Dr. Robert Lustig: UCSF’s Sugar Crusader

UCSF physician Dr. Robert Lustig’s book Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease could not have been published at a more appropriate time, just as the honeymoon phase of our New Year resolutions fade.  If anything, Dr. Lustig’s book acts as shock therapy, stimulating a reconceptualization of what it means to get healthy, urging us to hold tightly onto our goals and re-evaluate our role as consumers ... of  sugar.              

It is no surprise that Dr. Lustig’s name rings a bell. You may be one of the 3,192,165  viewers (the total as of this week) who watched his 2009 viral YouTube mini-series Sugar: The Bitter Truth. Dr. Lustig, Professor of Pediatrics in the Division of Endocrinology at UCSF and Director of the Weight Assessment for Teen and Child Health (WATCH) Program, is nationally recognized in the field of pediatric neuroendocrinology and a leading expert on childhood obesity. He is a sugar crusader at heart.

In his recent book, Fat Chance, Lustig puts forth his nuanced argument with fervor, uniquely weaving together biochemistry and policy, demonstrating the contradictions inherent in our current food-health landscape. This is not your typical scientific diatribe, but rather a palatable and persuasive compilation, a fresh meta-analysis, if you will, with a sharp bite. The book, he explains, took him “nine months of every spare moment while still performing my job.”

Fat Chance begins with a memorable clinical experience: a young child of 6, wider than he is tall, as Lustig tells the story, comes in with his mother. Lustig respectfully interrogates the mother, asking not what the child eats but rather what the child drinks. The response is simple: orange juice.

Lustig questions the absurdity of this situation, wondering why the government program Women, Infants and Children (WIC) perpetuates the problem and allows such sugar-laden beverages to be consumed pervasively by poor families. As he writes, “One kid, one mother, one question — my life was changed and the need for this book was born. ... There is real science behind our worldwide obesity catastrophe.”

In the opening pages, it becomes clear that Lustig’s mission is not to demonize obesity as the central cause of chronic metabolic disease, but rather to single out obesity as the marker of chronic metabolic syndrome (with its accompanying diseases, such as Type II diabetes, blood disorders, hypertension and cardiovascular disease).

The argument he lays forth extends beyond the detrimental biological effects of consuming cookies, candy and cake.  Lustig is interested in identifying how hidden sugars find their way into our diet and how our sugar consumption as a society has dramatically contributed to deteriorating health in the population at large, not just among those who are classically obese.

Now that such chronic diseases have begun to affect the non-obese, as Lustig asserts, this has become a problem worthy of intense scrutiny. In his final pages, he offers two broad mechanisms of change: the personal solution (e.g. changing personal values) and the public health solution. To reconstruct America’s health, however, we need an overhaul in the form of a new regulatory framework.     

Lustig challenges the dogma surrounding the issue of obesity. “But of course, you take your chances. Look at Galileo. Look at Harvey. Look at Krebs.  Now I don't put myself in those shoes, but it was clear to me that the obesity pandemic was being made worse by adherence to the dogma ‘A calorie is a calorie,’ which derived from a misguided interpretation of the First Law of Thermodynamics. Once you accept that ‘A calorie is not a calorie,’ and that obesity is about energy deposition rather than energy balance, then all the science falls into place,” he explains.  

Lustig concludes that not all calories are created equal and that they are metabolized in unique ways — with the calories from sugars such as fructose having particularly harmful consequences; this controversial conclusion has mixed academic support.

He is currently on partial sabbatical from UCSF to study health policy at UC Hastings College of the Law. “I am now armed with legal strategies which will help turn this medical knowledge into policy changes,” he says. “The faculty at UC Hastings have been very supportive of this effort, and I am hopeful that with their help, I will be able to bring about a sea change in how we prevent and treat obesity and metabolic syndrome medically, how costs get covered financially and how the food industry operates politically.”