of California, San Francisco, Ca.
May. 28, 2012
SAN FRANCISCO – Two seemingly benign nutritional maxims are at the root of all dietary evil: A calorie is a calorie, and You are what you eat.Both ideas are now so entrenched in public consciousness that they have become virtually unassailable. As a result, the food industry, aided and abetted by ostensibly well-meaning scientists and politicians, has afflicted humankind with the plague of chronic metabolic disease, which threatens to bankrupt health care worldwide.
The United States currently spends $147 billion on obesity-related health care annually. Previously, one could have argued that these were affluent countries’ diseases, but the United Nations announced last year that chronic metabolic disease (including diabetes, heart disease, cancer, and dementia) is a bigger threat to the developing world than is infectious disease, including HIV.
These two nutritional maxims give credence to the food industry’s self-serving corollaries: If a calorie is a calorie, then any food can be part of a balanced diet; and, if we are what we eat, then everyone chooses what they eat. Again, both are misleading.
If one’s weight really is a matter of personal responsibility, how can we explain toddler obesity? Indeed, the US has an obesity epidemic in six-month-olds. They don’t diet or exercise. Conversely, up to 40% of normal-weight people have chronic metabolic disease. Something else is going on.
Consider the following diets: Atkins (all fat and no carbohydrates); traditional Japanese (all carbohydrates and little fat); and Ornish (even less fat and carbohydrates with lots of fiber). All three help to maintain, and in some cases even improve, metabolic health, because the liver has to deal with only one energy source at a time.
That is how human bodies are designed to metabolize food. Our hunter ancestors ate fat, which was transported to the liver and broken down by the lipolytic pathway to deliver fatty acids to the mitochondria (the subcellular structures that burn food to create energy). On the occasion of a big kill, any excess dietary fatty acids were packaged into low-density lipoproteins and transported out of the liver to be stored in peripheral fat tissue. As a result, our forebears’ livers stayed healthy.
Meanwhile, our gatherer ancestors ate carbohydrates (polymers of glucose), which was also transported to the liver, via the glycolytic pathway, and broken down for energy. Any excess glucose stimulated the pancreas to release insulin, which transported glucose into peripheral fat tissue, and which also caused the liver to store glucose as glycogen (liver starch). So their livers also stayed healthy.
And nature did its part by supplying all naturally occurring foodstuffs with either fat or carbohydrate as the energy source, not both. Even fatty fruits – coconut, olives, avocados – are low in carbohydrate.
CommentsOur metabolisms started to malfunction when humans began consuming fat and carbohydrates at the same meal. The liver mitochondria could not keep up with the energy onslaught, and had no choice but to employ a little-used escape valve called “de novo lipogenesis” (new fat-making) to turn excess energy substrate into liver fat.
Liver fat mucks up the workings of the liver. It is the root cause of the phenomenon known as “insulin resistance” and the primary process that drives chronic metabolic disease. In other words, neither fat nor carbohydrates are problematic – until they are combined. The food industry does precisely that, mixing more of both into the Western diet for palatability and shelf life, thereby intensifying insulin resistance and chronic metabolic disease.
But there is one exception to this formulation: sugar. Sucrose and high-fructose corn syrup are comprised of one molecule of glucose (not especially sweet) and one molecule of fructose (very sweet). While glucose is metabolized by the glycolytic pathway, fructose is metabolized by the lipolytic pathway, and is not insulin-regulated. Thus, when sugar is ingested in excess, the liver mitochondria are so overwhelmed that they have no choice but to build liver fat. Today, 33% of Americans have a fatty liver, which causes chronic metabolic disease.
Prior to 1900, Americans consumed less than 30 grams of sugar per day, or about 6% of total calories. In 1977, it was 75 grams/day, and in 1994, up to 110 grams/day. Currently, adolescents average 150 grams/day (roughly 30% of total calories) – a five-fold increase in one century, and a two-fold increase in a generation. In the past 50 years, consumption of sugar has also doubled worldwide. Worse yet, other than the ephemeral pleasure that it provides, there is not a single biochemical process that requires dietary fructose; it is a vestigial nutrient, left over from the evolutionary differentiation between plants and animals.
It is therefore clear that a calorie is not a calorie. Fats, carbohydrates, fructose, and glucose are all metabolized differently in the body. Furthermore, you are what you do with what you eat.Combining fat and carbohydrate places high demands on the metabolic process. And adding sugar is particularlyegregious.
Indeed, while food companies would have you believe that sugar can be part of a balanced diet, the bottom line is that they have created an unbalanced one. Of the 600,000 food items available in the US, 80% are laced with added sugar. People cannot be held responsible for what they put in their mouths when their choices have been co-opted.
And this brings us back to those obese toddlers. The fructose content of a soft drink is 5.3%. Of course, many parents might refuse to give soft drinks to their children, but the fructose content of soy formula is 5.1%, and 6% for juice.
We have a long way to go to debunk dangerous nutritional dogmas. Until we do, we will make little headway in reversing an imminent medical and economic disaster.
Here’s Dr. Wilson’s reply to Dr. Lustig
Thanks Dr. Lustig for an excellent article on the toxic nature of sugar. We now believe that when you add high glycemic carbohydrates to an environment of insulin resistance from consuming too much fructose, the brain takes a hit. Over time these dietary elements can trigger a chronic disease called Carbohydrate Associated Reversible Brain syndrome or CARB syndrome.
People with CARB syndrome can develop up to 22 brain dysfunction symptoms that interfere with their ability to function. Because the brain plays a key role in auto-regulating fat stores, people with CARB syndrome start to store excessive body fat at virtually any caloric intake. At this stage they are often incorrectly diagnosed with depression, ADHD, PTSD, OCD, eating disorders, anxiety disorders, bipolar II, fibromyalgia, irritable bowel syndrome and similar conditions.