Blog | Monday, September 11, 2017

Putting sugar on trial


Saturated fat has gone on trial in both criminal and civil cases. Because the separation of saturated fat from the company it keeps in actual foods is virtually impossible in realistic trials of dietary alternatives, and because of the higher standard of evidence applied, the jury in the criminal trial could not reach a verdict, and a mistrial was declared. Saturated fat lost the civil trial, however.

Now, sugar goes on trial, under the same conditions. I note a bit of interesting and pertinent historical happenstance: I actually served as an expert witness in a real trial of sugar. In that case, however, the trial was not about charges brought against sugar on behalf of humanity. Rather, it was an argument between the makers of sucrose, and the makers of high-fructose corn syrup, about whether human bodies can “tell the difference.” In case you care, my position was: yes, bodies certainly can tell the difference, but the body politic doesn't have too much cause to give a hoot. The real and potential harms of the two are very comparable, as for that matter is the fructose content, and the main concern is the total dose of all added sugars consumed, not which one replaces the other.

I will say no more about that, for fear of leading the witnesses this time around. Let the trials begin!

This time, the prosecution/plaintiff make the case that “The sugar did it.” The basic argument is that sugar represents empty calories, and thus its consumption can only do one of two things to diets: add to the generally prevailing excess of calories consumed, or displace calories with greater (which is to say: any) nutritional value. There doesn't seem to be a third choice, and the prosecutorial arguments make that abundantly clear.

In addition, the case is made convincingly that sugar is used routinely by the food industry to “spike” foods in a manner that increases consumption not just of sugar, but of everything else, too. Evidence is presented that the threshold for fullness/satiety in the appetite center in the hypothalamus is higher for sweet than for any other taste. There is scientific evidence for this, but also the evidence of common experience: when full at the end of a meal, there is almost always still room for sweet dessert. The answer resides, the jury is told, not in a hollow leg or extra stomach, but in the hypothalamus and how sugar affects it.

Further, the jury is told, the food industry takes full advantage of this by engineering additions of sugar even into foods that are not even discernibly sweet, because the stealth sugar hiding there serves as a goad to appetite. If food manufacturers know that sugar can make people overeat, it's practically a confession of guilt, so argues the prosecuting counsel.

In addition, the case is made that specific metabolic effects of sugar are injurious. Sugar ingestion raises blood sugar levels, which in turn triggers a release of insulin. Both glycemic, and insulinemic responses, the jury is told, can contribute to the development of excess body fat, insulin resistance, and diabetes.

Just as the jurors are beginning to think there can be no defense, the defense gets its turn. They argue a lack of decisive evidence “blaming” sugar for any bad outcome, from obesity to diabetes to heart disease. They note that excess calories from any source can lead to weight gain, and excess body fat can increase the risk of most chronic diseases. They point out that many foods that contain added sugar also contain other ingredients that might be responsible for the harms attributed to sugar. Sugar, they suggest, could be an innocent bystander.

Besides, they go on, given the established harms of processed and fatty meats, what harm is there, really, left to blame on sugar? Since saturated fat was already found liable for its damage why look further? ”If you've got a prior perfect fit (like a glove), then this time you must acquit!” the lead defense counsel asserts, with noteworthy lilt and panache.

However, the prosecuting attorney redirects this adroitly just minutes later: “Bonnie's guilt did nothing to exonerate Clyde. What if saturated fat and sugar have been in on it together right along?”

The defense tries something else. Sugar does represent a potential source of calories, they concede, but those calories are readily addressed with just “a bit” of additional daily exercise. Something about their remarks on this topic evokes images of skipping through wild flowers or catching butterflies in everybody's mind.

Finally, the defense notes that sugar, contrary to popular opinion, is not “the cause” of diabetes. They very carefully avoid saying it is not “a” cause, and the savvy members of the jury note the distinction. But a few are drawn in, and interpret not “the cause” to mean that dietary sugar does not and cannot contribute to diabetes risk. The prosecution has a chance to cross-examine and redirect, and they make the distinction clear with this analogy: no single snowflake is “the” killer when an avalanche proves lethal, but that doesn't exonerate the snow. Sugar doesn't have to be “the” cause of diabetes to be fully complicit in its common development.

The prosecution, in a bit of closing flourish, reminds jurors that saturated fat recently lost its civil trial, and the evidence shows replacing saturated fat with sugar is a lateral move, making things not obviously worse, but not measurably better, either. Sugar, they assert, is fully as bad as saturated fat (and vice versa). ”Remember Bonnie and Clyde.”

The dual juries retire to their chambers for deliberation, where ice-cold, monogrammed bottles of Coke and Pepsi await them. Most drink up, while a few think to ask: is this really appropriate? Conversation quickly indicts the cleverly placed sodas, and the jurors all switch over to water. They also note that soda is an interesting consideration, since it is, in effect, a delivery vehicle for sugar, and not much else. They note that while isolating the potential harms of saturated fat is rather unrealistic, it is much more readily done for sugar.

After that, dual decisions come swiftly. Sugar is convicted of crimes against bodies and the body politic alike, and found liable, losing in both civil and criminal courts.

For a moment, it looks like justice is sweet. But then sugar promises to appeal, because to palates long habituated to its constant and copious presence, and corrupted by it―that's just what it always does.

Shaking her head in disgust, the judge reaches for a donut; there's always one handy.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.