Like alcohol and tobacco, sugar is a toxic, addictive substance that should be highly regulated with taxes, laws on where and to whom it can be advertised, and even age-restricted sales, says a team of UCSF scientists.
In a paper published in Nature today, they argue that increased global consumption of sugar is primarily responsible for a whole host of chronic diseases that are reaching epidemic levels around the world.
Sugar is so heavily entrenched in the food culture in the United States and other countries that getting people to kick the habit will to require much more than simple education and awareness campaigns, said the UCSF scientists.
It's going to require public policy that gently guides people toward healthier choices and uses brute force to remove sugar from so many of the processed foods we eat every day, said Dr. Robert Lustig, a pediatric endocrinologist at UCSF.
"The only method for dealing with this is a public health intervention," Lustig said in an interview. "Everyone talks about personal responsibility, and that won't work here, as it won't for any addictive substance. These are things that have to be done at a governmental level, and government has to get off its ass."
In response to the study, the food and beverage industries said in statements that sugar cannot be blamed for high rates of chronic disease in the United States and elsewhere.
Comparing sugar to alcohol and tobacco is "simply without scientific merit," the American Beverage Association said. "There is no evidence that focusing solely on reducing sugar intake would have any meaningful public health impact."
Lustig has written and talked extensively about the role he believes sugar has played in driving up rates of chronic illness such as heart disease and diabetes. Excessive sugar, he argues, alters people's biochemistry, making them more vulnerable to metabolic conditions that lead to illness, while at the same time making people crave sweets even more.
It's sugar, not obesity, that is the real health threat, Lustig and his co-authors - public health experts Laura Schmidt and Claire Brindis - say in their paper. They note that studies show that 20 percent of obese people have normal metabolism and no ill health effects resulting from their weight, while 40 percent of normal-weight people have metabolic problems that can lead to diabetes and heart disease. They contend that sugar consumption is the cause.
In other words, not everyone gains a lot of weight from over-indulging in sugar, but a large proportion of the U.S. population is eating enough of it that it's having devastating health effects, they say.
"The gestalt shift is maybe obesity is just a marker for the rise in chronic disease worldwide, and in fact metabolic syndrome, caused by excessive sugar consumption, is the real culprit," said Schmidt, a health policy professor who focuses on alcohol and addiction research.
Americans eat and drink roughly 22 teaspoons of sugar every day - triple what they consumed three decades ago - and most people aren't even aware of the various ways sugars sneak into their diets, often via breads and cereals and processed foods.
Ultimately, getting those sugars out of the American food culture is going to require a massive shift in how foods and beverages are made in the United States, the authors say. In the paper, they say that the Food and Drug Administration needs to remove sugar from the list of foods "generally regarded as safe," meaning they can be used in unlimited quantities.
But the food and beverage industries have repeatedly denied that sugar is the main villian behind rising rates of obesity, or the increases in diabetes and heart disease. Instead, industry representatives say that a complex cultural shift - toward a more inactive lifestyle and increased calories overall - is to blame.
And not all scientists agree that sugar should shoulder the entire burden for the chronic diseases afflicting modern Americans.
"When you get into this argument about sugar in the diet, you also have to look at the type of food that has a high sugar content," said Jo Ann Hattner, a San Francisco registered dietitian who teaches nutrition courses at Stanford. "Those foods have few nutrients and little fiber, and that's not good for you. So is it sugar itself, that's harmful?"
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That said, Hattner added, there's no doubt that people in general consume too much sugar and that everyone could benefit from eating less - and especially looking out for "hidden" sugars in their diets. Those sugars are often found in processed foods like sodas, cereals and breads. Even cookies contain much more sugar than they did a decade or two ago, nutritionists say.
But while individuals certainly can make small changes to their diets to eat more nutritiously, that alone is not going to effect major public health improvements, Lustig and his co-authors said.
In their paper, they argue for taxes on heavily sweetened foods and beverages, restricting advertising to children and teenagers, and removing sugar-ladened products from schools, or even from being sold near schools. They suggest banning the sale of sugary beverages to children.
Schmidt noted that those policies could nudge people toward healthier choices - but only if, at the same time, healthier choices are made widely available. Such policies have worked in reducing alcohol consumption and smoking rates, she said. There's no reason they can't work with sugar too.
Lustig said he realizes that there will likely be heavy resistance to the idea of largely removing sugar from American diets - and resistance not just from the food and beverage industries, but from the public at large.
"Everybody yells, 'Nanny state, this guy is trying to control our food,' " Lustig said. "But it's already being controlled. It limits consumer choice when so much of our food is controlled by these industries. I'm actually trying to undo the nanny state."
But while individuals certainly can make small changes to their diets to eat more nutritiously, that alone is not going to effect major public health improvements, Lustig and his co-authors said.
In their paper, they argue for taxes on heavily sweetened foods and beverages, restricting advertising to children and teenagers, and removing sugar-ladened products from schools, or even from being sold near schools. They suggest banning the sale of sugary beverages to children.
Schmidt noted that those policies could nudge people toward healthier choices - but only if, at the same time, healthier choices are made widely available. Such policies have worked in reducing alcohol consumption and smoking rates, she said. There's no reason they can't work with sugar too.
Lustig said he realizes that there will likely be heavy resistance to the idea of largely removing sugar from American diets - and resistance not just from the food and beverage industries, but from the public at large.
"Everybody yells, 'Nanny state, this guy is trying to control our food,' " Lustig said. "But it's already being controlled. It limits consumer choice when so much of our food is controlled by these industries. I'm actually trying to undo the nanny state."
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