Is Sugar to Blame for Our Chronic Disease Epidemics?

Ryan White, a 2011-12 California Endowment Health Journalism Fellow and a freelance writer, will be blogging for Reporting on Health during the 2012 National Health Journalism Fellowship July 22-26 in Los Angeles.

What if the real answer to runaway health care costs isn’t to be found in the legislative boxing rings of Washington, but rather in something as seemingly simple as curbing our sugar intake?

The notion that sugar and high-fructose corn syrup are key culprits in the ongoing epidemics of chronic diseases such as diabetes, heart disease and obesity might sound like a heavy load of blame to drop squarely on them. But leading childhood obesity expert and UCSF pediatrics professor Dr. Robert Lustig forcefully made the argument Thursday at a 2012 National Health Journalism Fellowship panel that our rising sugar intake is having devastating health consequences around the globe.

Very cursorily, Dr. Lustig’s argument goes as follows: Americans now consume more food and most of that increased caloric intake is carbs. “Which carbohydrate? Well, all carbohydrates, but in particular beverages,” Lustig said. Refined carbs in the form of sugar and high-fructose corn syrup (biochemically identical) create unhealthy conditions in the body when repeatedly ingested in high doses, according to Lustig. Over time, the resulting insulin spikes can promote storage of fat, insulin resistance and eventually, metabolic diseases. The deluge of sucrose and fructose in our diets over the past three decades, Lustig maintains, is the driving force behind the exploding numbers of chronic conditions such as hypertension, diabetes and obesity. Sugar isn’t just empty calories, as conventional wisdom puts it. In the quantities put forward by processed foods today, Lustig says, it’s worse than nothing: “It’s poison.” (The New York Times Magazine reported on his research last year.)

“Poison” is a strong label for a substance as ubiquitous as sugar and its variants. Of the 600,000 food items in the United States, 80 percent are laced with added sugar, according to Lustig, because sugar makes things taste better at a lower cost that other flavorings. “Processed food is cheap: Good for your wallet, good for the industry, bad for your health,” he said. It won’t come as a surprise that the doctor strongly supports policy interventions such as New York City’s recent ban on the sale of sweetened drinks larger than 16 ounces, or the tax on sweetened drinks heading to the ballot this fall in California cities Richmond and El Monte.

Industry advocate Melissa Musiker, vice president of food and nutrition policy at APCO Worldwide, not surprisingly took issue with some of Dr. Lustig’s conclusions, arguing that taxing high-sugar beverages like soda is the wrong approach. Not because the tax would curb industry profits or add costs to consumers, but because she said such a tax just wouldn’t work. Consumers will either not change their behavior because of higher prices or, like water flowing around a rock, find cheaper ways to get their sugar fix, she said.

But if it won’t work, why is the food and beverage industry lobbying so aggressively against the tax? When NHJF director Michelle Levander pressed Musiker on why the industry would spend millions of dollars to fight such tax initiatives if consumers would simply find ways around the tax, Musiker repeated her earlier assertion: “Because it won’t work. And I think that’s the point, let’s focus on finding policy solutions that will work.”

Dr. Lustig vehemently disagrees, and he points to the way in which alcohol is taxed and regulated as the best analogy for controlling sugar intake. “Personal responsibility does not work with addictive substances,” he said. Lustig believes that if the tax is big enough, sugar consumption will drop. “Taxation is cheap to implement, doesn’t cause market distortion and raises money,” he said, adding, “It’s gotta be a big tax. No one’s ready for it. No one’s ready for a $12 pack of cigarettes either.”

If the ultimate consequences of taxing sugary drinks have yet to play out, are there other compelling measures governments might implement to improve health? So far easy policy fixes remain elusive, as illustrated by Seattle Times reporter Maureen O’Hagan in her fellowship-sponsored 2011 series, “Feeling the Weight: The Emotional Battle to Control Kids’ Diet,” which won a James Beard Foundation Award.

O’Hagan looked into the childhood obesity epidemic in Washington state, and her reporting challenges the widely held belief that if people just had better access to healthy foods, they would eat the good stuff in lieu of junk. “One of the things I came to conclude is that everything you think you know about obesity is wrong,” O’Hagan told fellows Thursday.

A majority of public health experts surveyed in Washington state said they believed access to healthy foods was a big problem, and the goal of boosting “access” has often been used to argue for more amenities such as community gardens, farmers markets, and healthier vending machines and school lunches. “The idea is that if only carrots and cantaloupe were available, people would eat them,” O’Hagan said.

But when she began looking for the data supporting initiatives such as veggie-stocked corner stores, she found scant evidence. “If there’s one thing I want to leave you with, it is: Get the data,” she told fellow reporters.

O’Hagan visited a Seattle corner market that had received a 2009 grant to add healthy items and found the proprietor had given up because people weren’t buying the produce. “It’s actually more difficult than it would seem,” she said, citing a host of logistical and financial concerns. “But vegetables within walking distance sounds great.” Another grant project she looked at tried giving away free fruits and veggies. “People didn’t even want it when it was free,” she said.

The focus of her reporting began to shift. “My project then came about looking at what the money was being spent on and challenging what the county was doing with it,” she said. That ruffled some bureaucratic feathers. “The county government, which had received a $15 million grant to fight obesity and was spending much of the money on improving access to produce, wasn’t happy about the story,” she wrote in a blog post.

But as her series suggests, improving access to healthier foods alone isn’t enough to drive changes in the way people eat. “The battle is in people’s minds,” she said, and putting kale on every street corner isn’t always enough to help people vanquish their cravings for fat, salt, and yes, sugar.

Image by Judy van der Velden via Flickr