The Sugar Addiction Taboo
theatlantic.com
theatlantic.com
Robert Lustig is a research doctor. he works at UCSF (it's where my PhD in Biophysics is from), and sees patients there- highly obese, atypical patients. He promotes a particular position about metabolism and health. However - and this is the key thing - he has NOT published data which is convincing to reasonable scientists to support his position. At UCSF, he's generally considered a bit of a quack (personal comments from a number of professional scientists who work there).
Here is a list of Lustig's publications. http://scholar.google.com/scholar?hl=en&as_sdt=0,5&q=author:...
I, working with grad students at UCSF and elsewhere, have picked apart the materials and methods of his studies and found numerous statistical errors which make us doubt the validity of his conclusions. I won't claim that we have evidence he is being fraudful- it's more likely just an example of poor scientific behavior.
I'll give Lustig credit for one thing. Sugar- the Bitter Truth is one of the finest examples of manipulative sophistry I've ever seen. After seeing that I realized that most scientists are doing an absurdly poor job manipulating the public.
You have also stated that every epidemiology researcher is a quack, save ~5. https://news.ycombinator.com/item?id=7002375
Every scientific claim I hear I run through this http://norvig.com/experiment-design.html and "Sugar, the Bitter Truth" raised a lot of alarm bells for me.
Have you published your work anywhere? I'd like to read it.
the more fundamental problem with the study was that (if you read carefulyl) they found the same effect with glucose as they did fructose. You have to carefully read the chart/figure labels to figure that part out though :-(
In short, know the source here. His view is thought provoking but not without controversy, and not widely accepted in the medical community.
Robert H. Lustig, MD
Nationality: American
Education: MIT, Cornell University Medical College
Medical career
Profession: clinical medical practice, teaching and research
Field: neuroendocrinology, pediatric endocrinology
Institutions: University of California, San Francisco, UCSF Benioff Children's Hospital
Specialism: childhood obesity
Research: biochemical, neural, hormonal and genetic influences contributing to obesity
I don't know too much about him, but I'm curious as to whether or not any of his detractors have similar specialties. On the surface, most of the data would seem to agree with Dr. Lustig.
Could you point to the data which agrees with Lustig? can you vouch for its accuracy, compared to, say, some data people who don't agree with him?
I've talked extensively with people in the Biochemistry dept at UCSF (my phd is from biophysics there) and they mostly seem to think he's a buffoon.
http://circ.ahajournals.org/content/106/4/523.full
Admittedly, This isn't my area of expertise. However that's a 30 second google search compared to your "people I know say he's a buffoon" argument.
Given you are an anonymous voice in the inter-webs who may not even know how to get to UCSF, I'm pretty comfortable with my current assessment.
I can certainly be convinced otherwise, but "my buddies think he's a kook" is not exactly doing it for me.
(I'm confused ~ downvotes? There is absolutely nothing beyond ad homenem provided against me by dekhn, and yet I'm downvoted? Am I missing something here?)
The second article isn't very helpful either.
We are looking for high quality data that meets the criteria required to make nutritional advice:
1) almost certainly needs to be a controlled clinical trial with double blinding 2) needs to be replicated by multiple indepdendent groups who do not share data or methods or design before publishing 3) after that, get a Cochrane REview and ideally also allow Glantz and others to pick apart the methodology.
In the absence of definitive evidence, recommendations must rely on professional judgment. No data suggest that sugar intake per se is advantageous, and some data suggest it may be detrimental. The studies above, taken in total, indicate that high sugar intake should be avoided. Sugar has no nutritional value other than to provide calories. To improve the overall nutrient density of the diet and to help reduce the intake of excess calories, individuals should be sure foods high in added sugar are not displacing foods with essential nutrients or increasing calorie intake.
Can you point me to something substantial that suggests I should not consider the above accurate? I appreciate that evidence in support of the Lustig claims may not be complete, but evidence against them seems non existent. Why should I ignore what seems obvious?
First, the conclusion that it's detriment is admitted by the authors as being uncertain "some data suggest it may".
Second, most people in the area would say that in the absence of data showing harm, one should not conclude something is harmful, and then take action.
Third, let's turn their argument around. They state: "in the absence of evidence, use professional judgment. If something has no use, it should be avoided." OK. If that's their professional judgement, then to be fair it should apply to everything in their demesne, right? AKA, if there is somethign which is not absolutely necessary, and might be detrimental, these authors would say to avoid it entirely.
However, sugar makes food more palatable. So there are patients who don't want to eat food (cancer patients on chemo) but if the food is more palatable they eat it. Even sometimes getting kids to eat food is hard- shall I not add salt, or sugar if it gets them to eat a meal? Taken to its logical conclusion, their suggestion would shut down nearly all free choices that we make which have marginal risk concerns.
That seems to be a bit of a strawman based on an exaggeration of the quoted passage in the parent comment.
http://www.andrewkimblog.com/2013/02/quick-commentary-on-dr-...
Sucrose alongside adequate nutrients to process it is good for you. Sweet fruits and honey are not to be avoided.
FFS, The Atlantic should be embarrassed to publish articles with "correlation is causation" fallacies of this magnitude in them. This is standard food woo thinking: "people who heavily scrutinized and evaluated everything they ate because they have a strong adverse reaction to X means that not eating X will make YOU healthy too!"
Not considered: that maybe the simple act of THINKING before shoving whatever's handy into one's maw might be the health-inducing factor.
See also: "It has been found that laboratory research causes cancer in rats." Which, as it turns out, may actually hold some non-snarky truth - http://www.nature.com/news/chilly-lab-mice-skew-cancer-studi...
Do you see what I am saying? The two unique features of these people are fructose intolerance, and avoiding fructose. Unless fructose intolerance confers health, the act of avoiding fructose must aide in health. The precise reason for the improvement in health isn't important, if all you (on an individual basis) desire is to replicate their healthful results.
You basically just described all of epidemiology and why it has been so bad for nutritional research.
Food should confer wellness, not illness.
These sorts of platitudes that try to look "deep"... really put a bitter aftertaste on the tail end of articles that were serviceable otherwise.
If you are eating no 'sweet' sugar yet addicted to pretzels, pizza, bagels, and cereal with low fat milk - and thinking you're healthy because it's 'whole grain', like I was over a year ago, you may be killing yourself.
Your body doesn't need to ingest any carbs at all to survive, only protein and fat are required, and you can tolerate a lot more energy from fat than protein.
I count myself among the 33%-50% of the population that is carb intolerant and should avoid carbs at all cost. I've been on a wheat free, LCHF, close to ketogenic diet^H^H^Hlifestyle for a year and have been astounded at how well it works.
Sure, some people can tolerate low fat high carb diets even as they get older. But they're making a lot of other people sick by pushing those diets on us.
Before, I would have cravings and seek out food when I wasn't really hungry. Now, when I get hungry, I eat until I am no longer hungry, then stop. Afterward, I'm not hungry and not thinking at all about food for at least the next 6-12 hours. The hardest part is coordinating social meal schedules with people who now seem to be either eating or talking about food almost constantly.
Without sugar, I don't feel deprived or lacking one bit. And since my "dog food" is mainly comprised of three commodity food ingredients, it's very easy on the budget, too. I have noticed myself becoming more smug, though, so I have to be careful not to judge other people for their food choices.
eggs, chia seed, coconut oil, diatomaceous earth, Azomite, KCl, NaCl, pulverized vitamin pills, MgSO4, borax
It may still need a tiny bit of KI, methylsilanetriol, and betaine, but those are a bit harder to obtain. I tried to work out the ratios such that a 2200 kcal portion would come in above the minimum requirement and below the tolerable upper limit for all nutrients, where those amounts are known. Since commercial vitamin pills usually go on the USRDA values, it isn't exactly how I want it, but I have been using the color imparted to my urine by the massive excess of some of the B vitamins to determine if I need to drink more water or not.
I prepare the non-egg ingredients separately, and combine them before cooking. The result is similar to scrambled eggs, except somehow manages to have less flavor than eggs alone. Seasoning is essential for palatibility. Capsaicin and onion powder seem to work best.
Here's another recipe. Unsweetened soy/almond milk, large scoop of sugar-free whey protein powder with vitamins. One banana, and/or other fruit/veggies, ground flaxseed for fiber.
The long standing conventional wisdom that you want to be a sugar/carb burner is correct. Your cells function best on a steadily available supply of glucose backed with plenty of glycogen. Fructose is protective against stress, so a decent amount of sucrose is desirable.
They're different. You can be addicted to a substance or activity, without having any physical dependence on it. Yet people often use addiction to describe both scenarios, making it ambiguous.
One can get addicted to virtually anything imaginable.
Some addictions don't even have withdrawal symptoms at all, but are practiced largely due to inertia or some lack of motivation. Internet addiction is often one of these.
(serious question, btw. I'm not sure where I draw it, so it usually ends up subjective, which I would like to minimize.)
There is of course the extreme, like with our physical dependence on vitamin C. Somewhere back in our evolution we lost the ability to synthesize it, probably because it was abundant in food. Now we die if we don't get it. I doubt you are referring to that, though.
edit: not to imply case-by-case is bad. People are weird and very varied, any hard-line is likely to have straddlers.
You're not ADD, you're all-wound-up because your sitting in a chair for 8 hours a day only to come home and do homework for another hour, sit down and eat for another hour, shower, hygiene, etc for another hour, then finally bed. Nowadays kids spend probably a minimum of 12 hours doing sedentary work. Now combine that time spent sitting with a diet high in sugar, caffeine, and artificial food...
OF COURSE YOU HAVE BUILT UP ENERGY.
The recent work of Doctors(mostly Psychiatrists) is absolutely ridiculous and the people producing the fodder for mass hysteria (ADHD, ADD, Schizo, etc,) need to be held accountable for the mis-diagnosis they've created in the society(not to mention the lawsuits they're going to be facing when in 10 years we find out that the reason for all of these new mass-diseases are these new mass-drugs))
The ONLY classification of "addiction" should be to things that have TRULY addicting chemical qualities that can be proven in simple placebo A/B testing. All OTHER work is worthless because in the human mind, anything is liable to become "addictive". I can become addicted to carrots, that doesn't make carrots "addictive"(chemically) and doesn't necessarily warrant a doctor prescribing me with loads of drugs or classifying me inside of some kind of medical label for the DSM.
The only reason sugar is treated any different is because the potential fame and money. Not the mention the likelihood nowadays that the study was funded by the same corporation that stands to benefit from the results.
* I can only hope that my generation is the one that stands to really study how powerful the mind and the body are, rather than today's generation of simply patching the problem with a bandaid called Adderall.
While glucose is not essential, energy is, and glucose is the preferred energy for cellular metabolism (glycogen). Outside being in a sustained energy-surplus fructose is of little consequence.
Energy-balance (digested food calories - energy exerted living) is magnitudes more important than the macronutrient content of your diet.
That's a convenient fallacy which is so often repeated that it is simply assumed to be true, but some -- such as Gary Taubes, Dr. Lustig (the author of this article), Dr. Eric Westman, and others -- argue the exact opposite: the macronutrient content of one's diet matters very much. Different macronutrients provoke differing endocrinological responses. Our bodies are biological, not mechanical machines, and we process carbohydrates differently than fats or protein. It isn't controversial and it shouldn't come as a shock. New research is showing that the hormone cascade brought about by certain foods -- and by adipose tissue itself -- has an enormous impact on our health.
The problem is that people want to oversimplify nutrition into universal equation which assumes that everyone is the same, and they often cite epidemiological nutritional studies -- notorious for being inaccurate and unreliable -- to do so. The truth is probably more complicated: the diet that keeps one person healthy might make another fat and sick, and it's primarily dependent upon genetics, not physics.
For more on this, read any of Taubes's books. They are quite compelling. Dr. Lustig has written a few himself.
Every single hospital-ward double blind clinical trial over the last 100 years says exactly the same thing: net energy balance is what determines how fat you are, no matter the macronutrient content of the diet.
Nutrition's role in lifelong health is a LOT more complicated. What your lifetime Vitamin D levels probably matters a lot. But over a lifetime, eating a diet of mostly whole foods, and in amounts scaled to activity is going to give you benefits that will completely drown out what kind of fat you ate over the last 30 years or if you ate pop tarts for breakfast.
My point is, if you're fat and unfit, it's not any particular macronutrient's fault.
Here's my problem with this: the energy balance theory is the status quo, yet for as many studies as you can dig up to support it, you'll also find conflicting observations (some of which also go back over 100 years). I'm not saying it's wrong, I'm simply saying that the hormone theory of obesity shouldn't be disregarded solely because it doesn't fit the status quo. It needs to be tested.
Another problem I have is that the energy balance theory is just too convenient. It's a greay way to dismiss obesity as a simple failure of willpower, and to dismiss the obese as being morally inferior to the rest of us. In other words, our judgmental attitude toward obesity could be blinding us to its real cause. Let's test the hormone theory, and if it turns out wrong, we've only learned more about obesity. If it turns out correct, we could possibly save many lives and prevent a lot of suffering.
That said, I find it absurd to believe that only energy balance matters. In effect, this predicts that despite the dozens of hormones involved in human metabolism, it all boils down to caloric content. That doesn't make any sense to me. Taubes actually wrote an interesting thought experiment on this: http://garytaubes.com/2012/11/what-would-happen-if-thoughts-...
I think you are confusing weight & body composition with "health". They are interconnected but not the same thing. I believe (and it is just a belief) that a lifetime of staying lean (& strong) is the single best way to maximizes the health benefits of a diet, whatever that diet may be. You can't eat "unhealthy" amounts of any macronutrient if you're eating to stay lean (<15% body fat for men).
Don't pull out the "a simple failure of willpower" straw man; I never claimed that.
Hormones play a HUGE role in metabolism. My bedtime reading is how the chemical reactions they drive fit into human metabolism. you're comment seems to make them out to be "magical", which I suspect is due to your ignorance of them. I highly recommend reading up on them, just not via the media (Taubes only gives you his choice of the science), but via biochemistry text books like "Advanced Nutrition and Human Metabolism" http://www.amazon.com/Advanced-Nutrition-Metabolism-Sareen-G...
* there are extreme exceptions; liposuction is one way. :P
I'm not claiming that the body can somehow defy the laws of thermodynamics. Obviously to become "heavier" one must consume more energy than one expends, but to lose fat -- specifically fat, not muscle tissue or bone or water -- the question is this: how important is the role of hormones in fat regulation? Does an increased insulin load, coupled with insulin resistance caused by long-term exposure to chronically high insulin levels, promote greater fat storage? And does this greater mass of fat, which itself is a hormonally active organ, affect the body in a way that results in illness and further weight gain?
Would an endocrinologist tell a diabetic that macronutrient content doesn't matter? Should we give that same advice to people with metabolic syndrome or those who are at risk of developing it? If insulin resistance is the primary cause of Type 2 Diabetes, and insulin is the primary hormone involved in fat storage -- both non-controversial statements -- then wouldn't it make sense for those at risk of developing T2DM to eat foods that produced a minimal insulin response?
Read Taubes's thought experiment I linked above. If you're willing to make nutrition texts bedtime reading, then you will at least find it interesting, even if you disagree with it. Though Taubes is not a scientist and he doesn't claim to be, he does make a compelling argument.
> Don't pull out the "a simple failure of willpower" straw man; I never claimed that.
It wasn't intended to target you specifically, but this attitude is pervasive, even among medical professionals. There are people out there who would much rather believe that every obese patient is just a lazy glutton who can't control himself. I know a few of these people myself, one of whom is a prominent oncologist. Science requires that we put aside our biases and assumptions.
> Hormones play a HUGE role in metabolism. My bedtime reading is how the chemical reactions they drive fit into human metabolism. you're comment seems to make them out to be "magical", which I suspect is due to your ignorance of them.
I'm not claiming hormones are magical. I am merely suggesting that their known role in fat regulation might also play a critical role in obesity. It's been a while since I studied the topic in any great depth, so I can't compete with your bedtime reading, and I don't want to link spam, so I'm keeping it simple.
Anyway, I believe the science will eventually shed some light on this issue. There are clinical trials in the planning stages right now, so hopefully we won't have long to wait.
> And does this greater mass of fat, which itself is a hormonally active organ, affect the body in a way that results in illness and further weight gain?
These are very good questions. Here's what I know (caveat it may not be complete, but I am confident it is accurate):
1: Hmm, chronically high insulin levels is caused by chronically eating too much. Beef spikes insulin just as much as table sugar (http://ajcn.nutrition.org/content/66/5/1264.full.pdf#page=1&...). So I would say the problem of "chronically high insulin levels" is a problem of eating too much food, not too much sugar.
2: This is a hugely interesting area of thinking for me. Which fat though? White or brown adipose tissue? Brown fat is darker in colour due to it's huge cellular density of mitochondria when compared to white adipose tissue. It's essential fat-buringing fat, and plays a role in regulating temperature. It basically burns fat to warm us up when we're cold. This is why Michael Phelps can eat 10 million calories a day. 6 hours a day in water requires allocating a LOT of calories to maintain core body temp. We have learned SO much about fat tissue recently, but I don't think we have all the answers yet.
I noticed this red-flag from the thought-experiment:
> We know the liver will turn some of this fructose into fat and if the fructose is delivered quickly
Yep, but less than 1% is converted into fat (http://www.nutritionandmetabolism.com/content/9/1/89), and this is in a state of caloric surplus. The thought-experiment method is for the subjects to eat calories to match their TDEE (Total Daily Energy Expenditure), so it's much more likely that none of this fructose will be converted into fat, it's more likely to completely converted into glucose by the liver.
> Let’s assume two things for the sake of argument. the sugar in A’s diet causes A to become insulin resistant. And second, insulin works to put fat in fat tissue.
I would say both assumptions are fallacious. Eating @ TDEE means 100% of the food energy is used up, and fat cannot be made from nothing. More sugar in this case does not cause insulin resistance, beef stimulates insulin release into the blood just as much as sugar does, so one can't isolate a single macronutrient like that. Also, the "insulin works to put fat in fat tissue" is misleading at best and completely wrong at worst, depending on how you interpret it. Insulin works to move nutrients into cells. More insulin in the blood is a signal there is food calories available, so insulin also stops fat cells from releasing their fat. This makes total sense; why dip into your savings when you just got a fist full of cash? The point where your body transitions towards fat storage is the point where your energy intake exceed energy expenditure; again just simply eating less solves this.
My statements are all for average healthy people. I totally agree metabolic-syndromes like diabetes should be treated differently. But the VAST majority of people are fat because they sustain consuming more energy than they use. The micro-variables like how stressed you are (and therefor how much cortisol hormone is present) matter, but nothing gets diet-induced hormones working as they should better (in healthy people) by just eating food-energy (whatever the macros) to match your activity over the long run.
Yes, beef does have a high insulin response, but when total consumption is taken into account, and satiety, eating beef will have a lesser effect than eating jellybeans. Look at the insulin scores in the publication you cited. Those with the highest scores, as a group, are snacks and confectionaries, foods that are commonly eaten in Western countries. Some of the worst offenders in the groups tested are: beans, potatoes, white bread, jellybeans, etc. -- carbohydrates.
> 2: This is a hugely interesting area of thinking for me. Which fat though? White or brown adipose tissue? Brown fat is darker in colour due to it's huge cellular density of mitochondria when compared to white adipose tissue. It's essential fat-buringing fat, and plays a role in regulating temperature. It basically burns fat to warm us up when we're cold. This is why Michael Phelps can eat 10 million calories a day. 6 hours a day in water requires allocating a LOT of calories to maintain core body temp. We have learned SO much about fat tissue recently, but I don't think we have all the answers yet.
In this case we're talking almost exclusively about excess visceral fat, though the role of other fats in obesity and disease is, as you said, not fully known.
>> Let’s assume two things for the sake of argument. the sugar in A’s diet causes A to become insulin resistant. And second, insulin works to put fat in fat tissue. > I would say both assumptions are fallacious. Eating @ TDEE means 100% of the food energy is used up, and fat cannot be made from nothing.
True, but activity level must be taken into account. Fat can't be made from nothing, but the patient could reduce his overall activity level as he becomes fatter, which would make excess calories available for storage as fat. In other words, we could have causality backwards: being lazy doesn't necessarily make you fat, but becoming fat could certainly make you lazy.
> Also, the "insulin works to put fat in fat tissue" is misleading at best and completely wrong at worst, depending on how you interpret it. Insulin works to move nutrients into cells. More insulin in the blood is a signal there is food calories available, so insulin also stops fat cells from releasing their fat. This makes total sense; why dip into your savings when you just got a fist full of cash?
If insulin stops fat cells from releasing fat, then wouldn't it make sense to keep insulin levels as low possible? That means reducing carbohydrate and protein intake, and increasing dietary fat consumption to compensate: in short, a low-carb, high-fat diet.
> The point where your body transitions towards fat storage is the point where your energy intake exceed energy expenditure; again just simply eating less solves this.
Does it though? Obese people have much higher concentrations of circulating leptin than the general population, and they can become leptin resistant. What happens if we tell these people to eat less, and move more? Chances are, they're going to become very hungry. I would argue that eating less isn't enough. They need to eat less insulinogenic foods, and compensate by increasing dietary fat to satiety.
> My statements are all for average healthy people. I totally agree metabolic-syndromes like diabetes should be treated differently. But the VAST majority of people are fat because they sustain consuming more energy than they use. The micro-variables like how stressed you are (and therefor how much cortisol hormone is present) matter, but nothing gets diet-induced hormones working as they should better (in healthy people) by just eating food-energy (whatever the macros) to match your activity over the long run.
Fair enough. That's the commonly held belief at least, but I disagree. I think we have an incomplete picture. However, I believe in the scientific method, so I'd really like to see clinical trials (not epidemiological studies) to fully test the hormone theory. As I said earlier, if it's wrong, then we haven't lost anything, and we've learned more about the role hormones play in obesity. If it's correct, then the impact on nutrition and obesity will be enormous. It's worth looking into.
This is a terrible way to associate with and think about people.
There is another rampant addiction going around, phycological dependance on the feeling of smug satisfaction in one's own superiority given by partaking in – and to a larger degree talking about – the latest fad in ( health | diet | environment | programming language | life ).
In total I went 8 weeks without any sugar. I have no plans to ever return to incorporating it into my diet. I consider this move to be one of the best things I've done since removing nicotine and alcohol completely from my life.
You are limited to essentially 20g of carbs a day total. This is enough to get a healthy dose of vegetables (not fruit of any kind - leafy greens) and that is about it. Maybe a dollup of sriracha.
Either way, after being on the diet for a couple months I had one bite of a chocolate bar and let me tell you, the flavor was 1000x more intense and I felt no need for more after the first bite.
Of course this is one person's experience, YMMV.
Sustained low carb is a bad idea. You are mimicking the metabolism of starvation. For the most part you want to be operating with glycogen topped up.
Really? Because I feel a heck of a lot less hungry, and sometimes need to remind myself that it's past time to eat breakfast or lunch.
We did consume rye bread, but that was made ourselves and used only the amount of sugar needed to activate the yeast.
After 8 weeks I have returned fruit into my diet, but always whole.
The point I was trying to make on the root comment in this, was that simply going cold turkey on sugar, in my case, wasn't hassle free because of the headaches, but it was worth it.
sources: the art and science of low carb living, wheat belly
It's a thorny issue.
It's better to err on the side you're on, because that justification covers quite a lot of ground. For instance, it's hard to find tomato without sugar in prepared food. Or anything else without sugar, actually.
Seems that food companies are afraid of "tasting bad" and just throw sugar in there willy-nilly, with the consequences now in plain sight, to say the least.
We primarily only buy fresh vegetables. Lots of cabbage, spinach, lettuce, mushrooms, onions, peppers, asparagus).
http://www.nytimes.com/interactive/2013/10/01/dining/nacho-g...
You could probably argue convincingly that sugar and doritos are actually more compelling to the public, because they are specifically engineered to defeat our body's natural mechanisms for regulating diet.
If you entertain the idea that some but not all people have a susceptibility to fructose addiction and then consider that a very large portion of the food supply is 'supplemented' with sugar you can begin to imagine just one of the reasons why obesity has been on such a rise.