Try reading the objections to Lustig’s characterizations again.
It’s not that it’s unreasonable to conclude that excessive sugar intake leads to health problems. We know that already (though the degree to which it is linked to various conditions is still highly debatable).
What’s idiotic is calling sugar (or any component of normal, healthy diets including fat, protein etc.) “toxic” or “poisonous” as Lustig does. That falls into the same realm of fundamental misunderstanding of what constitutes a toxin that alt med woo-sters are prone to. The dose makes the toxin. It’s not that hard to comprehend.
I pity nutritionists who constantly have to deal not only with mistaken/unproven concepts about how major classes of nutrients are Toxic or Bad, but with delusional thinking about how eating Superfoods will prevent or cure lots of diseases.
So the issue is the hyperbole? How the study is being marketed to the public at large?
Ignore the stupid word choice of “toxic” – the findings seem pretty impressive. Controlling for BMI and exercise level, for other food types (including fibers, meats, fruits, oils, cereals) and total calories, for socioeconomic status, age, etc., additional calories from added sugar were more correlated with diabetes rates than calories from other sources.
“Toxin” is not an accurate word for that finding, agreed. But no other single word I can think of comes close to capturing the intended meaning that added sugars seem to have a specific role in metabolic syndrome by means greater than its effect on BMI or by triggereing excess intake. Sure there can be residual confounders but it seems like a pretty good study.
That is a big deal and if true, handling added sugars in a similar way to how we deal with substances we label as “toxins” is worthy of discussion.
I don’t know if I would go as far as saying it’s completely bogus. They are conducting clinical trials of ketogenic diets to slow tumor growth for certain kinds of cancers, especially for brain tumors since only glucose and ketones can cross the blood-brain barrier.
I don’t know; no one has posted a link to the complete text of the study and I’m not an expert at picking apart limitations of studies, how they conflict with other studies, etc. I’ve been interested in this topic for some time and have never seen strong evidence that sugar consumption independent of other variables such as obesity can be to blame for diabetes.
For now, below is Mark Hoofnagle’s opinion of the article linked to in the OP (he has an M.D. and Ph.D. in physiology).
The article linked to the study. And yes no doubt the NYT article was hyperbole and hype. At that same time the actual study article is pretty clear and reasoned. Hoofnhale’s summary is reasonable as well but in his percieved need to deflate the hyerbole I think he undersells what the study does say:
“Only”? The increase in sugar availability can explain 1/4 of the increase in diabetes! Above and beyond it’s already well identified contribution to BMI and body composition, beyond its well established role in contributing to excess caloric intake. 1/4th!
Hoofnhale also is mistaken to use bariatric surgery as proof that it’s all obesity as it is very well established that the effect of bariatric surgery on diabetes is not exclusively caused by the weight loss, often dramatically improves diabetes control before there is any significant weight loss, and definitiely involves multiple factors other than weight loss. I appreciate his desire to deflate the hype machine but it behooves him to be accurate himself.
By removing the first part of the sentence, you made it seem that something entirely different was said than actually was.
If I’m parsing that statement correctly, 1/4 of the increase in diabetes is correlated with populations with more availability to sugar. Nice correlation, but it says very little for sugar being to blame. I’m sure populations with more sugar availability also have more availability to the other things that cause people to get diabetes.
He didn’t say that. He specifically said " Obesity* is* still the main cause of diabetes…"
Yes, as stated a residual confounder is possible. The study is not indisputable proof. That said the known confounders for DM were controlled for. It’s a pretty damn suggestive study and seems pretty solid as these studies go.
He used bariatric surgery as proof of the overwhelming importance of obesity. It actually does not support that.
I was describing how Lustig calculated the percentage of calories from various food groups for use in his study. I had no part in developing the categories he used, which is why I thought it was necessary to point out that they were a little…funny. As I said.
I’d still like to see more posters address ing this part of the op.
Now I admit I clearly fall into the camp (and have stated on these boards previously) that feels that obesity is not so much the problem as it is the symptom of the problem; the problem being a set of behaviors endemic to modern society, the combination of poor nutritional habits, both how much and of what, and a lack of acivity (both exercise and of daily living … which could also be defined as too much sedentary time).
Large amounts of added sugars is part of that problem.
This study, and others referenced in the study itself, suggests that excess calories in the form of added sugar is a significant contributor to DM risk at any given BMI, activity level, other nutritional habits, genetic predisposition, or socioeconomic status.
Added sugars also trigger excess consumption. Most simply put it is much easier to consume excess calories in a few 16 oz plus servings of soda, or in a few Oreos, than it is in broiled salmon with steamed broccoli served with pasta dressed in garlic olive oil.*
If we look at the population of our society as the patient to take care of, an intervention that increased activity levels, deceased the amount of added sugars and low nutritional value foods in general, is an easy recommendation to make. The impact of that change on issues like DM rates, if actually implemented across the board, would be greater than its impact on obesity alone. The benefit to society would be immense.
Does anyone really find that statement controversial at this point?
The issue however is that we are a nation of individuals who have the right, within broad limits, to do stupid things. Within broad limits … not inviolate. The masive amounts of added sugars that we consume, that is extensively marketed to usm clearly causes harm to the society as a whole. Enough harm that it is outside those broad limits?
So far what we are doing about it is attacking it mostly in childhood with some regulations on advertising, the Let’s Move campaign, greater promotion of obesity prevention and early identification on pediatric offices, attempting to change the school environment, and greater public awareness in general. With some moderate success.
Is there any role for stronger measures at a societal level?
*The combination of having during the day two 16 oz Cokes and two doublestuffed Oreos comes to 640 KCal. Amounts very easy for most to consume in addition to their normal meals without even thnking about it and certainly not feeling satisfied from. About the same as eating a 6 oz serving of broiled salmon, 1 cup of steamed broccoli, and a cup of pasta dressed in a tablespoon of garlic olive oil.
Frankly, the article is about 10 years behind the science.
It isn’t sugar per se that’s the problem, it’s the overabundance of fructose. To the body, fructose in and itself is metabolically useless because the mitochondria cannot burn fructose as an energy source. It must be converted to glucose by the cell and, until that time, it acts as a (useless) solute which increases blood pressure by sequestering uric acid from renal nephron. This uric acid is kicked from the interstitial fluid to the blood via the vasa recta where it perturbs the vasculature by preventing endothelial cells from releasing nitric oxide (a vasodilator). So much so, that having chronic high levels of uric acid makes you more likely to have all sorts of cardiovascular problems.
Some clown mentioned (sarcastically) that fruits have fructose in it. Yes, you’re right. Fructose is a pancreatic carcinogen: just ask Steve Jobs (the one with the high IQ) who decided to eat nothing but fruit and ended up being diagnosed with <drumroll> pancreatic cancer. If you or anyone else thinks that fructose doesn’t cause pancreatic cancer, then I encourage you get on a diet of high-fructose foods and see for yourself. Or, better yet, you can ask this guy.
You’ll probably read an article in another ten years telling you that fructose-rich foods increase your appetite for sugar. Believe it. Fructose doesn’t turn off the molecular switch to let you know to stop consuming energy-dense foods; therefore, if you want to make your cakes and pies sell, you just pump them up with fructose and sell them in low-income areas. Fructose levels in foods should be regulated but given the anti-government political climate in this country, I doubt there’s a scholastic aptitude to understand the problem nor the political will to regulate it.
I didn’t bother because there’s no need for me to cite something that I know is 100% fact. But since you’ve asked: feel free to look at some evidence here, here, and here. The second link is a free article if you’re unable to access scientific journals through your university or school access.
Colander, I encourage you not worry about the cites but to join in on a high-fructose diet that many poor, low-income Americans eat everyday. In the morning, your diet should include a flour-based, energy-dense carbohydrate (e.g. twinkies, cinnamon buns, etc), Welch’s grape juice, and a banana. Lunch and dinner should also topped off with copious amounts of fructose-rich foods like fruit juices and processed sugars. Do this for about a year and let us know how your pancreas is doing (tell your doctor to run a blood test for carbohydrate antigen 19 - your doctor will know what I mean) as well as your blood pressure.
From a practical POV, please remember that the table sugar (sucrose), high fructose corn syrup, honey, all contain roughly the same amount of fructose to glucose. Some fruits contain a slighty higher percent of fructose relative to glucose than those sweeteners do but generally contain fairly small amounts of sugar compared to a 16 oz soda: a large apple has less than half the sugar (23 grams) of a 16 oz Coke’s 56 grams, and comes with both soluble and insoluble fiber (over 1/5 of your recommended daily allowance) plus a bunch of other good stuff. A large banana? Only 17 grams of sugar, 14% of your daily fiber, and if not too ripe some resistant starch that functions as a prebiotic and satisfies longer.
The study found no correlation of increased DM risk with more fruit intake. The correlation was with added sugars. Again, it does not prove it was the added sugar. Added sugar could just be a marker for highly processed food created by the food industrial complex as a general category, for example. But a diet high in fruit, as part of an varied diet of real foods with adequate protein and vegetables? Few will have anywhere near the amount of daily sugar as a diet that contains lots of processed foods with added sugars. Diets high in fruit are consistently associated with overall lower cancer risks.
