 is sugar the new tobacco. Understanding the impacts of sugar on our health is not an easy task. Food science is complicated and imperfect, but some level of confusion has been added in by sugar industry stakeholders who have spent millions over the past few decades to support studies that would produce desirable results for their industry. That's why a little historical journey will help us spot conflicts of interest and put current findings in perspective. Why sugar is a modern problem? For thousands of years, the human appetite for sweetness could only be satisfied by eating fruit or, when our ancestors got lucky, from the honey produced by wild bees. But around 2,500 years ago, people found that they could produce sugar by extracting and drying the sap of sugarcane. Producing and extracting sugar was time-intensive and challenging. This made sugar incredibly expensive. Only the rich could afford it, and still only in small quantities. By the 1850s, the world production of sugar was around 1.5 million tons per year, with new methods of sugar extraction and refinement driving prices down. As sugar became increasingly affordable, consumption rose to mind-boggling levels within just a few decades. How much sugar do we consume today? Today, the world production of sugar has climbed to around 180 million tons per year. On average, Europeans eat 30 kilos of added sugar per capita every year. That is a whopping 82 grams per day. As wealthier countries became more health-conscious, sugar consumption began declining in the 80s, while sugar consumption rose in poorer countries. Yet, compared to pre-war times, western sugar consumption levels still remain high. In Italy, my country, people would eat 9 kilos of sugar per capita per year before World War II. Today, that number has risen to 25 kilos. Why is there sugar in everything? Many of us will be shocked to read that Europeans eat that much sugar on average. While European families have been buying less household sugar over the years, sugar has been added in a lot of 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, and even crackers and chips. Today, unless we read otherwise, 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 to produce foods that can both last long and taste good. Today, sugar is a booming industry, worth more than 63 billion euros in 2018. Early sugar research and the obesity epidemic. Until only 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. But during World War I, questions around the health benefits of sugar began circulating. Physicians speak up against sugar. Several US 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 US men started to suffer from heart disease and obesity, that many began to question how sugar could be intrinsically bad for us. The link to heart disease, sugar versus fat. What was responsible for the rising weight and heart disease? Two physiologists had brought forward their own hypothesis. John Yudkin, British, hypothesized that sugar was the culprit of obesity and heart disease. In contrast, Ansel Keyes, American, thought excess fat was responsible for the increasing cholesterol, which would cause coronary arteries to harden and narrow, and so cause heart disease. Yudkin and Keyes 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 be both problematic, Keyes discredited Yudkin's theory as a mountain of nonsense. Instead of collaborating, the two ensued in a row of personal quarrels. The sugar industry ensued science. This is where the sugar industry enters the story. It's no surprise that Yudkin's theory threatened the interests of sugar companies and associations that represented sugar producers, processors, and refiners. To discredit Yudkin's sugar theory further, the sugar industry used his quable with Keyes. The British sugar borough dismissed Yudkin's claims about sugar as emotional assertions. The World Sugar Research Organization called his book Science Fiction. As the Guardian puts it, Yudkin wasn't just silenced, he was buried. Simultaneously, in the US, the Sugar Research Foundation's director suggested that the foundation could embark on a major program to counter negative attitudes towards sugar. This program involved funding studies whose research question had been carefully designed to either drive attention away from sugar or to assess the data in ways that could allow researchers to conclude that sugar doesn't cause disease. Here are some examples of how the sugar industry attempted to affect research and public opinion of sugar. Fat, not sugar, is responsible for heart disease. In 2016, a group of researchers exposed correspondence between the Sugar Research Foundation and some Harvard scientists from the 1960s. The correspondence demonstrated that the sugar industry funded research that turned attention away from sugar slink to heart disease toward fat and cholesterol as the bigger culprits. Industry funded amounts to the equivalent of a half a million dollars in today's money. Harvard scientists were asked by the Sugar Research Foundation to review available evidence that linked nutrients to heart disease. At the time, scientific evidence was still quite weak for both fat and sugar in their link to heart disease. However, when they published their review in the New England Journal of Medicine, the Harvard scientists downplayed the studies that pointed at sugars linked to heart disease but did not do so for the study that researched fat. On top of this, the scientists didn't disclose any conflict of interest as this practice wasn't compulsory yet in scientific publishing. As a result, the Harvard review was accepted uncritically by many. 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 Sugar Research Foundation 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 promoted by the National Carries Program 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 oral health researchers have complained that the sugar industry is still influencing 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 just some advertisements from the 1970s. The fat time of the day. You're really hungry and ready to eat two of everything. Here's how sugar can help. 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? I spoke with NYU professor of nutrition, health studies and public health, Marion Nestle, who by the way has nothing to do with the Nestle food company. In her book on savory truth, she has claimed that 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 shift attention away from studies that condemn the health effects of sugar. But they don't stop here. 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 still 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. When looking at sugar sweetened beverages and their health risk, industry-funded studies were eight times more likely to produce favorable conclusions than those funded by known industry sources. Marion Nestle shared with me that, in general, industry-funded studies and opinion pieces tend to support the commercial goals of the funders. At least scientists are now compelled to disclose conflict of interest and funding sources. So this can help us put their findings in perspective. 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 Organization strongly recommends to reduce intake of free sugars down 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 U.S. 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 calorie intake recommended for males, 2,500 calories per day, sugar should not exceed 60 grams per day. For women eating a diet including 2,000 daily calories, that would be even less, around 50 grams. That's quite a lot less than the current European average, which surpasses 80 grams per day. Sugar's 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. But we have to be careful. Although it would be fantastic to have found the cause of weight gain, attributing the responsibility of a complex phenomenon such as obesity to a single nutrient would be a sloppy simplification. The majority of studies have actually shown that if you remove sugar from your diet but substitute the same amount of calories from other sources, your weight won't change. So sugars are not the cause of obesity, but one strong contributing factor. 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 and that's why 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. This means that even if sugar is not directly linked to those diseases, if we overeat sugar and become overweight as a result, we're also going to increase our risk of developing them. The politics of the sugar industry. Regardless of the strength of evidence for specific diseases, today many of us 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 of 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 US sucrose industry, for example, has been trying to identify high fructose corn syrup as the only evil around and to give you an idea of how far they went, high fructose corn syrup can't be legally referred to as sugar. If you dare to call it sugar publicly, you could be brought to court. Because high fructose corn syrup was much cheaper than sucrose, food processors put 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 high fructose corn syrup as the new evil of the sugar world. To understand the argument against high fructose corn syrup, we need to understand its molecular structure. You see, high fructose corn syrup 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 in it, while a molecule of high fructose corn syrup 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. High fructose corn syrup includes more fructose compared to sucrose. So high fructose corn syrup must be worse for you than sucrose. In reality, scientists claim that 5% more fructose does not represent a significant difference between the two types of sugar. And so both high fructose corn syrup and sucrose would present the same exact risks to the human body. Sucrose, or natural cane sugar, is not the healthy alternative to high fructose corn syrup, contrary to what the industry has been trying to convince us. It's also important to point out that many of the 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. 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 profits, 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. First of all, 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's happening 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. So when a single food or macronutrient is demonized as the soul 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 are aware 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 the 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 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. Thank you for listening to this episode of our Food Unfolded Audio Articles. Has listening to this article given you a new perspective on marketing claims? Let us know on social media linked in the description box. This article was written and read by me, Sylvia Lazaris, originally posted on foodunfolded.com. Food Unfolded explores the stories behind the food on our plate, reconnecting us to the origins and sustainability of our food, co-funded by the EU and powered by EIT Food.