Life is as sweet as ever for many people, but a growing body of medical opinion suggests that too much sugar is as bad for health as alcohol and tobacco
SUGAR, oh honey, honey. You are my candy girl and you got me wanting you. From The Archies to Flo Rida, from Chitty Chitty Bang Bang to Echo and the Bunnymen, the sweet, white stuff – once a status symbol, now the opium of the masses – is synonymous with love, desire and scrumptiousness. And no wonder. Not only are our palates programmed to prefer sweet to sour from the moment we are born, but eating sugar releases pleasure-inducing endorphins and dopamine to our brains, the same chemical reaction produced by falling in love or having sex.
Now, however, we are being told to adjust our dietary and cultural preconceptions. For decades we have been warned saturated fat, which raises cholesterol, and salt, which hardens the arteries, are our enemies and sugar a mostly benign, if somewhat short-lived, mood enhancer. But, in the last few months, a succession of reports has suggested science has got it all wrong: it is sugar, which we consume in excessive quantities, not fat which is to blame for the obesity epidemic that threatens western countries. Linked to migraines, heart and liver disease, skin conditions such as psoriasis, Alzheimer’s and, of course, diabetes, it is the nutritional nemesis holding our wellbeing to ransom.
Last week, the World Health Organisation (WHO) said cutting the recommended daily allowance of sugar from 12 to six level teaspoons a day (less than the quantity contained in a 50g Mars bar) would help tackle obesity, which affects more than one in four adults and costs the UK more than £5 billion a year (although it retained its formal recommendation that adults should eat no more than ten teaspoonfuls a day). Halving the recommended intake would mean adults deriving 5 per cent, as opposed to 10 per cent, of their daily calories from sugar. In reality, however, most people are now way over the upper limit, consuming more than 22 teaspoons a day, either consciously in sweets and fizzy drinks or unwittingly in so-called healthy foods.
The WHO advice came on the back of warnings from a coalition of experts that sugar is as dangerous as alcohol and tobacco. Action on Sugar, modelled on the successful Consensus Action on Salt and Health (CASH), has called on the food industry to cut the amount of sugar in processed foods by 40 per cent and asked the government to impose a tax on carbonated drinks and fines on those who fail to meet the targets.
Meanwhile, leading heart scientist Dr James DiNicolantonio is claiming saturated fat has been falsely maligned. Cutting down on butter, cheese and chocolate does not, he says, lower cholesterol or the incidence of heart disease.
“What many people don’t realise is that added sugar has no nutritional value and, contrary to what the food industry wants you to believe, you do not require any energy from it,” says London cardiologist Dr Aseem Malhotra, Action on Sugar’s science director. “On top of that we now have growing scientific evidence that if you consume too much sugar you are increasing your risk of type 2 diabetes and heart disease, even if you are not obese.”
Malhotra points to a study carried out at Stanford University which looked at sugar availability and consumption in 175 countries. It found that for every extra 150 calories of sugar available per person per day (equivalent to, say, a can of coke), the prevalence of diabetes rose by 1 per cent, compared to a rise of just 0.1 per cent for every additional 150 calories from another source.
Some experts have accused Action on Sugar of scaremongering: they say that while there’s strong epidemiological evidence linking smoking to cancer and there is evidence linking obesity to cancer and heart disease, it is difficult to prove a causal link between sugar and obesity. And they dispute the notion that sugar is dangerous so long as the calories it contains are being burned off. For its part, the campaign group talks of vested interests stacked against it and compares taking on the food industry to taking on the tobacco companies in the 80s.
There is also debate over whether or not sugar is addictive. One study found adults who binged on dense carbohydrates, had the same dopamine gene marker found in those who suffer from alcoholism, but again this is strongly disputed by the food industry.
It’s confusing for consumers who have to pick their way through often conflicting reports to make the best dietary choices. As more and more studies link sugar to a startling range of diseases, however, it seems increasingly likely the majority of us are consuming sugar in excessive quantities and that doing so is exposing us to increased health risks.
The question is: how did we arrive here? How did sugar go from being a delicacy so rare that VIPs at Tudor banquets were ushered into an special room to sample it to a palliative for poverty?
Britain’s love affair with sugar began in the 12th century when Crusaders returned full of tales of the “sweet salt” they had tasted in the Holy Land where Muslim caliphs flaunted their wealth by producing elaborate marzipan sculptures. But it remained a rarity until around 1650 when Britain took over Barbados and other parts of the West Indies from Spain and planted sugar cane, shipping in slaves to do the hard labour.
“At that point, we gained control of our own stocks,” says food historian Dr Annie Gray, a regular panellist on Radio 4’s The Kitchen Cabinet. “The amount of sugar coming in increased and the price started to drop. As you’d imagine, that was the growth period for cakes and biscuits and ice cream.
“Then in the 19th century, the taxes on sugar, which were reasonably high, also dropped and sugar substitutes such as treacle and molasses became much more popular.
“That’s when it started to be the scourge of the working classes because that’s when people started to get a lot of calories from sugar and it started to be damaging to their health.”
In 1700, the average Briton consumed 4lbs of sugar a year. By 1800, he ate 18lbs and by 1900 he was up to 100lbs. Sugar and cheap bread fed factory workers during the Industrial Revolution. Though rationed during both world wars, consumption kept on increasing either side of them as manufacturers started adding it to processed foods: soups, sauces and eventually ready meals.
During the early 1970s, as rates of heart disease were rising, however, one British doctor, John Yudkin, began to suspect sugar was responsible for more than just tooth decay. In his book Pure, White And Deadly he claimed animals fed sugar and carbohydrates showed raised blood levels of triglyceride (a type of fat), which was then, as now, considered a risk factor for heart disease. Sugar also raised insulin levels, linking it directly to type 2 diabetes.
Elsewhere, however, an alternative view was emerging; led by American Ancel Keys, a rival group of scientists decided saturated fat was the main culprit for the rise in heart disease. From this broad consensus, a potentially lucrative new market was established for “healthy” foods, in which saturated fat was often replaced with sugar.
“Back then, the big problem was heart disease. One of the big risk factors was cholesterol and one of the drivers of cholesterol is saturated fat, so the focus was on saturated fat and smoking,” says Naveed Sattar, professor of metabolic medicine at Glasgow University.
“Only 4-8 per cent of people were obese, diabetes rates were at 1 per cent, so sugar slipped into lots of food which were marketed as low-fat. The result is that nowadays an individual may think they’re doing well – they’ll have given up crisps, say – and they’ll think ‘I’ll just have a low-fat yogurt or two’, and suddenly they’re getting 20-30g more sugar without any fibre. They would be better getting those extra calories from an apple or a banana because they’d get fibre and other nutrients and the process of chewing sends signals to the brain saying they are going to be full.”
Yudkin was marginalised as organisations such as the British Sugar Bureau undermined his work. But a few years ago, Robert Lustig, paediatric endocrinologist at the University of California, who was already thinking along the same lines, stumbled across the book and gave a talk which is credited with kicking off the anti-sugar movement. According to Lustig and the scientists involved in Action on Sugar, excess sugar is the principal driver behind the obesity crisis which is in turn linked to many life-threatening diseases.
A key development has been the realisation that whereas glucose – one of two main carbohydrates in refined sugar – is metabolised by all the cells in the body, fructose is chiefly metabolised by the liver. As a result fructose places added pressure on the liver, which turns it into fat. This causes a condition known as insulin resistance, or metabolic syndrome, now recognised as a major risk factor for diabetes, obesity and many cancers. Fructose also raises uric acid which is a trigger for heart disease and strokes.
While the idea that excessive consumption of sugar contributes to obesity is pretty widely accepted, the idea that sugar is in itself toxic has proved contentious, though Malhotra says it is now entering mainstream.
“There was an American study recently which demonstrated that those people who consume more than 25 per cent as opposed to just 10 per cent of their calories from added sugar have a threefold increased risk of developing heart disease, irrespective of their weight.” Malhotra says 40 per cent of normal weight people will eventually develop diseases of the metabolic syndrome: type 2 diabetes, high blood pressure, fatty liver disease.
The difficulty is trying to persuade people something they’ve viewed for so long as a source of pleasure must now be excised from their diet. Sattar believes that, with time, the desire for sugar can be reduced. Once possessed of a sweet tooth, he changed his ways when his mother was diagnosed with type 2 diabetes. “I used to have two sugars in my tea and loved it. If there was no sugar in it, I didn’t like it,” he says. “But recognising my family’s history, I have switched. The point is you can retrain your palate but it takes a bit of time and effort.”
But Action for Sugar believes it is unrealistic to get consumers to reduce their sugar intake unless they can translate the WHO’s recommendations into something meaningful – and that means better labelling. So far the food industry has shown little enthusiasm for better labelling or for slashing the amount of added sugar in processed food and it wields enormous power. “We know that, back in 2003, when there were representations to the WHO that they should reduce the recommended intake of sugar, the industry leaned on the US and George Bush threatened to withdraw all money unless they agreed not to,” Malhotra says.
In Scotland, as elsewhere in Europe, obesity levels have soared – from 17.2 per cent in 1995 to 26.1 per cent in 2012 – and, although they appear to be plateauing, something has to be done. Malhotra is digging in for the long haul. Yet, given CASH has made progress achieving a 15 per cent reduction in the UK’s salt intake, he believes the battle can be won.
“It is difficult but I think there’s much greater awareness now. People are asking questions and at the very least it will encourage consumers to be more wary of sugar and to choose products that are lower in sugar,” he says. “Ultimately what will happen is that the industry, which is interested only in making profits, will respond to consumers if they start choosing products which are lower in sugar. Hopefully that will shift the balance to create more healthy foods in the supermarkets.”