KQED’s Stephanie Martin interviewed one of the study’s authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video “Sugar: The Bitter Truth” has more than three million views on YouTube.

Lustig told Martin that the study was very carefully done — researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.

In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. “Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.”

Lustig said their findings point to proof of causation that should be accepted by doctors. “This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s,” he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.

Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.

“Twenty percent of obese people have completely normal metabolic signatures,” Lustig told Martin. “Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than  a cause.” He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.

The study was not designed to address whether the type of sugar mattered — for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.

At present, sugar is classified by the Food and Drug Administration as “Generally Regarded As Safe.” Lustig believes the FDA should re-evaluate whether sugar should stay on that list. He has previously called for sugar to be regulated in the same way alcohol is.

Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to “advise people to keep their sugar a lot lower than it normally is.”

In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. “The question is,” he asked rhetorically, “what does that do to you? What does that do to your liver? What does that do to your pancreas?”

Learn More:

Sugar’s Role in Rise of Diabetes Gets Clearer (NPR)

(Uwe Hermann: Flickr)

A spoonful of sugar may have helped the medicine go down when Julie Andrews sang the song, but fast forward to the 21st century and sugar isn’t looking so sweet. Today in a provocative commentary in the journal Nature, researchers argue that sugar is so toxic to our bodies, it should be regulated in the same way alcohol and tobacco are.

The three writers, all from UC San Francisco, say that every country that has adopted the Western diet, with its hallmark of highly-processed food, has seen rising rates of obesity and the diseases that go with it, such as heart disease and diabetes. But, in a turn, they argue against blaming obesity itself. “Obesity is not the cause,” they write, “rather, it is a marker for metabolic dysfunction, which is even more prevalent.” Metabolic syndrome leads to diabetes, high blood pressure, heart disease, fatty liver disease and even cancer, they say.

And the culprit, they insist, is sugar, particularly its fructose component. “Fructose, which is the sweet part of sugar,” said co-author Robert Lustig in an interview, “is toxic beyond its caloric equivalent.” People often refer to sugar as “empty calories,” but they are far from that, the writers say. “A growing body of scientific evidence shows that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills slowly.”

At this point I was getting a sinking feeling. Maybe it’s the way smokers felt when the bad news started coming out about tobacco in the late 50s and early 60s.

Sugar consumption has tripled worldwide in the last 50 years, the writers assert, and they say to combat the myriad health problems we face today, regulation is necessary. Sugar meets four criteria that merit government action. “The first in unavoidability,” Lustig said, “it’s everywhere. The second is toxicity beyond its calories. The third is potential for abuse because it activates the same areas of the brain as alcohol and tobacco creating a cycle of consumption and disease, and the fourth is negative impact on society.” The negative impact on society is largely seen through high health care costs because of the many diseases associated with high sugar consumption.

The authors suggest a combination of taxes on processed foods that contain sugar, and limiting access to children through tighter controls on vending machines in schools, for example. They also recommend promoting healthier foods in government programs for the poor, including the Women, Infants and Children program and Supplemental Nutrition Assistance Program (formerly called Food Stamps).

Not surprisingly, the Sugar Association doesn’t buy much of this. In a statement on their website, the Association says:

… the assertion that a food is less healthy just because it contains sugar is misleading and not science based. Numerous studies have confirmed that sugar makes many healthful foods palatable, which helps contribute to intakes of key vitamins and minerals necessary to maintain good health.

But Lustig views today’s commentary as the “opening salvo” in a long public health discussion. “I don’t expect anything to change anytime soon,” he said. “Nothing in public health changes overnight. It’s not possible to.”

And judging from some of the comments on a CNN story about the issue today, Lustig is right.  Here are just two examples:

• “unbelievable nannyism. But I forgot that this is America, the land of the hopelessly dependent and depressingly irresponsible,”
• “This article should be regulated as total garbage.”

But as the writers close their commentary in Nature, they point to other public health issues: the bans on smoking in public places; the promotion of the designated driver; and airbags in cars. “These simple measures–which have all been on the battleground of American politics–are now taken for granted as essential tools for our public health and wellbeing,” Lustig said. “It’s time to turn our attention to sugar.”

More: The Trouble With Sugar from KQED’s Forum