Sugar the evidence

Just as this page documents recent academic articles questioning current dietary advice, so this page documents recent academic articles about sugar. All the papers are from 2015 onwards except the first two position papers, which are important to capture:

Position statement on Sugar & cardiovascular health: Johnson RK, Lustig RH, et al. “Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association”. Circulation. 2009

Position statement on Sweeteners & health: Gardner C, et al. “Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association.” Circulation. 2012.

Articles from 2015:

Summary of evidence (Cochrane link). October 2015: Public Health England. “Sugar Reduction: The evidence for action.

Fructose & Cardiometabolic health. October 2015: Malik VS, Hu FB. “Fructose and Cardiometabolic Health: What the Evidence From Sugar-Sweetened Beverages Tells Us”. J Am Coll Cardiol.

Sugar sweetened drinks & Hypertension. October 2015: Jayalath VH, et al.”Sugar-sweetened beverage consumption and incident hypertension: a systematic review and meta-analysis of prospective cohorts”. Am J Clin Nutr.

Sugar & Tooth decay. October 2015: Meyer BD, Lee JY. “The Confluence of Sugar, Dental Caries, and Health Policy“. J Dent Res.

Sugar sweetened drinks & Global burden of disease. August 2015: Singh GM, et al; “Estimated Global, Regional, and National Disease Burdens Related to Sugar-Sweetened Beverage Consumption in 2010.” Circulation.

Refined carbohydrates & Depression. August 2015: Gangwisch JE, el al. “High glycemic index diet as a risk factor for depression: analyses from the Women’s Health Initiative”. Am J Clin Nutr.

Sugar, Tooth decay & Obesity. July-Aug 2015: Yeung CA, Goodfellow A, Flanagan L.”The Truth about Sugar”. Dent Update.

Sugar sweetened drinks & Type 2 diabetes, independent of obesity. July 2015: Imamura F, et al. “Consumption of sugar sweetened beverages, artificially sweetened beverages, and fruit juice and incidence of type 2 diabetes: systematic review, meta-analysis, and estimation of population attributable fraction”. BMJ.

Sugar consumption & Addiction. June 2015: Tryon MS, et al. “Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body”. J Clin Endocrinol Metab.

Sugar sweetened drinks, Diabetes & Kidney disease. June 2015: Yracheta JM, et al. “Diabetes and Kidney Disease in American Indians: Potential Role of Sugar-Sweetened Beverages“. Mayo Clin Proc.

Sugar & Aging. March-April 2015: Ross SM. “Sugar-induced aging: the deleterious effects of excess dietary sugar intake”. Holist Nurs Pract.

Fructose & Type 2 diabetes. March 2015: DiNicolantonio JJ, O’Keefe JH, Lucan SC. “Added fructose: a principal driver of type 2 diabetes mellitus and its consequences”. Mayo Clin Proc.

Sugar sweetened drinks & early onset of menstruation. March 2015: Carwile JL, et al.Sugar-sweetened beverage consumption and age at menarche in a prospective study of US girls”. Hum Reprod.

Sugar sweetened drinks & Snacking. March 2015: Bleich SN, Wolfson JA. “U.S. adults and child snacking patterns among sugar-sweetened beverage drinkers and non-drinkers”. Prev Med.

Sugar sweetened drinks, Hypertension & CVD. March 2015: Xi B, et al. “Sugar-sweetened beverages and risk of hypertension and CVD: a dose-response meta-analysis”. Br J Nutr.

Conflicts of interest in the sugar industry & UK institutions & individuals. February 2015. Gornall J. “Sugar: spinning a web of influence”. BMJ.

Sugar & CVD. Jan-Feb 2015. Ross SM. “Cardiovascular disease mortality: the deleterious effects of excess dietary sugar intake”. Holist Nurs Pract.

Sugars, Metabolic Syndrome & Cancer. January 2015. Das UN. “Sucrose, fructose, glucose, and their link to metabolic syndrome and cancer”. Nutrition.

Sugar & FDA approval: Is it even safe? 2015: Card MM, Abela JF. “Just a Spoonful of Sugar Will Land You Six Feet Underground: Should the Food and Drug Administration Revoke Added Sugar’s GRAS Status?” Food Drug Law J.

(Please note, this is just a selection of articles on sucrose/sugar from 2015. On the date of this post, a pubmed search of (“sucrose”[tiab]) OR “sugar”[tiab])(tiab picks up the words sugar or sucrose in the title or abstract) in humans from 1 January 2015 to 19 January 2016 produced 677 articles. I picked review articles, which looked easier to digest than this one!)

For older articles, see the c.140 references at the end of this post.

25 thoughts on “Sugar the evidence

  • avatar
    July 20, 2016 at 2:31 pm
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    Excellent. One suggestion- can you add a Pinterest button to your Share the Knowledge line-up there?? Will link this page in a couple of my own blog posts on prevention and nutrition. Thanks for the info!

    Reply
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      July 20, 2016 at 2:59 pm
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      Hi Joyce
      Many thanks for this – if you go to the bottom of the article the share buttons are there. The green one has “more options”. One of these is pinterest :-)
      Share away!
      Best wishes – Zoe

      Reply
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  • avatar
    March 22, 2016 at 2:19 pm
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    It pains me to link to this blogpost, as I am a guest blogger on this blog, and they are rigorous when it comes to their political research. I don’t know what prompted them to publish this, on a subject not usually covered by them. But Stephen Hoffman, Parliamentary Liaison Officer for Conservatives for Liberty’s arguments (and “facts” to support his arguments) against the sugar tax are dismal:

    I have replied to him in the comments there.

    http://hurryupharry.org/2016/03/21/a-sugar-tax-would-leave-a-sour-taste-in-the-mouth/

    Reply
  • avatar
    February 14, 2016 at 10:16 pm
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    Just read this outrageous report in today’s Sunday Times: HIGH-SUGAR baby and toddler foods have been removed from a new government app designed to alert parents to food with high levels of sugar.
    PHE said it had removed the baby foods because some of the products contain natural as well as added sugar, and it is now considering how best to label them. Currently the app does not distinguish between the two sugars. Many nutritionists say such a distinction is arbitrary. igned to alert parents to food with high levels of sugar…

    Zoë Harcombe, an obesity expert, said: “The ignorance about sugar is shocking. Sugar is sugar, the body doesn’t distinguish where it comes from. The sugar from fruit is no different from the glucose and fructose from sucrose — the body has no means of discerning one from the other.”

    http://www.thesundaytimes.co.uk/sto/news/uk_news/Health/Sugar/article1668033.ece

    Reply
  • avatar
    February 5, 2016 at 12:49 pm
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    Hi Zoe,

    How far do you take this ‘recent’ information that the sat fat molecule will bind to a glucose molecule, and make it even more difficult for your insulin to shuttle the glucose out of your blood, because the two molecules together are ‘sticky.’ (If what I’ve said is medically correct).

    So for example, after I go to the gym (in the morning) I drink this smoothie at 9am; whole milk, oats, banana, avocado (or coconut or cashews), honey, cacao, maca, goji berries.

    It’s all 100% organic… so should I been worried that the fat element, the sat fat in the avocado or coconut, is binding together with the carbs in the oats, banana and honey and causing me long term problems?

    Best wishes,
    Mary

    Reply
    • avatar
      February 5, 2016 at 1:40 pm
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      Hi Mary
      You’d have to send a link – I have heard of nothing along these lines. I have written about the impact for weight of eating carb/proteins and fat/proteins together extensively in my diet books (Stop Counting Calories & Why do you overeat?) If you’re worried about weight, this may interest you.
      http://theharcombediet.com/2014/03/the-harcombe-diet-phase-2/
      Best wishes – Zoe

      Reply
      • avatar
        February 5, 2016 at 2:18 pm
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        Hi Zoe,

        I first heard it on this video at 1m 10s ;

        https://www.youtube.com/watch?v=j-Ylx25SmV0

        It’s just someone’s opinion who I respected, but perhaps it’s not a good idea to listen to every person who has a Youtube channel and just stick to one source – ie your good-self! :)

        I have just ordered your book from Waterstone’s website to get properly educated!

        Best wishes,
        Mary

        Reply
        • avatar
          February 5, 2016 at 6:39 pm
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          Hi Mary
          I watched a few mins – I agree with Chris on blood glucose being a concern, but the fat stuff doesn’t make sense:
          1) Why single out sat fat? All food with fat contains all 3 fats – you can’t eat sat fat alone – not many people seem to understand this http://www.scirp.org/journal/PaperInformation.aspx?paperID=28741

          2) How does sat fat get into the blood stream (assuming we eat food rather than intravenously inject it?!)

          3) The ‘but for’ in all of this is carbs – things that raise blood glucose – so worry about those and pretty much only those.

          I would recommend looking at lots of different info sources – then you can build up a view on what you trust. Chris seems open to Qs so best to ask him what he thinks about what he says, rather than me.

          I would worry about the honey (pure sugar)/banana (sugar)/berries (sugar) and oats – starch and sugar – that you have after the gym, not the avocado. Plus all of this needs to be in the context of you as an individual and what your goals are. If you’re young, slim, healthy, not type 2 diabetic and you exercise a lot, worry less about carbs. If you’re not, worry more :-)

          Best wishes – Zoe

          Reply
          • avatar
            February 6, 2016 at 2:22 am
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            Please correct me if I’m wrong, but my understanding is that excess carbs, when processed by the liver, get converted into saturated fat. If that’s accurate, then is it possible that saturated fat in the blood (really, in the lipoproteins) could indicate excess carb intake?

            I grant that I could very well be wrong on the premise, but it might explain why sat fats seemed to be an indicator of metabolic problems, apart from sat fats in the diet.

          • avatar
            February 6, 2016 at 9:03 am
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            Hi David
            Interesting. I’m not a biochemist but then I tried to talk to a biochemist once about how sat fat could ever become LDL and he couldn’t answer this (this is the famous Dr Malc Kendrick challenge – since 2007) or much else about food!

            Carbs impact VLDL (triglyceride in the blood) directly. (Elizabeth J. Parks, “Effect of dietary carbohydrate on triglyceride metabolism in humans”, The Journal of Nutrition, 2001.) That’s one route.

            Plus – as you say – excess carbs are removed from the blood stream and stored by the liver as glycogen. If not used (within c. 24 hrs) the liver turns the glycogen to fat. The fat is packaged into lipoprotien taxis to be transported for storage in fat cells, so, yes, it is temporarily in the blood stream in transit – but it’s in ‘taxis’ – not floating around clogging up arteries as some daft people think!

            Then – the fat made by the liver will not just be saturated fat. In food, all foods that contain fat contain all 3 fats (sat, mono, poly) – no exceptions. I say this at conferences and people look like I’ve told them the earth is round! Humans are just cat food – we are also, therefore, made up of all 3 fats. So the liver will make a fat composition with sat/mono and poly in it. That’s also why the video Mary sent a link to didn’t make sense on fat – why just talk about sat fat? What does he think the mono and poly fat in all foods with fat are doing to this sticky blood glucose theory? Notwithstanding that fact that all lipids are in lipoproteins?!

            That’s my understanding!
            Best wishes – Zoe
            p.s. plus there’s fructose which just goes direct to the liver and can make the liver fat!

          • avatar
            February 6, 2016 at 6:02 pm
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            Thanks for the thorough reply. (I’m replying to your latest, but it doesn’t have a reply link. Must be the deepest allowable comment in the chain.)

            It got me thinking, so I looked up to figure out why I was thinking about the relationship between sat fats and the liver. When the liver turns carbs to fats, the first processes create palmitic acid, which is a sat fat. If the processes stop early, you get shorter chains. But from palmitic, further extension to stearic, etc. happens by a different process. And de-saturation is by different processes as well.

            So you’re absolutely right: the liver produces all three fatty acids. My confusion was that a sat fat is the “hub” of all fatty acid production in the liver. There are probably some correlations to palmitic acid vs. other fatty acids than give insight to the amount of production in the liver, but that’s not the same as saying that the liver produces only palmitic acid. (And incidentally, de-saturation is limited and cannot produce certain fatty acids, which is why there are essential fatty acids that we must have by diet.)

            It’s all clear now. Thanks again!

          • avatar
            February 7, 2016 at 5:55 pm
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            Someone (Feinman?) recently pointed out that Free Fatty Acids were higher in the blood of high carb eaters for the simple reason that the body was concentrating on metabolising the glucose to get it out of the way ASAP, and left the fats until later as they were less harmful.

  • avatar
    February 5, 2016 at 12:39 pm
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    Hello Zoe,
    So I have read a synopsis of the sugar stuff, and since I read Yudkin in the 70’s I havei long been convinced. I know Aylcohol is not a sugar, but am confused as to how the body treats it. Can you or another knowledgeable reader enlighten me?

    Reply
    • avatar
      February 5, 2016 at 5:16 pm
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      Hey Chrissoh,

      As best as I understand, so far as the liver is concerned, alcohol is metabolized in basically the same fashion as fructose. There are some differences in the beginning of the process, but they end up following the same metabolic chain of events. Lustig’s video “Sugar: The Bitter Truth” on Youtube ( https://www.youtube.com/watch?v=dBnniua6-oM ) goes through the technical details. He shows the liver processes for glucose, alcohol, and then fructose starting at about 44:00 or so, and then coming to his conclusion at around 1:09:00.

      Short story: the liver treats alcohol like fructose, with a couple of differences. Alcohol obviously has other effects elsewhere in the body, however.

      (Aside: I’m not endorsing or criticizing his stance on anything, as I’m not yet sure what I think about his affection for glucose, but those slides on metabolic pathways are very useful to me.)

      Reply
  • avatar
    January 27, 2016 at 11:25 pm
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    Again, the media, and the Government, piles in on the wrong target.

    In the 1970s it was saturated fat.

    In the 1980s, it was cholesterol.

    In the 1990s, and so on, it was lack of exercise….

    Now that these have pretty much been debunked as the monsters under the bed, they have to find a new target, and it is ‘sugar’.

    Most ‘sugar’ these days is fructose which, as far as I am aware, isn’t the main culprit as far as obesity is concerned as it is dealt with by the liver and not insulin.

    The target that the health authorities should be aiming at is good old, “healthy pasta, wholegrain bread, and potatoes (that has lots of vitamin C under the skin)”.

    Plus ca change, and all that….

    I think Zoe’s blog will run for another 30 years.

    Reply
  • avatar
    January 26, 2016 at 8:39 am
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    Hi Zoë,

    A little off subject – dear old BBC is running a new series on sugar (first episode last night) that I watched for a little comic relief. Some truth in there but, as with so many BBC health programs they present old information along the lines of “new research”. Last night they were advising a group of people on how to reduce sugar intake but the emphasis was on refined sugar rather than all sugars. I wondered how they would deal with fruit bearing in mind that fruit, according to officialdom, should form part of the mythical five-a-day. Sure enough they stated that fruit doesn’t count when reducing sugar as it contains lots of vitamins etc. (perhaps they should analyse some fruit to see just what the vitamin content is – not as much as they think I suspect) and it good for you. Nor did they mention the dangers of fructose and the variation between fruits. Unless I missed it they also didn’t point out that all carbohydrates are broken down to glucose. But they are not going to say cut back on carbs because that would mean an increase in fat consumption and of course that is verboten!
    Another three thrilling episodes to come.

    Meanwhile it appears that many of us may be suffering from orthorexia nervosa and are in danger of becoming a CHE. I sense a pill to cure that in the not too distant future – thank God, I’m saved!
    http://www.naturalnews.com/052748_orthorexia_nutritious_food_mental_disorder.html

    Take care.

    Reply
    • avatar
      January 26, 2016 at 8:47 am
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      Hi Barry
      Many thanks for the heads up – too many progs at this time of year on diet stuff and most would raise BP!
      Good to hear you’ve worked out the fat from the trees ;-)
      Best wishes – Zoe

      Reply
    • avatar
      February 4, 2016 at 7:10 pm
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      Oh yeah, for millennia we all suffered from Orthorexia Nervosa because we had no dieticians (backed by “food” manufactures and drug companies) to tell us we were going wrong by eating hunted animals and gathered veggies, eggs, fish, small mammals, insects etc.

      Thank @deity we now know better and can eat all those hearthealthywholegrains and industrially produced Omega 6 seed oils laced with trans fats that are so much healthier.

      Oh, wait a minute . . .

      Reply
  • avatar
    January 23, 2016 at 10:19 pm
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    I’ll look through these later. The problem with concentrating on sugar though – or fructose – is that it diverts attention away from glucose and all the other carbs which are metabolised directly into it. I was always accused of eating “too much sugar” when my problem was actually caused by too much starch. This mindset is still being reinforced in doctors.

    Reply
  • avatar
    January 20, 2016 at 10:00 pm
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    Thank you so much for compiling this list of recently published work on sugar. It is very helpful to me with my work looking at renal disease prevention in a very high risk population with massive consumption of sugary drinks, foods and highly refined junk foods.

    Reply
    • avatar
      January 25, 2016 at 4:33 pm
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      Thank you for posting the links. I am glad that so many scientists and doctors begun fighting the sugar industry but it is probably not enough. Even a few years ago there were only a few papers per year. It seems to have reached an avalanche stage. Also, it is not as simple as fighting the sugar and high fructose producers. Food companies are much more clever than betting on sugar and beverages alone. They have been promoting high carbohydrates nutrition under the disguise of “healthy” natural fruit and vegetables plus anti-meat lies & propaganda which subtly pushes people towards high starch in one form or another. Which brings me to another point I have to make since it is so rarely being mentioned and it is not just about sugar:

      – Plant based nutrition is inferior for humans than animal produce based diet!

      I was appalled how many vegetarian restaurants have sprung up in many European cities (I am in Warsaw at the moment). It is hurting many of my friends and families who don’t seem to be aware what is hitting them. I see more thyroid disorders, metabolic syndrome and mood disorders then ever before.

      Stan (Heretic)

      Reply

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