The Bittersweet Truth
For millennia, humanity's craving for sweetness was primarily satisfied through the consumption of fruit or, on rare occasions, honey from wild bees. However, approximately 2,500 years ago, humans discovered a new method of producing sugar by extracting and drying the sap of sugar cane.
*John Yudkin (1972). Pure, White and Deadly. Penguin Group.*
The process of producing and refining sugar was labor-intensive and complex, which made it an exceptionally costly commodity. As a result, only the wealthy could afford it, and even then, only in limited quantities. By the 1850s, global sugar production had reached approximately 1.5 million tonnes per year, thanks to advancements in extraction and refinement techniques that gradually reduced its price. As sugar became more accessible and affordable, its consumption began to rise significantly.
to mind-boggling levels within just a few decades.
How much sugar do we consume today?
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Today, global sugar production has surged to approximately 180 million tonnes per year. On average, Europeans consume around 30 kilograms of added sugar per person annually, which translates to a staggering 82 grams per day.
In wealthier countries, sugar consumption began to decline in the 1980s as health awareness increased, while in lower-income nations, it continued to rise. This shift highlights the disparities in consumption patterns across different economic groups. For instance, research indicates that the poorest Americans consume significantly more sugary drinks than the wealthiest, underscoring the potential for soda taxes to address health inequalities.
*Patricia Smith, Jay L. Zagorsky (2020). Poorest Americans drink a lot more sugary drinks than the richest – which is why soda taxes could help reduce gaping health inequalities. The Conversation. Accessed on 13 October 2020.*
*Jennifer L. Harris et al (2020). Sugary Drink Advertising to Youth: Continued Barrier to Public Health Progress. UConn Rudd Center for Food Policy & Obesity. Accessed on 13 October 2020.*
Despite these trends, sugar consumption in Western countries remains elevated compared to pre-war levels. In Italy, my country of origin, sugar intake was approximately 9 kilograms per capita annually before World War II. Today, this figure has climbed to 25 kilograms per person per year, reflecting a significant increase over the past century.
Why is there sugar in everything?
Many of us will be shocked to read that Europeans eat that much sugar on average. Yet, while European families have been buying less “household” sugar over the years, sugar has been added to many packaged foods for decades. Sugar doesn’t come to us just in the form of sweets such as confectionery, sodas, or biscuits; it hides in savory foods too: pasta sauces, soups, spreads, stews, even crackers, and chips. Today, unless we read otherwise (i.e., “No added sugar”), we can assume that sugar is in the list of ingredients.
And there’s no mystery as to why sugar seems to hide everywhere: it simply is one of food manufacturers’ best friends. It’s not only its sweetness that makes it attractive but also its cheaply added bulk, its solubility in water, and its ability to inhibit the growth of mold and bacteria. For these and many other qualities, sugar is a versatile ingredient and helps produce foods that can last long and taste good. Today, sugar is a booming industry: worth more than 63 billion euros in 2018.
Early Sugar Research & The Obesity Epidemic
Until a couple of centuries ago, people in the West were consuming low enough quantities of sugar to be considered irrelevant. So, the effects of sugar on our bodies managed to go unnoticed for a long time – no one thought sugar could be bad for us. However during World War I, questions about the health impacts of sugar began circulating.
Physicians speak up against sugar
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Several U.S. physicians signed a letter in 1918 suggesting a reduction of sugar in people’s diets. According to them, sugar was starting to dominate a big chunk of our calories without bringing any other nutritional benefit. It wasn’t until the 1950s and 1960s, when many more U.S. men started to suffer from heart disease and obesity, that many began to question if sugar could be intrinsically bad for us.
The link to heart disease: Sugar vs fat
What was responsible for the rise in weight and heart disease? Two physiologists had brought forward their hypotheses: John Yudkin (British) hypothesized that sugar was the culprit of obesity and heart disease; in contrast, Ancel Keys (American) thought excess fat was responsible for the increase in cholesterol, which would cause coronary arteries to harden and narrow and so cause heart disease. Yudkin and Keys were both trying to answer the same question, but they ended up with opposing theories to one another. While Yudkin thought sugar and fat could both be problematic, Keys discredited Yudkin’s theory as “a mountain of nonsense.” Instead of collaborating, the two ensued into a row of personal quarrels.
The Sugar Industry & Skewed Science
The sugar industry became a pivotal actor in this story, as Yudkin’s theory presented a substantial threat to the interests of sugar companies and the organizations representing producers, processors, and refiners. To undermine Yudkin’s work further, the industry exploited his disagreement with Ancel Keys. The British Sugar Bureau dismissed Yudkin’s claims about sugar as "emotional assertions," while the World Sugar Research Organisation labeled his book as nothing more than "science fiction." As noted by The Guardian, Yudkin was not merely silenced but effectively discredited and marginalized.
*Ian Leslie (2016). The sugar conspiracy. The Guardian. Accessed on 8 October 2020.*
Simultaneously, in the United States, the director of the Sugar Research Foundation proposed launching a "major program" to counteract negative perceptions of sugar.
*Cristin E. Kearns et al. (2016). Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA (The Journal of the American Medical Association) Internal Medicine. Accessed on 9 October 2020.*
This initiative involved financing studies with meticulously designed research questions aimed at diverting attention from sugar or reinterpreting data to conclude that sugar did not contribute to disease. Below are examples illustrating how the sugar industry sought to shape both scientific research and public opinion regarding sugar.r.
Fat, not sugar, is responsible for heart disease.
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In 2016, a team of researchers uncovered correspondence between the Sugar Research Foundation (SRF) and certain Harvard scientists dating back to the 1960s. These documents revealed that the sugar industry financed studies designed to shift the focus away from sugar's connection to heart disease, instead emphasizing fat and cholesterol as the primary culprits. The funding provided by the SRF to these scientists would equate to approximately half a million dollars in today’s currency.
*Cristin E. Kearns et al. (2016). Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. JAMA (The Journal of the American Medical Association) Internal Medicine. Accessed on 9 October 2020.*
The SRF requested that the Harvard scientists evaluate existing research linking various nutrients to heart disease. During this period, the scientific evidence implicating both fat and sugar in heart disease was still limited. However, when the scientists published their review in the *New England Journal of Medicine*, they minimized the significance of studies highlighting sugar's role in heart disease while failing to apply the same scrutiny to studies focusing on fat.
Furthermore, the scientists did not disclose any potential conflicts of interest, as such disclosure was not yet mandatory at the time. As a result, the Harvard review was widely accepted without critical examination, influencing public perception and dietary guidelines for decades..
“Sugar doesn’t damage teeth”
This is not an isolated case. To distract dental professionals from suggesting limits on sugar to prevent tooth decay, the SRF also lobbied the National Institute of Dental Research to fund studies on causes of tooth decay that focused on the effects of literally anything but sugar: vaccines, fluoride treatments, mouth bacteria, tooth brushing, and any other possible cause. The result? In 1971, among the methods the National Caries Program promoted to reduce tooth decay, there was no mention of exposure to sugary foods and drinks.
Attempts to influence dental research are not just something of the past. In a 2019 article published in The Lancet, a group of researchers complained that the sugar industry still influences oral health policies and professional organizations through well-developed corporate strategies.
“Sugar doesn’t make you fat”
Using distorted research for marketing strategies, the Sugar Association managed to claim sugar’s health benefits for decades – at some point, sugar was even positioned as a diet aid to counter obesity. Here are some advertisements from the 1970s:
The “fat time of day:” you’re really hungry and ready to eat two of everything. Here’s how sugar can help.
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You’ve probably had people tell you they’re avoiding this or that because it has sugar in it. If you want to see how much sense there is to that idea, next time you pass a bunch of kids, take a look. Kids eat and drink more things made with sugar than anybody. But how many fat ones do you see?
As NYU Professor of Nutrition, Health Studies, and Public Health, Marion Nestle (who has nothing to do with the Nestlé food company) put it in her book Unsavoury Truth, the sugar industry has been using the same methods applied by the tobacco industry to influence policy and public opinion for decades. These methods include casting doubt on the science and funding research to produce desired results or shifting attention away from studies that condemn the health effects of sugar, but they don’t stop there. The sugar industry has also been using courts to challenge critics and unfavorable regulations.
Marion Nestle told me that the sugar industry is pursuing similar goals even today. “The sugar industry’s goal in funding research is still to demonstrate that sugar has no adverse health consequences, that research demonstrating the contrary is so badly done that it should be ignored and that physical activity is a more important determinant of obesity than diet.”
The issue with industry-funded studies is that they tend to be more biased – intentionally or not. Several studies found that most industry-funded studies favored sponsors and their products.
,So Is Sugar Really Bad For You?
Despite what the industry wants us to believe, the short answer is yes: excess sugar is bad for you. The World Health Organisation strongly recommends reducing the intake of free sugars to less than 10% of total energy intake and even states that it would be better (if possible) to reduce it to below 5% of our total energy intake.
The US Dietary Guidelines Advisory Committee gives similar indications, suggesting that in an ideal diet, added sugars would take only 6% or less.This means that for the average caloric intake recommended for males (2500 calories per day), sugar should not exceed 60g per day. For women eating a diet including 2000 daily calories, that would be even less – around 50g. That’s quite a lot less than the current European average, which surpasses 80g per day.
Sugars’ effects on our bodies
There are two fundamental reasons behind these recommendations: too much sugar in our diets will at least lead us to develop cavities and to gain weight.
Some of us might have heard that sugar is linked to many other diseases, such as diabetes and cardiovascular disease, and might be surprised that these links are not included in the reasons behind public health guidelines. However, evidence directly linking sugar consumption to other diseases is low, so health organizations can’t include those arguments in their rationale until more robust conclusions are reached. Plus, the link between weight gain and many other diseases, such as diabetes, cardiovascular disease, and even cancer, is already well established.
Learn more about the limitations of current research on sugar.
The Politics Of The Sugar Industry
Regardless of the strength of the evidence for specific diseases, many people today believe that a healthy diet should include as little sugar as possible—and the industry knows that.
But in its struggle for a better public image, the industry has proven not to be a cohesive whole. Producers of sweetened foods and different kinds of sugar have started to battle within the industry over which sugar or product is the worst – and, in turn, which one could be advertised as the healthiest.
High-fructose corn syrup
The U.S. sucrose industry, for example, has been trying to identify high-fructose corn syrup (HFCS) as the only evil around, and to give you an idea of how far they went: HFCS can’t be legally referred to as “sugar.” If you dare to call it sugar publicly, you could be brought to court.
Because HFCS was much cheaper than sucrose, food processors put it in every product they could since the 1980s – just as obesity numbers began quickly rising. But as soon as some early (and far from conclusive) research suggested that fructose would be digested in a different, potentially more harmful, way than other sugars in our bodies, the sucrose industry took the opportunity to identify HFCS as the new evil of the sugar world.
To understand the argument against HFCS, we need to understand its molecular structure. You see, HFCS and sucrose are molecularly very similar: both are made up of glucose, fructose, and water. However, a molecule of sucrose has the same amount of glucose and fructose, while a molecule of HFCS carries 5% more fructose than glucose.
With this in mind, this is how the industry-supported reasoning goes:
- Some studies have concluded that fructose could be more harmful than glucose,
- HFCS includes more fructose compared to sucrose,
- So, HFCS must be worse for you than sucrose.
In reality, scientists claim that 5% more fructose doesn’t represent a significant difference between the two types of sugar, and so both HFCS and sucrose would present the same risks to the human body. Sucrose, or natural cane sugar, is not “the healthy alternative” to HFCS, contrary to what the industry has been trying to convince us.
It’s also important to point out that many fructose studies administered exceptionally high doses of fructose to participants. So, until we have research with more realistic fructose intakes, we can’t quantify its impact on the human body in a reliable way.18
The take-home message from nutrition scientists is the same here: the problem is not one type of sugar against another, but too much total sugar consumption.For Profit Or For People?
The history of sugar research is not unlike that of many other foods. Conflicts of interest loom in nutrition research, and we need to build an intellectual toolkit to discern honest and unbiased scientific claims from bogus and marketing claims. Firstly, we need to remember that science is slow and complex, and we often have to wait for several studies to reach the same conclusions over many years before we can be confident that a conclusion reflects what happens in reality. The problem is that the slowness and complexity of science often can’t compete with the simplicity of marketing concepts specifically designed to be digestible and easy to spread, regardless of their truth.
Discover how the meat lobby influences EU policy
So when a single food or macronutrient is demonized as the sole responsible for many diseases, or some other food is celebrated as carrying the most wonderful healing properties, let’s be on the lookout for who could benefit if we were to believe that. Let’s inquire for a link to the original source of information, and then check at least the conflict of interest section.
Knowledge is important. Now that most citizens in wealthy countries know that eating too much sugar is bad for us, the industry has accepted defeat and moved on to some extent. But in turn, they are now marketing most of their sugar-filled products to poorer countries and minorities in wealthier countries, who don’t always have the resources to make healthier choices. That’s why once we’ve built our own anti-bogus kit, we should share it as widely as possible so that humanity as a whole can benefit from it. Only once we all know about the practices that the food industry uses to skew science and influence our opinion will our societies be vaccinated against – and therefore immune to – this kind of malpractice.
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