Contradicting Dr Lustig’s accusations and giving the taste of a real scientific approach – updated
Update 06/08/2014: I have just checked the article of Dr Lustig on which I have written the response below. The article does not seem to exist anymore on their Institute for Responsible Nutrition website. Good. I do not know the reason why they took it off, maybe they realized their error. Or because I was muted on his Facebook page the article was not needed anymore. Never mind. I will keep this article here, as a memento of how even famous and globally endorsed professionals can be wrong in their judgement and actions. I still congratulate Dr Lustig to the big battle against the processed food industry and how this helps people getting healthier. Just please, doctor, do not promote regular breakfast consisting of processed meat (bacon, even microwaved!) and eggs as healthy, while refusing to have a slice of bread with it. Thank you.
Below is my original response to the now non-existing article of Dr Lustig.
So I have been accused as not having an academic interest but having some ‘vested interest’ instead, when opposing some of Dr Lustig’s claims about sugar consumption, according to his statement. This statement was a reaction on my activity on his Facebook page, where I lastly suggested to acknowledge the misleading claims about the trends in sugars consumption in the U.S. which he has been repeatedly presenting to the audience: “The fat is going down, sugar is going up and we are all getting sick.“ (Sugar: The Bitter Truth, 2009). These my comments do not exist anymore, they have been deleted or disabled, ALL of them, so that nobody can actually check what I have been writing.
I would like to contradict some points in his statement to clean my name. I insist that sugar consumption went down during past 15 years, whereas the fat consumption went up (in % of total energy and also in grams per person) and I guess that Dr Lustig has not read my article properly when omitting that I have also supported my arguments with the NHANES data, along with those of USDA. These both agree with trends of macronutrients and energy consumption in the U.S. population, in contrast to what he repeatedly presented to the audience in 2009 and onwards. My suggestions to put these figures right were apparently unwelcomed on his page, as was my comment that having bacon on breakfast every day (as he said to the air that he does) is not healthy. However, he never contacted me to discuss this issue, or saying to stop or anything like this. I did contact him some time ago, but he never replied. He simply wrote this dishonesting article about me, accusing me of having a vested interest, not the scientific or academic interest and he banned me from his Facebook page. I consider this behavior rude, at least.
Let me firstly say this: I am not funded by any industry, any research organisation, any other party to question Dr Lustig’s claims. This is just a result of my drive to put the facts right and to see the truth in such materials presented worldwide. I have based my claims on the independent research – a critical review of the scientific literature published in peer reviewed journals and other official information, pretty much the same ones which he used to back up his claims. I have no personal objections against Dr Lustig and, in fact, I actually agree with his mission to reduce the impact of processed food on peoples health and well-being by promoting healthy and wholesome diet and the lifestyle overall. I have cut down on processed food myself, including sugar. Despite that, I have a strong scientific and academic interest in seeing the real facts in materials presented to the public and also the professionals of all kinds. I suppose that this gives me the right to disagree with some of his claims and to suggest or even demand their update as per real scientific evidence, using a proper scientific approach.
Once upon a time, I was in a second year of my BSc Human Nutrition course and starting researching the subject of Fructose and metabolic syndrome. My interest in this topic was triggered by watching one of Dr. Lustig’s videos. Then we exchanged few e-mails, it was in 2012. I have done my research and found less convincing evidence about the sole role of fructose in the development of metabolic syndrome and obesity in the U.S. population and also that the trends in sugar consumption do not actually correlate with the constantly increasing prevalence of obesity and metabolic diseases among people. I have decided to share my findings with the world, also by creating this website. On the 10th March 2014 I sent a private message to Dr Lustig, giving him a chance to express whether there was some change in his views from those presented in his famous 2009 video about the bitter truth of sugar. He never replied.
Point by point
In one of his most recent posts on the Facebook page, Dr Lustig shared his statement, highlighting that ‘science first’.:
Of course, science first, that is exactly my aim, too. His statement contained four points he picked up and commented on, hoping to settle the issue. I am now going to take his statement point by point, literally, to contradict his conclusions, some based on either misunderstanding or underestimation of the context I have presented in my original article.
I want to take a moment to respond to Ms. Slamenik’s assertions that the concerns about sugar and metabolic disease are misplaced. For the most part, her entire argument centers around the issue of how much sugar we actually eat.
Firstly, I did not say that the sugar is harmless in high quantities. I have repeatedly expressed my view, based on the independent research, within a specific context for several times on his Facebook page as a response to other peoples comments, and also elsewhere. I would rather say that Dr Lustig’s conclusion of the center of my entire argument was misplaced. I did not question the actual amount of sugar consumed, I contradicted his claims about the TRENDS in sugar consumption by the U.S. population for the past few decades. The data shows something different than what he was presenting and that was the core argument of my Part 2 article he commented on. The basic logic says: when the sugar consumption (majority of the caloric sweeteners) have had a decreasing tendency since 1999, one cannot positively link it with ever increasing obesity and metabolic diseases prevalence. THIS IS SCIENCE. First or last, it does not matter.
All of the curves that she shows come from USDA disappearance data.
Sure, the curves do, because I had a continuous data available. The same data he used before to support his claims to a certain point in the history, but presenting it as the current trends. When I used the whole amount of data up to the most recent ones, Dr Lustig refuses their validity. WHY? In contrast to this restricted argument of his, I have also reported the findings based on the NHANES data, which supported the USDA data in trends, although not in amounts, which is nothing unusual. I am very well aware of the limitations of both data sources. But if these were good to support Dr Lustig’s arguments before, why they are suddenly not good to support my arguments?
…it does not include fruit juice, which is still sugar, just not added.
Sure. I was aware that some sources of sugars were not included in USDA data and I have discussed this as well in my article and also in my dissertation work. However, fruit juice has been a common food/drink item among the U.S. population for decades. It is not a new thing added to their diet just recently although the variety on the market may suggest otherwise. Based on my observation, people in general do not tend to add fruit juice to their diet, it rather replaces the soft drinks already present in their diet, because they believe that fruit juice is a healthy alternative. Here I have to come back to the main problem of Dr Lustig argument: I do not primarily question the actual amounts of sugar consumption, but the trends. I continue with his point:
Rather, I used the NHANES data, which is based on consumption
So did I! Please read the article properly, do not just look at the diagrams based on the USDA data, on which you have probably based your critique, Dr Lustig. I have properly referenced the data below the article. Just have a look. I have repeatedly stated, also on the Facebook page, that both USDA and NHANES data agree on the trends of sugar consumption, but nobody can check it right now, because these were removed. But my article states this, too.
While it is true that sugar consumption is declining to 15% of total calories (Welsh et al. JAMA 2011), this is still triple the threshold of 5% as recently set by the World Health Organization. If a substance is toxic, and you are consuming 4x the threshold, and then you cut back to 3x the threshold, do you really think you will get better?
Finally, Dr Lustig has admitted the decrease in sugar consumption. I agree that even 15% of total calories can be harmful, depending on the individual circumstances. However, this is an average of the population. Some eat more, others eat less. I do not want to elaborate on this as it would be pointless. What I wanted to highlight was the DECREASE in sugar consumption finally admitted by Dr Lustig, while the metabolic diseases continue rising. Does this add up? I do not think so. This only supports the trends presented by the USDA. In addition, as I have also discussed in my original article and which Dr Lustig did not comment on at all, both USDA and NHANES data suggest increased energy intake, decreased sugar consumption, increased non-sugar carbohydrates, increased fat calories in grams and also in % of total energy intake (which are completely in contrast to his claims in the videos so praised by uneducated public or the public without this specific insight).
One Australian group made the same mistake by using bad data.
I have read about that already. This was an unfortunate case and I agree on that.
However, Robertson exposed the Paradox by showing that the ABS database excluded imports. When the ABARE database was instead used, the correlation between sugar and obesity was present and robust.
While that was true, and the USDA also does not include imported goods with sugar content, this did not have the power to show trends in sugar consumption different to what NHANES showed. They both agreed on this. So if Dr Lustig wanted to disprove USDA data for trends in sugar consumption, there still was so endorsed (by Dr Lustig) NHANES data that actually supported the refused USDA. So apparently this detail of not including some imported sugar in the USDA data was not significant. Again: I did not question the actual amounts, but the trends. USDA and NHANES show the same trend.
Don’t even take my word for it. WHO and FDA and the UK Scientific Advisory Group on Nutrition (SACN) and the Australian Dietary Guidelines Committee have all agreed within the last year that our sugar consumption is way too high, that it is a primary cause of obesity and metabolic disease, and that it needs to come down.
If the official bodies say that, it must be true, right? Completely, however you take it, from whichever angle. Simple scneario and a simple result. Well, it is not that easy. I have already outlined the discrepancy between the trends of sugar consumption and the rise in metabolic diseases. One does not have to be an Einstein to realize it. However, some people seem to be resistant to this, regardless of how hard I am trying and how many times I point this out. Another point is, that there is a group of the population having high intake of sugar while other people have rather lower sugar intake, and intake of other stuff as well, which is not taken into account by Dr Lustig and many others. However, I do care about those confounding variables as well, because Science First, remember?). In plain words: among those over-consuming sugar, it is only logical that they will suffer with metabolic diseases, especially when not balancing this consumption with other dietary and lifestyle factors, such as fat consumption and physical activity, or the intake of vegetables, fruits or complex carbohydrates. So yes, I do agree that high consumption of sugar, if on top of normal diet and when contributing to positive energy balance, is the primary cause of obesity and metabolic diseases in this group of people, and it should come down.
Meanwhile, I have started reading the SACN report. For example, on the page 94 of their draft document recently published, they have found conflicting evidence for the relationship between the sugar sweetened beverages consumption and BMI among children and adolescents. This somehow does not match the readily announced statement by Dr Lustig quoted earlier: “it (sugar) is a primary cause of obesity and metabolic disease“. Nonetheless, I recognize that too much sugar (and basically of everything, especially when in unlucky combination, such as such as sugar and fat, is not healthy. Glucose, insulin, fat in the diet, fat stored… Dr Lustig knows this very well, too. Fructose does not stimulate insulin rise to the same extend as glucose does. Fructose does have some negative effects on metabolism when consumed in large amounts, but its independent role in most of the metabolic syndrome features is less unequivocal, based on my independent research and research of others. I will write another exhausting article about this in one of my other articles of this series.
While I do not deride Ms. Slamenik’s efforts to arrive at the truth, the vehemence of her assertions in the face of overwhelming evidence suggests that she has a vested interest, rather than a academic interest, in the outcome.
Overwhelming evidence? Of what, Dr Lustig? Outlining a correlation and present it as a causation with an apparent discrepancy in the trends of sugar consumption and metabolic diseases prevalence? The USDA data and also the NHANES data endorsed by you, and also your admission about the reduced sugar intake just do not match the constantly increasing trends in the ill health of the U.S. population.
Dr Lustig has become famous by blaming fructose for most of the metabolic syndrome features, saying that glucose is good as such. I disagree and the data also suggests, both of USDA and NHANES, that it was the non-fructose containing carbohydrates intake that has been rising more, along with added fats and oils, aka the fast-food chains boom during the past 20 years or so. What is MacDonald and similar food chains typical with? Sugary milkshakes? Sugary cola? How about diet soft drinks gaining more popularity; how about white buns and fries soaked with burned oil rich in omega-6 and the diet like this generally poor in omega-3? How about the known effect of high glycemic index (glucose, not fructose) of foods, promoting fat storage instead of fat burn when consumed along fat in the diet? This is what I call science. Not basing a fame on one macro-nutrient, distorting the picture of long-term trend in its consumption, and ignoring the other macro-nutrients, probably contributing to the current ill health of America more than just the sugar/fructose alone.
80% of processed foods contain sugar
Dr Lusting likes to repeat this statement in the media when being interviewed and his followers also like it and repeat it after him. However, this statement does not distinguish between different amounts of added sugar in the items and it does not say anything about the proportion of products containing negligible amounts of added sugar and those with high sugar content. It might be 1 gram (i.e. 1%), of which the metabolic effect is insignificant in comparison to 100 of flour content of that particular product, or it can be 50% of the content, which would rise a concern in me as well. Hence those 80% say little about the amount of sugar consumed by the population, but in uneducated and unaware public it has already created an impression about the horrible amounts of sugar sneaked into their mouths and bodies. Science first! Do you remember, Dr Lustig? Questioning statements like this (those 80%) is also a part of science, is it not? Nobody of the Dr Lustig’s followers seem to question this statement. They are simply amazed by it and repeat it like pupils repeat the alphabet, trying to use it against my evidence based information, that the sugar consumption in the U.S. has been on the fall for the past 15 years. Taking this, even the possible accumulative consumption of sugar in these products does not seem to negate the decreasing trends in the sugar consumption based on the survey data of NHANES, endorsed by Dr Lustig earlier on. And one thing has to be remembered: the white flour is more likely to mess up with your blood glucose and subsequently the insulin than the sugar, which is half fructose.
Another point to remind you: Do you remember the claims that fructose does not satiate the body as much as glucose because it does not rise insulin levels to the same extent the glucose does and which the brain reads as a signal to stop eating? It looks that the scientists have changed their opinion about the function of insulin in body weight regulation. I will expand more on this in one of my following articles.
I am not as famous as Dr Lustig; I do not have official bodies behind me; sponsors, other scientists, probably millions of followers not understanding the real science and accepting simple scenarios as the whole picture. Even people expressing a positive experience with a low-carbohydrate diet, based on the high consumption of meat and fat, and sharing it with Dr Lusting on his Facebook page or elsewhere, are not the scientific evidence, unless scientifically studied. These are just anecdotal cases, who did not have their diet analyzed prior and post dietary changes so we do not have the whole complex of the relevant data. Gary Taubes hugely criticized this kind of conclusion behavior when trying to disprove the outcomes of observational studies as not sufficiently scientific.
Even when another NHANES study will be made in the future, mapping peoples dietary patterns and overall health status of the population, and after reduction of sugar intake the health will be improved, it will not be scientifically sufficient to make a conclusion that sugar was the main and a sole evil. I will be interested in seeing what has happened with the fat consumption, physical activity, overall energy balance and similar things at the same time. And this still will be just an observational data, not a proper double-blinded, randomized and cross-over intervention trial, which is still considered as a gold standard in research, aside from the properly conducted meta-analysis. Let’s put the science first, Dr Lustig. Just because the official body makes some statement, it does not automatically mean that it is absolutely correct and complete in the eyes of the science. The possible failure of such official statements based on Ancel Keys, also criticized by Dr Lustig, is just an example. However, I agree that sugar is a good place to start. But sugar is not the whole story. There is more to be done and that was what I aimed to prove with the scientific evidence we have so far, taken in its complexity instead of cherry picking some factors and completely ignoring other factors (such as true fat consumption trends).
Now, coming to the end of my response to Dr Lustig’s article, I just repeat: I have nothing personal against Dr Lustig and no hidden interest other than wishing to see the complete and whole truth presented in the media. I stand my ground and insist on this. Dr Lustig has disabled the possibility for me to comment on his accusations. What I have seen was that as a result the people only gathered closer to him, theorizing about my motivations and even accusing me of being in someones pocket as I saw in one specific comment. My professors from the university could confirm how persistent I was in finding the links between different facts presented on the lectures and tutorials, trying to confirm my understanding, giving sometimes too difficult questions, beyond their knowledge… My drive for the truth, learning it and sharing it with others is just as strong.
UPDATE (25.7.2014): Just by a chance I came across this blog on the website of The Nutrition Society: Fallacies about fructose-containing sugars and their effect on health. There is a link to the recent article Misconceptions about fructose-containing sugars and their role in the obesity epidemic published by the scientists from Europe. What they say is pretty much the same as I have found out and I will write about it later on.