Is sugar poison?

Summary

In this nutrition-focused discussion, the speaker addresses the misconception that sugar is akin to poison, emphasizing the importance of dose and context. They argue that 'sugar is poison' is an unhelpful and emotionally charged phrase, advocating for a more nuanced understanding of sugar's biochemical effects at various doses and metabolic conditions. The speaker shares their personal experience with high sugar intake during intense training periods without adverse health effects, highlighting the significance of overall dietary patterns and physical activity levels. They also touch on the potential role of fructose in non-alcoholic fatty liver disease and offer a holistic 2x2 framework for assessing nutritional needs based on metabolic health and body composition.

Takeaways

• 🍬 The term 'sugar is poison' is considered unhelpful and overly simplistic.
• 🧬 The concept of 'poison' is relative and depends on dosage, frequency, and context.
• 💊 Common household items like acetaminophen can be toxic in high doses.
• 🍷 Alcohol can be toxic depending on the amount consumed.
• 🥗 The impact of sugar should be considered in terms of overall dietary patterns.
• 🏋️‍♂️ Physical activity can significantly influence how the body handles sugar intake.
• 🧪 There's a lack of evidence showing that fructose is worse for health than glucose when total energy intake is the same.
• 🍇 Fructose is often consumed in the form of fruit and is not typically restricted unless for specific health reasons.
• 🥤 Sugary drinks, especially in liquid form, can increase appetite and calorie consumption.
• 🏥 For patients with non-alcoholic fatty liver disease, fructose intake might be advised to be limited.
• 📊 A holistic approach to nutrition involves considering a person's metabolic health, body fat, and muscle mass.

Q & A

What is the main topic of discussion in the transcript?

The main topic of discussion is the concept of whether sugar can be considered poisonous, and the broader implications of sugar consumption on health.

What does the speaker mean when he says 'the dose makes the poison'?

The speaker is referring to the principle that toxicity is dependent on the amount or dose of a substance consumed, not just its inherent properties.

What example does the speaker use to illustrate the concept of dose-dependent toxicity?

The speaker uses acetaminophen (Tylenol) as an example, explaining that while it's safe at recommended doses, consuming 20 grams can lead to liver failure and death.

How does the speaker view the phrase 'sugar is poison'?

The speaker finds the phrase 'sugar is poison' unhelpful, loaded, emotional, and nonsensical, suggesting that it oversimplifies the complex issue of sugar consumption and its effects on health.

What does the speaker believe should be the focus of the discussion instead of labeling sugar as poison?

The speaker believes the discussion should focus on the biochemical effects of different types of sugars at various doses and under different metabolic conditions.

What is the speaker's stance on the impact of fructose on health?

The speaker does not see evidence to support that isocaloric substitution of fructose for glucose is worse for health outcomes when total energy intake is preserved.

How does the speaker's view on sugar consumption differ based on the context of overall dietary patterns?

The speaker emphasizes that sugar consumption in the context of a healthy, balanced diet and active lifestyle may not be harmful, but excessive sugar intake, especially in liquid form, can drive appetitive behavior and lead to increased calorie consumption.

What is the speaker's personal approach to sugar consumption?

The speaker consumes fructose primarily through fruits and limits his intake of sugary beverages, choosing diet versions occasionally and focusing more on the impact on his dental health than on sugar being poisonous.

What is the '2 by 2 framework' of nutrition mentioned in the transcript?

The '2 by 2 framework' refers to a method of assessing an individual's nutritional needs based on whether they are overnourished or undernourished, adequately muscled or undermuscled, and metabolically healthy or unhealthy.

How does the speaker suggest approaching sugar consumption for patients with non-alcoholic fatty liver disease (NAFLD)?

While acknowledging the lack of compelling clinical trials, the speaker suggests that patients with NAFLD should avoid alcohol and limit fructose intake, as part of a broader approach to reducing caloric intake and potentially improving their condition.

What is the role of exercise in the speaker's perspective on sugar consumption?

The speaker shares a personal anecdote about consuming large amounts of sugar while training extensively as a teenager, suggesting that high levels of physical activity can mitigate the potential negative effects of sugar intake.

Outlines

00:00

🍬 Sugar as Poison: Debunking Myths

The speaker addresses the misconception that sugar is akin to poison. They argue that the term 'poison' is not helpful and that it's more about the dose and frequency of consumption. Using acetaminophen (Tylenol) as an example, they explain that any substance can be toxic if consumed in excessive amounts. The speaker also discusses the biochemical effects of different types of sugar, emphasizing that the impact varies with dose and metabolic conditions. They critique the simplification of sugar's role in health and advocate for a nuanced view that considers total energy intake and the broader dietary context.

05:00

🧬 Metabolic Health and Sugar Consumption

In this paragraph, the discussion shifts to the impact of sugar on metabolic health, particularly in the context of controlled calorie intake. The speaker references a study involving mice that showed no significant difference in body weight when total calories were controlled, regardless of fructose levels. They stress that 'the dose makes the poison,' suggesting that high doses of fructose might affect metabolic parameters. The speaker shares personal anecdotes about high sugar intake during intense training periods without negative health effects, highlighting the importance of context such as physical activity levels. They conclude by advocating for a balanced approach to sugar consumption, rather than viewing it as inherently harmful.

10:02

🏃‍♂️ Nutritional Framework and Sugar Intake

The speaker outlines a 2x2 framework for understanding nutrition, focusing on whether a person is overnourished or undernourished, their muscle mass, and metabolic health. This framework helps determine dietary and exercise recommendations. They discuss the potential role of fructose in non-alcoholic fatty liver disease (NAFLD), acknowledging ongoing research but noting a lack of clinical trials proving fructose's unique impact independent of weight loss. The speaker advises against excessive sugar and alcohol for patients with NAFLD, even if the evidence is not definitive, because it may contribute to weight loss. They reiterate the importance of considering the overall dietary pattern and individual metabolic health when discussing sugar intake.

Keywords

💡Sugar

Sugar is a sweet, short-chain carbohydrate used as a food additive. In the video, the discussion revolves around whether sugar is harmful or not. The script challenges the notion that sugar is inherently 'poisonous', emphasizing that the impact of sugar depends on the dose and context of consumption.

💡Poison

Poison refers to a substance that is harmful, toxic, or lethal when introduced into the body. The video script uses the term to discuss the toxicity of substances like sugar, acetaminophen, and alcohol, highlighting that toxicity is relative to the dose and frequency of consumption.

💡Dose

Dose refers to the quantity of a substance administered or ingested. The script emphasizes that the effects of a substance, including sugar, are dependent on the dose. It uses acetaminophen as an example to illustrate how a common medication can become toxic with an excessive dose.

💡Fructose

Fructose is a type of sugar found naturally in fruit and used in processed foods. The video discusses fructose in the context of its potential health impacts, particularly when consumed in high quantities or in liquid form, and its role in metabolic health.

💡Acute

Acute refers to a rapid onset and short duration of an effect or condition. The script mentions 'acutely a poison' to describe substances that can cause harm or death quickly if ingested in large amounts, such as alcohol or acetaminophen.

💡Chronic

Chronic indicates a long duration or frequent recurrence. In the context of the video, chronic consumption of sugar is discussed as potentially harmful, suggesting that long-term, regular intake can lead to health issues.

💡Biochemical Effects

Biochemical effects refer to the changes that substances have on biological processes within the body. The video emphasizes the need to understand the biochemical effects of sugars like fructose at different doses and under various metabolic conditions.

💡Isocaloric

Isocaloric means equal in caloric content. The script discusses isocaloric substitution of fructose for glucose to argue that if total energy intake is controlled, there may not be a significant difference in health outcomes.

💡Appetitive Behavior

Appetitive behavior refers to actions that lead to the consumption of food. The video suggests that high consumption of sugar, particularly in liquid form, can drive appetitive behavior, leading to increased calorie intake.

💡Metabolically Healthy/Unhealthy

Metabolically healthy or unhealthy refers to a person's metabolic state, which includes factors like blood sugar levels, cholesterol, and blood pressure. The script discusses a framework for understanding nutrition that includes assessing a person's metabolic health.

💡Nonalcoholic Fatty Liver Disease (NAFLD)

NAFLD is a condition where fat builds up in the liver not due to alcohol consumption. The video mentions NAFLD in the context of discussing whether fructose might play a unique role in its development, separate from overall energy imbalance.

Highlights

The conversation simplifies the complex topic of sugar's impact on health.

The premise of the question 'is sugar poison' is questioned as being logical.

The definition of 'poison' is discussed in terms of dose and frequency.

Acetaminophen (Tylenol) is used as an example to illustrate the concept of dose making a substance poisonous.

Alcohol is mentioned as another substance whose toxicity depends on the dose.

The phrase 'sugar is poison' is deemed unhelpful and emotionally charged.

The importance of considering biochemical effects of sugars at different doses and metabolic conditions is emphasized.

Data does not support that fructose is worse for health outcomes than glucose if total energy intake is the same.

High consumption of fructose, especially in liquid form, can drive appetitive behavior.

The impact of sugar is debated in the context of overall energy intake.

A nine-month study on mice found no significant difference in body weight under isocaloric conditions with high fructose versus low fructose diets.

The concept of 'dose makes the poison' is reiterated.

The speaker's personal experience with high sugar intake during intense training is shared.

The context of sugar intake matters, and it should be viewed within the overall dietary pattern.

The speaker consumes fructose mainly in the form of fruit and limits sugary drinks.

The speaker's view on nutrition is influenced by a 2x2 framework considering metabolic health and body composition.

For patients with non-alcoholic fatty liver disease (NAFLD), fructose intake may need to be restricted despite limited clinical evidence.

The 2x2 framework for nutrition is briefly mentioned as a holistic approach to understanding dietary needs.

Transcripts

another Topic in this realm of nutrition

that we get asked about a lot it seems

there's a ton of confusion and we're

going to very simplify it just for this

conversation is an idea of like is sugar

poison what's your thought on

that H all the hits Nick Greatest Hits

right now baby it is the greatest hits

that's why you can't agree to doing

these things we get to ask you all the

stuff that you traditionally don't want

to talk about on amas yeah again a very

loaded question but I would argue that

the question the is the premise of the

question even logical right so what is a

poison

um again I poison is a is a is a it's

it's a it's a it's a word that that

speaks to a dose speaks to a frequency

speaks to chronicity uh acuteness I mean

all of these things right so you know

broadly speaking when I think of a

poison I'm thinking is something

chronically a poison is it an acutely a

poison okay so let's let's start with

something that everybody has in their

house acetaminophen Tylenol is it a

poison I mean doesn't have a skeleton on

the cover with like bones through it

right I meaning it doesn't look like the

you know Drano you have under your sink

that is clearly marked as a

poison

um tells you to take 500 to 1,000

milligrams every 4 to 6 hours or

whatever the instructions are but what

happens if you took 20 grams of that

stuff 20 times the

dose well you would be dead of liver

failure in 3 days if someone wasn't able

to pump your stomach in time or get you

a liver transplant so that sounds like a

poison um that's actually acutely quite

toxic right um is alcohol a

poison depends on the dose right um

we've talked about and written about

this at Great length there are clearly

doses at which alcohol is quite toxic uh

it's neurotoxic and

um again there's there's certainly a

scenario where you know you have a glass

of wine a few times a week and it would

be almost impossible to discern or

measure a negative effect of

that so I say all of those things just

to kind of anchor people in what we're

talking about and I think this type of

word I think I just think that the

phrase sugar is poison is not helpful

right uh um it's loaded it's emotional

it's like it's just it's it's sort of

nonsensical right what we should really

be asking I think is a is a question

that's more along the lines of what are

the biochemical effects of sucrose or

high fructose corn syrup or fructose in

general at different Doses and under

different metabolic

conditions and understandably that's a

mouthful that nobody wants to say so

it's just easier to just say sugar is

poison but

again I think this is an area where my

view has changed quite a bit

um and it's changed because of the data

right I I just don't

see the data to demonstrate that an

isocaloric substitution of fructose for

glucose is demonstrably worse for health

outcomes if total energy intake is

preserved now does that

mean that eating sugar in an

unrestricted manner in a free living

environment is of no consequence no it

doesn't mean that at all and it

certainly appears that in at least a

susceptible individual a high

consumption fructose and it seems even

more clear in liquid

fructose can drive appetitive Behavior

meaning to put that in English if you're

drinking a lot of sugar it makes you

want to eat more

calories now we can debate how many

calories and I believe that these data

have been misrepresented I think that

these data have been misrepresented and

overstated um

I you know again I I think

that in a free living environment people

will consume more energy if they have

more access to

Sugar but if you control for calories

and you may recall I had this discussion

on the podcast with Rick Johnson using

what I think was probably one of the

most robust experiments I had seen on

this topic given how long it lasted and

my recollection was it lasted nine

months which in mice is an eternity

under isocaloric conditions when these

mice were fed um when their total

calories were controlled and you had

high fructose versus versus low fructose

groups you did not see a statistically

significant difference in body

weight um that's that's a big deal

now would you see a statistically

significant difference in metabolic

parameters I think you might if the

fructose dose gets high enough but this

comes back to something I said at the

outset the dose makes the

poison and I think what's what appears

to be the case to me is that I don't

think we know yet what that dose looks

like as a function of the other

parameters so when I was young when I

was a teenager and I trained six hours a

day which I did right like I was I never

ran less than eight miles in the morning

I mean I was in the gym like I I it was

a training

machine i i i i there's no way I was

eating fewer than 200 Gams of sugar a

day right like a I mean I just ate

everything that was in front of me I I

mean I I had I would drink 2 lers of

orange juice as my you know snack box

other kids were drinking little juice

boxes I had a 2 L can of orange juice um

I didn't eat bowls of cereal I ate them

a box at a time so

was I unhealthy no chance right like I

probably had 4% body fat um but I was

exercising six hours a day so so again

like the context matters now if I ate

that much food today never mind sugar I

mean you wouldn't even know my name

anymore I'd be dead right so um

everything about this is problematic

because I think people want to focus on

just one

macronutrient in this case fructose or

sugar uh as a molecule and we don't want

to sort of focus on the overall dietary

pattern that accompanies it and um

so I would say the following if I was

going to try to sum this

up when I consume fructose which I do

all the time it's it's it's generally in

the form of fruit right like I don't

restrict my consumption of fruit

um I generally don't drink calories

outside of protein shakes um those

happen to be sweetened with artificial

sweeteners anyway these days they're

mostly like sucrose and things like that

um if I'm drinking a beverage like the

once or twice a month that I want kind

of a carbonated beverage that's sweet

it's a diet Dr Pepper as opposed to a Dr

Pepper okay would the do pepper kill me

no but again I'm only having like one a

month so it probably doesn't matter but

truthfully Nick that's more because of

my teeth like what I really care more

about is not putting an overall strain

on my teeth than I do in the belief that

sugar is somehow uniquely poisonous

um

so you know I guess I do limit sugar

intake

um but what you're what you're hearing

me kind of react to is not because I

think sugar is poison but I think that

sugar as part of a I think a high sugar

diet is just a dietary pattern that is

incongruent with eating the right kinds

of foods that I generally want to eat

anyway I hope that makes sense and it's

not too waffly but I'll let you push

back on

it no I think it does and I think even

though you've talked about this so much

I think and we can link to it where you

go in more detail but I think it would

be helpful for people just how you look

at nutrition do you want to give your

quick 2 by two framework of you know

metabolically healthy unhealthy that

whole piece so it kind of I think paints

a bigger picture on why you don't just

look at Sugar being toxic poison

whatever it is but how you kind of look

more holistically because I think a lot

of what you said there would relate to

you because you are metabolically

healthy and you know where you sit in

that 2 x two framework but if you have

patients who maybe are metabolically

unhealthy and they need to lose weight

they need to increase their muscle mass

you might not be so liberal with the

sugar for them yeah and and I'll say

this like there's definitely an area

where I'm still actively trying to

investigate this and you know we'll even

be doing a podcast on this topic right

which is is there is there a unique role

that fructose plays in the development

of nafal D um so non-alcoholic fatty

liver disease is obviously you know

running rampant right now um in in the

world and one hypothesis is that it's

not just energy imbalance which is

clearly associated with naff d in other

words you take a person with naff d and

they lose 20 lbs their fatty liver is

going to get better no matter what um

but then the question is should those

people be restricting fructose um and

again lots of great mechanistic data for

why fructose rather than glucose would

disproportionately play a role in the

development of Na D and I think there's

even more compelling evidence for why

liquid fruct to is potentially playing a

greater role but what I haven't seen yet

is a really compelling clinical trial

that can

demonstrate that independent of weight

loss um isocaloric substitution of

fructose for glucose results in an

improvement of um Na D that said if I

have patients with naal d we're going to

tell them not to drink alcohol and not

to consume fructose out of you know mild

amounts of fruit so again we're making a

recommendation that is not necessarily

one for which we would have incredible

evidence but we're saying look even if

nothing else that change in Behavior

reduces in less caloric intake which

results else in weight loss ultimately

that's what we care about and then just

to kind of end that little piece do you

want to just walk through your 2 by two

framework for nutrition again we'll link

to places you talk about in more detail

but I think it's just helpful for people

who maybe aren't familiar to have that

anchoring yeah I mean it's it's really

three questions and it's you know kind

of is a person overnourished or

undernourished um and you know that's

determined by total amount of body fat

and visceral fat are they adequately

muscled or underused looking at things

like fat-free mass index or appendicular

lean mass index and then are they

metabolically healthy or not and so by

understanding the answer to those

questions you you pretty quickly can

come up with a point of view on how a

person needs to train and how a person

needs to eat and maybe even in some

cases how you want to tweak their

macronutrients

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