Sugar and Health
Sugar is one of the staples of our diet. It pro-vides about 15 percent of our calories-and it is calories that supply the energy that permits us to live, to work, to play.Most nutritionists agree that sugar, in mod-eration, is an economical, enjoyable source of energy and at the same time a useful ingre-dient in food preparation. Yet sugar is fre-quently accused of being a detriment to health. Some of these accusations come from food faddists and non-scientists. Some come from physicians and researchers whose views are not generally accepted. Some are matters about which there is considerable dispute in the scientific community.
Claims about sugar's "dangers" are some-times accepted with little examination. This may be because they have been repeated fre-quently enough to seem. valid, or on the grounds that "where there's so much smoke, there must be fire." Yet those who are con-cerned about food and health want to know the facts about sugar's place in the American diet, and if there are adequate answers to the sometimes angry questions being asked.
Here are fifteen of these questions. We have answered them to the best of our ability, drawing on the scientific literature and the knowledge of specialists. We believe the answers help to throw light on sugar's actual performance in health and nutrition. They may not offer the emotional excitements of faddists' fancies, but they sum up what is gen-erally accepted by the scientific community.
The following questions are
discussed and answered in this booklet:
Page
Are we Americans eating more 3 sugar today than we used to?
Are Americans the biggest sugar 4 consumers in the world?
Do we eat too much sugar? 5 Would we be better off eating raw 6 sugar instead of refined white sugar?
Does sugar make you fat? 8
Is sugar a factor in causing coronary 9 heart disease?
Does sugar contribute to heart 12 disease by causing a rise in the
fat content of the blood?
Does sugar cause diabetes? 14 Is the rise in blood sugar level 16 after eating sugar followed by
a serious "letdown"?
Does eating sugar lead to 1 7 hypoglycemia?
Is sugar the major cause of tooth 19 decay?
Does eating sugar rob the body of 21 B vitamins?
Does sugar slow down the absorption 21 of calcium?
Why is sugar accused of supplying 22 only "empty calories" to the diet?
Q.
Are we Americans eating more sugar today than we used to?A.
According to U.S. Department of Agricul-ture records, our sugar consumption today is almost exactly the same as it was in 1925.1 Per capita consumption from 1925 to 1929 averaged 102.4 pounds a year;1 per capita consumption in 1974 was 99.7 pounds.2 Except for the periodwhen sugar was rationed because of World War II, our sugar intake has generally ranged between 97 and 103 pounds a year since 1931. 1
• 3 Use of sugar began to grow in the 19th century as a result of the rising American standard of living. A cen-tury of increasing consumption ended in 1925, when a plateau was reached.1 Consumption has shown no significant variation since that date.
References:
1. Historical Statistics of the United States: Colonial Times to 1957. Washington: Bureau of the Census,
I 960, pp. 26, 187.
2. Economic Research Service, U.S. Department of Agri-culture: National Food Situation, February 1975. 3. Statistical Abstract of the United States. Washington:
Q.
Are Americans the biggest sugar con-sumers in the world?A.
There are several countries in which sugar intake per person is far higher than here in the United States. (Some of these coun-tries are among the healthiest in the world.) Following are reported per capita sugar consumption figures for leading sugar consumers in 1971/72, based on F.O. Lichts reports: 11. Israel 132.2 pounds 2. Ireland 124.5 3. Australia 118.6 4. Iceland 114.0 5. New Zealand 114.0 6. Denmark 109.9 7. United Kingdom 103.8 8. Netherlands 103.6 9. Switzerland 103.4 10. USA 103.4 11. Canada 101.2 12. Bulgaria 99.6 13. Finland 98.8 14. Sweden 95.3 References:
Q.
Do we eat too much sugar?A.
There is no commonly accepted, scientific guide to what constitutes "too much" of most foods. Nutritionists generally agree that the Recommended Dietary Allow-ances1 published under the auspices of the Food and Nutrition Board of the National Research Council is a dependable guide to the nutrients needed daily to maintain health. This publication (revised 1974) sets a daily requirement of 2700 total cal-ories for men between ages 23 and 50, and 2000 calories for women in the same age group.Although the portion of the calories assigned to carbohydrates is not stated, many nutritionists agree that some 50 per cent of the daily calorie intake should be carbohydrates. About 1350 calories a day for an adult man, therefore, would be in the form of sugar or starch.
Average daily per capita consumption of sugar in the United States is about 4½
ounces, or approximately 500 calories. 2 This would hardly be described as "too much sugar" except in the case of very low-calorie diets.
References:
l. Recommended Dietary Allowances, 8th rev. ed. Washington: National Academy of Sciences, 1974. 2. Economic Research Service, U.S. Departr1ent of
Q.
Would we be better off eating raw sugar instead of refined white sugar?A.
When people talk about "raw sugar," they are usually referring to cane sugar after its initial processing in a sugar mill, or to a stage in beet sugar after it has been clari-fied from diffusion juice but before it is fully refined. Raw sugar is about 96% pure carbohydrate, with such extraneous material as bits of soil, yeast, molds, waxes, bacteria, lint and beet pulp or cane fibers. 1 It also contains moisture, mineral salts and organic non-sugars. 1 The propor-tions of these vary depending on the source of the original sugar cane or sugar beet. At this stage, it must be noted, raw sugar is not considered under Food and Drug regulations as suitable for direct home consumption.What advantages does raw sugar offer over refined sugar? It is sometimes sug-gested that raw sugar contains minerals and vitamins lacking in the refined prod-uct. -This claim demands further examina-tion.
Minerals: Raw sugar contains less than one-half of one per cent (0.49%) of minei:als-containing ash. Of this, calcium, potassium, magnesium, silicon and phos-phorus are found in limited amounts. 2 Still smaller amounts of iron, sodium, manganese, aluminum and other metals can be detected. 2 There is more iron in three slices of calf's liver, and more cal-cium in a serving of oyster stew, than in a pound of raw sugar.3
• 4
Vitamins: A study by two Yale scien-tists,2 working under a grant in aid pro-vided by the Sugar Research Foundation, concluded that raw sugars and other sugar products contain vitamins in such small quantities "as to be completely imprac-tical as a nutritional source." The thiamine in raw sugar, they found, is
"reduced to the vanishing point." Eating a full pound of raw sugar a day would pro-vide about 10 per cent of the recom-mended allowances of riboflavin and niacin (in the B-complex group of vita-mins).3• 4 It should be noted that two scrambled eggs offer 22 per cent of the dai:ly riboflavin requirement, and a serving of broiled halibut contributes more than half of the niacin allowance. 3• 4
Raw sugar hardly seems the answer to our need for these nutrients. There is no good reason why sugar should be required to supply minerals, vitamins or proteins in addition to calories-any more than eggs should be criticized for not supplying Vitamin C, or orange juice for being defi-cient in fat. Diets that include a proper variety of foods contain all necessary vita-mins and minerals. If diets do not include these nutrients, the small amounts pro-vided by raw sugar cannot be of much help.
References:
1. Lyle, 0.: Technology for Sugar Refinery Workers, 3d ed. London: Chapman & Hall Ltd., 1957, p. 290. 2. Kreh!, W.A., and Cowgill, G.R.: Nutrient content of
cane and beet sugar products. Food Research
20:449-468, 1955.
3. Recommended Dietary Allowances. 8th rev. ed. Washington: National Academy of Sciences, 1974. 4. Church, C.F., and Church, H.N.: Food Values of
Por-tions Commonly Used: Bowes and Church. 11th ed.
Philadelphia: J.B. Lippincott Company, 1970.
Q. Does sugar make you fat?
A.
We don't get fat from sugar alone, or potatoes, desserts, meat, milkshakes, bread or candy. We get fat from eating too much. We gain weight when we take in more calories in food than we bum up for energy needs. Those extra calories are stored as fat. When our food calorie in-take drops below our calorie outgo-by eating less or by doing more work and more exercise-we lose weight. 1Although fats contribute more than twice as many calories as sugar, ounce for ounce, the wise dieter does not eliminate all fats or carbohydrates from his diet. He cuts down, not out. Even those on a weight-reduction diet need a variety of foods in order to get all the nutrients essential to health. It is true that a diet that eliminated all sugar, or that cut all carbohydrates to a minimum, might aid in weight loss if there was enough of a reduc-tion in the total intake of calories. It would be difficult to stay well on such a diet, for eventually carbohydrates would be needed for metabolic balance.2• 3• 4
References:
I. Cahill, G. F., and Owen, 0. E.: Some observations on carbohydrate metabolism in man. In Dickens, F., Randlc,P. J., and Whelan, W. J.: Carbohydrate Meta-bolism and Its Disorders, vol. 1. London and New York: Academic Press, 1968, pp. 497-522.
2. Stare, F.J ., and McWilliams, M.: living Nutrition. New York: John Wiley & Sons, Inc., 1973, p. 256.
3. Danowski, T.S., Nolan, S. and Stephan, T.: Obesity. World Review of Nutrition and Dietetics 22:270-279,
1975.
4. Council on Foods and Nutrition: A Critique of
Low-Carbohydrate Ketogenic Weight Reduction Regimens.
A Review of Dr. Atk.in's Diet Revolution. J. Am. Med. Assn. 198: 157-162, 1966.
Q.
Is sugar a factor in causing coronary heart disease?A.
Coronary heart disease (CHD) is thelead-ing cause of death in the USA. Many fac-tors have been cited as increasing the risk of CHD. The major risk factors seem to be age, serum cholesterol, cigarettes, hyper-tension and body weight. Other elements reported as being suspect include de-creased consumption of fiber, use of soft water, increased sugar consumption and an imbalance in zinc and copper metabo-lism.
The important point to realize is that the cause of CHD, as with most other dis-eases, is multifactorial in nature. Because of interactions and interdependence of the proposed factors (and additional un-known ones) it is not possible to select a single factor as the causative agent.
When reliable evidence is available showing both involvement and non-involvement of a factor in a given disease, then it is certain that some other variable is not being considered in establishing the
etiology of the disease. But the evidence must be sound and any proposed involve-ment brought thereby out of the hypo-thetical to a realistic stage.
Even John Yudkin, the most avid pro-ponent of the hypothesis that a high con-sumption of sugar is a major factor in CHD, agrees that there are factors other than sugar involved.1 Yudkin claims
sup-port of his hypothesis from secular trends and from statistics both between popula-tions and within populapopula-tions.1 • 2
Recently the hypothesis has been analyzed critically by Dr. Ancel Keys3 of
the University of Minnesota and Dr. A.R.P. Walker4 of the South African
Medical Research Council. In separate ver-dicts, these authorities find no justifica-tion for the claim in any of the evidence that has been presented in its support.
a) Proponents of the theory that sugar consumption contributes significantly to coronary heart disease claim that countries with high sugar consumption have higher death rates from coronary heart disease than countries with lower sugar levels. A study5 of 33 countries, published in 1970, shows that such a relationship is dubious. In Sweden and Finland, for example-two neighboring countries-sugar consumption is almost identical. Yet, as Dr. Keys points out, deaths from coronary heart disease for males in Finland are about twice those in Sweden.3 Sugar consumption per person in the United Kingdom averages 16 per cent higher than in the United States, but deaths of men from coro-nary heart disease is 20 per cent lower.5 Similar comparisons may be
made for two neighboring South
American countries: Colombia and
Venezuela. Colombia's per capita sugar consumption, according to United Nations statistics, is 16 per cent higher than Venezuela's; its male mortality rate from coronary heart disease is only 20 per cent of its neighbor's.5 It is dif-ficult to accept the assertion that the intake of sugar is "the basic component of nutrition leading to atherogenesis." b) Another argument1 claims that the
in-cidence of heart disease has risen during the period that consumption of sugar has increased. If rates of coronary heart disease go up when sugar consumption rises, then heart disease should be ex-pected to level off when sugar intake stays put. In fact, however, while sugar intake per capita in the United States has hardly varied from year to year since 1925, the death rate from coro-nary heart disease has steadily in-creased,6• 7 plateaued and decreased. Deaths due to major cardiovascular
dis-eases peaked at 515 per 100,000
population in 1960, essentially
pla-teaued through 1968 then trended
Dr. Walker asserts that sugar cannot be proved to be a contributor to coro-nary heart disease until it is demon-strated that a lowering of sugar intake is followed by a drop in the disease.4 No such demonstration has ever been made.
c) A third form of evidence that has been offered to show a link between sugar consumption and heart disease is a study of the sugar-eating habits of men who had suffered myocardial infarc-tion-a type of heart attack. Through a questionnaire filled out by patients and a control group, Yudkin determined that the men who had had the heart attack ate more sugar than the healthy men. The number of men studied was fewer than 100.1 A similar question-naire, given to more than 1,300 men, did not reveal any correlation between their sugar-eating habits and heart dis-ease or even between sugar intake and weight gain after the age of 25.8 Still
another study9 sponsored by the
British Medical Research Council in four medical centers found no basis for the claimed sugar-heart disease link. Its conclusion: ". . . the evidence. . . is extremely slender."
One of the key factors in the hypothesis that sugar consumption is involved in coronary heart disease is the assumption that the disease is increasing in incidence. The raw data support such an assumption. Yet experts in medical statistics remind us that this apparent increase may actually be the result of the steady lessening of other causes of death, mainly infectious disease.10 This change permits more people to live to the ages at which they are more likely to develop coronary heart disease.
One other reason for the greater inci-dence of coronary heart disease should be mentioned. The increase in medical knowledge has tended to heighten the accuracy of diagnosis, so that today
coro-nary heart disease is detected with far greater frequency.
In establishing causes for CHD or any other disease, the existence of conflicting evidence indicates a lack of knowledge or consideration of all causative factors. Any
evidence brought to bear must be valid. Evidence presented presumably involving sucrose with incidence of CHD has by and large been discredited by experts in the field. 3, 4, i 1
References:
l. Yudkin, J.: Dietary intake of carbohydrate in relation to diabetes and atherosclerosis. In Dickens, F., Randle, P.J ., and Whelan, W.J .: Carbohydrate
Metab-olism and Its Disortlers, vol. 2. London and New York: Academic Press, 1968, pp. 169-184.
2. Yudkin, J., and Roddy, J.: Levels of dietary sucrose
in patients with occlusive atherosclerotic disease. Lancet 2:6-8, 1964.
3. Keys, A.: Sucrose in the diet and coronary heart
dis-ease. Atherosclerosis 14: 193-202, 1971.
4. Walker, A.R.P. Sugar intake and coronary heart
dis-ease. Atherosclerosis 14:137-152, 1971.
5. Soukupova, K., and Prusova, F.: Nutrition and the ischemic heart disease mortality rates in 33 countries. Nutrition & Metabolism 12:240-244, 1970.
6. Historical Statistics of the United States: Colonial Times to 195 7. Washington: Bureau of the Census, 1960, pp. 26, 187.
7. Statistical Abstract of the United States. Washington: Bureau of the Census, annual.
8. Howell, R.W., and Wilson, D.G.: Dietary sugar and
ischaemic heart disease. British Medical Journal 3: 145-148, 1969.
9. Platt, Lord, et al.: Dietary sugar intake in men with
myocardial infarction. Lancet 2: 1265-1271, 1970.
10. Robb-Smith, A.H.T.: The Enigma of Coronary Heart Disease. London: Lloyd-Luke Ltd., 1967.
11. Grande, F.: Sugar and Cardiovascular Disease World Review of Nutrition and Dietetics 22: 248-269, 1975.
Q
.
Does sugar contribute to heart disease bycausing a rise in the fat content of the blood?
A.
Serious concern has been shown about the relation between coronary heart disease and the levels of blood lipids or fats. Higher blood fats, it is suggested, result in an increase in the risk of heart disease. Most attention has been paid to one type of fat in the blood-cholesterol. It has also been claimed that diets high in sugar pro-duce an increase in another type of blood lipids-triglycerides.1Studies of the importance of sugar in producing triglycerides have been ana-lyzed and reviewed by researchers. One group of investigators found that a higher sugar diet increases the amount of tri-glycerides in the serum only when the diet also includes a high proportion of satu-rated fats.2 Other investigators3 have
found that when smaller, but still high proportions of sugar are in the diet, the sugar has no more effect on triglyceride production than other carbohydrates.
Dr. Ancel Keys4 points out that the use
of high amounts of sugar in experimental diets has little to do with "the natural hu-man situation." This is particularly true in the United States, where the average diet has a lower carbohydrate content (and higher fat content) than most other coun-tries. 5 It cannot be claimed that an
over-consumption of carbohydrates is a major factor in lifting blood fat levels.
A Harvard review of the literature6 on
the effect of nutrition on coronary heart disease emphasizes that when "dietary simple sugars" like sucrose are replaced by complex carbohydrates like starches, the reduction in blood lipids are of such a small order that "they have no practical importance." It also points out that popu-lations habitually consuming diets low in fat and high in carbohydrate have low levels of blood lipids, including the tri-glycerides.
Here again, the part played by sugar as a cause of coronary heart disease is highly questionable.
References:
1. Yudkin, J .: Dietary intake of carbohydrate in relation to diet and atherosclerosis. In Dickens, F, Randle,
P.J ., and Whelan, W.J .: Carbohydrate Metabolism and Its Disorders, vol. 2. London and New York:
Academ-ic Press, 1968, pp. 169-184.
2. Antar, M.A., et al.: Interrelationship between the kinds of dietary carbohydrate and fat in
hyperlipo-proteinemic patients. Part 3. Synergistic effect of sucrose and animal fat on serum lipids. Athero-sclerosis JI: 191-201, 1970.
3. Dunnigan, M.G., et al.: The effects of isocaloric ex-change of dietary starch and sucrose on glucose toler-ance, plasma insulin and serum lipids in man. Clinical Science 38: 1-9, 1970.
4. Keys, A.: Sucrose in the diet and coronary heart
dis-ease. Atherosclerosis 14: 193-202, 1971.
5. Perisse, J.: The nutritional approach in food policy
planning. Nutrition Newsletter (FAO), vol. 6, no. 1, 1968, pp. 30-45.
6. McGandy, R.B., Hegsted, D.M., and Stare, F.J.:
Dietary fats, carbohydrates and atherosclerotic
vas-cular disease. New England Journal of Medicine 227: ]86-192, 242-247, 417-419, 1967.
Q.
Does sugar cause diabetes?A.
Diabetes mellitus is a disorder of the body's metabolism. When a normal person eats carbohydrates-sugars and starches-they are converted into glucose, a simple sugar, which is absorbed into the blood-stream and is used by the body for energy. The diabetic person cannot utilize carbohydrates efficiently. As a result, his blood has a higher-than-normal amount of glucose, and glucose is often present in the urine. 1 It is common to refer to theincreased glucose content of the blood as
"high blood sugar," and to the glucose in
the urine as "sugar in the urine." Glucose, however, is not the same substance as ordinary refined sugar (sucrose). It would be more accurate to say "glucose in the blood" rather than "sugar in the blood." The primary cause of diabetes remains unknown. The only reasonably certain statement that can be made about it is that diabetes seems to occur in persons who have inherited a predisposition to the disease.2 The actual appearance of
When diabetes does develop, doctors formerly restricted the intake of
carbo-hydrates, including sugar, to lower the
glucose level in the blood.
In 1971, however, the Committee on Food and Nutrition of the American Diabetes Association reassessed this
prac-tice on the basis of scientific findings. 3
They concluded that most diabetics may be allowed to eat the same amount of car-bohydrates as any other person, as long as meals are regular and treatment is under
medical supervision. 3
• 4
Neither sugar nor carbohydrates in gen-eral are regarded by medical textbooks or
medical authorities as immediate causes of
diabetes. Those who advance this claimS, 6
base it on the observation that the death rate from diabetes and the level of sugar consumption have both risen during the past century. They also note that in cer-tain countries where sugar consumption is low the death rate from diabetes is corre-spondingly low.
In actual fact, the diabetes death rate may or may not parallel sugar intake. In the United States, for instance, annual
sugar consumption per capita has varied
little since 1925.7
•8 The diabetes death
rate, on the other hand, showed a general decline from 1949 to 1955 and a general increase, year by year, from 1956 to
1968. 7•8 In Cuba, where sugar
consump-tion is high, death rates from diabetes are
low.9
References:
I.Fact Sheet on Diabetes, New York: American Dia-betes Association, Inc., 1970.
2. Steinberg, A.G., and Wilder, R.M.: A study of the
gem:tics of diabetes. American Journal of Human Genetics 4: 113-135, 1952.
3. Committee on Food and Nutrition, American Dia-betes Association: Principles of nutrition and dietary recommendations for patients with diabetes mellitus: l 97 l. Diabetes 20: 633-634, 1971.
4. Bierman, E.L., and Nelson, R.: Carbohydrates, Dia-betes and Blood Lipids. World Review of Nutrition and Dietetics 22:280-287, 1975.
5. Cleave, T.L., Campbell, G.D., and Painter, N.S.:
Di-abetes, Coronary Thrombosis, and the Saccharine
6. Yudkm, J .: Dietary intake of carbohydrate in relation
to diabetes and atherosclerosis. In Dickens, F .,
Randle, P.J., and Whelan, W.J.: Carbohydrate
Meta-bolism and Its Disorders, vol. 2. London and New
York: Academic Press, 1968,pp.169-184.
7. Historical Statistics of the United States: Colonial
Times to 1957. Washington: Bureau of the Census,
1960, pp. 26, 187.
8. Statistical Abstract of the United States. Washington:
Bureau of the Census, annual.
9.Demographic Yearbook 1969. New York: United
Nations, 1970, p. 625.
Q.
Is the rise in the blood sugar level after eating sugar followed by a serious "let-down"?A.
In the normal person, the glucose level of the blood rises within 30 to 60 minutes after food is eaten. Sucrose provides energy very quickly-the glucose level (blood sugar) rises within one to five minutes after ingestion.' The level returns to normal within two hours. This se-quence of increase followed by decrease is called a food tolerance curve.2A "letdown" occurs when the blood sugar level drops well below normal after a meal. This may be caused by any of a number of disorders, such as hypothyroid-ism, hypopituitarhypothyroid-ism, Addison's disease,
early diabetes, or the metabolic effects of
liver damage.2 It may also occur in a small
percentage of persons when they are sub-jected to emotional stress. The tolerance curve produced by sugar is not signifi-cantly different from the curve produced by starch, bread, glucose or other carbo-hydrates.3
References:
I. Rabinowitch, J.M.: Short period blood sugar time
curves following ingestion of sucrose. Journal of Nu-trition 29:99-105, 1945.
2. Steinke, J.: Hypoglycemia. In Marble, A., et al.: Jos-lin 's Diabetes Mellitus, 11th ed. Philadelphia: Lea & Febiger, 1971.
3. Plooij, M., Verleur, H., and Meyer, D.: Suiker en suikerziekte. Nederlands Tijdschr. Geneesk.
Q.
Does eating sugar lead to hypoglycemia?A.
The subject of hypoglycemia has received a great deal of publicity in recent years. The effort to "popularize" this disease has resulted in large amounts of misinforma-tion and false impressions suggesting that it is a major ailment. A recent magazine article stated that no fewer than ten mil-lion Americans have hypoglycemia. This would make it twice as prevalent as dia-betes.In fact, hypoglycemia is an infrequent condition. It is caused by the too-rapid movement of glucose out of the blood, or too little entry of glucose into the blood.
It is believed that functional hypogly-cemia is due to an overproduction of in-sulin by the pancreas. This abruptly low-ers the blood sugar (glucose) level. Usually the intake of a prescribed amount of sugar will relieve all immediate symptoms. The proper treatment of functional hypogly-cemia is to increase protein intake, and also to increase the number and decrease the size of daily meals so that the intake of sugar and starches can be evened out. 2
In response to the inaccurate publicity given to the supposedly widespread occur-rence of hypoglycemia in this country, three organizations of physicians and scientists-the American Diabetes Associa-tion, the Endocrine Society, and the American Medical Association-joined together in a statement on hypoglycemia, which begins: "Hypoglycemia means a low level of blood sugar. When it occurs, it is often attended by symptoms of sweating, shakiness, trembling, anxiety, fast heart action, headache, hunger sensa-tions, brief feelings of weakness, and, occasionally, seizures and coma. However, the majority of people with these kinds of symptoms do not have hypoglycemia; a
great many patients with anxiety reac-tions present similar symptoms. Further-more, there is no good evidence that hypoglycemia causes depression, chronic fatigue, allergies, nervous breakdowns, alcoholism, juvenile delinquency, child-hood behavior problems, drug addiction
or inadequate sexual performance. "3 The statement goes on to point out that there are many causes of hypoglycemia, and indicates that careful medical diagnosis is necessary before any treatment is started. The intake of starches and sugars is often reduced to control the symptomatic reac-tive hypoglycemia of chemical diabetes or other origins. However, starch and sugar such as sucrose are not its cause.4 (In the case of chemical diabetes, hypoglycemia results from insulin effects promoted by the disease.)
A major medical publication on the subject5 stresses that hypoglycemia is not
a disease, but a defect in the complex mechanisms that maintain blood sugar levels. Generalizations about its causes and mechanisms, its author concludes, "are to be avoided."
References:
l. Wright, M.: Hypoglycemia: the sugar-starved society.
Town & Country, June 1971, pp. 41, 93.
2. Low blood sugar: fact and fiction. Consumer Reports
36:444-446, July 1971.
3. Statement on Hypoglycemia. Journal of the
Ameri-can Medical Association 223:682, 1973.
4. Danowski, T.S., Nolan, S., and Stephan, T.:
Hypogly-cemia. World Review of Nutrition and Dietetics 22, 288-303, 1975.
5. Cornblath, M.: Hypoglycemia. In Dickens, F.,
Randle, P.J., and Whelan, W.J.: Carbohydrate Metab-olism and Its Disorders, vol. 2. London and New York: Academic Press, 1968, pp. 51-86.
Q.
Is sugar the major cause of tooth decay?A.
Sugar by itself does not cause dental caries, or tooth decay. Dental researchers have found that teeth will not decay unless 1) tooth surfaces are already sus-ceptible; 2) certain bacteria are present in the mouth; and 3) fermentable carbo-hydrates are also in the mouth cavity. 1A conference on Mechanisms of Dental
Caries2 held under the auspices of the
New York Academy of Sciences
concluded that there is no one simple answer to the question what causes caries. The environment plays a part. Tooth decay is more prevalent in temperate regions than in the tropics. It is more fre-quently found at the seacoasts than in-land. 3
The host also has something to do with its appearance. Resistance or susceptibil-ity to dental caries may depend on ethnic group, age, sex, family heredity, nutrition, and emotional states. 3
Epidemiological evidence makes it clear that bacterial infection is the principal factor involved in dental caries. Caries are spread via human carriers throughout the world, and must therefore be considered a communicable disease.4 People who have never used sugar or sugar-containing processed foods may nevertheless have dental caries, indicating that caries should not be considered as due to a single cause dependent on a single kind of food.4
There is little or no risk of increased caries incidence when sugar is consumed with meals. The cariogenicity of foods in general depends on other factors than sugar content alone. For example, stickier foods are more cariogenic than non-sticky foods.5
Nevertheless sugar is more frequently implicated in tooth decay than the other carbohydrates, especially when eaten
between meals. 6 Proper dental habits are necessary if the prevalence of this disease
is to be reduced. Authorities counsel
brushing teeth after each meal. . . using dental floss ... cutting down on between-meals snacking. . . regular visits to the dentist.
As long as sugar remains one of our cheapest sources of calories in the form of a carbohydrate, and at the same time the most pleasurable of foods, it is doubtful if people will reduce their consumption of sugar for dental health. Most authorities agree that tooth decay can be drastically reduced, if not halted, by more wide-spread fluoridation of water supplies and the use of fluorides in dentifrices, tablets,
and direct application to the teeth.6
• 7
Such new approaches as selective
anti-bacterial agents, 6 enzymes that break
down dental plaque,2 and tooth-sealing
procedures8 are also under study by the
National Institute of Dental Health, the Eastman Dental Center, and many other centers of scientific research in the United States and abroad. They offer hope that
dental caries can become a preventable ail
-ment rather than a chronic disease.
References:
1. Harris, R.S.: Dietary chemicals in relation to dental caries. In Dietary Chemicals vs. Dental Caries. Wash-ington: American Chemical Society, 1970, pp. l -6.
2. Fredrick, J.P. and Schole, M.L.: Mechanisms of dental caries. Ann-New York A cad. Sci. 131:685-930, 1965.
3. Dunning, J.M.: Progress in the epidemiology of dental caries.Ann. New York Acad. Sci. 131:913-921, 1965.
4, Russell, A.L., quoted in Darby, W.J.: Some com-ments on sugars in nutrition. Naeringsforskning 17 (suppl. 9): 31-33, 1973.
5. Glass, R.L.: The lack of association between dental
caries incidence and the consumption of breakfast
• cereals. Naeringsforskning 17 (Suppl. 9):26-30, 1973. 6. Scherp, H.W.: Dental caries: prospects for prevention.
Science 173: 1199-1205, 1971.
7. Glass, R.L. and Finn, S.B.: Sugar and Dental Decay.
World Review of Nutrition and Dietetics 22:304-326,
1975.
8. Buonocore, M.: Adhesive sealing of pits and fissures for caries prevention, with use of ultraviolet Light. J.
Amer. Dent. Assoc. 80:324-328, 1970.
20
Q.
Does eating sugar rob the body of B vita-mins?A.
The notion that sugar "robs" the body of B vitamins is based on a misunderstanding of the proper function of these vitamins. Thiamine (B1 ), riboflavin (B2 ), niacin, and pantothenic acid, all of which are Bvitamins, are required in the normal metabolism of all carbohydrates, sugar included.1 Only when the level of these vitamins in the diet is very low, and the intake of carbohydrates very high, does the B-vitamin supply become inadequate. These conditions occur only with a highly unbalanced diet, and are usually seen only
in poverty-stricken areas of
under-developed countries. References:
1. Stare, F .J ., and McWilliams, M.: living Nutrition. New York: John Wiley & Sons, Inc., 1973, pp. 254, 376.
Q.
Does sugar slow down the absorptionof calcium?
A.
Popular nutritionists sometimes make this claim, based on the contention that sugar stimulates production of alkaline digestive juices which render calcium insoluble before it can be absorbed in the intestine. Actually, calcium absorption is always ahighly inefficient process, because calcium tends to combine with many elements that appear in the intestine, forming insol-uble phosphates, carbonates, oxalates, sul-fates, or soaps.1 Normally, only ten to twenty per cent of calcium present in food is absorbed, and the remainder is excreted unused.1 In this vast normal "wastage" of calcium, the role played by sugar is only a small part of the whole.
References:
I. Orten, J.M. and Neuhaus, O.W.: Biochemistry, 8th ed. St. Louis: C.V. Mosby Company, 1970.
Q.
Why is sugar accused of supplying only "empty calories" to the diet?A.
The term "empty calories" is applied to white refined sugar because it provides no nutrients other than carbohydrate. Users of this term are suggesting that all foods must be a source of several nutritional requirements, not just one, and that calo-ries are relatively unimportant. An ade-quate supply of calories, as is known, is essential for health and work. 1 In the United States, as in most developed coun-tries, carbohydrate supplies 45 to 50% of total daily calories.2 Of this, sugar makesup one-third of total carbohydrate. 2 As has been pointed out, it would be difficult to find substitute calorie sources if our
supply of sugar was cut out or even cut
down.
Sugar should not be faulted as a source of calories. It is one of our purest foods, and is so quickly digested in the body that it is available for energy use in a matter of minutes. 3 The calories in sugar are no more empty than the calories in any other food. Calories, as a measure of heat and energy, cannot be anything other than calories, any more than inches can be any-thing other than inches.
The type and amount of nutrients con-tributed by foods vary considerably; some foods offer minute amounts of minerals or vitamins in addition to fats or carbo-hydrates. Canned pears, to take an
example, offer carbohydrate and
potas-sium, and extremely small amounts of
other nutrients. Pears are not criticized for their paucity of nutrients.
Perhaps the soundest observation about "empty calories" is the nutritional fact that when a person eats foods that supply the daily requirements of carbohydrates, proteins, vitamins and minerals, the rest of the calorie quota can be filled from any food. What should be guarded against is to start with foods whose value is almost entirely in calories alone. The want of essential nutrients would be perilous.
References:
1. Recommended Dietary Allowances, 8th rev. ed. Washington: National Academy of Sciences, 1974. 2. Statistical Abstract of the United States. Washington:
Bureau of the Census, annual.
3. Rabinowitch, 1.M.: Short period blood sugar time
curves following ingestion of sucrose. Journal of
Nutrition 29:99-105, 1945.
4. Watt, B.K., Merrill, A.L., et al.: Composition of
foods. Agriculture Handbook No. 8, rev. December
1963. Washington: Cons. and Food Econ. Res. Div., Agricultural Research Service, United States Depart-ment of Agriculture.
5. Bogert, L.J., Briggs, G.M. and Calloway, D.H.: Nutri-tion and Physical Fitness, 9th ed. Philadelphia: W.B.
Q.
Do we need sugar in our diet?A.
Nutritionists are in general agreement thatabout 50 per cent of our calories should come from carbohydrates, to supply the bulk of our energy needs and for other nutritional requirements. About one-third of the U.S. carbohydrate intake is sugar .1
There is a psychological need for sugar. People enjoy it. They like to eat foods that are sweetened. It is sugar that adds to grapefruit's palatability, that enhances the flavor of salad dressings and soups, that increases the desirability of baked goods
and dairy products, such as ice cream.2
Infants and children usually need more
calories than are supplied by milk, their
main food.2 Foods containing sugar help
to even out this requirement.
There is an economic need for sugar, too. Sugar provides more calories at lower cost than other common foodstuffs. In other terms, sugar cane and sugar beets provide by far the largest food yield when expressed as calories per acre of land. If we could eliminate sugar from our diet, it would be difficult to make up the calorie loss with other foods.
References:
l. Friend, B.: Nutritional review. National Food
Situa-tion 134:21-24, November 1970.
2. Robinson, C.H.: Fundamentals of Normal Nutrition.
