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By Elizabeth Svoboda for Men's Journal
You already know that eating too much sugar causes your teeth to rot and can lead to diabetes and obesity. But could it also trigger high cholesterol, high blood pressure, heart disease and possibly even cancer? That's the theory of a group of progressive medical researchers who argue that sugar acts as a toxin in the body and is responsible for not only our rising rates of diabetes and obesity but also increasing incidences of heart disease, cancer and other chronic illness. Because sugar is so prevalent in food today -- in obvious items like ice cream, cookies and soda, as well as in "healthy" foods like crackers, energy bars and salad dressings -– experts contend that most people are living in toxic overload.
"Sugar is the biggest public health crisis in the history of the world," says Dr. Robert Lustig, an endocrinologist at the University of California, San Francisco, whose 2009 speech "Sugar: The Bitter Truth" has received more than 2.5 million hits on YouTube. In an opinion paper published earlier this year in the journal Nature, Lustig and colleagues provoked debate when they stated that sugar is so harmful, it should be regulated like alcohol and tobacco. "Every substance of abuse -– cocaine, heroin, you name it -– has required personal or social intervention," says Lustig. "For sugar we have nothing, and my prediction is that we will need both."
At first blush, this antisugar advocacy may seem alarmist. But Lustig and his University of California colleagues argue that sugar is harmful in significant amounts –- not necessarily because it's high in calories but rather because it triggers a toxic chain of reactions in the body that produce harmful fats, hormones and other metabolic by-products.
Sugar is found in nearly every food except meat, oil and butter. But there's a big difference between the sugar that occurs naturally in raw, unprocessed foods like fruits, vegetables, milk and whole grains and the type added to prepared or processed foods. Added sugars include every sweetener imaginable: white sugar, brown sugar, corn syrup, high-fructose corn syrup, dextrose, honey, agave nectar. It's these added sugars that experts say are the root cause of our sugar problem because high amounts of them are found in almost every food we eat, most of which are also high in calories and devoid of nutrients. "Nature made sugar hard to get," Lustig and his colleagues wrote in Nature. "Man made it easy."
Among all the different types of sugar, fructose may be the most harmful, many experts believe. Fructose is found naturally in small amounts in fruit, but is also combined with glucose (the other basic sugar molecule) to make nearly every type of commercial sweetener, including table sugar and high-fructose corn syrup. Why is fructose so harmful? "It's unique," says Dr. Miriam Vos, a gastroenterologist at Emory University. "It's primarily metabolized by the liver," so when you eat it, it's processed and then stays in your liver and starts producing harmful blood fats called triglycerides.
Sugars that don't contain fructose, on the other hand, like pure glucose and corn syrup, are processed by the liver and then sent out into the bloodstream, whether you need the fuel or not. Eat enough fructose and build enough triglycerides, and the result can be a fatty liver and insulin resistance -– when the body can't produce enough insulin to break down the sugar you eat.
For years, researchers have known that insulin resistance can lead to weight gain and diabetes. More recently, though, they've also discovered that it can cause heart disease, in part because eating too much sugar suppresses "good" HDL cholesterol. Eating too much sugar of any kind also seems to increase blood pressure, yet the effect is worse when glucose and fructose are consumed together, which is the case with high-fructose corn syrup and white sugar. Some researchers suspect that the effects of sugar on insulin metabolism may even cause cancer or accelerate its growth. "The cancer story is very early," says Lustig. "But we know that sugar drives insulin resistance, and insulin resistance drives cancer." One theory is that the high levels of insulin drive tumor growth, as the hormone already stimulates cancer cells to grow faster in the lab.
Unfortunately, exercise can't entirely save you from the negative effects sugar has on the body. While exercise may improve your cholesterol numbers by a few points, it's usually not enough to bring levels into a healthy range. "If you're a thin, active person, having a diet high in sugar is still harmful," says Vos. If you're an athlete, you may not want to cut out sugar entirely, especially before and during hard workouts. "There's some evidence for the super-athlete that small amounts of fructose are good," says Dr. Richard Johnson, a nephrologist at the University of Colorado, noting that the effect is beneficial only when sugar is consumed in moderate amounts before or after intense activities.
Other experts insist that sugar isn't as much of a threat to anyone -– including those of us who don't exercise intensely –- as Lustig and others have claimed.
Dr. David Katz, director of the Yale Prevention Research Center, says that while too much sugar isn't great for us, Lustig's dismissal of it as "poison" goes too far, pointing out that our bodies manufacture it naturally as an energy source. "The notion that sugar is toxic is silly," says Katz. "You can show dreadful effects of a high dose, but so what?" He's also skeptical of experts who push elimination of sugar to the exclusion of all else. "This is exactly the sort of dietary boondoggle we've been bogged down in for decades. We fell in love with low-fat; we fell in love with low-carb. If we fall in love with low-sugar, we won't improve our overall nutrition. It's a classic missing-the-forest-for-a-single-tree scenario."
Though Katz does agree that most Americans probably eat too much sugar, he doesn't recommend giving up the sweet stuff entirely because that can lead to food bingeing. Instead, he and most nutritionists advise learning to keep your quantities under control. For men, this means limiting yourself to nine teaspoons of added sugar per day and six for women (a can of cola has eight) if you want to meet the American Heart Association's recommendation. To gauge that limit, start scanning the nutrition labels of the packaged products you eat every day for at least one week. Add up your daily intake, keeping in mind that four grams of sugar on a food label is equivalent to one teaspoon of sugar. If you exceed the recommended limit on a regular basis -– and most of us do -– start by substituting lower-sugar options for foods that shouldn't taste sweet, like crackers and salad dressings. Ditch all sugar-sweetened drinks, like soda and even fruit juice, which packs a condensed amount of fructose without the fiber or other healthy nutrients of real fruit. Finally, prioritize eating whole, unpackaged foods, which don't contain added sugars.
參考譯文：
伊麗莎白•斯沃博達發表于《男士期刊》
你已經知道吃過多的糖果會讓你的牙壞掉，還能導致糖尿病和肥胖癥。但是是否也會引發高膽固醇、高血壓、心臟病甚至癌癥呢？這個理論來自一群激進的藥物研究者，他們認為糖分在身體中扮演的角色是毒素，它不僅要對糖尿病和肥胖癥的高發率負責，也增加了心臟病、癌癥和其他慢性疾病的發病率。由于糖分在今天的食物中如此常見——存在于明顯的食物如冰淇淋、曲奇和蘇打水中，也存在于“健康”食物如薄脆餅干、能量棒和沙拉調料中——專家們認為，大多數人都生活在過量的毒素中。
“糖是世界歷史上最大的公共健康危機，”羅伯特•拉斯汀博士，舊金山加利福尼亞大學一位曾在2009年發表演講“糖：苦澀的真相”而在YouTube上獲得250萬點擊量的內分泌學家說。拉斯汀和他的同事今年在《自然》雜志上發布了一篇見解性論文，陳述糖的傷害性，并認為糖應該像酒精和煙草一樣被管理起來，進而引發了爭論。“任何遭到濫用的物質——可卡因，海洛因，你隨便列舉——都需要個人或社會的介入，”拉斯汀說，“而對于糖我們哪方面都沒有介入，我的預測是我們未來會需要個人和社會都介入。”
許多專家認為，在所有類型的糖中間，果糖是最具傷害性的。果糖天然以小劑量存在于水果中，但也與葡萄糖（另一種基礎糖分子）相結合生成幾乎任何類型的商業甜味劑，包括蔗糖和高果糖分的玉米糖漿。為什么果糖如此有害？“它是獨一無二的，”米里亞姆•沃斯，一位來自埃默里大學的胃腸病學家說，“它主要都進入了肝臟進行新陳代謝，所以你吃的時候，它就會進入肝臟等待處理，然后留在你的肝臟中，并開始生成有害的血液脂肪——甘油三酸酯。”
另一方面，不含果糖成分的糖類，比如純葡萄糖和玉米糖漿，在肝臟中經過處理后被送入血液，不管你需不需要這種燃料。吃太多的果糖、生成過多的甘油三酸酯，會導致一個肥胖的肝臟，并對胰島素產生抵抗——身體不再造出足夠的胰島素來化解你吃的糖。
數年來，研究者已經知道胰島素抗體會導致體重增加和糖尿病。而最近，他們還發現這會導致心臟病，部分因為吃太多的糖會抑制“好的”高密度脂蛋白膽固醇。吃任何糖類過多還會導致高血壓，而且如果葡萄糖和果糖一起被消耗，結果會更糟，高果糖分玉米糖漿和白糖就是這樣。一些研究者還懷疑糖在胰島素新陳代謝中的作用有可能會導致癌癥，或者加速癌癥擴散。“癌癥的故事已經很早了，”拉斯汀說，“但是我們知道糖分帶來胰島素抗體，而胰島素抗體催生癌癥。”但有一個理論認為高水平的胰島素會讓腫瘤加速生長，正如在實驗中激素會刺激癌細胞生長更快。
不幸的是，鍛煉并不能將你從糖的副作用中完全拯救出來。它可能能夠提高幾個百分點的膽固醇指數，但通常不足以將數值拉回健康范圍。“就算你是一個很瘦、而且活躍的人，飲食中糖分過多也是有害的。”沃斯說。如果你是一個運動員，你也許不想完全切斷糖分，尤其是在訓練前和訓練中。“有證據表明對一個超級運動員來說少量的果糖是有益的。”理查德•約翰遜，一位科羅拉多大學的腎病學家說。他指出有益的效果只在糖分劑量合適、并在劇烈活動前后才會出現。
其他專家堅持認為糖并不是對任何人——包括那些不劇烈運動的人——都構成像拉斯汀和其他人所宣稱的那樣的威脅。大衛•卡茨博士，耶魯預防研究中心的主任說，雖然過量的糖對我們身體不好，但是拉斯汀對其像“毒”一樣的拒絕也太過偏激，因為我們的身體機能天生就需要能量來源。“認為糖是有毒的觀念太愚蠢了，”卡茨說，“過量的糖會顯示出糟糕的后果，但那又怎樣？”他對那些主張在任何食物中消除糖分的專家也持懷疑態度。“這就是一種毫無意義的飲食問題，而我們居然陷入了數十年的爭論。我們愛上了低脂肪；我們愛上了低碳水化合物。如果再愛上低糖，我們就沒法提高整體的營養了。這是一個典型的只見樹木不見森林劇情。”
雖然卡茨同意美國人可能吃了太多的糖，但他并不推薦完全放棄甜食，因為那有可能導致暴飲暴食。他和多數營養學家建議你對糖保持數量上的控制。如果你想遵從美國心臟協會的建議，對于男人來說這意味著一天限制在9勺額外的糖，對于女人來說是6勺（一瓶可樂有8勺）。要判斷這個量，就注意瀏覽你每天吃的食品的外包裝上的營養標簽，保持一個星期。如果在日常飲食中你已經超過了推薦的量——我們大部分人都超過了——那就開始用糖分低一些的食物來取代吧，比如嘗起來沒那么甜的薄脆餅和色拉調料。拋棄所有過甜的飲料，比如蘇打水甚至果汁，那里頭包含了高濃度的果糖，而且沒有纖維和其他真正水果應有的健康營養。最后，優先吃完整的、非包裝食品，這些食品里不要含額外的糖分。
You already know that eating too much sugar causes your teeth to rot and can lead to diabetes and obesity. But could it also trigger high cholesterol, high blood pressure, heart disease and possibly even cancer? That's the theory of a group of progressive medical researchers who argue that sugar acts as a toxin in the body and is responsible for not only our rising rates of diabetes and obesity but also increasing incidences of heart disease, cancer and other chronic illness. Because sugar is so prevalent in food today -- in obvious items like ice cream, cookies and soda, as well as in "healthy" foods like crackers, energy bars and salad dressings -– experts contend that most people are living in toxic overload.
"Sugar is the biggest public health crisis in the history of the world," says Dr. Robert Lustig, an endocrinologist at the University of California, San Francisco, whose 2009 speech "Sugar: The Bitter Truth" has received more than 2.5 million hits on YouTube. In an opinion paper published earlier this year in the journal Nature, Lustig and colleagues provoked debate when they stated that sugar is so harmful, it should be regulated like alcohol and tobacco. "Every substance of abuse -– cocaine, heroin, you name it -– has required personal or social intervention," says Lustig. "For sugar we have nothing, and my prediction is that we will need both."
At first blush, this antisugar advocacy may seem alarmist. But Lustig and his University of California colleagues argue that sugar is harmful in significant amounts –- not necessarily because it's high in calories but rather because it triggers a toxic chain of reactions in the body that produce harmful fats, hormones and other metabolic by-products.
Sugar is found in nearly every food except meat, oil and butter. But there's a big difference between the sugar that occurs naturally in raw, unprocessed foods like fruits, vegetables, milk and whole grains and the type added to prepared or processed foods. Added sugars include every sweetener imaginable: white sugar, brown sugar, corn syrup, high-fructose corn syrup, dextrose, honey, agave nectar. It's these added sugars that experts say are the root cause of our sugar problem because high amounts of them are found in almost every food we eat, most of which are also high in calories and devoid of nutrients. "Nature made sugar hard to get," Lustig and his colleagues wrote in Nature. "Man made it easy."
Among all the different types of sugar, fructose may be the most harmful, many experts believe. Fructose is found naturally in small amounts in fruit, but is also combined with glucose (the other basic sugar molecule) to make nearly every type of commercial sweetener, including table sugar and high-fructose corn syrup. Why is fructose so harmful? "It's unique," says Dr. Miriam Vos, a gastroenterologist at Emory University. "It's primarily metabolized by the liver," so when you eat it, it's processed and then stays in your liver and starts producing harmful blood fats called triglycerides.
Sugars that don't contain fructose, on the other hand, like pure glucose and corn syrup, are processed by the liver and then sent out into the bloodstream, whether you need the fuel or not. Eat enough fructose and build enough triglycerides, and the result can be a fatty liver and insulin resistance -– when the body can't produce enough insulin to break down the sugar you eat.
For years, researchers have known that insulin resistance can lead to weight gain and diabetes. More recently, though, they've also discovered that it can cause heart disease, in part because eating too much sugar suppresses "good" HDL cholesterol. Eating too much sugar of any kind also seems to increase blood pressure, yet the effect is worse when glucose and fructose are consumed together, which is the case with high-fructose corn syrup and white sugar. Some researchers suspect that the effects of sugar on insulin metabolism may even cause cancer or accelerate its growth. "The cancer story is very early," says Lustig. "But we know that sugar drives insulin resistance, and insulin resistance drives cancer." One theory is that the high levels of insulin drive tumor growth, as the hormone already stimulates cancer cells to grow faster in the lab.
Unfortunately, exercise can't entirely save you from the negative effects sugar has on the body. While exercise may improve your cholesterol numbers by a few points, it's usually not enough to bring levels into a healthy range. "If you're a thin, active person, having a diet high in sugar is still harmful," says Vos. If you're an athlete, you may not want to cut out sugar entirely, especially before and during hard workouts. "There's some evidence for the super-athlete that small amounts of fructose are good," says Dr. Richard Johnson, a nephrologist at the University of Colorado, noting that the effect is beneficial only when sugar is consumed in moderate amounts before or after intense activities.
Other experts insist that sugar isn't as much of a threat to anyone -– including those of us who don't exercise intensely –- as Lustig and others have claimed.
Dr. David Katz, director of the Yale Prevention Research Center, says that while too much sugar isn't great for us, Lustig's dismissal of it as "poison" goes too far, pointing out that our bodies manufacture it naturally as an energy source. "The notion that sugar is toxic is silly," says Katz. "You can show dreadful effects of a high dose, but so what?" He's also skeptical of experts who push elimination of sugar to the exclusion of all else. "This is exactly the sort of dietary boondoggle we've been bogged down in for decades. We fell in love with low-fat; we fell in love with low-carb. If we fall in love with low-sugar, we won't improve our overall nutrition. It's a classic missing-the-forest-for-a-single-tree scenario."
Though Katz does agree that most Americans probably eat too much sugar, he doesn't recommend giving up the sweet stuff entirely because that can lead to food bingeing. Instead, he and most nutritionists advise learning to keep your quantities under control. For men, this means limiting yourself to nine teaspoons of added sugar per day and six for women (a can of cola has eight) if you want to meet the American Heart Association's recommendation. To gauge that limit, start scanning the nutrition labels of the packaged products you eat every day for at least one week. Add up your daily intake, keeping in mind that four grams of sugar on a food label is equivalent to one teaspoon of sugar. If you exceed the recommended limit on a regular basis -– and most of us do -– start by substituting lower-sugar options for foods that shouldn't taste sweet, like crackers and salad dressings. Ditch all sugar-sweetened drinks, like soda and even fruit juice, which packs a condensed amount of fructose without the fiber or other healthy nutrients of real fruit. Finally, prioritize eating whole, unpackaged foods, which don't contain added sugars.
參考譯文：
伊麗莎白•斯沃博達發表于《男士期刊》
你已經知道吃過多的糖果會讓你的牙壞掉，還能導致糖尿病和肥胖癥。但是是否也會引發高膽固醇、高血壓、心臟病甚至癌癥呢？這個理論來自一群激進的藥物研究者，他們認為糖分在身體中扮演的角色是毒素，它不僅要對糖尿病和肥胖癥的高發率負責，也增加了心臟病、癌癥和其他慢性疾病的發病率。由于糖分在今天的食物中如此常見——存在于明顯的食物如冰淇淋、曲奇和蘇打水中，也存在于“健康”食物如薄脆餅干、能量棒和沙拉調料中——專家們認為，大多數人都生活在過量的毒素中。
“糖是世界歷史上最大的公共健康危機，”羅伯特•拉斯汀博士，舊金山加利福尼亞大學一位曾在2009年發表演講“糖：苦澀的真相”而在YouTube上獲得250萬點擊量的內分泌學家說。拉斯汀和他的同事今年在《自然》雜志上發布了一篇見解性論文，陳述糖的傷害性，并認為糖應該像酒精和煙草一樣被管理起來，進而引發了爭論。“任何遭到濫用的物質——可卡因，海洛因，你隨便列舉——都需要個人或社會的介入，”拉斯汀說，“而對于糖我們哪方面都沒有介入，我的預測是我們未來會需要個人和社會都介入。”
許多專家認為，在所有類型的糖中間，果糖是最具傷害性的。果糖天然以小劑量存在于水果中，但也與葡萄糖（另一種基礎糖分子）相結合生成幾乎任何類型的商業甜味劑，包括蔗糖和高果糖分的玉米糖漿。為什么果糖如此有害？“它是獨一無二的，”米里亞姆•沃斯，一位來自埃默里大學的胃腸病學家說，“它主要都進入了肝臟進行新陳代謝，所以你吃的時候，它就會進入肝臟等待處理，然后留在你的肝臟中，并開始生成有害的血液脂肪——甘油三酸酯。”
另一方面，不含果糖成分的糖類，比如純葡萄糖和玉米糖漿，在肝臟中經過處理后被送入血液，不管你需不需要這種燃料。吃太多的果糖、生成過多的甘油三酸酯，會導致一個肥胖的肝臟，并對胰島素產生抵抗——身體不再造出足夠的胰島素來化解你吃的糖。
數年來，研究者已經知道胰島素抗體會導致體重增加和糖尿病。而最近，他們還發現這會導致心臟病，部分因為吃太多的糖會抑制“好的”高密度脂蛋白膽固醇。吃任何糖類過多還會導致高血壓，而且如果葡萄糖和果糖一起被消耗，結果會更糟，高果糖分玉米糖漿和白糖就是這樣。一些研究者還懷疑糖在胰島素新陳代謝中的作用有可能會導致癌癥，或者加速癌癥擴散。“癌癥的故事已經很早了，”拉斯汀說，“但是我們知道糖分帶來胰島素抗體，而胰島素抗體催生癌癥。”但有一個理論認為高水平的胰島素會讓腫瘤加速生長，正如在實驗中激素會刺激癌細胞生長更快。
不幸的是，鍛煉并不能將你從糖的副作用中完全拯救出來。它可能能夠提高幾個百分點的膽固醇指數，但通常不足以將數值拉回健康范圍。“就算你是一個很瘦、而且活躍的人，飲食中糖分過多也是有害的。”沃斯說。如果你是一個運動員，你也許不想完全切斷糖分，尤其是在訓練前和訓練中。“有證據表明對一個超級運動員來說少量的果糖是有益的。”理查德•約翰遜，一位科羅拉多大學的腎病學家說。他指出有益的效果只在糖分劑量合適、并在劇烈活動前后才會出現。
其他專家堅持認為糖并不是對任何人——包括那些不劇烈運動的人——都構成像拉斯汀和其他人所宣稱的那樣的威脅。大衛•卡茨博士，耶魯預防研究中心的主任說，雖然過量的糖對我們身體不好，但是拉斯汀對其像“毒”一樣的拒絕也太過偏激，因為我們的身體機能天生就需要能量來源。“認為糖是有毒的觀念太愚蠢了，”卡茨說，“過量的糖會顯示出糟糕的后果，但那又怎樣？”他對那些主張在任何食物中消除糖分的專家也持懷疑態度。“這就是一種毫無意義的飲食問題，而我們居然陷入了數十年的爭論。我們愛上了低脂肪；我們愛上了低碳水化合物。如果再愛上低糖，我們就沒法提高整體的營養了。這是一個典型的只見樹木不見森林劇情。”
雖然卡茨同意美國人可能吃了太多的糖，但他并不推薦完全放棄甜食，因為那有可能導致暴飲暴食。他和多數營養學家建議你對糖保持數量上的控制。如果你想遵從美國心臟協會的建議，對于男人來說這意味著一天限制在9勺額外的糖，對于女人來說是6勺（一瓶可樂有8勺）。要判斷這個量，就注意瀏覽你每天吃的食品的外包裝上的營養標簽，保持一個星期。如果在日常飲食中你已經超過了推薦的量——我們大部分人都超過了——那就開始用糖分低一些的食物來取代吧，比如嘗起來沒那么甜的薄脆餅和色拉調料。拋棄所有過甜的飲料，比如蘇打水甚至果汁，那里頭包含了高濃度的果糖，而且沒有纖維和其他真正水果應有的健康營養。最后，優先吃完整的、非包裝食品，這些食品里不要含額外的糖分。
