Weight Maven

Wow. I wish I could remember who to credit for the pointer to this video, but can’t. I’ve embedded it above, but encourage you to go to YouTube and watch the larger version.

Here’s the description from YouTube:

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.

The video is long (an hour and a half) and the middle section is pretty hard-core biochemistry. But it’s well worth the watch!

But if you don’t have the time, here are some of the nuggets I found particularly interesting (numbers are timestamps from the video), with some additional links I dug up separately (they aren’t from the video).

First, Lustig points out that the real problem is not high fructose corn syrup alone. He notes that sucrose (our other major source of dietary sugar) has nearly as much fructose as HFCS. So the problem is the increase in our sugar consumption overall, which HFCS contributes to. He suggested that HFCS is an “economic evil” … it costs so much less than other sugar, it got added to all sorts of foods that weren’t typically associated as sweet foods.

Lustig traces our obesity epidemic to the “perfect storm from three political winds” (23:29):

• The “cheap food” policies of Richard Nixon and Earl Butz (“food should never be an issue in a presidential election”)
• Introduction of HFCS in the US in 1975
• USDA, AMA, and AHA call for reducing dietary fat

Lustig points out that fructose acts more like alcohol (ethanol) in terms of how the body treats it. The big difference is that fructose isn’t metabolized by the brain, and so its effects are seen more from chronic overuse. Contrast this with alcohol which can be problematic from both a chronic standpoint (e.g., cirrhosis) and an acute standpoint (e.g., alcohol poisoning).

Most importantly, Lustig notes that the byproducts of fructose metabolism are all contributors to the individual factors of metabolic syndrome.

After laying this out (the biochem section), Lustig discusses the interventions he and his colleagues use at UCSF’s WATCH Clinic to treat children and teens with obesity (1:09:42):

• No sugared liquids — only water and milk.
• Eat carbs with fiber.
• Wait 20 minutes for seconds.
• Buy screen time minute for minute from physical activity.

He notes that the last is particularly hard with their patients, but that compliance with the first generally leads to better outcomes.

Lustig shared why exercise was important to health, not weight loss (1:11:20):

• It improves skeletal muscle insulin sensitivity.
• It reduces stress and resulting cortisol release.
• It makes the TCA cycle run faster, and detoxifies fructose, improving hepatic insulin sensitivity.

Although Lustig is pretty down on fructose, he’s okay with fruit (1:13:01). He notes:

When G-d made the poison, he packaged it with the antidote.

Early in the video Lustig commented that any attempts to explain obesity as a simple matter of calories in vs calories out (or gluttony vs sloth) needed to explain one thing: the increase in obesity of infants under 6 months.

At the end of the video, he comes back to this point, and ties this increase to WIC promotion of formula (also here) and the amount of sugar in formula. Lustig calls formula a “baby milkshake” and notes that there is nearly as much sugar (by weight about 10%) in some formulas as there is in a can of Coke!

Lustig begins the video stating that he wants to “debunk the last 30 years of nutrition information in America.” He certainly does a pretty good job of that! He is kinder to Keys than some (doesn’t mention the data manipulation Tom Naughton includes in Fat Head).

I also don’t know if I completely buy his assertion that a high fructose diet is essentially a high fat diet because of the way the liver metabolizes fructose. To me, that sounded like a “bad thing” in and of itself, and the link to insulin and leptin metabolism wasn’t as strongly stated as I would have liked. But perhaps I misunderstood his point.

Anyways, I highly recommend watching this, especially if you have kids. Skip over the biochem if you must (start back around 1:08:30), but watch and decide how much sugar you really want to keep eating or feeding your family!

Update, 2/7: For the record, an interesting counterpoint re “fructose alarmism” (be sure to check the comments; Lustig responds).

I suspect Lustig doesn’t have it exactly right (I don’t think Taubes does either), but for now, I’m keeping my fructose consumption low.