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Nature, the prestigious science magazine from Great Britain, has just published a commentary with a provocative title–The toxic truth about sugar—and an even more provocative subtitle: Added sweeteners pose dangers to health that justify controlling them like alcohol.

The authors, Robert Lustig, Laura Schmidt and Claire Brindis, are researchers at the University of California medical center in San Francisco (UCSF).

They argue that although tobacco, alcohol and diet are critically important behavioral risk factors in chronic disease, only two of them—tobacco and alcohol—are regulated by governments to protect public health.

Now, they say, it’s time to regulate sugar.  By sugar, they mean sugars plural: sucrose as well as high fructose corn syrup (HFCS).  Both are about half fructose.

Their rationale?

• Consumption of sugars has tripled over the last 50 years.
• Many people consume as much as 500 calories a day from sugars (average per capita availability in the U.S. is about 400 calories a day)
• High intake of fructose-containing sugars induce metabolic syndrome (high blood pressure, insulin resistance), diabetes, and liver damage.
• Sugars have the potential for abuse.
• Sugars have negative effects on society (mediated via obesity).
• Too much of a good thing can be toxic.

Therefore, they argue, societies should intervene and consider the kinds of policies that have proven effective for control of tobacco and alcohol:

• Taxes
• Distribution controls
• Age limits
• Bans from schools
• Licensing requirements
• Zoning ordinances
• Bans on TV commercials
• Labeling added sugars
• Removal of fructose from GRAS status

In a statement that greatly underestimates the situation, they say:

We recognize that societal interven­tion to reduce the supply and demand for sugar faces an uphill political battle against a powerful sugar lobby, and will require active engagement from all stakeholders.

But, they conclude:

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 well-being. It’s time to turn our attention to sugar.

What is one to make of this?  Sugar is a delight, nobody is worried about the fructose in fruit or carrots, and diets can be plenty healthy with a little sugar sprinkled here and there.

The issue is quantity.  Sugars are not a problem, or not nearly as much of a problem, for people who balance calorie intake with expenditure.

Scientists can argue endlessly about whether obesity is a cause or an effect of metabolic dysfunction, but most people would be healthier if they ate less sugar.

The bottom line?  As Corinna Hawkes, the author of numerous reports on worldwide food marketing, wrote me this morning, “there are plenty of reasons for people to consume less sugar without having to worry about whether it’s toxic or not!”

Are you puzzled, annoyed, or irritated beyond belief by the word “natural” on food product labels?

FoodNavigator must think so.  It conducted an opinion survey on what to do about marketing foods as “natural”.

FoodNavigator asked: Do we [food companies] need a clearer definition of ‘natural’ for food marketing?

The response options:

Are you as puzzled about the latest cantaloupe outbreak as I am?  This time it’s Listeria again (see previous post on this particular pathogen).

According to the CDC, 72 people have been infected with the strains of Listeria associated with the outbreak in 18 states.  Most appalling,  13 people have died.

The CDC says that the people who have become ill range from 35 to 96 years, with a median age of 78 years.  Most are over age 60 or have health conditions that weaken the immune system.  Pregnant women are at especially high risk as are their fetuses.

As always, the recall occurred after most of the cases were reported to the CDC.  The cantaloupe were traced to Jensen Farms, which issued a recall on September 14.

Why cantaloupe?  They are, after all, grown in dirt and their skin is rough, textured, and has plenty of places for bacteria to hide.  People pick up Listeria by handling the fruit and cutting into it.  FDA’s information page lists the recalls and press releases on the Jenson Farms outbreak.

The FDA’s advice: throw it out.

Do not try to wash the harmful bacteria off the cantaloupe as contamination may be both on the inside and outside of the cantaloupe. Cutting, slicing and dicing may also transfer harmful bacteria from the fruit’s surface to the fruit’s flesh.

What do food safety experts say you have to go through to avoid getting sick from eating cantaloupe?

• Wash the melon under running water with a clean vegetable brush.
• Blot with paper towels to remove excess water.
• Put melon on a clean surface, one that hasn’t come into contact with meat or poultry or other foods that could cause cross-contamination.
• Cut off the stem end about 3/4 to 1 inch from the end, using a clean kitchen knife.
• Place melon on a clean cutting board, plate, or other clean surface with the cut end facing down.
• Using a clean knife, cut the melon from the blossom end to the stem end.
• Follow this by washing the knife with clean running water and setting it aside.
• Gently scrape out the seeds with a clean spoon and cut the melon into slices or whatever is desired.
• Don’t use dish soap or detergent; cantaloupes can absorb detergent residues.
• Do not allow the rind to touch any part of the edible fruit.
• Melon that isn’t eaten should be peeled, covered and refrigerated.
• Discard any melon that has been at room temperature for longer than 2 hours, or 1 hour when the temperatures are over 90 degrees F.
• Follow these procedures for all melons, no matter where they were grown.

What?  No HazMat suit?

We are talking about cantaloupes here.

How about a food safety system where everyone makes sure—and tests—that Listeria don’t get on cantaloupe in the first place.

Single food agency anyone?

_____

*Translation: Weapon of Mass Destruction

Michael Siegel, MD, MPH, a Professor at the Boston University School of Public Health (whom I do not know), has been mailing me copies of his recent blog posts on partnerships between food corporations and health organizations, particularly the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP) (see my previous posts), and the American Dietetic Association (ADA) (see my previous posts on this one too).

Dr. Siegel’s current post discusses two reasons why these partnerships do more for the food companies than they do for the organizations:

1. Coca-Cola and other Big Food companies are using these partnerships to enhance their corporate image, and therefore, their bottom line: sales of unhealthy products that are contributing towards the nation’s obesity epidemic.

In its 2010 annual report, Coca-Cola writes: “…researchers, health advocates and dietary guidelines are encouraging consumers to reduce consumption of sugar-sweetened beverages, including those sweetened with HFCS or other nutritive sweeteners. Increasing public concern about these issues…may reduce demand for our beverages, which could affect our profitability.”

…Pepsico, in its 2010 annual report, also makes clear the connection between the company’s public image and its bottom line: “Damage to our reputation or loss of consumer confidence in our products for any of these or other reasons could result in decreased demand for our products and could have a material adverse effect on our business, financial condition and results of operations, as well as require additional resources to rebuild our reputation.”

2. The American Dietetic Association, American Academy of Pediatrics, and American Academy of Family Physicians are supporting companies that oppose virtually every state-specific public health policy related to improvement of school nutrition, reduction of junk food and soda consumption, and environmental health and safety.

…Through its contributions to the Grocers Manufacturers Association (GMA), Coca-Cola is opposing any and all taxes on sugar-sweetened beverages (soft drinks), opposing the removal of BPA from bottles containing liquids consumed by infants, opposing legislation to simply require the disclosure of product ingredients, opposing taxes on candy, opposing bottle bills, opposing all restrictions on BPA-containing packaging, opposing standards for food processing, and opposing school nutrition standards.

…That the AAP, AAFP, and ADA have fallen for Coca-Cola’s tricks is one possibility. The other, which I find more likely, is that they have been bought off. In other words, that the receipt of large amounts of money has caused them to look the other way. It’s amazing what a little financial support will do. And of course, this is precisely the reason why companies like Coca-Cola and Pepsico include the sponsorship of public health organizations in their marketing plans.

I’m just back from the American Society of Nutrition meetings in Washington, DC, where the daily newsletter put out by the society included full-page advertisements from Coca-Cola, the beef industry, and the Corn Refiners Association (see yesterday’s post).  And then there is the astonishing example of Coca-Cola’s $10 million gift to Children’s Hospital of Philadelphia to head off a potential city soda tax.

It is completely understandable why food and beverage companies would want to buy silence from health professionals.  It is much less understandable why health organizations would risk their credibility to accept such funding.  Professor Siegel’s analyses of these issues are worth close attention.

I write a monthly (first Sunday) Food Matters column for the San Francisco Chronicle.  Today’s is about the difficulties of doing nutrition research.  The Chronicle headline writer titled it, “Be skeptical of food studies.”  Oops.

I’m not skeptical about Food Studies—the capitalized field of study—at all.  My NYU department started undergraduate, master’s, and doctoral programs in Food Studies in 1996 and they have flourished ever since.

The column is about small-letter food studies, meaning nutrition and food research studies:

Q: You were quoted saying that you didn’t believe newspaper reports linking diet sodas to an increased risk of stroke and heart disease. How do you decide whether research is good or bad?

A: This one was easy. I didn’t think it made sense. Mind you, I’m no fan of diet sodas. They violate my rule never to eat anything artificial. And I don’t like the taste of artificial sweeteners.

Whenever a study comes out claiming harm – or benefits – from eating a single food or ingredient, I get skeptical. That’s why I also questioned these recent study results: high-fructose corn syrup (HFCS) makes rats gain weight faster than sucrose (table sugar); zinc supplements prevent symptoms of the common cold; and pomegranate juice has greater health benefits than any other kind of fruit.

When I read about single-factor studies, I want to know three things: Is the result biologically plausible? Did the study control for other dietary, behavioral or lifestyle factors that could have influenced the result? And who sponsored it?

Plausibility: The diet soda study used a self-reported questionnaire to find out how often people reported drinking diet sodas. Nine years later, people who reported habitually drinking diet sodas had a 60 percent higher rate of stroke and heart attacks. The rate was somewhat lower when controlled for age, sex, race, smoking, exercise, alcohol, daily calories and metabolic syndrome.

Leaving aside the unreliability of self-reported dietary intake, the study raises a more important question. Was it designed to investigate the link between diet sodas and stroke or was this just an accidental finding? The questionnaire undoubtedly asked hundreds of questions about diet and other matters. Just by chance, some of them could be giving results that look meaningful. And the increase in stroke risk seems surprisingly high for something not previously known to be a stroke risk factor.

Mostly, I can’t think of a biological reason why diet sodas might lead to cardiovascular disease unless they are an indicator for some other stroke risk factor such as obesity, high blood pressure or binge drinking. It would take a study designed to test this idea specifically – and a good biological explanation – to convince me that diet sodas cause strokes.

The plausibility issue also rises in the HFCS study. Again, I’m not a fan of HFCS – we would all be healthier if we ate less sugar – but from a biochemical standpoint, HFCS and table sugar are pretty much the same. They have similar amounts of glucose and fructose, are digested as quickly and are metabolized the same way. Even the average amounts consumed are about the same. That soda companies are replacing HFCS with sucrose is strictly about marketing, not health.

Controls: The zinc-and-colds study was a comprehensive review (a “meta-analysis”) of previous studies done since the first one in 1984. Eleven studies have showed some benefit; seven have not. All of them were placebo controlled, double-blind. This meant that half the participants were given a dummy pill, and neither participants nor investigators were supposed to know who was taking what.

But in some studies, the zinc takers complained about the taste of the pills, hinting that they knew what they were.

I’ve heard this before. In the early 1970s, National Institutes of Health investigators did a study of vitamin C and the common cold. They got about 300 NIH employees to take either vitamin C or a placebo, double-blind. The tantalizing result: People taking vitamin C reported fewer colds and milder symptoms than people taking placebos.

Alas, many participants withdrew from the study before it ended. When asked why, they admitted tasting the pills. The investigators reanalyzed the results. Bingo! No matter what pill the participants actually took, those who thought they were taking vitamin C reported fewer colds and milder symptoms.

If the studies were not really blinded, the zinc results are questionable. I have no doubt that many people feel better when they take zinc supplements, but I’m not sure whether that’s because of something zinc really does or just its placebo effect.

Sponsorship: Vested interests influence the design and interpretation of studies. The best-designed studies control for factors that might influence results. Even so, their results require interpretation. Interpretation requires interpreters. Interpreters bring their own biases into the interpretation.

I mention pomegranate juice because one of its major producers sponsors studies to hype its benefits. Yes, pomegranates are delicious, but antioxidant powerhouses? So are most fruits. Pomegranates may have high antioxidant activity, but compared with what? Its maker does not say. Sponsored research is also about marketing, not health.

Nutrition research is hard to do, which makes study design and interpretation particularly challenging. Nutrition is a thinking person’s field, requiring careful analysis at every step. When you hear a result that sounds too good to be true, it usually is.

Thanks to alert reader Glen for pointing out that the FDA already has a regulation for Corn Sugar in the Code of Federal Regulations, under food substances Generally Recognized as Safe (GRAS).  CFR Section 184.1857 reads:

(a) corn sugar (C6H12O6, CAS Reg. No. 50-99-7), commonly called D-glucose or dextrose, is the chemical [alpha]-D-glucopyranose. It occurs as the anhydrous or the monohydrate form and is produced by the complete hydrolysis of corn starch with safe and suitable acids or enzymes, followed by refinement and crystallization from the resulting hydrolysate.

(b) The ingredient meets the specifications of the Food Chemicals Codex, 3d Ed. (1981), pp. 97-98 under the heading “Dextrose….”

(c) In accordance with 184.1(b)(1), the ingredient is used in food with no limitation other than current good manufacturing practice.

The Corn Refiners have just petitioned the FDA to be allowed to use the name Corn Sugar to apply to both glucose/dextrose and High Fructose Corn Syrup (HFCS).  But the existing definition seems to exclude HFCS.  While HFCS is about half glucose, it is also about half fructose, and its manufacture from corn starch requires one more enzyme.

A reminder about sugar chemistry:

• Glucose is the sugar in blood, and dextrose is the name given to glucose produced from corn but biochemically they are identical.
• Fructose is the principal sugar in fruit.  In fruit, it raises no issues because it is accompanied by nutrients and fiber.
• Sucrose is table sugar.  It is a double sugar, containing one part each of glucose (50%) and fructose (50%), chemically bound together.  Enzymes in the intestine quickly and efficiently split sucrose into glucose and fructose, which are absorbed into the body as single sugars.
• HFCS is made from corn starch.  It contains roughly equivalent amounts of glucose (45 to 58%) and fructose (42 to 55%).

HFCS raises several issues, health and otherwise:

• Quantity: the U.S. food supply provides to every American (all ages) about 60 pounds of sucrose and another 60 pounds of HFCS each year.  This is way more than is good for health.  Sugars of any kind provide calories but no nutrients.
• Fructose: increasing evidence suggests that the metabolism of fructose–which differs from that of glucose–is associated with abnormalities.  This means that it is best to reduce intake of fructose from table sugar as well as HFCS.
• Farm subsidies: these go to large corn producers and have kept down the cost of HFCS relative to that of sucrose.  The use of corn to make ethanol has raised the relative price of HFCS.
• Genetic modification: Most corn grown in the United States is genetically modified to resist insects or herbicides.

From a health standpoint, it makes no difference whether the sweetener is sucrose or HFCS.

As for agave sugar as a substitute: it can have much higher concentrations of fructose than either sucrose or HFCS but its labels do not give percentages so you have no way to know how much.

Given all this, what’s your guess about what the FDA will decide?

My Sunday (September 20) column in the San Francisco Chronicle deals with the sugar “crisis” I discussed here a few weeks ago:

Q: I saw you on “The Colbert Report” (Aug. 19) talking about sugar policy. Explain, please. I don’t understand why sugar policy is a topic for Comedy Central.

A: Neither did I until I saw Stephen Colbert douse himself with 5 pounds of sugar over the impending “crisis.” We have a sugar crisis? According to processed food manufacturers, we are about to run out of sugar. Horrors!

Earlier in August, Kraft and other food processors asked the U.S. Department of Agriculture to raise the quota on sugar imports. Sugar availability, they complained, is the lowest in years and it’s the USDA’s fault.

The USDA firmly controls amounts of sugar (sucrose) produced by American cane and beet growers through quotas. It even more firmly controls sugar imported from other sugar-growing countries through quotas and tariffs. And as corn is increasingly diverted to biofuels, less high-fructose corn syrup (HFCS) is around to make up the shortfall.

Should we worry?

The shortage is no crisis. At worst, it is temporary and will end as soon as the 2009 harvest is in. But processed food makers are right about one thing: Sugar is the most absurdly protected agricultural commodity in America.

For decades, no matter what it cost on the world market, quotas and tariffs ensured that Americans paid two or three times as much for sugar. High sugar prices cost American consumers about $3 billion a year. But because this works out “only” to about $10 per year per capita, nobody much cared.

If you think of $10 as trivial, you won’t give sugar protectionism another thought. But if you look at this system as an unnecessary transfer of $3 billion a year from 350 million Americans to a few thousand sugar growers and processors, you can understand why sugar policy is ripe for satire.

Here’s how the system works:

Quotas allow U.S. producers to grow only specified amounts of sugar cane and sugar beets each year, for which the USDA guarantees a higher-than-market price. Beets get 55 percent of the quota; cane gets 45 percent. The quotas are fixed. If you want to grow sugar beets in your backyard and sell the sugar to USDA at the favorable support price, too bad for you. You only get a quota if you already have a quota.

As for tariffs, the 2008 Farm Bill requires 85 percent of total sugar in the United States to be produced domestically, and allows only 15 percent to be imported. That 15 percent is distributed through quotas awarded to about 20 countries.

Above and beyond the quotas, imported sugar is subject to high tariffs. Mexico is an exception. Under NAFTA, Mexico gets to sell us as much sugar as it wants at the favored price. However, few countries in Africa hold quotas. What if you are an African cane-growing country and want the high quota price for your sugar? Not a chance.

Imports are never supposed to top 15 percent, so the USDA can’t increase the percentage. But we participate in the World Trade Organization, which obligates us to take world market sugar. Oops. These policies don’t match. Processed food makers must think the contradictions will allow the USDA to let in more sugar. Maybe, but the legalities are not yet decided.

Mind you, sugar producers and processors love this system. They argue that it keeps jobs in rural America and eliminates dependence on foreign sugar imports. To make sure nobody scrutinizes the system too carefully, they formed cooperatives to avoid antitrust laws.

Sugar producers are among the most generous and equal-opportunity contributors to congressional election campaigns, giving to both Democrats and Republicans. For decades, administrations of both parties have tried to end sugar supports. No such luck.

A shift’s brewing

Policies may change, because the gap between the prices for domestic and world market sugar – and for high fructose corn syrup – has narrowed recently. Sugar is now at war with HFCS. As HFCS is increasingly known as a key junk food ingredient, manufacturers are rushing to replace it with sucrose, which they can tout as “natural and unprocessed.”

Other sugar issues are also ripe for comedy. Most sugar beets are now genetically modified, leading many companies to avoid using beet sugar. In the South, sugar cane production pollutes the Everglades, which is costing billions of dollars to clean up. Investigative reporters are riveted by the feudalistic labor practices of sugar plantations.

And then there’s Cuba. Until the Castro revolution, that’s where we got most of our imported sugar. When relations improve, will Cuba get a sugar quota?

If sugar is responsible for any true crisis, it is because of its role as an ingredient in processed foods. Cheap sugar reduces the cost of candy and soft drinks. Cheap junk foods are highly profitable. Otherwise, our sugar policies make no sense in today’s global marketplace.

But we would be healthier eating less sugar, anyway. So here’s my solution to the non-crisis: Eat less sugar!

Colbert Report, August 19: I was interviewed on the Colbert Report about sugar policy, of all things.  U.S. sugar policy is so absurd that I did not think it could be satirized, but Colbert managed just fine.  Here’s what I would have said if I hadn’t been completely disconcerted by his dousing himself with five pounds of sugar:

The sugar “crisis”: On August 5, several groups representing makers of processed foods wrote a letter asking the USDA to raise the quota on imported sugar because stocks are lower than they have been in years.  Why?  Because domestic sugar production is thoroughly governed by quotas, imported sugar is thoroughly controlled by quotas and tariffs, and high fructose corn syrup (HFCS) is increasingly diverted to ethanol.  Got that?

Reminder about definitions: “Sugar” usually refers just to sucrose made from sugar cane and sugar beets; it is glucose and fructose stuck together.  The other major sweetener is high fructose corn syrup (HFCS).  It is also made of glucose and fructose, but separated.   Sucrose and HFCS work the same way in the body and are hardly distinguishable physiologically.   For the purposes of this discussion, I use sugar to refer to the sweetener refined from sugar beets and sugar cane, and HFCS for the sweetener made from corn.

Sugar protection policies: Even though it amounts to only 1% of agricultural production, U.S. sugar is the single most heavily protected agricultural commodity.  No matter what the price on the world market, U.S. sugar producers and processors get paid a high price.  Historically, this price has been two to three times higher than world market prices.   Although this has for decades cost American consumers $2 billion to $3 billion a year in higher sugar prices, nobody much noticed because it “only” amounted to about $10 per year per person over and above what you would pay for sugar anyway.  Today, the gap between domestic and world market prices has gotten much smaller, mainly because there isn’t as much HFCS around (more on this later).

Quotas and tariffs: These are amazing, really.  U.S. producers are allowed to grow a certain amount of cane and beets each year for which they are guaranteed a price set by USDA.    Beets get 55% of the total quota allotment and cane gets 45%. This works like a closed shop.  If you want to start growing beets or cane for domestic sugar production, too bad.  Catch 22: You only get to have a quota if you already have a quota.  As for tariffs:  The 2008 Farm Bill says that 85% of total sugar in the U.S. must be produced domestically, and only 15% can be imported.  That 15% comes in through quotas distributed among about 20 countries.   Any other sugar they want to send us is subject to high tariffs, except from Mexico.  Under NAFTA, Mexico can export as much sugar to us as it wants to at the favored price.  But imported sugar is never supposed to exceed 15%.

International issues: Our agreement with the World Trade Organization (Uruguay Round) says we have to take a certain amount of world market sugar.  But the 2008 Farm Bill restricts imports.  Oops.  The contradictions in these policies still have to be resolved.  The processed food people think the USDA can raise the percentage.  Can it?  Hmmm.  We don’t know this yet.

Who benefits: A few thousand beet producers in about 15 states and a few hundred cane producers, and the sugar processors.  They get paid amounts that are higher than world market prices.   The countries that have sugar quotas also get higher prices for their sugar quotas.  Producers of sugar cane and beets love this system.   Florida cane producers defend it this way: “U.S. sugar policy ensures that jobs in rural America are not sent overseas, and that American consumers are not held captive by unreliable foreign suppliers of subsidized sugar.”  Like American-owned sugar plantations in the Dominican Republic, for example?

Who loses: According to the Government Accountability Office, everyone in America pays higher prices for sugar than we need to.  This amounts to a transfer of wealth from 350 million of us to a few thousand sugar producers and processors.   International sugar-producing countries that do not have quotas, those in Africa, for example, are also out of luck.

How this happened: The system started out in the Great Depression with the best of intentions.  Despite endless attempts to get rid of sugar supports and let prices fluctuate according to the world market, Congress continues this elaborate and expensive system to protect sugar producers and processors.  These groups have banded together in cooperatives so they avoid anti-trust laws.   Even the New York Times thinks we should get rid of sugar protections.  These groups, of course, are among the most generous and powerful contributors to congressional election campaigns.  Even more, they are equal opportunity contributors: they give to both Democrats and Republicans.  The Fanjul family in Florida is especially influential.  In the best known example, Mr. Fanjul was able to get President Bill Clinton to take his call on a federal holiday when Clinton was in the midst of a tryst with Monica Lewinsky (source: the Starr report).

What about HFCS: The public now puts HFCS in the same category as trans fats: poison (it’s not; it’s just sugars).   In response, makers of processed foods and beverages are starting to replace it with cane and beet sugar.   As explained in the current Advertising Age, sugar is now at war with HFCS.  HFCS used to be a lot cheaper than sugar, but its cost has gone up as more of it is used for ethanol.  Supply is down; costs are up.

Other issues: As if all this wasn’t complicated enough, sugar beets are largely genetically modified, leading more than 70 companies to say they won’t use that sugar.  Sugar cane production in the Southern states pollutes the Everglades, leading to billions of dollars in clean up costs.  And the labor practices of sugar cane plantations have long been the subject of much investigative reporting.  And what about relations with Cuba?  Until the Castro revolution, we got nearly all of our imported sugar from our Caribbean neighbor.  If relations with Cuba improve, will that country have a quota?

So what’s really going on? Food processors want cheap ingredients.   Cheap sugar makes for relatively cheap junk foods and high profits for manufacturers.  Current sugar policies make no sense in today’s global marketplace and we all ought to be eating less sugar anyway.  On average, we have about 70 pounds of sugar and another 70 of HFCS available per year for every man, woman, and child in the country along with a few pounds of other caloric sweeteners to boot.  That’s close to half a pound of sugary calories per day.   Less of all of them would be better, no? 

A final happy thought:  Maybe the processed food makers’ request – which is entirely self-interested – might lead to improvements in U.S. farm policy as well as relations with sugar-producing countries in the Caribbean and Africa.