Wednesday, April 27, 2011

The Source of All Evil - Sugar

The advice out there for those who want to understand the increasing levels of obesity and related health issues is both wildly inconsistent and unthinkably vast.  If you peruse the internet looking for the causes you will find many things implicated from TV to transfats to high fructose corn syrup to cars to simple laziness.  If you are willing to be suckered into obvious scams you will be sold acai berries, weight loss pills, exercise regiments, herbal supplements, detoxifiers, antioxidants and more.  What is even more challenging is how fast the villain in question changes.  When I was young my father was told that he had very high cholesterol and was forbidden to eat eggs because of their high cholesterol content.  This was a struggle for my parents because my father loves eggs and tends to ignore that sort of advice while my mother was much more willing to cut out eggs in an attempt to improve his health.  In the end it turns out that dietary cholesterol does absolutely nothing of significance to increase the risk of cardiovascular failure so the advice that was given was very poor indeed.  We were first told to cut back on fat in our food decades ago and many people still look for low fat content food and items with 'light' marked on them despite the evidence that 'light' products are not at all better for your health or weight.

Recently I found this article and this video (It is 90 minutes long but I highly recommend taking the time to see it) that talked about the real reason for the increases in cardiovascular problems and obesity in our society.  Of course *everybody* knows the real reason, but some are more real than others... and this guy seems about as legit as it is possible to be.

1.  He isn't selling anything.  Never trust anybody telling you what you need to do when they follow it up with a pitch asking for your money.

2.  He obviously has a deep grasp of both the practical and theoretical components of his argument.  Don't trust advice from people unless they obviously have a tremendous personal understanding of the issue at hand.

3.  He presents a lot of good science to support his position and has no stories or testimonials.  Relying on testimonials is basically admitting that you don't have sufficient evidence to support your idea properly.

What is the conclusion?  Sugar is the villain - fructose in particular.  High fructose corn syrup is bad, bad, bad but it only continued the trend established by its more respected cousin sucrose (50% glucose, 50% fructose).  Fructose is cheap, very sweet, and causes all kinds of problems.  It is the primary cause of metabolic syndrome (high blood pressure, obesity, bad cholesterol, high insulin) and all the attendant problems and health risks.  The movie in particular attacks soft drinks, sugared juices and gatorade as being the #1 culprits but makes it clear that adding sugar to the vast majority of manufactured foods is a huge problem.

This isn't any big news in some ways.  Anyone who thought that drinking a Big Gulp at 7-11 was good for their health clearly was tuned out pretty seriously.  However, there are probably a lot of people that drank Gatorade and thought they were drinking something targetted at elite athletes instead of a giant bowl of sugar that would ruin their bodies after sufficient abuse.  The amount of sugar we as a society drink in our pop and juice is disastrous but those are the obvious things - knowing that bread all has high fructose corn syrup in it is something you only find out but carefully reading the ingredients list.  Solutions to the current dietary problems we face are easy to think of but very hard to implement as there are tremendous vested interests trying to maintain the status quo.  Sure, we should all stop drinking pop and adding fructose to our foods but how do you implement that when the majority of the food we purchase in stores has this stuff in it and it isn't dangerous in the short term?  Presumably we do it the same way we have reduced the incidence of trans fats in food - educate people until eventually they demand foods that are fructose free and let the market respond accordingly.  Not exactly fast, but I don't see it going any other way.


  1. I would like what you've written here better if you replaced "High fructose corn syrup" with "sugar" - which is one of the points Lustig is making. Sugar is bad for you. HFCS is, most of the time, about 55% fructose & 45% glucose (but can be as high as 95% fructose, especially when it is going into baked goods). Sugar is 50% fructose & 50% glucose which isn't actually much better (unless you happen to be fructose intolerant and then having an equal balance of fructose and glucose becomes important).

    I thought his most important point was that eating a diet high in sugar (or fructose, or honey, or agave syrup, or whatever you're substituting which happens to contain some amount of sucrose/fructose) is equivalent to eating a high fat diet. And that the type of fat which fructose gets converted into is the type most likely to cause coronary artery disease. BUT, when you package your fructose with tons of fiber, say in an apple, the fructose gets metabolized slowly enough that it doesn't cause the same problems. So keep eating your fruit. In moderation. Because fiber is very important.

  2. Wendy, I read an article in the NYT about this and emailed the author because I was curious about honey (and maple syrup and molasses). He responded that these were not nearly as problematic as suger/HFCS.

    Is there somewhere I can go to understand which sweet things are the culprits and which aren't? If the reason that an apple is okay is because it's packaged with a lot of fiber, then is All Bran cereal okay because it has a much higher fiber to sugar ratio than an apple? Or is added sugar always bad regardless of the fiber with it? Does this mean I shouldn't each cooked onions? That seems really rough.

  3. Sthenno: I'm pretty convinced that honey and maple syrup and any other sweeteners containing sucrose or fructose are just as bad for you, but people probably use them in smaller quantities.

    If you watch the video Sky linked, Lustig does a wonderful job of explaining the metabolic pathways in the liver - it winds up in the mitochondria, then if there is excess energy it leaves the mitochondria and gets turned into VLDL (HDL = good, LDL = bad, VLDL = very bad). So this means that the more slowly you're absorbing the fructose (by eating it with fiber say) or the faster your metabolism (because you're exercising) the more fructose is getting used up in the TCA cycle, and the less is winding up as VLDL. So yes, to a degree dumping All Bran on everything will help, and in fact is one of their interventions for obese kids. Of course, too much fiber probably means you don't wind up absorbing everything, so your gut bacteria get very well fed.

    I think the reason it is fine to eat apples and onions is that you've got lots of fiber along with your fructose. There's enough stuff making you feel full that you'll likely stop eating before you have too much fructose. The problem with added sugar is that it is often being added to fix the flavour after they've put in a ton of salt to increase the shelf life of a product, so to make something taste as sweet as that apple they've added way more sugar than you'd find in an apple. A 355mL can of coke has 42g of sugar - thats 10 teaspoons of sugar. Now imagine adding 10 tps of sugar to your tea! So I think the problem with added sugar is mostly that someone else is doing the adding for you.

  4. I guess the thing that struck me in the article is that it compared sugar to alcohol and cigarettes. Of course alcohol and cigarettes are both bad for you, but there is a really big difference between them. Most people seem to agree that drinking in moderation is totally fine, while smoking is not fine at all.

    Of course I think the main difference there is that cigarettes are so incredibly addictive that you don't find people who smoke "in moderation" very often. If someone has a cigarette once a week then regardless of what my gut says about that, it's hard for me to believe that they are really doing something all that bad rationally.

    But when people talk about the health risks of sugar they always mention that it is addictive. While it may be perfectly healthy for a person to have a drink or two now and then (or even a drink or two a day as is the custom in many cultures) it is certainly not healthy for an alcoholic to tell themselves that they should just have a drink or two now and then. With cigarettes it's probably not a good idea for anyone to ever have one. With so much sugar in everything it's hard to get a sense of whether you've really got a problem or not.