When Dr. Robert Lustig says the fight against sugar is a matter of life and death, he’s not being hyperbolic. He’s not even being alarmist. He’s being honest.

He knows this truth first-hand. He witnesses it every day in his job as a pediatric endocrinologist at the University of California San Francisco Medical Center. In his role at UCSF, Lustig, who also serves as the president of the non-profit Institute for Responsible Nutrition, treats children of all ages who have been diagnosed with metabolic disorders. These disorders, like type 2 diabetes and fatty liver disease, weren’t seen in children just a single generation ago.

What’s to blame for this sudden rise in conditions that were once only diagnosed in adults? It’s quite simple, Lustig says: sugar.

“By far and away, the single biggest issue in processed food today is too much sugar, and 74 percent of the items in the grocery store today are spiked with added sugar because the food industry knows when they add it, you buy it,” Lustig says.

Previously, Lustig notes, a collective uprising from nutrition allies and experts helped defeat one dangerous nutrient and remove it from the American diet. “Trans fats were the devil incarnate. Trans fats were consumable poison,” he says. “But in 2013, the Food and Drug Administration recognized that trans fats were not generally recognized as safe, and they are now coming out of our food.”

With one food foe down, Lustig hopes the same uprising will point its collective aim to sugar next. “Sugar is the biggest problem in our diet.”

Dr. Robert Lustig Quote

“The problem that we have is not that people don’t know how much sugar is in any given food,” Lustig says. “The problem that we have is that people don’t even know the difference between real and processed food because [parents] today, growing up in the 1980s, never saw real food. They don’t know what it is. They wouldn’t know how to cook it even if they did. And so they’re passing this lack of knowledge and information on to their children. This is what has to change.”

That may become easier, thanks in large part to a recent decision by the FDA. Beginning in 2018, food manufacturers will be required to include added sugar numbers on nutrition labels. That number, however, doesn’t tell the real sugar story, Lustig points out.

“The sugar that is in a piece of fruit molecularly is exactly the same as the sugar that’s in a soda. There’s no difference in terms of the molecules themselves,” he says. What’s different is the other nutrients that accompany that sugar — and how they interact with your body.

Take for example, an apple. When you eat an apple in its natural form, you’re consuming two kinds of fiber — soluble and insoluble — in addition to sugar. The insoluble fiber will form a gel on the inside of your small intestine and will actually form a secondary barrier that will prevent the absorption of the sugar from your gut into your bloodstream. Therefore, the insoluble fiber reduces how much sugar your liver is exposed to. It’s protecting your liver from unnecessary sugar. When we consume too much sugar from processed foods like sodas, cereal, and sugar-sweetened yogurt, they have no protective fiber. The liver becomes overwhelmed by the amount of sugar that is being delivered. The excess turns into fat, and over time, that fat can precipitate. The result is non-alcoholic fatty liver disease, and it’s a precursor to type 2 diabetes.

“In the last 10 years or so, we’ve been putting the pieces together in terms of how this phenomenon of obesity and these diseases, which we call metabolic syndrome, develop,” Lustig says. “And it starts with sugar.”

At the UCSF pediatric obesity program, which Lustig runs, the number of obese children they treat is high — and climbing. “These kids are coming in at younger and younger ages. Now most people think, ‘Well, you know, obese kids, they do it to themselves or their parents do it to them.’ But we’re seeing obese six-month-olds,” Lustig says. “In fact we’re seeing obese newborns. They don’t diet and exercise.”

That’s why, maybe somewhat in jest, Lustig suggests we should be carding kids for sugar purchases. Indeed, Lustig suggests that restricting them from purchasing sugar-sweetened beverages may help moderate their sugar consumption.

Dr. Robert Lustig Quote

Lustig argues fructose molecules — a component of sugar — are metabolized in the liver virtually identically to the way alcohol is metabolized in the liver. Alcohol is a known addictive substance. So too is sugar, Lustig says.

“Sugar does exactly the same things as alcohol does. It’s treated by the body the same,” he says. “Sugar is the alcohol of the child, and that’s why children today are getting the diseases of alcohol — type 2 diabetes and fatty liver disease — without alcohol.”

Lustig notes that non-alcohol fatty liver disease, which wasn’t recognized as a disease until 1980, now affects 30 percent of all Americans. It affects 13 percent of all children. Fatty liver disease is found in 38 percent of obese children, and one-third of America’s children are now obese. “You want to talk about an epidemic? There’s your epidemic,” he says.

So how do Lustig and his colleagues hope to right this sugary ship? In behaviors, of course, but also in environment.

“What we have learned is that if you can modulate that toxic environment for obese children with the help of their parents, of course, we can actually turn this around. We can make the disease reverse. We can make weight go down. The question is how do you keep that up in our toxic environment? That’s the difficult part.”

For his part, Lustig suggests education plays a role: “It can provide the information that can allow for public interventions to be adopted,” he says.

Soda taxes, or taxes on sugar-sweetened beverages, are another option. “Now I’m not suggesting taxation is the answer to this, but what it’s showing is that people are recognizing the problem and recognizing that some sort of public intervention will ultimately be needed in order to solve this problem, and the sooner we start talking about it, the sooner we will solve it.”

Lastly, it’s about food, too. “The new food label in 2018 will hopefully address some of these issues for the consumer who looks for it,” he says. ‘However, there’s a much easier way of dealing with this issue. It’s called real food. Real food doesn’t have a label, and if we get people to consume real food, this problem would go away.”

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Allison Schaffer

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