— June – July 2013
J
UST as the issue of climate change is rarely
deemed newsworthy, in a world where con-
sumption is God, the obesity pandemic is
seldom recognised. Compared to a terrorist
outrage the slow impact of dietary and life-
style change makes little impact in an increasingly
squeezed media focused on impact, and com-
promised by the advertising buck. That is the
difference between news creep and a single dra-
matic event.
But the cumulative effect of over-consump-
tion is havoc: for the first time since the Industrial
Revolution, in the United States parents are likely
to live longer than their offspring. Over % of
US death certificates now list diabetes as the cause
of death, up from % twenty years ago. The
increasingly-prevalent Type diabetes is usually
a consequence of ‘metabolic syndrome’: “a clus-
ter of chronic metabolic diseases characterised
by energy overload of the mitochondria” usually
caused by obesity. The long-term cost in medical
bills and lost productivity in the US is staggering.
Already $bn (and rising) in medical expenses
clock up each year. This includes , bariat-
ric surgeries – such as gastric bypasses or fitting
gastric bands – at $, a pop.
Robert Lustig may be the most articulate US
public health advocate confronting the pandemic.
His recent book, ‘Fat Chance: The Bitter Truth
About Sugar’, is a triumph of clarity and presci-
ence. His lecture: ‘Sugar: the Bitter Truth’ has
been a Youtube sensation, garnering over .m
hits. He is a medical doctor steeped in the science
but sensitive to his patients’ needs, and, impor-
tantly, aware of the economic and social context.
As a communicator he has Bill Clintonesque
empathy. He closed his book with the words: “I
love you all”, and I believed him.
But Big Love is nothing to Big Food. One
member of the Obama administration revealed
to Lustig that nothing could be done to help his
campaign against sugar. Big Food is too powerful,
even for the federal government. The successful
legal challenge to New York Mayor Bloomberg’s
soda tax reveals the strength of the industry.
It seems the Irish government is similarly
cowed, as their unwillingness to introduce a ‘fat
tax’ in the latest austerity budget shows. This is
despite a recent UCC study which estimated the
cost of obesity to the Irish exchequer to be in the
region of €bn. Now even developing countries
are contending with increased health expendi-
ture as the US diet spreads.
For Lustig, the ‘Professor Moriarty’ of an
admittedly very complicated piece is sugar which,
besides offering empty calories, generates hor-
monal imbalance and toxic overload comparable
to the effect of alcohol. It is far from being the
only cause for people being overweight and in bad
health, but its ubiquity is revealed by the follow-
ing statistic: “Of the , food items for sale
in the United States, % are laced with sugar’’.
As a result -% (or teaspoons daily) of all
US calories come in refined sugar.
Health and weight
The best policy is to avoid all processed food. As
Lustig puts it: “If the food comes in a wrapper, the
wrapper has more health benefits than the food.
Fast food is the antithesis of real food”.
Body mass index (BMI) is a rather crude
measurement of obesity, as it is often not indica-
tive of health, and does not take account of race.
Underweight individuals can be just as suscep-
tible to the deleterious effect of poor diet while
you can have a high BMI and be perfectly healthy.
Brian O’Driscoll may be categorised as obese but
much of his weight is muscle, though even highly
active people are not immune from the effects of
bad diet.
frank armstrong
culture
First: exercise; then: cut
sugar and add fibre
Sugar,
dietary devil
Interestingly, according to Lustig, numerous
studies have shown that exercise does not lead
to weight loss because once we put it on our body
seems to retain a memory of its old weight. So
when you leave fat camp – so to speak – the sat-
isfaction of your appetite will return your body
to its previous size: “Once the balloon is filled, it
doesn’t want to be deflated”.
But exercise is the best thing we can do for
our health, and being moderately overweight
has even been shown to be healthier than being
underweight. That is the flaw with a TV show such
as Operation Transformation which uses weight
loss as the criterion for success. When weight
returns, as it seems to, patients feel discouraged
and resume eating pathogenic foods. A message
needs to be sent out that you can appear over-
weight and be healthy so long as you are active
and eat the right food.
It is where we store excess baggage that really
counts. Visceral fat around our organs (big-belly
fat) is very dangerous, but substantial sub-cutane-
ous (mainly stored in our posteriors) fat actually
correlates with longevity. Where we put on weight
is determined by the type of food we eat and the
effect of cortisol, the steroid hormone we release
under stress: “Insulin makes you gain weight,
while cortisol tells you where to put it”.
Concentrated fructose derived from sugar
cane, sugar beet or high-fructose corn-syrup (they
are equally bad) causes a spike in insulin secretion
which inhibits the release of the hormone ghre-
lin that otherwise would tell us we are full. It is
also metabolised as fat in the liver, and works in
our brain like alcohol or cocaine when it releases
dopamine. Humans have not adapted to fructose
– a highly refined industrial product which, when
encountered in nature, is safely encased in fibre
or guarded by bees.
Caveman cravings
Fibre is the great lacuna in the industrial global
diet. Paleo-biologists performed DNA footprint
dietary devil
If the food comes in a
wrapper, the wrapper has
more health benets than
the food
“
— June – July 2013
culture
analysis of -,-year-old stool samples
from caves in Texas and estimated that these
cave dwellers consumed about g of fibre per
day, yet our median consumption of fibre today
is a mere g.
Lustig has a simple solution to the deficiency
of fibre: “I would propose that all we need to do
is eat ‘safe carbs’. That means low sugar to pre-
vent insulin resistance, and high fibre to reduce
flux to the liver and prevent insulin hypertension”.
Refining grain is a threat to our health.
The main reason fibre does not feature promi-
nently in the modern industrial diet seems to be
that it does not preserve well, while sugar actu-
ally adds shelf life. Furthermore, high-fibre,
unlike sugary, foods promote satiety. Naturally
the food industry wants to sell more food, and
sugar has the benefit of being something we eat
without causing us to feel full, which is great for
business.
Sugar is also cheap, owing in large part to
the perverse subsidy regime in the United States
promoting an artificially low price for maize even
though its cultivation is dependent on climate-
change expediting fertilisers. Thus: “only
percent of all money spent on food in the United
States is for the food itself. The other percent is
for packaging and marketing”. The Farm Bill orig-
inally promulgated by the Nixon administration
and now costing $bn annually was designed to
keep the cost of food low, in part to bring politi-
cal quiescence in the wake of the rambunctious
Sixties. It has succeeded spectacularly.
Lustig advocates a complete change in subsi-
dies, to bring down the price of healthy vegetables
and fruits. He argues that horticulture is environ-
mentally beneficial due to its low carbon impact
and that short shelf-lives militate in favour of local
production. That advice has important implica-
tions for Ireland where subsidies are devoted
almost exclusively to environmentally-egregious
livestock production and where fresh local veg-
etables and grains are a rarity. This healthy food
could be much cheaper.
He says: “If you eat a vegetarian or vegan diet
the way our gatherer ancestors did – eating the
food as it comes out of the ground – you’re good
to go, although you might need to supplement
the diet with calcium and vitamin D”.
He shows how high meat consumption is
tied to metabolic syndrome which is a combina-
tion of medical disorders that, when occurring
together, increase the risk of developing cardi-
ovascular disease and diabetes. Many sufferers
exhibit a prevalence of branched-chain amino
acids – meat from animals fed on corn – in their
bloodstream.
Lustig endorses aspects of the so-called
‘Paleo’ diet of foods available to our ancestors
before the ascent of agriculture, including meat
from grass-fed livestock. But he reckons it leaves
a deficiency of vitamin D and calcium and ques-
tions the necessity of excluding wholegrains
which were present in the pre-agricultural diet:
that explains why they were domesticated in the
first place. But for him its biggest drawback is
expense: “the poor aren’t invited to the Caveman
party”. Also, advocates are unwilling to recog-
nise its unsustainability. Perhaps a vegan diet
which excluded all refined foods would be the
best option: there is substantial evidence that
vegans and vegetarians have lower BMIs, and
would be much cheaper.
Big Food needs Big Profit
One area that Lustig does not explore is the
extent to which our staple grains have been
bred for yield as opposed to for nutrition. Lower
yielding, ancient varieties often have a supe-
rior nutritional profile but. with most farmland
devoted to the production of grain as livestock
feed. there is little scope for their cultivation.
Anyway, there is no rationale for Big Food to
produce food we would need to consume less of,
and niche producers only reach a limited, gen-
erally elite, market.
Lustig’s work shows the futility of propos-
als by our Minister for Health for restaurant
menus to include calorie counts, since there
is little benefit to a low-calorie meal high in
refined sugar. It is how we metabolise calories
that count: the interplay of hormones that dif-
ferent foods generate and the extent to which
fibre is part of the meal. Further, calorie-count-
ing menus do not include the drinks which are
often high in fructose; Lustig is critical of any
calories contained in liquid form such as fruit
juices.
No easy answers
Lustig is clear there is no pharmaceutical pan-
acaea for the problems we are facing. He says
of the prospect of a wonder drug: “that’s a pipe
dream because, first, obesity isn’t one disease,
it’s many; second, our bodies have many redun-
dant pathways to maintain our critical energy
balance, and one drug can’t possibly be effective
for everyone; and third, there’s no one drug that
will treat metabolic syndrome”.
He also sees bariatric surgery as being of
limited use: “One of the biggest public miscon-
ceptions is that bariatric surgery consistently
works in the long term…[But] the underly-
ing causes of the obesity…the behaviours of
reward and stress…are not remotely allevi-
ated”. Furthermore: “[It] doesn’t prevent you
from drinking your calories”.
Lustig acknowledges that exercise is the sin-
gle most important measure we can take for our
health, but, as indicated, this has little or no rel-
evance to weight loss in the long term. “Exercise
is the single best thing you can do for yourself.
It’s way more important than dieting, and eas-
ier to do”. Thus, health rather than weight loss
should be recognised as the desired outcome.
But health is intangible and difficult to deter-
mine, and the delayed pleasure of avoiding
disease usually takes second place to the appeal
of being able to fit into a dress or pair of jeans.
The trick is to incorporate exercise into daily
routines as opposed to punishing gym sched-
ules which are invariably abandoned.
One obvious way would be to seriously dis-
courage motor-car usage, though here again
vibrant lobbies distort the approach. He believes
our urban environments in particular should
be arranged so that cycling is given top prior-
ity, rather than the current arrangement where
safe cycle tracks are a rarity and the absence of
contra-flows makes journey unnecessarily long
in Dublin’s city centre. With its temperate cli-
mate Dublin could be a cycling city comparable
to Copenhagen and Amsterdam. Further, it is
anomalous that Iarnród Éireann charges for all
train journeys with a bicycle, unlike in the UK.
Any sugar tax or other measure to curb the
consumption of unhealthy foodstuffs obviously
has to be carefully considered as it is potentially
regressive. Lustig counsels that proceeds should
be invested in subsidising wholefoods.
Changing behaviour
We should recognise the obesity pandemic for
what it is: a crisis of industrial civilisation com-
parable and linked to climate change, in the
cynicism of its proponents if not the longevity
of its consequences. Countering an urge to con-
sume highly calorific, unnatural food and live
lifestyles of low energy expenditure is a huge
challenge for a species that has above all evolved
mechanisms for coping with periodic shortages:
storing calories in particular. But how do we reg-
ulate our behaviour in this era of plenty?
Alas these questions are not being addressed
in our education system, and the abandonment
of mainstream religion has removed many con-
straints on behaviour of all sorts. Jettisoning
much of what has become gospel is essential in
this still new millennium.
If you eat a vegetarian
or vegan diet the way our
gatherer ancestors did –
eating the food as it comes
out of the ground – you’re
good to go, although you
might need to supplement
the diet with calcium and
vitamin D
“
