The Politics of Sugar

05/01/2011 12:34 pm ET | Updated Jul 01, 2011

We -- Americans, and ever more of the global population -- eat too much sugar, and eating too much sugar is bad for us. ("Too much" of anything is bad for us, hence the name.)

One of the reasons we eat too much sugar is because high-fructose corn syrup can be derived inexpensively from subsidized corn. An inexpensive sugar source makes it economical for food manufacturers to add copious amounts of sugar to our diets. The more sugar we get, the more we eat, and the more we want. So high-fructose corn syrup is an important reason we eat too much sugar, and eating too much sugar is bad for us. That, in turn, is why high-fructose corn syrup is bad for us; because it contributes to our excessive sugar intake. What makes HFCS bad is far more about quantity, than quality.

Qualitatively, HFCS and table sugar -- sucrose -- are all but identical, both biochemically and metabolically. Sucrose is comprised of pairings of glucose and fructose in a 1:1 ratio. HFCS can have a bit more fructose than glucose, or vice versa, but averages out very close to that same 1:1. Swapping out sugar for HFCS, or the opposite, is a lateral move -- and not one for which food manufacturers deserve any credit or thanks.

That's just about the whole story, stripped of any sugar coating.

Since my recent post on sugar, I've "enjoyed" comments from many of you; learned lots of new things about hummingbirds; entered an ongoing and spirited dialogue with Dr. Robert Lustig I look forward to continuing; shared in a briefer and slightly-less-cordial exchange with Gary Taubes; and have had cause to rethink my indulgence in literary flourishes.

The take-away messages here are too important to get lost in a sauce of hummingbirds and breast milk.

All nutritionists of any standing recognize that an excess of sugar is among the cardinal problems of the typical American diet (and other diets resembling it around the world). I know of virtually no nutrition or health professionals who fail to recognize this.

Further, formal guidance to limit intake of added sugar is provided by the Dietary Guidelines for Americans; the Dietary Reference Intakes of the Institute of Medicine; the World Health Organization; the American Dietetic Association; the American Diabetes Association; the American Cancer Society; the American Heart Association; the American Academy of Pediatrics; and just about everybody else.

So there is nothing remotely newsworthy in noting that an excess of sugar is harmful. To get headlines on this topic, you have to be more provocative than that. Others say sugar is bad -- maybe news can be made by claiming that sugar is poison, whether or not it's true. (Since sugar, in the form of glucose, is manufactured by our bodies and circulates in our blood, labeling it 'poison' is intrinsically problematic.)

Dr. Lustig, in his video and his published work, emphasizes the unique potential harms of fructose as opposed to sugar in general. Leaving aside the legitimacy of the case against fructose, the question arises: how is it relevant? Much of the sugar in the food supply is either sucrose, or high-fructose corn syrup. They may sound very different, but as noted above, they are not. Both are roughly half fructose.

As for fructose on its own, it's found in fruit, which is clearly not a problem, and fruit juice, which can be when consumed in excess, but is much less of a problem than soda. So then, on what basis is there an indictment of fructose to be made?

Hard on the heels of all this sugary hullabaloo came a report in the Journal of Consumer Research telling us this:

"...'healthy' consumers who strive to eat a wholesome and healthy diet may become so focused on trying to eat well that they become more likely to choose unhealthy foods that are labelled as healthy. "

I have seen this many times, so it comes as no surprise to me. In fact, the very notion that more nutritious foods inevitably cost more is actually urban legend, propagated by food labeling. Food that claims to be, or implies it is, more nutritious, reliably does cost more -- because the shopper seeking out better nutrition is willing to spend more to get it. But often, perhaps more often than not, such food is more expensive, and less nutritious! Talk about adding insult to injury.

This is not merely my opinion; we've studied it. Using objective criteria to distinguish more from less nutritious foods, we found no net difference in price.

We have also seen, in the course of applying the NuVal scoring system to roughly 100,000 foods, innumerable examples where the product implying better nutrition on the basis of one nutrient attribute has lesser nutritional quality overall. One prime example of this is low-fat peanut butter, from which a bit of healthy oil is removed, and to which a lot of sugar and salt are added. On the NuVal scale, regular peanut butter scores a 20 on average; low-fat peanut butter scores a lamentable 7. Another example was a "1/3 less sugar" cereal, that did have less sugar- but also less fiber, more sodium, more trans fat, more starch, and poorer overall nutrition! A clear example of the dangers in vesting all dietary ills in any one nutrient.

Then, of course, there is the recent history of diet trends. We just cut fat, and got fatter and sicker because our diet quality did not improve. We just cut carbs, and repeated the folly. We might, now, just cut sugar, or fructose, and play it again, Sam. The ONAAT fallacy is a real and recurrent threat.

You might well find the case against sugar convincing. But T. Colin Campbell makes a similarly compelling case against animal protein. I recently had a discussion with Dr. Caldwell Esselstyn at a conference at the Cleveland Clinic, and he showed every sign of having as elaborate an argument prepared against lecithin.

If there are multiple contenders for the single nutrient that is public health enemy #1, the logical conclusion is that none is. If researchers who focus on alternative metabolic pathways can use them to indict alternative nutrients as causes of epidemic obesity and related chronic disease, it strongly suggests that no one such indictment may be taken too seriously. We should round up all of the usual suspects!

The reality has always been, and remains, that the overall quality of our foods, and our diets, is what matters to our health. Competing theories about which bad thing is worst, or which good thing is best about our diets have long distracted us, and may simply forestall progress in a favorable direction.

Let's not let that happen...again.

Dr. David L. Katz;