Sugar, the alcohol of children

Source: Dr Robert Lustig on Pediatric Metabolic Health: “Sugar Is the Alcohol of the Child”

Audition (10:01)

Dr. Robert Lustig, on metabolic health in children:

Sugar, the alcohol of children

A recent scientific event focused on the treatment of obesity.

Obesity is considered a risk factor for diabetes and cardiovascular disease.

However, “obesity is not the problem, obesity is just a marker of the problem,” says Dr. Robert Lustig, an endocrinologist and professor of pediatrics at the University of California, San Francisco.

In the following interview, he seeks answers to two questions:

What are the most significant environmental and nutritional factors that increase the risk of obesity in children?

First, we need to understand that obesity is not the problem. Obesity is a marker of the problem.

Metabolic disorders are the problem, and today 93% of Americans have metabolic disorders, including children!

Today, children are diagnosed with adult diseases, diseases that appear during aging, and alcohol-related diseases.

Previously, it was type 2 diabetes and fatty liver disease, diseases caused by alcohol, and now it's even diseases of 5-year-olds!

So the question is not what causes obesity, but what causes metabolic disorders , of which obesity is another manifestation.

If we understand this, then we can begin to think about what the real problem is.

We currently have 3 types of fat stores

There is subcutaneous fat , this is the fat we measure on the scale – the “do I look fat in this swimsuit?” fat.

This fat tissue is actually metabolically active and benign. That's where we want to store excess energy, where it's safe.

But that's what we measure on the scale, so when we say someone is obese, it's because their body mass index, or weight, is high.

But that's not really the problem, because there are many metabolically healthy obese people, and there are also many metabolically unhealthy thin people.

So understanding this is very important.

25% of children have fatty liver disease that they have never had before

The second fat storage site is visceral fat . This is mostly due to stress.

It is not 'due' to diet; it is not directly 'due' to the environment per se, unless it causes stress.

How do we know this?

Because clinically depressed patients who are hospitalized eat very little because they are anhedonic. (Anhedonia is when we are unable to feel pleasure. It is a common symptom of depression and other mental disorders.)

They don't want to eat at all. They lose subcutaneous fat, but in their case, visceral fat increases .

This fat is due to stress, not food or the environment.

And finally, there is the third fat depot: liver fat .

This is where nutrition does its “dirty work.” This is where the real problem lies.

So, what makes the liver fat?

And by the way, can we measure liver fat on the scale?

No! Even a quarter of a kilo of liver fat causes significant metabolic disturbances, and this cannot be detected by weighing yourself.

So, what makes this grow?

From sugar and alcohol.

But children don't drink alcohol, so in their case, it's sugar!

Sugar is the alcohol of children

Sugar is the reason why today's children suffer from type 2 diabetes and fatty liver disease.

How would healthcare professionals go from measuring BMI to measuring cardiometabolic health?

The question is, how do we measure cardiometabolic health?

• The simplest and cheapest way to do this is to measure your waist.

Well, the problem with waist size is the standards, and different measurements give different answers, so in that respect it's far from perfect, but at least it indicates the problem.

• The next level: lab tests.

So what is the lab test that tells you the most about your metabolic health?

• The answer is fasting insulin levels .

However, according to the American Diabetes Association, it is not necessary to measure fasting insulin levels.

I think the most important thing is to measure this !

But why is there this contradiction?

There are 2 reasons why people say not to measure fasting insulin levels, and unfortunately, both are bogus.

• The first is that there are no standardized platforms or tests for measuring fasting insulin levels; that's true. That could be a big problem, I agree.

However, if our fasting insulin levels are high, that doesn't matter. It means there's a problem, and we didn't know it before, that we had a problem, and something needs to be done about it.

However, as long as blood insulin levels are measured using the same method each time, the results can be used to track progress.

• The second reason they say not to measure this marker is that they claim that fasting insulin is not associated with obesity.

This is indeed true, fasting insulin correlates with cardiometabolic health because obesity is the marker, not the cause!

But they don't understand this... I think fasting insulin is the single best measure of cardiometabolic health. Unfortunately, they don't measure it today, insurance wouldn't pay for it, and that's a big mistake.

Another thing we can do is measure ALAT (ALT), alanine aminotransferase

This is now part of a standard chemistry blood panel, so it's not difficult to perform.

This gives a lot of information about the health of the liver, and it helps determine what form of liver disease is present.

The problem with ALAT is the current reference range.

When I started medical school in 1976, the upper limit for ALT was 25, so anything above that indicated liver problems.

And today this value has reached 40!

Same test. How come he was 25 and now he's 40?

The whole curve has shifted to the right because so many people today have fatty liver disease – 45% of adults and 25% of children have fatty liver disease, which wasn't the case before!

This was a disease that had never been seen before 1980, and over the past 45 years it has become the largest epidemic in the history of the planet , COVID doesn't even come close!

So the problem is what do we use to measure ALAT. What is the reference range?

If we take 10,000 “normal” people today and measure their ALT levels, we get a standard deviation curve and say:

– “Oh, the upper limit is 40.”

But that's not right!

The correct value is 25, because this was the reference value before the problems started!

So, if we use this number, then ALT could be an extremely beneficial and very useful indicator in relation to fatty liver disease.

Summary

The essence of childhood metabolic disorder

Children today get the same diseases that alcoholics used to get: fatty liver, type 2 diabetes, insulin resistance.

Society confuses cause and effect; it is not obesity that causes diseases, but the deterioration of metabolic processes that causes obesity!

Closing message

The modern diet – especially added sugar! – is causing metabolic disorders previously only seen in alcoholics.

Sugar is therefore the alcohol of children, and the key to maintaining metabolic health is to drastically reduce sugar consumption , not solely to combat excess weight.