Sugar: America’s Favorite—and Most Dangerous?—Drug

While we have always known that sugar isn’t good for us, mainstream medical research is now quantifying just how dangerous the sweet stuff can be. Long thought to be empty but relatively harmless calories, sugar, as we now understand, plays a role in the development of heart disease and other chronic disease, independent of its association with body weight. According to a recent New York Times article, the disorders that sugar most often contributes to—obesity and type 2 diabetes—-in turn elevate our risk of virtually every major chronic disease, from heart disease to cancer and Alzheimer’s. Sugar has also been shown to be addictive, and to have harmful effects on mental health.

And while you might think this excessive sugar consumption affects a small number of people, consider this: According to data from National Health and Nutritional Examination Survey (NHNES), during the nation’s peak sugar consumption, between 1999 and 2004, more than 25 percent of African-Americans got upwards of 25 percent of their total daily calories from added sugar. For Mexican and white Americans, these percentages were 17.6 and 15.6, respectively. In 2015, consumption on average was down to 94 grams (358 calories a day), according to the US Department of Agriculture, nearly double the government's "recommended" 50 grams a day.

Sugar and the Heart

A study chronicled in the Journal of the American Medical Association showed that there is a linear increase in cardiovascular mortality associated with increased sugar intake. Using data from the NHNES, which followed more than 30,000 individuals over 25 years, the authors determined that people who get more than 15 percent of their total daily calories from sugar have a substantially increased risk of dying of heart disease.

What is notable about this analysis is that the authors carefully controlled for other cardiac risk factors, including hypertension, smoking, and high cholesterol, as well as body weight. In effect, this was the first major study to show that sugar is an independent and significant risk factor, not only for heart disease but also for mortality associated with heart disease. Indeed, people who get 30 percent or more of their total dietary calories from added sugar have fourfold risk of dying from heart disease, compared to people who consume less than 10 percent. 

Another study, this one of 43 obese children, emphasized that the negative health impact of sugar goes beyond weight. After nine days on a sugar-restricted diet, the children's metabolic health improved on all measurement scales—without any change in weight. 

Is Sugar a Drug?

So now we know, definitively, that sugar is dangerous, and at a far lower dose—essentially one 20-ounce can of Mountain Dew per day—than expected. But is it really a drug, as some say? To answer this question, we need only look to a practice employed by hospitals around the country. Newborns undergoing procedures like heel sticks or blood draws are routinely prescribed a sucrose solution to relieve their pain. During my residency in family medicine, it was considered safer to give infants the sugar solution than Tylenol. Drug-like? You bet. Research in animals and humans has shown that sugar affects the same dopamine-related pathways activated by cocaine.

Indeed, I believe it’s the drug-like effect of sugar that helps explain the current astronomical consumption of sugar in this country. It's not simply free will that causes people to pick Mountain Dew over tap water. It’s a complex interaction of taste, brain chemistry, habit, easy accessibility, consumer marketing, and cost, all colluding to create a toxic “choice.” Isn’t it time we take steps to regulate sugar, through the same public health measures we used to curb tobacco abuse—by limiting the marketing of sugary foods to children, and considering a “sugar tax” to provide incentives to cut down?

Sugar and Mental Health

While we know anecdotally that sugar consumption can affect our mood (and that of our children!), research is showing dire links between sugar and mental health. Sugar has been shown to correlate with depression; one study found a link between sugar consumption and schizophrenia. A study done on rats found that those who binged on sugar showed both anxiety and signs of drug-like dependence.

In the words of journalist Michael Pollan, “We are in the middle of a national experiment in mainlining glucose.” In the research world, there’s an ethical obligation to cut short randomized clinical trials when a significant benefit or risk becomes clear. For sugar, the risk is clear. Let’s end the experiment now, and get our sweetness from life instead.

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