He does not even get the biochemistry right

This is a strong announcement, is it not? Who am I to question such a famous and experienced doctor who has based his fame on fighting against sugar and delivering the lectures about fructose metabolism over and over again for the past years? 

Well, the data says something in contrary to his claims and this data has been available before 2013 when he delivered the speech I am focusing on right now. In fact, the sentence I have used as a title for this article was said by a Masters student of human nutrition in a private correspondence to me. She examined the link between fruit juices and health and I had a chance to read her dissertation work. It was an enriching experience, building up on my knowledge gathered until then. 

At about 38 minute of the video you could hear him discussing the liver metabolism of fructose, when he said: 

"Only the liver has the fructose transporter. Only the liver has the GLUT5 transporter that lets fructose to enter the cell."

I remember questioning this statement in my e-mails to Dr Lustig back in 2012 when I commenced my own research on the topic of fructose and metabolic syndrome. His famous video Sugar: The bitter truth was the trigger so I actually am thankful to him for that. What an irony. In my e-mail to him I highlighted that studies have shown the activity of gene for fructose transporter (GLUT5) in other tissues, including brain. His response that time was: 

"Other organs can "transport" fructose across their apical membranes, because they have the Glut5 transporter, such as the kidney and intestine. But they do not metabolize fructose for energy, because they do not possess the enzyme fructokinase, which is necessary to phosphorylate fructose to fructose-1 phosphate for production of energy."

So, in 2012 other organs had the fructose specific transporter and in 2013 it suddenly did not? How strange. 

I am not going to elaborate on the ability of other tissues or organs to metabolize fructose. Maybe there is some other mechanism in them to use fructose differently for energy or other purposes (absorption as in the intestine cells), and that needs to be studied yet, if it has not been already of which I am not aware. But the basic logic says: if the tissue has this transporter, it is likely the fructose inters the cells of this tissue and, if so, the cells must do something with the fructose after all. 

Another untrue statement of Dr Lustig at 39:04 time was that liver does not convert fructose into glycogen. He said:

"Let's follow what happens to that fructose. Can you see glycogen anywhere? Nope. No glycogen, it comes all the way here to the mitochondria, does the same as the alcohol does, makes that fat lipid droplet..."

And all that illustrated by a diagram that I remember seeing back in 2009: 

Of course, if the formation of glycogen from fructose was not painted into that diagram, it cannot be seen there, can it? 

In fact, a certain portion of fructose IS converted into glycogen by the liver, and this was proven by isotope tracer study when they labelled fructose molecules and followed their metabolic fate after its consumption by the participants. Some time after the fructose ingestion they received a glucagon which is a hormone for breaking down the glycogen and releasing glucose when its concentration in the blood drops. Guess what? The labelled glucose appeared in the blood stream. But the participants did not receive any labelled glucose. It was the fructose that was metabolized by the liver, converted to glucose, stored in glycogen and when the blood glucose dropped as in the fasting state, they sped the process of releasing the glycogen by administering extra glucagon and recovered the traced carbons in the blood again. And this was done in 2009, so Dr Lustig had enough time to get familiar with this detail after he firstly announced publicly the lack of glycogen formation from fructose in 2009 but before he said this again in 2013.

One point I would like to highlight here. All the simple mathematics he presented, such as the split of 120 kcal of glucose into the 80:20 for the liver and rest of the body metabolism, while 100% of fructose is metabolized in the liver only shows that Dr Lustig can count. All the rest is less certain regarding to how much glucose and fructose is converted to what when these two carbohydrates are consumed at the same time. The scientists have only an approximate idea and each study shows different figures. How the liver handles individual carbohydrates really depends on whether it was on an empty stomach or in a fed state, whether it was an athlete or a physically passive person, whether it was a man or a woman, etc. 

Let's say that these diagrams were only meant to illustrate a generally accepted approximate ratio of these two sugars metabolism by the liver, so they are fine. However, I cannot leave alone the previous two pieces of information that were far from the reality, but presented as facts with such a convincing authority. 

This is the final bit and the best one. The wine makers can confirm whether I spotted it right or not. Dr Lustig said that fructose and alcohol are THE SAME and that alcohol comes from fructose in fruits. Well, according to the Wikipedia, in wine making process it is the glucose that is fermented first and the different levels of fructose in the grapes will determine whether the wine will be more or less sweet, which means that not all fructose is converted to alcohol. It came out that not only Dr Lustig presented wrong information about the metabolism of fructose and the presence of fructose transport proteins in the body, but he again left out the glucose as the main alcohol producing sugar. So, are glucose and fructose so much different sugars?

You could see that fructose and alcohol are NOT the same, because although they share some metabolic pathways and they differ in their ability to be converted to glycogen (fructose) while ethanol is not, fructose also shares metabolic pathways with glucose and their metabolic intermediates are interconvertible. Especially fructose can be easily converted to glucose and other molecules such as lactate or glycogen. Yet the fructose has been presented here as COMPLETELY differently metabolized from glucose as I pointed at in my other article. 

So, based on this knowledge, the one-sided push of Dr Lustig, when he said that: 

Alcohol is metabolized through the fat pathway. Fructose is metabolized through the fat pathway. 

is not absolutely correct and this is regardless of how many articles Dr Lustig has written about this, as he said in at 1:01:10 in another video of this kind. There he again repeated that we get the alcohol from fermentation of fructose (nothing about the initial glucose fermentation in wine making process) and that people get fatty liver either from alcohol or from sugar, more specifically the fructose. All the time the same story all over again. 

NOTE:

It seems that Dr Lustig changes his facts over time. Only recently I watched a video from 2012 when he said more information about how the fructose is metabolized by the body and this time he made things a little bit clearer. However, this was not according to the facts and data - the body of evidence. He rather backed his claim sup with one study which has to be interpreted with caution. From the minute 45:25 onward he said this:

• he agreed that fructose receptors were found also in pancreatic beta-cells which also respond to glucose and release insulin. However, if fructose is bad because it makes pancreas producing insulin, why glucose is left out again? He also says that at 35 g of fructose load the blood concentration rises to 6 micromoles and that is enough to stimulate the beta cells to release the insulin. However, glucose appears in blood in millimoles, which is 1000 times higher concentration. So what is the deal? Can it really be a fructose action on pancreas that makes people sick and causes hyperinsulinemia with a subsequent insulin resistance? I doubt so. 
• he agreed that the extent of DNL in hypercaloric settings is higher in animals than humans, but he said that in humans it is still very significant. 
• He mentioned a study of Parks and Hellerstein (JSA 1998) that the DNL in humans, when fructose was given orally (they also test it intravenously), was just 3%. 
• However, he then continues that these were normal people, not calorically overloaded and they were fasting - so they were already glycogen depleted. Finally, we have heard Dr Lustig indirectly say that fructose does convert to glycogen, but he conditions this state as being on a fasted state. My question is - what happens with excess glucose in fed state? Is it COMPLETELY differently metabolized by the liver and body as he and his followers constantly repeat? 
• Then you hear, that it was pure fructose, which has a poor absorption rate on its own, so in real life situation we can expect that the absorption of fructose is higher and the liver is burdened more - which should eventually lead to more DNL.  
• As a contrasting scenario, Dr Lustig said that if this amount of fructose is given to obese, insulin resistant, fed people and give glucose and fructose at the same time (Hudgins and Hellers, 2011), the DNL increased to 25%, which was 6 times higher than in fasting state (I guess of the same obese and insulin resistant people). I have written a whole article about this issue and you will not like it if you are a follower of Dr Lustig.
• Dr Lustig ended this explanation with suggestions to take all these and to re-thing the whole argument of DNL. 

I have already mentioned earlier that it matters under which conditions and in what quantities the fructose is consumed (along glucose) in our diet and that it also depends what the diet actually is overall. But there are still some BUTs. Go back to the article I wrote elsewhere and you will find that fructose is oxidized (therefore not converted to fat) at a higher rate than glucose, when tested separately and we can expect that this is the case for the combined sugar - since fructose oxidation is less regulated by its by-products, which also leads to the metabolic issues with fructose overload. Higher supply of carbohydrates (fructose and/or glucose) also led to reduced oxidation of fats, which is probably the main problem in weight gain and failing weight loss, especially when refined sugars are consumed along fats, aka DONUT. 

You could also read the different findings with different methodologies used in the assessment of fructose induced DNL. That Hudgins and Hellers study from 2011 was probably the one I have already looked at and discussed here. Please check it out if you have not already read it. It is also an interesting reading. Just a recap: that 25% increased DNL was not assessed via isotope labelled fructose and the poor sick and obese participants, maintained at sedentary lifestyle, received 2g of sugar per body weight each. Take a person weighing 130 kg receiving 260 g of sugar (130 g of fructose) in a fluid that they had to consume within 15 minutes. Would you be surprised to find such alarming results? They also received their bolus on fasted state which means that although they had the glycogen depleted in the liver, at the same time the absence of food in the stomach made the fluid just flush through the intestines, being absorbed rapidly and overwhelming the liver. The reported the results were monitored over the following 24 hours when consuming normal food, so even this huge load of sugar was not administered at a fed state. Dr Lustig got it confused again. 

A really final word now: My dissertation work on the link between fructose and metabolic syndrome has focused on normal and metabolically healthy people because I have investigated what evidence we have that fructose alone (independently of the general diet rich in fats and being hypercaloric) makes people sick, not that it makes sick people even more sick with such horse doses.  

PEACE.

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. 

Have we had presented the whole picture or was there something missing?

At about 38:30 Dr Lustig says that liver is the only site for energy metabolism. He presented a slide showing: 

During that time, as he did not want to appear a fructocentric, he pointed out at these four food substrates that drive the metabolic disease by overloading the mitochondria in the liver and producing fat. Well, where is glucose? Is glucose not an energy molecule? Is it not metabolized by the liver? And, more importantly: is it not converted to fat when in excess? Of course it is. But Dr Lustig has some sort of sympathy for glucose and blaiming only fructose for everything, with the recent addition of these three substrates on top of it. The only difference is that glucose metabolism is regulated by insulin - in a secondary manner, it does not need insulin to enter the liver. 

Yes, I agree that about 80% of glucose is metabolized in the rest of the body, but the truth also is that the isotopes of labelled fructose were found in breath in higher concentrations than of labelled glucose (Chong et al 2007). This means that more fructose was burned straight away than of glucose and other isotope tracer studies confirmed this as well: non-exercising people proportionally burned more fructose while exercising subject burned more glucose, according to the concentrations of recovered labelled carbons (originating from each sugar) in their breath. 

Of course, liver can store unlimited amount of glycogen, from glucose molecules. But this applies mainly on people with genetic disease called glycogen storage disease, as Dr Lustig once said. What he did not say was that the remaining population with functional enzymes for glucose metabolism in the liver do not store excess amount of glycogen when overeating on carbohydrates. And some amount of fructose is also converted to glucose in the liver and even stored as glycogen especially when the glycogen stores are not full. We know it because the isotopic tracer studies have been examining the different fates of labelled fructose as I have discussed earlier and in more detail here. And there is also no pop-off in glycogen from glucose, when the glycogen stores are full. Mitochondria has to deal with excess substrates from either the fructose or glucose (which they have common, interconvertible) and now you already know that it was glucose based carbohydrates the consumption of which has increased much more than of sugar and since 2000, when sugar intake started to decrease in the U.S., the non-fructose carbohydrates stayed the same. 

In this article you can learn how flawed were the conclusions about the de-novo lipogenesis (DNL) of fructose, based on rather indirect assessment methods and how the addition of the same amount of glucose tripled the allegedly measured DNL as a result of fructose intake. 

I am glad Dr Lustig pointed at alcohol in the first slide of this article. He said that little is OK, but too much is not. However, that applies to the fructose, too. In one of my articles I criticized his statement that alcohol is better than sugar because it sends you under the table only once a day. He stated that about 20% of people are addicted to alcohol (1 in 5). Well, have a look at this diagram about the trends in sugar sweetened beverages (SSB) consumption and alcohol consumption among the U.S. adults. *Alcohol is not part of the SSB. The study of Duffy and Popkin (2012) can be found here. 

So, if fructose is an alcohol without the buzz, which allegedly led the metabolic diseases in the U.S. population, how about the alcohol? Even many teenagers have drinking problems. While alcohol is not responsible for the NAFLD, do you think this trend has not affected the population somehow? Just a reminder: from the number of calories within the total SSB fructose forms only about half, which brings it very close to the amount of calories obtained from alcohol. Moreover, fructose is converted to many other compounds (glucose, lactate, glycogen, fat), not just the toxic glyceraldehyde. In comparison, alcohol is temporarily broken down to also a toxic compound - acetaldehyde, but it has not such capacity to be converted to the other compounds as fructose does - except the fats, when consumed in excess. both of them. 

The diagram above is a very crude overview of the trends, and the data may not be absolutely representative of the real situation, but it gives you a hint about what was going on. Many people do not report their guilty pleasures and this is one of the many weaknesses of the dietary surveys. Moreover, this refers to date before 2002 and it would be interesting to see newer trends. But Dr Lustig also likes to present old trends (especially between 1989-1995) as the current ones, so look at the diagram what was happening in those years with alcohol. I also sense some weakness in the data of the NAFLD that it partially could be due to alcohol consumption among youth (or even adults), but because they are under-age their alcohol intake may not have been captured sufficiently and their liver problems only ascribed to other dietary components (sugars, fats). 

Moving on, I particularly appreciate the mention of the corn-fed beef that has a higher profile of branched chain amino acids (and also less healthy fatty acids profile). Is it a news for you that the cheap fast-food has boomed in the western countries in the past decades? What they put into the burgers? Cheap corn fed beef! While the sugar consumption in the U.S. has been decreasing since 2000, the added fats and oils have been increasing, and the consumption of cheap meat as well, while the grass-fed beef and pasture raised chicken meat is rather expensive and not commonly consumed by ordinary people. I am not saying that people consume significantly more meat than they used to decades ago, I am saying that there was a shift from healthy meat to the cheap meat produced on a massive scale today. People also cook less at home today and they rather go to the fast-food and take-away, often serving as cheap ingredients as possible, including the cheap food items such as fries and soft drinks. It is the cocktail of unhealthy foods and drinks is responsible for the poor health of the Western population, not only sugar or fructose alone. 

And, regarding the trans fats: yes their intake has slowly decreased. But what is the real picture? Have you heard about the interesterified fats? Probably not. But you will, in the future. For now, please check what these fats actually are and make your own opinion about this particular statement of nutrient made by Dr Lustig. I think that even he should update his knowledge about the diet, at least within his own country. This article was published in 2007 but his lecture delivered in 2013.

So, I completely agree with his statement: A calorie is not a calorie. Especially after finding out that these interesterified fats actually increase blood sugar (glucose), too. 

This article aimed to show five main things: 

• Alcohol followed the curve with sugary drinks for adults
• There is no glycogen pop-off when the liver or any glycogen stores (muscles) are full, even from glucose. 
• Fructose can also be converted to glucose and glycogen, when the glycogen stores are not full. 
• Since glucose and fructose have common metabolic intermediates, they both in excess can choke mitochondria in any cell in the body, not just the liver. It only happens that fructose has more capacity for this in the liver while the excess of glucose and fat can negatively affect muscle tissue. 
• Although the trans-fats were reduced, they were replaced with equally bad interesterified fats.

The processed food doom continues... 

PS: Every body cell is a site for energy metabolism, not just liver, as Dr Lustig said. 

Another example of manipulative focus on sugar and sugar alone.

Dr Lustig presented a legitimate results of a study examining the brain response to unknown stimuli (it does not say that it was sugar in the obese person). This is mediated via dopamine and its receptors. That is fine. But look at the slide he showed: 

The metabolism of what carbohydrate they refer to? GLUCOSE. Our brain asks for glucose. Not fructose. Fructose is only a marker that there is glucose in the fruit that our ancestors used to consume, and as such it provided them not only with easy energy but also with vitamins and other plant protective compounds, with a small amount of safe fluids to rehydrate. Fruits and vegetables are very refreshing. And it is already known that the large part of the ingested fructose is converted into glucose by the liver, especially when people are physically active as our ancestors once used to be.

I admit - I am "addicted" to fruit. Is this bad? Not at all. It makes me feel great and I crave it every day but I have a healthy BMI, no abdominal obesity, my blood tests come out perfectly normal and I have no interest in processed food items from the supermarket shelves. I even easily avoid confectionery that is almost jumping on me at every supermarket till or local newsagents. The sugary snacks simply do not exist for me. 

While writing this article I finished two figs and two ripen sharon fruits. We are supposed to like sweet taste because we have evolved this way. Even the human milk has almost twice the amount of lactose than cattle has, which makes it sweeter. The problem is we are getting our energy from wrong food sources today. People have replaced the healthy source of glucose and fructose, rich in vitamins, minerals, antioxidants, for processed food items lacking all these benefits and load their bodies with fat calories on top of it.

The diagram above was only used to demonstrate how addicted people have a lower dopamine mediated brain response to the same stimuli as the non-addicted people. But Dr Lustig forgot to tell you that there are people who have affected genes coding for the D2 dopamine receptors and these are particularly vulnerable to developing addiction to virtually anything: cocaine, sugar, fat (yes, fat), alcohol, anything, according to the Food Addiction Institute in Sarasota, Florida. There are also malfunctions in the serotonin processing, which have been linked to the addiction to not only sugars, but also FLOUR, which is not sweet itself but is broken down to glucose, absorbed as such and delivered to the brain. Hence the glucose metabolism mentioned at the beginning.

That diagram above shows how the obese person has similar dopamine response as the addicted one and Dr Lustig highlights that obese people are also addicted. However, are they obese because they are addicted to sugar (alone) or are they addicted because they were born with the affected D2 gene and sugar just happened to be the guilty substance for this particular individual? I have already said that sugar is not the only dietary compound that such people get addicted to and binge on. In general, they tend to seek energy dense food items, which means that not only sugar, but also fat, figures in their lists of bingeing foods.

Saying that, I agree that even people without this genetic trait can develop addiction to some sort of food or the food constituents. But is it only because of the sugar as Dr Lustig constantly suggests? It would be fair to examine other food items and observe the brain activity. He did not do that. I believe that if he had the data and only sugar had produced such response, he would not hesitate to make it stand out. Or, did he have the data, but ignored it and still focused on sugar only? 

Let's continue with debunking this sugar focused push. Look better what the 'Supersize me' man is holding:

It is not too clear, but if you have watched the clip, you would see: Mac burger and Mac fries. Also the cover of the DVD portrays him with mouth full of french fries. Where is the sugar? This is all energy dense, nutrients deprived, rubbish food based on glucose from starch (bun and fries) and fats/oils (beef, cheese and again - the fries). He did not show you the milk-shake or a liter of Cola, that often comes with fast food and makes the situation worse.

I agree, sugars add up on this fast food doom, but are they the trigger that makes people coming to the 'restaurant'? Do they go to McDonald to have a Coke? NOPE. They want to EAT. Eat the burger and fries. Most of them. In fact, back to 2009 I remember reading about why the fast food is so magic to many fast food addicts. It was not only sugar. It was the combination of sugar, FAT and salt. If the fast food was fat-less it would appeal to nobody. But they manage to eat the burger and fries with just a hint of sugar in the pickle or ketchup. The soft drink is just an addition to it. And exactly as in the first slide above, this deadly three-combo of tastes was compared to the effect of cocaine on peoples brains via dopamine activity. There are even policies throughout the world that limit advertisement of the high fat, sugar and salt (HFSS, not to be misled to HFCS) foods to children. Google it. One such related to the UK is here. 

And my personal addition to this is that you also get savory sauces and condiments in your fast food that tricks your brain into thinking that savory fruits or vegetables are on the way, providing the so needed nutrients your body is craving for. But, at the end, it gets nothing again. That little lycopene in the ketchup is nothing. 

Or take the other addicts: they abuse the only substance that brings them pleasure, might it be cocaine or heroin or alcohol. Have you seen anybody pouring white sugar to their mouth like cocaine addicts sniff the cocaine or alcoholics empty the bottle of spirit in one sitting? I doubt so. I hope that you understand now that this food addiction problem is more complicated than just pointing at sugar and making it a single villain. 

In the light of what you could read in this article I would finish it with this little snapshot: 

At 48:04 Dr Lustig talks about substances that are being abused: 

Where is the fat? Where is the fat:sugar:salt? Where is the fast food? Fat consumption went up while sugar consumption went down. Why the constant focus on sugar alone? 

Agenda. 

You want more proof? 

I am adding this material to the already published article because I have noticed another example of the audience manipulation. At 56:10 minute of another video, to which I have dedicated few of my later articles, you can see this: 

Read the title and the text and contrast it with the picture put in there probably by Dr Lustig or somebody from his team. Can you read anything about sugar in the title or the description? Nothing. HIGH-CALORIE FOODS. That is the fast-food, not soft drinks per se, not even sugar and definitely not fructose as such. 

And what is more, Dr Lustig tries to support his agenda with a number of published books about how the sugar is addicted, criticizing the Washington (government, experts) that they do not know about it while multiple authors with little scientific background knew it for years:

Well, to me these books only are the jump on the bandwagon against the sugar to bring money to the publishers and the authors. They are not the scientific studies. There are many such books about ANYTHING and many people believe that anything, despite it is sometimes a complete nonsense, or not a complete truth at least. Dr Lustig also published several books and he promoted them to the audience of students and other attendees to his multiple lectures worldwide, but unfortunately he did not give them access to its content free of charge, unlike the number of peer-reviewed articles he brought to their attention and which they could find online if they wanted - he said. 

Overall, I am not saying that people do not get addicted to sugar. Many certainly do. But is it only the sugar that causes addiction to junk food? I doubt so and the information presented above supports my view. 

Is alcohol BETTER than soft drinks?

Watch the 30:13 minute and the reasoning why Dr Lustig announces that alcohol is better than soft-drinks - because it is 'self-limiting' in terms that "you can drink yourself under the table once a day".

I might take it as a joke, but it does not sound like one. 

But let's say it was meant serious: if something does not make you unconscious daily it makes you worse? 

Does regular drinking, especially when it gets you under the table once a day,  pose no health risk to people??? Is soda worse because you can keep drinking it all day without getting unconscious, violent or at least unresponsive in your usual ways?

How far this anti-sugar agenda can go? 

You could have heard Dr Lustig saying that fructose is an alcohol without a buzz. His article in this spirit was even published in a journal. However, I know that a high portion of fructose (depending on the energy status) can be converted to glucose or lactate (or even glycogen) as an immediate and future source of energy. 

Alcohol, aside from the buzz that is often behind violence, car accidents and other incidents, can also be converted to energy, but it is rather via fat and energy intermediates, that are metabolized preferentially, because they and alcohol itself are otherwise toxic substances and the body deals with them before it will turn to proteins or carbohydrates as the next in the established hierarchy of substrate oxidation. 

And that is probably the reason why those countries, where alcohol is not served at such a large scale, suffer obesity and diabetes more: alcohol does not drive insulin as high as soda does via its glucose portion. However, alcohol, as well as carbohydrates, can help spare fats, because both of the former substrates are metabolized first. The body tends to store the excess fat when it does not need its energy when it got enough energy from either the carbohydrates or alcohol. It is glucose that drives insulin up much more, promoting fat storage when fatty food is consumed along (which is often the case of these countries), than alcohol or fructose alone.

That was regarding the metabolic mechanism in relation to obesity. That does not mean that alcohol is better than sugar. Only when watching another video from 2014, you could hear Dr Lustig saying that it was a joke. Well, firstly it did not sound like a joke. And perhaps somebody advised Dr Lustig to make sure that the audience understands it was not meant seriously. 

I see that as I proceed by watching more videos of Dr Lustig on this topic, that he alters his claims and adds some information which he did not say in his older materials. So if you see me commenting on something which he added or explained in his later videos, while my comments were based on his older materials, please bear this in mind. I try to alter the text where necessary, but I may not have captured them all. 

Are we having presented the whole picture or is there something missing?

At about 38:30 Dr Lustig says that liver is the only site for energy metabolism. He presented a slide showing: 

During that time, as he did not want to appear a fructocentric, he pointed out at these four food substrates that drive the metabolic disease by overloading the mitochondria in the liver and producing fat. Well, where is glucose? Is glucose not an energy molecule? Is it not metabolized by the liver? And, more importantly: is it not converted to fat when in excess? Of course it is. But Dr Lustig has some sort of sympathy for glucose and blaming only fructose for everything, with the recent addition of these three substrates on top of it. 

Yes, I agree that about 80% of glucose is metabolized in the rest of the body, but the truth also is that the isotopes of labelled fructose were found in breath in higher concentrations than of labelled glucose (Chong et al 2007). This means that more fructose was burned straight away than of glucose and other isotope tracer studies confirmed this as well: non-exercising people proportionally burned more fructose while exercising subject burned more glucose, according to the concentrations of recovered labelled carbons (originating from each sugar) in their breath. 

Of course, liver can store unlimited amount of glycogen, from glucose molecules - when there is a genetic disorder present which prevents liver to release free glucose, called glycogen storage disease. However, in healthy people the liver can store glycogen, forming about 5% of its total mass. However, some amount of fructose is also converted to glucose in the liver and even stored as glycogen especially when the glycogen stores are not full (in a fasted state, especially morning). We know it because the isotopic tracer studies have been examining the different fates of labelled fructose as I have discussed earlier and in more detail here. 

There is also no pop-off in glycogen from glucose, when the glycogen stores are full. Mitochondria has to deal with excess substrates from either the fructose or glucose (which they have common, interconvertible) and now you already know that it was glucose based carbohydrates the consumption of which has increased much more than of sugar and since 2000, when sugar intake started to decrease in the U.S., while the non-fructose virtually carbohydrates stayed the same. 

In this article you can learn how flawed were the conclusions about the de-novo lipogenesis (DNL) of fructose, based on rather indirect assessment methods and how the addition of the same amount of glucose tripled the allegedly measured DNL as a result of fructose intake. 

I am glad Dr Lustig pointed at alcohol. He said that little is OK, but too much is not. However, that applies to the fructose, too. In one of my articles I criticized his statement that alcohol is better than sugar because it sends you under the table only once a day. He stated that about 20% of people are addicted to alcohol (1 in 5). Well, have a look at this diagram about the trends in sugar sweetened beverages (SSB) consumption and alcohol consumption among the U.S. adults. *Alcohol is not part of the SSB. The study of Duffy and Popkin (2012) can be found here. 

So, if fructose is an alcohol without the buzz, which allegedly led the metabolic diseases in the U.S. population, how about the alcohol? Even many teenagers have drink problems. While alcohol is not responsible for the NAFLD, do you think this trend has not affected the population somehow? Just a reminder: from the number of calories within the total SSB fructose forms only about half, which brings it very close to the amount of calories obtained from alcohol. Moreover, fructose is converted to many other compounds (glucose, lactate, glycogen, fat), not just the toxic glyceraldehyde. In comparison, alcohol is temporarily broken down to also a toxic compound - acetaldehyde, but it has not such capacity to be converted to the other compounds as fructose does - except of fats. 

This diagram above is a very crude overview of the trends, and the data may not be absolutely representative of the real situation, but it gives you a hint about what was going on. Many people do not report their guilty pleasures and this is one of the many weaknesses of the dietary surveys. Moreover, this refers to date before 2002 and it would be interesting to see the newer trends. I also sense some weakness in the data of the NAFLD that it partially could be due to alcohol consumption among youth (or even adults), but because they are under-age their alcohol intake may not have been captured and their liver problems only ascribed to other dietary components (to sugars by Dr Lustig and also to fats by other, more realistic, scientists). 

Moving on, I particularly appreciate the mention of the corn-fed beef that has a higher profile of branched chain amino acids (and also less healthy fatty acids profile). Is it a news for you that the cheap fast-food has boomed in the western countries in the past decades? What they put into the burgers? Cheap corn fed beef! While the sugar consumption in the U.S. has been decreasing since 2000, the added fats and oils have been increasing, and the consumption of cheap meat as well, while the grass-fed beef and pasture raised chicken meat is rather expensive and not commonly consumed by ordinary people. The same applies to farmed salmon while the wild salmon is rather rare and expensive. I am not saying that people consume significantly more meat than they used to decades ago, I am saying that there was a shift from healthy meat to the cheap meat produced on a massive scale today. 

These people today also cook less at home and they rather go to the fast-food and take-away, which often serve as cheap ingredients as possible, including the cheap food items such as fries and soft drinks. This cocktail of unhealthy foods is responsible for the poor health of the Western population, not only sugar or fructose alone. 

And, regarding the trans-fats: yes their intake has slowly decreased. But what is the real picture? Have you heard about the interesterified fats? Probably not. But you will, in the future. For now, please check what these fats actually are and make your own opinion about this particular statement for this nutrient made by Dr Lustig. I think that even he should update his knowledge about the diet, at least within his own country. This article was published in 2007 but his lecture delivered in 2013.

So, I completely agree with his statement: A calorie is not a calorie. Especially after finding out that these interesterified fats actually increase blood sugar (glucose), too. 

This article aimed to show five main things: 

• Alcohol followed the curve with sugary drinks for adults
• there is no glycogen pop-off when the liver or any glycogen stores (muscles) are full, even from glucose. 
• Fructose can also be converted to glucose and glycogen, when the glycogen stores are not full. 
• Since glucose and fructose have common metabolic intermediates, they both in excess can choke mitochondria in any cell in the body, not just the liver. It only happens that fructose has more capacity for this in the liver. 
• Although the trans-fats were reduced, they were replaced with equally bad fats.

The processed food doom continues... 

PS: Every body cell is a site for energy metabolism.