
It’s the Sugar, Folks - joecurry
http://opinionator.blogs.nytimes.com/2013/02/27/its-the-sugar-folks/?smid=tw-share
======
Uhhrrr
Two comments from the article that I liked:

As the principal author of this study, I wanted to clarify some of its details
for scientifically-minded readers, in order to avoid misinterpretations:
<http://epianalysis.wordpress.com/2013/02/27/sugardiabetes/>

\-----

The opening line ("Sugar is indeed toxic.") is distorted and inane. Sugars are
not toxic, as evidenced by our evolution of taste buds that respond so
positively to them. Sugars are a dense source of energy, which is why our
metabolic systems cherish them. Let's leave such excessive, unsubstantiated
commentary to The Onion or Mad Magazine, and just apply common sense to our
diets.

~~~
Nathanael47
It's a problem of translation between the chemistry definition of toxic (it
will kill you in short order) and the common definition (poisonous, noxious).
Bittman was using the latter, with an understanding that the dose makes the
poison.

~~~
Uhhrrr
I don't think either of those definitions are well served by evidence.

------
pdeuchler
A NYT Editor's Pick Comment:

""" I'm glad the smoking gun has been found.

High fructose corn syrup is in virtually everything people buy to eat. It
needs to go. Enough people's lives have been ruined. The design and
engineering of prepared foods people commonly buy is toxic and addictive.

Now we need to re-educate people and make sure long-held views are erased.
People have long blamed gluttony for obesity and obesity for diabetes. We now
know it isn't true and that the super-sugars we are being force-fed are the
culprit. We must all, together, demand that processed sugars such as high-
fructose corn syrup be banned or, at the very least, severely restricted. I
don't use the words force-fed lightly. Those among us who are on food stamps
or a limited income have no choice but to buy the cheapest foods. Those are
the ones that most commonly have the highest amount of sugars added. Anyone
with a busy lifestyle eats out a lot. Fast foods, including the ones that
claim to be "better," are laced with sugars, sodium, and fat.

We must demand policies that protect us from harm and the greed-driven
irresponsible practices of Big Food.

Thank you, Mr. Bittman, for keeping us informed. """

So is "Big Food" the new scapegoat? I guess the next article we'll see a
comment proclaiming how "Big Grocery" prices unhealthy foods too low, so now
it's their fault.

This is a great study, and it's results are extremely interesting, but this
article, and the inferences people are getting from it border on witch trials.
The article does a great job of doing everything but coming out and saying
what the commenter does "They're force feeding us toxins!". There is such a
clear departure from responsibility in today's culture it's almost
astonishing. The blame lies 100% with nobody, but the individual has just as
much a part to play as those producing the food.

Edit: Does anyone notice the language used in the comment? "Force-fed", "re-
educate", "We must all, together", "Enough people's lives have been ruined".
It sounds almost like something from 1984.

Also, look how easily the commenter provides inclusion to victimhood... anyone
"with a busy lifestyle", or those who "are on food stamps or a limited
income". Limited income is pretty broad. It's interesting also, how they "have
no choice but to buy the cheapest foods".

~~~
JumpCrisscross
One of the harder lessons stamped into me by the last few years in finance is
just how wrong the myth of the rational consumer is, regardless of my liberal
individualist world-view. The best of us make terrible decisions in almost
everything we don't consciously analyse, i.e. almost everything. The rest busy
ourselves with illustrating Murphy's Law in strings of bad decisions. When a
system provides individuals with easy bad decisions it should not be
surprising when people behave per expectation, and thus, not sufficient to
blame them.

~~~
pdeuchler
It's extremely dangerous to excuse someone of not wishing to make conscious,
good decisions.

~~~
anthonyb
Despite studies showing that people have a limited amount of willpower, after
which they revert to habit?

~~~
d23
I would think HNers of all people would understand the idea of abstraction and
information hiding. We have so many parts of our lives that to try to get a
complete understanding of even _one_ of them is pretty complicated.

 _What's the best toothpaste to buy if I want white teeth? Will it hurt my
enamel? What about gingivitis? What about tooth brush hardness? What about
flossing? What's the proper technique? Should I do it before or after I
brush?_

And that's just dental hygiene.

So yes, while this libertarian ideal of "the free market solves everything"
and "fuck the consumer if they won't educate themselves" is nice in theory, in
practice it's not effective public policy. It simply isn't possible to be
completely informed on everything that goes into every part of our lives -- if
you actually want to live, that is.

~~~
Gotttzsche
that doesnt mean there's a better option though. what else are we gonna do,
have some committee tell us which toothpaste to use?

~~~
d23
Basic regulations about what makes a toothpaste fit to sell is a good start.

------
mbreese
This is ridiculous. Sugars are fundamental bio-molecules and are essential for
life.

Yes, we know that over-eating causes diabetes and obesity. And this study says
that foods high in sugar pose the greatest threat. But seriously, are we going
to start to say that sugar is _toxic_ in the same way that cigarettes are
toxic? We can manage the dangers of sugar toxicity pretty easily by
exercising. The damage done by smoking... not so much.

This reminds me of a pet peeve that my grad advisor had. In our area it was
common to see signs that said something to the effect of "No dumping of
chemicals". He loved to point out that water was a chemical.

~~~
JPKab
I think the point that is left out by the article, but emphasized by Robert
Lustig (Dr. mentioned in the article) is that sugar, in nature, is almost
always accompanied by large quantities of fiber, which prevent it from being
absorbed too quickly.

Sugar isn't toxic, but refined sugar, or sugar that has been separated from
the fiber it sits with (fruit juice) is indirectly toxic. Dr. Lustig's
research has demonstrated this, and he has some very detailed lectures on the
subject. He isn't some quack: he is a leading researcher in both understanding
AND TREATING pediatric Type II Diabetes, which is a newly occurring disease.

When I drink a beer, I understand that the alcohol I love so much in it is
essentially a toxin, that in low enough quantities won't hurt me. I also know
that regualr, periodic consumption of it will negatively effect my health.
Oddly enough, Lustig's research has shown that fructose, in quantities which
are completely normal for someone who has just consumed a moderate amount of
refined sugar or fruit juice, has a very similar effect on the liver to
alcohol. Not completely identical, but similar. I suggest you watch the video.

I have a 6 year old son and a second child on the way. The only fruit juice he
gets to have is extremely diluted with water. This isn't me overreacting as an
ignoramus. I've looked at the data, evaluated the research, and found it
extremely compelling. Ever use a juicer? Think about how many oranges it takes
to make an 8 oz. glass. (It takes several, and if you tried to eat that many,
you would be full halfway through due to the fiber.) Refined sugar is just
juiced sugar cane with extra chemical preparation.

Oranges are good for you. Orange juice is bad for you. I know it screams out
BS, but I assure you, look at the science. You will, as I was, be shocked. How
the hell can this stuff I've been eating all my life be THIS bad for me,
without me knowing it.

~~~
bostonOU
I made juice this morning: 2 oranges, 2 kiwi, and 1 grapefruit. Made two cups
of juice for my wife and me. I don't know about the science of sugar, but
eating 1 orange, 1 kiwi, and half a grapefruit doesn't seem excessive to me.

~~~
lnanek2
If you ate the fruit it would be much better for you. Instead you are
basically taking something healthy overall, extracting the candy part out, and
throwing away the parts that are best for you.

~~~
cooldeal
Well, atleast he's getting some vitamins and minerals.

Eating fruit is better than drinking fresh fruit juice, which is better than
drinking Mountain Dew.

~~~
learc83
If hewere drinking the fruit juice in place of Mountain Dew it might be
better, but I doubt he was chugging Mountain Dew for breakfast before he
started drinking fruit juice.

The problem is that people think fruit juice is healthy and nutritious, and
they aren't aware they should limit consumption.

------
awolf
>In other words, according to this study, obesity doesn’t cause diabetes:
sugar does.

 _Sigh._ No, according to this study, there is a stronger _correlation_
between sugar and diabetes than between obesity and diabetes.

>Each 150 kilocalories/person/day increase in total calorie availability
related to a 0.1 percent rise in diabetes prevalence (not significant),
whereas a 150 kilocalories/person/day rise in sugar availability (one 12-ounce
can of soft drink) was associated with a 1.1 percent rise in diabetes
prevalence.

Much better! Lead with that next time, medical research reporter.

All in all, this seems like a pretty good study that controls for a lot of
confounding variables that a lot of diet related studies completely neglect. I
just wish the reporting here, and in general in all medical research
reporting, wasn't so sloppy. The goal should be to spread awareness of new
findings, not to spread misconceptions.

~~~
JPKab
"The study controlled for poverty, urbanization, aging, obesity and physical
activity. It controlled for other foods and total calories. In short, it
controlled for everything controllable, and it satisfied the longstanding
“Bradford Hill” criteria for what’s called medical inference of causation by
linking dose (the more sugar that’s available, the more occurrences of
diabetes); duration (if sugar is available longer, the prevalence of diabetes
increases); directionality (not only does diabetes increase with more sugar,
it decreases with less sugar); and precedence (diabetics don’t start consuming
more sugar; people who consume more sugar are more likely to become
diabetics)."

As far as observational studies, (of which I am a huge skeptic), this one is
pretty well controlled for. It's not like they studied 7 nations, or 11
nations. They studied 175 nations. That allows for a whole lot of
controllability for various factors.

~~~
snowwrestler
Not on that list: family history/genetics. I believe that has already been
identified as a significant risk factor for diabetes. So it's not just the
sugar.

~~~
marcosdumay
It controls for etnic variables, by using trends instead of comparing raw
numbers and some more advanced techniques.

It can not control for family because it was population-wide, not person-wide
(and yes, that is a flaw that the authors acknoledge).

------
tptacek
Wouldn't it be better for us to link directly to the study, rather than to
Bittman's editorial about it? I find the study harmonizes nicely with my view
of the world, and I'm even ok with Bittman, but he's not a subject matter
expert at all. He's the NYT's former food writer who recently decided to write
more about food policy.

------
3am
They had better change the messaging. I'm in favor of common-sense regulation
of mass-production food ingredients, and "sugar is toxic" even rubs me the
wrong way.

~~~
kansface
We need to tax sugar like we tax tobacco for the same reasons. It will
decrease consumption. Those taxes will pay for the medical expenses of people
with diabetes.

~~~
deelowe
When is this going to stop? Endless government regulation is not the solution
to everything. Look, there's a huge health movement going on in the country
_right_ _now_. Just like there was an anti-smoking movement starting up before
the government ever got involved with that. The people who fund this crap
aren't looking to do good, they just want more tax revenue (or more grant
dollars from those who want more tax revenue). That's what they've always
wanted.

Don't believe me? Restaurants are now voluntarily adding calorie numbers to
menus, because the lower calorie stuff is higher margin and people buy it.
Vitamin water, coke zero, pepsi one/0, izze, baked chips, etc... etc... etc..
take up much more room in the grocery stores than they used to. Trader joes
and whole foods are massive businesses now and threatening the big boys like
kroger. I'm not saying obesity isn't a problem, but I do think we'll see the
trend start changing for the better soon.

There's no need for regulation. The public will shift on it's own. All we need
is better education. Almost everyone I know(in my age group and younger) eat
much more healthily than their parents do/did simply because they are better
informed. Contrary to popular belief, people do make rational decisions when
it comes to eating (excluding socioeconomic factors).

~~~
__david__
> Don't believe me? Restaurants are now voluntarily adding calorie numbers to
> menus, because the lower calorie stuff is higher margin and people buy it.

Actually, if you are in California then it's more likely because of a 2009
law[1]:

"Putting our heads in the gastronomic sand became a bit harder starting July
1, 2009, when a new law went into effect making California the first state to
mandate that chain restaurants--those with 20 or more locations--provide a
calorie count for everything on the menu."

[1] [http://www.examiner.com/article/calorie-count-california-
res...](http://www.examiner.com/article/calorie-count-california-restaurant-
law-urges-restraint)

~~~
breckinloggins
I moved from Texas to California and I can confirm that, while there _does_
seem to be a trend toward more and more restaurants voluntarily including this
information, you don't really SEE it until you cross the border into
California.

This is an example of a business regulation that has had a directly positive
impact on my daily food choices... I find that I automatically choose lower
calorie foods just because the calorie numbers guilt me into doing so. In
fact, this one thing led to a general softening of my hard-core libertarian
"no regulations ever let the market decide" stance of the past.

~~~
__david__
Yeah, I have to say I really appreciate this as well. It's especially eye
opening to go into a movie theater and see the large popcorn labelled as 1500
calories (!!!).

------
degenerate
A very related, and VERY WELL PRESENTED and scientific video explanation of
why sugar is poison, presented to residents at the University of California:
<http://www.youtube.com/watch?v=dBnniua6-oM>

If you like TED talks, this will just blow your mind. It gets highly medical
at one point of the talk, but HN should be able to follow along. I recommend
watching this when you have an hour of absolute free time and want to learn.

------
Pkeod
There is no mention of it in this thread so far, so here:
<http://reddit.com/r/keto> Check the sidebar out.

See the transformations which happen to people when they (mostly) give up
consuming sugars:
[http://www.reddit.com/r/keto/search?q=progress&sort=top&...](http://www.reddit.com/r/keto/search?q=progress&sort=top&restrict_sr=on)

~~~
drivers99
Keto cuts out carbs including those that are converted to just glucose, not
just sugar (which is 50% fructose). It's not the same thing at all.

~~~
Pkeod
Uh, sorry, what exactly did I say? I said mostly giving up sugars, which is
why I mentioned keto.

------
sukuriant
I'm sitting here, dumbfounded, in a mix of response between "no shit" and
"this isn't something that needs to be regulated".

------
tocomment
Is there something special about sugar compared to other carbs? If I had to
choose between eating bread or cake for the same calories will cake hurt me
more?

~~~
frankus
The difference is that table sugar and high fructose corn syrup are about 50%
fructose (the rest glucose).

While glucose (which is what bread is mostly metabolized into) can be used by
every cell in the body, fructose must be broken down by the liver using a
metabolic pathway similar to that used by alcohol.

There is a hypothesis that once a person's metabolism has been damaged by
enough fructose, that any carbohydrate is likely to cause obesity. Basically,
that insulin resistance seems to affect fat cell last and once it sets it
glucose will be preferentially absorbed by fat cells.

So people with a well-functioning insulin response should be able to eat
relatively large amounts of (non-fructose-containing) carbohydrates without
issue, but those in whom the insulin response is damaged (probably a majority
of Americans over age 25) might need to cut back on all carbohydrates to stay
lean.

But again, this is very much an untested hypothesis.

------
tocomment
What do they mean by sugar "availability" in the study? How is that measured,
by the price in a given country, imports?

~~~
mamoswined
I was going to publish a comment on the study about that- my background is in
agricultural economics so I'm very familiar with the database they used. I am
curious to know which FAOstat data they used. Was it Sugar, Raw Equivalent or
Sugar, Refined Equivalent? Either way, the FAO data is calculated based on
production + imports - exports. They admit in the paper itself that this is
not a perfect proxy ("It is thought that much of the FAO data on foods and
nutrients in the food supply have limits to their reliability") for
consumption so it is alarming, but predictable to see this being termed as
such by the media.

I don't know if it's the best series of data to use for this. I would have
used a much longer series if possible because to be honest the past ten years
have not seen a dramatic change in sugar consumption, but I guess their
diabetes prevalence dataset only spanned that long. But that brings up the
question of the lag for developing diabetes itself, it's not like 50 extra
calories. I also couldn't find if they threw out countries with weird or
obviously low quality data. Israel's data, for example, is a bit strange. It
goes from around 500 kcal/capita/day sugar to 230. I find it hard to believe
that consumption habits changed so drastically there.

They also do not discuss much about why they, as non-economists, chose to use
econometric rather than epidemiology or biostat methods. I also hate that
their final graph is totally unlabeled and there is no option to download a
format that would allow one to see which dots correspond to which country.

It would be wise for some of the alarmists on this thread to read the paper
and this sentence in particular " Hence, any of the findings we observe here
are meant to be exploratory in nature, helping us to detect broad population
patterns that deserve further testing through prospective longitudinal cohort
studies in international settings, which are only now coming underway."

------
bcoates
There's an interesting idea in this article:

    
    
      ... and ideally removing fructose (the “sweet” molecule in sugar 
      that causes the damage) from the “generally recognized as safe” 
      list, because that’s what gives the industry license to 
      contaminate our food supply.
    

Ignoring the loaded language, does anyone know what the consequences of
removing fructose from the GRAS list would be?

~~~
derleth
If fructose is removed from the GRAS list, that would imply fruits are no
longer considered safe to eat.

~~~
bcoates
Does not being GRAS imply a duty to test edible plants for containing
something? That seems difficult. Of course, it wouldn't be the first crazy
regulation...

------
ImprovedSilence
>>> The next steps are obvious, logical, clear and up to the Food and Drug
Administration. To fulfill its mission, the agency must respond to this
information by re-evaluating the toxicity of sugar, arriving at a daily value
— how much added sugar is safe? — and ideally removing fructose (the “sweet”
molecule in sugar that causes the damage) from the “generally recognized as
safe” list, because that’s what gives the industry license to contaminate our
food supply."

Oh fer cryin out loud, just try to educate people a little better on how to
MODERATE intake of everything, don't go overboard here and try to get a ban on
sugar.... What is this world coming to when everybody expects some bigger
force to make all the decisions for them and keep them safe. Learn how to
think for yourselves and take some vested interest in you actions and
decisions. Gotta strike a balance between natural selection and idiotracy I
suppose...

~~~
anigbrowl
I don't want a bigger force to make the decisions for me, but I am quite happy
to delegate some of my authority to the government and have it act on my
behalf by requiring more accurate labeling and so forth. I eat a very healthy
diet, but I don't have the time or inclination to keep up with every last
additive and food manufacturing process out there. In fact, I'm happy to pay
some of my taxes so other people can study that as their full-time job.

~~~
thatswrong0
There's a huge difference between banning sugar and regulating labeling. Even
Libertarian candidate Gary Johnson supports food labeling (though purists
might be opposed to that).

~~~
anigbrowl
Nobody's proposing a ban on sugar.

------
Semaphor
Every time I see an article related to Medicine on HN it seems a high amount
of people comment without reading or at least comprehending the article. It's
pretty and remind me of the negative parts of Reddit.

------
zmmmmm
I'm uncomfortable with how this article keeps repeating that because it's "not
possible" to do a better study, that the result must be conclusive. That
simply does not follow. The fact that you can't do a better study doesn't mean
we should believe the result of the best study we have uncritically - and it
certainly doesn't mean by itself that the "smoking gun" has been found. So
many health myths have been conclusively believed in the past that we should
know better than this by now.

------
Nux
I think many people know by know sugar is "toxic" and is responsible for
pandemic obesity, type 2 diabetes and 99% of the dental mafia, erm...
industry; at least I for one preach against sugar every time there's a
discussion on diets and food.

This might have just reached a level where authorities need to get their shit
together and do something about it... And this is the sad and hard part as
many of our politicians may be "subsidised" by the food industry.

------
ChuckMcM
With luck, this will encourage people to cook their own food. It isn't that
hard to do, doesn't really take that much time, and the benefit of knowing
what you are eating really helps inform your diet choices.

------
iaskwhy
Is aspartame a good alternative?

~~~
vixen99
No it isn't. If you're going to use it or products containing it, I strongly
suggest you research this subject for yourself since this is not the place to
argue the toss. When you do so, as ever, look to the money.

~~~
mynameishere
_look to the money_

What is that supposed to mean? Coke ( _et al_ ) probably make more money per
volume on the diet drinks. So now that we've looked at the money, so what? As
for health, you've got conspiracy nuts on one side, and a clear link with
obesity, diabetes, and tooth decay on the other.

~~~
marcosdumay
> What is that supposed to mean?

It means that, when you read a study, also read the name of the entity
financing it.

~~~
mynameishere
What study are you referring to?

<http://en.wikipedia.org/wiki/Aspartame_controversy>

 _Aspartame has been deemed safe for human consumption by over 100 regulatory
agencies in their respective countries_

...are they all financed (corrupted) by your unidentified bogeyman?

