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Natural Foods Merchandiser

UCSF effort digs deeper into the science behind sugar

Sugar Science infographic
One of the leaders of University of California, San Francisco's newest public health education campaign,, talks about the science of sugar and how the natural products industry can advance education and sugar-reduction efforts.

Laura Schmidt

SugarScience is a new website designed to educate the public about the health impacts of sugar consumption and help people make healthier choices. Behind the site is a team of health scientists at the University of California, San Francisco (UCSF), who have reviewed thousands of research papers on sugar and health and found that the strongest scientific evidence for sugar’s overall health impacts connects it to diabetes, heart disease and liver disease.

Laura Schmidt, a professor at the UCSF school of medicine and SugarScience’s chief scientist and principal investigator, spoke with us about the project.

Who is your target audience?

Our initial launch in November 2014 was co-launched with health departments from major cities around the country, which can take the [educational] materials and use them in their public health outreach efforts.

A key target for us is people who are in a position to share the materials. We’ve had a lot of interest from physicians’ offices, dental offices, nutritionists, all sorts of people in the health world, also nongovernmental organizations, religious groups, YMCAs. Schools have been a huge target.

UCSF, which has five campuses and numerous hospitals and clinics, is rolling out SugarScience as our newest public health education campaign for our employees as well as patients and families in our medical center. So large institutions are another potential target audience.

Were there any findings that surprised you the most?

I think one of the most surprising sets of findings is around the impact of one particular kind of sugar, called fructose, on the liver. This is where the science is most clear. We’ve got a very robust body of evidence supporting the conclusion that this particular sugar, fructose, is largely metabolized in the liver. It’s very common; it’s in about half of table sugar and anywhere from 40 percent to 90 percent of high fructose corn syrup. When consumed in very high doses, the effects on the liver, from a metabolic standpoint, are identical to those of alcohol.

We’re seeing rising rates of fatty liver disease and cirrhosis of the liver in populations that don’t drink alcohol or don’t overconsume alcohol. This is a very, very important area of research because the liver is such a vital organ.

And just like a beer belly, you can get a sugar belly—it’s actually the same metabolic process. In the scientific community, they call it visceral fat, but we’re trying to use phrases that will stick in people’s memory. What goes along with this is a whole complex of harmful consequences for human health that go under the category of metabolic syndrome, and we believe that metabolic syndrome underlies most forms of chronic disease—heart disease, diabetes, even cancer.

We think about 31 percent of the American adult population has non-alcoholic fatty liver disease already; we think about 13 percent of children do. And it’s the fastest-rising indication for liver transplantation in America.

Graphics like this one and additional educational tools are available at

What can natural products retailers do to advance education about sugar and its impacts?

I think my main response would be to use the SugarScience toolkit. Everything on the website is free and easily downloadable. So have a stack of pamphlets by the cash register. And pointing out what’s unhealthy is a very good thing to do.

Is there anything else the natural products industry at large can do?

There’s a tremendous amount of public interest in having a label that allows people to look at how much added sugar they’re consuming.

People say they look at the label, and want to live within their limits, but don’t know if they are because the labels don’t disclose how much sugar is added. From the standpoint of producing products that are supportive of health, certainly anyone who reduces the quantity of added sugar in products is going to be supporting public health.

Our current consumption is so out of whack—the average American consumes 2.7 times the American Heart Association limit on a daily basis. That’s the average American, so there are a lot of Americans consuming way, way more than that.

So a label that would allow people to know how much sugar is added the product, and/or a product with less added sugar would be great.

Labeling issues, though, are really a matter for the FDA, and there is a discussion going on at that level right now about providing a line on the label for added sugar.

A lot of products designed to be healthier will use fruit juice as a sweetener. On SugarScience, fruit doesn’t count as added sugar. Where does the science come down on these types of products, and on fruit juice generally?

Fruit consumption is a protective factor for metabolic disease, and in particular, heart disease. The research on fruit juice right now is in flux. We only have, to my knowledge, about four papers and one review demonstrating that fruit juice probably doesn’t have the same harmful effects, particularly on the liver, as sugary beverages like sodas and sports drinks. It’s too soon to tell, but we share with people what we know so far from the research.

For foods made with fruit juice, to my knowledge, we don’t have any evidence. The issue is, I think we really need to be researching what happens to the antioxidants and various nutrients that are in natural fruit and may wind up in fresh juice—what happens to them when they undergo cooking and processing. Do they still retain their capacity to promote health? Those are questions that I’m not aware have been studied. Those would be wonderful studies, I would think, for natural food producers to conduct.

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