Sugar MADNESS:
How metabolic syndrome drives obesity
and what you can do about it
Tom´s J. Arag´n, MD, DrPH
a
o
Health Offic...
Acknowledgments (in alphabetical order)

Beatrice Cardenas-Duncan, Shape Up San Francisco
Charles M. Collins, Shape Up San...
Overview
1

What is the Sugar MADNESS?

2

What is the diagnosis? → M-A-D
Metabolic syndrome
Addictive potential of sugar
...
What is the Sugar MADNESS?

What is the Sugar MADNESS?
Sugar
Sugar consumption, especially from sugary drinks, is the sing...
What is the Sugar MADNESS?

Use Sugar MADNESS to remember the cause (sugar),
the diagnosis (MAD), and the treatment (NESS)...
What is the diagnosis? → M-A-D

Metabolic syndrome

Metabolic syndrome is the key condition, not obesity

Figure : Humans ...
What is the diagnosis? → M-A-D

Addictive potential of sugar

Addictive potential of sugar, especially with added salt,
fa...
What is the diagnosis? → M-A-D

Disordered fat (energy) storage

Disordered fat storage drives behavior to eat more and
mo...
What is the treatment? → N-E-S-S

Nutrition

Nutrition is key to better metabolic health
Avoid added sugars (i.e., fructos...
What is the treatment? → N-E-S-S

Environments

Environments—make healthy choices easy everywhere
Current state
Fast food ...
What is the treatment? → N-E-S-S

Stress reduction

Stress reduction improves your metabolic health
Bottom line: Chronic s...
What is the treatment? → N-E-S-S

Sleep and exercise

Sleep and exercise improves your metabolic health

Sleep
Less than a...
What is the treatment? → N-E-S-S

Sleep and exercise

Remember, Sugar MADNESS summarizes the cause
(sugar), the diagnosis ...
What is the treatment? → N-E-S-S

Sleep and exercise

Resources
Choose Healthy Drinks
http://www.choosehealthydrinks.org/
...
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Sugar MADNESS: How metabolic syndrome drives obesity and what you can do about it

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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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Sugar MADNESS: How metabolic syndrome drives obesity and what you can do about it

  1. 1. Sugar MADNESS: How metabolic syndrome drives obesity and what you can do about it Tom´s J. Arag´n, MD, DrPH a o 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: tomas.aragon@sfdph.org Blog: http://medepi.com February 16, 2014 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 1 / 14
  2. 2. Acknowledgments (in alphabetical order) Beatrice Cardenas-Duncan, Shape Up San Francisco Charles M. Collins, Shape Up San Francisco Christina Goette, MPH, SFDPH Laura A. Schmidt, PhD, MSW, MPH, UCSF Marianne Szeto, MPH, SFDPH Robert H. Lustig, MD, MSL, UCSF Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 2 / 14
  3. 3. Overview 1 What is the Sugar MADNESS? 2 What is the diagnosis? → M-A-D Metabolic syndrome Addictive potential of sugar Disordered fat (energy) storage 3 What is the treatment? → N-E-S-S Nutrition Environments Stress reduction Sleep and exercise Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 3 / 14
  4. 4. What is the Sugar MADNESS? What is the Sugar MADNESS? Sugar 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 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 believes we have 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 memory aid to learning about sugar, metabolic syndrome, and what to do about it. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 4 / 14
  5. 5. What is the Sugar MADNESS? Use Sugar MADNESS to remember the cause (sugar), the diagnosis (MAD), and the treatment (NESS) Diagnosis M A D etabolic syndrome ddictive potential of sugar isordered fat storage Treatment N E S S utrition nvironments tress reduction leep and exercise Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 5 / 14
  6. 6. 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 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 6 / 14
  7. 7. 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, sugar triggers reward centers in the brain and induces sugar cravings. Source: Ahmed SH, Guillem K, Vandaele Y. Sugar addiction: pushing the drug-sugar analogy to the limit. Curr Opin Clin Nutr Metab Care. 2013;16(4):434-9. PMID: 23719144. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 7 / 14
  8. 8. What is the diagnosis? → M-A-D Disordered fat (energy) storage Disordered fat storage drives behavior to eat more and move less Metabolic syndrome (MetS) results in disordered fat storage. Biochemistry Chronic high insulin Leptin resistance (LR) Leptin (from fat cells) not able to notify brain that sufficient fat has been stored; therefore, MetS drives behavior to: Eat more Move less (↓ exercise) Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Figure : Source: UCTV The Skinny on Obesity Sugar MADNESS February 16, 2014 8 / 14
  9. 9. 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, and micronutrients Hu FB. Resolved: There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev. 2013;14(8):606-19. Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 9 / 14
  10. 10. 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 sugar and removed fiber Future state Water instead of sugary drinks Portion sizes reduced Fresh food affordable and available Healthy food policies and systems Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 10 / 14
  11. 11. What is the treatment? → N-E-S-S Stress reduction Stress reduction improves your metabolic health Bottom line: Chronic stress promotes unhealthy weight gain. Figure : Abbreviations: HP, highly palatable; HPA, hypothalamic-pituitary-adrenal; GC, glucocorticoids; Source: Sinha R, Jastreboff AM. Stress as a common risk factor for obesity and addiction. Biol Psychiatry. 2013;73(9):827-35. doi: 10.1016/j.biopsych.2013.01.032. PMID: 23541000 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 11 / 14
  12. 12. What is the treatment? → N-E-S-S Sleep and exercise Sleep and exercise improves your metabolic health Sleep Less than adequate sleep results in ↓ leptin and ↑ ghrelin → weight gain (↑ body mass index) http://news.stanford.edu/news/2004/december8/med-sleep-1208.html Exercise Exercise regulates fat and glucose metabolism and results in an increased action of insulin, while it also lowers blood pressure and improves blood pressure 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 Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 12 / 14
  13. 13. What is the treatment? → N-E-S-S Sleep and exercise Remember, Sugar MADNESS summarizes the cause (sugar), the diagnosis (MAD), and the treatment (NESS) Diagnosis M A D etabolic syndrome ddictive potential of sugar isordered fat storage Treatment N E S S utrition nvironments tress reduction leep and exercise Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 13 / 14
  14. 14. What is the treatment? → N-E-S-S Sleep and exercise Resources Choose Healthy Drinks http://www.choosehealthydrinks.org/ Shape UP San Francisco http://shapeupsfcoalition.org/ The Skinny on Obesity —UCTV Prime http://www.uctv.tv/skinny-on-obesity/ Robert H. Lustig. Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease. Plume Publishing 2012 HBO’s The Weight of the Nation http://theweightofthenation.hbo.com/ Gary Taubes. Why We Get Fat: And What to Do About It. Anchor Publishing, 2010 CDC. Overweight and Obesity : http://www.cdc.gov/obesity/ Tom´s J. Arag´n, MD, DrPH (SFDPH) a o Sugar MADNESS February 16, 2014 14 / 14
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