I came by this book via NPR. I heard the author describing the effects of sugar and heard the title of his book, and decided I needed to know more. That is how I came by one of the scariest books I’ve ever read. Robert Lustig describes sugar as a poison, and by all accounts, including his, he’s right. I’ve been mainlining poison all these years!

Before we get into the book itself, let’s start with some background. Who is Robert Lustig, and how did this book come to be?

Right from his profile on the UCSF website, “Robert H. Lustig, M.D. is Professor of Pediatrics in the Division of Endocrinology at University of California, San Francisco, and Director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.”

So what, you might say. What does that have to do with this book? The answer is actually pretty easy. What Lustig discovered from all his years in medicine is that there is one element that rises above all others as the primary driver of all the metabolic issues and diseases (collectively referred to as “metabolic syndrome”) facing consumers of food (i.e., every human on the planet): sugar.

Things really got rolling with a YouTube video of Lustig giving a presentation to an audience regarding the dangers of sugar. Entitled “Sugar: The Bitter Truth“, Lustig spends nearly ninety minutes taking the audience through the ins and outs of sugar, focusing on fructose. This is not a lighthearted journey. He goes into the statistics behind what Americans are consuming today versus what they were consuming at the turn of the twentieth century; how glucose, alcohol, and fructose are metabolized in meticulous, borderline mindbogglingly biochemistry detail; and how we got to where we are. First posted to YouTube in 2009, it’s been viewed an whopping 4.4 million times.

This presentation eventually morphed into the book “Fat Chance“, which was released last year, and which has been released in paperback to coincide with the release of a “Fat Chance Cookbook“. The presentation, and the book as well, are almost story-like in their presentation, at least as much as a medical-laden book and presentation can be. And as any writer will tell you, a good story needs a good villain. For Lustig, that villain is sugar. Fructose to be exact. A villain so diabolical, he refers to it as every evil storybook villain you can think of, from the Darth Vader of food to the Voldemort of food. Or, perhaps more telling, he refers to sugar as a poison.

Okay, so that’s the background. How about the book itself?

It’s hard to review a book like this because it operates on a couple of different levels. From a pure readability standpoint, the book often times gets bogged down in its own technical terminology and descriptions. There was more biochemistry in this thing than in Dr. Torrence’s junior year chem class (in which I SCRAPED by with a D). There are so many terms that eventually I stopped trying to remember them all and simply take for granted that someone with a hefty amount of scientific background proofed the book prior to publication.

As far as narrative voice goes, Lustig’s voice is fairly unique when it isn’t drowning in terminology. He’s a firebrand, preaching from the pulpit of a man who has seen it all and been there. He is not afraid to call out a naked emperor, and it’s not unusual for him to repeat the refrain “We’re screwed”. In one very notable passage, he describes us all as “fructed”. The majority of his chapters open with a brief vignette of a patient case he has dealt with, and more than a few are heartbreaking. There is a force of passion behind his message, one that is not easily ignored nor argued. He is a pediatric endocrinologist, after all, and he knows his shit cold.

This, then, is where the book really shines. Amidst the preaching of the author, and the technical jargon that will make your head spin, is the long litany of facts, stats, and studies that are at the heart of this book. He makes a point early on saying that every point he makes in the book is based on scientific fact, the sources of which are contained in a notes section at the end of the book. Without these to support his argument, Lustig would likely be seen as an extremist, a fringe-scientist shouting at the masses and not being heard. Because the villain here, again, is sugar, not fat as most diets vilify. And not just the high fructose corn syrup sugar that everyone was up in arms about a few years ago. This is ALL sugar.

Back in the late seventies/early eighties, the low-fat movement began. Want to control heart disease? Decrease your fat intake and that will help lower you bad cholesterol (LDL). The food industry moved in this direction, lowering the yummy, tasty fat, and ended up with a bunch of bland, boring foods that needed a zing. Enter sugar. At a time when corn crops were subsidized, whether the crop was a boom or a bust, and the price of a newly derived sweetener called high fructose corn syrup sank to incredibly cheap levels, it became easy for the food industry to beef up the flavor using this form of sugar.

But it didn’t help, did it? No. Because the population has grown more obese. So we instead turned to diets and exercise. Denis Leary laughing described us as gerbils as we continually climbed stairs on the StairMaster. “Where are you going?” “I’m going up!” But even that didn’t help. Why? Because the human body metabolizes different parts of food in different ways. In the heavy biochem part of his YouTube video, Lustig demonstrates that glucose, alcohol, and fructose metabolize differently. And even though he starts off with 120 calories of each, it’s not 120 calories that are absorbed by the body. So you can’t burn 120 calories in exercise and assume that you’ve got a net effect. It just doesn’t work that way. Because (and this is also a constant refrain in the book), “a calorie is not just a calorie.”

Both the book and the video are eye-opening, and if the book comes off medical-heavy and overly didactic, well that’s really the point. It’s not meant to be a touchy-feely self-help volume about how “You Can Do It If You Just Try Hard Enough”. No, the book argues, you can’t. The odds are stacked against you. The politics of food processing are enormous here, and to make a top-down change is certainly not likely to happen.

Is it all doom and gloom? Did I spend a week reading a book that scientifically demonstrates the problem but fails to provide a solution. Not at all. While the book spends more time on the problem than the solution, the solution does indeed exist in fiber an exercise. But I won’t go into the details here because you should dive into this book yourself. It’s eye-opening in a way I didn’t think possible. Ever wondered why you feel down after a sugarfest, hungry after a huge sweet and sour infused Chinese meal, or why you Just. Can’t. Escape. Donuts, especially when your stressed? Then this book is for you. You will never look at food, food labels, and ingredient lists the same way again. And trust me, that’s a good thing.