Is Sugar Worse For You Than Alcohol?

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

Nature calls

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.

Aussie response

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.

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Comments

    Excellent article saw a pice on it channel 9 this morning certainly something to be careful of.
    Responsible diet and balance.
    Thursday 2/2/2012

    Is the Nature article talking about sugar in the form of Fructose rather than Sucrose?
    The US produces masses of High Fructose Corn Syrup (HFCS) which is used an alternative to Sucrose (table sugar) to sweeten processed foods/drinks. The HFCS reduces their dependency on imported Sucrose and has been used as a "health benefit" cause Fructose (fruit sugar) has been considered a "good" sugar in the past.
    Australia on the other hand is pretty much self-sufficient for Sucrose from Sugar Cane, and it would be VERY unusual to find products with high Fructose levels here which probably explains the “Many of the statements simply do not apply to Australia..." quote from Dr Alan Barclay.

      My thoughts too. Being Nature, it's likely US centred and really talking about HFCS. I remember reading something recently about the proportions of fructose and sucrose basically being reversed in the US compared to Australia, where fructose is the sugar with the strongest negative effects.

      The point about obesity and diabetes climbing while sugar intake drops is interesting though. I wonder if fat intake has skyrocketed in the same period.

        Just because you can't pimp this out enough:
        Sugar - the bitter truth
        http://www.youtube.com/watch?v=dBnniua6-oM

        A doctor demonstrates step by step just how bad fructose (as found in HFCS *and* sucrose) is for you. It is a toxin which, like alcohol, our bodies can deal with just fine in moderation.

          As someone on a ketogenic diet, if I was gonna eat carbs I'd technically be better eating a chocolate bar than an apple or a banana. Layman's explanation: Fructose is not distributed to the muscles to be burned like glucose is, instead being stored in the liver as glycogen, inhibiting weight loss. Fructose is the enemy!

          http://www.reddit.com/help/faqs/keto#Whatisketo

            Perhaps if you were only comparing fructose levels in a chocolate bar vs fruit that might be true - but fruit also contains fibre in the flesh, which helps the body actually breakdown the fructose. A chocolate bar doesn't contain that fibre so it really is empty.

            I've been living sugar free for 6 months and feel heaps better in terms of energy but also I love just bypassing all the crap you can't eat. Walking into a servo there is so little that isn't sugar filled it's scary.

        @StevoTheDevo, sucrose is a disacchiride, consisting of two sugar molecules - glucose and fructose. Each has the same molecular weight (180 g/mol). This means sucrose is half fructose by weight.

        When you eat sucrose the enzyme sucrase and other enzymes break it down into glucose and fructose. For every 100g of sucrose you eat, 50g is metabolised as fructose and 50g is metabolised as glucose.

        HFCS can be produced with a rnage of different fructose/glucose ratios, but these are typically 40:60 to 60:40. I.e. not much different from regular sugar.

        Don't kid yourself - if you're trying to minimise fructose consumption, you need to minimise sucrose consumption too.

      This was going to be my point as well. While neither are great for you the strain fructose puts on your liver that sucrose otherwise wouldn't just makes it that much worse.

      (Also, I accidentally reported your comment when I tried to reply, so I apologise to whoever that inconvenienced)

    For anyone interested in this debate, David Gillespie's book, Sweet Poison is excellent and highly readable.

    Also if you go onto the Mercola site you will a lot of material about the effects of fructose - some good videos also

    I've never been a huge sweet food lover, having always preferred savoury flavours. Nevertheless, I have been slowly reducing my sugar intake anyway. It's empty calories I don't need and (unlike booze) it's not so much fun at parties ;-)

    Tea without sugar was an easy enough adjustment. Coffee is tougher. I've slowly dropped from 2 spoons per cup to half a spoon, but I find unsweetened coffee is generally too bitter. Of course you can switch sugary soft drinks for diet varieties, but I really don't like the idea of consuming synthetic sweeteners.

    In the 70s there was a trend towards low fat high carb diets brought on by US medical studies. These were adopted by the Australian government and designed to reduce instances of obesity, diabetes & heart disease. Well, obesity & diabetes rates are higher than they ever were. Fat isn't the culprit, sugars & starches are!

    I've been on a low carb high fat diet for 9 months, lost 30kg and lowered my cholesterol & blood pressure by a large amount. I eat bacon & eggs daily, lots of cheese, and I don't really exercise due to a separate condition. Fat is nothing to be scared of.

    Read this, please. http://www.alanaragonblog.com/2010/01/29/the-bitter-truth-about-fructose-alarmism/

      Appreciate the attempt to inject a bit of sanity, Paul, but "moderation" is a concept the public isn't ready for. We've been through low-fat. Gotta wait until everyone quits getting bamboozled by low-carb, before common sense might take root.

        Eric I agree. Seems moderation in all things is becoming rare in this age of polarisation.

        Anyway, although it probably isn't a good idea to go down the whole Atkins "carbs are the enemy" route, reducing carbs can make a big difference to one's weight. It seems to work because people don't feel they have to starve to lose weight, but it still steers them away from sugar (empty calories) and high calorie dishes like pizza and pasta.

        I'm no nutritionist but I've found if my jeans get too tight that lightening up on carbs (basically only getting them from vegies and fruit, not from grains) can get things back on track and keep them there.

      i always welcome some counter argument but the way people attack Lustig and other anti-sugar people for manipulatig data is funny since they ARE ALL GUILTY of doing the same thing. bottom line is, (added) sugar is still an artificial sweetener and there is no harm in saying dont eat it except in the form nature gives it to us - in fruit and vegetables (honey is arguably not "from nature" either as mankind "farm" the bees). because fructose is apparently only metabolised in the liver as alcohol is, the load it puts on it should be taken into account. as with alcohol, fructose should be consumed in "moderation" but, as with alcohol, it rarely is. the big problem with fructose is (apart from being in everything) people say "its not as bad as alcohol" which is why its bad, just because its second worst, doesnt make it good either. if you ease off on alcohol and sugar, yes you can lose heaps of weight, I lost 10kg in 3 months - no diet, no exercise - just no sugar and alcohol (cutting out either one on its own doesnt work, at least for me). unlike other "diets" that say only eat red meat etc etc, there is no harm what so ever (except to the sugar industry) in saying stop adding sugar. if Lustig is wrong the worst thing is you have to drink coffee which is a little bitter. big deal. if he is right the effects on our health will be staggering.

    A few interesting comments here and proof yet again that there is no simple answer to many health questions.
    @Tim - there are obvious sugar products that one would drop in a "no sugar" diet but what are some of the more obscure or harder that you have found?
    @Danielle - low carb, high fat, no exercise and not only do you lose over a kilo a week every week but your cholesterol and blood pressure improve? That just doesn't gel with me. How can that be?

    Sugar is in everything - peanut butter, tomato sauce, mayo, 'health' bars, cereal, even in meal replacement shakes and bars designed to help people lose weight!!! If it comes in a packet, jar or tin you better check the ingredient list. And they call sugar by so many different names as well! I've been almost completely sugar free for 10 months now, the only sugar I consume is 2 pieces of fruit per day. Don't miss it AT ALL, and I've lost 30kgs.

    I have been sugar- and grain-free for forty-three days now, and have lost 4.5 kg and reduced my waist and hips by 5cm and 6cm respectively. The only exercise I do is some weights to failure every few days (about 10 or 15 min worth), and the rest of my diet is the same. I am also far less moody, have a constant energy level, and don't feel sleepy or sluggish at all during the day, even after doing hard work.

    One should avoid starches because they're just chains of glucose, but having said that, I do eat fruits and candy and so on if I feel like it; the real change is that grains and sugar are now just treats rather than staples.

    When it comes to substances that can harm the Alcohol,Tobbacco,Fat,Sugar,Caffine,Dope I believe the government should introduce laws to notify consumers what's in certain products(food,Drinks,Recreational Drugs) but providing your 18, be givin the right to use or not use these substances yourself.

    Excellent discussion! So which makes the liver work harder? A jumbo chocolate bar or half a litre of vodka? Way I see it, starches break down into sugars and your liver needs to work hard to remove sugars from your body.. So dont eat sugar and save your liver for beer and vodka and whiskey! Also a liver not saturated in sugar can metabolize fat easier making you thin yes? Also if you dont eat much fat bit eat a lot of sugar, is it still the fat you eat that sticks to your belly due to a busy liver or is it funky starch that sticks to your belly? What kind of sugar is in honey? Coffee tastes good with honey :) real bean coffee that is, not the instant stuff. Also, exercise is good, even just walking. Plenty food junkies are fit.

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