Is sugar as toxic as alcohol?

In a ‘provocative’ commentary article, several scientists have called for sugar to be regulated as a harmful substance like alcohol and tobacco, prompting debate over individual liberty and the western diet.

In the article, published in the leading science journal Nature,  international scientists argue that added sweeteners pose dangers to health that justify controlling them like alcohol.

Highlighting the myriad of negative health impacts – and subsequent healthcare costs- caused by added sweeteners such as high-fructose corn syrup, the authors call for government intervention to reduce the level of sugar added to foods.

“Ultimately, food producers and distributors must reduce the amount of sugar added to foods. But sugar is cheap, sugar tastes good and sugar sells, so companies have little incentive to change”, the article states.

The authors suggest that the US Food and Drug Administration should no longer list sugar as ‘generally regarded as safe’ (meaning manufacturers can add as much as they want to foodstuffs) and that authorities should tax or place other limitations on high sugar foods.

Our colleagues at the Australian Science Media Centre contacted experts for further comment and context on the arguments put forward in the Nature article:

Prof Leonie Segal is Foundation Chair of the Health Economics & Social Policy Group at the University of SA, with an international profile in the economics of nutrition. She was a member of the Ministers Preventative Health Taskforce

“A focus on added sugar is most timely, with increasing evidence of its negative health effects.
“The public health arguments for intervening are indeed strong, with perhaps the most important consideration, not highlighted by the authors, the imperative of governments to protect vulnerable members of society, especially where the capacity for well-informed decision making is limited or non-existent.

“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. This provides a strong case for governments to intervene to encourage healthy food choices, by children and thus families. And as the authors argue excess sugar is a crucial aspect of current poor food choices and thus an important focus of such policies.

“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.”

Prof Peter Clifton is Head of Nutritional Interventions at Baker IDI Heart and Diabetes Institute

“Alcohol toxicity is not just metabolic – it causes violence and road deaths and sugar in any of its forms cannot compete with this statistic. Almost all of the evidence against sugar is epidemiological – that is association not necessarily causation.

“In intervention studies with fructose, up to 10% of calories show no metabolic effects while a few studies with fructose at 25% of energy do show a modest increase in triglycerides but not high enough to cause pancreatitis.

“There are no controlled interventions that show feeding fructose or sucrose causes hypertension and none that show that a controlled reduction in sugar alone reduces blood pressure. However, there is evidence to show that increasing sugar-sweetened beverage intake does cause modest weight gain as the liquid calories are not compensated by a reduction in calories from other foods.

“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.”

Dr Alan Barclay is an accredited practicing dietitian and nutritionist, Chief Scientific Officer for the Glycemic Index Foundation Ltd and head of research at the Australian Diabetes Foundation

“This commentary is a provocative piece intended to encourage debate. 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.

“The authors believe that attention should be turned to ‘added sugar’, which they have defined as any sweetener containing the molecule fructose that is added to food in processing. The authors suggest that fructose can trigger processes that lead to chronic diseases including liver toxicity, however one would need to eat at least 135g, or about 32 teaspoons, of pure added fructose per day on top of what one already eats. Only one per cent of Americans eat more than 100g per day of total fructose. The only disease proven to be related to excess frequent sugar consumption is tooth decay – a significant problem – but even then, refined starch is at least equally as cariogenic but is rarely acknowledged as a problem.

“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.”

Article: The toxic truth about sugar, A Comment piece, Lustig et al., Nature, 2012 (482), pp27-29