Saturday, 28 May 2016 / TRUTH-OUT.ORG

Four Decades of the Wrong Dietary Advice Has Paved the Way for the Diabetes Epidemic: Time to Change Course

Friday, 05 June 2015 00:00 By Jeff Ritterman, M.D., Truthout | News Analysis
  • font size decrease font size decrease font size increase font size increase font size
  • Print

When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. (Photo: Soft drinks via Shutterstock)When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. (Photo: Soft drinks via Shutterstock)

In 1977, the McGovern Commission, chaired by then-Senator George McGovern, issued dietary guidelines that we follow to this day. The commission recommended that Americans receive no more than 30 percent of their energy requirements from fat and that we consume no more that 10 percent of our calories as saturated fat.

Dr. Robert Olson, professor of medicine and chairman of the Biochemistry Department at St. Louis University and an expert on nutrition science argued that the recommendations were not supported by the available science. In Dr. Olson's words:

"I pleaded in my report and will plead again orally here for more research on the problem before we make announcements to the American public."

Senator McGovern, speaking for the commission stated that:

"Senators don't have the luxury the research scientist does of waiting until every last shred of evidence is in."

Senator McGovern's comment concerning "every last shred of evidence" was widely off the mark. It was never a question of having supportive, but incomplete, evidence. There simply was no convincing scientific evidence at all in support of the commission's recommendations. There still isn't.

At the time that the commission issued its dietary guidelines, only 2,500 men had been studied in randomized control trials, the gold standard in clinical research. No study included women. No study showed that a low-fat diet was superior to a diet higher in fat content in any measure of health outcome. In fact, in the one study that compared a 10 percent saturated fat intake to a diet with unrestricted saturated fat, the low-fat subjects had a higher death rate from all causes, including heart disease.

Yet, without any study recommending the dietary guidelines, and without any science to back up the guidelines, and with some evidence that the contrary was in fact true, 220 million Americans were advised to lower their saturated fat intake.

Unfortunately, these recommendations were not only wrong, they were dangerously wrong. They have helped lead the way to the present epidemics in type-two diabetes, obesity, coronary heart disease, and hypertension: the modern day "Four Horsemen of the Apocalypse."

When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. This worked well economically as the introduction of high fructose corn syrup (HFCS) made cheap sugar plentiful.

It didn't work so well metabolically. The huge increases in our sugar intake have exceeded our physiologic limits. The result is the pathophysiology that we see all around us.

Let me explain.

Sugars occur naturally in nature in fruits (fructose) and milk (lactose). These sugars are fine when consumed. The problem is that sugar is now added to a dizzying array of processed foods. It is this added sugar that causes problems. All of the added sugars we consume, whether table sugar (sucrose), high-fructose corn syrup, agave nectar or whatever are combinations of fructose and glucose. The fructose is the sweet part. Table sugar is half fructose and half glucose. HFCS is 55 percent or more fructose.

The liver is the only organ in the body that can process fructose. The huge fructose dose we get, for example, when drinking a sugary soda, overloads our liver's ability to handle the sugar in a healthy way. The liver shovels as much of the fructose into the furnaces that produce energy in our mitochondria as the furnaces can handle. The liver converts a bunch more into glycogen, stored starch, and shelves this energy for a rainy day.

But what to do with the huge pile of fructose remaining? The liver has only one choice: DNL, de novo lipogenesis, new fat-making. The liver turns the excess fructose into fat. We store the fat everywhere, our cheeks, our bellies, our thighs, our arms and legs, even our fingers.

But it's not the fat that we see that's the problem. It's the fat that we don't see. The liver itself gets packed with fat and becomes deaf to the signal of the hormone insulin. This is known as insulin resistance. Insulin is the hormone that regulates the metabolism of carbohydrates and fats. As such, it is the main hormone responsible for energy use and fat storage.

When the liver becomes insulin resistant, a dangerous cascade of events is set in motion that ultimately results in diabetes, heart attacks, strokes, obesity and hypertension. The pancreas responds to the liver's insensitivity to insulin by producing more insulin. Eventually the enhanced insulin requirements cause the overworked pancreas to poop out. Diabetes is the result. And with diabetes come amputations, blindness and kidney dialysis.

In addition to the fat that packs the liver, fructose metabolism also results in unhealthy fats, which circulate in the blood stream. These unhealthy fats can get embedded in the walls of our arteries ultimately resulting in blockages causing heart attacks and strokes.

We are witnessing the unfolding of a scientific revolution.

The planets revolve around the sun.

E=mc squared.

And it's the sugar, not the saturated fat!

Yes, fat is the problem. But it's not the fat you eat that's the problem. It's the fat that your liver makes when overwhelmed with a huge sugar load!

The medical community is beginning to catch on and to acknowledge that the old paradigm is crumbling.

In March of 2015, The Mayo Clinic Proceedings published a review article entitled, "Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences." The article points out that each of us, on the average, consumes 30 times more added sugar than an American did when the Declaration of Independence was written.

Another review article published in April of 2015, in the medical journal Hepatobiliary Surgery and Nutrition, had the provocative title of "Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction." Fructose was identified as the culprit leading to fatty liver disease and the resulting type-two diabetes, coronary artery disease, obesity and stroke.

One of the leaders in this field, Dr. James J. DiNicolantonio, put it this way in the British Medical Journal:

" … The global epidemic of atherosclerosis, heart disease, diabetes, obesity and the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat, a revelation that we are just starting to accept."

Now, the so-called French Paradox makes sense. Frenchmen and women with their high intake of fatty foods, like brie and frois gras, do not have a correspondingly high incidence of coronary artery disease. Now we know why. Dietary fat doesn't cause coronary artery disease.

We also now understand how the Inuit could exist on seal meat and seal fat with its high saturated fat content and not develop coronary artery disease. They ate no sugar.

For four decades the wrong dietary advice has been given over and over again. A huge amount of harm has been done.

It's high time that the Centers for Disease Control, the American Heart Association, the American Diabetes Association and mainstream medicine revise the guidelines and demonize sugar, the real culprit, and leave fat alone.

As for dietary advice:

Begin by avoiding all added sugars, especially liquid sugar like soda.

Eat your fruits, don't juice them. Juicing concentrates the sugar and removes the beneficial fiber.

But personal choice is only a small part of what we need to do. We need to make the healthy choice, the easy choice.

We need our hospitals, clinics, dental offices and other health facilities to be free of foods and beverages with added sugar. We need to do the same with schools, day care centers, and municipal, county, state and federal facilities.

We need a national Soda Tax like the one in Mexico, with the proceeds invested in programs to further reduce added sugar consumption. It's working in Mexico, let's learn from our neighbor.

Old paradigms die hard. Galileo spent the last six years of his life in house arrest for the heresy of believing that the earth is not the center of the universe. During Galileo's time, the Catholic Church was all powerful. The Church found Galileo's ideas heretical because the science contradicted "in many places the sense of Holy Scripture."

Today, there are again vested powerful interests that are threatened by scientific truth. A global food system now exists that promotes the consumption of a high fructose diet. How much longer will it take for us to realize that it's the sugar, not the fat, that is killing us? How many more of us will succumb to the ravages of a diet high in fructose?

Copyright, Truthout. May not be reprinted without permission.

Jeff Ritterman, M.D.

Jeff Ritterman, M.D. is vice president of the board of directors of the SF Bay Chapter of Physicians for Social Responsibility. He is the retired chief of cardiology at Kaiser Richmond and a former Richmond, California, city councilman. Follow him on Twitter @JeffRitterman.


Hide Comments

blog comments powered by Disqus
GET DAILY TRUTHOUT UPDATES
Optional Member Code

FOLLOW togtorsstottofb


Four Decades of the Wrong Dietary Advice Has Paved the Way for the Diabetes Epidemic: Time to Change Course

Friday, 05 June 2015 00:00 By Jeff Ritterman, M.D., Truthout | News Analysis
  • font size decrease font size decrease font size increase font size increase font size
  • Print

When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. (Photo: Soft drinks via Shutterstock)When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. (Photo: Soft drinks via Shutterstock)

In 1977, the McGovern Commission, chaired by then-Senator George McGovern, issued dietary guidelines that we follow to this day. The commission recommended that Americans receive no more than 30 percent of their energy requirements from fat and that we consume no more that 10 percent of our calories as saturated fat.

Dr. Robert Olson, professor of medicine and chairman of the Biochemistry Department at St. Louis University and an expert on nutrition science argued that the recommendations were not supported by the available science. In Dr. Olson's words:

"I pleaded in my report and will plead again orally here for more research on the problem before we make announcements to the American public."

Senator McGovern, speaking for the commission stated that:

"Senators don't have the luxury the research scientist does of waiting until every last shred of evidence is in."

Senator McGovern's comment concerning "every last shred of evidence" was widely off the mark. It was never a question of having supportive, but incomplete, evidence. There simply was no convincing scientific evidence at all in support of the commission's recommendations. There still isn't.

At the time that the commission issued its dietary guidelines, only 2,500 men had been studied in randomized control trials, the gold standard in clinical research. No study included women. No study showed that a low-fat diet was superior to a diet higher in fat content in any measure of health outcome. In fact, in the one study that compared a 10 percent saturated fat intake to a diet with unrestricted saturated fat, the low-fat subjects had a higher death rate from all causes, including heart disease.

Yet, without any study recommending the dietary guidelines, and without any science to back up the guidelines, and with some evidence that the contrary was in fact true, 220 million Americans were advised to lower their saturated fat intake.

Unfortunately, these recommendations were not only wrong, they were dangerously wrong. They have helped lead the way to the present epidemics in type-two diabetes, obesity, coronary heart disease, and hypertension: the modern day "Four Horsemen of the Apocalypse."

When the food manufacturers started removing the fat from our food, the taste went with the fat. The answer: Add sugar and lots of it. This worked well economically as the introduction of high fructose corn syrup (HFCS) made cheap sugar plentiful.

It didn't work so well metabolically. The huge increases in our sugar intake have exceeded our physiologic limits. The result is the pathophysiology that we see all around us.

Let me explain.

Sugars occur naturally in nature in fruits (fructose) and milk (lactose). These sugars are fine when consumed. The problem is that sugar is now added to a dizzying array of processed foods. It is this added sugar that causes problems. All of the added sugars we consume, whether table sugar (sucrose), high-fructose corn syrup, agave nectar or whatever are combinations of fructose and glucose. The fructose is the sweet part. Table sugar is half fructose and half glucose. HFCS is 55 percent or more fructose.

The liver is the only organ in the body that can process fructose. The huge fructose dose we get, for example, when drinking a sugary soda, overloads our liver's ability to handle the sugar in a healthy way. The liver shovels as much of the fructose into the furnaces that produce energy in our mitochondria as the furnaces can handle. The liver converts a bunch more into glycogen, stored starch, and shelves this energy for a rainy day.

But what to do with the huge pile of fructose remaining? The liver has only one choice: DNL, de novo lipogenesis, new fat-making. The liver turns the excess fructose into fat. We store the fat everywhere, our cheeks, our bellies, our thighs, our arms and legs, even our fingers.

But it's not the fat that we see that's the problem. It's the fat that we don't see. The liver itself gets packed with fat and becomes deaf to the signal of the hormone insulin. This is known as insulin resistance. Insulin is the hormone that regulates the metabolism of carbohydrates and fats. As such, it is the main hormone responsible for energy use and fat storage.

When the liver becomes insulin resistant, a dangerous cascade of events is set in motion that ultimately results in diabetes, heart attacks, strokes, obesity and hypertension. The pancreas responds to the liver's insensitivity to insulin by producing more insulin. Eventually the enhanced insulin requirements cause the overworked pancreas to poop out. Diabetes is the result. And with diabetes come amputations, blindness and kidney dialysis.

In addition to the fat that packs the liver, fructose metabolism also results in unhealthy fats, which circulate in the blood stream. These unhealthy fats can get embedded in the walls of our arteries ultimately resulting in blockages causing heart attacks and strokes.

We are witnessing the unfolding of a scientific revolution.

The planets revolve around the sun.

E=mc squared.

And it's the sugar, not the saturated fat!

Yes, fat is the problem. But it's not the fat you eat that's the problem. It's the fat that your liver makes when overwhelmed with a huge sugar load!

The medical community is beginning to catch on and to acknowledge that the old paradigm is crumbling.

In March of 2015, The Mayo Clinic Proceedings published a review article entitled, "Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences." The article points out that each of us, on the average, consumes 30 times more added sugar than an American did when the Declaration of Independence was written.

Another review article published in April of 2015, in the medical journal Hepatobiliary Surgery and Nutrition, had the provocative title of "Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction." Fructose was identified as the culprit leading to fatty liver disease and the resulting type-two diabetes, coronary artery disease, obesity and stroke.

One of the leaders in this field, Dr. James J. DiNicolantonio, put it this way in the British Medical Journal:

" … The global epidemic of atherosclerosis, heart disease, diabetes, obesity and the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat, a revelation that we are just starting to accept."

Now, the so-called French Paradox makes sense. Frenchmen and women with their high intake of fatty foods, like brie and frois gras, do not have a correspondingly high incidence of coronary artery disease. Now we know why. Dietary fat doesn't cause coronary artery disease.

We also now understand how the Inuit could exist on seal meat and seal fat with its high saturated fat content and not develop coronary artery disease. They ate no sugar.

For four decades the wrong dietary advice has been given over and over again. A huge amount of harm has been done.

It's high time that the Centers for Disease Control, the American Heart Association, the American Diabetes Association and mainstream medicine revise the guidelines and demonize sugar, the real culprit, and leave fat alone.

As for dietary advice:

Begin by avoiding all added sugars, especially liquid sugar like soda.

Eat your fruits, don't juice them. Juicing concentrates the sugar and removes the beneficial fiber.

But personal choice is only a small part of what we need to do. We need to make the healthy choice, the easy choice.

We need our hospitals, clinics, dental offices and other health facilities to be free of foods and beverages with added sugar. We need to do the same with schools, day care centers, and municipal, county, state and federal facilities.

We need a national Soda Tax like the one in Mexico, with the proceeds invested in programs to further reduce added sugar consumption. It's working in Mexico, let's learn from our neighbor.

Old paradigms die hard. Galileo spent the last six years of his life in house arrest for the heresy of believing that the earth is not the center of the universe. During Galileo's time, the Catholic Church was all powerful. The Church found Galileo's ideas heretical because the science contradicted "in many places the sense of Holy Scripture."

Today, there are again vested powerful interests that are threatened by scientific truth. A global food system now exists that promotes the consumption of a high fructose diet. How much longer will it take for us to realize that it's the sugar, not the fat, that is killing us? How many more of us will succumb to the ravages of a diet high in fructose?

Copyright, Truthout. May not be reprinted without permission.

Jeff Ritterman, M.D.

Jeff Ritterman, M.D. is vice president of the board of directors of the SF Bay Chapter of Physicians for Social Responsibility. He is the retired chief of cardiology at Kaiser Richmond and a former Richmond, California, city councilman. Follow him on Twitter @JeffRitterman.


Hide Comments

blog comments powered by Disqus