The Sour Side of Sugar

The sugar industry, like the tobacco industry, wants to hide something from you. It doesn’t want you to know it’s killing you.

In September 2016, The New York Times revealed that in the 1960s, the sugar industry paid Harvard researchers the modern equivalent of $50,000 to say that fat, not sugar, was the dietary villain causing an uptick in chronic disease. The Harvard studies paved the way for half a century of public health policy that ignored the health risks of sugar and insisted that a low-fat diet was the way to prevent heart attacks and obesity. In 1954 sugar lobbyist Harry Hess said that the industry’s goal was to teach “people who had never had a course in biochemistry . . . that sugar is what keeps every human being alive with energy to face our daily problems.” The lobbying was effective. A USDA table on sugar consumption shows sugar use almost doubling from 1966 — the first year on the table — to 2015.

Correlated with the rise in sugar consumption is the rise in obesity. The Centers for Disease Control and Prevention reports a 655 percent increase in the number of Americans diagnosed with diabetes — almost all of that type 2, or acquired, diabetes — since the 1950s. The obesity epidemic, according to the British science journal The Lancet, “is a bigger health crisis globally than hunger, and the leading cause of disabilities around the world.” A paper from the Harvard School of Public Health notes that “two out of three adults and one out of three children in the United States are overweight or obese, and the nation spends an estimated $190 billion a year treating obesity-related health conditions.”

What’s causing the explosion in obesity and related health problems like diabetes and heart disease? Traditional nutrition science blames such problems on an “energy imbalance,” but others say that sugar is the culprit.

In his new book The Case against Sugar, science writer Gary Taubes sets out to demonstrate beyond a doubt that sugar is a killer. Just as smoking turned out to be a unique cause of lung cancer, he says, evidence is mounting that sugar consumption is a unique cause of diabetes. The “energy

TAUBES ARGUES IN HIS BOOK THAT IT’S NOT JUST DIABETICS AND THE OVERWEIGHT WHO BENEFIT FROM SLASHING SUGAR FROM THEIR DIETS

BUT ALSO PEOPLE PRONE TO CORONARY HEART DISEASE, CANCER AND ALZHEIMER’S DISEASE. ALL ARE CHRONIC DISEASES LINKED WITH INFLAMMATION, WHICH IS CLEARLY WORSENED BY A HIGH-SUGAR DIET.

imbalance” theory “ignores decades of medical science, including much of what has become textbook endocrinology,” he writes in a January 2017 article for The New York Times that summarizes the tenets of his book. “By the 1960s, researchers . . . had clearly demonstrated that different carbohydrates, like glucose and fructose, are metabolized differently, leading to different hormonal and physiological responses, and that fat accumulation and metabolism were influenced profoundly by these hormones.”

Dr. Madhavi Garimella, an endocrinologist in Los Alamos who specializes in diabetes and other metabolic disorders, explained the process: “Insulin is a hormone that is produced by the pancreas in response to elevated levels of sugar in the blood,” she said. “Insulin is like a key which then unlocks muscles and liver cells to let the blood glucose in. It is then used as energy or stored. It also promotes storage as fat. Consequently, the more sugar we eat, the more insulin we need to produce to process it. The more weight we gain, the harder the pancreas has to work to produce more insulin to process the sugars. The body then stops responding to insulin the way it should: we develop insulin resistance. The pancreas keeps working harder to overcome this, and eventually the amount of insulin you produce is not sufficient to keep the sugar levels normal, leading to prediabetes and then diabetes if no dietary modification is made.”

The evidence of sugar as a unique instigator of insulin resistance is so convincing from a scientific and medical point of view, Garimella said, that when she sees patients with diabetes and insulin resistance, she starts by examining their diets. “I always talk about diet first for diabetic patients. Our goal is to reduce the need for more medicine,” she said. “Absolutely no sugar is the best thing; there is no room for refined sugar in the diet. But if you do indulge, the WHO [World Health Organization] suggests getting 5 percent of calories from sugar. No more.” That’s 25 grams or less per day for a 2,000-calorie diet. For perspective, the average American consumes 82 grams of sugar per day.

Taubes argues in his book that it’s not just diabetics and the overweight who benefit from slashing sugar from their diets but also people prone to coronary heart disease, cancer and Alzheimer’s disease. All are chronic diseases linked with inflammation, which is clearly worsened by a high-sugar diet. But don’t just turn to alternative sweeteners like honey, agave syrup or stevia for your sweet fix, Garimella warned: “We have to be aware of things that are so-called natural but are not better. You can’t trick the gut.” The body responds to natural sugars such as honey and to artificial sugars such as sucralose in similar ways. It’s best, she said (and Taubes agrees), to kick the sweets entirely.

Because the sugar industry has been so successful at sneaking its product into virtually everything we consume, cutting sugar can be trickier than you’d think. Sweetened beverages like sodas and sports drinks are the primary culprit and the first thing to cut, but consumers should read labels to find hidden sugars, Taubes says. “Sugar has become an ingredient avoidable in prepared and packaged foods only by concerted and determined effort, effectively ubiquitous,” he writes in his book. “Not just in obvious sweet foods — candy bars, cookies, ice creams, chocolates, sodas, juices, sports and energy drinks, sweetened ice tea, jams and jellies, and breakfast cereals (both cold and hot) — but also in peanut butter, salad dressing, ketchup, barbecue sauces, canned soups, cold cuts, luncheon meats, bacon, hot dogs, pretzels, chips, roasted peanuts, spaghetti sauces, canned tomatoes, and breads.”

Garimella agreed. “You really want to get your ‘sugars’ from complex carbs, which you can do by shopping the periphery of the grocery store, avoiding food in boxes and packets,” she said. “Cereal is really not a healthy food choice. Avoid sugary drinks: preferably drink water. Eat the fruit — don’t drink the juice — and beware of diet drinks as well.” In a departure from standard nutritional orthodoxy, she recommends eating foods that contain their natural fats. “Choosing low-fat is not a better option,” she said. “Low-fat usually means more carbs, and it’s often not natural.”

The chronic diseases associated with excess sugar consumption aren’t just unpleasant and expensive: they kill. A 2015 American Heart Association paper estimated the disease burden caused by “sugar-sweetened beverage consumption” and found that 184,000 deaths worldwide each year were associated with sugary-beverage consumption. That includes deaths related to diabetes mellitus (type 2), heart disease and cancer. Meanwhile, the sugar industry maintains, as an industry ad asserted decades ago, “All foods supply calories and there is no difference between the calories that come from sugar or steak or grapefruit or ice cream.” The numbers tell a different story.