Sugar: The gateway drug

Ok, so first the good news: dietary fat and cholesterol have been cleared of all charges (for the most part). With the exception of trans fat and hydrogenated oils. Recent meta-analysis has shown no strong link between dietary fat and heart disease, or stroke - yes, even saturated fat. That is a large departure from what we have been told for the last 40 years. Which means that steak for dinner is not likely to clog your arteries or make you fat. Unless you have it with a glass of juice or soda or a donut. 

Now, for the bad news: sugar is a killer, and is likely responsible for not only the fattening of America, but also the epidemic of type 2 diabetes, heart disease and possibly even cancer. This has been known since the 1970’s, but thanks to some “contributions” to key scientists and politicians, sugar got a hall pass while dietary fat got wrongly incarcerated. This is not a conspiracy theory, there is evidence to back this up that was published November 2016 in JAMA Internal Medicine, after being picked up by the New York Times on September 12, 2016. 

The result of these dietary shenanigans is what we see today all around us. Obesity rates have increased 50% per decade since the 1970’s (from 13% to more than 40% of Americans today). In the next few years we will be surpassing the high water mark, with 50% of US citizens classified as obese! This is not an aesthetic issue, we are not concerned with cellulite and love handles. The explosion of metabolic-related diseases may represent the downfall of the American Healthcare system, which is already taking a bit of a beating. With 30 million American adults and children now having Type 2 diabetes and many more with Metabolic Syndrome (insulin resistance/pre-diabetes leading to high blood pressure and increased cardiovascular disease risk) the projected costs of caring for these folks will likely bankrupt Medicare in the next few years. Over a 5 year span from 2012-2017, the estimated cost of caring for Type 2 diabetes spiked from 240 to 327 billion dollars in 2017. Yes, billion. Per year. Spent on a disease that is almost completely preventable (and in many cases reversible) with diet and lifestyle adjustments. And by the way, Alzheimer’s disease (which represent the most costly long term debilitating disease ever seen) may be to some degree preventable with diet and exercise- and some are referring to Alzheimer’s as Type 3 Diabetes. 

If these diseases of western culture are so preventable, why aren’t we preventing them? It appears to be the perfect storm of politics, money, the food industry, and our biology. 

We are genetically designed to like sweet things. In nature, sweet food, such as fruits, were only available seasonally in most climates. We would gorge on fruit in the fall to gain weight for the winter, knowing that in a few months it would be gone until the following year. In nature, concentrated sugar was not available 24 hours a day, 365 days a year. In fruits, the sugar comes packaged with a lot of fiber, and healthy antioxidants as well. Throughout most of history, sugar was not concentrated into liquid or powdered form, where we could get hundreds of calories of sugar in a few gulps or bites with no fiber, no antioxidants. This concentrated sugar overloads our body’s capacity to process the fructose component of sugar in a healthy manner, and leads to increased “bad” fat in the bloodstream and our livers, increased levels of inflammation in our bodies leading to pre-diabetes and eventually type-2 diabetes, obesity and heart disease. 

Sugar is addictive: These large boluses of concentrated sugar have recently been shown to stimulate the “reward center” in our brains in a manner identical to cocaine or other drugs of abuse. The food industry has been aware of this for some time. Start reading your food labels and look at the number of foods that have added sugar in them. It may go under any of a dozen names, but there is added sugar pumped into the majority of the processed foods sold. This is not just in cookies and candies, but other items you wouldn’t expect, but in breads, condiments, meats, packaged dinners, peanut butter, baby food, etc. Sweet foods sell more, and we unconsciously keep eating more of them. 

This constant dosing of sugar is silently damaging our bodies and leading us down the road to ruin. Just one sweetened drink per day was estimated to increase risk of type 2 diabetes by almost 20% (Imamura, BMJ 2015). Contrary to popular belief, the damage goes on even in those people who are not significantly overweight or obese. There are actually more “normal weight” Americans with metabolic dysfunction on the road to type 2 diabetes than there are obese individuals with the same condition. This is called “TOFI," Thin Outside and Fat Inside. They may not look it from the outside, but these folks may be ticking time bombs, with their internal organs cased in fat, their arteries narrowing, but outside appearing relatively normal weight. 

Despite the mounting evidence that sugar is a killer, little has been done about it. There are powerful forces that have prevented any real action for years, as the low fat fiasco continued to be perpetuated. 

The tide is slowly turning

Medical professionals are slowly beginning to appreciate the evidence showing the dangers of excessive sugar. Diet guidelines are being revised. An advisory committee to the department of health and human services stated in 2015 that they could not recommend a low fat high -carb diet for any health reason. Cities are passing their own “sugar tax” on sweetened drinks to help offset the cost of caring for all the diabetics. Some schools (not enough) are finally outlawing soda machines on campus. The military is very concerned about this obesity trend, which is viewed as a major threat to our national security. The document entitled “Too Fat to Fight” (published in 2010 by a committee of high-ranking retired military officers) should have been a wake-up call long ago, yet 71% of young adults are not eligible for military service, largely due to health and obesity related reasons. 

Here's how you can take action: 

• Start with your own diet and your children’s diet, and commit to drastically reducing your intake of sugar.

•  Eat more “real” unprocessed food and cut down on packaged/prepared/processed foods full of sugars and additives. 

• Read labels 

• Buy food from local farms and ranches. 

• Drink water and cut out the sweetened drinks and save them for a special occasion.

• Ditch the desserts and stop using candy as a reward for your kids. 

• Make sure that your schools are removing the sugary drinks from their campuses if they have not done so.

By Thomas Flass, MD, MS, pediatric gastroenterologist​ at Montana Children's.