Flash in the Pan 

Sugar: How sweet it isn't

Sugar is a danger to society and should be regulated like alcohol and tobacco. So says an opinion piece published in the journal Nature. The authors blame sugar consumption for the fact that "[l]ast September the United Nations declared that for the first time in human history, chronic non-communicable diseases such as heart disease, cancer and diabetes pose a greater health burden worldwide than do infectious diseases, contributing to 35 million deaths annually."

The article's lead author is Dr. Robert Lustig of the Department of Pediatrics at the University of California, San Francisco. Lustig is well known for an oft-viewed YouTube video of his lecture Sugar: the Bitter Truth. In it, Lustig argues that sugar, especially fructose (which makes up half of sucrose, aka table sugar), causes fat deposits in the liver, which leads to insulin resistance, which causes the body to create too much insulin. Insulin resistance causes diabetes, has been linked to hypertension and promotes tumor growth in the colon and the breast. In the liver, fructose is converted to palmitate, which correlates with an increased risk of heart disease.

The combination of high blood pressure, high blood sugar, excess body fat and abnormal cholesterol levels is called metabolic syndrome, and it leads to increased risk of heart disease, stroke and diabetes. In their Nature article, Lustig and company put the blame for metabolic syndrome on the sweet shoulders of sugar.

Worldwide sugar consumption tripled in the last 50 years, they write. That has created a public health crisis on par with those created by alcohol and tobacco. "Passive smoking and drunk-driving fatalities provided strong arguments for tobacco and alcohol control, respectively," they write. "The long-term economic, health-care and human costs of metabolic syndrome place sugar overconsumption in the same category."

Skeptics of the anti-sugar case, including the sugar industry, often point to an observation called "the Australian Paradox." Sugar consumption in Australia declined by 16 percent between 1980 and 2003. During the same period, Australian obesity rates tripled.

The Australian Paradox suggests that added sugar is not the only cause of obesity, which will come as no surprise to those who've successfully lost weight through carb-cutting diets like Atkins. Processed carbohydrates, like those in pasta and bread, are quickly broken down to simple sugars in the body.

While not addressing the Australian Paradox directly, Lustig et al. make it clear that while sugar can lead to obesity, it's sugar that's the problem, not obesity. "Many people think that obesity is the root cause of these diseases. But 20 percent of obese people have normal metabolism and will have a normal lifespan. Conversely, up to 40 percent of normal-weight people develop the diseases that constitute the metabolic syndrome."

Thus, the Australian Paradox can be explained be people eating more processed carbohydrates, even if their sugar consumption is down.

click to enlarge PHOTO BY ARI LEVAUX

After making their case against added dietary sugar, the authors go on to suggest ways the government could regulate added sugars, including a sugar tax, distribution controls and age limits.

It's one thing to argue that too much sugar is a bad thing; regulating it as a controlled substance is a more complicated sell. Lustig would be the first to agree, as he pointed out in his famous lecture, that government meddling against the boogeyman du jour helped trigger an increase in sugar consumption to begin with. USDA efforts in the early 1980s to decrease our fat intake compelled food processors to add sugar in order to make processed fat-free foods more palatable.

Even if government meddling were based on sound science, it's fair to argue that personal accountability coupled with education would be a more effective way to address the problems posed by sugar. Empowering the food police to dictate what we eat, on the other hand, would annoy a lot of people.

But then,what happens when the uninsured sugar-sick show up at the hospital, and we all have to pay for their treatment in the form of higher medical costs? As Lustig and his co-authors note, "The United States spends $65 billion in lost productivity and $150 billion on health-care resources annually for morbidities associated with metabolic syndrome."

They suggest other measures to counter added sugars, like a sugar tax that could help pay for treatment of the diseases associated with metabolic syndrome. They also suggest barring foods with added sugars from the list of foodstuffs purchasable with food stamps.

These measures, and others they suggest, have potential, but in the U.S. they would face strong opposition from the politically powerful sugar industry. So it's surprising that Lustig and company make no mention of the governmental support the sugar industry receives.

This support includes low-interest loans to sugar producers and limits on sugar imports, which help boost sugar prices by keeping out cheap foreign imports.

Eliminating price supports would allow the price of sugar to drop. If sugar were cheaper, one could argue, that might encourage food processors to use more of it. But on the other hand, allowing the price of sugar drop would create space for a sugar tax to bring the price back up to where it was, and the revenue generated by this tax could be used to offset sugar-related medical expenses, as Lustig and company suggest.

More importantly, removing the American sugar industry's sweetheart deals would reduce its profits, and hence its ability to fight against the public's perception of the dangers of sugar. A weaker sugar industry would be less able to lobby against measures like food-stamp reform or a sugar tax. As the ancient saying goes, the enemy of my enemy is my friend. What's bad for the sugar industry is good for public health.

Dismantling governmental support for the sugar industry may not be a complete solution to this complicated worldwide problem, but it's an obvious place to start.

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