
Cutting Back Sugar Improves Obese Children's Health in Just 10 Days - imjk
http://well.blogs.nytimes.com/2015/10/27/cutting-sugar-improves-childrens-health-in-just-10-days/
======
tomkinstinch
Here is a link to the actual journal article on the study, since the NYTimes
omitted it for some reason (currently free to access):

[http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/abstrac...](http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/abstract)

PDF:

[http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/pdf](http://onlinelibrary.wiley.com/doi/10.1002/oby.21371/pdf)

Lustig, R. H., Mulligan, K., Noworolski, S. M., Tai, V. W., Wen, M. J., Erkin-
Cakmak, A., Gugliucci, A. and Schwarz, J.-M. (2015), Isocaloric fructose
restriction and metabolic improvement in children with obesity and metabolic
syndrome. Obesity. doi: 10.1002/oby.21371

As an aside, it's very strange that the article is not cited in the NYTimes
post. A journalist should at least give the DOI at the bottom if there is not
a link to the article in the body of the text.

Edit: I left this same comment on the NYTimes article and the text now links
to the journal (though my comment was not approved). Seems like a win! NYTimes
editorial staff: thank you!

~~~
cle
It constantly frustrates me how news articles _never_ cite research articles,
they always just mention "a study" and the author, leaving me to fumble around
for 10 minutes to find the actual study. Does anyone know why this is SOP?

~~~
kragen
Because journalism is a systematically dishonest profession populated largely
by people who do not want their readers to be able to catch their mistakes and
do not want to give credit to the researchers who made the discovery that
earned the clicks for the news article. They care about entertaining, not
informing; the truth or falsehood of what they are writing is irrelevant to
them, except as a constraint that might impede the telling of a sensational
story (all else being equal, a story is more sensational if it is true than if
it is fiction). Like PageRank-hungry SEO scum, they will only name sources if
they think some of that the source's credibility will rub off on their
article, never vice versa.

~~~
albertsun
It's really depressing how cynical that is. (Developer working at the NYTimes
here).

The actual reason links to studies are often left off articles (particularly
in cases like this with sharp deadline pressure to publish fast before the
competition) is that the software powering the editing and publishing workflow
really badly needs improvement. An incredible amount of work and knowledge
goes into a story like this.

Versioning rich text through many different software tools designed for
writing/editing and publishing across many platforms is hard. Sometimes people
copy/paste by hand and in doing so a link can go missing. The news industry
needs more technologists to work on these problems. We're hiring for people to
do that, by the way:
[http://developers.nytimes.com/careers/](http://developers.nytimes.com/careers/)

(Also, the link to the study is now in.)

~~~
TeMPOraL
It's cynical because that's what we, regular readers of news, have to deal
with. NYT may be top of the line, but sadly it's not above the line.

Now I don't want it to sound dismissive or personal in any way, but tell me -
if say, few of great software devs now drop everything they do and come to NYT
to help, sit down for months and develop the most awesome software package the
world of press has ever seen, will it actually solve the quality issues
articles have? And more importantly, if sold to other papers, will it suddenly
solve _their_ problems?

Will it make journalism honest and trustworthy instead of lies and clickbait
bullshit?

I'm not sure how much blame to put on broken publishing workflow, a lot of
this seems really to be about broken incentives - "deadline pressure to
publish fast before the competition" that leads to the "many articles, as
sensationalist as possible, truth be damned" mentality, especially in the
management layer.

But you did give me a pause here. Only recently I had a chance to peek at
internals of a tiny part of manufacturing industry, and _oh boy how much money
they waste_ on badly designed software, which is badly designed because of
deadline pressure and top management pressuring to iterate over a broken
software package (and then messing with the process) instead of scrapping it
altogether and doing it right. Maybe software is more to blame than I thought.

~~~
kragen
> Now I don't want it to sound dismissive or personal in any way, but tell me
> - if say, few of great software devs now drop everything they do and come to
> NYT to help, sit down for months and develop the most awesome software
> package the world of press has ever seen, will it actually solve the quality
> issues articles have?

This actually happened and that's how we got d3.js. It didn't fix journalism
though.

~~~
TeMPOraL
Oh, didn't know the origin story; I only thought they just like it over there.
D3 is absolutely awesome!

------
lasryaric
I completely removed added sugar from my diet for the past 6 months. It is
hard to describe how my life changed.

I am much better at swimming, less tired, I eat a lot less. I lost weight the
first 3 months and now my weight is very stable.

Cutting added sugar is not very hard but it requires some willingness.

The food producers put sugar everywhere: bread, red beans, smoked salmon,
yogurt, etc. You just need to read the ingredients to avoid it. You will
quickly learn which type of product is ok and which type is not.

Today I am more attracted to a fruit than a cup cake or an ice cream, and it
feels good :)

~~~
marknutter
I have become so wary of comments about lifestyle or diet changes that result
in a bevy of subjective improvements. Like when people start running and they
have all these wonderful side effects — more energy, better sleep, mood
improvements, etc — where in my experience I really didn't experience any of
it when I trained for a triathlon a couple years back. It just reminds me of
infomercial testimonials. I need to see double-blind clinical trials that
prove the effects outperform placebo at this point. It all sounds logical,
because "sugar bad" but I have become far too skeptical these days.

~~~
jeffdavis
Double blind dietary study? It would be quite hard to fool someone into
thinking they are eating cupcakes when they are really eating a bowl of
unsweetened oatmeal.

Dietary studies are very hard. There is no conspiracy preventing rigorous
studies, they are just really hard. You need a large enough sample, you need
to control the subjects very tightly (people don't self-report accurately),
and you need to do it for long enough to see if the effects are lasting or
illusory.

If you want real science here, we need to change our expectations and think in
terms of $10B not $10M. Probably still a good investment in health, comparable
to cancer research.

Until that time, what are you using to make your dietary decisions, given
there's not much real science behind any of it?

~~~
marknutter
I completely agree that it would be very difficult to perform such studies, if
not impossible, but that doesn't make me desire them any less. Instead I've
become very skeptical of everything and – if you'll pardon the pun – follow my
gut instincts.

I find maintaining a high level of skepticism tends to dissipate any longterm
benefits of the placebo effect. So sometimes I'll try a fad, or a lifestyle
change, but hold my judgement until months later and most of the time I'm left
disappointed in the overall results.

Other than that, I follow the golden rule of health and nutrition: "everything
in moderation".

~~~
jdminhbg
"Everything in moderation" is just a tautology. "Moderation" for kale is
different from "moderation" for sugar is different from "moderation" for
opiates. "Everything in moderation" means "the right amount of everything,"
which is just begging the question of what the right amount is in the first
place.

~~~
wutbrodo
Ah, thank you for articulating the problem I have with that statement that I
could never quite put my finger on.

------
iSnow
>The proposed changes have been strongly opposed by the food industry as
unscientific. The Sugar Association, a trade group, said the F.D.A. was
“making assertions that lack adequate scientific evidence,” and the Grocery
Manufacturers Association criticized the standards the agency used to
establish the daily value as being “inadequate.”

That's the tobacco industry smoke-screening evidence about the dangers of
smoking all over again.

~~~
Grue3
But also sounds like, for example, producers of vaccines arguing against that
one study that vaccines cause autism. Just because they have an ulterior
motive in defending their product doesn't mean they're wrong.

~~~
ch4s3
Every medical researcher argues that vaccines don't cause Autism. There is
literally no study published in any serious peer reviewed journal that
suggests otherwise.

~~~
PepeGomez
You mean, except that one study which started it...

It's crazy to start freaking out over something just because of one small
study, especially if it's something that didn't seem to have any observable
negative effects until then.

------
vox_mollis
Critical omission from title: _obese_ children.

These are kids whose livers are already suffused with fatty tissue, not
average kids.

~~~
jonlucc
Mean age is 13.3 ± 2.7 and the mean body weight is 93.0 ± 22.1 (~205lbs) at
study start. That's pretty big for a 13 year-old.

~~~
mfoy_
So the mean height would have to be around 5'11 for them to just be
"overweight" and not "obese". Which seems unlikely for a group of young teens.

~~~
nommm-nommm
Obesity in children is measured a bit differently. They use BMI-for-age
percentiles, not Straight BMI.

From the CDC:

Overweight is defined as a BMI at or above the 85th percentile and below the
95th percentile for children and teens of the same age and sex. Obesity is
defined as a BMI at or above the 95th percentile for children and teens of the
same age and sex.

------
sgt101
Note : the study selected children who were considered to be "particularly
high risk of diabetes and related disorders. All the subjects were black or
Hispanic and obese, and had at least one or more symptoms of metabolic
syndrome, a cluster of risk factors that includes hypertension, high blood
sugar, abnormal cholesterol and excess body fat around the waist."

I did not read that there was a control group.

~~~
cle
The paper discusses this:

However, there are some limitations to our paradigm. Athough inclusion of a
separate external control group would have been optimal, it would have
presented novel challenges of its own, such as: 1) if subjects under- or over-
estimated their baseline fructose consumption, then providing them their
reported daily fructose content would be problematic; 2) altering each
subject's diet while trying to maintain the baseline fructose content would
require changes in liquid versus solid, which may also result in caloric
change, altered absorption, and altered satiety; and 3) our participants were
all patients in an obesity program. We did not believe that maintaining
fructose at the same level, even within a study, is commensurate with the
message that the change in macronutrient composition is important for their
health, and in order to use the study as an “educational moment.” Furthermore,
others have looked longitudinally at children with obesity over time without
any intervention, but still within the confines of a study, and had seen no
changes in metabolic outcomes [39]. Rather, each participant served as his or
her own control. Our paradigm of dietary sugar and fructose restriction, which
included mid-study dietary adjustments to compensate for weight loss, resulted
in a 4% decrease in percentage of calories from carbohydrate, a 2% increase in
percentage of calories from protein, and a small increase in dietary fiber,
which could have reduced macronutrient absorption [18], flux of fructose to
the liver, and also increased satiety. Recognizing that consumption data by
recall is routinely underestimated [24], we made every effort to maintain our
participants' baseline weight throughout the 10-day study interval, and even
increased the caloric allotment partway through the cohort, yet a decline of
0.9 ± 0.2 kg was noted during the 10 days.

~~~
gus_massa
I'll quote part of your quote, because it's interesting:

> _We did not believe that maintaining fructose at the same level, even within
> a study, is commensurate with the message that the change in macronutrient
> composition is important for their health, and in order to use the study as
> an “educational moment.”_

This is a very bad excuse to avoid a control group. There are many unknown
factors that are difficult to estimate. For example: Did the children also
change the fat consumption because a doctor was going to examine them in a few
days? Did they change some habits, like walking to medical center instead of
no walking? I can invent a few more, because it's very difficult to guess the
baseline and the changes in the subjects.

To be sure that "the change in macronutrient composition is important for
their health" you need a scientific study. And to be sure that the study is
reliable you need a control group.

------
dekhn
This article has all the hallmarks of poor science: 1) very small study size
2) very short study period 3) self reported consumption 4) marginal p-values
5) highly biased first author.

~~~
hindenburg
I completely agree. I'm surprised that the HN community, which so often points
out poor science in other articles, in this case seems to include a lot of
people posting personal anecdotes about their diets.

For those people, I think it's very nice that you had a good experience
dieting. Your story isn't science however, and the rest of us aren't going to
learn anything generalizable from it. Perhaps you should be posting to a
reddit support group?

~~~
dekhn
Did you mean to reply to another comment? I didn't say anything about dieting.

------
kazinator
I cut back my kid's syntactic sugar, and he developed a Lisp.

------
zubspace
There's a very revealing and entertaining documentation about the rise of
sugar in our lives, drawing parallels between the tobacco lobby and the sugar
lobby: Sugar Coated (2015). Highly recommended. It was streaming on tvo, but
somehow the stream does not work anymore. I only found a german version on
arte.

[http://www.imdb.com/title/tt4425138/](http://www.imdb.com/title/tt4425138/)

[http://www.arte.tv/guide/de/054774-000/die-grosse-
zuckerlueg...](http://www.arte.tv/guide/de/054774-000/die-grosse-zuckerluege)

[http://tvo.org/video/documentaries/sugar-
coated](http://tvo.org/video/documentaries/sugar-coated) (not working)

In some ways, sugar is even harder to control than tobacco. Smoking is a
choice, but sugar is essential for living. It plays a big role in our society.
Remember the last birthday party/christmas/anything without sugar overdose?...
Me neither.. And its hard to prove that over-consumption is unhealthy.

------
nekopa
With all the discussion going on here, I would like to pop up a quick
question:

How can one go about learning about nutrition?

I have tried many, many times to do this, but I always run into these
problems:

1: I can't find a "big picture" overview of the field, and thereby learn which
areas to focus on

2: Most of what I find seems to be anecdata, or poorly constructed studies _"
We followed these 7 people..."_

3: The rest of which I find is always biased by what the author is trying to
promote - Low Carbs! No Carbs! Water! Fruit fruit fruit!!! and suffers from
points 1 and 2 above...

I would really like some good recommendations for books on learning nutrition
science. From the ground (coffee) up.

~~~
wizeman
This is not a book, but could be a starting point:
[http://www.hsph.harvard.edu/nutritionsource/](http://www.hsph.harvard.edu/nutritionsource/)

~~~
nekopa
Thanks for the link!

But I still have problem 1: A big picture view of the field.

I am looking for a kinda Cliff's Notes of the nutrition field. Then I feel a
lot of the sections on that site I would be better prepared to deal with in an
informed way.

------
gloves
I'm not sure how this is news to anyone these days. There are a billion and
one places you could go on the web, see on TV, read in books, or even speak
with neighbours and the same advice would be given. Lots of sugar = bad. Less
sugar = generally good.

The human body is quite remarkable in it's ability to adapt, the only thing
this article adds is the '10 days' portion (pun intended), but even that isn't
too surprising!

------
pierrec
I'm seeing a lot of reactions that seem to imply the current situation with
added sugar is okay, and that this research can be dismissed as being too
specific in terms of sample subjects.

Let's be clear, this research is specific, and all it does is add yet another
point in a massive cloud of evidence pointing towards the current dietary
disaster that is added sugar.

But don't take my word for it, please, do your own quick research on the
subject. Look up terms like Sugar+Diet or Sugar+Nutrition on Google scholar.
Go through the abstracts, the literature reviews. And stop spreading baseless
opinions, especially when it's potentially very harmful to the people reading
them.

When you see a comment that poorly defends a valid position, reply by
defending it properly, not by pointing out the flaws and/or following up with
FUD when you haven't done basic research on the subject.

~~~
leshow
You certainly aren't upholding your own statements by defending your position
properly.

I find that the added sugar=bad position is backed up with a lot of studies
that don't control for total calories between groups (meaning the total
calories are the culprit), or macronutrient ratios not being controlled
between groups (meaning lower protein or higher carbohydrates are the
culprit). There are a 'massive cloud' of studies which have both of those 2
errors present.

Aside, I realize the study in question did control for total calories, I'd
have to read through the full study to be able to comment on it. However,
drawing conclusions on the population at large from obese kids with metabolic
syndrome and abnormally high sugar consumption isn't exactly "another point"
in my books.

I don't think anybody is arguing that any level of sugar consumption is fine,
but it's unfair and intellectually dishonest to say 'sugar is bad' or 'sugar
is unhealthy'

~~~
pierrec
Who is being "unfair and intellectually dishonest"? The idea is not that
'sugar is bad' or 'sugar is unhealthy', but that sugar is bad and unhealthy
_as it is being used in our current society_. I thought this was pretty clear
in the first comment. This is why much of the research that comes up uses the
HFS for reference levels.

I agree about my laziness (making my own literature review would be a lot of
work), however, controlling for total calories as you suggest could be
misleading, because sugar provides lots of calories but often does not reduce
hunger:

[http://www.medicalnewstoday.com/articles/254512.php](http://www.medicalnewstoday.com/articles/254512.php)

~~~
pmelendez
> however, controlling for total calories as you suggest could be misleading,
> because sugar provides lots of calories but often does not reduce hunger

I don't see how could it be misleading. You trade sweat treats for fullness,
and you could even add low calories side meals to balance the count. That's
what a lot of diet regimes do and have been proved to work.

------
nichochar
My mother always told me how angry it made her to see obese children.

If you're an obese adult, it sucks and there are things to say, but whatever
you do you. But kids don't know, kids need to be taught. And you're basically
100% responsible for any kind of extra weight on your child.

------
halotrope
When experimenting with intermittent fasting
([https://en.wikipedia.org/wiki/Intermittent_fasting](https://en.wikipedia.org/wiki/Intermittent_fasting))
I have also observed that my lust for sweets and other "unhealthy" foods
completely disappeared. Somehow after a grace period the taste (In my
subjective experience) gets much more aligned to foods that we know are
considered healthy. I think adjusting ones diet to minimise sugar and highly
processed food can do wonders for ones general health and well-being.

------
Nemant
Great, so scientist are now telling me what my mom had been telling me for
years. I guess I should listen to my mom more often.

------
CIPHERSTONE
I believe it (not having read the article). I went Paleo when my blood sugar
finally went from borderline diabetic to your blood sugar is now diabetic, you
either get results or go on pills at my doctors suggestion. Just had my three
month bloodwork done and the reduction in blood sugar and cholesterol are
staggering.

~~~
Gibbon1
I saw a couple of videos' through the UCSF web portal by this guy (Lustig) a
few years ago. I can summarize what he said about various diets. The Paleo and
Atkins diets work not because what they include but by what they exclude;
processed carbs, sugar, and booze.

Another comment. Dr Lustig is a pediatric endocrinologist. If you start
looking though the literature. Doctors, nutritionists, etc are all doing
research to prove low fat diets work. And high fat diets are bad. And it's all
about will power. The pediatric endocrinologists started working the processed
carbs, sugar (fructose) are bad angle about ten to fifteen years ago. Probably
about five years ago they became absolutely convinced this is correct.

------
sugarcube
They don't mention any kind of blind? Maybe the kids just improved because
they were receiving attention...

------
joeyspn
As an anecdote, 10 days ago I decided to try and go nuclear with sugar and
high GI foods (bread, rice, etc) for a month after watching this video:

[https://www.youtube.com/watch?v=wyeor3z9EdQ](https://www.youtube.com/watch?v=wyeor3z9EdQ)

The first week I've been feeling _odd_ and lethargic with the second day
including flu-like symptoms. In little more than one week I've lost 1.5kg (~3
lbs). Now I start to feel more energetic and tomorrow I'll be hitting the gym
for the first time since I started. If I manage to lose 10 lbs, I'll probably
stick to the diet for some months more. (I needed to lose 40 lbs or so
anyways)...

~~~
drumdance
We're on almost the exact same timeline. The only added sugar I get right now
is from about 2 grams in balsamic vinaigrette salad dressing. I've dropped
roughly 10 pounds. My goal is to stay sugar free until Thanksgiving, then see
how I feel after pigging out and the next couple days after.

Edit: btw I was already in good shape. A little bit of belly fat but I can
still wear slim clothes. So for me at least the effect is there despite
starting in the normal weight range.

~~~
joeyspn
I have started with slight overweight, but I'm a regular in the gym so I'm in
good (muscular) shape, I just need to drop some extra lbs.

Before cutting sugar and high GI foods, I had to do 4-5 days of intensive
cardio in order to drop 2 lbs in one week. Now I'm losing them almost without
exercising (only walking here and there)...

My goal is to adjust my diet to a minimum of sugar (complex carbs, fruits, raw
honey, etc) that allows me to stay in my BMI and 6–13% BFP (I was at 5% in my
early 20s!)

------
bluedino
I can almost understand why Soylent makes headlines here, but articles about
sugar being bad for you and bacon being bad for you? There are a hundred other
places online I can read about this.

~~~
vixen99
It's not about you; it's about getting the message to those who need it. And
that's an awful lot of people who are over-indebted to the success and
productivity of the food producing industries worldwide.

------
lasryaric
I posted a comment earlier today describing my own experience. I never said
that everybody should stop eating food with added sugar, I just said it worked
for me.

One main thing we don't mention in this thread is that sugar is addictive.
Cutting sugar was hard like quitting somking was hard. If you never got
addicted like I was, I guess it os hard to understand the problem. But when
you are addicted it is hard to just know if you are hungry or not. So I
choosed to go on the other extreme which works better for me.

------
suneilp
I read an interesting article on how excess sugar clogs the tiny blood vessels
and tissues where there aren't really any blood vessels.

Circulation in these areas won't be as great by the nature of things so
clogging them up has a greater impact. It prevents nutrient/waste flow to
tissues. Just think about that for a bit. Accumulating waste and blocking
delivery of nutrients.

Balancing sugar intake and moving around, even if it's just walking, on a
regular basis will fix you up real fast.

------
dewarrn1
Robert Lustig, first author on this paper, has written a very accessible book
on the same topic titled "Fat Chance" [0]. I enjoyed it, although I can't
vouch for all of the science.

Full disclosure: I did stop eating sugary food after reading and watching some
of Lustig's presentations, and I'm generally pleased with the results.

[0] [http://amzn.to/1S7LmQY](http://amzn.to/1S7LmQY)

------
suprgeek
This is a very good first step - now we need more research into whether this
holds for non-obese kids who are not Hispanic or black.

I.e. does cutting out almost all added sugars from the diet of a normal weight
kid improve health outcomes?

Also note that the lead Author is Robert Lustig - I first ran into a lecture
called "The bitter truth" by him against Sugar. So it seems to be a pet
crusade of his (not that that invalidates the result).

------
damnmachine
Sure, I noticed an immediate difference when I cut back on extraneous sugar
content like soda and junk food. I also lost about 15 pounds over the course
of a month. I noticed a mild withdrawal but once you get past that and as time
goes on, you crave it less and less. The human body does need a certain amount
to function but those amounts are easily obtained via a healthy diet with
plenty of fruits and vegetables.

------
_superposition_
"the findings add to the argument that all calories are not created equal."
Well pardon my french but no f _cking sh_ t. Anyone person/system who strictly
counts calories and completely looks over the fact that there are literally
millions of other organisms involved in the digestive/energy process gets no
love from me. Unfortunately its not as simple as calories in/calories out.

~~~
jonlucc
I think the problem here is that of BMI. While it is true that BMI is not
always accurate as a measure of fitness, it usually is for people who go
around saying that BMI doesn't mean anything. It is only incorrect for people
who are extremely muscular, and those people _know_ they're fit enough because
they have other measures (like precise measures of body composition) to tell
them.

So while it is true that not all calories are created equal, the people who
most often seem to go around saying that seem to be the same people who refuse
to pay attention to portion size and then bitch about not losing weight
because they're only eating healthy foods.

~~~
billmalarky
>While it is true that BMI is not always accurate as a measure of fitness

You're right. I've never seen a fit person complain about the inaccuracy of
BMI in anything other than a joking manner. It isn't precise, but it's "good
enough" for the majority of people. It's a heuristic.

On the other hand, people who are clearly in poor shape love to scream up and
down about how inaccurate BMI is at determining fitness levels. Ironic because
BMI generally puts non-active people in a positive light. If we switched to
body-fat percentage something tells me a lot of these folks would be clamoring
to get BMI back since it under-reports people who have low enough mass to be
not considered obese, but too high body fat to be healthy (thus are at greater
risk for diabetes etc).

------
fomoz
Lustig just doesn't give up. He has already been crushed by Alan Aragon five
years ago.

[http://www.alanaragonblog.com/2010/02/19/a-retrospective-
of-...](http://www.alanaragonblog.com/2010/02/19/a-retrospective-of-the-
fructose-alarmism-debate/)

~~~
knappador
Credentials would tend to support the practicing endocrinologist. Also, the
data Lustig really had to go get was the causal inference where increasing
fructose had a delayed response of increased metabolic syndrome. That study
has been done now.

------
acd
There is something called blue zone food, Okinawa islands. There have been a
studies of the people who live longest and what they eat.

The study concluded you should cut down on sugar and white flour. Use fresh
locally produced food and avoid processed foods.

------
c3534l
Even the New York Times is not immune to the impulse towards click-baity,
misleading article titles.

------
malkia
Sugar is the drug that makes us sick, but we keep it (and I love it in many
different forms). I'm addicted to it...

------
genuinejack
Just in time for Halloween!

------
cdnsteve
Go watch Forks over Knives on Netflix.

------
brianmback
Anyone's health _

