Seriously Spooky Sugar

When you walk into a Walgreens (“at the corner of happy and healthy”) and make your way past the cigarette section, you’ll soon hit the candy aisle. Halloween’s coming up and there are, without exaggeration, at least a thousand big bags of candy for you to pass out to unsuspecting children. This year, don’t do it. Give them an apple. Ignore their frowns, their “yech!” If they persist, tell them to be nice or next year they’ll get kale.

Look, I know you’re addicted to sugar. We all are. Our taste buds are far more sensitive to sugary tastes than they are to the subtleties of superstar chefs. Food manufacturers today throw sugar into everything, from chili to coleslaw, and the total amount of sugar we eat every year is downright astonishing.

Back in the pioneer days, anything sweet was a genuine luxury. A piece of candy was a treat, not an everyday occurrence. According to an analysis of grocery store records, in the mid 19th century an average American consumed about 15 pounds of sugar per year. Today, according to data from the sugar industry itself, each and every American eats about 150 pounds a year, or a little less than a half pound of sugar every day.

Here’s where the story gets really spooky

Back in the 1950s and 60s, men were dropping like flies from heart attacks and doctors were scrambling to find lifestyle issues that could be contributing to the epidemic. Smoking was a likely suspect but, as we later learned, the tobacco lobby was hiding data, so it wasn’t front and center. The two dietary villains were thought to be fats, especially saturated fats, and sugar.

Undeniably, fats had a guilty look about them. Think of that can of bacon grease your mom collected to fry your eggs. And sugar? The numbers linking both fat and sugar to heart disease looked bad, but as public health officials began to prepare announcements warning the public to cut back on sugar and saturated fats (especially dairy and beef), food lobby groups from both groups stepped in and started writing checks to influential people.

The dairy industry was quite vociferous. I well remember as a child how the Healthful Eating Charts at Bret Harte School, courtesy of the American Dairy Association, directed you to eat dairy products until they practically came out of your ears. Already a chubby and sugar-addicted kid, my mother was not amused when I explained to her that ice cream every night of the week was good for me.

However, both the meat and dairy industries were unable to ward off the medical profession’s insistence that the real heart disease villain was fat.

Any non­fat food was good. We all learned about good and bad fats, and Big Pharma introduced statins to lower our cholesterol. The annoyingly self-righteous Dean Ornish, MD, (author of Reversing Heart Disease) proposed an onerous diet so low in fat it almost didn’t make life worth living. Opposing Ornish as the only voice in the wilderness, Robert Atkins, MD, blamed carbs and sugars instead of fats, recommending that everyone chow down on bacon and eggs for breakfast and snack on beef jerkies. Ornish came close to accusing him of mass murder.

But some research began to show that sugar was more dangerous than fat

Smaller medical journals, the kind that no one read, began to publish data recommending we refocus on sugar. Meanwhile, the larger journals, like the New England Journal of Medicine, were publishing articles written by scientists paid by the sugar industry. Sugar, so the sugar industry itself said, was a good source of taste pleasure, quick energy, and “fun.” Fat was bad, clogging your arteries and shortening your life. Source of the sugar ­good/fat­ bad mantra? You guessed it–­­the sugar industry itself.

And now, after 50 years of misinformation and cover-­ups, and likely millions of unnecessary deaths worldwide, the truth came out last week in JAMA Internal Medicine. Here’s a New York Times story that tells the sorry tale.

Throughout the 1960s and 70s, a division of the sugar industry’s lobbying group, called the Sugar Research Foundation (SRF), poured vast sums of money into medical research projects that deliberately shifted the blame for heart disease off sugar and onto fat.

In an incredibly well-researched piece of medical detection, the authors  gained access to the internal documents of the SRF, which revealed a complex network of using large sums of money to control research projects and editorial policies with the single goal of getting both doctors and the public to believe that fat was the villain and sugar the good guy.

For example, in 1965 the very first research project on coronary heart disease (CHD) was published in the prestigious New England Journal of Medicine. It was a type of article called a “review of literature,” meaning an analysis of other articles on the subject. At the time, this article simply changed the way medicine was practiced. Every physician’s goal, if he or she wanted to practice preventive medicine, was to reduce the patient’s fat intake.

Last week’s revelation showed the review had been funded by the sugar industry, the authors having received financial “grants” to selectively weed out articles that might put sugar in a less than favorable light. In the years that followed, the SRF would give grants only to those researchers who would prove sugar healthful or disparage studies that showed sugar was a danger.

Understanding what sugar does to you

Let’s quickly review how sugar can be held responsible for an estimated 35 million deaths annually around the world. This means all sugars, not just the SRF’s sugar (sucrose). If you click through you’ll see that the list of other names for sugar includes the much-marketed agave nectar as well as fruit juice concentrates, dextrose, honey, syrup, and so on.

The 35 million deaths are due to three sugar­ triggered conditions: metabolic syndrome (and its consequences–diabetes, high blood pressure, and heart disease), non­alcoholic fatty liver disease, and, less commonly, non­alcoholic steatohepatitis.

Start thinking of sugar not simply as a source of empty calories, utterly devoid of nutritional value, but also as a molecule metabolized in your body like alcohol, which makes perfect sense since alcohol comes from sugar.

For example, you drink a can of Coke (18 teaspoons of sugar). After absorption through your intestines, the sugar molecule enters your liver. However, your liver can only tolerate a certain amount of sugar and when overwhelmed starts converting the sugar into fat molecules, which are stored in liver cells themselves. This scenario, formerly called fatty liver, was recently renamed non­alcoholic fatty liver disease (NAFLD). Your once healthy liver, deep red and vibrant in color, turns sickly yellow and greasy. No kidding.

NAFLD, once considered a generally harmless condition (perhaps deemed “harmless” by a sugar industry-funded study), is today known to put sufferers at increased risk for a second condition, called metabolic syndrome (more below) and the especially severe form of fatty liver called non­alcoholic steatohepatitis (NASH), which can lead to cirrhosis or liver cancer.

Over the past 20 years, the frequency of fatty liver in the general population has skyrocketed, directly correlated to our escalating sugar consumption. The stored fat in your liver changes how your liver functions, causing it to produce more bad cholesterol (LDL) and less of the good (HDL) type. A fatty liver also increases inflammation in your body, triggering LDL cholesterol deposits inside your arteries and clogging them up.

Metabolic syndrome

The most common and dangerous consequence of excess sugar intake is not fatty liver, but rather metabolic syndrome, again kept under wraps via SRF-funded “research.” Faced with the daily onslaught of 45 teaspoons of sugar, your pancreas–desperate to lower your blood sugar–pumps out insulin, the hormone that lowers blood sugar levels by driving sugar into cells, where it’s used for energy.

Ultimately this whole system of pancreas/insulin production/sugar transport becomes exhausted, pooped from overuse. Insulin production drops, your cells become increasingly resistant to insulin, your blood sugar rises, and you develop diabetes. But before your insulin collapses in exhaustion, all the excess insulin triggers your brain to release a chemical called leptin.

Leptin is seriously important. At normal levels, leptin tells your brain that you’re no longer hungry so you’ll stop eating.

But with too much leptin the reverse occurs. You lose your ability to tell when you’re no longer hungry. So you keep eating and eating and getting fatter and fatter. Ever sit across from an obese person eating? You marvel at how he or she can pack so much food away. With excess leptin on board, obese people have no way to tell they’re full.

Doctors are seeing more patients with metabolic syndrome than ever before. It’s a significant concern because patients who develop metabolic syndrome have a very substantial risk of progressing to diabetes and heart disease.

By our current definition, metabolic syndrome is a combination of the following:

• Abdominal obesity (for men greater than 40 inches, for women greater than 35 inches).
• Elevated blood triglycerides (a blood fat).
• Low HDL (the good cholesterol).
• High blood pressure
• Elevated fasting blood sugar, elevated insulin level, elevated hemoglobin A­1c or abnormal glucose tolerance

This devastating health crisis comes courtesy of the sugar industry, buying off researchers and journal editors, hiding data, and shifting the spotlight to fats.

If there’s a positive spin on metabolic syndrome, it’s that it’s reversible by changing your overall eating habits, losing weight, and exercising regularly. A solid first step is to drastically cut back on sugar, foods containing sugar, and foods that quickly turn to sugar in your body. You need to approach better health with the same enthusiasm of a freshly minted Evangelical telling the world about Jesus. If you’re unsure how to proceed, schedule with one of our nutritionists, Seanna Tully, Marla Feingold, or Marcy Kirshenbaum.

By the way, the conclusion of the JAMA article is almost laughably simplistic: “(Government) policy­making committees should consider giving less weight to food industry funded studies.”

After nearly half a century of unmitigated lying to the public, leaving two thirds of us overweight or obese and dying of heart disease and diabetes, I’d give less credence to food industry-funded studies too.

Be well,
David Edelberg, MD