Guest Essay by Kip Hansen
Prologue: This is the third in a series of several essays that will discuss ongoing scientific controversies, a specific type of which are often referred to in the science press and elsewhere as “Wars” – for instance, this essay covers the War on Sugar. Kahan, in his recent “On the Sources of Ordinary Science Knowledge and Extrarodinary Science Ignorance”, refers to such controversies as “the Science Communication Problem” characterized by their “signature form of persistent contestation”. For the record, I admire Kahan’s analysis, but do not agree with it. The purpose of the series is to illuminate the similarities and differences involved in each of these controversies. I will share my analysis in an essay at the end of the series. Earlier essays in this series are here and here.
Warning: This is not a short essay. Dig in when you have time to read a longer piece.
“Our bodies need one type of sugar, called glucose, to survive. ‘Glucose is the number one food for the brain, and it’s an extremely important source of fuel throughout the body,’ says Dr. Kristina Rother, an NIH pediatrician and expert on sweeteners. But there’s no need to add glucose to your diet, because your body can make the glucose it needs by breaking down food molecules like carbohydrates, proteins, and fats.
“Some sugars are found naturally in foods, such as fruits, vegetables, and milk. ‘These are healthful additions to your diet,’ says Dr. Andrew Bremer, a pediatrician and NIH expert on sweeteners. ‘When you eat an orange, for instance, you’re getting a lot of nutrients and dietary fiber along with the natural sugars.”
“Although sugar itself isn’t bad,’ says Rother, ‘sugar has a bad reputation that’s mostly deserved because we consume too much of it. It’s now in just about every food we eat.” – NIH “Sweet Stuff”
I’ve bolded the central issue in the War on Sugar. The proponents of the War on Sugar – those fighting to eliminate — or at least sharply reduce the amount of – sugar from the American diet have painted sugar as bad – have made sugar into a villain – because it is too popular – people like it and, in the opinion of the anti-sugar advocates, eat too much of it. We should additionally note that sugars are one of the carbohydrates that the body breaks down into glucose – also known as blood sugar. This illogic – sugar is bad because we eat too much of it — is then used to vilify food producers who use sugar in their products – positioned as unnecessary, too much, wrong kind – an endless attack on a substance that is not only innocent, but is a necessary part of the human diet and the main source of quick energy for most higher life forms on earth.
The War on Sugar is dissimilar to the two previous Science Wars discussed so far in this series: The Salt Wars and the Great Barrier Reef Wars. In those previously covered wars, we found two groups of scientists, one on each apparent more-or-less polarized side of the issue, each surrounded by followers in civil society – activist groups, media, and citizens – who are also polarized on the issues involved. In the War on Sugar, we find almost exclusively a large monolithic body of science and health researchers, ‘science popularizers’ and government agencies waging an endless battle against what they see as the inertia of the general public – who for the most part refuse to do as they are told and give up, or at least eat less, sugar — and, as is common in science wars, assert that there is a conspiracy called Big Sugar (which includes all food producers and anyone else not aligned with their view).
The anti-sugar forces use logic like this: “Several studies have found a direct link between excess sugar consumption and obesity and cardiovascular problems worldwide,” Bremer says. Because of these harmful effects, many health organizations recommend that Americans cut back on added sugars.” (NIH – ibid)
All of us who have studied and trained ourselves to read health studies and findings see right away the problem here. The finding of “links” (direct or not) between two or three things is [almost] meaningless. To then make society-wide health or diet recommendations on this sort of weak evidence is not scientific.
As in both of the previous wars, we find that the War on Sugar, has at its core a simple and basic truth, with which most people would agree is true (or, more precisely, true enough). All sugars have high caloric values – they are loaded with calories, packed with chemical energy. [Simplification Warning – the following is actually far more complicated, but this will suffice for now.] In a very general sense, human bodies need to take in as much energy as they expend – they operate on an energy budget. If one expends more energy than one takes in, the body starts using itself as an energy/food source. It begins breaking down its stored fat and uses it for energy. If it runs out of fat stores, it begins to break down the fabric of the body itself – one is starving. On the other hand, if one takes in more energy – more calories – than one expends, then the body stores the extra energy by converting it to fat – its ready pantry of food storage – which can be used later if needed.
The current public health view is that all “excess body fat” is bad, bad, bad – a view that ignores the incontrovertible evidence that so-called overweight people live the longest compared to so-called normal weight and obese people– a fact named The Obesity Paradox.
It is well established that the morbidly obese – those with body mass indexes exceeding 35 or so – are prone to a bevy of health problems which include diabetes and cardiovascular problems associated with high blood pressure. It is not yet entirely clear what type of comorbidity exists between obesity and the related health problems – the choices being: direct causation, associated risk factors, heterogeneity, independence – but the general view is that obesity is either a direct cause or a very high risk factor and thus, if there were less obesity, there would be fewer cases of diabetes and heart disease, a win for individual health, public health and a savings in health care costs.
Thus, the current prominent public health view that eating sugar leads to weight gain which can lead to overweight which can then, if the trend continues, lead to obesity which is a risk factor for diabetes and heart disease – therefore: Eating excess sugar must stop.
The basic truth is that people who are concerned about unwanted weight gain, who are dangerously overweight or who have problems related to the body’s sugar-processing functions, should consider reducing the overall calorie intake – with sugars, particularly added sugars, being the easiest calories to identify and reduce.
If this were The Public Health Message About Sugar all would be well – there would be no controversy and no need of a science war. This true and accurate health message has apparently – see the rising tide of obesity – failed to convince, or failed to help, those to whom it is rightly addressed. The “chain-of-evidence” indicting dietary sugar as the [or even a] cause of diabetes or of high blood pressure or of obesity and related heart disease involves way too many “can lead to”s – the evidence itself is weak.
It is because the evidence is so weak that anti-sugar forces, which include the FDA (plus the usual cadre of health food and health fad advocacy groups), must rely on exaggerated framing of the evidence in order to justify their policy recommendations.
In a nutshell: The claimed basis for the War on Sugar is that sugars – particularly added sugars, a phrase used to avoid indicting fruits, fruit juices, sweet vegetables and milk – are “empty calories” that when ingested in excess can lead to weight gain which can then lead to diabetes, metabolic syndrome and cardiovascular disease.
[ It might be well to point out, as an aside, that when I was in hospital following a heart attack, the nice nurse, on orders from my doctor, plugged a tube into my arm that fed me normal saline solution (salt water) laden with dextrose/glucose (sugar) – those vilified “empty calories” – to sustain my life while I was unable to eat other foods. ]
On the same advice page from the National Institutes of Health, the conclusion is given as:
“In the long run, if you want to lose weight, you need to establish a healthy lifestyle that contains unprocessed foods, moderate calories, and more exercise,” Rother says. [Dr. Kristina Rother, an NIH pediatrician and expert on sweeteners]….
“The key to good health is eating a well-balanced diet with a variety of foods and getting plenty of physical activity. Focus on nutrition-rich whole foods without added sugars.” [emphasis mine – kh]
The majority of this conclusion is scientific and based on good research that returns useful information to nutritionists who have translated it into good clinical advice. The emphasized words and phrases are advocacy and are only very vaguely based on science at all.
There is no evidence, given a well-rounded diet, that “unprocessed” foods are more healthful than processed foods or that well-rounded diets should focus on “whole foods” (a marketing term, not a scientific term) and foods that are free of added sugars.
By the way, the science expressly states, contrary to common belief, that sugar consumption, even excess sugar consumption, does not cause diabetes. (WebMD, supplier of the video making this point, is apparently so sure of the opposite opinion that they named the video file “kahn-eating-sugar-cause-diabetes”.]
Back to Earth: None of these facts should be taken to mean that I, or anyone else, would not suffer health consequences if I ate nothing but ice cream, sugared donuts, honey-sweetened smoothies, drank liter-after-liter of full-sugar soft drinks or chug-a-lugged can-after-can of sugar-laden, over-caffeinated energy drinks alternated with Snickers and Mars bars. That, my kind friends, does not a well-rounded diet make. As with all things, the poison is in the dose, and sugars, as with every other type of food, probably have some natural limit.
[voice-over] AND NOW FOR A LOOK AT THE HEADLINES:
The War on Sugar and How We Can Win It — 05/20/2015 — Jose Aristimuno at HuffPo Blog
“If every candy bar and soda across the country carried a warning label just like a pack of cigarettes does, then our country would start to see our sugar consumption go down, just as we have been able to see it happen within the Tobacco industry.”
Eating too much added sugar increases the risk of dying with heart disease — February 06, 2014 –Julie Corliss, Executive Editor, Harvard Heart Letter
“Nutritionists frown on added sugar for two reasons. One is its well-known links to weight gain and cavities. The other is that sugar delivers “empty calories” — calories unaccompanied by fiber, vitamins, minerals, and other nutrients. Too much added sugar can crowd healthier foods from a person’s diet.”
AND BOOK TITLES:
Sweet Poison: Why Sugar Makes Us Fat by David Gillespie
Suicide by Sugar by Dr. Nancy Appleton
Sugar Nation: The Hidden Truth Behind America’s Deadliest Habit and the Simple Way to Beat It by Jeff O’Connell
The Sugar Addict’s Total Recovery Program by Kathleen DesMaisons
The Real Truth About Sugar: Dr. Robert Lustig’s “Sugar: The Bitter Truth” by Samantha Quinn
Sweet Pete: A story about a bunny who ate too much sugar (a children’s book) by Maria Alony and Heidi Rodis
Sugars and Flours: How They Make us Crazy, Sick and Fat, and What to do About It by Joan Ifland
[ Disclosure: I have read all the articles linked, plus approximately 100 others, as well as dozens of journal articles on the sugar issue, but have only read one of the books: Sweet Pete: A story about a bunny…. ]
“Sugar is poison” (Dr. Lustig and others), “sugar is killing or will kill us”, “sugar is like tobacco”, “sugar makes us crazy”, “sugar is addictive (like cocaine or heroin)”.
These are not the messages of calm, deliberative nutritional science. They are wild and unfounded exaggerations, unlikely extrapolations, symptoms of “public health epidemiology” and the inevitable propagandists’ tool, “sugar is the first step on the slippery slope to morbid obesity, metabolic syndrome, diabetes, and eventual death from heart disease.”
Who, you may rightly ask, is on the side of rationality in this controversy? Very few, and far between.
In this War, we see industry forces whose profits depend in part on high-sugar content foods and drinks funding research in hopes of clarifying the science. Regardless of the findings, the strength of the science, and the thoroughness of the methods, industry science is discredited and discounted.
There are a few voices that occasionally fight back against the exaggerators – write articles pointing out that sugar is not poison, for instance, Ross Pomeroy and David Katz among them. Those who are too outspoken are accused of working for Big Sugar.
The War on Sugar is intertwined with the Obesity Wars, the Soda Wars and HFCS Wars (a sub-set of the War on Sugar).
But we see some common features with the two previously discussed Wars: there is polarization among scientists and the general public, there is resistance to those changes in public policy being insisted on by those speaking for Science, when evidence is weak or only associational, proponents of policy change have exaggerated risks and inflated expected benefits of proposed policy changes to make their messages more powerful (but less true), the general public may pay lip service to the messages (many say they are avoiding sweets) but does not change its behavior (sales of sugar laden StarBigBucks coffee continue to soar, so-called energy drinks – contents: sugars and caffeine — have grabbed a huge bite of the canned drinks market, US candy sales increased from 6.8 billion dollars in 2009 to 8 billion dollars in 2014).
As of 2015, the combined billions of dollars of research expended on the sugar question have allowed us to reach this conclusion:
“Conclusion: There are epidemiological data, plausible mechanisms and clinical data from diet intervention studies that provide strong support for a direct causal/contributory role of sugar in the epidemics of metabolic disease, and for an indirect causal/contributory role mediated by sugar consumption promoting body weight and fat gain. Yet, these are still controversial topics.” Kimber L. Stanhope (2016) Sugar consumption, metabolic disease and obesity: The state of the controversy, Critical Reviews in Clinical Laboratory Sciences, 53:1,52-67 DOI: 10.3109/10408363.2015.1084990
Medical/Nutritional science has made the long, long loop back to where it stood 40 years ago: sugar, representing calories, may cause or contribute to ‘metabolic disease’, meaning 3-out-of-5 of obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low high-density lipoprotein (HDL) levels. [NB: Metabolic syndrome is associated with the risk of developing cardiovascular disease and diabetes.] and may indirectly cause or contribute to “promoting body weight and fat gain”.
Overeating, over-consumption of calories beyond your energy expenditure may cause you to gain weight and, if you do become too heavy, too fat, it can adversely affect your health. This we already knew.
The policy proposals that the general public must be somehow forced to reduce their intake of sugars, through FDA nutritional advice, pressure on the food industry to reduce added sugars, through outright propaganda aimed at the public, and through attacks-by-regulation (so-called soda taxes) on the sugared-drinks industry are all based on the premise that if the public consumed less sugar they would be less fat and more healthy – yet another “one substance solution” which is almost certain to be only a part of the problem that is as yet only vaguely understood. Policies to enforce the premise as a society-wide solution to obesity or metabolic syndrome or diabetes are most likely to fail because they do not solve the right problem and the general public will not act on such weak evidence of potential harms. The general public recognizes the “advocate that exaggerates” as an untrustworthy source of information and discounts all his advice, rejecting the good along with the bad.
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Author’s Comment Policy:
I have personal experience with added calories – if I drink highly-sugared beverages and eat primarily restaurant food – which I did for months at a time when traveling for business, staying in hotels, in the 1990s – I put on 10-15 pounds of extra weight. I knew it would happen, but one pays the price of doing business. On return home, to home-cooked meals and more choices, I readily dropped the extra weight. The cycle was repeated several times. I am now, as I have habitually been, a perfectly normal-weighted middle-age-shaped man, with a current BMI of 24. I have a sweet tooth and childishly enjoy a bit of candy or a dish of ice cream occasionally. I don’t have any stake in the War On Sugar, with the exception of my concern for the extent of the harm that these modern scientific controversies do to the reputation of science.
I will be glad to answer your questions about the War on Sugar – I have been following it for at least 15 years.
I realize that many readers here will want to move on immediately to discuss the parallel problems in the Climate Wars. I ask that you please try to restrain yourselves – we’ll get to that later on in the series.
I am still open to suggestions on which of the current Science Wars to cover in this series, I am aware of a half dozen or more. I have more-or-less promised to cover the Ozone Wars dealing with the so-called hole in the ozone layer.
The last essay in the series will be an attempt to layout a coherent pattern of modern science wars and maybe suggest ways that the different science fields themselves can break these patterns and return their specific area of science back to the standards and practices that should exist in all scientific endeavors.
Thank you for reading here.
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