7
Sugar Blues
Concerns about the health effects of consuming sugar have been expressed for the past four centuries. The main early concern was the relationship between sugar consumption and dental caries (cavities). One of the first references to this is in the writings of Paul Hentzner, a German visitor to England who met the 66-year-old Elizabeth I in 1598. He described her as having black teeth, commenting that it was ‘a defect the English seem subject to from their too great use of sugar’. The medical authorities agreed: sugar rotted the teeth. William Vaughan, a doctor of civil law, condemned sugar for various reasons; one, as he wrote in his work Approved Directions for Health (1612), was that it blackened and ‘corrupted’ teeth. James Hart, author of Klinike; or, the Diet of the Diseases (1633), proclaimed that the immoderate use of sugar in sugar candy, sweet confections and sugar-plums produced ‘dangerous effect in the body,’ including constipation, consumption, blockages and ‘rotten teeth, making them look blacke’. He went on to warn ‘young people especially to beware’ of consuming these confections. Writers continued to note the relationship for centuries. Jonathan Swift, for instance, proclaimed that ‘sweet things are bad for the teeth’ in one of the dialogues in A Complete Collection of Polite and Ingenious Conversation (1722).
Colour lithograph after Reginald Mount, and issued by the Ministry of Health, 1950s.
American medical authorities later expressed their own concerns about refined sugar. The health advocate Sylvester Graham, in his final work, Lectures on the Science of Human Life (1839), advocated banning refined sugar because it was stimulating: ‘The stern truth is, that no purely stimulating substances of any kind can be habitually used by man, without injury to the whole nature.’ Many health reformers followed Graham’s beliefs. The hydropath Russell Trall violently attacked sugar in editorials and in his books on health:
Sugar is made into an immense variety of candies, confections, lozenges, etc., most of which are poisoned with coloring matters, and many of which are drugged with apothecary stuff. The intelligent physiologist will repudiate their employment in every form or shape. The raw sugars of commerce contain various impurities; and the refined and very dry sugars tend to constipate the bowels.
Not all health reformers heeded Trall’s absolutist views on sugar. John Harvey Kellogg, the Seventh-Day Adventist who directed the sanatorium in Battle Creek, Michigan, felt that his childhood gastrointestinal problems were caused by meat and candy, and believed that the American love of candy and sweet desserts needed to be rigidly controlled, for sugar interfered with proper digestion. But he did not call for the complete elimination of sugar, recommending only that people should eat much less of it, and replace it with honey, dates and raisins.
Dentists, understandably, condemned sugar, but medical authorities were also concerned. In 1942, the American Medical Association’s Council on Food and Nutrition stated that ‘it would be in the interest of the public health for all practical means to be taken to limit consumption of sugar in any form in which it fails to be combined with significant proportions of other foods of high nutritive quality.’ The medical profession also worried about sugar consumption, particularly its effects on hypoglycaemia (low levels of sugar in the blood). E. M. Abrahamson, MD, and A. W. Pezet, in their book Body, Mind, and Sugar (1951), concluded that refined sugar caused a ‘constellation of diseases’, and that its removal from the diet led to immediate improvement in patients’ health. The book was mainly based on personal experiences – Abrahamson was a physician specializing in diabetes who dosed Pezet with ‘hyperinsulinism’ – but it received wide publicity and sold more than 200,000 copies. Other medical professionals agreed. A British Royal Navy surgeon, Thomas L. Cleave, and a South African physician, George D. Campbell, examined a number of different societies and found that diabetes, heart disease, obesity, peptic ulcers and other chronic diseases were correlated with increased consumption of refined sugar, white flour and white rice. The less refined carbohydrates that were consumed, the lower the incidence of these diseases. They published their views in the book Diabetes, Coronary Thrombosis and the Saccharine Diseases (1966). While their beliefs were scoffed at by some, most medical professionals did recommend that their patients reduce their intake of added sugar.
Sugar Substitutes
Concern with increasing diabetes and obesity led to the invention of non-caloric and low-calorie artificial sweeteners. The first artificial sweetener was saccharin, a white crystalline powder that has 300 to 500 times the sweetness of sugar, but no calories. It was discovered by a graduate student at Johns Hopkins University in Baltimore in 1879. Saccharin was commercialized by several companies, including Monsanto, but was not widely used until sugar rationing was encouraged during the First World War.
After the war, saccharin became a boon to diabetics, and eventually was used in diet products for weight-loss regimes. In 1977, a Canadian study reported that saccharin caused cancer in test animals, and the U.S. Food and Drug Administration (FDA) placed a moratorium on its use until more studies were conducted. Further studies did not confirm earlier test results and the ban was lifted in 1991.
Broadside encouraging Americans to consume less sugar during the First World War.
A second artificial sweetener, calcium cyclamate, was used in diet soda beginning in 1952. Variations of it were used in a variety of other products. Lab studies carried out in the late 1960s showed that cyclamates were likely carcinogenic, and they were banned by the FDA in 1970. By the late 1970s, most diet products were being made with a third sugar substitute, aspartame (marketed under the names NutraSweet and Equal).
Stevia is a non-caloric natural sugar substitute derived from plants in the sunflower family. The plant extract is 300 times as sweet as table sugar. Stevia became popular in Japan in the 1970s and since then has been widely used in many countries in Asia and South America. In 1994, the FDA classified stevia as a herbal supplement and required it to be listed on the food labels. In 2008, the FDA approved two sweeteners derived from stevia: Truvia, developed by Cargill and the Coca-Cola Co., and PureVia, developed by PepsiCo and the Whole Earth Sweetener Company. The following year, the FDA placed a purified form of stevia on the ‘Generally Recognized as Safe’ list.
Another recent introduction is Sucralose, which is 600 times sweeter than table sugar. It was approved for use in Canada in 1991, and seven years later in the U.S. Marketed under several brand names – Splenda, SucraPlus, Candys, Cukren and Nevella – it is found in thousands of diet products. Acesulfame potassium, another non-caloric sweetener, is 200 times as sweet as table sugar. It is approved for use in the United States and the European Union. Neotame, an artificial sweetener made by NutraSweet, is 7,000 to 13,000 times sweeter than table sugar. The FDA approved it for use in the U.S. in 2002, but it has not yet come to be widely used. Little evidence has surfaced about negative short-term effects of approved artificial sweeteners; the long-term health risks, if any, remain under debate.
Sugar substitutes sold in an American supermarket.
The term ‘empty calories’, meaning calories derived from foods with few or no nutrients other than carbohydrates or fat, was first employed during the 1950s. At the top of the empty calorie food chart are sugary foods and drinks such as candy, cookies, cakes, pies, ice cream, breakfast cereals and sodas.
John Yudkin, who established the nutrition department at the University of London in 1953, was convinced that there was a clear connection between sugar consumption and many chronic diseases. By the end of the 1950s, Yudkin was campaigning for the elimination of sugar from the diet to prevent coronary heart disease and aid in weight loss. In 1958, he published a diet manual, The Slimming Business (1958), which advocated a very low-carbohydrate diet for weight loss. Yudkin published a number of studies supporting his views, which were popular in Britain during the 1960s. In 1972, he published Pure, White and Deadly: The Problem of Sugar, a tirade that generated considerable interest among the public in Britain and the United States; still, his views were generally rejected by the medical community, which concluded that dietary fat – not sugar – was the major cause of heart disease.
Medical professionals in the United States concluded that American children consumed too much sugared baby food and sweetened breakfast cereals, resulting in hyperactivity and other health problems throughout their lives. William Duffy, an American journalist and macrobiotic advocate, published the best-selling Sugar Blues (1975) about ‘the multiple physical and mental miseries caused by human consumption of refined sucrose’. He compared sugar to heroin and called it at least as addictive as nicotine and just as poisonous.
Despite these warnings, Americans continued to increase their per capita sugar consumption, although not all of it was from sucrose. Much of it was from the misnamed high-fructose corn syrup (HFCS). In the 1950s, scientists had learned to refine corn into starch, then convert the starch into glucose, and finally convert the glucose into fructose by adding enzymes. Although it is made from corn, commercial HFCS is chemically similar to sucrose. HFCS contains 45 per cent glucose and 55 per cent fructose, while sucrose contains equal amounts of glucose and fructose. HFCS’s advantage was that it was sweeter than sucrose. Its disadvantage was that it was more expensive than sucrose at the time. This changed in the 1970s, when the price of sugar increased in the United States due to quotas and tariffs on imported sugar and subsidies for corn growers which lowered the price for corn. American manufacturers added HFCS to products, particularly beverages. Most subsequent studies have concluded that the human body handles HFCS in the exact same way that it does sucrose. The majority of researchers now conclude that the health issues are associated with the total consumption of refined sugar, not with HFCS.
The term ‘junk food’, meaning calorie-dense processed foods, particularly sweets, salty snacks and fast foods and sugary beverages that have little nutritional value other than calories, was first used in the 1970s, It was popularized during the following decade by Michael Jacobson, the director of the Center for Science in the Public Interest (CSPI), which from its earliest days has decried high-sugar foods. The problem, according to the CSPI (and many others), is not just eating junk foods, but allowing them to crowd out more nutritious ones.
Refined sugar is an important contributor to excess calorie consumption. According to studies published in 2011 in the prestigious British medical journal The Lancet, the global prevalence of obesity has almost doubled since 1980, ‘when 4.8 percent of men and 7.9 percent of women were obese. In 2008, 9.8 percent of men and 13.8 percent of women in the world were obese.’ An estimated 1.3 billion people worldwide are overweight – half of whom are obese – and the number of people who are overweight is increasing in nearly every country in the world. Excess weight has been linked with high blood pressure, arthritis, infertility, heart disease, stroke, Type 2 diabetes, birth defects, gallbladder disease, gout, impaired immune function, liver disease, osteoarthritis and several types of cancer (including breast, prostate, oesophageal, colorectal, endometrial and kidney cancer).
There are many causes of obesity and overweight, but an examination of research findings led the research institute of the Zurich-based financial firm Credit Suisse to conclude in 2013 that ‘While medical research is yet to prove conclusively that sugar is the leading cause of obesity, diabetes type II and metabolic syndrome, the balance of recent medical research studies are coalescing around this conclusion.’ They believe that sugar meets ‘the criteria for being a potentially addictive substance’. Nowhere is this problem more acute than in the United States, where 61 per cent of Americans are classified as overweight. The annual cost, concludes the Credit Suisse’s Research Institute, is also staggering: 30 to 40 per cent of all healthcare expenditures in the United States – about $1 trillion – ‘go to help address issues that are closely tied to the excess consumption of sugar’, it reports.