Americans Sweet on Sugar: Time to Regulate?

Researchers Say Excess Sugar Should Be Regulated Like Alcohol and Tobacco

From the WebMD Archives

Feb. 1, 2012 -- Americans are eating unhealthy amounts of sugar, and excess sugar should be regulated like alcohol and tobacco, say researchers from the University of California, San Francisco.

"We are now seeing the toxic downside [of excess sugar intake]," Robert H. Lustig, MD, a professor of clinical pediatrics at the UCSF Center for Obesity Assessment, Study, and Treatment, tells WebMD. "There has to be some sort of societal intervention. We cannot do it on our own because sugar is addictive. Personal intervention is necessary, but not sufficient."

His views on regulating sugar are published as a commentary in the journal Nature.

Regulating Sugar: Industry Weigh-In

WebMD asked the Sugar Association, an industry group, to review the recommendations.

Charles Baker, PhD, the association's chief scientific officer, responded by email. "When the full body of science is evaluated during a major review, experts continue to conclude that sugar intake is not a causative factor in any disease, including obesity," he says.

Sugar and Its Effects in Excess

Excess sugar in the diet does not just add calories, Lustig writes. Too much sugar has been linked with health problems, and they occur even in people who are normal weight, he says.

According to Lustig, too much sugar can be linked with some health problems including:

Sugar has the potential for abuse, he tells WebMD. "Like tobacco and alcohol, " he writes, "it acts on the brain to encourage subsequent intake."

A key point: Lustig is talking about added sugars, not those naturally occurring in such foods as fruit or milk. He defines added sugar as ''any sweetener containing the molecule fructose that is added to food in processing."

Men should eat no more than nine teaspoons of added sugar a day, according to the American Heart Association. Women should eat no more than six teaspoons.

A typical 12-ounce regular soda includes about eight teaspoons of sugar, according to the AHA. The average intake of added sugars in the U.S. is about 22 teaspoons a day.


Regulating Sugar: Perspective

"The commentary should be a wake-up call to policymakers," says Marion Nestle, PhD, MPH, the Paulette Goddard professor of nutrition, food studies, and public health at New York University.

She reviewed the commentary for WebMD. "He has the science to back it up," she says of Lustig's suggestion that it is time to regulate sugar.

"That Americans would be healthier consuming less sugars is obvious and easily demonstrated," Nestle tells WebMD. "Sugars themselves are not harmful if eaten with other nutrients, as in fruits, and in diets that balance calories. But it's hard to balance calories when eating a lot of sugars."

Some people eat so much sugar that it adds up to half their daily calorie limit for maintaining weight, Nestle tells WebMD.

"At the very least, the FDA should require listing added sugars on package labels," Nestle says.

A good first step for anyone trying to reduce sugar, Nestle says, is to cut back on or cut out sugary drinks.

Sugar: How to Regulate?

Models used to regulate alcohol and tobacco could work for sugar, Lustig says.

His suggestions:

  • Tax sugary foods. (The soda tax is already being considered, he notes. To work, he says the tax must be hefty, such as a $1 tax on a $1 can of soda.)
  • Limit availability. Licensing requirements on vending machines could be stricter.
  • Set an age limit for the purchase of sugary drinks and foods.

The FDA could help, he says, by removing fructose from its GRAS (Generally Recognized as Safe) list. This allows food makers to add it without premarket review and approval.

Spelling out the amount of added sugars on the Nutrition Facts label would also help, Lustig says. Although total sugars are listed on the label, it does not spell out the amount of added and the amount of natural.

Regulating Sugar: FDA Response

"A change in the GRAS status for sugar is not currently under consideration," says Douglas Karas, an FDA spokesperson.

Consumers can inspect the ingredients list to find out if a product has added sugars, he says. Among the various names for added sugars, he says, are:

  • Corn syrup
  • High-fructose corn syrup
  • Fruit juice concentrate
  • Maltose
  • Dextrose
  • Sucrose
  • Honey
  • Maple syrup


Age Limits for Purchasing Sugary Drinks Extreme?

The American Beverage Association, another industry group, released a statement in response to the commentary. It says, in part, that ''their comparison of sugar to alcohol and tobacco is simply without scientific merit."

It continues: ''Moreover, an isolated focus on a single ingredient such as sugar or fructose to address health issues noted by the World Health Organization to be caused by multiple factors, including tobacco use, harmful alcohol use, an unhealthy diet and lack of physical activity, is an oversimplification. There is no evidence that focusing solely on reducing sugar intake would have any meaningful public health impact."

Suggesting age limits for purchasing sugary beverages is "extreme," according to the association.

WebMD Health News Reviewed by Laura J. Martin, MD on February 01, 2012



Lustig, R. Nature, Feb. 2, 2012.

Robert Lustig, MD, pediatric endocrinologist at the University of California, San Francisco Benioff Children's Hospital; professor of clinical pediatrics, UCSF Center for Obesity Assessment, Study, and Treatment.

Marion Nestle, PhD, MPH, Paulette Goddard professor of nutrition, food studies and public health, New York University.

Douglas Karas, FDA spokesperson.

Charles Baker, PhD, chief scientific officer, the Sugar Association.

News release, American Beverage Association.

© 2012 WebMD, LLC. All rights reserved.


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