Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity.

Posted: July 29, 2011 in low-carbohydrate diet
Tags: , , , , , ,

“The truth?  If I wanted the truth, I would have called Sixty Minutes.”

– Spiros Focás in Jewel of the Nile.

Sugar is an easy target. These days, if you say “sugar” people think of Pop-Tarts® or Twinkies®, rather than pears in red wine or tamagoyaki the traditional sweet omelet that is a staple in Bento Boxes.  Pop-Tarts® and Twinkies® are especially good targets because, in addition to sugar (or high fructose corn syrup (HFCS), they also have what is now called solid fat (the USDA thinks that “saturated” is too big a word for the average American ) and the American Heart Association and other health agencies are still down on solid fat.  Here’s a question, though: if you look on the ingredients list for Twinkies®, what is the first ingredient, the one in largest amount?  (Answer at the end of this post).

The Threat

What went wrong in the obesity epidemic?  There is some agreement that by focussing on fat, the nutritional establishment gave people license to over-consume carbohydrates. The new threat is that by focusing now on fructose, the AHA and USDA and other organizations are giving implicit license to over-consume starch — almost guaranteed since these agencies are still down on fat and protein.  The additional threat is that by creating an environment of fructophobia, the only research on fructose that will be funded are studies at high levels of total carbohydrate where, because of the close interaction between glucose and fructose, deleterious effects are sure to be found. The results will be generalized to all conditions.  Like lipophobia, there will be no null hypothesis.

The latest attack on sugar and on fructose itself (sugar and HFCS are half fructose) comes from Robert Lustig, a pediatrician at University of California San Francisco. His lecture describing fructose as a virtual poison got more than a million and a half hits on YouTube.  The presentation has an eponymous style (Lustig, Ger. adj., merry, amusing, e.g. Die Lustige Witwe, The Merry Widow) and includes a discussion of the science bearing on fructose metabolism. While admitting the limitations of that science, even Gary Taubes was worried. Comments on YouTube and other sites say they liked the science but did not agree with his recommendations — it will turn out that he now wants government control of sugar consumption, especially for my kid and yours.

The presentation of the science is compelling but, while it has a number of important points, it is clearly biased and, oddly, a good deal of it is totally wrong, some of it containing elementary errors in chemistry that border on the bizarre — how hard would it have been to open an elementary organic chemistry text?  In trying to draw parallels between alcohol and fructose, Lustig says “ethanol is a carbohydrate.” Ethanol is not a carbohydrate.  A horse is not a dog. If you said that ethanol is a carbohydrate in sophomore Organic Chemistry, you would get it wrong. Period. No partial credit. Such elementary errors compromise the message and raise the question in what way Lustig is an expert in this field.  It gets worse.

It is biological function that is important and ethanol is not processed like fructose as Lustig says. There is very little chemical sense in saying that ethanol and fructose are processed biologically in similar ways.  And a metabolic pathway is shown in which glycogen is absent. Glycogen is the storage form of glucose and is generally taken as a good thing because of its relation to endurance in athletes but, like fat, glycogen is a storage form of energy and having a lot is not always a good thing.  In any case, it is not true that fructose does not give rise to glycogen.  In fact, fructose is generally better at forming glycogen than glucose is.  This is especially true when you consider the effect of exercise which is why Gatorade® may actually be a good thing if you are in a football game rather than watching one. This is the general error in Lustig’s talk.  Metabolism is not static and has evolved to deal with changing conditions of diet and environment. A metabolic chart, like any map only tells you where you can go, not whether you go there. And the notable absence in Lustig’s talk is data.

It is possible that  sugar and ethanol have behavioral effects  in common but this is not due to similarities in metabolism.  And even the behavioral effects are not settled within the psychology community; alcoholism is far different from “sugar addiction,” if there is such a thing; polishing off the whole container of Häagen-Dazs® may not technically qualify as addictive behavior.

The Threat of Policy

All of this might be okay — Lustig’s lecture was not a scientific treatise — except that he has gone to the next step.  Convinced of the correctness of his analysis, he wants government intervention to control sugar and sweeteners in some way .  There is an obvious sense of deja-vu as another expert attempts to use the American population as Guinea pigs for a massive population experiment, like the low fat fiasco under which we still suffer. It is not just that we got unintended consequences (think margarine and trans-fats) but rather that numerous people have pointed out that the science was never there for low-fat to begin with (brilliantly explained in Fat Head).  In other words leaving aside the question of when we should turn science into policy, is the science any good?

Fructose

It is important to understand that fructose is not a toxin. It is a normal metabolite. If nothing else, your body makes a certain amount of fructose.  Fructose, not music (the food of love), is the preferred fuel of sperm cells. Fructose formed in the eye can be a risk but its cause is generally very high glucose. Fructose is a carbohydrate and is metabolized in ways similar to, if different in detail, from glucose but a substantial amount (can be 60 %) of fructose is turned to glucose — that is why the glycemic index of fructose is 20 and not zero.

The extent to which fructose metabolism has a uniquely detrimental effect is strongly dependent on conditions.  Fructose may be worse than glucose under conditions of very high carbohydrate intake but its effect will change as total carbohydrate is lowered. And since carbohydrate across the board is what is understood to be the problem — Lustig states that clearly in his YouTube — policy would suggest that that is the first line of attack on health — reduce carbohydrate (emphasizing fructose if you like) but as carbohydrate and calories are reduced, any effect of fructose will be minimized.  In the extreme, if you are on a very low carbohydrate diet, any fructose you do eat is likely to be turned into glucose.

The Opportunity

Lustig makes his case against fructose in terms of fundamental biochemistry which is really how it should be.  Can biochemistry be explained to the general population?  Can the problem be explained in a simple but precise way so that we really have the sense of talking about science and not politics?  So what is needed is somebody who actually knows biochemistry.  Maybe somebody with experience in teaching biochemistry to future doctors.  Hey, that’s my job description.  In fact, I’m going to try that in the next few blogs and on YouTube. I and others have  taught courses that try to reduce the three year sequence that professional chemists follow: general chemistry-organic chemistry-biochemistry.  I will try to give everybody a window into organic chemistry, biochemistry and metabolism. In fact, that might be a good focus for government intervention. Instead of punishing the patient, how about funding for teaching biochemistry to the public. For the moment, though, let’s look at some population data.

Sweetener Consumption.

What about sweeteners?  Well, of course, consumption has gone up. Surprisingly, not as much as one would have thought.  According to the USDA about 15 %.  One question is whether this increase is disproportionately due to fructose. The figures below show that, in fact, the ratio of fructose to glucose has remained constant over the last 40 years.  (The deviation from 1:1 which would be expected for pure sucrose or HFCSA, is due to a  relatively constant 20 % or so of pure glucose that  is used in sweetening in the food industry). It is possible that, although the ratio is the same, that the absolute increase in  fructose has a worse effect than the increased glucose but, of course, you would have to prove it.  The figures suggest, however, that you will have to be careful in determining whether the effect of increased sweetener is due to fructose or glucose, or the effect of one on the other, or the effect of insulin and other hormones on both.  An unrestrained, lustige, lack of anything careful is exactly the current threat.

Answer to “puzzler:” The main ingredient in Pop-Tarts® and Twinkies® is flour. Some people say that if you add up the different forms of sugar that will be greater but like all ideas derived from Lustig, there is an advantage in looking at the data: 38 g. of carbohydrate, 17 g. of sugars.

Comments
  1. Jay Wortman MD says:

    Hi Richard,

    I understand your concern in terms of the need for accuracy and the potential danger in running off half-cocked as was done with fat prohibition. On the other hand, what is the downside of making sugar less accessible? You argue that in the current climate of lipophobia, the only place to go then is more starch. Yes, technically true. But in the real world, possibly not. When my 11 year old son leaves our sugar-free home and goes out into a sugar-soaked world, he is not tempted by pizza, rice and potatoes (well, maybe chips), it is the soda, juice, cookies, candies, etc that he is bombarded with that challenge his resolve to eat according to our wishes. If those are gone, will he then over-indulge in pizza, rice and potatoes? I don’t think so. And, even if more starchy things become available, they are usually combined with fats when eaten (eg pizza) which, I believe, mitigates the harms of refined carbs by reducing post-prandial hyperglycemia. If they are not combined with sugar (eg cakes, cookies) what will people eat instead? Excess starch consumption in the absence of sugar would be not that appetizing, methinks.

    It is for these reasons that I think a pogrom against sugar is perhaps not a bad place to start.

    Regards,
    Jay

    • rdfeinman says:

      The alternative to Lustig’s punitive un-tried experiment, is the masterpiece project, already-tested in the real world that you have carried out with the first nations people (http://www.cbc.ca/thelens/bigfatdiet/wortman.html). Only an opinion but the Big Fat Diet seems to have derived from compassion and understanding rather than from the unconscious resentment of the patients who refuse to follow Lustig’s advice.

      It’s great that your son follows your advice. My daughter is younger and is amazingly not always willing to take mine. But, hey, Jay, wait until he’s 14.

      • Jay Wortman MD says:

        My son at 11 already thinks he’s 14. And he has put us on notice that his first act after emancipation will be to return home and consume a chocolate bar in front of his father. To which I reply, “if you want to damage yourself, why waste your money, why not just hit yourself on the head with a rock? And why wait?”.

        My son and I have a great relationship and he has a wicked sense of humour.

        With tobacco we know that a combination of education, taxation and controlled access reduces consumption. Yet, some people still smoke. I would expect we would find the same thing with sugar. The question is whether it is worth a try.

    • Adrienne Larocque, Associate Director, Healthy Nation Coalition says:

      Dr. Wortman, I see your point, but I never had a sweet tooth. I was actually a starch junkie. I loved my pasta, rice, potatoes and bread, with nothing more than salt and butter (margarine, actually – no wonder I ended up overweight and somewhat insulin resistant!). So it is possible to eat a lot of starch without sugar.

      I would have no problem with government bans on pseudo-foods or dangerous foods if I felt confident in the process itself and the ability of those making the decisions to be able to understand good science. Sadly, it’s clear to me that greed drives the process and decisions would not be made on the basis of science, but profit. So the next best approach is to educate people so that they can make appropriate decisions themselves. Some won’t care, and will eat their twinkies anyway. Some will be grateful for the knowledge and will make appropriate changes. A kind of voluntary natural selection at work?

    • Lance Strish says:

      ‘mitigates the harms of refined carbs by reducing post-prandial hyperglycemia’ What do you think of physiological insulin resistance?: http://www.facebook.com/livinlavidalowcarb/posts/218444358220341?notif_t=share_reply comment#4

  2. Debbie C. says:

    I bet if “corn syrup, high fructose corn syrup, dextrose and sugar” were all lumped together they would probably edge out flour as the number one ingredient in Twinkies. In my mind there is fructose and there is fructose. My diet is pretty low carb, but it does include some fructose. But I think there is a huge difference between eating a clementine and eating a Twinkie.

    • rdfeinman says:

      Lustig is opposed to low carbohydrate diets. Lustig generalize one set of conditions to all. If you are starving, you are way better off with a Twinkie than with a clementine.

      • Paula says:

        Actually, when Dr. Lustig finally agreed to appear on Jimmy Moore’s podcast, he said on it that he’s not OPPOSED to opposing carbs – he just wants to see the results of some random controlled studies on the subject. Gary Taubes HAS wickedly remarked ;-) that Dr. Lustig IS a little pudgy…

      • rdfeinman says:

        First we need to see the RCT on the diet that he recommends. When you step back you realize that he, and the USDA, and the American Heart Association, etc. talk as if their is an established healthy diet but nobody knows what it is, where it’s been tested and against what. It is, in fact, what they call in computers, vaporware. The RCT has long since been discredited by the parachute study. The real question for Dr. Lustig, however, is: if the low carb diet is not the “default diet,” then what is. What does he use with his patients and what are the outcomes. If he doesn’t have good success, where does he come off telling us the techniques for weight reduction. If he does have good success why haven’t we heard about it.

    • Paul says:

      I completely agree with Debbie – this is a practice called ‘fractioning’, which is a deliberate tactic to mislead people who don’t read labels critically. You take an ingredient that you want to de-emphasize and ‘fraction’ it into different forms. As Debbie points out, among the first six ingredients are four forms of sugar:

      corn syrup
      high fructose corn syrup (a pretty funny distinction)
      dextrose
      sugar

      Individually, each of these only needs to be a fraction of a percent less (by weight) of the total than flour is, in order for flour to be listed first. There could potentially be almost four times as much sugar (in various forms) as flour, but in this case, someone taking a superficial look at the label sees flour as the first ingredient.

      Also, anything listed that is less than, I believe, half a gram can be listed as ‘zero’. Portion sizes can be adjusted to assure this. Then, you can claim ‘ZERO’ of whatever it is in big type on the front of the package, even though you may be getting significantly more than zero when consuming a realistic portion size.

      Ingredients are listed in order of weight. The other common tactic is to list the ingredients you want to de-emphasize in dry form and the ones you want to emphasize in liquid form. You see this a lot in pet food – they make it appear as though there is more meat in the product by listing meat in broth form, which can be a very, very small quantity of meat in a very large volume of water. When the water is eventually removed (as it would be in kibble), there is almost nothing left, but the weight of the water will make the broth heavier than, and listed before, a very large quantity of dry starches, especially if all the starchy ingredients are fractioned, as they nearly always are.

      • rdfeinman says:

        Good point although I am not sure I wanted to draw too many conclusions from all this. In truth, we don’t even know that Pop Tarts are inherently bad but if you do look at the composition on the label of Pop-Tarts (at the end of the article), you can see that they have 17 g of sugar and 20 g of non-sugar, non-fiber carbohydrates.

    • rdfeinman says:

      This does not seem to be true (that HFCS + dextrose, etc. is more than the flour). The label says that there are 38 g of carbohydrate of which 17 g are sugars but, in any case, Pop Tarts are a starchy food so whatever is wrong with them, you can’t jump to the conclusion that it is the sugar.

  3. Joe Lindley says:

    Richard,

    Thanks for kicking the ball down the field on this. I too, felt that Lustig was a little extreme (e.g. let’s just card kids who want to buy candy), but sometimes it takes a hard-line opinion to get the debate going. And that may well be his intention. To me (I’m a low carb guy) the culprit is all the sugars and refined carbs that dominate our restaurants and stores. Sugar is addictive when it is consumed for years, so it’s not as immediately dangerous as say, cocaine, but it is ruining the lives of people who face a mighty struggle to get off it – if they even come up with the will to try. Fructose is just one component of the discourse. I’m not educated enough on biochemistry to enter into a debate on what you’ve stated about fructose, but I am eager to hear more.

    Let’s see if we can use an ongoing discussion on fructose, as you are proposing, to keep the heat on the whole issue of carbohydrates (particularly sugars and refined carbs) and their devastating impact on our lives.

    Thanks!

    …Joe…

    • rdfeinman says:

      I will tell more. His intention is to keep low-fat, high -carbohydrate in place and keep being invited to sit on the boards of AHA and other health agencies and to keep his friends’ research funded. Of course, he doesn’t think that that is his intention but his unwillingness to discuss alternative theories as we do in science speaks to his intention. I usually try to be collegial and constructive with other researchers but he has crossed a line into explicit politics and wants to get somebody in Washington to tell my kid what to eat so it’s a different ball-game to me.

      • Paula says:

        “…to keep his friends’ research funded.” Wooooo, that’s pretty harsh! Them’s fightin’ words! If it’s true, I’d say it’s the result of “where he’s at,” — how he truly sees things — and is not his intention.

        I adore you Dr. Feinman (FYI I esp. love your hilarious bit to be found online to the effect that “Carbohydrate restriction has attained the status of the name of G-d in Hebrew: it’s never pronounced out loud.” Ha ha!); and of course, compared to the incomparably blinkered Lustig, you have the good fortune to know the WHOLE story. So be happy!

        But now, with respect, I think you take Dr. Lustig way too seriously, so that you’ve lost your clear view of what he HAS done. HE has opened this whole conversation. The GOOD that has come of his view being “blinkered” (i.e. the good that has come of his NOT concommitantly railing against carbs) is that people ARE daring to look at how bad sugar / HFCS is.

        Had he, in his video, told viewers AT THE SAME TIME as they’re aborbing their “sugar blow” how bad lots of OTHER things they are that they also love — Believe me, Dr. Lustig’s video would have about 304 hits right now. (I know, ’cause no one listens to me ’cause once I get wound up, I spew TOO MUCH INFO out at one time, and they think, “Nah, this sounds crazy, CAN’T give up this much stuff, eat saturated fat… my life won’t be worth living. Uh, gee, Paula, gotta go and watch my goldfish….”)

        Dr. Lustig’s feints at gov’t restriction are pure rhetoric. By the way, have you seen “King Corn” and it’s follow-up, “Big River” (documentaries)? THEY are enlightening.

      • rdfeinman says:

        “…to keep his friends’ research funded.” Did I say that? Sometimes what you’re thinking actually pops out. Intentions are in the behavior and the reinforcers. Everybody thinks that they are doing good. I definitely do give Dr. Lustig credit for coming out and and discussing the issues. I am not sure the problem was with the info. After all, he snowed everybody with the metabolic charts. I do not even know that sugar is not the major culprit behind the adverse effects of high carbohydrate. Government restriction is real enough. Try to get whole milk in a public school. The rhetoric only encourages them. I hope to see King Corn and Big River but have not yet.

  4. Margaretrc says:

    Thank you, Dr. Feinman, for this sane discussion! I saw the Lustig video and, while I took the gyst of the message to heart, I, too, wondered about the whole “alcohol is a carbohydrate” and the fact that he made no mention of the conversion of at least some fructose into glucose. And, like you, I think the bigger problem is over all consumption of carbohydrates, not just fructose, and Dr.Lustig’s latest video in which he advocates for government regulations of fructose was a bit scary, to say the least. Like you said, too De Ja Vu. What we need is more people like you educating the public and telling them how wrong the government’s position on fat and carbohydrates is, so we can make our own decisions and return to sanity.

    • rdfeinman says:

      Thanks for the encouragement. Most people don’t want to be like me but you can bring your case to the government. Your elected officials are interested. It may take a while to get a critical mass but I think they want to know the truth (if nothing else, they’re likely to be on statins).

  5. (For the record: One year zero carb, just to get people to shut up about scurvy. Currently randomly cycling ketogenic lacto-paleo, for life unless the economy collapses to the point where it’s literally eat grains or die of starvation.)

    The development of agriculture may have encouraged the rise of humanity as a collective, but in terms of individual health it has been nothing short of disastrous. In contrast, Lustig’s proposed cure for the diseases of civilization might improve the health of individuals, while destroying what little civil society remains intact. His so-called solution is repugnant to any moral individual and antithetical to a free society. It is destroying the village in the name of saving it. His “cure” would be worse than any disease, and if he wants to use violence to prevent others from exercising their right to choose, I invite him to get off his ass and try it himself rather than getting others to do his dirty work.

    Metabolic syndrome is healthier than fascism.

  6. Joe Lindley says:

    Richard,

    Enjoyed your post and am glad you are keeping up the dialogue. I too was a little surprised at the idea of carding 12 year olds to buy a Snickers, but I think Dr. Lustig has done us all a big favor by getting this topic out there with enough buzz, that perhaps we will do something about it. I don’t have the background on biochemistry so I am looking forward to your rebuttal on the evils (or not) of fructose.
    My issue is the overall sugar and refined carbohydrate dominance of our national diet. We have to find a way to do something about that – so the more discussion, the better. Please keep it up and many thanks for kicking this ball down the field.

    Thanks.

    …Joe…

  7. Martin Levac says:

    What’s the rationale behind the sugar/flour substitution risk? I don’t see it. Sugar is used for taste, flour is used for other stuff like structure and texture. Fat is used for taste, structure, texture and more. When fat was reduced, we didn’t add more sugar or flour, we added more HFCS. HFCS is used for structure, texture, taste and more. How will flour and starch replace sugar’s function?

    • rdfeinman says:

      These are broad generalizations. When fat was reduced all kinds of things went up including fruits and vegetables. My point, however, is that what we know works well for obesity and the metabolic syndrome is carbohydrate reduction. It could be that that is because of the de facto removal of the fructose in the carbohydrates but the burden of proof is on those who say that. Lustig has not even begun to meet that burden of proof. Reducing sugary drinks is a good quick way to help some people reduce carbohydrate but that’s different than knowing for sure that it is the fructose. In science, when you don’t know, you don’t know. In medicine, you have to do the best you can. So it doesn’t seem like a good idea to start making laws based on science that is controversial. Of course, there is the question as to whether Lustig is an expert in social planning and psychology.

    • Paula says:

      Taubes points the finger at SUGAR & FLOUR. Explicitly those two. Before these, pardon me, two “white man’s foods of commerce” were shipped all over the world (by European, esp. British, colonizers, which interestingly included scientists like Darwin in The Beagle…), native populations had NO cancer, cavities, appendicitis, heart disease… ESP. interesting is the lack of CANCER. Taubes read all the British doctors’ and missionaries’ dispatches back home. Ditto Albert Schweitzer. This CANCER angle is HUGE. Inuit had NONE till they started consuming sugar and flour, which were “foods of commerce” because they can be shipped around the world on boats BECAUSE THEY DON’T ROT.

      My general take (after by great good fortune discovering GCBC via Jorge Cruise) is that since our living bodies’s destiny is to ROT, we need to eat what can ROT, i.e. what is compatible with our bodies.

      Sugar and Flour (and their counterparts) DO NOT ROT. They are DEAD food. They are dead (Taubes remarks how they have to be “fortified” with vitamins since they contain none). Insulin, the Grim Reaper of the Body, banishes them when they appear, sending them to the Hinterlands (our excess flesh) where they slowly kill us. 18-22 years, but they’ll do it.

      LCHF forever!

  8. Jim Anderson says:

    Sugar does seem to have caught the attention of many people as something to avoid. I just wrote about a poll of adult Americans that identified, among other things, reasons that they change their diets. Insofar as it is to reduce a certain dietary component, fat led the list with 66% saying they have changed their diet to reduce it. No surprise there, given the propaganda efforts of the last 30-40 years. But in second place was sugar, with 59% saying they have changed their diet to reduce it. Carbs in general were well down the list, with 45%.

    While it’s good that people are forming a negative impression of caloric sweeteners — at least when consumed in large amounts — I agree with you that those seeking to cut both fat and sugar will turn even more to starch. And that won’t be good.

  9. Hans Keer says:

    Can biochemistry be explained to the general population? I estimate you have the skills to make it understandable. The thing is; how can we bring it to the public (and the “establishment)? It is not enough to present your valuable information to “only” your metabolic society. They are already “converted”.

    I’ll be back on this point soon.

    VBR
    Hans Keer

    • rdfeinman says:

      I don’t know what you mean. Organic chemistry is not a religion. It is the “converted,” that is, those who don’t want to take expert advice without questioning it, who want to understand organic chemistry.

      • Hans Keer says:

        Perhaps “converted” is not the word I should have chosen. It refers to the Dutch expression “Preaching to the converted”. It is used in the non-religious sense that you are giving your opinion to those who already agree.

        The challenge is to reach the broad public with the right information. How can they be informed in a way that they can make healthy choices?

        I hope I’m more clear this time.

      • rdfeinman says:

        The expression in English is “preaching to the choir.” On the low carb message, we have been doing that for years. The nutritional establishment has long given itself the privilege of not reading or citing articles on carbohydrate restriction although conversion to low carb does tend to be a ratchet — few who are converted go back the other way. In any case, I will try to teach organic and biochemistry to anybody who wants to listen — in modern science, nobody is an expert on everything. One does have to start at the beginning which is tough but there have been great examples of popular education. In music, Leonard Bernstein and Victor Borge who explained the evolution of the piano very simply: “the first piano had only one key. Then somebody invented the crack.”

  10. Martin Levac says:

    The preferred fuel argument is flawed. If one fuel is preferred over another when both are present, then we can say alcohol is the preferred fuel of the liver. Since fructose can only be metabolized by the liver, we can say that fructose is the preferred fuel of the liver. Better to use the absence argument instead. If one fuel source is absent from the diet, then whatever is used is the preferred fuel. A common theme is that glucose is never used in large quantities if it’s absent from the diet. The same is probably true of fructose.

    We can’t ignore scale when we argue whether a substance is toxic or not. Stating that the body can make fructose does not refute the claim that fructose is toxic. The body also makes glucose but even you acknowledge that we must not eat so much of that, i.e. low carb diets.

    The dose makes the poison. With fructose, we’ve surpassed the toxic dose many times over already. With carbs in general, with fiber and with vegetables oils too but that’s for another discussion.

    Richard, I don’t mean to favor Lustig, I’m just pointing out the flaws in your arguments.

    • rdfeinman says:

      I don’t have an argument. Fructose is not a poison. Glucose is not a poison. Both are undesirable at high levels as you say. “we’ve surpassed the toxic dose many times over already.” Whose we? Not all of us. Most important, we do not know even what level constitutes high or low, never mind toxic. And high and low are meaningless unless you specify what else is or isn’t in the diet. I don’t think we know yet. My only point is that the biochemistry in Lustig’s lecture has many errors and many are serious. I would not accept the content from an undergraduate. It also does not reflect current thinking in the field. All of which is okay — all of us make mistakes. However, Lustig has crossed a line. He wants to go beyond to policy on the basis of this flawed science. The value of his punitive measures is debated by more experienced people than me but insofar as the question of whether it is based on adequate science is relevant, I can offer my expertise. I also have experience on the underlying nutritional politics whose great triumph is the obesity and diabetes epidemic.

      It is no longer just the chemistry. It is that Lustig has an agenda. He wants to keep high carb, low fat going and use as a smokescreen, demonizing sugar. He is spokesman for the AHA committee who have co-authored the paper he refers to and which is composed of long-standing lipophobes, as Michael Pollan calls them. I have no idea what any of them are thinking — whether they still believe that fat is bad — but intention is judged by actions and consequences. They have continued to stone-wall carbohydrate restriction and continue to be rewarded for it.

      I have no argument. If you don’t want to eat fructose, don’t. Also, on the science, one can’t go on credentials. I have taught biochemistry for many years and much of the content of Lustig’s presentation is off the mark. But maybe I’m wrong. In this, you may have to be your own expert but there’s lots of information out there. I will try to put some reliable reviews on the Nutrition & Metabolism website (http://www.nmsociety.org) or on this blog.

  11. gregory barton says:

    “It is that Lustig has an agenda. He wants to keep high carb, low fat going and use as a smokescreen, demonizing sugar.”

    In his interview with Sean Croxton, Lustig acknowledges the claim that LDL divides into small dense and large ‘buoyant’ particles. He claims that saturated fat raises large buoyant LDL, “no ifs, ands or buts. I totally agree with that”. (30′, 40″)

    “But what makes your small dense go up? – Carbohydrate. And in particular, sugar,” he says at 30′, 50″.

    He claims that Ancel Keys’s research is problematic because sugar wasn’t taken out of the equation.

    He claims that a high TG/HDL ratio is the most important marker for heart disease and is “driven by carbohydrate. It is driven by sugar. It is not driven by fat”.

    Do these sound like the comments of a lipophobe with an agenda of promoting high carb – low fat?

    gb

    • rdfeinman says:

      First, let me say that I have discussed some of these issues with Lustig in the past and I would never impugn his motives, especially not in public, if it weren’t that he has stepped over the science line into policy, policy that is negative and punitive. I will discuss this in a future post but a disadvantage of an aversive approach is that you get backlash, counter-control as it’s referred to in behavioral psychology
      (e.g., http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2731607/pdf/behavan00008-0065.pdf), or as Shakespeare put it:

      “…we but teach
      Bloody instructions which, being taught, return
      To plague th’inventor.”

      Whatever is wrong with his science, and there is plenty, it is for technical discussion until he wants to use it to get some fool in Washington to bear down on my daughter. It’s a different ball-game.

      On his statements on diet, he is also an author on our paper on diabetes and low-carbohydrate diets (http://www.nutritionandmetabolism.com/content/pdf/1743-7075-5-9.pdf) but I don’t think he ever cites it. He was clear on Jimmy Moore’s podcast that he is opposed to low-carbohdyrate diets. Remember the American Diabetes Association, strongly opposed to low-carbohydrate diets, lists all the things you say but they don’t let it influence their recommendations. The American Heart statement on sugar is the essence of the problem. The sin of omission of carbohydrate restriction is much closer to passive aggressive than anything else. In the end, of course, when they can’t stone-wall the science any more, they will say, “we always saw the advantage of low-carb. We were never opposed.”

      What the science shows is that dietary carbohydrate restriction is the best overall strategy if you are overweight, have diabetes or metabolic syndrome and individually the features of atherogenic dyslipidemia that you list. If you think that the effects of carbohydrate restriction are due solely or largely to the removal of the fructose — still possible if unlikely -, you have to show it. It is not easy to do, especially under a variety of conditions. If you are on a low-carbohydrate diet, for example,any fructose that you do consume probably turns to glucose. If you only talk about fructose and ignore the possibility that any effect may be due to fructose as a carbohydrate, that is not science. If you restrict yourself to studies with 55 % carbohydrate and 30 % fat and then show an effect of fructose, nobody will argue with you but you have stacked the deck. If you make the observation that fructose consumption has features in common with ethanol consumption, that may have some insights but when you put up a slide that says “ethanol is a carbohydrate,” you have an agenda. (Ethanol is not a carbohydrate. Carbohydrates are polyhydroxy-aldehydes and ketones and their derivatives; a horse is not a dog).

      Lustig and I will be at a meeting in Los Angeles next week and we plan to discuss all this. He is personally a nice guy and there may be some grounds for cooperative moving ahead. As in Charlie Wilson’s War: we’ll see.

  12. poisonguy says:

    I think the whole “ethanol is a carbohydrate” is metaphorical. That viral video was meant to make a point. Obviously, it made quite an impact and people are paying more attention. He clearly addresses, IMO, the biochemisty in his article: Fructose: Metabolic, Hedonic, and Societal
    Parallels with Ethanol. He does not call it a carbohydrate there.

    To be fair, I’ve been a big fan of his for a while (he publishes quite a bit…anyone can PubMed him). I took a different view of him from the Jimmy Moore podcasts that you site. He seemed perfectly fine with a low-carb approach but would recommend a more “carbsafe” approach, whatever that means (but which I took as being lower carb than what is recommended). I’ve found his lack of clarity on increase “fiber” disconcerting. I always assumed he meant the fiber that comes with the fruit and that vegetables. The fact that he hasn’t stated his position on the fiber from grains is, as I said, disconcerting.

    And, in his latest paper “Childhood obesity: Adrift in the Limbic Triangle” he has this to say about saturated fat: The incessant din of junk food advertising, in alliance with a food-production juggernaut that pours high fructose corn syrup, salt, and saturated and trans fats into developing brains, while seducing them into staying seated for the next show, is better funded than any health program and ruthlessly profit-oriented. This seems to lead credence to your claim that he’s a “well disguised” lipophobe.

    As a follower of a low carb diet and a father of two young children, I have to question the whole low carb message. For me, who’s been insulin resistant (but seems to have recovered a lot of my sensitivity back in the last year, and the shedding of pounds), it makes perfect sense and works. For my daughters, however, I’m not sure it’s meaningful at all. There are too many examples of high carb cultures that have not exhibited signs or symptoms of the metabolic syndrome that I’m skeptical that “carbs” are the causative agent. So, I’m more interested in limiting the exposure of this/these potential causative agents that limiting the consumption of agents that take over after the damage is done (carbs, in general).

    To me, it seems plausible (from animal studies, mostly) that high fructose consumption could lead to metabolic syndrome. I don’t know if fructose is unique in this, or that other agents might be co-conspirators (or sole culprits), but I do believe that there is a prior trigger to set about metabolic syndrome prior to carbs taking over the reigns (ie. I don’t particular believe that things like potatoes and rice are harmful in “non-damaged” individuals like my daughters). So, as a dad, I think the reduction of soda and fruit juice consumption is advice that I take home with me.

    Oh, btw, I believe Lustig has repeatedly said that athletes and people who are active don’t need to worry about fructose consumption because it gets converted to glycogen or glucose in those who are not glycogen replete.

    • rdfeinman says:

      Low carb diets are primarily therapeutic although many people who are not overweight or insulin resistance find them better. “I think the reduction of soda and fruit juice consumption is advice that I take home with me” sounds fine to me but he is suggesting that the government should make that choice for you. Which would be Ok — we regulate or ban many things — but the science would have to be solid which it is not. His article Parallels with Ethanol is not accurate biochemistry. If he has said that athletes turn fructose to glycogen one place, he has left glycogen off the metabolic map for fructose someplace else. His own work has shown the importance of insulin which is now suddenly swept under the rug. I have taught biochemistry for many years and I don’t consider this an accurate portrayal of metabolism but I could be wrong. What’s great is that he has now couched the problem in terms of biochemistry and now we will learn something.

  13. pnemechek says:

    I am a physician who provides medical care to children up to the elderly. I’m personally worried carbohydrates are affecting a large number of my pediatric patients. Many are developing symptoms of autonomic neurological dysfunction (heartburn, constipation, urinnary frequency, urinary incontinence and symptoms of poor cerebral blood flow – lightheadedness, headaches, fatigue and poor concentration) at a very younf age. There is an alarming number of children on Prilosec and Zantac for heartburn who aren’t even 10 years old!

    I have found a general reductionis all carbohydrates in their diets can have a rather profound reversal of these symptoms in just a few weeks. I cannot say whether fructose versus glucose (starch) reduction are preferentially beneficial. I simply ask partents to get rid of the bulk of carbs at breakfast and lunch.

    I worry that we are seeing neurological effects from the well-known systemic inflammation trigger by excessive carbohydrates. This inflammation has been shown in studies to affect heart rate variablitiy (HRV; a general marker of autonomic dysfunction), and HRV is also commonly found to be abnormal in patients with diabetes, heart disease and metabolic syndome.

    Am I seeing an early stage of “carbohydrate toxicity” in children that is being brushed over as simple nuisance symptoms only to be followed by early onset disorders associated with insulin resistance?

    • rdfeinman says:

      The essence of my complaint about Lustig and the American Heart Association statement is that “I cannot say whether fructose versus glucose (starch) reduction are preferentially beneficial. I simply ask partents to get rid of the bulk of carbs at breakfast and lunch.” is the prudent approach. They really can’t say whether reduction of fructose versus glucose is preferential because they don’t recommend reducing carbohydrates and they ignore any published data that does.

  14. tgeisner says:

    I must admit I was intrigued by Lustig´s YouTube-perfomance, and planned to make a blogpost about the dangers of fructose. However, reading up on the Biochemistry part (I´m a Cardiothoracic Surgeon), I realized that giving fructose the bad rap might be premature. You express my concerns better than I do myself, so I hope it´s OK that I link to this post on my blog!

    I believe knowledge is the most powerful tool we can give the public, with the overt aim of bringing about a shift of paradigm regarding dietary advice. If you can teach the public enough Biochemistry to make people able to show the same scientific skepticism that you as a Biochemist are able to, then we´ll be one step closer to giving everybody a real freedom of choice! I look forward to future posts!

  15. [...] En som er skeptisk til Lustigs forelesning, er Robert David Feinman. Han er biokjemiker og påpeker flere grove feil i Lustigs fremstilling av fakta. Feinman påpeker blant annet at Lustigs agenda er å opprettholde lavfett-høykarbo-diett-anbefalingene og heller få til et forbud mot HFCS, som brukes i stor grad som søtningsmiddel i USA. Feinman presiserer også at effektene av inntak av fruktose ikke vil være de samme hos individer som spiser lavkarbo-høyfett. Feinmans kommentar finner du her [...]

  16. Interesting post again and wonderful discussion. Thanks! I hope many diet bloggers would find this wonderful blog. Hopefully, a handful of other nutrition professors will follow your example gradually too. I have heard lately that sodium in diet may only be problematic while on high Carb diet. Perhaps you could touch upon sodium (if you already haven’t) one day.

  17. maryblushes says:

    Does anyone in the USA remember a time known as “Prohibition” ? Government discovered that didn’t work and for very sound reasons. Certain things have to be personal choices, having said that I will comment that it is difficult to find foods without certain unhealthy additives, such as High Fructose Corn Syrup and unless a person reads the label every time they buy something, they don’t know what is in it.

    They can change the ingredient label and leave the nutritional label alone, as I discovered recently. My blood sugar began to spike with the use of diet coke in my area. I read the label, yep… still sugar free, still showing zero carbs…. wait a minute!!!! they changed sweeteners and now have added maltodextrin (a sugar as far as my body knows) Sometimes there is a designation on the label known as Natural Flavors, so would someone please tell me what that is exactly? I think it covers a broad area and is basically used to hide what is actually in the product.

    If one is really into healthy eating, they will make their own mayonnaise to be certain they know what it contains. They will make their own convenience foods from fresh meat and fresh vegetables. Even then it will contain things they don’t want. If you want to prohibit something, how about prohibiting the use of pesticides in my food? Or the use of hormones in my meat and/or eggs and milk? This really is not a simple subject and as we all know, the government can mess up even simple things… consider the food pyramid now known as the plate… sigh

    My point is that when the government gets involved too much we get worse problems from it, not improvements.

    • rdfeinman says:

      Thanks for the comments. You make several good points. The general principles that I think apply are that:
      1. Government is the only group that can regulate some things. We don’t want manufacturers putting copper salts in the pickles to make them green. The science has to be strong, however. When less strong, regulation may be good. Tobacco is an unambiguous risk for most but not all people. Below that, we need information. Sugar, HFCS are carbohydrates. We need to be informed as to what the problems with high carbohydrate are and when and if, sugar has a unique effect compared to starch. Lustig’s YouTube is pure propaganda and thoughtless. No biochemist would present anything like that to a class. Because it contains a mixture of truths, half-truths, falsehoods and howlers, it is hard for us to quickly pick it apart. There are thousands of papers on fructose. The sad thing is that, from my conversations with him, Lustig actually knows a lot but what he is doing is not responsible science.
      2. I only want to focus on the science but there is the psychology. Prohibition is aversive and you get back-lash, what psychologists call counter-control so that you are actually at war with people you supposedly want to help. Also, if you take the route of information and encouragement, although it is harder and you have to be patient and not give up too soon, if it truly doesn’t work, you can always get tough. If you start out with aversive methods and punishment, you can’t go back. If you try to loosen up, you get permissiveness and harsher measures in response — as in Russia.
      3. Most important: how do you make your mayonnaise? While generally good at cooking, I have never been able to make mayonnaise reliably.

  18. Hans Keer says:

    You can make an excellent mayonnaise with egg yolks, lemon, salt, mainly coconut oil (the cheap odorless, melted 79° F) and a little bit of olive oil. Since you know your way in the kitchen, I don’t need to give further instructions. Good luck!!

  19. After watching “Sugar: The Bitter Truth”, I became anxious about the amount of fructose I was consuming and began to track it for this past week or so. For the record, I have been very low carb for over two years now, and have not been eating fruit. The video made me reluctant to eat a piece of fruit, even if I could fit it into my very low carb lifestyle, which I could not.

    In an effort to increase carbs a little bit to try to break out of my long weight-loss stall, I started eating one piece of fruit per day. It turns out that, with eating a piece of fruit per day, my fructose consumption is 2-5g per day. So much for fructose being the main driver of obesity in my personal body, even at the exclusion of glucose, which I also eat precious little of.

    I realize that Lustig’s main point is probably aimed at HFCS and not a daily piece of fruit, but, all in all, he lost me when he said that glucose is not suspect, but fructose is.

    Thanks for the article. Not being a scientist, I need help in looking at things through the proper filter, which you have provided in this case.

    • Makro says:

      Hi!

      Some points: 1: If Lustig scared you away from eating fruit, that´s certainly not his intent. Indeed, if we go by everything he has said about fruit, his point is that fruit is fine. “Fructose is toxic” – as with all toxins – is an issue of dose. In the case of fructose, a pretty large one.

      2: Lustig is probably right about glucose not being the core issue regarding what causes metabolic syndrome (obesity being a symptom in some people, but not all, of the development of metabolic syndrome).

      3: However, once you have started developing metabolic syndrome, glucose does become a problem, as your insulin regulation will be screwed up, making glucose problematic.

      I think it´s worth going through Lustig´s presentations a bit more thoroughly:

      • rdfeinman says:

        I’ve spent my whole professional life doing biochemistry and none of this makes sense but I could be wrong. I am willing to learn from anybody. Lustig’s octreotide paper, however, includes a mind-boggling idiotic explanation of how he’s going to redefine the laws of thermodynamics which would be laughable to any physical scientist. He also says that ethanol is a carbohydrate when it is not. Finally, he writes in Nature that ethanol is like sugar because it is made from sugar which is probably the single stupidest thing that was ever written in Nature. His YouTube has simple mistakes in biochemistry. Ethanol is NOT metabolized like fructose and is inter-convertible with glucose. It is hard for me to see that this is a guy whose opinions I should look at more thoroughly.

        So, why don’t real biochemists jump in here? Because we don’t know and no biochemist would make the kind of sweeping statements you make. Not that they are necessarily wrong. In fact, could be right but we just don’t have the knowledge to say such things. When I asked Lustig for the best study to show my medical students he pointed me to Stanhope, et al. In that study, and in others, subjects were on a 55 % carbohydrate diet — higher than we have been able to attain during the obesity epidemic. They show that substituting fructose for glucose makes things worse. Fine, but the title of Stanhope’s paper does not in any way suggest that it is not a universal effect.

        The big difference between science and medicine, is that in science, if you don’t know, you don’t know. In medicine, with a patient etherized upon a table, you have to do something. That’s why we think highly of doctors — they shoulder responsibility that few of us would be happy with. There is a down-side, however. You get to think that your opinion is more important than data. It suggests that doctors might become arrogant and think that their opinion is more important than the facts. Can you imagine something like that happening?

  20. [...] Threat of Fructophobia. And the Opportunity. August 29, 2011By: rdfeinman Read the Full Post at: Richard David Feinman “The truth?  If I wanted the truth, I would have called Sixty Minutes.” – Spiros [...]

  21. [...] Richard Feinman has put together a nice article about where Lustig went wrong. Interestingly this seems to not only take some blame away from sugar, but also coincides with the [...]

  22. [...] together a nice article about where Lustig went wrong. Interestingly this seems to not [...]

  23. majkinetor says:

    Hello there.

    Fructose from fruit, HFCS and sucrose is obviously not the same thing:

    Sucrose contain glucose and fructose which are covalently bonded and need sucrase enzyme to break that bond, unlike HFCS which is just collection of fructose and glucose with usually a little bit more fructose. Expression of this enzyme can differ in people and this can be genetic or more probably acquired – when mucosal epithelium of the small bowel is damaged (read wheat). With severely diminished levels of this class of enzymes you will get bloating and diarrhea but with less pronounced deficiencies this will probably mean that there will be more food for microbiota (with possibly more short SFA) and less glucose available for digestion which translates to lower blood glucose levels.

    Sugars from fruit are completely another thing since they are now part of the another context. In this context there are some flavonoids which can block GLUT receptors (quecertin for instance). We also don’t have such a big level of industrial toxins. Then, there is fiber. Fruits themselves differ in content of fructose which can be natural or GMO stuff. Then, there are different kinds of fruit – apples will deliver big amount of fructose (not 2-5g, but more like 16 – 18g per day) but kiwi will not.

    So all those different scenarios will have to be addressed if one want to see what is really damaging, and this looks like impossible task and renders most of the case studies meaningless.

    One interesting thing to note is that in the book “How to live longer and feel better” Linus Pauling devoted several pages to the damage fructose is causing to the body. I am still waiting to see where this man was wrong in his conclusions.

    That said, I think taxing food is idiotic. Congratulations, professor, for far better approach – education.

    • rdfeinman says:

      I think this is an excellent summary of the issues involved in dietary fructose. However, I think all of this is secondary to the role of total carbohydrate in control of weight, insulin resistance and other metabolic problems. Fructophobia holds to the idea that fructose is so uniquely damaging that it will outweigh the effect of the far greater amounts of glucose in the diet. While possible, data do not support such an idea and the AHA statement that Lustig cites is the kind of highly biased pronouncements that we have come to expect from this organization. If one does want to appeal to authority, however, Linus Pauling is certainly better than Judy Wylie-Rosett who is also first author on the American Diabetes Association Statement that sugar is Ok if “covered by insulin.”

  24. [...] Her er et populært foredrag fra youtube der Robert H. Lustig nakker om fruktose, biokjemiker Richard D. Feinman kommenterer. [...]

  25. Ted Hu says:

    Alcohol as a nutrient: interactions between ethanol and carbohydrate.

    http://www.ncbi.nlm.nih.gov/pubmed/2178466

    This study examined metabolic interactions between two nutrients–ethanol and carbohydrate. Both nutrients are metabolized by a common pathway to fatty acids from acetyl-coenzyme A by lipogenic enzymes. The effects of ethanol and carbohydrate on the induction of lipogenic enzymes in livers of rats were examined using two types of base diets differing in carbohydrate and lipid content and using isocaloric substitutions of ethanol, carbohydrate, and fat.

    • rdfeinman says:

      Thanks for the link. The premise is Lustig’s idea that “Both nutrients are metabolized by a common pathway to fatty acids from acetyl-coenzyme A by lipogenic enzymes” which, while literally true, doesn’t mean anything except that all nutrients are connected. The study may have some interesting facts but I don’t see that that idea is useful. And insofar as the question was worth asking, the study shows that they are not similar nutrients in most ways.

  26. Mike Ellwood says:

    Dr Feinman,

    This comment is rather late, so I hope it will be seen (if only in moderation):

    I’m a low-carber. When I first saw “The Bitter Truth”, I assumed that Dr Lustig knew what he was talking about, so took it more or less at face value (although I wondered if fructose was so bad, he thought fruit was ok – I didn’t believe that the fibre would make all that much difference).

    And also the early critics were mostly low-carb bashers, so I tended to ignore them. So it’s interesting that a low-carb supporter like yourself is questioning Lustig.

    I really want to come on to the question of HFCS versus sucrose. Both Lustig and Taubes fairly casually said that they were effectively identical and (though I have no qualifications in the biological sciences, but do know some organic chemistry), I simply found this to be unlikely, so this always made me uneasy.

    It was Ray Peat who first gave me (listening to various of his interviews) some support for this uneasiness by suggesting that HFCS contained some residues from the corn, and that the carbohydrate values were much higher than those claimed on standard labels of HFCS-containing products. He also mentioned a Californian study relevant to this. I think this _may_ have been what he had in mind:

    http://www.fasebj.org/cgi/content/meeting_abstract/24/1_MeetingAbstracts/562.1

    See also:

    http://goranlab.com/pdf/Ventura%20Obesity%202010-sugary%20beverages.pdf

    Not sure about this one, but:
    http://drhyman.com/5-reasons-high-fructose-corn-syrup-will-kill-you-5050/ and:

    http://www.ajcn.org/content/79/4/537.short

    http://www.princeton.edu/main/news/archive/S26/91/22K07/

    http://www.ncbi.nlm.nih.gov/pubmed/22152650

    It seems to me that this should be pretty easy to test in the lab/in clinics/wards, with humans, comparing sucrose and HFCS, and using the actual HFCS that is put into regular food and drink products, not some theoretical model of what HFCS should be, since it is the commercial food and drink products that have (probably) led to the obesity epidemic.

    Lustig, it seems to me, has taken a (probably) valid case against HFCS and turned it into a (probably) invalid case against fructose in general.

    It would be very good if you could possible comment on this in a comment or in an article.

    With thanks,
    Yours sincerely,
    Mike Ellwood

    • rdfeinman says:

      A colleague and I are trying to put together our own review on fructose but it goes slowly partly because the kinds of studies that you want to see on any unique nutritional effects of fructose have not been done or are not done right. To a first approximation, sugar and HFCS are almost exactly the same (speaking of HFCS-55, there are many variations). What’s wrong is that it is i everything, in things where it doesn’t belong — salad dressing, herring and sour cream.

      The first reference you cited is methodolgic but is really about the purity of the product which is an important but not metabolic question. Trying not to make this ad hominem — I am referring to work from their labs or, worse, the content of their speculation — most of the other papers that you have links to are so biased that you can’t tell anything at all. Lustig’s work is the product of a monkey at an iPad. Some is true, some is exaggerated, some is false. This is just one of the areas where we need a neutral panel to evaluate the information.

      The tack we are working on and you can review for yourself is that there are numerous papers showing dramatic effects of replacing carbohydrate with fat and when you compare that to the effect the weak effects of replacing fructose with glucose, e.g. Stanhope, et al. (and the experiments are usual done at high total carbohydrate), the idea that fructose is a unique danger just doesn’t hold up.

      • majkinetor says:

        You should also look into the connection between Vitamin C deficiency, typically at near-scurvy level nowdays and fructose. See:

        Theodore E. Woodward Award: The Evolution of Obesity: Insights from the Mid- Miocene

        http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2917125/?tool=pmcentrez

      • rdfeinman says:

        That is a very interesting article but has a lustig style. (April Smith says that I am allowed to make fun of people’s names if they are male, over 50 and make more than $ 150, 000 a year and I am guessing that Lustig is close). The article says “the introduction of sugar and high fructose corn syrup in the current American diet has skyrocketed, with a nearly 30- to 50-fold increase in fructose intake since 1700 (15)” The figure in my original post shows that sugar and HFCS have increased by about 15 % since 1970 and fructose from sweeteners has increased by 30 %, not 30-fold! (I rarely use exclamation points).

        Your assertion that Vitamin C deficiency is near-scurvy level strikes me as absurd. It would be good to see the data. One of the good things about junk food is that it is laced with vitamins. Anecdotally, physicians tell me that admissions of alcoholics to emergency rooms has declined and it is attributed to McDonalds (now generic for fast food). One of the problems for alcoholics beyond effects of alcohol per se is that they frequently don’t eat and it is common practice to give alcoholics admitted to ER, a vitamin cocktail, the so-called “banana bag” because it is yellow (presumably due to riboflavin).

        Incidentally, my father was a physician and, as a resident at King’s County Hospital in Brooklyn, he did see a kid with scurvy and he told the mother to feed the kid oranges which fixed things and they thought he was some kind of god.

    • majkinetor says:

      Hello professor, thx for the input

      One of the good things about junk food is that it is laced with vitamins.
      RDA prevents final meltdown of organism only and its determined for healthy young population.
      Furthermore, many vitamins are unstable and deteriorate fast with cooking, exposure to oxygen etc.

      Here is just some data for C deficiency from head

      Vitamin C depletion is associated with alterations in blood histamine and plasma free carnitine in adults.

      http://www.jacn.org/content/15/6/586.short

      These data indicate that blood histamine and plasma free carnitine are altered in individuals with subnormal, non-scorbutic vitamin C status and provide evidence that metabolic changes independent of collagen metabolism occur prior to the manifestation of scurvy. Thus utilizing scurvy as an end-point to determine vitamin C requirements may not provide adequate vitamin C to promote optimal health and well-being.

      Anti-aging therapeutics, Volume 6
      One very obvious point that was only realized a couple of years ago is that people in intensive care may effectively have scurvy. Because their plasma vitamin-C levels drop very low, they are not eating, and vitamin-C is not usually added to IV infusion fluids. And as we know vitamin-C plays a key role in wound healing

      Vitamin C Deficiency and Depletion in the United States: The Third National Health and Nutrition Examination Survey, 1988 to 1994

      http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.94.5.870

      Vitamin C deficiency and depletion were common (occurring among 5%–17% and 13%–23% of respondents, respectively). Smokers, those who did not use supplements, and non-Hispanic Black males had elevated risks of vitamin C deficiency, while Mexican Americans had lower risks.

      [Decreased in NHANES 2003–2004: The overall prevalence (±SE) of age-adjusted vitamin C deficiency was 7.1 ± 0.9%.]

      Age-associated decline in ascorbic acid concentration

      http://www.fasebj.org/content/12/12/1183.full

      The hepatic ascorbic acid concentration was 54% lower in cells from old rats when compared to cells isolated from young rats

      Vitamin C and acute respiratory infections

      http://www.ingentaconnect.com/content/iuatld/ijtld/1999/00000003/00000009/art00004

      The dietary vitamin C intake in the UK is low, and consequently the benefit may be due to the correction of marginal deficiency, rather than high vitamin doses.

      Vitamin C Deficiency, High-Sensitivity C-Reactive Protein, and Cardiac Event-Fee Survival in Patients with Heart Failure

      http://circ.ahajournals.org/cgi/content/meeting_abstract/124/21_MeetingAbstracts/A14667?sid=6929860a-dd87-4c1a-b544-c2de026fd650

      Eighty-two patients (39%) had inadequate vitamin C intake.

      Vitamin C deficiency in early postnatal life impairs spatial memory and reduces the number of hippocampal neurons in guinea pigs

      http://www.ajcn.org/content/90/3/540.full.pdf

      Vitamin C–deficient subpopulations include pregnant women sharing blood vitamin C with their fetus, mothers, who convey their vitamin C deficiency to newborns during breastfeeding (5), and a recent Mexican study found severe vitamin C deficiency in ’30% of young children (age 0–2 y)

      Roles of Vitamins E and C on Neurodegenerative Diseases and Cognitive Performance
      Paleolitic humans consumed 4000mg daily.

      Paleolithic nutrition revisited: A twelve-year retrospective on its nature and implications
      Ascorbate input x 8.38 of todays input.

      Micronutrient intakes of wild primates: are humans different?
      Primates have markedly more C, E etc.. consumption

      This is all vitamin c only stuff. But there is a lot more data really, even if you do not consider genetic hypoascorbemia due to GULO loss.

      When combined with glucose and fructose we have a lot more studies. For instance:

      http://orthomolecular.org/library/jom/2005/pdf/2005-v20n03-p179.pdf

      The inhibitory effect by glucose of the actions of ascorbic acid could well explain the lack of beneficial effect of ascorbic administration in many studies reported in the literature because few, if any, such studies controlled for dietary carbohydrates

  27. This is a very nice post, Dr. Feinman. I think Dr. Lustig has a lot of important things to say, and he is basically right, but I do have serious concerns over suggesting government policy should correct the problem. Once you say something really good, like I think Lustig did, and then say that the government can fix it, it’s like when you thought your team scored a touchdown and then it gets overruled on a challenge. What Lustig has done, and what you do, that is: teaching people what you are passionate about as honestly as you can with the best information that you have is the ONLY real tool any of us have. It’s a damned great tool. The government has shown over and over again that they bungle policy, through lack of enforcement, policy loopholes, and not punishing bad behavior. Why screw up the traction that has been achieved by someone like Lustig, by suggesting the government should help us.

    • rdfeinman says:

      Wait a minute. It’s the government that funds research by me and Lustig. These days, more Lustig than me, but most scientific research is funded by the government. And the part of the government that funds research is staffed with doctors so if you don’t like the direction of research funding, it’s not the government you want to talk to, it’s the board-certified cardiologists who say we need to be cutting out saturated fat and will only fund research that thinks so too.

      Also, the government is a republic, that res publica, thing of the public. You can talk to the NIH. You can talk to your congressperson, you can support groups that try to talk to congresspeople (did I mention the Nutrition & Metabolism Society?) Government should hold a public hearing in which low-carb people have a dialogue with their critics and bring out the information that people can use. They should fund real tests of dietary interventions. To support this, the government has taxes. That’s what taxes are for. To raise money. When you confuse taxes with social planning, you are enforcing ideas and you have to be very careful. Careful is not in the plans to tax sugar. If you want to enforce sugar as an evil, you have to get agreement from the experts. You think Lustig said something really good. I don’t. The content of his writing and popular presentations is exaggerated, incorrect in places and says with certainly stuff that we don’t know at all.

      It took me a while to figure out the overall problem: recommendations are supposed to come from research. Now research comes from recommendations. I think Lustig honestly believes the party line (sugar is bad. Atkins is bad (“I’m not opposed to Atkins. I would just never recommend it.”)) and he will surely be funded to prove it. That’s not how you do research. But the part of the Government that is at fault are the same doctors who are on the AHA panels and the ADA panels. Those are the guys you want to be down on. Farragut’s quotation is now more widely used in the parody: “We have met the enemy and he is us.”

  28. Mike Ellwood says:

    Thank you for your considered reply Dr Feinman.

    On a slightly different tack, bearing in mind Dr Lustig’s comparison of fructose to ethanol, I found some ironic amusement when finding this fairly old study demonstrating that fructose speeded up the metabolism of alcohol:

    http://journals.cambridge.org/download.php?file=%2FPNS%2FPNS31_02%2FS0029665172000229a.pdf&code=c356d135985a84f19ea5704c1f57a0b3

    (In case that long link fails, the title is:
    “Metabolism of alcohol (ethanol) in man
    By G. L. S. PAWAN, Metabolic Division, Department of Medicine,
    The Middlesex Hospital Medical School, London WIP 7PN ” )

    (There seem to be several later studies on the same lines. I haven’t looked closely).

    By the way, I enjoyed your organic chemistry videos on Youtube, but I could only find two. It sounded as if more were in the pipeline. Do you have any information about further ones?
    Thank you.
    Regards,
    Mike Ellwood

  29. George Henderson says:

    This is a great discusion and a worthwhile public service.
    A fan of Gary Taubes’ at the PolicyMic blogsite hit on what I think is the perfect compromise; before we look at taxing or restricting access to sugar/HFCS, let’s first REMOVE THE SUBSIDIES we are paying to the people who produce them.
    The US taxpayer, even those who don’t touch HFCS, are paying out of their own pockets to help put it out there cheaply.
    Surely any subsidies and tax-breaks for refined carbohydrates are the low-hanging fruit legislators should go after first.
    Similarly, perhaps, if the oceans are being overfished, why do so many countries still subsidise fishing? And why is it the so-called “market led economies” that subsidise these things the most? Does the Chinese government pay subsidies for farming or fishing (or non-farming, for that matter)?

    Anyway, some questions – I read somewhere that HFCS features a different stereoisomer of fructose from that found in fruit. Is this true, and can it make a difference?

    What about galactose? I don’t mean in relation to insulin, but as a potential source of health problems. This website below may seem far-fetched to some, but to me it gives a very accurate description of the particular problems I’ve had with milk over the years. I can pretty much rule out lactose IBD or casomorphin sensitivity now, on a hunch I googled galactose + mucus and came up with this.

    http://www.health-science-spirit.com/cold.htm

    Babies need galactose as an important building block of the brain, the central nervous system and several proteins. Because of our bigger and more complex brain mother’s milk is even higher in lactose than animal milk to ensure that the baby obtains sufficient galactose.

    In later life, very little galactose is needed and this can easily be synthesized from other sugars. Therefore, most of the ingested galactose is converted to glucose in the liver and used as body fuel. However the amount that can be converted is rather limited, even in a healthy liver.

    This conversion is a slow and complex process requiring four different enzymes. One of these enzymes is sometimes missing from birth, giving rise to a condition known as galactosaemia. In this case continued milk-feeding leads to a build-up of galactose in the baby and causes cataracts, cirrhosis of the liver and spleen, and mental retardation.

    If the liver is not healthy or fully functional, it is even less able to convert galactose. This fact has sometimes been used as a clinical liver-function test. If galactose is injected into someone with a defective liver, most of the galactose will be unused and will show up later in the urine.

    However, lactose intolerance is only a minor problem compared to the much more serious health problems caused by galactose. Lactose intolerance actually appears to be a wise precaution of nature rather than a regrettable accident, because it helps to protect us from the great danger of galactose overload as most Caucasian adults and older children who can digest lactose are unable to use galactose efficiently or dispose of it safely.

    In societies that traditionally used milk products, individuals were protected from galactose overload by a series of defences. Commonly lactose content was reduced by fermenting, and making cheese and quark and butter while discarding most of the whey. These individuals had an intestinal flora that converted much of the ingested galactose into energy. They had strong liver enzymes to convert any absorbed galactose into glucose. Finally, on a traditional diet they would have had sufficient antioxidants to minimize the formation of mucic acid, and instead would just discharge any surplus galactose with the urine.

    Most of these protective defences are greatly reduced or no longer available in modern society. Therefore, preventing excessive mucus accumulation in the body is much easier than trying to remove it afterwards. It is a sensible precaution to reduce your intake of lactose to an amount that does not cause mucus congestion or related problems.

    • rdfeinman says:

      Before we tax or look at subsidies, we should look at the science bearing on the effect of sugar or fructose. As shown in the post that you cite, there has not been a disproportionate increase in fructose. Fructose consumption went up but so did almost everything else (except red meat and eggs).

      On “I read somewhere that HFCS features a different stereoisomer of fructose from that found in fruit. Is this true, and can it make a difference?,” this is not true. I think the confusion comes from the old systems of nomenclature.

      I will try to make it simple:

      1. Assymetric molecules frequently come in right- and left-handed versions (geometry or stereochemistry).

      2. The effect of the asymmetry is that plane polarized light will be rotated due to the asymmetric field produced by the electrons of the chemical bonds. So there are two things: geometry and the measurement of rotation of polarized light.

      3. The current system for describing the stereochemistry is D- and L- which is derived from comparison to the structure of the compound glyceraldehyde (shown in tomorrow’s post). Almost all naturally occurring sugars have the D-configuration. D-glucose, D-fructose, etc. Fructose form sugar, fruit or HFCS is D-fructose. There is no difference.

      4. Direction of rotation of polarized is indicated by (+), rotation to the right, and (-), rotation to the left. There is no predictable relation between geometry and rotation; compounds are known that are D(+),D(-),L(+) and D(-).

      5. Glucose is D(+)-glucose (D configuration, rotation to the right) while the natural isomer of fructose is D(-)-fructose (D configuration, rotation to the left). Because fructose is (-) it had the old name levulose (levi- left). But all fructose, from fruit or HFCS, is the same as levulose.

      6. The complication. In the old nomenclature (which should never be used), lower case d and l referred to rotation so what we call D(+)-glucose was called d-glucose while D(-)-fructose was called l-fructose. d stood for dextrorotatory and l for levorotatory. That is why glucose is sometimes called dextrose (for example on an IV container).

      Bottom line: Almost all naturally occurring sugars are D-. Fructose is D(-)-fructose regardless of source.

  30. majkinetor says:

    The article says “the introduction of sugar and high fructose corn syrup in the current American diet has skyrocketed, with a nearly 30- to 50-fold increase in fructose intake since 1700 (15)” The figure in my original post shows that sugar and HFCS have increased by about 15 % since 1970 and fructose from sweeteners has increased by 30 %, not 30-fold! (I rarely use exclamation points).

    Dear Mr. Feinman,

    Their reference year was 1700. Yours was 1970. From the paper http://goo.gl/sNrJZ Table 1 we see that from 1986 there is between 15-50% increase in sugar consumption depending on location.

    They actually refer to this paper: http://www.ajcn.org/content/86/4/899.long and figure 1:

    which itself is based on Yudkin and Deerr work.

    • rdfeinman says:

      My mistake but the obesity epidemic is really from 1970 and it is hard to attribute any unique effect to fructose, especially beyond its effect as a carbohydrate.

  31. George Henderson says:

    Thanks for settling the stereoisomer question. The fructose in HCFS is being made from the glucose, it’s not present in corn naturally in those proportions, like it is in sugar cane and beet?

    Cameron English is the blogger who drew my attention to the HFCS corn subsidies.
    If one is opposed to a punitive tax on HFCS and sugar (I’d be wary just because of the law of unintended consequences; I’m sure they can be replaced with something worse), don’t subsidies for corn amount to a tax intended to INCREASE carbohydrate consumption (by making carbohydrate foods – and also one of the worst oils – cheaper than they would otherwise be)?
    Either one is government interference in the food supply. Why not level the field (one might even subsidise eggs and red meat, to bring things back to a pre-epidemic state).

    In the NHAMES charts it looks as though increased PUFA or MUFA consumption by women is associated with increased enegy intake. Men’s fat proportions stayed more the same and the increase was fat less.

    • rdfeinman says:

      Let me see if I have this straight. You think that the government has inconsistent, poorly thought out mess of different programs that have been pushed by corporate interests. Hmm. Have to think about that one.

      My concern is that this crazy sugar tax is obscuring the science which says that fructose is a carbohydrate. There is extensive evidence from mechanism, small studies and epidemiology that high carbohydrate plays a major role in obesity and especially diabetes. So science dictates that you show that the effects of carbohydrate are due, in a major way, to the presence of fructose or, conversely that any detrimental effects of fructose are due to more than the fact that it is a carbohydrate. That fructose added on top of a high carbohydrate diet may be especially bad is related but unimportant question.

      Whatever you want to say about subsidies, though, they are positive steps however misguided. Taxing the patient is punitive and is an excuse for failure. Lustig failed to help his kids. (Otherwise he wouldn’t need a tax). Ludwig failed to help his kids. (Otherwise he wouldn’t need a tax). They did so because they refuse to explore the approaches of those pediatricians who have reported success.

  32. George Henderson says:

    It occurs to me that since 1970 a growing number of individuals have increasingly reduced their sugar consumption, meaning that the people who still consume it may consume significantly more than the charts suggest. And the obesity epidemic doesn’t hit everyone equally. We need to be more like Brillat-Savarin, asking the adipose what foods they liked best when gaining.

  33. majkinetor says:

    One of the good things about junk food is that it is laced with vitamins.
    Actually, it doesn’t look like that. Dr. Ames, who is among the few hundred most-cited scientists in all fields has a theory of aging:

    Low micronutrient intake may accelerate the degenerative diseases of aging through allocation of scarce micronutrients by triage

    That is an excellent read, IMO. Among the other stuff he cities paper Consumption of energy-dense, nutrient-poor foods by adult Americans which concludes:

    The results suggest that EDNP foods were consumed at the expense of nutrient-dense foods, resulting in 1) increased risk of high energy intake, 2) marginal micronutrient intake, 3) poor compliance with nutrient- and food group-related dietary guidance, and 4) low serum concentrations of vitamins and carotenoids
    • rdfeinman says:

      I might be wrong. Will take a look. By the way, does “nutrient” now mean “micronutrient?” Having decided never to utter the words “low carbohydrate,” the nutrition establishment is now giving up the work “macronutrient.” “All-seeing heaven, what a world is this!”

  34. Fliff says:

    It should be noted that:

    – Lustig is very down on fatophobia, and connects the low-fat movement with the obesity epidemic.

    – He prescribes low-carb diets for dealing with obesity, if just the “no sugar, real food” approach fails.

    I.e. see his slides here, about targetting insulin in obesity treatment:

    http://www.mcw.edu/FileLibrary/User/bcozza/LustigMay20th.pdf

    • rdfeinman says:

      So the first line of attack is “no sugar, real food.” Remind me again how we know when food is real? Is rice real? How about fried rice? Is kielbasa real? How about high fiber bread? Hamburgers? Cheeseburgers? So, where are the data on the “no sugar, real food” approach? There are numerous studies on low carbohydrate diets. Do you have a reference to a no sugar, real food study? My guess is Lustig does not have good success with his own patients. Otherwise, he would recommend the diet that has given him such great success rather than feeling the need to punish all of us with his sugar tax.

      Lustig’s pdf is about targeting insulin with drugs which is what he is trained for. In the post, I pointed out that he is down on Twinkies but the major ingredient is flour. Real flour. He always says that the combined sugar, HFCS and other sweeteners adds up to more than the flour but when you actually add them up they are not. Data is not a big deal with Lustig.

      • Makro says:

        Well, “realness” is a relative matter. So if the original diet consists of hostess twinkies and fruit juice, moving to potatoes and kielbasa will probably be a step in the right direction, and might lead to improvement / remission. It´s not as real as full-carcass consumption of a wild-caught deer, though.

        As for how he treats his own patients, from the PDF:

        “How I treat obese children semi-empirically

        1. Get fasting blood on first visit for glucose, insulin, lipids, HbA1c, LFT’s, BUN, Cr.

        2. Remove sugar and promote exercise as the initial behavioral intervention.

        3. If they respond, great, keep going.

        4. If they don’t respond, don’t assume they’re non-compliant;

        5. Perform an Oral Glucose Tolerance Test with insulin levels, leptin.

        6. If they’re insulin resistant, try metformin.

        7. If they’re insulin hypersecretors, you might try octreotide (if insurance will pay for it), or a low-carb diet.”

        Personally, I´d prefer low-carb diets higher up the list, but I can´t say it´s a terrible plan of action. Big focus on insulin status, and a variety of treatments that all seem to have decent evidence behind them.

        The sugar tax is a side issue, where I agree completely with you that it´s a bad, bad idea.

        It´s important to emphasize that Lustig posits that carbohydrate intolerance is due to insulin dysregulation and the knock-on effects of that. I think he´s mostly correct in that assessment, and that fructose is probably one of the agents that have contributed to the obesity epidemic. I´d bet that there are more suspects out there, especially ones related to “lo-fat” mania, say, trans fats, etc.

        I don´t think that carbohydrate per se will cause metabolic syndrome in most populations – it takes something more novel to screw up insulin regulation first. Carbs – especially non-refined ones – have been with us for too long for them to cause metabolic dysregulation, imo.

        As for low-carb diets, they seem to be particularly effective in those people who have dysregulated insulin systems, for a given weight level, which bolsters the notion that carb reduction is therapeutic by mitigating insulin hypersecretion.

        PS.
        Hostess Twinkies are a perfect storm of badness (especially the old ones w/ trans fats), I.e. trans fats, sugar and white flour in one package. From the nutrition info for the new ones (found here: http://caloriecount.about.com/calories-hostess-twinkies-i113361 ) it does seem as if they are sugar bombs, at 27 g total of carbs, of which 18 g are sugars, leaving about 9 g for the flour.

      • rdfeinman says:

        Okay. How about one good study that supports this point of view. Remember, Occam’s razor dictates that since fructose is a carbohydrate, that its effect is as a carbohydrate and you have to show the extent to which any effect is specifically due to fructose.

  35. Here is one good review for start, great because it excludes studies with unphysiological fructose dosing.

    Mayes, P A. “Intermediary Metabolism of Fructose.” The American Journal of Clinical Nutrition 58, no. 5 Suppl (November 1993): 754S–765S.

    BTW, I would define level of ‘food realness’ as its level of industrialization (and that includes genetic manipulation however its done). That’s what ‘real’ means, right, that stuff exists in nature on its own. So, white rice is so unrealistic :)

    • rdfeinman says:

      The Mayes article is quite good but does not allow jumping to any Lustige conclusions. Rice isn’t real? How about trans-cinnamic acid? Or, veratraldehyde? Are they real?

  36. Margaretrc says:

    Dr. Feinman, I’m sure you figured out what to do with the Mayo ingredients listed by the commentator above. There are many ways to combine those ingredents to create the emulsion that Mayo is. However, in case you haven’t come across this yet, (and are still reading comments here) here is the absolute easiest and fastest way: http://www.lastappetite.com/how-to-make-mayonnaise-in-20-seconds/ I use a blend of coconut and light olive oil, but any oil that you like and doesn’t have a lot of flavor (to interfere with the flavor of the lemon juice or whatever other acid you use will do. :)

    • rdfeinman says:

      No, I have not solved the problem although have not been pursuing it actively. A few years ago, I had an immersion blender which worked the first time just like in the YouTube but did not when I tried it again. Same experience with the Magic Bullet but I will get back to it. I assume temperature is important but despite learning one trick of the trade — if you freeze an egg, after it thaws, it has greater thickening power — still can’t do it every time.

  37. Laura says:

    Hi Prof I finally reached you. I truly enjoyed your critique of dr Lustig….and I realy apprecite what you are trying to do as a scientist to readdress the balance. I started to become suspicious of Dr Lustig anti fructose campaign but we all want a culprit and my own superficial research fuelled by a few reputable anti-fructose papers (not authored by Lustig I made sure of that) in Nutritional journals seemed to confirm some of the points made by Lustig. However he has fallen in the very same pitfalls of other countless ‘anti-something’ people before him.

    The only thing I agree with (Lustig I mean although he seems to use the phrase for effect) and I cna see you also concur is that a calorie is not a calorie that each food type or even individual components will be dealt with by the body enzymatic machinery differently depending on amounts and combinations of other nutrients they come with. Yes the time of taking those flat linear metabolic maps as set in stone is over. But I believe that this knowledge is scary for people because it means that we are both as individuals and as a society more responsible for what food combinations and portions we put in our bellies! People don’t like this!They was easily identifiavle culprits NOT an entire food group like starches for example. Having forsaken our ancestral insticts of what was good for us we now should rely on a level of scietific knowledgeto guide our choices through the nutritional maze that not eveybody is willing or cares to acquire. I mean when I tell people colleagues (and I work in an academic/medical environment) that we are NOT adapted to consume grains in any amount especially at the doses we are offered today as breakfast and lunch and dinner and snack people jsut smile..basically it is carb mania outthere and they feel it is IMOSSIBLE to avoid them and many of us are quite frankly addicted.
    As a vegan for 16 years I am used to avoid foods read labels check provenance of ingredients also for ethical and nutritional reasons etc…but most people jsut wanna eat..it is a pleasurable thing. I see their point of view but two thing motivate me actually three:
    1) when i simply ‘ate’ I was FAT
    2) at this point in life I care what goes in as i have suffered damage that i think I can attribute ot food
    3) You can still enjoy food even if you have to do a bit more thinking and planning before getting it into your mouth!
    so there. SO thanks again I shall read your site with interest and follow it and sorry if I thought you were a ‘novice’…..it still makes me laugh!

  38. George Henderson says:

    Perhaps this quote is relevant:
    If Hitler invaded hell I would make at least a favorable reference to the devil in the House of Commons.
    Winston Churchill

    To invert the analogy, Lustig is invading Hell. His tanks are crappy, his maps are old, and his tactics are often misguided. He doesn’t have a democratic form of government and is prone to liquidating his internal political opposition.
    But, people, he is invading Hell.
    Should our support be withheld or conditional?

    This Hyperlipid post http://high-fat-nutrition.blogspot.co.nz/2012/05/on-glut5.html
    begins the squaring of the circle on fructose.
    It suggests that the interaction between fructose and glucose is important; that fructose by itself may be more benign than either sugar, or fructose plus starch.

    • rdfeinman says:

      Lustig is invading his own definition of hell. Support? Is he running for office?
      Hyperlipid link is good because it has some data. “Follow the data.”

      • George Henderson says:

        Ah, but it seems to me that, whether or not you are running for office, you also promote programmes that require some degree of support to be effective.
        Perhaps a good question is, what sort of support can a blogging community provide?

        I signed Gary Taubes’ petition: I write letters to the editor consonant with its ideas.
        They are simplistic but they don’t ring my pedant alert.

        The most effective form of support for Lustig appears to be repeating his claims in bulk, Dr Mercola -style. Which I can’t do because of a few wrong details. It’s not my agenda to increase the amount of ignorance and misunderstanding.

        To go back to the analogy, in a war you can be Allied to another power, in which case you share their strategy and goals.
        or you can be a co-belligerent; this means that you do not want to be allied to them (perhaps they are a recent enemy) but you recognise they are now fighting the same enemy as you.
        And my enemy’s enemy…

        Follow the data – it amazes me how scant this still is, a legacy of the lipid hypothesis.
        Of course, social interventions also generate data.

        The question is, is there any health benefit of sugar that we have been overlooking?

      • rdfeinman says:

        The data is voluminous. We have been collecting it for centuries. We may not want to look at it and some times it is hard to analyze but it’s there.

        Is there any health benefit to sugar? Well, it might keep you from dying of starvation if you were stranded in the Andes for months. Sugar is not a medicine. It is a food and like any food, it’s effects depends on what else and how much you consume.

        Why support Lustig? He is not a scientist, any more than Ancel Keys was. Repeat his claims? Claims are not science. Why not support the scientific data?

        The blogging community can support investigation of the science and demand impartial panels to evaluate the data. The target should be diabetes because it is where we have the clearest science, where carbohydrate restriction has the most obvious benefit and where, following the idea of metabolic syndrome, results may generalize to obesity and other areas. I gave three demands that we can make and 15 theses that are the basis for therapy and prevention http://wp.me/p16vK0-c3 but they may not be the best and anybody can modify but we have to have something to ask for.

        The blogging community can get together and demand action from their elected officials. The trouble with the blogging community is that there is a lot of blogging but very little community. Feel free to be the person to get everybody to begin a campaign.

        The three demands, as I wrote them.
        1. Open hearings on nutrition in which all credentialed researchers participate and, in particular, researchers in low carbohydrate diets meet with their critics (a kind of Diet of Worms).
        2. Funding of a comparative study in which researchers in carbohydrate restriction and experts in other diets cooperate in the design and analysis of outcomes. Possible results and their meaning are agreed upon in advance and finally,
        3. New oversight agencies (possibly from National Science Foundation or Office of Science and Technology Policy) where truly neutral scientists can evaluate information and make recommendations (or not if there is no evidence).

      • George Henderson says:

        An important point here is, that the opposite of the cure isn’t necessarily the cause.
        If restricting sugar helps control (say) diabetes, we still have not proved that sugar causes diabetes.
        If low-carb dieting provides a clearer improvement than any other intervention, we still haven’t shown that sugar (or pathogens, toxins, allergens, micronutrient deficiencies, or yet another Mossad, Monsanto, and/or Big Pharma conspiracy) can be ruled out as the causative agent.
        So that debating 1) what we should do to treat these diet-sensitive diseases, 2) what we could do to prevent them, and 3) what actually causes them, are three different ballgames.
        To syllogistically argue from 1) to 3), while we may well be correct, is going out on a limb.
        We have a lot more data around 1) than we may ever have around 3).

      • George:An important point here is, that the opposite of the cure isn’t necessarily the cause.

        Indeed. People, in my experience, dismiss low carb in many cases by using false deduction that dietary carbs can not be cause of diabetes/obesity so removing them, hence, is not a solution ….

        The question is, is there any health benefit of sugar that we have been overlooking?
        Since there is definitely no value in refined sugar, the real question is, does the sugar come with some friends ? For instance, policosanol is AFAIK found only in starch rich plants. Who knows how many substances aren’t even discovered.

        About other “issues” most that I found are related to thyroid function (see for instance http://goo.gl/iM7A2). I personally get cold hands when I work on ketones to the point that I must sit on them. That never happened before (and I am probably not deficient since I eat nutrient rich food on top of vitamin megadoses). This also seem to be one of the main reasons for “safe starch” movement started by Jaminets of “Perfect Health Diet” (there are some other things they mention like abnormal glycosilation, dry eyes etc… which I don’t think is supported by evidence). Any though on thyroid issues ?

      • rdfeinman says:

        I don’t understand. Who says that we know that dietary carbs can not be cause of diabetes/obesity. It is true that because they are a treatment, it does not follow that they are a cause. But they are not excluded as a cause.

        And refined sugar is a food. There is no “refinement” receptor. If you need food and it’s sugar, refined or otherwise, it will keep you alive.

      • George Henderson says:

        Perhaps the question should be whether refined sugars have benefits that cannot be as easily served by starch, fruit, or honey.
        Personally I think a case can be made for sugar in jam or chutney etc. If you think berries are healthy, and you don’t have a freezer, then jam is a cheap way of having berries all year round.

        Even fructose may be innocuous in an intermittent-fasting lifestyle.

        http://www.salk.edu/news/pressrelease_details.php?press_id=560

        “The Salk study found the body stores fat while eating and starts to burn fat and breakdown cholesterol into beneficial bile acids only after a few hours of fasting. When eating frequently, the body continues to make and store fat, ballooning fat cells and liver cells, which can result in liver damage. Under such conditions the liver also continues to make glucose, which raises blood sugar levels. Time-restricted feeding, on the other hand, reduces production of free fat, glucose and cholesterol and makes better use of them. It cuts down fat storage and turns on fat burning mechanisms when the animals undergo daily fasting, thereby keeping the liver cells healthy and reducing overall body fat.

        The daily feeding-fasting cycle activates liver enzymes that breakdown cholesterol into bile acids, spurring the metabolism of brown fat – a type of “good fat” in our body that converts extra calories to heat. Thus the body literally burns fat during fasting. The liver also shuts down glucose production for several hours, which helps lower blood glucose. The extra glucose that would have ended up in the blood – high blood sugar is a hallmark of diabetes – is instead used to build molecules that repair damaged cells and make new DNA. This helps prevent chronic inflammation, which has been implicated in the development of a number of diseases, including heart disease, cancer, stroke and Alzheimer’s. Under the time-restricted feeding schedule studied by Panda’s lab, such low-grade inflammation was also reduced.”

      • rdfeinman says:

        I don’t know what this is about. “chutney?…jam?…fructose may be innocuous…” What about chocolate mousse? What about pears in red wine and tamogoyaki? A thing I don’t like about the lipophobes is how they are here to save us from béarnaise sauce and other excesses of haute cuisine. Now, the fructophobes are going to save us from all the desserts. If you have a weight problem or relevant medical problem, you may not be able to eat everything in the Larousse Gastronomique but that’s because you have a problem but fructose is not a poison and still … one good study that shows me replacing fructose with glucose is better than replacing all carbs with fat.

      • George Henderson says:

        “one good study that shows me replacing fructose with glucose is better than replacing all carbs with fat”

        You’ll be waiting a long time, methinks!
        But really, that is what should be put to Lustig. It is perhaps the first experiment that should be lined up by the body Gary Taubes is proposing. Is it on the Nutrition and Metabolism to-do list?

        If you’re avoiding sugar as a source of bulk energy, then you have more room to use it for flavour, preserving and other small but food-rewarding uses.

      • rdfeinman says:

        The experiment has really been done in different places, and one has to compare different studies. Blogging about that is on my to-do list. The to-do list for Nutrition & Metabolism is the sum of any to-do list the members have. What’s on your to-do list?

      • George Henderson says:

        I’m really looking forward to reading about comparative studies of sugar versus carb restriction. I didn’t realise there was research could be used to demonstate the difference.
        This is what is needed to steady the Lustig debate.

        If GLUT5 increases in intestine when fructose is fed, clearly fructose in nature is not a metabolic poison the body tries to avoid, but another resource to be exploited.

        Once exposure exceeds design parameters, as with anything, we have a problem. We have to understand what factors set those parameters in the case of fructose. That’s on my to-do list.

      • rdfeinman says:

        The studies that are out there are total carbs but the effects are very large and it is hard to believe the it is due solely to the fructose in the diet and, of course, even the fructophobes admit that glucose is the major problem in diabetes where Nuttal and Gannon‘s major work shows a striking effect of reducing “bioavailable glucose.”

      • George Henderson says:

        http://www.fas.harvard.edu/~hbe-lab/acrobatfiles/critical.pdf

        Hadza men eating 30% calories as honey.

  39. George Henderson says:

    Also, fructose is obtained from root veges and most tubers (except yams), with onion, sweet potato, beet and carrot comparing with fruit as a source…http://en.wikipedia.org/wiki/Fructose#Food_sources

  40. Alfonzo Luz says:

    Dear Richard,
    This website called Wait a Minute, Lustig is truly a service to humanity. Human Biochemistry and Endocrinology are works of art and science. It’s hard to tell where one starts and the other leaves off and this kind of discussion will inevitably lead to more discovery and greater comprehension.
    I am trying to absorb all of the learned offerings of Feinman, Listig, Taubes, Moore and the rest. One of these days there will be enough pieces of the puzzle visible on the table to make a clearer picture. If some of the pieces are missing, it is for us to find or restore them so that things are clear enough for everyone.
    Thanks for taking the time and making the effort to create a project table for this very worthwhile undertaking.
    AL

  41. Richard says:

    I thought about this for a while, and it seems to me that carbohydrate reduction is probably the best way to lose weight and avoid metabolic issues. (It works for me.) And maybe resolve them. Sugar is a carbohydrate, so sugar reduction is almost certainly a good thing in those terms, and for that purpose. Sugar is also a very direct precursor of glucose in the blood, but a few other things are also pretty effective at raising blood glucose levels. In any event, there is no clear need for sugar consumption.

    So sugar need not be singled out as some sort of plague, it is just at the top of the list, perhaps, of foods that need to be minimized, in a modern diet.

    The modern diet is not the same as ancestral diets. Adding sugar on top of heaps of carbs already being consumed may be (probably is…) entirely different from occasionally getting your hands on a large ration of honey, or gorging on some other sweet item. In a modern context, the body is already working hard to deal with the excess glucose created by excess rice and wheat consumption.

    The problem is that it doesn’t make a lot of sense to ban sucrose for people who are not eating many carbs, so maybe we should ban excessive carb consumption first? When? Can we do it now? Should we make it impossible to buy more than one small serving of pasta at a time? Or too many potatoes?

    I agree it’s bad science, but it’s really almost comical. Why ban sugar when the other carbs are taking the population to the precipice of metabolic issues? Sugar might be the last straw, but why start with sugar? Carbs are the gateway drug in this situation.

  42. [...] the idea of regulating a heavily subsidized product like HFCS, as I do, although his argument is much less scatalogical that Penn & [...]

  43. I’ve linked to this article in my discussion of carbs vs calories as drivers of DNL from fructose.

    http://hopefulgeranium.blogspot.co.nz/2012/07/what-does-hypercaloric-actually-mean.html

    Sort of gave you the job of summing up, really.

  44. [...] Feinman, R. D. (2011, 29. Juli). Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity. Richard D. Feinman (http://rdfeinman.wordpress.com/2011/07/29/wait-a-minute-lustig-the-threat-of-fructophobia-and-the-op…); [...]

  45. jliss says:

    Thanks for the interesting discussion. I understand everyone’s points and overall I am just pleased to be awakened to the potential effects of fructose and/or refined carbs etc and await further data (hopefully) on the subject as the debate and research continue.

    One point that struck me as dubious in Lustig’s book (haven’t seen the video) is his statement that putting fruit into a blender to make a smoothie destroys the fiber and you are left with, basically, sugar without the counterbalance of fiber. I’m an ophthalmologist without the chemistry knowledge to know if this is so, but I would have thought that the molecular structure/ultrastructure of the fiber is maintained enough to serve it’s purpose in the intestine despite going through a blender. After all, doesn’t our mouth do the same thing to it, if not as thoroughly? What do you think? I like smoothies.

    I understand that the issue of whether fruit is good or bad or neutral is unresolved and I do not wish to get started on that with this comment.

    • rdfeinman says:

      Lustig is a smoothie. He makes all this stuff up but because you never actually saw the data, you’re not quite sure. Sometimes he gets caught as in the hysterical moment at a conference when he didn’t know that breast milk is sweet. The effect of fiber is iffy to begin with but I would make the same assumption that you did. But we will check. His method is to make a didactic statement and put you in the position of proving him wrong. He’s a smoothie.

  46. […] Biochemist Richard Feinman, for example, could’ve reminded Dr. Gupta that while it may be true that the focus on fat gave the food industry license to replace many foods with carbohydrate, it’s overconsumption of carbohydrate “across the board” that’s contributing calories fueling the obesity epidemic. What comes of demonizing just table sugar or high-fructose corn syrup? It will simply lead folks to eat/drink too much of something else, argues Feinman. […]

  47. […] google skills: The bitter truth about fructose alarmism. | Alan Aragon's Blog Debunking Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity. | Richard David Feinman And because people are probably too lazy to click into the articles, just an example of how Lustig […]

  48. […] Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity.  […]

  49. […] insulin resistance. Have your read Prof. Richard Feinman contrary views on Lustig fructose ideas. Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity. | Richard David Feinman google_ad_client = 'ca-pub-7865546952023728'; google_ad_channel = '2299620440'; […]

  50. […] meme, he is not even a low carber himself. So he most not believe much of what he talk. Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity. | Richard David Feinman google_ad_client = 'ca-pub-7865546952023728'; google_ad_channel = '2299620440'; […]

  51. […] If you reduce portions, change for types of less rapid acting carbohydrates and you exercise you change insulin dynamics and probably end up with less insulin resistance. Have your read Prof. Richard Feinman contrary views on Lustig fructose ideas. Wait a Minute, Lustig. The Threat of Fructophobia. And the Opportunity. | Richard David Feinman […]

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