Is sugar the new smoking?

Imagine sneaking a cigarette into your child’s lunchbox as a “Friday treat”. Picture yourself celebrating a birthday party by laying on a nicotine feast for the whole class, or even trotting off to visit family friends with a pack of cigarettes for each of the kids in your pocket.

Ridiculous, right?

The American physicist-turned-journalist Gary Taubes doesn't think so. When we offer our children sugar, he believes, we might as well be feeding them cigarettes.

Taubes is one of dozens of health experts working in the field of nutrition who seems to be on a mission to shock us into radically rethinking the way we eat. What they can’t seem to agree on is how.

A recent study from the London School of Economics (LSE) suggests that eating the way our parents ate – three times a day, and up to 2,500 calories for men and 2,000 for women – is simply far too much food for the sedentary lives we now lead. The World Health Organisation puts it more baldly still: “The fundamental cause of obesity and overweight is an energy imbalance between calories consumed and calories expended.”

Other research suggests that the answer may lie in microbiome activity in our guts, in something called “metabolic syndrome”, or in our genes.

But Taubes – in common with others, such as the paediatric endocrinologist Robert Lustig, whose 2009 YouTube video, Sugar: The Bitter Truth, has so far been viewed 6.8 million times – makes a compelling argument for treating sugar as the cause of the global obesity epidemic. Taubes argues that it is an actual toxin, as opposed to merely a source of "empty calories".

In a new book, The Case Against Sugar, he makes the case for sugar being not only the cause of obesity and diabetes, but also related to heart disease, hypertension, many common cancers and Alzheimer's, which some researchers now refer to as "type-3 diabetes".

We've grown inured to reading about the obesity crisis, but the data should be enough to frighten us into action or at least into wanting to learn more. Some 23 per cent of Irish adults are obese, the second-highest proportion in Europe. One in four of our children are either overweight or obese. Unless we make dramatic changes, Ireland is at risk of becoming the fattest nation in the world.

Worldwide, obesity rates have doubled since 1980; in 2014, more than half a billion adults on the planet were obese and more than 40 million children under the age of five were either obese or overweight.

Western diets

The link to the way we eat is impossible to ignore: as Taubes points out, anywhere populations have been eating western diets and living typical western lifestyles, obesity rates rise, and so does diabetes.

Until the 1970s, there was very little debate about the cause of the burgeoning diabetes epidemic.

“When sugar and sugar-rich products spread around the globe, so did diabetes,” Taubes writes.

But sometime during the 1970s, dietary fat took over as the bad guy, coming to be seen as the cause of heart disease and the rising rates of the obesity linked to type-2 diabetes. Doctors began advising patients to eat a low-fat diet, and the message caught on that if you eat fat, you’ll get fat.

Taubes believes it wasn't just misguided advice that saw the focus move away from sugar and sugar substitutes, such as high-fructose corn syrup. He believes the change was fuelled by a conspiracy. Indeed, last year, the New York Times published evidence uncovered by a researcher at the University of California, San Francisco, which revealed that in the 1960s the sugar industry paid three Harvard scientists to downplay links between sugar and heart disease, and instead point the finger at saturated fat.

Another article in the New York Times revealed that Coca-Cola funded researchers – to the tune of millions of dollars – who sought to water down the link between sugary drinks and obesity.

Since then, Taubes writes, major nutrition authorities “have spent the last 50 years blaming dietary fat for our ills while letting sugar off the hook”.

More recently, there has been a palpable shift in thinking on nutrition, and in public policy. In a 2008 analysis, the UN's Food and Agriculture Organisation found "no probable or convincing evidence" that a high level of dietary fat caused heart disease or cancer.

Nutritionists, dietitians and doctors tend to caution against a “war on one food”, preferring to advocate a more balanced approach to healthier eating, combined with more exercise. But a growing number have begun to promote a low-carb, low-sugar diet with some “healthy fats”.

Until December 2016, the Food Safety Authority of Ireland (FSAI) was still recommending a food pyramid introduced in 2011, which advocated that people eat more high-carb processed foods than fruit and veg daily. The new food pyramid – although still predominantly a high-carb, low-fat diet – now puts fruit and vegetables at the bottom of the pyramid, meaning those are the type of foods it is advocating consumers eat most often.

Tax on sugary foods

In April 2018, Ireland will implement its tax on sugary foods, prompting an immediate commitment by the makers of Lucozade and Ribena to stripping out 50 per cent of the sugar in the Irish market.

The FSAI also revised downwards the daily calorific requirements for men and women, for years given as 2,500 and 2,000 respectively, figures that the organisation now says were excessive. It is advocating reduced levels for inactive adults of 2,200 calories for men and 1,800 for women, with lower rates for the over-50s and higher ones for active adults.

Consultant dietitian Paula Mee argues that overall "there is far too much focus on calories. It's much more complex than that. We need to understand why we eat the way we eat, and our habits and our beliefs around food."

She points to a number of other intriguing areas of research that could help to explain the obesity crisis.

“Obese people have a different microbiome than normal-weight people, and they don’t know yet whether it is the microbiome that changes first and causes the obesity or whether it’s the obesity that changes the microbiome,” she says. “There are about 10 genes they have identified that can have glitches in them that make you more likely to be obese.”

She believes the answer to controlling the crisis in the way we eat is to understand the patterns.

“If people are stressed in work and they feel overwhelmed and they need something to drive the blood-sugar levels up, they go to the vending machine. They feel instantly better, but at the end of the day they’ll put on weight. Bord Bia recently did a study which found we snack up to six times a day,” she says.

“It’s not that there’s rampant gluttony out there, but eating just 200 or 300 calories more than we need over time, throw in a bit of stress, and it’s very easy to see that gradual weight gain.”

Even Taubes finishes his book with on a note that seems to advocate a more balanced approach. Even if we removed sugar from our diets completely, we would still get sick, he concedes.

We are a long way from scientific certainty that sugar really is the cause of obesity, diabetes and the other degenerative diseases he cites, many of them chronic conditions that develop slowly.

So while we wait for the data, how much sugar is too much? Taubes answers this question with one of his own.

“How many cigarettes are too many cigarettes? What if the person who smoked a pack a week outlived the person who smoked a pack a day? Would we conclude that inhaling a pack of cigarettes a week is safe?”