Sugar or fructose? Or something else?

When watching the TEDx talk of Dr Lustig, where he just repeated what he used to say elsewhere and other times, he finally showed this list of added sugars to the food (15:40 minute), saying that 80% of food on the supermarket shelves is spiked with sugar. 

Do you remember saying that it is just fructose that is a poison and that glucose is fine? Well, dextrose, dextran, glucose, glucose solids, malt syrup, maltose, diastatic malt, barley malt, are all glucoses or polymers of glucose. Lactose and galactose also contain no fructose. Regarding the rice syrup I have only managed to find a brown rice syrup, which is again only glucose or glucose polymers. Similarly the corn syrup is not the same as high-fructose corn syrup and it again only contains glucose molecules. Ethyl maltol or maltol are not sugars as such and are related to maltose, so again, no fructose I am afraid. Caramel is rather a food coloring, not a form of sugar - to my knowledge. According to diatase (second column) I have found nothing in the Google of this name, but instead there was a diastase, which is an enzyme, not a sugar. After all, refer back to the diastatic malt above. 

This  impressive list of 56 names of sugar is suddenly shorter by 15 items which are not fructose related. 

Moreover, as I discussed elsewhere, saying that 80% of foods on the market contain added sugar also sounds impressive, but it says nothing about the amount of consumed sugar. Adding a gram or two of some sweet flavor enhancer into a 100g of final product is something different than a pure candy or a soft drink, especially if the sweet taste is not readily detectable. Claiming that this sugar contributes to the rise in insulin and weight loss, while ignoring the remaining 98g of mainly starch is a nonsense. Yet many tend to repeat this 80% figure like a mantra, not understanding the whole concept.

It would be more practical to provide a stratified chart about the amount of foods containing different amounts of added sugars so that we could actually see how bad it is.

For now I am confident to announce that the sugar consumption in the U.S. has been on the decline since 2000 and this included all the major caloric sweeteners, not just the items called either sugar or high-fructose corn syrup. The following diagram illustrates the trends of per capita availability for various caloric sweeteners in the U.S., based on the USDA data. 

Dr Lustig tried to dismiss these trends as not reliable and referred to the NHANES data instead. However, the NHANES data also support these trends in consumption of sugars. The amounts of consumed sugars vary between these two sources but they both agreed on the trends. And you know that the metabolic health does not get better in the U.S. population with the decreasing sugar consumption, does it? So is it sugar or fructose or something else contributing to ill health of America and possibly other countries worldwide?

Which carbohydrate?

You could hear Dr Lustig repeatedly saying in his many lectures that we eat more sugar and that the fat intake has gone down. I have already debunked this claim, but I would like to return to it and demonstrate how sophistically you have been manipulated into thinking that it is only the sugar that has been behind the increasing prevalence of obesity and metabolic diseases.

At 22:56 minute you could (again) see this picture: 

SnackWells. I want you to focus on the figures at the bottom of the slide. You can see that the fat has been reduced in this product by 2 grams but the sugar has increased by 4 grams. Now, let's calculate: 1 gram of fat has 9 kcal whereas 1 gram of sugar has about 4 kcal (the metabolisable energy can differ, some sources use 3.75 kcal). So if the energy content of biscuits was lowered by 18 kcal, the sugar brought back 'only' 16 kcal. Was that all? 

How much the non-sugar carbohydrate has been added in the new 'healthier' version of the biscuits? It was additional 9 grams of substance, which was mostly starch in this case, hence a glucose based carbohydrate, contributing by additional 36 kcal. So, while the sugar substituted the fat with slightly lower amount of calories, the addition of other carbohydrate - starch largely exceeded the contribution of sugar calories and made the new product significantly more caloric than the old one. And now you can think: was it really the sugar fault or rather the starch? You were not told this detail although it was right in front of your eyes. Sugar went up while fat went down and that was behind the obesity and metabolic diseases of Americans. 

Why the starch contribution to calories has been ignored? I tell you why: because of the anti-sugar, or rather the anti-fructose agenda. You could repeatedly hear Dr Lustig saying on several occasions elsewhere that glucose is good, that every living organism needs it while fructose is a poison.

This biscuits example reminded me the general trends of the macronutrients (energy) consumption of the Americans over the decades. Look at the diagram I made for my dissertation work, based on the USDA data: 

Can you see the trends and what was really been happening? Up to year 2000, both sugar and fat consumption were on the rise, slightly, but rising. In comparison to them the calories from starch increased much more. And here comes the dual scenario: while the fat consumption has been rising in grams, its % of calories of the total energy intake decreased, because the consumption of total energy has increased MORE than the fat calories. But, from the diagram, it is apparent that the same happened for sugar.

And now tell me: did Dr Lustig keep saying that the fat consumption went up or down and what he said about the sugar? Something completely different, right? His claim was based on a selectively chosen data between two dietary surveys back to 1989/91 and 1994/5. There he either reported the increased sugar consumption in one case, or in another he compared the % of fat calories (going down) while the obesity prevalence went up. At some moment he admitted that the fat consumption went up by 5g, saying that it was nothing. But this detail was buried under his continuous focus on sugar and fructose further on. He never put the sugar and fat together like in the diagram above, except of using a single product like the SnackWells. If he did that, his anti-fructose agenda would be gone. And did he ever mention starch? No. Do you remember him saying a DONUT? He did not comment on processed starch - white flour from which it is made of. He used it as an illustration of combination of sugar (containing fructose) and fat only. Sugar and fat eaten together certainly are not healthy, but so is not the processed starch consumed along. But glucose is our friend, do you remember? WRONG.

Does this need any more comment, especially in the light of my first articles in this blog where I debunked his outdated information which he presented as current trends? 

Although Dr Lustig tried to dismiss the USDA data source in the past, saying that he preferred the NHANES data, the same trend in the consumption of sugar and fat has been confirmed by the NHANES and I have produced a detailed discussion on these in one of my other articles here. 

One more thing I would like to correct in that slide at the beginning. According to my knowledge and based on the reports freely available in databases, the HFCS-55 is mainly used in the drinks whereas the baked goods and confectionery tend to contain HFCS-42, hence containing only 42% of fructose, not 55%. The overall content of the fructose in all the examined added sugars was estimated to fluctuate around the 40%, because other sweeteners were used in the processed foods, such as dextrose, which contains no fructose. Therefore the remaining 60% was provided by glucose. So whenever the sugar/HFCS consumption has increased and the fructose within, glucose consumption also went up and this was still within the sugars. Add the even higher increase of glucose from starches, mainly the processed ones (donut, without the fibre), for which the data also exists, and you get the picture of what has been happening over the decades. 

So, now you have the true answer on the question: WHAT CARBOHYDRATE? 

- GLUCOSE.

How much? 

- TOO much. 

What happened to fat? 

- It also went UP and kept going up all the time in absolute amounts. The relative percentage of calories is not important here and it was only used to mislead the audience towards the picture it was wanted to see. 

Using outdated figures to falsely claim a positive correlation between sugar intake and obesity for the past 14 years

In 2013 Dr Lusting delivered a less known lecture called Sugar Pandemic Policy vs. Politics vs. Law. 

I have written a lengthy article about the imprecise, or rather misleading, information shared by Dr Lustig about the trends of particular nutrients (sugar, non-sugar carbohydrates and fat) intake in the U.S. over the past few decades. I am not going to repeat it here. Instead I would like to focus on few points in his 2013 lecture and write my comments, split into several blog articles. Some content will be repeated though. 

At about 6:20 minute of the 2013 video time Dr Lustig said in 2013:

“We are eating more, no argument. 275 kcal more in teen boys over the past 20 years”  

Over the past 20 years? What do the years show under the diagram? Look better: 1989/91 and 1995/96.

Does this look like the past 20 years in 2013 or rather 20 years ago and more? 

At 6:34 he said that Americans were told to eat low-fat, so the fat consumption has not changed, but it was the sugar consumption that went up.  Dr Lustig precisely said:

"...we consume THE SAME AMOUNT OF FAT as before, showing only 5g increase, making it 45 kcal increase per day in children and adolescents"

That was meant to be of those 275 kcal increase among the same age group. 

The diagram following after that was of the secular trends of specific food intake from the same time period, but covering the whole U.S. population, originated from the study of Chanmugam et al. 2003 (therefore it again did not cover the past 20 years). 

Since 2000 the both sources: USDA and NHANES indicate, that sugar consumption went down, but the fat intake continued to rise. 

Moreover, if you had a chance to watch the 2009 video, you would hear Dr Lustig saying something different regarding the fat intake. That time he precisely said: 

"The fat is going down, sugar is going up and we are all getting sick."

This was in time when he already had access to the publicly available data of USDA indicating that the sugar intake per capita in grams went down, while fat intake went up. And this was not in relative ratio to the total energy intake as you will see later the attempt to use this tactics as well to mislead the audience. 

In 2011 the NHANES data analysis further proved that this trend was real. The sugar intake decreased while the fat has increased in grams per person. You can find the details of it on my own website with the corresponding references.

So how it was possible that although the consumption of sugar has been decreasing since 2000 the obesity and metabolic diseases kept rising? And why the doctor kept saying that sugar consumption was on the rise for the past 20  years when it was not? He was making sugar/fructose responsible as a sole factor for the constantly increasing metabolic diseases.

One more thing: The trends presented by Dr Lustig fall within about 5 years period 20 years ago. Would you consider this period of time as being representative of the long-term trends, up to the recent past, so that you would talk in the present continuous tense? I bet not.

I hope you have now realized the errors in the presented content of Dr Lustig and that these should be corrected. I do not need to have any vested interests to see and highlight this. These are the FACTS that should have been presented by him in the first place.