[462436347]

US sugar consumption declined from 2000-2020 to 1970s levels, while its T2D prevalence only increased: https://news.ycombinator.com/item?id=38094768

And if sugar is so metabolically harmful, where are the RCTs showing this? All I've seen is that outside of a caloric surplus, it isn't especially metabolically harmful, and ironically, even outside of a surplus, saturated fat is much worse:

https://diabetesjournals.org/care/article/41/8/1732/36380/Sa...

https://link.springer.com/article/10.1007/s00394-015-1108-6

Meanwhile tribes of hunter-gatherers in Africa get 15-80% of their daily calories from honey during certain seasons; why aren't they obese and diabetic? https://www.sciencedirect.com/science/article/abs/pii/S00472...

[throwawaycities]

> US sugar consumption declined from 2000-2020 to 1970s levels, while its T2D prevalence only increased

Seems like you are cherry picking data and ignoring other data from the chart - sure the total sugars from 2000-2020 are down slightly while what’s being labeled as “corn sweeteners” or HFCS is up 3x.

Since you mention diabetes it’s probably worth noting from 1970-1985 “corn sweeteners” more than 3x and before 1985 T2D was called adult onset diabetes considered an adult disease and 1983 was the first case of pediatric nonalcoholic fatty liver disease.

> Meanwhile tribes of hunter-gatherers in Africa get 15-80% of their daily calories from honey during certain seasons;

The chart shows honey is a nominal source of sugar for Americans. There are other facts about honey, like its low glycemic index compared to other forms so it doesn’t raise blood sugar levels as dramatically as regular sugar and especially HFCS.

The fact is the US government just lumps all forms of sugar together and labels it all genetically as sugar…ignores there are different forms of sugar, each processed by our bodies differently and having different metabolic impacts and harms.

People will spend the next 100 if not 1000 years arguing if sugar is responsible for metabolic diseases like T2D and nonalcoholic fatty liver disease - yet it’s settled now that T2D & NAFLD are both 100% preventable diseases and in some cases T2D can be reversed by minimizing sugars/carbs and increasing fats so your mitochondria is primarily using ketones rather than glucose.

[462436347]

> Seems like you are cherry picking data and ignoring other data from the chart - sure the total sugars from 2000-2020 are down slightly while what’s being labeled as “corn sweeteners” or HFCS is up 3x

HFCS consumption is still higher than it was in 1970, but it has declined since 2000, and its decline has driven the overall decline in sugar consumption, yet obesity and diabetes incidence have only increased.

> some cases T2D can be reversed by minimizing sugars/carbs and increasing fats so your mitochondria is primarily using ketones rather than glucose.

"Reversed" means you can eat carbohydrates normally again. If anything, high-fat, low-carb diets seem to worsen actual insulin sensitivity, which carbohydrate restriction just masks (even then, not always, as many on keto find when they check their BG): https://pmc.ncbi.nlm.nih.gov/articles/PMC5291812/

Severely restricting carbohydrate enough to get an artificially low HbA1c or fasting BG and claiming you "reversed" diabetes is like claiming you "reversed" your lactose intolerance by never drinking milk. But actual weight-loss (however you achieve it) does improve real insulin sensitivity, but low-carb isn't magic when it comes to that either.

[PittleyDunkin]

> The fact is the US government just lumps all forms of sugar together and labels it all genetically as sugar…ignores there are different forms of sugar, each processed by our bodies differently and having different metabolic impacts and harms.

At the same time, these differences can be overstated. E.g. look at how "added sugar" is distinct from other carbohydrates but no "total sugar" metric on nutritional boxes on food products.

[AI_beffr]

yup. seed oils also play a role

[hn_throwaway_99]

> And if sugar is so metabolically harmful, where are the RCTs showing this?

Look at the details of this study. The reason there are no RCTs is, at least for what this study looked at regarding very early childhood, they are impossible because they would be highly unethical. You can't take two groups of babies and randomly assign them to control group vs high-sugar group and test for the outcomes.

What this study is arguing is that the lifting of sugar rationing acted as a "best possible" form of a natural RCT as babies born relative to that lifting date had vastly different levels of sugar consumption in the first 1000 days. Note you see these types of "natural cohort" studies in a bunch of areas. E.g. it's not ethical to say group a is the "high levels of lead" group and group b is the control, but by looking at neighboring states that restricted leaded gasoline at different times you can try to tease out cause and effect.

I see tons of comments here arguing "how can they say it's just sugar!" I had a similar initial reaction, but I see very few comments that are arguing about the specifics of the study itself, and I'd argue the study is quite interesting and, at least from my layman's perspective, well done.

[123yawaworht456]

>US sugar consumption declined from 2000-2020 to 1970s levels, while its T2D prevalence only increased

obesity did not decline

>And if sugar is so metabolically harmful, where are the RCTs showing this? All I've seen is that outside of a caloric surplus, it isn't especially metabolically harmful

https://en.wikipedia.org/wiki/Fructose#Potential_health_effe...

>Meanwhile tribes of hunter-gatherers in Africa get 15-80% of their daily calories from honey during certain seasons; why aren't they obese and diabetic?

if you are are physically active and don't overeat, you can eat whatever the fuck you want and never get obese. if you are not obese, you will (most likely) never develop T2D

[devilbunny]

Physically very active. I used to gain 10 kg when my sport (American football) was not in season, although I did some training year-round.

I don’t have the time for that level of activity as an adult. In season, it was about 20 hours a week.

[erik_seaberg]

Just one cheeseburger is three miles of running. Not only is it very easy to shop and overeat, your body continually encourages it. The only way out is determination not to eat whatever you want.

[Johanx64]

> Meanwhile tribes of hunter-gatherers in Africa get 15-80% of their daily calories from honey during certain seasons; why aren't they obese and diabetic?

The fact you even have to ask this question is telling. Specifically you're talking about Hadza tribe that spends pretty much all of their waking hours outdoors hunting and tracking pray, day in and day out.

They quite literally track honeyguide birds, climb tall baobab trees, get stung repeatedly and then they eat freshest highest quality honeycombs whole, including larva, and not just extracted, industrially processed honey.

Westeners that show up to film hadza can barely keep up to them because just how fast, long and exhausting their hunts are.

This is akin to asking why do long-distance cyclists who spend 10-16hrs a day on bike on long cross country rides can drink liters of cola every day and be skinny like a fig.

I'm getting second hand embarrassment from just reading the question.

[462436347]

> The fact you even have to ask this question is telling. Specifically you're talking about Hadza tribe that spends pretty much all of their waking hours outdoors hunting and tracking pray, day in and day out.

Look up Pontzer's Constrained Total Energy Expenditure Model. His doubly-labeled water experiments show that Hadza and other hunter-gathers have--contrary to his (and your) initial expectations--roughly comparable TDEEs to sedentary western counterparts (controlling for lean body mass) due to metabolic compensation (i.e., the more they exercise, the more their bodies compensate by expending less energy elsewhere, on things like inflammation and thyroid/sex hormones): : https://pmc.ncbi.nlm.nih.gov/articles/PMC4803033/

Regardless, they're in energy balance, meaning they aren't gaining or losing weight, and despite their high-sugar diets, they aren't presenting any of the metabolic maladies that Lustig ascribes to sugar specifically, and not to weight gain--maladies that saturated fat seems to cause with no weight gain.

> This is akin to asking why do long-distance cyclists who spend 10-16hrs a day on bike on long cross country rides can drink liters of cola every day and be skinny like a fig.

Sugar has 4 calories per gram. Fat has 9. Are you arguing that sugar calories are more fattening than fat calories?

> I'm getting second hand embarrassment from just reading the question.

It's remarkable that I've had less derogatory and flippant comments than yours downvoted and even flagged in this thread: https://news.ycombinator.com/user?id=462436347

[nightski]

Readers here probably aren't hunter gatherers in Africa though. If you live sedentary lifestyle with an abundance of food you may need to take a different approach to nutrition. Sure it would be ideal if we were all hyper athletes, but the reality is that probably isn't going to happen and I am not sure it's even better holistically.

[schmidtleonard]

The reason to do RCTs and establish causality isn't to generate excuses for a sugar diet, it's to head off bullshit alternatives that don't fix the problem but advertise like they do.

[462436347]

What's your point? The article implied that sugar magically causes obesity and diabetes, all calories being equal, when the weight of the evidence supports neither assertion, and ironically implicates saturated fat as being worse, showing an ability to cause an increase in visceral fat and worsened insulin sensitivity (measured with oral glucose tolerance tests), even in weight-stable subjects.

> different approach to nutrition

The "different approach" HNers gravitate towards is eating bacon and butter (i.e., keto/low-carb) and denying all of the evidence linking these foods to CVD, probably because fat and sodium are so addictive, much more so than sugar: https://news.ycombinator.com/item?id=42028432

[truculent]

> Early-life sugar could drive later-life disease in various ways, Gracner says. Exposure in the womb might affect fetal development in a way that predisposes someone to metabolic diseases. Infants eating a sugary diet might also develop a taste for sweet foods, causing them to eat more sugar as adults—an outcome for which her team has some preliminary evidence.

If there's a significant lag between early-life exposure and disease outcomes, then it seems reasonable that the effects of the 2000-2020 drop won't be seen for some time.

[chiefalchemist]

I'm reading "Epigenetics" by Richard C Francis and he mentions the influence of diet during pre-birth as well during early development.

https://www.penguinrandomhouse.ca/books/404271/epigenetics-b...

[ipython]

If sugar is not part of the problem, why did the sugar companies pay to suppress studies and promote fat as harmful? No company is going to spend money to suppress results that would show their products in a positive light…

https://www.npr.org/sections/thetwo-way/2016/09/13/493739074...

[462436347]

Good thing the beef and diary industries aren't spending any money to convince you that saturated fat is harmless.

[callmeal]

>15-80% of their daily calories from honey during certain seasons; why aren't they obese and diabetic?

Maybe because it's "during certain seasons" and not the whole year around?

[kmoser]

Also, just speculation on my part, but their daily caloric intake may be less than that consumed by a Westerner. Combined with their (presumably) greater expenditure of calories than Westerners, that sugar is not going to result in any significant health issues.

[omikun]

Try eating mostly honey and roots and see how much you can over consume. The problem in US is the variety of food and how engineered they are to be hyper palatable. Snacks are designed to pump sugar into the blood stream, with just enough salt, fat, or carbonation (in drinks) to mask just how much sugar is in everything. That's the reason why warm flat soda tastes disgustingly sweet.

It's not just sugar, but the amount of it, and how fast it is consumed, and how and when do we expend energy (walking after meals directly consume blood glucose b/c calve muscles don't have a glycogen store) impacts fat buildup and T2D. Check out books by Robert Lustig on the subject.

[462436347]

> The problem in US is the variety of food and how engineered they are to be hyper palatable

The best study done to date on hyperpalatable foods found that fat and sodium were the most common drivers of hyperpalatability:

https://onlinelibrary.wiley.com/doi/10.1002/oby.22639

> The HPF criteria identified 62% (4,795/7,757) of foods in the FNDDS that met criteria for at least one cluster. Most HPF items (70%; 3,351/4,795) met criteria for the FSOD cluster. Twenty-five percent of items (1,176/4,795) met criteria for the FS cluster, and 16% (747/4,795) met criteria for the CSOD cluster. The clusters were largely distinct from each other, and < 10% of all HPF items met criteria for more than one cluster.

(CSOD, carbohydrates and sodium; FS, fat and simple sugars; FSOD, fat and sodium; HPF, hyper-palatable foods.)

> Check out books by Robert Lustig on the subject

Lustig is a crackpot who relies on animal studies and mechanistic speculation, because the highest-quality RCTs (like the ones I cited) don't support his theory.

[anonym29]

>Meanwhile tribes of hunter-gatherers in Africa get 15-80% of their daily calories from honey during certain seasons; why aren't they obese and diabetic?

I'd be willing to entertain a hypothesis that the demographic cohort of T2D Americans aren't getting most of their sugar in the form of organic, unprocessed honey taken directly from the hive.

[chiefalchemist]

I don't quite understand the details but diet plays a role in epigenetics. The effects a diet (in this case sugar) can imprint itself across multiple generations.

[PittleyDunkin]

> US sugar consumption declined from 2000-2020 to 1970s levels

I think this is added sugar only. It wouldn't surprise me if actual sugar consumption reduction were tempered compared to the linked graph. Hell, actual sugar consumption may have even increased. It's certainly far easier to get (fairly high-sugar) juice now than when I was a child.

[astura]

>It's certainly far easier to get (fairly high-sugar) juice now than when I was a child.

What? Excuse me!?? This comment is just flooring me.

I am on my 40s, so I was born in the early 80s. Back in the 80s children were expected to drink juice, and LOTS of it. It was considered a health food for kids.

Juice came in frozen concentrate and WIC paid for it. Every family had juice, every younger (1-12 yr old) kid was expected to consume juice every single day. Grocery store freezer sections were PACKED with it, I remember being memorized by all the colors of the packaging.

I don't know anyone who feeds their children juice like I was fed it growing up. Even when people allow their kids juice now it's "eh, it's not healthy but at least it's better than soda."

[gitaarik]

So what is your point, you think sugar is not such a big problem and we're not eating too much of it? Then what is according to you the major cause of diabetes and obesity?

To me it sounds logical that nutrition plays a major role in our health, and that sugar is a kind of food our bodies aren't made to process in such high quantities.