Why are Asian Rice Eaters Thin?

Thin Rice Eater

It’s a common question. If carbs can make you fat, why were some populations (e.g. Japanese people) thin while eating a high carb diet?

Dr Peter Attia has written a nice post on this: The War on Insulin: How do some cultures stay lean while still consuming high amounts of carbohydrates?

I basically agree with his ideas, although I think there is a few more answers to this question: 

The three big reasons

Here are the main reasons why I think populations could stay thin on high carb diets:

  1. Low to insignificant consumption of refined sugar (fructose). This may stop insulin resistance from developing.
  2. Eating mainly unrefined starch (e.g. brown rice, root vegetables) that is slow to digest, due to high fiber content etc.
  3. Traditionally more physical activity then sedentary western population. Compare a Japanese rice farmer (in the field all day) to an American office worker with a car. If you burn more glucose (via physical activity) then less insulin is needed when you eat carbs.

If you avoid sugar (fructose) and refined high GI starch and stay physically active you can probably stay thin and healthy on a high percentage of carbs. Lots of populations have done so.

Three more factors

  1. Poverty: These traditionally thin populations were on average fairly poor by todays standards, meaning perhaps they could not always afford all the food they would like to eat.
  2. Food reward / addiction. This may be controversial but I think there is a point to all this food reward talk that’s been going on in the blogosphere. Our processed junk food and candy is carefully designed to artificially make it taste great and be addictive. It also contains a lot of sugar and starch. It’s like cigarettes: The nicotine makes people addicted, thus they smoke a lot and the smoke gives them cancer. Fast food and candy is also addictive, thus people eat more of it and the sugar / starch overdose makes them fat.
  3. Genetic makeup. Asians do not look like Caucasians or Africans. They have (on average) way less musculature, they have a thinner build. This means that comparisons between the weight of Americans / Europeans and Asians using BMI is misleading, it exaggerates the difference. Asians are often “skinny fat” or even get diabetes at BMI levels that are considered normal for Caucasians (e.g BMI 24).

What do you say?

What do you think about this common question and the possible explanations?

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288 Comments

  1. Ossi
    Just to correct your second point, Asians don't eat brown rice but white and for a good reason. Brown has all the bad stuff in it and white rice is "safe(r) starch".
  2. I think this is a good reminder of the fact that not all carbohydrates are bad. Carbohydrates are very widespread in our food. Although chemically related, they have very different effects on our health. In short; there are both good and bad carbs.
    Although overconsumption of sugar and carbohydrates has without doubt contributed to the world obesity epidemic, it may be mainly due to junk food and unhealthy refined sugars. However, this does not change the fact that obese or overweight people generally get good results by reducing the total amount of carbohydrates consumed.
    Much has been written about good and bad carbs, here is one short article from my blog if you are interested: http://www.docsopinion.com/2012/03/good-carbs-bad-carbs.html
  3. I have spent a lot of time in Asia over the last 30 years and I've never seen any emphasis on eating low fat combined with rice and other starches. In the same way that we didn't start our upward trend towards obesity until we vilified fat and drastically increased out carb consumption, in Asia, my guess would be the one of the reasons they stay slim is that that they still consume a reasonable amount of fat. Also, they consume almost no sugar. One doesn't find sugar added to virtually everything like one does in the west.
  4. Tia
    Sorry, no, there aren't good or bad carbs. Because every carb will be glucose in your bloodstream, earlier or later, with all consequences concerning insulin etc.

    In my opinion you cannot compare isolated nutrients to find out, why some humans stay slim and other are getting overweight. It is not simple! ;)

    Find out how much carbs and which amount of energy fits into your life style and metabolism and enjoy your meals.
    Only my two cents....

  5. KD
    I suspect since calories are the ultimate arbiter of weight, Asians just eat fewer of them than western populations. A big factor in that is that they've done a better job of keeping a traditional food culture in place and avoiding soda, fast food and sugary junk. As those things creep into Asian diets the average waist size goes up- because they're eating more calories. It's certainly not the carbs in and of themselves. For example 10 years ago no Chinese would drink juice, now it's close to becoming a staple- that's an extra 100 calories a glass when there would have been 0 before. No fancy insulin calculations are needed- follow the calories!

    And the commenter above is correct, Asians eat mostly white rice.

  6. Jean
    I'm currently living in Korea. I'm seeing quite a few more overweight/obese Koreans now than I did when I lived here in 1995, and have also seen ads for glucose meters in the subway trains. When we eat Korean food, rice is not a big part of the meal. It's mostly meat and vegetables, many of them pickled or fermented. The rice isn't even served automatically with some of the meals. However, I'm seeing more western bakeries and convenience stores full of sugary, carby junk foods than last time, too. Also, the Koreans who eat at the American establishments frequently ( on my military base) seem to be slightly more pudgy than their counterparts. Overall, the Koreans are still thin and quite fit, though.
  7. Violeta A.
    One possible reason for eating carbs and not gaining weight is that they are eaten with no substantial amount of protein to go with them. It is ok to combine carbs + fats and protein + fats but combining carbs + protein is not.

    I know this from experience - when I was still eating more carbs than I eat now I never ate them with protein at the same meal. The effect on digestion is much better than when I used to eat protein+carbs at the same meal.

    Having said that, though, I am not sure that eating large amounts of carbs every day is the healthiest option in the long run. I tend to believe that it is not. Unfortunately, I know that large numbers of the population in Asia cannot afford to eat much more than a bowl or two of rice per day. And I don't think you can be overwight/obese on that amount of food even if it comes only from carbs.

  8. osteoDH
    Well since the western diet got its way to Asia ( higher refind carb++) , they're not so thin anymore and yes , more satured fat = less carbohydrates
  9. Great post. I think the genetic argument is very important because it highlights the problems with our current concepts of obesity, rather than looking at metabolic health.

    Also, in regards to food reward, I think the main issue is that we are not computers--we can not so easily separate are hardware and software. A brain with out a body is usually pickled in a jar in medical school anatomy classes while a body without a brain is found often in the US government, especially in the halls of the USDA!

    The point is we can separate things theoretically, but often in reality, it is much more integrated and complex, and the boundaries are not so clear and distinct as we would like them to be!

  10. JAUS
    It's a myth that Japanese people are healthy. It's the older generation that eats traditional food with much from the sea that live quite a long life, but the young generation eats pure junk: potato chips, candy, pasteries, sodas and fast food. All people don't have the genetic to get fat easily, but that dosen't mean that they are healthy.
  11. dr-no
    Furthermore, the main cause of death in Japan is Stroke, with Coronary Heart Disease being on the third place. So it is still a population with a large vascular disease problem. Yet the traditional diet seems to postpone morbidity to a higher age. Of course, Japan became very Westernized with regard to the diet, at least if the visitors I've spoken to reported correctly.
  12. Rose
    I was skeptical of a genetic basis for Asian leanness until I saw the BBC documentary "Why Are Thin People Not Fat?" They overfed a group of naturally thin people for several weeks, and all gained some body fat, but in strikingly different amounts. The standout was a young man of Asian descent who gained almost no body fat whatsoever despite eating 10,000 cals/day; it turns out his basal metabolic rate had increased by 30%! Granted, he's one guy, it's one experiment, and there could be other factors involved -- but not one of the other participants experienced the same leap in BMR.
  13. I traveled to Hong Kong in 2000. There was a 7-11 near our hotel that stuck in my mind. It had a small selection of candy that was not very sweet. The aisles were filled with packages of dried crustaceans instead of chips and pretzels. The selection of sodas was limited, and it seemed to be there for the Westerners.

    In the markets, we saw piles of prawns and other fresh seafood. There weren't any bakeries or ice cream shops. There was a two-story McDonald's, but without all of the other elements found in our culture that lead to obesity, it didn't seem to have much of an impact.

    Plus, everyone walked. Everyone. Apparently it costs a crazy amount of money to drive.

    And those ducks--like the ones from the end of A Christmas Story--were everywhere. Not cakes and sandwiches and desserts, but ducks with the heads still attached.

    The lack of refined carbohydrates, along with the desire for them (food reward!), was obvious. The obsession with food and weight that saturates the West didn't exist, either.

  14. chuck
    there could be something about rice that doesn't cause obesity as much as wheat. the addition of wheat to the diet of chinese has correlated to increases of obesity. the same problem doesn't seem to occur with rice.
    http://wholehealthsource.blogspot.com/2008/07/wheat-is-invading-china...
    http://rawfoodsos.com/2010/12/15/new-china-study-links-wheat-with-wei...
  15. Sam
    Is epidemiology but rice is associated with increased diabetes including Asians.

    http://www.sciencedaily.com/releases/2012/03/120315225751.htm

    The authors analysed the results of four studies: two in Asian countries (China and Japan) and two in Western countries (USA and Australia). All participants were diabetes free at study baseline.

    White rice is the predominant type of rice eaten worldwide and has high GI values. High GI diets are associated with an increased risk of developing type 2 diabetes. The average amount of rice eaten varies widely between Western and Asian countries, with the Chinese population eating an average of four portions a day while those in the Western world eat less than five portions a week.

    A significant trend was found in both Asian and Western countries with a stronger association found amongst women than men. The results also show that the more white rice eaten, the higher the risk of type 2 diabetes: the authors estimate that the risk of type 2 diabetes is increased by 10% with each increased serving of white rice (assuming 158g per serving).

  16. Moreporkplease
    Jaus is correct - Asia is now fat & diabetes is sharply rising. I've posted links to the evidence here before. Why does the myth of skinny Asia, poor Asia persist? Do Hong Kong, Singapore, Bombay, Jakarta, Seoul, Tokyo not exist? These are wealthy glittering cities!
  17. chuck
    @sam
    appears that study only measured risk of diabetes not actual incidence of diabetes. here is an interesting blurb from a blog post:

    "If anything, diabetes incidence goes down as rice consumption increases. Countries with the highest white rice consumption, such as Thailand, the Philippines, Indonesia, and Bangladesh, have very low rates of diabetes. The outlier with 20% diabetes prevalence is the United Arab Emirates."

    http://perfecthealthdiet.com/?p=5755

  18. bill
    Cigarettes are doped with molasses (sugar). This may be why they are addictive.
  19. John Myers
    Good article - thank you.
    I'm curious about sumo wrestlers. They put on weight purposefully and seem to have found the perfect recipe to do so. I found some information about how they do it - apparently they eat large quantities of stew and then go to sleep in the middle of the day. I'm fascinated by this.
  20. I have worked with many people of Asian descent in my practice. It is mainly the inclusion of vegetable oils and HFCS here in the US that has contributed to the rise in obesity along with a sedentary job. Diabetes and weight gain occurs in many other ethnic groups when they adopt the American diet as well.
  21. Mike W
    I agree with Liz - there are so many differences in the culture and food environment, singling out rice to explain thin Asians is a gross oversimplification. I worked in Taiwan for a month in the 90's, and I noticed some of the same things. Everybody walked. Everywhere. Every day. I had rice at each meal, but that was the only carb-y food - the rest was usually seafood, fowl and vegetables. There was virtually no snacking on sweets, that I could see. When I visited private homes, everyone drank tea, not soft drinks.

    Another thing: in the small town where I was working, middle-aged men and women were definitely pudgy. It's not American-style obesity, but clearly it shows that a rice-based diet doesn't guarantee a lifetime of thinness.

  22. Do we think that because carbohydrate-restriction is the best therapeutic approach (usually), that therefore it is established as the diet that everybody has to follow? What will help us move forward is to recognize what we know and what we don't know. "Why are Asian Rice Eaters Thin?" is a good question and all the points made above are relevant but we don't know the answer to all questions especially complicated ones involving humans. In science, if you don't know, you don't know. That's why real biochemists don't jump in on Lustig's flights of fancy. The answer isn't there yet. A doctor has to do the best they can because you can't say you don't know. We like Dietdoctor because he is talking about the data and experience but that is different than saying we know all the answers. Among the relevant facts, though, as Cate says, my observation (anecdotal) is that Chinese-Americans cook with a lot of fat and use vegetable oils.
  23. I don't believe "a calorie is a calorie" in general, but I think it applies in this case. You can "safely" eat a carb-rich diet if total calorie intake is low and/or energy expenditure is high (and you're skinny).
  24. Laura
    THere are well known 'ethnic' patterns of fat deposition many of them are adaptations to climate. In may African tribes for examples fat if present is deposited mostly on teh buttocks and only under extreme pressure through overfeeding it is deposited in other parts of the body. This pattern of fat deposition is believed to aid heat dissipation in such hot climates.
    Why would rice eating asians living in tropical and subtropical areas be so thin (on traditional diets one must emphasise this because many of them do gain weight if they let themselves go to Western diets

    But fat deposition patterns are not relevant to what actually controls whether excess calories should be burnt or stored. I am a supported of the insulin master switch and must assume that some peoples/ehtnicities are 'burners' that is faced with excess calories their body adjsuts by simply burning more. EAch one of us knows at least one or two such true LEAN people so they exist even within Western populations exposed as they are to all the high carb. they can quite literally eat as much as they like stop exercise adn they remain at teh same weight. They are in some sort of equilibrium. My modest theory is that some role must me played by the number of insulin receptors in fat tissue. We know these vary even within the body of the same person. I think that lean people have much fewer insulin receptors on their adipose tissue and since glucose is toxic and must be got rid of their body can do nothing but switch to burning teh excess. This is my theory and some support comes from transgenic mice experiments where mice have been engineered not to have insulin receptors in their adipose tissue and not surprisingly these mice stay lean even when over fed (via gastric tube).
    Some ethinicities may have more 'burners' just like some have more lactose intolerance.

    The other end of the spectrum are 'storers' like myself. My adipose tissue is sooo exquisitley sensitive to insulin action that even a little excess can and will make me put on weight. Even something as small as going on holiday abroad and therefore changing what I eat etc will usually result in weight gain...but I also lose weight very easily (whereas true Lean people seem to resits even weight loss....and this)

    Not very impressed by this food palatability theory. I agree that certain sustances are addictive. Dr Lustig pints out that fructose the sweetest of all sugars and of plant origin has an almsot indetical metabolic pathway in teh liver to ethanol...another great addictor! Plants have been alluring animal to their ripe seed carrying organs for millions of years. As it turned out luckily for them fructose proved the most 'palatable' and it is addictive. They do want the animals that feed on them to come back over and over again so that by consuming the fruit they spread the seed of the mother plant.! Now we humans whether intentionally or not have harnessed this addictive substance and have started to put it EVERYWHERE I heard that even cigarette paper is soaked in sucrose....obviously the addictive effects of nicotine not being enough!!
    Spooky and disturbing to think the food industry might be doing this!

    Food for thought indeed!

  25. One quick comment on this: "fructose the sweetest of all sugars and of plant origin has an almsot indetical metabolic pathway in the liver to ethanol" is completely false. This is utter nonsense. There is no way in which they are processed similarly except in that all metabolic pathways for foods pass, in some way, through the same oxidative pathways. In fact, in the range of high ethanol which might be associated with addiction by-passes the usual metabolic pathways.

    Lustig has now cast himself as the new Ancel Keys. He will say anything no matter how idiotic. He has probably done as much harm as anybody I can think of. Was Ancel Keys completely wrong about everything? Unlikely. What part of his stuff can we use? No way to know. He gave up on scientific method so you can't tell the real from the imaginary.

    Fructose is metabolized like a sugar which it is. It is metabolized by a parallel but similar pathway to glucose and they are, in fact, interconvertible. That's why the GI of fructose is 20 and not 0. You can easily make glucose from fructose. But from the basic metabolism of ethanol, you cannot easily make glucose from ethanol -- in this sense, ethanol is more like fat than like carbohydrate. Of course, there are minor exceptions but Lustig's ethanol-fructose is not science.

    On the lighter side, maybe we should start some candy-eater jokes like the alcoholic jokes...Two candy-eaters walk into a Dunkin' Donuts....

  26. Laura
    Dear RFD alas u r highly disinformed on the topic. Despite their duperficial chemical similarity these two sugars are handled very differently by the body. Some conversion of fru to glu does occur but itis a very tortous and indirect pathway. This is in every txtbook every nit on info you can find on glu/fru metabolism. Neithet myself nor Dr Lustig lucked this info out of thin air! It is a simple fact so i let do some simple research yourself as itwill be very instructive for you. You don't seem to have much biochemistry...
    Ps one of the reasons fructose is treated so differently and is detoxified by the liver is because it is much more toxic and bioactive and can glysosylate proteins leading to aggregates and cytotoxicity...
  27. Laura, I think one would be hard pressed to find someone more knowledgeable about the biochemistry of metabolism than Dr. Feinman. Just saying....
    http://rdfeinman.wordpress.com/bio/
  28. Zepp
    Could it be that there is a more simple explanation why those peopel dont be obese?

    There is the same pattern in Sweden to.. for some generations they eat a lot of potatoes and bread, and they wasnt obese eighter.

    But they did eat real food, and they do cook there food from real groseries, there was no supermarkets.

    And there is about incidens, they do get sick in old times to, both swedes and chines, and they do get diabetes and obesety, but it was rarley.

    One thing is that if a population gets wealthyer they often live longer and get other disises on old days, then the incidens increas.

    But the big thing I belive is, when wee started to eat a lot of prepacked, precookt and higly processed food, its nearly looks like real food but lacks all the nutrients wee need.

    And like RFD points at, becuse wee know how to revert metabolic syndrome for moste peopel, wee dont know everything.

  29. Dear Laura
    I am a Professor of Biochemistry but we all have a lot to learn.

    1. The concept of tortuous metabolic pathway is not in the biochemical texts. Both fructose and glucose proceed through separate pathways of glycolysis but converge at the level of the triose-phosphtates so, at that point, they are essentially the same. The difference in metabolism has to do with the relative rates of the different enzymes and depends on a large number of factors. Ethanol does not proceed through this path except possibly under some unusual conditions. Ethanol is oxidized ultimately to acetyl-CoA and goes into the TCA cycle.

    2. Reading your comment, though, it hit me that this process is not called detoxification. In fact, the metabolism of alcohol through the dehydrogenates to acetyl-CoA is not called detoxification either. Detoxification of alcohol usually refers to the process at high alcohol ingestion where alcohol is less like a food than like a drug. In this case, it is not oxidized through the normal pathway but rather through the cytochrome P450 system which is completely different from normal metabolism and is considered detoxification but I don't think that fructose ever enters this system.

    3. On the specific point you raise though, glucose is the major source of protein glycosylation. This is because, although fructose exists to a greater degree in the open (free aldehyde) form, there is much less fructose in the blood. First, there is more glucose altogether but, remember, your body maintains blood glucose while it clears fructose. I challenged Lustig on this once and he did have an example where fructose was more important than glucose but this is rare.

    That's some of the biochemistry that I do have although I admit that I could use more.
    RDF
    (i answered this in email so forgive possible duplication)

  30. Cate, I love when you talk like that.
    RDF
  31. Laura, I did not mean to give you a hard time. We are in agreement about the primacy of insulin and how just because you and I are "storers" that everybody should be so sensitive to carbohydrate. The insulin receptor knockout mice are a good abstract example but many strains of mice will get fatter on high fat even if there is no carbohydrate. As for fructose it is part of the picture but the reason people who know more biochemistry than I do don't jump in here is that we don't really know the answer and when people start out by calling fructose a poison, there's little room for rational discussion, you know, like the data.

    But in the way of agreement, Lustig has given me permission to quote from one of his emails:
    "I think that when carbohydrate is at low dose, the fructose is not an issue"

  32. Alexandra M
    I'm sure there's a name for it somewhere but I don't know it. It's the tendency for people who agree with each other on some BIG issue to spend most of their energy slicing and dicing themselves into ever smaller and more specialized factions and investing energy into defending their differences, differences that can be plotted on a graph that is 1/2 of a parabola - the more trivial the issue, the stronger the defense.

    It would be really great if all the "A Calorie is NOT a Calorie" people would spend their time on the blogs of the "A Calorie IS a Calorie" people trying to explain the science to them.

    Dr. Feinman - I realize you are a renowned biochemist and I'm sure you know what you're talking about - but as you've said (and I totally agree with this) there are things we just don't know. Dr. Lustig may have over-reached in his certainty about certain details, but I don't think he's being dishonest, and I don't think he's over-reaching with the general warning about fructose over-consumption. There seems to be a set of data, and some difference of opinion as to the interpretation of that data. To accuse him of being willing to say anything, "no matter how idiotic" is falling into the same emotional excess that he has in calling for the government to regulate sugar like a drug. IMHO.

    I would love for you to take on the people who really don't have a clue about biochemistry or endocrinology, namely people like Steve Novella and Harriet Hall - they have large followings and none of them ever question the "calories in / calories out" paradigm. It would be heresy - HERESY!

    http://theness.com/neurologicablog/index.php/how-to-lose-weight-eat-l...

    You could start by pointing out that "I have repeatedly taken the position that, based mostly upon the clinical evidence but also what makes sense..." relies partly on the argumentum ad ignorantiam, or more accurately, "argument from incredulity" - which would be quite rich since Novella has actually done a series for The Great Courses about critical thinking in which he describes the various logical fallacies.

    Then there's Harriet Hall who's very well respected as a debunker of junk medicine, but who embraces the idea that saturated fat is dangerous with religious fervor.

    http://www.sciencebasedmedicine.org/index.php/eat-fat-get-thin/#more-...

    Please, please go rip her to bits!

    Yes, I do think the truth is the most important thing! If somebody proves absolutely tomorrow that a vegan diet is the best thing for our health and for the planet - I'll commit suicide. :) I just think it's more important to convince everyone that in fact the earth does go around the sun before we get down to the cage matches about whether or not Pluto is really a planet.

  33. Laura
    Hello Professor
    Sorry I am a humble doctor in Genetics and it shows how specialised we have become to our own major detriment so it is I who has strayed into unfamiliar territory. But your statement was made with such strength that although it could have indeed come from an expert i favoured the other possibility that it come from someone with little knowledge of the field. Apologies for my rather patronising message writte on iphone and full of typos!!!
    And thanks Cat for putting me right
    I have peered through the intricacies of sugar absorption and metabolic pathways in txt books and wikis and they all show the fact that:
    1) free glucose can and is metabolised directly by cells even in the intestine and on its' way to the liver;
    2) fructose is trapped in teh liver and is then modified and conveyed into two possible paths glygogen and/or fat. I have taken the licence to use the term ' detoxification' so the blame is all mine.
    3) I believe that fruc and gluc cannot even share the same transporters but please correct me on that.
    4) it is probably correct that most of the glycosilation observed especially in diabestics probably comes from glucose but i believe that at least in vitro fruc proves to be most bioreactive molecule..the reason why in vivo it does not get to do that is because the body seems to want to clear fruc from circulation even faster that gluc....wonder why...

    By the way I am not necessarily a Lustig follower but I am intrigued by fructose by why it has ended up the the equivalent of nectart to the bees to entice them to carry pollen. I think plants are manipulating us to their work. By placing fructose in abundance in their seed bearing organs they entice us to eat them even gorge on them when we can. I am quite frankly addicted to furctose hence I am doing the strict 2 weeks Atkins induction, because even on a paleo/lchf diet I ahd started to reintroduce fruit/honey almsot surreptiously into everything and the more I ate the more i wanted....

    I am also intrigued by why the food industry is adding sugar to almost anything even savoury and non foods?

    Back to the argument of storers and burners I think we agree that even the burners suffer high carb exposure damage, theyir proteins will get glycosylated, they can and do get diabetes, cancer heart disease..in that sense their thinness might be a blessing in disguise because whilst we fatties desperately triy to do something about our weights and hopefully eventually stumble on the right track of lchf, they the burners may not feel compelled to change their diet...sooo

    Anyway apologies again I stand humbled...but if you have a good resource to point me to with regards sugar metabolism, differences b/w fruc/gluc differential effects on satiety etc....i would be most grateful
    Laura

  34. Laura
    Hi Alxandra I like your post...I was just reading it now.....

    You are right but also the devil is indeed in the detail...what we should remember to do mnore often is to lift our eyes from the single tiny piece of mosaic we are peering at and look at the whole picture....

    I was vegan for 16 years and as well as being consistently overweight on that diet I ahve developed gall stone diesease and multitple uterine fibroids with haemorraging both of which needed surgery... I can tell you that having the priviledge to watch a short video of my hysterectomy gave me an amazing insight...my uterus was riddled with tumors. I realsied my body was like a culture vessel for all these tumors (I had also had some benign skin tumors removed years earlier). Something I was eating was creating ideal conditions for growth my tissues were thriving but to the detriment of me as an individual...what was going on...this is when I started to look at ancestral diet and then the penny dropped with insulin and its direct and indirect growth and mitogenic role......

    What a journey of discovery and it is not over yet! I love it....thank you all for fruitful discussions...

  35. Laura
    Hello again prof
    Sorry I missed to comment on your comment about trans mice.....That mice will get fat on high fat diets is not surprising...they are rodents not adapted like us homos to meat/fat consumption...di you read my post on comparative gall bladdes anatomy of vegetarian vs meat eating species?....the point of the matter is tigers don't get fat on fat but almsot all animals get fat on sugar (exept bees i think...!)
    Remember the old experiments on poor rabbits?...fed fat they developed aterosclorosis-like plaques.....well well (I could say this old bad experiment has done more to vilify fats and still does than anything else!!!). All this makes sense if one thinks about things from the ancestral point of view from the point of view of evolution and adaptation. If you eat foods your body is adapted to you have all the metabolic biochemical machinery to process it extract energy and make it safe.
    Even fat deposition is not necessarily bad but when it becomes the predominant pathway because of excess food then the problem starts!
    There is FAR TOO Much food around in general we are over loaded deluged drowned in food....the only way not to succumb is to impose on yourself some sort of restricion hence all the various setcs and followers of this and that diet or philosophy of food...it is survival strategy in a world of constant artificial abundance... having said that time for my mid morning snack
  36. Laura,
    No problem. One thing Lustig and I have in common is that we grew up in Brooklyn and are not easily insulted. I may have gotten carried away a bit but once you give up on science (or corrupt it), then everything falls apart. On the specific question, There is a specific fructose transporter, GLUT5 and fructose can be processed by hexokinase, the first enzyme in the glycolysis pathway for glucose but only poorly and there is a specific alternative enzyme, fructokinase but the two pathways do come together. On specific sources, the things I said here are also in my blogpost on Lustig http://p16vK0-6W. Among other things, it has a remarkably ironic quotation at the beginning. There is no doubt that sugar tastes good but satiety and taste and eating are primarily about behavior and depend on particular conditions and, although that interacts with metabolism, it is primarily a separate phenomenon.
  37. Alexandra,
    Lustig and I try to avoid ad hominem. I did not say he was dishonest. I don't know what his motivation is. As I pointed out in my current blogpost: "Avoiding ad hominem is tough. Lustig’s Nature paper contains the single stupidest line in the history of the journal – in suggesting that fructose has the same toxic effect on the liver as alcohol he says “This is no surprise, because alcohol is derived from the fermentation of sugar” but nobody would suggest that Lustig is stupid."

    On “a calorie is a calorie,” I have published things in the literature that anybody can read: The paper in Theoretical biology http://www.tbiomed.com/content/4/1/27 has a good intro and references to the others. The paper is a little tedious but the first few pages tell you what you need to know.

    I also wrote something about the first law on a blog post http://wp.me/p16vK0-5S

    I don’t know Steve Novella and Harriet Hall but you can send them the references above.

  38. Laura
    Dear Prof Feinman
    Pure spookey coincidence is that I have just received through the post the book by Volek and Phinney Low carbohydrate Living the art and science of.
    I had to look at fructose...our friend and foe (I love it you know it is my drug) and guess what on page 57 they dedicate a separate little box just to this hexamer I quote verbatim:
    'Most of the fructose we eat [....] gets made into fat by our liver. This is because our bodies can't convert fructose to glucose and the first step in cellular fructose metabolism diverts it away from the primary pathway of glucose metabolism (the Myerhoff-Embden pathway). Thus these two 6 carbon sugars , furctose and glucose, follow separate metabolic paths. In the case of fructose is if cleaved into two 3 carbon fragments both of which primarily contribute to fat production (lipogenesis) in the liver' unquote. No reference given but assuming this is not another example of misinformation (remeber what happened to cholesterol for 60 years!) that gets passed around and around then I guess it must be true. I have seen this in scientific papers, sugar metabolism diagrams the lot. I am starting to believe it.
    It also makes sense from evolutionary point of view..we would haev feasted on ripe fruit at the end of the summer at msot msot latitudes and deposited some fat jsut like other animals to help us in the lean months of winter.....
    look forward to your opinion...or perhaps you could ask them at the Obesity conference??
    ta' and look forward to your talk as well.
  39. Laura
    But I found this paper a bit old from 1964.......Conversion of fructose to glucose by human jejunum absence of galactose-to-glucose conversion
    P.A. Öckerman,
    H. Lundborg
    ouch! Why is science Never simple...ignorance is bliss I say
  40. I will discuss this with Volek and Phinney this afternoon. I am at the ASBP-NMS conference in Denver and we are all speakers: http://www.asbp.org/resources/uploads/files/ObesityConf_2012.pdf.

    The specific entry is not right as written:
    our bodies CAN and do convert fructose to glucose, and whereas they "follow separate metabolic paths up to a point, when they say that "fructose is if cleaved into two 3 carbon fragments both of which primarily contribute to fat production," this is not quite right since the 3 carbon fragments are also produced by glucose.

    The origins of unique properties of fructose stem from the relative activities of the enzymes involved. The technical explanation: Fructose is converted rapidly to fructose-1-phosphate but the enzyme that creates the 3-carbon fragments (aldolase-B) is slower and F-1-P accumulates which when there is high input can disrupt normal control. Also, the enzyme that processes glucose (phosphofructokinase-1) is a key control point which fructose by-passes but how this plays out depends on conditions. In other words, a metabolic map is like any map. It shows you where you can go but doesn't show you the traffic lights, the road construction or the kid chasing his ball into the street.

    Phinney and Volek is still authoritative book but they didn't get this quite right.

    The bottom line is that high fructose sitting on top of high total carbohydrate is probably worse than high glucose sitting on top of high carbohydrate but that is not the question.
    Here's the question: if you have high carbohydrate diet (say 55 % as studied in common fructose experiments), which is more beneficial: replacing fructose with glucose, or replacing carbohydrate, any carbohydrate, with fat? Which is it? Replace fructose with glucose, or replace carbohydrate, even glucose, with fat?
    What do you think.

  41. gallier2
    Hi Laura, fructose can be "changed" to glucose by the liver to refill the glycogen store. Unfortunately, these stores are filled quite rapidly which means that any supplemental fructose will go the Acetyl-CoA pathway to be changed in fat.

    Here a link to a biochem book by Prof. Horn with all the details.
    http://www.medbio.info/Horn/Time%201-2/carbohydrate_metabolism%20Marc...

  42. Laura
    Please say it...the RATE LIMITING STEP....
    Ever heard of the late Dr Enrik Katcher and his theory (controversial by the way) that in vivo when the organism as a whole is considered there are no metabolic rate limiting steps....not bottle necks...this is how he would explain why genetic heterozygotes look like the wild type homozygous...remember Mendel's peas? Imagine trying to answer a why question inn science by marrying a genetic observation with underlying biochemical pathway I think it was genius and way a head of his time (he taught me at the University of Edinburgh where I did both my degrees) I must check the spelling of his name and find a few papers on his biochemical networks to post links to.... tough reading

    But thanks for offering to discuss the fructose bit with Phinney and Volek I think they will appreciate being put right after all we all jsut want the truth and the history of nutrition has been marred with misinformation all along ...so when authoritative books start giving misleading info ...thank you and enjoy the conference.
    I can jsut feel the buzz

  43. gallier2, The link to Horn's book looks good. On glycogen, though, as carbohydrate intake is reduced, glycogen becomes a major source of blood glucose (replaced through gluconeogenesis) so fructose can be a major supplier of glycogen. That is why it is observed that during exercise, fructose is preferential source for glycogen. In essence, the problem is that you want to be careful about generalizing across different conditions.

    Laura. The field, no longer controversial, is called Metabolic Control Analysis and it is generally agreed that it is difficult to deduce a rate-determining step and in many, or maybe most cases, there is no such thing, the matrix of different reactions determines outcome.

    what is the link to your gall bladder post?

  44. Galina L.
    Everybody is too much concentrated on the visible part of the complications of the wrong diet because people are getting fat and it is very easy to notice multiple people in any crowd who are even morbidly obese. I grew-up in the society without a fast food and prepared meals (in Soviet Russia). People cooked their food and walked everywhere, but it didn't keep them in the perfect shape for life or free from the diseases of Western civilization. General crowd did look much thinner, there were no morbidly obese, children and adolescents were thin. However, all self-cooked food protection was over by the middle-age for the most. Now I live in the south of USA and the rate of obesity here is pretty high.If they saw the soviet Russia crowd they wood think mistakenly people were eating the perfect diet . The people here rely so much on the fast and prepared food, that they started to think that there is something magic in the real self-cooked food, but it is not. The better option is not the best. I put my mother who still lives in Russia and eats traditional food on a low-carbohydrate diet and her health and weight improved dramatically. For example, she doesn't need to control her high blood pressure at 75 years old with medications. Eggs with butter instead of oatmeal for breakfast and no bread equals health. Of course, it is better to eat sourdough rue bread, root vegetables and rice, then the Standard American Diet, but limiting carbs is even better. If people who eat rice and stay thin still have diabetes and abnormal bp, it doesn't prove the benefits of eating rice at all.
  45. dr-no
    Prof. Feinman, thank you very much for your elaborate and thoughtful responses.
    As far as I can see, one of Lustig's main point is the fact (?) that ingested fructose can only be metabolized by the liver, whereas ingested glucose can be metabolized and burned by all other organs. So he proposes a kind of overloading of the liver, and the liver does what it is supposed to do: prepare the energy overhead for storage. One could still overload oneself with glucose alone, but that could be compensated for by exercise or hard work, something that does not happen in a mostly sedentary society.
    I admire your integrative thinking. I hope that the refreshed debate can finally bring together the fields of internal medicine (esp. endocrinology and cardiology), nutrition and biochemistry. They have been too far away from each other for too long.
  46. Toward a unifying hypothesis of metabolic syndrome Here is the abstract.
    Despite a lack of consistent diagnostic criteria, the metabolic syndrome (MetS) is increasingly evident in children and adolescents, portending a tsunami of chronic disease and mortality as this generation ages.
    The diagnostic criteria for MetS apply absolute cutoffs to continuous variables and fail to take into account aging, pubertal changes, and race/ethnicity.
    We attempt to define MetS mechanistically to determine its specific etiologies and to identify targets for therapy.
    Whereas the majority of studies document a relationship of visceral fat to insulin resistance, ectopic liver fat correlates better with dysfunctional insulin dynamics from which the rest of MetS derives.
    In contrast to the systemic metabolism of glucose, the liver is the primary metabolic clearinghouse for 4 specific foodstuffs that have been associated with the development of MetS: trans-fats, branched-chain amino acids, ethanol, and fructose.
    These 4 substrates (1) are not insulin regulated and (2) deliver metabolic intermediates to hepatic mitochondria without an appropriate "pop-off" mechanism for excess substrate, enhancing lipogenesis and ectopic adipose storage.
    Excessive fatty acid derivatives interfere with hepatic insulin signal transduction.
    Reactive oxygen species accumulate, which cannot be quenched by adjacent peroxisomes; these reactive oxygen species reach the endoplasmic reticulum, leading to a compensatory process termed the "unfolded protein response," driving further insulin resistance and eventually insulin deficiency.
    No obvious drug target exists in this pathway; thus, the only rational therapeutic approaches remain
    (1) altering hepatic substrate availability (dietary modification),
    (2) reducing hepatic substrate flux (high fiber), or
    (3) increasing mitochondrial efficiency (exercise).

    Unfortunately the full text of Lustig's paper won't be freely available till next March.
    If anyone has a copy I'd be interested in reading it.
  47. Deficiency in omega-3-fatty acid exacerbates dysfunctions in insulin receptor signaling and cognition
    high-dietary fructose consumption leads to increase in insulin resistance index, insulin and triglyceride levels, which characterize MetS.Metabolic syndrome
  48. Insulin Resistance Promotes Early Atherosclerosis via Increased Proinflammatory Proteins and Oxidative Stress in Fructose-Fed ApoE-KO Mice High fructose intake induces an insulin resistance state associated with metabolic syndrome
    Free full text online.
    Bear in mind as you read the paper, most people now (because of atmospheric & light pollution and modern lifestyles) also have low levels of the natural anti-inflammatory anti-oxidants Vitamin D3 and melatonin in addition to low omega 3 & low magnesium status.
  49. Nick
    Dr. Feinman, Novella and Harriet Hall are MDs who write on a blog entitled 'Science Based Medicine'. http://www.sciencebasedmedicine.org/ Their main purpose is to fight CAM and 'magical thinking' that is not based on science. Unfortunately, they regularly recite the dogma about nutrition without citation.
  50. Nick
    You said

    "Traditionally more physical activity then sedentary western population. Compare a Japanese rice farmer (in the field all day) to an American office worker with a car. If you burn more glucose (via physical activity) then less insulin is needed when you eat carbs."

    Why not compare a Japanese office worker with a car with an American office worker with a car? Or with a American farmer in the field all day?

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