Public health: The toxic truth about sugar

Journal name:
Nature
Volume:
482,
Pages:
27–29
Date published:
DOI:
doi:10.1038/482027a
Published online

Added sweeteners pose dangers to health that justify controlling them like alcohol, argue Robert H. Lustig, Laura A. Schmidt and Claire D. Brindis.

References

  1. Lustig, R. H. J. Am. Diet. Assoc. 110, 13071321 (2010).
  2. Babor, T. et al. Alcohol: No Ordinary Commodity: Research and Public Policy (Oxford Univ. Press, 2003).
  3. Vio, F. & Uauy, R. in Food Policy for Developing Countries: Case Studies (eds Pinstrup-Andersen, P. & Cheng, F.) No. 9–5 (2007); available at http://go.nature.com/prjsk4
  4. Joint WHO/FAO Expert Consultation. Diet, Nutrition and the Prevention of Chronic Diseases WHO Technical Report Series 916 (WHO; 2003).
  5. Tappy, L., Lê, K. A., Tran, C. & Paquot, N. Nutrition 26, 10441049 (2010).
  6. Garber, A. K. & Lustig, R. H. Curr. Drug Abuse Rev. 4, 146162 (2011).
  7. Finkelstein, E. A., Fiebelkorn, I. C. & Wang, G. Health Aff. W3 (suppl.), 219226 (2003).
  8. Engelhard, C. L., Garson, A. Jr & Dorn, S. Reducing Obesity: Policy Strategies from the Tobacco Wars (Urban Institute, 2009); available at http://go.nature.com/w4o5uk
  9. Room, R., Schmidt, L. A., Rehm, J. & Mäkela P. Br. Med. J. 337, a2364 (2008).
  10. Sturm, R., Powell L. M., Chriqui, J. F. & Chaloupka, F. J. Health Aff. 29, 10521058 (2010).

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Author information

Affiliations

  1. Robert H. Lustig is in the Department of Pediatrics and the Center for Obesity Assessment, Study and Treatment at the University of California, San Francisco, California 94143, USA.

  2. Laura A. Schmidt is at the Clinical and Translational Science Institute and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California 94118, USA.

  3. Claire D. Brindis is at the Clinical and Translational Science Institute and the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California 94118, USA.

Corresponding author

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Comments

  1. Report this comment #38056

    Geoff Russell said:

    Australia provides a natural test of the sugar-is-the-evil-bullet theory. We don't produce much corn here, so continue to use cane sugar for most of our sweetening. In the 1960s we didn't have an obesity epidemic. How much sugar did we consume? According to the FAO, 52.3 kg per person per year in 1965 (of 55kg total sweeteners).

    What about now, in the midst of our own obesity and type 2 diabetes epidemics?

    We are down to 39.6 kg of cane sugar per person per year, with an additional 8kg of non-sugar sweeteners. Overall there has been a modest decline in all sugars despite a rise in obesity and diabetes. How has our food supply has changed over the past 4 decades? We have more Calories. If may be tempting to attribute the US obesity crisis to sugars, but obesity increases elsewhere demonstrate that more Calories and less exercise are a sufficient explanation.

    Similarly, compare Cuba and Italy. Cuba consumes 500 kCal per day of sugar and Italy just 300 kCal, Italy has an obesity/type 2 diabetes problem while Cuba's rates are very low. Historically, Cuba has eaten even more sugar than she does now ... without the evil consequences that this article portends.

  2. Report this comment #38071

    Martin Klvana said:

    No one has the right to punish anybody for eating sugar. If I want to eat sugar, smoke cigarettes, drink alcohol etc. it is my own decision; no one but me has the right to regulate my sugar/nicotine/alcohol intake. Why? Because my body is my property. Governments can make laws to come up with novel ways to steal property from people — that's all governments do after all — and yes, tax is theft — and regulation of sugar intake by governments will be yet another anti-human action — like the ongoing anti-fat and pro-grain propaganda — and I can't help myself from thinking that governments want to kill people. And that puzzles me a bit.

  3. Report this comment #38091

    David Horowitz said:

    From the article: "It can also be argued that fructose exerts toxic effects on the liver that are similar to those of alcohol. This is no surprise, because alcohol is derived from the fermentation of sugar."

    This is nonsense. Alcohol results from fermentation, by definition under anaerobic conditions. I am not sure what that has to do with human metabolism of fructose. The "logic" of the argument appears to be that any chemical will share the toxic properties of any of its biological metabolites in any organism. Fructose (or glucose), for example, is metabolized to formaldehyde in people (in the synthetic pathway for methylene-tetrahydrofolate). Fructose, using the novel blame-the-precursor argument, should share the toxic properties of formaldehyde.

    I am going to assume that the rest of this Comment is similarly grounded.

  4. Report this comment #38106

    Leon Rozanov said:

    That is true, the phrase "...because alcohol is derived from the fermentation of sugar" may be nonsense, and yet there is a great deal of good sense in what the author states. If you actually follow the references, particularly the first one, "Fructose: Metabolic, Hedonic, and Societal Parallels with Ethanol", you will see that there are indeed molecular parallels in metabolism of fructose and ethanol. To a large degree that article discusses other parallels as well, and this might be not such a bad perspective to view the problem: after all, by simply picking on the logic in a certain sentence you don't make a real existing problem of obesity go away. At the same time following the authors' advices could actually help solving part of it.
    The fact is that sugar is addictive. With a strong will and some luck you might never fall victim of sweet cravings, but there are other people out there with different lives and characters. It could be a matter of the future, yet I believe that some day most people will recognize the priority of common good over petty selfish claims.
    There is one serious problem with the proposed solutions however: we can fight for a healthier society all we want, but in the end it's the system itself that promotes the use of addictive substances. In other words, isn't it more sane to face the real obstacle: consumerism and unsustainable model of economy because these drive obesity a lot stronger than fructose and ethanol combined.

  5. Report this comment #38121

    Arun Karpur said:

    I commend these scientists to have brought a laser sharp view on consumption of sugar and its impact on public health. I believe as a knowledge-based society we need to introspect with the tools that science offers to examine ways of making our lives better. One of the arguments made against the govermental regulation is that everyone would like to attribute their behaivor to personal choice. Well, my question to those who belive personal choice will regulate our behavior, then why do we have an epidemic of obesity despite us knowing that it is costing us a whole lot in terms of healthcare expenditures. With food business engaging in neuro-marketing practices (General Mills included) it is hard for one to belive that self-control will previal, especially when business have used strategy to marketing to the very human instinct of desire controlled by our brain. Also, it would be irresponsible to say that I do not want government to regulate. In fact many in US and around the world have not learnt lessons from the economic down fall due to lack of regulations. Besides, it was the government that came to rescue for the disingenous practices of corporates, meaning taxpayers ultimately had to bail out. When we as citizens expect government to bail us out during dire circumstances that we ourselves create, I belive it is utterly irresponsible as well as disingenous to stand against government regulations.

  6. Report this comment #38125

    Sean Elliott said:

    Hey do you know what else directly causes thousands of deaths a year, in large quantities can have the same effect as alcohol, and is abused mostly in developed countries? Dihydrogen monoxide. Maybe we should regulate and tax Dihydrogen monoxide in the same way we do alcohol.

  7. Report this comment #38133

    Mauricio Fabbri said:

    Just a remark about Martin Klvana´s comment. Your body is certainly your property, but, as it applies to any other private property you might have, there are rights and duties. You must agree with your duties when you are of age and decided to live in society. So the issue is not solved as simply as that.

  8. Report this comment #38134

    Balu Vemula said:

    A remark about Sean Elliott's comment: Water (dihydrogen monoxide) would not be considered to have abuse potential. Reference page 2 of this DEA document: http://www.justice.gov/dea/pubs/abuse/doa-p.pdf

    What one can say about any substance, even water, is that at a high enough dose/amount, any substance can be lethal.

  9. Report this comment #38165

    Donald Weaver said:

    It seems to be a bit premature to be discussing regulatory action against something as basic as sugar. Obesity and metabolic syndrome are extremely complex issues that we still understand poorly. The relative contribution of various factors remains controversial.
    However, obesity does not occur when one is undernourished. After WWII, we have made great inroads in the fight against hunger and probably "overshot" in many areas. We have also changed the types and processing of our food dramatically in the US. Fast foods with fiber depletion, "predigestion", and excess fats/carbohydrates cause changes in the endocrine response to food ingestion. The other factor which does not get enough attention is exercise. Multiple studies have shown exercise improves the hormonal correlates of the metabolic syndrome and that it is necessary for sustained weight control. This problem would likely cease to exist if we worked like our ancestors.
    Perhaps we should remember the old aphorism - "For every complex problem there is usually a simple straight forward answer – and it is usually wrong."

  10. Report this comment #38167

    Edward A. Oates said:

    Many of the ailments mentioned by the authors increase in frequency and severity as people age: heart disease, hypertension, etc. The author notes increases in "metabolic syndrome" problems as sugar consumption has increased in the last few decades, but does not show that this statistic has been age adjusted. That is, if 30 years ago, life expectancy was significantly lower that it is today, then then to be alarmed about sugar consumption would require that these metabolic syndrome diseases increased in the same age groups, not overall.

    We all eventually die of something; unless these studies are life span adjusted, we don't know if we are just seeing increases in diseases that would have occurred 30 years ago if people lived longer.

  11. Report this comment #38220

    Aishwarya Swaminathan said:

    Any food consumed in excess is a problem. If one person is addicted to candy someone else may be addicted to potato chips. While this is a problem, I believe these suggested regulations are a bit extreme. Yesterday we battles against trans-fat, today it's against sugar tomorrow it may be against something new that we discover we've become addicted to. Patient and continued education about healthy eating habits is the need of the hour.
    The government cannot restrict what we choose to eat. I believe it defies democracy. May be the government should just ban food all together and propose nutrition pills with a specified amount of calories and a precise proportion of all nutrients. That'll get us all healthy.

  12. Report this comment #38222

    Kim de Riel said:

    I agree with Don Weaver's point about the significance of exercise. He says "This problem would likely cease to exist if we worked like our ancestors." You don't have to go that far back! A huge change has occurred over the course of my career. I'm an academic. I spend a lot of time reading and writing. Not exactly manual labor. But, 25 years ago, I would walk over to the library most afternoons and scamper around for a couple hours with armloads of bound journals. Today I can do the same job — faster and better — without budging from my computer station.

    Our "epidemic" of obesity is a result of the sedentary lifestyle visited on us by the electronic revolution. Want to cure it? Eat your fructose and get rid of your computer. Of course I'm being facetious. We all know that's not going to happen. We are addicted all right, and not to sugar.

  13. Report this comment #38265

    Kevin Cahill said:

    The authors are right: governments should limit the amount of sugar the processed-food industry adds to its products. But why stop with sugar? Governments also should limit added fat and sodium.

  14. Report this comment #38272

    Andres B. Fernandez-Revelles said:

    High vitamin A ingestion, or high serum retinol have been postulated to increase the risk of fractures and osteoporosis by reduced bone mineral density. Drinking water is good for health and should drink at least 2 or 3 liters of water. And referring to what he says Seam Elliott Dihydrogen monoxide is water, do not try to divert attention from the reader with technical jargon. That if people die every year by natural disasters or drowned in the swimming pool access imprudence. If I advise everyone to learn to swim well and so there would be fewer accidents in the summer, swim frequently also helps to burn the sugar we eat.

  15. Report this comment #38285

    Jerry Cowhig said:

    Another reference worth citing by these authors is John Yudkin's book "Pure, White and Deadly", 1972, which implicated sugar in many diseases including coronary heart disease and Type II diabetes. The book was controversial and influential, summarising decades of Yudkin's research and anti-sugar advocacy. John Yudkin was Professor of Nutrition and Dietetics at London University and an early promoter of the low carbohydrate diet.

  16. Report this comment #38356

    William Barendse said:

    With regards to the comment above using FAO data for Australia, Italy and Cuba to test the influence of sugar on health and obesity, such a comparison is no substitute for a mechanistic understanding of the issue. Firstly, FAO food supply data do not take account of wastage or changes in accuracy of recording over time. Secondly, one may look at the data and pick some other food use statistic that is changing and link that to changes in rates of obesity. Rather, there is good evidence that easily digested carbohydrates such as sucrose are causally involved in these diseases.

  17. Report this comment #38460

    Raymond Mawson said:

    The Australian situation is probably related to the relaxing of government regulation on the extraction rate required for white flour milling, which also occured at about this time, that significantly reduced the amount of complex carbohydrate in the flour. All in the name of whiter flour and higher extension (loaf volume). So much so that standard Australian white bread has a higher glycemic index (metabollic impact) than pure glucose. I belive the highest correlate to obesity in Australia is time spent in front to the television, not the computer or gaming console. The latter keep the brain ticking over and burning significant glucose and reduce snacking. But I agree excersise is also key to solving this problem, I fell very sluggish if I am not excersising.

  18. Report this comment #38490

    Fred Brouns said:

    It is premature and there is insufficient science to make any such recommendation!
    Have banana's, apricots, apples, honey and all other foods that are relatively rich in fructose, as well as juices suddenly become toxic and bad for your health.?
    Our body does not make a difference in absorbing and metabolizing fructose whether it comes from an intrinsic source or as added sugar.
    Moreover,there is no difference in metabolic effects of sugars contained in a soft drink or a juice.
    Although there is sufficient science to substantiate that pure fructose in very high dosages has detrimental effects, there is not such good evidence when fructose is consumed along with glucose, as it is in virtually all foods and drinks, by humans in amounts as consumed by most humans.
    Drinking too much water may cause water intoxication en death as has been observed in plenty of cases. Do we therefore need to say that water is toxic and put extra taxes on water?

    Putting the finger on aded sugar is as a cause of obesity misleading the public as well as policy makers about the" truth of obesity "and isolated reductions in added sugar intake will certainly not lead to a decrease in obesity rates. Similar misconceptions concerning added fats and the desired reduction in fat intake have completely failed in the past.
    The fact that now sugar is the culprit is a consequence of yet blaming something else than our personal responsibility to remain physically active and consume less food overall. Why are over 40% of US pets overweight and suffering for diabetes and CVD. NOT because they consume so much sugars! Rather because they are not taken out to exercise and consume all day long bits and pieces of the food that is surrounding us all day.We have studied many professional athletes such as cyclists and triathletes who regularly consume large amounts of sugars (during competitions exceeding 500g/day) as energy drinks. We have never observed any detrimental effect in these athletes. non of them has show any evidence of impaired insulin sensitivity or overweight.
    Accordingly, sugar is isolation does NOT cause obesity. This does not mean that the food and drink industry should not make an attempt to reduce the energy density of foods and drinks. This, however, concerns apart from sugar content also fat and starch content. Sugar as such is not toxic. The "thought that it is is toxic" Long ago Paracelsus stated "All is poison and nothing is without poison, only the dose (exposure) determines its safety".
    Prof Dr Fred Brouns
    Chair "Health Food Innovation"
    Faculty of Health, Medicine and Life Sciences
    Dept of Human Biology
    Maastricht University
    Maastricht, Netherlands

  19. Report this comment #38542

    Karl Brand said:

    @Martin Klvana I can sympathise with your desire for dietary liberty. By all means live it up. But please do so in a country without social health care. I don't want my tax contributions covering the consequences of your indulgence. We have (some) social health care here in Holland, so for me cigarettes can't cost enough. Now that I have children, I 'd gladly welcome any measures which reduce the availability of sugar. And it's their generation who'll be the doctors doing the lipectomies for those determined to exercise their liberties. Best hope they haven't over indulged before treating you.

  20. Report this comment #38615

    Brian Ward said:

    If you want to legislate sugar, then you should also legislate exercise.

    Why hit things just from one side? Inactivity is the real problem. I say we ban lunch breaks, force all work-providers to install gyms and tracks at their site, and make people exercise instead!!!

    Bleahhh what a crock... Nature loves to publish alarmist articles.

  21. Report this comment #39679

    Roseann Campbell said:

    Posted on behalf of Brian Williams

    On reading the excellent paper by Lustig et al. on ?The toxic truth about sugar?1 I was reminded of the book published 46 years ago by Cleave and Campbell on what they called the Saccharine Disease.2 Campbell, who I knew well, remains one of the unsung heroes of public health in South Africa. He argued then that refined carbohydrates, especially sugars, are addictive, not needed and may eventually kill you, and that for these reasons they should be included in the list of banned substances. Their book may have been one of the first to take a Darwinian view of diet and health and Sir Richard Doll, in his foreword wrote that ?If only a small part of [the predictions made in this book prove to be correct] the authors will have made a bigger contribution to medicine than most University Departments of medical research units make in the course of a generation?. Living in KwaZulu-Natal, the main sugar producing province of South Africa, these arguments did not find favour with Campbell?s compatriots.

    In their book Cleave and Campbell considered the impact of refined carbohydrates on diabetes, obesity, dental caries, peptic ulcer, coronary disease and diseases caused by certain strains of Escherichia coli. As a result of this work Cleave and Campbell were invited to make representations to the United States Senate Select Committee on Nutrition and Human Needs chaired by Senator George McGovern in 1970. It would be encouraging if their early studies, now confirmed, supported and extended as described in the article by Lustig et al.1, were to bring about a change in attitudes to refined carbohydrates and lead to a significant improvement in public health throughout the world.

    References

    1 Lustig, R. H., Schmidt, L. A. & Brindis, C. D. Public health: The toxic truth about sugar. Nature 482, 27-29 (2012).
    2 Cleave, T. L. & Campbell, G. D. Diabetes, coronary thrombosis and the saccharine disease. (John Wright & Sons, 1966).

  22. Report this comment #39981

    Roseann Campbell said:

    posted on behalf of Richard Hammersley

    Since the 1970s, sugars have been compared with drugs and alcohol regarding harmfulness and dependence potential. Fructose in high doses seems metabolically problematic, but links between other sugars and health are complex.

    Were sugars to be regulated, what would count as ?sugar?? Many starches convert rapidly to sugars so should starches be regulated too? Actually there is no such thing as ?sugar?, only sugars. Maybe fructose should be regulated, but not other sugars? An intensely sweetened diet may promote over-eating and obesity. So would all sweeteners be regulated? Sweetness may be a primary reinforcer. The history of regulating basic human appetites for sex, power, money and drugs, is not edifying.

    Lustig et al are enthusiastic about regulating sugars, like alcohol. While regulating alcohol prevents some of the wilder public health abuses such as methanol poisoning, sadly in many countries alcohol regulations are ineffectual, for instance alcohol brands can still sponsor sports and music events, and examining the World Health Organization data on alcohol, there is very little correlation between the regulation of alcohol and national intake. Comparing the USA and Europe, the USA is in the middle for alcohol regulation and drinks more lightly than anywhere in Europe. Across Europe, strict regulations and high prices occur in some of the heaviest drinking countries and some of the lightest drinking ones. The heavy drinking countries think it would be even worse without regulation, the light drinking ones think that they have succeeded.

    It may be feasible to tax added sugar products, but for alcohol high tax has led to strategic increases in the alcohol content of some drinks; many wines are now over 13% alcohol. If products got sweeter and more expensive this would be counterproductive. The disadvantages of regulation also include displacing consumption, for sugars probably on to artificial intense sweeteners, which may be as or more psychologically problematic, generating a black market, and abdicating social controls and norms (which must be what cause variations in alcohol intake) to gangsters, as has happened with drugs. We do not want sugar dealers selling candy at the school gates.

    Richard Hammersley
    Marie Reid
    Department of Psychology
    University of Hull

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