• CORRECTION: This story was updated on Oct. 14, 2014, to correct the description of how different grades of high-fructose corn syrup are prepared. HFCS is made by enzymatically isomerizing glucose from cornstarch to produce a 42% fructose syrup. The syrup is concentrated via an ion-exchange column to form a 90% fructose syrup, which is blended with 42% syrup to make a third syrup containing 55% fructose. The 55% and 42% syrups are used in food and beverages.
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Volume 92 Issue 31 | pp. 11-17
Issue Date: August 4, 2014

Cover Story

The Case Against Sugar

Amid calls to cut back or even ban added sugars, scientists hunt for alternative ways to satisfy our cravings
Department: Science & Technology | Collection: Economy, Life Sciences
News Channels: Biological SCENE, JACS In C&EN
Keywords: high-fructose corn syrup, artificial sweetener, obesity, sugar, nutrition

Reader,

As you read this article, please let us know what you think by responding to the questions. Your responses will appear below soon.



Sugar is toxic. The fat and sodium we’ve spent so much time fretting over may in fact be the lesser of the evils in our diet. New evidence suggests that sugar—and possibly artificial sweeteners—might be the ultimate cause of high blood pressure, high cholesterol, heart disease, diabetes, and liver disease.

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Download a PDF version of this story here.
Credit: Shutterstock
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Download a PDF version of this story here.
Credit: Shutterstock

Natural sugars in our diet aren’t the ones on trial here. It’s added sugars that are under greater scrutiny than ever before. Former New York City Mayor Michael R. Bloomberg’s 2012 effort to curb the sale of supersized soft drinks put a spotlight on the added sugars in soda. But added sugars are prevalent in many foods and beverages: coffee and sports drinks, juices, grain-based desserts, candy, and ready-to-eat cereals.

Naturally, the food and beverage industries—and the sweetener purveyors who supply them—officially disagree with sugar’s bad rap. That position hasn’t changed in 40 years. But they are increasingly looking for ways to reduce added sugars in their products by combining natural and artificial sweeteners, adding flavor enhancers to improve the taste of low- or zero-calorie sweeteners, and even searching for new kinds of sweeteners. They hope to avoid regulation as public health officials and government agencies consider ways to curb how much sugar we consume.

Some scientists, however, argue that the evidence against added sugar is so damning that we need to remove it from our diets entirely. Leading the crusade is endocrinologist Robert H. Lustig of the University of California, San Francisco. Lustig doesn’t mince words when he calls sugar “the most demonized additive known to man.”

Lustig coauthored a paper providing the basis for the American Heart Association’s recommendation that men consume less than 150 calories (37.5 g or about 9 teaspoons) of added sugar per day. That’s about the amount in one regular 12-oz soft drink. For women, the recommendation is less than 100 calories (25 g or about 6 teaspoons).

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WE ASKED READERS
“What sweetener do you prefer?” They responded via Facebook and Twitter. If you missed the poll but want to weigh in go to http://cenm.ag/sugarpoll.
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WE ASKED READERS
“What sweetener do you prefer?” They responded via Facebook and Twitter. If you missed the poll but want to weigh in go to http://cenm.ag/sugarpoll.

Although added-sugar consumption in the U.S. remains significantly higher than it was 50 years ago, the amount we take in has gone down during the past 15 years. Still, the average American consumes more than double AHA’s recommendation—some 365 calories per day, according to the Department of Agriculture’s Economic Research Service.

Not everyone thinks the case against added sugar is as clear as Lustig makes it out to be. Fergus M. Clydesdale, a food science policy expert at the University of Massachusetts, Amherst, thinks that the data don’t condemn sugar but rather suggest its moderation.

Clydesdale points to a position statement by the Academy of Nutrition & Dietetics noting that consumers can safely enjoy a range of natural and artificial sweeteners when consumed within an eating plan that follows federal nutrition guidelines (J. Acad. Nutr. Diet. 2012, DOI: 10.1016/j.jand.2012.03.009). There is no difference in how we metabolize natural and added sugars, the statement notes. But foods high in added sugars tend to be higher in calories and lower in essential nutrients and dietary fiber.

“In dealing with an obesity and public health crisis, the worst thing we can do is tell people not to have sugar,” Clydesdale says. “A sweetened drink is fine once in a while. The biggest problem is that we are eating too darn much of everything. We’ve got to cut down.”

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A SWEET SAMPLER
The innate human need to taste something sweet has led to the development of many sweeteners.
NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.
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A SWEET SAMPLER
The innate human need to taste something sweet has led to the development of many sweeteners.
NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.

Sugar Essentials

Among added sugars the most common is table sugar, or sucrose. It’s a disaccharide made of equal amounts of glucose and fructose and is typically derived from cane or sugar beet juice. In the U.S., high-fructose corn syrup (HFCS) is a close second. HFCS cropped up as a sweetener in the 1970s when sugar import tariffs and corn subsidies suddenly made it a cheap sugar substitute. Its introduction coincided with an increase in added sugar in the average American’s diet.

HFCS is made by enzymatically isomerizing glucose from cornstarch to produce a 42% fructose syrup. The syrup is concentrated via an ion-exchange column to form a 90% fructose syrup, which is blended with 42% syrup to make a third syrup containing 55% fructose. The 55% and 42% syrups are used in food and beverages.

As a consequence, its glucose-fructose ratio is not so different from that of table sugar, except in HFCS the sugars are monosaccharides and in table sugar sucrose is a disaccharide. But that matters little because sugar’s disaccharide breaks apart in the low pH of soft drinks and in the digestive tract.

Although this subject was once a source of heated debate, scientists, the sugar and corn trade associations, and consumer groups now agree that there is no significant nutritional difference between sugar and HFCS (Physiol. Rev. 2010, DOI: 10.1152/physrev.00019.2009). In fact, the three key dietary monosaccharides—glucose (starch sugar), fructose (fruit sugar), and galactose (milk sugar)—all have the same caloric count, 4 cal/g.

But there are differences once they enter the bloodstream. Insulin-regulated glucose is involved in getting energy into cells throughout the body, whereas insulin-independent fructose plays a role in glycogen, triglyceride, and cholesterol production in the liver. Meanwhile, galactose is converted to glucose in the liver.

Lustig suggests that abnormal spikes in sugar cause trouble by interfering with normal regulation of insulin, leptin, and ghrelin. These hormones control glucose and fat metabolism and signal hunger and the feeling of being full to the brain (Nature 2012, DOI: 10.1038/482027a).

Lustig posits that fructose is the most damaging. Some fructose is converted to glycogen for immediate energy purposes, he notes. As with ethanol in alcoholic beverages, any excess is converted to liver fat. This can eventually overwhelm the liver, Lustig believes, leading to a condition known as insulin resistance.

The long-term result is fatty liver disease, Lustig says, which leads to obesity, heart disease, and diabetes. Lustig’s review of global diabetes and nutrition data has convinced him that obesity does not cause diabetes—however, too much sugar does (PLOS One 2013, DOI: 10.1371/journal.pone.0057873).

Given the complex biochemistry of the human body, Lustig’s theory may be hard to prove experimentally. But in one research study, genetically engineered mice unable to metabolize fructose appeared to be protected from these health problems (Nat. Commun. 2013, DOI: 10.1038/ncomms3434).

Critics note that most studies of the health effects of added sugar have looked at animals, not humans. The handful of human studies done so far draws on national surveys. As such they provide only correlations between sugar and health outcomes.

For example, a study published earlier this year evaluating data from the National Health & Nutrition Examination Survey found that the average American derives 14.9% of their calories from added sugar. Those who derived 17 to 21% of calories from added sugar had a 38% greater risk of dying from cardiovascular disease compared with those who consumed only 8% of their calories from added sugar (JAMA Intern. Med. 2014, DOI: 10.1001/jamainternmed.2013.13563).

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NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.
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NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.

Cutting Back

An obvious way to reduce added sugar is to rely more on artificial sweeteners. Their intense sweetness means we can use less. But this switch may not have the intended benefit, according to Purdue University behavioral neuroscientist Susan E. Swithers, who studies correlations between eating and weight management.

“Substituting a part of the diet with a similar-tasting item that has fewer or zero calories sounds like a commonsense approach to lose weight and possibly improve health,” Swithers says. “But common sense is not always right.”

When the mouth tastes something sweet, it tells the body to prepare for the calories, Swithers notes. But when those calories aren’t present, she believes the body’s mechanisms to control food intake become ineffective.

Swithers points to Russian digestive physiologist Ivan Pavlov’s research on conditioned responses to explain. In Pavlov’s classic experiment, he learned that making a sound when giving food to a dog would condition the dog to associate the sound with the presentation of food. When hearing the sound, the dog would salivate whether the food was delivered or not.

“Pavlov demonstrated that there are many cues—when we see and smell something and then when it hits our mouths—that trigger physiological responses and help us prepare for what is going to arrive in our bodies,” Swithers says. “So if we trick the mouth and interrupt that conditioned response with an artificial sweetener, it is going to be problematic.”

Swithers reviewed research studies that explored links between consuming zero- or low-calorie sweeteners and overeating, weight gain, and health problems. She concluded that people who consume artificially sweetened beverages don’t have any better health outcomes than people who don’t.

To test the idea, Swithers and her team have observed that rats consuming a noncaloric sweetener, such as saccharin-sweetened yogurt, failed to adjust their food intake to account for the sweetener’s lack of calories. The animals overate and gained more weight than rats receiving sugar-sweetened yogurt.

Swithers says the inability to accurately predict the arrival of energy in the gut appears to weaken the cascade of hormone-controlled events that leads to the feeling of being full. Swithers has also observed this unexpected effect in lab animals with fat substitutes used in snack foods.

Additional evidence comes from functional magnetic resonance imaging studies of the brain. In one example, Erin Green and Claire Murphy of San Diego State University and the University of California, San Diego, compared people who regularly drank diet sodas with those who didn’t drink diet sodas.

While brain scans were under way, the researchers randomly had study participants sip sugar water or saccharin water. The reward-processing regions of the brain that lit up differed sharply, depending on past diet drink consumption, not what the participants were drinking at the time. According to Swithers, the findings suggest that, once fooled, the brain’s sweet processing system may no longer be able to reliably gauge calorie intake.

“I am a scientist, but I am also a consumer, so it is hard to differentiate sometimes my scientific versus my personal opinions,” Swithers admits. “But it is clear we have oversweetened our food supply. It’s important that the public understands the science in order to help them make the best health decisions.”

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NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.
09231-cover-artificial
 
NOTE: Most common sweeteners are mentioned; there are many others out there.
a Relative to sucrose.
b A measure of how much a food raises a person’s blood glucose; glucose is defined as 100. SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.

New Options

Consumers seem to be getting the message. People in the U.S. have been shifting away from carbonated soft drinks and toward bottled water, tea, and energy drinks for years. But they defected at an even faster rate in 2013, according to data reported by Beverage Digest, an industry newsletter. Per capita consumption of carbonated soft drinks is at its lowest level since 1986.

But that’s not to say our appetite for added sugar is gone. Far from it. To satisfy the innate urge to eat something sweet, scientists and manufacturers are looking for ways to reduce sugar in the products we love.

It’s a difficult problem. “Sugar plays many functional roles in foods and beverages, from taste to providing the texture of creamy foods and the appealing browning of baked goods,” Clydesdale says. Artificial sweeteners, such as saccharin or sucralose, are more intense so we use less. They are also zero calorie and don’t increase blood glucose levels, which are blessings to diabetics. But they can’t replace all of sugar’s properties, he notes.

And they can come with an objectionable bitter aftertaste. As humans evolved, the need to identify nutritious foods such as fruits, vegetables, and grains resulted in a single sweet-taste receptor in the taste buds on the tongue—a G protein-coupled receptor dimer known as T1R2/T1R3. But the ability to taste something bitter, often a sign of toxicity, was perhaps more important: Humans have some 25 bitter receptors.

About a decade ago, when scientists began to better understand these receptors, they started to use high-throughput screening techniques to identify new sweetener additives that might block the bitter aftertaste of artificial sweeteners. They’ve used the same methods to find additives that might enhance the sweetness of sugar and HFCS. The technology is allowing scientists to come up with sweetener taste packages that optimize the desired sweet taste with fewer calories.

For example, Givaudan’s TasteSolutions line of flavor ingredients includes 4-(2,2,3-trimethylcyclopentyl)butanoic acid, which reduces the bitterness of artificial sweeteners (Curr. Biol. 2010, DOI: 10.1016/j.cub.2010.04.043). Senomyx’s Sweetmyx products include heterocyclic compounds such as aryl-substituted thioureas and benzothiadiazines, which have structures that resemble saccharin and improve sugar’s sweetness (Proc. Natl. Acad. Sci. USA 2010, DOI: 10.1073/pnas.0911670107).

But scientists continue to hunt for a natural sugarlike molecule that is low-cal, tastes the same as sugar, and imparts the same functional properties.

One popular alternative is stevia. Originating in South America, the stevia plant has been used as a sweetener in some countries for years. In the past decade, scientists have managed to isolate a series of the plant’s sweet-tasting glucose-coated diterpene molecules, called steviol glycosides. Rebaudioside A, the version with the most preferred taste profile, is more than 200 times as sweet as sugar and has little or no effect on blood glucose levels. The sweetener is available in Cargill’s Truvia used by Coca-Cola, PureCircle’s Pure Via used by PepsiCo, and others.

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SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.
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SOURCES: sugar-and-sweetener-guide.com, International Table of Glycemic Index & Glycemic Load Values, glycemicindex.com, company data.

Stevia’s taste has a slower onset, and it retains its sweet taste longer than sugar. But at high concentrations it imparts an unfavorable aftertaste. To counter that, Truvia, for example, is made up of 90% erythritol mixed with rebaudiosides and natural flavor additives. Erythritol is a sugar alcohol commonly used as a bulking agent to take up dead space so that artificial sweeteners behave more like sugar. Erythritol is about 60% as sweet as sugar, and at 0.2 cal/g has 5% of the calories, which is low enough to be considered zero calorie on nutrition labels.

Just as they did with saccharin, cyclamate, and other artificial sweeteners, regulatory agencies and consumer advocacy groups have questioned stevia’s safety. Although stevia has stood up to this scrutiny, the search for alternatives continues.

Another promising sweetener is tagatose, a stereoisomer of fructose. Unlike fructose, tagatose is a little less sweet than sugar. But it has a calorie count of 1.5 cal/g relative to sugar’s 4 cal/g and only slightly affects blood glucose levels, according to Yang Hee Kim, a senior scientist at CJ CheilJedang, a South Korean sweetener producer. The company is trying to introduce tagatose to a global market.

The minor structural difference between fructose and tagatose means that tagatose doesn’t bind to digestive enzymes the same way and is not fully metabolized. Tagatose controls blood glucose levels, Kim explains, because it inhibits carbohydrate digestion in the small intestine and promotes glucose conversion to glycogen in the liver. In taste tests people rate the sweetness and texture of tagatose and sugar as being about the same, she notes.

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SWEET TOOTH
The American Heart Association’s added sugar recommendations.
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SWEET TOOTH
The American Heart Association’s added sugar recommendations.

Tagatose also functions well in ice cream and soft drinks, Kim says, and it produces good browning for baking. However, it exists in small amounts in nature. CJ CheilJedang has therefore developed a two-step process to produce tagatose from the disaccharide lactose derived from milk processing. Lactose is first hydrolyzed into galactose and glucose by β-galactosidase, and then galactose is converted into tagatose by l-arabinose isomerase.

The company currently produces 2,000 metric tons of tagatose per year for table consumption. But Kim is enthusiastic about the prospects of tagatose catching on as a full sugar replacement.

Scientists are also taking a closer look at natural sweeteners such as honey, maple syrup, and molasses. Beyond their primary constituents glucose and fructose, these sweeteners contain other classes of bioactive compounds including complex carbohydrates, amino acids, and polyphenols that might impart health benefits, scientists have found (C&EN, April 14, page 10).

The complex carbohydrates in particular could offer a sweet advantage. For example, earlier this year at the American Chemical Society national meeting in Dallas, Mercedes G. López of the Center for Research & Advanced Studies of the National Polytechnic Institute, in Mexico, described studies on the composition and potential health benefits of agavins, which are branched polysaccharides (a type of dietary fiber) found in agave, the plant used to make tequila.

Agave syrup, which has become a popular sweetener recently, is obtained by cooking down the raw plant and is about 85% fructose monosaccharide. Being high in fructose is not particularly desirable, López admits. But agavins are mildly sweet with no aftertaste. And the largely nondigestible fiber would not be expected to raise blood glucose, but it would help people feel fuller so they would eat less.

López and her team wondered whether agavins might have beneficial effects similar to inulin, a related polysaccharide found in wheat, bananas, and other plants. Inulin has been shown to help increase insulin secretion and has been used as a sugar substitute by diabetics for years. It is also now being used as a bulking agent in some stevia-based sweeteners.

The researchers found that mice receiving agavin supplements in their water eat less, gain less weight, and have lower blood glucose levels compared with mice that consume sweeteners such as sugar, agave syrup, and aspartame. Agavins also increase levels of glucagon-like peptide-1, a hormone that slows the stomach from emptying and stimulates production of insulin. López thinks they are promising. “Our study represents the first attempt to evaluate agavins as sweeteners,” she says.

Public Pressure Mounts

No matter how many substitutes become available in the attempt to improve on sugar, society’s current means of sweetening its food isn’t ideal. Public officials and health regulatory agencies are under pressure to start finding solutions.

Two-thirds of the nearly 1,300 respondents to a 2013 New England Journal of Medicine poll favored government regulation of sugar (DOI: 10.1056/nejmclde1215057).

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SUPERSWEET
Lugduname is estimated to be some 300,000 times as sweet as sugar and to be the sweetest molecule on the planet. The acetic acid group attached to guanidine along with a perpendicular tail group is a molecular arrangement set up to perfectly bind to the human sweet-taste receptor on the tongue.
09231-cover-lugduname
 
SUPERSWEET
Lugduname is estimated to be some 300,000 times as sweet as sugar and to be the sweetest molecule on the planet. The acetic acid group attached to guanidine along with a perpendicular tail group is a molecular arrangement set up to perfectly bind to the human sweet-taste receptor on the tongue.

But opposition remains, as New York City’s experience shows. A judge blocked implementation of Bloomberg’s proposed regulation on sugary soft drinks because it was not uniformly enforceable. Meanwhile, industry, advocacy groups, and others argue that a 16-cal spoonful of sugar should be an unalienable right alongside life, liberty, and the pursuit of happiness.

The range of public opinion represented in the NEJM poll varied widely. Some believe personal responsibility should be enough to control our sugar diet without limits or an outright ban. Yet others point out that all of society must bear the consequences of too much sugar, which include rising health care costs, lost wages, and reduced productivity.

UC San Francisco’s Lustig is more blunt. Sugar has gone from being a condiment to a dietary staple, Lustig says, and he thinks it should be controlled like a narcotic. “If a substance is abused and addictive and it contributes to societal problems,” he contends, “that’s criteria for regulation.” Lustig believes sweeteners should at least be removed from the Food & Drug Administration’s “generally recognized as safe” list.

UMass’s Clydesdale suggests that instead of worrying about controlling added sugar, fat, and sodium, “we should concentrate on having people eat differently.” Food science has given us excellent-tasting low-cost fresh, frozen, and canned prepared foods that contain vegetables and protein and are low in fat, sodium, and added sugar, Clydesdale says. “But the public backlash against processed foods is preventing their broader adoption. I find it a great frustration that people line up to buy the latest electronic gadgets but they aren’t lining up to buy the latest in food technology.”

Part of the problem is that the economic incentive for buying foods is currently upside down, Purdue’s Swithers believes. “It is often cheaper to buy processed foods and eat at fast-food restaurants than it is to buy fresh foods at restaurants or to prepare them at home. From a public health policy perspective, that needs to be addressed.”

She points to lessons learned from reducing sodium to meet recommended healthy levels in the diet. When salt is not added to processed or fresh prepared food, and the consumer is given a saltshaker to add as much salt as they want, people tend to use less salt overall, Swithers notes. She thinks this behavior would hold for sugar as well.

Swithers also points to lessons learned with tobacco. Cigarettes have known negative health consequences and no real health benefits, she says. The use of age restrictions, higher taxes, scare-tactic labeling, and peer pressure have drastically curbed smoking, making it unnecessary to resort to an outright ban. Swithers thinks that public health and government agencies could use the same strategies to reduce the use of natural and artificial sweeteners.

“It might be a so-called nanny state,” Swithers says, “but I don’t think it is unreasonable as a start to tax sweetened beverages, to restrict the size so that buying more is more expensive, and to curtail advertising and marketing to children.”


Dear Reader

After reading this article, please let us know what you think. Responses to the survey questions will appear below soon.




Would you support a national tax on added sugar in food and beverages? Why or why not?


Gordon Aubrecht

Yes, sugar is too cheap, and the harm it does is documented in this and other articles.

Laurel

YES
Sugar consumption leads to many illnesses. Also, healthy people who don't eat junk, like sugar and HFC, pay high rates for health insurance because the system is set up so healthy people pay for the sick. If someone is sick because of bad consumer choices, then they are the ones who should pay the high rates.

Casey Hinds

Yes. We found this was effective in reducing the number of youth smokers and it's an important step to reduce the rates of type 2 diabetes and fatty liver disease in children.

KC

It should be added to all foods/beverages that have any artificial or natural sugar. Better yet, those collecting food stamps should not be allowed to use food stamps to purchase these foods/beverages.

Jessica

No, because sugar is still an essential piece of the human diet. As a chemist I do understand the processes that are discussed in the article. I also believe in self control. I understand that not every person is the same but if you are raised to have self control when it comes to food it most likely will carry through to adult-hood. It did for my siblings and me. Not everybody is going to understand the science behind this so I think a tax would only worsen the matter. Most people understand the difference between healthy and unhealthy, it's making the choice between the two lifestyles where people fall short. In my opinion, that is their own fault. Within reason sugar is good to eat. Those of us who choose to eat it right should not be punished because of those who lack self control.

Marie Clements

Yes. A few should not make profits from the masses. Added sugar means fewer nutrients for the body. The tax should go to inform consumers the dangers of eating food-like products rather than food. The health costs should be considered also. If you smoke, you usually pay more in the long run for health related issues of the body. If you eat refined sugar and sugar substitutes, your health is less than ideal.

Richard Fedder

No, People have eaten sugar for so long. And, anyone who has a brain knows to cut way down on sugar. I bake, and I always use less sugar than the recipes call for.

I don't eat processed foods - or cereals.

It does not take the govt to control people on this issue.

I support govt regulation of toxic chemicals however. If sugar really is toxic, then it is proper to regulate it. But first you have to educate people and convince them its toxic. Otherwise the backlash would be huge.

Ski Cyn

Yes. Cost to society for the increasing obesity in children with all of its health costs is a burden to our country's productivity that, like tobacco, should be taxed.

Additionally, need to eliminate the govt. subsidies for growing foodstuffs like corn.

Alfred Jauciasn

yes as that would curb consumption

camille_martina@urmc.rochester.edu

yes, because in too much sugar has detrimental health implications. We were not meant to consume this much (hidden sugars in processed foods).

Lynn Becky

No I would not. People are going to consume sugar regardless of cost. We can not tell people what to do. If they choose to be unhealthy knowing that excess sugar is an inflammatory that is their problem. We cannot control other people.

Gary

Yes. It is something that needs to be addressed. We have not done a good job of addressing it ourselves. One part is consumer action, another part is gentle persuasion to make better choices. There are alternatives to high sugar foods, they just are not as available or cheap as high sugared foods.

Ivan Tsoi

If it is taxed like alcohol and tobacco in Singapore, yes.

Phil Thompson

No. It is disproportionate. It also unscientific, if bread and sugar have the same glycaemic index where's the case for picking on sugars rather than starches - which are glucose polymers.

Edna

Probably not. The problem isn't isolated to sugar but to the entire "processed white food" category. It would be too tricky to tax. Regulation, however.....

çasdfa pfv

Yes.

Marissa DeMichele

I would not support tax on added sugar because it's not up to anyone else but myself what I put in my body. If someone wants to abuse sugar consumption through various foods and drinks to lead to obesity and diabetes, I should not be penalized if I want to treat myself every once in a while. I take care of my health by watching what I eat, but there's already enough taxes on things and this definitely doesn't need to be added to that list.

Stephen D

Yes, most consumer goods should be taxed at roughly the same rate. Just because something is taxed does not mean consumers have no choice.

Janice

No, I do not support a national tax on sugar. It is just another way for my personal life to be controlled by people who do not know my personal needs and requirements, and generally do not care about my personal needs and requirements. This is a non-issue that is being used to enhance political and social control.

Jeanette King

Yes. Sugar does not need to be added to foods, and it creates so many costly health concerns.

James Gaidis

No. Taxes on food, in the name of directing behavior, are an overreach of government regulation.
This article is an example of chemistry wrapped up by ideologues.

Lenore

Yes

Mary F

No, too much regulation and too much work to regulate.

William P. King

Yes, provided the connection to health issues is developed as with smoking and the revenues used appropriately using the experience with tobacco product taxes.

Megan

Yes - because I never drink soda, so it wouldn't affect me. And it would promote people to buy less sugar and promote businesses to make more healthy alternatives.

Tulika Dalavoy

yes. National tax will discourage purchase of foods/beverages with high added sugars, but consumers will still have access to it. Better than outright ban.

Thomas Sun

No. Tax should not be used to regulate how people eat their food. We have enough taxes to bear. Tax on added sugar won't do any good to anyone.
Individual control is the best way to deal with the overconsumption of sugar.

Michael Zviely

Yes

Ron

No, this whole flap about added sugar is pure hype! The government is already far too intrusive in our lives. We need to stop all this nonsensical over-taxing and over-regulation and simply behave as responsible adults. We should responsibly limit our sugar intake to a reasonable level! Sugar is fine, in moderation.

John

No. Let the market decide what it wants.

Shawn

Only if the tax is levied against the manufacturer, not the consumer. It is very difficult to find any foods, other than fresh produce or fresh meats that do not have added sugars or artificial sweeteners. Consumers have no idea what's in most of the foods they eat, and those that do have a hard time finding good options. Motivate the manufacturers to put out better options.

Grant E DuBois

No; At least 2 reasons why not......1) The tax would likely have no effect on consumption of added sugar by consumers; and 2) There are examples after examples of tax revenues being collected by the government and not being used for the intended purpose.

F. Warren

Yes

Jim Lang

No, if you start taxing the added sugar foods, ALL foods pricing will go up. We have the cheapest food in the world and the main reason is the effective cost to produce the sugars. People need to understand their choices and make them appropriately. We don't need more government deciding for us.

Barbara Charton

No. This is consumer choice. One can regulate what a child does but doing this to adults (who are presumed sentient) is outrageous.

Mike L

Absolutely NOT. Government intervention is not the solution -- people must want to change for themselves. The responsibility is for parents to educate their children, and raise them to recognize the importance of good health.

Michael McHenry

No. As we can see from the articles glycemic indexes plenty of every day foods have indexes higher than sucrose and HFC. Lets tax the potato while were at it. Lustig is not mainstream in his thinking. Sugar is not toxic thats absurd on its face. Food in America is cheap and people eat too much and exercise too little.

Alex Yokochi

Yes. Excess free sugar promotes various diseases, primarily amongst older and/or lower socio-economic groups, and the costs are therefore borne by society in general.

Wolfgang Gunther

This whole campaign is an appalling, pseudoscientific proposal. Next, should we have a tax on French Fries, or on breathing air?

Dirk Vander Ende

No. Prohibition doesn't work! Any effort to tax or regulate a substance will have unintended consequences. Tax sugar and you'll create a black market for it. Or you'll drive people to use other "sugary" substances, or fake sugar substitutes, with unknown medical consequences. Rather than tax or regulate, educate!

Harvey F Carroll

Yes. It would increase revenue and decrease long-term medical costs. A win-win.

Geoff Patton

No

Janis

Yes. It's better to discourage people through higher prices than try to ban sugar altogether. We could use the revenue for diabetes research and treatment.

Gabriela de la Torre

Yes. That way the products would be more expensive and, hopefully, people would take a warning about it, and probably would cut down sugar consumption. And, companies would do something to offer products without added sugar.

Mike Kerner

No tax on sugar.

The primary role of a tax is, and should be, to raise revenue necessary for legitimate government functions.

History has shown that the use of taxation as an economic or social incentive or disincentive leads to both economic and social distortions.

Robert Buntrock

No. The amount of "added" sugar is too difficult to determine and is best handled by labeling.

Charles Heimerdinger

No, because this will just empower an already too powerful central government even more. In addition, this kind of tax is just more wealth redistribution which is inequitable and confiscatory.

Moshe Einav

No. I would assert however for a healthy substitute for sugar that will be affordable. I didn't stop smoking because of cost, but due to being convinced that it is bad for my health.

Todd

It depends. It would seem to fall in the "sin tax" category (like alcohol and tobacco) and to the extent the government would consider taxing sugar and reducing taxes on other things I'd be open to the idea. But the costs of implementation would also need to be considered, and might be too daunting.

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Do you think sugar should be regulated like alcohol or a drug?


Gordon Aubrecht

That seems impracticable to me.

Laurel

No. Just hit the consumer in the pocketbook.

Casey Hinds

Like other substances that are harmful and addictive, we should be regulating the marketing of it to children.

KC

No. But insurance companies can put on higher premiums on those who consume too much.

Jessica

No, becasue it is not a drug. It does not produce the adverse effects which occur when taking drugs. I do believe that a person can become addicted to sugar but the same can be said for steak or carrots or water. People can have addictions to anything they consume. This brings me back to self control. If you realize it is out of your control you have the ability to ask for help. See a dietian if you need assistance in adjusting your diet to consume less sugar. This is in no way the same as going to rehab for drug addiction. What sugar does to your body is no where near what drugs do to your body. What about people who put ketchup on everything? Is that going to be regulated like a drug? What about basil or garlic? Regulation of sugar as a drug will bring a lot more to the debate table than is necessary.

Marie Clements

Yes, it should be regulated. It obviously harms people when it is consumed. It is not a naturally occurring product in nature, except for honey. We should be eating real food, not food-like substances.

Richard Fedder

No. Same reason as above.

Plus our regulation of "drugs" aside from alcohol is completely irrational and counter-productive. If we don't know how to regulate marijuana, how can we handle sugar.

Ski Cyn

No. This would be over-regulation. What is needed is better food labeling to discern how much 'Added sugar' v 'Inherent sugar' is in foods.

Alfred Jauciasn

no, that would just add another layer of bureaucracy

camille_martina@urmc.rochester.edu

yes

Lynn Becky

No, that is ridiculous. Alcohol and drugs cause people to become impaired in their thought process. Their actions when impaired can kill others. The person who has consumed sugar isn't going be impaired to the point of killing some one. Again, people need to take responsibility for their own health, we CAN NOT legislate good health into being.

Gary

Yes. It was in WWII and people survived somehow without it. It was rationed at "On May 5, 1942, each person in the United States received a copy of War Ration Book One, good for a 56-week supply of sugar. Initially, each stamp was good for one pound of sugar and could be used over a specified two-week period. Later on, as other items such as coffee and shoes were rationed, each stamp became good for two pounds of sugar over a four-week period. " from http://www.sarahsundin.com/make-it-do-sugar-rationing-in-world-war-ii-2/. Or one lb every 2 weeks or 26 lbs/year. Today we average >100 lbs/year (http://www.dhhs.state.nh.us/dphs/nhp/adults/documents/sugar.pdf). We can do with a lot less sugar and still be fine. It is said that over 50% of our sugar consumption is from soft drinks/flavored waters

Ivan Tsoi

No, that type of regulation seems quite extreme.

Phil Thompson

No, there is no evidence of direct harm in a dose-dependent manner and no credible evidence of addiction. Human behaviours (eg violence, judgment etc) are not affected by sugar.

Edna

Yes. Sugar is addictive to many people.

çasdfa pfv

No.

Marissa DeMichele

After studying Forensic Toxicology in school, I've learned and heard a lot about regulated drugs and alcohol. To consider sugar a "drug" or "addictive" is ludicrous. Over consumption of sugar affects no one other than that person; if someone wants to ruin their health by eating too much sugar for their body to handle then that's their prerogative. There is no physical dependence when sugar is consumed, or side effects when it is not consumed, unlike any of the Schedule I drugs listed. Are we going to start throwing people in jail who have eaten more then 6-9 teaspoons of sugar a day? I think it's a little more important to catch real criminals and just educate the public about healthy life choices and diet options than to punish people for making a personal choice in food consumption.

Stephen D

No.

Janice

No, I do not think that sugar should be regulated. It is just another way for my personal life to be controlled by people who do not understand nutrition or medicine, and certainly do not really care about my health or welfare. We certainly do not need more government intrusion into our lives.

Jeanette King

Yes. It is addictive like alcohol and drugs.

James Gaidis

No. Sugar has been in our diet for centuries without harm. Anything that has an effect can be used properly or improperly. Sugar is a food. Overeat to your own disadvantage.

Lenore

yes

Mary F

No

William P. King

Only if the results of research (ideally funded by sugar tax revenues) substantiate the need to do so.

Megan

This seems like it could be too harsh. I would just stop subsidizing corn to drive up the price of corn syrup.

Tulika Dalavoy

no

Thomas Sun

No, no, no. Don't we have enough regulations?

Michael Zviely

Yes

Ron

No way! This concept is way over the top!

John

No. Let the market decide what it wants.

Shawn

Hmm, because regulations work so well . . . .

Grant E DuBois

No; People must take responsibility for their own health and I think a way to do it is to have them pay higher health insurance costs for engaging in unhealthy behaviors. BMI is not a perfect metric, but health insurance premiums paid by individuals could be BMI dependent. Certainly automobile insurance works this way; if you have a lot of moving violations and accidents, you pay......other people are not compelled to pay for your bad behavior.

F. Warren

Yes

Jim Lang

No, again this is more government where government is not needed.

Barbara Charton

No. This is nvasive.

Mike L

Absolutely NOT. How well has our "war on drugs" worked for keeping drugs off the streets? The responsibility is for parents to educate their children, and raise them to recognize the importance of good health.

Michael McHenry

No. You would need to regulate the potato, rice, white bread, etc

Alex Yokochi

Yes. Added fructose in particular should be more tightly regulated.

Wolfgang Gunther

Crap! What a great scaremongering article! Let's be a touch more logical. So sugar has been bad for generations of people. Except that taking out calories by replacing sugar with artificial sweeteners in soft drinks seems to have made no difference. Doesn't that squarely point at getting the fattening effect from another soft drink ingredient? Like phosphoric acid? Just do two Google searches and to hint at the effective mechanism: first the tissues swell a little with every phosphate-containing soft drink, then the body fills the new interstitial spaces with fat cells. The obvious study would be a long-term comparison of weight gain after soft drinks with only phosphate (Colas) or only citrate (like Sprite). The closest I have found is a study of bone density (1) that probably explains why hog fattening benefits from feeding calcium phosphate.
(1) Tucker KL, Morita K, Hannan M, Qiao N, Cupples LA, Kiel DP. Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study. Am J Clin Nutr. 2006;84:936-42.

Dirk Vander Ende

Absolutely not! See above.

Harvey F Carroll

No. Education is the best solution. What should be made clear when quoting "experts" on the dangers (or safety) of sugar is to also state conflict of interests. Where do they get their research funding?

Geoff Patton

No

Janis

There should be some regulations, like what can be marketed to children, the sugar content of school lunches, etc. Mainly, we need to educate people so they can make better choices.

Gabriela de la Torre

Yes. It's as harmfull as alcohol, but people don't know.

Mike Kerner

Sugar should not be regulated.

Robert Buntrock

No. No valid comparison. misconceptions abound including the flagrant misuse of "toxic".

Charles Heimerdinger

No, because it is an essential nutrient.

Moshe Einav

No. I believe that regulations should be enforced only at cases where a person might cause damage or intimidation to others. Don't know of any sugar consumer doing that because of his/her uptake.

Todd

Meaning what exactly? 18 and over (like alcohol)? An outright ban (like controlled drugs)? I wouldn't support either of those.

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Should food and beverages with added sugar be given health warning labels like alcohol and tobacco?


Gordon Aubrecht

That seems doable. Whether it would help? ...

Laurel

Yes. but I doubt people will read them.

Casey Hinds

Yes and the sooner, the better.

KC

Yes. But so should juice beverages which are nearly all sugar.

Jessica

No. Sugar is not a drug. It is absolutely not the same and therefore should not be treated the same. It is nutritional and should be listed in nutrition facts. If people are overdosing on sugar they will get fat and increase their chances of diabetes, not die. (Again, self control. Also, I realize people can die from diabetes but if you have your hands on that much sugar you are probably also seeing a doctor regularly which would prevent such a death.) Sugar does not degrade a body or mind as a drug or alcohol does.

Marie Clements

Yes. Warning to the consumer, beware later consequences. Include 100% fruit juices also. Fruits contain many healthy benefits. Fruit juice is just another name for refined sugar.

Richard Fedder

Yes.

This seems to me the right approach.

Everyone buys food. The labels will educate people about the toxic nature of sugar (if it is toxic as claimed). Remember, labels must be transparent and accurate.

Ski Cyn

Yes, If there are evidence-based studies (like Lustig's) that can link consumption of various sweetners to bad health outcomes, or studies in rats/mice.

Alfred Jauciasn

yes because too many people are mis/malinformed

camille_martina@urmc.rochester.edu

Yes, if it exceeds a certain limit or percentage of the entire food product or drink.

Lenore

yes

Mary F

yes

Lynn Becky

I would be in favor of warning labels on food and beverages. The purchaser than has no excuse, they have been warned. Either heed the warning or suffer the consequences.

Gary

Yes

Ivan Tsoi

Yes, especially if one serving meets/exceeds the recommended daily consumption.

Phil Thompson

No, because there is no demonstrable health problem due to "added sugars" compared to any other sugars, or any other carbohydrate in normal doses as part of a mixed diet.

Edna

Yes.

çasdfa pfv

Yes.

Marissa DeMichele

Personally, I believe sugar is sugar; if it's bleached sugar or honey or sugar in the raw or brown sugar...it's still sugar. Eating a tablespoon of "added" sugar seems like it would be the same as taking a spoonful of honey from a comb. We're in a day in age where majority of the public has been sucked into learning about every new diet under the sun and what foods to avoid and what food are essential; people are aware that sugar leads to obesity and diabetes when not consumed in moderation. There doesn't need to be a warning because there has never been a need for a warning. People are obsessed with eating healthy, and maybe we should be counseling them that sugar is an essential part of our metabolism, it just has to be monitored.

Stephen D

yes.

Janice

No, I do not think that sugar requires a health warning label, nor do I think that such a label makes any difference on things such as alcohol and tobacco. Sugar does not cause any medical conditions. It can be a problem for some people who have certain conditions, but that doesn't mean that we should all be punished with higher prices and inconvenience, just for the sake of a few people that already understand the connection between their conditions and what they eat or drink.

Jeanette King

Yes. Sugar is known to cause many specific diseases.

James Gaidis

No. There is enough publicity given to the caloric value of sugar for people to decide for themselves. Next, you'll be going after M&Ms.

Lenore

Yes

Mary F

Yes

William P. King

Yes. I believe the experience with tobacco has shown this to be an effective approach.

Megan

No, people aren't stupid. Sugar should just be limited to reasonable amounts.

Tulika Dalavoy

yes

Thomas Sun

There could be a reminder of the right amount daily intake of sugar.

Michael Zviely

Yes

Ron

No. The sugar industry would fight this "tooth and nail."

John

No. Let the market decide what it wants.

Shawn

Absolutely. It is appalling that there is so much added sugar in foods, and I firmly believe that manufacturers are deliberately misleading consumers by being able to list added sugar under so many chemical names. Also, while it's great that nutrition labels include total sugar per serving, it's misleading not to specify how much is naturally-occurring (as carbohydrates in whole grains, fructose in raisings, etc) vs. added refined sugars. Artificial sweeteners need to be included, as well.

Grant E DuBois

No; consumers already know that they need to control their caloric intake. The issue is maintenance of a healthy body weight. People w/ high BMIs have an excessive number of medical problems. And today, everyone has to pay for their bad choices in eating behavior. If their health insurance premiums were tied to their BMIs, or perhaps body fat levels, I think we would see more people try to control their body weight......and thereby positively affect their health.

F. Warren

Yes

Jim Lang

No, if you are going to start warning/disclaimer labeling, then it needs to be consistent among all foods. Eating too many carbs or red meat can have similar adverse affects as sugar does.

Barbara Charton

No. One cannot suffer acute poisoning from an excess.

Mike L

No, labels are not effective and represent an additional burden on industry. The government can mandate all the warning labels they want, but consumers still buy tobacco and alcohol.

Michael McHenry

No. Again the potato, etc would need labeling too

Alex Yokochi

Yes. See answer above, in particular for foods containing added fructose.

Wolfgang Gunther

No, they should not. We should guard against people making such proposal.

Dirk Vander Ende

Yes. This is reasonable and fully in keeping with proper government roles in educating and protecting the public from dishonest marketing practices. Inform, educate, let people decide for themselves.

Harvey F Carroll

Yes. Can't hurt and may help.

Geoff Patton

No

Janis

Yes.

Gabriela de la Torre

YES! Specially thinking of our kids!

Mike Kerner

No warning label. We risk credibility by applying warning labels to everything.

Robert Buntrock

No, for similar reasons outlined in other responses.

Charles Heimerdinger

I'm really getting fed up with the federal government that has become way too involved in all aspects of my life so no.

Moshe Einav

Yes. Education at any level should be the way to change people behavior.

Todd

Probably not. The costs of implementation and enforcement would need to be considered. For something like alcohol and tobacco, it would not surprise me if the labels have absolutely no value now (people already feel informed enough about these things and aren't going to be swayed by a label). To the extent that new information is out about added sugar, I think that just a label identifying added sugar might be enough.

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