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 Fat was the food villain these past few decades but sugar is quickly muscling in to take its place. As rates of sugar-related disorders such as diabetes, obesity and heart disease climb, many experts believe that when Americans rid themselves of fat, they simply replaced it with sugar in all its forms. 
 
 But proving that the rise of the chronic diseases was actually linked to higher sugar consumption is a challenge. Dr. Robert Lustig, from the department of pediatrics at the University of California, San Francisco, who has made a name for himself publishing books and research addressing the question of sugar’s effects on the body, wanted clearer answers. Now, in a paper published Tuesday, he and his colleagues believe they have come up with the definitive evidence that sugar, as Lustig says, “is toxic.” 
 
 In most lab studies, the doses of sugar that scientists test are quite high; they want to see what the effect is quickly and, depending on the research, they may not have time to wait to study the more gradual effects that might emerge. And in studies where people reduce the amount of sugar they eat, for instance, those people end up eating fewer calories overall, so it’s difficult to know whether any changes are due to the removal of sugar or to the drop in calories. 
 
 Lustig and his colleagues think they’ve produced the “hard and fast data that sugar is toxic irrespective of its calories and irrespective of weight.” 
 
 MORE: FDA Wants Nutrition Labels to Include More Detail on Added Sugars 
 
 Lustig’s confidence comes from the unique study, described in Obesity, of 43 Hispanic or African-American children aged eight to 18 years old. He collected detailed food questionnaires from each of the adolescents to get an idea of the average amount of calories they ate per day, then designed a special menu for each of them for nine days that matched the total numbers of calories they would normally eat. The only difference in the nine-day diet was that most of the sugar the children ate was replaced by starch — the overall number of calories remained the same. The children weighed themselves daily, and if they were losing weight, they were told to eat more of the provided food in order to keep their weight the same throughout the study. 
 
 “Everything got better,” says Lustig. Some of the children went from being insulin resistant, a precursor state to developing diabetes, in which the body’s insulin levels can no longer keep up with the pace of breaking down sugar that’s coming in from the diet, to insulin sensitive. 
 
 MORE: Artificial Sweeteners Aren’t the Answer to Obesity: Here’s Why 
 
 “We took chicken teriyaki out, and put turkey hot dogs in. We took sweetened yogurt out, and put baked potato chips in. We took pastries out and put bagels in,” says Lustig. “So there was no change in [the children’s] weight and no change in calories.” 
 
 After nine days of having their total dietary sugar reduced to 10% of their daily calories, however, they showed improvements in all of these measures. Overall, their fasting blood sugar levels dropped by 53%, along with the amount of insulin their bodies produced since insulin is normally needed to break down carbohydrates and sugars. Their triglyceride and LDL levels also declined and, most importantly, they showed less fat in their liver. 
 
 MORE: 7 Amazing Things That Happen to Your Body When You Give Up Soda 
 
 Because some of the children lost weight, to convince themselves that the effects weren’t due to the small amount of weight that some of the children lost, Lustig and his team compared those who lost weight to those who didn’t during the study, and found similar improvements in both groups. 
 
 “Up until now, there have been a lot of correlation studies linking sugar and metabolic syndrome,” says Lustig. “This is causation.” 
 
 The diet he provided the children isn’t considered ideal from a health perspective — starches are still a considerable source of calories and can contribute to weight gain. But Lustig relied on the starches to prove a point in a scientific study — that the effect sugar has on the body goes beyond anything connected to its calories and to weight. “I’m not suggesting in any way, shape or form that we gave them healthy food,” he says. “We gave them crappy food, shitty food, processed food — and they still got better. Imagine how much even better they would have gotten if we didn’t substitute and took the sugar out. Then they would have gotten even better yet. That’s the point.” 
 
 MORE: The Trouble With Sugar Free Kids 
 
 Not everyone is convinced that the results definitely prove sugar, and not weight loss, is the culprit, however. Susan Roberts, professor of Nutrition, USDA Nutrition Center at Tufts University notes that because some of the children lost weight, it’s still possible that shedding the pounds helped their metabolic measures to improve. She also points out that the children self-reported their initial diet, which can often be inaccurate. “We know that a healthy diet and weight loss cause good metabolic changes, and although this study tries to attribute its effects to low fructose, in fact it is impossible to do that because of the study design.” 
 
 Some experts are concerned for other reasons. They’re worried that the findings may shift attention away from what they consider to be the more fundamental issue — that overall, we’re eating too much. “Too much calorie intake is still the biggest problem,” says Dr. Mark Corkins, professor of pediatrics at University of Tennessee Health Science Center and member of the American Academy of Pediatrics committee on nutrition. He notes that the study involved children who were obese already and consuming too many calories. “It’s an important study, and the facts coming out of it are very important. It means we need to look at sugars, and at the type of sugars and sugar intake. But I worry that people are going to hang everything on this when we still need to reduce consumption.” 
 
 Lustig hopes that won’t happen as more data emerges that details how sugar is altering the body in unhealthy ways outside of its caloric contribution. That wasn’t the subject of the current paper, but he promises follow up studies based on this work that will address that. This study does hint however, at what might be happening. While there has been a lot of attention on the presence of belly fat and its connection to metabolic syndrome, the fact that the children saw improvements in the amount of fat in their liver suggests that might be an important way that sugar is contributing to chronic disease. Obese children and those with diabetes often suffer from fatty liver, a condition normally associated with alcohol abuse but increasingly common among non-drinkers who gain excessive amounts of weight. 
 
 This new view of sugar could change the advice that doctors and government health officials give about eating the sweet stuff. Lustig’s hope is that the information is considered as the U.S. Department of Agriculture finalizes its latest Dietary Guidelines, expected by the end of the year, which delineate recommendations for what, and how much of different types of foods and nutrients Americans should eat. ||||| Researchers at UC San Francisco have launched SugarScience, a groundbreaking research and education initiative designed to highlight the most authoritative scientific findings on added sugar and its impact on health. 
 
 The national initiative is launching in partnership with outreach programs in health departments across the country, including the National Association of City and County Health Organizations and cities nationwide. 
 
 Developed by a team of UCSF health scientists in collaboration with scientists at UC Davis and Emory University School of Medicine, the initiative reflects an exhaustive review of more than 8,000 scientific papers that have been published to date on the health effects of added sugar. 
 
 The research shows strong evidence of links between the overconsumption of added sugar and chronic diseases, including Type 2 diabetes, heart disease and liver disease. It also reveals evidence linking sugar to Alzheimer's disease and cancer, although the team assessed that more research is needed before those links can be considered conclusive. 
 
 Laura Schmidt, PhD 
 
 “The average American consumes nearly three times the recommended amount of added sugar every day, which is taking a tremendous toll on our nation’s health,” said Laura Schmidt, PhD, a UCSF professor in the Philip R. Lee Institute for Health Policy and the lead investigator on the project. “This is the definitive science that establishes the causative link between sugar and chronic disease across the population.” 
 
 The initiative aims to bring scientific research out of medical journals and into the public domain by showcasing key findings that can help individuals and communities make informed decisions about their health. For example, SugarScience.org cites research showing that drinking just one can of soda per day can increase a person’s risk of dying from heart disease by nearly one-third, and can raise the risk of getting Type 2 diabetes by one-quarter. 
 
 Kirsten Bibbins-Domingo, MD, PhD 
 
 More than 27 million Americans have been diagnosed with heart disease, which is the nation’s leading cause of death. Another 25.8 million Americans have Type 2 diabetes, caused by the body’s resistance to the hormone insulin coupled with the inability to produce enough insulin to regulate blood sugar levels. Of greatest concern is the rising number of children suffering from these chronic diseases. 
 
 “Twenty years ago, type 2 diabetes was unheard of among children, but now, more than 13,000 children are diagnosed with it each year,” said Kirsten Bibbins-Domingo, MD, PhD, a UCSF professor of medicine, epidemiology and biostatistics, and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Diabetes is a devastating disease and we know that it is directly related to the added sugar we consume in food and beverages.” 
 
 Robert Lustig, MD, MSL 
 
 Another rising concern is the impact of added sugar on Non-Alcoholic Fatty Liver Disease (NAFLD), which affects 31 percent of adults and 13 percent of children, and can lead to cirrhosis and liver failure. 
 
 “As pediatricians, we had evidence of the connection between sugar and diabetes, heart disease, and liver disease for years, but we haven’t had this level of definitive scientific evidence to back up our concerns,” said Robert Lustig, MD, MSL, a pediatric endocrinologist at UCSF Benioff Children’s Hospital San Francisco and a member of the SugarScience team. “Our goal is to make that science digestible to the American public, and take the first step toward a national conversation based on the real scientific evidence.” 
 
 While there are no federal recommended daily values for added sugar, the American Heart Association recommends consuming less than 6 tsp. (25 g) for women and 9 tsp. (38 g) for men. Guidelines for children depend on caloric intake, but range between 3-6 tsp (12-25 g) per day. Americans currently consume 19.5 tsp. of added sugar, on average, every day. 
 
 Added sugar is defined as any caloric sweetener that is added in food preparation, at the table, in the kitchen or in a processing plant. It can be difficult for people to know how much sugar they are consuming, since roughly 74 percent of processed foods contain added sugar, which is listed under at least 60 different names on food labels. 
 
 The 12-member SugarScience team will continue to monitor scientific research about added sugar and will track findings at SugarScience.org. The initiative harnesses the power of UCSF’s extensive health sciences enterprise, which ranges from basic laboratory research to clinical, population and policy sciences, with an emphasis on translating science into public benefit. All four of UCSF’s graduate schools – dentistry, medicine, nursing and pharmacy – lead their fields in research funding from the National Institutes of Health, reflecting the caliber of their research. 
 
 SugarScience is made possible by an independent grant from the Laura and John Arnold Foundation. It is supported by the Clinical and Translational Science Institute and the Philip R. Lee Institute for Health Policy Studies at UCSF. 
 
 UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals. ||||| Is sugar making us sick? 
 
 A team of scientists at the University of California in San Francisco believes so, and they're doing something about it. They launched an initiative to bring information on food and drink and added sugar to the public by reviewing more than 8,000 scientific papers that show a strong link between the consumption of added sugar and chronic diseases. 
 
 The common belief until now was that sugar just makes us fat, but it's become clear through research that it's making us sick. For example, there's the rise in fatty-liver disease, the emergence of Type 2 diabetes as an epidemic in children and the dramatic increase in metabolic disorders. 
 
 Laura Schmidt, a UCSF professor at the School of Medicine and the lead investigator on the project, SugarScience, said the idea is to make the findings comprehensible and clear to everyone. The results will be available to all on a website (SugarScience.org) and social media platforms like Facebook and Twitter. 
 
 Added sugars, Schmidt said, are sugars that don't occur naturally in foods. They are found in 74 percent of all packaged foods, have 61 names and often are difficult to decipher on food labels. Although the U.S. Food and Drug Administration requires food companies to list ingredients on packaging, the suggested daily values of natural and added sugars can't be found. 
 
 The FDA is considering a proposal to require food manufacturers to list information on sugars in the same way they do for fats, cholesterol, sodium, carbohydrates and protein. But because so much added sugar is dumped into so many products, one average American breakfast of cereal would likely exceed a reasonable daily limit. 
 
 "SugarScience shows that a calorie is not a calorie but rather that the source of a calorie determines how it's metabolized," said pediatric endocrinologist Robert Lustig, a member of the SugarScience team and the author of "Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease." Lustig said that more than half of the U.S. population is sick with metabolic syndrome, a group of risk factors for chronic diseases such as heart disease, diabetes and liver disease that are directly related to the excessive consumption of added sugars in the Western diet. 
 
 Figures from the Centers for Disease Control and Prevention show the category of heart attack/stroke as the leading cause of death in the United States. Every day, 2,200 Americans die of cardiovascular disease. That's about 800,000 a year, or one in three deaths. 
 
 The latest statistics from the American Diabetes Association show that 29.1 million Americans, or 9.3 percent, have diabetes. Of that number, 21 million have been diagnosed and 8.1 million have not, and the numbers continue to grow, according to the association. 
 
 It doesn't stop there. The American Liver Foundation says at least 30 million Americans, or 1 in 10, has one of 100 kinds of liver disease. 
 
 Clinicians widely believe that obesity is the cause of metabolic disease. Although it is a marker for these diseases, Lustig said, it's not the cause. "Too much sugar causes chronic metabolic disease in both fat and thin people," he said, "and instead of focusing on obesity as the problem, we should be focusing on our processed-food supply." 
 
 The average American consumes 19.5 teaspoons (78 grams) of sugar a day, substantially more than the amount recommended by the American Heart Association. The association sets these limits: 6 teaspoons (24 grams) for women, 9 teaspoons (36 grams) for men, and 3-6 teaspoons (12-24 grams) for children, depending on age. Just one 12-ounce soda contains 8 to 9 teaspoons (32-36 grams) of sugar. 
 
 Liquid sugar in sodas, energy drinks and sports drinks is the leading source of added sugar in the American diet. That represents 36 percent of all added sugars consumed, according to the Department of Health and Human Services. And because liquid does not include fiber, the body processes it quickly. That causes more sugar to be sent to the pancreas and liver than either can process properly, and the resulting buildup of sugar leads to heart disease, diabetes and liver disease. 
 
 Consuming too much sugar causes the level of glucose sugar in the bloodstream to increase. That, in turn, causes the pancreas to release high levels of insulin that cause the body to store extra calories as fat. 
 
 Too much insulin also affects the hormone leptin, a natural appetite suppressant that signals the brain to stop eating when full. But the imbalance of insulin levels caused by the intake of too much sugar causes lipid resistance, and the brain no longer gets that signal. 
 
 Another member of the SugarScience team, Dean Schillinger, is a professor of medicine at UCSF and a practicing primary care doctor at San Francisco General Hospital. He believes the overconsumption of added sugars is a social problem, not a problem of individual choice and freedom. 
 
 "People are becoming literate about the toxic effects of sugar," Schillinger said, "and have more understanding of the idea that high doses are bad for one's health." He sees evidence that those in a higher socioeconomic bracket are taking steps to limit intake of sugar when compared with poorer, less literate people. 
 
 Healthy food is expensive and less readily accessible in poorer neighborhoods, and because corn is so abundant and cheap, it is added to many food products. "Dumping high fructose corn syrup into cheap foods, sodas, sports drinks and energy drinks is toxic to the body, causing epidemic metabolic diseases and a serious health crisis," Schillinger said. 
 
 To underscore the scope of the problem, he pointed out that during the Iraq and Afghanistan wars, 1,500 American soldiers lost a limb in combat. In that same period, 1.5 million people in the U.S. lost limbs to amputations from Type 2 diabetes, a preventable disease. "We have yet to mobilize for a public health war," he said, "but the time has come to do so." 
 
 Such a war would have to take on the root causes of the problem. As a nation, Schillinger added, we would need to look at our food policies, food pricing, availability of healthy foods, and the marketing being carried out by food and beverage industries to hook the public on unhealthy choices loaded with added sugar. 
 
 Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, is not a SugarScience researcher, but he agreed that the amount of sugar consumed by the American public is too high. SugarScience, he said, is being helpful by bringing the information about added sugar to public attention. ||||| Move over salt. Step aside, saturated fat. There’s a new public enemy in the pantry, and it’s … sugar.In a provocative commentary coming out in Thursday’s edition of the journal Nature, Dr. Robert Lustig and two colleagues from UC San Francisco argue that the added sugars in processed foods and drinks are responsible for so many cases of chronic disease and premature deaths that their use ought to be regulated, just like alcohol and tobacco.To those who view sugar as more of a treat than a poison – and especially to libertarian-minded people who oppose government regulation in general – Lustig’s proposal is certainly a nonstarter. Public health advocates have spent years trying to enact a soda tax to discourage consumption of added sugar, and none of their efforts is close to succeeding.But if you set aside both political reality and your sweet tooth, you have to admit that Lustig makes some good points.For starters, he and coauthors Laura Schmidt and Claire Brindis of the Philip R. Lee Institute for Health Policy Studies at UCSF aren’t claiming that sugar should be illegal or removed from the diet completely. They are focused on added sugars, which they define as “any sweetener containing the molecule fructose that is added to food in processing.”In this country, the average American consumes 222 calories worth of sugar from sugar cane and sugar beets each day, along with 165 calories with of sugar from high fructose corn syrup, or HFCS, according to data from the U.S. Department of Agriculture . But the proposed regulations wouldn't make any distinction between these sweeteners -- any caloric sweetener that contains fructose would be subject to scrutiny.Why? Because even the United Nations recognizes that the greatest threat to public health now comes from non- communicable diseases , including diabetes heart disease and cancer . Together, these play a role in more than 35 million deaths each year. And they get a big boost from the choices people make about tobacco, alcohol and diet.Of these three “risk factors,” only tobacco and alcohol are currently subject to regulation, the authors write. Of course, these differ from food in that they are not necessary for survival. But added sugars – and the items made with them – aren’t necessary either.When it comes to alcohol, there are four criteria that justify government regulation, according to the 2003 book “Alcohol: No Ordinary Commodity”:* It’s unavoidable in society.* It’s toxic.* It can be abused.* It’s bad for society.“Sugar meets the same criteria,” Lustig and colleagues write, “and we believe that it similarly warrants some form of societal intervention.”The U.N.’s Food and Agriculture Organization says that in 2007, Americans consumed more than 600 calories' worth of added sugar each day. And the damage it does goes beyond supplying empty calories. In fact, it may not be excess fat that causes diabetes, heart disease, high blood pressure non-alcoholic fatty liver disease and other manifestations of metabolic syndrome – there’s scientific evidence that suggests sugar itself is to blame. After all, 20% of obese people don’t have these diseases, but 40% of normal-weight people do.“For both alcohol and tobacco, there is robust evidence that gentle ‘supply side’ control strategies which stop far short of all-out prohibition – taxation, distrbution controls, age limits – lower both consumption of the product and the accompanying health harms,” the UCSF trio writes. “Consequently, we propose adding taxes to processed foods that contain any form of added sugars.”Though this is a pipe dream in the U.S. (despite the authors’ attempt to call their proposal “the possible dream”), they do note that Canada and some countries in Europe already impose small taxes on some artificially sweetened foods. Denmark, the country that imposed a “fat tax” last year, is now eyeing a sugar tax as well.Short of taxes, there are other things regulators can do to discourage consumption of added sugar. “States could apply zoning ordinances to control the number of fast-food outlets and convenience stores in low-income communities, and especially around schools,” the authors argue.States could also impose a “drinking age” for buying soda, sports drinks and other sugar-sweetened beverages. (The authors suggest age 17.)And how about “a limit – or, ideally, ban – on television commercials for products with added sugars”?At a minimum, the U.S. Food and Drug Administrationcould remove fructose from its list of items Generally Recognized as Safe . That would force food makers to seek an FDA review of products with added sugars.“The food industry knows that it has a problem,” the authors write. “With enough clamour for change, tectonic shifts in policy become powerful.”A link to the commentary (which is behind a paywall) is online here An earlier version of this post said that most added sugar consumed in the U.S. is in the form of high fructose corn syrup, or HFCS. It should have said that Americans consume more HFCS than people in other countries. In 2010, the average American consumed 34.8 pounds of HFCS and 47 pounds of cane and beet sugar, according to data from the U.S. Department of Agriculture.Return to the Booster Shots blog ||||| The maverick scientist has long argued that sugar is as harmful as cocaine or tobacco – and that the food industry has been adding too much of it to our meals for too long. A convert hears more about his theory 
 
 If you have any interest at all in diet, obesity, public health, diabetes, epidemiology, your own health or that of other people, you will probably be aware that sugar, not fat, is now considered the devil's food. Dr Robert Lustig's book, Fat Chance: The Hidden Truth About Sugar, Obesity and Disease, for all that it sounds like a Dan Brown novel, is the difference between vaguely knowing something is probably true, and being told it as a fact. Lustig has spent the past 16 years treating childhood obesity. His meta-analysis of the cutting-edge research on large-cohort studies of what sugar does to populations across the world, alongside his own clinical observations, has him credited with starting the war on sugar. When it reaches the enemy status of tobacco, it will be because of Lustig. 
 
 "Politicians have to come in and reset the playing field, as they have with any substance that is toxic and abused, ubiquitous and with negative consequence for society," he says. "Alcohol, cigarettes, cocaine. We don't have to ban any of them. We don't have to ban sugar. But the food industry cannot be given carte blanche. They're allowed to make money, but they're not allowed to make money by making people sick." 
 
 Lustig argues that sugar creates an appetite for itself by a determinable hormonal mechanism – a cycle, he says, that you could no more break with willpower than you could stop feeling thirsty through sheer strength of character. He argues that the hormone related to stress, cortisol, is partly to blame. "When cortisol floods the bloodstream, it raises blood pressure; increases the blood glucose level, which can precipitate diabetes. Human research shows that cortisol specifically increases caloric intake of 'comfort foods'." High cortisol levels during sleep, for instance, interfere with restfulness, and increase the hunger hormone ghrelin the next day. This differs from person to person, but I was jolted by recognition of the outrageous deliciousness of doughnuts when I haven't slept well. 
 
 "The problem in obesity is not excess weight," Lustig says, in the central London hotel that he has made his anti-metabolic illness HQ. "The problem with obesity is that the brain is not seeing the excess weight." The brain can't see it because appetite is determined by a binary system. You're either in anorexigenesis – "I'm not hungry and I can burn energy" – or you're in orexigenesis – "I'm hungry and I want to store energy." The flip switch is your leptin level (the hormone that regulates your body fat) but too much insulin in your system blocks the leptin signal. 
 
 It helps here if you have ever been pregnant or remember much of puberty and that savage hunger; the way it can trick you out of your best intentions, the lure of ridiculous foods: six-month-old Christmas cake, sweets from a bin. If you're leptin resistant – that is, if your insulin is too high as a result of your sugar intake – you'll feel like that all the time. 
 
 Robert Lustig: 'I'm not a fitness guru. I'm 45lb overweight.' 
 
 Telling people to simply lose weight, he tells me, "is physiologically impossible and it's clinically dangerous. It's a goal that's not achievable." He explains further in the book: "Biochemistry drives behaviour. You see a patient who drinks 10 gallons of water a day and urinates 10 gallons of water a day. What is wrong with him? Could he have a behavioural disorder and be a psychogenic water drinker? Could be. Much more likely he has diabetes." To extend that, you could tell people with diabetes not to drink water, and 3% of them might succeed – the outliers. But that wouldn't help the other 97% just as losing the weight doesn't, long-term, solve the metabolic syndrome – the addiction to sugar – of which obesity is symptomatic. 
 
 Many studies have suggested that diets tend to work for two months, some for as long as six. "That's what the data show. And then everybody's weight comes roaring back." During his own time working night shifts, Lustig gained 3st, which he never lost and now uses exuberantly to make two points. The first is that weight is extremely hard to lose, and the second – more important, I think – is that he's no diet and fitness guru himself. He doesn't want everybody to be perfect: he's just a guy who doesn't want to surrender civilisation to diseases caused by industry. "I'm not a fitness guru," he says, puckishly. "I'm 45lb overweight!" 
 
 "Sugar causes diseases: unrelated to their calories and unrelated to the attendant weight gain. It's an independent primary-risk factor. Now, there will be food-industry people who deny it until the day they die, because their livelihood depends on it." And here we have the reason why he sees this is a crusade and not a diet book, the reason that Lustig is in London and not Washington. This is an industry problem; the obesity epidemic began in 1980. Back then, nobody knew about leptin. And nobody knew about insulin resistance until 1984. 
 
 "What they knew was, when they took the fat out they had to put the sugar in, and when they did that, people bought more. And when they added more, people bought more, and so they kept on doing it. And that's how we got up to current levels of consumption." Approximately 80% of the 600,000 packaged foods you can buy in the US have added calorific sweeteners (this includes bread, burgers, things you wouldn't add sugar to if you were making them from scratch). Daily fructose consumption has doubled in the past 30 years in the US, a pattern also observable (though not identical) here, in Canada, Malaysia, India, right across the developed and developing world. World sugar consumption has tripled in the past 50 years, while the population has only doubled; it makes sense of the obesity pandemic. 
 
 "It would have happened decades earlier; the reason it didn't was that sugar wasn't cheap. The thing that made it cheap was high-fructose corn syrup. They didn't necessarily know the physiology of it, but they knew the economics of it." Adding sugar to everyday food has become as much about the industry prolonging the shelf life as it has about palatability; if you're shopping from corner shops, you're likely to be eating unnecessary sugar in pretty well everything. It is difficult to remain healthy in these conditions. "You here in Britain are light years ahead of us in terms of understanding the problem. We don't get it in the US, we have this libertarian streak. You don't have that. You're going to solve it first. So it's in my best interests to help you, because that will help me solve it back there." 
 
 The problem has mushroomed all over the world in 30 years and is driven by the profits of the food and diet industries combined. We're not looking at a global pandemic of individual greed and fecklessness: it would be impossible for the citizens of the world to coordinate their human weaknesses with that level of accuracy. Once you stop seeing it as a problem of personal responsibility it's easier to accept how profound and serious the war on sugar is. Life doesn't have to become wholemeal and joyless, but traffic-light systems and five-a-day messaging are under-ambitious. 
 
 "The problem isn't a knowledge deficit," an obesity counsellor once told me. "There isn't a fat person on Earth who doesn't know vegetables are good for you." Lustig agrees. "I, personally, don't have a lot of hope that those things will turn things around. Education has not solved any substance of abuse. This is a substance of abuse. So you need two things, you need personal intervention and you need societal intervention. Rehab and laws, rehab and laws. Education would come in with rehab. But we need laws." 
 
 The Obamas hate him, he says, because they don't want to fight the industry. "They've got a lot of enemies. I'm not mad at them. I actually kind of like them." On paper, Lustig is absolutely livid. "In America we have this thing, it's called the Declaration of Independence. We are entitled to life, liberty and the pursuit of happiness. It doesn't say a damned fucking thing about the pursuit of pleasure." But he has seen how it worked with tobacco. It took a long time, he says, but industries can't poison people en masse for ever. 
 
 "We have to do something about it, or there will be no healthcare. In fact, there will be no society. Are you ready for that? That's what's gonna happen. It's just not OK. There will be no money left for anything else." 
 
 His predictions for world health are apocalyptically pessimistic. Yet in his bearing, he has the deep-rooted optimism of a person who knows the fight is worthwhile, and believes that, in the end, he'll win it. 
 
 Fat Chance is published by Fourth Estate at £8.99. To order a copy for £7.19 with free P&P, visit guardianbookshop.co.uk or call 0330 333 6846 ||||| TIME Health For more, visit TIME Health 
 
 The link between sugar and chronic diseases like obesity and type 2 diabetes is well established, but even though many public health groups recommend limiting sugar intake, they differ widely on the recommended daily limits. 
 
 The most recent U.S. dietary guidelines recommend Americans get less than 10% of their daily calories from added sugars—which is roughly the equivalent of a 16-ounce soda. The World Health Organization has issued similar guidelines, while other groups say 25% of total calories should be the cap. 
 
 Complicating things is a new study published Monday in the Annals of Internal Medicine, where researchers looked at the evidence used to support daily sugar limits of less than 10% of a person’s total calories. Ultimately, they concluded that those public health recommendations were based on low-quality science. 
 
 So does that imply that sugar should get carte blanche in the American diet? 
 
 Not exactly, say the researchers. “Although our findings question the recommendations from guidelines produced by leading authorities, the findings should not be used to justify high or increased consumption of nutrient-poor, energy-dense foods and beverages like candy and sugar-sweetened beverages,” said Bradley Johnston, principal investigator of the review, in a statement. 
 
 Still, some researchers expressed concern about the trustworthiness of the new findings since the research was funded by the North American branch of the International Life Sciences Institute (ISLI), a trade group whose board is made up of scientists as well as representatives for major food and beverage companies. ISLI members include Coca-Cola Company, The Hershey Company, Dupont, Mars, Inc., Monster Energy Company, Nestlé USA, PepsiCo and more. (You can see the organization’s membership list here.) 
 
 “Our concerns about the funding source and methods of the current review preclude us from accepting its conclusion that recommendations to limit added sugar consumption to less than 10% of calories are not trustworthy,” writes Dr. Dean Schillinger, a professor of medicine at the University of California San Francisco (UCSF) in a corresponding editorial in the same journal. “Policymakers, when confronted with claims that sugar guidelines are based on ‘junk science,’ should consider whether ‘junk food’ was the [funding] source.” 
 
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 The authors of the new study say they conducted the study without input from the International Life Sciences Institute. “However, given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully,” the authors wrote in their conclusion. 
 
 A separate Nov. 2016 study, lead by Schillinger, found that industry-funded studies are significantly less likely to connect sugar or sugary beverages to bad health outcomes than studies funded by independent researchers. It was the latest in a series of recent reports about the connection between the sugar industry and researchers. 
 
 A Sept. 2016 report by Dr. Cristin Kearns, a dentist turned investigative researcher at UCSF, found that the sugar industry sponsored research that blamed fat for heart disease rather than sugar. Another report by Kearns found that sugar industry advocacy groups influenced federal cavity prevention recommendations through strategies like getting sugar experts on federal panels concerning tooth decay. 
 
 Today, the food industry funds a lot of health research. As one example, a recent study published in the American Journal of Preventive Medicine reported that between 2011 to 2015, more than 95 national health organizations accepted money from Coca-Cola or PepsiCo or both. 
 
 When asked why they chose to publish the new industry-funded study, the editors of the Annals of Internal Medicine sent this statement by email: ||||| Photo 
 
 Obese children who cut back on their sugar intake see improvements in their blood pressure, cholesterol readings and other markers of health after just 10 days, a rigorous new study found. 
 
 The new research may help shed light on a question scientists have long debated: Is sugar itself harming health, or is the weight gain that comes from consuming sugary drinks and foods mainly what contributes to illness over the long term? 
 
 In the new study, which was financed by the National Institutes of Health and published Tuesday in the journal Obesity, scientists designed a clinical experiment to attempt to answer this question. They removed foods with added sugar from a group of children’s diets and replaced them with other types of carbohydrates so that the subjects’ weight and overall calorie intake remained roughly the same. 
 
 After 10 days, the children showed dramatic improvements, despite losing little or no weight. The findings add to the argument that all calories are not created equal, and they suggest that those from sugar are especially likely to contribute to Type 2 diabetes and other metabolic diseases, which are on the rise in children, said the study’s lead author, Dr. Robert Lustig, a pediatric endocrinologist at the Benioff Children’s Hospital of the University of California, San Francisco. 
 
 “This paper says we can turn a child’s metabolic health around in 10 days without changing calories and without changing weight – just by taking the added sugars out of their diet,” he said. “From a clinical standpoint, from a health care standpoint, that’s very important.” 
 
 Added sugars — the extra sweeteners food companies put in their products, not the sugar that occurs naturally in foods like fruit – are a topic of growing debate. In February, the federal government’s Dietary Guidelines Advisory Committee recommended that Americans limit their intake of added sugars to no more than 10 percent of daily calories. 
 
 In 2014, the Food and Drug Administration proposed that food companies include a line on their nutrition labels listing the amount of added sugars in their products. After the dietary guidelines committee issued its report earlier this year, the agency expanded on its 2014 proposal, saying that companies should also list a “daily percent value” for added sugars on their labels in line with the 10 percent recommendation. 
 
 The proposed changes have been strongly opposed by the food industry as unscientific. The Sugar Association, a trade group, said the F.D.A. was “making assertions that lack adequate scientific evidence,” and the Grocery Manufacturers Association criticized the standards the agency used to establish the daily value as being “inadequate.” 
 
 The newly released study is timely in part because it lowered sugar intake among children to roughly 10 percent of daily calories, the amount recommended by the dietary guidelines committee. 
 
 For their study, the scientists recruited 43 children between the ages of 9 and 18 who were considered at particularly high risk of diabetes and related disorders. All the subjects were black or Hispanic and obese, and had at least one or more symptoms of metabolic syndrome, a cluster of risk factors that includes hypertension, high blood sugar, abnormal cholesterol and excess body fat around the waist. 
 
 On average, the subjects had been getting about 27 percent of their daily calories from sugar. By comparison, the average American takes in about 15 percent, though children typically consume much more than this in part because they have the highest intake of sugar-sweetened beverages. 
 
 The study authors paired the subjects with dietitians. They then replaced the sugary foods in their diets with other foods purchased from local grocery stores. The goal was not to eliminate carbohydrates, but to reduce sugary foods and replace them with starchy foods without lowering body weight or calorie intake. 
 
 “Wherever there was food with added sugar in their diets, we took it out and we replaced it with a no-added-sugar version,” Dr. Lustig said. 
 
 So instead of yogurt sweetened with sugar, the children ate bagels. Instead of pastries, they were given baked potato chips. Instead of chicken teriyaki – which typically contains a lot of sugar – they ate turkey hot dogs or burgers for lunch. The remaining sugar in their diet came mostly from fresh fruit. 
 
 Because the scientists were working on a tight N.I.H. budget, they could only carry out the costly intervention for nine days. But in that short space of time, they saw marked changes. 
 
 On average, the subjects’ LDL cholesterol, the kind implicated in heart disease, fell by 10 points. Their diastolic blood pressure fell five points. Their triglycerides, a type of fat that travels in the blood and contributes to heart disease, dropped 33 points. And their fasting blood sugar and insulin levels – indicators of their diabetes risk – likewise markedly improved. 
 
 One expert who was not involved in the new research, Dr. Frank Hu of the Harvard T.H. Chan School of Public Health, said that the study “strengthens the existing evidence on the relationship between added sugar intake and metabolic disease.” 
 
 “This kind of study is very difficult to do,” he said. “But it provides a proof of concept that in a high risk population, reducing consumption of added sugar can have multiple metabolic benefits.” 
 
 Dr. Sonia Caprio, a pediatric endocrinologist and professor of pediatrics at Yale Medical School, said that although the study was small, “it addressed the issue in an original way and tried to isolate the effect of sugar on metabolic syndrome and insulin resistance.” 
 
 “This is an important area of research that might solve some of the metabolic issues that we are facing in children, particularly in adolescents,” she said. “This study needs to be taken seriously, and we need to expand on it.” 
 
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– Dr. Robert Lustig has studied childhood obesity for 16 years and cross-analyzed numerous studies to come to a not-so-sweet conclusion: Sugar should be thought of along the same lines as tobacco, cocaine, or alcohol, he told the Guardian in August. Now Lustig is a member of a 12-scientist team working on SugarScience, a University of California-San Francisco initiative that hopes to showcase reputable studies on added sugars and how they impact health, a UCSF news article reports. The SugarScience group has already reviewed more than 8,000 papers and found evidence to support Lustig's previous assertions, linking excess sugar consumption to such chronic diseases as Type 2 diabetes and liver and heart disease. Laura Schmidt, the initiative's lead researcher, told the Chicago Tribune in December that the point of the project is to make these findings accessible to the public through its website and social media. The average American consumes 19.5 teaspoons of added sugar a day, significantly higher than what the American Heart Association recommends (6 teaspoons for women, 9 teaspoons for men, and 3 to 6 teaspoons for kids, according to UCSF). Schmidt notes that added sugars show up in 74% of all packaged foods and appear under at least 60 different names, making them hard to find on food labels. Though some have said that calling sugar a poison is high-fructose hyperbole—a 2013 Scientific American article noted that "many worrying fructose studies use unrealistic doses" of sugar and that rodents used as subjects process it differently than humans—not many are disputing we should eat less of it. The FDA is considering expanding its food labels to include an "Added Sugars" category to help consumers keep their sugar intake in check. (The WHO says just 5% of your calories should be from sugar.)