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Richard J. Johnson,
MD, author of The Sugar Fix: The
High-Fructose Fallout That’s Making You Fat and Sick Richard J. Johnson, MD, is currently the J.
Robert Cade Professor of Medicine and Chief of the Division of
Nephrology, Hypertension, and Renal Transplantation at the University
of Florida College of Medicine. In addition to his many honors and
accomplisments, he received the ASN Young Investigator Award in 1994
and gave the Barry N. Brenner Endowed Lecture at Renal Week 2003.Dr. Johnson is the author of a new book, The Sugar Fix: The High-Fructose Fallout That's Making You Fat and Sick. The book reports on the rapid escalation of fructose consumption in the United States and how this phenomenon affects health. He has graciously agreed to answer 10 questions for this edition of Renal Express. RE: Your book, The Sugar Fix: The High-Fructose Fallout That’s Making You Fat and Sick, was recently published. Please tell your fellow ASN members what it’s about and why you were inspired to write it. I wrote The Sugar Fix to increase public awareness of the potential health issues related to eating too much fructose. Fructose is a simple sugar whose main source is table sugar (where it makes up 50% of sucrose) and in high fructose corn syrup (HFCS), a sweetener that was developed in the early 1970s. Currently, HFCS is used extensively in foods, and can be found in soft drinks, candies, and a surprising amount of processed and other foods (including jellies, jams, yogurts, and ketchup). Over the last 200 years, there has been a progressive increase in fructose intake that has directly paralleled the increasing rate of obesity, and this has increased sharply in the last 20 years due to the introduction of HFCS. Today, we are eating 30% more fructose than 20 years ago, and about three to four-fold more than 100 years ago when obesity rates were less than 5%. Fructose is worrisome because unlike other carbohydrates, such as dextrose, it can rapidly cause obesity in animals and all of the features of the metabolic syndrome (including elevated triglycerides, insulin resistance, increased blood pressure, and weight gain). Fructose can also cause fatty liver in animals, as well as microvascular disease, kidney disease, and inflammation. Furthermore, studies in humans have also shown that the ingestion of large amounts of fructose can cause a rise in blood pressure, insulin resistance, elevated triglycerides and a rapid increase in intraabdominal fat. We have also linked high fructose intake with fatty liver. These changes are not observed when animals or humans eat starch. This suggests to us that fructose may be a bad carbohydrate, especially if it is eaten in excess. We have also learned why fructose is distinct from other carbohydrates. Unlike glucose, for example, fructose has its own enzymes that are unique. When these enzymes metabolize fructose, they cause depletion of energy in the cell and release inflammatory substances. One of the substances is uric acid, for which our group has shown can cause many of these bad effects. In addition, fructose seems to cause leptin resistance, in which the brain does not receive the signal to stop eating when a meal is ingested. This causes one not to have the sensation of being full, and the result is disastrous, as one will keep eating. Even more worrisome, the levels of your enzymes will increase the more fructose you eat, so that you will become supersensitive to the effects of sugar. This may make it hard to lose weight. The good news is that one can reverse these effects. First, by reducing fructose intake to a minimum, the fructose enzymes will return to normal levels. Then, one can increase smaller amounts of fructose (amounting to about one-third the current mean intake) with safety. Eating two or three fruit a day at this stage is encouraged. With this regimen, one can lose weight and develop a healthier lifestyle with less risk for developing diabetes, hypertension, or heart disease. RE: You mention that "fructose may be important in the development of diabetes, kidney disease, and heart disease." Can you specify what you mean by this statement? If you feed fructose to animals, you can document many features of metabolic syndrome (induction of insulin resistance, hypertension, obesity), as well as early renal injury (glomerular hypertension, renal hypertrophy, glomerular and interstitial injury, renal inflammation), systemic inflammation (ICAM induction), leptin resistance, and fatty liver. Fructose can also induce metabolic syndrome and inflammation in people, and we have recently shown that it is likely the cause of fatty liver (NASH syndrome). Epidemiological studies also strongly support fructose as a driving force for diabetes, heart disease and hypertension. Need I say more? RE: You wrote this book for a lay audience. How is it useful for health-care providers, particularly nephrologists? I believe the book will also be useful for health professionals, including nephrologists, dieticians, and specialists in diabetes and hypertension. The first half of the book focuses on the science behind fructose, and the latter half provides nutritional information on how to reduce our exposure to excessive fructose. RE: An analysis presented last year by the University of Maryland Center for Food, Nutrition, and Agriculture Policy (CFNAP) claims there isn't enough research to conclude that high fructose corn syrup contributes to weight gain any more than any other energy source, including sugar and fructose. Can you elaborate on the specific harm caused by high fructose corn syrup (HFCS), as opposed to only fructose? We always have to be careful in reading reviews sponsored by the HFCS industry. Having said this, the problem is not HFCS or sugar per se, but the marked excessive intake of fructose. One can rapidly show, in humans and in animals, that fructose can induce features of metabolic syndrome. Other sugars do not do this. The question of whether HFCS is any different from sugar is beside the key point, for it is excessive fructose that seems to be driving t he problem. RE: You include a low-fructose (but not low-carb) diet that you claim will help people lose weight and may also prevent diabetes and heart disease. How did you develop this diet, what are its basic requirements, and does it prohibit the editor of Renal Express from putting sugar in his daily coffee? One wonderful thing is that it is not fructose that is the problem, but excessive fructose. While it is important to cut out all fructose for two weeks to allow normalization of the fructose enzymes (see above), once this is complete one can eat small amounts of fructose each day—roughly one quarter what the average American is eating. Yes, you can add sugar to your coffee, but just don’t drink 10 cups of coffee per day. Two or three fruit a day is great—just don’t eat that whole bowl of grapes in front of the TV set tonight! RE: You completed your fellowship training in nephrology at the University of Washington Medical Center in Seattle, WA. What was your most memorable training experience? Telling Dr. (William G.) Couser in my first interview that I was interested in all of nephrology except glomerulonephritis. I did not realize at that point that he was a world expert on this. He immediately set me straight and got me into his lab. It was the best experience of my career. RE: What are your research interests? We are interested in anything with the word kidney in it. I have a passion for glomerular disease, thanks to my time in Seattle, but currently I am driven more by the question of what is driving the hypertension and diabetes epidemic. We are convinced that the answer is not bittersweet—just sweet—and that fructose likely has a key role. Interestingly, it looks like it acts in part by the unique effect of fructose to raise uric acid levels. RE: How has the research process changed since you entered medicine? What do you see as the future way in which research will be conducted? There are more rules and it is harder to get grants. Nevertheless, the molecular biology revolution has led to more abilities to study so many more questions, and the questions keep popping up. It is a great time for research and I encourage fellows and young faculty to jump in. Investigation is exciting and rewarding. RE: What factors were most influential in deciding to be a nephrologist? Luck, in my case. I performed a two month rotation in nephrology during my third year of residency in which we had no renal fellow. I lived in the hospital, and became very fond both of nephrology, nephrology patients, and the nephrology faculty and staff. Scrib (Belding H. Scribner, MD) then called me and offered me a position. Luck. RE: Can you share with Renal Express any of your special talents or personal interests that might give your ASN colleagues a better sense of Dr. Johnson, best-selling author? How can I answer this one? First, the book is not a best seller—but let’s hope! Second, I tend to live with passion, and to be enthusiastic. I do not know if this is delusional, but it does keep me happy. I do love to sail, play tennis, dance, hike, and generally have a good time. |
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| ASN Comments on FDA
Regulation of Prescription Drugs ASN commented Thursday, May 8, 2008, on the American College of Physicians’ (ACP’s) draft policy monograph, “Improving FDA’s Regulation of Prescription Drugs.” The monograph presented five recommendations for improving the US Food and Drug Administration’s (FDA’s) regulation process, with particular attention paid to the pre-approval process and post-marketing review. While ASN supported some of the recommendations, the Society had a number of suggestions for improving the monograph. In particular, ASN suggested that ACP:
ASN-ASP Chronic Kidney Diseases in Older Adults Workshop The American Society of Nephrology (ASN) and the Association of Specialty Professors (ASP), along with the National Institutes of Health (NIH), held an invitation-only workshop Friday and Saturday, May 9-10, 2008, to address the “Prediction, Progression and Outcomes of Chronic Kidney Disease (CKD) in Older Adults.” The goals of the workshop were to:
Responses from the workshop were positive, particularly from junior attendees. According to Dr. Schopick, “Since it was a small conference, as a junior investigator I was able to interact with more senior investigators in a way that we are rarely given the opportunity to do.” ASN Signs Letter in Support of Health, Education, and Labor Funding Along with over 300 education, public health, medical research, child welfare, and labor unions and organizations, ASN signed a letter in support of increased funding for programs within the Departments of Labor, Health and Human Services (HHS), and Education in fiscal year (FY) 2009. The letter urges Representative David Obey (D-WI), Chair of the House Appropriations Committee and its Labor-HHS-Education Subcommittee, to increase overall funding for the FY 2009 Labor-HHS-Education appropriations measure to $15 billion over the FY 2008 level. The letter—orchestrated by the Coalition for Health Funding (CHF), of which ASN is a member—argues that the increase will restore programmatic cuts from the past four years and “more appropriately account for four years of inflation and population growth to maintain service levels and purchasing power.” The National Institutes of Health, Agency for Healthcare Research and Quality, and Centers for Disease Control & Prevention are all funded via the Labor-HHS-Education appropriations bill. In related news, ASN and other CHF members met with House Appropriations Committee staff to discuss prospects for the Labor-HHS-Education bill in FY 2009. Due to a combination of election politics, war funding, and “pay-go” spending rules, it appears unlikely that the bill will pass before the start of the fiscal year. A related meeting with Senate staff presented a similar timeline. |
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ASN Seeking
Education Director for BRCU The American
Society of Nephrology (ASN) is seeking an individual to become the
Society’s Education Director for the ASN
Board Review Course and Update (BRCU). The ASN Education Director
BRCU is responsible for the design, oversight, and delivery of the
annual BRCU. This course is intended for nephrologists as well as
physicians in other fields and allied health professionals who work in
nephrology. The education director maintains the excellence of the ongoing educational portfolio for this program and develops novel aspects to ensure that the ASN membership is able to obtain ongoing information on the science and practice of nephrology. The position requires an individual who is eloquent and adept at maintaining interpersonal relationships. To ensure that the participants meet these goals, the Education Director BRCU:
ASN is seeking applications, nominations, and recommendations for this position, which will report directly to the ASN Education Committee. The expected effort for this position is approximately 10 percent and appropriate compensation will be offered. For more information about the position or to recommend potential candidates, please contact ASN Councilor Ronald J. Falk, MD—who is leading the search process—at (919) 966-2561 or ronald_falk@med.unc.edu. To apply for the position, please email your letter of interest and curriculum vitae to ASN Executive Director Tod Ibrahim at tibrahim@asn-online.org by Wednesday, June 11, 2008, at 4:00 p.m. EDT. Please note that the Society can only accept online applications. |
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JASN Device
Reduces Risk of Death from Acute Kidney FailureFor patients with acute kidney injury (AKI), an external device containing human kidney cells promotes recovery of the injured kidneys and significantly reduces the risk of death. TOC; Full Study CJASN  Uric
Acid May Provide Early Clues to Diabetic Kidney DiseaseFor patients with type 1 diabetes, increased levels of uric acid in the blood may be an early sign of diabetic kidney disease—appearing before any significant change in urine albumin level, the standard screening test. May TOC; Full Study New
Lab Test Predicts Risk of Kidney Injury After SurgeryA simple laboratory test may provide a new way for doctors to identify patients at risk of developing potentially severe acute kidney injury (AKI) after surgery—up to three days before the problem would otherwise be detected. May TOC; Full Study NephSAP  Glomerular, Vascular, and
Tubulointerstitial DiseasesThe May issue of NephSAP focuses on Glomerular, Vascular, and Tubulointerstitial Diseases. This issue includes an editorial by Daniel C. Cattran, MD, and commentary by Claudio Ponticelli, MD. The syllabus is created by Patrick Nachman, MD, and Richard J. Glassock, MD. May TOC; May Editorial |
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| ASN Reminders
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| Employment/Appointments Scott P. Liggett, MD, recently accepted an appointment to join the medical practice and staff at Mayo Clinic at Rochester. Fuad N. Ziyadeh, MD, FASN, Professor of Medicine and Biochemistry at the American University of Beirut in Beirut, Lebanon, was appointed Chairperson of the Department of Internal Medicine. Ankush Gulati, MD, switched practices six months ago. He now sees patients daily at Lehigh Regional Medical Center in Fort Myers, FL, and three times a week in his office at the Lee Kidney Center. David J. Shih, MD, has joined the Hawthorn Medical Associates group practice in Dartmouth, CT. Honors Martin Schreiber, MD, will receive an honorary doctor of humane letters degree from John Carroll University. He is chairman of the nephrology and hypertension department at the Cleveland Clinic. John Daugirdas, MD, received the Lifetime Achievement Award for Hemodialysis at the 28th Annual Dialysis Conference. He is the Associate Chief of Staff for Research and Development at the University of Illinois at Chicago School of Medicine. Mrinal Dasgupta, MD, FASN, received a Lifetime Achievement Award for Peritoneal Dialysis at the 28th Annual Dialysis Conference. He is a researcher at the University of Alberta. Robert S. Brown, MD, Clinical Chief and Nephrology Program Director at Beth Israel Deaconess Medical Center in Boston, MA, was awarded one of the 2008 Parker J. Palmer "Courage to Teach" Awards of the Accreditation Council for Graduate Medical Education. Todd Ing, MD, received the American Association of Kidney Patients Medal of Excellence Award at the 2008 Renal Physicians Association meeting. Dr. Ing is currently courtesy staff physician in the Department of Medicine at the Veterans Affairs Hospital in Hines, IL, as well as Professor Emeritus of Medicine at Loyola University Chicago, Stritch School of Medicine. Please send ASN Member News to bcarver@asn-online.org |
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