We've told you before about the effects of sugar on your brain and body. A controversial paper in Nature argues that the impact of sugar on global health is such that it should be subject to similar restrictions as alcohol. Australian medical experts aren't particularly convinced we should go that far, but agree that sugar represents a major health threat and we need to moderate our consumption.
Picture by Uwe Hermann
In the paper, Robert H. Lustig, Laura A. Schmidt and Claire D. Brindis argue that the health impact of sugar is potentially so great that it should be subject to similar restrictions as alcohol. Options proposed include increased levels of taxation on soft drinks with added sugar; tighter licensing requirements on vending machines and their removal from schools; restrictions on establishment of fast-food chains in low-income areas; and even potential bans on soft drinks for under-17s.
Why single out sugar for such drastic treatment? The paper argues:
Authorities consider sugar as 'empty calories' — but there is nothing empty about these calories. A growing body of scientific evidence is showing that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills — slowly.
Given that sugar has the same impacts as alcohol — pervasiveness, toxicity, potential for abuse and a demonstrable impact on society — the authors argue that regulation is appropriate. They also point out that sugar consumption levels have risen drastically in a world dominated by processed food, compared to primitive societies where sugar access would be harvest-dependent and infrequent: "Nature made sugar hard to get; man made it easy." A chart showing world sugar consumption underlines the point, but the number that really threw me was that the average US citizen drinks 216 litres of soft drink every year.
Australian health experts don't particularly agree with the take published in Nature, but many asked to comment on the issue by the Australian Science Media Centre concur that the issue of excess sugar consumption does need addressing even if the risks have been exaggerated.
"This commentary is a provocative piece intended to encourage debate," said Dr Alan Barclay, head of research at the Australian Diabetes Foundation. "Many of the statements simply do not apply to Australia and on certain issues there is little evidence to support their views. ‘Sugar’ is not the issue, it is far more complicated than that.
"The authors state that over the past 50 years, consumption of sugar has tripled worldwide. However, in Australia sugar consumption has dropped 23% since 1980. Despite this, during that time cases of overweight or obese people have doubled, whilst diabetes has at least tripled.
"Lustig and his colleagues claim that sugar should be regulated like alcohol because it is unavoidable, toxic, has potential for abuse and has a negative impact on society. However, it is certainly not unavoidable, it is only ‘toxic’ in unrealistic amounts and to suggest that consuming sugar is a form of abuse is one of the worst cases of puritanism that I have seen in a while. It’s worth noting that soft drinks and other non-core ‘party’ foods are already taxed (GST) in Australia.
"Just like anything else, sugar should only be eaten in moderation. As we continue our research we are finding out more and more about the importance of refined starch and specific fatty acids and the average Australian can do a lot to improve their diet, but casting sugar as the ultimate villain and calling for regulation is misleading, unfounded and unnecessary."
A key issue is that a taste for sugar, if acquired young, can persist into adulthood. "Because eating habits and taste tend to be influenced by what we eat as infants and young children, an unhealthy habituation or addiction to sugar, which influences lifetime health, can be established from a very young age when the ability and capacity to make informed eating choices are simply unavailable," said Professor Leonie Segal, foundation chair of the Health Economics & Social Policy Group at the University of SA. "This provides a strong case for governments to intervene to encourage healthy food choices, by children and thus families."
But as anyone who has experienced both a massive hangover and a sugar rush will attest, one feels much worse than the other. "Alcohol toxicity is not just metabolic - it causes violence and road deaths and sugar in any of its forms cannot compete with this statistic," said Professor Peter Clifton, head of nutritional interventions at Baker IDI Heart and Diabetes Institute. "Almost all of the evidence against sugar is epidemiological - that is association, not necessarily causation. Sugar is just another form of over-consumed calories - easily available and very palatable but no more metabolically deadly than starch or fat calories and certainly not equivalent to alcohol."
While it's certainly possible to argue that drinking can have more drastic consequences than sugar, it's worth remembering that sugar abuse is much more widespread and could have a longer-term social cost. "While at its extreme alcohol may have more damaging effects than sugar, excessive consumption of sugar is considerably more prevalent than excessive alcohol consumption, part of the reason why population level strategies make sense," Professor Segal said.
My final comment? If you're drinking sweet premix alcoholic stuff in cans, you've absolutely got the worst of all possible worlds. The question of how to regulate sugar intake is likely to be debated for a long time, and I can't imagine any nation will go as far as the paper authors propose, but if you want to take control of your own health you should look to cut down on unneeded sugars in your diet. Dumping soft drink (the biggest-selling product in Australian supermarkets) and drinking water is a really obvious place to start.