Letter to the Sugar Industry

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.

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).”

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.

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."

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.

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. 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. 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. 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.

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.

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.”

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.

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."

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. Addiction to sugar was also confirmed in a multitude of other studies.

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.

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.

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.

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.

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. 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.

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. 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.

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.

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.” Numerous other studies have repeatedly documented the relationship between high blood sugar levels and increased heart disease.

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.

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.

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.

Schoenthaler also studied thousands of juvenile delinquents on junk-free diets and always observed dramatic improvement in mood and behavior. 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.

The sugar industry has often cited four different small-scale studies to deny any link between consumption of sugar by children and hyperactivity. 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. 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. Schauss, in two studies, examined over 2,000 juvenile delinquents. 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.

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%). 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 , 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.

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. A host of other studies establish that the consumption of sugar significantly increases the incidence of dental carries.

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. More recently, Yabunaka found that sugar caused an increase in a protein that inhibits macrophage activity. Elevated levels of blood sugar have also been linked to bacterial invasion and infectious diseases, such as sepsis and vaginal candidiasis.

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. Several other studies faithfully document that since 1995, there has been a dramatic rise in obesity in American children.

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.

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.

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. 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. 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. 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.”

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