Monthly Archives December 2012

Q&A with Dr. Richard Johnson

December 12, 2012  |  Post by:  |  Blog, News No Comments

Q&A with Dr. Richard Johnson

By Michele Conklin view the source here.

(November 2012) Richard Johnson, MD, just published his bookThe Fat Switch, which reveals what he and his research team suggest could be the mechanism behind a worldwide obesity and diabetes epidemic.

The CU medical school professor and chief of the Division of Renal Diseases and Hypertension has investigated health mysteries around the globe, from cobalt poisoning in the Andes to kidney disease in Tibet and Venezuela to lung fluke infections in Indochinese refugees. But it’s his book that may have the most widespread effect.

In the following interview Johnson tells a tale of fat storage, evolution, the perils of fructose and a potential solution to the obesity epidemic.

Q: Tell me about The Fat Switch.  

A: The Fat Switch is a pretty grand story. At the heart, it tries to identify the cause of obesity and diabetes, and it also hits a lot of other diseases like celiac disease, Crohn’s disease, attention-deficit disorder and others.

Q: You believe it all comes down to eating sugar?

A: Yes, fructose, in particular, as well as some other types of foods.

Q: Why is your theory different than what we already know?

A:  Historically, most of us think we get fat because western culture encourages us to eat large portions of food and to exercise less. According to this, we are to blame for poor habits.
However, our work shows that obesity is triggered by a “switch” in our metabolism that makes us want to eat more and want to exercise less. I should make clear that none of these discoveries would have been made without major contributions by my colleagues and collaborators.

Q: What’s the story behind this team discovery?

A: Well, I am a kidney doctor, so this is a very good question. In essence, we were studying high blood pressure, in which it is known that the primary problem is a defect in the ability of the kidney to excrete salt. In the process we concluded that this defect in salt excretion resulted from disease of the small blood vessels in the kidney. What caused that?
We discovered that a major contributor was the effects of a high serum uric acid. We then looked for what was driving uric acid levels up, and eventually this took us to fructose. We found that fructose was not only driving high blood pressure, but also other features of metabolic syndrome. When we lowered uric acid in fructose-fed animals, we not only blocked high blood pressure from developing but also other features of the metabolic syndrome. This led us to study fructose in more detail.

Q: You studied animals first. The same thing happens in humans?

A: Yes. Fructose is a major component of the American diet, and is primarily in table sugar (sucrose) and in high fructose corn syrup. Intake of these sugars is associated with increased risk for high blood pressure, and for obesity, diabetes and fatty liver. And those sugars also are associated with higher uric acid levels and the problems that causes.

Q: How did that translate into obesity?

A: Our most recent studies suggest that one of the major ways fructose increases fat is by its unique ability to raise uric acid inside the cell. In the liver, for example, we can show that fructose is a major factor driving fatty liver, and that this is driven in part by the uric acid.
The uric acid works on the energy factories in the cell, the mitochondria, and preferentially blocks their ability to degrade fat while at the same time reducing the energy output. When a cell has less energy, it communicates to the brain to eat more. At the same time, the inability to burn fat leads to fat accumulation. Soon you have fatty liver.
Q: You looked at fat in people and other animals. What did that tell you?

A: Weight is normally tightly regulated among animals. They tend to gain weight to help survive during periods of food shortage or famine. When they do this, they develop fatty liver, they’ll increase the fat in their blood and their abdomen, and they even become insulin resistant. So they develop all the features of metabolic syndrome.
It’s clear that what people are calling metabolic syndrome is actually a form of fat storage. The difference is that humans continue to store and accumulate fat, whereas an animal gains fat and loses it in a regulated way.

Q: So uric acid signals the body to gain weight?

A: Yes. One of the first clues came from studies of starving animals. Uric acid was the factor that goes up in the starving animal, and we believe it signals to the animal to try to reaccumulate fat. In our society sugar turns out to be a major way for activating this switch. Soon we realized that the activation of this metabolic switch might be very important in the cause of obesity in humans.

Q: In your book, you also discuss the evolution of humans and of sugar in our diet.

A: As we looked for what could activate this switch in animals and we realized that fructose was a big way to activate it, we then started looking at humans and saw that this mechanism we had discovered could actually account for a lot of the obesity in humans.
We further linked the susceptibility of humans to fructose to a mutation that occurred 15 million years ago during a period of famine. The mutation resulted in a greater increase in uric acid in response to fruit, and thereby allowed us to increase our fat stores more easily in the setting where fruit availability was decreasing. Thus, this mutation likely acted to protect us during periods of famine in our past.
However, sugar was not available then, and as sugar was gradually introduced into society, suddenly there was much more fructose available than in the past. Then we found that there are other foods that can activate the switch, though not as much as fructose.

Q: Such as?

A: Umami foods, the type of food that’s called savory, such as gravies and shellfish. However, beer is the greatest culprit after sugar. We realized that you can activate the switch a number of ways. Then we looked at what happens when the switch gets activated and how it might play a role into not just diabetes and obesity, but a lot of other diseases, including celiac disease, food allergy and attention deficit.
The book makes the case that the fructose/uric acid switch is probably the underlying major mechanism for the obesity epidemic. It’s very controversial. But the data is the data. I use everything, from anthropology and evolution and comparative physiology to biology and molecular biology and history, to put together the total argument.

Q: Do you believe this could be the breakthrough to end this health crisis?

A:  I believe the book provides major insights that could lead to not only how to prevent and treat obesity, but also one day to curing obesity.

Dr. Johnson discusses “The Fat Switch” on “How On Earth Radio”

December 04, 2012  |  Post by:  |  Blog, News No Comments
Link to the description and podcast here

Dr. Johnson’s interview on “How On Earth” debuts tomorrow, check it out!

December 03, 2012  |  Post by:  |  Blog, News No Comments

Here is the transcript from Dr. Johnson’s interview with

RICK JOHNSON: Fruits tend to have not so much fructose, and they have a lot of good ingredients. However when you drink fruit juice, it’s combining a number of fruit in one glass and so you get a larger amount of sugar — you get a larger amount of fructose, and when you drink it really fast, you get high concentrations very rapidly in your blood. So it turns out that fruit juices are probably not healthy–instead, the amount of fructose overwhelms the good things in the juice and there’s now a very good data showing that children who drink too much fruit juice are at high risk of becoming obese

SHELLEY: Well, let’s talk some more about children, because they are our biggest concern We adults, we can make choices because we’re grownups. But kids, other people make choices for them. And children are in the time of their life when their habits are forming, and already, we have a number of children who are obese or have high blood pressure or have other signs that their health is in trouble. Does that group of children, those with obesity or high blood pressure and so on, need a different diet and exercise program than other children do? Because of how their bodies are working?

RICHARD JOHNSON: Yes. I think we need to have a health policy for everybody. But I agree that children childhood obesity is becoming an increasingly major problem. One in six children now are obese. Many of them are developing high blood pressure. Many of them are developing insulin resistance, and we are now seeing type II diabetes occurring in child Not only that, but it affects their performance. There are now studies that show that it affects their ability to perform tasks. Cognitive function, can be effected.

SHELLEY: They can be more hyperactive. They can have trouble learning. They can be easily falling asleep when they’re trying to learn, because they’re so tired.

RICHARD JOHNSON: And we have actually published a paper linking chronic sugar intake with attention deficit hyperactivity syndrome.

SHELLEY: Now Rick Johnson, when you say “chronic,” that means something that happens for a long time. Meaning regular use over days and weeks and months and even years. Which is kind of how all children use sugar.

RICHARD JOHNSON: Yes. Back in the 1980s there were some studies done to look at how sugar might have a role in attention deficit hyperactivity disorder. Or “ADHD.” And those studies involved giving a single dose of sugar or a very short period of sugar intake to look for how it might affect attention deficit disorder. The studies were negative and so the conclusion was that sugar didn’t have a role in ADHD. But they were looking at acute effects of sugar. When we look at the studies and the literature in terms of trying to to look at the relationship between chronic sugar intake and ADHD, suddenly it becomes a very very strong compelling argument that eating sugar for months to years may dramatically increase the risk for ADHD.

SHELLEY: That’s just one example of a health issue that might be affected by eating sugar.


SHELLEY: This is a dilemma, because right now, USDA food policy has stated that as many as 1/3 of calories can come from sugar in food. And it’s been deemed that if it’s a calorie, and it’s not too many calories, that’s not a problem.

RICHARD JOHNSON: Yes so what we’re learning is is that fructose is biologically active. It isn’t just a calorie. In fact we even have some experimental data suggesting that it may increase the risk for food allergies. Fructose intake and sugar intake in children may have a role in why we’re seeing such an increased risk of anaphylaxis and severe allergies to peanuts and other proteins.

SHELLEY: And perhaps celiac disease and other autoimmune conditions.

RICHARD JOHNSON: That’s correct.

SHELLEY: So, if we have all of this happening, and there are some children who can drink as much chocolate milk as they want. And some children that can eat cookies, and they don’t have a problem. And then you have some children who are overweight and tired. And they’re told, make sure that you eat the chips that are baked, not fried. And avoid eating any cheese. and instead, drink the no-fat chocolate milk. And not the whole milk. Because, it has fewer calories. And exercise more. What’s going to happen to those children who already have metabolic syndrome?

RICHARD JOHNSON: You’re bringing up a very interesting point which is that not everyone seems to be so sensitive to the effects of sugar. There are young people out there who are eating huge amounts of sugar and they still stay skinny and the question is why? Studies that we’ve done here at the University as well as elsewhere, have shown that, especially in children, many children don’t absorb fructose very effectively. Perhaps two out of three young children won’t absorb all their fructose. We did a study which is not published yet, but it was done at Children’s Hospital here, and we looked at children who have fatty liver, and we found that those children who have fatty liver and who were overweight, when they received a dose of fructose, they absorbed almost all of it. Whereas the lean children did not. Most of them mal-absorbed some of the fructose.

SHELLEY: On the playground, some of the children who are leaner might tell the heavier children, well, I’m thinner just because I’m quicker than you. And I have higher energy, and you guys that are slow, you’re fat and lazy.

RICHARD JOHNSON: That’s not the way it works. So the sugar, once you start absorbing the sugar, it will over time, reduce your mitochondria so, mitochondria, our body is made up of cells, and we have millions and millions of cells that constitute our body. And each cell has a nucleus, which is kind of brain of the cell, but each cell also contains little units called mitochondria. These mitochondria are what produce energy

SHELLEY: Are they like batteries? Our EverReady battery inside the cell?

RICHARD JOHNSON: They are like our batteries. They’re basically the energy factories of the cell, and they produce the energy that runs our cells. When you produce a lot of energy, that it is important in being able run, and to bicycle, and to climb mountains, and to swim and stay up. The energy we produce is very important, and that energy is called ATP. When a person eats more food, generally they will produce more energy. But with fructose, when you eat more, it actually slows the production of the energy, so it has an opposite effect. So you produce less energy, and you accumulate more fat, and when you produce less energy, you tend to be more tired. Now what happens over time — the more sugar you eat, it actually seems to cause damage to the mitochondria. Over time, you may actually lose mitochondria. At that point, you are almost locked into a lower energy state. Unless you can stimulate the growth of more mitochondria to allow you to get back to your original energy level.

SHELLEY: You mean that once a child or a grownup’s body is in trouble, metabolically, then eating more sugar will help them feel more energetic for a few minutes or perhaps an hour or so. But in the long run, eating that sugar might be killing more of the batteries inside of their cells?

RICHARD JOHNSON: Yes. Basically over time, you start to lose these mitochondria. Now in children who become obese, most of them still are have quite a few mitochondria, so they can recover quicker. You can get them back to normal weight easier than you can a 55-year-old or 60 year old, who may have lost quite a few mitochondria. It’s going to be harder to get that person back to a low stable weight, unless you find ways to stimulate their mitochondria to increase their numbers. The very best way is exercisek

SHELLEY: So even though it really will be harder for a child who’s overweight to exercise, because their body is not as good at handling energy yet, it might be even more important for that child to exercise.

RICHARD JOHNSON: That’s right. Exercise is one of the best ways to stimulate mitochondrial growth, and that will allow one to help reset to their weight.

SHELLEY: Let’s talk a little bit more about what fructose can do to a person’s body, if their body doesn’t handle fructose very well. You have mentioned in your research that if a body is not handling fructose well, it can start to mean that the body cannot handle any starch or sugar well. The body starts to turn any kind of carbohydrate that it takes in, into fructose, which starts messing up the body again.

RICHARD JOHNSON: Yes, and classically we think that most the fructose that we get is coming from our diet. So we think the greatest amount of fructose is coming from the sugars we eat because those sugars contain fructose. But it is true that our group has recently discovered that inside our bodies, fructose can be made from carbohydrates, even when those carbohydrates don’t contain fructose. So unfortunately under certain circumstances our bodies convert carbohydrates that we’re eating into fructose. Now, our paper on this hasn’t yet been published, but we do have strong data that this does occur at least in animals, and and so it would be interesting to determine if this is one of the mechanisms driving obesity today, and one of the reasons why carbohydrates have been so strongly associated with obesity and diabetes.

SHELLEY: I’m thinking about the overweight child who goes to lunch, and is told especially because you’re overweight, child, you should be eating your bread, and you should be eating your potato and you should be eating your chocolate milk, and you should not be adding any oils to what you’re eating, and you should certainly avoid that cheese, because fat contains more calories per spoonful, and you should be limiting your calories. For a child whose body is turning their carbohydrates into fructose, and then storing those fructose calories as fat instead of using it as energy, or for an adult whose body is doing this counter-productive conversion of fuel into fructose, is getting most of your energy from carbs a recipe for success, telling them to eat their bread and potatoes but cut the fat, or is that a recipe for disaster?

RICHARD JOHNSON: Probably not a good recipe for success. I think that if you have a child who’s overweight, the first thing to do is to try to limit the amount of sugar that child is eating. Without a doubt that’s the number one first thing you should do. You should try to look at all that packages, trying to see if they’re eating sources of sugar you may not know. High fructose corn syrup can be concentrated in certain foods foods that we think of as healthy, such as fruit yogurt, which can sometimes be filled with sugar – and fruit juices. So the first thing is to try reduce the sugar — maybe all it takes and we’ve had some overweight or obese children become suddenly lean in a period of a few months just with that maneuver alone.

SHELLEY: And more energetic

RICHARD JOHNSON: And more energetic.

SHELLEY: And more happy and less tired.

RICHARD JOHNSON: Absolutely. It can be an amazing transformation and children can turn around very quickly. If that’s not working it’s possible that those children, their bodies may already have found a way to be converting the carbs they eat into fructose, even when they’re not eating fructose.

SHELLEY: And it’s not that these children have done something that’s diabolical or bad. It’s just that their cells are struggling with the modern way that we eat. And they’re using a compensation that isn’t really working for their body.

RICHARD JOHNSON: That’s right. And we’re still trying to figure out how that happens but it looks quite likely that some people are converting carbs to fructose in their body

SHELLEY: And then they’re storing the fructose as fat instead of burning it for energy.

RICHARD JOHNSON: Right. So if just reducing sugar is not enough to see a very significant change in weight, it may be reasonable to restrict carbohydrates in general. And so I think that that is something we should be thinking more and more about. I know everyone’s worried in children, to restrict carbs too much, but I do think that the data is the data, and it looks like some carbohydrate restriction may be of significant benefit to these children who are overweight, who do not respond just to restricting sugar.

SHELLEY: Then could you give them a little bit more fat?

RICHARD JOHNSON: Yes, so foods like cheese and milk and dairy products are actually I feel are very healthy. They actually help neutralize some of these effects of fructose, and so I do believe that dairy products are good. I think unsalted nuts are good. There are a variety of foods that I would recommend. And if they have to eat a sweet, I would give them 70% dark chocolate, which actually contains substances that stimulate mitochondrial growth, and it still tastes good and it doesn’t have that much sugar!

On The Wide World of Health, Cary talks with Dr. Richard Johnson about his book The Fat Switch

December 03, 2012  |  Post by:  |  Blog, News No Comments

Oon The Wide World of Health, Cary talks with Dr. Richard Johnson about his book The Fat Switch. To learn more, please visit the clickable link here.