Sugar can harm like alcohol and tobacco; regulate it, article says

Move over salt. Step aside, saturated fat. There’s a new public enemy in the pantry, and it’s … sugar.

In a provocative commentary coming out in Thursday’s edition of the journal Nature, Dr. Robert Lustig and two colleagues from UC San Francisco argue that the added sugars in processed foods and drinks are responsible for so many cases of chronic disease and premature deaths that their use ought to be regulated, just like alcohol and tobacco.

To those who view sugar as more of a treat than a poison – and especially to libertarian-minded people who oppose government regulation in general – Lustig’s proposal is certainly a nonstarter. Public health advocates have spent years trying to enact a soda tax to discourage consumption of added sugar, and none of their efforts is close to succeeding.

But if you set aside both political reality and your sweet tooth, you have to admit that Lustig makes some good points.

For starters, he and coauthors Laura Schmidt and Claire Brindis of the Philip R. Lee Institute for Health Policy Studies at UCSF aren’t claiming that sugar should be illegal or removed from the diet completely. They are focused on added sugars, which they define as “any sweetener containing the molecule fructose that is added to food in processing.”

In this country, the average American consumes 222 calories worth of sugar from sugar cane and sugar beets each day, along with 165 calories with of sugar from high fructose corn syrup, or HFCS, according to data from the U.S. Department of Agriculture. But the proposed regulations wouldn’t make any distinction between these sweeteners -- any caloric sweetener that contains fructose would be subject to scrutiny.

Why? Because even the United Nations recognizes that the greatest threat to public health now comes from non-communicable diseases, including diabetes, heart disease and cancer. Together, these play a role in more than 35 million deaths each year. And they get a big boost from the choices people make about tobacco, alcohol and diet.

Of these three “risk factors,” only tobacco and alcohol are currently subject to regulation, the authors write. Of course, these differ from food in that they are not necessary for survival. But added sugars – and the items made with them – aren’t necessary either.

When it comes to alcohol, there are four criteria that justify government regulation, according to the 2003 book “Alcohol: No Ordinary Commodity”:

* It’s unavoidable in society.

* It’s toxic.

* It can be abused.

* It’s bad for society.

“Sugar meets the same criteria,” Lustig and colleagues write, “and we believe that it similarly warrants some form of societal intervention.”

The U.N.’s Food and Agriculture Organization says that in 2007, Americans consumed more than 600 calories’ worth of added sugar each day. And the damage it does goes beyond supplying empty calories. In fact, it may not be excess fat that causes diabetes, heart disease, high blood pressure,non-alcoholic fatty liver disease and other manifestations of metabolic syndrome – there’s scientific evidence that suggests sugar itself is to blame. After all, 20% of obese people don’t have these diseases, but 40% of normal-weight people do.

“For both alcohol and tobacco, there is robust evidence that gentle ‘supply side’ control strategies which stop far short of all-out prohibition – taxation, distrbution controls, age limits – lower both consumption of the product and the accompanying health harms,” the UCSF trio writes. “Consequently, we propose adding taxes to processed foods that contain any form of added sugars.”

Though this is a pipe dream in the U.S. (despite the authors’ attempt to call their proposal “the possible dream”), they do note that Canada and some countries in Europe already impose small taxes on some artificially sweetened foods. Denmark, the country that imposed a “fat tax”last year, is now eyeing a sugar tax as well.

Short of taxes, there are other things regulators can do to discourage consumption of added sugar. “States could apply zoning ordinances to control the number of fast-food outlets and convenience stores in low-income communities, and especially around schools,” the authors argue.

States could also impose a “drinking age” for buying soda, sports drinks and other sugar-sweetened beverages. (The authors suggest age 17.)

And how about “a limit – or, ideally, ban – on television commercials for products with added sugars”?

At a minimum, the U.S. Food and Drug Administrationcould remove fructose from its list of items Generally Recognized as Safe. That would force food makers to seek an FDA review of products with added sugars.

“The food industry knows that it has a problem,” the authors write. “With enough clamour for change, tectonic shifts in policy become powerful.”

A link to the commentary (which is behind a paywall) is online here.

[For the record, 12:01 p.m. Feb. 2: An earlier version of this post said that most added sugar consumed in the U.S. is in the form of high fructose corn syrup, or HFCS. It should have said that Americans consume more HFCS than people in other countries. In 2010, the average American consumed 34.8 pounds of HFCS and 47 pounds of cane and beet sugar, according to data from the U.S. Department of Agriculture.]

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