No Sugar Added? In the last decades, society and government deemed alcohol to be the menace of the masses.

In more recent years, anti-tobacco legislation has found its way through the chambers of Congress. Now, the ongoing healthcare battle is turning towards yet another consumable: sugar. In their **Nature** article The Toxic Truth about Sugar, Robert H. Lustig, Laura A. Schmidt and Claire D. Brindis argue that added sugars in foods must be carefully regulated to limit consumption, using the reasoning that the effects of sugar meet all of justifications used to control alcohol (2012). Of course, regulating sugar is no simple task. Unlike that of such luxury items as cigars and wine, supply-side control of foods with added sugars leaves a gaping hole in not only the food industry, but also consumer culture. An altogether ban on sugar, similar to the ban on trans-fatty acids, is also unreasonable, as the human body periodically requires sugar in some amount and in some form. If regulation is to be justified, two sets of questions must first be addressed. Firstly, in what quantities can added sugars be considered harmful, and what quantity must therefore be regulated? Secondly, what kinds of regulation are feasible, who carries the burden of the regulation, and how can the total burden on society as a result of sugar regulation be minimized? Lustig et al. are nonspecific in answering the first question. They assert that excessive sugar consumption has effects similar to those of alcohol consumption, but provide no specific amounts. This leaves the question, how much is too much? A general estimate can be made by correlating average number of calories derived from sugar per day in a country with the rate of metabolic syndrome in that country; indeed, Lustig et al. attempt to do this in a figure in their article (The Global Sugar Glut). However, even such a correlation would not warrant establishing a magic number amount of sugar that can be safely ingested in one day; there are many factors that affect the rate of non-communicable diseases within a country, and it would be illogical to assign the responsibility to added sugars alone. Nor can the safe amount of sugar be derived experimentally as with alcohol. States generally have a legal intoxication level for blood alcohol concentration, above which the average adult cannot perform certain tasks. However, such an immediate effect as intoxication is not apparent with sugar consumption. The onset of metabolic disease occurs after years of repeated exposure to sugar, and metabolic syndrome is not due solely to sugar. This makes it nearly impossible to control all variables in an experimental study. It follows then that sugar could be treated similarly to tobacco, which also has long-term health effects. However, this classification also does not answer the question at hand. Routine consumption of any amount of tobacco has been shown to cause adverse effects, but consumption of sugar in moderation is safe, necessary even. (Sugar is, after all, a nutrient.) Until research ascertains a specific amount above which the ill effects of sugar consumption outweigh the benefits, attempts at regulation have no concrete foundation. Lustig et al. propose several methods of regulation, including removal of fructose from the U.S. Food and Drug Administration (FDA) Generally Regarded as Safe (GRAS) list, taxation, advertising limits, and age limits. The first method seems interesting at a glance; how better to control a substance than to legally declare it unfit for regular consumption? However, this will only be feasible once the safe

amount of sugar intake is determined, as regulation of substances outside of the GRAS list depends on such information. Supply-side regulation through taxation is certainly an effective economic control, but it is important to consider who receives the burden of the tax. The authors of The Toxic Truth state that in order for consumption of soda to noticeably decrease, the price has to double. This suggests that even if a change in consumption were to occur due to a tax, the tax itself would pose an undue financial burden on consumers, especially those in low-income areas. In order for this effect to be minimized, viable alternatives, such as healthier foods, must be presented and made as accessible as the original products. While this is not impossible, it is difficult and expensive in areas such as food deserts, which have limited or no access to fresh foods. Including healthy alternatives in these areas as well as others must be heavily subsidized to avoid putting the onus of regulation on the small fraction of the populace which depends largely on the consumption of sugary products. As such, supply-side regulation is ultimately costly for the same public whose welfare the government is trying to protect in the first place. It is logical, then, that curbing demand remains the only option for economically decreasing consumption. The second proposal, which is to limit advertising, has two goals: to limit knowledge of products with added sugars and to decrease attractiveness of (and the resulting demand for) these products. However, banning television commercials advertising such products, as Lustig et al. suggest, achieves neither goal, as modes of communication have stretched beyond television. It is certainly not viable to ban advertisements of these products altogether; tobacco advertising, which is arguably more regulated than tobacco itself, is still prevalent in sources without a primarily young readership. Furthermore, demand for sugar cannot be decreased simply through lack of physical advertising. Sugar is so pervasive in society that consumption is virtually inevitable, and tasting is perhaps the most effective method of advertising. The impracticality of economic regulation leaves the strongest form of control, a legal age limit, as the only option. This cover-all approach undoubtedly decreases consumption alcohol and tobacco provide well-established precedents but at what cost? Unlike alcohol and tobacco, sugar is too intertwined in culture, too widely utilized in common foods, to easily wean people from using it as frequently. Such an aggressive ban would serve only to criminalize parents who allow their children the occasional cookie, and execution of this legislation would place increased responsibility on local law enforcement. The sudden pressure on the food industry would take an economic toll as well, and this would marginalize not only many businesses, but also those from low-income backgrounds who consume sugary foods on a regular basis out of necessity. How, then, can society reduce consumption of this substance which is evidently so harmful to the public health? How can the government naturally decrease demand without the adverse societal side effects of regulation? The answer, perhaps, lies in an approach which is lightly brushed over in The Toxic Truth. This approach is education. Lustig et al. affirm that individualized methods such as school lessons on healthy living demonstrate little efficacy and give little attention to the possibility of national implementation through educational advertising about the effects of added sugars. Though

informative advertising is hardly regulation, anti-smoking advertisements and cautionary statements concluding advertisements for alcoholic beverages provide successful precedents for this approach. Of course, educating a nation is a gradual process which will likely take years to produce appreciable results and which must be preceded by concrete research. If anything is certain, though, it is that the decrease of sugar consumption will be gradual regardless of the approach taken to achieve it. Ultimately, the responsibility of health falls upon the people, and only when the people agree that sugar must be controlled will any steps towards lowering sugar consumption and improving public health yield fruit.