Gary Null: The Effect of Sugar on the American Diet

March 14, 2003

Mr. Jeffrey S. Tenenbaum

Venable, Baetjer, Howard & Civiletti, LLP

1201 New York Avenue, N.W., Suite 1000

Washington, D.C. 20005-3917

                    Re:    The Effect of Sugar on the American Diet

Dear Mr. Tenenbaum:

As you may recall, I am General Counsel to Gary Null’s Anti-Aging Center, Inc. and a personal attorney for Gary Null, Ph.D.  On June 21, 2002, you wrote Mr. Null a letter calling into question some of the statements that he made in his PBS public health documentary, “Seven Steps to Perfect Health.”  In large part your letter challenged Mr. Null’s opinion that sugar, as it is currently consumed, is an unhealthy component of the modern American diet.  On June 26, 2002, we responded by writing you a brief letter saying that we would take your letter under advisement, review the research that you presented, and undertake our own independent investigation.

Your letter was particularly important to us because we believe that we were removed from certain public television stations, such as WETA in Washington, D.C., because of the negative statements in your letter concerning our Seven Steps program.  We understand that you sent copies of your letter to Pat Mitchell, the President of PBS, as well as to Sharon Rockefeller, the President of WETA.   In your letter you attempted to convey that our program contained certain improper opinions and inaccurate statements regarding the consumption of sugar and its effects on human health. Despite the show’s proven success as both a fundraiser for PBS stations and as an educational primer on good health and nutrition, we were surprised to discover that WETA was influenced by your letter to remove our program from their schedule.  Specifically, we were advised that Ms. Rockefeller, as a recipient of your letter, prevailed upon the program director of WETA to censor Seven Steps and remove it from the station’s schedule.

While we can appreciate that our viewpoints on the benefits and harms of sugar in human diets may differ—and we respect your right to present a viewpoint different from ours—we must draw the line where you have actively sought to suppress our viewpoint and our program from the public media.  This is especially true where we believe we have been falsely accused of making inaccurate statements about sugar and the possible risks that it poses in the American diet.

At the outset it should be noted that we are not beholden to any special interest groups, as is the case with the Sugar Association.  Quite the contrary, Mr. Null has been motivated primarily by a compelling lifetime interest in improving public health both in America and the world, and has led some of the most important public health campaigns of our generation.  In the past, Mr. Null has thus made major contributions to the banning of DDT and harmful pesticides, discrediting the widespread use of electro-convulsive shock therapy, and eliminating abusive practices by the pharmaceutical industry.  More recently, Mr. Null has brought much needed attention to the looming crisis of toxic nuclear radiation and waste, and preventing the over-prescription of anti-depressants, pain-killers, hormone replacement drugs, and Ritalin.  Mr. Null, whose Ph.D. is in human nutrition, is the author of over 80 books on health and nutrition, including the New York Times bestsellers, Get Healthy Now! and For Women Only (with Barbara Seaman).  Finally, Mr. Null is the host of the nation’s longest running syndicated radio show on health, Natural Living.  As demonstrated by Mr. Null’s books, documentaries, radio programs, and seminars, Mr. Null’s actions are not motivated by any commercial interest group or industry association, but by the desire to improve the health and nutrition of all society.

          With this in mind we would now like to respond to the specific charges made in your letter regarding sugar.  On page 2 of your letter you cite a December 2001 Report from the United States Department of Agriculture (USDA), which allegedly states that "sugar intake alone is not associated with the development of diabetes."  This statement, however, is misleading, as our research has shown that there never has been a study that either proves or disproves that sugar alone, as a single factor, is the cause of diabetes.  Further, even assuming arguendo that sugar is not the sole or primary cause of some forms of diabetes, the fact that it may have any significant influence on the increase of diabetes, in our view, justifies labeling it as a potential health hazard.

In contrast to your reliance on a USDA statement taken out of context, our research shows that the major studies on sugar have demonstrated that a refined foods diet has been a major factor in the current American epidemics of obesity, diabetes, and heart disease. Your suggestion that sugar does not have any relationship to these serious health problems plaguing American society, on the other hand, is without any support in the current scientific literature, is contrary to most of the independent studies that have actually been performed on sugar, and appears to be motivated by factors other than improving the public welfare.

A large portion of your letter is devoted to challenging our statistics regarding how much sugar is actually consumed by the average American.  You appear to cite a 1994-1996 USDA Study for the statement that “total caloric sweetener” consumption in the U.S. is only 80 grams per person per day, which is equivalent to 2.8 ounces.  We believe that your statistics are incorrect and that the actual amount of caloric sweetener consumed is much more than you indicate.  Part of your underestimate apparently stems from your restriction of the definition of “sugar” to just refined white sugar.

We do not believe that the definition of sugar should be restricted to just refined white sugar, and neither does the American Heart Association (AHA) or the USDA.  In a 2002 AHA Statement to Healthcare Professionals, the AHA provided a broad definition of what constitutes “sugar”:

There are many, sometimes confusing, terms used in the literature. Simple carbohydrate (sugar) refers to mono- and disaccharides; complex carbohydrate refers to polysaccharides such as starch. Common disaccharides are sucrose (glucose+fructose), found in sugar cane, sugar beets, honey, and corn syrup; lactose (glucose+galactose), found in milk products; and maltose (glucose+glucose), from malt.  The most common naturally occurring monosaccharide is fructose (found in fruits and vegetables).  The term dextrose is used to refer to glucose.  Intrinsic or naturally occurring sugar refers to the sugar that is an integral constituent of whole fruit, vegetable, and milk products; extrinsic or added sugar refers to sucrose or other refined sugars in soft drinks and incorporated into food, fruit drinks, and other beverages.[1]

In the same 2002 Statement, the American Heart Association concludes that in 1995, the “average US sugar utilization” reached “68 kg (150 lb) per year in 1995 (almost 0.5 lb per day).”[2]

The statistics of sugar consumption as reported by the American Heart Association, are based in part on data originally gathered by the USDA. According to the most recent USDA statistics:

Per capita consumption of caloric sweeteners increased by 28 pounds, or 22 percent, from 1970 through 1995, and has continued to increase since 1995.  In 1999, per capita sweetener consumption was estimated at 158 pounds per capita.  Sugar and sweeteners have maintained a 36-40-percent share of the steadily growing U.S. per capita consumption of carbohydrates.[3] 

Added sugar was not a significant component of the human diet until the advent of modern food-processing methods. Since then, the intake of sugar has risen steadily. The USDA’s 1995 Continuing Survey of Food Intakes by Individuals reported that "the intake of sugar and other refined sweeteners increased from about 55 kg (120 lb) per person per year in 1970 to 68 kg (150 lb) per person per year in 1995."[4]

Similarly, a USDA Report on Food Consumption, Prices and Expenditures during the period 1970-1997, made certain findings and recommendations with respect to sugar consumption in the U.S.:

Americans have become conspicuous consumers of added sugars and sweet-tasting foods and beverages.  Per capita consumption of caloric sweeteners (dry-weight basis)—mainly sucrose (table sugar made from cane and beets) and corn sweeteners (notably high-fructose corn syrup, or HFCS)—increased 34 pounds, or 28 percent, between 1982 and 1997.  In 1997, each American consumed a record average 154 pounds of caloric sweeteners.  That amounted to more than two-fifths of a pound—or 53 teaspoonfuls—of added sugars per person per day in 1997.  USDA’s Food Guide Pyramid suggest that people consuming 1,600 calories limit their intake of added sugars to 6 teaspoons per day.  The daily suggested limit increases to 12 teaspoons for those consuming 2,200 calories, and to 18 teaspoons for those consuming 2,800 calories. [5]

Thus, according to the U.S. Department of Agriculture, by consuming 53 teaspoonfuls of sugar a day, the average American is consuming close to three times the maximum of 18 teaspoons recommended by USDA food guidelines for even the highest calorie diets.

The same USDA report also showed that a steep rise in caloric sweetener consumption since the mid-1980's coincided with a 47-percent increase in annual per capita consumption of regular (nondiet) carbonated soft drinks, from 28 gallons per person in 1986, to 41 gallons in 1997 (that is 14.5 ounces per person per day, an amount that contains 11 teaspoonfuls of sugar).  Carbonated soft drinks provided more than a fifth (22 percent) of the refined and processed sugars in the 1994 American diet.[6]  A more recent USDA Table of U.S. Per capita Consumption of Caloric Sweeteners shows that in 1999, consumption of total caloric sweeteners totaled 151.3 pounds.[7] A copy of this table is attached at the end of this letter.  The average amount of sugar consumed by Americans today, whether it is 150, 151, 154, or 158 pounds, is excessive, and, as demonstrated by the studies cited below, contributes to the modern epidemics of obesity, diabetes, heart disease, and even cancer.

Some have argued that the cited figure of 158 pounds, direct from the USDA, may even understate the actual amount of sugar consumed in the U.S., as the USDA may not fully take into account the millions of people who do not eat sugar at all.  In other words the total U.S. sugar consumption is divided over the entire population of the United States, and fails to exclude the millions of people, such as diabetics, infants, and babies that do not consume any sugar.  Also, many other individuals in American society have decided to eliminate sugar from their diets for health or other reasons.  Excluding all these individuals from the general population of sugar consumers means that the general population is consuming even more sugar than the official statistics would seem to indicate.

Your attacks on Mr. Null for presenting his own opinion that Americans consume too much sugar missed the point of his program.  For instance, in your letter you dwelled upon the precise amount of sugar that Mr. Null poured onto a plate and argued that it was more than what the average American consumes.  Part of your argument, however, can be traced to our disagreement as to what constitutes “sugar” and how much of it the average American consumes.  We agree with the American Heart Association and the USDA, that sugar is defined to include all simple carbohydrates and that based on this definition, the average American consumes approximately half a pound of sugar a day.  You, however, apparently limited the definition of sugar to refined white sugar and said that the total amount consumed is only 2.8 ounces, or less than one-fifth of a pound.  Your narrow view of the term “sugar” is at odds with both the AHA and the USDA definitions.  Additionally, Mr. Null was not measuring out an exact amount of sugar onto a laboratory scale with scientific precision.  Instead, he was trying to physically demonstrate the approximate amount of sugar consumed by pouring an actual pile of it onto a plate.  The amount of sugar that poured was not totally inaccurate, as you suggest, but was an appropriate depiction of an approximate amount of total daily sugar consumed.

The history of sugar shows that over the last 200 years the consumption of sugar in industrialized society has grown astronomically.  For instance, in Britain, the annual consumption of refined sugar rose from only about 15 pounds per person in 1815 to about 120 pounds per person in 1955.[8] Thus, the precipitous introduction of refined sugar into the human diet only started in the last few hundred years.  As reported by the authors of Sugar Busters! (three of whom are doctors of medicine):

We have only had refined sugar for a mere blink of time in man’s digestive evolution; think about it.  Is it any wonder that the incidence of diabetes and hyperglycemia (pre diabetes) continues to get higher and higher?  Maybe we simply wear out our pancreases.

Where did the observations on sugar’s ill effects originate?  Since refined sugar did not exist anywhere in the world until around 700 A.D., it must have been after that.[9]

Apparently, Gary Null is not alone in believing that the consumption of sugar at current levels can be toxic to good health.  The medical authorities of Sugar Busters! concluded:

It is quite logical that we should have added refined sugar to the priority list of things that are, or may be, “Hazardous To Your Health” when you see the increase in disease caused by our huge consumption of refined sugar and certain other carbohydrates.  Sugar just may be the number one culprit in lowering the quality of life and in causing premature death.  There is certainly enough evidence to bring us to that conclusion.[10]

In an article for Eating Well, Robin Edelman describes four aspects of sugar use and its effects: a Princeton University study on depression and food intake; childhood obesity; a study of a sugar-dependent adult woman; and the prevalence of added sugars in processed foods.  Thus, in 1999, Professor Bart Hoebel at Princeton found that rats showed significant signs of withdrawal from a sugar solution when Naxolone was used to block the effects of sugar in the rats’ brains.  The study suggested that attraction to sugar may extend beyond simple yearning into the realm of chemical dependence.  In Boston, pediatrician David Ludwig found in his clinical experience that childhood obesity could be directly traced to consumption of carbonated soft drinks, sweetened baked goods, candy and sweetened fruit drinks. He concluded that once a child established this pattern of eating, it was a very difficult rhythm to break.  Edelman found that an overweight woman viewed sugar as an energizing drug, and although she felt miserable shortly after, she could not stop eating sweets. Edelman explained that added sugars are found in virtually every type of prepared food we buy, and result in the average consumption of 20 teaspoons of added sugars per day in the United States. This exceeds the USDA’s recommended limit of 10 teaspoons per day.

Finally, Edelman showed how a 30% increase in sugar consumption during the last two decades has led to a doubling in the number of overweight and obese children over the same time period.  This sharp increase in sugar consumption and its effects on American obesity led The Center for Science in the Public Interest (CSPI) to petition the Food and Drug Administration to require new food labels declaring just how much sugar is added to soft drinks, ice cream and other foods.  Their petition was joined by 39 organizations, ranging from the American Public Health Association and former Surgeon General Koop’s Shape Up America! to the YMCA and Girl Scouts of America, along with 33 experts on obesity, heart disease and dental caries. Marion Nestle, chair of the Department of Nutrition and Food Studies at NYU, said: “Because sugary foods often replace more healthful foods, diets high in sugar are almost certainly contributing to osteoporosis, cancer and heart disease.”[11]

As far back as 1942, the American Medical Association stated it would be in the interest of public health to limit consumption of sugar in any form when it is not combined with significant proportions of foods high in nutritious quality. Presently, however, the AMA and other medical organizations have been largely silent about sugar consumption.  A 1998 report from the CSPI found that soft drinks account for more than 27 per cent of Americans’ beverage consumption accompanied by low intake of calcium, magnesium, ascorbic acid, riboflavin and vitamin A.  Six of the seven most popular soft drinks contain caffeine even though caffeine increases the excretion of calcium in urine. Despite these and many other health risks the soft drink industry consistently portrays its product as being positively healthful.  In 1997 Coca-Cola spent $277 million in advertising targeted towards children.  The advertising placed their logos and products within easy reach of children, and Pepsi, Dr. Pepper, and Seven-Up have licensed their logo to a maker of baby bottles, Munchin Bottling, Inc.[12]

In 1998, Ron Lord wrote in the Agricultural Outlook Forum: "Sugar at one time had a rather negative public image, if I remember the 1970s correctly.  Then in the 1980s, public attention became focused on fat as something to avoid; and about the same time a rather successful advertising campaign to promote the healthy and natural aspects of sugar was conducted. The result: gains to carbohydrates, and sugar in particular. Such gains, due to the movement away from fat, may be exhausted.  If true, this contribution to the growth in sugar consumption may be over."[13]

Our society is now experiencing the results of the sugar industry’s successful advertising campaign to promote the healthy and natural aspects of sugar.  Your client, a sugar lobby group, has a very different agenda than ours. You are in the business of promoting and selling sugar.  We are on a mission of trying to educate people to stay healthy. These are two opposite ends on the spectrum of health and disease.  As responsible health educators we take a preventive approach to chronic disease; it is far easier, far less expensive, and far less painful to prevent diabetes, heart disease, and cancer than to wait for them to occur. The tools to do this lie in educating the public that half a pound of sugar a day is unhealthy and leads to disease.

We now turn to the research that we have assembled on the consumption of sugar and its effects on health and nutrition in the United States today. 

SUGAR AND ADDICTION

The links between sugar and addiction are well documented in a multitude of studies.  Colantuoni, in Obesity Research, showed that excessive sugar intake causes opioid dependence and that the removal of sugar causes withdrawal symptoms to occur.  The authors conclude that withdrawal from sugar is qualitatively similar to withdrawal from morphine or nicotine, suggesting that the rats had become sugar-dependent.[14]  Addiction to sugar was also confirmed in a multitude of other studies.[15]

SUGAR AND AGING

As the large baby boomer generation enters their 50s and 60s, there has been a greater focus on the aging effects of sugar.  Anti-aging research has begun to show that sugar is one of the most powerful aging substances known. Bonding between glucose and collagen, called glycation, can result in many negative effects, including thickened arteries, stiff joints, pain, feeble muscles and failing organs. According to Melton, diabetics age prematurely because this sugar-driven damage can not be curtailed. Diabetics suffer a very high incidence of nerve, artery and kidney damage because high blood sugar levels in their bodies markedly accelerate the chemical reactions that form advanced glycation products. According to Melton, "after years of bread, noodles and cakes, human tissues inevitably become rigid and yellow with pigmented glycation deposits." It may come as no surprise that scientists are trying to find a drug to break the AGE bonds rather than just tell people not to eat so much sugar.[16]

SUGAR AND APPETITE SUPPRESSION:

Anderson, et al., reasoned that a primary mechanism by which carbohydrates are thought to regulate satiety and food intake is through their effect on blood glucose. They found that food intake and subjective appetite are inversely associated with blood glucose response in the 60 minutes following consumption of carbohydrates. Carbohydrates with a high glycemic index (glucose, polycose, and sucrose) suppress subjective appetite and food intake in the short term, but those with a low glycemic index (amylose and amylopectin) do not. This study shows that sugary foods cause appetite suppression and prevent people from achieving a balanced diet with proper nutrients unavailable in sugary products.[17]

SUGAR AND CANCER:

In the 1930s, Otto Warburg, Ph.D., a Nobel Laureate in medicine, discovered that cancer cells have a fundamentally different energy metabolism compared to healthy cells. He found that increased sugar intake could increase cancer cell production. The more primitive nature of cancer cells requires a direct supply of glucose, not being able to master the more complex synthesis of glucose from larger molecules. The build up of lactic acid and an acidic pH from direct consumption of glucose in cancer cells is a diagnostic factor for cancer.[18]

Earlier research using a mouse model of human breast cancer demonstrates that tumors are sensitive to blood-glucose levels. Sixty-eight mice were injected with an aggressive strain of breast cancer, then fed diets to induce either high blood-sugar (hyperglycemia), normal blood-sugar (normoglycemia) or low blood-sugar (hypoglycemia). There was a dose-dependent response in which the lower the blood glucose, the greater the survival rate. After 70 days, 8 of 24 hyperglycemic mice survived compared to 16 of 24 normoglycemic and 19 of 20 hypoglycemic. The researchers suggest that regulating sugar intake is key to slowing breast tumor growth.[19]

An epidemiological study in 21 modern countries by Seeley followed morbidity and mortality (Europe, North America, Japan and others) and revealed that sugar intake is a strong risk factor that contributes to higher breast cancer rates, particularly in older women.[20]  A four-year study in the Netherlands at the National Institute of Public Health and Environmental Protection compared 111 biliary tract cancer patients with 480 controls. Moerman concluded that cancer risk associated with the intake of sugars, independent of other energy sources, more than doubled for the cancer patients.[21]

Michaud, et al., at the National Cancer Institute followed up on two large studies conducted over the past 20 years on approximately 50,000 men and 120,000 women.  They concluded that obesity significantly increased the risk of pancreatic cancer and that physical activity appears to decrease the risk of pancreatic cancer, especially among those who are overweight.  Preventing obesity by dietary intervention and exercise is by far the better avenue of approach for treating pancreatic cancer.[22]  The Michaud team continued their investigation of the triggers of pancreatic cancer and found that evidence from both animal and human studies suggests that abnormal glucose metabolism plays an important role in pancreatic carcinogenesis. They investigated whether diets high in foods that increase postprandial glucose levels are associated with an increased risk of pancreatic cancer.  They studied 180 patients with pancreatic cancer and concluded that their data support other findings that impaired glucose metabolism may play a role in pancreatic cancer etiology.  A diet high in glycemic load may increase the risk of pancreatic cancer in women who already have an underlying degree of insulin resistance.[23]

SUGAR AND CARDIOVASCULAR DISEASE

On July 23, 2002, the American Heart Association released a report on “Sugar and Cardiovascular Disease.”  The report concluded that scientific data indicates that sugar consumption is detrimental to health, that no data indicates that sugar consumption is advantageous, and that high sugar intake should be avoided.  The report also stated that obesity is a definite cause of cardiovascular disease and death.[24]

A study in August, 2000, from the State University of New York at Buffalo reported that excess sugar in the blood increases the production of free radicals, which have been linked to aging and heart disease. Healthy adults who were given a drink containing 75 grams of pure glucose, the equivalent of two cans of cola, experienced a significant rise of free radicals in the blood one hour after the drink, and a doubling of free radicals after two hours.  The sugar drink also produced an increase in a part of an enzyme that promotes free radical generation and a four percent decrease in levels of Vitamin E.  Dr. Paresh Dandona concluded, “We believe that in obese people, this cumulatively leads to damage and may cause hardening of the arteries.”[25]  Numerous other studies have repeatedly documented the relationship between high blood sugar levels and increased heart disease.[26]

          In a 2001 UN report commissioned by the World Health Organization and the Food and Agricultural Organization, a team of global experts identified the excessive consumption of sugar from snacks, processed foods, and drinks, as one of a few major factors causing worldwide increases in cardiovascular diseases, cancer, diabetes, and obesity.  In 2001, such chronic diseases contributed approximately 59% of the 59.6 million total reported deaths in the world and 46% of the global burden of disease.[27]

SUGAR AND CHILDREN’S BEHAVIOR

Several important studies have shown the relationship between sugar consumption and behavioral changes in children.  Between 1973 and 1977, Dr. William Crook did a follow-up study to his 1961 elimination-challenge diets of 50 children with systemic and nervous symptoms. This time he saw 182 new pediatric patients with hyperactivity, attention deficits and other behavioral and learning problems. The ingredients eliminated from the childrens’ diets were food coloring and additives, sugar, wheat, eggs, milk, corn, chocolate and citrus.  If the child showed improvement after eliminating these ingredients, the child was challenged with one eliminated food per day.  Of the 182 patients, the parents of 128 children reported that they were certain their child’s condition was related to one or more of the dietary ingredients.[28]

Dr. Stephen Schoenthaler conducted diet research in children for almost 30 years.  His original seminal studies eliminated sugar and junk foods from the lunch programs of one million school children in over eight hundred New York schools during a seven-year period (1976-1983).  Learning performance was established first, and then in 1979, diet changes were introduced.  High sucrose foods were gradually eliminated or reduced and there was a gradual elimination of synthetic colors and flavors and selected preservatives (BHA and BHT).  There was a 15.7% gain (from 39.2% to 55%) in learning ability compared with other schools during the years in which these changes in diet were introduced.  Schoenthaler also noted that out of 124,000 children who, before the dietary changes, were unable to learn grammar and mathematics, 75,000 were able to perform these basic tasks after dietary changes alone.[29]

Schoenthaler also studied thousands of juvenile delinquents on junk-free diets and always observed dramatic improvement in mood and behavior.[30] With regard to sugar intake in particular, Schoenthaler worked with the Los Angeles Probation Department Diet-Behavior Program and observed 1,382 incarcerated delinquents at three juvenile detention halls. They showed a 44% drop in antisocial behavior on a low sucrose diet. The greatest reductions were seen in: repeat offenders (86%), narcotics offenders (72%), rape offenders (62%), burglars (59%), murderers (47%) and assault offenders (43%).  The second part of his study followed 289 juvenile delinquents at three juvenile rehabilitation camps. They exhibited a 54% reduction in antisocial behavior after sugar consumption was reduced. A similar Alabama Diet Behavior study by Schoenthaler observed 488 incarcerated delinquents for 22 months.  The decline in antisocial behavior resulting from reduction in sugar consumption ranged from a low of 17% to a high of 53% (an average of 45%) depending upon gender, race and type of offender.[31]

The sugar industry has often cited four different small-scale studies to deny any link between consumption of sugar by children and hyperactivity.[32]  Although there were many flaws in those studies, the conclusions were generally used to suppress any objections to increasing the amounts of sugar in children’s diets.  The problems with these studies included that the amount of sugar used was too small, the size of the trial was very small, the observation times were short, the control group was denied a nutritious alternative to sugar, and artificial sweeteners, that had their own unmeasured effects, were used as the placebo controls.

Thus, one study used an average of only 65 grams (13 teaspoons) of sugar daily for a trial group of 21 persons.[33]  This is the average amount of sugar in a single ten-ounce can of soft drink.  A milkshake alone has 30 teaspoons of sugar, and a sugar-loaded birthday party can net a child as much as100 teaspoons of sugar within several hours.  Some researchers have calculated that a growing pre-teen may consume on average as much as 50 teaspoons of sugar a day.  So a clinical study based on giving children only 13 teaspoons of sugar, or about 25% of their normal daily consumption of sugar, will not produce any appreciable results.  Yet, this study concluded that the mothers of these children were wrong in saying their children were hyperactive as a result of the sugar they consumed.

Further, in the four studies quoted by the promoters of sugar, the trial size of the studies was quite small, using only 10 to 30 children, and followed them only for a period of a few hours.  In contrast, in one study, Schoenthaler examined 800,000 school children, and in six other studies, 5,000 juvenile delinquents.[34]  Schauss, in two studies, examined over 2,000 juvenile delinquents.[35]  Both the Schoenthaler and Schauss studies showed how diets high in sugar can lead to juvenile delinquency and behavioral problems in children.  Their studies were also conducted over a period of several years, not just a few hours as was the case with some of the “pro-sugar” studies.  For instance, Behar's pro-sugar study gave 21 males their 13-teaspoon sugar drink and observed them for only five hours on three mornings.  Wolraich observed his 32 hyperactive school-age boys for only three hours before concluding that consumption of sugar has no effect on human behavior.[36]

Other criticisms of the pro-sugar studies include that there were usually no controls on the childrens’ normal diets.  Thus, the studies were performed with children who were told not to eat any breakfast in the morning.  They would then go to school where they would be given a sugared drink and then tested for changes in behavior. Yet, for these children, the drink was equivalent to their missing breakfast, and would therefore not necessarily cause any changes in behavior.

Additionally, artificial sweeteners are often used as the placebo control, instead of a nutritious meal or nothing at all. The effects of these sweeteners themselves are not taken into consideration.  Yet, these effects can be quite significant as shown in a study of aspartame side-effects by the Center for Disease Control (CDC).  In a study of 231 cases, the CDC registered the following complaints based on consumption of aspartame: (a) neurological behavior (67%); (b) gastrointestinal (26%); (c) allergic (17%); (d) menstrual (6%).[37]  Accordingly, the pro-sugar studies are often deceptive when they state that compared to the control group (on aspartame) there was no difference in behavior.

Other problems with the pro-sugar studies included ignoring the proven behavioral effects of artificial colorings and flavorings[38], as well as the "Hawthorne effect" which states that the testing and observation of the children by strangers can affect their behavior, and hence, the results of the study.  Finally, the premise of many of these pro-sugar studies—to add sugar to the diet in order to prove or disprove that it causes behavioral changes—has been criticized on the basis that children are already eating too much sugar, and adding more sugar to their diets is not going to make a measurable difference.  In Schoenthaler's and Schauss's studies, the assumption was that children’s diets already contain too much sugar, and that by removing sugar from their diets for a sufficient period of time, will cause observable changes in behavior.  The studies based on this assumption that sugar should be removed from, as opposed to added to, children’s diets showed appreciable changes in behavior.

SUGAR AND DENTAL CARIES

Studies have repeatedly confirmed that sugar causes dental caries.  Sheiham, a professor of Epidemiology and Public Health, found that sugars, particularly sucrose, are the most important dietary cause of dental caries.  Both the frequency of consumption and the total amount of sugars are important factors in the etiology of caries.  The evidence establishing sugars as a cause of dental caries is overwhelming, with the foundation in the multiplicity of studies rather than the power of any one.  According to Sheiham, the intake of extrinsic sugars beyond four times a day leads to an increased risk of dental caries. Further, sugars above 60 grams per person per day increases the rate of dental caries. Sheiham concludes that the main strategy to further reduce the levels of dental caries is to reduce the frequency of sugars in the diet.[39]

Jones, et al., studied over 6,000 fourteen-year-olds to examine the association between consumption of different drinks and dental caries. The study concluded that consumption of sugared drinks and carbonated drinks was associated with significantly higher levels of dental caries. Drinking tea was associated with lower levels of caries.[40]  A host of other studies establish that the consumption of sugar significantly increases the incidence of dental carries.[41]

SUGAR AND THE IMMUNE SYSTEM

Several studies have confirmed the linkage between high consumption of sugar and the suppression of the body’s immune system.  For instance, in one study, 10 healthy people were assessed for fasting blood-glucose levels and the phagocytic index of neutrophils, which measures immune-cell ability to envelop and destroy invaders such as cancer. Eating 100 grams (24 teaspoons) of carbohydrates from glucose, sucrose, honey and orange juice all significantly decreased the capacity of neutrophils to engulf bacteria; the neutrophils became “paralyzed.” Complex carbohydrates from starch, on the other hand, did not have this effect.[42]  More recently, Yabunaka found that sugar caused an increase in a protein that inhibits macrophage activity.[43]  Elevated levels of blood sugar have also been linked to bacterial invasion and infectious diseases, such as sepsis and vaginal candidiasis.[44]

SUGAR AND OBESITY

Obesity in American children is becoming epidemic.  In December, 2001, The Journal of the American Medical Association presented a comprehensive national picture of weight trends among children over a twelve-year period.  From 1986 to 1998, the number of overweight non-Hispanic white children doubled from 6% to 12%.  Roughly one in five, or 20% of African-American and Hispanic children are overweight, a 120% increase during the 12-year study period.[45]  Several other studies faithfully document that since 1995, there has been a dramatic rise in obesity in American children.[46]

The relationship between increased sugar consumption and obesity in children is well documented in an abundance of recent studies.  In the late 1990s The Children’s Hospital Boston and the Harvard School of Public Health conducted the first long-term study to examine the impact of soda and sugar-sweetened beverages on children’s body weight.  The study involved 548 sixth and seventh graders over a 21-month period.  During this time, 57 percent of the children increased their daily intake of soft drinks, and more than half of them by nearly a full serving.  The results showed that the odds of becoming obese increased 1.6 times for each additional can of soft drink consumed above the daily average.  According to government studies, soft drinks are the leading source of added sugars in the diet of young Americans. In a six-year period, soft drink consumption by adolescent males rose from 11.7 ounces per day to 19.3 ounces per day.[47]

More recently, Ludwig, et al., supported by Bellisle’s work, found that one daily soda increases the risk of obesity by 60%.  He found that about 65% of adolescent girls and 74% of adolescent boys consume soft drinks daily. The amount of sugar added to the diet by soda is 36.2 grams (9 tsp) daily for adolescent girls and 57.7 grams (14 tsp) for boys.  It was said that Ludwig’s was the first study of its kind in spite of the fact that the majority of American children have been consuming empty caloric sodas from an early age.[48]

Adult obesity is also at record levels.  Researchers at the CDC report that in 2000, most Americans were overweight (more than 56%), nearly 20% of adults were obese, 7.3% had diabetes and about 3% were both obese and diabetic. They said that diabetes rates could be as high as 10% if undiagnosed cases are considered.[49]  Whitaker surveyed 9,000 people over a 17-year period and found that more than 25% of American adults are obese in their 30s, and over 60% are overweight.[50]  The total number of individuals that are morbidly obese (generally at least 100 lbs overweight) rose from 0.78% in 1990 to 2.2% in 2000.[51]  Dr. Mokdad, a researcher of obesity, cautions that, "Obesity continues to increase rapidly in the United States.”  To alter these trends, Dr. Mokdad argues that “strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.”[52]

The link between sugar consumption and obesity is well established.  Raben et al., investigated the effect of long-term supplementation with drinks and foods containing either sucrose or artificial sweeteners on ad libitum food intake and body weight in overweight subjects.  They found that overweight subjects who consumed fairly large amounts of sucrose (28% of energy), mostly as beverages, had increased energy intake, body weight, fat mass, and blood pressure after 10 weeks. These effects were not observed in a similar group of subjects who consumed artificial sweeteners.  The study lasted for only ten weeks, and did not consider that these effects would probably be even greater for individuals that consume high sugar diets over an entire lifetime or until they get diabetes.[53]

Elliott, et al., examined whether fructose consumption might be a contributing factor to the development of obesity and the accompanying metabolic abnormalities observed in the insulin resistance syndrome. They made a remarkable conclusion that, “there are existing data on the metabolic and endocrine effects of dietary fructose that suggest that increased consumption of fructose may be detrimental in terms of body weight and adiposity and the metabolic indexes associated with the insulin resistance syndrome.”[54]

          The medical authors of Sugar Busters! summarize how increased sugar in the blood causes increased secretions of insulin, which leads to obesity:

Carbohydrates are broken down to glucose (sugar) in our body, and the glucose raises our blood sugar.  Insulin is then secreted by the pancreas to lower our blood sugar, but in the process, insulin causes the storage of fat and also increases cholesterol levels.  Insulin also inhibits the mobilization of (loss of) previously stored fat.[55]

According to Public Health Journal, obesity raises the risk of heart disease, osteoarthritis, diabetes, high blood pressure and certain types of cancer.[56]  Wolf and Tanner noted the following complications of obesity: hypertension, Type 2 diabetes mellitus (80% are obese), gallbladder disease, hyperlipidemia, and sleep apnea.  The relative risks included coronary artery disease, knee osteoarthritis, gout, breast cancer, endometrial cancer, colon cancer, and low back pain.[57]

Hill and Billington report that 97 million Americans are now either obese or overweight.  They note that since 1997, the World Health Organization, the American Heart Association, the National Institutes of Health, the U.S. Surgeon General and the U.S. Centers for Disease Control and Prevention have all issued statements and nutrition guidelines stressing the grave health risks associated with obesity.   Moreover, excess weight is a major risk factor for high blood pressure and diabetes.  Along with sedentary lifestyle, obesity is associated with more than 300,000 deaths due to heart disease each year in the U.S.[58]

In a December 2001 Washington Post article, Sally Squires summarized the disturbing statistics on obesity and what the U.S. Surgeon General wants the country to do about it.  She reported that, "a staggering 61% of American adults currently meet the scientific definition of obesity, putting them at increased risk of heart disease, diabetes, stroke, arthritis, depression and several forms of cancer. Obesity rates among U.S. adults have gone up 30% since the late 1970s." She further stated, "The U.S. Surgeon General called for sweeping changes in schools, restaurants, workplaces and communities to help combat the growing epidemic of Americans who are overweight or obese."[59]

Surgeon General David Satcher noted the link between sugar consumption and obesity. Outlining the “first national plan of action for overweight and obesity,” he recommended that schools make their lunch programs “less fattening, restrict students' access to vending machines that sell calorie-dense foods and soft drinks, and resume daily physical exercise classes for all children and adolescents, as well as recess for elementary school students."[60]

According to Ms. Squires,"Obesity is considered by many public health experts to be one of the nation's most important problems because it is a major risk factor of maladies that include heart disease, stroke, cancer and diabetes.  Nearly 2 out of 3 adults in the United States are overweight or obese, and … an estimated 1,200 people die daily from weight-related illnesses.  That adds up to 300,000 deaths a year—more than the number killed annually by pneumonia, motor vehicle accidents and airline crashes combined—and nearly as many as the 430,000 who die yearly from tobacco-related conditions.  Health care costs for overweight and obesity total an estimated $117 billion annually.[61]

 

SUGAR AND DIABETES

Various anthropological studies have demonstrated that upon the introduction of refined sugar to a culture, the incidence of diabetes increases after a latent period of about 20 years.  According to Cleve, author of The Saccharine Disease: "The virtual absence of diabetes in primitive communities who live on complex carbohydrates such as various grains and tubers compared with populations eating carbohydrates which are refined is anthropological proof that sugar is a leading cause of diabetes."[62]

Other studies demonstrating the link between sugar consumption and diabetes are well documented.  Salmeron, et al., at the Harvard School of Public Health examined the relationship between glycemic (i.e., sugar) diets, low fiber intake, and the risk of non-insulin-dependent diabetes mellitus.  They found that diets with a high glycemic load and a low cereal fiber content increase risk of diabetes in women.[63] A host of additional studies demonstrate that sucrose added to the diet of laboratory animals or increased in the diet of healthy volunteers has been shown to be associated with impaired glucose tolerance, retinopathy and nephropathy, and reduced insulin sensitivity of the tissues.[64]

Reported statistics on the increase in diabetes are staggering.  Between 1990 and 1998 the number of people diagnosed with diabetes in America increased by 33%, to 6.5 percent of Americans of all age groups, not just the elderly.[65]  The August 23, 2000, Associated Press reported that adult-onset diabetes rose 70 percent in the previous eight years among people in their 30s.[66]  In 2000, the Journal of General Internal Medicine estimated that 16 million Americans have been diagnosed with type 2 diabetes.[67]  According to Diabetes Care, the number of Americans diagnosed with diabetes will rise 165% over the next 50 years.  Dr. James P. Boyle from the CDC says that 29 million Americans will be diagnosed with diabetes in 2050, compared with about 11 million today.[68]

And now there is an increase in adult-onset diabetes in children.  According to Sinha, et al., "Childhood obesity, epidemic in the United States, has been accompanied by an increase in the prevalence of type 2 diabetes among children and adolescents."  One in four extremely obese children under the age of 10 and one in five obese adolescents under the age of 18 in the US have impaired glucose tolerance -- a precursor to type 2 or adult-onset diabetes, which increases the risk of heart disease, kidney failure, blindness and limb amputations. Adult onset diabetes is a chronic degenerative disease that is typically seen in people past the age of 60.[69]

Obesity and diabetes are also causing birth defects that destroy a child’s chance of a normal life. Researchers studied 23,000 pregnant women and found that obese women who also have type 2 diabetes are three times more likely than non-obese non-diabetic women to have a baby with a birth defect, and seven times more likely of giving birth to a child with a craniofacial defect such as cleft palate, or abnormal limb development. Nearly 6% of all women with type 2 diabetes had babies with major defects, compared with 1.34% of women without diabetes.[70]

SUGAR AND ITS SOCIOECONOMIC IMPACT

          The sugar industry has a long and sordid history of using both slave labor and child labor to harvest the sugar, refine it, and bring it to market.  In an October 17, 2001 article for Creative Loafing, senior editor John Sugg reported the current exploitation of child labor by the sugar industry:

While we're talking sweet, take a hard look at your sugar bowl. Much of the sugar on American tables comes from the Dominican Republic. The Rev. Kirton recalls seeing cane-cutters, braceros, as young as 6 labor dawn-to-dusk shifts. And it's not a Dominican company that works the children. ‘Those plantations were owned by Gulf & Western, the same people who make movies at Paramount studios,’ Kirton says.  (In 1985, Gulf & Western sold its 240,000 acres of plantations—along with a posh resort—to the politically powerful Fanjul family of Palm Beach. That clan is often accused of widespread abuses of labor in its fields in the Everglades, so it is unlikely to have improved conditions in the Dominican Republic.)[71]

The sugar industry was also one of the largest exploiters of slave labor.  The University of Calgary, in its applied history tutorial “The Sugar and Slave Trades,” provides a concise review of sugar production’s historical origins:

Sugar cane cultivation had its origins in Southwest Asia.  From there it was carried to Persia and then to the eastern Mediterranean by Arab conquerors in the twelfth and thirteenth centuries.  Shortly after sugar cane's introduction to the Mediterranean, it was being grown on estates similar to the later plantations of the Americas.  By the fourteenth century Cyprus became a major producer using the labor of Syrian and Arab slaves.  Eventually sugar made its way to Sicily where a familiar pattern of enslaved or coerced labor, relatively large land units, and well-developed long-range commerce was established. The Portuguese and the Spanish both looked to Sicily as a model to be followed in their own colonies in the Atlantic, and in 1420 Prince Henry sent to Sicily for cane plantings and experienced sugar technicians.

An innovation in sugar production, the roller mill, was introduced to the Mediterranean (perhaps by the Sicilians) and the Atlantic Islands in the fifteenth century. The roller mill reduced the time and labor needed to prepare the sugar cane, thereby increasing the mill's capacity. It was this technology, combined with the system of production developed in the Mediterranean, which was transplanted and expanded to the Atlantic Islands. The final component necessary for the industry's growth was satisfying its requirement of a large labor force. The solution was the incorporation of African slaves.[72]

Herbert Klein, in his book African Slavery in Latin America and the Caribbean (1990), traces the history of the sugar industry and compares it to other exploiters of African and indigenous Indian slavery:

Once we enter the more familiar history of the “Atlantic Islands”, sugar and slavery become the economic foundation for European imperialism, even more so than the cotton and tobacco industries.  Before the cotton and tobacco plantations there was the sugar industry in Brazil.  When the Dutch became the direct competitors of their former Brazilian partners in 1630, their first step was to deny Brazil access to its sources of African slaves because slavery was the pivotal component of the sugar industry.  So much so, that the Brazilians were forced to enslave the indigenous Indian populations of the interior regions of Brazil.  Dutch Brazil then became “the source for the tools, techniques, credit and slaves which would carry the sugar revolution into the West Indies, thereby eliminating Brazil’s monopoly position in European markets and leading to the creation of wealthy new American colonies for France and England.[73]

According to Klein, by the 1650s, with the later decline in their Brazilian production, the Dutch were forced to bring their slaves and sugar-milling equipment to the French and British settlers in the Caribbean. When the Dutch themselves migrated to the Caribbean, the sugar plantation system took hold on the islands and by the 1670s sugar became a larger commercial operation than tobacco and indigo.  The accompanying slave trade led to a declining population of indentured whites and soon blacks outnumbered whites on Barbados for the first time.  By 1700 every year saw the arrival of at least 1300 black slaves and Barbados, with 50,000 slaves, became the most densely populated region in the Americas.[74]

          Kretchmer and Hollenbeck, authors of Sugars and Sweeteners (1991), estimate that in the four centuries prior to the abolishment of slavery, the transport of slaves involved 22 million people, 12 million of whom were utilized in the Americas.  The remainder died on board ship or shortly after arrival. Further, “a number of historians state that sugar was responsible for 70% of the traffic of slavery.”[75]  The critical historical role that slavery played in the development of the sugar industry in the Americas has also been well established in several other scholarly volumes on the subject.[76]

Kevin Bales in his book, Disposable People: New Slavery in the Global Economy (2001), states that even today, large amounts of slave labor exists in Africa, Asia, Pakistan, Brazil, and the Carribean, among other places.  As a result of globalization and the international commodities markets, products tainted with slavery are being broadly distributed  throughout the world.  According to Bales, “Maybe 40 percent of the world's chocolate is tainted with slavery. The same is true of steel, sugar, tobacco products, jewelry - the list goes on and on.  Thanks to the global economy, these slave-produced products move smoothly around the globe.” Banes points out that the global market in commodities, such as cocoa and sugar, functions as a money-laundering machine. Cocoa, for instance, coming out of West Africa and entering the world market almost immediately loses its ‘label.’ If you're a buyer for a candy maker, you don't say, ‘I'd like to buy six tons of Ghanaian cocoa.’ You just say you want six tons of cocoa. When the cocoa is delivered to your factory, you can't tell where it's from, so you may be passing on a slave-tainted product without knowing, and consumers will buy it without knowing.  The same is true of sugar and other commodities, where the source is not easily identifiable.[77]

Peter Cox in the New Internationalist (November, 1998) asked the question, “Slavery on sugar plantations is a thing of the past. Or is it?”  Cox’s investigation revealed the following:

‘We suffered all kinds of punishment,’ one witness told the Brazilian Justice Ministry.  ‘We were hit with rifle butts, kicked and punched.  I tried to escape, so did my uncle.  He was shot and killed by farm gunslingers.’

The word is peonage - a vicious system of forced labor, common in many parts of Latin America, Asia and even in the southern US.  A recruiter entices the poor and the homeless with promises of employment, good wages, food and shelter.  Then they are trucked long distances to toil on remote plantations where they are held prisoner and compelled to work at gunpoint.  The victims aren’t paid cash—they receive notional ‘credits,’ which are offset by extortionate charges for the tools they use and the hammocks they sleep in.

‘Life for these people is worse now than it was under slavery,’ says Wilson Furtado, of the agriculture federation in Bahia state, Brazil. ‘Then the owners had some capital tied up in their slaves so it cost them if one died, but now they lose nothing.’  No matter how hard the victims work - cutting sugar cane or felling trees—they can never break even.  A loaded rifle keeps them in line, but it’s debt that keeps them working.[78]

However, Cox points out an irony for those countries relying on sugar as a cash crop while the sugar industry focuses on more research and development into artificial sweeteners. According to Cox, the plight of non-Western nations whose economies are dependent on cash crops such as sugar, is identical to the position of the victims of peonage.  Both are held to economic ransom by a system that ensures they can never free themselves of debt - no matter how hard they try.  The more they produce, the more indebted they become.  In 1981 the Dominican Republic earned $513 million from its sugar exports, yet by 1993 its income had dropped almost by half—to $263 million, despite increasing its production by 84,000 tons.  This disastrous decline in income saw the Dominican Republic’s debt swell from $600 million in 1973 to a staggering $2,400 million in l983.  And not only sugar producers are crippled: plummeting prices for commodities in general have impoverished many Third World economies, leading to widespread starvation.[79]

Cox also investigated how one of the richest islands of the Philippines could become the setting for another Ethiopia-type famine, where an estimated 85,000 Philippine children under six were suffering from moderate or severe malnutrition. Well, partly, according to Cox, because the corrupt Marcos regime mismanaged the industry.  Also the U.S. market for Philippine sugar disappeared (being replaced by corn syrup), throwing a quarter of a million sugar workers out of their jobs. And the land—rich and fertile—was exclusively used for sugar cane which prevented self-sufficiency in food production.  Cox concludes that a disaster was waiting to happen.[80]  Quite a few other authors have documented exploitations of modern slavery, and its variants, by the sugar industry.[81]

SUGAR AND THE ENVIRONMENT

As cash-crop economies vainly struggle to repay their debts, another consequence of the modern sugar industry surfaces—environmental devastation. In 1997, American University in Washington, D.C. issued a special-case study on the environmental consequences of the sugar industry on the environment of the Philippines:

The relationship between sugar production and environmental damage is found in deforestation, soil erosion, and consequent bio-diversity loss caused by forest conversion to sugar cane field.  Forest clearing caused widespread soil erosion and had a devastating effect on the ecology, wiping out a third to a half of the known species of snail and birds in the Philippines.

          . . . 

In the overall Philippines, cultivated upland areas increased from 582,000 hectares in 1960 to over 3.9 million hectares in 1987.  Soil erosion was estimated at about 122 to 210 tons per hectare annually for newly established pasture, compared to less than 2 tons per hectare for land under forest cover.  Forest cover declined from 50 percent of the national territory in 1970 to less than 21 percent in 1987. [82]

The deforestation rate of the Philippines, driven in large part by the sugar industry, is now pegged at 25 hectares an hour or 219,000 hectares a year.  Experts say the country can expect its forests to be gone in less than 40 years.[83]

SUGAR AND MULTINATIONAL CORPORATIONS

Quite a few large multinational companies are invested in the sugar industry.  One example, explored by Daniel Hellinger and Dennis Brooks in their book The Democratic Façade (Cole Publishing Co., 1991), is Gulf+Western.  They write:

Gulf+Western came to the Dominican Republic in 1966, two years after an invasion by U.S. Marines.  Aided by major tax concessions granted by President Balaguer to foreign investors, economic penetration of the country quickly followed U.S. military and political intervention.  With loans from Chase Manhattan Bank, Gulf+Western gained a foothold in the island's economy with its purchase of the South Puerto Rico Sugar Company.  By 1976, its investment had grown to $300 million in sugar, meat, citrus, tourism, and tobacco.  Other transnational corporations also operated in the Dominican Republic, but Gulf+Western dominated the economy as the country's largest landowner, employer, and exporter.  Because the yearly revenues of Gulf+Western were greater than the Dominican Republic's Gross National Product, it could accurately be called ‘a state within a state.’

Immediately on entering the country, Gulf+Western broke the sugarcane workers' union, Sindicato Unido.  Denouncing the union as communist controlled, the corporation fired the entire union leadership, annulled its contracts, and sent in police to occupy the plant while the American Institute for Free Labor Development (an agency financed in part by the CIA) formed a new union that obtained immediate acceptance from the Dominican president. The possibility of free unions on Gulf's sugar plantations disappeared (along with dozens of labor leaders), with the result that of the country's 20,000 cane cutters, only one out of ten is Dominican. Most of the cane workers are Haitian immigrants paid $1.50 to $3.00 a day to do what Dominicans call ‘slave work.’[84]

Hellinger and Brooks also describe how Gulf+Western set up the first of the industrial free zones that thrive in the Dominican Republic.  Often called ‘runaway shops’ (because businesses relocate there from U.S. communities) or ‘export platforms,’ such zones offer a low-wage labor force, government subsidies, and freedom from taxes and environmental regulations.  Unions are not permitted in these zones, and thus in the mid-1980s, 22,000 workers earned an average of 65 cents per hour working in factories surrounded by barbed wire and security guards.  Dominican Law 299 grants corporations a 100 percent exemption from Dominican taxes and also provides them with a 70 percent government subsidy of plant construction costs to set up business in the zones.  Bestform, Esmark, Milton Bradley, Ideal Toys, Fisher Price, and North American Phillips are among the U.S. corporations that take advantage of the free zones to assemble and manufacture their products for export back to the United States.[85]

CONCLUSION

          Our research has shown that, contrary to the assertions of the Sugar Association, the consumption of sugar at its current rates is harmful to the public health.[86]  The research studies cited in this letter have demonstrated that the consumption of sugar, particularly in large amounts, has been scientifically linked to obesity, diabetes, heart disease, cancer, dental caries, delinquent behavior, weakened immunity, addictive behavior, premature aging, and appetite suppression.  Further, the history of the sugar industry, as a major cause of slavery and environmental devastation, is not a particularly proud one.

          Gary Null has dedicated his life to improving public health and will not be intimidated by threats from the Sugar Association.  As my client’s programs often present research and information on health and nutrition that is adverse to powerful economic interests in the status quo, he has often been required to fight those who would seek to silence or censor him.  The Sugar Association is only the latest to try to do this by its letter to Mr. Null, with copies sent to WETA in Washington, D.C.  We believe that WETA and Sharon Rockefeller made the wrong decision to succumb to this pressure from the Sugar Association to remove Mr. Null’s show from its programming.  The information provided in the program 7 Steps to Perfect Health, including that the consumption of sugar is bad for one’s health, was accurate and helpful, and should have been broadcast for the benefit of the many WETA viewers that wanted to see it.  WETA’s decision, grounded in fear of threats from the Sugar Association, is in sharp contrast to other public television stations that were not afraid to air the program.  We are requesting that the executives at WETA review the information and studies presented in this letter, and that they reconsider their decision to censor a program that was important to their viewers’ health.

Again, while we respect your right to disagree with us, and your right to present a different viewpoint, we must draw the line where you actively seek to suppress and censor our program.  We are sure that our program would have aired on WETA had it not been for your letter attacking us.  Yet, we believe that your letter, defending the alleged benefits of sugar, was incorrect and motivated by economic interests, not by any concern for public health.  If you disagree with our research and data, we have no objection to you presenting your own research and data in your own program.  We do, however, have an objection to you seeking to pressure and intimidate WETA into censoring and removing our program.  Such conduct constitutes tortious interference with our business and media relations.

Accordingly, we request that you refrain from such actions that would seek to censor or suppress our programs in the media.  We will not be daunted by your tactics of fear and threats.  We will continue to fight so that the public may have the benefit of the information that is vital to making important decisions about their health.

                                                                      Very truly yours,

                                                                      David M. Slater

                                                                      General Counsel

cc:      See Attached Mailing List

---

[1] Howard, B.V. and J. Wylie-Rosett. Sugar and cardiovascular disease: A statement for healthcare professionals from the Committee on Nutrition of the Council on Nutrition, Physical Activity, and Metabolism of the American Heart Association. Circulation 2002 Jul 23;106(4):523-7.  American Heart Association Report at: http://circ.ahajournals.org/cgi/content/full/106/4/523.

[2] Id.

[3] Sugar and Sweetener: Background, “U.S. Sweetener Consumption.” Economic Research Service, U.S. Department of Agriculture, April 24, 2002.  http://www.ers.usda.gov/briefing/sugar/background.htm

[4] George Mateljan Foundation. Low Fat Diet, “Nutrition Excesses/Deficiencies,” © 2002 http://www.whfoods.com/genpage.php?tname=diet&dbid=11, citing USDA’s 1995 Continuing Survey of Food Intakes by Individuals.

[5] Food Consumption, Prices, and Expenditures, 1970-97. “Caloric and Low-Calorie Sweeteners.”  Economic Research Service, U.S. Department of Agriculture, p.24. http://ers.usda.gov/publications/sb965/sb965f.pdf 

[6] Id.

[7] Economic Research Service, USDA. Sugar and Sweetener: Data Tables. Table 50—U.S. Per capita consumption of caloric sweeteners, by calendar year. http://www.ers.usda.gov/briefing/sugar/data/data.htm.

[8] Cleave, T.L. The Saccharine Disease, John Wright & Sons. Bristol, l974, p 7.

[9] Steward, H.L., M. Bethea, MD, S. Andrews, MD, and L. Blart, MD. Sugar Busters!, Sugar Busters LLC, 1995, pp 34-35.

[10] Id. at pp 40-41.

[11] CSPI newsroom. America: Drowning in Sugar: Experts Call for Food Labels to Disclose Added Sugars. Center for Science in the Public Interest Website, 1999 Aug.3. http://www.cspinet.org/new/sugar.html 

[12] Jacobson, M. Liquid Candy: How Soft Drinks Are Harming Americans’ Health. Center for Science in the Public Interest Website, 1998 October. http://www.cspinet.org/sodapop/liquid_candy.htm

[13] Lord, R. Agricultural Outlook Forum Tuesday, February 24, 1998. U.S. SUGAR OUTLOOK, Ron Lord Agricultural Economist, USDA. http://jan.mannlib.cornell.edu/reports/erssor/specialty/sss-bb/1998/sss223f.asc  

[14] Colantuoni. C., et al. Evidence that intermittent, excessive sugar intake causes endogenous opioid dependence. Obes Res 2002 Jun 10(6):478-88.

[15]  See, e.g., Grimm, J.W., et al. Effect of cocaine and sucrose withdrawal period on extinction behavior, cue-induced reinstatement, and protein levels of the dopamine transporter and tyrosine hydroxylase in limbic and cortical areas in rats, Behav Pharmacol 2002 Sep 13(5-6):379-88;  Frisina, P. and A. Sclafani. Naltrexone suppresses the late but not early licking response to a palatable sweet solution: opioid hedonic hypothesis reconsidered. Pharmacol Biochem Behav, 2002 Dec 74(1):163l;  Levine, A.S., et al. Naltrexone infusion inhibits the development of preference for a high-sucrose diet. Am J Physiol Regul Integr Comp Physiol 2002 Nov 283(5):R1149-54.  Pecoraro, N., et al. Brief access to sucrose engages food-entrainable rhythms in food-deprived rats. Behav Neurosci 2002 Oct 116(5):757-76.  Bartley, G. Neural systems for reinforcement and inhibition of behavior: relevance to eating, addiction, and depression. Well-being: Foundations of Hedonic Psychology 1999 pp. 558-572.  Matthews, D.B., et al. Effects of sweetened ethanol solutions on ethanol self-administration and blood ethanol levels. Pharmacol Biochem Behav 2001 Jan 68(1):13-21.  Rogowski, A. et al. Sucrose self-administration predicts only initial phase of ethanol-reinforced behaviour in wistar rats. Alcohol 2002 Sep-Oct 37(5) 436-40.  Olson, G.A., et al. Naloxone and fluid consumption in rats: dose-response relationships for 15 days. Pharmacol Biochem Behav 1985 Dec, 23(6):1065-8.  Cichelli, M., and M. Lewis. Naloxone nonselective suppression of drinking of ethanol, sucrose, saccharin, and water by rats. Pharmacol Biochem Behav 2002 Jun 72(3):699.  Files, F.J., et al. Sucrose, ethanol, and sucrose/ethanol reinforced responding under variable-interval schedules of reinforcement. Alcohol Clin Exp Res 1995 Oct 19(5):1271-8.  Czachowski, C.L., Independent ethanol- and sucrose-maintained responding on a multiple schedule of reinforcement. Alcohol Clin Exp Res 1999 Mar 23(3):398-403.

[16] Melton, L.  AGE breakers, Rupturing the body's sugar-protein bonds might turn back the clock. Sci Am. 2000 Jul 283(1):16.  See also. Cerami, A., H. Vlassara, and M. Brownlee. Glucose and Aging. Scientific American May 1987: 90.

[17] Anderson, G.H., et al. Inverse association between the effect of carbohydrates on blood glucose and subsequent short-term food intake in young men. Am J Clin Nutr 2002 Nov 76(5):1023-30.

[18] Warburg, O. On the origin of cancer cells. Science 1956 Feb 123:309-14.

[19] Hoehn, S.K., et al. Complex versus simple carbohydrates and mammary tumors in mice. Nutr Cancer 1979 1(3):27.  Santisteban G.A., et al. Glycemic modulation of tumor tolerance in a mouse model of breast cancer. Biochem Biophys Res Commun 1985 Nov 15;132(3):1174-9.

[20] Seeley, S. Diet and breast cancer: the possible connection with sugar consumption. Med Hypotheses 1983 Jul 11(3):319-27.

[21] Moerman, C.J., et al. Dietary sugar intake in the aetiology of biliary tract cancer. Int J Epidemiol 1993 Apr 22(2):207-14.

[22] Michaud, D.S., et al. Physical activity, obesity, height, and the risk of pancreatic cancer. JAMA 2001 Aug 22-29 286(8):921-9.

[23] Michaud, D.S., et al. Dietary sugar, glycemic load, and pancreatic cancer risk in a prospective study. J Natl Cancer Inst 2002 Sep 4 94(17):1293-300.

[24] Burfoot, A. Sugar and cardiovascular disease, and other health issues. Runner’s World Website, 2003;  http://www.runnersworld.com/home/0,1300,1-53-84-3623,00.html.  The American Heart Association Report “Sugar and Cardiovascular Disease” is located at http://circ.ahajournals.org/cgi/content/full/106/4/523.

[25] Rostler, S. Excess blood sugar may boost free radical production. Atkins Diet & Low Carbohydrate Website 2000.

[26] See Mohanty, P., et al. Glucose challenge stimulates reactive oxygen species (ROS) generation by leucocytes. J Clin Endocrinol Metab 2000 Aug;85(8):2970-3.  Hoogwerf, B.J., et al. Blood glucose concentrations < or = 125 mg/dl and coronary heart disease risk. Am J Cardiol 2002 Mar 1;89(5):596-9.  Norhammar, A., et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002 Jun 22;359(9324):2140-4.  McGill Jr., H.C., et al. Obesity accelerates the progression of coronary atherosclerosis in young men; Circulation 2002 Jun 11;105(23):2712-8.  Ziccardi, P., et al. Reduction of inflammatory cytokine concentrations and improvement of endothelial functions in obese women after weight loss over one year. Circulation 2002 Feb 19;105(7):804-9.

[27] World Health Organization Press Release, March 3, 2003, “WHO/FAO release independent Expert Report on diet and chronic disease.”  www.who.int/mediacentre/releases/2003/pr20/en/

[28] Crook, W., Sugar and children’s behavior. New England Journal of Medicine 1994 June 30;330(26):1901-1904.

[29] Schoenthaler, S., et al. The Impact of Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools. l986, Int J Biosocial Res 8:2.

[30] Schoenthaler, S., Detention Home Double-Blind Study: Sugar Goes on Trial. Int J Biosocial Res l982 3(1):1-9.  Schoenthaler, S., Northern California Diet-Behavior Program: An Empirical Examination of 3,000 Incarcerated Juveniles in Stanislaus County Juvenile Hall. l983, Int J Biosocial Res 5(2):99-108.

[31] Schoenthaler, S. The Los Angeles Probation Department Diet-Behavior Program: An Empirical Analysis of Six Institutional Settings. l983, Int J Biosocial Res 5(2):88-89.  Schoenthaler, S. Alabama Diet-Behavior Program: An Empirical Evaluation at Coosa Valley Regional Detention Center. l983, Int J Biosocial Res 5(2):78-87.

[32] See, e.g., Aylsworth, J. Sugar and Hyperactivity. Winter l990 Priorities; 31-33.  Behar, D., et al. Diet and Hyperactivity. Nutr Behav l984; 1:279-288.  Rapoport, J.L., et al. Behavioral Response to Sweeteners in Preschool Children. Presented at the International Conference on Nutrients and Brain Function, Scottsdale, Arizona, Feb 12, l986.  Originally published in American Journal of Psychiatry, November 1987, Vol. 144, No. 11; http://www.cmer.org/class/articles/sugar1.html.  Prinz, R.. et al. Associations Between Nutrition and Behavior in 5-Year-Old Children. May l986 Nutr Rev.  Rapoport, J. Diet and Hyperactivity. May l989 Nutr Rev Supp 158-161.

[33] Behar, D., et al. Diet and Hyperactivity; Nutr Behav l984 1:279-288.

[34] Schoenthaler, S., et al. The Impact of Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools. l986, Int J Biosocial Res. 8:2.  Schoenthaler, S. Detention Home Double-Blind Study: Sugar Goes on Trial. l985, Int J. Biosocial Res 3(1):1-9.  Schoenthaler, S. Types of Offenses Which Can be Reduced in an Institutional Setting Using Nutritional Intervention: A Preliminary Empirical Evaluation. l983, Int J Biosocial Res 4(2):74-84.  Schoenthaler, S., The Los Angeles Probation Department Diet-Behavior Program: An Empirical Analysis of Six Institutional Settings. l983, Int J Biosocial Res 5(2):88-89.  Schoenthaler, S. Alabama Diet-Behavior Program: An Empirical Evaluation at Coosa Valley Regional Detention Center. l983, Int J Biosocial Res 5(2):78-87.  Schoenthaler, S. Northern California Diet-Behavior Program: An Empirical Examination of 3,000 Incarcerated Juveniles in Stanislaus County Juvenile Hall. l983, Int J Biosocial Res. 5(2):99-108.  Schoenthaler, S. The Effects of Citrus on the Treatment and Control of Antisocial Behavior: A Double-Blind Study of an Incarcerated Juvenile Population. l983, Int J Biosocial Res 5(2):107-17.

[35] Shauss, A., et al. Published in two parts with Simonsen and Bland-Simonsen J. A critical analysis of the diets of chronic juvenile offenders. Orthom Psychiatry l978 8(3):149-157, and l979 8(4):222-226.  Shauss, A. Diet Crime and Delinquency; Parker House. Berkley, California. l981.

[36] See Graves, F., July-Aug l984: Common Cause, p 25.  Wolraich, R., et al. J Pediatr; l985, 106:675-682.31.  Schoenthaler, S. J., et al. The Impact of Low Food Additive and Sucrose Diet on Academic Performance in 803 New York City Public Schools. l986 Int J Biosocial Res 8:2.

[37] Bradstock, M. K., et al. Evaluation of Reactions to Food Additives: The Aspartame Experience. Am J Clin Nutr l986 43:464-469.

[38] See, e.g., Egger, J., et al. Controlled Trial of Oligoantigenic Treatment in the Hyperkinetic Syndrome. l985 Lancet 1:540-545.  Swanson and Kinsbourne, Food Dyes Impair Performance of Hyperactive Children on a Laboratory Learning Test. Mar 28, l980, Science, p.207.

[39] Sheiham, A. Dietary effects on dental diseases. Public Health Nutr 2001 Apr 4(2B):569-91.

[40] Jones, C., K. Woods, G. Whittle, H. Worthington, and G. Taylor. Sugar, drinks, deprivation and dental caries in 14-year-old children in the northwest of England in 1995. Community Dent Health 1999 Jun 16(2):68-71.

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[42] Sanchez, A., et al. Role of sugars in human neutrophilic phagocytosis. Am J Clin Nutr 1973 Nov;26(11):1180-4.

[43] Yabunaka, N., et al. Elevated serum content of macrophage migration inhibitory factor in patients with type 2 diabetes. Diabetes Care 2000 Feb;23(2):256-8.

[44] See, Donders, G.G. Lower Genital Tract Infections in Diabetic Women. Curr Infect Dis Rep 2002 Dec;4(6):536-539.

[45] Strauss, R.S. and H.A. Pollack. Epidemic increase in childhood overweight, 1986-1998; JAMA 2001 Dec 12;286(22):2845-8.

[46] Troiano, R.P., et al. Overweight prevalence and trends for children and adolescents; The National Health and Nutrition Examination Surveys, 1963 to 1991. Arch Pediatr Adolesc Med 1995 Oct;149(10):1085-91.  Melnik, T.A., et al. Overweight school children in New York City: prevalence estimates and characteristics. Int J Obes Relat Metab Disord 1998 Jan;22(1):7-13.  Adair, L.S. and P. Gordon-Larsen. Maturational timing and overweight prevalence in US adolescent girls. Am J Public Health 2001 Apr;91(4):642-4. Styne, D.M. Childhood and adolescent obesity: Prevalence and significance. Pediatr Clin North Am 2001 Aug;48(4):823-54(vii).  Strauss, R.S. and H.A. Pollack. Epidemic increase in childhood overweight, 1986-1998. JAMA 2001 Dec 12;286(22):2845-8.  Ogden, C.L., et al. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 2002 Oct 9;288(14):1728-32.

[47] Ludwig, D.S., K.E. Peterson, and S.L. Gortmaker. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001 Feb 17;357(9255):505-8.

[48] Ludwig, D.S., K.E. Peterson, and S.L. Gortmaker. Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet 2001 Feb 17;357(9255):505-8.  Bellisle, F., et al. How sugar-containing drinks might increase adiposity in children. Lancet 2001 Feb 17;357(9255):490-1.

[49] Mokdad, A.H., et al. The continuing epidemics of obesity and diabetes in the United States. JAMA 2001 Sep 12;286(10):1195-200.  Flegal, K.M., et al. Prevalence and trends in obesity among US adults, 1999-2000. JAMA 2002 Oct 9;288(14):1723-7.

[50] Whitaker, R.C. Understanding the complex journey to obesity in early adulthood. Ann Intern Med 2002 Jun 18;136(12):923-5.

[51] Freedman, D.S., et al. Trends and correlates of class 3 obesity in the United States from 1990 through 2000. JAMA 2002 Oct 9;288(14):1758-61.

[52] Mokdad, A.H., et al. The spread of the obesity epidemic in the United States, 1991-1998. JAMA 1999 Oct 27;282(16):1519-22.

[53] Raben, A., et al. Sucrose compared with artificial sweeteners: different effects on ad libitum food intake and body weight after 10 weeks of supplementation in overweight subjects. Am J Clin Nutr 2002 Oct;76(4):721-9.

[54] Elliott, S.S., et al. Fructose, weight gain, and the insulin resistance syndrome. Am J Clin Nutr 2002 Nov;76(5):911-22.

[55] Steward, H.L., M. Bethea, MD, S. Andrews, MD, and L. Blart, MD, Sugar Busters!, Sugar Busters LLC, 1995, pp 34-35.

[56] Public Health June 2001;115:229-235.

[57] Wolf, C. and M. Tanner. Obesity; Western Journal of Medicine January 2002;176:23-28.

[58] Hill, J.O. and C.J. Billington. Obesity: its time has come. Am J Hypertens 2002 Jul;15(7 Pt 1):655-6.

[59] Squires, S. Washington Post, December 14, 2001, p A03.

[60] Id.

[61] Id.

[62] Cleave, T.L., The Saccharine Disease, John Wright & Sons, Ltd., Bristol, l974,       p 83.

[63] Salmeron, J., et al. Dietary fiber, glycemic load, and risk of non-insulin-dependent diabetes mellitus in women. JAMA 1997 Feb 12;277(6):472-7.

[64]Cohen, A. M., et al. Experimental Models in Diabetes. In Sugars in Nutrition; San Francisco, Academic Press, l974, p 483-511.  Storlien, L.H., et al. Effects of Sucrose vs. Starch Diets on in Vivo Insulin Action, Thermogenesis, and Obesity in Rats. l988, Am J Clin Nutr 47:420-7.  Levine, R. Monosaccharides in Health and Disease. l986, Ann Rev Nutr 6:221-24.  Schusdziarra, et al. Effect of Solid and Liquid Carbohydrates Upon Postprandial Pancreatic Endocrine Function. l981, J Clin Endocrinol Metab 53:16-20.  Bruckdorfer, K.R., et al. Insulin Sensitivity of Adipose Tissue of Rats Fed with Various Carbohydrates. l974, Proc Nutr Sci 33:3A.  Wright, D., et al. Sucrose-Induced Insulin Resistance in the Rat: Moduclation by Exercise and Diet. l983, Am J Clin Nutr 38:879-883.  Reiser, S., et al. Serum Insulin and Glucose Insulinemic Subjects Fed Three Different Levels of Sucrose. Nov 1981 AM. J. Clin. Nutr. 34:2348.

[65] Mokdad, A.H., et al. The continuing increase of diabetes in the US. Diabetes Care 2001 Feb;24(2):412.  Mokdad, A.H., et al. The continuing epidemic of obesity in the United States. JAMA 2000 Oct 4;284(13):1650-1.

[66] Journal of Hensley, T., and M. Sones. Major Increase in Diabetes Among Adults Occurred Nationwide Between 1990 and 1998. National Center for Chronic Disease Prevention and Health Promotion, Diabetes Public Health Resource, News & Information
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[67] General Internal Medicine. January 2002;17:1-7.

[68] Boyle, J.P., et al. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care 2001 Nov;24(11):1936-40.

[69] Sinha, R., et al. Prevalence of impaired glucose tolerance (prediabetic) among children and adolescents with marked obesity. N Engl J Med 2002 Mar 14;346(11):802-10.

[70] Epidemiology, November, 2000; 11: 689-694.

[71] Sugg, J. “Suffer the Children, Tykes Toil to Fatten Corporate Coffers,” Creative Loafing, Atlanta, October 17, 2001; http://www.atlanta.creativeloafing.com/2001-10-17/fishwrapper.html

[72]University of Calgary Applied History Research Group, The European Voyages of Exploration: The Sugar and Slave Trades, 1997. http://www.ucalgary.ca/applied_history/tutor/eurvoya/Trade.html

[73] Klein, Herbert; African Slavery in Latin America and the Caribbean; 1990, pp.45-47.

[74] Id. at 49-51.

[75] Kretchmer, Norman and Claire B. Hollenbeck. Sugars and Sweeteners, CRC Press, June 27, 1991, Preface, p v.

[76] See, e.g., the following.  Beckles, H. “Sugar and Slavery, 1644-1692”, in H. Beckles, A History of Barbados from Amerindian Settlement to Nation State. Cambridge Univ. Press: Cambridge, 1990.  Chardon, R.E. “Sugar Plantations in the Dominican Republic, 1770-1844”, Geographical Review, 74, 4 (1984).  Curtin, P.D., “The Sugar Revolution and the Settlement of the Carribean”, in The Rise and Fall of the Plantation Complex: Essays in Atlantic History. Cambridge Univ. Press: Cambridge, 1990.  Dunn, R., Sugar and Slaves: The Rise of the Planter Class in the English West Indies, 1624-1713 (1972).

[77] Jensen, D, “The New Slavery: an Interview with Kevin Bales,” © 2001, The Sun Magazine, Chapel Hill, NC, http://www.thesunmagazine.org/slavery.html.

[78] Cox, Peter, “Sweetness and plight: Slavery on sugar plantations is a thing of the past.  Or is it?”  New Internationalist Magazine, Oxford, England, Issue 189 (November 1988), http://www.newint.org/issue189/plight.htm

[79] Id.

[80] Id.

[81] See, e.g., Dr. Charles Jacobs, “Slavery: Worldwide Evil, From India to Indiana, more people are enslaved today than ever before,” © 2001 Abolish.com, the Anti-Slavery Portal, http://www.iabolish.com/today/background/worldwide-evil.htm.

[82] American University, TED Case Studies, “Philippine Sugar and Environment,” January 11, 1997, http://www.american.edu/TED/PHILSUG.HTM

[83] Id.

[84] Hellinger, Daniel and Dennis Brooks. The Democratic Façade. Cole Publishing Co, 1991, p 233-241; http://www.thirdworldtraveler.com/Democracy_America/Exporting_Facade_TDF.html

[85] Id.

[86] For the preparation of the letter, we gratefully acknowledge the research and writing contributions of Gary Null, Ph.D., Robert F. Dean and Carolyn F.A. Dean, M.D., N.D.