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Comment by pvnick | Hacker News Reader

I'm getting sick of this ignorant sugar alarmism. Sugar is not the culprit behind all the diseases listed in the article. Obesity is [5] [6]. Unless of course you're talking about cavities. Then not brushing your teeth is the culprit. The reason sugar gets such a bad rep is that high-sugar foods tend to be less-filling and lead to overeating [1]. Stay at a healthy weight by controlling caloric consumption [2].

The article mentions such scientific evidence as "nearly two-thirds of the studies cited there to repudiate Lustig's views were funded by Coca-Cola." Seriously?

Normally I wouldn't care - sugar alarmism = more candy for me - except that, as the article notes, "Lustig ... calls for sugar to be treated as a toxin, like alcohol and tobacco, and for sugar-laden foods to be taxed, labelled with health warnings and banned for anyone under 18." That's just bullshit extremism. Doughnuts, one of my favorite foods, can be part of a healthy diet just like anything else. In fact, sugar is fantastic for stimulating muscle growth [3], and can help with diet adherence during a caloric deficit [4].

[1] http://en.wikipedia.org/wiki/Insulin_index - this page lists satiety indexes for common foods. Notice all the lowest scores are bakery goods and sugary snacks.

[2] http://ajcn.nutrition.org/content/early/2009/10/14/ajcn.2009...

[3] http://jcs.biologists.org/content/122/20/3589.full

[4] http://www.ncbi.nlm.nih.gov/pubmed/11126336?ordinalpos=47&it...

[5] http://www.nhlbi.nih.gov/health/health-topics/topics/obe/ris...

[6] http://www.ncbi.nlm.nih.gov/pubmed/19801534

Edit: People are taking my words out of context. This is my reply to another comment below that elucidates my meaning: "I advocate moderation and balance. Consume reasonable calorie and macronutrient (protein, fat, carbohydrate) quantities. Eat what allows you to do that. For me, those carbs come from doughnuts and candy but also from brown rice and pasta. Just like my meats include both lean meats (chicken breast) and fatty, delicious meats (bacon). Combine this with exercise and all you'll avoid all the scary things the article talks about."

View on HN

No, the reason sugar gets a bad rep is because of what it does to your body. The insulin response to sugar is the primary way your body stores fat and sugar itself is readily converted to fat. The glucose & fructose spikes are also source of inflammation. It is believed that this inflammation is the cause of some of the damage related to heart disease, etc.

Heart disease etc, including[1]:

"This is why hemoglobin A1C is frequently used in studies that try to correlate blood sugar control to various disease processes like Alzheimer’s, mild cognitive impairment, and coronary artery disease. It’s well documented that glycated hemoglobin is a powerful risk factor for diabetes, but it’s also been correlated with risk for stroke, coronary heart disease, and death from other illnesses. These correlations have been shown to be strongest with any measurement of hemoglobin A1C above 6.0 percent. We now have evidence to show that elevated hemoglobin A1C is associated with changes in brain size. In one particularly profound study, published in the journal Neurology, researchers looking at MRIs to determine which lab test correlated best with brain atrophy found that the hemoglobin A1C demonstrated the most powerful relationship.[2]”

[1] Perlmutter, David. “Grain Brain.”

[2] “C. Enzinger, et al., “Risk Factors for Progression of Brain Atrophy in Aging: Six-year Follow-up of Normal Subjects,” Neurology 64, no. 10 (May 24, 2005): 1704–11.”

Blood sugar levels are not a reliable proxy for dietary sugar intake.

Tell that to diabetics

Diabetics know better than anyone that dietary sugar is not the only food that can increase blood sugar. Rice cakes have no sugar in them at all, for instance, but have a higher glycemic index than chocolate cake.

Dietary sugar intact/dietary carb intake - at the end of the day, it turns into sugar

But that's not what the article is about. It a about dietary sugar--sucrose and fructose specifically.

Nondiabetics have normal A1c because they do not exhibit wild blood glucose swings, even postprandially.

Perlmutter's stuff is way out of the left field. If you read the actual study, it does not support his conclusions. Interestingly, there are studies that show that a vegan grain-rich diet lowers hemoglobin A1C. So much for his made-up "grain brain" condition. Of course most diets studied lower it, because they are much healthier than the standard american diet of overeating.

And it's also perfectly possible to be a moderate consumer of sugar and have low hemoglobin A1C depending on other lifestyle factors.

>The insulin response to sugar is the primary way your body stores fat and sugar itself is readily converted to fat

This is a common myth, but it's wrong. Dietary fat is what is primarily stored and leads to weight gain during caloric excess; dietary carbs just decrease the amount of fat being used for energy, but can also get stored as fat tissue during overfeeding in a process called de novo lipogenesis (which is what you're describing) [1] [4]. Would you believe protein also elicits an insulin response? [2] So why not just eat butter? Well, it turns out fat can get stored without insulin at all, with the help of a little molecule called acylation stimulation protein [3].

Nutrition is harder than it seems. Again, it all comes back to calories in vs calories out.

[1] http://ajcn.nutrition.org/content/74/6/707.full

[2] http://ajcn.nutrition.org/content/66/5/1264.full.pdf

[3] http://www.bodyrecomposition.com/fat-loss/insulin-levels-and...

[4] http://www.bodyrecomposition.com/nutrition/nutrient-intake-n...

We can go back and forth on this, but HN isn't the place. I've had this debate many times and it ends nowhere. Bottom line, calories-in vs calories-out is a fine and dandy statement, but tells us nothing of value about the cause of increased calorie consumption. I agree with you that for weight gain to occur, there must be a greater energy intake than burn, but what causes more caloric intake?

Eating? I'm only partially joking. Calories don't just magically appear.

Sugar makes you feel like you're starving. You get sleepy at the peak, "starving" at the trough... like a repeating sine wave. Leads to overeating.

But who eats sugar to get full? I (and everyone I know) eat sweets after a meal, or because I see them, not because I expect to sate my hunger with it.

Lustig's point is that you don't know you're eating sugar when you actually are. Up to 10% corn syrup in white breads, sauces, any precooked meal, sausages. If you eat BBQ sauce, you're eating sugar.

Salt and sugar save low aroma food (>80% processed food). Their combined power on the human body is vicious.

As the other commenter said, this is pretty much just the US, I just didn't realize the article wasn't talking globally.

Ask anyone who isn't American what the first thing they notice about the food when they visit the US.

How sweet everything is.

That's me, and you're right, everything's very sweet and buttery. I guess I was thinking the article applied to me, when the answer to my question was "Americans".

My friend is from England and the few times she's been to America the primary thing she's said is that the portions here are ridiculously large.

At places like Chili's or Applebees she ended up ordering appetizers and eating half of that as a meal. I got a regular meal but I knew in advance I would be taking it to go halfway through, as I usually do.

Yes, the problem with coke isn't that it's got a lot of sugar in it. The problem with coke is that people drink litres of it each day.

I can't tell if you are being sarcastic or agreeing or not.

Usually your comments are good so I am going to believe you are sincere here.

Somewhat related I am one of those people who needs to make a change as I get >1000 calories from soda a day. I did quit years ago (just cold turkey) and after the initial headaches and tiredness the biggest change I saw was that I was constantly hungry. Much like quitting smoking made me for quite a while.

Coke has a lot of sugar in it. Some people drink a small amount of coke, and get pleasure from it, and are not fat.

Increasing portion sizes (see for example the increasing sizes of servings in McDonalds menus) mean that people now drink huge quantities of this sugary drink.

The volume of drink, the quantity of the sugar, is the problem.

Two cookies are not a problem. Two packets of cookies are a problem.

I'm not sure why you would think the response was sarcastic. Coke having sugar is NOT the issue. Drinking literally liters of it each day is certainly the issue. On top of a normal diet all those extra calories are bound to be a problem.

Now it seems silly but while I was going through the thread many responses had something worded similarly. After reading so many of those comments I was probably primed to see negativity everywhere.

eg. It's not THIS it's THAT. (It's not sugar, it's sugar in excess.)

More generally, it is calories in excess.

As mentioned, there is a lot of sugar hidden in processed foods. Also, a plate of pasta is about the same as far as the body is concerned, just a bit slower on the uptake.

It causes people to lack discipline in what they eat. That's really the issue here. Sugar isn't some poison and it is not a magical 10x the normal calorie. People who eat a lot of sugar are usually still eating a lot of everything else. All those calories add up and lead to weight problems.

The first thing to losing weight is to get serious about how much you are eating. Write it all down. People tell me all the time they don't understand why they are gaining weight, and then we go through a day of eating. It's not just sugar or fat or some other thing someone has said trying to sell a book, it is simply eating too much. Oftentimes people don't even realize it.

I had the opposite problem with I started weight lifting years ago. I simply couldn't gain weight, and thought it was impossible based on how much I thought I ate. When I started writing things down I realized I was barely breaking 2k calories/day if I was lucky. It took concerted effort to eat more, and results quickly followed. Now I'm older and am not as active, so I simply don't eat as much. My weight has stayed the same for a long time.

It's not really about discipline. If you're "starving" (low blood sugar), you eat big to stop that feeling. There's few people who can will themselves to suffer instead, and really why should they?

Better to avoid the problem entirely in the first place. If you don't feel hungry (stable blood sugar) eating becomes a moot point/routine task.

Right on, and thats why they brand sugar as deadly poison -- it affects your brain and tricks it into wanting more of it because its a drug of pleasure. Then it makes you never full so you eat more of other stuff that eventually gets you sick.

Like with anything else, including alcohol or even heroine (altho that one very limited) - nothing in reasonable limitations will kill you. If you have strong will then you keep your brain on leech and treat it as a pleasure you consume time to time in limitations. If you eat it daily in large quanitities, then you helping yourself to get sick.

it all comes back to calories in vs calories out.

12 cans of Coke a day = healthy diet?

Hey man, calories-in, calories-out! Calorie-is-a-calorie! Sugar is fine! All in moderation! Heroin is fine, all in moderation!

Heroin is fine, all in moderation!

In fact, numerous studies have found exactly this.

Not true--it causes constipation.

Could you post links to some reputable ones?

When heroin was legal, addicts often took it in pill form which was cheap and sufficient to deter cravings. The chief negative long-term effect of being addicted to heroin is constipation...IF you can reliably keep a supply of it in pill form.

The negative effects we see in addicts today are mostly caused by two factors: (1) if you shoot up, needle - especially dirty needles - can be a vector for infection and diseases such as HIV, (2) if you can't get a reliable supply of known potency you can go through withdrawal or overdose - the wild swings are harmful. (Impurities in the drug can also be harmful depending on what it's been "cut" with.)

So if the drug were legal it'd be fine. But when it's illegal, some characteristics of an illegal market make it bad for people - those are problems related to the illegality, not really having much to do with the drug itself.

I'm sure that both sugar and heroin are fine in moderation.

The problem is that moderate consumption of either is known to cause overconsumption.

So, perhaps not so fine in an environment of abundance.

Most people eat sugar. In fact, I'm willing to bet that the proportion of people in the western world who have eaten sugar is close to 100%.

Not everyone is obese. Even in the US, where obesity is at its worst, it's around 35%. That suggests that 65% of people can consume sugar and then not become obese.

Certainly amongst my peer group of middle class graduates almost everyone eats sugar and almost nobody is obese. That suggests that people are perfectly capable of consuming moderate amounts of sugar without becoming rampant sugar addicts rapidly turning obese.

The physical cause of obesity may be the overconsumption of simple carbohydrates, but the socioeconomic distribution of obesity suggests that there's many factors which drive that consumption.

You and your peer group are at the age where your metabolism is high.

Try having the same diet when you're in your 40s and I am sure you will have a different experience.

Shit, 40s? I had to start busting my ass at 28 to not be a fat land whale.

I'm in my 40's and I'm fat because I sit on my ass all day and eat when I'm not hungry. There is no reason to blame a certain subset of the calories.

Causation does not require 100% determinism. If X causes Y, it means that inducing X will increase the likelihood of Y.

So counterexamples are not disproof. You'd have to construct a lab experiment with enough subjects and measure over a long enough time.

Unfortunately, it's difficult to construct a perfect double-blind study, because people usually know if they are eating sugar or not. Maybe if artificial sweeteners are good enough it might work, or maybe the experiment would still be convincing even if the subjects know.

I'd be interested to see the results of such a study for sugar and heroin. I probably should be able to cite one before I claim it as fact, but I didn't think it was a very controversial claim. I think it's mainly a question of degree.

Which is why it is used medically with pregnant women and newborns.

It was never argued that 12 cans of Coke a day is healthy. It was simply argued that body weight gain/loss is governed by calories in vs calories out. These are two entirely separate statements.

Not all calories are absorbed. Also, I think it's safe to say that minerals and vitamins can contribute to structural/weight changes. Even water can.

Water can certainly affect weight, but only temporarily. You will not get fat drinking water.

Calories in-calories out declare the upper bound. No matter what vitamins you take, you can't make body produce more energy that it takes in, or else something in thermodynamics is seriously broken.

True, but useless. If the human body is extra efficient, it should have about 20% efficiency at converting energy. This means your upper bound rule tells you that if a male adult eats 400cal/day he'll lose weight. Duh! He'll lose weight at 1800cal/day; the 400cal mark is useless.

Thank you for putting into words what I was trying to think of. Different bodies operate at different metabolic/thermodynamic efficiencies depending on level and type of exercise and nutritional intake. (including non calorie nutrients like vitamins, minerals, flavanoids, etc.)

Body weight gain/loss is also governed by mass in versus mass out. So make an effort to inhale less than you exhale, drink less water than you expel via urination or sweat, and poop more than you eat. Any of those are guaranteed to work if you could sustain them, but you can't.

Which is nicely analogous to telling someone to focus on calories in versus calories out.

You lose mass by exhalation of CO2, not defecation. Since you inhale O2 and exhale CO2, you don't need to inhale more than you exhale (a mathematical impossibility anyway, of course) to lose weight.

Don't forget donating more organs than you receive transplants for.

If you consumed nothing but 12 cans of coke a day you would probably lose weight.

Healthy? Maybe not.

Yes, you heard the man with bunch of citations.

*diet coke

> Again, it all comes back to calories in vs calories out.

Which is both true and irrelevant, because the system that governs calories in and calories out is a complex control loop. When it's working correctly, weight is effortlessly maintained within a narrow range thanks to compensating adjustments in appetite and, to a lesser extent, metabolism.

When it isn't working right, people try to drive the process with their frontal cortex instead, which only a small fraction of population can actually achieve for any significant length of time.

So the most interesting questions in nutrition science are all around what effects satiety and why we have an epidemic of people with broken control loops. Sugar is a very strong suspect in that investigation.

And before someone says we aren't evolved for an environment of plenty, and our bodies just hoard every calorie they can get in case of famine -- that's really not it. No mammal simply hoards every calorie it can get without homeostatic feedback. Survival incentivizes balance -- hoarding a calorie means you don't spend that calorie today on something else that would aid your reproductive success. Which is why we (and most animals) have an extremely dynamic system to monitor and maintain appropriate energy stores.

> Which is both true and irrelevant, because the system that governs calories in and calories out is a complex control loop. When it's working correctly, weight is effortlessly maintained within a narrow range thanks to compensating adjustments in appetite and, to a lesser extent, metabolism.

What evidence leads you to believe this? There's no prima facie reason to believe evolution has adapted mammals to a glut of food, since for all but, generously, about the last ten thousand years, it wasn't really a problem that a significant portion of the gene pool faced. It would require some evidence to believe that the body has this capability.

a bear is a perfect example of an mammal that uses its insulin response during glut times to store fat.

1. gain weight during the summer by eating high sugar, high starch, high calorie foods such as fruit, berries, roots, honey/insects, and as much whole fatty fish as it can get its hands on for a super high calorie kick. it HAS to gain weight in the summer, and does so easily on that diet.

2. during the winter it hibernates and burns nothing but fat, losing the weight and avoiding starving. people can do this too, believe it or not. fasted ketosis is a thing you can sustain for quite a while as long as you drink water.

this doens't prove anything in humans, but is an obvious counter-example to no evidence to believe that mammals don't have food glut adaptations.

but just for anecdotes' sake, what does an obese human typically eat? exactly the same diet. high sugar (soda/fruit juice), high starch (all junk food), roots (LOTS of potatoes, mostly fried), and extremely high calorie kickers like cheeseburgers and pizza to ensure a calorie surplus.

Um. Bears don't have a glut in the summer. They eat everything they can and some still die from not getting enough. A glut is when there is so much food that you can eat more than is healthy. You don't see bears passing up salmon saying, nah, I had enough.

define:glut in google says "an excessively abundant supply of something."

i'm pretty sure if a bear can gain hundreds of pounds in a few months, there's an excessively abundant supply of food.

if not, well, there isn't a glut, now is there. and there's soon going to be no more bear, either.

> You don't see bears passing up salmon saying, nah, I had enough.

I thought it was interesting to learn from Alaskan's that when salmon are plentiful, bears will gut the salmon and just eat those tasty eggs.

Who knew? My mental picture had never included them possessing much of a palate. This article suggests they also go for the brains and skin.

http://grizzlybearblog.wordpress.com/2010/07/21/grizzly-bear...

The !Kung people were a hunter-gatherer tribe in South Africa that persisted with the traditional way of life into the modern era. They had tons of food (the mongongo nut is available year-round in "truly massive quantities") and were still fit by modern standards (even thin), so it's not merely a question of the availability of food. This lends credence to the idea that it isn't merely the quantity of food availability, but its unnatural palatability that makes people overeat.

http://ajcn.nutrition.org/content/71/3/665.full?ijkey=f7644b...

There is lots of evidence, of several different kinds.

At the biochemical level, we actually know a lot about some of the pathways that allow food and body fat composition to govern appetite. See, for example, leptin signaling.

At the anthropological level, we have good examples of several different pre-agricultural societies where food was abundant and obesity was rare.

At the whole-animal experimental level, researchers have demonstrated in both rats and humans that when you give an animal unlimited access to food, it doesn't gain unlimited weight. It reaches a plateau and then resists further changes up or down from there. Interestingly enough, rats fed a diet of unlimited human junk food reach a much higher plateau than rats fed a diet of unlimited standard rat chow.

And finally, we all know people (perhaps even our younger selves) who never consciously worry about what they're eating yet undergo very little fluctuation in weight. Judged from the perspective of a control system designer, getting that kind of stable outcome from wildly varying inputs doesn't just happen by luck. And indeed, experimenters have shown repeatedly that "naturally lean" people experience reduced appetite in the days following a period of overeating. You can even deliberately perturb the system by force-feeding them, and they bounce right back to their long-term weight thanks to reduced appetite and increased metabolism.

>>This is a common myth, but it's wrong.

Stop your nonsense. Its chemistry.

> Dietary fat is what is primarily stored and leads to weight gain during caloric excess

Do you have a source for this? The sources [1], [4] you quoted don't seem to say that, at least in a way I could understand.

I could have posted a better reference for that claim, but I was actually very busy when I wrote that. This article by the same author (Lyle Mcdonald, a revered expert on nutrition) clears up that point very well: http://www.bodyrecomposition.com/fat-loss/how-we-get-fat.htm...

So your reference is a guy posting stuff on a blog? Well, here's a counter for you: I've lost 7 kgs on a ketogenic (low carb, high fat) diet. I eat as much as I want until I feel full. And according to body measurement scans, I lost mostly visceral fat and almost no muscle, which is amazing.

Yeah, try telling me you get fat from eating proteins and fat.

Calories in vs. calories out would assume we all have identical digestive physiologies which we don't.

Furthermore there are many practices in cattle raising that allow for more fat and muscle gain without increasing calories but instead changing other factors.

The following shows the hormone regimen for cattle to increase fat without changing the calories in aspect of the equation.

http://www.gov.mb.ca/agriculture/livestock/production/beef/g...

Sugar is not the culprit behind all the diseases listed in the article. Obesity is

And sugar is culprit behind overeating and obesity.

Precisely. Experiment: eat 500 calories of sugar (ice cream, soda, candy). Wait 15-20 minutes, how hungry are you?

Now, eat 500 calories of fat (heavy cream, bacon, pork belly, etc). Wait 15-20 minutes, how hungry are you?

I've done this experiment a few times now, and without fail, I crave more food after the sugar and can't eat another bite after the fat.

I can confirm that from my own experience. I lost 20kg in 6 months. Yes I restricted my calorie intake. But how I did that? By controlling my appetite with avoiding carbs especially sugar. Ketogenic diet is powerful tool for restricting calorie intake.

Concur. I didn't restrict my calorie intake, and lost 40lbs eating 65% fat, 30% protein and 5% carb. As soon as I add in sugar or other carbohydrates in any capacity, I gain weight and eat much more. On a ketogenic diet I rarely even think about food - I am rarely hungry.

> I didn't restrict my calorie intake

>On a ketogenic diet I rarely even think about food - I am rarely hungry.

You probably did lower your caloric intake. The trick is that you did it in a way that it did not bother you. In other words, you ate a healthy diet.

But this is giving away the farm; if the way to eat healthy is a high-fat diet that cuts out the empty carbs (and especially sugar), and then you just naturally eat a healthy amount of food after that without any sort of bizarre calorie counting, that's not proof that "it's all just calories", it proves the exact opposite, that the calorie type matters a lot and conventional nutritional wisdom up to this point on what constitutes a healthy diet is dead wrong.

Which it is. But I find it bizarre that people will fall back to this defense, or, at least, I find it bizarre how many people still think this is some sort of defense, when it is in fact the exact, total, polar opposite of the position they think they are defending.

>that's not proof that "it's all just calories", it proves the exact opposite

At this point we are just arguing semantics. If you eat fewer calories, regardless of how you accomplish it, you will lose weight. Yes, it is easier to lose weight with healthy diet.

The whole line about "it's just calories" is precisely that it does not matter what you eat, it's all just calories. If you agree that it does matter what you eat, it is a fundamentally different position, and it means that, like I said, you are no longer defending the conventional wisdom, you are stipulating the correctness of the attackers, while still confusing yourself into the idea that the original position that you have now stipulated is inaccurate is still somehow true.

You misunderstood me.

You can lose weight focusing solely on calories. It is easier to keep your calories in check while eating wholesome foods for numerous reasons, but at the end of the day, the gain/loss is governed by calories.

you didn't KNOWINGLY restrict it, or you upped your calorie expenditure...

calories in, calories out.

OTOH I lost 20Kg eating lots of fruit (evil addictive fructose in there) and no meat.

Any one-sided diet can work if your awareness rises. More wholesome diets might even work better in the long run.

How many of those 20 kilos was lost muscle mass? Protein intake is crucial for muscle maintenance. Body cannot synthesize it from either fat or carbs.

I can one up everyone. I lost weight on an almost all-fruit diet. And also weight on an almost all-meat diet. What they had in common was simple foods that satiated me and did not impel me to overeat.

I've been part of diet communities with keto dieters for awhile and I have met people who have gained weight on keto. These people seem to not be as satiated from things like bacon as more successful keto dieters.

I eat a more diverse diet now. I stay away from foods that cause me to overeat like fries.

I've been doing Keto for 5 weeks now, it's an improvement and very easy to follow. Restricting calories is definitely a good way to approach weight loss. I'm so far happy with all the results.

Can you think of any other ways?

As long as you get the right amount of calories and nutrients, keto can be healthy long-term, as can veganism. People should chose the diet that works for them. The diet they like enough to follow.

For me, keto naturally reduces calories. I'm not the kind of person to overeat bacon or butter. I like them, but I won't overeat them. Whereas when I was vegan I found myself overeating a variety of things.

Lustig is primarily concerned with fructose (and sucrose, which quickly metabolizes into a 50-50 mix of fructose and glucose).

Carbs in general (ones that metabolize mostly into glucose) have been widely available for a long time. They are also processed in a more "normal" way than fructose.

It might still be a good idea to reduce carbs, but I'm skeptical that the ketogenic diet is healthy.

Why skeptical? It has been used for quite a while to treat children with epilepsy. If you're trying to lose weight, it makes sense to avoid things that are uniquely fattening (starches, sugars, etc). Ask anyone that was around before the low-fat fad of the 80's and 90's how you would lose weight - eat less bread, sugar, candy, cake, potatoes, etc.

Ketogenic diets are indeed not healthy over prolonged periods and should be limited in time. They're very effective though, so if you wanna do it just seek advice from a nutritionist and keep being supervised. It's like putting the body in emergency mode, something you don't want to do for several weeks at a time.

Unfortunately, dieting will not change anything unless you really change your lifestyle and eating habits forever.

Any diet is a failure if it's just something you do for some time, just to get back to the old habits once you shaved off some pounds. Because of that, keto diets are not a good solution, since people get the wrong assumption about dieting ("I can eat like an animal and then do some keto to get fit again") and they're very likely to induce some sort of weight cycling (the so called yo-yo effect).

Therefore keto should be used with caution, by people who do that with knowledge and with the help of a professional. Sticking to healthier eating habits over time is much more difficult and you need a very, very strong commitment. At some point in time, though, there's a switch that finally clicks and everything becomes more easy. Exercise should be a big part of this journey.

In the end it's much more rewarding and you'll discover a whole range of benefits. Weight loss will be just an insignificant detail, then.

> Ketogenic diets are indeed not healthy over prolonged periods and should be limited in time.

They aren't? Are there strong hints* that this is true? I didn't see any so far, but that may be due to my limited research.

For one thing: kidney stone are a very common issue when ketosis is sustained for a long period. That means that you always have ketonic bodies in your blood (checkable with a quick urine self-test), which may not be the case for many diets that are just low-carb and not strictly "keto".

I don't think the idea that junk food is bad for you is surprising to anyone, even if Lustig paints it as a revelation. Have you tried 500 calories worth of apples?

The closer people move to actual food and sanity, the further I feel we'll move away from obesity. Rehashed sensationalism helps few other than diet gurus and their brand.

How about 500 calories worth of 100% natural apple juice (about 4.5 cups)

Try it. Drink it and come back in 15-20 minutes and let me know.

Then try 11 slices of pan fried bacon (43 cal/slice according to google) and then tell me how hungry you are in 15-20 minutes.

I don't think that is a fair comparison, can you drink fried bacon? Why would you compare liquid juice with hard meal? It is much easier to digest juice, why not just take a kilo of apples (520 calories)?

because fiber.

Okay, how about half a cup of heavy cream instead of bacon. I guarantee you won't feel hungry 15-20 minutes late.

All this is fun for experimenting, but none of it proves that we need to remove sugar from our diets. Food is complex and shouldn't be reduced to macronutrients. Maybe the protein in the bacon or the nitrites challenging your bowels contribute to your satiety too.

If Lustig's views stop people from pounding soda all the way to the diabetician's office, then great, but if they start putting you off of fruit and vegetables then I think it becomes highly questionable.

Fruits in their natural state with lots of good cleansing fiber and lots of non-starcy vegetables are awesome! I think everyone agrees that should be the core of a healthy diet. I think even most people agree protein is generally a "good thing".

What we don't agree on are the roles of starches, sugars (added and in drinks), and fats. What we do know is that the combination of both leads to bad things in excess. What a lot of folks that have cut out sugar/most carbohydrates will tell you, is that they feel much much better and lose weight easily and effortlessly, even without making a conscious effort to restrict calories or exercise more.

On the other hand, many people on high-carb, low-fat diets struggle to lose weight without careful caloric restriction and additional exercise.

Of course, anecdotal and such, but come on - it is sorta kinda obvious here.

I don't see why this is downvoted. Actually 500 calories worth of apples will keep you satisfied at least an hour. And try to eat a thousand, I bet you can't. I believe that low fat, high carb diet is much more sustainable, but one have to try it to see how it works. All that sugar blaming is just a fad and it will pass on, the main problem with sugar is that is almost always accompanied with tons of fat, you would not believe it. Take raw potato with <1g of fat on a kilo, and french fries that have 154g of fat per kilo! Are carbs from potato the problem?

Perhaps, but it seems to me at this point in time most every variety of special diet has been tried, and I've never heard of a low fat high carb being effective, whereas there are MANY thousands of people that rave about the amazing effectiveness of a low carb high fat/protein diet.

If you have evidence to the contrary, preferably including a forum of people who have had success, but even just the common name of such a diet, I'd be quite interested to read about it.

> Take raw potato with <1g of fat on a kilo, and french fries that have 154g of fat per kilo! Are carbs from potato the problem?

From anything I've read, the answer is yes, the carbs are the technical problem, but another at least as important factor is: french fries are delicious, so you'll eat 3 times as many.

Thanks for honest answer :) It's interesting how there is so much evidence for whatever approach you take on foods :D I guess one can only try and see how anything works for him.

Well, there is no consensus about common name and there are more than one approaches to this kind of eating (high carb, low fat, low protein) I will list you some references so you can see what I'm talking about. In no special order:

http://www.heartattackproof.com/articles.htm http://www.drmcdougall.com/health/shopping/books/starch-solu... http://www.youtube.com/watch?v=4XVf36nwraw http://www.youtube.com/watch?v=d5wfMNNr3ak http://www.nealbarnard.org/ http://www.youtube.com/user/PrimitiveNutrition/videos http://nutritionstudies.org/

Here's another experiment. Eat 500 calories of 50% fat, 50% sugar. For example, ice cream. You'll feel much hungrier than both a fat and sugar only diet. It's fat and sugar combined that cause obesity problems.

I agree. Sugar (in some people) can cause the storage of extra calories - if those calories are from fat, it will be stored.

Here's another experiment - take 300 million people, tell them to eat primarily carbohydrates and limit their fats. Observe the trend for 30 years.

I eat a pint of ice cream as a meal on rare occasions, it fills me up and I'm only a little hungrier than normal when the next meal time comes round, which I attribute to a pint of ice cream not having as many calories as a typical meal.

>>Doughnuts, one of my favorite foods, can be part of a healthy diet just like anything else.

When you say "doughnut" you mean this[1], right? If so that's 100%, Grade A nonsense and abruptly ends any consideration I was giving your comment.

1. http://twincitiesdonut.com/images/donut.jpg

I'm not a particularly big fan of doughnuts but I do tend to eat one or two large bagels (which don't have nearly as much sugar content as doughnuts but do tend to get lumped into that whole "carbs are evil" thing) before going on a long run or bike ride. I also eat more fatty meats than average but that goes along with doing heavy weight training at least 3 times a week.

There are many foods that looked at out of context aren't particularly "healthy" if considered against an average modern sedentary lifestyle but which are sources of either quick energy or useful protein which can be beneficial for weight management and overall health if properly utilized.

All of this is why talking about diet without also talking about exercise is useless.

My completely non-scientific belief is that while over-consumption of sugar isn't a great thing, the primary thing making us fat is that we've switched to a massively sedentary lifestyle on average. We aren't toiling in the factory or on the farm or walking door to door selling vacuums, and mostly that's a good thing because those jobs aren't particularly interesting for many of us, but at the same time our bodies aren't really evolved for sitting down 8-16 hours a day.

I agree with your comment.

Once every 2 months or so, I buy one of these[1]. But there's no way it can be "part of a healthy diet just like anything else", as the person I replied to seems to think. It is an exception to my healthy diet, not part of it. I deviate from my healthy diet once every 6 - 8 weeks to indulge. I'm also aware of Micheal Phelp's diet[2] would work for me too if I could swim back & forth for at least 4 hours a day instead of standing[3] in front of a computer for 8+ hrs.

1. http://www.militarydiscountscentral.com/wp-content/uploads/2...

2. http://blogs.wsj.com/health/2008/08/13/the-michael-phelps-di...

3. I have a standing desk and never use my chair.

Have you ever eaten a dessert? How is that any worse than eating a donut?

Great way to prove that you lack any understanding of dietary health AND cannot argue rationally.

According to this guy, sugar and carbs contribute to the development of cancer:

http://www.youtube.com/watch?v=WUlE1VHGA40

According to this guy, Jesus rode a dinosaur to work:

(insert appropriate YouTube link here)

Unless my irony detector is off, you can't make that accusation without posting some kind of evidence. That guy happens to be the president of the Memorial Sloan–Kettering Cancer Center, so I'm willing to accept he knows a bit more about cancer than me.

As you said elsewhere in the thread its calories-in, calories-out.

This simple fact is a very big win for science, but it is very unpopular - no one likes to actually calculate calories, so a lot of people prescribe to dubious unbalanced diets that sound convincing by catering to their food preferences and aesthetics.

No regulation short of destroying consumer choice and imposing an approved-foods-list will defeat obesity. Trying to just limit sugar is pointless because industry and consumers will substitute the current form of sugar for something else, raising the cost of food in the meantime, which will hurt the poor. (Just like an import quota on sugar in the US has not reduced consumption of sweets, because sugar got substituted for HFCS).

I think the best way to solve obesity is to find some chemicals that satisfy appetite easily and cheaply or sweeteners that are as good or better tasting than sugars, but are not caloric. (Aspartame is very sweet, but tastes significantly worse than sugar).

Yet the pendulum has swung so far away from "just a bit of Moderation" that the now all-pervasive sugar (virtually) cannot be avoided.

Left to their own devices, industry will NOT comply so regulation is a valid tool to stave off the massive public health risk that unchecked industry has introduced.

While muscle growth does require sugars, it is not required in anywhere near the amounts present in every single food on shelves.

Your arguments reek of industry propoganda and astroturfing. They've got an air of populism and fallisciousness about them... "But sugar is needed for muscles... See science?"

Come on... You're one of those paid forum commenters we keep reading about right? Some guerilla marketer working for big sugar? Is it an agency with lots if clients or just one topic?

Doughnuts, one of my favorite foods, can be part of a healthy diet

Can they?

If it's ok to otherwise eat responsibly but allow oneself one doughnut a week—and I think that this is ok—then yes, they can.

If you start from the assumption that sugar is a poison, then you'd probably say no. That seems like begging the question to me, though.

If you examine the diets of healthy people, you'll see that some of them eat donuts occasionally. That would seem to indicate yes.

There's not a dietitian on this planet that when asked to define a "healthy diet" would include donuts. This guy is living in denial if he honestly think this.

You're assuming the healthy diet concept is entirely prescriptive, in that there's a List of Healthy Things to Eat which thou must not deviate from. That's not how dietitians approach it. It mostly revolves around ensuring your macro and micro nutrient intake keeps to certain levels determined largely by your activity level.

Actually, any dietician who knows their stuff and isn't trying you sell you something on comission will allow for a "healthy diet" to include pretty much anything you want in sensible amounts. Because they know that people aren't going to stick to a diet that completely bans their favorit foods.

I didn't think he was advocating eating only doughnuts. Doughnuts are great, unless you eat nothing but doughnuts, in which case the diet is not particularly balanced, nor is it healthy.

I'd argue almost anything can be part of a healthy diet, when consumed in moderation. But in itself, there really is nothing in a doughnut your body needs, except energy. I wouldn't even call it 'food' in the sense that you eat it because your body needs it.

The OP seems to make a really big point out of justifying sugar as 'not a toxin' just because you can consume sugar without killing yourself or instantly getting fat. There's probably some denial and 'I like eating sugar' sentiment going on there or something.

I didn't find any convincing arguments as to why adding sugar to processed food, or consciously consuming suger because you think you need it is warranted. Alcohol can be part of healthy diet as well, or motor oil, for that matter. That doesn't mean these things are healthy, or that there aren't any health benefits not consuming those.

Sugar is a simplex carbohydrate. Carbohydrates are a nutrient. Your body needs nutrients.

Alcohol is not a nutrient.

That doesn't make sense, your body needs minerals as well but that doesn't mean you have to eat dirt, rust, or chalk. As far as nutritional value goes, sugar is one of the least healthy sources of energy, especially in its refined form (which is what this article is about). Mankind evolved through millions of years without even having access to refined sugar.

Also, how is alcohol less of a nutrient than sugar? It gets metabolised to carbohydrates your body can use as energy, store as fat, etc. Apart from the fact there's an extra metabolic step required to convert them to carbohydrates your body can burn as fuel, there isn't much difference compared to sugar, at least not from a nutritional point of view (obviously this says nothing about other health effects alcohol has).

You need minerals. You get minerals from food. Those minerals are in a bioavailable form. Eati g dirt or rust or chalk isn't useful because the minerals contained by those items are not so bioavailable and they contain far more minerals than are needed.

You're totally right about sugar being a problematic source of energy. A thin spread of honey on toast? Tasty and not so bad. A fistful of sugar in a drink twice a day every day? Obviously really bad.

One of the problems with the "sugar is toxic" mantra is that we risk making the same mistake as that "fat is evil" crowd. Selling a sack of sugar (sweets / candy) as "FAT FREE!" Is obviously really bad.

Alcohol isn't a nutrient, but the carbohydrates it provides are. But alcohol is actually toxic.

Yes. They can be the unhealthy minority in an otherwise healthy diet.

Personally, I eat a lower-carb diet of fruits, vegetables, meat, fish, and other healthy foods most of the time. A few times a year I have a doughnut. Do I have an unhealthy diet because of that?

I'd like for you to actually explain how it's wrong to say that replacing a fat-heavy diet with a sugar-heavy diet is bad for health. You dismiss their premises and conclusions by saying they're looking at the wrong culprit for health problems. I'd prefer if you dealt with their premises and conclusions by falsifying said premises and conclusions.

I advocate moderation and balance. Consume reasonable calorie and macronutrient (protein, fat, carbohydrate) quantities. Eat what allows you to do that. For me, those carbs come from doughnuts and candy but also from brown rice and pasta. Just like my meats include both lean meats (chicken breast) and fatty, delicious meats (bacon). Combine this with exercise and all you'll avoid all the scary things the article talks about.

Moderation and balance, based on what precisely? Who defines what balanced is? Who pays to have their product a bigger portion of a balanced diet?

You mentioned bacon as an example of a fatty meat, but one should think twice before having bacon at every breakfast:

  We estimated that 3.3% (95% CI 1.5% to 5.0%) of deaths
  could be prevented if all participants had a processed
  meat consumption of less than 20 g/day.

http://www.biomedcentral.com/1741-7015/11/63/abstract

Again, you deal with their argument by avoiding it and offering an alternative plan of action. I am asking if you can explain why what OP is saying is wrong, not how we can make OP's issues become non-issues. Asking as you seem quite passionate about the subject.

Your assumptions about a high fat diet are a function of the "greatest health scam of the century":

“Somehow we have been led to believe that dietary fat will raise our cholesterol, which will in turn increase our risk for heart attacks and strokes. This notion continues to prevail despite research from nineteen years ago that proved otherwise. In 1994, the Journal of the American Medical Association published a trial that compared older adults with high cholesterol (levels above 240 mg/dl) to those with normal levels (below 200 mg/dl).9 Over the course of four years, researchers at Yale University measured total cholesterol and high-density lipoprotein (HDL) in almost one thousand participants; they also tracked hospitalizations for heart attack and unstable angina and the rates of death from heart disease and from any other cause. No differences were found between the two groups. People with low total cholesterol had as many heart attacks and died just as frequently as those with high total cholesterol. And reviews of multiple large studies have routinely failed to find correlation between cholesterol levels and heart disease.10 Mounting research like this has prompted Dr. George Mann, a researcher with the Framingham Heart Study, to go on record stating: The diet heart hypothesis that suggests that a high intake “of fat or cholesterol causes heart disease has been repeatedly shown to be wrong, and yet, for complicated reasons of pride, profit, and prejudice, the hypothesis continues to be exploited by scientists, fund-raising enterprise, food companies, and even governmental agencies. The public is being deceived by the greatest health scam of the century.11”

9. H. M. Krumholz, et al., “Lack of Association Between Cholesterol and Coronary Heart Disease Mortality and Morbidity and All-cause Mortality in Persons Older Than 70 Years,” JAMA 272, no. 17 (November 2, 1994): 1335–40.

10. H. Petousis-Harris, “Saturated Fat Has Been Unfairly Demonised: Yes,” Primary Health Care 3, no. 4 (December 1, 2011): 317–19.

11. http://www.survivediabetes.com/lowfat.html.”

I never said that a high-fat diet was good or bad and certainly never made any assumptions on that matter. I asked parent to comment on OP's thoughts on the transition from high-fat diets to high-sugar diets. Very different.

The thing with fat is that for cardiovascular disease(CVD) prevention especially polyunsaturated fats are best compared to saturated fats and simple carbohydrates. Replacing lots of fat in your diet with sugar risks replacing polyunsaturated fats. Even replacing the saturated fat with sugar appearst to be at most CVD neutral, but possibly raises your heart attack risk.

One reasonable overview on the subject is http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2824150/

"Very few fossil hominins have cavities. The decline in oral health started with agriculture and resulting changes to oral microbiome." — John Hawks (paleoanthropologist).

Diet has a lot to do with cavities.

At what age did these pre-agricultural people die?

Age might have a lot to do with cavities.

Pre-agricultural people lived longer & healthier lives than post: The development of agriculture was terrible for individual health, but once invented we couldn't go back because the hunter gatherer approach couldn't support as many people.

Regarding cavities: I recently read of a pre-agricultural tribe who had very high cavity levels due to a diet which was very high in nuts. Most H-G tribes appear to have lower levels of cavities than modern people at all ages I believe.

An acquaintance I once met, that used to work on the product design team for one of the major brands of snack/potato chips makers, had a witty response to what a friend asked, along the lines of:

"so, tell us, how can you work at something that you know is bad for people's health?" and he answered:

"I am certainly used to the opinion that garbage food is bad for your health, and what I think is that garbage food does NOT exist. What it actually DO exist are garbage diets. If you eat one bag of chips every now and then, nothing bad will happen to you. However if you eat one bag a day for 10 years, you will probably feel the effects."

So the bottom line is as usual, everything in moderation. I mean, the often used analogy is with water. You can't live without drinking it and yet you can certainly die if you drink too much of it.

Isn't this like an overdone debate? I mean, you can definitely start an alarmist attitude towards almost anything you can think of, no?

The only thing this tells me is that your acquaintance has a good working "moral deflection" system. What? Cigarettes are bad? No, no, I wouldn't work on a bad product. All is good in moderation! What? I spam people with ads all day and that could be bad? No, no, I wouldn't work on a bad product. I only inform people!

And so on. No one thinks he does bad* things. Your mind forbids it or you would probably go insane. That doesn't change the reality.

* For various values of bad

I actually never thought of it that way. You could be right to some extent in that he is indeed a good "moral deflector", but the main point I was trying to make still stands, in that one bag of chips is not something that will significantly change your chances for cancer or whatever other disease could be associated with eating a lot of the stuff.

Same with cigarettes. Indeed they have been undoubtedly linked to cancer, but still, if I smoke only one it really won't make a difference. Same with spam, one email every few months, as has been my experience with gmail for the past several years for example, really does not annoy me more than a mosquito could. There's a difference between working on a bad product such as, let's say hand grenades or other stuff actually made to harm, and working on a product that is definitely bad but only if you actually let it be, i.e. abuse it.

My point is that the blame is not on who makes the product, as the product maker does not make said product with the intention to harm, even if they do know that if you cross a line it will be harmful. The blame is on the person that lets this product ruin its life. Just like any drug. If I hit a joint right now, I guarantee that it won't harm me. But if I let it run my life and I stop working because I want to smoke weed, then the blame's on me, not on whoever grows the weed or even the one who sells it to me. Precisely the reason as to why we usually put age restrictions on certain things, as we deem children to be not capable of drawing this line between use and abuse of things that could end up being very harmful. However as we grow up we believe that we are then capable of taking responsibility for your life choices. Including giving yourself cancer or diabetes by only drinking cola and eating chips.

It's not the smoking that gets you, it's the lung cancer and emphysema.

You're right, but the extremely low visibility of wonderful resources like http://www.youtube.com/watch?v=dBnniua6-oM (and the articles it's based on, even in the medical research community) make "pulling in the other direction" (even if it's just as wrong) a good course of action for achieving a properly balanced view of the scientific facts.

Re: 4, don't you think it's a bit of a stretch to go from a study that notes that temporary carbohydrate overfeeding can increase leptin, to saying that a little bit of sugar will keep you on your diet? (It's an intriguing result, no doubt, just not something that I'd make sweeping extrapolations from.)

If you watch the video, that is referenced in the article. Robert Lustig explains why sugar leads to obesity.

Here it is for easy reference: http://www.youtube.com/watch?v=dBnniua6-oM

Obesity is an effect. Not a cause. Seriously. Do you blame fire?. The problem here is that sugar is addicting. http://www.ncbi.nlm.nih.gov/pubmed/23719144

http://www.businessinsider.com/whats-wrong-with-the-modern-d...

Aspirin can be good for you too, but I wouldn't go drinking 32 ounces of aspirin solution every day.

Because skinny people don't get diabetes right? /s

Rates of type 2 diabetes are in the non-overweight population are extremely low.

Skinny people can get type 1 diabetes, but that's a completely different disease -- acquired hypoinsulinaemia, as opposed to hyperlipedaemia. (Note, neither diabetes is essentially about glucose; it just happens that hyperglycaemia is a symptom of both diseases, and Aretaeus didn't know better.)

The only point I'm trying to make is that blood sugar is culprit of the numerous conditions afflicting wealthy countries, not just obesity. Clearly obesity isn't a neutral variable in this equation.

And my point is that (aside from glycation damage), blood sugar is a symptom of disease, not a cause of disease.

If only we could figure out a way to not eat foods that increase the amount of sugar in our blood....

Did you completely ignore the comment you were replying to?

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