Sugar is toxic

Sugar is indeed toxic. It may not be the only problem with the
Standard American Diet, but it's fast becoming clear that it's the
major one.

A study published in the Feb. 27 issue of the journal PLoS One links
increased consumption of sugar with increased rates of diabetes by
examining the data on sugar availability and the rate of diabetes in
175 countries over the past decade. And after accounting for many
other factors, the researchers found that increased sugar in a
population's food supply was linked to higher diabetes rates
independent of rates of obesity.

In other words, according to this study, it's not just obesity that
can cause diabetes: sugar can cause it, too, irrespective of obesity.
And obesity does not always lead to diabetes.

The study demonstrates this with the same level of confidence that
linked cigarettes and lung cancer in the 1960s. As Rob Lustig, one of
the study's authors and a pediatric endocrinologist at the University
of California, San Francisco, said to me, "You could not enact a
real-world study that would be more conclusive than this one."

The study controlled for poverty, urbanization, aging, obesity and
physical activity. It controlled for other foods and total calories.
In short, it controlled for everything controllable, and it satisfied
the longstanding "Bradford Hill" criteria for what's called medical
inference of causation by linking dose (the more sugar that's
available, the more occurrences of diabetes); duration (if sugar is
available longer, the prevalence of diabetes increases);
directionality (not only does diabetes increase with more sugar, it
decreases with less sugar); and precedence (diabetics don't start
consuming more sugar; people who consume more sugar are more likely to
become diabetics).

The key point in the article is this: "Each 150
kilocalories/person/day increase in total calorie availability related
to a 0.1 percent rise in diabetes prevalence (not significant),
whereas a 150 kilocalories/person/day rise in sugar availability (one
12-ounce can of soft drink) was associated with a 1.1 percent rise in
diabetes prevalence." Thus: for every 12 ounces of sugar-sweetened
beverage introduced per person per day into a country's food system,
the rate of diabetes goes up 1 percent. (The study found no
significant difference in results between those countries that rely
more heavily on high-fructose corn syrup and those that rely primarily
on cane sugar.)

This is as good (or bad) as it gets, the closest thing to causation
and a smoking gun that we will see. (To prove "scientific" causality
you'd have to completely control the diets of thousands of people for
decades. It's as technically impossible as "proving" climate change or
football-related head injuries or, for that matter, tobacco-caused
cancers.) And just as tobacco companies fought, ignored, lied and
obfuscated in the '60s (and, indeed, through the '90s), the pushers of
sugar will do the same now.

But as Lustig says, "This study is proof enough that sugar is toxic.
Now it's time to do something about it."

The next steps are obvious, logical, clear and up to the Food and Drug
Administration. To fulfill its mission, the agency must respond to
this information by re-evaluating the toxicity of sugar, arriving at a
daily value — how much added sugar is safe? — and ideally removing
fructose (the "sweet" molecule in sugar that causes the damage) from
the "generally recognized as safe" list, because that's what gives the
industry license to contaminate our food supply.

On another front, two weeks ago a coalition of scientists and health
advocates led by the Center for Science in the Public Interest
petitioned the F.D.A. to both set safe limits for sugar consumption
and acknowledge that added sugars, rather than lingering on the "safe"
list, should be declared unsafe at the levels at which they're
typically consumed. (The F.D.A. has not yet responded to the
petition.)

Allow me to summarize a couple of things that the PLoS One study
clarifies. Perhaps most important, as a number of scientists have been
insisting in recent years, all calories are not created equal. By
definition, all calories give off the same amount of energy when
burned, but your body treats sugar calories differently, and that
difference is damaging.

And as Lustig lucidly wrote in "Fat Chance," his compelling 2012 book
that looked at the causes of our diet-induced health crisis, it's
become clear that obesity itself is not the cause of our dramatic
upswing in chronic disease. Rather, it's metabolic syndrome, which can
strike those of "normal" weight as well as those who are obese.
Metabolic syndrome is a result of insulin resistance, which appears to
be a direct result of consumption of added sugars. This explains why
there's little argument from scientific quarters about the "obesity
won't kill you" studies; technically, they're correct, because obesity
is a marker for metabolic syndrome, not a cause.

The take-away: it isn't simply overeating that can make you sick; it's
overeating sugar. We finally have the proof we need for a verdict:
sugar is toxic.