Every calorie counts but a calorie is not a calorie

In this video you could hear how Dr Lustig treated the patients after having a trauma on their hypothalamus by lowering the insulin levels using a drug. It certainly worked and my respects for that. It even worked in one lady who was not presented as being obese because of the trauma on her hypothalamus. She started to lose weight and also suddenly loved the exercise. But this was a treatment of the symptoms, not the causes. And Dr Lustig also started this lecture by intention to show how fixing the metabolic problem helps to lower the obesity instead of fixing the obesity in order to treat the metabolic issues. This fits his previous statement that the obesity is not a problem and it should not be called a disease. In principle I do not agree with that. 

I agree that if people have a defective tissue in their hypothalamus, the medication or other less natural invasion to their body is necessary to overcome the obstacle and to bring them a better health back. But is that necessary for other people who overate themselves to obesity and metabolic disturbances? 

In his attempts to make sugar responsible for this Dr Lustig pointed at the 'fiction' promoted by the sugar industry that Every calorie counts: 

This was an initiative of the beverages industry to promote artificially sweetened drinks in response to the current prevalence of obesity epidemics and because they were made to do it by the government and also to keep the customers who do not want to drink sugar anymore. The basic background is that regardless of what the beverages are sweetened with, the company wants to sell their drinks and earn profit. Simple as that. They acknowledged that their sugar helped to drive the current prevalence of obesity levels and they offered an alternative. They only said that all calories count and this was aimed at people who do not usually see the sweet beverages as source of energy because they only see calories in food. This statement had no intention, from my understanding, to suggest that all calories are equal as Dr Lustig also tried to imply in his TEDx talk at 10:51 and a couple times more in other lectures. 

Then you could hear Dr Lustig saying that it does not matter where the calorie comes from, that you can drink the sugary beverage or eat a carrot or a cheese cake and that the calorie is a calorie... ironically. He did not mean it. His many times repeated statement was the opposite: Calorie is not a calorie. I agree, different sources of energy trigger different metabolic processes to handle them. 

Here I would like to bring to your attention that there is a difference between the amount of consumed energy and the amount of absorbed energy, which is then available for the metabolism. The nutritionists know this very well. While you manage to absorb almost all sugar from the soft drink, from a food rich in fiber this is different. It is the fiber that prevents some portion of the energy molecules from being absorbed. And that is why people, when having a wholesome diet, they absorb less energy from a food than those who consumed the same amount of calories in the same food but more processed and depleted of fiber. This is just to highlight that every calorie matters - but every absorbed calorie, not every calorie in the food. And this is the point I would like to use against the results of the causal medical inference study Dr Lustig presented in this video and other videos as well. He reported 11-fold increased correlation between the prevalence of diabetes and 150 kcal from sugar in comparison to 150 kcal of total energy of whatever kind. Please remember this important fact when you will hear him repeating the results of their study again. 

So, if a calorie is not a calorie, what is their difference? 

You could hear Dr Lustig saying at 37:15 minute that

"we are all hyperinsulinemic now and that we all have higher insulin levels by two or three times than we used to." 

And I add, in agreement with Dr Lustig statements elsewhere: we are also heavier than out parents used to be. 

When answering the question why we all produce so much insulin today he played a video pointing at SUGAR. Then you already know that in this sugar it is the fructose moiety that is to be blamed for our insulin issues. I have a different answer and part of it has already been disclosed to you by Dr Lustig himself: 

Not only the alcohol contributes to the metabolic diseases and extra weight of people. Have you heard about the interesterified fat? These replaced the trans-fats and were also found to increase blood glucose (upon which the pancreas responds by producing more insulin). And you can see in another my article that not only the consumption of sugar is high in the U.S., but also the fast food, which is typical for the cheap vegetable oils, rich in omega-6 but low in omega-3.

Now, back to sugar. You could hear Dr Lustig dismissing the usual perception that it is the defect of energy balance that is the primary cause of obesity. I partly agree and that is because of the differences in metabolism of various energy molecules (fats, sugars, proteins). At some point all these molecules are absorbed and used or stored if in excess of the immediate use. There is a constant turnover of energy molecules in the body over the 24 hours. When we sleep the body reaches for the energy deposits, burning what we have temporarily stored in various energy compartments (liver, muscles, fat tissue). Unless a person over-eats and balances the inner energy scales over 24 hours, there will always be a balance and a stable body weight.

The problem is what makes us overeat during the day and why some people are hungrier than others? Is it because of the fructose in sugar?

In my other article I tried to explain to you why it is rather a result of consumption of glucose that makes people eating more after consuming a soft drink before going to the restaurant. And it is the glucose that is in starch and potatoes - fries. It is glucose that increases insulin far more than fructose or even fat and it is this insulin in response to consumed glucose that opens the fat cells for more fat to be taken in. 

Now I would like to remind you why I think the problem is somewhere else than in fructose (alone). I agree that too much fructose can also contribute to the insulin resistance, making people pre-diabetic. The basic problem is that obese people, or those that are yet to become obese, eat usually too much of everything: sugar, fat and also proteins. Please refer back to my simple explanation of positive energy balance while having a little energy expenditure, which makes the muscles unable to take any more of glucose and fats. This is also the cause of pre-diabetic condition. Since fructose is almost exclusively metabolized by the liver, it affects mainly the liver, not the muscles, which become insulin resistant because of too many calories consumed and too little burned off. Start exercising and the blood glucose and fat (also insulin) will go down, together with the insulin resistance.

So if Dr Lustig tried to treat the patient by interfering with the insulin response to GLUCOSE in the diet (not the fructose as he says that fructose causes insulin resistance) by cutting down on sugar, it would be more correct to say that people should stop over-eating in general. Cutting down sugar while munching on french fries and burgers will not do much change. Some weight will go away as many have reported dropping off some pounds, but if the positive energy persists and too much of processed carbohydrates will keep the high glycaemic LOAD (not index, these are different), the insulin problem will not be fixed completely. 

The solution for people without the previous hypothalamic trauma  is easy: start eating more wholesome diet and make an effort to keep your muscles working. With time it will be easier and easier and more enjoyable. Cutting down on sugar also helps but the amounts of consumed and absorbed calories will naturally also come down with a wholesome diet (my experience). Consider supplementation, especially with minerals.