Nutrition and Health Series Editor: Adrianne Bendich James M. Rippe Editor Fructose, High Fructose Corn Syrup, Sucrose and Health Nutrition and Health Adrianne Bendich, Ph.D., FASN, FACN, Series Editor For further volumes: http://www.springer.com/series/7659 James M. Rippe Editor Fructose, High Fructose Corn Syrup, Sucrose and Health Editor James M. Rippe, M.D. Professor of Biomedical Sciences University of Central Florida Medical School Orlando, FL, USA Founder and Director Rippe Lifestyle Institute Shrewsbury , MA and Celebration, FL, USA ISBN 978-1-4899-8076-2 ISBN 978-1-4899-8077-9 (eBook) DOI 10.1007/978-1-4899-8077-9 Springer New York Heidelberg Dordrecht London Library of Congress Control Number: 2014931369 © Springer Science+Business Media New York 2014 T his work is subject to copyright. 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Foreword Sugar, Sugar-Sweetened Beverages, and Obesity: Separating Supposition from Demonstrated Fact, from Misinformation T he word s cience derives from the Latin s cientia, meaning “to have knowledge.” So science is about knowing. As stated in a maxim often attributed to the French mathematician Henri Poincaré, “Science is built up with facts, as a house is with stones. But a collection of facts is no more a science than a heap of stones is a house” [1] (p. 127). Therefore, science is not merely about the accumulation of facts we know, it is about how we come to know these facts. What distinguishes knowing in science from knowing (or belief) in other domains is that the confi dence in one’s knowledge derives not from the strength of one’s convictions but from the strength of one’s evidence. In the fi elds of biology, medicine, and behavioral science, we generally do not have strong enough theories to derive our evi- dence mathematically through deductive reasoning and must instead depend on empirical evidence. Thus, almost all of our knowledge is dependent on empirical data. For this reason, the integrity of the generation and communication of collected data must be sacrosanct. B ut scientists are humans fi rst and susceptible to the passions of any human. Many scientists in the realms of nutrition, medicine, and public health feel a passion for their duty to benefi cence and see a key role for the profession as protecting the public from harm—noble passions in any accounting. In their passion, some scientists come to view themselves as being at war with the presumed enemies of health, which then drives them to rally the troops. We have all heard of the “war on drugs” [2], the “war on tobacco” [3], and the “war on drunk driving” [4]. Now, many are using similar language to describe a war on obesity [5]. We are told that obesity is a “public health threat” [6] and a “crisis” [7, 8]. Obesity is indeed a serious and prevalent problem, and we do need to prioritize fi nding ways to reduce obesity and the suffering it creates. But the war and crisis mentalities may have a downside. As Aeschylus is said to have told us, “the fi rst casualty of war is truth,” and just as in war where demon- izing and dehumanizing the enemy may lead to atrocities, there is a concern that the war metaphor in obesity, while mobilizing, may have the result of demonizing certain industries, persons, and foods and consequently lead to oversimplifying messages, relying on ad hominem reasoning, and distorting information [9]. N ow, a growing number of authors [10–19] are pointing out that the fever pitch reached about certain obesity issues, especially sugar-sweetened beverages and sugar in general, appears to be lead- ing to exaggerations and distortions of the evidence base and dialogue around these issues in the sci- entifi c and public health literature. In that light, the authors of the current book deserve praise for stepping forward in an attempt to offer a reasoned and balanced view of the health consequences of sugar in general, of specifi c sugars (e.g., fructose), and of sugars in specifi c forms (e.g., sugar- sweetened beverages). The story of sugar’s health effects is complex. Today, sugar is demonized by many [20], whereas at some points in history, it was viewed as an elixir of good health [21]. Today, we are often told that it will promote weight gain because sugar consumption, especially in liquid form, will not be suffi - ciently compensated for by lesser subsequent energy intake. Ironically, in 1942, when national vii viii Foreword sentiment in the United States was also against sugar, perhaps in part due to the desire to ration it for the war effort, the S cience News-Letter stated, “Sugar rationing certainly will harm no one. P eople will meet the restriction on sugar by adding calories from other sources [emphasis added]” [22]. The opinion offered in this 1942 quotation stands in stark opposition to the modern statements about indi- viduals being incapable of reducing their caloric intake to compensate for calories consumed as sugar or sugar- sweetened beverages. Another publication from that era [23] addressed concerns that the addition of cocoa to milk (i.e., chocolate milk), which provided additional calories in liquid form, led to less weight gain for the same energy consumed than did milk without the addition of chocolate. Similarly, Science published a paper showing that rats could indeed grow adequately on a diet com- posed only of chocolate milk and gained no less (and no more) weight on such a diet than did control rats fed non-chocolate milk [24]. In 1980, scientists again studying rats wrote, “Rats decrease total caloric intake, sometimes to the point of starvation, when sugar solutions are offered in conjunction with a daily pellet meal. This phenomenon appears to be based on a tendency to behave as if overes- timating the caloric value of simple sugars” [25]. The researchers further showed that this overcom- pensation for sugar-sweetened beverages in rats was relatively impervious to elimination, in other words, the complete opposite of today’s belief that sugar-sweetened beverages are not compensated for. Research today is exploring why simply tasting sugar (even if one does not swallow it) leads to benefi ts in terms of cognitive, social, and athletic performance [26]. Now, let us not be Pollyannaish about sugar. Sugar consumption is not necessary for human life. It does have metabolizable energy, and many in our modern societies could do well with less energy intake. So, most people in most situations are unlikely to experience much if any harm by decreasing their sugar intake. Furthermore, it would be wise that those struggling to control their weight and who consume a great deal of sugar try decreasing their sugar intake (just as it would be wise for them to decrease their intake of any nonessential foods). Sugar consumption may also have deleterious effects on health other than as a source of unneeded calories for many people. Though dental caries is perhaps the most commonly cited ill effect of sugar, speculation abounds that sugar is addicting [27], a gate- way drug to violence [28], a cause of hyperactivity [29], and a cause of diabetes [30]; that sugar reduces fertility, evolutionary fi tness, and life-span [31]; and that sugar promotes cognitive decline [32]. For each of these effects, there is (or at least at one point was) a legitimate basis for speculation. But a basis for speculation is not a basis for conclusion. A s you read the reasoned reviews of evidence compiled in this book, you may wonder why the authors’ conclusions seem so tempered and circumspect compared to more dramatic statements in the literature. There are many factors involved, and these have been discussed elsewhere. In brief, we believe that, perhaps because of the zeal to achieve public health benefi ts and the mentality of war described above, the evidence has been distorted and exaggerated. We delineate some of these distor- tions and exaggerations, cite examples, and quantify evidence elsewhere [10, 11]. In brief, some of the distorting factors include the following: • Investigators describing studies demonstrating associations as having demonstrated causation [11, 33]. • Press releases that markedly distort the evidence in studies [10, 11]. • Statements in abstracts that do not accord with the results in the same papers [11]. • Incorrect citations of past studies in ways that exaggerate their fi ndings [10]. • Publication bias in which studies with supportive results seem more likely to be published than are those with negative results [10]. • Mathematically unverifi able statements in public health media advertisements [11, 34]. • R evision of the primary outcomes of a study when a signifi cant result is not obtained with the origi- nal primary outcome [11]. A s scientists, we can rely on only data and logic as a basis for our conclusions. Doing otherwise vitiates any claims we may have to knowledge as scientists in a way that is distinct from intuition, superstition, tradition, ad hominem arguments, appeals to authority, and other nonscientifi c ways of Foreword ix coming to beliefs. In understanding the effects of sugars and sugar-sweetened beverages on health, the scientifi c community seems to have occasionally lost its compass, but fortunately the trend may be reversing. The current book offers a thoughtful guide to the challenging and complex evidence about sugar’s effects on health. Readers will hopefully bring the combination of open- mindedness and skep- ticism that this discussion, and all scientifi c discussions, is due. And as individual scientists working in this domain, it is paramount to recognize that with academic freedom comes the responsibility to exercise this freedom with integrity when communicating the knowledge we obtain from our results. As has been wisely stated, both the buck and the “spin” must stop with us [35]. St Louis , MO , USA Mark B. Cope Morgantown , WV , USA Mallory Koenings Birmingham , AL , USA David B. Allison References 1. Poincare H. Hypotheses in physics. In: Cattell JM, editor. The foundations of science: science and hypothesis (trans: Halsted GB), vol. 1. Lancaster, PA: The Scientifi c Press; 1946. p. 127–39. 2. NIDA’s role in war on drugs. Science. 1988;242(4875): 15–6. http://www.ncbi.nlm.nih.gov/pubmed/2845574. Accessed September 5, 2013. 3. Gottlieb S. New York’s war on tobacco produces record fall in smoking. BMJ. 2004;328(7450):1222. 4. Marwick C. Intensifying the war against drunken driving by discouraging alcohol consumption in general. JAMA. 1989;261(6):819. 5. Grynbaum MM. Will soda restrictions help New York win the war on obesity? BMJ. 2012;345:e6768. 6. Fincham JE. The expanding public health threat of obesity and overweight. Int J Pharm Pract. 2011;19(3):214–6. 7 . 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