FAT  CHANCE  -  Beating  the  odds  against  Sugar, Processed Foods, Obesity, and Disease

by  Robert Lustig, M.D.

The "Empire" Strikes Back: Response of the Food Industry

"Obesity is a complex problem with many causes and no single, easy solution. It is irresponsible and scientifically spurious to single out HFCS or any other food or ingredient as the chief cause of obesity. The only effective and lasting way to combat obesity is to encourage people to live a balanced lifestyle, eating a variety of foods in moderation and incorporating lots of physical activity into their daily lives."

—National Soft Drink Association press release, March 25, 2004

Sort of. HFCS and sucrose are, for all intents and purposes, biochemically and metabolically equivalent. But the truth stops there. Both the Sugar Association and the Corn Refiners Association have gone out of their way in their attempts to exonerate sugar, whatever the source. They want the public to think that "a calorie is a calorie." They want us to believe that fructose—and, by inference, all sugar—is just "empty calories." If it were, then sugar would be the same as—no better, no worse than—any other nutrient. In their view, for a standard sedentary adult consuming 2,000 calories per day, approximately 1,800 calories are "essential" calories, in that they are directed to producing lipids for cell membranes, protein for muscles and enzymes, and carbohydrates for normal energy metabolism, growth, and repair. This leaves about 200 calories per day as "discretionary calories," which can be spent any way we want.1 And if we exercise, we have the capacity to consume an even higher number of discretionary calories.

If we want to use them all on sugar, then we should have the choice to do so. And we do—and then some.

Figure 16.1 shows the number of calories per day of added sugar eaten by children in different age groups in the United States. The fiftieth percentile consumes between 320 and 350 calories of sugar per day throughout their life span, and the ninetieth percentile consumes above 600 calories. Even the two-to three-year-old age group is consuming an average of 180 calories per day in added sugar. We have far exceeded our discretionary calorie limit; in fact, we've left it in our dust. The food industry continues to add more sugar to processed foods because they can. And they know that when they do, we will buy more (see chapters 5 and 11). Soft drinks account for one third of all the sugar consumed. But other foods that never had sugar before are now busting at the seams from the sugar overload (e.g., yogurt, ketchup).

A Short History of the U.S. Sugar Glut

The U.S. sugar glut is the result of more political distortion and behind-the-scenes manipulation than the 2000 Bush-Gore election. We've always had a

Fig. 16.1a. Sugar in the Morning, Sugar in the Evening, Sugar at Supper-time ... Daily consumption of added sugars (kilocalories per day) in U.S. children, broken down by age and sex. This comprises all foods, including cereals, desserts, soda, and juice.

Fig. 16.1b. Daily consumption of added sugars (as a percentage of total calories) in U.S. children, broken down by age and sex. All age groups are consuming more sugar than the upper limit of 10 percent of calories recommended by the American Heart Association.

"sweet tooth," but our consumption of sugar was not a problem until the second half of the twentieth century. North America was consistently a sugar deficit area, requiring more imports than exports to meet growing consumption needs. In chronological order, the events of the past fifty years escalated the problem to bring us to the precipice of our current public health collapse.

1. The Cuban revolution in 1959 and the subsequent assumption of power by Fidel Castro cut off our standard sugar supply. The Bay of Pigs incident in 1961 ended any further dialogue or trade with the Castro regime; we needed a new "sugar fix."

2. High-fructose corn syrup began to hit our shores in the early 1970s. Initially, the U.S. food industry was somewhat wary of this new product. The eventual introduction of HFCS to the Western diet resulted in stability of the U.S. Producer Price Index for sugar because the cost of HFCS, on average, is about half that of sucrose (figure 16.2).

3. President Richard Nixon astutely noted that fluctuating food prices foment political unrest, and he directed his secretary of agriculture, Earl (Rusty) Butz, to "take food off the table" as a political issue. Butzs job was to find ways to make food cheap. HFCS fit the bill. This was one of the impetuses for developing the corn subsidy as part of the Farm Bill. Basically, the U.S. government would underwrite the cost of corn, even when it cost more to grow it than to sell it. The low cost of HFCS drove down the price of both, making both substances cheap and readily available.

4. The McGovern Commission (see chapter 10) edict led to a directed policy on the part of the U.S. Department of Agriculture in the late 1970s to reduce our consumption of dietary fat.2 How do you make low-fat taste good? Add sugar. HFCS was the cheapest alternative around, and homegrown to boot. In the process of switching various processed foods to the low-fat, high-sugar versions, the food industry found that its profits were increasing.

5. The final nail in our coffin came from the second worst hurricane in our history. Everyone remembers Katrina in 2005. Hurricane Allen in 1980 wiped out the entire Caribbean sugar crop in one fell swoop. Sugar futures skyrocketed to $0.55 a pound (a record for that era) and more than $1.00 per pound retail. Coca-Cola, which had been holding out in terms of switching from sucrose to HFCS, now saw a shortage of raw sugar and ushered an HFCS-containing version onto supermarket shelves. The rest of the food industry quickly followed suit.


In the late 1990s, HFCS became the most commonly used sweetener in the United States. Currently, 5 percent of all the corn grown in this country is turned into HFCS.3 HFCS is no worse for your health than other forms of fructose, though it is always devoid of fiber. However, its cheap, easy to produce, and readily available—so it now permeates nearly all our food. And we like it, so we buy more. While HFCS is cheaper to produce than sugar, the prices on various foods containing it have remained the same if not gotten higher. (Check out the price of a box of cereal.) A win-win for the food industry.

Fig. 16.2. A Cheap Fix. a) The U.S. producer price index (PPI) for sugar before and after introduction of corn sweeteners in 1975. Upon its introduction, PPI hovers, at 100%, which infers price stability, b) Price of U.S. sugar compared to London price, documenting price stability and allowing for increased usage overseas, c) Price of refined sugar compared to HFCS in the U.S. HFCS was so cheap, it started appearing in every food. And that's where it remains today.


The Food Industry's Justification

The food industry will counter that there are many reasons to add sucrose or HFCS to food and to remove the food's fiber. And some of them are very reasonable, both industrially and economically. But how about biologically? How about in terms of our health?

Sugar Adds Sweetness

Our tongue is able to distinguish five tastes: sweet, salty, sour, bitter, and savory. Sugar covers up the other four. It covers up salty (trail mix, honey roasted peanuts), sour (the acidity in processed tomato sauce provided by less-than-ripe tomatoes, or lemonade), bitter (milk chocolate), and savory (sweet-and-sour pork). Sugar covers up the inequities of foods, making not-so-tasty food seem like it is worth eating. Bottom line, you can make pretty much anything taste good with enough sugar. And the food industry does.

Sugar and Browning

The browning of foods is appealing to your eye and to your taste buds. We slather our ribs in barbecue sauce before we cook or grill them, to get just the right browning effect. All foods brown better with sugar. And the browning of meats provides a smokier, tangier flavor. As discussed in chapter 11, the browning of food is the Maillard reaction.4 While appealing on the plate and to the palate, its not so appealing in your arteries.

Sugar Adds Texture

Baked goods wouldn't be nearly as interesting without sugar. Try to make a cake with Splenda. It will taste just as sweet, but it won't puff up. In baked bread, the yeast needs something to work on to give it its airiness. Conversely, wafer crackers wouldn't be crisp if it weren't for sugar. Sugar provides viscosity (thickness) to various foods, such as gummy bears. Sugar also provides the "glass" appearance and crunch of hard candies. Furthermore, sugar lowers foods' freezing point (which is essential for ice cream to have that creamy consistency) and raises their boiling point (which makes caramels chewy).

Sugar Stops Spoilage

Sugar reduces water activity, or the intensity with which water associates with solids. The higher the water activity, the more easily bacteria and mold grow on food. And easily moldy food means quicker spoilage. But sugar (and salt, for that matter) reduces water activity, and makes it less likely that any given food will be able to spoil. This is why the food industry uses sugar as a preservative. When was the last time you tasted a rancid soft drink? Flat maybe, but never rancid. Nothing can grow in that bottle.

The addition of sugar to a food also adds humectancy, which is the ability to hold on to water. This is extremely important for preventing your favorite treats from going stale, particularly your baked goods. One way to gauge the effect of sugar on humectancy is the staling of bread. How long does a loaf of bread purchased at your local bakery take to go stale? About two days. How long does a loaf of commercial bread purchased at the supermarket take to go stale? About two to three weeks. This works for the consumer because it retards spoilage and reduces waste. The food industry and the supermarket associations are happy because it reduces depreciation, thereby increasing profits. I checked my local supermarket: of the thirty-two commercially available breads there, thirty-one were made with HFCS, added for both browning and humectancy. And what were they lacking? Fiber.

Fast Food and Fiber

Currently, the median U.S. fiber consumption is 12 grams per day. This is on purpose. The food industry removes fiber from food because fiber limits shelf life. Bread devoid of fiber is going to last far longer in your pantry than if you buy it fresh at the farmers' market. And the food industry capitalizes on this. Reduced depreciation means reduced costs, which means increased sales. What's the definition of fast food? It's fiberless food. Because you can't freeze fiber and expect to maintain the same texture. Fiberless food can be frozen, shipped globally, and cooked quickly. But getting rid of fiber has obviated satiety, and exacerbated the negative impact of the carbohydrates, contributing to hyperinsulinemia, obesity, and metabolic syndrome.

When You Can't Justify, Deflect

So there you are. Lots of reasons to add sugar and remove fiber. Good for the visual presentation. Good for the palate. Good for the pocketbook. Good for the industry. But bad for your health. 

Let's take a generic cookie as an example: 30 percent flour, 30 percent fat, 30 percent sugar, and about 6 percent protein. This is the ultimate concoction of fat and carbohydrate possible in one food item. And sweetness has more salience (appeal) when you add fat. (Which would you rather eat: Pixie Stix or a Cinnabon?) One cookie is a treat. But bet you can't eat just one, because sugar is addictive, and sugar plus fat is even more so. Our caloric overload, generated specifically by added sugars, proves it.

The food industry says they do not understand what all the fuss is about. Sugar has been around for millennia. Sugar is a source of energy.  Sugar is a "natural" part of our diet. 

True, but irrelevant in terms of our health. 

Here are some samples of the claims the food industry or their ambassadors have used to persuade the public that the addition of added sugar to food or drinks is as American as apple pie (with extra HFCS).

Food Industry Argument #1: 

Fructose Doesn't Raise Blood Glucose

The industry argues that fructose doesn't raise blood glucose, and they're right. Fructose has a very low glycemic index (see chapters 11 and 17), which is a measure of a food's generation of an insulin response and is used as a method for quantifying a food's potential for weight gain. But remember, there's no fructose alone in nature. It is always found with glucose (either as sucrose or HFCS), and the glucose contribution generates quite a hefty insulin response.5 So when the glucose is metabolized, it drives up insulin, while the fructose causes liver fat and liver insulin resistance. Carbohydrates and fat together. A great way to get metabolic syndrome.

Food Industry Argument #2:

Switch 'Em Up: Fructose for Glucose

The food industry would like to develop crystalline fructose (alone) as an FDA-approved sweetener. They base this idea on several "controlled" studies that demonstrate that when you substitute fructose for glucose (calorie for calorie) there is no rise in HbAlc (what doctors test the blood for in order to assess blood sugar control in diabetic patients), a fact that suggests that fructose would be desirable for diabetics.6 Perhaps one reason for this is that crystalline fructose is incompletely absorbed by the small intestine, and thus its effects on glucose and HbAlc may be minimal. However, if your body doesn't absorb the crystalline fructose, the GI symptoms caused by the residual fructose wreak havoc on the intestine, generating pain, bloating, and diarrhea.7 Remember how Olestra was going to revolutionize America? As a fat substitute, it purported to add no fat, calories, or cholesterol to products. True, but it quickly lost its market share due to side effects. As described by the health warning label, "This product contains Olestra. Olestra may cause abdominal cramping and loose stools. Olestra inhibits the absorption of some vitamins and other nutrients." The additive quickly became synonymous with "anal leakage" and has since disappeared. Crystalline fructose may follow the same path.

Furthermore, just because fructose doesn't raise HbAlc levels in the bloodstream of diabetics, that doesn't mean it's not doing damage; Japanese researchers have shown that fructose binds to proteins in people.8 It also doesn't mean that fructose is not doing damage to proteins inside cells. Studies of animals receiving ad lib sucrose versus starch show marked inflammation of liver cells leading to cirrhosis.9 Likewise, studies of humans have demonstrated that sucrose consumption correlates with the degree of liver inflammation.

The food industry points to controlled studies in which fructose is substituted for glucose, with no increase in weight. (After all, if the calories eaten are the same, then one would expect this.)10 They also like to quote a famous 1999 study showing that the liver turns fructose to fat at a very low rate (less than 5 percent).11 If you believe this, you should be able to drink as much soda as you want! 

Not so fast. It holds true only if you're thin, fasting (and therefore glycogen depleted), and given fructose alone (which is poorly absorbed). Rather, if you're obese, insulin-resistant, fed, and getting both fructose and glucose together (a sizeable percentage of the population), then fructose gets converted to fat at a much higher rate, approximating 25 percent. In other words, the toxicity of fructose depends on the context. If you're an elite athlete and glycogen-depleted, you can eat or drink pretty much anything you want. But if you're not, then our current excessive sugar supply doesn't work for you.

Food Industry Argument #3: 

The Food Label Is Right There!

The food industry argues that the information on sugar and fiber in our food is right there on the Nutrition Facts label, in plain sight, for all to see. Based on that information, people can make their own conscious decisions. Not quite. Under the carbohydrate heading, the Nutrition Facts label lists "total sugars." This signifies a combination of all versions of monosaccharides, which include glucose, fructose, and galactose (milk sugar); and all disaccharides, which include maltose (glucose-glucose, found in beer), lactose (glucose-galactose, found in dairy), and sucrose (glucose-fructose, found everywhere!). For instance, one cup of low-fat milk has 12 grams of sugar, which comes from lactose. The galactose is not a problem, as it is metabolized to glucose and does not pose a significant health threat, unless you have the disease galactosemia, in which case you'd have died of an overwhelming infection before you were two months old.

Furthermore, the fructose that is found naturally in many foods is also not a problem. This amount is usually small, and invariably there is some associated fiber, which limits its negative effects. "All-natural" juice may not contain added sugar, but because the fiber has ben removed from it (see chapter 12), its just a sugar-sweetened beverage. Again, ounce for ounce, juice has more fructose and more calories than soft drinks. 

What about canned fruit? The fruit itself is fine, but they can't add water to the can, because the sugar in the fruit would leach out. They instead add sugar syrup in high concentration, to keep the fruit sweet and soft and to prevent spoilage. Its the "added sugar" that we need to know about, which is always either sucrose or HFCS, put in the food specifically by the food industry for palatability and shelf life. Likewise, we need to know how much fiber is included and how much has been removed.

But you're not allowed to know this. The Nutrition Labeling and Education Act (NLEA) of 1990 allows for the declaration of "total sugars" as a whole.12 There is no differentiation between them or provision for "added sugars." The FDA stated that there was no scientific evidence to argue that the body makes any distinction between natural or added sugar. The inclusion of "added sugars" in the label under-represents the sugar content of foods high in endogenous or natural sugars. However, the fiber is the mitigating factor, not the sugar. Lastly, the FDA believes there would be no way to enforce such a rule and that the food industry would have no impetus to conform to it. 

But the real reason were not allowed to know is pressure from food industry lobbyists. Their argument to the FDA in 1989 was, "If we listed the added sugars on the label, then all our competitors could duplicate our recipes. This is proprietary information, and we won't release it." And the FDA bought that argument. Do you? You may not believe the premise, but you buy the products.

You'll also notice that there are Recommended Daily Values for every one of the other nutrients on the food label. But there is no Recommended Daily Value or Dietary Reference Intake (DRI) for sugar, either natural or added. 

I recently had the occasion to sit on a panel with Sam Kass, Michelle Obama's personal chef and her pointman to the White House Childhood Obesity Task Force. I asked him straight out, "Why is there no DRI for sugar?" His response might surprise you: "Why would you need a DRI for something that is not a nutrient?" Wow! Sugar is not a nutrient? That might be news to the USDA. I actually kind of agree with Mr. Kass. Sugar is certainly not an essential nutrient, in the sense that there is not one single biochemical reaction that requires it. Sugar is extraneous, and our bodies certainly don't need it. As elaborated in chapter 11, sugar is more toxin than it ever was a nutrient.

Food industry Argument #4: 

It's All About Supply and Demand

There are two philosophies of marketing, and the food industry has mastered both.

We give the public what it wants. 

The food industry is just responding to a need by filling a "niche" in the American economy. This is how the industry would like to be portrayed—as "reactive." Portion sizes in this country are significantly larger than they were twenty years ago. You buy a larger portion because you feel you're getting a better deal. You buy more, you eat more. Everybody wins. Well, not everybody. The food industry wins by selling more, the middleman wins by levying the markup, the government wins by levying the sales tax. You lose.

If you build it, they will come. This is the real story: 

developing a market out of nowhere—or being "proactive." As I like to tell my children, "Advertising is necessary only for products that we don't want and don't need." The food industry (manufacturers, retailers, and food service) is outranked only by the automobile industry in terms of monetary expenditure for marketing. Like it or not, we are influenced in our choices by what the media tell us to want. Especially our children. You may "know" that you should eat more fruits and vegetables, but how many commercials do you or your kids watch that say so? Less than 5 percent of all food advertising dollars is spent by the fruit, vegetable, and grain sectors. The government and USDA can't compete with the almost unlimited funds of the food industry. In 1997 the USDA spent $300 million to promote healthy eating, in comparison to the $11 billion spent advertising junk food, of which $4.2 billion was directed at children13 (see chapter 20).

Grease Their Palms to Grease the Wheels

That fast food and beverage companies sponsor teams, sporting events, charity walks, and other physical activity-related venues to take the heat off the sugar they peddle is as American as apple pie. It's another thing entirely for them to finance the uniforms and the scoreboards for schools around the country. In exchange for financial compensation, schools sign exclusive marketing contracts with beverage companies to permit on-campus advertising through product donations, scoreboards and signs, clothing, and school supplies. The more beverages sold, the more money for the school and more profits for the company. In a 2000 survey, 72 percent of California high schools allowed advertising for fast food and beverages on campus, while only 13 percent prohibited it. And if you think it's bad in the United States, try Latin America. Consumption of soft drinks doubled in Mexico in seven years. Despite the fact that 75 percent of Mexican adults are currently overweight, Coca-Cola sponsors more physical activity programs than all other companies put together.14

If You Can't Beat 'Em, Join 'Em

Despite the rhetoric, the food industry knows it has a problem. Enter the new market of "functional foods." As Pepsico chairwoman Indra Nooyi so eloquently stated in The New Yorker (May 16, 2011), "Its not a question of selling less. It's a question of selling the right stuff." In response to the obesity pandemic, Pepsi now has three lines: "Fun for you" (e.g., chips and soda), "Better for you" (e.g., juice and beef jerky), and "Good for you" (e.g., whole grains, fruits, vegetables, low-fat dairy, nuts).

Americans know that they're gaining weight and that they should be eating healthier. So the food industry helps us assuage our guilt with processed products labeled "natural" and "whole wheat," or containing "extra nutrients." You buy them, probably paying extra, and feel better about eating them. None of these taglines has any meaningful definition, and there is little to no regulation about when they can be used. 

We are currently in "throwback" mode: many soft drink manufacturers, such as Pepsi, are substituting sucrose for HFCS based on the myth that sucrose is more "natural" and therefore better for you. 

Sobe Drinks, with 100 percent of your daily vitamin C requirements, are essentially flavored sugar water. Just because you don't feel any guilt doesn't mean your body won't feel the effects. 

Promise—if all the HFCS-containing candy bars in the world somehow mysteriously were replaced by their sucrose-containing equivalents, they would still be junk food, and your body wouldn't know the difference— although they might cost more and you might balk at the increased price.

Investors are watching Pepsi carefully. As it promotes its "Good for You" line, it has reduced the marketing of its "Fun for You" line, to the tune of $349 million. In the process, Pepsi-Cola has fallen to third place in soft drink sales, behind Coke and Diet Coke. It remains to be seen if what is essentially a "junk food company" can recreate itself. If not, don't expect any risk taking from the others.

Who's in Charge?

If there's any lesson to be gleaned from this book, it's that food is health. But while you are ostensibly in charge of your health, you are clearly not in charge of your food. In fact, those who are in charge of your food are doing their level best to make a buck off you. Food companies in the year 2010 generated nearly $1 trillion in sales. 

And if your health goes down the tubes, that's your problem. But it's not just your problem. It's everyone's problem. The cigarette industry was chastised for an irrational business model: poisoning your best customers is not considered a growth strategy.

But if you can hook more people on the front end, you can guarantee your supply of users, so you can afford to lose a few. The food industry has a leg up on this model: corner the food market, and people will have no place else to go. 

Is it any wonder that the food industry, in the midst of two negative trends—the economic downturn and the obesity pandemic—is making money hand over fist?





Keith Hunt