Does Sugar Cause Obesity? | JRE Obesity Debate

I want to talk about some interesting observations because Gary you like to talk about You know what's going on in different dietary trends in different cultures, and I find that pretty interesting, too. I want to talk about the fact that sugar intake in the United States has been declining for the last 20 years. So it peaked in 1999 and it is currently depending on which source of evidence you believe 15 to 23 percent lower than it was in 1999. This has been corroborated by a number of different sources of evidence. This is number 17 on my blog. And of course, we know that obesity has increased, diabetes has increased substantially over the last 20 years. In the percentage of the population or actual numbers? Correct, percentage. Yeah. And in the UK sugar intake has been declining for 50 years. I don't believe that. Okay. Well, you can argue with the data there number 17 on my blog. They're about 22 percent lower. And this is what we see across a number of different industrialized countries. You see a stagnation or decline in sugar intake in recent decades as obesity rates are continuing to increase. And of course that 50-year period that covers the decline in the UK covers the entire UK obesity and diabetes epidemics. But there's another one I want to talk about that. Can I respond to that? Yeah, we should respond to that. Stephan, actually I'll let you respond for me because we had this debate with the Cato Foundation. So you know my counter argument. You want to give it? Yeah, sure. Absolutely. I mean, are you sure you want to let me give it though? I might correct it. Okay. All right. So your counter argument is that the amount of sugar that we consumed 20 years ago or even maybe 50 years ago may be continuing to fatten us today. And it's about the sugar that we used to eat 20 or 50 years ago and not necessarily about the sugar we eat today. Well, it's not exactly right. Okay. So the argument I made was because he brought this up when we had to do a written debate on the Cato Foundation website. And it's interesting if you think about used tobacco as an example. So tobacco smoking per capita smoking in America peaked in 1965 right after the Surgeon General's report and it took 30 years before lung cancer rates turned over. Okay, and I think we both agree that cigarettes are a major cause of lung cancer smoking. So what you basically have is a system in which if there are any, there's the assumption that Stefan is making when he quotes this kind of data is that the relationship between sugar and obesity is linear. So as sugar goes up, obesity and diabetes goes up and if sugar turns over they don't. So here's the thought experiment I used in Cato, which is 1965 or smoking per capita about 20 cigarettes a day. As it starts to come down, imagine we only cut that to 17 cigarettes or 16 cigarettes, a 20% reduction in smoking. Would you expect to see a reduction in the lung cancer rates? Again, this is the point I made about what you would expect to see rather than using simplistic metaphors. So the question is would you like, Joe, we go from 20 to 16, do you expect to see the lung cancer rates turn over? No. No. And in sugar we went from- Probably see them drop. No, you might, the derivative might drop. You might expect it to slow a tiny bit. Still, there's a weird comparison because one of them is poison, the other one's food, right? Well, but in this case the food, the question is how toxic is the food? So in sugar we have a variety. In sugar what happened is the equivalent of going from 20 cigarettes to 16 beginning in 1999 and Stefan is saying I would expect to see an immediate change in obesity. In fact, if you actually look at the rates, the rate of increase, the prevalence appeared to plateau around six or seven years later. Who knows whether that's relevant? But to get a small decrease in sugar, even if it's 20%, that's 20 to 16 cigarettes. And the other factor that I talk about in my book and Stefan knows this is you very clearly have maternal transmission of the propensity to obesity and diabetes. So there's a generational effect. This is studies that were done in the same Pima, the same Native American tribe where each generation it gets more and more susceptible to whatever it is in the diet that's triggering obesity and diabetes. So if that's been happening in the United States and around the world, you've got a generational effect that could last far longer, might even keep going indefinitely even if the sugar levels drop. So you have the sugar quick kicking off the obesity epidemic and yes, Stefan's about to say this is a story and it is a story. But it's clearly the case that mothers who are obese during pregnancy are diabetic or gestationally diabetic. They become diabetic during pregnancy or they have metabolic syndrome. They're just insulin resistant or they gain a lot of weight in pregnancy. We'll give birth to children who are at higher risk of becoming an obese and diabetic when they get older and at younger ages. And those children will pass it on. So again, we have, you know, I would be nice. I would love it if sugar consumption came down and with it obesity and diabetes plummeted. But it's not in any way a refutation of this hypothesis, which I just want to state what it is because people get confused about it. We never got to it. The sugar hypothesis is a little different than what we've been talking about. And it's pretty simple. We have obesity and diabetes epidemics worldwide, as we talked about. It doesn't matter the genetics of the population. You add something about a Western diet to those populations, Western diet and lifestyle. You get these explosions of epidemics of obesity and diabetes. And what I'm hypothesizing in this book is that sugar is something that has to be added. Maybe it's sugary beverages for all I know. Or it could be, you know, a more complex hypothesis. The single possible one is you add sugar to any population's diet in sufficient, whether it's Southeast Asians living on rice or the Inuit living on reindeer and whatever. Or the Native Americans of the Great Plains or, you know, Caucasians living in the Upper East Side of Manhattan add enough sugar. And eventually, through the metabolic effects of the sugar and the generational effects, you will get explosions of obesity and diabetes and metabolic. Stephen, you want to respond to that? Sure. I mean, Gary, you called it, man. It's always possible to tell a story to salvage your hypothesis, but that doesn't necessarily make the story correct. I mean, I can come up with a story that cosmic rays cause obesity by hitting my fat cells and making them fat. You can't disprove that. Nobody here can disprove that. But there's no evidence. We could do an experiment to protect you from cosmic rays. But that's where science comes into it. We don't have the data right now. You don't have data supporting your hypothesis. No, we do. You're just dismissed. No, no, no, no, no. Can I get back to the Kevin Hall study? I'm responding right now. Let's let him respond then. We'll go to Kevin Hall later. Yeah. So what do you think about what he's saying about sugar and increased rates of diabetes and that this is the cause? Yeah, I mean, so let me put it this way. We don't have any evidence supporting what he just said. So that is a story that is not supported by evidence. Now, does it does that mean that it's definitely incorrect? No, I cannot say that that's definitely incorrect. Same way I can't say it's definitely incorrect that cosmic rays cause obesity. But, you know, I'm going to I'm going to use a Christopher Hitchens quote here. That which is asserted without evidence does not require evidence to refute. And that's the way I feel about this particular story. But, you know, there are cultures that consume large amounts of sugar and do not develop obesity. We've we've talked about that. Yeah, we're going to talk about it again right now. So this is reference number 21 on my blog. I'm going to talk about three different cultures, one of which we have not talked about, Gary. The first one is the Hadza hunter gatherers of Tanzania. This is a really interesting non-industrial culture. They as part of their hunter gatherer diet eat a lot of honey. Honey is a very common food among hunter gatherers living similarly to how our ancestors used to live. And if you measure their year round honey intake, it's about 15 percent of their calories. So this is a major calorie source for them. That's about as much sugar as the average American eats. And they eat fruit sugar on top of this. They eat a lot of fruit on top of that. And so they're eating quite a bit of sugar. And the Hadza men have about 12 percent body fat. Women have about 18. So they correspond pretty closely to our Western ideals. But isn't that high for hunter gatherers? No, not really. I mean, that's higher than me. I'm running around. Let me ask you this. How have you had your body fat is measured? Well, I've had it measured a bunch of ways. Electricity. I've had this machine where you hold on to these things, you stand on this platform. And it measures it. So I've done it in physicians office. Okay. So I've done it with calipers. Okay. So all the methods that you measure that you mentioned are not gold standard methods. So the gold standard methods are underwater weighing and. Are the underwater weighing these people on this island? Actually, I'm not sure. I'm not sure how they bring that equipment to this island. Correct. But okay. Look, I can tell you that you can look up photos. I don't remember how they, how they measure their body fat, but you can look, I am 12% as measured by DEXA. So I'll just tell you that. Okay. So you can get a sense of what 12% is by DEXA, which is a gold standard method. So you can look at photos of these people. They are very fit. They're lean. They're not like ripped, you know, they're not Arnold Schwarzenegger in peak form, but they are. No, I understand that. But it seems to correlate with a higher consumption of sugar that they seem to have a higher percentage of body fat than the average hunter gatherer. No. If you look at a lot of that average hunter gatherers, like a friend of mine does a lot of work with the pygmies and the Congo and they're very lean. Okay. So the pygmies. That's the second culture I was going to cite that eats a ton of honey. Do they? Yeah. The, the, if they're the same ones, the Mabuti pygmies of the Congo, they eat up to 80% of their calories can come from honey during the rainy season. So they also eat a lot of honey and are lean, not just lean. Part of the year. Uh, correct. Yeah. For them, it's part of the year, the Hadza eat it more consistently and the Hadza have low levels of body fat. They're cardiovascular risk markers are excellent. They don't have diabetes. Same for, but this is absolutely not like a controlled study in the consumption. Absolutely not. I absolutely agree with you. That's exactly the point I'm trying to make is that when you have an, a culture that is eating a lot of sugar, but everything else is in place, they're doing everything else, right. The sugar is not enough to make them fat. It's not single handedly enough. I'm not saying it doesn't contribute. I think sugar does contribute just to be very clear. I think sugar does contribute to obesity and diabetes and cardiovascular disease, but it's not single handedly responsible as Gary has argued. So the third culture is pretty interesting. The Kuna of Panama. And the reason they're interesting is that they actually aren't eating honey. They're actually eating white sugar. So they're a culture that, um, they live primarily a non-industrial lifestyle. They're farmers and hunter gatherers. And, um, they, but they do a little bit of trade. And one of the things they trade for is sugar and they eat sugar sweetened foods as well. So like donuts and pastries and they drink soda and Kool-Aid. What, what is their lifestyle in terms of like, what do they have a natural lifestyle? They are hunter gatherers and subsistence farmers. So they're, you know, living a physically active natural lifestyle. So this is the problem in comparison with any Westernized civilization that you, you, you burn off so many more cows. I 100% agree with you. And I think that is exactly the point I'm trying to make is that it's more complicated than just sugar. It is more complicated than just sugar, but with a normal lifestyle, it may not be. This is, you know, I, the consumption, the thing about burning of the calories is also the, the glucose demands, the glycogen demands on the muscle. You're, you're, you're not just existing. Like the, one of the problems with Western lifestyle is that many people are just existing. They're sitting in a chair, they're walking to a desk, they're sitting in their car. They're not doing anything to burn any of this off. So even if you have like, if you get a baseline of a minimal amount of calories that you require for the day, I think what Gary's getting at is that if you, if you have this lifestyle, the lifestyle that many of us have, and then with that lifestyle, consume sugar that you're going to get fat, I don't think you can compare that to athletes. And in that respect, I don't think you can compare that to hunter gatherers because you're requiring this is a much more significant load on your body. You like when I, I did this sober October fitness challenge with my friends during October and we, I was working out four hours a day and I was fucking eating everything that moved. I was drinking soda. I never drink soda. I was eating cookies. I didn't gain any weight other than muscle. I didn't get any fat at all. Yeah. And I was eating a terrible fucking diet, but I was going crazy when you're trying to stay alive and you're running around plowing and growing foods and hunting and gathering and fishing, you're burning off insane amounts of calories. It's just the hiking that's required, the amount of exercise that's required. It's off the charts in comparison to a standard Western lifestyle. We are on the same wavelength here. I mean, I completely agree with you that it is more complicated than just sugar. And, but if you read what Gary has written and please correct me if I'm wrong here, Gary argues that sugar is the primary cause of obesity and that physical activity does not matter. Calorie intake does not matter. Do you think that physical activity doesn't matter? I think it's a, uh, uh, no, I don't think it makes a hell of a lot of difference for fat. When we're talking about the cause of obesity, I don't believe obese people get obese because they're sedentary. But let me put it this way. So if you take someone who's an elite athlete and they start consuming a lot of sugar, but they, they ramp up their exercise accordingly, like say if someone does what I did during the sober October, they're working out three, four hours a day every day. You don't think that they have higher sugar demands and that their body would just burn that off? No, absolutely. I think that if there's a real benefit to exercise, it's burning off the carbohydrates you consume, then you need less insulin to do it. Can I respond to the Kuna? Get back to them for a second. Okay. I mean, one of the, the issues I have with Stephen is he writes off my stories as stories, which they are all science begins as stories, um, hypotheses and then what you do is go look for the evidence and then he quotes studies and refers to it as evidence as though this is somehow by calling it evidence that may, and then we had this discussion a year and a half ago and you didn't disagree with me at the time and it had no influence. So I'm just going to read from the email I wrote to Stephen. Oh boy. We're reading emails. It's gotten to that point in the conversation. Well, because it's, I'm not only going to read from the email. If I have time, I'm going to read from your book. Read the Kuna, the study you cited is interesting. Okay. So this was a study that professed to measure sugar intake of this population on an Island, Alagandi and compare it to the population in Veracruz where they, uh, they had emigrated and I say, but they're added sugar intake on Alagandi according to figure one is 25 teaspoons per week, plus the equivalent of 24 ounces of sodas at 78 grams. If it's Coke, 32 ounces of Kool-Aid that's 96 grams. So I'm leaving out the cup of a sugar cane because I don't know what that has meant or how they assess it. One way or the other, it's not processed sugar. So it's roughly 274 grams of sugar per week or about 32 pounds per year. Now that alone is very low intake and we don't know how it changed over the years. We have no idea if it's increasing recently or been low for years. So you just use the Kuna as an example of a population that eats a lot of sugar and stated it dogmatically, but that lot of sugar is 32 pounds a year. And then I said, wait, hold on. I thought you did. That's what I heard. If we believe the study, the Kuna and Veracruz are consuming roughly the same amount, but I'm not sure I believe the study when it comes to the Veracruz population. Do you really think these urbanized Kuna are consuming only three, eight ounce sodas per week? So the implication was this population of Caribbean Islanders immigrates to Veracruz. They move into the city and they consume more sugar back where they used to live because they trade for it than when they get into the city. Um, so five glasses of Kool-Aid, no candy, no ice cream, nothing. I'd like to know more about the urban Kuna before I accept such an analysis is valid on top of this, as they say, the analysis is done mostly of women because quote, the women were available to study because they were at home during the day. Unquote. So what were the men consuming and what were the children consuming when they weren't at home? And was there something magical about this freak food frequency questionnaire and these researchers that they captured it accurately? So this is what science is. You have studies, you have evidence. And the question always is you've got competing hypothesis. Does this evidence really speak to the hypothesis? And I'm one of my issues with Steven is what provoked our initial discord is that he's constantly citing studies that don't actually either they only speak to one hypothesis like the overfeeding study or they're poorly constructed and poorly done. So even this Hozda example with the honey is something we discussed in email very kindly and we went back and forth and I said, I don't actually think it's a reputation because the hypothesis I'm defending here, the case against sugar is you add sugar to any population's native diet and you get epidemics of obesity and diabetes. So here's a population that's been eating honey for maybe thousands of years. In fact, when they emigrated to this area, they made, I've added honey to their diet and had obesity and diabetes then. And as Steven points out in the book, obesity and diabetes in a hunter gat, populations, a death sentence for the child and for the mother who gives birth. So you're going to very quickly weed out anyone. So again, it just comes back to this question of does this actually, is it a refutation, the hypothesis that I found a hunter gatherer population that eats a lot of honey and is in fact, and the answer is I don't think so. Steven thinks it does. You could flip a coin. All of this can be settled with experiments. One of the experiments we did at Newsy. So one of the metabolic problems that goes along with obesity and diabetes is non-alcoholic fatty liver disease. It's endemic. It used to be 20 years ago, if you had alcoholic fatty, if you had fatty liver disease, the doctor would, and you told the doctor you didn't smoke, they would assume you were lying. Now it's so common and so common in children and particularly common in Hispanic children that it's clear it's not caused by alcohol. And the question is what causes it? Because if you could create a fatty liver with a macronutrient, you could probably create insulin resistance as well. And then this whole slew of disorders, including obesity and diabetes. So my not-for-profit funded a pilot study where we just took 40 kids, by the researchers at UC San Diego and at Emory University in Atlanta, took 40 kids who had non-alcoholic fatty liver disease and randomized them into two groups. In one group, we gave them the entire family all the food they needed so they could overeat to their heart's extent, but no added sugars in their diet, no sugary beverages. And this study was published in JAMA four months ago, and it's just to get rid of the sugar in the diet the fatty liver disease resolves. You know, it was pretty simple. I could, there tells you nothing about mechanism. The kids lost a little bit of weight. Maybe it was a weight loss. The conventional wisdom would be they just ate less, which I wouldn't be at all surprised because they probably didn't like the food as much without sugar in it. But these are the kinds of ways you could test these hypotheses. And problems I have with like the meta-analysis getting back to Kevin and Hall, there's two ways you could do science. You could say, let's look at all the junk that was done for 30, 40, 50 years. Let's find everything we can that even vaguely speaks to the experiment and ignore any quality of the study. So if it may be asked, it asks this question. Like we want to know what happens when people do this, but in doing this, we switch their, you know, fat intake around, fat and carbon take around. And then we can throw all that garbage into a meta-analysis. And the one thing I'm pretty confident is they did a poor job because the one study I looked up, the one with the biggest effect, they mistook kilojoules for kilocalories. So they reported that 400 kilocalorie decrease in energy expenditure on the low-fat diet when it was a 400 kilojoule, which is what's that factor? You know these numbers. 0.8, 0.18 or something. Several of the other studies were Jim Hill studies. We've talked about Jim Hill, the biggest studies were Jim Hill. And the way we approached it, the not-for-profit, it's say, you've got to understand what the question is. And you've got to design an experiment to get the right answer.