These days you can barely get out of bed before coming into contact with the anti-sugar message. Newspapers, Facebook feeds, books and morning television segments: the anti-sugar movement has truly arrived.
Many of the sentiments of the current anti-sugar movement were first expressed in 1972 by Professor John Yudkin in his book Pure, White and Deadly. But it wasn’t until 2009 that the movement gained momentum after Professor Robert Lustig posted his lecture entitled Sugar: the Bitter Truth on YouTube.
Three films released in the last few years have sought to champion the cause. Last year That Sugar Film grossed $AUS 1.5 million in box office takings. The official Hungry for Change trailer has received 1.5 million views on YouTube to date and excerpts of Jamie’s Sugar Rush have been viewed a combined total of 85,000 times in the last six months. Judging by their popularity, the movement has now spread to all corners of the globe.
Here we examine these films closely to see how their claims compare with current scientific knowledge:
That Sugar Film
Australian actor/director Damon Gameau sets himself a challenge to test the health effects of consuming the “average Australian’s intake” of 40 teaspoons of total sugar per day for 60 days. The sugar must only come from foods commonly perceived as healthy such as processed breakfast cereals, low-fat flavoured yogurt, snack bars, fruit juices and smoothies, liquid breakfasts and meal bases. During the challenge Gameau must maintain the same level of energy expenditure as before the challenge. With no apparent change in his kilojoule intake, he gains 8.5kg and 10cm around the waist, his triglycerides increase from 0.08 to 1.5 mmol/L and his alanine aminotransferase (ALT) level, a measure of liver health, indicates that his liver has “turned to fat”.
The film presents the argument that high sugar consumption may be the real cause of fatty liver disease, obesity, diabetes, heart disease and other diet-related diseases and that fructose is the main culprit. A secondary message is that it is the addictive nature of sugar that has brought about the obesity epidemic.
This film has probably been able to reach a wider audience than most documentaries. It is highly entertaining and amusing and viewers are engaged even before they have realised that a serious message – and perhaps even some science – is being presented. Gameau has certainly drawn attention to the over-consumption of sugar by many Australians and to the presence of “hidden” sugars in foods perceived as healthy. This documentary may even motivate people to eat less sugar sweetened processed foods – something many Western government health bodies have been trying to do.
Some parts of the film’s message receives support from the scientific literature. Evidence does exist for a link between high sucrose consumption and visceral obesity, increased plasma lipid levels and hepatic insulin resistance but it suggests fructose is no worse than sucrose.Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiological Reviews; 2010(90) DOI: 10.1152/physrev.00019.2009 However, contrary to evidence from rat studies, there is no evidence to support the theory that sugar is physically addictive in humans.Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition; 2010(29)(3) DOI: 10.1016/j.clnu.2009.12.001
In the opening scenes, Gameau says his reason for taking on the challenge is to find definitive answers to the question of how sugar effects our health. But due to the flaws in his experimental design, no credible conclusion can be drawn.
Firstly, this is an experiment with one subject and no controls. Secondly, the claim that Gameau’s weight gain occurs with no change in energy intake is unverifiable. Self-reported data is notoriously unreliable – it is too easily biased towards a desired outcome and there is no way to confirm its veracity. In addition, as has been noted elsewhere, Gameau’s daily sugar intake totals 50 teaspoons on one occasion that we know of. Finally, when his pre-challenge and challenge diets are compared, sugar is certainly not the only difference. Such an experiment is not capable of delivering “definitive answers” about the adverse effects of high sugar consumption.
The stated effect of the challenge on Gameau’s liver is likely to be an exaggeration. Gameau’s plasma ALT level is tested 18 days into the challenge. It is true that slightly elevated plasma ALT levels can be an indication of increased liver fat and high levels are usually seen with liver damage. However, to say that one’s liver can “turn to fat” after just 18 days is highly unlikely.
Taking a closer look at the show’s talent, we find a lack of relevant expertise. The show’s chief sugar adviser, David Gillespe, is a former lawyer and founder of a software company. He has no scientific or nutrition qualifications and his book Sweet Poison, which supposedly reveals the true health effects of dietary fructose, has no scientific basis. It is certainly true that Australians are consuming too much sugar but Gillespe’s claim of 40 teaspoons as the average Australian’s daily sugar intake is an over-estimate by about 10 teaspoons. He also says that the average family of four consumes the equivalent of 6 x 1kg bags of sugar each week. Doing the math, based on his own figure of 40 teaspoons, a family of four would consume 4.48kg. Based on 30 teaspoons, this figure is 3.36kg.
The show’s nutritionist, Sharon Johnston, also has no nutrition qualifications but is a naturopath. Dr. Kimber Stanhope, who holds a PhD in Nutrition, appears only very briefly in the show. Her area of research is the adverse metabolic effects of high fructose corn syrupStanhope KL, Medici V, Bremer AA, Lee V, Lam HD, Nunez MV, Chen GX, Keim NL, Havel PJ. A dose-response study of consuming high-fructose corn syrup–sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. The American Journal of Clinical Nutrition; 2015(101) DOI: 10.3945/ajcn.114.100461 yet she doesn’t speak about it on the show.
On examination of the film’s central theme, we find that there is no evidence to support the idea that sugar is the main culprit in causing obesity and its related metabolic diseases. Evidence points to over-consumption of cheap, convenient, and palatable energy-dense foods, regardless of its particular macronutrient composition,Drewnowski A. The real contribution of added sugars and fats to obesity. Epidemiologic Reviews; 2007(29) DOI: 10.1093/epirev/mxm011 coupled with physical inactivity, as the cause of obesity. Those foods are almost always high in fat and refined carbohydrates as well – not just sugar.
Jamie’s Sugar Rush
Jamie Oliver’s sugar documentary is an appeal to garner industry and public support for the introduction of a sugary drinks tax by the UK government. Oliver advocates for funds raised to go towards children’s nutrition education. He stresses that a tax is necessary due to the inability of personal responsibility and voluntary regulation of the food industry to improve dietary habits and that this has had dire consequences.
Oliver highlights the £30 million ($AUS 56 million) burden placed on the National Health Service due to the dental treatment of 26,000 children for sugar-related tooth decay each year. Like That Sugar Film, Oliver draws attention to the over-consumption of sugar by the average person and to hidden sugars in foods regarded as healthy. He emphasises the £9 billion ($AUS 16.8 million) burden that 3.5 million people with type 2 diabetes are placing on the NHS and the 7000 diabetes-related amputations that were performed in 2015. He laments the increasing prevalence of obesity and type 2 diabetes among children.
Oliver visits Mexico to investigate the effects of the 10% soda tax imposed there in 2014. He discovers that substantial funds were raised for the provision of water fountains in schools and sugar-sweetened soda consumption has reduced by 6-10%. To show the positive effect a sugar tax could have in the UK, he visits a school whose curriculum is centred on nutrition and healthy food preparation. This school has an obesity prevalence of virtually zero.
At the films conclusion, Oliver states that a 20p (37c) per litre sugary drinks tax could raise up to £1 billion ($AUS 1.87 billion), reduce the prevalence of obesity by 200,000 people and save the NHS £15 million ($AUS 28 million) per year. He then announces he is introducing a 10p (19c) sugar tax on drinks in his restaurants and encourages other restaurateurs to do the same.
Strongly in this films favour is the consensus among the scientific community that reducing sugar-sweetened beverage consumption will reduce the prevalence of obesity and its related diseases.Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar‐sweetened beverage consumption will reduce the prevalence of obesity and obesity‐related diseases. Obesity Reviews; 2013(14) DOI: 10.1111/obr.12040 Bearing this in mind, Oliver’s argument for the need for action regarding the problems of obesity and diabetes is certainly compelling.
In general, the overall tone of Jamie’s Sugar Rush is consistent with widely held views about the role sugar plays in poor health outcomes. For example Oliver states, “Experts warn that eating too much sugar can help make people obese, increasing their risk of developing diet-related illnesses like heart disease and some types of cancer”. However, in the show’s introduction the following unsubstantiated messages taken from the British media appear: “Sugar is as dangerous as alcohol and tobacco, warn health experts” and “Sugar is to blame for obesity epidemic – not couch potato habits”.
One of the experts appearing on the show is Graham MacGregor who, among other claims to fame is Professor of Cardiovascular Medicine at the Wolfson Institute of Preventive Medicine. He is certainly well qualified to speak on matters of public health, having founded the Consensus Action on Salt & Health and the World Action on Salt and Health. He is the Chairman for Action on Sugar which is a charity concerned with sugar and its effects on health. However, one could argue that his expertise centres on the effects of salt, rather than sugar.
N.B: On March 16, 2016, the UK government announced a sugary drinks tax will come into effect in April, 2018. The government expects to raise £520 million pounds in the first year and funds will go towards school sport programs.
Hungry for Change
Through a series of interviews with an array of self-proclaimed experts, this film aims to promote the major role that sugar, processed food, MSG and artificial sweeteners have played in bringing about the obesity epidemic. The experts relate their view that sugar is as damaging and addictive as heroin, cocaine and cigarettes.
The most scientifically sound message of the film is voiced by Mike Adams, who holds an MA in Nutrition and is an author and health journalist. Adams states that it is a diet of processed junk food combined with an indoor sedentary lifestyle that has led to the obesity epidemic. Probably the show’s only strength is that it highlights the obesogenic nature and poor nutritional quality of many processed foods.
It is unfortunate that credible messages such as these are embedded with completely unsubstantiated ones. The show’s “addiction specialist”, Jason Vale, is an author of juice-diet books with no qualifications in nutrition or addiction. He states, “Sugar, without question is the cocaine of the food world but they kind of get away with hiding that drug in – quote unquote – food”. We have already seen there is no evidence to support the idea that sugar is addictive. As for the idea that sugar is damaging, sugar in all its forms is digested or converted to glucose which is the brain’s preferred energy source.Whitney E, Rolfes SR. Understanding Nutrition. Nelson Education; 2015 The over consumption of sugar may be considered damaging, but then the over consumption of any energy dense food could also be considered damaging.
Jon Gabriel is an author of non-diet books and the show’s “weight-loss expert”, yet holds no dietetic or nutrition qualifications. He says that sugar, bread and salt are among “man-made foods” which “trick your body into thinking you’re getting specific nutrients and so your body stays hungry for them but then the cells don’t get nourished and… you’re starving on a cellular level.” He goes on to say that we over-eat in order to get those nutrients and become obese. Micronutrient deficiencies, which may cause “starvation on a cellular level” are generally not a problem in a society where over-consumption is the norm. In fact, micronutrient deficiencies exist in both normal and overweight individuals alike. Where they do exist, it is usually due to the omission of entire food groups such as dairy products among adolescent girls and meat, eggs and dairy among vegans. Morbidly obese patients do tend to have deficiencies Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Obesity Surgery; 2008(18) DOI: 10.1007/s11695-007-9350-5, but this may be due to impaired absorptionZimmermann MB, Zeder C, Muthayya S, Winichagoon P, Chaouki N, Aeberli I, Hurrell RF. Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification. International Journal of Obesity; 2008(32) DOI: 10.1038/ijo.2008.43 rather than a lack of nutrients in their food.
Gabriel’s mistrust of mainstream science is demonstrated through his belief that scientists know MSG causes obesity in mice but they are not telling us that MSG also makes us fat. Unfortunately the most recent evidence presented by the scientific community shows that normal consumption of MSG is unlikely to cause obesity in mice or men.Brosnan JT, Drewnowski A, Friedman MI. Is there a relationship between dietary MSG and (corrected) obesity in animals or humans? Amino Acids; 2014(46) DOI: 10.1007/s00726-014-1771-6
These films have successfully highlighted the link between dietary factors and obesity, type 2 diabetes and tooth decay. Most notibly, Jamie Oliver’s proposal to incentivise a reduction in sugar-sweetened beverage consumption is, according to the scientific literature, a plausible strategy.
The literature does point to a role for sugar in contributing to the development of obesity. Many obesogenic processed foods are high in sugar, which helps to make them extremely palatable and difficult to resist – but not addictive. However, sugar’s role has by and large been overstated and some “facts” presented in the films have little or no scientific basis. This may have the effect of weakening messages possessing greater credibility.
Perhaps the greatest criticism of the anti-sugar movement is a gross under-representation of the views of qualified nutritionists and scientists for whom the adverse health effects of sugar is their area of expertise.
Despite the flaws of these sugar films, if they motivate consumers to replace sugar-sweetened beverages and energy-dense processed foods with healthy alternatives, perhaps they have served a worthy purpose.
References [ + ]
|1.||⇪||Tappy L, Lê KA. Metabolic effects of fructose and the worldwide increase in obesity. Physiological Reviews; 2010(90) DOI: 10.1152/physrev.00019.2009|
|2.||⇪||Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition; 2010(29)(3) DOI: 10.1016/j.clnu.2009.12.001|
|3.||⇪||Stanhope KL, Medici V, Bremer AA, Lee V, Lam HD, Nunez MV, Chen GX, Keim NL, Havel PJ. A dose-response study of consuming high-fructose corn syrup–sweetened beverages on lipid/lipoprotein risk factors for cardiovascular disease in young adults. The American Journal of Clinical Nutrition; 2015(101) DOI: 10.3945/ajcn.114.100461|
|4.||⇪||Drewnowski A. The real contribution of added sugars and fats to obesity. Epidemiologic Reviews; 2007(29) DOI: 10.1093/epirev/mxm011|
|5.||⇪||Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar‐sweetened beverage consumption will reduce the prevalence of obesity and obesity‐related diseases. Obesity Reviews; 2013(14) DOI: 10.1111/obr.12040|
|6.||⇪||Whitney E, Rolfes SR. Understanding Nutrition. Nelson Education; 2015|
|7.||⇪||Kaidar-Person O, Person B, Szomstein S, Rosenthal RJ. Nutritional deficiencies in morbidly obese patients: a new form of malnutrition? Obesity Surgery; 2008(18) DOI: 10.1007/s11695-007-9350-5|
|8.||⇪||Zimmermann MB, Zeder C, Muthayya S, Winichagoon P, Chaouki N, Aeberli I, Hurrell RF. Adiposity in women and children from transition countries predicts decreased iron absorption, iron deficiency and a reduced response to iron fortification. International Journal of Obesity; 2008(32) DOI: 10.1038/ijo.2008.43|
|9.||⇪||Brosnan JT, Drewnowski A, Friedman MI. Is there a relationship between dietary MSG and (corrected) obesity in animals or humans? Amino Acids; 2014(46) DOI: 10.1007/s00726-014-1771-6|