A reader sent me a link to an interview with Dr. Robert Lustig, telling me that a registered dietitian called into the show to explain how it’s all about low-fat diets and calories in/calories out, which prompted Lustig to slap her down.
I listened to the entire interview, but if you only have time to enjoy hearing a dietitian put in her place, skip ahead to about 47 minutes in. You can listen to the interview here.
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re: PUFAs… I wonder if the real problem with PUFAs is a broken metabolism that’s incapable of burning fat in general, PUFA or SFA. SFA can get stored. But PUFA’s probably just rot in the body. So, if we accept that insulin and leptin resistance are preventing the body from properly oxidizing energy (glucose or fats), then excessive dietary PUFAs, like excessive dietary glucose, may just be more fuel to the out-of-control metabolic fire. Just speculating…
wow! She must have picked the short straw in order to get on the air with him. Even though I disagree with him on many points, I wouldn’t want to go head to head with him without lots of notes and some back-up. One thing you can say about Lustig is that he is passionate about his topic.
He definitely exudes confidence, which may be what it takes to pound the message into people’s heads that sugar calories aren’t just calories like any other.
@Ken, is the biochemistry of fructose metabolism presented by Lustig unconvincing? If so, how?
She’ll basically say that it’s a dietary fad when there’s an oversimplification of what you should do to lose weight and keep it off; and yet, she’ll tell people that all you have to do to get those exact results is to focus on more physical activity and less total calorie intake. 😛
Make up your freaking mind, lady!
If anything is a fad diet, it’s the low-fat diet.
great stuff by lustig there, i did not listen to the rest, but that one bit was worth it!
trying to not argue with strangers/idiots from now on.
someone told a friend on facebook that “people who try low carb diets typically die of massive organ failure”
i’m resisting so far…
I still argue with idiots now and then, but only for sport.
That was fun! I’m glad he’s willing to be direct.
sits down with popcorn (yes I know it’s not healthy) to listen
I have been following Lustig for a while and like Taubes, I find most of what he says persuasive. While in some presentations he has come across as a bit of zealot, I have heard him in conversation where his ideas and approach are a bit more nuanced than just sugar is the root of all evil and would include refined carbs and seed oils as other important actors in the development of metabolic syndrome.
For those of us of a Libertarian bent, I was somewhat glad to hear him temper his call for government intervention with the caution that he does so with great reluctance as the government always gets things wrong (paraphrasing from a recent interview, might have been on crazy Jimmy’s show).
The government usually gets these things wrong, which is why (okay, partly why) I don’t want them using taxes, regulations, or other forms of coercion to decide what we should eat. We’ll end up with a fat tax, a sodium tax, etc.
What the previous post from Eddie Watts said about trying not to argue with idiots reminded me of the G. K. Chesterson quote: “If you argue with a madman, it is extremely probable that you will get the worst of it; for in many ways his mind moves all the quicker for not being delayed by the things that go with good judgment.”
Too true.
I think it would have been better if he hadn’t beat around the bush so much.
Yeah, he should just speak his mind more often.
Dietitians are a class of people who have chosen a vocation based upon the assumption that dissemination of advice that is known institutionally but not generally can provide public benefit (similar to MDs in this way). This model can work, but is fatally flawed when the institution is pedalling incorrect dogma, of course.
I think Lustig is on the right track with some ideas, but he is a zealot who wants to employ “government to coerce us”, like the “guy from CSPI”.
Also, my very first, successively-reinforced and lasting impression from his famous Youtube video and other tip-offs is that he is obviously tightly hooked up with the AHA (and maybe also George Bray — see GCBC for relevant history) in his effort to demonize sugar — this serves those interests well by implicitly exonerating starch while scapegoating sugar. Lustig is the guy who said that “ethanol is a carbohydrate” and he is consistently wrong technically about such a bewildering variety of simple facts that he has NO credibility in his public arguments, to me. People who have hidden agendas, like Lustig, often have to resort to constant exaggeration and distortion. It is no accident, I believe, that Lustig eschews the overall low-carb concept.
There is wisdom in crowds that is entirely lacking in the murky world of social engineering via government — I am sure you agree. Ideas should be tested, one person at a time. The truth will out eventually, and so will the untruths. What Lustig is trying to do is little different than that of CSPI, and the science is so far pretty weak, incomplete and unconvincing. I myself think that fructose is merely the strongest monosaccharide — probably an order of magnitude stronger than glucose in most of its metabolic effects (e.g. glycosylation factor). I do not buy the idea that it is otherwise fundamentally different than glucose (or galactose) — just stronger in general. But “strength” of biochemical effect makes a huge difference still, if the generalization is valid, because it is obviously much easier to overconsume fructose-containing sugars vs. starches (i.e. glucose) to get the same insidious long-term bad effect (i.e. the same number of calories yields ten times the effect). The evolutionary reason that fructose metabolism is favored in the bio-factory of the liver vs. in other end-user tissues probably relates to its potency of glycosylation and other factors.
Still, when one examines animal-model studies of diabetes from the 1960s and earlier, one sees that mice and rats were routinely made overtly diabetic by pure glucose feeding in roughly one week back then, before the standardization of commercial lab chows containing fructose today. Of course, back then, glucose was relatively cheaper to produce (and more generally available as a monosaccharide) than fructose because massive industrial catalytic conversion of corn-glucose into fructose had not yet begun.
Lustig may or may not have mostly the right ideas, but he is pursuing them in a dangerous way. He is completely unskeptical in all of his views, and it shows through blatantly. We (as a society) have been down this path too many times already.
I am somewhat disappointed by the amount of enthusiastic support Lustig receives from the blog community — we should be more cautious, methinks. On the other hand, Gary Taubes’ yet-to-be-released book on sugar should be very interesting, especially because he is a SKEPTICAL thinker unlike Lustig. I suspect that one of the problems Gary may be wrestling with, though, is precisely the relatively weak amount of scientific research on sugar (even today). His standards are high, and I predict that he will not exit his current project with as strongly formed hypotheses (regarding sugar specifically) as he did with GCBC (regarding carbohydrates in general).
By the way, I personally consume NO refined sugar in my diet whatsoever. I believe that dietary sugars (in amounts greater than thresholds which are individually unique, age-dependent and mostly unknowable) are harmful to health. But I would not impose this judgment on others, and I do not think excessive dietary sugar is anything close to the entire cause of the modern diseases of civilization — just one important contributor.
I applaud Lustig for pointing out the problems with sugar and for pointing out what a mistake the anti-fat hyteria was. I of course disagree with him about using government’s coercive powers to prevent people from eating sugar — I think we should start by eliminating government’s coercive subsidies. I also don’t believe fructose is the only problem. In that picture I posted of myself in my low-fat days, sugar and fructose weren’t the issue. Too much starch was. That’s a potato-grain belly on me in the picture, not a sugar belly.
P.S. In Lustig’s “Sugar: the Bitter Truth”, I was “annoyed” by too many things to count. But maybe the single motif that irritated me most consistently was his argument that glucose, as the most primitive metabolite/fuel for organisms in general, was obviously benign — the “stuff of life” or something like that.
This is, of course, an absurd and incorrect evolution-based argument. Evolution is based solely upon ability to reproduce as a species, not on individual longevity or immortality. Lustig is probably intelligent enough to know this very well.
Use of fatty acids as a primary fuel is associated with higher-order organisms — eukaryotic-cell based organisms maybe especially even ruminants and simple vegetarian animals metabolize fatty acids produced exogenously (in their guts, by bacteria). Fatty-acid metabolism is probably an evolutionary adaptation of more complex organisms for exactly the opposite reason that Lustig suggests: sugars are intrinsically somewhat toxic and less efficient as a fuel. Hence, the higher-order organism evolves aways from use of carbohydrates.
As I said, Lustig has an agenda. And behind it is an effort to protect and further the reputation, power and control of the same “bad actors” (e.g. AHA since Keys, Stamler et al coopted them) that got us into this dietary mess. George Bray (old man though he is) has been on a crusade to demonize fructose and exonerate all other carb’s for the last decade, but this idea seems to have occurred to him late in his career. And suspiciously closely following after Gary Taubes’ famous articles in Science and the NYT over a decade ago. Beware!
I heard an argument recently that instead of gluconeogensis proving we don’t need carbs, it actually proves glucose is so important, we should be eating carbs. I wonder if that applies to carnivores that only eat meat and fish that only eat other fish. They produce glucose through gluconeogensis, therefore they probably should be eating more potatoes.
I don’t know if you heard the entire interview, but Lustig did mention that refined carbohydrates besides sugar are a problem for many people.
re: PUFAs… I wonder if the real problem with PUFAs is a broken metabolism that’s incapable of burning fat in general, PUFA or SFA. SFA can get stored. But PUFA’s probably just rot in the body. So, if we accept that insulin and leptin resistance are preventing the body from properly oxidizing energy (glucose or fats), then excessive dietary PUFAs, like excessive dietary glucose, may just be more fuel to the out-of-control metabolic fire. Just speculating…
Tom,
Thanks for your replies. I did listen to the whole interview, but only after penning my initial comments I think.
To be more precise, Lustig (as well as many others) has a model in which he maintains that excess-fructose-induced NAFLD is a REQUIRED precursor for whole-body insulin resistance to develop. I think he acknowledged that starch can be a problem in the aftermath, once the IR is developed. Even Gary Taubes finds this model plausible (although is not convinced of it) — I do not.
I, like you, have never included much sugar of any kind in my diet. I never drank soda pop. I don’t care for sickly sweet foods. But I very gradually developed what I now (looking back) know was IR and a belly as I aged (I am 54). During most of my younger years I am sure that I ate much too much starch and drank somewhat too much beer at times — I didn’t know any better then. Even so, carbohydrate intolerance only developed slowly with age, as I think is pretty common. When I was really young I ate like a pig and stayed completely lean and fit, always and effortlessly (like your son). I could NOT get overweight, and others my age noticed this and commented regularly (often with either feigned or sincere jealousy).
In a large number of well-done studies in the field of diabetes research (generally using the most state-of-the-art lab instrumentation), in which typically study cohorts are made up of offspring from two T2D parents and are studied from the age of teens or twenties when they are lean and normoglycemic, skeletal-muscle IR is already well-developed before any other physiological abnormalities are yet detectable. Other early markers of diabetic pathogenesis, such as loss of acute (1st-phase) glucose-stimulated insulin response/secretion, come much later but still before so-called decompensation in the pre-diabetic period, and well before frank diabetes. This pattern is highly related to genetic susceptibility, and repeatedly well demonstrated. There is no NAFLD in most of these cohorts, which are often studied continuously for decades (during which many or most develop T2DM). The quality and breadth of research in diabetes is pretty stellar in comparison to that in obesity (which is mostly clownish).
I cannot prove that I have never had NAFLD, but knowing a lot about it I doubt that I ever did even when my diet was worse and I had moderate IR. Michael Rose’s theory of “going back in evolutionary time” with increasing age (i.e. tissue genetic expression changes with increasing age to align with an earlier ancestral state) rings true to me — that’s why it is so common for people to tolerate a modern diet until maybe 30 or so, and gradually become less and less carb-tolerant after this, I believe. And that matches my own experience.
Lustig’s model is probably correct with regard to kids who develop IR and diabetes and so on, via the hepatic IR/dysfunction route due to overload by fructose. T2DM in youth was absolutely unheard of when I was a kid, and fat children were rare.
I have read every one of the scientific papers in which Lustig is a co-author, I think, curious as to whether there is anything there to change my thinking. I have not seen anything close to the kind of data that would justify Lustig’s public stances in these or other papers on the subject of dietary fructose and its metabolic effects.
I would maintain that carbohydrate intolerance is fundamental to our species but varies with genetics, with age, with sex, and (indirectly, via insulin and so forth) with tissues (within the same individual, predisposing to different chronic diseases) and that fructose is merely one form of carbohydrate that we are admittedly over-exposed to in comparison to any conceivable paleolithic environment (but the same is true for starch). Fructose is ten times sweeter than glucose. But I doubt it had anything to do with my own experience or that it represents a fundamental (i.e. necessary) trigger for metabolic syndrome — there are clearly other common pathways (beer drinkers have been known to be highly prone to diabetes for thousands of years), but this is not convenient for Lustig to admit. In the interview, Lustig said that fructose was THE element that made sugar sweet, as if glucose is not also sweet! He could have said that fructose dominated the sweetness of sucrose and (even more so) HFCS — no problem. But instead he implied that fructose, uniquely amongst monosaccharides, is sweet. He pulls this kind of BS all the time — that’s why I have trouble listening to him.
Anyway, my point is that I think Lustig is wrong on the science in profound ways. And if he is successful in his endeavors he may harm the science, just as did Keys and McGovern and so forth. In fact, I don’t really consider him a bona fide researcher — he is an academic MD with notions of social engineering. That’s why he can be so inaccurate, undisciplined, and generally cavalier and sloppy in his statements and behavior.
I guess he is OK in some respects — I certainly agree with much of what he says wholeheartedly. He is not unintelligent. But he worries me.
On a different note, I think you do a FANTASTIC job (I LOVED Fathead, and your blog is excellent) — please keep up the great work. I think many share my opinion.
We agree that fructose isn’t the only problem. I think it’s possible to get fat and develop insulin resistance by over-consuming pasta, white bread and other refined starches. Another researcher I interviewed likewise isn’t happy because he believes Lustig is too focused on fructose exclusively and doesn’t seem interested in talking about the health effects of over-consuming refined starches.
I told him I look at it this way: as a nation we consume more sugar than ever before. Kids guzzle juices, sports drinks and sodas. They eat sugary foods. Sugar is a huge part of the problem. If Lustig’s anti-sugar campaign can convince more parents and kids to view sugar as a threat to their health, then he’s fought the food fight on one major front of the war.
wow! She must have picked the short straw in order to get on the air with him. Even though I disagree with him on many points, I wouldn’t want to go head to head with him without lots of notes and some back-up. One thing you can say about Lustig is that he is passionate about his topic.
He definitely exudes confidence, which may be what it takes to pound the message into people’s heads that sugar calories aren’t just calories like any other.
@Ken, is the biochemistry of fructose metabolism presented by Lustig unconvincing? If so, how?
I have been following Lustig for a while and like Taubes, I find most of what he says persuasive. While in some presentations he has come across as a bit of zealot, I have heard him in conversation where his ideas and approach are a bit more nuanced than just sugar is the root of all evil and would include refined carbs and seed oils as other important actors in the development of metabolic syndrome.
For those of us of a Libertarian bent, I was somewhat glad to hear him temper his call for government intervention with the caution that he does so with great reluctance as the government always gets things wrong (paraphrasing from a recent interview, might have been on crazy Jimmy’s show).
The government usually gets these things wrong, which is why (okay, partly why) I don’t want them using taxes, regulations, or other forms of coercion to decide what we should eat. We’ll end up with a fat tax, a sodium tax, etc.
I was getting ready to strangle the woman who was conducting the interview. She must know someone in the industry to have gotten that job. Her voice was like nails moving SLOWLY across a chalkboard.
wanted to listen to it, but couldn’t hear it 🙁
the sound was turned up all the way too.
No, the problem is NOT sugar. Kids are diabetic because they’ve inherited it from their parents. Obesity later in life can be accurately predicted from 6 months of age.
Insulin resistance causes diabetes. What causes insulin resistance? An excess of non-esterified fatty acids. NOT sugar. Blaming diabetes on excess blood sugar is yet another correlation = causation mistake, just like blaming saturated fat for heart disease.
Am I saying we should be eating nothing but sugar? No of course not, but like I said in my first comment, it’s stress. And the reason it’s stress is because of the effects it has on how your mitochondrion processes glucose. It shunts it down the randle cycle, not the krebs cycle. You need to take the blinkers off or you will just end up like all the other internet quacks – with no credibility.
I see. So since this is inherited and diabetes rates have skyrocketed in just the past 20 years, I assume you believe we’ve undergone a major genetic mutation in that time. And since we eat less fat than previous generations did but have become far more diabetic, I assume you also believe we’re inhaling those fatty acids from the atmosphere. And when people who were diabetic are able to achieve normal blood glucose levels and give up their medications after dumping the carbs and eating more fat, they’re just crazy outliers. And the slew of studies demonstrating that HFCS produces a fatty liver are all wrong.
Yeah, I’m the one with no credibility …
Tom,
Thanks for your replies. I did listen to the whole interview, but only after penning my initial comments I think.
To be more precise, Lustig (as well as many others) has a model in which he maintains that excess-fructose-induced NAFLD is a REQUIRED precursor for whole-body insulin resistance to develop. I think he acknowledged that starch can be a problem in the aftermath, once the IR is developed. Even Gary Taubes finds this model plausible (although is not convinced of it) — I do not.
I, like you, have never included much sugar of any kind in my diet. I never drank soda pop. I don’t care for sickly sweet foods. But I very gradually developed what I now (looking back) know was IR and a belly as I aged (I am 54). During most of my younger years I am sure that I ate much too much starch and drank somewhat too much beer at times — I didn’t know any better then. Even so, carbohydrate intolerance only developed slowly with age, as I think is pretty common. When I was really young I ate like a pig and stayed completely lean and fit, always and effortlessly (like your son). I could NOT get overweight, and others my age noticed this and commented regularly (often with either feigned or sincere jealousy).
In a large number of well-done studies in the field of diabetes research (generally using the most state-of-the-art lab instrumentation), in which typically study cohorts are made up of offspring from two T2D parents and are studied from the age of teens or twenties when they are lean and normoglycemic, skeletal-muscle IR is already well-developed before any other physiological abnormalities are yet detectable. Other early markers of diabetic pathogenesis, such as loss of acute (1st-phase) glucose-stimulated insulin response/secretion, come much later but still before so-called decompensation in the pre-diabetic period, and well before frank diabetes. This pattern is highly related to genetic susceptibility, and repeatedly well demonstrated. There is no NAFLD in most of these cohorts, which are often studied continuously for decades (during which many or most develop T2DM). The quality and breadth of research in diabetes is pretty stellar in comparison to that in obesity (which is mostly clownish).
I cannot prove that I have never had NAFLD, but knowing a lot about it I doubt that I ever did even when my diet was worse and I had moderate IR. Michael Rose’s theory of “going back in evolutionary time” with increasing age (i.e. tissue genetic expression changes with increasing age to align with an earlier ancestral state) rings true to me — that’s why it is so common for people to tolerate a modern diet until maybe 30 or so, and gradually become less and less carb-tolerant after this, I believe. And that matches my own experience.
Lustig’s model is probably correct with regard to kids who develop IR and diabetes and so on, via the hepatic IR/dysfunction route due to overload by fructose. T2DM in youth was absolutely unheard of when I was a kid, and fat children were rare.
I have read every one of the scientific papers in which Lustig is a co-author, I think, curious as to whether there is anything there to change my thinking. I have not seen anything close to the kind of data that would justify Lustig’s public stances in these or other papers on the subject of dietary fructose and its metabolic effects.
I would maintain that carbohydrate intolerance is fundamental to our species but varies with genetics, with age, with sex, and (indirectly, via insulin and so forth) with tissues (within the same individual, predisposing to different chronic diseases) and that fructose is merely one form of carbohydrate that we are admittedly over-exposed to in comparison to any conceivable paleolithic environment (but the same is true for starch). Fructose is ten times sweeter than glucose. But I doubt it had anything to do with my own experience or that it represents a fundamental (i.e. necessary) trigger for metabolic syndrome — there are clearly other common pathways (beer drinkers have been known to be highly prone to diabetes for thousands of years), but this is not convenient for Lustig to admit. In the interview, Lustig said that fructose was THE element that made sugar sweet, as if glucose is not also sweet! He could have said that fructose dominated the sweetness of sucrose and (even more so) HFCS — no problem. But instead he implied that fructose, uniquely amongst monosaccharides, is sweet. He pulls this kind of BS all the time — that’s why I have trouble listening to him.
Anyway, my point is that I think Lustig is wrong on the science in profound ways. And if he is successful in his endeavors he may harm the science, just as did Keys and McGovern and so forth. In fact, I don’t really consider him a bona fide researcher — he is an academic MD with notions of social engineering. That’s why he can be so inaccurate, undisciplined, and generally cavalier and sloppy in his statements and behavior.
I guess he is OK in some respects — I certainly agree with much of what he says wholeheartedly. He is not unintelligent. But he worries me.
On a different note, I think you do a FANTASTIC job (I LOVED Fathead, and your blog is excellent) — please keep up the great work. I think many share my opinion.
We agree that fructose isn’t the only problem. I think it’s possible to get fat and develop insulin resistance by over-consuming pasta, white bread and other refined starches. Another researcher I interviewed likewise isn’t happy because he believes Lustig is too focused on fructose exclusively and doesn’t seem interested in talking about the health effects of over-consuming refined starches.
I told him I look at it this way: as a nation we consume more sugar than ever before. Kids guzzle juices, sports drinks and sodas. They eat sugary foods. Sugar is a huge part of the problem. If Lustig’s anti-sugar campaign can convince more parents and kids to view sugar as a threat to their health, then he’s fought the food fight on one major front of the war.
Why does Dr. L. seem to have a problem with marbled meat? I recently bought Argentinian beef and it was nicely marbled – and delicious! Is he a fatphobe after all?
I was wondering about that myself, since he took apart the Lipid Hypothesis in his “Sugar: the bitter truth” speech.
I was getting ready to strangle the woman who was conducting the interview. She must know someone in the industry to have gotten that job. Her voice was like nails moving SLOWLY across a chalkboard.
wanted to listen to it, but couldn’t hear it 🙁
the sound was turned up all the way too.
To quote Mark Twain:
It ain’t what you don’t know that get’s you into trouble. It’s what you know for sure that just ain’t so.
No, the problem is NOT sugar. Kids are diabetic because they’ve inherited it from their parents. Obesity later in life can be accurately predicted from 6 months of age.
Insulin resistance causes diabetes. What causes insulin resistance? An excess of non-esterified fatty acids. NOT sugar. Blaming diabetes on excess blood sugar is yet another correlation = causation mistake, just like blaming saturated fat for heart disease.
Am I saying we should be eating nothing but sugar? No of course not, but like I said in my first comment, it’s stress. And the reason it’s stress is because of the effects it has on how your mitochondrion processes glucose. It shunts it down the randle cycle, not the krebs cycle. You need to take the blinkers off or you will just end up like all the other internet quacks – with no credibility.
I see. So since this is inherited and diabetes rates have skyrocketed in just the past 20 years, I assume you believe we’ve undergone a major genetic mutation in that time. And since we eat less fat than previous generations did but have become far more diabetic, I assume you also believe we’re inhaling those fatty acids from the atmosphere. And when people who were diabetic are able to achieve normal blood glucose levels and give up their medications after dumping the carbs and eating more fat, they’re just crazy outliers. And the slew of studies demonstrating that HFCS produces a fatty liver are all wrong.
Yeah, I’m the one with no credibility …
Why does Dr. L. seem to have a problem with marbled meat? I recently bought Argentinian beef and it was nicely marbled – and delicious! Is he a fatphobe after all?
I was wondering about that myself, since he took apart the Lipid Hypothesis in his “Sugar: the bitter truth” speech.
To quote Mark Twain:
It ain’t what you don’t know that get’s you into trouble. It’s what you know for sure that just ain’t so.
Seems the people who typically line up to become registered dietitians are the same kind that volunteered en masse to be VoPos (Druzhina). Eager to assert moral superiority (and thus, inferiority of everyone else), absolutely confident in knowledge handed down to them by the elite (the less they understand of it the more vindicative), and basking in the glow of authority. They’re all too often bullies with a pretension of moral high-ground – not all of them of course, fortunately, but that’s been my experience so far.
I learned first-hand that, to them, criticizing any state-made nutrition plan is assimilated as a lèse-majesté crime, or as defiling their idol the all-mighty, all-knowing and all-benevolent state. To say that calories don’t matter, that fat is good and that all the obese people didn’t make themselves sick by overeating (but rather the opposite), is viewed as lauding immorality and gluttony. People who dissent, and destroy their (quasi-religious) beliefs about food and health are considered as, for lack of a better word, “nutrition-satanists”.
So it’s nice to see some well-deserved smack-back.
As for Lustig’s reliance on the government to correct then disseminate nutritional advice, well… the same reasons that made them back the wrong theories and cling to them in the face of decades of science, will still be at work in full effect if and when they decide to overhaul the food pyramid. The very moment the state anoints an expert or group of experts, their ideas, beliefs and hypotheses become untouchable and de facto superior to others’, even if wrong, and scientific progress dies. The same is at work in economic science, in climate science, and basically any science domain with lots of public funding of research and a national plan to leverage the results politically.
Amen.
@js290
Lustig’s biochemistry is convincing because of his excellent style, but it is not correct. In many details but, more important in general understanding. Fructose is not a toxin. Fructose is a normal part of metabolism. If nothing else, fructose and glucose are interconvertible. That’s why the glycemic index of fructose is 20 and not zero.
More important, the metabolism of the two sugars comes together at the level of the triose-phosphates (three carbon products of the lysis in glycolysis). At that point, they are indistinguishable and both can contribute to fat storage (by providing glycerol-phosphate). So, you have to answer why fructose is more lipogenic than glucose (and whether it is and under what conditions). In other words, the sugars are more similar than different and we need to understand what the real biochemical differences are. That will never happen as long as we have unscientific, infomercials of the type that Lustig is putting out. In the end, he is the Ancel Keys of sugar.
So where does Lustig’s data come from? All the experiments, from Havel, Hellerstein and Bantel and from other labs look at diets with 55 % total carbohydrate, more than we have been able to attain in the obesity epidemic. Under these conditions, is fructose worse than glucose? Probably. But is that really the question? When you ask the key question: is replacing fructose with glucose better than replacing carbohydrate with fat, any fat, you don’t get a straight answer. We don’t explicitly have the data because the agencies keep funding the high carbohydrate studies but we have strong data on total carbohydrate and it is stronger than the fructose data.
The problem is that they want to draw a conclusion that for health, we have to keep carbohydrate high (there is never a low carbohydrate control) and we should do this by replacing fructose with glucose. Pressed to it, they might say starch is not good but it is always “refined” starch (although nobody has ever isolated a “refinement” receptor”). But it is always sugar in what they actually write. So this is what the AHA, NIH is still pushing. High carbs but not fructose. So is Lustig following a conspiracy to keep carbs high? Unlikely but then, clearly, self-knowledge is not his long suit. In the science, one has to avoid ad hominem but once you step into policy the lines are less clear.
Lustig is as ubiquitous as high fructose corn syrup itself but, in my view, in his effect on science, he is more toxic.
@Dr. Feinman, thanks for the thoughtful reply. If getting people off refined sugar is a gateway to lowering overall carbohydrate consumption, there may be some good in that. Definitely don’t believe govt coercion is the best way to do that, though.
What are your understanding on Dr. Richard Johnson’s claim that the the body can convert glucose into fructose? I think he mentioned one of his studies has demonstrated this.
@Wait a minute, the Randle cycle is not actually a metabolic cycle like the TCA/Krebs cycle. It’s a hypothesis that states you can get ATP from fat or from glucose (or their intermediaries), but not from both at the same time.
Seems the people who typically line up to become registered dietitians are the same kind that volunteered en masse to be VoPos (Druzhina). Eager to assert moral superiority (and thus, inferiority of everyone else), absolutely confident in knowledge handed down to them by the elite (the less they understand of it the more vindicative), and basking in the glow of authority. They’re all too often bullies with a pretension of moral high-ground – not all of them of course, fortunately, but that’s been my experience so far.
I learned first-hand that, to them, criticizing any state-made nutrition plan is assimilated as a lèse-majesté crime, or as defiling their idol the all-mighty, all-knowing and all-benevolent state. To say that calories don’t matter, that fat is good and that all the obese people didn’t make themselves sick by overeating (but rather the opposite), is viewed as lauding immorality and gluttony. People who dissent, and destroy their (quasi-religious) beliefs about food and health are considered as, for lack of a better word, “nutrition-satanists”.
So it’s nice to see some well-deserved smack-back.
As for Lustig’s reliance on the government to correct then disseminate nutritional advice, well… the same reasons that made them back the wrong theories and cling to them in the face of decades of science, will still be at work in full effect if and when they decide to overhaul the food pyramid. The very moment the state anoints an expert or group of experts, their ideas, beliefs and hypotheses become untouchable and de facto superior to others’, even if wrong, and scientific progress dies. The same is at work in economic science, in climate science, and basically any science domain with lots of public funding of research and a national plan to leverage the results politically.
Amen.
@js290
Lustig’s biochemistry is convincing because of his excellent style, but it is not correct. In many details but, more important in general understanding. Fructose is not a toxin. Fructose is a normal part of metabolism. If nothing else, fructose and glucose are interconvertible. That’s why the glycemic index of fructose is 20 and not zero.
More important, the metabolism of the two sugars comes together at the level of the triose-phosphates (three carbon products of the lysis in glycolysis). At that point, they are indistinguishable and both can contribute to fat storage (by providing glycerol-phosphate). So, you have to answer why fructose is more lipogenic than glucose (and whether it is and under what conditions). In other words, the sugars are more similar than different and we need to understand what the real biochemical differences are. That will never happen as long as we have unscientific, infomercials of the type that Lustig is putting out. In the end, he is the Ancel Keys of sugar.
So where does Lustig’s data come from? All the experiments, from Havel, Hellerstein and Bantel and from other labs look at diets with 55 % total carbohydrate, more than we have been able to attain in the obesity epidemic. Under these conditions, is fructose worse than glucose? Probably. But is that really the question? When you ask the key question: is replacing fructose with glucose better than replacing carbohydrate with fat, any fat, you don’t get a straight answer. We don’t explicitly have the data because the agencies keep funding the high carbohydrate studies but we have strong data on total carbohydrate and it is stronger than the fructose data.
The problem is that they want to draw a conclusion that for health, we have to keep carbohydrate high (there is never a low carbohydrate control) and we should do this by replacing fructose with glucose. Pressed to it, they might say starch is not good but it is always “refined” starch (although nobody has ever isolated a “refinement” receptor”). But it is always sugar in what they actually write. So this is what the AHA, NIH is still pushing. High carbs but not fructose. So is Lustig following a conspiracy to keep carbs high? Unlikely but then, clearly, self-knowledge is not his long suit. In the science, one has to avoid ad hominem but once you step into policy the lines are less clear.
Lustig is as ubiquitous as high fructose corn syrup itself but, in my view, in his effect on science, he is more toxic.
@Dr. Feinman, thanks for the thoughtful reply. If getting people off refined sugar is a gateway to lowering overall carbohydrate consumption, there may be some good in that. Definitely don’t believe govt coercion is the best way to do that, though.
What are your understanding on Dr. Richard Johnson’s claim that the the body can convert glucose into fructose? I think he mentioned one of his studies has demonstrated this.
@Wait a minute, the Randle cycle is not actually a metabolic cycle like the TCA/Krebs cycle. It’s a hypothesis that states you can get ATP from fat or from glucose (or their intermediaries), but not from both at the same time.
A few more points:
You’ve built a mighty fine straw man, but:
Inherited does not mean genetic. I mean the conditions the baby is exposed to during pregnancy have a large effect. So if the mother is diabetic, the baby is more likely to be during childhood and later in life.
From http://www.andrewkimblog.com/2012/12/fruit-starches-and-perils-of-low.html?m=1:
“A few decades later, Yudkin proposed, based on observational data, that sugar was the cause of heart disease (Yudkin, 1966). But as late as the 1980s, sugar was regarded as being safe because coronary heart disease trended upwards as sugar consumption stayed constant. There was little evidence implicating sugar in obesity, diabetes, or nutritional deficiencies either. Actually, sugar consumption was inversely associated with obesity (e.g., Keen et al., 1979).”
So in this case not only does correlation not prove causation, but the correlation isn’t even there to begin with.
As I have already said, it is the stress response, or more accurately the body’s inability to cope with the amount of stress it is exposed to, ie chronically elevated levels of cortisol and the down cycle effects on the body long term. And the stress response is the same regardless of the stress source. It can be poor sleep, nutritional deficiency, poor coping skills, any number of things. You again built a straw man saying you doubt kids are overly stressed, but you only factor in psychological stress. I have already said stress can come from many sources.
I suggest you read Andrew Kim’s blog, and read up on the work of pioneers in the field such as Han Selye, who even though they may not be 100% right on everything, have come a damn sight closer to the real causes of disease and obesity than an overly reductionist view such as “It’s the sugar” or “it’s the carbs”.
So what happened with the surge in diabetes is that all in one generation, everyone became more stressed, eh? — including 10-year-old kids. Okay, that makes sense. And when diabetics achieve normal blood sugars after dumping the sugar and refined carbs, it’s just a coincidence that they became less stressed over the same period.
I see you’re trying the old “fat people drink diet sodas, so diet sodas make people fat” trick. No, fat people drink diet sodas because they’re fat. People who are resistant to getting fat don’t bother drinking diet sodas. Same with your inverse-relation-to-sugar study. But if we want to play the association game, here are some associations:
High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2004.059477
These results suggest that high fructose intake, in the form of added sugar, independently associates with higher BP levels among US adults without a history of hypertension.
http://jasn.asnjournals.org/content/early/2010/07/01/ASN.2009111111.abstract
First, fructose intake correlates closely with the rate of diabetes worldwide. Second, unlike other sugars, the ingestion of excessive fructose induces features of metabolic syndrome in both laboratory animals and humans. Third, fructose appears to mediate the metabolic syndrome in part by raising uric acid, and there are now extensive experimental and clinical data supporting uric acid in the pathogenesis of metabolic syndrome. Fourth, environmental and genetic considerations provide a potential explanation of why certain groups might be more susceptible to developing diabetes.
http://edrv.endojournals.org/content/30/1/96.full
Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality in stage III colon cancer patients.
http://jnci.oxfordjournals.org/content/early/2012/11/02/jnci.djs399.abstract
A few more points:
You’ve built a mighty fine straw man, but:
Inherited does not mean genetic. I mean the conditions the baby is exposed to during pregnancy have a large effect. So if the mother is diabetic, the baby is more likely to be during childhood and later in life.
From http://www.andrewkimblog.com/2012/12/fruit-starches-and-perils-of-low.html?m=1:
“A few decades later, Yudkin proposed, based on observational data, that sugar was the cause of heart disease (Yudkin, 1966). But as late as the 1980s, sugar was regarded as being safe because coronary heart disease trended upwards as sugar consumption stayed constant. There was little evidence implicating sugar in obesity, diabetes, or nutritional deficiencies either. Actually, sugar consumption was inversely associated with obesity (e.g., Keen et al., 1979).”
So in this case not only does correlation not prove causation, but the correlation isn’t even there to begin with.
As I have already said, it is the stress response, or more accurately the body’s inability to cope with the amount of stress it is exposed to, ie chronically elevated levels of cortisol and the down cycle effects on the body long term. And the stress response is the same regardless of the stress source. It can be poor sleep, nutritional deficiency, poor coping skills, any number of things. You again built a straw man saying you doubt kids are overly stressed, but you only factor in psychological stress. I have already said stress can come from many sources.
I suggest you read Andrew Kim’s blog, and read up on the work of pioneers in the field such as Han Selye, who even though they may not be 100% right on everything, have come a damn sight closer to the real causes of disease and obesity than an overly reductionist view such as “It’s the sugar” or “it’s the carbs”.
So what happened with the surge in diabetes is that all in one generation, everyone became more stressed, eh? — including 10-year-old kids. Okay, that makes sense. And when diabetics achieve normal blood sugars after dumping the sugar and refined carbs, it’s just a coincidence that they became less stressed over the same period.
I see you’re trying the old “fat people drink diet sodas, so diet sodas make people fat” trick. No, fat people drink diet sodas because they’re fat. People who are resistant to getting fat don’t bother drinking diet sodas. Same with your inverse-relation-to-sugar study. But if we want to play the association game, here are some associations:
High consumption levels of sugar-containing soft drinks were associated with mental health problems among adolescents even after adjustment for possible confounders.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2004.059477
These results suggest that high fructose intake, in the form of added sugar, independently associates with higher BP levels among US adults without a history of hypertension.
http://jasn.asnjournals.org/content/early/2010/07/01/ASN.2009111111.abstract
First, fructose intake correlates closely with the rate of diabetes worldwide. Second, unlike other sugars, the ingestion of excessive fructose induces features of metabolic syndrome in both laboratory animals and humans. Third, fructose appears to mediate the metabolic syndrome in part by raising uric acid, and there are now extensive experimental and clinical data supporting uric acid in the pathogenesis of metabolic syndrome. Fourth, environmental and genetic considerations provide a potential explanation of why certain groups might be more susceptible to developing diabetes.
http://edrv.endojournals.org/content/30/1/96.full
Higher dietary glycemic load and total carbohydrate intake were statistically significant associated with an increased risk of recurrence and mortality in stage III colon cancer patients.
http://jnci.oxfordjournals.org/content/early/2012/11/02/jnci.djs399.abstract
That dietitian must have been really embarrased afterwards, ha!
By the way, during your 30-day fast food diet, where you ever really hungry, or did the food fill you up?
I personally know that a Double QP with Cheese can fill me up for hours.
I only felt really hungry once. I had small breakfast and small lunch, then went for a Monster Thickburger (a.k.a. the “heart attack in a bun,” according to the Guy From CSPI) for dinner. I wanted to get that Monster Thickburger on videotape. By the time I got all set up to shoot, it was well past my usual dinnertime and I was pretty hungry.
In response to;
Dave Wilson says:
January 10, 2013 at 10:48 pm
From http://thedianerehmshow.org/diane
In 1998, Rehm’s career nearly ended because of spasmodic dysphonia, a neurological voice disorder that causes strained, difficult speech.
I worked in DC for over 40 years and often heard her show on WAMU (an NPR station) when she was in her prime. She was quick with her questions which were always well enunciated. It was agony for me to listen to her having heard her before. I went to her show’s web page and found out why. Thought I would share so others would understand what her problem was.
Check her entry on Wikipedia.
http://en.wikipedia.org/wiki/Diane_Rehm
That dietitian must have been really embarrased afterwards, ha!
By the way, during your 30-day fast food diet, where you ever really hungry, or did the food fill you up?
I personally know that a Double QP with Cheese can fill me up for hours.
I only felt really hungry once. I had small breakfast and small lunch, then went for a Monster Thickburger (a.k.a. the “heart attack in a bun,” according to the Guy From CSPI) for dinner. I wanted to get that Monster Thickburger on videotape. By the time I got all set up to shoot, it was well past my usual dinnertime and I was pretty hungry.
In response to;
Dave Wilson says:
January 10, 2013 at 10:48 pm
From http://thedianerehmshow.org/diane
In 1998, Rehm’s career nearly ended because of spasmodic dysphonia, a neurological voice disorder that causes strained, difficult speech.
I worked in DC for over 40 years and often heard her show on WAMU (an NPR station) when she was in her prime. She was quick with her questions which were always well enunciated. It was agony for me to listen to her having heard her before. I went to her show’s web page and found out why. Thought I would share so others would understand what her problem was.
Check her entry on Wikipedia.
http://en.wikipedia.org/wiki/Diane_Rehm
What you inherit, in terms of propensity for diabetes etc, can accumulate over generations. Epigenetics (not genetics, theres a difference). And for the third time, 10 year old kids getting stressed is not what I am saying. Repeat after me, physiological, psychological, nutritional deficiencies, any form of stress will do it.
[We’ve had a sharp rise in diabetes in one generation. Did everyone suddenly become more stressed? Are mothers more stressed now than, say, during The Depression or WWII? Or is it perhaps that the mothers have changed their diets?]
How many times does it need to be said – CORRELATION IS NOT CAUSATION! Need I remind you of the same mistakes made in implicating saturated fat as the cause of heart disease? Apparently I do. I did not say sugar prevents obesity, only that there is actually a weak inverse association. Big difference.
[And I was pointing out that people who restrict anything suspected to cause weight gain — fat, sugar, carbs, etc. — are more likely to be overweight and thus can create an inverse association.]
And any weight loss achieved will reduce stress, so whether that happens by cutting back on carbs, fat or protein, does not matter. Calories count, no matter how much you like to think otherwise.
[My father-in-law is a type 2 diabetic and has never been fat. He is, in fact, still quite lean and muscular at age 72. He didn’t get his blood sugar under control until he was finally convinced to dump the carbs. He hasn’t gained or lost weight since changing his diet. I’d say the type of calories made the difference, since I haven’t detected a sudden drop in his stress levels.]
I’ll ask again, if carbs / sugar are the reason for making you fat, why is lustig still overweight despite eliminating them from his diet? According to the simple theory Lustig himself is espousing which you agree with, that carbs cause obesity, all his excess adipose tissue should be melting away. Yet it hasn’t. Why not? Is it just possible that its far more complex than that?
[Lustig doesn’t consume sugar but thinks starchy carbs are just fine. He also believes (and told me when I interviewed him) that subcutaneous fat is harmless and perhaps even beneficial. He’s not on a mission to lose weight and isn’t on a low-carb diet either.]
And exactly where did I say anything about fat people drinking sodas? I said nothing of the kind anywhere! That statement is just plain baffling.
[See above. I was offering an example of why the choices overweight people make can produce inverse associations.]
Oh and one more thing, “people who are resistant to getting fat don’t bother drinking sodas”.
That’s funny, because I’m 37, do no exercise apart from walking, drink a lot of coke, oj, sugared milk and Gatorade (in fact I don’t drink plain water ever), yet I’m lean, and much leaner now that I was when I was 21, and both my parents were significantly overweight by my age.
I did it by simplifying my life and eliminating as much stress as possible. Basically just learning how to be happy and cutting out all the unnecessary crap out of my life.
Now I’m not suggesting that eating the same as me would make others lean, merely highlighting that there is far more to it than “sugar alone makes you fat”. If it did, I’d be the size of a house by now.
Well then, I’ll be sure to change the advice offered on this blog based on your experiences, not mine. From now on, I’m going to tell people they can drink sodas and chocolate milk and still lose weight if they just reduce their stress. Okay, people, learn to be happy, cut the unnecessary crap out of your life, drink your Coca-Colas, and start losing weight.
What you inherit, in terms of propensity for diabetes etc, can accumulate over generations. Epigenetics (not genetics, theres a difference). And for the third time, 10 year old kids getting stressed is not what I am saying. Repeat after me, physiological, psychological, nutritional deficiencies, any form of stress will do it.
[We’ve had a sharp rise in diabetes in one generation. Did everyone suddenly become more stressed? Are mothers more stressed now than, say, during The Depression or WWII? Or is it perhaps that the mothers have changed their diets?]
How many times does it need to be said – CORRELATION IS NOT CAUSATION! Need I remind you of the same mistakes made in implicating saturated fat as the cause of heart disease? Apparently I do. I did not say sugar prevents obesity, only that there is actually a weak inverse association. Big difference.
[And I was pointing out that people who restrict anything suspected to cause weight gain — fat, sugar, carbs, etc. — are more likely to be overweight and thus can create an inverse association.]
And any weight loss achieved will reduce stress, so whether that happens by cutting back on carbs, fat or protein, does not matter. Calories count, no matter how much you like to think otherwise.
[My father-in-law is a type 2 diabetic and has never been fat. He is, in fact, still quite lean and muscular at age 72. He didn’t get his blood sugar under control until he was finally convinced to dump the carbs. He hasn’t gained or lost weight since changing his diet. I’d say the type of calories made the difference, since I haven’t detected a sudden drop in his stress levels.]
I’ll ask again, if carbs / sugar are the reason for making you fat, why is lustig still overweight despite eliminating them from his diet? According to the simple theory Lustig himself is espousing which you agree with, that carbs cause obesity, all his excess adipose tissue should be melting away. Yet it hasn’t. Why not? Is it just possible that its far more complex than that?
[Lustig doesn’t consume sugar but thinks starchy carbs are just fine. He also believes (and told me when I interviewed him) that subcutaneous fat is harmless and perhaps even beneficial. He’s not on a mission to lose weight and isn’t on a low-carb diet either.]
And exactly where did I say anything about fat people drinking sodas? I said nothing of the kind anywhere! That statement is just plain baffling.
[See above. I was offering an example of why the choices overweight people make can produce inverse associations.]
Oh and one more thing, “people who are resistant to getting fat don’t bother drinking sodas”.
That’s funny, because I’m 37, do no exercise apart from walking, drink a lot of coke, oj, sugared milk and Gatorade (in fact I don’t drink plain water ever), yet I’m lean, and much leaner now that I was when I was 21, and both my parents were significantly overweight by my age.
I did it by simplifying my life and eliminating as much stress as possible. Basically just learning how to be happy and cutting out all the unnecessary crap out of my life.
Now I’m not suggesting that eating the same as me would make others lean, merely highlighting that there is far more to it than “sugar alone makes you fat”. If it did, I’d be the size of a house by now.
Well then, I’ll be sure to change the advice offered on this blog based on your experiences, not mine. From now on, I’m going to tell people they can drink sodas and chocolate milk and still lose weight if they just reduce their stress. Okay, people, learn to be happy, cut the unnecessary crap out of your life, drink your Coca-Colas, and start losing weight.
i actually got kicked out of a dietician’s office once…
While Dr Lustig’s theories and evidence may seem convincing to the general public and reporters, the real test is how well he performs with his fellow scientists!
He was certainly called out for overstating the evidence and poorly extrapolating rat research at a conference he spoke at earlier in the year – check out the Q and A video in the attached article by David Despain (as well as the other lectures)!
http://evolvinghealthscience.blogspot.com.au/2012/04/sugar-showdown-science-responds-to.html for a full review and links to all lectures – if not just watch the Q and A at http://www.youtube.com/watch?v=ypWe6npULUQ and http://www.youtube.com/watch?v=cnGhfX2yaU4
What research shows that it is fructose that causes addiction? At the Q and A at the Sugar Symposium, Dr Lustig was called out on this and one researcher showed that rats liked glucose based carbohydrates over sucrose, and another questioned the applicability of rat research to be extrapolated to humans!
I agree that rats aren’t little bitty people and we shouldn’t make too much of rodent studies. I don’t know if fructose is addicting per se. I believe cravings for carbohydrates have a lot to do with roller-coaster blood sugar levels, although the rise in dopamine may be a factor as well.
i actually got kicked out of a dietician’s office once…
While Dr Lustig’s theories and evidence may seem convincing to the general public and reporters, the real test is how well he performs with his fellow scientists!
He was certainly called out for overstating the evidence and poorly extrapolating rat research at a conference he spoke at earlier in the year – check out the Q and A video in the attached article by David Despain (as well as the other lectures)!
http://evolvinghealthscience.blogspot.com.au/2012/04/sugar-showdown-science-responds-to.html for a full review and links to all lectures – if not just watch the Q and A at http://www.youtube.com/watch?v=ypWe6npULUQ and http://www.youtube.com/watch?v=cnGhfX2yaU4
What research shows that it is fructose that causes addiction? At the Q and A at the Sugar Symposium, Dr Lustig was called out on this and one researcher showed that rats liked glucose based carbohydrates over sucrose, and another questioned the applicability of rat research to be extrapolated to humans!
I agree that rats aren’t little bitty people and we shouldn’t make too much of rodent studies. I don’t know if fructose is addicting per se. I believe cravings for carbohydrates have a lot to do with roller-coaster blood sugar levels, although the rise in dopamine may be a factor as well.
What part of the following did you not comprehend: Now I’m not suggesting that eating the same as me would make others lean, merely highlighting that there is far more to it than “sugar alone makes you fat”.
I guess I’ve completely wasted my time and yours by bothering to comment, since you don’t actually read what I write, just what you imagine I’m writing.
You do build a mighty fine straw man though. Adios.
Well, gee, I’ll sure miss you.
I’ll ask again: Are the biochemical reactions that Lustig presents incorrect? If the biochemical reactions are correct and that fructose reduces ATP production, stimulates DNL, and disrupts hormonal signaling, then that’s compelling enough to limit, if not all out avoid, any form of fructose. Whether there’s any studies that show fructose is especially addicting is not particularly interesting to me.
I also agree with Dr. Feinman that all carbs are probably a problem. He’s not the only person advocating this position. Given there are no essential carbohydrates and that fat produces more ATP than glucose, limiting high glycemic carbs (processed or not) may also be a prudent thing to do.
If you’re going to attack Lustig, at least go after the biochemistry he presents because ultimately that’s where the rubber hits the road. Him focusing on fructose doesn’t really take away from the glucose intolerance paradigm. I’m not sure I’d would criticize him just because he wasn’t advocating *my* message.
My thoughts exactly. Attacking Lustig because he focuses on sugar is a bit like attacking Dr. Davis because he focuses on wheat.