Sugar intake should be regulated to control its toxic effects, researchers say

Sugar consumption is driving disease and obesity epidemics in the U.S. and should be regulated like tobacco and alcohol, according to researchers at the University of California, San Francisco.  

In an article published Thursday in Nature, UCSF researchers argue for increasing taxes on foods containing added sugars, tightening licensing requirements on vending machines in schools and workplaces, and limiting sales of added-sugar foods during school hours.

Sugar consumption contributes to diseases such as diabetes, heart disease and cancer. These and other non-communicable diseases cause 35 million deaths worldwide each year, and the United Nations declared in September that for the first time in human history they now pose a greater health burden than infectious diseases.

The researchers targeted sugar rather than high-fat or high-calorie foods because it contributes to diseases even in healthy-weight people. The levels of sugar consumed by most Americans change metabolism, raise blood pressure, alter the signaling of hormones and damage the liver.  

"There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates, but sugar is toxic beyond its calories," said Dr. Robert Lustig, UCSF professor of pediatrics and one of the article's authors, in a news release.

Sugar can have toxic effects on the liver similar to those caused by alcohol. This is not surprising, researchers said, because alcohol is produced from fermented sugar. It can also be addicting, like alcohol and tobacco, because it activates the same pleasure areas of the brain, they said.

Sugar consumption has tripled worldwide in the past 50 years and is now found in a wide variety of processed foods, making it less avoidable than ever before.

"I was making chicken soup the other day and I read the ingredients and it had sugar in it," said Claire Brindis, director of UCSF's Institute for Health Policy Studies and one of the article's authors. "Thirty years ago our diets were not so reliant on processed food. Now there is this 'secret' ingredient in so many foods that relies on sugar."

Sugar intake has financial costs in addition to health costs. Seventy-five percent of health-care dollars in the U.S. are related to non-communicable diseases and disabilities, many of which are fueled by sugar.

"The tipping point for regulating tobacco was when we realized that second-hand smoke hurt other people," said Brindis. "The analogy is that children who grow up relying on sugar impact everyone's health-care costs."

The researchers advocate taxation, distribution control and age limitations on sugar-added foods because traditional methods such as educating people about risks are not effective.

They recommend adding a tax that would double the price of soda, reducing the number of retailers that can sell sugar-added foods in a given area, and providing incentives for grocery stores and farmer's markets to replace fast-food restaurants and convenience stores in low-income communities and around schools.

The researchers acknowledge the difficulties in regulating an ingredient that is the center of many cultural and celebratory occasions and they are not advocating prohibition.

"We aren't telling you not to eat your birthday cake," said Brindis. "We are talking about the environment in which our children are growing up and whether there are healthy alternatives for them every day."

Lisa Powell, an economist at the University of Illinois at Chicago, agrees that taxation can be an effective way to discourage people from buying sugar products. She says this does not necessarily result in weight loss but can lead to improved health overall.

"There is a large body of literature that has emerged that show consumption of sugar is sensitive to price," Powell said. "The extent to which changes in consumption result in changes in weight depend on substitution effects. If someone drinks a glass of milk with as many calories as soda they won't lose weight, but milk has nutrients that may contribute to health."

Powell says effective methods for controlling sugar intake vary across populations.

"For children captive at school, consumption depends on what is offered in the cafeteria," said Powell. "For low-income families, it could depend on access to supermarkets and the price of fruit and vegetables. There has to be a comprehensive approach to availability and access."  

Chicago residents surveyed on the street had mixed feelings about government controls on sugar products.

"I'm all for a tax on items you don't need or that have no nutritional value," said April Kelley. "I don't think there should be an age limit on buying food though."

Other residents were less conflicted.

"No, there should not be controls," said Gary Evans. "This is America. If you want to eat yourself silly go ahead."