Question: What is the basis for arguments to restrict sugar consumption?
Takeaway: Robert Lustig, Laura Schmidt, and Claire Brindis argue sugar is not merely toxic but ubiquitous, potentially abuse-forming, and detrimental to society; taken together, these conditions justify aggressive action to reduce sugar consumption.
In this 2012 commentary in Nature, Robert Lustig, Laura Schmidt, and Claire Brindis claim sugar harms individuals and society in similar ways to tobacco and alcohol. They argue similar measures to restrict its consumption are warranted.
According to United Nations data (1), 2011 was the first year in recorded history when noncommunicable disease mortality exceeded that of infectious disease. Obesity and metabolic disease have spread to lower- and middle-income countries. Now, a larger share of the worldwide population is obese rather than malnourished, and 80% of deaths are attributable directly or indirectly to obesity and poor metabolic health. Rates of these diseases have increased over the past 50 years alongside a three-fold increase in the consumption of added sugars.
Thomas Babor, writing on alcohol in 2003, established four criteria that justified regulation of a commodity: unavoidability, toxicity, abuse potential, and a negative impact on society (2). Lustig et al. argue sugar meets these criteria.
Sugar is ubiquitous in our current processed-food-rich environment, as it can be found in nearly all processed foods (3). The figure below outlines mean daily sugar consumption by country; consumption in many countries exceeds 300 calories per day.
Increasingly robust evidence indicates sugar is uniquely toxic and is not merely “empty calories” but instead specifically deleterious to health (4). Fructose is directly toxic to the liver, having similar effects to alcohol; increased sugar consumption has been linked to fatty liver disease, impaired liver health, hypertension, diabetes, insulin resistance, heart disease, and other associated conditions.
Animal and human data suggest sugar has significant abuse potential, with sugar consumption encouraging additional sugar consumption (5). Sugar simultaneously increases consumption of all foods by impairing the normal hormonal response to food intake.
Finally, sugar negatively impacts society by directly and indirectly contributing to billions in annual health-care spending, with 75% of U.S. health care dollars spent treating chronic diseases and their consequences (6).
Given these observations, Lustig, Schmidt, and Brindis argue there is sufficient basis for systemic efforts to reduce sugar consumption, which may include taxation, availability restrictions (e.g., making illegal the sale of sugar-containing beverages to minors), or other measures similar to those used to reduce alcohol and tobacco consumption.