by Alejandra "Alex" Ruani — Get free science updates here.
We thought it’d be fun to review a book and highlight the kinds of things we noticed that perhaps most readers are not aware of.
Before we get started, just bear in mind that this is not a full, exhaustive, comprehensive analysis. Instead, we’d like to share some pointers so when you do read a diet or health book you keep them in mind.
Fat Chance by Dr Lustig
The Author: Dr Robert Lustig is an American paediatric endocrinologist at the University of California, San Francisco, where he is a professor of clinical paediatrics.
Fat Chance is firmly against the consumption of sugar. It is 336 pages of (mostly) scientific evidence that sugar is making the population sick. It has a good selection of references (although not a complete selection) allowing the reader to do their own follow up research and, rather like a textbook, this had a glossary for some of the more technical terms. These are particularly useful to refer to throughout as it can be tough remember all those Latin names for hormones and metabolites!
The author strongly believes that sugar is poison. He has been gaining some notoriety in recent years on both sides of the Atlantic for his strong anti-sugar campaigning and, in parts, Fat Chance feels like an extension of that campaign. In fact, on the final page he summarises by stating “this book is my outcry for a better world for our children.”
The top 3 highlights
1. In the challenge to reduce sugar intake, Lustig promotes eating what he calls ‘real food’ over processed throughout Fat Chance. His argument for this is that processed foods are high in sugar, low in fibre, and should be avoided at all costs. This is a positive message to promote; however, he does take it a little far though when he states “if the food comes in a wrapper, the wrapper has more health benefits than the food.”
2. Fat Chance removes some of the stigmas attached to overweight and obese individuals. Lustig believes obesity is due to genetics, metabolic adaptation, and the food environment. He strongly believes (largely based on his own observations and medical background) that losing weight requires more than behaviour change and people are not overweight due to sloth and gluttony. He argues if people do exhibit gluttonous or slothful behaviours, it is due to leptin resistance and therefore biological, not purely behavioural. Lustig says that an obese individual’s hypothalamus cannot see their leptin, so their brains think they’re starving, and will therefore try to increase energy storage (gluttony) and conserve energy usage (sloth).
3. Fat Chance, and indeed Lustig himself, raises awareness of sugar intake, its effect on population health and highlights the extent of the risks if the food environment is not changed. If what Lustig tells us about sugar is correct and it is toxic, then this has big global policy implications and suggests more government action is required to tackle the obesity epidemic.
As a clinician, Lustig sees first-hand the effects of obesity. Obesity is a factor in Metabolic Syndrome along with diabetes, high blood pressure, high blood lipid levels and cardiovascular disease. As a paediatric clinician, he notes that all these diseases are ‘now found in children as young as five years old and we even have an epidemic of obese six-month-olds’. Lustig argues that the young age at which we are now seeing obesity suggests that it is not due to personal responsibility. “It is not a choice to become obese,” he says, because obesity offers no personal advantage. Based on this reasoning, Lustig investigates the obesity epidemic and firmly points to one carbohydrate: sugar.
Sugar – good or bad?
Bad, according to Lustig! He makes it very clear early in Fat Chance (paragraph six of the introduction in fact) that sugar is the enemy. An enemy which is slowly killing us and “permeates nearly all food and drink worldwide.” Lustig considers sugar as an addictive substance like alcohol, tobacco or recreational drugs. He says the consumption of sugar and junk foods release a surge of dopamine, heightening the sense of reward (to learn more about reward pathways, read our Science Report: Why Is Sugar So Hard To Resist? – premium subscription needed).
Lustig reasons that the neurological response to sugar is the same as recreational drugs (and as addictive). The American Psychiatric Association (APA) Diagnostic and Statistical Manual, the DSM-IV-TR, uses seven criteria to determine substance dependence; Lustig argues that all seven criteria are evident in the obese, especially those who frequent fast-food outlets. This leads him to conclude “that sugar acts on the same reward pathways as drugs of abuse and poses the same harms to health” and governments should treat it as such (see: Should Sugar Be Taxed Like Tobacco and Alcohol?).
But there are also more complex biological mechanisms at work here. Lustig suggests that sugar consumption itself creates an almost unbreakable cycle and points to cortisol (a hormone related to stress) as a key culprit in this cycle. He says that “when cortisol floods the bloodstream, it raises blood pressure and increases blood glucose levels, which can precipitate diabetes.” On top of that, research shows that cortisol specifically can increase food intake (read our Science Report: What Influences Our Food Choices? – premium subscription needed).
To his credit, Lustig leaves no stone unturned in his explanation of how sugar is making people sick. From addiction, to neurological mechanisms, to the food environment, Lustig considers it all. However, his focus is fructose, which he demonises throughout Fat Chance based on the fact it is “very sweet and is inevitably metabolized to fat.” Other sneaky added sugars such as glucose, galactose, and maltose are largely left to their own devices in this book (discover 65 alternative names of sugar in this link).
Here at The Health Sciences Academy, we believe that the demonising of any single nutrient in isolation is dangerous, like fructose in this case. This could be misleading to readers and lead them to reduce fruit intake. However, one chapter is solely dedicated to fibre, which goes someway to justifying why whole fruits are preferable to the fructose found in soft drinks and processed foods – mainly in the form of high-fructose corn syrup (HFCS). But this distinction is not made clear enough throughout Fat Chance.
In his introduction, Lustig clearly claims that “every statement throughout this book is based on scientific study, historical fact, or recent statistics” (although he later suggests that on at least four occasions his imagination ‘runs wild’). Whilst the statement about scientific facts may be true on the face of it, there are some missing pieces of the jigsaw here and omitting information can lead to incorrect conclusions being drawn. In particular, whilst Lustig considers the metabolism of fructose, he doesn’t consider nutrigenomics and the role of personal genetics. And he completely dismisses the role of physical activity in fructose metabolism. For example, fructose metabolism is different in athletes and those who are very active and use it immediately for energy, without storing it as fat. At the other end of the scale, the Inuit population (Eskimos!) tend to be allergic to sucrose (fructose and glucose), due to an inherited gene mutation (a condition known as congenital sucrase-ismaltase deficiency). This evidence is not referred to in this book.
We also need to consider what people are replacing sugars with in the diet. Do they move from soda to orange juice? Lustig himself argues that “calorie for calorie, 100 percent orange juice is worse for you than soda, because the orange juice contains 1.8 grams of fructose per ounce, while the soda contains 1.7 grams of fructose per ounce.” Of course orange juice does contain vitamins but if the population replaced their sugary drinks with orange juice, the issue would not be solved.
Our critique points
If you are looking for a light, easy read, Fat Chance may not be for you. The language is somewhat convoluted and it lacks a complete and consistent explanation (although the glossary may help if you’re new to biochemistry). Lustig goes into a lot of detail about the biological mechanisms of metabolism. Understanding biochemistry is important to the comprehension of this book; the reader would benefit from a clearly-defined elucidation at the beginning, which could then be referenced regularly throughout. Despite the claim in the introduction that “you don’t need to be a biology or medical expert to understand the science,” it felt like there was a presumption that the reader has more than a basic understanding of human biochemistry and metabolism.
In the media
Given Lustig’s high profile campaign against sugar, Fat Chance received a considerable amount of media attention when it was released. He has been heavily criticised by the scientific community for using theoretical mechanisms to support his argument particularly around liver toxicity. He has also been under the spotlight for misrepresenting the current state of policy and current government actions. There are regulations in place for advertising to children, some States in the USA have introduced their own sugar tax or limited the size of sodas available to purchase.
A country which introduced sugar tax is Mexico, whereby a 10% levy on sugary drinks (imposed in 2014) led to declines in purchases of up to 12%. And in the UK there is an ongoing e-Petition recently discussed in Parliament (I was there together with Jamie Oliver and some of our team!), which triggered a report on child obesity and some MPs calling for a 20% tax on sugary drinks and a ban on advertising junk food during family TV shows.
If you feel inspired by his book (or even our review), Lustig has also written a Fat Chance cookbook. Unfortunately, some of the recipes do contain sugar or honey (which is about 55% fructose by the way!), and this seems slightly contrary to Lustig’s lectures and beliefs; although he does say added sugar is optional. A preview of his recipes book can be found here.
To read or not to read
Well, you might need an advanced course to understand some of the biochemistry jargon, but Fat Chance does raise some interesting points around behaviour change and the food environment. If you are interested in this topic, besides reading Fat Chance, please also do your own research, as some of the references may have been selected to support the author’s argument. We never get tired of saying that it’s crucial to look at the scientific evidence from all angles, so you can get the full picture before making up your mind!
To read or not to read? READ FOR FURTHER LEARNING Entertainment value: 3/5 Impartiality: 3/5 Context and completeness: 3/5 New discoveries: 3/5 Readability: 2/5 Scientific references: 4/5 Our total score: 3/5
To read or not to read? READ FOR FURTHER LEARNING
Entertainment value: 3/5
Context and completeness: 3/5
New discoveries: 3/5
Scientific references: 4/5
Our total score: 3/5
Available upon individual purchase. Learn more here!
Available upon individual purchase. Learn more here!