Researchers at UCSF argue that sugar poses a danger to health and should be regulated like alcohol and tobacco. Is sugar just empty calories, or something much worse?

Original Broadcast: Fri, Feb 3, 2012 -- 9:00 AM

Host: Dave Iverson

Guests:
• Claire Brindis, professor of pediatrics and director of the Philip R. Lee Institute for Health Policy Studies at UCSF
• Fredric Kraemer, professor of medicine and chief of the Division of Endocrinology, Gerontology and Metabolism at the Stanford University School of Medicine
• Jo Ann Hattner, registered dietician and consultant at the Stanford School of Medicine
• Robert Goldberg, vice president and co-founder of the Center for Medicine in the Public Interest and author of "Tabloid Medicine"

More info:
• Sugar: A Sweetener Gone Sour? : from KQED's State of Health blog
• Edible Education 101: Sugar Is Not So Sweet After All
• KQED's Forum: Sugar and Health

Nutrition, Health, and Diet Related Disease

America’s obesity epidemic was the topic of discussion at the September 27 Edible Education: The Rise and Future of the Food Movement session at UC Berkeley. Dr. Robert Lustig, a neuroendocrinologist who studies childhood obesity at the University of California at San Francisco, spoke along with Patricia Crawford, a UC Berkeley professor who has traced the rise of the obesity epidemic and studies healthy food in schools.

Obesity Growth in U.S.
The most startling information came from Patricia Crawford who showed the rise in obesity in the U.S. over the past twenty years through a series of maps. In 1991 there was less than ten percent obesity in most state populations. But we gradually watched the map of the entire country get washed over in bright red, the color indicating the highest rates of obesity. Crawford says, "We need to create healthier food and activity environments to reduce obesity." She’s been working in the school system to figure out how to achieve these goals. Crawford has found that even Berkeley kids, who live in a healthy food mecca, share similar eating patterns to kids in the rest of the state. Crawford listed four activities that can help to control the obesity epidemic:

• Reduce sweet beverage intake
• Reduce fast food intake
• Control portion size
• Reduce time on the computer or tv

Crawford is working in policy development to reduce obesity by trying to get high calorie snacks out of schools and advocating for zoning policies on fast food restaurants near schools. Following Crawford's obesity maps were the equally startling comments on the toxicity of sugar by Dr. Robert Lustig.

Big Sugar's Nemesis

Robert Lustig’s bracing argument in a recent New York Times magazine article on the dangers of sugar convinced me to quit my own habit. Something about his explanation of the biochemistry of sugar resonates. He explains how sugar can be toxic because of the way it breaks down and overwhelms your liver. Lustig blames sugar for the skyrocketing obesity rates in the U.S. "A type of sugar called fructose is the cause of the current epidemic," says Lustig. “Our entire food supply has been adulterated with the addition of fructose for palatability and removal of fiber for shelf life." Lustig explains how so-called healthy snacks, like low fat yogurt, can be full of sugar. According to Lustig, sugar is even added to hamburger buns and hamburger meat. He ran through several decades of food policy to explain why sugar has become an additive but the main point Lustig makes is that there has been a lot of attention on fat but fat consumption has gone down in the U.S. while our sugar and refined carbohydrate intake has gone up.

Eat Your Fruit Don’t Drink It

Even if you skip the Milky Way and go for something healthier like an orange, you still have to watch out. That orange is much healthier if you don’t juice it. Says Lustig, “A good part of the fruit is fiber but when you juice a fruit you destroy the insoluble fiber. You need it to limit the rate of carbohydrate and fat absorption into the blood stream which gives your liver a chance to catch up. Fruit is good. Juice is bad and smoothies suck.”

Sugar has been linked to not only obesity but other chronic health problems like heart disease, cancer and memory loss. Lustig says the obesity epidemic is responsible for a 65-billion dollar decrease in work productivity and a 50-percent increase in health insurance premiums. Lustig left the audience with a question to ponder: “Can our toxic environment be changed without government or societal intervention especially when there are addictive substances involved? For Lustig the answer may be regulating sugar just like we do with alcohol and cigarettes.

View the video of the entire class:

The 13 week course, which is funded by the Chez Panisse Foundation in collaboration with West Oakland’s People’s Grocery, makes tickets available each Wednesday to the public.

UCSF professor Robert Lustig became an Internet video sensation when he spoke out about the evils of sugar in a post that went viral on YouTube. He was also recently featured in a New York Times Magazine cover story, "Is Sugar Toxic?" Lustig joins Forum in the studio to discuss sugar's role in diabetes, obesity and related diseases.

Original Broadcast: Thu, Apr 21, 2011 -- 10:00 AM

Host: Michael Krasny

Guest:
Robert Lustig, professor of pediatrics in the Division of Endocrinology and director of the Weight Assessment for Teen and Child Health (WATCH) Program at the UCSF Medical Center

Robert H. Lustig, MD, UCSF Professor of Pediatrics in the Division of Endocrinology, explores the damage caused by sugary foods. He argues that fructose (too much) and fiber (not enough) appear to be cornerstones of the obesity epidemic through their effects on insulin.

Related Article:
Is Sugar Toxic? (NYTimes)

If all the raindrops
Were lemondrops and gumdrops
Oh, what a rain that would be!
Standing outside, with my mouth open wide
Ah, ah, ah, ah, ah, ah, ah, ah, ah, ah
If all the raindrops
Were lemondrops and gumdrops
Oh, what a rain that would be!

If all the snowflakes
Were candy bars and milkshakes
Oh, what a snow that would be!
Standing outside, with my mouth open wide
Ah, ah, ah, ah, ah, ah, ah, ah, ah, ah
If all the snowflakes
Were candy bars and milkshakes
Oh, what a snow that would be!

These are lyrics from a horrible song by Barney, the big purple dinosaur. The fact that I know it means I've spent too much time working with small children. As you can sense here, the tune unfolds as a series of meditations on a central theme. The first section poses a question and offers up a winsome, catchy answer; the second breathlessly imagines an equally scrumptious scenario, and resolves in the same fashion. Each verse ends with a fantasy plucked straight out of some powdered sugar-smeared four-year old's optimistic re-write of Cloudy with a Chance of Meatballs. What's (sort of) fun about the song though -- at least for four-year olds -- is that the verses lend themselves to inspired free association. If all the night fog were 'nilla fudge and eggnog, for example. The possibilities are limitless so long as you adhere to the childish conceit.

Unless all the sunbeams happened to be kosher salt and sea bream, the world described in this tune would be a wretched place for me to inhabit. Even if widespread stickiness and insect onslaughts didn't pose insurmountable sanitation problems, I would be submerged in gastronomic hell, soaked in a deluge of food I didn't like and everyone else -- joyous screaming little ones skating on lakes of jelly, old ladies slipping on hard candy cobblestones, climbers chewing their way to the tops of cookie mountains -- seemed to love.

Sweets can pretty much shove it. That's the short story, I suppose, but in truth, it's a complicated issue of taste. You see, I like most pies, especially plum, chocolate in croissants and puddings, lemon bars, caramel ice cream, malts, and jelly beans. I respect carrot cake, mostly for its steadfast association with cream cheese frosting. I will rarely refuse a sandwich cookie when it's offered. I am open to enlightenment courtesy of thrilling and creative restaurant desserts of all sorts. Yet I never crave sweet things or go out of my way to consume them. I'm convinced the very bland affection I do muster is a product of 29 years spent immersed in a culture obsessed with them. Desserts are not central to my eating routines, or even peripheral. If they disappeared, I would shed no corn syrupy tears. In the end, I eat them if they are around because, simply put, I will eat nearly anything. Unfortunately, they are often around -- one-dimensional and over-bearing, yet brutally effective at providing the jolts of fat and sugar we're conditioned to desire. Two weeks ago, I was substituting for a flu-ridden history teacher at Lowell High. A kid suggested I let the class leave five minutes early, and I said no. He then asked if I'd accept a chocolate bribe. Having left my meager lunch of leftovers at home, I wondered out loud if he might be able to find me fried chicken instead. Give me the choice between savory and sweet and I'll always lean towards the former.

This frosting-heavy time of year, sweet reigns supreme. In the days leading up to Christmas, office kitchens look like Candyland blooming with cheap chocolate truffles, tins of shortbread, fruitcake, and panettone from Walgreens. Red-and-white canes and Hershey's kisses bulge in stockings. Avid bakers exchange trays of garish cookies iced green, red, and snowy white. Holiday celebrations can be as much about sugar as booze -- particularly work parties, oddly enough. Four years ago, I wore a crisp shirt in the basement of a Financial District hotel and sipped whiskey, glumly watching pastries and puddings vanish from platters as the big boss -- white-maned, stooped, a long arm wrapped around his beaming wife -- grimly intoned that it had been a good year. Hooray, everyone had shouted, thinking of their bonuses, toasting, lowering slices of a towering cake onto plates. The sight of so much confection made me feel sicker than did all the Jack Daniel's I was drinking. I'm prejudiced against sweets. Individuals are reasonably fine, but as a whole population, they rub me the wrong way. So I give out homemade hot sauce and artisanal salame as holiday gifts, and refrain from ordering dessert in restaurants unless I'm with someone's mom or dining in a professional capacity. Part of the problem is the infantile glee sweets elicit in people -- even though they're often described in silly quasi-adult terms -- sinful, indulgent, naughty, and lusty -- and framed as transgressions for which to (eventually) feel guilt. It puts me off. Every late December, cubicle jockeys scuttle down hallways, scarfing whatever delights happen to be circulating around their offices. At the same time, they vocally fret over how their excesses will impact their health and appearance. Inevitably, they resolve to do penance the following week, once the season is over. "I shouldn't be doing this," I once heard a co-worker sigh blandly, her hands digging determinedly into a box for the last lumpy cupcake, "but I'm doing it." Weirdly enough, I first heard those words muttered by the slimy male lead of a classic 1980s adult film. He was committing adultery with the help of two video store clerks, and surfing past a fleeting twinge of contrition.

The love/hate relationships people carry on with sweets may come from culture, but we're actually biologically wired to want them in the first place. Last year, some scientists figured out that our brains can sense the calories in food independent of what we're tasting by presenting "sweet-blind" mice with water samples laced with sucralose and real sugar. The mice preferred the samples with calories. As it turned out, the mousy reward system is galvanized into action by caloric intake, as levels of the brain chemical dopamine, known to be central to sparking that system's circuitry, spike with each sip. My chemicals too may sizzle in the presence of a Twix bar, but my reward system clearly responds more feebly than most -- because I never feel rewarded after an encounter. I'm not alone in my attitude. I know people with heartier aversions. A friend from college won't even drink orange juice. Another friend's dad candidly once told me he didn't like sweets because he drank too much, and something about the combination didn't jive with his system.

Sweets are even harder to take after the holidays, once they're stale. Mass-produced candies may outlive us all, but those old abandoned cookies, their iced tops hardened and cracked, the fossilized fruitcakes -- a few days after Christmas, they start looking like ruins, diminutive Grey Gardens, once decadent, now downtrodden, in shambles. There's something very lonely about them -- especially when its clear time and care went into their preparation -- and they're hard to throw away -- even if you didn't really want them in the first place.

In London's Victoria and Albert Museum is a small, silver sugar bowl from the late 1700s, complete with a tiny latch for a tiny lock. The mistress of the house would have kept the key herself, as sugar was far too precious to leave unprotected.

Today, sugar flows freely at every table. No longer spice or medicine, no more exotic or expensive than salt or pepper or clear tap water, sugar is now a basic and powerful commodity. It rarely concerns anyone who's not worried about calories, insulin or childrens' attention spans. With corn syrup currently wearing the black hat and ethanol a favorite of politicians, cane sugar has suddenly been rehabilitated. What sugar blues?

But Bill Haney and his documentary, The Price of Sugar (opening this weekend at the Opera Plaza Cinema) are here to show us exactly what it takes to bring us that stuff of sweetness.

I know, you're already rolling your eyes or reaching for your mouse. Who wants to add sugar to the growing list of politicized food? Chocolate, coffee, corn, every fish and fowl and four-legged creature under the sun, and now this? Is nothing safe for the conscientious eater to enjoy?

If it makes you feel any better, know that centuries ago, cooks and diners were wrestling with these very same issues.

"EAST INDIA SUGAR not made by SLAVES"

In 1791, abolitionists in the United Kingdom declared a boycott on sugar from the West Indies, where sugar plantations flourished with the help of the burgeoning slave economy. Diaries from the period mention how troublesome it was to entertain guests who were boycotting sugar, while Punch cartoonists poked fun at "anti-saccharrite" families that refused to offer sugar at teatime. There were valiant attempts to hold awareness-raising bake sales with cakes and cookies prepared without sugar or else only with sugar from India. (Thanksgiving cooks everywhere can empathize--how to fit the tofu next to the turkey?)

An ambitious little pamphlet, "Address to the People of Great Britain on the Utility of Refraining from the Use of West Indian Sugar and Rum," written by Thomas Clarkson, set a publishing record for the time: 50,000 copies were distributed in the UK in only four months.

On the back of this anti-slave sugar bowl: "East India Sugar not made By Slaves. By Six families using East India, instead of West India Sugar, one Slave less is required."

The slave-free sugar movement faced much greater opposition in the US, where rum was filling the new nation's coffers. While Clarkson and his followers helped turn the tide against slave labor in the UK (an estimated 300,000 British families boycotted West Indies sugar) American abolitionists had another century of fighting before slavery was outlawed in the US.

But here's the problem: Slave labor is not a thing of the past.

Ships no longer ply the Middle Passage, but we still have human trafficking in containers and vans. If trapping entire families on plantation land to work their whole lives, guarding them with rifles day and night, stringing barbed wire over their ceilings so they can't escape, paying with vouchers for the company store or not bothering to pay at all, and enjoying the full support of governments do not all add up to institutional bondage -- or slavery -- then someone needs to rewrite the dictionaries.

In the US, the major sugar-cane states are Florida, Louisiana and Texas. A long-growing crop with intensive irrigation requirements, heavy chemical inputs and back-breaking, hand-maiming occupational risks, sugar cane is not an easy crop to grow. Increasingly, American growers depend on a mechanized harvest (especially after a lawsuit was filed in the mid-1990s demanding that companies pay their guest workers the contracted $5.70 a ton rather than merely $3.70 a ton.)

However, environmental devastation is still a serious issue. As sugar cane is re-framed by politicians and growers as an eco-friendly source of energy here in California, we need to keep a closer watch on the discussion. Close ties to Washington help big sugar companies maintain generous subsidies, while import restrictions keep domestic sugar cane prices artificially high.

So yes, there's still a long way to go. Luckily for us, courageous and determined individuals continue to lead the way. Person by person, family by family, nation by nation...changes will happen.

THE PRICE OF SUGAR
Directed by Bill Haney
Landmark's Opera Plaza
601 Van Ness Avenue
(415) 267-4893

The documentary really should be titled "The Life and Work of Father Christopher Hartley" since this Catholic priest, who compares himself to Mother Theresa, stars in the film. Father Hartley fought for years to improve the horrendous living and working conditions of undocumented Haitians on the sugar plantations of the Vincini family, powerful players in the Dominican Republic. The family has tried blocking the release of the film, and both the crusading priest and the director have received death threats. The film depends more on slow motion and plaintive music than data or historical context to make its points. In the end, though, I came away with an understanding of the human side -- both the good and the bad -- of this complex issue.

SMALL STEPS TO GOOD SUGAR

There are no easy answers. The US produces 80% of the sugar it consumes, so international free-trade sugar, already a small fraction of the industry, is just one part of the solution. Domestic sugar's impact on ecosystems, energy production, public health and political power are other important considerations.

• Awareness and education are the first steps. Seeing the above documentary is one way to begin. There are many resources on the internet for anyone curious and committed. I've included a few links at the end of this post for those who'd like to read more. Taking on all the issues is overwhelming. Instead, choose subjects already close to you and learn how they relate specifically to sugar production and consumption.

• Spend your money wisely to express your desire for a better world. Do what you can when you can. Buying fair-trade sugar supports companies and cooperatives that meet international standards for worker rights and environmental sustainability. Go for little but consistent changes for the long haul. Our small individual acts really do add up.

• Spread the word. While you might not have a sugar bowl that speaks for you, there are many opportunities to influence others, whether it's the office manager who stocks your company's break room or the grocery store in your neighborhood or the bakery that's going to craft your wedding cake. Ask if fair-trade sugar is an option, and if it's not, ask why not.

• Finally, one of the most important things we can do is to fax or call our elected representatives to remind them that we want an agricultural industry in California that is environmentally sustainable and fair to its workers. The California Coalition for Food and Justice offers several different sample letters as well as a detailed tip sheet on how to meet your respresentatives in person. Join the coalition or sign up for their newsletter to keep in touch with food policy issues in California. You can adapt their language to your own specific concerns. Encourage your friends and family to write letters, too.

Look for these marks of fair trade certification on sugar that you buy.

SUGAR LINKS

If you're interested in learning about the sugar cane industry, especially a little closer to home, here are some online resources:

• Sugar Knowledge International offers a basic description of how cane sugar is processed.

• Fair Trade Certified provides a fact sheet on fair-trade sugar.

• Read about the call for growing sugar cane in California's Imperial Valley to provide energy and ethanol.

• Environmental Entrepreneurs estimates

how many megawatt-hours of electricity might be converted from cane sugar fiber in California.

• The Center for Responsible Politics describes the electoral politics of sweeteners in "Iron Triangle of Beet Sugar, Cane Sugar and Corn Syrup."

• For a historical view of Big Sugar from, of all places, The American Conservative, this critique of guest worker programs for the US sugar industry describes how growers take advantage of their workers.

• In its National Wetlands Newsletter, the Environmental Law Institute discusses how growing sugar cane in the Florida Everglades affects the ecosystem and taxpayers.

• Alter Eco, based in San Francisco's Mission Bay, distributes fair-trade sugar. Their controversial financial model, melding the business structure of a corporation with the social mission of a nonprofit, helps them pursue their goal of mainstreaming free-trade products into supermarket chains.