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By Dr. Robert H. Lustig

First it was our national embarrassment, then our national tragedy, and it is rapidly morphing into our national time bomb. On its present trajectory (a 70 percent increase since 2000), obesity and related chronic diseases will break the bank on Medicare by 2024. This is maddening, especially because 75 percent of these diseases and resultant health care expenditures are preventable. The solution must start with a re-evaluation of the American food system.

The prevailing wisdom is that obesity is the cause of these diseases. Yet up to 40 percent of normal-weight people also manifest some aspect of the medical disorders associated with obesity – high blood pressure, high cholesterol, heart disease, diabetes – and will die of one of these diseases. Add it up, and more than half of the U.S. population is at risk. We must look past the number on the scale to the underlying cause of this phenomenon.

The other prevailing wisdom is that weight is just a matter of personal responsibility: “Eat less, exercise more, ” we are cautioned. But how can personal responsibility explain our epidemic of obese 6-month-olds? Our exercise levels have not changed over the past several decades, but the content of our supermarket shelves sure have. How can we claim personal responsibility when we don’t even know what is in the food we’re eating?

We can argue our pet theories as to why we’re getting fat and sick, but scientific data are pointing to one big reason – our sugar habit. Our daily median consumption of added sugars is 22 teaspoons, yet the American Heart Association recommends we cut back to 6 to 9 teaspoons. Although soda and juice are responsible for one-third of our excess sugar consumption, the other two-thirds may constitute an even bigger problem because it is hidden throughout our processed food. Until we start ratcheting down our added sugar consumption, expect to keep ratcheting up the health care dollars wasted.

Of the 600,000 items in the American food supply, some 80 percent are laced with added sugars. The food industry uses two business models to justify this practice:

(1) We give the public what it wants; and

(2) If you build it, they will come. And when the food industry adds sugar, oh boy, do we come.

Thus far, all attempts at getting the populace to “eat less” have met with failure – in part because sugar interferes with the signaling of hunger and reward in the brain, fostering overconsumption, and because the food industry hides the sugar well. There are 56 names for sugar; listing different names as the fifth, sixth, seventh and eighth ingredients on the labeling meets the letter of the law but obscures the fact that, when the amounts of each are added up, sugar is the No. 1 ingredient.

Personal responsibility is a non sequitur without public education. How can we expect anyone to make a rational dietary decision when the information on which to make that decision is withheld? We’re not allowed to know how much sugar is added or where the added sugars hide.

The Nutrition Labeling and Education Act of 1990 requires the disclosure of total sugars on the nutrition facts label for processed food. That includes the strawberries in your strawberry ice cream, the lactose in the milk (neither of which is a problem), and the added sugar. Yet how much of that sugar is lactose, and how much is added sugar? The label doesn’t say, but you can figure it out. (See box.)

The U.S. Food and Drug Administration recently proposed requiring an added sugar disclosure as part of the Nutrition Facts Panel. Requiring this disclosure is a step in the right direction, but it will not go far enough.

The FDA has established a disqualifying level of certain nutrients for manufacturers making health claims. The levels monitored include total fat, saturated fat, sodium and cholesterol. This is an outdated list. The FDA needs to provide a disqualifying level for added sugar as well.

Walk down the cereal aisle at your local supermarket and you will see candy-named products marketed to children (sometimes with appealing cartoon characters) that tout how healthy the cereal is. Really? Put simply, sugar is toxic at high doses, and we’re overdosing on a daily basis.

Does anyone even read the nutrition facts label? Does anyone really care? More important, will it change consumer behavior? Restaurant menu labeling thus far hasn’t.

Some may decry the need to list added sugars on the food label, arguing that it’s not necessary and that people will ignore it or be confused by it. But listing added sugars is no different from distinguishing subcategories of total fat (i.e., saturated fat, trans fat), information that people have come to expect.

Others might support the removal of total sugar in place of listing added sugars. Bad idea. Take freshly squeezed orange juice: Once the fiber is gone, the sugar content of juice is higher than an equal volume of soda. Yet the added-sugar label would yield a big fat zero. Thus, listing both total sugar and added sugar will yield two positives: it’s the rational way to educate that fraction of the public who cares and, most important, it will force the hand of the food industry to reduce its practice of sugar supplementation, as they won’t want to appear to be the purveyor of a poison.

Such a proposal is a step in the right direction, but does not go far enough to convey the type of information that consumers really should be assessing. Consider this hypothetical proposal the “Alice Waters” approach to food labeling, because it’s based on the premise that all naturally occurring food is inherently good.

The real problem is how industry processes food. Why not list how much sugar was added for palatability, and also list the addition of preservatives and the removal of fiber for shelf life? (See chart.) The food industry would fight such a labeling scheme tooth and nail, as it would force food processors to come clean on how they’ve rigged the game. We would learn that not all carbohydrates and fats are equal. Carbohydrate with fiber (like beans) beats the pants off refined carbohydrate (like white bread), and saturated fat (butter) leaves trans fats (margarine) in the dust.

Tick, tick, tick. The health care explosion will reverberate across generations. But just maybe, when the food industry retools to give the public the information (and the food) it needs to be healthy, we can defuse our national time bomb for everyone’s benefit.

Yogurt’s a health food?

Consider a 6-ounce carton of pomegranate yogurt, which has 19 grams of sugar. A plain yogurt has 7 grams of sugar, all lactose.

Thus, each pomegranate yogurt has 12 grams of added sugar, the same as a bowl of Cap’n Crunch (although not as much as Cracklin’ Oat Bran, with 15 grams). Not so healthy after all.

What’s in a name?

Question: What do these foods have in common?

Fructose, demerara, castor, honey, turbinado, diatase, Florida crystals, agave nectar, moscovado, refiner’s syrup

Answer: They are all sugar.

Dr. Robert H. Lustig is a professor of pediatrics at UCSF Benioff Children’s Hospital, and the author of “Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease” (Hudson Street Press, 2013).

This article was published by SFGate.

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