Sugar MADNESS: How metabolic syndrome drives obesity and what you can do about it Tom´ as J. Arag´ on, MD, DrPH Health Officer, City & County of San Francisco Director, Population Health Division (PHD) San Francisco Department of Public Health Adjunct Faculty, Division of Epidemiology UC Berkeley School of Public Health Email: [email protected]Blog: http://medepi.com February 16, 2014 Tom´ as J. Arag´ on, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 1 / 14
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Sugar MADNESS: How metabolic syndrome drives obesity and what you can do about it
Sugar consumption, especially from sugary drinks, is the single largest and preventable contributor to the global epidemic of diabetes, heart disease, high blood pressure, bad cholesterol, and unhealthy weight gain. Fructose is the part of "sugar" that is the culprit. Fructose in liquid form is worse! Fructose is metabolized by the liver. With repeated exposures, it causes fatty liver, high insulin, insulin resistance, excessive fat storage, and leptin resistance. We call this metabolic syndrome. Our brain is tricked into believing our body is starving. Hence, we eat more and exercise less. It's a complicated, but important story: "Sugar MADNESS" is a memory aid to learning about sugar, metabolic syndrome, and what to do about it.
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Overview
1 What is the Sugar MADNESS?
2 What is the diagnosis? → M-A-DMetabolic syndromeAddictive potential of sugarDisordered fat (energy) storage
3 What is the treatment? → N-E-S-SNutritionEnvironmentsStress reductionSleep and exercise
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 3 / 14
What is the Sugar MADNESS?
What is the Sugar MADNESS?
Sugar
Sugar consumption, especially from sugary drinks, is the single largest andpreventable contributor to the global epidemic of diabetes, heart disease,high blood pressure, bad cholesterol, and unhealthy weight gain.
Fructose
Fructose is the part of “sugar” that is the culprit. Fructose in liquid formis worse! Fructose is metabolized by the liver. With repeated exposures, itcauses fatty liver, high insulin, insulin resistance, excessive fat storage, andleptin resistance. We call this metabolic syndrome. Our brain believes wehave less fat stored than we need. Hence, we eat more and move less.
Metabolic syndrome
It’s a complicated, but important story: Sugar MADNESS is a memoryaid to learning about sugar, metabolic syndrome, and what to do about it.
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 4 / 14
What is the Sugar MADNESS?
Use Sugar MADNESS to remember the cause (sugar),the diagnosis (MAD), and the treatment (NESS)
Diagnosis
M etabolic syndrome
A ddictive potential of sugar
D isordered fat storage
Treatment
N utrition
E nvironments
S tress reduction
S leep and exercise
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 5 / 14
What is the diagnosis? → M-A-D Metabolic syndrome
Metabolic syndrome is the key condition, not obesity
Figure : Humans evolved with occasional natural fructose from fruits. Today,especially since 1980, our livers are insulted daily with fructose from added sugars,especially from liquid sources (e.g., sodas, juices, energy and sport drinks),contributing to metabolic syndrome. Source: UCTV The Skinny on Obesity
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 6 / 14
What is the diagnosis? → M-A-D Addictive potential of sugar
Addictive potential of sugar, especially with added salt,fats, or caffeine
Figure : Make no mistake: food is designed to build brand loyality. In some, sugartriggers reward centers in the brain and induces sugar cravings. Source: AhmedSH, Guillem K, Vandaele Y. Sugar addiction: pushing the drug-sugar analogy tothe limit. Curr Opin Clin Nutr Metab Care. 2013;16(4):434-9. PMID: 23719144.
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 7 / 14
What is the diagnosis? → M-A-D Disordered fat (energy) storage
Disordered fat storage drives behavior to eat more andmove less
Metabolic syndrome (MetS) results in disordered fat storage.
Biochemistry
Chronic high insulin
Leptin resistance (LR)
Leptin (from fat cells)not able to notify brainthat sufficient fat hasbeen stored; therefore,
MetS drives behavior to:
Eat more
Move less (↓ exercise)Figure : Source: UCTV The Skinny on Obesity
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 8 / 14
What is the treatment? → N-E-S-S Nutrition
Nutrition is key to better metabolic health
Avoid added sugars (i.e., fructose)
Sodas
Fruit juices
Sports drinks
Energy drinks
Chocolate milk, etc.
Add back real (unprocessed) food
Fiber, omega-3 fatty acids, andmicronutrients
Hu FB. Resolved: There is sufficient scientific evidence thatdecreasing sugar-sweetened beverage consumption will reducethe prevalence of obesity and obesity-related diseases. ObesRev. 2013;14(8):606-19.
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 9 / 14
What is the treatment? → N-E-S-S Environments
Environments—make healthy choices easy everywhere
Current state
Fast food available 24/7
Soda vending machines
Targeted advertising (see billboard)
Processed foods with added sugarand removed fiber
Future state
Water instead of sugary drinks
Portion sizes reduced
Fresh food affordable and available
Healthy food policies and systems
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 10 / 14
Exercise regulates fat and glucose metabolism and results in an increasedaction of insulin, while it also lowers blood pressure and improves bloodpressure control in overweight adult subjects.Source: Golbidi S, Mesdaghinia A, Laher I. Exercise in the metabolic syndrome. Oxid Med Cell Longev. 2012;2012:349710. doi:10.1155/2012/349710. PMID: 22829955
Tomas J. Aragon, MD, DrPH (SFDPH) Sugar MADNESS February 16, 2014 12 / 14