I love sugar and, as a kid, I had a lot of cavities.
Once, when I was in junior high, my dentist, the late Harvey Levinson, looked at me sternly and announced: "If you keep eating sugar, you are going to have no teeth left by the time you are an adult."
(This is a non sequitur, but with awards season in full swing, indulge me: When I was in high school, Levinson, who practiced in Studio City, created the mouthpiece that transformed Marlon Brando into a jowly bulldog for "The Godfather." Brando won the Oscar for his portrayal of Don Corleone but famously declined it, sending Sacheen Littlefeather onstage in his stead. It was my closest brush with fame at that point. )
Anyway, sugar.
What Dr. Levinson always knew is generally accepted now: Too much sugar is bad for you.
It can cause dental problems, obviously, but it can also lead to obesity, diabetes and inflammation, which can lead to all sorts of unpleasant outcomes.
In 2014, Harvard researchers published the results of a 15-year study showing an association between a high-sugar diet and a greater risk of dying from heart disease. In Harvard Health's bulletin, nutrition professor Frank Hu, who led the study, said, "Excess sugar's impact on obesity and diabetes is well documented, but one area that may surprise many … is how their taste for sugar can have a serious impact on their heart health."
People who consume a diet high in sugar, say the experts, have a greater risk of dying from heart disease.
My father is a good example. I'm pretty sure his sugar consumption crowded other, more beneficial nutrients from his diet. Sure enough, he died of a massive stroke. Of course, he was 91 years old, but he might have made it to 92 had he consumed fewer of his beloved Trader Joe's chocolate-covered peanut butter cups or slices of Ralph's lemon loaf. We'll never know.
Our intense love for sugar, and the knowledge that sugar can adversely impact health, particularly for people who have diabetes and/or obesity, has led to a booming market in artificial sweeteners — $7.2 billion globally in 2021. This, in turn, has led to a proliferation of studies about whether artificial sweeteners might also have adverse health effects.
In three words, the definitive answer so far: Maybe. Maybe not.
Last week, we learned that one popular sugar substitute — erythritol — has been associated with an increased risk of heart attack, stroke and blood clots. Researchers at the Cleveland Clinic studied more than 4,000 people in the United States and Europe and found that people with higher levels of blood erythritol were at elevated risk of having a "major adverse cardiac event such as heart attack, stroke or death."
But of course, the researchers point out, correlation is not causation, and — as always — more study is needed. There's no point in demonizing sugar or sugar substitutes, or in raising our already sky-high levels of anxiety about our eating habits as we report the latest incremental piece of research. I appreciated the cautious headline on last week's New York Times story about the erythritol research: "Study Suggests Possible Link Between Sugar Substitute and Heart Issues. Experts Say, Don't Panic." Not all outlets were so circumspect.
But we do know that people all over the world are consuming greater amounts of sugar than ever, particularly in the form of sugar-laden beverages. Some have called this the "sweetening of the global diet."
Three-quarters of Americans eat more sugar than they should; the federal government puts the suggested maximum amount of daily added sugar (that is, sugar that does not normally occur in the food you eat) at less than 12.5 teaspoons, or 50 grams.
The American Heart Association's guideline is even stricter: Men should consume no more than nine teaspoons of added sugar per day, which amounts to 150 calories. And women, sadly, should consume no more than six teaspoons of added sugar per day. That is a mere 100 calories, less than the typical amount of sugar in one 12-ounce can of soda.
That can of soda should probably make only a rare appearance on your table. Sugar-sweetened beverages don't really satisfy hunger. So you end up eating as much food as you normally would, plus the empty calories of soda or lemonade on top of that.
And, just to mess with conventional wisdom (which is the point of research, after all), some studies have found that using artificial sweeteners can actually lead to weight gain by increasing appetite and sugar cravings, possibly because the lack of calories "prevents complete activation of the food reward pathway."
At this point, my food reward pathways are well-worn ruts. I have tried to cut out as much sugar and artificial sweeteners as I can stand to because that's what's best for my health. But I am also drawn to the hedonism of Anthony Bourdain, who in his 2000 memoir "Kitchen Confidential" famously wrote, "Your body is not a temple, it's an amusement park. Enjoy the ride."
I have enjoyed the ride so far, and I am happy to report that Dr. Levinson's dire admonishment was overly harsh. Despite all the sugar I have consumed in my life, I still have all my teeth.
Well, almost all of them.
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