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 Our very first experience of exceptional sweetness—a dollop of buttercream frosting on a parent’s finger; a spoonful of strawberry ice cream instead of the usual puréed carrots—is a gustatory revelation that generally slips into the lacuna of early childhood. Sometimes, however, the moment of original sweetness is preserved. A YouTube video from February 2011 begins with baby Olivia staring at the camera, her face fixed in rapture and a trickle of vanilla ice cream on her cheek. When her brother Daniel brings the ice cream cone near her once more, she flaps her arms and arches her whole body to reach it. 
 
 Considering that our cells depend on sugar for energy, it makes sense that we evolved an innate love for sweetness. How much sugar we consume, however—as well as how it enters the body and where we get it from in the first place—has changed dramatically over time. Before agriculture, our ancestors presumably did not have much control over the sugars in their diet, which must have come from whatever plants and animals were available in a given place and season. Around 6,000 BC, people in New Guinea began to grow sugarcane, chewing and sucking on the stalks to drink the sweet juice within. Sugarcane cultivation spread to India, where by 500 BC people had learned to turn bowls of the tropical grass’s juice into crude crystals. From there sugar traveled with migrants and monks to China, Persia, northern Africa and eventually to Europe in the 11th century. 
 
 For more than 400 years, sugar remained a luxury in Europe—an exotic spice—until manufacturing became efficient enough to make “white gold” much more affordable. Christopher Columbus brought sugarcane to the New World in 1493 and in the 16th and 17th centuries European powers established sugarcane plantations in the West Indies and South America. Sugar consumption in England increased by 1,500 percent between the 18th and 19th centuries. By the mid 19th century, Europeans and Americans had come to regard refined sugar as a necessity. Today, we add sugar in one form or another to the majority of processed foods we eat—everything from bread, cereals, crunchy snacks and desserts to soft drinks, juices, salad dressings and sauces—and we are not too stingy about using it to sweeten many raw and whole foods as well. 
 
 By consuming so much sugar we are not just demonstrating weak willpower and indulging our sweet tooth—we are in fact poisoning ourselves according to a group of doctors, nutritionists and biologists, one of the most prominent members of which is Robert Lustig of the University of California, San Francisco, famous for his viral YouTube video “Sugar: The Bitter Truth.” A few journalists, such as Gary Taubes and Mark Bittman, have reached similar conclusions. Sugar, they argue, poses far greater dangers than cavities and love handles; it is a toxin that harms our organs and disrupts the body’s usual hormonal cycles. Excessive consumption of sugar, they say, is one of the primary causes of the obesity epidemic and metabolic disorders like diabetes, as well as a culprit of cardiovascular disease. More than one-third of American adults and approximately 12.5 million children and adolescents in the U.S. are obese. In 1980, 5.6 million Americans were diagnosed with diabetes; in 2011 more than 20 million Americans had the illness. 
 
 The argument that sugar is a toxin depends on some technical details about the different ways the human body gets energy from different types of sugar. Today, Americans eat most of their sugar in two main forms: table sugar and high-fructose corn syrup. A molecule of table sugar, or sucrose, is a bond between one glucose molecule and one fructose molecule—two simple sugars with the same chemical formula, but slightly different atomic structures. In the 1960s, new technology allowed the U.S. corn industry to cheaply convert corn-derived glucose intro fructose and produce high fructose corn syrup, which—despite its name—is almost equal parts free-floating fructose and glucose: 55 percent fructose, 42 percent glucose and three percent other sugars. Because fructose is about twice as sweet as glucose, an inexpensive syrup mixing the two was an appealing alternative to sucrose from sugarcane and beets. 
 
 Regardless of where the sugar we eat comes from, our cells are interested in dealing with fructose and glucose, not the bulkier sucrose. Enzymes in the intestine split sucrose into fructose and glucose within seconds, so as far as the human body is concerned sucrose and high-fructose corn syrup are equivalent. The same is not true for their constituent molecules. Glucose travels through the bloodstream to all of our tissues, because every cell readily converts glucose into energy. In contrast, liver cells are one of the few types of cells that can convert fructose to energy, which puts the onus of metabolizing fructose almost entirely on one organ. The liver accomplishes this primarily by turning fructose into glucose and lactate. Eating exceptionally large amounts of fructose taxes the liver: it spends so much energy turning fructose into other molecules that it may not have much energy left for all its other functions. A consequence of this energy depletion is production of uric acid, which research has linked to gout, kidney stones and high blood pressure. 
 
 The human body strictly regulates the amount of glucose in the blood. Glucose stimulates the pancreas to secrete the hormone insulin, which helps remove excess glucose from blood, and bolsters production of the hormone leptin, which suppresses hunger. Fructose does not trigger insulin production and appears to raise levels of the hormone grehlin, which keeps us hungry. Some researchers have suggested that large amounts of fructose encourage people to eat more than they need. In studies with animals and people by Kimber Stanhope of the University of California Davis and other researchers, excess fructose consumption has increased fat production, especially in the liver, and raised levels of circulating triglycerides, which are a risk factor for clogged arteries and cardiovascular disease. Some research has linked a fatty liver to insulin resistance—a condition in which cells become far less responsive to insulin than usual, exhausting the pancreas until it loses the ability to properly regulate blood glucose levels. Richard Johnson of the University of Colorado Denver has proposed that uric acid produced by fructose metabolism also promotes insulin resistance. In turn insulin resistance is thought to be a major contributor to obesity and Type 2 diabetes; the three disorders often occur together. 
 
 Because fructose metabolism seems to kick off a chain reaction of potentially harmful chemical changes inside the body, Lustig, Taubes and others have singled out fructose as the rotten apple of the sugar family. When they talk about sugar as a toxin, they mean fructose specifically. In the last few years, however, prominent biochemists and nutrition experts have challenged the idea that fructose is a threat to our health and have argued that replacing fructose with glucose or other sugars would solve nothing. First, as fructose expert John White points out, fructose consumption has been declining for more than a decade, but rates of obesity continued to rise during the same period. Of course, coinciding trends alone do not definitively demonstrate anything. A more compelling criticism is that concern about fructose is based primarily on studies in which rodents and people consumed huge amounts of the molecule—up to 300 grams of fructose each day, which is nearly equivalent to the total sugar in eight cans of Coke—or a diet in which the vast majority of sugars were pure fructose. The reality is that most people consume far less fructose than used in such studies and rarely eat fructose without glucose. 
 
 On average, people in America and Europe eat between 100 and 150 grams of sugar each day, about half of which is fructose. It’s difficult to find a regional diet or individual food that contains only glucose or only fructose. Virtually all plants have glucose, fructose and sucrose—not just one or another of these sugars. Although some fruits, such as apples and pears, have three times as much fructose as glucose, most of the fruits and veggies we eat are more balanced. Pineapples, blueberries, peaches, carrots, corn and cabbage, for example, all have about a 1:1 ratio of the two sugars. In his New York Times Magazine article, Taubes claims that “fructose…is what distinguishes sugar from other carbohydrate-rich foods like bread or potatoes that break down upon digestion to glucose alone.” This is not really true. Although potatoes and white bread are full of starch—long chains of glucose molecules—they also have fructose and sucrose. Similarly, Lustig has claimed that the Japanese diet promotes weight loss because it is fructose-free, but the Japanese consume plenty of sugar—about 83 grams a day on average—including fructose in fruit, sweetened beverages and the country’s many meticulously crafted confectioneries. High-fructose corn syrup was developed and patented in part by Japanese researcher Yoshiyuki Takasaki in the 1960s and ’70s. 
 
 Not only do many worrying fructose studies use unrealistic doses of the sugar unaccompanied by glucose, it also turns out that the rodents researchers have studied metabolize fructose in a very different way than people do—far more different than originally anticipated. Studies that have traced fructose’s fantastic voyage through the human body suggest that the liver converts as much as 50 percent of fructose into glucose, around 30 percent of fructose into lactate and less than one percent into fats. In contrast, mice and rats turn more than 50 percent of fructose into fats, so experiments with these animals would exaggerate the significance of fructose’s proposed detriments for humans, especially clogged arteries, fatty livers and insulin resistance. 
 
 In a series of meta-analyses examining dozens of human studies, John Sievenpiper of St. Michael’s Hospital in Toronto and his colleagues found no harmful effects of typical fructose consumption on body weight, blood pressure or uric acid production. In a 2011 study, Sam Sun—a nutrition scientist at Archer Daniels Midland, a major food processing corporation—and his colleagues analyzed data about sugar consumption collected from more than 25,000 Americans between 1999 and 2006. Their analysis confirmed that people almost never eat fructose by itself and that for more than 97 percent of people fructose contributes less daily energy than other sugars. They did not find any positive associations between fructose consumption and levels of trigylcerides, cholesterol or uric acid, nor any significant link to waist circumference or body mass index (BMI). And in a recent BMC Biology Q&A, renowned sugar expert Luc Tappy of the University of Lausanne writes: “Given the substantial consumption of fructose in our diet, mainly from sweetened beverages, sweet snacks, and cereal products with added sugar, and the fact that fructose is an entirely dispensable nutrient, it appears sound to limit consumption of sugar as part of any weight loss program and in individuals at high risk of developing metabolic diseases. There is no evidence, however, that fructose is the sole, or even the main factor in the development of these diseases, nor that it is deleterious to everybody.” 
 
 To properly understand fructose metabolism, we must also consider in what form we consume the sugar, as explained in a recent paper by David Ludwig, Director of the New Balance Foundation Obesity Prevention Center of Boston Children’s Hospital and a professor at Harvard. Drinking a soda or binging on ice cream floods our intestines and liver with large amounts of loose fructose. In contrast, the fructose in an apple does not reach the liver all at once. All the fiber in the fruit—such as cellulose that only our gut bacteria can break down—considerably slows digestion. Our enzymes must first tear apart the apple’s cells to reach the sugars sequestered within. “It’s not just about the fiber in food, but also its very structure,” Ludwig says. “You could add Metamucil to Coca Cola and not get any benefit.” In a small but intriguing study, 17 adults in South Africa ate primarily fruit—about 20 servings with approximately 200 grams of total fructose each day—for 24 weeks and did not gain weight, develop high blood pressure or imbalance their insulin and lipid levels. 
 
 To strengthen his argument, Ludwig turns to the glycemic index, a measure of how quickly food raises levels of glucose in the blood. Pure glucose and starchy foods such as Taubes’s example of the potato have a high glycemix index; fructose has a very low one. If fructose is uniquely responsible for obesity and diabetes and glucose is benign, then high glycemic index diets should not be associated with metabolic disorders—yet they are. A small percentage of the world population may in fact consume so much fructose that they endanger their health because of the difficulties the body encounters in converting the molecule to energy. But the available evidence to date suggests that, for most people, typical amounts of dietary fructose are not toxic. 
 
 Even if Lustig is wrong to call fructose poisonous and saddle it with all the blame for obesity and diabetes, his most fundamental directive is sound: eat less sugar. Why? Because super sugary, energy-dense foods with little nutritional value are one of the main ways we consume more calories than we need, albeit not the only way. It might be hard to swallow, but the fact is that many of our favorite desserts, snacks, cereals and especially our beloved sweet beverages inundate the body with far more sugar than it can efficiently metabolize. Milkshakes, smoothies, sodas, energy drinks and even unsweetened fruit juices all contain large amounts of free-floating sugars instantly absorbed by our digestive system. 
 
 Avoiding sugar is not a panacea, though. A healthy diet is about so much more than refusing that second sugar cube and keeping the cookies out of reach or hidden in the cupboard. What about all the excess fat in our diet, so much of which is paired with sugar and contributes to heart disease? What about bad cholesterol and salt? “If someone is gaining weight, they should look to sugars as a place to cut back,” says Sievenpiper, “but there’s a misguided belief that if we just go after sugars we will fix obesity—obesity is more complex than that. Clinically, there are some people who come in drinking way too much soda and sweet beverages, but most people are just overconsuming in general.” Then there’s all the stuff we really should eat more of: whole grains; fruits and veggies; fish; lean protein. But wait, we can’t stop there: a balanced diet is only one component of a healthy lifestyle. We need to exercise too—to get our hearts pumping, strengthen our muscles and bones and maintain flexibility. Exercising, favoring whole foods over processed ones and eating less overall sounds too obvious, too simplistic, but it is actually a far more nuanced approach to good health than vilifying a single molecule in our diet—an approach that fits the data. Americans have continued to consume more and more total calories each year—average daily intake increased by 530 calories between 1970 and 2000—while simultaneously becoming less and less physically active. Here’s the true bitter truth: Yes, most of us should make an effort to eat less sugar—but if we are really committed to staying healthy, we’ll have to do a lot more than that. ||||| Is sugar making us sick? 
 
 A team of scientists at the University of California in San Francisco believes so, and they're doing something about it. They launched an initiative to bring information on food and drink and added sugar to the public by reviewing more than 8,000 scientific papers that show a strong link between the consumption of added sugar and chronic diseases. 
 
 The common belief until now was that sugar just makes us fat, but it's become clear through research that it's making us sick. For example, there's the rise in fatty-liver disease, the emergence of Type 2 diabetes as an epidemic in children and the dramatic increase in metabolic disorders. 
 
 Laura Schmidt, a UCSF professor at the School of Medicine and the lead investigator on the project, SugarScience, said the idea is to make the findings comprehensible and clear to everyone. The results will be available to all on a website (SugarScience.org) and social media platforms like Facebook and Twitter. 
 
 Added sugars, Schmidt said, are sugars that don't occur naturally in foods. They are found in 74 percent of all packaged foods, have 61 names and often are difficult to decipher on food labels. Although the U.S. Food and Drug Administration requires food companies to list ingredients on packaging, the suggested daily values of natural and added sugars can't be found. 
 
 The FDA is considering a proposal to require food manufacturers to list information on sugars in the same way they do for fats, cholesterol, sodium, carbohydrates and protein. But because so much added sugar is dumped into so many products, one average American breakfast of cereal would likely exceed a reasonable daily limit. 
 
 "SugarScience shows that a calorie is not a calorie but rather that the source of a calorie determines how it's metabolized," said pediatric endocrinologist Robert Lustig, a member of the SugarScience team and the author of "Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease." Lustig said that more than half of the U.S. population is sick with metabolic syndrome, a group of risk factors for chronic diseases such as heart disease, diabetes and liver disease that are directly related to the excessive consumption of added sugars in the Western diet. 
 
 Figures from the Centers for Disease Control and Prevention show the category of heart attack/stroke as the leading cause of death in the United States. Every day, 2,200 Americans die of cardiovascular disease. That's about 800,000 a year, or one in three deaths. 
 
 The latest statistics from the American Diabetes Association show that 29.1 million Americans, or 9.3 percent, have diabetes. Of that number, 21 million have been diagnosed and 8.1 million have not, and the numbers continue to grow, according to the association. 
 
 It doesn't stop there. The American Liver Foundation says at least 30 million Americans, or 1 in 10, has one of 100 kinds of liver disease. 
 
 Clinicians widely believe that obesity is the cause of metabolic disease. Although it is a marker for these diseases, Lustig said, it's not the cause. "Too much sugar causes chronic metabolic disease in both fat and thin people," he said, "and instead of focusing on obesity as the problem, we should be focusing on our processed-food supply." 
 
 The average American consumes 19.5 teaspoons (78 grams) of sugar a day, substantially more than the amount recommended by the American Heart Association. The association sets these limits: 6 teaspoons (24 grams) for women, 9 teaspoons (36 grams) for men, and 3-6 teaspoons (12-24 grams) for children, depending on age. Just one 12-ounce soda contains 8 to 9 teaspoons (32-36 grams) of sugar. 
 
 Liquid sugar in sodas, energy drinks and sports drinks is the leading source of added sugar in the American diet. That represents 36 percent of all added sugars consumed, according to the Department of Health and Human Services. And because liquid does not include fiber, the body processes it quickly. That causes more sugar to be sent to the pancreas and liver than either can process properly, and the resulting buildup of sugar leads to heart disease, diabetes and liver disease. 
 
 Consuming too much sugar causes the level of glucose sugar in the bloodstream to increase. That, in turn, causes the pancreas to release high levels of insulin that cause the body to store extra calories as fat. 
 
 Too much insulin also affects the hormone leptin, a natural appetite suppressant that signals the brain to stop eating when full. But the imbalance of insulin levels caused by the intake of too much sugar causes lipid resistance, and the brain no longer gets that signal. 
 
 Another member of the SugarScience team, Dean Schillinger, is a professor of medicine at UCSF and a practicing primary care doctor at San Francisco General Hospital. He believes the overconsumption of added sugars is a social problem, not a problem of individual choice and freedom. 
 
 "People are becoming literate about the toxic effects of sugar," Schillinger said, "and have more understanding of the idea that high doses are bad for one's health." He sees evidence that those in a higher socioeconomic bracket are taking steps to limit intake of sugar when compared with poorer, less literate people. 
 
 Healthy food is expensive and less readily accessible in poorer neighborhoods, and because corn is so abundant and cheap, it is added to many food products. "Dumping high fructose corn syrup into cheap foods, sodas, sports drinks and energy drinks is toxic to the body, causing epidemic metabolic diseases and a serious health crisis," Schillinger said. 
 
 To underscore the scope of the problem, he pointed out that during the Iraq and Afghanistan wars, 1,500 American soldiers lost a limb in combat. In that same period, 1.5 million people in the U.S. lost limbs to amputations from Type 2 diabetes, a preventable disease. "We have yet to mobilize for a public health war," he said, "but the time has come to do so." 
 
 Such a war would have to take on the root causes of the problem. As a nation, Schillinger added, we would need to look at our food policies, food pricing, availability of healthy foods, and the marketing being carried out by food and beverage industries to hook the public on unhealthy choices loaded with added sugar. 
 
 Frank Hu, a professor of nutrition and epidemiology at the Harvard School of Public Health, is not a SugarScience researcher, but he agreed that the amount of sugar consumed by the American public is too high. SugarScience, he said, is being helpful by bringing the information about added sugar to public attention. ||||| The maverick scientist has long argued that sugar is as harmful as cocaine or tobacco – and that the food industry has been adding too much of it to our meals for too long. A convert hears more about his theory 
 
 If you have any interest at all in diet, obesity, public health, diabetes, epidemiology, your own health or that of other people, you will probably be aware that sugar, not fat, is now considered the devil's food. Dr Robert Lustig's book, Fat Chance: The Hidden Truth About Sugar, Obesity and Disease, for all that it sounds like a Dan Brown novel, is the difference between vaguely knowing something is probably true, and being told it as a fact. Lustig has spent the past 16 years treating childhood obesity. His meta-analysis of the cutting-edge research on large-cohort studies of what sugar does to populations across the world, alongside his own clinical observations, has him credited with starting the war on sugar. When it reaches the enemy status of tobacco, it will be because of Lustig. 
 
 "Politicians have to come in and reset the playing field, as they have with any substance that is toxic and abused, ubiquitous and with negative consequence for society," he says. "Alcohol, cigarettes, cocaine. We don't have to ban any of them. We don't have to ban sugar. But the food industry cannot be given carte blanche. They're allowed to make money, but they're not allowed to make money by making people sick." 
 
 Lustig argues that sugar creates an appetite for itself by a determinable hormonal mechanism – a cycle, he says, that you could no more break with willpower than you could stop feeling thirsty through sheer strength of character. He argues that the hormone related to stress, cortisol, is partly to blame. "When cortisol floods the bloodstream, it raises blood pressure; increases the blood glucose level, which can precipitate diabetes. Human research shows that cortisol specifically increases caloric intake of 'comfort foods'." High cortisol levels during sleep, for instance, interfere with restfulness, and increase the hunger hormone ghrelin the next day. This differs from person to person, but I was jolted by recognition of the outrageous deliciousness of doughnuts when I haven't slept well. 
 
 "The problem in obesity is not excess weight," Lustig says, in the central London hotel that he has made his anti-metabolic illness HQ. "The problem with obesity is that the brain is not seeing the excess weight." The brain can't see it because appetite is determined by a binary system. You're either in anorexigenesis – "I'm not hungry and I can burn energy" – or you're in orexigenesis – "I'm hungry and I want to store energy." The flip switch is your leptin level (the hormone that regulates your body fat) but too much insulin in your system blocks the leptin signal. 
 
 It helps here if you have ever been pregnant or remember much of puberty and that savage hunger; the way it can trick you out of your best intentions, the lure of ridiculous foods: six-month-old Christmas cake, sweets from a bin. If you're leptin resistant – that is, if your insulin is too high as a result of your sugar intake – you'll feel like that all the time. 
 
 Robert Lustig: 'I'm not a fitness guru. I'm 45lb overweight.' 
 
 Telling people to simply lose weight, he tells me, "is physiologically impossible and it's clinically dangerous. It's a goal that's not achievable." He explains further in the book: "Biochemistry drives behaviour. You see a patient who drinks 10 gallons of water a day and urinates 10 gallons of water a day. What is wrong with him? Could he have a behavioural disorder and be a psychogenic water drinker? Could be. Much more likely he has diabetes." To extend that, you could tell people with diabetes not to drink water, and 3% of them might succeed – the outliers. But that wouldn't help the other 97% just as losing the weight doesn't, long-term, solve the metabolic syndrome – the addiction to sugar – of which obesity is symptomatic. 
 
 Many studies have suggested that diets tend to work for two months, some for as long as six. "That's what the data show. And then everybody's weight comes roaring back." During his own time working night shifts, Lustig gained 3st, which he never lost and now uses exuberantly to make two points. The first is that weight is extremely hard to lose, and the second – more important, I think – is that he's no diet and fitness guru himself. He doesn't want everybody to be perfect: he's just a guy who doesn't want to surrender civilisation to diseases caused by industry. "I'm not a fitness guru," he says, puckishly. "I'm 45lb overweight!" 
 
 "Sugar causes diseases: unrelated to their calories and unrelated to the attendant weight gain. It's an independent primary-risk factor. Now, there will be food-industry people who deny it until the day they die, because their livelihood depends on it." And here we have the reason why he sees this is a crusade and not a diet book, the reason that Lustig is in London and not Washington. This is an industry problem; the obesity epidemic began in 1980. Back then, nobody knew about leptin. And nobody knew about insulin resistance until 1984. 
 
 "What they knew was, when they took the fat out they had to put the sugar in, and when they did that, people bought more. And when they added more, people bought more, and so they kept on doing it. And that's how we got up to current levels of consumption." Approximately 80% of the 600,000 packaged foods you can buy in the US have added calorific sweeteners (this includes bread, burgers, things you wouldn't add sugar to if you were making them from scratch). Daily fructose consumption has doubled in the past 30 years in the US, a pattern also observable (though not identical) here, in Canada, Malaysia, India, right across the developed and developing world. World sugar consumption has tripled in the past 50 years, while the population has only doubled; it makes sense of the obesity pandemic. 
 
 "It would have happened decades earlier; the reason it didn't was that sugar wasn't cheap. The thing that made it cheap was high-fructose corn syrup. They didn't necessarily know the physiology of it, but they knew the economics of it." Adding sugar to everyday food has become as much about the industry prolonging the shelf life as it has about palatability; if you're shopping from corner shops, you're likely to be eating unnecessary sugar in pretty well everything. It is difficult to remain healthy in these conditions. "You here in Britain are light years ahead of us in terms of understanding the problem. We don't get it in the US, we have this libertarian streak. You don't have that. You're going to solve it first. So it's in my best interests to help you, because that will help me solve it back there." 
 
 The problem has mushroomed all over the world in 30 years and is driven by the profits of the food and diet industries combined. We're not looking at a global pandemic of individual greed and fecklessness: it would be impossible for the citizens of the world to coordinate their human weaknesses with that level of accuracy. Once you stop seeing it as a problem of personal responsibility it's easier to accept how profound and serious the war on sugar is. Life doesn't have to become wholemeal and joyless, but traffic-light systems and five-a-day messaging are under-ambitious. 
 
 "The problem isn't a knowledge deficit," an obesity counsellor once told me. "There isn't a fat person on Earth who doesn't know vegetables are good for you." Lustig agrees. "I, personally, don't have a lot of hope that those things will turn things around. Education has not solved any substance of abuse. This is a substance of abuse. So you need two things, you need personal intervention and you need societal intervention. Rehab and laws, rehab and laws. Education would come in with rehab. But we need laws." 
 
 The Obamas hate him, he says, because they don't want to fight the industry. "They've got a lot of enemies. I'm not mad at them. I actually kind of like them." On paper, Lustig is absolutely livid. "In America we have this thing, it's called the Declaration of Independence. We are entitled to life, liberty and the pursuit of happiness. It doesn't say a damned fucking thing about the pursuit of pleasure." But he has seen how it worked with tobacco. It took a long time, he says, but industries can't poison people en masse for ever. 
 
 "We have to do something about it, or there will be no healthcare. In fact, there will be no society. Are you ready for that? That's what's gonna happen. It's just not OK. There will be no money left for anything else." 
 
 His predictions for world health are apocalyptically pessimistic. Yet in his bearing, he has the deep-rooted optimism of a person who knows the fight is worthwhile, and believes that, in the end, he'll win it. 
 
 Fat Chance is published by Fourth Estate at £8.99. To order a copy for £7.19 with free P&P, visit guardianbookshop.co.uk or call 0330 333 6846 ||||| 1. Why are you changing the Nutrition Facts label? 
 
 The current label is more than 20 years old. In order to make sure consumers have access to more recent and accurate nutrition information about the foods they are eating, it’s time to make changes to the Nutrition Facts label. The changes announced today are based on updated scientific information, new nutrition and public health research, more recent dietary recommendations from expert groups, and input from the public. 
 
 2. What major changes are you making? 
 
 The changes include modifying the list of required nutrients that must be declared on the label, updating serving size requirements, and providing a refreshed design. The new Nutrition Facts label will make it easier for consumers to make informed decisions about the food they eat. 
 
 3. Why must “added sugars” now be included? 
 
 The scientific evidence underlying the 2010 and the 2015-2020 Dietary Guidelines for Americans support reducing caloric intake from added sugars; and expert groups such as the American Heart Association, the American Academy of Pediatrics, the Institute of Medicine and the World Health Organization also recommend decreasing intake of added sugars. 
 
 In addition, it is difficult to meet nutrient needs while staying within calorie requirements if you consume more than 10 percent of your total daily calories from added sugars. On average, Americans get about 13 percent of their total calories from added sugars, with the major sources being sugar-sweetened beverages (including soft drinks, fruit drinks, coffee and tea, sport and energy drinks, and alcoholic beverages) and snacks and sweets (including grain-based desserts, dairy desserts, candies, sugars, jams, syrups, and sweet toppings). 
 
 The FDA recognizes that added sugars can be a part of a healthy dietary pattern. But if consumed in excess, it becomes more difficult to also eat foods with enough dietary fiber and essential vitamins and minerals and still stay within calorie limits. The updates to the label will help increase consumer awareness of the quantity of added sugars in foods. Consumers may or may not decide to reduce the consumption of certain foods with added sugars, based on their individual needs or preferences. 
 
 The final rule requires “Includes X g Added Sugars” to be included under “Total Sugars” to help consumers understand how much sugar has been added to the product. 
 
 4. How does the FDA define “added sugars”? 
 
 The definition of added sugars includes sugars that are either added during the processing of foods, or are packaged as such, and include sugars (free, mono- and disaccharides), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices that are in excess of what would be expected from the same volume of 100 percent fruit or vegetable juice of the same type. The definition excludes fruit or vegetable juice concentrated from 100 percent fruit juice that is sold to consumers (e.g. frozen 100 percent fruit juice concentrate) as well as some sugars found in fruit and vegetable juices, jellies, jams, preserves, and fruit spreads. 
 
 For industry and those interested in the more technical version of the definition, please consult page 33980 of the Nutrition Facts Label Final Rule. 
 
 5. Are you using the new label to tell people what to eat? 
 
 The Nutrition Facts label is designed to provide information that can help consumers make informed choices about the food they purchase and consume. It is up to consumers to decide what is appropriate for them and their families’ needs and preferences. 
 
 6. Why is trans fat still on the label if the FDA is phasing it out? 
 
 Trans fat will be reduced but not eliminated from foods, so FDA will continue to require it on the label. In 2015, the FDA published a final determination that partially hydrogenated oils (PHOs), the source of artificial trans fat, are not generally recognized as safe, but this determination would not affect naturally occurring trans fat, which would still exist in the food supply. Trans fat is present naturally in food from some animals, mainly ruminants such as cows and goats. Also, industry can currently use some oils that are approved as food additives and can still petition FDA for certain uses of PHOs. 
 
 7. Why are vitamin D and potassium being added to the Nutrition Facts label? 
 
 Vitamin D and potassium are nutrients Americans don’t always get enough of, according to nationwide food consumption surveys (http://www.cdc.gov/nchs/nhanes/), and when lacking, are associated with increased risk of chronic disease. Vitamin D is important for its role in bone health, and potassium helps to lower blood pressure. Calcium and iron are already required and will continue to be on the label. 
 
 8. Why are you no longer requiring vitamins A and C? 
 
 In the early 1990’s, American diets lacked Vitamins A and C, but now Vitamins A and C deficiencies in the general population are rare. Manufacturers are still able to list these vitamins voluntarily. 
 
 9. Will the new label look different? 
 
 You will still recognize the label, but we have made some improvements to the format to provide significant public health information. Changes include: 
 
 Highlighting “Calories,” “servings per container,” and the “Serving size” declaration by increasing the type size and placing the number of calories and the “Serving size” declaration in bold type. 
 
 Requiring manufacturers to declare the actual amount, in addition to percent Daily Value, of the mandatory vitamins and minerals. 
 
 Adding “Includes X g Added Sugars” directly beneath the listing for “Total Sugars.” 
 
 Changing the footnote to better explain the percent Daily Value. It will now read: “*The % Daily Value tells you how much a nutrient in a serving of food contributes to a daily diet. 2,000 calories a day is used for general nutrition advice.” 
 
 10. I heard that some serving sizes will actually be bigger. That doesn’t seem to make sense with the obesity epidemic. 
 
 Some serving sizes will increase and others will decrease because by law, the serving sizes must be based on the amounts of food and drink that people typically consume, not on how much they should consume. Recent food consumption data show that some serving sizes need to be revised. For example, the reference amount used to set a serving of ice cream was previously ½ cup and now is changing to â…” cup. The reference amount used to set a serving size of soda was previously 8 ounces and now is changing to 12 ounces. The reference amount for yogurt is decreasing from 8 ounces to 6 ounces. Nutrient information on the new label will be based on these updated serving sizes so it matches what people actually consume. 
 
 11. How much time will manufacturers have to make these changes? 
 
 The FDA extended the compliance dates for the Nutrition Facts and Supplement Facts label final rule and the Serving Size final rule, from July 26, 2018 to January 1, 2020, for manufacturers with $10 million or more in annual food sales. Manufacturers with less than $10 million in annual food sales would receive an extra year to comply – until January 1, 2021. 
 
 12. Will the new requirements apply to imported food? 
 
 Yes, foods imported to the United States will need to meet the final requirements. ||||| Blog 
 
 Sugar Terms 101 
 
 Here is a helpful sugar breakdown for those of you who are confused by the different types of sugar terms that have been tossed around in the media lately … Thank you to Linda Robbins who wrote an article in the Times Telegram titled Sugar Vocabulary. ||||| Eat additional foods from a food group above your daily recommendation. 
 
 Select a higher-calorie form of a food that’s higher in fat or contains added sugars (for example, sweetened vs. unsweetened cereal). 
 
 Add fats or sweeteners to foods (for example, sauce, dressing, margarine). 
 
 No, but added sugars add calories and zero nutrients to food. Adding a limited amount of sugars to foods that provide important nutrients—such as whole-grain cereal, flavored milk or yogurt—to improve their taste, especially for children, is a better use of added sugars than nutrient-poor, highly sweetened foods.Current nutrition labels don’t list the amount of added sugars (alone) in a product. The line for “Sugars” you see on the Nutrition Facts label includes both added and naturally occurring sugars in the product.You need to read the ingredient list on a processed food’s label to tell if the product contains added sugars. Some names for added sugars include agave syrup, brown sugar, corn sweetener, corn syrup, sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose), high-fructose corn syrup, fruit juice concentrate, honey, invert sugar, malt sugar, molasses, raw sugar, sugar, syrup.It will be important for policy makers, the food industry and other public health groups to make identifying added sugars simpler for consumers. In 2014, the FDA proposed updates to the Nutrition Facts label that would require information about the amount of added sugars in a food product to help consumers know how much sugar is added to their foods. Added sugars are sugars and syrups that are added to foods or beverages during processing or preparation. They do not include naturally occurring sugars such as those found in milk (lactose) and fruits (fructose). Added sugars (or added sweeteners) include natural sugars (such as white sugar, brown sugar and honey) as well as other caloric sweeteners that are chemically manufactured (such as high fructose corn syrup). Some names for added sugars include agave syrup, brown sugar, corn sweetener, corn syrup, sugar molecules ending in “ose” (dextrose, fructose, glucose, lactose, maltose, sucrose), high-fructose corn syrup, fruit juice concentrate, honey, invert sugar, malt sugar, molasses, raw sugar, sugar, syrup.All carbohydrates are made up of units of sugar ("saccharide"). Carbohydrates containing only one unit of sugar (called "monosaccharides") or two units of sugar (called "disaccharides") are known as simple sugars or simple carbohydrates. Simple sugars are quickly broken down and provide a very fast increase in blood sugar, while complex carbs take longer and cause blood sugar to rise more gradually. Complex carbohydrates are found in foods such as starchy vegetables (corn, potatoes, peas, etc.), breads, cereals, rice and grains. Complex carbs are broken down into the simple sugars during digestion, which causes them to be processed more slowly in the body.Sugars are often added to foods during processing to make them sweeter or change the taste.The American Heart Association recommends that no more than half of your daily discretionary calorie allowance come from added sugars. For most American women, this is no more than 100 calories per day (about 6 teaspoons). For men, it’s no more than 150 calories per day (about 9 teaspoons).Typically, foods high in added sugars do not have nutrients the body needs and only contain extra calories. To get the nutrients you need, eat a diet that’s rich in fruits, vegetables, fiber-rich whole grains, lean meats, fish, poultry and low-fat or fat-free dairy products.Discretionary calories are in addition to those that supply the nutrients to your body for daily function and activity. Your body does not actually need them to function. You have a daily energy need—the amount of calories (or energy units) your body needs to function and provide energy for your activities. Think of it as a budget. You’d organize a real budget with “essentials” (for example, rent and utilities) and “extras” (for example, vacation and entertainment). In a daily calorie budget, the essentials are the minimum number of calories you need to meet your nutrient needs. Depending on the foods you choose and the amount of physical activity you do each day, you may have more calories left over for “extras,” such as foods containing some added sugars. These are discretionary calories, or calories to be spent at your discretion. A person’s discretionary calorie budget varies depending on how physically active they are and how many calories they need to consume to meet their daily nutrient requirements.Common sources of discretionary calories (in addition to added sugars) are fats, oils and alcohol. Fats are the most concentrated source of calories. Discretionary calories can be used to:One teaspoon (tsp) of sugar has about 16 calories.Americans eat about 20 teaspoons of sugar a day according to a report from the 2005–10 NHANES (National Health and Nutrition Examination Survey) database. Teens and men consume the most added sugars. Average daily consumption for men: 335 calories, women: 230 calories, boys: 362 calories, girls: 282 calories.Sugar-sweetened beverages including regular soft drinks, sports drinks and fruit drinks (fruitades and fruit punch); syrup; candy; cakes and cookies; dairy desserts and milk products (ice cream, sweetened yogurt, and sweetened milk).You can choose how to spend your discretionary calories. Regular soft drinks are the No. 1 source of added sugars in Americans’ diets. A 12-ounce can of regular soda contains an estimated 130 calories (or 8 teaspoons) of added sugars. People who consume lots of sugar-sweetened beverages eat too many sugar calories and tend to gain weight. Carefully monitor the number of calories you get from sodas and other sources of added sugars.Sugars can promote enjoyment of meals and snacks. It is preferable that discretionary calories from sugar are added to otherwise nutrient-rich foods, such as dairy products (flavored milk and yogurt) and foods that provide whole grains and fiber (sugar-sweetened cereals).Some studies show that eating large amounts of added sugars is associated with diets low in calcium, vitamin A, iron and zinc. Also, diets that are high in added sugars are typically low in fiber. This is important because increasing dietary sources of fiber is associated with decreasing energy intake, which can result in weight loss.Some studies suggest that drinking too many calories is even more likely to cause weight gain than eating too many calories from solid foods. It is suggested that liquid calories are not as satisfying as calories consumed from solid foods, so people tend to consume more fluid calories to compensate. Reducing liquid calorie intake has a stronger effect on weight loss than reducing solid calories.People should carefully monitor the calories they drink and get enough water to maintain proper hydration every day.The American Heart Association recommends that all Americans consume no more than 450 calories (36 ounces) per week from sugar-sweetened beverages (based on a 2,000 calorie per day diet).The AHA hasn’t taken a position for or against certain types of added sugars or sweeteners, but we will continue to assess the science on this topic and any relevance to the impact on cardiovascular disease.You can drink diet sodas in moderation, but they don’t give you any nutrition and shouldn’t be used to excuse overindulging with other foods. Balance them with plain water and a variety of foods and beverages that are high in nutrients and low in added sugars. Just because a product is “sugar free” or made with non-nutritive (artificial) sweeteners doesn’t necessarily mean that it’s healthy.Last Reviewed 5/19/2014 ||||| Researchers at UC San Francisco have launched SugarScience, a groundbreaking research and education initiative designed to highlight the most authoritative scientific findings on added sugar and its impact on health. 
 
 The national initiative is launching in partnership with outreach programs in health departments across the country, including the National Association of City and County Health Organizations and cities nationwide. 
 
 Developed by a team of UCSF health scientists in collaboration with scientists at UC Davis and Emory University School of Medicine, the initiative reflects an exhaustive review of more than 8,000 scientific papers that have been published to date on the health effects of added sugar. 
 
 The research shows strong evidence of links between the overconsumption of added sugar and chronic diseases, including Type 2 diabetes, heart disease and liver disease. It also reveals evidence linking sugar to Alzheimer's disease and cancer, although the team assessed that more research is needed before those links can be considered conclusive. 
 
 Laura Schmidt, PhD 
 
 “The average American consumes nearly three times the recommended amount of added sugar every day, which is taking a tremendous toll on our nation’s health,” said Laura Schmidt, PhD, a UCSF professor in the Philip R. Lee Institute for Health Policy and the lead investigator on the project. “This is the definitive science that establishes the causative link between sugar and chronic disease across the population.” 
 
 The initiative aims to bring scientific research out of medical journals and into the public domain by showcasing key findings that can help individuals and communities make informed decisions about their health. For example, SugarScience.org cites research showing that drinking just one can of soda per day can increase a person’s risk of dying from heart disease by nearly one-third, and can raise the risk of getting Type 2 diabetes by one-quarter. 
 
 Kirsten Bibbins-Domingo, MD, PhD 
 
 More than 27 million Americans have been diagnosed with heart disease, which is the nation’s leading cause of death. Another 25.8 million Americans have Type 2 diabetes, caused by the body’s resistance to the hormone insulin coupled with the inability to produce enough insulin to regulate blood sugar levels. Of greatest concern is the rising number of children suffering from these chronic diseases. 
 
 “Twenty years ago, type 2 diabetes was unheard of among children, but now, more than 13,000 children are diagnosed with it each year,” said Kirsten Bibbins-Domingo, MD, PhD, a UCSF professor of medicine, epidemiology and biostatistics, and director of the UCSF Center for Vulnerable Populations at San Francisco General Hospital and Trauma Center. “Diabetes is a devastating disease and we know that it is directly related to the added sugar we consume in food and beverages.” 
 
 Robert Lustig, MD, MSL 
 
 Another rising concern is the impact of added sugar on Non-Alcoholic Fatty Liver Disease (NAFLD), which affects 31 percent of adults and 13 percent of children, and can lead to cirrhosis and liver failure. 
 
 “As pediatricians, we had evidence of the connection between sugar and diabetes, heart disease, and liver disease for years, but we haven’t had this level of definitive scientific evidence to back up our concerns,” said Robert Lustig, MD, MSL, a pediatric endocrinologist at UCSF Benioff Children’s Hospital San Francisco and a member of the SugarScience team. “Our goal is to make that science digestible to the American public, and take the first step toward a national conversation based on the real scientific evidence.” 
 
 While there are no federal recommended daily values for added sugar, the American Heart Association recommends consuming less than 6 tsp. (25 g) for women and 9 tsp. (38 g) for men. Guidelines for children depend on caloric intake, but range between 3-6 tsp (12-25 g) per day. Americans currently consume 19.5 tsp. of added sugar, on average, every day. 
 
 Added sugar is defined as any caloric sweetener that is added in food preparation, at the table, in the kitchen or in a processing plant. It can be difficult for people to know how much sugar they are consuming, since roughly 74 percent of processed foods contain added sugar, which is listed under at least 60 different names on food labels. 
 
 The 12-member SugarScience team will continue to monitor scientific research about added sugar and will track findings at SugarScience.org. The initiative harnesses the power of UCSF’s extensive health sciences enterprise, which ranges from basic laboratory research to clinical, population and policy sciences, with an emphasis on translating science into public benefit. All four of UCSF’s graduate schools – dentistry, medicine, nursing and pharmacy – lead their fields in research funding from the National Institutes of Health, reflecting the caliber of their research. 
 
 SugarScience is made possible by an independent grant from the Laura and John Arnold Foundation. It is supported by the Clinical and Translational Science Institute and the Philip R. Lee Institute for Health Policy Studies at UCSF. 
 
 UCSF is the nation's leading university exclusively focused on health. Now celebrating the 150th anniversary of its founding as a medical college, UCSF is dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals.
– Dr. Robert Lustig has studied childhood obesity for 16 years and cross-analyzed numerous studies to come to a not-so-sweet conclusion: Sugar should be thought of along the same lines as tobacco, cocaine, or alcohol, he told the Guardian in August. Now Lustig is a member of a 12-scientist team working on SugarScience, a University of California-San Francisco initiative that hopes to showcase reputable studies on added sugars and how they impact health, a UCSF news article reports. The SugarScience group has already reviewed more than 8,000 papers and found evidence to support Lustig's previous assertions, linking excess sugar consumption to such chronic diseases as Type 2 diabetes and liver and heart disease. Laura Schmidt, the initiative's lead researcher, told the Chicago Tribune in December that the point of the project is to make these findings accessible to the public through its website and social media. The average American consumes 19.5 teaspoons of added sugar a day, significantly higher than what the American Heart Association recommends (6 teaspoons for women, 9 teaspoons for men, and 3 to 6 teaspoons for kids, according to UCSF). Schmidt notes that added sugars show up in 74% of all packaged foods and appear under at least 60 different names, making them hard to find on food labels. Though some have said that calling sugar a poison is high-fructose hyperbole—a 2013 Scientific American article noted that "many worrying fructose studies use unrealistic doses" of sugar and that rodents used as subjects process it differently than humans—not many are disputing we should eat less of it. The FDA is considering expanding its food labels to include an "Added Sugars" category to help consumers keep their sugar intake in check. (The WHO says just 5% of your calories should be from sugar.)