Editing Sugar (section)

== Health effects ==

=== General ===

High sugar consumption damages human health more than it provides nutritional benefit, and in particular is associated with a risk of cardiometabolic health detriments.<ref name=huang>{{cite journal |vauthors=Huang Y, Chen Z, Chen B, Li J, Yuan X, Li J, Wang W, Dai T, Chen H, Wang Y, Wang R, Wang P, Guo J, Dong Q, Liu C, Wei Q, Cao D, Liu L |title=Dietary sugar consumption and health: umbrella review |journal=BMJ |volume=381 |issue= |pages=e071609 |date=April 2023 |pmid=37019448 |pmc=10074550 |doi=10.1136/bmj-2022-071609 |display-authors=5}}</ref>

=== Sugar industry funding and health information ===

{{main|Sugar marketing#Influence on health information and guidelines}}

Sugar refiners and manufacturers of sugary foods and drinks have sought to influence medical research and [[public health]] recommendations,<ref name=conflict_2017/><ref name=sweet_policies/> with substantial and largely clandestine spending documented from the 1960s to 2016.<ref name="jama2016"/><ref name=Kearns_caries/><ref name=selling_souls/><ref name=sponsorship/> The results of research on the health effects of sugary food and drink differ significantly, depending on whether the researcher has financial ties to the food and drink industry.<ref name=Schillinger_bias/><ref name=financial_Bes-Rasttrollo/><ref name=NYT_linked/> A 2013 medical review concluded that "unhealthy commodity industries should have no role in the formation of national or international NCD <nowiki>[</nowiki>[[non-communicable disease]]<nowiki>]</nowiki> policy".<ref name=profits_pandemics/> Similar efforts to steer coverage of sugar-related health information have been made in popular media, including news media and social media.<ref name=NYT_cocacola/><ref name=NYT_sweettalk/><ref name=time_soda/>

=== Obesity and metabolic syndrome ===

{{main|Diet and obesity#Sugar consumption}}

A 2003 technical report by the [[World Health Organization]] (WHO) provides evidence that high intake of sugary drinks (including [[fruit juice]]) increases the risk of [[obesity]] by adding to overall [[energy intake]].<ref name="WHO2003">{{cite web |url=http://apps.who.int/iris/bitstream/10665/42665/1/WHO_TRS_916.pdf?ua=1 |author=Joint WHO/FAO Expert Consultation |year=2003 |title=WHO Technical Report Series 916: Diet, Nutrition and the Prevention of Chronic Diseases |access-date=25 December 2013 |archive-date=25 June 2016 |archive-url=https://web.archive.org/web/20160625203948/http://apps.who.int/iris/bitstream/10665/42665/1/WHO_TRS_916.pdf?ua=1 |url-status=live }}</ref> By itself, sugar is doubtfully a factor causing obesity and [[metabolic syndrome]].<!--<ref name=WHO2003/>--><ref>{{cite journal |last=Stanhope |first=Kimber L. |title=Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome |journal=Annual Review of Medicine |volume=63 |issue=1 |year=2012 |pages=329–343 |doi=10.1146/annurev-med-042010-113026 |pmid=22034869 |quote=There is controversy concerning the role of sugar in the epidemics of obesity and metabolic syndrome.   |url=https://drive.google.com/file/d/1nIaViaOE9Noq8g4PwZr649w-1qi_cVKR/view}}</ref> [[Meta-analysis]] showed that excessive consumption of sugar-sweetened beverages increased the risk of developing [[Diabetes mellitus type 2|type 2 diabetes]] and metabolic syndrome – including weight gain<ref>{{Cite journal|last1=Hill|first1=J. O. |last2=Prentice |first2=A. M. |date=1995-07-01 |title=Sugar and body weight regulation|journal=The American Journal of Clinical Nutrition |volume=62 |issue=1 |pages=264S–273S |doi=10.1093/ajcn/62.1.264S |pmid=7598083 |doi-access=free}}</ref> and obesity – in adults and children.<ref>{{cite journal |title=Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes: A meta-analysis |doi=10.2337/dc10-1079 |year=2010 |last1=Malik |first1=V. S. |last2=Popkin |first2=B. M. |last3=Bray |first3=G. A. |last4=Despres |first4=J.-P. |last5=Willett |first5=W. C. |last6=Hu |first6=F. B. |journal=Diabetes Care |volume=33 |issue=11 |pages=2477–83 |pmid=20693348 |pmc=2963518}}</ref><ref>{{Cite journal |last1=Malik |first1=Vasanti S. |last2=Pan |first2=An |last3=Willett |first3=Walter C. |last4=Hu |first4=Frank B. |date=1 October 2013 |title=Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis |journal=The American Journal of Clinical Nutrition |language=en |volume=98 |issue=4 |pages=1084–1102 |doi=10.3945/ajcn.113.058362 |issn=0002-9165 |pmc=3778861 |pmid=23966427}}</ref>

=== Cancer ===

Sugar consumption does not directly cause cancer.<ref name="Australia">{{Cite web|date=2021|title=Does sugar cause cancer?|url=https://www.cancer.org.au/iheard/does-sugar-cause-cancer|website=Cancer Council Australia|language=en-GB|archive-date=28 March 2024|archive-url=https://web.archive.org/web/20240328003849/https://www.cancer.org.au/iheard/does-sugar-cause-cancer|url-status=live}}</ref><ref>{{Cite web|date=2021|title=Does Sugar Cause Cancer?|url=https://www.cancer.net/blog/2021-11/does-sugar-cause-cancer|website=American Society of Clinical Oncology|language=en-GB|archive-date=1 October 2023|archive-url=https://web.archive.org/web/20231001021316/https://www.cancer.net/blog/2021-11/does-sugar-cause-cancer}}</ref><ref name="CRUK">{{Cite web|date=2023|title=Sugar and cancer – what you need to know|url=https://news.cancerresearchuk.org/2023/08/16/sugar-and-cancer-what-you-need-to-know/|website=Cancer Research UK|language=en-GB|archive-date=6 January 2024|archive-url=https://web.archive.org/web/20240106023109/https://news.cancerresearchuk.org/2023/08/16/sugar-and-cancer-what-you-need-to-know/|url-status=live}}</ref> [[Cancer Council Australia]] have stated that "there is no evidence that consuming sugar makes cancer cells grow faster or cause cancer".<ref name="Australia"/> There is an indirect relationship between sugar consumption and obesity-related cancers through increased risk of excess body weight.<ref name="CRUK"/><ref name="Australia"/><ref>{{Cite web|date=2016|title=The Sugar and Cancer Connection|url=https://www.aicr.org/news/the-sugar-cancer-connection/|website=American Institute for Cancer Research|language=en-GB|archive-date=20 January 2024|archive-url=https://web.archive.org/web/20240120123107/https://www.aicr.org/news/the-sugar-cancer-connection/|url-status=live}}</ref>

The [[American Institute for Cancer Research]] and [[World Cancer Research Fund]] recommend that people limit sugar consumption.<ref>{{Cite web|date=2015|title=Curbing global sugar consumption|url=https://www.wcrf.org/wp-content/uploads/2021/07/Curbing-global-sugar-consumption.pdf|website=World Cancer Research Fund International|language=en-GB|archive-date=29 March 2024|archive-url=https://web.archive.org/web/20240329020750/https://www.wcrf.org/wp-content/uploads/2021/07/Curbing-global-sugar-consumption.pdf|url-status=live}}</ref><ref>{{cite journal|vauthors= Clinton SK, Giovannucci EL, Hursting SD|year=2020|title=The World Cancer Research Fund/American Institute for Cancer Research Third Expert Report on Diet, Nutrition, Physical Activity, and Cancer: Impact and Future Directions|journal=The Journal of Nutrition|volume=150|issue=4|pages=663–671|doi=10.1093/jn/nxz268|pmid=31758189|pmc=7317613}}</ref>

There is a popular misconception that cancer can be treated by reducing sugar and carbohydrate intake to supposedly "starve" tumours. In reality, the health of people with cancer is best served by maintaining a [[healthy diet]].<ref name=mis>{{cite journal |vauthors=Grimes DR, O'Riordan E |title=Starving cancer and other dangerous dietary misconceptions |journal=Lancet Oncol |volume=24 |issue=11 |pages=1177–1178 |date=November 2023 |pmid=37922928 |doi=10.1016/S1470-2045(23)00483-7 |url=}}</ref>

=== Cognition ===

Despite some studies suggesting that sugar consumption causes hyperactivity, the quality of evidence is low<ref>{{Cite journal |last1=Del-Ponte |first1=Bianca |last2=Quinte |first2=Gabriela Callo |last3=Cruz |first3=Suélen |last4=Grellert |first4=Merlen |last5=Santos |first5=Iná S. |date=2019 |title=Dietary patterns and attention deficit/hyperactivity disorder (ADHD): A systematic review and meta-analysis |url=https://linkinghub.elsevier.com/retrieve/pii/S0165032718329720 |journal=Journal of Affective Disorders |language=en |volume=252 |pages=160–173 |doi=10.1016/j.jad.2019.04.061|pmid=30986731 |hdl=10923/18896 |hdl-access=free }}</ref> and it is generally accepted within the scientific community that the notion of children's 'sugar rush' is a myth.<ref>{{Cite journal |last1=Mantantzis |first1=Konstantinos |last2=Schlaghecken |first2=Friederike |last3=Sünram-Lea |first3=Sandra I. |last4=Maylor |first4=Elizabeth A. |date=2019-06-01 |title=Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood |url=https://www.sciencedirect.com/science/article/pii/S0149763418309175 |journal=Neuroscience & Biobehavioral Reviews |volume=101 |pages=45–67 |doi=10.1016/j.neubiorev.2019.03.016 |pmid=30951762 |issn=0149-7634}}</ref><ref>{{Cite journal |last=Wolraich |first=Mark L. |date=1995-11-22 |title=The Effect of Sugar on Behavior or Cognition in Children: A Meta-analysis |url=http://jama.jamanetwork.com/article.aspx?doi=10.1001/jama.1995.03530200053037 |journal=JAMA |language=en |volume=274 |issue=20 |pages=1617–1621 |doi=10.1001/jama.1995.03530200053037 |pmid=7474248 |issn=0098-7484}}</ref> A 2019 [[meta-analysis]] found that sugar consumption does not improve [[mood (psychology)|mood]], but can lower alertness and increase fatigue within an hour of consumption.<ref>{{Cite journal|last1=Mantantzis|first1=Konstantinos|last2=Schlaghecken|first2=Friederike|last3=Sünram-Lea|first3=Sandra I.|last4=Maylor|first4=Elizabeth A.|date=1 June 2019|title=Sugar rush or sugar crash? A meta-analysis of carbohydrate effects on mood|journal=Neuroscience and Biobehavioral Reviews|language=en|volume=101|pages=45–67|doi=10.1016/j.neubiorev.2019.03.016|pmid=30951762|s2cid=92575160|url=http://wrap.warwick.ac.uk/115618/1/WRAP-Sugar-rush-crash-meta-analysis-carbohydrate-effects-mood-Maylor-2019.pdf|access-date=30 April 2020|archive-date=6 May 2020|archive-url=https://web.archive.org/web/20200506043832/http://wrap.warwick.ac.uk/115618/1/WRAP-Sugar-rush-crash-meta-analysis-carbohydrate-effects-mood-Maylor-2019.pdf|url-status=live}}</ref> One review of low-quality studies of children consuming high amounts of [[energy drink]]s showed association with higher rates of unhealthy behaviors, including smoking and excessive alcohol use, and with hyperactivity and [[insomnia]], although such effects could not be specifically attributed to sugar over other components of those drinks such as [[caffeine]].<ref>{{cite journal | last1=Visram | first1=Shelina | last2=Cheetham | first2=Mandy | last3=Riby | first3=Deborah M | last4=Crossley | first4=Stephen J | last5=Lake | first5=Amelia A | title=Consumption of energy drinks by children and young people: a rapid review examining evidence of physical effects and consumer attitudes | journal=BMJ Open | volume=6 | issue=10 | pages=e010380 | date=1 October 2016 | issn=2044-6055 | pmid=27855083 | pmc=5073652 | doi=10.1136/bmjopen-2015-010380 | url=}}</ref>

=== Tooth decay ===

The WHO, [[Action on Sugar]] and the Scientific Advisory Committee on Nutrition (SACN) consider free sugars an essential dietary factor in the development of dental caries.<ref name="WHO 2017">{{Cite web|date=2017|title=Sugars and dental caries|url=https://www.who.int/news-room/fact-sheets/detail/sugars-and-dental-caries|website=World Health Organization|language=en-GB|archive-date=11 August 2024|archive-url=https://web.archive.org/web/20240811044111/https://www.who.int/news-room/fact-sheets/detail/sugars-and-dental-caries|url-status=live}}</ref><ref>{{Cite web|date=2019|title=Sugars and tooth decay|url=https://www.actiononsugar.org/sugar-and-health/sugars-and-tooth-decay/|website=Action on Sugar|language=en-GB|archive-date=24 July 2024|archive-url=https://web.archive.org/web/20240724031923/https://www.actiononsugar.org/sugar-and-health/sugars-and-tooth-decay/|url-status=live}}</ref><ref>{{Cite web|date=2015|title=SACN Carbohydrates and Health Report|url=https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report|website=Public Health England|language=en-GB|archive-date=21 August 2024|archive-url=https://web.archive.org/web/20240821161928/https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report|url-status=live}}</ref> WHO have stated that "dental caries can be prevented by avoiding dietary free sugars".<ref name="WHO 2017"/>

A review of human studies showed that the incidence of caries is lower when sugar intake is less than 10% of total energy consumed.<ref>{{cite journal|pmc=3872848|year=2014|last1=Moynihan|first1=P. J|title=Effect on Caries of Restricting Sugars Intake: Systematic Review to Inform WHO Guidelines|journal=Journal of Dental Research|volume=93|issue=1|pages=8–18|last2=Kelly|first2=S. A|pmid=24323509|doi=10.1177/0022034513508954}}</ref> [[Sugar-sweetened beverage]] consumption is associated with an increased risk of tooth decay.<ref>{{cite journal|vauthors=Valenzuela MJ, Waterhouse B, Aggarwal VR, Bloor K, Doran T|year=2021|title=Effect of sugar-sweetened beverages on oral health: a systematic review and meta-analysis|journal=Eur J Public Health|url=|volume=31|issue=1|pages=122–129|doi=10.1093/eurpub/ckaa147|pmid=32830237}}</ref>

=== Nutritional displacement ===

The "[[empty calories]]" argument states that a diet high in [[Added sugar|added]] (or 'free') sugars will reduce consumption of foods that contain [[essential nutrient]]s.<ref>{{cite journal |vauthors=Marriott BP, Olsho L, Hadden L, Connor P |title=Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003–2006 |journal=Crit Rev Food Sci Nutr |volume=50 |issue=3 |pages=228–58 |year=2010 |pmid=20301013 |doi=10.1080/10408391003626223 |s2cid=205689533 }}</ref> This nutrient displacement occurs if sugar makes up more than 25% of daily energy intake,<ref name="dietary_reference">{{cite book |title=Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids |author1=Panel on Macronutrients |author2=Panel on the Definition of Dietary Fiber |author3=Subcommittee on Upper Reference Levels of Nutrients |author4=Subcommittee on Interpretation and Uses of Dietary Reference Intakes |author5=the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes |author6=Food and Nutrition Board |author7=[[Institute of Medicine]] of the [[National Academies of Sciences, Engineering and Medicine]]  |author8-link=National Research Council (United States) |author8=National Research Council |date=2005 |publisher=National Academies Press |location=Washington, DC |isbn=978-0-309-08525-0 |url=https://archive.org/details/isbn_9780309085250 |access-date=4 December 2018 |quote=Although there were insufficient data to set a UL [Tolerable Upper Intake Levels] for added sugars, a maximal intake level of 25 percent or less of energy is suggested to prevent the displacement of foods that are major sources of essential micronutrients }}</ref> a proportion associated with poor diet quality and risk of obesity.<ref name="2015_WHO_guidelines">{{cite report |title=Guideline. Sugars intake for adults and children. |author=World Health Organization |date=2015 |publisher=WHO Press |location=Geneva |isbn=978-92-4-154902-8 |url=http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf}}</ref> Displacement may occur at lower levels of consumption.<ref name="dietary_reference"/>

=== Recommended dietary intake ===

The WHO recommends that both adults and children reduce the intake of free sugars to less than 10% of total energy intake, and suggests a reduction to below 5%. "Free sugars" include monosaccharides and disaccharides added to foods, and sugars found in fruit juice and concentrates, as well as in honey and syrups. According to the WHO, "[t]hese recommendations were based on the totality of available evidence reviewed regarding the relationship between free sugars intake and body weight (low and moderate quality evidence) and dental caries (very low and moderate quality evidence)."<ref name="WHO 2015p4">{{cite web |title=Guideline: Sugar intake for adults and children |date=2015 |page=4 |url=http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf |publisher=World Health Organization |location=Geneva|archive-url=https://web.archive.org/web/20180704002426/http://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf|archive-date=4 July 2018|url-status=live}}</ref>

On 20 May 2016, the U.S. [[Food and Drug Administration]] announced changes to the Nutrition Facts panel displayed on all foods, to be effective by July 2018. New to the panel is a requirement to list "added sugars" by weight and as a percent of Daily Value (DV). For vitamins and minerals, the intent of DVs is to indicate how much should be consumed. For added sugars, the guidance is that 100% DV should not be exceeded. 100% DV is defined as 50 grams. For a person consuming 2000 calories a day, 50 grams is equal to 200 calories and thus 10% of total calories—the same guidance as the WHO.<ref>{{Cite web|url=https://www.fda.gov/food/guidanceregulation/guidancedocumentsregulatoryinformation/labelingnutrition/ucm385663.htm|title=Labeling & Nutrition – Changes to the Nutrition Facts Label|first=Center for Food Safety and Applied|last=Nutrition|website=www.fda.gov|date=22 February 2021|access-date=10 March 2017|archive-date=1 November 2014|archive-url=https://web.archive.org/web/20141101031958/https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm|url-status=live}}</ref> To put this in context, most {{convert|12|USfloz||0|adj=on}} cans of soda contain 39 grams of sugar. In the United States, a government survey on food consumption in 2013–2014 reported that, for men and women aged 20 and older, the average total sugar intakes—naturally occurring in foods and added—were, respectively, 125 and 99 g/day.<ref>[https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1314/Table_1_NIN_GEN_13.pdf What We Eat In America, NHANES 2013–2014] {{Webarchive|url=https://web.archive.org/web/20170224042515/https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/1314/Table_1_NIN_GEN_13.pdf |date=24 February 2017 }}.</ref>