Sugar commentary sparks controversy

February 8, 2012

In a commentary published in Nature, researchers at the University of California, San Francisco state that sugar should be controlled like alcohol and tobacco to protect public health. Robert Lustig, Laura Schmidt, and Claire Brindis argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet make it a primary culprit of this worldwide health crisis.

This partnership of scientists trained in endocrinology, sociology, and public health took a new look at the accumulating scientific evidence on sugar. Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones, and causes significant damage to the liver—the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, the researchers argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40% of people with metabolic syndrome—the key metabolic changes that lead to diabetes, heart disease, and cancer—are not clinically obese.

The authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar. Many of the interventions that have reduced alcohol and tobacco consumption can be models for addressing the sugar problem, such as levying special sales taxes, controlling access, and tightening licensing requirements on vending machines and snack bars that sell high sugar products in schools and workplaces.

The American Beverage Association has issued a statement in response to the commentary: “The authors of this commentary attempt to address the critical global health issue of non-communicable diseases such as heart disease and diabetes. However, in doing so, their comparison of sugar to alcohol and tobacco is simply without scientific merit. Moreover, an isolated focus on a single ingredient such as sugar or fructose to address health issues noted by the World Health Organization to be caused by multiple factors, including tobacco use, harmful alcohol use, an unhealthy diet and lack of physical activity, is an oversimplification. There is no evidence that focusing solely on reducing sugar intake would have any meaningful public health impact. Importantly, we know that the body of scientific evidence does not support that sugar, in any of its various forms—including fructose, is a unique cause of chronic health conditions such as obesity, diabetes, hypertension, cardiovascular disease or metabolic syndrome.”

In addition, The Sugar Association Inc. responded that, “We consider it irresponsible when health professionals use their platforms to instill fear by using words like ‘diabetes,’ ‘cancer,’ and even ‘death,’ without so much as one disclaimer about the fact that the incomplete science being referenced is inconclusive at best.”

UCSF press release

Nature abstract

ABA statement

Sugar Association statement