Is Sugar a Killer?

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That’s why Lustig is going to law school.

IN MANY WAYS, LUSTIG SEEMS BETTER SUITED to the bluster of the courtroom than the fastidiousness of the lab. His talks and his book are extensions of the truth. (As he writes in Fat Chance, obesity-related “diseases are eating away our health care dollars faster than we can print the money to pay for them.”) He hasn’t done much original research on this topic, which drives his endocrinology colleagues crazy. His sloppy errors leave experts wanting to, as one told me, “stick knitting needles” in their eyes. Lustig’s most prominent role is as an ideas man, a popularizer, a 60 Minutes talking head. When I asked him if he still did musical theater, he said, “Now I give lectures.”

This academic year Lustig is on partial sabbatical from the UCSF School of Medicine and attending Hastings College of the Law. Before he enrolled at Hastings he met with 14 lawyers; all agreed that case law supports using the judiciary to alter public health policy to moderate sugar consumption. “All health debacles were originally categorized as personal travails before they were declared public health issues,” Lustig writes in Fat Chance. “What if our breakfast cereal was laced with heroin by some unscrupulous food company?” Whose fault would it be if people became addicted? “Isn’t it the role of the government to protect us?”

One day this fall I attended a public health seminar at Hastings with Lustig. He had just received his first finished copy of Fat Chance. Still dressed as a doctor, in a sport coat and slacks, he ate a Trader Joe’s wrap for lunch and passed around his hardback, with a blurb by Alec Baldwin on the back cover. Most of Lustig’s fellow law students wore knee-high boots, cuffed jeans, bangle earrings. A few sipped Nantucket Nectars. The teacher was drinking a 16-ounce Coke. The topic of the day was compulsory vaccination. While the other law students cited the assigned reading, Lustig spoke personally, with great authority, as if he considered himself to be more than just a bystander to public health history. “When does a public health message become a public health intervention?” he asked rhetorically. “Happens all the time. I’ve seen it with tobacco: scientists who did not intend to become advocates found themselves in that position.”

Lustig grew up in Brooklyn. He loved Stuyvesant High School and MIT—the brilliant, eclectic students; his musical theater gigs—but hated Cornell Medical College. “The most dehumanizing experience of my life,” he told me. “Wherever you came from, you were supposed to think the same, act the same, study the same. The object was to create 100 carbon copies of the ideal medical student.” This was anathema to Lustig. He likes to stand out.

In 1995, when Lustig was a pediatric endocrinology attending physician at St. Jude Children’s Research Hospital in Memphis, Tennessee, a group of children with brain tumors set him on his career course. Lustig noticed that, after neurosurgery to remove the tumors, the children showed signs of hypothalamic obesity. Their hypothalamuses were damaged, and as a result their bodies started producing too much insulin. All became lethargic and fat. Then Lustig prescribed octreotide, a drug that blocks insulin. With no counseling or any effort at behavior modification, all of the children started eating less, moving more, and losing weight. According to Lustig, elated parents started calling him, saying, “I got my kid back!” A follow-up study, in 1998, showed that insulin suppression using the same medication caused weight loss in 20 percent of obese adults. Lustig concluded that adiposity—fatness—must stem from a hormonal problem, not a behavioral one. In other words, fat people eat too much and gain excess weight because chemical imbalances make them hungrier and lazier than they should be. These hormonal imbalances cause the behavior, not the other way around. So if you want to fix the behavior, you have to fix the biochemistry.