Fat Chance, by Dr. Robert Lustig

Just came across “Fat Chance:  Beating the Odds Against Sugar, Processed Food, Obesity, and Disease,”  by Dr. Robert Lustig.

Dr. Lustig is a pediatric endocrinologist and the Director of the Weight Assessment for Teen and Child Health Program at the University of California San Francisco’s Benioff Children’s Hospital.  Dr. Lustig came to the issue of weight and obesity via a start caring for children who had survived brain tumors.  The therapy to get rid of the tumor often damaged the hypothalamus.  Some of the kids developed hypothalamic obesity, because the neurons in the hypothalamus that sense the leptin signal are all dead.  ”Even if these kids eat only 500 calories a day, they gain weight.” Why?  ”Leptin is a protein made and released by fat cells.  It circulates in the bloodstream, goes to the hypothalamus, and signals the hypothalamus that you’ve got enough energy stored up in your fat.”   If the hypothalamus can’t hear the signal, the person will continue to store, not burn, energy.

So Dr. Lustig knew years ago that weight was not only about “calories in, calories out.”  His book argues forcefully that obesity is not a “choice” or the result of bad individual decisions.  He recounts the stories of obese 6 month and 1 year olds, and the fact that some kinds of infant formula have roughly the same amount of sugar per serving as coca-cola.  Did the 6 month old or the 1 year old make “bad choices?”

He would like to see a public health attack on what he believes are the true sources of obesity:  sugar, especially fructose, and processed food of all kinds.  He notes that many individuals, children among them, have no practical control over what they eat either because of lack of access to real food–in urban “food deserts,” for example, or because of poverty.  Nutrition programs that support low income people, such as Women, Infants, and Children (WIC) are not first and foremost nutrition programs but rather ways of disposing of federally-subsidized agricultural surplus crops.

Perhaps the most interesting part of the book for me, however, as the parent of a teenager who has tried most everything (except a starvation diet) to bring her weight down to a healthy level, is his estimation that in his practice, 60% of kids can resolve their weight issues by eliminating unhealthy carbohydrates such as sugar, flour etc., but 40% CANNOT.  They need additional support in the form of supplements, or drugs that do things such as improve insulin sensitivity, and even bariatric surgery.

This is the FIRST place I have ever seen a 40% failure rate for a low carb eating plan.  In Life Without Bread, about which I’ve written before, Dr. Wolfgang Lutz, practicing in Germany from about 1960 on reported 100% success with a low carb eating plan for his pediatric patients within a year except in very extreme cases, which might take longer to resolve, or in cases where it was subsequently learned patients hadn’t actually followed the plan.  And failure is too strong a word–there is no question that a low carb eating plan has vastly improved Juliana’s quality of life–she weighs less; she has far more energy, and a more positive and more stable mood on a low carb eating plan.  But she’s not all the way to a healthy weight and remains at risk for metabolic syndrome and diabetes.

In fact, in Fat Chance there is a description of something called acanthosis nigricans.  In all my low carb reading, I’d never heard of it.  It is a darkening, or thickening, and ridging of the skin at the back of your neck, armpits, and knuckles.  People think it’s dirt, or on the neck “ring around the collar.”   In fact, it is excess insulin working on the skin.  It can’t be washed off.  Juliana has had this on her neck, even after months on a low carb eating plan, and after her fasting insulin level was tested at an excellent “3″.  Even though her fasting insulin level is fantastic, I suspect there is still something else going on with her non-fasting insulin response–her hormonal response to food.

I wonder whether the difference between Dr. Lutz’s clinical experience and Dr. Lustig’s clinical experience is literally the change in the world in the past 50 years.  When Dr. Lutz began his practice, endocrine disruptive chemicals were not everywhere.  Now they are.  It is practically impossible to avoid exposure.

Oh, and is it any surprise, that Dr. Lustig is a buddy of my hero Gary Taubes, whose work first led us to try a low carb eating plan?

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