Life is Sweet?

An interview with Robert Lustig by Kate Womersley.

Dr Robert Lustig trained at Cornell Medical School and is now a professor of pediatric endocrinology at University of California, San Francisco. He is the author of Fat Chance: The Bitter Truth about Sugar, Obesity and Disease (2013) and his Youtube video, “Sugar: The Bitter Truth” (2009), has been viewed more than 4 million times.

 

How would you introduce yourself to our readers who may not be familiar with your work? 

I am a neuroendocrinologist, which means that I study how the brain controls hormones and how hormones control the brain. Obesity is the final frontier in this field. I got into obesity through the back door and this work has led me to try to understand what is wrong with our diet and how the changes that have occurred over the last 30 years have fermented this obesity and diabetes epidemic. And here I am.

It’s the holiday season, a period of excessive eating. Many people think that the butter on their roast potatoes or the fat in those desserts are the worst for their health. I imagine you might have a different message.

Right. Everyone has always assumed that fat makes you fat. Certainly fat has a higher energy density: fat is 9 calories per gram compared to protein or carbohydrate which are 4 calories per gram. But over the past 30 years, slowly but surely, there have been numerous studies which debunked that notion. Fat does not make you fat if you only eat fat. That is, if you’re a low-carber, such as if you’re on the Atkins diet, you actually lose weight. That’s because fat is enormously satiating and you end up eating fewer calories.

But, if you take that fat and lace it with a bit of sugar (and that’s called cookie dough) you have a potent combination to generate not only obesity, but also chronic metabolic disease. Over the last ten years, studies demonstrate that it is the sugar that makes you sick, not the fat. The fat contributes the energy, but the sugar actually makes you sick. It’s the combination of fat and sugar together which is familiar in the US, the UK and Australia. Throw in a simple carbohydrate like flour to the mix and you’ve got yourself a cookie. The bottom line is the sugar is driving the chronic metabolic disease. It has been my charge to bring the science to the policy and I have got myself in the eye of the storm.

One of your main contentions is with the mantra, “a calorie is a calorie”. Your detractors say that the first law of thermodynamics means that the mantra must be true. In your opinion, how does the human body differ from a closed system where energy going in must be matched by energy going out?

The first law of thermodynamics is sacrosanct. I believe in that law. The first law says that energy can neither be created nor destroyed, just shifted around. But there are two interpretations of that law. The standard interpretation (the mantra which the entire medical establishment espouses) goes as follows: if you eat it, you’d better burn it or you’ll store it. In which case, the weight gain is secondary to two behaviors: increased intake, gluttony, and decreased expenditure, sloth. Gluttony and sloth. If you believe that interpretation of the first law, then you see obesity as the result of two behaviors and therefore obesity is a matter of personal responsibility. It is your fault.

But there is another interpretation of the first law which I subscribe to as a result of the research and the data. And that is: if you’re going to store it and you expect to burn it, then you’re going to have to eat it. You’re going to store it (that is, an obligate weight gain set up by biochemical forces out of your control, the most common of which is high insulin levels) and you expect to burn it (that is, normal energy expenditure for normal quality of life, because energy expenditure and quality of life are synonymous – those things that increase your energy expenditure make you feel good, like exercise, ephedrines (now off the market), caffeine for two hours; whereas, those things that reduce your energy expenditure make you feel lousy, like hypothyroidism, starvation). In this interpretation, the two behaviors which we associated with obesity – the gluttony and the sloth – are the result of a biochemical problem. They are secondary, not primary. In other words, the biochemistry drives the behavior. If that is the case, then it’s not about personal responsibility, it’s about biochemistry.

The question is, “ok, what changed our biochemistry”? That’s where I come in. And the short answer in one word is sugar. That is the thing which has changed over the last 30 years and has driven this obesity and chronic metabolic disease epidemic, because it generates extraordinary levels of insulin, much higher than we have ever seen before, and it is driving energy into fat.

You discuss the legacy of nutritional theories which have contributed to the Western diet. From a historical point of view, how did our food get full of sugar?

Our diet has undergone several iterations over the past 35 or 40 years. Really there are five things that happened in a relatively short period of time to create this tsunami. It’s the perfect storm of five political winds. I’ll summarize them very quickly: the first was the fall of Batista in Cuba and the loss of America’s sugar fix from there. This started the US sugar growers in Florida which have enormous political power. The second was the advent of high fructose corn syrup (HFCS) from Japan in the late 1960s, which was introduced into the American diet in the 1970s. The third was Richard Nixon saying that altered food prices cause political unrest. He charged his Secretary of Agriculture, Earl Butz, to make food cheap to reduce political unrest. As you remember, Nixon was under a lot of pressure due to the Vietnam War and the riots in the US to try to reduce political unrest. One of the ways to do that was to make food cheap. And HFCS fitted that perfectly. By creating competition for sugar it lowered the price of sugar as well as the price of HFCS. Now sugar became cheap and it started appearing in all sorts of other foods. The fourth political wind was happening in the scientific world. We were very concerned with heart disease and we had learned about LDL (low-density lipoproteins). We learned that dietary fat raised your LDL and we knew that LDL correlated with cardiovascular disease. The thought was that if we reduce dietary fat, that would reduce LDL and therefore we would reduce coronary heart disease. So we were all told to go low fat. Unfortunately, low fat tastes like cardboard. So we had to do something to make the food worth eating. That meant high sugar. We started seeing things like Entenmann’s fat free cakes and SnackWells, where the fat was removed and sugar was added. The fifth political wind was the third worst hurricane to hit America, and it never even reached our shores: Hurricane Allen [in 1980]. Everyone knows Katrina and Sandy, but Hurricane Allen caused the loss of the Caribbean sugar crop. American manufacturers said, “we need a form of sugar which is grown on American soil which is not subject to foreign intervention, tariffs etc”. So people just migrated to HFCS, including the soda industry. And that was the advent of what we call here in America “new Coke” back in 1985. Basically HFCS was added to virtually every food. Our consumption of sugar has increased by about 50-60% just from 1980 alone, never mind the increase from about 4lbs per year to 80lbs per year that had occurred over the previous 150 years.

We have a sugar glut. It is not just America, it is the UK, it is Australia, it is New Zealand. We are the fattest countries and also have the highest rates of chronic metabolic disease such as diabetes. The other countries that are wrapped up in this are the Middle East. Saudi Arabia, Kuwait, The United Arab Emirates and Malaysia. Why? Because they drink soft drinks like they’re going out of style. And there are simple reasons for this: it’s hot, the water supply is in question, and there is no alcohol. Soft drinks are their reward. It’s legal, available, and it’s killing them.

How does the change in substance of our diet connect with other changes in society, such as high-stress lifestyles, a sedentary culture where people do less physical activity and have a habit of eating out?  

Of course our diet has changed, but it’s not just the diet at home that has changed, it’s the food we eat out. America now eats out almost as much as it eats in. The amount of food consumed outside the home is enormous, and all of that food is pretty much laced with added sugar. Of the 600,000 items in the American food supply, 80% of them have been spiked with added sugar because the food industry has learned that if they add the sugar, we buy more.

The change in exercise and physical activity is a relatively complex question. The data don’t really support that much of a change in physical activity in terms of actual calories spent. But there is no question that ipods and ipads and Blackberries and every other kind of electronic device have caused more sedentary time. The question is, is there a biochemical reason for that? What we have learned and what our research has shown is that when insulin levels go up, this reduces the output of the part of your nervous system which causes you to get up and move (the sympathetic nervous system). So insulin blocks the sympathetic nervous system, and this makes you want to sit on the couch. When your insulin gets up, you are 1) hungry, 2) you store energy faster and 3) you have less impetus to want to get off the couch. When insulin goes down (and we have done this experimentally using various methods) we see that people’s quality of life improves because they have the energy to burn and they have the sympathetic nervous system making them want to burn it. So we have seen that the ‘sloth’ part of the equation is also biochemically driven.

You say in your book, Fat Chance, that “physical activity is the most misunderstood aspect of obesity medicine”.

Correct. Everyone assumes that physical activity will result in weight loss. It doesn’t. There are no studies that show that exercise alone will lead to weight loss, that is, the number you see on the scale. There is no question that physical activity is the single best thing you can do for yourself. I am completely for physical activity and exercise. It’s all good. But it doesn’t cause weight loss. Why? Because what exercise does do is cause muscle gain, and muscle weighs more than fat. So, what you see is a change in your waist circumference and you see a change in your visceral fat (the fat around your belly). So your pant size will go down. But if you stand on the scale, you’ll actually more likely go up. And the problem is that physicians keep telling their patients, “if you’d only exercise, you’d lose weight”. So the patients try to exercise and see their weight going up, and think “it doesn’t work for me” and then they stop. And then they eat the bag of Doritos or a coconut cream pie because they’re drowning their sorrows. Bottom line is, physicians need to understand what the role of exercise is and promulgate it to their patients appropriately.

In your TED talk, “Sugar: The Elephant in the Kitchen”, you use the acronym TOFI (thin outside, fat inside) and paint a vivid picture of the dangers which  result from visceral and hepatic fat. But how can people know if they are TOFI?

It’s not easy. A lot of TOFIs don’t know they’re TOFI. Most of them don’t. The obvious way to do it is to use a tape measure around your middle. It really depends on how big your waist is. If your waist is less than 35 inches as a female, and less than 40 for a male, the chances that you’re TOFI are a little less likely. But if you’re up at 40, the chances are much, much greater. Another way you might be able to tell is by some lab tests. A fasting insulin might tell you. The other thing that might tell you is an ALT. That’s alanine aminotransferase, a liver function test which your doctor can do and is relatively sensitive, but not highly sensitive, for fatty liver. If your ALT is over 25, that’s a good bet that you have a fatty liver and that would be a sign of TOFI.

There are many loud and conflicting voices in the food arena: nutritionists, celebrity endorsements, food industry lobbying and advertisements from Big Pharma. No wonder the public is so confused. In your opinion, where can people go for evidence-based nutrition advice?

This is a huge controversy right now. I think that we are in the middle of re-making nutrition. I have often called nutrition “Harry Potter’s Defense against the Dark Arts Class”. Teachers come, teachers go. The rules change from episode to episode. Nobody ever really knows what’s going on. They make it up as they go along. The fact of the matter is that nutrition is very complex. A lot of people use correlation not causation to make cases. That is very, very dangerous.

Let me give you an example of how this could work. A lot of people with metabolic syndrome have very low vitamin D levels. Vitamin D deficiency correlates with diabetes, heart disease, obesity and metabolic syndrome in general. No arguments. That is true. The question is, is vitamin D deficiency the cause of chronic metabolic disease? It’s a snapshot in time. You don’t know directionality. How do you determine the relationship? One way would be to alter people’s vitamin D levels. That is, supplement vitamin D and see whether chronic metabolic disease improves. This has now been done several times. Every single time it has been useless. It turns out that vitamin D deficiency does correlate with chronic metabolic disease, probably because vitamin D deficiency means you’re not drinking milk. If you’re not drinking milk, what are you drinking? Chances are you’re drinking soda. Your sugar consumption is probably through the roof. It is probably the sugar consumption that is causing the chronic metabolic disease, not the vitamin D deficiency. In other words, vitamin D deficiency is a marker for metabolic syndrome, not a cause.

Well, there are a lot of markers for bad diet, and a lot of markers for disease. The question is, are they causes? And that is where you need to understand the nature of science, and you need to understand how to interpret papers. You also need good information coming from the scientific community. We have anything but. We have a lot of charlatans, we have a lot of people espousing all sorts of things to advance their own directives, especially the food industry. And they’re allowed to do it.

The question is, where do you go to get real honest-to-goodness, true nutritional information? At this point in time I can’t point you to one source. I really can’t. What I try to do in my book, Fat Chance, is sort the wheat from the chaff and take apart this correlation-versus-causation paradigm. I will tell you that sugar is proximate cause to chronic metabolic disease. I can say that because we did the studies. We have shown dose, duration, directionality and precedence for sugar and type 2 diabetes. This is as good a level of proof as we have for cigarettes causing lung cancer. We do not have scientific proof, because you couldn’t do those studies. You couldn’t randomize a group of people to consume high sugar versus low sugar and follow them for 50 years and see who got sick and who didn’t. That study can’t be done as it would be unethical, illegal and too expensive. So what you have to do is to look for causal medical inference. That is what we have done. That is why I am very comfortable in saying that sugar is causative for diabetes. In addition, some data will be coming out shortly that sugar is causative of heart disease. The question is, where do people go for good nutritional information and the answer is, at this point, hard to know.

One of the things which makes nutritional advice persuasive, regardless of whether it is right or wrong, is the language in which it is presented. As you write in your book, “every good story needs a villain,” and you go on to say that “sugar is your Darth Vader of the Empire”. You talk about the “four food stuffs of the apocalypse” and argue that “gaining weight is going over to the dark side”. Does your approach play to the public’s soft spot for a blame game, in which you lay the blame at sugar’s feet?

Number one, it’s not just sugar, and I make that clear in the book. There are eight things wrong with our diet. There are three things too little, and five things too much. Here are the three things that are too little: too little fiber, omega-3 fatty acids and micronutrients. Here are the five things that are too much: too much branch-chain amino acids such as lysine in corn-fed beef, fish and chicken; too many omega-6 fatty acids which come from seed oils, which we now cook and saute in; too much alcohol; too much trans fats, which we know are coming down. Finally, the one which is most actionable is sugar. Sugar is the one put there specifically for the food industry’s purposes, not for yours.

My question is about your language. Given this is such an emotional subject, do you think that you need to be more measured in the way you present these dangers?

Let’s put it this way. The data are there. I don’t talk about anything I can’t back up with hard science. The fact is that the food industry has been putting out bad science, pseudoscience, and has co-opted agencies for a long time and the only way to battle this is with science. The information that I am delivering to the public is unbiased science. I will stand by it. I never say anything I can’t back up. That will continue to be the case. My career and reputation are based on science. It is my shield and it is my sword. The public can use that information as they wish. But they need that information to make valid changes for themselves.

Let’s discuss the connection between environment and genetics in greater detail. Is reducing sugar and getting those 8 elements you describe in balance of equal benefit to everyone? Or genetically, are there some people who are pre-disposed to sugar-sensitivity?

We know from genetic analyses that there are certain ethnic groups that are more susceptible than others. Here in America, Latinos and African Americans are more susceptible. We think that South Asians, for instance Indians, are more susceptible. There might be very specific genetic reasons why that may be the case. Next month I’m going to a meeting in Montreal sponsored by Génome Québec to talk about the interaction between genetics and the environment in terms of cardiovascular disease prevention. When you do genetic analyses, these GWAS studies (genome-wide association studies), what you come to realize is that only about 10-15% of the variance in people’s obesity or diabetes risk can be explained by genetics. That means that 85-90% must be explained by the environment.

We can’t fix genetics. We can fix the environment. We have altered our environment over the last 30 years, and the only way I can see right now to mediate or mitigate these chronic metabolic diseases is by changing the environment back. While genetic studies suggest that some people are susceptible, what TOFI demonstrates is that everyone is susceptible. 40% of the normal weight population has the same chronic metabolic diseases as the obese. But they’re not obese. They don’t have genetic susceptibility. This is an environmental insult. How do you explain that this is going on in every country around the world? Did the genetics change? Of course not. This is an environmental change. This is where we need to focus our efforts.

In both your TED talk and your book you question the significance of personal responsibility, and seek to undo the prejudice that fat people are gluttonous and slothful. In other words, you say we don’t choose what we do. But if this ‘anti free will’ argument is true, what is the point of urging readers in the second half of your book that there is a self-help element to this problem and that individuals can improve their habits?

There are many drugs of abuse out there. Let me name them: nicotine, cocaine, alcohol, heroin, morphine. These are substances that are both toxic and abused at the same time. We have substances which are toxic but not abused, and they are not a problem. We have substances which are abused but not toxic (for instance caffeine) and they are not a problem and we don’t regulate them. But if they are toxic and abused at the same time, we do regulate them. We have personal interventions, which for lack of a better word we can call ‘rehab’. We also have societal interventions, which for lack of a better word we can call ‘laws’. Rehab and laws. For substances of abuse which are toxic and abused we have both. What I am saying is that we need a sugar policy that allows for both.

I am not suggesting that individuals can’t do something to help themselves. If that were the case I wouldn’t have written the book, and I certainly wouldn’t have written section 5 of the book which is about what people can do for themselves. But what I am saying is that we need government to help rein in the food industry so that the food industry will do the right thing.  The food industry, or at least members of the food industry, would like to do the right thing, and I have talked with many of them. But the problem is that because virtually every food company is publicly traded and on three-month profit cycles and has to answer to Wall Street every quarter, they can’t do the right thing. They would like to but they can’t. The only way they can do it is if they are not placed at a competitive disadvantage. The only way to do that is to get everyone to do it at the same time.

Basically we need to wean ourselves off sugar and we need for processed foods to reduce the amount of sugar across the board consistently. How are they going to do that? The only way is with government. The only way is to have some sort of outside agency monitoring and enforcing it. Which is what was proposed for salt in the US. The Institute of Medicine and the Food and Drug Administration said that we were going to wean America off its high salt consumption over a 5-year period. That was back in 2010. Here we are in 2014 and nothing has been done because the food industry is fighting this tooth and nail. government has not exerted its influence in making this happen, but it needs to. And this is true for sugar too.

You say that some members of the food industry are not deliberately harmful. So you don’t think this is a conspiracy?

Oh no, I don’t think this is a conspiracy. I don’t think the food industry went out and said “let’s make people sick and let’s make all the money we can while people are getting sick”. The tobacco industry did do that. The food industry I don’t think went into this with ill intention. I think that they found out as they changed the food supply in the late 1970s and early 1980s when they made the change to go low fat, “hey, the more sugar we add, the more people buy, this is good for out bottom line. Let’s add more!”

The job of business is to make money. The head of Goldman Sachs, Lloyd Blankfein, said that the only job of business is to make money. Not the primary job, the only job. So the question is, does the food industry know what they are doing? That was the point of the book: to make it clear that the food industry is doing this, and now they know it they should  want to come to the table to try to make things better, not only for the American public, but also the global community. The problem is that they don’t want to be put at a competitive disadvantage. I have it directly from food industry executives that they would be willing to change with two provisos: they won’t go it alone, and they can’t lose money. Right now, those are two non-starters. But if government interceded and brought all the food industry concerns to the table and we did this as a coordinated effort with public input, I think that it could be done. The food industry needs a new business model which rewards quality over quantity. Right now we have a food industry that is rewarded for quantity over quality, and it has been that way since Richard Nixon said “make food cheap”. We need to reinvent that.

Let’s imagine that the food industry does listen and there is real effort to reduce sugar in processed foods. Might other components, such as artificial sweeteners, be brought in which could in fact be more toxic to humans than sugar? 

It is a concern. I’m not going to say it isn’t. What I can say is that if we do nothing, Medicare in America will be broken before the year 2026. We have to do something; we can’t do nothing. The question is, what is the something we should do? That is absolutely worth having a debate about. I do not say that I have all the answers. The only thing I say is that doing nothing is not an option. Right now the food industry is arguing for doing nothing. What that means is we need to have a debate about what we should do and what we are all comfortable doing. I am worried about the possibility that something else might enter our diet that could be more problematic. I don’t argue that. This is exactly what happened in the 1970s: we took fat out, and we made things worse.

But to do nothing is what we call the pessimistic meta-induction theory. It goes like this: everything we believed ten years ago is already wrong, and everything we believe today will be wrong ten years from now. So why should we do anything differently? We should just leave things as they are. But if things are broken, that means you’re never going to fix them and that is not an option today. We have a public health crisis and we need public health action. We have to make decisions based on relatively low levels of data, but we still have to do it.

So you don’t have strong feelings either for or against substances like aspartame? 

There are concerns about diet sweeteners. The main concern is that even though you trick your tongue, you don’t trick your brain, and you end up releasing more insulin anyway. There was an article in Diabetes Care this past 30 April from a group at Washington University St. Louis that showed when you do glucose tolerance testing on obese people with a pre-treatment of a diet soda or without, it turns out that when you pre-treat with the soft drink the person releases 20% more insulin than if you didn’t pre-treat. This suggests that your pancreas gets the message that something sweet is coming, even if it’s not sugar. So you overload on insulin anyway, which drives weight gain and drives chronic metabolic disease. My concern is that diet sweeteners are not the answer. What we need to do is de-sweeten our lives. Sugar used to be safe and rare. I am a complete believer in dessert. Once a week.

Wow.

Once a week is a good reward, for being a good person across the board. What we have now though is sugar in every meal, rather than once a week. I don’t think we have to ban sugar or put skull and crossbones on it in the supermarket. What we do need to do is lower the amount of sugar in foods where sugar was added specifically for the food industry’s purposes. That is true for a lot of items.

A perfect example is yogurt. Yogurt is sour milk. Except in America where yogurt is dessert. Frozen yogurt is sold as a healthy alternative to ice cream. Garbage. That is absolute trash. The fact of the matter is that sugar has been added to yogurt very specifically to cut the sourness. The Europeans add whole fruit to yogurt to cut the sourness. That is an example of what needs to happen to try to undo the damage we have done.

Your wording, “what needs to happen”, suggests that you would certainly support government intervention.

I don’t see any way around government intervention because of the actions of the food industry.

How would you balance this need for intervention, such as New York City Mayor Michael Bloomberg’s policy on soda, with your belief that people should have free choice over what they eat?

If people had access to appropriate foods we wouldn’t have to worry about this. But they don’t. The fact is that if you go into an American grocery store today in a poor neighborhood, what they have are processed foods sitting on the shelf. The reason is that they are cheaper and have lower depreciation. This is what is available to the lower-income population of America.  Another example is food stamps. You can’t get whole fruit on food stamps. You can only get fruit juice because you can squeeze it, freeze it and it lasts forever. If you don’t have access, how can you exercise personal responsibility?

What is your definition of a “free choice”?

What we need to do is re-make the environment and then give people free choice. But we have to re-make the environment first. We have to bring the food back to where it used to be. That is going to be hard to do. I won’t argue that. Processed food is here to stay. We have two-parent working families who don’t have the time to be able to put together a full meal. They can’t go to the grocery store to get fresh ingredients each day. I understand this. This is the new America. This is the new world. But the fact of the matter is that people need to learn how to cook again, which is one of the reasons why we released a new cookbook, The Fat Chance Cookbook, specifically to allow people to have the opportunity to figure out how to get a meal on the table in less than a half an hour. Every one of the recipes was vetted by a Mount Diablo High School student to be producible and consumable within one American school period of 45 minutes. We’re hoping that this will be a method for getting people to cook again and consume fresh ingredients, and in doing so, reducing their risk of chronic metabolic disease.

Last year you took a master’s degree in law from UC Hastings College. What prompted you to do this, and what do you feel better equipped to do now that you have the qualification?

I went to law school based on a statement that I heard the year before which resonated with me and I haven’t gotten it out of my head yet. The statement goes like this: all significant public health advances involve and require the use of law. That’s right. I thought back to every single public health debacle that we have had since the Black Plague, and every one of them has required legal intervention in some fashion. The question is, how does a personal health issue, such as obesity, become a public health crisis?

Let’s harken back to the last public health crisis we had. HIV. 1979, Patient Zero. 1981, the term AIDS got coined. 1984, we found the virus. 1986, C. Everett Koop our Surgeon General said “we’ve got a problem here”. When did HIV become a public health crisis? 1991, when Magic Johnson announced he had HIV and straight people said, “Oh my god, it’s not the gays and the addicts and hemophiliacs anymore. This could happen to me.” And all of a sudden we saw a rash of legislation and a rash of litigation, which got us to the point where we are now. In other words, the law helps public health advance and we have seen this many times in our history. So I went to law school first to find out what legal doctrines can be brought to bear to advance a public health issue from personal responsibility to public health crisis. We did it with tobacco. We did it with immunizations. We did it with HIV. We’ve done it with vitamin deficiencies. We’ve done it with lead poisoning. But ultimately the law has to be involved and I wanted to understand what the legal doctrines are.

The second issue was, how did tobacco ultimately get defeated? 845 plaintiffs brought suit against the tobacco industry between 1950 and 1994. Two of them won, and then they were overturned on appeal. So 845 cases against the tobacco industry and none of them won. Finally, the Mississippi Attorney General brought suit against the tobacco industry for recoupment of Medicaid costs relative to lung cancer. All of a sudden it won. I wanted to understand the tobacco playbook. I wanted to understand what the legal issues were, because ultimately this is tobacco all over again. That is why I went to law school.

You describe yourself in your book as a “fledgling policy wonk”. Do you believe there is a public duty for doctors to be involved in dispelling health myths as far as they understand them, and addressing the public as their primary audience?

This is a really good question. In the past, academics in science and medicine have basically stayed in their ivory tower. We generate the science and then we let the policy people do what they do with the science. This has been going on for the last 100 to 200 years. The scientists generate the science and the policy makers utilize the science for the common good. In the past 30 to 40 years, we have seen that this has gone awry because the politicians are either ignoring the science or have been co-opted by private industry and other groups and are being paid off to be immune to the science. There was a book that came out a couple of years ago called The Republican War on Science, which made it very clear that science was being turned inside out. If scientists generate the science and the public doesn’t do anything with it, do the scientists have a role to play in advocacy? There was just a set of articles in Science magazine a month ago on exactly this issue. I am a great believer in the fact that scientists have an obligation, not only to get the science out to the public, but also to help the politicians utilize the science for the common good. That is what I am doing.

And you don’t feel that something gets lost in the popularization of medicine or nutrition science?

If bad science is used then something is lost. I am doing my utter best to be very careful about the science I espouse, to be very sure about what it is and what it says, and not to overstep my bounds. The food industry cannot wait for me to overstep my bounds. They can’t wait for me to stick my neck out so they can cut it off. They would like nothing better than to discredit me. The fact that they haven’t discredited me yet I think is a tribute that I stay within the science and will continue to do so. Once again, it is my shield and my sword. It is all I’ve got. The fact that you’re talking to me says that I have not been discredited yet. And I won’t be, because I stick to the science.

At the end of your book you make a rallying call for the beginning of a people’s revolution in nutrition. Do you feel that individuals both within and outside the science community are recognizing your message and acting on it?

I think it is starting. We are seeing signs of it in various ways. In September 2013, just 4 months ago, a report was issued by the international investment bank, Credit Suisse called ‘Sugar Consumption at a Crossroads’. It is a 46-page article evaluating the veracity of the science on both sides of the issue. They come to the conclusion that this is real and that taxation will be the only effective method for reducing sugar consumption to try to mitigate the negative effects of obesity and type 2 diabetes. This is an investment bank calling for taxation. When this reaches the business community and the business community gets onboard, I would say that it is a watershed moment and we are likely to see changes across the board in 2014 and beyond. I am very hopeful of that.

What was motivating Credit Suisse to be involved in this debate at all?

Very simple. Investors. They want to supply their investors with the best investment advice they can give, and they felt, based on what they saw, that this was a major issue for the business community and they wanted their investors to be aware of it. I applaud them.

For those who want to learn more, what would you say is the most interesting, surprising or thought-provoking reading on this subject?

I would say that they should be watching the food addiction literature over the course of the next year or two. There is a big fight going on in the scientific and psychiatric communities as to the veracity of the arguments about food addiction. One of the reasons that we have not made a lot of headway in the legal arena is because people say there is personal responsibility and personal choice. But as soon as something becomes addictive, that changes a little. As this concept of food addiction becomes more and more accepted by the scientific and psychiatric communities, you may see more pressure being brought to bear. I think that this is going to be one of the touchstones of the movement. I have looked at the data on sugar, and it fulfills all of the addiction criteria in animals and most (though not quite all) of the criteria in humans, at least based on the data we have so far. Whether or not this will lead us into a new paradigm of food availability is going to be the interesting issue for the next year or two.