Follow up on Dr Robert Lustig

In a recent blog post I embedded a 90 minute video produced at the medical school at UCSF. The video featured a lecture by a pediatric endocrinologist on staff there by the name of Dr. Robert Lustig M.D.  Dr. Lustig is a specialist in the system of organs secreting hormones directly into the blood stream and he further specializes in problems in this system in children (pediatric endocrinologist).  Diseases he would try to help are diseases of the thyroid, pituitary, adrenal glands and diabetes among others.

Your comments welcome

A fellow of strong opinion named Mike left a comment that he thought Dr. Lustig was biased and 9/10’s of the lecture was wrong.  He linked to a blog of a well credentialed health and fitness specialist named Alan Aragon.  Aragon had a few good things to say and many specific and documented criticisms.  Aragons main arguement is that Lustig had some non-essential facts wrong and that he was picking one thing, fructose,  and saying this is the reason we have all these health problems in adults and now some of the same problems in children.

Alan Aragon’s opinion

Aragon makes some stong and valid points and I agree with him largely.  One of the questions I would ask is this, “Is the policy of encouraging consumption of amounts of fructose unavailable in any other form in these quantities a good one?” I think not.  We give government support to growers who are not at fault, they are taking advantage of a market opportunity so that a large US based industry – manufactured/processed foods – can make a large profit.

Bad Social Policies

We have done this in the past with tobacco.  We provided price supports to encourage people to grow the crop for domestic consumption.  We now have falling cancer rates and the one thing it is most attributed to is not medical advances but social policy that discouraged consumption.  We no longer provide those price supports.  We do not allow TV advertising of the product.  Though people still smoke and young people still begin, it is less than in the past and with good public health benefits.

Now, neither Mike nor Aragon ( who is not aware of me) argue that high fructose consumption is bad. Aragon especially says it has gotten a bad rap. He says it is not just carbohydrates that are to blame for the obesity crisis but steadily increasing total caloric consumption 2100 cal per day 1970 vs more than 2700 today.  It is those extra calories and an increasing sedentary life-style that lead to increasing weight gain.

There are studies like Changes in Beverage Intake between 1977 and 2001 that show

For all age groups, sweetened beverage consumption increased and milk consumption
decreased. Overall, energy intake from sweetened beverages increased 135% and was
reduced by 38% from milk, with a 278 total calorie increase. These trends were associated
with increased proportions of Americans consuming larger portions, more servings per day
of sweetened beverage, and reductions in these same measures for milk

And concluded

There is little research that has focused on the beneficial impacts of reduced soft drink and
fruit drink intake. This would seem to be one of the simpler ways to reduce obesity in the
United States.
(Am J Prev Med 2004;27(3):205–210) © 2004 American Journal of Preventive Medicine

Fructose and NALFD in children

Below is a video I made and embedded about this very issue.  I think that Lustig has to be over the top in his presentation.  The marketing messages are over the top that encourage people to drink the 7+ cans of sweetened soda a day that results in 135 grams of extra carbohydrate in the diet every day.

This is about 4 calories per gram so that would be 540 calories per day of empty calories.  Just this week one of a colleagues patients confessed she was drinking 80 ounces of sweet tea per day.  This is more than six 12 ounce cans of soda and probably has more calories in the form of sucrose each day.

This high consumption of sweeteners by many Americans, over burdens the liver and causes non-alcoholic fatty liver disease (NAFLD) in adults and children.  We have never had this happen before so no one knows the long term results of growing up with liver dysfunction.

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