Australasian Science Magazine

By Various experts

Experts evaluate a commentary published in Nature* arguing that added sweeteners pose dangers to health that justify controlling them like alcohol.

“A focus on added sugar is most timely, with increasing evidence of its negative health effects.

“The public health arguments for intervening are indeed strong, with perhaps the most important consideration, not highlighted by the authors, [being] the imperative of governments to protect vulnerable members of society, especially where the capacity for well-informed decision making is limited or non-existent.

“Because eating habits and taste tend to be influenced by what we eat as infants and young children, an unhealthy habituation or addiction to sugar, which influences lifetime health, can be established from a very young age when the ability and capacity to make informed eating choices are simply unavailable. This provides a strong case for governments to intervene to encourage healthy food choices, by children and thus families. And as the authors argue, excess sugar is a crucial aspect of current poor food choices and thus an important focus of such policies.

“While at its extreme alcohol may have more damaging effects than sugar, excessive consumption of sugar is considerably more prevalent than excessive alcohol consumption, part of the reason why population level strategies make sense.”

Prof Leonie Segal is Foundation Chair of the Health Economics & Social Policy Group at the University of SA, with an international profile in the economics of nutrition. She was a member of the Minister’s Preventative Health Taskforce.

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“Alcohol toxicity is not just metabolic. It causes violence and road deaths, and sugar in any of its forms cannot compete with this statistic. Almost all of the evidence against sugar is epidemiological – that is, association not necessarily causation.

“In intervention studies with fructose, up to 10% of calories show no metabolic effects while a few studies with fructose at 25% of energy do show a modest increase in triglycerides but not high enough to cause pancreatitis.

“There are no controlled interventions that show feeding fructose or sucrose causes hypertension, and none that show that a controlled reduction in sugar alone reduces blood pressure. However, there is evidence to show that increasing sugar-sweetened beverage intake does cause modest weight gain as the liquid calories are not compensated by a reduction in calories from other foods.

“Sugar is just another form of over-consumed calories – easily available and very palatable but no more metabolically deadly than starch or fat calories, and certainly not equivalent to alcohol.”

Prof Peter Clifton is Head of Nutritional Interventions at Baker IDI Heart and Diabetes Institute.

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“This commentary is a provocative piece intended to encourage debate. Many of the statements simply do not apply to Australia and on certain issues there is little evidence to support their views. ‘Sugar’ is not the issue – it is far more complicated than that.

“The authors state that over the past 50 years, consumption of sugar has tripled worldwide. However, in Australia sugar consumption has dropped 23% since 1980. Despite this, during that time cases of overweight or obese people have doubled, whilst diabetes has at least tripled.

“The authors believe that attention should be turned to ‘added sugar’, which they have defined as any sweetener containing the molecule fructose that is added to food in processing. The authors suggest that fructose can trigger processes that lead to chronic diseases including liver toxicity. However, one would need to eat at least 135 g, or about 32 teaspoons, of pure added fructose per day on top of what one already eats.

Only 1% of Americans eat more than 100 g/day of total fructose. The only disease proven to be related to excess frequent sugar consumption is tooth decay – a significant problem – but even then, refined starch is at least equally as cariogenic but is rarely acknowledged as a problem.

“Lustig and his colleagues claim that sugar should be regulated like alcohol because it is unavoidable, toxic, has potential for abuse and has a negative impact on society. However, it is certainly not unavoidable, it is only ‘toxic’ in unrealistic amounts, and to suggest that consuming sugar is a form of abuse is one of the worst cases of puritanism that I have seen in a while. It’s worth noting that soft drinks and other non-core ‘party’ foods are already taxed (GST) in Australia.

Just like anything else, sugar should only be eaten in moderation. As we continue our research we are finding out more and more about the importance of refined starch and specific fatty acids, and the average Australian can do a lot to improve their diet, but casting sugar as the ultimate villain and calling for regulation is misleading, unfounded and unnecessary.”

Dr Alan Barclay is an accredited practicing dietitian and nutritionist, Chief Scientific Officer for the Glycemic Index Foundation Ltd and head of research at the Australian Diabetes Foundation.