I Wish I Were Far From the Madding Crowd

April 3, 2010

Obesity, HFCS, and fatty liver disease in children (as well as increased heart disease risk)

I personally am very interested in this topic because just over three years ago I had gone in to see my doctor because of abdominal pain.  My triglycerides and LDL were high.  He thought it might be my gallbladder so I went in for an ultrasound, which revealed that I had a fatty liver.

Fatty liver disease has not been considered a children’s disease, so it’s disturbing to read that children and adolescents are developing it, especially since there are usually few symptoms until the disease has progressed to a more advanced stage of steatohepatitis (aka hepatosteatosis) and scarring has already occurred.

According to the American Heart Association, more than 6 million children in the United States are affected.

High Fructose Corn Syrup Linked to Liver Scarring (HealthDay, March 19, 2010)

Reports on a study, “Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease,” which found that increased consumption of HFCS led to increased fibrosis (scarring) in patients suffering from NAFLD.

Fatty Liver Disease May Raise Heart Disease Risk in Overweight, Obese Kids (American Heart Association, April 3, 2010)

A fatty liver disease that is not well-known in overweight and obese children may be a precursor of cardiovascular disease, researchers reported in Circulation: Journal of the American Heart Association.

The overweight children with NAFLD had significant cardiovascular risk including higher levels of fasting glucose, insulin, total cholesterol, low-density lipoprotein (LDL, “bad” cholesterol), triglycerides and higher systolic and diastolic blood pressure than the control group.

NAFLD is the most common cause of liver disease in children and is associated with metabolic syndrome, a clustering of risk factors for the development of cardiovascular disease and type 2 diabetes. NAFLD is characterized by the presence of oily droplets of triglycerides in liver cells. More than 6 million children in the United States are affected.

NAFLD in overweight children is strongly associated with metabolic syndrome. The association is independent of both body mass index and insulin sensitivity.

Fatty liver disease often has no outward symptoms, which contributes to it going undetected. Although some children will have symptoms such as abdominal pain or fatigue, the majority remain symptom-free until the disease is in very advanced stages.

American Heart Association Scientific Statement on Metabolic Syndrome in Children and Adolescents (2009)

Since 2003, substantial new information has emerged in children on the clustering of obesity, insulin resistance, inflammation, and other risk factors and their collective role in conveying heightened risk for cardiovascular disease and type 2 diabetes. A constellation of these interrelated cardiovascular risk factors in adults has come to be known as the metabolic syndrome.

The scientific statement covers the following topics:

Selected References

Steinberger J, Daniels SR. Obesity, insulin resistance, diabetes and cardiovascular risk in children: an American Heart Association scientific statement from the Atherosclerosis, Hypertension, and Obesity in the Young Committee (Council on Cardiovascular Disease in the Young) and the Diabetes Committee (Council on Nutrition, Physical Activity, and Metabolism). Circulation. 2003; 107: 1448–1453.[Free Full Text]

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, Gordon DJ, Krauss RM, Savage PJ, Smith SC, Spertus JA, Costa F. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement [published corrections appear in Circulation. 2005;112:e297 and 2005;112:e298]. Circulation. 2005; 112: 2735–2752.[Free Full Text]

Non-alcoholic fatty liver disease (NAFLD)

Once considered an illness of adults over 40, more and more children are being diagnosed with non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).  NAFLD can be a precursor to NASH, which can progress to cirrhosis.

According to Children’s Memorial Hospital in 2005 an estimated 1.6 million children were affected with fatty liver disease

But the American Heart Association now says that 6 million children have NAFLD (see above).

Note: The Children’s Memorial Hospital’s NASH program is a member of the NASH clinical research network.  In 2005, the NASH clinical research network launched a trial for treatment of liver disease in children. The NASH CRN website contains links to related information for patients.  Most of the website, however, is technical and requires an account to access.)

When complications such as cirrhosis cannot be controlled with treatment or when the liver becomes so damaged from scarring that it completely stops functioning, a liver transplant is necessary.

Both NASH and NAFLD are becoming more common, possibly because of the greater number of Americans with obesity. In the past 10 years, the rate of obesity has doubled in adults and tripled in children. Obesity also contributes to diabetes and high blood cholesterol, which can further complicate the health of someone with NASH.  (From the NASH page on the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) website.)

From “Fatty Liver Disease is Common in the US

Source: Spare the exercise, spoil the liver

More information about fatty liver can be found on the American Liver Foundation’s Fatty Liver page and in their Fatty Liver Brochure.

In case you’re wondering what I did after my diagnosis…

At the ultrasound the technician had said, “Your gallbladder is fine, but you have a fatty liver.”  The way she said it made it sound like it was more than just a casual observation, so when I got home I did a quick search on the National Library of Medicine’s website, where I found a lot of information about NAFLD.  (I’m not a teetotaler, but I don’t drink much.)

The progression from NAFLD to NASH to cirrhosis to needing a liver transplant or you die got my attention. Even before I got the formal diagnosis from my doctor I changed my diet (I started eating fish, raisins, and nuts, as well as more fruit, nuts, raisins, whole grains, leafy green vegetables, and fiber (even tried quinoa); and fewer sugar-sweetened drinks) and lots more exercise.  I dropped about twenty pounds in four months and, more importantly, my triglyceride level dropped a lot.

I had relapsed a bit since then, but after viewing Dr. Lustig’s presentation on the effects of fructose (and having done some follow up reading on the topic) I have once again cut back on sugar consumption and have started working out more regularly once more.

If you’re been sort of blasé about fructose you might find yourself changing your mind if you look at the slides on the “Detrimental Effects of Fructose” from a presentation he gave at the National Institute of Environmental Health Sciences (NIEHS) (pp. 15-27, with final slides on p. 27 showing the end result) and look at how fructose metabolized by the liver ultimately results in the creation of lipid droplets (these are what create a “fatty liver”), FFA (free fatty acids) (which help trigger insulin resistance), and triglycerides (TG), resulting in higher blood pressure and inflammation (among other things).

April 2, 2010

Metabolic syndrome and exposure to persistent organic pollutants

Take a spoonful of sugar, add a pinch of chemicals that accumulate in fatty tissue, and voila, metabolic syndrome! So while Dr. Lustig may be on to something, it looks like fructose might not be the only thing to blame for the obesity epidemic.

The reason why persistent organic pollutants (POPs) are a problem is that they can bioaccumulate in fatty tissue.  (If fructose causes metabolic syndrome as Dr. Lustig says, and metabolic syndrome results in increased obesity, which in turn means more fatty tissue, and more fatty tissue can absorb more POPs, we would seem to have started a rather vicious cycle.)

The Editor’s Summary explains why the findings of this study are especially important (emphasis added).

The authors conclude that exposure to POPs through a diet high in fatty fish is capable of inducing insulin resistance and impairing both lipid and glucose metabolism. Furthermore, they found that n-3 polyunsaturated fatty acids failed to counteract the harmful metabolic effects of dietary POP exposure. This finding is important because the presence of n-3-polyunsaturated fatty acids in fish oil has been reported to have a wide range of beneficial effects, including protection against high-fat diet–induced insulin resistance. The authors conclude that there is a need to continue efforts to limit human exposure to dietary POPs even in foods containing protective factors such as polyunsaturated fatty acids.

Persistent Organic Pollutant Exposure Leads to Insulin Resistance Syndrome, Jérôme Ruzzin et al. Environmental Health Perspectives, 118(4) Apr 2010.

Related EHP news item:

Chew on This: Persistent Organic Pollutants May Promote Insulin Resistance Syndrome

March 21, 2010

U.S. Task Force on Childhood Obesity looking for ideas

We’ll see whether this has any impact, given some of the recent discoveries about the role of fructose in the obesity epidemic.

Task Force asks public for ideas on how to solve the obesity challenge (March 17, 2010, press release)

Federal Register request for input, March 16, 2010:

[Text version] [PDF version]

On Feb. 9, 2010, President Obama created the first-ever federal task force to enhance coordination between private sector companies, not-for-profits, agencies within the government and other organizations to address the problem of childhood obesity. The Presidential Memo that established the Task Force directed senior officials from executive agencies and the White House to develop a comprehensive interagency action plan that details a coordinated strategy, identifies key benchmarks and goals, describes research gaps and needs, and assists in the development of legislative, budgetary, and policy proposals that can improve the health and well-being of children, their families, and communities.

Now, Dr. Robert Lustig spoke about the basic problem with FDA and USDA on this issue in a lecture (see “The toxic effects of … sugar“).  He said that the biggest problem is not lack of exercise, but ingesting too much fructose.  (If lack of exercise is the reason, explain why there’s an epidemic of obese six-month-olds.)

Lustig says that the studies linking fat consumption and heart disease did not control for sugar consumption.  He pointed out that in Western societies high-fat diets are high-sugar diets.   And he said that FDA won’t regulate fructose because it’s not an acute toxin, but a chronic toxin leading to metabolic syndrome (plus, the FDA considers it “natural”—which Dr. Lustig notes is true only on the technicality that HFCS is made from a natural product—HFCS is highly processed and refined).  And the USDA, which controls the food pyramid, won’t touch high fructose corn syrup because it’s made from corn.  (See also “Junk food turns rats into addicts. Bacon, cheesecake, Ho Hos alter brain’s pleasures centers.”)

The Federal Register notice points people to First Lady Michelle Obama’s “Let’s Move” initiative – http://www.letsmove.gov/.  I certainly support this, but I think they need to go further and start looking at the connection between fructose and obesity.  The site has links to all sorts of useful information, including a link to the Food Environment Atlas from USDA which shows consumption of various foods around the U.S., as well as maps showing diabetes and obesity rates (under “Health”).

While there’s no acknowledgement that the type of sugar we’re consuming has an effect, I did notice that there are signs that someone in the government is paying attention.  Water is recommended as the main drink.  Fruit juices are discouraged, as are “added sugars.”  But they don’t appear to have made the leap yet to the connection between fructose and the metabolic syndrome, which appears to be even more important than the number of calories consumed or burned.

Related posts:

Update on fructose – Dr. Lustig on Nightline” and “Fructose overdose

See also:

Laura Sanders.  “Junk food turns rats into addicts. Bacon, cheesecake, Ho Hos alter brain’s pleasures centers.” Science News.  November 21, 2009.

Paul Johnson and Paul Kenny. “Society of Neuroscience Program.”  ‘Neuroscience 2009′ Conference. October 17-21, 2009.  Chicago.

March 19, 2010

Update on fructose – Dr. Lustig on Nightline

From post by Michelle Burton – “Dr. Robert Lustig on ABC’s Nightline”

Check out Dr. Robert Lustig on ABC’s Nightline discussing sugar and the damage it is taking on American’s Health.  (See post for link to video.)

Fructose overdose

Went grocery shopping after work today.  After listening to Dr. Lustig’s presentation on fructose (video itself) (see my post, “The toxic effects of … sugar“), I decided to pay a lot more attention to the labels on packages (that is to say, the area labeled as “Nutrition Facts”).

High fructose corn syrup here, high fructose corn syrup there.  Sugar here, sugar there.  What’s this?!  Ooh, I have to buy this!

I had been looking reading the labels on yogurt containers.  Some said “high fructose corn syrup,” some “sugar,” a couple even “fructose.”  Then I found the pièce de résistance!  99% fat free yogurt (with fruit on bottom).  Ingredients: Cultured Grade A low fat milk, fructose syrup, strawberries, sugar, high fructose corn syrup, blueberries, fructose….  23 g of sugars!

I won’t name the brand, but I think no matter which brand you look at you’ll find something similar.

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