Villain or Hero?
We like our villains simple and singular, whether in politics or food. Our brains crave order, but seeing issues as part of larger systems is too complicated, too effortful and time consuming to seem worth it. Besides, it makes for lousy copy.
Better to choose a villain
Recently, patients have been coming to me with questions about an article in the NY Times entitled "Is Sugar Toxic?" It's author, Gary Taubes, has been writing on nutrition for a long time. He previously had a big splash with an article in the Times defending fat against it's longstanding villain status which led to his book, "Why We Get Fat." Now, looking over the work of pediatric endocrinologist Robert Lustig, Taubes' next object in sight is the horrors of sugar, which Lustig is quite comfortable labeling as poison - when the term refers to table sugar and high fructose corn syrup.
We've been in this territory before. For a long time Ancel Keys and his epidemiologic and corporate companions declared fat to be diet's bad actor. The Department of Agriculture declared fat a national nasty, leading to the disastrous nutritional advice to push starches and carbohydrates through the 1980's. Much of the national cardiologic establishment got on the bandwagon (some never got off), and the drug companies devised effective cholesterol lowering drugs, so fat remained truly "bad" for a long time - something Taubes has written about extensively. That statin drugs derive a long part of their striking effectiveness from arterial effects wholly other than cholesterol lowering does not appear to have yet reached public consciousness. Lots of folks still compare their cholesterol levels like baseball scores, and feel triumphant when the numbers get really low.
What was the overall result to the public health? People ate a lot more starches and sugar, and got fatter and fatter
Other recent food villains include protein, which in the "China Project" is the font of our cancer epidemic, and high fructose corn syrup. Taubes, arguing on the basis of what Lustig has done, argues that
Table sugar and HFCS are nutritionally equivalent.
More of these added sugars in the diet leads to fatty livers and more body fat.
The more fat people have, the higher their rates of cardiovascular mortality.
Perhaps through making people fatter, or perhaps through other mechanisms, more added sugar means more cancer.
I cannot parse through these arguments in this short article. Fortunately, others will be doing it in detail soon, as this debate is still raging hot. I would argue that more sugar in the diet does lead to a fatter population; that fatter populations die earlier of diabetes, cardiovascular disease and thereby Alzheimer's, as well as cancer. Moreover, subsidizing cheap sugar with large government agricultural subsidies makes no public health or economic sense.
When much of the population is barely scraping by, making very sugary processed foods the cheapest available calorie source is setting our nation up for an obesity epidemic that will further bankrupt a precarious health care system. Worse, marketing very sugary foods to children, aggressively performed over the Net and traditional media, is leading to a population that will think high sugar content is a necessary ingredient of "tasty" food. That bodes even further ill for our long term health - including our economic health.
However, these debates over villains and non-villains miss several crucial points:
Food is very complex. There are hundreds of substances in food, which are metabolized differently depending on hundreds of environmental factors.
Diet is much more complex than food, as it involves culture, the different ways foods are prepared and cooked, and different sequences of food ingestion and digestion.
Eating behavior is inflected by many other factors, like when and how we move, where and with whom we eat. These related issues are so important they make a mockery of looking at food policy and behavior in terms of individual food ingredients like sugar, protein or fat - what Michael Pollan likes to call "nutritionism."
Connect the dots
People will eat 1/3 more in a red room than a blue room
Add bulk to the diet in the form of vegetables and people may eat 400 calories less a day
Eat in front of a TV set or computer monitor and people eat more
Change the sequence of a meal - broccoli before brussel sprouts, as compared with broccoli after brussel sprouts, and the liver churns out different pro-carcinogens
All activity - including fidgeting - changes how food is digested
Eat at night and people gain more weight and increase their lipid and glucose levels much more than when eating the same material in the morning.
People who sleep less than 6 hours gain weight.
In other words, eating is a complex system of different foods, chemicals, ingredients, additives, socializing, physical actions, rest, and cultural environment.
Moreover, you will not get humans to eat a diet of pure fructose for any long period of time, even if you can get a rat to do that. So you will not get perfect or sometimes even good data on what fructose does versus fructose combinations, like table sugar, in people.
So for your own sake, recognize the connections - and use them. Those connections between food and lifestyle are critical to rebuilding your body and remaking your health.
Sugar is not the enemy, any more than is fat or protein. Whole foods make sense for many reasons, just as walking after meals does - because it is sustainable, fits what humans evolved to do, and helps people keep regenerating their bodies in ways that truly make them new.
Sugar is not poison, but thinking about food policy one ingredient at a time can poison the debate - and make us draw unsound conclusions.