For much of the last 100 years, one observation has been seen repeatedly, but an explanation still eludes us, and it is a very important observation.

As societies, including ours, adopt modern Western ways of life, a set of maladies begin to appear that are dramatically less common in less developed societies.  Those maladies are the dreaded threats of old age in America, and all other developed societies:  cancer, dementia, heart attacks, strokes, and a host of auto-immune maladies.

We are familiar with the rise of cancer, heart disease, and dementia at the end of life from the experience we have had seeing older relatives and friends age, all along our lives.

Many of us may be less familiar with the fact that in societies that still function in a pre-modern mode, in particular the remaining hunter-gatherer societies, heart disease, the number one cause of death in the United States, barely exists.

Part of the explanation surely comes from the fact that we live longer in modern societies.  In societies where people tend to not live past 35, the chance of seeing a heart attack or stroke or even cancer will of course be far rarer.  But the incidence of these “diseases of modernity” remain dramatically low even in hunter-gatherers who survive to their 80’s.

Much effort has been devoted to finding out just what is it about being modern that led to the explosion of heart disease, stroke, cancer, and dementia.  We still have no definite answer.

The hunt for an answer is very urgent, since it holds the promise of protecting all of us and those we love from these scourges of modern life.

Imagine if we found, for instance, that eating substance X caused all these maladies.  It raises the possibility, that if we stop eating substance X, many of these problems might decrease or go away.

We don’t know if there is such a substance, or if avoiding it would truly protect us from these scourges, but some recent publications have put a surprising suspect into the witness box: sugar.

http://www.nytimes.com/2016/09/17/opinion/the-shady-history-of-big-sugar.html?_r=0

http://www.nytimes.com/2016/09/13/well/eat/how-the-sugar-industry-shifted-blame-to-fat.html

and, The Case Against Sugar, by Gary Taubes, published December 2016

What is Sugar?

Before we talk about sugar’s possible harms, let’s talk about what it is.

Sugar is a specific type of chemical, a class of molecules that all share a number of properties.

One property they all share is in their name, all names for molecules of sugar end in -ose.  Think of glucose, fructose, and galactose.

Sugar molecules also share the delightful property of activating our sense of sweet when they land on our tongues.  That is a delicious sensation for most people, and drives many of us to consume vast quantities of sugar.

Biologically, sugar is the ultimate fuel for animals.  Our cells love to burn sugar, really more than anything else, and we burn it well.  When our cells burn, or metabolize sugar, or respire, they create energy that drives every function of our bodies.  We can generate this energy from fat and protein, but often our body will convert the fat or protein to a sugar in order to use it as a fuel.

It may seem odd to think of sugar as a fuel, like gasoline, but that is exactly what it really is to our bodies.

Every gas-motored car generates its energy by burning a small chain of carbon atoms.  A simple example is gasoline, which is octane, a strip of 8 carbon atoms.   The car attaches oxygen to that chain of carbon atoms, in a process we call burning, and the engine hums.   A strip of carbon atoms plus oxygen, gives us all the energy cars have used for most of their history.  Ethanol and vegetable oils burn the same way, by combining oxygen with carbon atoms in the alcohol or fat.  No matter what, the gas fueled car only moves if some carbon gets burned.

We are no different.  But our preferred source of carbon to burn is sugar.  Sugars mainly come in strings of 5 or 6 carbon atoms, that are arranged in a ring.   Our cells do the same thing our car engines, and fireplaces, do, they join oxygen to a string of carbon atoms, releasing energy.

Sugar tastes sweet to us because it is such a valuable source of all our energy needs.  Like all vital functions our bodies need to do to survive, our brains have developed an intense desire for them.

When did sugar start being a suspect in causing problems?

The early 20th century was an incredible time of discovery in nutrition.  For as long as anyone could remember, people ate traditional foods, whatever your parents and grandparents ate, that’s what you ate.  No reason to worry, everyone just ate what their tribe had for millenia.

Then came the melting pot of the United States.  In a few generations it became clear that it was far from clear just what people should eat.  A major study done by the US Dept of Agriculture found that the best foods were fruits, vegetables, and whole grains.  Significant worries were raised about the impact of too much fat or sugar in the diet.

Did you know how fats became more worrisome than sugar?

From that time in the 1920’s, when in the US, the USDA alerted nutritional science to the potential harm from sugar and fat, a veritable war has been fought by industries that sell fatty and sweet foods.  Each industry strove to portray its item as safe, and all the trouble coming from the other.  Guess who won?

Sugar.

It turns out that sugar is quite the industry.   In the 1600’s and 1700’s, sugar plantations generated more wealth than any other colonies in the world.  The world wars of the 1700’s were fought for control of places like Haiti, Cuba, and St. Martinique, not North America.  Britain got North America when they won the Caribbean, but it was the sugar islands that were the top prize.   About 1/3 of British aristocratic houses were founded by the vast wealth from sugar.

Only the emergence of oil replaced sugar as the greatest generator of wealth of all commodities.  But even though oil now rules, sugar is still plenty big and powerful.  In 1880, a full 1/6 of the entire federal budget was paid for by taxes on sugar.  In the last 22 years, the sugar industry contributed over $57 million dollars to all Florida elections.

The power of the sugar industry was brought to bear on the question of what nutrients cause harm, working hard on the public relations fight from the 1920’s through the 1960’s to today.

From the ’20’s to the ’60’s, the sugar industry fought hard to take the concerns raised by the original Department of Agriculture studies and pin society worries about diet and disease on saturated fat.  These efforts culminated in actual bribes to leading Harvard nutrition scientists, a bribe only brought to light in 2016.

In 1967, the sugar industry paid three Harvard researchers the grand sum of $50,000 to publish a paper in the world’s leading medical journal, The New England Journal of Medicine, reviewing the issues of sugar, fat, and heart disease.    One of these researchers was chair of Harvard’s nutrition department, another went on to become Secretary of Agriculture, heading a 1977 effort to begin drafting USDA dietary guidelines.

These dietary guidelines eventually established our current sense that it is saturated fat that causes most heart disease, with barely a mention of the role of sugar beyond causing cavities.

The papers uncovered from Harvard and other research universities, expose explicit plans by executives in the sugar industry to shift public opinion, towards fat being bad and away from sugar being bad.

These discoveries in 2016 reveal a deep level of bribery from industry, buying support from Harvard’s Department of Nutrition and buying policy and recommendations from the US Department of Agriculture that define much of how we think about diet and the heart.

What we Do Know About Sugar and the Heart

The main thought on sugar really has to do with the hormone most associated with it, insulin.

The going reasoning on how sugar causes harm is that eating too much sugar stimulates too much insulin production.  Insulin appears because it is the hormone that is called on to store and use the sugar we eat.

So eat a lot of sugar, and your body will be soaked in insulin.  This exposes our bodies to more impact from insulin.  And, at the same time, moves the body towards resisting the impact of all that extra insulin.

Now, blunt insulin’s impact on the body enough and that is called Type II diabetes, and we all know just how big a deal diabetes is for the heart.

So the sequence is:  to much sugar, leads to too much insulin- which is hard on the body, and this leads to increased resistance to insulin- which leads to diabetes.

No one is sure how much heart disease, or obesity, or gout, or cancer, other problems of the modern era would disappear if nothing changed but eating sugar, but many are convinced much of our disease burden would ease.

There is more broad agreement on one general recommendation that will not only reduce sugar intake, but intake of so many items that are suspected of causing harm:

It is Michael Pollan’s plea:

1. Eat food
2. Eat plants
3. Eat less

That is, don’t eat junk or processed stuff, only material grown directly from the ground (food).  Focus on fruits, plants and whole grains (plants).  Don’t overeat (less).

BOTTOM LINES

1. The rise of the modern world in the 20th century has seen the emergence of high incidences of heart disease, stroke, cancer, and dementia in older age.  The cause of this appears closely related to the lifestyle of the modern West, since wherever that lifestyle is adopted, these problems jump up in incidence.
2. No one knows for sure what is driving this response to the modern Western lifestyle.
3. Many have proposed a role for our tendency to obesity and have looked at saturated fat and sugar as possible causes.
4. The concept of sugar, sweet and yummy, does not fit well with the reality of the industry, which is very, very big, and not sweet at all.  It is now known the sugar industry paid Harvard nutrition leaders to keep the focus on fat and away from sugar.
5. Whatever role sugar may play in the diseases of the modern West, and that role could in time be found to be quite profound, the best approach remains the same:  eat fruits, vegetables, and whole grains, they are the best, the very best foods to eat.

To your health,
Dr. Arthur Lavin