Sugar, Sugar

Last week there was a report about a patron of the Las Vegas-based Heart Attack Grill suffering a massive heart attack while consuming the restaurant’s famed “Triple-bypass Burger.”    It would be funny if it weren’t so awful, but it is clearly the height of irony.  I have written a few articles about the Heart Attack Grill (see here and here) mainly tongue-in-cheek but with a serious bent; but when you see an article like this, it is hard to say anything other than,  “coulda seen that coming.”    That issue of personal responsibility is a huge theme when it comes to poor eating behavior.  Typically, others look at the offender and say, “well, they shoulda known….they shoulda controlled their eating habits, serves them right…now pass the French fries.”

From an academic standpoint, however, that issue of diet-related personal responsibility is in question. Well-known physician and researcher, Robert Lustig, a leader in the UCSF Department of Pediatrics and the Director of the UCSF Center for Obesity Assessment, Study and Treatment believes there is more to the story.  This is a guy who has made a career of studying and treating obesity, particularly in teens and children.  Dr. Lustig and his colleagues recently authored an article in Nature called The Toxic Truth About Sugar, in which he and his colleagues take a very different view of things.  Rather than blame the eater, they suggest, sugar should be viewed and regulated like alcohol and tobacco because of the profoundly unhealthful qualities of the substance and its impact on the body.  In this video you can see Lustig et al say, “People don’t consider it [obesity and sugar] public health, they consider it personal responsibility.  With obese people we say you eat too much, you exercise too little, it’s all your fault.  You know what, it ain’t their fault.”  He blames this, in part, on sugar’s addictive qualities.

httpv://www.youtube.com/watch?v=ffoOeW5wZ9s

The opening sentence of Lustig’s Nature article says this, “Last September, the United Nations declared that, for the first time in human history, chronic non-communicable diseases such as heart disease, cancer and diabetes pose a greater health burden worldwide than do infectious diseases, contributing to 35 million deaths annually.”  The article goes on to say, “The UN announcement targets tobacco, alcohol and diet as the central risk factors in non-communicable disease. Two of these three — tobacco and alcohol — are regulated by governments to protect public health, leaving one of the primary culprits behind this worldwide health crisis unchecked.  Of course, regulating food is more complicated — food is required, whereas tobacco and alcohol are non-essential consumables. The key question is: what aspects of the Western diet should be the focus of intervention?”

The primary punch line of Lustig et al’s Nature article stems from that last sentence.  It is the authors’ view that, exactly like tobacco and alcohol, sugar should be regulated as a controlled substance.  They note that legally ingested substances are considered in need of regulation when they have four key criteria: unavoidability (or pervasiveness throughout society), toxicity, potential for abuse and negative impact on society.  The authors state that, “Sugar meets the same criteria, and we believe that it similarly warrants some form of societal intervention.”  Here is their rationale:

• Unavoidability: in recent years, sugar has been added to virtually every processed food, limiting consumer choice.  Go look in your pantry:  damn near everything in there has a sugar content.  The average U.S. adult consumes 22 teaspoons of sugar a day, according to the American Heart Association. Already, 17% of U.S. children and teens are obese, and across the world the sugar intake has tripled in the past 50 years.  You know what else has more than tripled in the past 50 years?  Sitting on your ass in front of the television watching commercials for sugar-laden products.  Coincidence? I think not.
• Toxicity. A growing body of research demonstrates that excessive sugar consumption affects human health in profound ways well beyond that of making you look bad in a swimsuit.  Importantly, sugar induces all of the diseases associated with metabolic syndrome, including hypertension, high triglycerides, diabetes.  Sugar speeds up the aging process and exerts toxic effects on the liver similar to those of alcohol. Sugar has also been linked to cancer and cognitive decline.  That last part really raised my eyebrows—I had no idea that every chocolate chip cookie I ate made me stupider.  Fatter, yeah, I got that, but less capable of doing the NYT crossword puzzle?  That’s no good.  What the hell is 17 across? I’m freaking out!
• Potential for abuse:  Like tobacco and alcohol, sugar acts on the brain in an addictive manner. There are now numerous studies examining the dependence-producing properties of sugar in humans.  Sugar interferes with the hormones that give people the feeling of satiety and it reduces dopamine signaling in the brain, thereby decreasing the pleasure derived from food and compelling the individual to consume more.  In other words, your morning Starbucks Mocha maybe a gateway drug to an afternoon Snickers Bar.
• Negative effects of sugar on society. The long-term economic, health-care and human costs of metabolic syndrome place sugar over-consumption in the same category as alcohol and tobacco, which have clear impact on others than just the users. The Nature article states that the United States spends $65 billion in lost productivity and $150 billion on health-care resources annually for co-morbidities associated with metabolic syndrome. Seventy-five per cent of all US health-care dollars are now spent on treating these diseases and resultant disabilities. The authors not that because 75% of military applicants are now rejected for obesity-related reasons, the past three US surgeons general and the chairman of the US Joint Chiefs of Staff have declared obesity a “threat to national security”.  God help us if we are attacked on U.S. soil—we will have only our fat layer to protect us.

The idea of applying alcohol and tobacco style regulation to sugar in the form of taxes, limits on advertising, limits on sales times and locations; limits on purchasing age, etc. is a very interesting one.  Neither alcohol nor tobacco was ever as pervasive as sugar, nor do either appeal to such a wide audience of Americans.  Not a lot of 5-year olds are knocking back a Jack & Coke while taking a drag on a Marlboro, but plenty of them are scarfing down Fruit Loops and Frosted Flakes.  Ours has become a world where the parents are the pushers, buying kids sugar cereals and soda in a manner that makes kids turn to the hard stuff later (M&Ms, Mocha Frappucinos and even more soda…get this:  each US citizen consumes an average of 216 liters of soda every year).

In a world where we actually taxed soda as is done in many European countries, even at a rate of one penny per ounce, we would raise roughly $14 billion in tax revenues, all of which could be channeled back into anti-sugar advertising.  This strategy has worked wonders in the tobacco world, where cigarette taxes and legal settlements have been funneled into highly effective stop-smoking campaigns.  There has long been a ban on hard liquor advertising on television as well.  If you applied such a ban to sugary foods, even if limited to prime time hours only, the impact could be profound (and the TV might be blank for large portions of the day!).   By taking sugary products off school grounds and requiring people to be 18 or older to purchase them, you could potentially make a real dent in the sugar consumption of school-age children, although you would probably destroy the entire market capitalization of Post Foods.  Plus, you might start seeing high school kids’ motivation for getting a fake ID change pretty dramatically.  Rather than spending their time trying to get people to buy them beer, they might be out there hanging outside 7-11 saying, “psst…hey, man, would you by me a Snickers bar?”

In fact, our friends at Mars, Inc., makers of the Snickers bar and numerous other sugar-coated time bombs, have begun to take defensive measures in light of the rising tide of anti-sugar sentiment.  They announced recently that they would phase out all candy bars that have more than 250 calories by 2013, among other things.  Of course, there is no law as yet that says you can’t buy two candy bars, so go crazy kids!   Mars notes that they have also stopped advertising in places “if more than a quarter of the audience is likely to be under 12 years of age” or “on websites aimed at those under 12.”   That is a nice gesture, I suppose, but I am guessing that by the age of 12, most kids are watching what their parents watch (Super Bowl anyone?).  Furthermore, it is those teenage years, when kids have unsupervised time and pocket money, which undoubtedly pose the most danger.  We might start seeing those old fashioned high school drug dealers who hang around behind the football stadium bleachers diversify into M&Ms, Pepsi and Juicy Fruit.

Clearly Mars, Inc. and its compadres in the sugar-based products business are not going to take a bullet to their own head by ceasing to produce the foods that make Halloween a happy day.  It’s gotta be tough to be in their marketing department these days, as sugar becomes more and more associated with the evils that plague our healthcare system, a topic which is getting a lot of press.  I wonder how long it will be before the pressure of our government’s own hypocrisy will lead to an end to corn subsidies, much of which ends up as high fructose corn syrup in the products that Dr. Lustig is hoping to see regulated.   Must be tough for Michelle Obama, proponent of healthy childhood diets and leader of the “Let’s Move” campaign, to engage in happy pillow talk with her husband when more than $1 billion/year comes from the federal budget to subsidize what ends up as corn syrup and its friends. If I were President Obama, I would roll over and point to this article to cool the marital angst over the evils of sugar:  Can dessert for breakfast help you lose weight?

In what appears to be proof that there is a God and she is female, new research from Tel Aviv University finds that, “eating a small dessert as part of a balanced breakfast can actually help you shed unwanted pounds.”  In this study, “researchers split 193 clinically obese, non-diabetic adults into two groups. Men got 1,600 calories a day and women got 1,400. Half the subjects had a 300-calorie, low-carb breakfast, while the other half got 600 calories in the morning, including a small piece of chocolate cake. Halfway through the 32-week study, both groups had lost an average 33 pounds per person. But in the subsequent 16 weeks, people eating the light breakfast gained back 22 pounds each, while the cake eaters lost another 15 pounds apiece, on average.”

According to Daniela Jakubowicz, one of the researchers on this study, “Breakfast is the meal that best helps regulate ghrelin, the hormone that increases hunger.  The group that consumed a bigger breakfast, including dessert, experienced few if any cravings for these foods later in the day.  The participants in the low-carbohydrate diet group had less satisfaction and felt that they were not full so their cravings for sugars and carbohydrates were more intense as the day passed. Many broke down and cheated on their diet, so they lost, on average, 40 pounds less than peers who got to have their cake, and lose weight too.”

This may be a well-structured and legitimate study, but it is also the kind of thing that makes people think you can prove anything you want with statistics, thus making them ignore all of the research that conflicts with how they want to live their lives.  I used to have a poster in my office that said, “We have charts and graphs to back us up so “F” off.”  I am guessing that the people in Mars’ research department and their colleagues in the sugary foods and corn syrup industries not only have this sentiment tattooed on their biceps, but are busily working to create a body of knowledge to counter the work being done to demonize sugar and its corollaries.  If you are thinking, hey, this sounds like what the tobacco industry did to show that its products weren’t unhealthy, you are right.  Makes me think that Lustig and his colleagues are really on to something.

Could not end this post without a gratuitous nod to the Archies and their 1969 hit Sugar, Sugar.  Enjoy.  This may soon be the only safe sugar you can get your hands on without a doctor’s prescription.  Medical sugar card anyone?!

httpv://www.youtube.com/watch?v=h9nE2spOw_o