Excess Sugar

 In Preventive Medicine Column

 

Too Much Sugar

Sugar seems to be everywhere these days, and I don’t just mean in the copiously over-sweetened standard American diet (“SAD”). I mean in the news about diet, too.

Partly, this is as it should be. Sugar is one of the principal liabilities of a dreadfully junk-laden and hypocrisy-laden diet, literally engineered to subjugate the health of the many to the profit of the few. So, it’s good that it gets the attention it deserves. Partly, though, it is the result of a well orchestrated, well funded effort by those with ties to the beef industry, and/or interest in sticking butter in your coffee, to divert your attention from the harms to people and planet alike of all those bacon-cheeseburgers, through the time-dishonored expediency of a scapegoat.

Still, excess added sugar is one of the principal liabilities of the prevailing American (and, increasingly, “modern global”) diet. From my perspective, there are three salient harms of excess added sugar in the diet: (1) excess sugar itself is metabolically harmful, via its effects on insulin release and fat deposition; (2) sugar contributes to the excess calories propagating obesity, and without any redeeming nutrient value; and (3) sugar is used expressly to make foods, even foods not overtly sweet, hyperpalatable– and thus contributes disproportionately to overeating in general.

It’s the total dose of added sugar in our diets that matters much more than which kind of sugar it is. The many aliases of sugar in the food supply are confusing, and problematic. There are dozens of alternatives, all of which are really just “added sugar.” I am not sure anyone knows the exact number, as the food industry is ever adept at adding more- but Prevention Magazine came up with 57!

My view, now as ever, is that the right approach is to list “total added sugar” and situate that in the ingredient list wherever that cumulative dose belongs- and then, in parentheses, spell out the kinds of sugar in order of abundance.

Some have claimed, famously, that sugar is “poison” and fructose is “toxic.” These contentions are, simply, untrue. Sugar includes the lactose in breast milk, and the glucose that floats constantly, and essentially, in our bloodstreams; it is absurd to declare the composition of mother’s milk and our own blood intrinsically “poisoned.” Rather, the dose makes the poison.

As for fructose, it occurs naturally in all fruits and many vegetables. If it is “toxic,” by extension, apples and berries are toxin delivery systems. There is no justification for thinking that, as fruit intake is not only good for health in general, but specifically associated with protection against the very harms of excess sugar intake, notably diabetes. Sadly, I have received innumerable emails over the years since fructose first became “toxic” asking me if it’s OK to eat whole fruits; and this matter has caused such widespread confusion that the New York Times felt obligated to address it. What a sad waste of time we can’t spare, though, to need to convince people that whole fruits are… still good for them!

The fact that excess sugar is bad for us does nothing to exonerate trans fat, processed meats, food chemicals, salt, refined starches, or for that matter, butter. But that’s exactly the case currently being made, or feigned, by the agents of meat, butter, and cheese. They are exploiting the hyperbole about the toxicity of sugar to imply that sugar is solely responsible for the sorry state of our diet – which is, in a word, baloney. Baloney also contributes to the sorry state of our diets.

The literature on artificial sweeteners is mixed, with some studies showing benefit from cutting out sugar and calories, and others suggesting that the currently prevailing sugar substitutes may do significant damage of their own. Whether or how this pertains to the newer entries such as stevia, or monk fruit extract, is still a work in progress. I avoid artificial sweeteners personally. When sugar is “put in its place” and one’s diet is made up overwhelmingly of unprocessed foods, there is neither need, nor place, for artificial sweeteners. I also think there is a better way to reduce sugar intake, which I call “taste bud rehab.” By trading up choices and eliminating stealth sugar first, and more overt sugar after, you can cut your intake of sugar and calories; avoid any actual or potential harms of chemical additives; and rehabilitate/sensitize your palate into the bargain, so you actually come to prefer more wholesome, less copiously sweetened food.

Despite the long line of claimants that has queued up under the “I discovered the harms of excess sugar last Thursday, so buy my book” sign- the reality is that advice to limit sugar has been not just present, but prominent, in the Dietary Guidelines for Americans since the first, in 1980. As a prominent critic of excess sugar in our diets for nearly three decades, I have been in excellent company.

-fin Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative

Dr. David L. Katz
DAVID L. KATZ MD, MPH, FACPM, FACP, FACLM, is the founding director (1998) of Yale University's Yale-Griffin Prevention Research Center, and current President of the American College of Lifestyle Medicine. He earned his BA degree from Dartmouth College (1984); his MD from the Albert Einstein College of Medicine (1988); and his MPH from the Yale University School of Public Health (1993). He completed sequential residency training in Internal Medicine, and Preventive Medicine/Public Health. He is a two-time diplomate of the American Board of Internal Medicine, and a board-certified specialist in Preventive Medicine/Public Health. He has received two Honorary Doctorates. Dr. Katz has published roughly 200 scientific articles and textbook chapters, and 15 books to date, including multiple editions of leading textbooks in both Preventive Medicine, and nutrition. Recognized globally for expertise in nutrition, weight management and the prevention of chronic disease, he has a social media following of well over half a million. In 2015, Dr. Katz established the True Health Initiative to help convert what we know about lifestyle as medicine into what we do about it, in the service of adding years to lives and life to years around the globe.
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