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Tuesday, March 11, 2014

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

By Lisa B. Nelson, M.Din Healthy Living
March 8, 2014

In early 2012, Kripalu’s Healthy Living department held a series of lectures for the community on nutrition and lifestyle medicine. Because I focus primarily on the prevention of diabetes and other chronic disease, the topic of my talk was sugar. When I came up with the title—“Sugar: America’s Favorite and Most Dangerous Drug”—I was intending to be hyperbolic and provocative.

Is sugar really a drug? And while we know that sugar isn’t good for us, is it really as dangerous as some people say?

Funny how much can change in two years. Not only has the tide of public opinion on sugar shifted dramatically, but now mainstream medical research has quantified just how dangerous sugar 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.

A study chronicled in the February 3 issue of 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 National Health and Nutritional Examination Survey (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 new, and 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 is 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 a fourfold risk of dying from heart disease, compared to people who consume less than 10 percent.

And, while you might think this excessive sugar consumption affects a small number of people, consider this, according to NHNES data: 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.

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?

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 dopaminergic 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?

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, in the words of Kripalu Lead Nutritionist Annie B. Kay, “get our sweetness from life” instead.

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