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.

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)
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Sugar MADNESS
February 16, 2014
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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)
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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)
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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
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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)
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o
Sugar MADNESS
February 16, 2014
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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)
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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)
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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
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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)
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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)
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Sugar MADNESS
February 16, 2014
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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)
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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)
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Sugar MADNESS
February 16, 2014
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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
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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/
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