The war on sugar is raging again.
This week, Walt Disney announced that it's going to stop advertising junk food to kids on its TV channels, radio station and website by 2015. It's eliminating ads for sugar-laden fruit drinks, candy and snack cakes.
Last week, New York Mayor Michael Bloomberg outlined a plan to ban large-size sugary beverages sold at the city's restaurants, movie theaters, sports venues and street carts. Some states and cities are working on "soda taxes" on sugary drinks. And in recent years, major health groups have discouraged the consumption of large amounts of added sugars.
The motivation is clear: The USA is in a full-fledged state of hand-wringing about overweight Americans who are among the most obese in the world and are heavier than they've ever been before.
It's a battle being waged on a number of front lines: Schools are beefing up their offering of fruits and vegetables, food and beverage marketers are being strong-armed to change how they market to kids and trans fats have been squeezed out of most processed foods.
Increasingly, the focus is being placed on sugar, the sweetener with a history that goes back 8,000 years.
Is something so sweet really that harmful to health? Or is it just being maligned as people look for a scapegoat for the obesity epidemic?
The American Heart Association says in a statement that research has tied a high intake of added sugars to many poor health conditions, including obesity, high blood pressure, type 2 diabetes and other risk factors for heart disease and stroke.
Diabetes educators often advise people with diabetes and pre-diabetes to watch their sugar intake, especially their consumption of sugary beverages. Nutritionists have said for years that sugar represents empty calories with no nutritional value.
The consumption of added sugars, especially from sugar-sweetened beverages, among some people in the country "is out of control," says Rachel Johnson, a spokeswoman for the American Heart Association and a nutrition professor at the University of Vermont.
Americans adults consume an average of 22 teaspoons a day, or about 355 calories, from added sugars, Johnson says. Every teaspoon has 15 to 16 calories.
You don't remember adding 22 teaspoons of sugar to your coffee or cereal?
Consider that sugar is used in everything from cakes, candy and cookies to muffins, jams, chocolates and ice cream.
People are downing table sugar, brown sugar, high-fructose corn syrup (in soda), maple syrup, honey, molasses and other caloric sweeteners. Added sugars make their way into many prepared and processed foods and beverages, from soda, sweet tea and lemonade to energy drinks and sports drinks.
One 16-ounce serving of regular soda, the proposed NYC cap, contains the equivalent of at least 12 teaspoons of sugar, says Cynthia Sass, a registered dietitian in New York City. "Many of my clients don't realize how much hidden sugar creeps into their diet, even in foods that don't seem sweet, like salad dressing, soups and crackers."
Sugar is "toxic" in the amount it's consumed by Americans, says pediatric endocrinologist Rob Lustig, a professor of pediatrics at the University of California-San Francisco and one of the country's most vocal critics of added sugars.
A little bit is OK, but it's the quantity that people are consuming that's harmful, Lustig says. "Everyone knows the dose determines the poison. I agree with that. There is a threshold, and right now we are way above that threshold."
The heart association recommends that most American women consume no more than 6 teaspoons a day, about 100 calories, from added sugars, Johnson says. For men, it's 9 teaspoons or about 150 calories. Kids should limit their intake to about the same amount, she says.
Others say not so fast. Added sugars have been "unfairly demonized" by some researchers, and "the reality is much more complicated," says James Rippe, a cardiologist who studies nutrition and fitness. He's worked with the food industry, including the Corn Refiners Association, which represents companies that make high-fructose corn syrup and other corn products. "Obesity is a bad problem, but to single out one component of the diet as a silver bullet to fix it is fantasy.
"And it distracts us from the serious multifaceted national commitment that we must have to solve this enormous public health problem of obesity," he says.
Sugar doesn't deserve to take the rap for the country's weight problem, says Andy Briscoe, president and CEO of the Sugar Association. "Sugar has been around for thousands of years. It's all natural. It's 15 calories (a teaspoon). It has been used safely by consumers by our grandmothers and our grandmothers' grandmothers."
What the research says
Research about the effects of excessive intake of sugary foods and drinks is coming out all the time, and there's not much that's reassuring, says Marion Nestle, a nutrition professor at New York University and co-author of Why Calories Count: From Science to Politics.
Johnson says recent studies show a link between high consumption of sugar-sweetened beverages and high blood pressure. So no surprise that when researchers conducted a study of people who reduced that consumption, their blood pressure dropped.
People with diabetes or pre-diabetes are often advised to watch their sugar intake. "The first thing we tell people to do for the prevention or management of diabetes is to not drink sugar-sweetened beverages," says Stephanie Dunbar, director of clinical affairs for the American Diabetes Association.
When someone with diabetes drinks a large quantity of sugary beverage, they get a huge dose of sugar at one time, she says. It hits their system quickly, raising blood glucose levels, she says.
That's not healthy for anyone, especially someone with diabetes or pre-diabetes, because high blood glucose causes damage to blood vessels, increasing risk of complications such as heart attacks, amputations and blindness, she says.
There are many kinds of studies that show sugared beverage consumption is linked to increased risk of obesity and type 2 diabetes, says Kelly Brownell, director of Yale University's Rudd Center for Food Policy and Obesity. There are a few studies showing no links, mainly funded by the beverage industry, but these stand against study after study showing that these beverages are having harmful health consequences, he says.
Is sugar to blame?
Much of the fuss about sugar comes because of questions about its role in a nation that has become way too heavy.
Thirty-six percent of adults in this country are obese, which is roughly 30 or more pounds over a healthy weight. About a third of children are overweight or obese. Obesity increases the risk of many chronic diseases including type 2 diabetes, heart disease and cancer.
Is sugar to blame for our bulging waistlines?
Overall, calorie intake has gone up since 1970, and about 16% to 17% of people's total daily calories come from added sugars, according to the U.S. Department of Agriculture's Economic Research Service.
Sugar is just one reason for obesity, but for many people, it's the big reason, Nestle says. "Some overweight kids drink 1,000 to 2,000 calories a day from sodas alone, and sweet desserts are a major source of calories in American diets."
The most important health concern about sugar intake is that it adds calories to the diet, which can be a ticket to weight gain and obesity, agrees Samuel Klein, director of the Center for Human Nutrition at Washington University School of Medicine in St. Louis. "The calories we consume in beverages that contain sugar do not make us feel as full as when we eat the same amount of calories in solid food, so consuming large amounts of sugar-sweetened beverages or fruit juices can pack on the pounds."
Klein, an expert on fatty liver disease, says that when you gain weight, fat can accumulate in your liver and reduce the effectiveness of insulin, the hormone that regulates blood sugar. Extra body fat affects the liver, and your pancreas works harder to try to keep blood sugar normal.
Whether or not you're overweight, consuming high amounts of sugar can increase triglycerides (blood fats) and increase fat production in your liver, he says. Possible explanations: High amounts of fructose, found in both sugar and high fructose corn syrup, can cause chemical reactions in the liver that lead to health problems, he says.
For many people, reducing the consumption of high-sugar beverages is a good first step for maintaining a proper body weight and improving their health, Klein says.
When it comes to added sugars' impact on health, including the liver, Rippe says, "this is some of the most complex biochemistry you can ever imagine. The literature on this is very mixed."
As for sugar's impact on obesity, Rippe says, "Americans are eating about 425 calories a day more than they were in 1970, according to the government statistics, but only 9% of those increased calories come from added sugars."
Briscoe adds: Most foods and beverages add calories to the diet and can lead to weight gain and obesity if overconsumed, "so we do not feel sugar should be singled out. We need to look at total caloric intake in the fight against obesity."
The addiction question
Studies on food and addiction show that sugar works on the brain very much like classic substances of abuse, Yale's Brownell says. He has researched the topic for an upcoming book, Food and Addiction: A Comprehensive Handbook. "Sugar doesn't have as strong of an effect on the brain as heroin or cocaine, or even alcohol or nicotine, but the addiction still exists. Sugar activates the same reward pathways of the brain."
When you are really addicted to something, your willpower goes out the window, he says. "If a kid gets off of the bus everyday and has to have a soda, is his brain hijacked by sugar?
"The question is: Is sugar addictive enough to create a public health menace? And I think the answer is yes."
Rippe says this theory "is very controversial." Most of that food-addiction research is based on work on animal brains, and animal brains are much different than human brains, he says.
"When we eat any food, the reward pathways light up. That's why we eat, because it's pleasurable," he says. "The scientific literature on this is very mixed and very inconclusive."
Charles Baker, chief science officer for the Sugar Association, says, "The same brain reward pathways are set in motion by any food a person happens to like. Unraveling the intricacies of the crosstalk within the brain and between the brain and digestive tract during eating, is still an evolving body of science. Reward pathways are simply one part of a multi-part system."
A matter of degree
Even nutritionists have a bit of a sweet tooth and don't want to come down too hard on something so tasty. Consuming some sugar is OK for many people, they say. "Even the staunchest anti-sugar advocates say it's a matter of degree," Nestle says. "Nobody worries about 10% of calories or less from sugar. It's only when the amounts go over that problems kick in."
Johnson agrees: "Sugar is not the root of all dietary evil. A little bit of sugar adds to the taste of foods. But we've lost sight of moderation because of the gigantic portion sizes. You have to be so vigilant about portion sizes to avoid overconsuming.
"We have to be careful not to demonize one ingredient in the diet," she says. "We did that with fat, and it backfired because then low-fat products came on the market that were low in fat but high in sugar.
"It didn't lead people to an overall healthier diet which is one that is rich in fruits, vegetables, whole grains, non-fat dairy and lean protein."
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