Is sugar the new tobacco?

Ah, sugar. What a wonderful, simple little substance that makes our world so much sweeter. It adds flavor and energy to our food; yeast turns it into fuel for our cars and alcohol for our drinks; bees seek it out and pollinate our plants in the process; it’s plentiful, cheap and ubiquitous. Some say oil powers the modern world, but I claim sugar is king.

Just about everything alive produces, uses, or consumes sugar, from the largest animals to the smallest microbes. Sugar is the fuel that bacteria use to produce acid, the source of tooth decay. The world has known about sugar’s effect on teeth for decades, but it wasn’t until a new process for the cheap and efficient production of high-fructose corn syrup in 1957 that the damaging effects of sweeteners moved from the mouth to the whole body. High-fructose corn syrup was rapidly introduced to processed foods and beverages throughout the 70’s and 80’s and Americans couldn’t get enough. (For the purposes of this article, sugar refers to refined sugar, high-fructose corn syrup, and other natural sweeteners)

Statistics from 2016 say we consumed 120 million tons of sugar worldwide, or roughly 40 pounds per person. That’s around 1/3 to 1/5 of average body weight. In sugar. That rate is growing, too, at 1.6% per year, which is higher than the world population growth rate of 1.1%. When sweetened foods and beverages first came on the scene it was thought the worst effects sugar caused were cavities and hyperactivity. Easy solution: just brush your teeth and exercise regularly and no harm done! Keep that sugar coming! All was well and good until people started to take notice of some troubling health trends.

In 1960, before the sugar craze got started, the type II diabetes rate in the U.S. was less than 1% of the population. Today it’s 9.3% and growing. In 1975 the obesity rate was around 12%, over the next twenty years it shot up to 25%, today it’s over 35%. Is sugar the culprit? The science is starting to say yes, at least in part. Sugar = calories, and that’s pretty much it. There is no nutritional value. Calories = energy. Back in the good old days when we were chasing animals around for dinner, or animals were chasing us around for dinner, energy equaled survival. Your body therefore placed a premium on energy, and stored it any chance it got in the form of fat. Today we are dealing with two harsh realities: we really don’t need sugar anymore, but we still want it; and our body doesn’t have an “off” switch for energy storage. As long as the calories keep coming in we will keep storing the extra energy in the form of fat, until it kills us. Literally.

“So, too much sugar causes weight gain? I already knew that!” Here’s where the new science comes in. It turns out sugar has other, more subtle effects, even in people considered “normal-weight.” Too much sugar can cause fat to accumulate in the liver and other organs, not just the belly, which can affect their function. Sugar has also been linked to higher levels of cholesterol and heart disease, cancer, insulin resistance, cardiovascular disease and liver disease. Newer studies suggest an effect on decreased immune function, accelerated aging, and cognition in children. Oh yeah, and tooth decay. Let’s not forget that.

So what’s a society to do? The two main avenues are educate and legislate. Education is the first and best option, but it takes a lot of time and money and participation is still voluntary. Just look at the anti-smoking campaign; it’s made progress, but not nearly as fast as we’d hoped given all the time, effort and money put into it. Nevertheless, education efforts regarding sugar consumption have already begun, focused on two key areas: The health dangers discussed above, and the ubiquitous nature of sugar in our everyday foods.

The two most common forms of sugar are the common granulated, refined variety, and the aforementioned high-fructose corn syrup. What would you think if you saw “malted barley extract” on a label? Sounds like it might even be something healthy, right? Sorry, it’s just sugar in disguise by calling it something that sounds better, kind of like “pre-owned’ is the new term for used, “right-sizing” means layoffs, and an “opportunity to participate in the system” is paying taxes. Almost makes you excited to pay taxes, right? OK maybe not.

Other names for sugar on food labels include anything ending in –ose, cane juice, dextrin, caramel, diatase or diatastic malt, fruit juice concentrate, turbinado, ethyl maltol, honey, and anything containing syrup. Sugar is present in high quantities in our granola/energy/snack bars, yogurt, ketchup and barbecue sauce, crackers, cereal, spaghetti sauce, salad dressing, bread, and packaged foods that advertise low fat content. They have to make it taste good somehow, usually with sugar and sodium.

Just like the anti-smoking efforts started off with education and followed up with legislation in the form of taxation and banning smoking in restaurants, bars, and other public places, some municipalities have taken the next big step in the battle against sugar. In 2015 the city of Berkeley, CA added a one-cent-per-ounce tax on sugary beverages, the first in the nation. The rationale behind such a tax is two-fold: to improve the health of the community and to raise revenues. The revenues come in immediately; any evidence on improvement in community health will have to wait. It wasn’t without controversy, and was vigorously opposed by the beverage industry, but was perhaps viewed as an aberration in an otherwise liberal-leaning jurisdiction. However other cities soon followed, many much larger, with similar measures recently approved in San Francisco, Philadelphia, Oakland, Denver and Seattle.

Once these cities started seeing the revenue benefits from the tax, larger localities became interested. Cook county, IL, which includes Chicago and has a population of 5.2 million, recently passed its own soda tax, the first county in the nation. Not to be outdone, the state of Massachusetts is considering a soda tax which could add as much as 2 cents per ounce. As more and more governments see shrinking revenues and budget shortfalls, soda taxes start to look very appealing.

But is it the right thing to do? Statistics show that the majority of sweetened beverage consumers are lower income, making a soda tax primarily regressive, something politicians are typically loathe to support. Also, the question must be asked if the government should be in the business of trying to influence citizen behavior. While these are important topics to consider, the reality is the government is already doing both in the form of tobacco taxes.

While not very controversial, and typically the go-to sin tax when governments need more money, ever-increasing tobacco taxes have indeed contributed to the steady decline in smoking rates in the U.S. The next obvious question, and truly the foundational question of this debate, is whether sugar consumption rises to the level of tobacco use. A decade ago this question would have seemed ludicrous; today it seems, well, still pretty ludicrous. Surely no rational person would equate giving your kids a cookie with giving them a cigarette, right? Or is sugar consumption the new social sin?

Experts at the World Health Organization (WHO) and the American Heart Association (AHA) are making the claim that “sugar is the new tobacco,” in the sense that Big Sugar is having its Big Tobacco moment. So, no, a cookie is not as bad as a cigarette (they actually used to make candy cigarettes for kids, how could they have possibly thought that was a good idea?) Nevertheless, the sugar industry has been put on notice. The WHO and AHA support taxes on sweetened beverages, and their recommendations carry a lot of weight in public policy decisions.

Tobacco taxes made it through despite heavy opposition from the wealthy tobacco industry, in part because most of the population doesn’t smoke. There just wasn’t that much uproar from the voters. Soda taxes don’t have that luxury, which means politicians will often be hesitant to even discuss them. Both sides have deep pockets and heavy hitters to bring to bear, notably Michael Bloomberg (a billionaire) on one side and Big Soda (a multi-billion-dollar industry) on the other.

So while the billionaires spend their millions it’s ultimately up to us (the thousandaires?) to decide. And it’s a tough decision. I think most people would tend to agree that those who make unhealthy nutritional choices should be the ones contributing more to our healthcare system. The catch is that we will be allowing the government more taxes on us and more influence on our behavior, something I think most people would tend to oppose.

The soda tax measures that have passed in Seattle, Philadelphia, and Cook County are serving as a sort of “testing ground” on whether such taxes can be successful. Governments across the country, from large to small, are assuredly watching very closely. Chances are you don’t live in an area with a soda tax, but if they can survive the legal and political challenges in those areas then a soda tax may soon be coming to a city, county or state near you.

Will that eventually happen? Soda taxes have some momentum, and there will surely be some defeats as well as successes for both sides along the way. As more and more information comes out about the damaging effects of sugar on our overall health we may very well see a shift in public attitude. So is sugar truly the new tobacco? The world always needs a villain; a shadowy, wealthy enterprise pretending to be our friend but secretly enriching itself at our expense. That villain used to be tobacco, but tobacco’s time in the spotlight is waning. I think the public will need a new villain soon, and Big Sugar is the leading candidate.

Dr. McGann