Volume 9  Number 2  August 23, 2012
Second Opinions

Is Sugar Toxic? Notes on Diets and the Food Police I

"Preserving health by too severe a rule is a worrisome malady."

Francois de La Rochefoucauld

"Part of the secret of success in life is to eat what you like and let the food fight it out inside."

Mark Twain

Should Sugar be Treated as a Controlled Substance?

The latest claim that sugar is toxic and should be taxed and regulated like alcohol is described by Dr. David Katz, Director, Yale Prevention Research Center as "humbug." He points out that the notion of "one nutrient at a time" is a pernicious fallacy, i.e. a single nutrient (fats, carbohydrate, or protein) or substance singled out for special attention. Never mind that we almost never eat sugar, salt, let alone cholesterol and trans fats, etc. even nutrients per se in pure form, but only combined in food. Then we demonize or praise that single substance as "bad" or "good" for your health, as if their ingestion was isolated from the food containing them. To make sense this sounds like Low Carbs all over again.

The toxic sugar story turned metastatic with an opinion piece by a pediatric endocrinologist and obesity specialist, Dr. Robert Lustig, in an issue of the prestigious journal Nature. The author, an outstanding researcher many of whose unsupported theories remain controversial, has linked sugar, (consisting of glucose and fructose, the latter found naturally in fruits) to metabolic syndrome, (obesity, high cholesterol, diabetes, heart attacks), dementia, and even cancer. Check the search term "sugar toxicity" on Google for over four million URL's, including a blizzard of alarmist major network shows featured on CBS's "60 minutes," CNN, Fox, and other networks. "60 minutes" was broadcast twice this year, fittingly on April Fools Day and again on August 5, featuring a respected CNN health journalist. The New York Times published a convoluted but supportive article by a busy writer, famous for championing the low carb and other diets.

The Dietitians Association of Australia (DAA) observed that "It is simplistic and unhelpful to blame sugar alone for rising rates of obesity and other related health problems across the world. Labeling sugar as 'toxic' and 'addictive' and placing it in the same boat as alcohol is incorrect and misleading." See also Kathy Goodwin's excellent critique of the demonstrably false theory that "...only carbohydrate in the diet will stimulate insulin production. The truth is that all ingested foods stimulate insulin production." This boils down to the ridiculous concept that sugar is "bad", since it produces insulin, and insulin stops people from losing weight.

If sugar is toxic, then so are candy bars, ice cream, cakes, pies, and cookies. (How often have you seen someone eat spoonfuls directly from a sugar bowl?) We have now come full circle and are back, as noted, to Dr. Atkins. Consider the astonishingly persistent belief in his low carbohydrate weight loss diet.

Atkins, Low Carbs and other Diets

In a previous blog, I pointed out that the low carbohydrate diet, basically a high fat diet which has been around since the 1860's, enjoyed an astounding re-awakening one-hundred years later thanks to Dr. Robert Coleman Atkins who lifted his theories from "research" of Dr. Alfred W. Pennington, who recommended removing all starch and sugar from meals. An article supporting Atkins explored Pennington's work in the JAMA, "A New Concept in the Treatment of Obesity". In 1965 Atkins appeared on "The Tonight Show" hosted by Johnny Carson, to promote his weight loss plan. This resulted in further hypertrophy of the weight loss industry. The Atkins Diet industry remains alive and well with its 6 million URL's on Google, nine years after Atkins' death at 72.

If one looks further at the history of weight loss diets, other magic methods based on relative composition of carbohydrates, fat and protein continue to capture the public imagination. So we have low fat, high protein, low protein, high carb, low carb, high fat and other "miraculous" diets. Rarely mentioned is the low calorie diet. Moreover, every week brings an avalanche of new and usually outrageous fad diets: the South Beach Diet, the Cheater's Diet, the Ornish Diet, the Dr. Phil diet, the Shangri-La diet, the Banana diet, the Raw Foods diet, the Cabbage Diet, etc. (The Weight Watcher's Diet is one of the very few I recommend.)

Atkins and his Diet had been convincingly debunked by numerous studies published in peer-reviewed journals, long before and after his death in 2003. One of the most exhaustive critiques was performed by the Danish investigator, Professor Astrup who analyzed the Atkins diet and assorted claims that low carbohydrate diets are effective for weight loss. In Astrup's article, published in The Lancet, he and his colleagues examined 2,609 articles on low carbohydrate diets, and found only 107 articles which could be reviewed. "Only five studies evaluated participants for more than 90 days, but were not randomized and had no control group. There was insufficient evidence to make recommendations for or against these types of diets."

Is the Atkins diet safe? According to Astrup, "...restricted intake of whole grain bread and cereals, fruits and vegetables does not equal a healthy diet, and absence of these food groups may increase the risk of cancer and cardiovascular disease." Moreover, the low carbohydrate content of the diet is "below the minimum needed to supply the brain and muscles with sugar." Atkins dieters more often report muscle cramps, diarrhea, halitosis general weakness, and rashes than those on a recommended low fat or low calorie diets.

Final Recall

When it comes to food phobias and fad diets, American suffer as a society from well-organized, repressive group-think. Far too many of us are inhaling the mists of repellent dietary theologies issuing from the spray can of Junk Science. Magisterial nonsense delivered to us via the media and Internet blitzes has made us potential victims of the food police and the nanny state. As sure as summer follows spring, we are regularly spritzed with new diets and food phobias, ever more unpalatable and alarmist. Sugar and carbs can never be as toxic as the media that propagate these messages.

Martin F. Sturman, MD, FACP

Copyright 2012, Mathemedics, Inc.

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