Home Food 101 The [Extremely Thorough and Rather Compelling] Case Against Sugar

The [Extremely Thorough and Rather Compelling] Case Against Sugar

by Erika Nicole Kendall

I’m surprised that I’ve never written about this video before, but it’s always better late than never.

Meet Robert Lustig, MD. He’s kind of a big deal.

Dr. Lustig is a childhood obesity expert… and recently, the NY Times posted a write-up about his presentation – a lecture given a few years back that has garnered almost a million views – to further detail what makes his argument so compelling.

Now, I’ve seen the video several times – believe it or not, I actually have it on DVD and watch it regularly to remind myself – so I’m very familiar with what he’s talking about, here. Of particular interest to me – and should be of extreme interest to those of us with type 2 diabetes – is where, at a little past an hour in, Dr. Lustig talks about the reversal of type 2 diabetes. Not living with diabetes, but reversing the condition.

Who, out there, has a doctor who explained that process to them?

Earlier this month, Gary Taubes – writer of “What If It’s All A Big Fat Lie?” as well as the book Good Calories, Bad Calories: Fats, Carbs, and the Controversial Science of Diet and Health – penned the aforementioned article, which doesn’t surprise me in the least. Taubes is a relatively predictible source of anti-carbohydrate lifestyling and has, if I’m not mistaken, written a book titled Why We Get Fat: And What to Do About It as well as proclaimed his alliance with Team Atkins. I’m simply not surprised to see his name in the byline.

That being said, the question that Taubes’ article asks in the title – is sugar toxic? – is one that I can easily respond to with a resounding YES. Before I get to that, there are a few parts of Taubes’ article that I’d like to highlight, for those of you who’ll see the fact that Taubes’ article is 9-some-odd pages long and decide to turn away from it… like I almost did.

At least I’m honest.

This development is recent and borders on humorous. In the early 1980s, high-fructose corn syrup replaced sugar in sodas and other products in part because refined sugar then had the reputation as a generally noxious nutrient. (“Villain in Disguise?” asked a headline in this paper in 1977, before answering in the affirmative.) High-fructose corn syrup was portrayed by the food industry as a healthful alternative, and that’s how the public perceived it. It was also cheaper than sugar, which didn’t hurt its commercial prospects. Now the tide is rolling the other way, and refined sugar is making a commercial comeback as the supposedly healthful alternative to this noxious corn-syrup stuff. “Industry after industry is replacing their product with sucrose and advertising it as such — ‘No High-Fructose Corn Syrup,’ ” Nestle notes.

Please keep this in mind the next time you watch TV and see a stupid soft drink or juice commercial saying “We use real sugar!” in it. It’s a brand-new day when table sugar is lauded as a “healthy alternative.” Seriously.

The conventional wisdom has long been that the worst that can be said about sugars of any kind is that they cause tooth decay and represent “empty calories” that we eat in excess because they taste so good.By this logic, sugar-sweetened beverages (or H.F.C.S.-sweetened beverages, as the Sugar Association prefers they are called) are bad for us not because there’s anything particularly toxic about the sugar they contain but just because people consume too many of them.

Those organizations that now advise us to cut down on our sugar consumption — the Department of Agriculture, for instance, in its recent Dietary Guidelines for Americans, or the American Heart Association in guidelines released in September 2009 (of which Lustig was a co-author) — do so for this reason. Refined sugar and H.F.C.S. don’t come with any protein, vitamins, minerals, antioxidants or fiber, and so they either displace other more nutritious elements of our diet or are eaten over and above what we need to sustain our weight, and this is why we get fatter.


Lustig’s argument, however, is not about the consumption of empty calories — and biochemists have made the same case previously, though not so publicly. It is that sugar has unique characteristics, specifically in the way the human body metabolizes the fructose in it, that may make it singularly harmful, at least if consumed in sufficient quantities.

The phrase Lustig uses when he describes this concept is “isocaloric but not isometabolic.” This means we can eat 100 calories of glucose (from a potato or bread or other starch) or 100 calories of sugar (half glucose and half fructose), and they will be metabolized differently and have a different effect on the body. The calories are the same, but the metabolic consequences are quite different.

This should sound familiar.

The fructose component of sugar and H.F.C.S. is metabolized primarily by the liver, while the glucose from sugar and starches is metabolized by every cell in the body. Consuming sugar (fructose and glucose) means more work for the liver than if you consumed the same number of calories of starch (glucose). And if you take that sugar in liquid form — soda or fruit juices — the fructose and glucose will hit the liver more quickly than if you consume them, say, in an apple (or several apples, to get what researchers would call the equivalent dose of sugar). The speed with which the liver has to do its work will also affect how it metabolizes the fructose and glucose.

In animals, or at least in laboratory rats and mice, it’s clear that if the fructose hits the liver in sufficient quantity and with sufficient speed, the liver will convert much of it to fat. This apparently induces a condition known as insulin resistance, which is now considered the fundamental problem in obesity, and the underlying defect in heart disease and in the type of diabetes, type 2, that is common to obese and overweight individuals. It might also be the underlying defect in many cancers.

If what happens in laboratory rodents also happens in humans, and if we are eating enough sugar to make it happen, then we are in trouble.

The highlighted part of this is another reason why it makes very little sense to ditch all fruit in an effort to ditch sugar. Aside from the fact that fruit is a source of nutrition, there’s also the fact that in a lot of fruits, the amount of sugar is nowhere near as much as what’s found in modern sources of sugar.

The last time an agency of the federal government looked into the question of sugar and health in any detail was in 2005, in a report by the Institute of Medicine, a branch of the National Academies. The authors of the report acknowledged that plenty of evidence suggested that sugar could increase the risk of heart disease and diabetes — even raising LDL cholesterol, known as the “bad cholesterol”—– but did not consider the research to be definitive. There was enough ambiguity, they concluded, that they couldn’t even set an upper limit on how much sugar constitutes too much. Referring back to the 2005 report, an Institute of Medicine report released last fall reiterated, “There is a lack of scientific agreement about the amount of sugars that can be consumed in a healthy diet.”

This makes me think of the article I brought up last week, about egyptian mummies having clogged arteries. Perhaps… never mind.

What we have to keep in mind, says Walter Glinsmann, the F.D.A. administrator who was the primary author on the 1986 report and who now is an adviser to the Corn Refiners Association, is that sugar and high-fructose corn syrup might be toxic, as Lustig argues, but so might any substance if it’s consumed in ways or in quantities that are unnatural for humans. The question is always at what dose does a substance go from being harmless to harmful? How much do we have to consume before this happens?

When Glinsmann and his F.D.A. co-authors decided no conclusive evidence demonstrated harm at the levels of sugar then being consumed, they estimated those levels at 40 pounds per person per year beyond what we might get naturally in fruits and vegetables — 40 pounds per person per year of “added sugars” as nutritionists now call them. This is 200 calories per day of sugar, which is less than the amount in a can and a half of Coca-Cola or two cups of apple juice. If that’s indeed all we consume, most nutritionists today would be delighted, including Lustig.

Let me see if I can put this in a different perspective. A teaspoon of sugar is 15 calories. That means you’d be somewhere around 13 teaspoons of sugar in a day in order to make sure you didn’t go over the 200 calories per day limit (15 calories x 13 tablespoons = 195 calories.) There are 210 calories of sugar in a simple 20oz of pepsi.

Couple that with the amount of sugar hidden – or not so hidden – in our processed foods, salad dressing, condiments and fruits (canned fruit, anyone?), you’re quite possibly overdoing it on the sugar.

In the early 20th century, many of the leading authorities on diabetes in North America and Europe (including Frederick Banting, who shared the 1923 Nobel Prize for the discovery of insulin) suspected that sugar causes diabetes based on the observation that the disease was rare in populations that didn’t consume refined sugar and widespread in those that did. In 1924, Haven Emerson, director of the institute of public health at Columbia University, reported that diabetes deaths in New York City had increased as much as 15-fold since the Civil War years, and that deaths increased as much as fourfold in some U.S. cities between 1900 and 1920 alone. This coincided, he noted, with an equally significant increase in sugar consumption — almost doubling from 1890 to the early 1920s — with the birth and subsequent growth of the candy and soft-drink industries.

Moving on:

Until Lustig came along, the last time an academic forcefully put forward the sugar-as-toxin thesis was in the 1970s, when John Yudkin, a leading authority on nutrition in the United Kingdom, published a polemic on sugar called “Sweet and Dangerous.” Through the 1960s Yudkin did a series of experiments feeding sugar and starch to rodents, chickens, rabbits, pigs and college students. He found that the sugar invariably raised blood levels of triglycerides (a technical term for fat), which was then, as now, considered a risk factor for heart disease. Sugar also raised insulin levels in Yudkin’s experiments, which linked sugar directly to type 2 diabetes. Few in the medical community took Yudkin’s ideas seriously, largely because he was also arguing that dietary fat and saturated fat were harmless. This set Yudkin’s sugar hypothesis directly against the growing acceptance of the idea, prominent to this day, that dietary fat was the cause of heart disease, a notion championed by the University of Minnesota nutritionist Ancel Keys.

Onward, again:

Rather the context of the science changed: physicians and medical authorities came to accept the idea that a condition known as metabolic syndrome is a major, if not the major, risk factor for heart disease and diabetes. The Centers for Disease Control and Prevention now estimate that some 75 million Americans have metabolic syndrome. For those who have heart attacks, metabolic syndrome will very likely be the reason.The first symptom doctors are told to look for in diagnosing metabolic syndrome is an expanding waistline. This means that if you’re overweight, there’s a good chance you have metabolic syndrome, and this is why you’re more likely to have a heart attack or become diabetic (or both) than someone who’s not. Although lean individuals, too, can have metabolic syndrome, and they are at greater risk of heart disease and diabetes than lean individuals without it.

Just as an extremely superficial side note, this further highlights the fact that cutting the sugar causes your waistline to shrink.

By the early 2000s, researchers studying fructose metabolism had established certain findings unambiguously and had well-established biochemical explanations for what was happening. Feed animals enough pure fructose or enough sugar, and their livers convert the fructose into fat — the saturated fatty acid, palmitate, to be precise, that supposedly gives us heart disease when we eat it, by raising LDL cholesterol. The fat accumulates in the liver, and insulin resistance and metabolic syndrome follow.

Michael Pagliassotti, a Colorado State University biochemist who did many of the relevant animal studies in the late 1990s, says these changes can happen in as little as a week if the animals are fed sugar or fructose in huge amounts — 60 or 70 percent of the calories in their diets. They can take several months if the animals are fed something closer to what humans (in America) actually consume — around 20 percent of the calories in their diet. Stop feeding them the sugar, in either case, and the fatty liver promptly goes away, and with it the insulin resistance.

This goes back to Lustig’s point, about an hour and 10 minutes into the lecture, about reversal of type 2 diabetes.

Diabetics, have your doctors discussed this with you? No? Oh, okay.

Moving on, though.

One of the diseases that increases in incidence with obesity, diabetes and metabolic syndrome is cancer. This is why I said earlier that insulin resistance may be a fundamental underlying defect in many cancers, as it is in type 2 diabetes and heart disease. The connection between obesity, diabetes and cancer was first reported in 2004 in large population studies by researchers from the World Health Organization’s International Agency for Research on Cancer. It is not controversial. What it means is that you are more likely to get cancer if you’re obese or diabetic than if you’re not, and you’re more likely to get cancer if you have metabolic syndrome than if you don’t.

My totally non-scientific opinion on this topic here? Look at the vessels through which a lot of sugars – the item that causes insulin resistance – are served… and that’s chemical-laden processed foods.


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Crissle April 18, 2011 - 10:36 AM

WHAT WILL I PUT IN MY COFFEE?!?! LOL but seriously. This is good to know but making the adjustment will be hard. Those two tablespoons of sugar every day keep me going.

Danielle1 April 18, 2011 - 11:45 AM

great article! Erika you have been stepping up your article game mama! (jk)

Can you tell me what the breakdown of grams of sugar is to teaspoons? Ive been researching on the net and Im not too sure.

You know when you read a label , its like 20g of sugar or whatever, like what’s that?

Erika Nicole Kendall April 18, 2011 - 11:50 AM

It’s approximately 4 grams of sugar to a teaspoon. Some will say it’s 5 grams, but I’d stick to the lesser estimate in this instance and go with 4 grams per teaspoon.

Curlstar April 18, 2011 - 12:14 PM

I took a chance this year and gave up sweets for Lent. It was certainly a good idea, but I went into it with a fight. Now, I feel better, I look better, my skin has cleared up significantly and the belly is going down. Now, if I can keep on working on my ability to run from the zombies… 🙂

Kirsten April 18, 2011 - 2:03 PM

I NEVER EVER heard about the link between too much sugar and hypertension/HBP. The way he broke that down, it made me say OF COURSE they link obesity to HBP, because most obese people are OD’ing on sugar thus increasing their risk of HBP and or diabetes. All these cardo diseases go together because of the link between sugar and fat in our bodies, especially our liver.

This was a worthwhile read/watch. I’ve got to get off the sugar! We drink OJ and Apple all the time, even if we have cut out soda, and other ‘sugary’ drinks.

Time for a detox.

JoAnna April 18, 2011 - 2:17 PM

Well I used to be addicted to pop. Ruby Red Squirt or 7-Up with grenadine if the store was out. This was a two 12 can-case-a-week habit (+ fast food, Doritos, and mac and cheese, etc) that shoved me into Type II diabetes. My diet is quite different now. I enjoy a ginger beer pop about once every 2 months, and only keep a couple of pieces of hard candy on me for emergencies. When I see my doctor for checkups, he tells me that he loves my current A1c levels, and I could be off meds in the future if I continue to improve. It’s also amazes me that in the waiting room other Type II patients are snacking on chips, Subways, regular pop– everything but fruit or a homemade sandwich, or something healthy. And they’re complaining about the cost of needles for insulin injections, blood glucose strips, or eyes failing, or other preventable stuff.

Eva April 18, 2011 - 4:01 PM

This is great.

The thing is there’s nothing really wrong with sugar. Years ago people used to eat sweets once in awhile, birthdays, holidays. When I was a child I as only allowed to drink soda for lunch. Nothing wrong with sweets a few times a year, even a month, but people today have the ability to eat sweets every day at every meal. I mean what they heck is chocolate cereal, that’s already sweetened with sugar? YUK. That’s just insane. I’m better off with an apple AND my homemade chocolate cookies.

Donna April 18, 2011 - 8:12 PM

This totally changed my life, atleast my view points. I eat better than most people I know. I don’t eat meat, only fish. Lots of vegs & fiber. But I’m so addicted to sugar. So no matter how much I work out, I’m super regular. I have been losing weight, but my stomach is getting bigger & bigger. I stopped using sugar instead used artificial sweetners. But feel the worst I ever have. This makes perfect sense, I will be making changes immediately. Thank You so providing info & varied viewpoints so ppl have the knowledge to make the best decisions for yourself.

Heather E April 18, 2011 - 8:36 PM

Wow… all I can say is wow. My husband wandered in about 15 minutes into this and watched it with me. After it was over, we went right to the fridge and dumped the rest of our 2-liter and will stop buying juice when this carton of OJ runs out. I LOVE pop and the kids love juice, so this will be hard, but he’s right. You wouldn’t give a kid a beer, so why do this?

Rachel April 19, 2011 - 2:54 AM

This has been so eye opening. Thanks for sharing this video…seriously. I understand what is happening so much more now.

Daybreak April 19, 2011 - 8:05 AM

LAWD have mercy. Thank goodness I majored in biology so I didn’t zone out, but this is insane. I’ve been trying to cut back on my processed food intake and know what’s going in my stomach, but this video made me more motivated.

“Fructose is ethanol without the buzz.” And HFCS is in almost everything… seeing the biochemical effects of that makes me repulsed. I need to step my cooking game up b/c I don’t even want to go to some of my favorite restaurants anymore. *downloading video from YT*

Beverly May 11, 2011 - 2:08 PM

Hi Erika –
thank you for this amazing inforamtion. Do you know where I may purchase the DVD of Robert Lustig, MD. “The Bitter Truth about Sugar”?
Kindest regards,

HerMindandBody November 21, 2011 - 12:22 PM

Wow, this was a great article. It made me rethink alot of things when it comes to weight loss. “A calorie is not a calorie”…hmmm…At one point I was inclined to think that sugar was akin to drugs like crack and cocaine, but then put it in the back of my mind. This is really something to think about. The part in the video where he talks about how the consumption of fructose has the same affect as ethanol was surprising to me..the same toxic effect? WOW! He also pointed out that when fructose is consumed, the brain does not recieve the signal that your hunger is satisfied, and thus you continue to eat. In my ongoing battle with food, I thought that the reason I overeat certain things (Oreo’s and Subway’s choc chip cookies to be more specific) is simply because the food tastes good…and what makes the food taste good? lol, again GREAT ARTICLE, VERY INFORMATIVE!

Catherine December 17, 2011 - 2:01 PM

I am showing this to my father. Hopefully, the more I try to educate him, the more I can help his and my mother’s health.

I mean, they’re Haitian. They know and have preached about natural food. I think my pleading for food from the American diet as a kid has changed that. Now I just need to change it back for all of us.

Crystal M December 19, 2011 - 1:46 PM

I work at a pediatric practice for a senior physician. He has copied that very article from the New York Times and hands it out to the parents of his overweight patients. Its a pretty lengthy article and from the looks on their faces…. I doubt that they actually read it….. Sugar is scary no matter how sweet it is. Reading that article for myself has really changed the way I shop and what I allow my kids to intake. A definite wake up call…… My family makes fun of how angry I get about hfcs, sugar, sustitute sugars, ect…. Basically, I feel that sugar should be classified as a controlled substance and in order to preserve or extend a persons’ quality of life we should need to present a prescription from a doctor prior to purchase sugar…lol

Anggie W September 3, 2012 - 5:43 PM

Thank you so much for your wonderful blog. This article was such an eye opener – and further clarified and solidified the reasons why I was already making changes. Thank you for the video as well it was so well worth taking the time to watch. Keep up the great job of educating and helping others learn to make better, more educated decisions about being healthier.

Bree January 10, 2013 - 6:17 AM

*sighs* *puts down the sugar cookies*

Karen April 4, 2013 - 1:21 PM

My biology teacher, a scientist I only learned to respect completely after I finished secondary school has long blamed sugar for high levels of bad cholesterol.
I am learning to give it up.
Also recently learnt that flour is bleached with CHLORINE. And apparently the chlorine once ingested first attacks your pancreas! The pancreas produces insulin. Connect the dots!

Kami September 3, 2013 - 11:25 AM

I will only ingest sugar on holidays and birthdays. But I will give it up. Now my goals are to be sugar free . Even though the sugar is not refined but mostly raw sugar and maple syrup it needs to be limited. This is very informative must keep this in mind when I reach for junk

Alinka August 28, 2016 - 9:12 AM

Amazing article and as relevant today as it was then. I still identify this prevalent belief from Americans writ large, particularly within the AA women that sugar is just the white granulated stuff that comes in the yellow box. As long as they do not have the white powder, fruit, fruit juices, fruit smoothies, sugary tuberose, white flour and rice; and sugar substitutes get a pass as not being sugar. I identify this belief on pretty much every comment here… Dr. Michael R. Eades. has an amazing blog that breaks ‘sugarisms’ down. Congrats!

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