Is Sugar Making the World Fat, Diabetic, and Hypertensive?

The new study inreminds us that in developing countries, sugar intake continues to rise. Therefore, the developing world needs policies that limit added sugars, hopefully before the train leaves the station.
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We're moving toward a world with a shared diet. Pizza Hut, Taco Bell, KFC, McDonald's, Coca-Cola and Pepsi can be found worldwide, and consumers around the world and in developing countries have developed a taste for our highly-processed food.

The shift from traditional diets in developing countries toward a Western diet -- a diet high in refined sugars, animal based foods and vegetable oils -- is known as nutrition transition. While this shift affords more food security and cheaper food, the move toward a Western diet has major health consequences, chief among them being obesity, diabetes and heart disease.

What is it about the Western dietary pattern that puts populations at risk?

Sugar, obesity and disease

A new study in Public Health Nutrition looked at the rates of overweight, obesity and high blood pressure (which are major risk factors for heart disease) in countries around the world and these countries' availability of foods, including cereals, sugars, vegetable oils, fruits, starchy roots, pulses, total vegetables, alcoholic beverages, total meat, animal fat, eggs, milk, and fish and seafood.

The study, led by Mario Siervo, found that sugar consumption was directly associated with overweight, obesity and high blood pressure. Low intake of cereals and physical inactivity were also contributors, but nothing predicted how fat a country would be as much as how much sugar it consumes.

Coincidentally, another article looking at what people eat around was just published in PLoS One. This widely-publicized article by Sanjay Basu, Paula Yoffe, Nancy Hills, and Robert Lustig looked at the relationship between sugar availability and diabetes prevalence in 175 countries. After accounting for many factors, such as obesity, exercise, poverty, age, etc., the study found that the higher the sugar in the countries' food supply, the higher the diabetes rates. Their conclusion was: "Every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1 percent."

What is it about sugar?

In a fascinating article about the science of creating addictive food in the New York Times, Michael Moss describes the well-known recipe to increase sales: "... one of the cardinal rules in processed food: When in doubt, add sugar."

Sugar makes food craveable. That's why sugar's in everything.

So does sugar just make us consume too many calories because it makes food tastier and more desirable, or is there something inherently fattening and unhealthy about sugar? Dr. Robert Lustig is one of the leading voices warning that sugar is a major culprit in obesity and disease, and that sugar punishes us beyond the 4 calories per gram it sneaks in. Sugar, and especially its fructose component, Lustig claims, when consumed in excess, hits the liver rapidly, drives a whole cascade of metabolic outcomes, and causes fat production and insulin resistance. Lustig's new PLoS One article supports this theory.

Lustig has his critics, of course, and other obesity and nutrition experts believe sugar drives obesity and disease just because of the quantities and rates we consume of the sweet stuff. Regardless of how we explain the sugar disease connection, there's no doubt that to improve health we need to reduce sugar intake.

The World Health Organization recommended in 2003 that "added sugar" be limited to 10 percent of a person's caloric intake. The American Heart Association (AHA) went further and recommended that women should consume no more than 100 calories of added sugars per day (6 teaspoons) and most men no more than 150 calories (9 teaspoons). One 12-ounce can of Coke contains 130 calories in added sugars, which puts women over the AHA upper limit -- no room for bread, sweetened yogurt, and just forget about dessert.

Unfortunately, we don't even know how much added sugar is in our processed food, as our food label only lists total sugars -- both innate carbs and added sugar -- in the sugar component of the label.

Efforts to curb sugar consumption in the U.S. face strong opposition from the industry. The Yale Rudd Center summarizes progress and efforts to reduce sugary drink consumption in different states in this nifty interactive map. Although sugar consumption is very high in the U.S. and in other developed countries, it has plateaued and even declined in the last decade. The new study in Public Health Nutrition reminds us that in developing countries, sugar intake continues to rise -- and will probably result in an increase in chronic conditions such as diabetes and heart disease. Therefore, the developing world needs policies that limit added sugars, hopefully before the train leaves the station.

Dr. Ayala

Disclosure: I'm vice president of product development for Herbal Water, where we make organic herb-infused waters that have zero calories and no sugar or artificial ingredients. I'm also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years.

For more by Ayala Laufer-Cahana, M.D., click here.

For more on diet and nutrition, click here.

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