Once the scourge of mostly dentists, sugar is taking a beating on a much larger scale these days, as public health and nutrition experts - along with politicians - take up the fight against what some are calling the single largest source of the country's collective weight problem.
It's impossible to blame sugar entirely for the obesity epidemic, most scientists agree, but there's no doubt that sugar consumption has increased along with Americans' waistlines.
"The average American caloric intake has increased by about 150 to 300 (daily) calories in the last 30 years. That's huge. And it's coming from processed foods, half of it from sugared beverages," said Candice Wong, a UCSF cardiovascular epidemiologist and a spokeswoman for the American Heart Association. "We have a long battle ahead of us."
Mayor Gavin Newsom recently joined the battle when he proposed last month that San Francisco become the first city in the United States to charge a fee to retailers that sell sugary beverages. And in August the American Heart Association for the first time suggested specific limits on the amount of sugar people should eat and drink.
The obesity epidemic is almost definitely due to a variety of factors, such as portion sizes and a lack of exercise. But the assault on sugar is based on multiple studies that show a correlation between sugar consumption and obesity - both on an individual level and on a national scale.
Over the past three decades, consumption of fructose - a type of sugar naturally found in fruits but also mixed with other sugars and used in a wide variety of processed foods - has more than doubled. In the 1970s, Americans consumed about 9 teaspoons a day of fructose, according to a 2008 study. By the mid-1990s, consumption had risen to 14 teaspoons.
Today, the average American packs away about 22 teaspoons of sugar a day, most of that in the form of fructose, according to the National Cancer Institute. Young people eat and drink the most - teenage boys take in about 34 teaspoons of sugar every day.
All that sugar adds up to a lot of extra calories.
"Most people probably have no idea how much sugar they're taking in," said Jo Ann Hattner, a San Francisco registered dietitian who teaches nutrition courses at Stanford University School of Medicine.
Whether the sugar itself is bad for people is still up for debate. Most nutritionists don't believe sugar is inherently unhealthy; the problem is that sugar has lots of calories and absolutely no nutritional value.
UCSF pediatrician Robert Lustig believes fructose is unhealthy. He said that sugars can affect hormone production in such a way that metabolism is thrown off and the brain is tricked into thinking the body is starved and needs more food, even as the person gains weight.
"A normal person will consume a certain amount of calories a day. You pour sugar on top and they will consume more calories, generating more weight gain and generating more hunger," Lustig said.
The new guidelines from the American Heart Association recommend that most women limit their intake of added sugars to only 100 calories a day and that men take in only 150 calories a day. Added sugars are those that aren't naturally found in foods like fruits and dairy products. For a majority of women, that would be less than one 12-ounce can of soda; men could have the soda plus a chocolate chip cookie.
Newsom is drafting legislation for a soda fee that would be assessed to retail outlets. If such legislation passes, San Francisco would be the first city in the country to essentially tax soda, although at least two states have a soda tax.
Soda may be the biggest culprit in Americans' growing girth, but it's far from the only source of sugar in most people's diet. In fact, nutritionists often complain, sugar shows up in almost every type of processed food - from bread and salad dressing to potato chips and energy drinks.
And it's not always easy for people to find out how much sugar they're eating. Nutritional labels must list grams of sugar, but they don't have to differentiate between naturally occurring sugar and added sugar. Nutritionists say before making a food purchase, it's important that people read the label and find out if something that seems healthy is actually loaded with extra calories from sugar.
Yogurt, for example, always has some sugar in the form of lactose, which comes naturally from milk. But many commercial yogurts have added sugar in the form of high fructose corn syrup that can bump up the calories. Shoppers would need to look for the total sugar content on the nutrition label then read the ingredient list to figure out that they're eating a lot of extra sugar.
"The No. 1 thing to do is to educate people on how to read labels. It's very, very tricky and the products are getting more and more sophisticated," Wong said.
Hattner is hopeful that most people can slowly wean themselves off their sugar habits. She suggests people make small behavioral changes - try switching to diet drinks, for example, or drinking half a soda instead of the whole can.
Lustig is less optimistic.
He appreciates attempts like the soda tax and the new American Heart Association guidelines to draw attention to the country's sugar addiction, he said. But until federal authorities take aggressive actions against food manufacturers and control sugar consumption like they control tobacco and alcohol, the country's going to have a hard time shaking the habit and losing weight.
"Sugar is addicting just like drugs of abuse," Lustig said. "If the only food you have access to is laced with sugar, that's like asking a drug addict to stop taking drugs when the food they're eating has drugs in it. The only way to fix this is to remove the sugar sources from the diet in the first place."
Sugar by definition
Naturally occurring sugars: Sugars found naturally in foods.
Simple carbohydrates (also called simple sugars): Carbohydrates that are made up of just one or two units of sugar. Simple carbohydrates include glucose, fructose and lactose.
Complex carbohydrates: Strings of sugar found in foods like starchy vegetables and breads, cereals and rice.
Total sugars: The total grams of sugar, both natural and added, found in a food or beverage. This amount is listed on nutrition labels.
Added sugars: Sugars added to products to make them taste better. These sugars can be natural, such as white sugar or honey, or manufactured, such as high fructose corn syrup.
Major sources of added sugars
12-ounce soda 133 calories from sugar
1 cup canned peaches in syrup 115 calories from sugar
10 jellybeans 78 calories from sugar
6-ounce fruit yogurt 78 calories from sugar
12-ounce fruit punch drink 62 calories from sugar
One-half cup vanilla ice cream 45 calories from sugar
One tablespoon pancake syrup 27 calories from sugar
Chocolate chip cookie 14 calories from sugar
Source: American Heart Association
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