My parents, whom I am currently living with, can attest to the fact that I can’t stop raving about Fat Chance by Robert Lustig, a pediatric endocrinologist at UCSF. My cliffs notes takeaway from this book can be summed up with the following statements:
- The lipid hypothesis (fat makes you fat) is false*. Fructose is causing the spike in obesity and metabolic syndrome.
- Calories are not processed equally.
- Everyone has the responsibility to manage their own health and make good choices. But not everyone has reasonable opportunities to do so.
Sneaking into the kitchen and eating gummi bears straight from the bag at 2 years old. I was a sugar addict practically from birth.
If you read the summaries of Fat Chance on sites like Goodreads or Amazon you will see people declaring that the book says losing weight is impossible. This is a critical misunderstanding of Lustig’s message. What he is trying to communicate is that the combination of our food environment and the brain’s pursuit of pleasure makes it incredibly difficult to lose weight. And also that the excess weight we need to focus on losing is visceral (belly) fat because this is the type of fat that is associated with metabolic syndrome. The subcutaneous fat that makes up a wide variety of body shapes and contributes to the large thighs of some is only kept off with extreme diligence that most aren’t interested in maintaining**. He believes that cutting out fructose/sugar is the key to losing the visceral fat, and after 5 months of nearly-eliminating added sweeteners in my diet I fervently agree.
I’ve read a lot of books about food and diet, but this was the first time that I was able to say out loud to myself “I am a Compulsive Overeater“. I realized that my overeating is a part of my unique neurological framework, and needs to be managed. Just as a diabetic manages their blood sugar, I must manage my food intake and environment. My brain loves to “take a hit”, and I was getting those hits from things like sugar and processed carbohydrates. Once I took those things away I found myself seeking out other avenues for the same effect, and thus far I’ve been successful in finding options that are personally rewarding without sending me out of control. Having young kids certainly doesn’t help any of this – screaming children raise cortisol levels, stress levels explode, and comfort food feels like the only solution at that moment.
I’m not going to attempt to explain in-depth the science behind Lustig’s claims, I would suggest you read the entire book if you’re interested in understanding his message, but I do want to touch on a few points that I found noteworthy.
The first is the myth that sugar is nothing but empty calories. I used to take advantage of this notion all the time, eating entire bags of gummi bears at once (a favorite of mine since I was a toddler, as evidenced by the photo above). Sugar is both a carbohydrate and a fat. Sucrose (commonly known as table sugar) is half glucose and half fructose. Fructose makes things sweet, but it causes chronic metabolic disease because it is metabolized as a fat in the liver. Glucose is metabolized as a carbohydrate. There is a lot of talk today about natural sugars versus processed sugars, and I have often heard people say that they avoid white sugar or high-fructose corn syrup but love to eat honey or agave nectar. After reading Fat Chance I now believe any type of added sweetener to be a problem. The fructose makes foods desirable and delicious, but outside of the usual fiber-filled context (like fruit) makes us fat.
In an interview with Diane Rehm there is an anecdote told by Lustig that illustrates this concept of natural context very well.
We actually did an experiment, my colleague Cindy Gershen in Walnut Creek, California, in her food science class. Took two students, gave one student six oranges and said, here, make juice. The kid makes orange juice out of the six oranges, a little over 12 ounces, drinks the whole thing down and says, okay, what’s for breakfast.
The other kid, we say, okay, here are six oranges. Eat the six oranges. By the time the kid gets to orange number four, the kid throws up and says, I couldn’t possibly eat another bite. Why? Very simple, it’s called fiber. Because the fiber is the thing that mitigates the negative effects of the fructose in fruit. Why? Number one, it delivers more of the nutrient downstream in the intestines so that the bacteria in the intestine can chew it up instead of you. So you don’t absorb all of it.Number two, it gives you the satiety signal sooner, because it delivers that to the end of the intestine faster, and number three, the fiber forms a barrier on the inside of the intestine, preventing the sugar from being absorbed so fast so your liver has a chance to catch up.
Orange juice is calorie for calorie worse for you than soda. There are 1.8 grams fructose/ounce for juice and 1.7 grams fructose/ounce for soda. Lustig comes out swinging for juice in the first chapter of his book telling the story of a little boy he treated:
Juan, a 100 lb. six-year old Latino boy whose mother is a non-English-speaking farm worker from Salinas, California, comes to my clinic in 2003. He is wider than he is tall. I ask the mother in my broken Spanish, “I don’t care what your kid eats, tell me what he drinks.” No soda, but a gallon of orange juice per day. On calories alone, this amount accounts for 112 lbs/yr of body fat. of course, some of that is burned off, and it might influence total food intake. I explain to the mother, “La frutta es bueno, el jugos es malo (the fruit is good, the juice is bad). Eat the fruit, don’t drink the juice.” source
The vehicle is irrelevant, it’s the payload that matters (it doesn’t matter were you are getting your fructose from, whether it’s HFCS, sugar cane, etc). One of my favorite quotes from Lustig is “Evolutionarily, sugar was available to our ancestors as fruit for only a few months a year (at harvest time), or as honey, which was guarded by bees. But in recent years, sugar has been added to nearly all processed foods, limiting consumer choice. Nature made sugar hard to get; man made it easy.”
The key is fiber, and most food processing removes fiber. Soluble fiber forms a gel in the stomach which slows digestion, limiting the absorption of things like starch and sugar. Insoluble fiber is a natural laxative that speeds up the passage of foods. (source) Can you see how an apple becomes the perfect package, with the sweetness of fructose to please your tongue but the power of fiber to speed up the passage of the sugar through your system and prevent some of the fructose from being metabolized as fat in the liver? Once you juice that apple and throw away the fiber you’re left with dessert. Another quote that helped me understand this concept came from an interview Lustig did with KQED forum:
Processed food is fiberless food. That’s basically what it comes down to. Processed food means that you’ve got to take the fiber out for shelf-life. And there are two kinds of fiber. There’s soluble fiber: which is the kind of stuff that holds jelly together, and pectins, and things like that. And then there’s the insoluble fiber: the stringy stuff, like, you know, cellulose, like what you see in celery. You need both. What I describe in the book is like it’s kind of like your hair-catcher in your bathtub drain. Um, you have this plastic lattice work with holes in it. So, if you take a shower and the hair is coming down, it blocks up the holes, but only if the hair catcher is there. So, imagine that the cellulose is the hair-catcher, and imagine the hair is the soluble fiber, blocking up the little holes. When they’re both there, it forms a barrier on the inside of your intestine.
You actually can see it during electron microscopy, that it’s a secondary barrier that reduces the rate of absorption of nutrients from the gut, into the bloodstream. And what that does is that it actually keeps the liver safe, because it reduces the rate at which the liver has to metabolize, the stuff. And if you overload the liver, what it does is it has no choice but to turn extra energy into liver fat. And that’s what drives this whole process. Is the process of liver fat accumulation, and the thing that does that the worst is sugar, especially when it’s not teamed up with fiber.
One of my favorite sections in the book is toward the end where he reviews a few of the diet plans popular at present, detailing why he personally thinks they do and don’t work. His thoughts on paleo, which are that it is too difficult for most to stick with and too expensive to be a widespread solution, reflect the ideas I’ve been developing over time.
Lustig is very sensitive to the plight of the lower class and frequently acknowledges that eating healthy is expensive. Lustig not only acknowledges the circumstances in our society which promote the obesity epidemic but proposes solutions (experts in the area of public policy say that this ideas are simplistic, but I enjoyed thinking through his suggestions). The problems preventing the disadvantaged from losing weight include how difficult it can be to exercise in some neighborhoods due to safety issues, stress and cortisol levels driving people to overeat, and food availability. He argues that we do not have a free market because food companies, farmers, and the government already decide what is available to us and this disproportionately affects the poor because of their limited choices. Over and over he rejects the idea that people are fat because of gluttony and sloth. The obesity problem we face today is about so much more than a lack of willpower.
I’ve been practicing what Lustig preaches since I started working to lose the weight from my second baby and at 5-months post-partum I’ve hit my pre-baby weight. I gained 50 pounds during my second pregnancy, and consider 15lbs of that to be baby, placenta, and swelling, which leaves me saying that I’ve worked off 30 lbs in four months. With my first child, losing the baby weight took me over a year. Next week I’ll show my progress pictures and talk more about specific things I’ve been doing to lose weight, but the simple answer is sugar addiction. I kicked my sugar addiction and feel like I’ve found the key to losing my baby weight for good.
**This, specifically, is the fat he is referring to when he says he will be surprised if you are able to “lose weight and keep it off for a year”.