Robert Lustig’s UCTV YouTube video
sensation, “Sugar, the
Bitter Truth,”
has been seen almost 4 million times. Recently, the UCSF pediatric
endocrinologist made a sequel, “Fat Chance: Fructose 2.0,” that will
also go viral. It’s 86 minutes long, so you’ll need to set aside a block of
time to watch it, but it’s worth it. Here’s a 45 second excerpt I transcribed (starting
at +/-12:00) that fits in with a theme I’ve been beating the drum about since
The Nutrition Debate #9, “The Metabolic
Syndrome,”
published almost 3 years ago.
Lustig: “Obesity is not the problem.
It never was. They want you to think it’s the problem, but it ain’t the
problem. What is the problem? Metabolic Syndrome is the problem. The cluster of
diseases that I’ve described to you. That’s where all the money goes. Obesity
costs almost nothing. Metabolic Syndrome is 75% of all health care costs today.
And there’s the list right there. [Slide lists: DIABETES, HYPERTENSION, LIPID
ABNORMALITIES, CARDIOVASCULAR DISEASE, NON-ALCOHOLIC FATTY LIVER DISEASE,
POLYCYSTIC OVARIAN DISEASE, CANCER, DEMENTIA] Everybody with me now? Do I have
your attention?”
A
brief recap – What is Metabolic Syndrome”? And how is it diagnosed? Definitions
vary but most have five “risk factors” in common, with the first always being obesity.
It is variously defined as “central
obesity,” or what I have coined “omental adiposity”, or a Body Mass Index
(BMI) ≥30, or elevated waist circumference (men ≥40 inches, women ≥35 inches).
The other four “risk factors” are elevated
triglycerides (≥150mg/dl), reduced
HDL, the “good” cholesterol (men ≤40mg/dl, women ≤50mg/dl), elevated blood pressure (≥130/85mm Hg,
or use of medications for hypertension) and elevated fasting glucose (≥100 mg/dl, or use of medications for
hyperglycemia). If you “present” with 4 out of 5, you have Metabolic Syndrome.
Do I have your attention?
The corollary to “obesity is not the
problem” is equally riveting: “everyone’s
at risk,” as Lustig explains: “Everyone’s at risk, because everyone is exposed.” That, of course, begs the question: exposed
to what?
Dr. Lustig precedes his “obesity is
not the problem” mantra with a nice explanation of the implications of the
difference between subcutaneous fat (fat near the surface of the skin) and
visceral fat (fat around the abdominal organs).The latter is the “bad” type of
obesity. He starts with a diagram showing 30% obese and 70% “normal” weight,
“and everybody assumes that the problem is this group over here [the 30% obese]
because 80% of the obese population is sick in some fashion: type 2 diabetes
problems, lipid problems, hypertension, cardiovascular disease, cancer,
dementia, non-alcoholic fatty liver disease, polycystic ovarian disease, etc.”
“But,” he continues, “you do the math
on this, 80% of 30% [of the 240 million adult population] is 57 million, and it
is those 57 million that are bankrupting the country, so it’s the obese
person’s fault only, and that’s the way everyone views this. This is wrong.
This is a mistake. This is a disaster, actually, ‘cause it’s not correct.
Here’s the real story. In fact, 20% of the obese population is completely
metabolically normal. They have normal insulin dynamics. They don’t get sick.
They live a completely normal life, die at a completely normal age, cost the
taxpayer nothing. They’re just fat.”
“Conversely, up to 40% of the “normal”
weight population has the exact same metabolic dysfunction that the obese do. They’re
just normal weight, and so they don’t even know they’re sick until it’s too late;
because normal weight people get type 2 diabetes, they get hypertension, they
get dyslipidemia, they get cardiovascular disease, they get cancer, they get
dementia, etc. etc. And so, when you do the math on that, that’s another 67
million, and so that’s actually outclassing the 57 million obese, and so the
total is 124 million; that’s more than half [the adult population] of America.”
So, that’s why Dr. Lustig says,
“Everyone’s at risk, because everyone is exposed.” Exposed to what, you ask? Metabolic Syndrome! And how do you
treat Metabolic Syndrome? Answer: you “treat” the risk factors: 1) central
obesity, 2) elevated triglycerides, 3) reduced HDL, 4) elevated blood pressure,
and 5) elevated fasting glucose. And what treatment, pray tell, addresses all
five risk factors for Metabolic Syndrome? In case you haven’t figured it out
yet, the answer is a Low Carbohydrate Way of Eating. No pills, no injections,
no surgery. Just a different way of eating.
Okay, you say, I can see how a low-carb
Way of Eating can help me lose weight and control my blood glucose. And I can
see that as I lose weight (as almost everyone wants to do anyway), how my blood
pressure will go down. (Mine did, from 130/90 to 110/70 on the same meds.) And
maybe I can believe that by eating low-carb, I can lose weight without hunger
and without snacks, and even
keep the weight off, so long as I
continue to eat low-carb. But how can I expect that eating low-carb
will cause my elevated triglycerides to go down and my HDL to go up? Well, mine
did, dramatically: My HDL doubled from
39 to 81, and my
triglycerides
dropped by about two-thirds, from 137 to 49, just by eating very low carb.
Scientifically, an n = 1 means nothing, unless
that n = 1 is you!
PS: Here’s another interesting n = 1 on Low Carb Lowers Triglycerides from Dr. Art Ayers’s blog.
PS: Here’s another interesting n = 1 on Low Carb Lowers Triglycerides from Dr. Art Ayers’s blog.