Hi. My name is Anna and I’m a sugar addict. (“Hi, Anna…”)
But I’m giving it up. Really! Since my toddler started mimicking my every move, I decided that instilling in her the best possible food habits meant kicking my own worst ones. For the past two months, I’ve had a zero-sugar policy on all weekdays. (Next step: no-sugar weekends). I’ve been clean for, um, let’s see, about 43 hours and 22 minutes.
I’m only partially joking. Addiction is serious; I don’t mean to make light of life-saving recovery programs. But sugar, even more than caffeine, is a substance I use and abuse. I self-medicate with sugar—for fatigue, stress, mood, pain.
Yep, I have a problem. But, I’m clearly not alone.
Americans are sugar junkies. According to the USDA, in 2000, Americans consumed an average 152 pounds of caloric sweeteners. “That amounted to more than two-fifths of a pound—or 52 teaspoonfuls—of added sugars per person per day.”
Since I’m waging my own private war on sugar these days, and as a fairly new mom looking for answers about nutrition for my kid, recent buzz about sugar being not only bad, but downright toxic caught my attention.
We know sugar is making us fat and diabetic and that it’s bad for our teeth, but is it also contributing to other chronic ailments like cancer, heart disease, and high blood pressure?
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Conventional medical wisdom has been that sugar is bad because it represents empty calories—and we’ve linked it to obesity and diabetes. Sugar is also a pretty common tag-along for “bad” fats (think: donuts).
But is sugar evil?
Robert Lustig says yes. And he’s getting lots of attention for his unconventional claims—including a piece by Gary Taubes in Sunday’s New York Times Magazine and a lecture he gave, gone viral on YouTube with over a million views. A specialist on pediatric hormone disorders and a leading expert in childhood obesity, Lustig says sugar “should be thought of, like cigarettes and alcohol, as something that’s killing us.” (By “sugar” he means both sucrose—beet and cane sugar, whether white or brown–and high-fructose corn syrup. He says they’re both poison.)
His lecture, given in 2009 at University of California, San Francisco, School of Medicine (where Lustig has his own practice) outlines both the biochemical properties of fructose and the political context in which it exists. His campaign against sugar has sparked some interesting debate in the medical community (see responses from Dr. Gerard Mullin, director of integrative gastrointestinal nutrition services at Johns Hopkins Hospital in the Los Angeles Times and nutrition expert and internist Dr. David Katz who pans Lustig’s claims at Huffington Post, writing, as one rebuttal, that “[b]reast milk—and I trust no one is foolhardy enough to suggest that breast milk is evil!—is a sugar-sweetened beverage.” Honestly, Katz doesn’t seem to have watched the lecture.)
Lustig argues that sugar consumption in the quantities that Americans are consuming it “is an independent risk factor for heart disease, high blood pressure and many common cancers.”
He makes a convincing case that fructose which not only metabolizes in our bodies as fat (making a low-fat, high-sugar diet pretty much worthless—for weight loss as well as disease prevention), but also claims that fructose basically has the properties of a poison, working in pretty much exactly the same way in our livers as alcohol and causing similar types of long-term havoc.
Unlike beer or vodka, of course, fructose is a substance we regularly feed to our kids.
Here’s the dumbed-down (by me) version of Lustig’s spiel for those of you who don’t have an hour and a half to watch the lecture.
First, the biochemical basics:
At the core of Lustig’s argument is the idea that all calories are not created (or metabolized) equally.
Lustig compares how the body processes glucose, ethanol and sucrose (50 percent fructose, 50 percent glucose).
- Take 120 calories of glucose (approximately two slices of white bread) and, Lustig says, 80 percent will be consumed by all the cells in the body for energy, with only 20 percent landing in the liver. The liver can handle this amount pretty well. Plus, with glucose, there’s a healthy feedback circuit between the liver, brain, pancreas—so once we’ve eaten, we get signals that we’re not hungry anymore.
- Compare that to 120 calories of ethanol (Lustig says that’s about one shot of Maker’s Mark). Twenty-four of the calories—or just 10 percent—go to the body’s cells for energy to burn, while a whopping 96 calories hit the liver, 4 times more than the same caloric intake from glucose.
- Now take 120 calories of sucrose (a glass of orange juice or some soda). Sucrose is half glucose and half fructose. Of the sixty glucose calories, 12 make it to liver, 48 to to the rest of the body (same 20/80 split as the carb-heavy bread). But all 60 calories of fructose are metabolized by the liver because only the liver can metabolize fructose. With glucose we had 24 calories going straight to the liver, now we have 72 calories in total. Lustig says it’s a volume issue.
More reasons Lustig says we should fear fructose…
- Processing fructose creates a lot of uric acid—a waste product that causes hypertension.
- Fructose is metabolized as fat, according to Lustig. When you consume it, Lustig says, 30 percent ends up as stored fat. Fructose also activates “new fat” creating enzymes—“the dyslipidemia of obesity.”
- Notably, unlike glucose, fructose does not suppress the hunger hormone, so your brain thinks you’re still hungry even after a binge.
- Fructose does not stimulate insulin (also a factor in making the brain not register that you ate something). It increases insulin resistance and liver insulin resistance.
- A significant amount of the fat from fructose never makes it out of the liver. A fatty liver is a risk for heart disease.
- Though many in the medical establishment don’t think it’s proven, Lustig says that chronic fructose exposure causes metabolic syndrome— the name for a group of health factors that occur together and increase the risk for coronary artery disease, stroke, and type 2 diabetes.
- Indeed, Lustig says that fructose is a compound that’s “foreign to your body that must be processed by the liver and causes a chain reaction of negative effects on the body.” Normally, he says, we call that a poison. In fact, Lustig says, fructose causes 8 out of 12 of the same chronic conditions known to be caused by chronic alcohol consumption, including hypertension, myocardial infarction, lipid disorder (too many fatty substances in your blood—a.k.a. dyslipidemia), pancreatitis, obesity, hepatic dysfunction, fetal insulin resistance, inflammation, and addiction.
He’s emphatic when it comes to the comparison to alcohol. “Fructose is ethanol without the buzz. A can of beer is just as bad as a can of Coke for your liver,” he says. His point is that alcohol—technically ethanol—is fermented sugar. Only alcohol is metabolized in the brain and fructose is not. One is a controlled substance, regulated by
the FDA and the other is available in seemingly unlimited quantities in the American diet.
So that brings us to the political stuff.
The political context:
Lustig talks about the “Fructosification of America,” explaining that prior to WWII, Americans consumed about 20 grams of fructose a day. In 1977 we had doubled that amount to 37 grams a day (8 percent of our total caloric intake). In 1994 it was 57 grams (10 percent of calories). Today, it’s almost 75 grams per day. “Adolescence consume 15 percent of their calories from fructose alone!” Taubes also reminds us that “In 1980, roughly one in seven Americans was obese, and almost six million were diabetic, and the obesity rates, at least, hadn’t changed significantly in the 20 years previously. By the early 2000s, when sugar consumption peaked, one in every three Americans was obese, and 14 million were diabetic”
If admitting you have a problem is the first step to recovery, America has work to do. For starters, Lustig says we’d need to undo thirty years of nutrition and food policy that gives a free pass to sugar without setting guidelines for safe amounts. The FDA only regulates acute toxins. Fructose, is what Lustig calls a chronic toxin. As he explains it: “it’s not toxic after one meal, but after 1,000 meals, but that’s how many we eat.” However, “lack of scientific agreement about the amount of sugars that can be consumed in a healthy diet,” as several FDA reports have phrased it, has been interpreted as an exoneration of sugar.
Taubes says that “that perception influenced the treatment of sugar in the landmark reports on diet and health that came after.”
Ironically, the chief author of the FDA reports, Walter Glinsmann (who now is an adviser to the Corn Refiners Association) says sugar, like any other substance under the sun, could be toxic if consumed in ways or in quantities that are unnatural for humans.
Even to the casual bystander (me), it looks like we’ve probably reached unnatural quantities.
Of course, there are socio-economic factors in play here as well—and Lustig addresses these too. America’s culture of food—in which high-calorie food is cheap, ubiquitous, and heavily marketed adn in which many low-income families live closer to convenience stores than real supermarkets—makes it harder and harder, especially for the poorest Americans and their kids—to make healthy choices. As NYT food blogger Mark Bittman laments, “14.6 percent of low-income preschool—PRESCHOOL—age children are obese, according to a 2009 report by the Centers for Disease Control.”
Clark here at Sightline has written often about how our diets are largely a function of the economics of food: “when fats and sweets are cheap, we eat more of them! Low prices are a powerful inducement for poor eating.” Plus, as Clark has pointed out, we’ve created a web of subsidies—everything from agricultural research to tax breaks to direct payments to farmers—that favor empty calories (e.g., corn syrup, vegetable oils, animal fats) over healthier foods, like fruits and vegetables. Meanwhile, Harvard professor of pediatrics David Ludwig points out, the government does not subsidize far healthier items like fruits, vegetables, beans, and nuts. “It’s a perverse situation,” he says. “The foods that are the worst for us have an artificially low price, and the best foods cost more.”
Call me crazy, but all of this makes soda and candy taxes sound like pretty decent ideas. There are smart people floating proposals that would create financial incentives to help tip the scales (no pun intended) away from all that cheap sugary food and drink. A recent experimental study conducted by researchers from the University of Buffalo School of Medicine and Biomedical Sciences found that taxing unhealthy foods was more effective at encouraging more healthful diets than subsidizing healthy foods. According to the abstract, “taxing less healthy foods with low nutrient density reduced energy (caloric) intake, while reducing the proportion of fat and increasing the proportion of protein purchased. Subsidizing more healthful foods with high nutrient density increased energy intake, without changing the macronutrient profile of foods purchased.”
And as Mark Bittman reported recently “the USDA’s Economic Research Service estimates that a hypothetical 20 percent tax on sugar-sweetened beverages in grocery stores and restaurants could result in an average yearly weight loss of 3.8 pounds for adults and 4.5 pounds for kids.” Not bad.
But Washingtonians, for their part, voted to discontinue existing sugar taxes this past November (It was by the way one of the most heavily funded campaigns in state history, mostly due to millions spent by soda and sugar lobbies).
Can Americans kick the habit? Can I?
Some of Lustig’s claims don’t sit well with his peers, but his practical advice for his young patients struggling with obesity is far from outrageous. He recommends four simple steps. To me they look like steps that would benefit all of us, whether you think sugar is evil or simply empty:
- Stop drinking sugar beverages—all of them. This includes pop, “sports drinks,” and juice. Notably, the diet only works for Lustig’s patients when sugar beverages are successfully eliminated.
- Always eat carbohydrates with fiber. According to Lustig, fiber is important because it helps reverse some of the ill effects of fructose, improving liver function, reducing the rate of carbohydrate in your gut, increasing signals to the brain that you’re no longer hungry, and inhibiting absorption of free fatty acids that suppress insulin. “When God made the poison he packaged it with the antidote,” says Lustig. “Wherever there’s fructose in nature, there’s way more fiber.” That’s why Lustig encourages eating fruit even though it often contains significant amounts of fructose.
- Wait 20 minutes for second portions. This allows signals to get to your brain (via hormones, including leptin) that tell you you’re no longer hungry.
- “Buy” screen time, minute for minute, with physical activity. Exercise, according to Lustig, is not so important for burning calories, but hugely important for reducing stress (which helps decrease appetite), improving insulin levels, and raising metabolism. Nobody can burn c
alories fast enough, he insists. It’s more about what kind of calories you eat than the numbers—and fructose has to go.
It may be that Lustig has gone too far by declaring war on sugar. It’s easy to dismiss (as many have) that this is just another in a long line of “all-or-nothing” nutrition and diet “fads.” We’ve gone down similar roads before—fat is bad (now we know there are good fats); carbs are bad (we know that there are good carbs and bad carbs).
The question is, even if you take Lustig’s claims with a grain of salt, what do Americans have to lose by reducing our inordinate sugar intake? Pounds—for one thing! And by cutting back on sugar, we’d be on our way to fewer cases of diabetes and obesity.
And if Lustig is correct about more serious damage caused by fructose, we ward off certain cancers and the specter of cardiovascular disease in the bargain. All the better.
Unfortunately it’s a matter of will power. For the time being, it looks like fructose is going to remain cheap and easy to come by. Lustig says, “it’s up to us.” He says he’s recruiting Americans in the war against bad food, because sugar isn’t going to be regulated.
For my part, going low sugar hasn’t been easy. I have had lapses of judgment and failures of will on a daily basis. But if my efforts help start my daughter on the right track to a lifetime of more healthful eating, my struggle is worth it.
That said, I probably won’t turn into a militant anti-sugar mom who serves carrot sticks instead of cake at birthday parties. But I’ll certainly limit my daughter’s intake and I’ll be keeping an eye on the debate among top nutritionists for a final verdict on sugar--evil or just really bad for you?
Image courtesy EmmiP of MorgueFile.
Thumbnail image: Sugar / Uwe Hermann / CC BY-SA 2.0
John Weaver MD
Anna I love you!I wish you would consider learning more about how the sweet and innocent fruit sugar molecule has been forced to do horrible things to us humans. Please, no… Pretty please be nice and read http:/FructoseFree.com Then consider helping me save us humans. I can tell from all you write about that you are the ONE. JohnWeaverMD@gmail.com.
So if “A can of beer is just as bad as a can of Coke for your liver” and liver problems beget obesity problems, why then were our colonial ancestors, who drank gallons (and gallons) of alcohol every year, not fat? First it was an excess of dietary fat that made America obese, now it’s fructose. What’s it going to be tomorrow? Everyone’s looking for the “silver bullet” theory of obesity when something as complex as human metabolism can’t be reduced so readily to one cause. Diet is certainly a part of the problem but genetics, activity level, and a host of other factors come into play as well.
Colonial ancestors’ average life expectancy: 35 years. Not a good example.
Sucrose breaks down into glucose and fructose, so any sugar intake will make our livers work. And sugar, in moderate amounts is normal human food – we like sweetness because sugar is good food. It’s too much sugar that’s the problem, and too high a fructose:glucose ratio that makes high fructose corn sweetener damaging.Moderation in all things.
In times gone by sugar was difficult to come by and was treatedlike a luxury. Now processed breakfast foods that are the standardfare in busy homes are laced with sugar while the advertisingtouts the wonderful effects of whole grain, or whatever.There should be a law against advertising to children whenhigh sugar content is in the product. At age 90 I hate cooking so I make it easy for myself.I shop for fresh vegetables, fruits, salmon and prepare simpledishes without using factory prepared frozen foods or packagedmeals. But yes, I love chocolate and have to restrict my use of it.You know that cholocate produces the same chemicala reaction of being in love. Well, I am dating again so I won’t need so muchof that, right?
First, I have to admit that I made a coconut cream pie this weekend. Probably the worst pie vis-a-vis sugar content. But, boy was it good!Sean—I don’t know enough about beer or sugar to answer your question. I don’t know how many gallons they consumed in the American colonies. You aren’t alone thinking this is just another nutrition fad. And Americans in the colonies were certainly eating less fat and getting WAY more exercise—both are significant factors in any diet. But I think what Lustig is saying is not that alcohol consumption would make people fat (although there is the beer belly) but that fructose and ethanol both act in similar ways on the liver—basically as poisons—hitting it with too much to process all at once. Ethanol and fructose both have high numbers of calories that can *only* be processed by the liver and cannot be turned into energy for the rest of the body’s cells. That’s how I understand it. Over time, they both work as chronic toxins that damage the liver and set up chain reactions that lead to risks for chronic diseases.Sugarholics are like alcoholics in that we consume large amounts all at once. Corn syrup is one big part of that problem—it’s a super efficient delivery system (especially in liquids). That brings us to soft drinks—which may be the biggest culprit in America’s sugar problem. One thing I left out of this post (because it was getting way too long as it was) is Lustig’s description what he calls the “Coca-Cola Conspiracy.” Not only have drink sizes increased over the years , Lustig points out, the recipes often include salt (hidden by excessive amounts of sugar) which make consumers thirstier as they drink, encouraging more consumption. A bottle of Coke used to be only 8 ounces—one a day would make for about 15 pounds of new fat over the course of a year. A Big Gulp (44 oz) a day would get you over 50 pounds of fat in a year. The soft drink association says there’s absolutely no association between sugar consumption and obesity. But hundreds of independent scientific peer reviewed studies refute this claim. Georgie—you are wonderful! We could all learn a thing or two from your healthful diet of simple, delicious ingredients prepared without much fuss. So glad to hear you are dating! I’ve heard that dark chocolate is still pretty good for you (and has less sugar than milk chocolate).
Matt the Engineer
I’ll join you Anna. This sounds like the perfect diet to keep me away from the candy machine 20′ from my desk: knowing that I can walk to a bakery and have real food (that sure doesn’t sound like a diet, but as long as I can keep portion sizes down I should be ok).My diet rules:1. 6 days a week no fructose, sucrose, or any sugar that can break down to fructose. Fruit is allowed.2. One day a week I’ll let myself have a limited amount of sugar. So those coconut cream pie emergencies don’t make me give up on the diet.3. Start with reasonable portion sizes, wait 20 minutes before getting seconds.4. Serious increase in excercise (that should be easy – summer’s here!).Oh, and I found this detailed NY Times story on this subject published this month.