Researchers at UCSF argue that sugar poses a danger to health and should be regulated like alcohol and tobacco. Is sugar just empty calories, or something much worse?

Robert Goldberg, vice president and co-founder of the Center for Medicine in the Public Interest and author of "Tabloid Medicine"
Jo Ann Hattner, registered dietician and consultant at the Stanford School of Medicine
Claire Brindis, professor of pediatrics and director of the Philip R. Lee Institute for Health Policy Studies at UCSF
Fredric Kraemer, professor of medicine and chief of the Division of Endocrinology, Gerontology and Metabolism at the Stanford University School of Medicine

  • Blake

    I first encountered this topic when I watched a video on Youtube featuring Robert Lustig, entitled Sugar: The Bitter Truth, wherein he explained the detailed biochemistry of how fructose is metabolized in the body. That was fascinating, but it occurred to me that during a period when I managed to lose substantial weight while living very healthily, I did not consume sugar — I was experimenting with alternatives at the time like Xylitol. Since then, consuming sugar while otherwise living healthily has not led to weight loss for me. So I wasn’t surprised when I recently heard that Alec Baldwin lost a bunch of weight, something like 40 pounds, and that he attributed his achievement mainly to removing sugar from his diet.

  • DanielAyer

    I live in San Francisco, but went to high school in Marin county.  I’ve always thought it unconscionable that we foist sugary drinks and junk foods on teenagers who are dealing with physical, emotional, and sexual changes.  We then expect them to sit quietly, focus on tasks, and learn.
    I know that the schools get lots of money from these deals, but do we have to fund our schools by selling our children as a commodity?  Should education outweigh health concerns?

  • Diana Jacobs

    What about the role of starch (e.g. from refined flours) in health problems?  Isn’t starch broken down into simple sugars during digestion?  Since refined flours are a triple negative (no fiber, no protein, added sugar) perhaps white bread, white pasta, white pizza dough are a better or at least equal target to start with.a major health initiative.

    • RegularListener

      The guest addressed this: the “sugar” in white flour is glucose and it is metabolized very differently from fructose, which is in both table sugar and high fructose corn syrup. In short, fructose is metabolized in liver and glucose is metabolism in all body cells. The effect on the body is therefore quite different. If you want more detail on the chemical mechanisms I recommend the YouTube video of Robert Lustig (it’s called Sugar the Bitter Truth). I think his organic chemistry mini-lecture about glucose & fructose is about 20 minutes into the video. It is very illuminating 

      • $311151

        Table sugar is sucrose.

        • RegularListener

          I said fructose is IN table sugar, not that table sugar is frucose. Sucrose (table sugar) is made up of a fructose molecule and a glucose molecule, as is high fructose corn syrup. According to Lustig & others, its the fructose part of those molecules that is metabolized differently and thereby causes much bigger problems than either pure glucose (in white flour), or the glucose molecules that are also in sucrose or high fructose corn syrup. And the fructose in most fruits is not a such problem because fruit contains so much fiber that people rarely over consume it they way they can easily overcome sweets.. Please watch Lustig’s video before commenting.

  • Sarahmae

    Interesting topic…I hope there will also be a discussion of the government subsidizing these sugary, disease-inducing foods! How can the gov tax consumers for buying foods we’re already being taxed to pay for? It’s not a nanny state if the government stops putting our money there, while it could be considered so if we were taxed for buying them (a sort of double jeopardy).

  • Timothy

    Having knowledge of the dangers of sugar consumption is important but then what is one to do?  It is very difficult to find foods in the in supermarket without added sugar. I’d like to cut sugar from my diet but appreciate the convenience of packaged foods.  One of your guests mentioned lists of processed food that don’t have added sugar and salt.  Can she recommend such lists?

  • Victor

    Although I agree that sugar is just as bad as tobacco, I see some challenges in changing the behavior and eating habits of sugar in children and adults like was done with tobacco. Tobacco had a face – lung cancer. I was shown images of healthy lungs and cancer lungs when I was in high school, that was impact full. My question is, what do your guests propose to do in regards to giving a face to diabetes or obesity, when it’s so common around us? I bet we all know someone who is “obese” these days.

  • ECWriter

    I removed almost all sweeteners from my diet last year (with the indispensable help of the TQI diet by Kathy Abascal), and it was a revolutionary experience. I stopped craving sugar once I stopped eating it and the TQI plan helped to recalibrate what kinds of foods my body craves. Sugar is absolutely addictive. We need to change the way we advertise sugary foods and focus on advertising healthy, whole foods.

  • Threetwins

    Why stop with sugar? Let’s tax air too; consuming too much carbon dioxide will kill you too….Neal Gottlieb, Founding Twin of Three Twins Ice Cream

  • John

    In the 1950’s and 60’s Americans were not obese and consumed sugar and many other things. The problem is not sugar but portion sizes. To put a tax on sugar penalizes those of us who eat responsibly.

  • guest

    Where do I find concrete directions on what I should eat and what I should not eat?  Don’t even whole, unprocessed foods (like high fiber, high protein bread) break down into sugars?

  • Andreastottler

    What are the effects of artificial sweeteners? How do they compare to the effects of sugar?

  • Taxation is a poor social engineering tool. Education works much better even though it takes longer. If the goal is raising the price of the food to reduce consumption, then we should stop subsidizing the production of corn and sugar.

  • Andrew Yee

    Nice topic. I don’t see how taxing sugar makes sense though. There is a time and place for sugar. It’s a great fuel source for athletes – why would you want to penalize them even though they might be the opposite of obese? The solution lies in education of the general public, letting demand change what people sell, and much healthier options in school.

  • Lorri

    I would like to see healthy foods subsidized – fresh fruits and vegetables, whole grains, non fat milk products and minimally processed foods.

    Menlo Park

  • Anders

    Excellent topic.  The earlier comments about a 95% recidivism rate make sense to me, given what I’ve heard (from Robert Lustig about how our body chemistry changes in response to consuming excessive amounts of sugar.  If I understand him correctly, our bodies are essentially fighting against us, based on how they’ve been formed by years of sugar consumption.

    So it seems to me that the main focus need to be on children, whose biochemistry hasn’t yet been poisoned by a lifetime of overdosing on sugar.  Of course there are healthy choices to be made at any age, but with children, there is the opportunity to avoid poisoning the body in the first place.

  • Mekahel Francois

    One solution is subsidizing fresh fruits and vegetables not high processed foods which are a major cause of the problem. The fact is healthy fruits and veggies are NOT affordable so there are serious economic and class issues. Our government should not invest in subsidizing unhealthy foods. By investing it invests in the epidemic rate of heart attack, diabetes and stroke only costing us more in the end. Lastly, many doctors try to medicate you to health rarely emphasizing nutrition.

    • Erin Lamb

      Wholeheartedly agree – and would add one point – high quality fruits and veggies. Not the produce that is mass produced with chemicals, harvested prematurely, and contains far less nutritional value than its organic counterpart. Let’s look at the broader picture, and if we’re going to subsidize, let’s subsidize those foods that really SHOULD be at the top of the list in our diet.

      • Hilary Mills

        YES! subsidizing nutritionally rich food would make those foods more attainable and lead by example of what to eat!!!  The currently subsidized corn processed food products falacy of “affordability” would be lifted if funding was cut off to them and price themselves naturally out of the game. 
        I am against taxing sugar as a way to make it more out of reach for the consumer esp..if tax payers are going to continue subsidizing the producers in the first place…we are smarter than that, aren’t we?

        Nutritional education and affordable nutrient rich food availabilty is the most logical answer in my view.

  • Marc

    Dr. David Kessler former head of  FDA and former dean of UCSF and Harvard Med says in The End of Overeating that fat salt and sugar are more addictive than heroin and alcohol.

  • Mrahn50

    we are all idiots.

    our ancestors, hunter/gathers had al life span of 35 years and in a time of feast or famine taste for sweets and fats was genetically essential.

    i am angry with anti sweet substitute i.e. sucralose (yellow packet) advocates

    we are genetically programmed and should not feel guilty for  who we are!!!!

  • alisonguan

    Thank you to the researchers for writing this article!  We need to do more as a society to help people make better choices.  I would vote for a tax on sugar.  This is NOT a radical idea as Goldberg suggests – it’s not outlawing sugar, just pushing the industry a bit to give us better choices. 

  • Gayt

    It seems to me that we should start with the marketing – we do regulate cigarette advertising and it has helped reduce smoking. Can we start with ads and then move into the broader educational needs to achieve the goal of reducing consumption?

  • Blake

    Poor people make poor decisions not only in their food choices, but in many areas. Knowing this, society’s vultures have established many “poverty traps” that keep the poor in their predicament. These include check cashing scams, liquor stores, and yes, fast food joints and corner stores that sell sugary junk.

    What your guests are not recognizing is that poverty traps such as sugary foods are a social justice issue. If saving the poor from victimization is socialism, so be it, let’s have more of it, and to your male guest who is siding with society’s predators my statement to you is, take a hike.

    • Bob Fry

       Couldn’t have said it better. I’m tired of arguments that basically amount to removing any hint of moral obligation or responsibility in the corporate world.

  • Hans

    I equate what is going on here with what happened a few years ago with the Greenies dog treat, which is a multi million dollar business.  It was proven that the treats would mame or pill pets by getting stuck in the digestive track of animals. Prior to losing a class action law suit, the company’s solution to the problem was NOT to remove the product from pet store shelves, but to instead  provide directions on the box directing pet owners to not allow their pets to gulp their food.   How many pet owners can teach their pets not go gulp their food?  Back to sugar, if most of the food our children are exposed to is processed and has large amounts of sugar, will our  next step be to instruct our children not to gulp their food?  Or will we  do a critical evaluation of the product at hand and determine that changes that should  be made? Or will we wait for a long winded law suit to force needed changes? In the case of Greenies, they lost the law suit and were forced to reformulate their product without admitting any fault. 

  • Anneke

    Isn’t part of the problem with the socio-economic link to sugary eating not related to the price of the food, but related to the price of transportation? If you have to pay for gas to get your food, and you have little money, you’re going to make fewer trips to the grocery store. That means that you need shelf-stable food, which makes produce a difficult choice. Produce spoils much faster than  preservative- (and sugar-) laden processed food. Will taxing sugar change that at all? The need for shelf-stable foods will continue until produce is available at walking distance for everyone.

  • Jay Dee

    I read that the Center for Medicine in the Public Interest is a front group for pharma; did you mean to invite the Center for Science in the Public Interest instead?

  • Timtraveler

    How does a quack like Robert Goldberg get on the show?

  • Linda

    I’ve been collaborating with public health nurses and educators to develop curriculum to educate the public about diabetes prevention.  For certain communities that are difficult to reach, the concensus is JUST FOCUS ON THE DRINKS – if we can simply get people to cut back on sugary drinks, without any other diet or life-style changes, that would make a huge difference.

  • Lola

    There is another way out of the sugar jungle than just depriving ourselves of sweet tasting food. I found a cookbook that uses no sugar or sugar like products. And now I am off sugar and feel great. A Sweet Life Without Sugar set me FREE! It is fabulous. Check it out!

  • Erin Lamb

    Going back to the “diet sodas cause no harm and do not contribute to obesity… Are you serious?? What about aspartame, which is a neurotoxin? What about the way diet sodas still raise insulin injection into the blood stream?
    On another note, how about taking the sugar tax money and pouring it into programs that educate the lower and middle economic classes, encourage grocery stores to carry more fresh produce (incentive programs?) and put some of that money into the healthcare system to lower the health insurance costs for those of us that DO mind what we put into our bodies and ARE healthy?

  • Melanie Smith

    Your guest, Mr. Goldberg, characterized diet soda–with its high sugar and sugar-substitute content–as “benign.” This is shocking, as research on high-fructose sugars and substitutes like aspartame is well documented. They not only add weight to those who drink them, but–in the case of aspartame–contribute to other maladies, specifically heart and neurological problems. Mr. Goldberg also characterized the proposal discussed in the hour as being “low on science,” while the other guests who oppose his position have presented a lot of documented research. Mr. Goldberg must have an agenda here, and it isn’t to prevent obesity or educate.

    • JWong

      In response to the first part of your post, it was actually Dr. Kraemer who characterized diet soda in that way (29:00).

  • Jack LaLanne
    was a self-described surgarholic until the age of 15 when he gave up
    sugar and then proceeded to revolutionize the fitness industry.

    Many people can easily self-regulate their sugar consumption, but some
    can’t. The omnipresence of low-cost sugar-leaden foods in our daily
    lives poses a health risk for lots of folks, so some kind of
    regulation might make sense, but it requires some careful thought.

    One can still become obese and unfit eating other things
    besides refined sugar. Boosting our activity levels, more so than
    regulating any particular food substance, is absolutely essential if we want to improve the health & fitness of kids and adults. “Exercise is king,” as Jack was
    fond of saying, and it has to be a key part of the overall battle plan.

  • Jenn Z.

    Both taxes and subsidies are, at best, very indirect means of influencing people’s choices. Some have argued that a “sugar tax” would amount to a “tax on the poor” might consider that those who lack financial resources are the ones who suffer disproportionately from fructose-induced diseases such as type-2 diabetes, stroke, etc. Just think of the family in Food Inc. who regularly eat fast food meals because they can’t “afford” to buy their girls healthier foods in the supermarket – but are paying over $100/month for dad’s diabetes medicine. They haven’t “saved” the money they didn’t spend on good food, they are now using it to buy medicine instead.

    Additionally, it doesn’t need to be more expensive to eat healthier. A box of processed cereal costs $4 and up; a pound of oatmeal from the bulk food aisle costs $1.75… and a bowl of oatmeal will keep you full longer than the cereal. If you shop in the Asian supermarket, the cost for fruits and vegetables can drop by as much as 50% when compared to Safeway. There are creative ways eat well on a tight budget… but it will take some additional effort.

    Taking another step back, we might trace the real problem to a lack of solid science education in our schools. Everyone should have an opportunity to learn about the basics of nutrition and health so they are empowered to make better choices. Parents who haven’t had a chance to learn about these topics should be able to attend special seminars at their children’s schools so that the entire family can make lifestyle changes together and support one another.

    I’m not for sugar taxation (though I do believe corn subsidies should be ended), but I don’t think kids should be exposed to unhealthy eating habits at school. That is, take away the junk food and soda vending machines. Serve wholesome foods in the cafeteria. Send the kids home with recipes if they express an interest in the food.

    I’m glad this conversation is finally breaking into mainstream media.

    Why sugar is so bad for us:
    Great article from NYTimes Magazine: (article also provides a link to Dr. Robert Lustig’s YouTube video explaining metabolism of glucose and fructose in humans)

    Why artificial sweeteners and diet drinks are worse for us:
    A book called The Bitter Truth About Artificial Sweeteners, available used on Amazon:

    How corn subsidies affect the broader food system in the US: The Omnivore’s Dilemma:

  • Mekahel Francois

    Subsidies are just one tool the Govt. can use to make healthy foods affordable, i.e. accessible. Families access to fresh fruits and vegetables should not be tied to their socio-economic status but as it stands, that is the case. Corporations spend millions on lobbying efforts to garner these subsidies.

  • Haines

    husband needed an action plan to get off sugar. After I started making delicious
    sugar-free dessert recipes from A Sweet
    Life Without Sugar (no artificial sweeteners – just healthy ones) he’s eating
    less (especially at night); he’s lost weight and feels like exercising. Will
    miracles never cease?

  • Aaron

    Leave it to the conservative Robert Golberg to throw in the red herring of a Red Scare within the first minute of his comments! Why can’t conservatives engage arguments on their scientific merits rather than descend immediately into fear-mongering, trying to scare people into thinking that regulations, however sensible, will turn us into the next North Korea? 

  • Joan Miller

    Knowledge is important, and offering healthy alternatives has been my passion for many years. There are sweeteners and ingredients that have health benefits. Becoming familiar with them allows people to enjoy special treats for celebrations without compromising health. This is a more ‘grass-roots’ approach. I agree with the caller who mentioned education as the most important approach for her. is one tool.

  • Kurt

    And to add to Blake’s comment. The folk’s that live in the poverty traps are the least likely to have access to medical care save a trip to the emergency room when a health crisis occurs.

  • christian

    It is amazing how twisted this is. Here is this woman advocating a “sugar tax” and government intervention to limit food choice in schools. And Lord knows what else. And why? Because obesity has knock-on effects, analogizing to second-hand smoke. Well, ignorance has knock-on effects too. First, she advocates government interference in the market for sugar without ever stopping to consider the detrimental effects that such interference will cause, in terms of loss of liberty, financial hardship likely on the people who can least afford it, the cost of evasion of the rules, the increased presence of government in our private lives, the infantilizing of the populace, etc etc. Second, she implicitly assumes that a government program intended to protect “the people” from eating too much sugar will work as intended and will achieve her good intentions. But such programs never, ever work as intended and she ignores the perverse and unintended effects the program will certainly have, much less does she attempt to weigh these against the expected benefits. Third, she fails to realize that another person’s obesity isn’t inherently costly to me or other third parties — it is only costly because we are well along the way to becoming a nanny state where all of us are forced to bear the costs of the government’s “generosity” to others. If we did not have a system, heavily the result of government intervention, where you are forced to subsidize the health costs incurred by others, the “secondary smoke” argument would go up in, well, smoke. Sugar is not the cause of these costs, it is the system of cross-subsidization and the inability to opt out which is primarily the result of existing government regulation. Once you accept the “secondary smoke” argument for sugar, you are well along the weigh to regulating any lifestyle choice — any food, any activity, and lifestyle — that can arguably increase healthcare costs. (She also fails to consider the cost to society of better health — all those hospital and healthcare jobs would need to go somewhere. An honest scientist would look at the net, not gross, cost).

  • tm

    I was a poor person as a child and I resent people acting as though being poor equals making poor decisions. We ate healthful foods such as whole grains, whole beans and fruits and vegetables. I know I was an exception to many of the poor people eat badly rule but we are out there. A pound of great northern beans cooked  with onions, water and what ever else is available is a cheap source of good food. A little brown rice, yes, that is what we ate, was a perfect addition. fancy food? No! Good food, purchased in bulk bins, yes!  In fact, I still eat better than many of the comfortably well off people I know and definitely eat much better than many of the non-obsessed super wealthy people I know. By the way, in the 70’s we taught classes to other poor people so they would know how to save money by eating the way we did.

  • CaptHootie

    I was deeply disappointed with the panel’s conclusions about the metabolic effects of  ingesting HFCS — I have followed UCSF’s research on the metabolic pathways of fructose in the body — especially the work of Dr. Rob Lustig — and Dr. Lustig’s conclusion that fructose creates excessive fat deposits in the liver and disrupts healthy insulin production  which in turn causes a whole host of cardiovascular problems JUST WAS NOT DISCUSSED!  WHY NOT? 

    Are Dr. Lustig’s conclusions WRONG? I have heard him speak and seen his presentations and they are absolutely compelling — More importantly he states that he has the scientific proof that supports his position. To him HFCS is a toxic additive and must be regulated.  

    Dr. Robert Goldberg – whose organization “Center for Medicine in the Public Interest”  has historical associations with Phillip Morris Tobacco Company and more lately with pharmacological corporations –  support of unregulated and unconstrained consumption of junk fast foods was appalling and so dismissive of the UCSF findings  — Yet the UCSF panelist let him GET AWAY WITH SUCH OUTLANDISH BEHAVIOR and CONCLUSIONS. 

    We have children who are developing fatal diseases because of the quality of food that they eat. Is the UCSF Panel telling the world we do not have clinical proof of that supposition –because that is what it sounded like. 

    David Haskell
    Fairfax CA

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