Book Review: Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease

Book By Dr. Robert Lustig
Reviewed by Rosalind Michahelles

In FAT CHANCE Dr. Lustig analyzes sugar (meaning, carbohydrates generally, glucose and fructose) scientifically, psychologically, and sociologically. He explains the subject from different perspectives:

• How we digest, use, and store the sugars in our diet
• Why sugars are addictive and hard to forego
• And what our society does to encourage their consumption

This book is also a call to action because he feels that of all the possible dietary approaches to better national health, reducing sugar is the most “actionable.” We ought to be able to get Coca-Cola out of the schools and high-sugar juices off the lists approved by USDA for the food subsidy programs SNAP and WIC. The science of digestion is necessarily complex so as to equip us for a variety of potential challenges to our survival.

A key to hunger and fat storage is the balance between two independent hormones – insulin and leptin – that share the same ‘signaling cascade’ although they bind to separate receptors. What this means is that when insulin levels are chronically high leptin cannot signal satiety, which is leptin’s job.

With no feeling of satiety, the eater goes on eating. Insulin is usually raised by eating refined, high-glycemic starches and sugar. However, there are also drugs that increase insulin levels, among them steroids, anti-psychotics, and oral hypoglycemic diabetes drugs (p.82).

The kind of sugar called fructose, found in vegetables and fruit, has a somewhat different path from that of glucose. Because it doesn’t enter the bloodstream as quickly, it is less immediately disrupting to diabetics. However, too much spells trouble. The book elucidates the havoc that fructose can wreak.

One result of a liver over-dosed with fructose is insulin resistance, which misguidedly triggers the pancreas to produce more insulin and that leads to more fat accumulation and obesity. When fat accumulates in the liver, it exports triglycerides — and high serum triglycerides have the highest correlation with heart disease according to standard blood tests. Besides obesity and heart disease, the author also tracks the high fructose trail to cancer and dementia.

The book develops Dr. Lustig’s conviction that sugar in all its forms is an addictive and that category includes alcohol, cigarettes, caffeine, and certain drugs. Of seven criteria for establishing addictive status, sugar rings all the bells in the way that, say, salt or fat do not: tolerance (needing more for the same effect), withdrawal, bingeing, attempts to quit, craving, life disruption, and continued use all the same. Are you skeptical about the opiate effect of sugar? Consider Sweet-Ease, “a sugar solution into which hospitals dip pacifiers for newborn boys undergoing circumcision, to reduce the pain of the procedure.”

If you are reading this you may be wondering what diet or approach to menu planning would be best for you. Dr. Lustig makes it clear that reducing sugar and refined starches is important for everyone. Beyond that he says “Your insulin profile is the most important factor in determining what diet approach works best for you.” If your pancreas produces a lot of insulin, then choose a low-glycemic diet. If you are insulin resistant, then choose a low carbohydrate diet. If your insulin resistance is from genetic inheritance, go for the low fat diet.

The book ends with a section on public advocacy. Where is sugar being promoted and how? Where and how can concerned people like you and me intervene? This probably has to start at the grassroots level as, indeed, it has in some towns and cities. Although the public costs of sugar consumption are high, a sugar tax looks unlikely in the U.S. any time soon. But consider the precedents in curbing fast-food calories: New York City requires restaurant menu labels and San Francisco has banned toys in fast-food orders.

This book requires an attentive and motivated reader, despite its folksy tone, because the subject is a complicated and demanding one for a non-scientist. However, reading it repays the effort, as the problems of sugar consumption are very serious for the society as a whole and for certain individuals in particular. If we are not one of those, we surely know and care about someone who is.

Fat Chance is currently available under two titles:

Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease (Hudson Street Press – US version) and Fat Chance: The Bitter Truth about Sugar (Fourth Estate, London, 2013)
Rosalind Michahelles is a Certified Holistic Health Counselor in Cambridge.
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