Feb 2 2012 --- Sugar should be controlled like alcohol and tobacco to protect public health, according to a team of UCSF researchers, who maintain in a new report that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer.

Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.

In the Feb. 2 issue of Nature, Robert Lustig MD, Laura Schmidt PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at the University of California, San Francisco (UCSF), argue that sugar's potential for abuse, coupled with its toxicity and pervasiveness in the Western diet make it a primary culprit of this worldwide health a crisis.

This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.

Sugar, they argue, is far from just "empty calories" that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver – the least understood of sugar's damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome—the key metabolic changes that lead to diabetes, heart disease and cancer—are not clinically obese.

"As long as the public thinks that sugar is just 'empty calories,' we have no chance in solving this," said Lustig, a professor of pediatrics, in the division of endocrinology at the UCSF Benioff Children's Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

"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," Lustig said. "But sugar is toxic beyond its calories."

Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. "We recognize that there are cultural and celebratory aspects of sugar," said Brindis, director of UCSF's Philip R. Lee Institute for Health Policy Studies. "Changing these patterns is very complicated"

According to Brindis, effective interventions can't rely solely on individual change, but instead on environmental and community-wide solutions, similar to what has occurred with alcohol and tobacco, that increase the likelihood of success.

The American Beverage Association released a statement challenging the group’s findings: "The authors of this commentary attempt to address the critical global health issue of non-communicable diseases such as heart disease and diabetes. However, in doing so, their comparison of sugar to alcohol and tobacco is simply without scientific merit.

“Moreover, an isolated focus on a single ingredient such as sugar or fructose to address health issues noted by the World Health Organization to be caused by multiple factors, including tobacco use, harmful alcohol use, an unhealthy diet and lack of physical activity, is an oversimplification. There is no evidence that focusing solely on reducing sugar intake would have any meaningful public health impact. Importantly, we know that the body of scientific evidence does not support that sugar, in any of its various forms - including fructose, is a unique cause of chronic health conditions such as obesity, diabetes, hypertension, cardiovascular disease or metabolic syndrome."

The reports’ authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar.

"There is an enormous gap between what we know from science and what we practice in reality," said Schmidt, professor of health policy at UCSF's Philip R. Lee Institute for Health Policy Studies (IHPS) and co-chair of UCSF's Clinical and Translational Science Institute's (CTSI) Community Engagement and Health Policy Program, which focuses on alcohol and addiction research.

"In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level," she said.

Source: Nature, Feb 2 Edition