Doctor's Review: Medicine on the Move

May 27, 2017
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Does sugar kill?

The history is long and tortured, but perhaps not fatal

Sugar was not always regarded as the dubious foodstuff it has come to be seen as today. For thousands of years, on the island of New Guinea where it originated, it was considered a magic elixir of health. In its raw form, the cane requires vigorous chewing to extract a pleasantly sweet juice – virtually impossible to eat too much of before exhausting one’s jaw muscles. But, in the spirit of Mae West’s decree that “too much of a good thing can be wonderful,” inventors in India figured out how to distill the sugar cane juice into an irresistible powder by 500BCE.

Mosques made entirely of marzipan expressed the Muslim love for sugar, discovered by Arabs while conquering Persia. British and French crusaders travelling east to wrench the holy land from the infidel were similarly smitten, and by 1500 demands for the “sweet salt,” as it was known, turned refinement into an industry whose work was so brutal it was considered suitable only for the lowest of labourers. Later, in 1791, when the horrors of slave work on the plantations became evident in England, Quaker leader William Fox would declare that, “In every pound of sugar used we may be considered as consuming two ounces of human flesh.” A little later, when slavery was on the verge of abolition, poet Robert Southey spoke of tea as “the blood-sweetened beverage.”

Early on, European fondness for sugar spawned the search for tropical places to colonize which were favourable to the cane, as well as locals to enslave, in what came to be known as the “age of exploration.” Madeira, a Portuguese archipelago in the north Atlantic Ocean southwest of Portugal, was one of the earliest islands to be colonized, cleared and planted with sugar cane in 1425 or so, soon to be followed by The Cape Verde Islands, the Canaries, Hispaniola, Brazil and eventually, Barbados, Jamaica, Cuba, Puerto Rico, and Trinidad. Initially a luxury “spice” available only to the rich, sugar steadily sifted down to the lower classes as availability rose, eventually becoming a staple. In 1700, the average Englishman consumed four pounds of sugar a year. A hundred years later the figure rose to 18 pounds and, by 1870, commoners consumed 47 pounds annually. A mere 30 years later, in 1900, they were gobbling up 100 pounds of the sweet every 12 months.

Did all this sugar cause the English to rocket into a collective state of obesity? No, it doesn’t seem to have. For centuries, obesity rates in the UK were stable at a mere six percent. But then in 1980, in Canada and the United States as well as in the UK, the rates began a steady upward climb, doubling in children and tripling in adults 2015. What could possibly be to blame for this sudden increase? A quick glance at the news today seems to name sugar as the culprit as the health crime against humanity that is obesity. While sugar has played a role, it is not the only villain that many would like to believe it is. Sugar has had accomplices.

Sugar shock

Truth be told, nutritionists may have been responsible for what happened in 1980 and thereafter. One currently popular theory, suggested by journalist Nina Teicholz in her painstakingly researched 2015 book The Big Fat Surprise, is that an establishment of senior nutrition scientists whose research was abundantly backed by the sugar industry maligned research that showed sugar to be harmful and exaggerated the case for low-fat diets. The low-fat diet, promoted by nutritionist Ancel Keys at the University of Minnesota, was first suggested to the public in 1955, right after US President Dwight Eisenhower suffered a heart attack. The “fat hypothesis” asserted that an excess of saturated fats in the blood from the consumption of meat and dairy products caused heart disease by raising blood cholesterol levels and hardening arteries. Eisenhower himself cut saturated fats from his diet completely – he died from heart disease in 1969.

Concurrent with Keys research was the work of John Yudkin, a British professor of nutrition who became convinced that excess sugar, not fat, was responsible for heart disease. “If only a small fraction of what we know about the effects of sugar were to be revealed in relation to any other material used as a food additive,” Yudkin wrote in his 1972 book, Pure, White and Deadly, “that material would promptly be banned.”

In fact, the Food and Drug Administration (FDA) was in the process of considering changes to its sugar recommendations some time in the 1960s, but after what is now an extensively documented aggressive campaign by Big Sugar to cover up negative research on its product, the agency settled on the conclusion that sugar was “generally considered safe.” By the early 1980s, the “fat-causes-heart-disease” theory made it into the national food guides in Canada, the US and the UK, and obesity rates began their rapid ascension.

People were cautioned to avoid saturated fats like the devil and eat moderate amounts of unsaturated vegetable oils, which are now known to produce oxidation by-products and are recognized as potentially harmful. To replace the loss of calories caused by the dramatic reduction in fat, dietary guides upped the number of daily recommended calories, and gave carbohydrates the biggest slice of the pie out of the four primary food groups. This calorie increase, combined with the increased consumption of carbs, is now widely recognized as signaling the start of the obesity epidemic. An attempt to steer the public away from an awareness of the dangers of sugar resulted in what some have called a major global health catastrophe.

A report on the obesity crisis in Canada in 2014 by the Standing Senate Committee on Social Affairs, Science and Technology is in agreement with this theory. The report reads: “Health Canada, for the past 25 years has advised a low fat diet, primarily of unsaturated fats and oils from vegetables and fish, with minimized saturated fat consumption. Review of the scientific evidence, suggesting that saturated fats are unhealthy, indicates a misinterpretation of the data.”

Sugar and the heart of it

The link between heavy sugar consumption and heart disease is now readily acknowledged by the American Heart Association, and has been confirmed by a multitude of recent studies. The World Health Organization recommends that adults and children reduce their daily intake of added or “free” sugars to less than 10 percent of their total energy intake — this is about 50 grams or 12 teaspoons a day. However, they stress that half that amount — just six teaspoon daily — would provide additional health benefits.

Last year, the FDA echoed the WHO’s daily sugar intake recommendation, in addition to announcing a new Nutrition Facts label for packaged foods. The label reflects “new scientific information, including the link between diet and chronic diseases such as obesity and heart disease,” says the agency. “Added sugars” in grams and as percent of “Daily Value” is included on the new label, as a reflection of research that shows that consuming more than 10 percent of one’s total daily calories in added sugar makes it difficult to meet dietary needs.

Health Canada has yet to chime in on a daily recommended amount of sugar for Canadians. New labelling laws put in place in December 2016 (with a five-year transition period) indicate a percentage value for total sugars, but do not make a distinction for added sugars. The ingredients listing is required to group all sugars together in brackets, making those sugars with obscure names (there are 52 different names for sugar!) easier to identify.

The imposition of a 20 percent tax on all sugary beverages is the subject of a heated debate in Ottawa. Places like Mexico and Berkeley, California where sugar taxes have been put in place have shown significant reduction in sugary drink consumption, with a 7.9 percent reduction in Mexico and a 21 percent in Berkeley over a two year period. Many other cities and countries are planning to impose some form of tax in the hopes of reducing the fiscal impact of obesity.

Sugar has been proven to elevate the risk for cardiovascular disease and diabetes, but its causal relationship to obesity is not quite as clear. The senate committee reported that 62 percent of the Canadian diet is comprised of pre-packaged, processed foods, most of which contain sugar, together with refined, genetically modified carbohydrates and a host of chemically formulated emulsifiers and preservatives. Among northern First Nations populations, which in an absence of fresh foods rely on processed foods for most of their nutrition, obesity and overweight rates are at a shocking 70 percent and higher. While the world is focused on the evils of sugar, the white stuff may be little more than a scapegoat for the deeper, and harder-to-face truth: that it isn't a single ingredient, but the entire food landscape we have created for ourselves in the last 30 years that is to blame.

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Comments

Showing 2 comments

  1. On May 2, 2017, David Cameron said:
    The article is interesting but the skill of the author is amazing!! It is so nice to see people who can express information and ideas so well and with such precision. Way to go Tilke!!
  2. On May 18, 2017, Tilke Elkins said:
    Thanks so much for your kind words, David! Much appreciated :)

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