According to the 1964 Walt Disney musical “Mary Poppins,” just a spoonful of sugar helps the medicine go down. But while sugar may help the medicine go down, you don’t hear anyone singing these praises anymore. Instead, many in the healthcare community claim that “sugar is toxic,” “sugar causes obesity,” and “sugar makes you fat.”
The Debate Over Health Effects of
High Sugar Consumption Continues
For decades, both consumers and health experts have been pondering the potential negative health effects related to sugar consumption. The classic 1986 book “Sugar Blues” by William Dufty exploded onto the sugar-busting scene. People were shocked to read they were consuming, on average, 100 lbs. of sugar per year.
Fast forward to today, when Americans are consuming even more of the sweet stuff. According to the U.S. Department of Agriculture (USDA), per capita consumption of caloric sweeteners, mainly sucrose and corn sugars, increased 39 percent between the 1950s and 2000 to an average of 152 lbs. per year.(1) People are now eating an average of about 30 tsps of sugar per day, which contributes a whopping 476 kcal per day.(2)
And along with the rise in sugar intake has come a growing sense of dread among the public over the potential health fallout. Findings from the International Food Information Council Foundation 2012 Food & Health Survey revealed consumers’ attitudes about sugar and health. Consumers were asked which calorie sources (sugars, carbohydrates, fats, protein, or all sources) they believe are more responsible for weight gain. 20 percent said calories from sugars are most responsible. While 62 percent believed a moderate amount can be part of a healthful diet and 61 percent said it’s not necessary to completely eliminate sugar to lose weight. Only 28 percent believed all sugars (including high-fructose corn syrup (HFCS), table sugar, and honey) are similar and used by the body in the same way. 51 percent of Americans are trying to limit or avoid sugars when choosing foods and beverages, while 35 percent pay no attention to sugar content.(3)
Sugar hits the airwaves
What’s fueling the public’s sugar fears? “Consumers have been hearing for years the stories linking sugar to hyperactivity, diabetes, obesity, and other chronic diseases,” says Jeannie Gazzaniga-Moloo, PhD, RD, a national spokesperson for the Academy of Nutrition and Dietetics (AND). “They’ve also heard reports disputing connections between sugar and all these conditions. I think many consumers are confused about sugar’s role in disease development and management.”
The volume on the sugar-health debate turned up a notch when a recent wave of media reports called on the opinions of Robert H. Lustig, MD, a professor of pediatrics in the division of endocrinology at the University of California, San Francisco, who’s a leader in the anti-sugar movement. Lustig has spoken out at several recent nutrition conferences on the adverse health effects of sugar, including the Annual Nutrition & Health Conference and the Experimental Biology meeting.
Lustig reported at the Annual Nutrition & Health Conference in May 2011 that fructose intake, an egregious component in the Western diet, has doubled over the past 30 years from all its sources, including HFCS, sucrose, and juice. “The ‘fructosification’ of our food supply increases its palatability. Low-quality foods have high-fructose corn syrup added on purpose. It’s used as a browning agent,” Lustig said.
He reported that our growing dependence on fructose has fueled the obesity and type 2 diabetes epidemics and has led to increased energy intake, decreased resting energy expenditure, excess fat deposition, nonalcoholic fatty liver disease, insulin resistance, hyperglycemia, cardiovascular disease, and metabolic syndrome in humans.
Lustig has become a hit among mainstream audiences, thanks to his YouTube lecture, “Sugar: The Bitter Truth,” which has received more than 2.6 million hits to date. In April, 60 Minutes aired a segment featuring Lustig as an expert on sugar and health. He reported that sugar is toxic and that it’s to blame for the public health crisis more than any other food substance.(4)
One year earlier, Lustig was featured in a New York Times article titled “Is Sugar Toxic?”, which was written by Gary Taubes, author of “Good Calories, Bad Calories,” who shares similar views as Lustig. Sugar isn’t just an empty calorie, Lustig argues in the article. Its effects on us are much more insidious. “It’s a poison by itself,” Lustig was quoted as saying. Taubes wrote:
“Lustig’s argument, however, is not about the consumption of empty calories. Biochemists have made the same case previously, though not so publicly. It is that sugar has unique characteristics, specifically in the way the human body metabolizes the fructose in it, that may make it singularly harmful if consumed in sufficient quantities.”(5)
Is sugar really dangerous?
Lustig’s views on sugar and health bring to light the crux of the sugar argument, raising the question, is there proof that the negative impact of sugar extends beyond its provision of empty calories?
“The concept that sugar is toxic simply has no credibility,” says David M. Klurfeld, PhD, national program leader for the Human Nutrition USDA Agricultural Research Service, who edited a June 2009 Journal of Nutrition supplement, titled “The State of the Science on Dietary Sweeteners Containing Fructose.” “There’s little doubt that Americans consume too much sugar, but we have no data to tell us how much is too much for any health endpoint we ask about.”
Walter Willett, DrPH, MD, chair of the Department of Nutrition at the Harvard School of Public Health, says, “There are problems with sugar due to adverse metabolic effects, but the idea that fructose is dangerous – the science doesn’t support this. To only focus on sugar as the problem, the science isn’t there. There may be subtle metabolic differences in the body with fructose. Cutting back on sugar is an important part of a healthful diet, along with cutting back on refined starches and fruit juice, which have the same glycemic load as sugar.”
The 2009 American Heart Association’s (AHA) “Scientific Statement on Dietary Sugars Intake and Cardiovascular Health” reported that excessive consumption of sugars has been linked with several metabolic abnormalities and adverse health conditions. Though the mechanisms are unclear, relative to other carbohydrate sources, sugar intake appears to be associated with increased triglyceride levels, a known risk factor for coronary heart disease, and some studies show that a higher consumption of high-sugar beverages and foods is associated with increased inflammation and oxidative stress, according to the AHA.
While acknowledging that obesity is a multi-factorial condition, it’s likely that Americans’ recent history of weight gain must be related in part to increased intake of added sugars, even though research thus far has been insufficient to confirm a direct link, the AHA stated.(2)
Almost everyone agrees that the increase in sugar intake has led to a sea of unwanted calories. The Dietary Guidelines for Americans report that added sugars are consumed in excessive amounts, resulting in a high intake of calories that offer little nutritional payback. However, the guidelines state that foods with added sugars are no more likely to contribute to weight gain than any other source of calories in an eating pattern that’s within calorie limits.(6)
Joanne Slavin, PhD, RD, a professor in the Department of Food Science and Nutrition at the University of Minnesota who served on the 2010 Dietary Guidelines Advisory Committee, says, “There’s no data that refined sugar or refined starch have different metabolic effects, except that fructose is a lower glycemic than glucose.”
Kelly Brownell, PhD, a professor at Yale University and director of the Yale Rudd Center for Food Policy & Obesity, sums it up: “Sugar is a major issue, but it will take more science for us to know whether it promotes all of these metabolic effects. Sugar is certainly an important culprit in the obesity problem, but it’s not the only one. Sugar is important for several reasons: It’s added to the diet in large amounts; it makes things extremely palatable so that it pushes people to over consume it; and it’s a major source of calories, especially from sugars added to beverages.”
The sugar landscape
Consider that our early ancestors never knew the intensely sweet flavor of refined sugar; they knew only honey and fruit. Since early humans had to battle the bees for a taste of honey, the mild natural sweetness of sugar, which came packed with nutrients and fiber, defined our knowledge of sweetness.
“The brain didn’t evolve to handle sugar and the amounts not found in nature,” Brownell says. “Once it became processed and we started putting sugar in so many foods, the body doesn’t know how to recognize it. When I go back to when I was a boy, the number of fast-food restaurants was much lower and the available size and containers for foods were much smaller. Sugar-sweetened beverages were reserved for special occasions, and they were in smaller bottles. Now they’re huge, and there’s sugar in so many foods now. The sugar landscape has changed in profound ways.”