Should sugar be regulated like alcohol? That's the premise of a new position paper, published today in the journal Nature by three leading obesity researchers from the University of California, San Francisco School of Medicine.
They argue that added sugar in all forms -- sucrose and high-fructose corn syrup alike -- is as perilous to public health as a controlled substance like alcohol. Bolstering their argument with statistics on obesity and other chronic disease, as well as evidence that our bodies process sugar in a way that is harmful to our health, they advocate for regulation to temper sugar consumption worldwide.
The researchers' main impetus came from a 2010 United Nations report revealing, for the first time, that more people are dying from chronic, non-communicable diseases, so-called "lifestyle diseases" like heart disease, than from infectious disease. "The UN announcement targets tobacco, alcohol and diet as the central risk factors in non-communicable disease," wrote the researchers. "Two of these three -- tobacco and alcohol -- are regulated by governments to protect public health, leaving one of the primary culprits behind this worldwide health crisis unchecked."
The paper's lead author, pediatric endocrinologist Dr. Robert Lustig, is well known for this line of argument, most notably in his popular lecture, "Sugar: The Bitter Truth" -- a YouTube phenomenon with close to 2 million hits. It's rare that a medical researcher achieves world-wide renown -- or that an endocrinology lecture goes viral, for that matter -- but his argument is a compelling one. He explains that our bodies process fructose in much the same way they process alcohol and other poisons. Sugar isn't just a source of empty calories, responsible for obesity and Type 2 diabetes, in this scenario: at high quantities, it is a full-fledged toxicant and contributes to many of the major fatal non-communicable conditions, like cardiovascular disease and cancer.
Explained Gary Taubes in a New York Times Magazine cover story in April of 2011 on the subject:
The fructose component of sugar and H.F.C.S. is metabolized primarily by the liver, while the glucose from sugar and starches is metabolized by every cell in the body. Consuming sugar (fructose and glucose) means more work for the liver than if you consumed the same number of calories of starch (glucose). And if you take that sugar in liquid form -- soda or fruit juices -- the fructose and glucose will hit the liver more quickly than if you consume them, say, in an apple (or several apples, to get what researchers would call the equivalent dose of sugar). The speed with which the liver has to do its work will also affect how it metabolizes the fructose and glucose.
"It's not about the calories," Lustig is quoted in the New York Times Magazine as saying. "It has nothing to do with the calories. It's a poison by itself."
Now, in this new position paper Lustig and his colleagues, Laura A. Schmidt and Claire D. Brindis, take the argument a bit further. They apply criteria used to justify the control of alcohol (pervasiveness, toxicity, potential for abuse and negative impact on society) to sugar. Not only is sugar toxic in high doses, they argue, high doses are unavoidable in modern society. They write:
Evolutionarily, sugar as fruit was available to our ancestors for only a few months a year (at harvest time), or as honey, which was guarded by bees. But in recent years, sugar has been added to virtually every processed food, limiting consumer choice. Nature made sugar hard to get; man made it easy. In many parts of the world, people are consuming an average of more than 500 calories per day from added sugar alone.
They recommend implementing stopgaps to sugar access -- strategies like enacting sugar taxes, placing age limits on food purchases and limiting advertising of sugar-sweetened foods.
Do you agree? Should we control added sugar? Let us know in the comments.
For more, here are the paper's authors in conversation: