Toxic Truth About Sugar Essay
But surely it should be up to us how much sugar we eat. We don’t want the sugar police, do we? Even as I was thinking this, I realised something slightly alarming: part of me doesn’t want to hear really, seriously bad news about sugar. I have enough to worry about. I’d like to remain in mild denial, thank you. Sugar is part of life. It’s pleasant. It’s everywhere. Poison, schmoison. Who is this Robert Lustig, anyway?
He’s a professor of clinical paediatrics at the University of California, San Francisco, and an expert on childhood obesity.
Scientifically, Lustig is an endocrinologist. His area of expertise is human metabolism — how our bodies break down food and turn it into energy. Some of his lectures are on YouTube. Recently, he’s gone viral. This middle-aged, grey-haired, slightly stocky guy, who wears a suit and tie and talks about the metabolism of fructose, has had more than two million hits.
In the lectures, Lustig is mesmerising. He tells us more or less the same story he’s outlined in a recent issue of the journal Nature. “The UN Secretary General,” he says, “declared that non-communicable disease — that is, diabetes, heart disease, obesity, cancer and Alzheimer’s disease — is a bigger threat to the entire world, developed and developing, than is infectious disease.” He tells us that these diseases kill 35 million people every year. He says that there are 30 per cent more obese people in the world than undernourished people. In 2011, there were 366 million diabetics in the world — more than double the number in 1980, and 5 per cent of the population. In the US, by 2030 this figure might be as high as 33 per cent.
At this point, he had my attention. Remember when almost nobody had diabetes? That wasn’t long ago. These days, many of us know somebody with the disease. And what about high blood pressure, heart disease, fatty liver, and chronic fatigue? What about depression, food cravings, addictive overeating? Think about all the people we walk past every day who are really, really fat. Not just plump but off-the-scale fat. Within living memory, these people were rare.
Now you see them every day. And it’s not necessarily their fault.
“Nobody chooses to be obese,” says Lustig. “Nobody. Especially not children. This is a global pandemic. D’you think, all of a sudden, everybody in the world became gluttons and sloths at the same time? Get with the programme!”
What’s going on? “It ain’t the fat,” says Lustig, when I speak to him on the phone. The obesity epidemic, and the sudden flourishing of all these non-communicable diseases, is not a result of people eating too much fat. We know this because, in the Seventies, the entire Western world went low-fat. The medical establishment believed it had discovered a link between dietary fat and heart attacks.
As we now know, the situation was fairly complicated — some fats, notably Omega-3 oils, are actually good for your heart. Still, in the Seventies, the food industry cut back on fat. We had low-fat yogurt, low-fat ready meals, low-fat sauces, low-fat everything. The problem, Lustig tells us, “is that, when you take the fat out, it tastes like cardboard. They had to do something.” What did they do? “They added carbohydrate. Which carbohydrate? High-fructose corn syrup and sucrose.”
So about 35 years ago, the developed world made a radical change in its diet. We stripped away fat, and added sugar. For instance, since 1990, consumption of sugar in Britain has increased by 31 per cent – now we eat 1.25lbs per person a week. There are seven spoonfuls of sugar in a can of cola. Lots of people know that. But do you know that more than 60 per cent of a Slimfast drink is made up of sugar? Did you know that, in Britain, children get around 17 per cent of their calories from sugar?
One interesting fact is that, year on year, we’re buying fewer actual bags of sugar — “visible sugar”. The big increases are in “invisible sugar” — the sugar the food industry sneaks into things. Looking around my local supermarket, let me tell you what I found. There is glucose-fructose syrup in one organic yogurt; organic sugar and organic invert sugar syrup in another. There is fructose in Müller Light. There is sugar in Hovis bread, sugar in healthy-looking Burgen bread, dextrose in Warburton’s wholemeal bread. There is fructose syrup in my Forest Feast dried berries. There is sugar in the steak pie. There is sugar in the smoked salmon. There is sugar in the seafood sticks. There’s a cheese I like, Wensleydale with apricots, which is delicious – thanks to the added fructose. There are sausages with sugar.
Why is there sugar in all these things? Partly, it’s because we, the consumers, want it. We want everything to be sweeter these days; we wouldn’t like to go back to the good old days, when smoked salmon tasted fishy and salty and dried cranberries tasted tart. The food writer, Felicity Lawrence, recently conducted a study of fruit. She found it was getting sweeter. That’s how farmers are breeding it. We want our apples, strawberries and grapes to taste sweeter — partly because everything else does. When you add sugar to one thing, you have to add it to other things, too, so they won’t be left behind. Have you got a headache? Take an ibuprofen. It’s probably sugar-coated, like a Smartie.
There’s undoubtedly a correlation between our increased sugar intake, over the past 30 years, and this explosion in obesity, diabetes and other metabolic problems. But are things so simple?
Robert Lustig is very busy when I speak to him. He’s rushing around a great deal, giving talks. This, it seems, is his moment. I ask him about the correlation between sugar intake and obesity. “Correlation is not causation,” he says forcefully. “If we didn’t have causation I wouldn’t be speaking in public. And I’m happy to stack the science up against anybody who wants to countermand it.”
One of the most important things he says concerns what happens in your liver when you eat fructose. There’s a complicated chain of events, but the upshot is something called “leptin resistance”. Leptin is a hormone produced to tell us when we’re full; it’s the “satiety hormone”. When we eat too much fructose, leptin is sometimes switched off. We don’t know when we’re full. That’s why so many people are off-the-scale-fat these days. They don’t have a proper satiety signal. The sugar they eat causes them to produce too much insulin, which gives them blood-sugar crashes, which makes them crave more sugar, and on and on. Meanwhile, they develop insulin resistance. Next stop: diabetes. Somewhere down the line: huge health care costs.
Sugar’s everywhere. It’s addictive, it’s toxic, and, in the end, we all have to pay for it, if not with our health, then at least in our taxes. That’s why Lustig thinks it should be controlled like alcohol and tobacco. For a substance to be controlled, it must have four characteristics. It must have the potential to be abused. It must be toxic. It must be widespread. And it must cause problems for people other than those who abuse it. Sugar, of course, ticks all these boxes.
Incidentally, there’s a reason why fructose switches off our satiety signal. Or at least a hypothesis. Lustig says it might be because there was a time of year, harvest time, when ancestral humans had an abundance of fruit, followed by a time of year, winter, when they had almost nothing. So we evolved to overeat at harvest time. Fructose makes us want to eat more; it tells us not to be satisfied. That was good, then, when food was scarce. It wasn’t so good later, when it was less scarce. It’s a disaster now, when it’s everywhere. That’s Lustig’s argument.
There is, of course, a really big problem. That’s the food industry.
“The food industry,” Lustig tells me, “has no impetus to change. They’re making money hand over fist.” We’ve all heard of Big Tobacco. Well, there’s something even bigger to worry about — Big Sugar. The obesity expert Philip James puts it this way: “The sugar industry has learnt the tricks of the tobacco industry. Confuse the public. Produce experts who disagree. Try to dilute the message.”
Lustig has been accused of “irresponsible” fear-mongering by the food industry. He has some allies but none of the big hitters, while broadly agreeing with him that sugar is a problem (although disagreement exists about which type of sugar is the worst) goes as far as him in terms of regulation. There’s Kelly Brownell, an obesity expert and professor of psychology at Yale. “He thinks a penny-an-ounce soda tax will reduce consumption. I don’t,” says Lustig.
There’s Marion Nestle, professor of nutrition, food studies and public health at New York University, and author of Food Politics: “she isn’t necessarily for regulation”. Gary Taubes, the low-carb guru, “doesn’t believe that leptin is crucial to the argument. I do.” Michael Pollan, the author of In Defence of Food, “doesn’t even pretend to understand the science”, and “doesn’t specifically come out against sugar per se”. And is there anyone in the UK even remotely on the same page as Lustig? “Not that I know of,” he says.
What if Lustig is right? What if sugar is the culprit? What can we do? We can start the long, laborious process of coming out of denial. We’re doing it with alcohol. We’ve done it with tobacco, which was a huge struggle. But it’s working. Most people used to smoke. Now most people don’t. We made it expensive, harder to buy, and harder to advertise. We kept it away from children. We made it taboo.
Can we do this with sugar? I’d love to think we could. But sugar is a tougher opponent than tobacco. Tobacco was in cigarettes, cigars and pipes. Sugar is everywhere. It’s in the pies. It’s in the beans and the toast. It’s in the sausages and the gravy. To radically cut our intake would be to radically shake up the economy. So don’t expect miracles.
For an example of what Lustig is up against, look no further than the Starr Report, the investigation into Bill Clinton by the prosecutor Kenneth Starr. One section describes the moment President Clinton was interrupted by a phone call during an intimate moment with Monica Lewinsky. The person on the line was reportedly Alphonso Fanjul, a Florida sugar baron, complaining about a proposed sugar tax. Clinton took the call. The tax was dropped.
This article also appeared in SEVEN. Follow SEVEN on Twitter @TelegraphSeven
If you have any interest at all in diet, obesity, public health, diabetes, epidemiology, your own health or that of other people, you will probably be aware that sugar, not fat, is now considered the devil's food. Dr Robert Lustig's book, Fat Chance: The Hidden Truth About Sugar, Obesity and Disease, for all that it sounds like a Dan Brown novel, is the difference between vaguely knowing something is probably true, and being told it as a fact. Lustig has spent the past 16 years treating childhood obesity. His meta-analysis of the cutting-edge research on large-cohort studies of what sugar does to populations across the world, alongside his own clinical observations, has him credited with starting the war on sugar. When it reaches the enemy status of tobacco, it will be because of Lustig.
"Politicians have to come in and reset the playing field, as they have with any substance that is toxic and abused, ubiquitous and with negative consequence for society," he says. "Alcohol, cigarettes, cocaine. We don't have to ban any of them. We don't have to ban sugar. But the food industry cannot be given carte blanche. They're allowed to make money, but they're not allowed to make money by making people sick."
Lustig argues that sugar creates an appetite for itself by a determinable hormonal mechanism – a cycle, he says, that you could no more break with willpower than you could stop feeling thirsty through sheer strength of character. He argues that the hormone related to stress, cortisol, is partly to blame. "When cortisol floods the bloodstream, it raises blood pressure; increases the blood glucose level, which can precipitate diabetes. Human research shows that cortisol specifically increases caloric intake of 'comfort foods'." High cortisol levels during sleep, for instance, interfere with restfulness, and increase the hunger hormone ghrelin the next day. This differs from person to person, but I was jolted by recognition of the outrageous deliciousness of doughnuts when I haven't slept well.
"The problem in obesity is not excess weight," Lustig says, in the central London hotel that he has made his anti-metabolic illness HQ. "The problem with obesity is that the brain is not seeing the excess weight." The brain can't see it because appetite is determined by a binary system. You're either in anorexigenesis – "I'm not hungry and I can burn energy" – or you're in orexigenesis – "I'm hungry and I want to store energy." The flip switch is your leptin level (the hormone that regulates your body fat) but too much insulin in your system blocks the leptin signal.
It helps here if you have ever been pregnant or remember much of puberty and that savage hunger; the way it can trick you out of your best intentions, the lure of ridiculous foods: six-month-old Christmas cake, sweets from a bin. If you're leptin resistant – that is, if your insulin is too high as a result of your sugar intake – you'll feel like that all the time.
Telling people to simply lose weight, he tells me, "is physiologically impossible and it's clinically dangerous. It's a goal that's not achievable." He explains further in the book: "Biochemistry drives behaviour. You see a patient who drinks 10 gallons of water a day and urinates 10 gallons of water a day. What is wrong with him? Could he have a behavioural disorder and be a psychogenic water drinker? Could be. Much more likely he has diabetes." To extend that, you could tell people with diabetes not to drink water, and 3% of them might succeed – the outliers. But that wouldn't help the other 97% just as losing the weight doesn't, long-term, solve the metabolic syndrome – the addiction to sugar – of which obesity is symptomatic.
Many studies have suggested that diets tend to work for two months, some for as long as six. "That's what the data show. And then everybody's weight comes roaring back." During his own time working night shifts, Lustig gained 3st, which he never lost and now uses exuberantly to make two points. The first is that weight is extremely hard to lose, and the second – more important, I think – is that he's no diet and fitness guru himself. He doesn't want everybody to be perfect: he's just a guy who doesn't want to surrender civilisation to diseases caused by industry. "I'm not a fitness guru," he says, puckishly. "I'm 45lb overweight!"
"Sugar causes diseases: unrelated to their calories and unrelated to the attendant weight gain. It's an independent primary-risk factor. Now, there will be food-industry people who deny it until the day they die, because their livelihood depends on it." And here we have the reason why he sees this is a crusade and not a diet book, the reason that Lustig is in London and not Washington. This is an industry problem; the obesity epidemic began in 1980. Back then, nobody knew about leptin. And nobody knew about insulin resistance until 1984.
"What they knew was, when they took the fat out they had to put the sugar in, and when they did that, people bought more. And when they added more, people bought more, and so they kept on doing it. And that's how we got up to current levels of consumption." Approximately 80% of the 600,000 packaged foods you can buy in the US have added calorific sweeteners (this includes bread, burgers, things you wouldn't add sugar to if you were making them from scratch). Daily fructose consumption has doubled in the past 30 years in the US, a pattern also observable (though not identical) here, in Canada, Malaysia, India, right across the developed and developing world. World sugar consumption has tripled in the past 50 years, while the population has only doubled; it makes sense of the obesity pandemic.
"It would have happened decades earlier; the reason it didn't was that sugar wasn't cheap. The thing that made it cheap was high-fructose corn syrup. They didn't necessarily know the physiology of it, but they knew the economics of it." Adding sugar to everyday food has become as much about the industry prolonging the shelf life as it has about palatability; if you're shopping from corner shops, you're likely to be eating unnecessary sugar in pretty well everything. It is difficult to remain healthy in these conditions. "You here in Britain are light years ahead of us in terms of understanding the problem. We don't get it in the US, we have this libertarian streak. You don't have that. You're going to solve it first. So it's in my best interests to help you, because that will help me solve it back there."
The problem has mushroomed all over the world in 30 years and is driven by the profits of the food and diet industries combined. We're not looking at a global pandemic of individual greed and fecklessness: it would be impossible for the citizens of the world to coordinate their human weaknesses with that level of accuracy. Once you stop seeing it as a problem of personal responsibility it's easier to accept how profound and serious the war on sugar is. Life doesn't have to become wholemeal and joyless, but traffic-light systems and five-a-day messaging are under-ambitious.
"The problem isn't a knowledge deficit," an obesity counsellor once told me. "There isn't a fat person on Earth who doesn't know vegetables are good for you." Lustig agrees. "I, personally, don't have a lot of hope that those things will turn things around. Education has not solved any substance of abuse. This is a substance of abuse. So you need two things, you need personal intervention and you need societal intervention. Rehab and laws, rehab and laws. Education would come in with rehab. But we need laws."
The Obamas hate him, he says, because they don't want to fight the industry. "They've got a lot of enemies. I'm not mad at them. I actually kind of like them." On paper, Lustig is absolutely livid. "In America we have this thing, it's called the Declaration of Independence. We are entitled to life, liberty and the pursuit of happiness. It doesn't say a damned fucking thing about the pursuit of pleasure." But he has seen how it worked with tobacco. It took a long time, he says, but industries can't poison people en masse for ever.
"We have to do something about it, or there will be no healthcare. In fact, there will be no society. Are you ready for that? That's what's gonna happen. It's just not OK. There will be no money left for anything else."
His predictions for world health are apocalyptically pessimistic. Yet in his bearing, he has the deep-rooted optimism of a person who knows the fight is worthwhile, and believes that, in the end, he'll win it.
Fat Chance is published by Fourth Estate at £8.99. To order a copy for £7.19 with free P&P, visit guardianbookshop.co.uk or call 0330 333 6846