Sugar, the New Tobacco
It’s a deadly public health risk-but the food industry fends off regulation.
There's an industry selling a product that is bad for Europeans' health.
A generation ago that industry was tobacco and its product was cigarettes. Today it is the food and beverage industry and its product is sugar-sugar that is being added to food and drink.
Dr Aseem Malhotra, a 37-year old London, England cardiologist, is a leader in the anti-sugar campaign in Europe. He charges that the food industry has borrowed the "corporate play book" of the tobacco industry to fend off regulation.
"The only difference," he says, "is that while tobacco was avoidable, sugar is currently almost unavoidable."
Added sugar-not natural sugars that exist in fruits and vegetables-is everywhere. One of the largest sources is in beverages like soft drinks, energy drinks and fruit drinks. But a stroll though the supermarket shows that there is added sugar in bread, yogurt, peanut butter, soup, wine, sausage-indeed, in nearly any processed food. A single tablespoon of ketchup can contain a teaspoon of sugar.
This "invisible sugar" comes under many names. In fact, across the US and Europe, there is the possibility that a consumer might come across any one or more of at least 83 different names for added sugar.
Helen Bond, a dietitian from the British Dietetic Association says, "It's clever marketing -- with terms like 'fructose' making people think they are cutting down on added sugars whereas they might as well be scattering white sugar over their food."
"This added sugar is completely unnecessary," says Dr Malhotra. "Contrary to what the food industry wants you to believe, the body doesn't require any carbohydrate energy from added sugar."
Dr Robert Lustig, a pediatric endocrinologist at the University of California, San Francisco and a world leader in the anti-sugar campaign, notes that sugar consumption worldwide has tripled in the past half-century. But with the population having doubled in the same time, per capita increase of sugar consumption has increased 50%.
"Our food supply now contains so much added sugar that our metabolic (energy processing) systems just can't handle it," he says. "Your body does different things with different types of calories. Fructose (added sugar) in quantities eaten today primarily gets stored as fat. Usually, that fat will go to your belly."
And the danger to our health is not just obesity: There is evidence linking sugar to liver disease, Type 2 diabetes, heart disease and tooth decay. Nevertheless the food and drink industry continues to promote sugar with extensive advertising of its sugary products. It also spends large sums of money opposing clearer labeling of its products, as well as fighting increased taxation on sugary food and drink.
It's hard to find Europe-wide statistics but in the UK, for example, in 2014 alone the food and drinks industry spent 256 million GBP promoting unhealthy foods-those high in sugar and/or fat. According to a recent report of the American Union of Concerned Scientists, nearly $7 billion was spent in the US on advertising products with added sugars in the same period. Of this, about $1.7 billion was specifically earmarked to promote such products to children.
Last year the World Health Organization [WHO] reaffirmed its previous recommendation that ideally our intake of sugar-except that naturally occurring in fruits and vegetables-should not exceed ten percent of total energy intake. The WHO presented strong data linking the consumption of sugar to rates of obesity and, as Type 2 diabetes is clearly linked to obesity, then to this disease as well.
In the average diet, ten percent of total energy intake would work out to about 12 teaspoons of sugar per day. A single 330ml can of soft drink typically contains around ten teaspoons of added sugar. The average adult consumption in Western Europe is 20 teaspoons per day-and the average for children is even higher.
"We have solid evidence that keeping intake of free sugars to the ten percent limit reduces the risk of overweight, obesity and tooth decay," said Dr Francesco Branca, Director of WHO's Department of Nutrition for Health and Development in the press release launching the report.
An industry lobby group, The International Council of Beverages Associations, brushed aside the WHO report, commenting, "Regarding obesity, there is no scientific basis for treating free sugars differently than intrinsic [non-added] sugars."
Dr Malhotra counters: "That's not true. You have to take into account the quality of that calorie. Intrinsic sugar occurs in foods which have other nutritional benefits."
The advertising of sugary foods continues. Overweight and obesity in children, and the amount of sugary food children continue to eat and drink is of particular concern to health professionals. One area where experts see that a difference can be made is in reducing or stopping TV advertising of sugary foods and drinks around children's programming.
The Canadian province of Quebec has been a leader in this regard, restricting such "junk food" TV advertising to children since 1978. Quebec now has substantially lower obesity rates than the rest of Canada. Other countries that have restricted commercials for sugary drinks, cereals and other junk foods during times when kids watch TV are Norway, Sweden, Denmark, Mexico and the UK.
However, one analysis found that in the UK food manufacturers have found other ways to advertise junk food to kids-on the Internet, in product placements on popular TV shows and through video games.
An encouraging initiative to limit advertising to children is the EU Pledge. This began in 2009 as a way for the industry to help meet the European Union's goal to reduce obesity. Major food and beverage companies voluntarily agreed to limit advertising sugary junk food to children under 12. They do not show TV commercials or run Internet ads to this age group and don't market in primary schools, which marks a significant change in the way these foods were sold to children. Since the EU Pledge began, membership has grown to 22 companies, covering more than 80% of food and beverage advertising in the EU.
Marlene Schwartz, PhD, is the Director of the US-based Rudd Center for Food Policy & Obesity - a non-profit organization dedicated to finding solutions through research and policy for childhood obesity, poor diet and weight bias. She says what the EU Pledge is doing is not enough.
"The EU Pledge guidelines don't go far enough. We would like to see it extend to [children] age 14 and under."
Another area of food and drink advertising which Dr Malhotra strongly opposes is the association of products with athletes, a tactic used by the tobacco industry just over 50 years ago when both celebrities and athletes were employed to endorse cigarettes. He questions allowing the Olympics to be sponsored by Coca-Cola. The company's partnership with the Olympics that began in 1928 has just been extended to 2020. "Coca-Cola ... associates their products with sport, suggesting it is okay to consume their drinks as long as you exercise," he wrote recently in the British Journal of Sports Medicine.
"Let us bust the myth of physical inactivity and obesity. You cannot outrun a bad diet."
Public health advocates say two approaches that worked to reduce smoking-consumer education and taxation-are needed to combat over-consumption of sugar.
A ten percent tax on sugary drinks was introduced in Mexico in January 2014 and drinks sales there fell by 12 percent in the first year. In France, a tax on sodas introduced in 2012 has resulted in a gradual decline of consumption. Norway has been active in taxing sugary foods and drinks as well as education for many years, with good results. In March this year UK Chancellor George Osborne announced the introduction of a tax on sugary drinks there, targeting producers and importers of soft drinks and based on the amount of sugar they contain.
Although there has been some success with taxation, the food and beverages industries continue to lobby against consumer education-again, just as the tobacco companies fought government attempts to place warning messages about the dangers of smoking on cigarette packages.
One proposed approach to inform consumers of the levels of added sugars in food was to have "traffic light" labels-red, yellow and green circles -- to indicate the "healthiness" of food and drink products. This scheme, currently a voluntary and successful program in the UK, was defeated in July 2010 by a majority of MEPs in the European Parliament.
Advocates for labeling spoke out in frustration. Peter Hollins, then chief executive of the British Heart Foundation, said: "The European parliament should be ashamed of putting the interests of the food lobby ahead of the health of the people they represent."
Mella Frewen, director general of FoodDrinkEurope (the food and beverage advocacy group, formerly called The Confederation of Food and Drink Industries of the EEC) said existing labelling requirements give sufficient information. "Europe's food and drink manufacturers are [already] providing clear information on labels, listing calories and key nutrients, including sugars, which enables consumers to make informed choices."
The European Consumer Organization (BEUC), which represents some 41 consumer groups in 31 countries, disagrees. "Consumers have no idea of how much sugar they eat," says Ilaria Passarani, head of the Food and Health Department of the Brussels-based organization.
While the debate about clearer labeling continues in the EU, most recently the US Food and Drug Administration announced their new template for nutrition labels. On May 20, the regulatory body added a line on its label guidelines for "added sugar" - to be placed below a line for total sugar. This is specifically to allow consumers to distinguish between sugars that occur naturally in foods and those that do not.
The evidence against sugar and its ill effects on our health continues to mount as study after study is published. Dr Kimber Stanhope, a nutritional biologist at the University of California, Davis, completed a five-year investigation in 2015 linking high fructose corn syrup-a common sweetener in the United States-to increased risk of heart attack and stroke.
"People should realize that there are no risks associated with reducing sugar intake," says Dr Stanhope, "but there are risk factors in continuing to eat high amounts while waiting for more evidence. Parents should wean their kids and themselves off daily sugar consumption and consider it a special occasion food."
New research also indicates that sugar, like tobacco, may be addictive. Eric Stice, a neuroscientist at the Oregon Research Institute, is using MRI brain scans on adolescents that show that "sugar activates the brain in a way that is reminiscent of a drug like cocaine." He adds that people build up a tolerance to sugar much the way smokers and drug users do. "That means the more sugar you eat, the less you feel the reward. The result, you eat more than ever." Other studies point to sugar being addictive because it activates the brain's pleasure-generating circuitry.
What can you do to reduce your intake of added sugars?
"There's actually an easy way to solve this problem in the home; it's called real food," says Dr Lustig. "Unprocessed items, the things you cook yourself. A piece of fish is real food; a fish stick is not. We have to feed ourselves and our children accordingly."
And we can effect change in the food and beverages industry. "Advocacy on the part of ordinary citizens got cigarettes out of restaurants, airplanes, workplaces and schools. We have to do the same when it comes to the avalanche of sugar in our food supply," Dr Lustig continues.
"If we don't stop poisoning our systems with sugar, we and our children will only get fatter and sicker. And the costs will be astronomical."
Additional research by Nancy Coveney
Norwegians consume at least 37 percent less sugar - as of 2014 - than in 2000, and the amount of sugar in food has been reduced from 17 to 13 percent of the food's energy content. A combination of taxes, food labeling, public health programs, media attention and an increased public interest in healthy food have all played important roles in Norway's success with reducing sugar intake.
Currently, Norway has three excise duties on sugar: A general sugar duty, one on chocolate and sugary groceries, and a soft drink tax.
However, health authorities and organizations argue that sugar consumption is still too high. In the summer of 2015, health experts advised the government to further increase taxes on sugar, and a higher soft drink tax has been proposed
Food labeling has been used in Norway since 2009. The Keyhole symbol (pictured here) is designed to make it simpler for consumers to identify and choose healthy food, and the symbol is recognized by 98% of Norwegians. The labeling is voluntary for food producers but it is widespread.
The Keyhole signals food products that contain less fat, sugar and salt, and more fiber than other products in the same category. Although the label is not targeted at sugar alone, health authorities believe it is important to reducing sugar intake. Norwegian health authorities are now working with the food industry to further reduce hidden sugars in food.
The total income from sugar excise duties in 2014 (most recent figure) was $400 million US. -by Stig Michaelsen
A Tax on Added Sugars
Czech Republic - 63.4%
UK - 63.4%
Poland - 61.1%
Spain - 60.9%
France - 60.7%
Slovenia - 60.6%
Hungary - 59.6%
Norway - 58.5%
Romania - 57.6%
Belgium - 56.9%
Netherlands - 55.9%
Sweden - 55.9%
Portugal - 55.6%
Finland - 55.2%
Germany - 54.8%
Country % of overweight adult population (18+) (BMI =>25 and <30)
Source: WHO Global Health Observatory (age-standardised estimates), 2014