Invited Commentary
April 2014

New Unsweetened Truths About Sugar

Author Affiliations
  • 1Philip R. Lee Institute for Health Policy Studies, Clinical and Translational Sciences Institute, and Department of Anthropology, History and Social Medicine, School of Medicine, University of California at San Francisco

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JAMA Intern Med. 2014;174(4):525-526. doi:10.1001/jamainternmed.2013.12991

We are in the midst of a paradigm shift in research on the health effects of sugar, one fueled by extremely high rates of added sugar overconsumption in the American public. By “added sugar overconsumption,” we refer to a total daily consumption of sugars added to products during manufacturing (ie, not naturally occurring sugars, as in fresh fruit) in excess of dietary limits recommended by expert panels. Past concerns revolved around obesity and dental caries as the main health hazards. Overconsumption of added sugars has long been associated with an increased risk of cardiovascular disease (CVD).1 However, under the old paradigm, it was assumed to be a marker for unhealthy diet or obesity.2 The new paradigm views sugar overconsumption as an independent risk factor in CVD as well as many other chronic diseases, including diabetes mellitus, liver cirrhosis, and dementia—all linked to metabolic perturbations involving dyslipidemia, hypertension, and insulin resistance.3 The new paradigm hypothesizes that sugar has adverse health effects above any purported role as “empty calories” promoting obesity. Too much sugar does not just make us fat; it can also make us sick.

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