The story of sugar is steeped in tragedy and underscored by greed. Are we slowly poisoning ourselves? 

 

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Executive Summary

• The ambitions of ancient soldiers were stopped dead in countries with refined sugar.
• Sugar became cheap and ubiquitous because of the transatlantic slave trade. 
• Consumption increased dramatically each century from the 16th century. 
• In the UK, we eat x3 the recommended daily amount of 5% added sugar—over 23 teaspoons per day. 
• Ultra-processed foods and sugary drinks are the biggest source of added sugar in people’s diets which are now made up of 57% ultra-processed junk foods. 
• Humans are hardwired to seek sugar because it used to come with nutrients inside fruits and vegetables.  
• Sugar is highly addictive. 
• Sugar escaped scrutiny because health institutions blamed fat for ever-increasing obesity rates. 
• Because we need to maintain a certain level of blood sugar, eating it in its simplest forms was considered to be ‘just energy’. 
• Today, people get excessive energy (calories) but not enough nutrients. 
• Excess fructose causes insulin resistance, which is the gateway to cardiovascular disease, metabolic dysfunction, and other modern diseases. 
• Sugar is associated with obesity, non-alcoholic fatty liver disease, cardiovascular disease, cancer, dementia and, of course, diabetes, to name a few. 
• Sugar industry scientists deliberately muddy the research waters, allowing confusion into the debate and preventing anti-sugar legislation. 
• The mantras ‘everything in moderation’ and ‘eat less, move more’ place the blame on individuals and away from the companies selling highly addictive, high-energy, low-nutrient products. 
• Avoid added sugars by swapping high-sugar products for low-sugar ones. 

 

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Introduction 

Humans domesticated sugar cane about 10,000 years ago, but it wasn’t until 500 BC that it became recognisable as a granulated, refined sugar. Before refining, the sugar contained some nutrients at least. After refining, it became pure energy. The irony is that this simple unit of energy doesn’t invigorate people but quite the opposite. Marauding armies, full of ambitions and vitality, ground to a halt everywhere they came to know refined sugar.

Crusaders in the 11th century returned to Europe from the Holy Land with bags of sugar. It was an instant hit but well out of reach for the common folk. As Europeans began settling in the Americas, they found the perfect environment for sugar plantations. Using slaves brought from Africa, plantation owners could not make enough sugar for the Europeans who clamoured for it, changing centuries-old recipes and creating new foods with sugar at their core. Facilitated by slaving, sugar became cheap and ubiquitous, even more so when sugar beet, grown in Europe, was industrially processed into sugar right on our doorstep.

Peaking in 1999, average consumption was about 50 kg per person per year. This has reduced slightly, but here in the UK, we’re still consuming three times the recommended daily amount of added sugars, over 23 teaspoons every day. Most of that comes from junk foods, especially soft drinks. As the decades go by, and chronic diseases of ‘modernity’ continue to skyrocket, researchers are finally amassing enough evidence against sugar for people to take seriously the risks that it poses to their health. The sugar industry, unwilling to give up their ‘tobacco’, pays scientists to dilute the pool of research against sugar and, by doing so, contribute to the poor health of people everywhere. And, because sugar is addictive, people will use any excuse not to give up their sweet treats.

 

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We’re all hardwired to seek out sugar. 

Like many survival mechanisms that still exist within us, sugar-seeking and the pleasure we experience from eating it has become anachronistic and damaging. Instead of being naturally limited within our environment, nowadays, pure sugars surround us. Cheap, convenient, tasty and addictive, sugar is added to seemingly everything. But the sweet saccharine has been altering our behaviour and health since it became freely available. Until relatively recently, added sugars have escaped scientific scrutiny because much of it is a match for the sugar within our blood, a source of energy. Sugar, added or otherwise, is used by our bodies as energy or storage (delayed energy). Still, this simple truth has lulled us into a false sense of security, making it all too easy to overeat sugar in its worst forms.  Excessive added sugar is pernicious and slow to act against us. For this reason and because sugar-industry scientists churn out papers that deliberately muddy the pool of research against it, it has taken centuries for people to realise that behind that sweet taste is poison. 

When did we start eating sugar?

Sugar has a history quite unlike any other food—much of it disgraceful.

Sugar cane, the first crop to be converted into granulated sugar as we know it today, was likely domesticated about 10,000 years ago in New Guinea.[4] The locals sucked and chewed away at the stalks of what is technically a grass to enjoy 17% sugar water plus nutrients. Nursing their little sugar cane sprouts, people cultivated the early crop, spreading it around Asia, including the Indian subcontinent. There, around 500 BC, early farmers created molasses by simple processes. Refining it further, the inquisitive bunch transformed the brown syrup into white crystals, making only the second example of a pure chemical substance used in our diet—salt being the first.

This new form of sugar came with all the energy and none of the nutrients.
In about 325 BC, Alexander the Great’s troops encountered the ‘Indian salt’ or ‘honey without bees’ in the Indus Valley, Pakistan today. A writer in the Roman Emperor Nero’s time (38-68 AD) described it as a ‘sort of concreted honey which is called saccharum found in canes in India and Arabia Felix [Yemen]; it is in consistence like salt and brittle between the teeth.’[5]

In his book Sugar Blues, the author, William Dufty, makes a convincing case that everywhere marauding armies came into contact with refined sugar, it began eating away at their ambitions like tooth enamel; they ground to a halt.[6] ‘The Crusaders,’ Dufty tells us, ‘soon acquired a taste for the sauce of the Saracens. Some of them wanted only to languish in the land of the infidels until they could get their fill of fermented cane juice and sugar candy.’[7]

Physician and botanist Leonhard Rauwolf (1535 - 1596) wrote in his journal what the sweet concoction did to the formerly impressive soldiers; ‘The Turks and Moors cut off one piece [of sugar cane] after another and so chew and eat them openly everywhere in the street without shame ... in this way [they] accustom themselves to gluttony and are no longer the intrepid fighters they had formerly been.’[8] When European Crusaders returned home in the eleventh century, they brought sugar with them.

It was an instant hit.

When did sugar become popular?

Originally a luxury in Britain, sugar, recorded as a spice, can be found in the kitchen expenditures of King Henry II (1133 - 1189 AD).[9]

In 1288, Edward I impressed his court with nearly three tonnes of the stuff. For everyone else, the cost was still prohibitive, but its price gradually decreased. In the 16th century, the Portuguese began producing sugar in Brazil as the British, French, and Dutch fought over each Caribbean island for the sole purpose of farming as much sugar as possible. As European tastes began sweetening, growers had guaranteed buyers.

Individuals, governments and the Church were making a fortune.

But natural healers warned people of sugar’s danger to health. Those people who had once been central to communities far and wide became an existential threat to Britain’s sugar-coated prosperity. The Church proclaimed herbalists and other natural healers witches and wizards, evil entities beset on the destruction of God-fearing people, the State, and all that is good. Pious and petrified people looked on as these ‘evil-doers’ were burnt at the stake, drowned or both with frightening regularity until the 18th century dawned.[10] Anyone getting in the way of the booming sugar industry was exorcised one way or the other. Free from any tedious negative health claims, the sugar industry continued to grow.

They needed more manpower.

Succumbing to European diseases, the indigenous peoples of the Americas and the Caribbean had died in their millions and thus were of no use to sugar plantation owners. Colonists began what we now know as the transatlantic slave trade. For the next four hundred years, 11 million Africans were forced—three-quarters of them to support the growth in the sugar industry—across the Atlantic to toil endlessly.

Half of them died en route.[11]

By the 1600s, slavery had made sugar more affordable; Britain imported over seven million kilograms annually. In the 1700s, ships delivered nine million kilograms of sugar to British ports. Men with increasingly wobbly and rotten teeth freighted 73 million kilograms a year to our shores in the 1800s as consumption skyrocketed, multiplying eight times in a single century.[12] But by today’s terms, the sugar trend was only just getting started.

Slaving facilitated this meteoric rise in sugar quantity.

But this abhorrent chapter in European and American history began crumbling after a German chemist, in 1747, started experimenting with a ‘a kind of parsnip’ thought to originate from Babylonia (Iraq). Nearly half a century later, Napoleon Bonaparte became fed up with the scarcity of his favourite sweetener after an effective decades-long Royal Navy blockade robbed French ports of its Caribbean cargo. The French Emperor offered a cash reward to anyone who could advance the technologies of the sugar industry. Finally, in 1812, a French industrialist unlocked the root vegetable’s secret sauce for which he was made a Baron of the French Empire, an award presented by the Emperor himself–which tells you how much Napoleon liked sugar.

For the first time, sugar could be grown and processed in Europe, by Europeans, for Europeans.

No longer a necessity, the French, followed by the British, transcended the barbaric slave trade without the issues of it costing their ruling classes a fortune and the loss of an addictive substance.

Sugar consumption in the 19th century kept climbing whilst the cost went the other way.

In 1874, the British parliament passed a vote to remove the import tax on cane sugar making it cheaper still. Then, increasingly available to the masses and considered a healthy food, people added sugar to everything, coming up with novel ways of slating their increasingly sweet tooth.[13] The Industrial Revolution turbo-charged the production and delivery of new sugar-based foods and drinks.
Instead of being made singly by a confectioner, identical sweets could now be churned out in the thousands being transported by rail and steamship worldwide—foods very high in sugar have almost limitless shelf-lives. In 1838, the Swiss confectioners Lindt, became the first people to mass-produce chocolate bars. The Cadbury family, based in Birmingham, UK, started adding milk in 1905—an idea they probably stole from Hershey's, who already did it. Mass-produced ‘milk chocolate’ had a mellow and sweet taste making it moreish for kids.

Dentists had never been busier.

Tracking precisely our historical consumption of sugar is tricky, however, two American scientists found old US Department of Commerce reports dating back to 1822, which they adjusted for consumption figures.[14] We’re using their data as a proxy for UK consumption because it’s likely to be similar, give or take a kilogram or two per person. Their data features added sweeteners such as cane and beet sugar, high-fructose corn and maple syrup. The chart starts at 6.3 Lbs (2.9 kg) per person in 1822, maxing out at 107.7 Lbs (50 kg) per person in 1999.
Fifty kilograms is about the average weight of a 12-year-old boy.

That’s about 137 grams per day or 34 teaspoons of added sugar. Before sugar refining you’d need to eat about thirty dried dates or ten bananas to equal that portion—but you’d be getting nutrients too, unlike in sugar.

How many added sugars (free sugars) are we eating today?

In the UK, we call added sugars ‘free sugars’. 

But for the purposes of this article, we’ll stick with the more common and explicit name ‘added sugars’. Here’s a definition from the NHS website:

‘The government recommends that free sugars–sugars added to food or drinks, and sugars found naturally in honey, syrups, and unsweetened fruit and vegetable juices, smoothies and purées–should not make up more than 5% of the energy (calories) you get from food and drink each day. 

This means:

• Adults should have no more than 30g of free sugars a day (roughly equivalent to 7 sugar cubes).
• Children aged 7 to 10 should have no more than 24g of free sugars a day (6 sugar cubes).
• Children aged 4 to 6 should have no more than 19g of free sugars a day (5 sugar cubes).
• There's no guideline limit for children under the age of 4, but it's recommended they avoid sugar-sweetened drinks and food with sugar added to it.’ [16]  (Emphasis ours). 

Before 2015, Public Health England recommended no more than 10% come from added sugars. But, as the evidence against sugar piled up like toppings on a Nickabockaglory, advice came from the World Health Organisation and Scientific Advisory Committee on Nutrition—an expert advisory committee that provides the UK government with scientific advice on matters relating to nutrition and health—[17] to slash it to 5%. However, despite a reduction in sugar consumption since the turn of the 21st century, people in the UK are still consuming three times more than the 5% upper limit of daily calories.[18]

Shockingly, 4 to 10-year-olds consume 13.5% of their daily calories from added sugars. For 11 to 18-year-olds that number is 14.1%.[19] That’s a large slice of their daily energy requirements, and what’s more, it’s a slice that contains little to no micronutrients.

Herein lies the problem. 

The only good news is that kids of all ages seem to be drinking fewer sugary soft drinks than they were in 2008.[20] However, sugary drinks still account for about 22% of their daily added sugars, contributing to obesity more than any other single food group. The slight drop may be because they’ve replaced them with diet versions, and/or it may mean people are awakening to the dangers of added sugars, or both. But the fact remains, as a nation, we’re eating and drinking far too much sugar—93.2 grams of added sugar each and every day.

Here’s what that looks like:

Where do most of our added sugars come from?

 Today, people eat more junk food—called ultra-processed foods [d]by scientists—than ever before.

In fact, Brits are getting most of their daily energy from junk foods[e], nearly 57%![22] Junk foods are laden with sugar, none more so than fizzy drinks (sugar-sweetened beverages).[23] Very nearly two-thirds of people’s added sugars are coming from these ultra-processed ‘foods’ and drinks.[24]

Ultra-processed ‘products’ is a better description; all taste and energy, but very few nutrients.

This awful combination of high energy and low nutrients is a driver of obesity and chronic disease.

Those things we buy from shops that are sugary: fizzy drinks, fruit juices, biscuits, sweets, milk chocolate bars, cakes, pastries, most breakfast cereals (especially kids’ cereals), but also so many savoury snacks and so-called ‘healthy’ granola bars and the like which contain hidden sugars. Often, food manufacturers will ‘hide’ sugars by balancing their sweet taste with salt. Your brain registers the sugar, and because you’re hardwired to seek it (a now unhelpful survival mechanism), you reach for another biscuit, crisp or whatever, until the whole packet has vanished. Whether the taste is sweet or sour, when something contains sugar it makes no difference to the sweet receptors in your gut. The calories pile up, and the nutrients go wanting.

These foods are cheap, convenient and absolutely everywhere.

The ‘other sources’ from the pie chart, Added Sugars from Junk Food, are those we mix into a recipe or spoon into a hot drink. They account for about half as much as the sugars from junk foods and, as such, are a fraction of the issue—the main driver of sugar consumption is junk food, not the cake your Granny makes. That said, Granny’s cake is still a source of added sugar, and many people would be wise to eschew it, at least regularly eating it. The point is people are not surrounded by Granny’s cake, but they are surrounded by convenient, cheap, junk food.

The pie charts below provide a detailed representation of added sugar sources—soft drinks are the worst offenders, especially for kids.[25]

How much sugar should we be eating?

A human’s requirement for sugar is zero.

Our liver produces sugar in a process called gluconeogenesis, which makes sugar, added or naturally present in whole foods, from proteins and fat. This makes dietary sugar non ‘essential’. An essential nutrient is one that we need to function but cannot produce in our bodies and, therefore, must get from our diet. You could live your life perfectly healthily from this moment on without adding a single gram of sugar into your diet. However, whether that is optimum for health or not is still out for debate.

Why do we like sugar so much?

In nature, bitterness serves as a warning.

Our ancient ancestors knew that all too well. Sweetness, on the other hand, is a warm embrace. It’s a green light for consumption, the fruit tree offering up its seeds encased in a tempting package of stored carbon and water as carbo-hydrate. This sweet, soft, ripe fruit signals its readiness to be eaten, ensuring the tree's seeds are spread far and wide. In varying fractions, fruits contain glucose and fructose, which are monosaccharides known as simple sugars. Together, they make sucrose, a disaccharide (two simple sugars). Table sugar, made from refined sugar cane or sugar beet, is 100% sucrose, so about half fructose and half glucose.

The difference between whole foods, including fruits, is that they always contain nutrients.

All whole foods contain nutrients. Macronutrients (proteins, carbohydrates including fibres, and fats) and micronutrients (vitamins and minerals) in varying amounts and kinds. These whole foods also contain other beneficial bioactive compounds. Human survival is, in part, about getting enough macro and micronutrients. In the past, whenever our bodies sensed sugar via taste receptors in the mouth and others in the gut, it meant incoming nutrients. There was a time when people had to take any and all the energy and nutrients they could get because there was no supermarket around the corner, just an empty stomach and a prowling pride of predators. Physiologically, we’re exactly the same as those people. Then as now, the chemical messages we receive from eating sugar, which we perceive as pleasure, ensures we keep eating.

Some carnivorous animals have completely lost their sweet taste receptors.[26]

Humans, on the other hand, are hardwired to seek sugar because, in its natural state, it provides nutrients, energy, and, therefore, survival. Andrew Huberman, associate professor of neurobiology at Stanford University School of Medicine, tells the listeners to his popular podcast, ‘Huberman Lab’, that humans are ‘hardwired’ to seek sugar by at least 3 different ‘pathways’.[27] The sweet taste, the nutritive value of sweet whole foods, and a dopaminergic (feel-good hormone) response.

It’s easy to become addicted to this dopamine response.

Is sugar addictive?

 

The lead author, James DiNicolantonio, said in an interview with the Guardian, ‘In animals, it [sugar] is actually more addictive than even cocaine, so sugar is pretty much probably the most consumed addictive substance around the world, and it is wreaking havoc on our health.’[29]

The researchers, looking at both animal and human studies, believe it’s the refining of sugar that makes it addictive and so hard to limit especially in our modern day food-environment, which looks more like Willy Wonka’s Chocolate Factory every year.

Sugar replaced fat everywhere

After the US dietary guidelines of 1980—which became the de facto guidelines for most countries—fat (particularly saturated) became public enemy num[f]ber one.[30] Despite the advice to reduce sugar, all eyes were on the fat content of food. Reducing fat fits perfectly into the overly simple energy-in energy-out model of metabolism. Fat has 9 calories[g] per gram versus carbohydrate which has 3.75 calories per gram. Therefore, the belief goes if you reduce fat in your diet, it’s easier to reduce the total amount of energy (calories) you're consuming. Hey presto, you’ll lose weight. Except that’s not what happened after the guidelines.

Since 1980, obesity around the globe has almost tripled.[31] [32]

In the UK, our guidelines came in 1983 and were, for all intents and purposes, a carbon copy of the US dietary guidelines. The nutritional recommendations reshaped food offerings across a spectrum of institutions, from school cafeterias to university dining rooms, hospital wards, military messes, and within the curricula of medical schools. Doctors and dieticians everywhere began berating the fat in people’s diets. Meanwhile, sugar slipped unnoticed in ever-increasing amounts by replacing the lost flavour of fats in so many foods.

‘Fat-free!’ labels proclaimed, but not sugar-free.

The junk food industry licked its collective lips because sugar is cheaper than fat and much cheaper than protein. And, after all, what harm could sugar do, it’s just energy. Humans need sugar in our blood, or we’re in serious trouble.

Sugar is energy

Sugar is just energy, and that’s precisely the problem. 

As mentioned, sugar is the second only example of a pure chemical substance we add to our diets, the first being salt. The difference is that salt is an essential mineral. Added sugar, in any of its simplest forms, except honey and some natural syrups, gives us energy but no nutrients at all. This is a feat all on its own. 

All other real foods give us energy plus nutrients. 

The energy-in, energy-out model of metabolism, introduced by Wilbur Atwater, simplified our understanding of dietary energy requirements. In the 1870s, Atwater conducted meticulous experiments in which he combusted various foods in his patented Bomb Calorimeter to quantify their caloric content. People started counting calories and became energy-obsessed, forgetting all about nutrients. 

Nowadays, in the world’s richest countries, people have become overfed yet undernourished. 

This means that many of us get too much energy (calories) and not enough nutrients. For the whole of human existence, and in parts of the world where convenience foods still do not flood the streets, people have faced a classic kind of malnutrition: insufficient energy and nutrients. Sugar, refined grains and vegetable oils (seed oils) dominate the ingredients of most junk foods. Those three ingredients are devoid of nutrients themselves, save for some desperately needed fortification. 

Junk food makes up nearly 60% of our caloric intake but offers minimal nutrients.

Blood Sugar is important

Healthy humans keep their blood sugar levels tightly controlled, between about 3.9 and 5.4 mmols/l (70 to 99 mg/dl). If people lose this ability, they become metabolically dysfunctional, which precedes a host of chronic diseases.

The type of sugar found in blood is glucose.

It’s precisely the same as about half the sugars found inside fruits and, to a lesser extent, vegetables. Glucose makes up half of sucrose refined from sugar cane and sugar beet. The blood glucose level is so important that when it drops below that central range, see chart above, a stress response will trigger the liver to create glucose from substrates, including fats and proteins in a process called gluconeogenesis.[33]

However, when the blood glucose levels go above that range, our body must respond quickly by secreting insulin from the pancreas. Insulin brings the blood sugar back down—preferably into its ‘normal’ range as quickly as possible—by carrying glucose from the blood into cells for use as energy or storage (mainly fat). This process humans are well adapted for, however, our high-sugar, modern diets push the limits of what is reasonable, and we’re breaking our ability to balance our blood sugar.

This ‘metabolic dysfunction’ is undermining our health and nibbling away at our life expectancy.

Insulin resistance - the plague of modernity

With varying degrees of seriousness, insulin resistance is a metabolic condition at the heart of a great many diseases of modernity which we’ll cover a little later. It’s characterised by a resistance of the cells to the action of insulin. Insulin acts as an escort to sugar, unlocking the cell door so it can enter to be used for energy or storage. When someone becomes insulin-resistant, it’s like the cell locks have been changed. Blood sugar cannot get into the cells and stays put in the blood vessels, causing inflammation and oxidative stress.[34] Responding to this threat, the pancreas secretes still more insulin in a bid to balance the blood sugar. Now, both blood sugar and blood insulin levels are higher than they should be. Chronic high blood sugar levels are called hyperglycaemia, and chronic high blood insulin levels are called hyperinsulinemia; both conditions are central to the constellation of metabolic diseases that have recently become pandemic.

Excessive sugar consumption, particularly fructose,[35] increases insulin resistance.[36]

Excessive fructose has a lot to answer for

As mentioned, sugar in its most popular form, sucrose, is about half glucose and half fructose. Researchers believe that it’s the fructose that causes the metabolic dysfunction at the heart of so many modern noncommunicable diseases[37] because of the way it’s broken down by the body. Fructose is known as fruit sugar because fruits contain it in varying amounts. Table 1 shows the ten lowest-sugar fruits easily found in the UK.

Fructose is popular with processed food manufacturers because it’s sweeter than glucose. It’s also cheaper in its modern guise, high-fructose corn syrup. Some soft drinks contain three times more fructose than glucose because of the addition of high fructose corn syrup.[38] But, and this is a critical distinction, fruits are satiating and come with nutrients both of which prevent overeating. Unlike glucose, which can move from the gut to the blood with little interference, fructose must be broken down in the liver.

And that’s where many of the problems begin.

What are the diseases of excess sugar

Does sugar make you fat?

For the first time in history, most of the world is now overweight.[40]

According to data from the 2021 Health Survey for England, approximately 26% of English adults fall into the category of obesity, while an additional 38% are classified as overweight.[41] Diets high in sugar cause obesity in a dose-dependent manner[42]—the more sugar someone eats, the more overweight they become and the more likely they are to suffer from almost any disease you care to mention.

We’ll cover some of the worst now.

Does sugar cause non-alcoholic fatty liver disease?

Consuming even a moderate amount of fructose—which is easy today—can overload the liver.[43]

In a bid to protect this precious organ from excessive fructose, the small intestine converts some of your food's fructose into glucose.[44] However, overeating sugar causes this defence mechanism to fail. Fructose floods the liver, which struggles with the conversion. The result is an overproduction of fat that stays inside the liver. This is a condition called non-alcoholic fatty liver disease.

As sugar consumption has increased, particularly fructose from fizzy drinks, so too has this dangerous liver condition.[45] In Western countries, it affects about 25% of the adult population.[46] But kids are far from immune. Between 2009 - 2018, kids saw an increase of 62% in fatty liver.[47] In the early stages, there are few definitive symptoms, so diagnosis is often delayed.

As the liver continues to fill with fat, inflammation results.

The critical organ’s performance begins to splutter. Irreparable liver damage can start people down the road towards cirrhosis and eventually liver cancer.[48] But earlier on the path—a path people are often unaware they’re on—fatty liver increases the likelihood of heart disease,[49] dementia,[50] diabetes, high blood pressure and kidney disease, to name a few.[51] It’s interesting to note that so many of the conditions closely associated with obesity share this increasingly common liver pathology and insulin resistance, both of which track closely with the rise in added sugar consumption.[52]

Notice the word ‘associated’.

Most nutritional studies that look for links between certain foods and conditions have to be conducted observationally (epidemiology). Researchers ask a group of people (a cohort) for information about their diet, often in the form of a long list of tick boxes known as a food frequency questionnaire. These forms have problems with accuracy. Time passes. At certain points, the researchers will examine which people have become ill and/or died of a noncommunicable illness. At the end of the study, they’ll see if any dietary commonalities exist between those people and their conditions.

These studies can only show associations.

Clinical intervention trials, including the gold-standard randomised control trials (RCTs), are more powerful and can show cause and effect. RCTs are expensive to run and need to be held within a tightly controlled dietary environment for long enough to see whether certain foods have an effect on particular diseases. This means locking people away for weeks or months at a time, away from their normal patterns of eating and away from the temptations that plague us all. There are also ethical considerations. Take sugar. If a group of scientists think that sugar is disease-causing, they can’t recruit healthy people to see if they can make them unhealthy by feeding them sugar. The only way to do it is to watch groups of people who eat lots of sugar and groups that don’t and then see what happens over the duration of the observational trial. Of course, sugar isn’t the only problem in people’s diets and lifestyles, so extrapolating a single dietary element as the cause of a disease is impossible.

Despite these issues, it’s still worth running these trials, but it’s important to acknowledge their limitations.

Does sugar cause heart disease?

In a study following a large group of Swedish people, researchers found that those drinking more than eight sugary drinks a week had a higher chance of stroke. Also, eating sweet treats like cakes and cookies twice a week or less was linked to a greater risk of not only stroke but also heart attacks and irregular heartbeats, known as atrial fibrillation.[53]

A diet rich in added sugars has been linked to a tripled risk of dying from heart conditions. The proposed mechanisms were increases in chronic blood sugar, blood pressure and blood fat (known as triglycerides), all of which are reliable markers for heart disease risk.[54] The authors recommended greater public reductions in added sugars mentioning table sugar and high-fructose corn syrup found in many ultra-processed foods and drinks.[55]

Observational research involving more than 25,000 adults revealed that those eating higher amounts of added sugar faced an increased risk of heart disease and related complications compared to those who consumed less added sugar.[56]

In a meta-analysis of 39 randomised controlled trials, each lasting at least two weeks, researchers showed sugary drinks versus ‘diet’ versions caused a significant rise in triglyceride levels as well as other markers of heart disease risk.[57]

The sugar and cancer connection

‘Cancer, above all other diseases, has countless secondary causes. But, even for cancer, there is only one prime cause. Summarised in a few words, the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.’
Otto Heinrich Warburg, Scientist and medical doctor. (1928).[58]

After making a groundbreaking discovery that would become known as the ‘Warburg Effect.’[59] Otto Warburg won the 1931 Nobel Prize in Physiology or Medicine.[60] He demonstrated that most cancer cells burn sugar in a low-oxygen environment for energy to grow and metastasise, unlike normal healthy cells.[61] But what could have—should have?—changed cancer therapies worldwide flopped. There’s no money in telling people to quit sugar.

The world chemotherapy market was valued at USD 9.5 billion in 2022 and is predicted to metastasise to USD 17.61 billion by 2031. That’s great news for pharmaceutical companies and those in their pay but terrible news for the rest of us. As cancer begins to knock heart disease off the world’s biggest killer podium, researchers have begun to take a more active interest.

Using animal studies, scientists revealed that a ketogenic diet—a diet so low in carbohydrates that fat rather than sugar (glucose) becomes the body’s main fuel source—significantly prolonged life and shrunk tumours.[62]

Other studies point to sugar as a molecule of interest.

A comprehensive review of 27 different studies found that people who regularly drink sugary drinks are more likely to develop breast cancer, colorectal, pancreatic and prostate cancer compared to those who drink less. The same review also found an increase in the risk of prostate cancer for those who frequently consume fruit juices.[63] Two further studies also found links between sugary drinks and breast cancer.[64] Insulin resistance increases belly fat (visceral fat stores) and chronic systemic inflammation, both of which create a favourable environment for cancer growth.[65]

Another review paper noted that out of fifteen studies examining the intake of sugary foods and drinks, eight reported higher consumption of sugary beverages was linked to a 23% to 200% increase in cancer risk.[66] A nine-year study involving more than 22,000 men indicated that those who drank more sugar-sweetened beverages had a higher likelihood of developing prostate cancer.[67]
Higher intakes of sucrose (table sugar) from sweetened desserts and drinks increased the occurrence of oesophageal cancer.[68]

Does sugar cause dementia?

Alzheimer’s disease is the most common form of dementia. Since 1990, this malevolent disease has increased by 150%.[70] Only 5% of Alzheimer’s is genetic, the rest is about lifestyle and environment, a large portion of which is diet.[71] There is now so much research pointing towards added sugar as a potentially causative player via ramped-up insulin resistance,[72] that some scientists have taken to calling the condition diabetes type 3.[73]

A research review in The Journals of Gerontology examined how fructose consumption impacts cognitive deterioration and neurodegenerative conditions.[74] The study's findings, based on animal research for ethical reasons, indicate a connection between fructose intake and the development of Alzheimer’s disease and other cognitive disorders. Human observational data also shows a link between Alzheimer’s disease and sugar consumption.

In a study spanning nineteen years with nearly 2,000 participants, those with higher consumption of sugary beverages had an increased risk of developing dementia, including Alzheimer's Disease.[75] Four thousand individuals from the Framingham Heart Study revealed a significant link between consuming sugary drinks and brain shrinkage and a weaker memory. This association held true even after accounting for various lifestyle and demographic variables.[76]

Up to 80% of people with Alzheimer's either have full-blown diabetes or insulin resistance.[77]

Does sugar cause diabetes mellitus? 

The name ‘diabetes’ comes from the ancient Greek word syphon because frequent urination characterises the condition. ‘Mellitus’ means ‘honey-sweet’ in Latin, denoting the sugary taste of a patient’s urine. From ancient times until the beginning of the 20th century,[78] doctors would diagnose diabetes by tasting a patient's urine. Sweet-tasting urine would signal disaster because, until the discovery of insulin in 1921, diabetes meant a painful, lingering death.[79]

Diabetes mellitus (type 2) can be thought of as insulin resistance to the point of chronic illness.

Despite fructose not raising blood sugars directly, in those countries consuming the most, there is a 20% increase in diabetes.[80] Remember that non-alcoholic fatty liver disease can be caused by excessive fructose in the liver.[81] Fatty liver increases someone's chances of developing type 2 diabetes two-fold, irrespective of whether they are overweight or not.[82] Regular sugary drinkers are 25% more likely to develop type 2 diabetes.[83] Adding just one sugary drink to your daily routine increases the chances by 13% independent of weight gain. In other words, you don’t necessarily have to be overweight to get diabetes.[84] Interestingly, when people reduce their sugar intake to below 5% of their total daily calories, their chances of getting pre-diabetes drop by 50%.[85]

Remember that people in the UK are tripling that daily 5% and inviting diabetes in.

Some say sugar is fine ‘in moderation’

You’d be forgiven for thinking that all of the scientific evidence has revealed that added sugars are disease-causing, but that’s not the case. James Rippe MD and Theodore Angelopoulos PhD, quoted above, performed a review of the literature that purports to show neither causation by or association of added sugars and disease prevalence. 

Some of the clinical studies they assessed used pure forms of either fructose or glucose, rather than sucrose, ‘neither [of] which is consumed to any appreciable degree in the human diet’, they write. 

Clinical studies speculate about the causes of chronic illnesses using data from short-term trials, which is more guesswork than science. The two research scientists remind us that observational studies cannot show causation and have ‘clouded the debate’. Data from animal research ‘translates poorly to humans, particularly in the areas of nutrition [and] metabolism’ they add. The two researchers deplore those scientists who fail to draw attention to the limitations of their own studies, which the media then misrepresent, opting for sensationalism rather than objective reporting. Concluding their paper, the authors write, ‘We wish to emphasise that we are not recommending excessive consumption of added sugars.’ They feel a ‘reasonable recommended upper limit’ of up to 20% of daily calories from added sugars is safe. Beyond that level, they agree, sugar probably elevates triglyceride levels (blood fat)—a marker of cardiovascular disease and metabolic conditions, including diabetes type 2, high blood pressure, fatty liver disease and a host of others. 

A 2014 review found that singling out fructose as responsible for the overweight and obesity epidemic wasn’t possible because consumption is calculated based on sales of added sugars, which doesn’t actually tell us how much people are eating.  Similarly, another review demonstrated that our fructose consumption hasn’t ‘disproportionately increased’ in the past ninety years. And that ‘fructose is safe at typical intake levels but can produce adverse metabolic effects when abused—as is true of most nutrients.’ 

The truth behind ‘everything in moderation’

Papers funded by the sugar industry are 96.2% more likely to be negative for links between sugar consumption and disease.[91] Funny that. At the risk of sounding cynical, it’s almost as if there are scientists out there working for sugar and junk food companies to deliberately muddy the waters of research and deflect attention away from their revenue maker. Take the main author of the paper cited in the above section, James Rippe, MD. Based on his research, he believes that we could all be eating more sugar, not less. Up to 20% of our daily energy requirements if you fancy it—from a refined carbohydrate that contains no other nutrients at all.

There’s nothing moderate about that.

Now, we’re not for a second saying that Dr Rippe—or any of the other scientists at the beck and call of the sugar industry—are anything but truth-seekers, working away in science for the well-being of their fellow human beings, the hefty weight of their paychecks just a cross they have to bear, but we do think that it’s worth looking at the conflicts of interests in all research. The following quote is worth considering: ‘J.M. Rippe’s research laboratory has received unrestricted grants, and J.M. Rippe has received consulting fees from ConAgra Foods, Kraft Foods, the Florida Department of Citrus, PepsiCo International, The Coca-Cola Company, the Corn Refiners Association, Weight Watchers International and various publishers.’[92]

The 2014 paper mentioned above that discusses the impossibility of calculating fructose consumption by sales was sponsored by the International Life Sciences Institute (ILSI), which purports to be a non-profit organisation advancing science for the benefit of the public. In reality, it’s a lobby group working with companies, including Coca-Cola and Monsanto (now Bayer) who make high fructose corn syrup. They have been instrumental in trying to counter public health policies regarding advice to reduce added sugar consumption further.[93]

Dean Shillinger and his team of researchers looked into sugar industry funding of intervention trials, including randomised control trials and reviews of them.[94] They did not cover observational trials because the findings are generally weak, as mentioned. Searching the literature, they found sixty studies to include. Sugar-industry-sponsored studies numbered 26. Unsurprisingly, 25 of them showed no links between sugar consumption and disease. Included were 34 independently funded studies, 33 of which showed clear links between the ubiquitous sweetener and disease. By flooding the research pool with papers that show no disease risks with a ‘reasonable recommended upper limit’—which they define—the sugar industry working together as The Sugar Association[95] continues to peddle their wares whilst blaming anything but sugar.

They hide behind the mantra 'everything in moderation' and ‘move more, eat less’ which firmly places the blame on the individual, not their products. Junk food manufacturers surround us with sugar-based convenience products which they have deliberately designed to have addictive qualities.[96] These companies know full well that once you pop, you just can't stop. At the same time, they hide behind the energy in energy out model of metabolism because in a 3000-calorie per day diet, who's to say that it's their junk foods that have caused the energy surplus? Surely it's the fat which has more than twice the amount of calories per gram than sugar? If only it were that simple. 

Does sugar turn into fat?

Diets high in added sugars are more likely to promote obesity via several mechanisms. 

Firstly, sugary drinks are not satiating, which means people don’t compensate at meal times, leading to an overall increase in dietary energy. They’re also addictive, meaning more are consumed. Additionally, the rapid absorption of large amounts of sugar from these drinks can cause a spike in the storage hormone insulin, leading to more fat gain, especially when someone is insulin-resistant. 

Moreover, the excessive intake of fructose can lead to non-alcoholic fatty liver disease, inflammatory fat settling around the internal organs (visceral fat) and high triglyceride levels, all of which contribute to increased health risks independent of weight gain.

Sugar-sweetened beverages are the number one route of added sugars, including fructose, in people’s diets. The weight of the evidence, even when industry-sponsored papers are included, shows a ‘strong’ causative relationship between their intake and overweight, obesity, type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease. 

What can you do about it?  

Avoid added sugars wherever you can

Whilst the scientists on either side of the debate fight it out on why sugar is bad for you, your lifetime ticks by. These issues are not settled quickly; don’t wait until you have metabolic dysfunction, cardiovascular disease, or both before you cut back or eliminate completely your added sugars. Fortunately, it’s pretty easy to do once you’ve got past the first couple of weeks when certain sugar-loving intestinal flora attempt to take over your mind. These little gut bugs hijack your mind and body, directing you zombie-like to the local corner shop for a milk chocolate bar and a can of fizzy drink. 

You have to break the cycle. 

The easiest way to get rid of added sugars from your diet is to make direct swaps for your sugary favourites for added sugar-free ones. Heinz BBQ sauce, one of the world’s favourites, contains 27.8 grams of sugar per 100 grams. Now, swap that for our Hunter & Gather Barbecue sauce, which only contains 7.9 grams per 100 grams—that’s 74.1% less sugar.  Or, swap Heinz tomato ketchup for our Hunter & Gather Unsweetened ketchup and get a 72% reduction in sugars, all of which are natural sugars from tomatoes. 

Once you’ve done that and broken the cycle of sugar addiction, you can begin improving your diet in other ways by aiming for nutrient density and complete proteins in every meal, choosing unrefined whole foods, and dropping habitual convenience foods completely. 

No doubt you’ll start feeling better. 

And that’s when you can bolt on more health-sustaining lifestyle habits like exercising regularly. To a certain extent, exercise protects your liver from fructose because some of it is converted into glucose to be used as energy in the muscles.[99]

Just one benefit of exercising, but remember, you can’t out-train a bad diet. 

 

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About the author

Tim Rees, BSc mBANT rCNHC, is a registered clinical nutritionist specialising in dietary and lifestyle interventions for chronic diseases. Combining his dual passions of nutrition and history, Tim crafts engaging narratives that breathe life into subjects that might otherwise be considered dry. Operating from his home base in scenic Bavaria, Tim immerses himself in the natural beauty of the surrounding mountains and lakes whenever possible.

 

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