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EventsObesity and the trouble with sugar
Here is professor Robert Lustig’s insightful talk from AHS – again. This time the slides are included in the video (not always perfectly synced) which makes the video much more watchable.
Lustig has a very believable explanation to how our weight regulation works, and why it sometimes do not. The core of his message: Too much fructose (or even more glucose) in the diet increases the hormone insulin which induces leptin resistance and makes us want to eat too much.
See his talk and you will understand more about obesity than many confused experts do. Personally I have seen it three times, which makes me feel very smart.
Interventions to Reduce Sugar Consumption
Authors@Google: Robert Lustig
I suppose I'm a bit of a slow learner as hearing the same information in different presentations seems to work for me.
I've listened to all the Taubes Adiposity 101 online versions for the same reason.
I'm assuming everyone has listened to Sugar: The Bitter Truth - YouTube
It may also be that if you are on a very high carbohydrate diet replacing some of the fructose with glucose (replacing sugar with starch) may be beneficial but this effect is very small compared to replacing any carbohydrate with fat. This has been demonstrated many times especially by Ron Krauss who is a co-author on the AHA paper that Lustig cites.
His presentation of the science is also full of gross mistakes. Fructose is a sugar and is metabolized like a sugar, different from glucose but the metabolism has little in common with the metabolism of ethanol. The metabolism of fructose and glucose come together at a certain point and so are inter-convertible. That is why the glycemic index of of fructose is 20 and not zero. (Glycemic index is a measure of the effect of carbohydrate on blood glucose; glucose - 100) What's really wrong with the biochemistry is that Lustig acts as if this is all known and simple. It's not. The concern is that setting up fructose as a villain will be another smoke screen like trans-fat, saturated-fat, fiber, for not facing the need for carbohydrate restriction.
Bottom line: your best bet for obesity and metabolic problems, is carbohydrate restriction. Which carbohydrate is strictly secondary. Lustig's talk was part true, part snow-job, part gross mistakes. Much better from AHS was Andreas's talk which nailed the problem beautifully.
Thanks!
Interestingly Lustig said in the Q&A (starting at 44 min) that he had no problem with anything I said in my talk, he basically agreed, he just wondered if it was necessary to be that "extreme". :)
Lustig acknowledges in this talk that fructose can end up refilling the liver glycogen (turning into glucose first) but only if it needs a refill, not when it's already full. So Gatorade might be ok for athletes (except for their teeth), but not for the rest of us.
Regarding the fructose-ethanol comparison from his Sugar: The Bitter Truth talk, that sounds a bit dodgy for me too. I don't have the biochemistry expertise myself to say for sure, but I guess you are right.
I love Lustig's "baby step" approach for these people. It's easy to first switch to diet soda with splenda. Then it's easy to switch to cooking with splenda.
Then it's easy start reducing the splenda or cutting back on servings of diet soda. Most folks will have lost some weight after about a month of this, and be motivated to continue on. There's no social sanction about giving up sugar; in fact, most people will congratulate you for it, even.
Then it's easy to avoid bread - by choosing either bread OR pasta - not both. After avoiding bread, avoid the pasta. Weight loss will increase, providing more motivation. And again, becoming gluten-free is something that is now receiving more social approval.
And so on. In a month or 2 people will be easily low-carb without feeling "deprived" or running into the social backlash against low-carb, or "Atkins," which in many circles will get you serious social punishment. :) To avoid the Atkins backlash is why I think Lustig calls low-carb "extreme." :)
As for his science, he's a professor. I'm sure if you simply point out the errors in biochemistry to him, he will gladly correct them. This is normal scientific behavior, to accept feedback, correct, and improve. :) I've read people who meet him saying that altho' he seems combative in speeches, he's actually rather nice as an acquaintance. :)
Lustig is a nice guy. We had a long talk at AHS and we continue to communicate. I explained what we agreed on. On our disagreements, we are trying to discuss things and neither of us want it to be personal. His position is, in my opinion, way off the mark. One way to describe the differences is that in science if you don't know, you don't know. In medicine, if you don't know and the patient is sick, you have to do something. That's why people think highly of doctors because they are willing to shoulder that responsibility. So without blaming him, there is a real threat of fructophobia.
Can you clarify regarding fructose being inter-convertible with glucose. Is fructose inter-convertible with glucose in the context of a caloric deficit, but not inter-convertible when consumed along with an excess intake of calories (or, I should say, when glycogen is replete)?
Is it possible that metabolic derangement from fructose occur only when excess calories are eaten or glycogen stores are full?
The question I have about Lustig's AHS lecture is the idea of seasonal insulin resistance. The idea makes sense to me from a high northern latitude perspective. However, I have no idea about the climate of Africa, nor the available fruit, over the past 2.5 million years. I've read accounts of African peoples having no problem catching different animals at different times of the year. It would be interesting to look up sources, if I had the time.
You are correct that at high caloric or specifically high carbohydrate intake, F will contribute more to fat synthesis but, even here, again, the effect is much less than replacing any carbohydrate with fat. The effect of glycogen is probably not known. The idea that it is not interconverted with F if glycogen is high is probably made up by Lustig. Glycogen is broken down and resynthesized all the time.
What's wrong with Lustig's biochemical map is that, like any map, it only tells you where you can go, not whether you are going there. If this is not concrete enough, I think it is the state of the art. We don't know the relative responses under every condition. We are not ready to say that fructose is inherently worse than glucose under most conditions. And we are especially not ready to start making policy. The government can do a lot of things. Provide education have hearings, etc. The first response of politicians is to tax or otherwise punish. That's what Lustig wants. Don't see much promise there.
Now both have behavioral effects and may stimulate convergent neuronal pathways but this is not really my area of expertise. Both can be consumed to excess but not always by the same people. Psychologists distinguish between reinforcing value (continued behavior) and hedonic value (tastes good). I am fond of single malt whiskey but rarely drink two days in a row. On the other hand, I avoid ice cream because I find it personally habit-forming. My guess is that Lustig and I could drink to that.
Yes, generally sugar and high carbs go together. Both are used as a quick solution to replenish our good mood chemical, serotonin. I explain how there are legitimate reasons for cravings for sugar and carbs. Stress, in any form, mental, emotional or physical usually results in cravings due to the disruption of hormones, depletion of good mood chemicals and low blood sugar. As a former compulsive eater, I have a personal understanding of how difficult it is to overcome emotional-eating due to our addicting modern foods. There is so much more at play than just craving a bowl of ice cream after a emotionally-taxing day; there is just as much physiologically as there is psychologically.
http://www.youtube.com/watch?v=tdMjKEncojQ
I'm not sure I see Lustig setting out to demonize Fructose itself but rather the *excessive amounts* of it that are eaten/drunk these days. In his follow-up podcast interviews with Jimmy Moore at "The Livin’ La Vida Low-Carb Show" he is quite clear in calling it a "dose-dependant hepato-toxin"... just like alcohol: a small amount may be beneficial or at the very least harmless, but above a certain level it causes harm. Presumably the frequency of intake is also a factor, although if amounts are small, less so.
http://www.thelivinlowcarbshow.com/shownotes/2112/dr-robert-lustig-ep...
http://www.thelivinlowcarbshow.com/shownotes/2925/dr-robert-lustig-be...
With that all said though, I still see a very clear common thread from many voices advising that we reduce/avoid sugar and refined starches as found in processed/packaged "foods"... and that we have no need to fear naturally occurring fats as found in real whole food.
Breaking down the Chain: A Guide to the soft drink industry gives us an idea of the size and power of this industry.
Apples to Twinkies: Comparing Federal Subsidies
of Fresh Produce and Junk Food" summarises the food subsidy element.
I think maybe the current arguments in the Paleo/low carb community we are getting our knickers in a twist about the biochemical details when what is really at fault is our over-reliance on ultra processed foods.
This paper makes some interesting points.
Technology, Diet, and the Burden of Chronic Disease
and makes some sensible suggestions.
Example of Measures to Promote a More Appropriate Use of Food Technology
Government
Restructure agricultural subsidies to promote highquality foods (eg, vegetables, fruits, and legumes)
Regulate food advertising/marketing, especially to children
Adequately fund school lunch and related nutrition programs
Public
Buy fewer ultraprocessed products
Prepare meals from basic ingredients in the home
Give preference to restaurants that prepare meals from scratch
Schools
Prepare lunch and snack foods from whole ingredients
Institute a new “home economics” curriculum to promote cooking
Restaurants
Provide intermediate option between gourmet food and fast food—convenient, inexpensive meals prepared from whole foods (eg, Chipotle Mexican Grill)
Industry
Use higher nutritional value ingredients vs commodities
Market minimally processed/traditionally processed products (eg, stone ground bread, steel-cut oats)
Use preservation methods that protect polyunsaturated fats
Ditto, you said it beautifully. I used to NEED chocolate everyday with cravings I liken to when I smoked and NEEDED a cigarette. Therapists convinced me of a food addiction along with emotional eating. The cravings ruled my life even after I had dealt with the emotional issues. My depression was gone; I felt happy but for those cravings and my so called lack of willpower. In March 2011 I watched FatHead and my whole view changed. I stopped the sugar I stopped the carbs and began LCHF. Today I have zero cravings and I only think of food when I am hungry. I find I am so sensitive to sugar that even fruit will bring the cravings back.
Another side to this is the fact that I had always been very thin naturally. I was a model. When I was pregnant I gained 100 lbs because my cravings were so intense that I never felt satiated. These cravings were a new phenomenon with me. This cycle of cravings, self blame and weight gain has continued until now when my child is 16 yrs old. I finally feel back in balance and the weight is coming off. When Dr. Lustig mentioned the times when it is normal to gain weight, puberty and pregnancy, I got the answer I had been searching for. My issue was a continuing imbalance between my leptin and insulin not my willpower. I am the same strong woman I was in March 2011.
Oh yes, and also during my pregnancy I became lactose intollerant, now I can gleefully take heavy whipping cream in my coffee with no problem. My child was also lactose intollerant until I stopped nursing.
Basically, the problem is excessive carbohydrates, all carbohydrates. some people can a few, but which do need need top cut first, and see where our settling point is at. Too high, cut more.
Lustig says cut fructose,
Many say all sugars.
Davis said wheat first.
Kessler says all.
The simple solution is to cut all carbohydrates, transfats, omega 6 oils, until we reach an acceptable settling point.
I did the HCG diet of 500 calories a day and the drops. I felt horrible had no energy and was starving all the time and constantly thought of food. A complete nighmare that lasted 10 days. You can say I needed to up my dosage or that the shots are better; I dont think that matters, HCG is a bunch of baloney.
Would a therapist ever say: "there is nothing wrong with you, you just need to stop eating most carbs." BTW My lactose intolerance also went away when I started eating LCHF.
@Fredt I agree... and once it's gone, you really don't miss it...
Also, for those trying to decide, I think eating to satiety at each meal is such an important component. This is not about starvation. You will see, you won't even want a snack! and, as I said before, forgeting about food for most of the day is bliss.
truly eye opening
"The Impact of Weight Stigma on Caloric Consumption"
http://www.nature.com/oby/journal/v19/n10/full/oby2011204a.html
The more people say "It's simply Calories in = calories out, so exercise more and eat less = problem solved the worse the situation gets.
We gave got to understand what drives the need to eat and what prevents/discourages activity and if we want to prevent weight regain we have to understand how to reset the natural control system and restore mitochondrial function.
and seen the points about high insulin increasing iron overload you'll realise why the quality and amount of sleep (melatonin - iron chelator- mitochondrial protecting) is part of the obesity story. I'm also concerned that people will be bored/put off by the infighting and think it's not worth the effort. Those here who have followed the Taubes/Dalhqvist/Diet Doctor strategy and found it was sufficient to help, don't really have to worry if it was the insulin/leptin or simply the fact that the absence of food cravings led to a reduction of calorie intake that enabled the weight loss to occur. I'm sure the anti inflammatory (vitd/mag/omega3/melatonin status of the Kitavans/Masai privitive cultures would have impacted on their ability to eat high unrefined carbs with impunity.
We just have to consider how sunlight affects the progress of NASH in rats
http://www.ncbi.nlm.nih.gov/pubmed/21184788
to be able to make a reasonable guess about how outdoor living in sunny countries may impact on insulin/leptin resistance. But how that applies to Western Cultures glued to PC/TV indoor living is a different matter.
Just because the sundrenched Kitavans survived on a high carb diet may not apply to those living in the UK for whom the current sunny weather is a welcome change I hope all other UK readers are taking full advantage of.
my concern is that the fall outs over certain aspects will lead to a "divide and conquer" situation wherein lowcarb/paleo loses out due to the infighting.
also Andreas: i finally got my wife to watch your speech last night, been trying since it first appeared on youtube. she was enthralled and it really helped towards getting her to cut down her chocolate and other occasional treats (read occasional as daily) as she quit smoking earlier and did confess that she feels like her food treats, which are always sweet and sugary, are the only vice she has left.
anyway looking forward to a healthier and leaner future for her :D
Dr. Lustig should do a multivariant analysis on himself, and see what happens if either the amount of glucose or fructose are changed.
Soda obviously contains a lot of fructose.
However, regarding wheat there are heaps of other problems then just the starch it contains. Check out Dr Davis new book Wheatbelly
http://www.wheatbellyblog.com/
If you do these two actions, you probably achieved 80% of the benefits of a low carb diet.
I think you are right.
I found going instantly low carb no problem at all. I get really tired of people's claiming it is difficult. I also get tired of claims that it is harmful, by people who when quizzed can't tell you a single food in it.
I am with Alexandra. In the face of this extreme emergency... Obesity epidemic... Diabetes explosion.... Cancers... Heart attack.... surely the most logical thing is to stop doing what doesn't work i.e. food pyramid/healthy plate, and start doing the thing that seems to work for everyone, even if we don't know why. No drug ever given to me as a critically ill, undiagnosed celiac caused any improvement in my health. In contrast, LCHF Paleo gave me the ability to walk again, and see properly, within days. I lost fifty pounds without even trying. I cured my ataxia. The answer does not lie in a medicine bottle. Nor, sadly, with most doctors at the moment. There is massive and overwhelming ignorance.
I wasn't able to attend, but it sounds like he gave his usual lecture, emphasizing the impact particularly on Latino kids whom he described as having "a genetic predisposition to developing health issues from overconsumption of fructose. . . Sugar-sweetened drinks are prevalent in the Latino culture, he said." (http://www.pressdemocrat.com/article/20111014/OPINION/111019699?p=2&tc=pg)
Now here's the really scary part! Leann Weintraub of Sherman Oaks, California, felt compelled to respond to Lustig's lecture by writing a letter to the editor in our local paper. She described herself as "a registered dietician counseling children and adults with obesity", and the thrust of her letter is that "sugar is not to blame for America's health and weight problems". She attributes the obesity epidemic to "lack of physical inactivity [sic--was this a typo, or a Freudian slip??], and (here's the fun one) "lack of science-based nutrition information." She counsels her (poor!) clients to adopt a more "balanced approach" (because everyone needs sugar in their balanced diet!) including "nutrition literacy, sensible portion sizes, and physical activity."
Amusing in and of itself, but it was the last paragraph of her letter to the editor tells all:
"When I consult for food and beverage companies such as Coca-Cola . . . "
'Nuff said!
Ms. Sherman's letter to the editor of the Santa Rosa Press Democrat may be seen in its entirety here:
http://www.pressdemocrat.com/article/20111024/OPINION/111029763/1044/...