A spoonful of sugar may have helped the medicine go down when Julie Andrews sang the song, but fast forward to the 21st century and sugar isn't looking so sweet. Today in a provocative commentary in the journal Nature, researchers argue that sugar is so toxic to our bodies, it should be regulated in the same way alcohol and tobacco are.
The three writers, all from UC San Francisco, say that every country that has adopted the Western diet, with its hallmark of highly-processed food, has seen rising rates of obesity and the diseases that go with it, such as heart disease and diabetes. But, in a turn, they argue against blaming obesity itself. "Obesity is not the cause," they write, "rather, it is a marker for metabolic dysfunction, which is even more prevalent." Metabolic syndrome leads to diabetes, high blood pressure, heart disease, fatty liver disease and even cancer, they say.
And the culprit, they insist, is sugar, particularly its fructose component. "Fructose, which is the sweet part of sugar," said co-author Robert Lustig in an interview, "is toxic beyond its caloric equivalent." People often refer to sugar as "empty calories," but they are far from that, the writers say. "A growing body of scientific evidence shows that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills slowly."
At this point I was getting a sinking feeling. Maybe it's the way smokers felt when the bad news started coming out about tobacco in the late 50s and early 60s.
Sugar consumption has tripled worldwide in the last 50 years, the writers assert, and they say to combat the myriad health problems we face today, regulation is necessary. Sugar meets four criteria that merit government action. "The first in unavoidability," Lustig said, "it's everywhere. The second is toxicity beyond its calories. The third is potential for abuse because it activates the same areas of the brain as alcohol and tobacco creating a cycle of consumption and disease, and the fourth is negative impact on society." The negative impact on society is largely seen through high health care costs because of the many diseases associated with high sugar consumption.
The authors suggest a combination of taxes on processed foods that contain sugar, and limiting access to children through tighter controls on vending machines in schools, for example. They also recommend promoting healthier foods in government programs for the poor, including the Women, Infants and Children program and Supplemental Nutrition Assistance Program (formerly called Food Stamps).
Not surprisingly, the Sugar Association doesn't buy much of this. In a statement on their website, the Association says:
... the assertion that a food is less healthy just because it contains sugar is misleading and not science based. Numerous studies have confirmed that sugar makes many healthful foods palatable, which helps contribute to intakes of key vitamins and minerals necessary to maintain good health.
But Lustig views today's commentary as the "opening salvo" in a long public health discussion. "I don't expect anything to change anytime soon," he said. "Nothing in public health changes overnight. It's not possible to."
And judging from some of the comments on a CNN story about the issue today, Lustig is right. Here are just two examples:
- "unbelievable nannyism. But I forgot that this is America, the land of the hopelessly dependent and depressingly irresponsible,"
- "This article should be regulated as total garbage."
But as the writers close their commentary in Nature, they point to other public health issues: the bans on smoking in public places; the promotion of the designated driver; and airbags in cars. "These simple measures--which have all been on the battleground of American politics--are now taken for granted as essential tools for our public health and wellbeing," Lustig said. "It's time to turn our attention to sugar."