Congratulations to Damon Gameau for his documentary "That Sugar Film". I know how hard filmmaking is and credit to him and his team for following through with the dream!
Damon is engaging and entertaining and the movie is well paced and fun to watch.
However from a scientific point of view, the film holds little to no water whatsoever.
The film sets out to blame the rise of obesity and other metabolic diseases that are crippling the health of the world on sugar - then says it isn't the main reason behind it all in a seemingly subtle touch of damage control.
BAD SCIENCE
Damon embarks on a scientific experiment for 60 days, eating 40 teaspoons of sugar daily - but only from seemingly "healthy" foods: museli bars, many fruit juices, smoothies, etc.
First of all, I would note that a "healthy" food depends on context - a Mars Bar isn't unheatlhy if it's the first one you've had all week following a well balanced diet of meats, poultry, fruits vegetables, etc. And somehow a McDonalds soft serve makes it's way into Damon's diet - but again - it's a food that's not "healthy" or "unhealthy" because it's all about context.
But this is the problem with this film, it just isn't a proper representation of dietary life for a lot of people.
I'm also not sure where the 40 teaspoons a day came from but in the 2011-2012 ABS survey an average adult now has 26 teaspoons (not 40) of sugar, whilst men from the age of 19-30 have 33 teaspoons. Futhermore, data in America from 2005-2010 shows that the estimated average intake of added sugars among adults is 13-14% of total calories. In the film, Damon's is 29.2%.
It's a shame with a few of the doctors he had access to that the study wasn't drawn up and completed properly, instead we have to take his word for it. And we'll get to why this is a problem later.
Damon's sugar intake equates to 4.2 grams of sugar (carbohydrate) per spoonful and therefore 168 grams of sucrose a day which equates to 672 calories. He's eating at least 672 calories out of the 2300 calories in his experiment diet from sugar.
We're told that before the experiment his paleo style diet was 50% fat, 26% protein and 24% carbohydrate from fresh fruit and vegetables - which was 2300 calories. He had eggs and bacon for breakfast in that diet - the protein and fat are great for satiety (the feeling of being full) whereis there's none of that in the new diet which is half the problem.
But the film would rather focus on bagging the macronutrient subtype fructose. Why? Well, because it's a lot more catchy then asking people to eat more protein, fat and fibre and consume sugar in moderation I can assure you.
Using a Total Daily Energy Expenditure (TDEE) calculator which measures how many calories Damon burns a day (and guessing he would be about 6ft and factoring in his exercise for 4 days a week) you get 2483 calories.
We're told Damon is eating 2300 calories - so he's 183 calories in the clear before he starts storing body fat.
The massive problem I have with the film is the utter carelessness and the self reported estimated data of how many calories he was consuming. Also, how was Damon exercising in his home gym whilst in America? His spoonfuls are also poorly measured.
But there's one moment when Damon's sitting at the lap top and attempting to count his calories, that the film falls into the scrap heap as anything holding any scientific merit whatsoever. He says it's hard to count calories and it's "hard to be accurate, obviously" and he guesses his way through recording everything.
Wow. Really?
The whole point of the film is that you'll get fat (specifically liver fat) even in a calorie deficit with the hidden added sugars in foods that you think are "healthy" - yet Damon skips over the important part of counting the calories precisely which is what the hypothesis of the film rests on.
And this sums up the point about reported data - he was most likely underestimating it and eating MORE calories then he's burning, especially given he wasn't exercising whilst on the road documenting his journey, but was before he left?
Damon's diet is so pretty far removed from anything real-world it's insane - there's hardly ANY protein (especially not in the morning) there's a little chicken at lunch time and a chicken dish at dinner that's not specified with the calories (another problem).
And this is what doesn't sit well with me - because science has endeavoured to discover whether or not fructose can cause one to experience liver fat by consuming a certain amount of fructose alone, WITHOUT eating more calories then they burn.
And does the research agree with Damon's poorly calculated experiment?
NO, SCIENCE DISAGREES
This notion has been studied directly in randomised controlled trials, which is the "gold standard" of scientific research. When groups were put on either high fat, low carb or high carb (yes, including sucrose which obviously includes fructose [50%]) - there was no difference in weight gain or improvement in lipid profile (fats in the blood) (1).
And there's plenty more - a 10 week trial looking at consuming low-fat milk with either high fructose corn syrup (that found in soft drink) or sucrose, totalling the added sugar range of 8%, 18% or 30% of total calories resulted in no fat in the liver and no changes in bad cholesterol (2).
Science shows clearly that self reported data (like in Damon's case) in terms of calories consumed and exercise performed, is grossly inaccurate.
Subjects have been found to under report their food intake by 47% and OVER-REPORT their physical activity by up to 75% (3). This is the likely explantion as to what has happened here.
The other catch cry in the film is that fructose doesn't spike insulin and therefore you get hungrier following ingestion.
Science says this is partly correct - but only when we get FREE fructose.
BUT.....we do NOT get free fructose on it's own - it comes as 50% fructose and 50% glucose in sucrose (aka sugar), and 55% fructose and 45% glucose in high fructose corn syrup (found in soft drinks).
The film fails to point out that the fructose alarmism is based on unrealistic studies into human beings (that give them up 40 bananas worth of fructose a day to prove their point) and rats, who in fact turn more than 50 percent of fructose into fats in the liver.
Human beings on the other hand however, convert up to 50% of fructose into glucose, about 30 percent of fructose into lactate and LESS than one percent into fats (4).
That's a little issue for the film - which makes me maintain my position that Damon Gameau would had to have been consuming more calories then he burnt off to have gained so much fat.
So when we consume sucrose or high frutose corn syrup (essentially the same thing) we STILL spike insulin and supress appetite (5), which is why the authors of this paper note:
"When High Fructose Corn Syrup is compared with sucrose, the more commonly consumed sweetener, such differences are not apparent, and appetite and energy intake do not differ in the short-term."
Another author and pseudo scientist David Gillespie says: "once you remove that hormone disrupter, fructose, from your diet, your appetite control works again and your weight drops."
Such an bold statement that is just simply not proven effectively in science and disproven in the papers cited above.
THE INSULIN FALLACY
And speaking of insulin, I was absolutely amazed at the out of date information spread pertaining to the most misunderstood hormone.
In a magnificently designed CGI demonstration (I loved that about the film) showing the insides of the human body, Damon Gameu stated:
"But the key point for us is that when this insulin is in the blood dealing with all the glucose, it tells our fat cells to hold onto the fat! It actually turns off our fat burning processes. So when we're eating lots of sugar we're putting fat into our bodies via the fatty liver, plus because of all the glucose we maintain the level of insulin, which tells our fat cells to hold onto the fat! We can't burn off fat when insulin is around dealing with all the sugar! This is what may be happening to a huge number of the population!"
Damon is only telling half the story, the half isn't remotely as bad.
Damon is right that when you spike insulin you inhibit fat burning, but this is overplayed. For years, people wrongly drew the link that more spikes in insulin meant you'd burn less fat, so therefore if you keep carbs and sugar low you'd lose weight.
It sounded good in theory, but was found to be wrong (6).
The insulin spikes are so short lived that fat loss picks up again not long after carbohydrate intake, but you must be in negative energy balance to lose weight. That is, eating LESS calories then you burn.
Take a look at the graph below from impartial scientist James Krieger:
It doesn't matter that you spike insulin - you'll still lose weight as long as you are NOT eating more calories then you burn. Damon blames the insulin spike that apparently causes fat loss, on sugar.
But here's the big error - PROTEIN spikes insulin too (7). Yep.
Another "nutrition expert" in the film David Wolfe, makes the same mistake. He says we need to get nutrients "without spiking blood sugar."
Well because carbohydrates and protein have many nutrients and both spike insulin largely, this is damn difficult Mr Wolfe!
In fact - beef can spike insulin just as much as rice and milk, a great protein source, spikes insulin MORE than white bread.
If you have to, read that passage again. It's information that still blows many people away and a lot of "experts" still don't know.
The film is made up of authors, a former NASA employee? Very few doctors, and an actor (Damon Gameau) as the subject. Science just isn't the winner here at all and the film is grossly underresearched.
Fructose (in the form of sucrose) and high fructose corn syrup consumption doesn't correlate too well with obesity, look at Mexico below for example, it has hardly any high fructose corn syrup yet is massively obese (8,9).
Now this doesn't really prove anything - but I will point out it was simply drawing a link that started the fructose alarmism in the first place following this "let's draw a link" report back in 2004.
The film also omits the fact that technology (think being able to do everything from our smart phones) means we're moving less.
It also ignores the fact we're exercising less too (10), which itself pays a huge role in obesity.
But the final point I want to make that I feel blows a huge hole in the films merit, pertains to Larry Hammons, a 17 year-old from Kentucky who is as skinny as a rake and has completely rotted teeth from the soft drink.
In the film, Larry has his horrible teeth partly operated on by a dentist in a mobile van.
Larry says he consumes 12 cans of Mountain Dew a day and has been drinking it since he was "2 or 3."
Now hold on a second....yes, it's self reported data which is inaccurate as we've gone through...but if he is consuming really ANYWHERE NEAR that, why isn't he obese and a diabetic patient?
Damon Gameau obviously wanted him in the film for the purpose of the showing how bad teeth can get from too much sugar (a point I'll never argue) but by including him it indirectly blows a massive hole in the story.
Yet, we have to believe that in just 18 days, Damon started developing a fatty liver assessed by a ALT test which we know to not always be accurate.
And further to the point of ALT accuracy, one study found 30% of those tested with elevated ALT scores ended up being in the normal range, when a fortnight later they were tested again (11).
It just doesn't look good.
FRUCTOSE ALARMISM - SUGAR IS NOT THE SOLE PROBLEM
The film is entertaining and fun to watch, and I hope Damon Gameau makes a stack of money from it moving forward with his wife and newborn, I wish him all the best!
However, the film is not scientific, and is nothing more than entertaining propoganda.
It's a real shame that only one doctor from the other side of the debate is approached, John Sievenpiper, who as the film points out is paid by the sugar industry.
But there are so many doctors and independant reseachers that are NOT paid by the sugar industry, and can build a case again them to make their out of context alarmism look pretty silly pretty quickly. But they simply can't afford to approach those people.
However, the good thing Damon manages to do is let people know about the excess calories (via sugar) lurking in what they eat. If he gets Australians to reduce calories that's a good thing.
But the alarmism and lack of an explanation of moderation means the world walks away with a great misunderstading of fructose and exactly how they can enjoy the foods they love in moderation.
But is sugar the sole problem? No. We're made to believe that if we got rid of sugar, the world's metabolic diseases would disapear, a claim not supported by the scientific literature.
The big picture is not being looked at here, and even though Damon does say he doesn't think sugar is to blame, he still says at another stage that he would argue a can of Mountain Dew cannot be enjoyed in moderation because of the caffeine and sugar content - this is a claim that strong science disagrees with.
"That Sugar Film" is unwarranted alarmism that at the end of the day holds no scientific merit and fails to address the big picture.
Take it with a grain of salt or shall I say, a grain of sugar.
"Stay Fit, Stay Flexed!"
REFERENCES
(1) Saris et al. Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. The Carbohydrate Ratio Management in European National diets. Int J Obes Relat Metab Disord. 2000 Oct;24(10):1310-8.
(2) Bravo S, Lowndes J, Sinnett S, Yu Z, Rippe J. Consumption of sucrose and high-fructose corn syrup does not increase liver fat or ectopic fat deposition in muscles. Appl Physiol Nutr Metab. 2013 Jun;38(6):681-8. doi: 10.1139/apnm-2012-0322. Epub 2013 Feb 12.
(3) Lichtman SW et al. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992 Dec 31;327(27):1893-8.
(4) Sun S, Empie M. Fructose metabolism in humans – what isotopic tracer studies tell us. Nutrition & Metabolism 2012, 9:89 doi:10.1186/1743-7075-9-89
(5) Melanson KJ, Angelopoulos TJ, Nguyen V, Zukley L, lowndes J, Rippe JM. High-fructose corn syrup, energy intake, and appetite regulation. Am J Clin Nutr. 2008 Dec;88(6):1738S-1744S. doi: 10.3945/ajcn.2008.25825E.
(6) Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, McManus K, Champagne CM, Bishio LM, Laranjo N, Leboff MS, Roos JC, de Jonge L, Greenway FL, Loria CM, Obarzanek E, Williamson DA. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. N Eng J Med. 2009 Feb 26;360(9):859-73. doi: 10.1056/NEJMoa0804748.
(7) Holt, S.H., Miller, J.C., & Petocz, P. (1997). An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. American Journal of Clinical Nutrition. 66, 1264-1276
(8) Fereday N, Forber G, Girardello S, et al. HFCS industry annual review—a year of changing expectations. Sweetener analysis. Oxford, United Kingdom: LMC International Ltd, 2007.
Author
Dayne Hudson