Sugar: The Bitter Truth, with Dr. Robert Lustig

Dr Daniel Amen and Tana Amen BSN RN On The Brain Warrior's Way Podcast

Back in 1955, President Eisenhower suffered a heart attack, prompting a nationwide inquiry as to what was causing cardiovascular disease. The two camps of thinking centered around either fat or sugar as the culprit. Fat won out and was subsequently demonized. In this episode of The Brain Warrior’s Way Podcast, author Robert Lustig and Dr. Daniel Amen explain why this was the wrong decision, and the eventual fallout that resulted from this misconception.

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Dr Daniel Amen: Welcome to the Brain Warrior's Way Podcast. I'm Dr. Daniel Amen.
Tana Amen: I'm Tana amen. In our podcast, we provide you with the tools you need to become a warrior for the health of your brain and body.
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Dr Daniel Amen: Welcome back. I'm here with Dr. Robert Lustig, professor at UC San Francisco in the Department of Pediatrics. He's a neuroendocrinologist.
On the Brain Warrior's Way Podcast, we talk a lot about hormones because it's very important in our bright mind's mnemonic. One of the things I learned, I saw this study that showed if you get a sugar burst, it drops testosterone by 25%. So, I thought to myself, if I go to the Cheesecake Factory and share cheesecake with my sweetheart, nobody's getting dessert when they get home because [crosstalk 00:01:33].
Robert Lustig: I would say no one's getting anything.
Dr Daniel Amen: Let's talk about the sugar story, and why fat became demonized and sugar became the darling that, in many ways, ruined our society.
Robert Lustig: I couldn't agree more. This is a very sordid story, and was very specifically driven by the Sugar Association, a trade group of the industry from way back, started back in 1943 but really sort of picked up steam in the '50s and '60s. Now, the thing that really turned the tide was 1955. Eisenhower had a heart attack and everyone want to know why. At that point, the data had started to amass that America was suffering from big time cardiovascular disease. Paul Dudley White at Mass General had demonstrated that the incidents of coronary disease in the United States had gone up something like six-fold over the previous five decades.
Everyone wanted to know what caused heart disease because the president had a heart attack, and there were two camps. One camp which was led by a British physiologist, nutritionist, physician by the name of Dr. John Yudkin said that it was sugar that was driving this. Back then, Dr. Yudkin had correlation, not causation. Those studies remained to be done over the course of the next several decades, but he had studies that looked at the amount of sugar consumed and the amount of heart disease, diabetes, gout, several other chronic diseases, and he made that case.
On the other side, there was a second camp which, unfortunately, won out. That camp was led by a Minnesota epidemiologist by the name of Ancel Keys. He was actually on the cover of Time Magazine, Scientist of the Year back in 1980. He did a study which was called the seven countries study. What he looked at was the percent of the diet as saturated fat versus the incidence of coronary heart disease in seven countries, and showed this very linear relationship between the two. Here's the problem. It wasn't the seven-country study. It was the 22-country study. He picked the seven that fit his line. The other 15 he left out. We only found that out later.
In addition, there were three things that happened in the 1970s that sort of sealed the deal against Yudkin and for Keys. We learned three things. The first thing we learned was this molecule in our bloodstream called LDL, low density lipoprotein, and we learned that LDL was a driver of cardiovascular disease because of these kids with genetic inability to clear LDL called familial hypercholesterolemia. These would be the kids who would get heart attacks at age 18. The second thing we learned was that dietary fat raised your serum LDL, which is true. As it turns out, there are two LDLs that raised one, not the other, and it's the one that didn't get raised that causes the heart disease but that, when you measure it, you measure both but we didn't know that then.
Dr Daniel Amen: Just so people know, LDL is often thought of as A particles and B particles; A, the big fluffy ones that are harmless basically, B, the little demon ones-
Robert Lustig: Small dense.
Dr Daniel Amen: … that are like shards of glass that cause blood vessel damage.
Robert Lustig: Exactly. We always say LDL is bad cholesterol. It turns out that LDL is actually probably neutral cholesterol for the most part, but this one particular species called small dense LDL turns out that's what's driven by sugar, but we didn't know that back then. Then finally, epidemiologic studies showed that LDL levels did correlate with coronary disease. These three things, basically, if A leads to B and B leads to C, then A must lead to C, therefore no A, no C. Get rid of the fat, therefore get rid of the heart disease. That sealed Yudkin's fate. He was thrown under the bus, left to the dustbin of history, and we went low fat and we went whole hog low fat.
The problem is when you take fat out of the food, it tastes like crap. Okay? I mean it just does. Food industry knew that they had to do something to make the food palatable, to make the food worth eating, to make you want to eat it. So, what they do? Added sugar. They took the fat out, put the sugar in. You prove this to yourselves right now if you go to the store, do not buy them, just look at the food label of Snack Well's. Okay? They were an invention of 1982. They are still with us. Two grams of fat down, 13 grams of carbohydrate up, four of which are sucrose dietary sugar, and Snack Well's drive heart disease. I'm sure Nabisco will not be too happy about me saying that, but that is basically what happened. It happened to our entire diet.
My father got his heart attack eating Entenmann's fat-free cakes, so I have a vested interest in fixing this issue because my father got his heart attack from it. So, I understand this issue and [crosstalk 00:07:36].
Dr Daniel Amen: My grandfather who I'm named after, who is my best friend when I was a child, was a candy maker. He had his first heart attack at 49, and his second heart attack in his 70s that took him away from me. I'm genetically loaded for it but I don't have heart disease. Why? Because I don't eat sugar.
Robert Lustig: Right, because you're not candy maker.
Dr Daniel Amen: It was hard. Breaking up with sugar was hard because it was attached to love when I was a child. So often and you see this is we love children, we praise children, we reward children, we sooth children with sugar which is just the wrong thing to do.
Robert Lustig: I couldn't agree more. If you're listening to this and you're a parent, and you bring cupcakes for your kid's birthday at school, you are the problem. Okay? I'm telling you right now, I'm calling all of you out, stop it. Stop it right now. If any other mother brings cupcakes for their kid's birthday, stop them.
Dr Daniel Amen: You're going to be a brain warrior general.
Robert Lustig: Okay.
Dr Daniel Amen: I love that. That's decisive. Why is it from Halloween to New Year's Day, we just are stupid as this society. Why do we celebrate Christ's birth or Thanksgiving by hurting people?
Robert Lustig: Excuse me, Valentine's day, Memorial Day.
Dr Daniel Amen: Easter.
Robert Lustig: 4th of July, Easter. It's year round, and it's daytime to nighttime because what do you feed your kids out there? Breakfast cereal. Really? Okay. Why donut you take a look at that nutrition facts label again? The 17 most common breakfast cereals for children are all over 40% sugar, 40%.
Dr Daniel Amen: What is happening?
Robert Lustig: The highest, Kellogg's Honey Smacks is 56% sugar. You really want to feed your kid a breakfast cereal that has 56% sugar. Who would do that?
Dr Daniel Amen: Let me just have a few more minutes with this one. What is happening to the brains of children who get that sugar burst in the morning? It's not just cereal, it's also waffles, pancakes and syrup, which is just nothing but liquid sugar-
Robert Lustig: Orange juice.
Dr Daniel Amen: … and orange juice. My dad hates this because he grows oranges. I'm like, "Eat the oranges, donut juice it."
Robert Lustig: Exactly.
Dr Daniel Amen: The fruit, don't drink the juice. There's a reason for that. But what happens in their brains? I know because I used to do this and I apologize… I used to go to Winchell's on the way to work and get in two donuts, and then I learned you can't do that because a half an hour later, my brain is mud. I just can't think because I get that insulin burst, which then drops my sugar level and I can think.
Robert Lustig: There are probably two different phenomenon going on. There's one that's direct and there's one that's indirect. We know more about the indirect one and that is what you just described. That is you get a big pancreatic insulin burst, which then drives your blood glucose down, making you relatively hypoglycemic. Your brain functions on glucose and when you drop your serum glucose, which is usually around the three to four-hour mark, you get a little fuzzy and you get a little irritable. You end up wanting to eat something early in order to bring that blood glucose up, and that could change temperament. It could change cognitive function in school. That's one potential.
Dr Daniel Amen: Could it make kids look like they have ADD?
Robert Lustig: Possibly. No one's proven that. There's some correlative, not causative data. That's a tough one also. The question is, are you talking about kids who don't have ADD who act like they have ADD or kids who really have ADD who just get worse ADD? There's complications in trying to study that. There's a little correlative data but, for sure, it's not a slam dunk. That's the indirect effect.
The direct effect may be even more pernicious and that is fructose, this sweet molecule in sugar, normally gets metabolized by the liver but, when you eat too much of it, your liver gets overwhelmed, you end up with a serum fructose level. Now, your brain is not designed to metabolize fructose. However, we now know that the astrocytes, not the neurons, the astrocytes, the supportive cells of the brain can take up fructose. When they metabolize it, what it does is it depletes their ATP. If it depletes their ATP, God knows what that's doing to neuronal function. It's conceivable that that fructose bolus that comes when you over consume sugar might have direct effects on cognitive function as well.
We also know that insulin resistance, which occurs not from one sugar meal but from multiple, over time, leads to brain shrinkage and cognitive decline in adolescence. This is work of Antonio Convit at the NYU Medical Center showing that adolescents with metabolic syndrome have bad brain.
Dr Daniel Amen: Yeah, and it goes with the work we've done on our studies that show as your weight goes up, the actual physical functional size of your brain goes down, which should scare the fat off anyway.
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