Societal Control of Sugar Essential to Ease Public Health Burden

Robert H. Lustig, MD, and a team of the University of California, San Francisco (UCSF) researchers argue that sugar should be controlled like alcohol and tobacco to protect public health. In a new report, they maintain that sugar is fueling a global obesity pandemic, contributing to 35 million deaths annually worldwide from non-communicable diseases like diabetes, heart disease and cancer. 



Non-communicable diseases now pose a greater health burden worldwide than infectious diseases, according to the United Nations. In the United States, 75 percent of health care dollars are spent treating these diseases and their associated disabilities.

Robert Lustig, MD

In the Feb. 2 issue of NatureRobert Lustig, MD, Laura Schmidt, PhD, MSW, MPH, and Claire Brindis, DPH, colleagues at UCSF, argue that sugar’s potential for abuse, coupled with its toxicity and pervasiveness in the Western diet, make it a primary culprit of this worldwide health crisis.

This partnership of scientists trained in endocrinology, sociology and public health took a new look at the accumulating scientific evidence on sugar. Such interdisciplinary liaisons underscore the power of academic health sciences institutions like UCSF.

Sugar, they argue, is far from just “empty calories” that make people fat. At the levels consumed by most Americans, sugar changes metabolism, raises blood pressure, critically alters the signaling of hormones and causes significant damage to the liver – the least understood of sugar’s damages. These health hazards largely mirror the effects of drinking too much alcohol, which they point out in their commentary is the distillation of sugar.

Worldwide consumption of sugar has tripled during the past 50 years and is viewed as a key cause of the obesity epidemic. But obesity, Lustig, Schmidt and Brindis argue, may just be a marker for the damage caused by the toxic effects of too much sugar. This would help explain why 40 percent of people with metabolic syndrome — the key metabolic changes that lead to diabetes, heart disease and cancer — are not clinically obese.

“As long as the public thinks that sugar is just ‘empty calories,’ we have no chance in solving this,” said Lustig, a professor of pediatrics, in the division of endocrinology at the UCSF Benioff Children’s Hospital and director of the Weight Assessment for Teen and Child Health (WATCH) Program at UCSF.

“There are good calories and bad calories, just as there are good fats and bad fats, good amino acids and bad amino acids, good carbohydrates and bad carbohydrates,” Lustig said. “But sugar is toxic beyond its calories.”

Limiting the consumption of sugar has challenges beyond educating people about its potential toxicity. “We recognize that there are cultural and celebratory aspects of sugar,” said Brindis, director of UCSF’s Philip R. Lee Institute for Health Policy Studies (IHPS). “Changing these patterns is very complicated.”

According to Brindis, effective interventions can’t rely solely on individual change, but instead on environmental and community-wide solutions, similar to what has occurred with alcohol and tobacco, that increase the likelihood of success.

Laura Schmidt, PhD, MSW, MPH

The authors argue for society to shift away from high sugar consumption, the public must be better informed about the emerging science on sugar.

“There is an enormous gap between what we know from science and what we practice in reality,” said Schmidt, professor of health policy at UCSF’s IHPS and co-chair of UCSF’s Clinical and Translational Science Institute’s (CTSI) Community Engagement and Health Policy Program, which focuses on bridging academic research, health policy, and community practice to improve public health. In order to move the health needle, this issue needs to be recognized as a fundamental concern at the global level,” she said.

The paper was made possible with funding from UCSF’s CTSI, UCSF’s National Institutes of Health-funded program that helps accelerate clinical and translational research through interdisciplinary, interprofessional and transdisciplinary work.

Claire Brindis, DPH

Many of the interventions that have reduced alcohol and tobacco consumption can be models for addressing the sugar problem, such as levying special sales taxes, controlling access, and tightening licensing requirements on vending machines and snack bars that sell high sugar products in schools and workplaces.

“We’re not talking prohibition,” Schmidt said. “We’re not advocating a major imposition of the government into people’s lives. We’re talking about gentle ways to make sugar consumption slightly less convenient, thereby moving people away from the concentrated dose. What we want is to actually increase people’s choices by making foods that aren’t loaded with sugar comparatively easier and cheaper to get.”

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For more information, please visit

Photos by Susan Merrell



Lustig RH, Schmidt LA, Brindis CD. Public health: The toxic truth about sugar. Nature 2012; 482 (7383): 27-9.


Is Sugar Toxic?

If you are what you eat, then what does it mean that the average American consumes 130 pounds of sugar a year? Dr. Sanjay Gupta reports on new research showing that beyond weight gain, sugar can take a serious toll on your health, worsening conditions ranging from heart disease to cancer. Some physicians go so far as to call sugar a toxin (CBS News, 2012).


Big Sugar

 Big Sugar (CBC, 2005) explores the dark history and modern power of the world’s reining sugar cartels. Using dramatic re-enactments, it reveals how sugar was at the heart of slavery in the West Indies in the 18th century, while showing how present-day consumers are slaves to a sugar-based diet. Going undercover, Big Sugar witnesses the appalling working conditions on plantations in the Dominican Republic, where Haitian cane cutters live like slaves. Workers who live on Central Romano, a Fanjul-owned plantation, go hungry while working 12-hour days to earn 2 USD.


Nutrition and Behavior (Lecture)

In this lecture, Dr. Russell Blaylock explains one of the most important connections between nutrition and our health, how nutrition affects our behavior. Citing a series of important studies, he shows that good nutrition can powerfully enhance our memory, mood, and behavior in a socially desirable way. Likewise he shows us that poor nutrition can lead our youth into a world of violence, crime, depression and suicide. By using an impressive array of studies on both juvenile and adult prisoners, Dr. Blaylock demonstrates these principals and outlines specific measures you can take to protect your children from these detrimental effects. Most importantly, he shows us that it is never too late to make these nutritional changes.



The Dangers of Energy Drinks

Energy drinks have become increasingly popular in recent years. There are many brands on the market. Each contain caffeine and some have added stimulants such as guarana, an herbal form of more caffeine, as well as ginseng. Most of these drinks, in moderation, are probably relatively harmless for healthy people. However, when consumed to excess or by those with certain medical conditions, they may have harmful effects. 



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Sugar: The Bitter Truth (Lecture)

Robert H. Lustig, MD is Professor of Clinical Pediatrics, at the University of California, San Francisco (UCSF). He is nationally recognized in the field of neuroendocrinology, with an emphasis on the regulation of energy balance by the central nervous system. Dr. Lustig has a special interest in childhood obesity. He has become publicly notable through his efforts to draw attention to the effects that the natural sugar fructose can have on human and especially children’s health if consumed in large amounts. On May 26, 2009, Robert Lustig gave this lecture called “Sugar: The Bitter Truth” which was posted on YouTube the following July and has become a viral success with over a million viewings. In this lecture, Lustig notably calls fructose a “poison” and compares its metabolic effects with those of ethanol. He is particularly critical of the widespread use of High Fructose Corn Syrup in the United States.

Sugar: The Bitter Truth. Series: UCSF Mini Medical School for the Public [7/2009] [Health and Medicine] [Show ID: 16717].


Too Much Sugar Is Bad, But Which Sugar Is Worse: Fructose Or Glucose?

In 2005, the average American consumed 64 kg of added sugar, a sizeable proportion of which came through drinking soft drinks. Now, in a 10-week study, Peter Havel and colleagues, at the University of California at Davis, Davis, have provided evidence that human consumption of fructose-sweetened but not glucose-sweetened beverages can adversely affect both sensitivity to the hormone insulin and how the body handles fats, creating medical conditions that increase susceptibility to heart attack and stroke.

In the study, overweight and obese individuals consumed glucose- or fructose-sweetened beverages that provided 25% of their energy requirements for 10 weeks. During this period, individuals in both groups put on about the same amount of weight, but only those consuming fructose-sweetened beverages exhibited an increase in intraabdominal fat. Further, only these individuals became less sensitive to the hormone insulin (which controls glucose levels in the blood) and showed signs of dyslipidemia (increased levels of fat-soluble molecules known as lipids in the blood). As discussed in an accompanying commentary by Susanna Hofmann and Matthias Tschöp, although these are signs of the metabolic syndrome, which increases an individual’s risk of heart attack, the long-term affects of fructose over-consumption on susceptibility to heart attack remain unknown.


Stanhope KL, Schwarz JM, Keim NL, Griffen SC, Bremer AA, Graham JL, et al. Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. J Clin Invest. 2009;119 (5): 1322-34.

Hofmann SM, Tschöp MH. Dietary sugars: a fat difference. J Clin Invest. 2009;119 (5): 1089-92.