Do You Have a Sugar Belly? UCSF’s SugarScience Educates the Public on the Truth behind Added Sugar

Columnist
Graduate Division

SugarScience is a website developed by UCSF to act as an authoritative source for the scientific evidence about the effects of sugar on health and disease. It aims to educate the public and provide resources for medical professionals. It was launched in November 2014. Laura Schmidt, principal investigator of the project, is Professor of Health Policy in the UCSF School of Medicine. She spoke about the project’s launch and early success with Synapse on Dec. 19.

Synapse: How did the SugarScience project begin?

LS: SugarScience grew out of the UCSF Clinical & Translational Science Institute (CTSI) and work that I had been doing with colleagues at the Institute of Health Policy Studies. Over the last few decades, and even more recently in the last ten years, scientists have really been thinking about sugar and health in a different way. It used to be that you’d hear the phrase “a calorie is a calorie,” and the focus was reducing over-consumption of “empty calories.” More and more, the paradigm has shifted away from looking at just obesity as the outcome, and instead looking at chronic disease and the mechanisms having to do with metabolic dysfunction, inflammation, and how sugar affects the underlying systems for metabolizing all foods.

The problem is that a lot of information is locked up in medical journals and out of the public awareness. And yet, this is a product that is consumed in very large quantities and is extremely abundant in the American diet. We were approached by the Laura and John Arnold Foundation, a philanthropic foundation who was interested in the science of sugar and health and figuring out a way to translate and convey that information to the public.

Synapse: What studies did the project compile?

LS: We wanted to create a toolkit of informational materials that are science-based but also accessible to the lay public. We got two librarians from the campus library to do very comprehensive literature searches to help us find the best studies… The library weeded through all relevant publications, removing those with conflicts of interest, and made a carefully-curated set of studies.

We wound up with 8,000 papers, and a subset of about 3,000 that were in the higher impact journals and right on target. We sorted these into different categories, looking through all the evidence for predominant things that rose to the surface… The three major disease outcomes that we uncovered and thought were areas that the public really needs to know about, because they are public health problems that people don’t fully understand: diabetes, heart disease and liver disease.

Areas of emerging research also came up in our review. There are some pretty compelling findings, and we should track them, but they’re not at a point where it’s all figured out. These areas are: cognitive decline (dementia, Alzheimer’s disease), addiction and cancer. We really want to keep people informed about work that is being done.

Synapse: How does the SugarScience website present all these findings?

LS: It’s not simple. How sugar leads to diabetes is really different from how sugar is implicated in liver disease. It’s actually different sugars, so we have to explain the differences between fructose and glucose. The content is not simple.

SugarScience started out as a static toolkit. We have a very coherent set of messages. We picked areas that are very defensible and scientifically accurate. We use observational studies and clinical trials with robust evidence that all point in the same direction. The components of our diets impact disease outcomes and our risk of dying of particular chronic diseases. Metabolic syndrome underlies most forms of chronic disease. People need to consider whether they might have it.

We all love sugar. It’s really a bummer to have doctors or parents or anyone telling you not to eat this stuff. It’s not a popular or fun message to convey to people. It’s really easy to turn people off. At the very get-go, you’re not going to get very far if you don’t have very smart, very knowledgeable communications people who are helping you think through how to convey that information to people in a way that will get them interested and not close their minds.

Scare tactics work for smoking, but for something as popular and seemingly benign as sugar – it’s in your grandmother’s cookies – you have to think very carefully about how you’re going to present that information in a way that engages people… How do we, in a compelling way, using metaphors and pictures, make people understand?

We need to get terms like “metabolic syndrome” into the vocabulary of average people. There’s one thing that you can see when you look at a person who might have metabolic syndrome, and that is visceral fat. Our communications people came up with a great metaphor: the “Sugar Belly.” It’s fun and non-threatening and gets in your head like the “beer belly.” Everybody knows what a beer belly looks like. The same metabolic process that produces the beer belly, de novo lipogenesis, occurs when fructose is metabolized in the liver. We put this idea in someone’s head and give them a call to action: you might have a sugar belly, so get a blood test! That’s good messaging. That’s the spirit behind all of this.

Synapse: Does SugarScience want to shape policies?

LS: With the issue of sugar in health, there is a lot of political polarization, and science gets caught up in the middle. Scientific evidence often becomes manipulated; there’s a lot of confusion and misinformation. We’re trying to rise above all that and say, look, here’s what we know. We’ll explain to you how it works. If we don’t know about it, we’ll tell you. You can trust us.

We’re not anti-sugar. We don’t want to take your sugar away from you… Reporters and the public ask us: What’s your agenda? Our agenda is to tell you the truth! As a medical center, we can speak about research with authority and without any agenda other than helping people – because that’s what we do.

The problem is that our population is ill-informed on this issue – not about the politics, but about the actual problem itself – why is sugar harmful to your health? Until people understand that we have a problem, how can they formulate opinions on what particular solutions to that problem they would support?... As a citizen, I might want to advocate for a particular thing that I believe in. As a scientist, I inform voters so that they can make their own choices.

Even very well-educated, regular readers of the press, are shocked to hear that 30% of Americans have non-alcoholic liver disease, and that the only risk factor other than trans-fat and obesity is fructose consumption! We’re a public university and have a commitment and responsibility to share what we know with the people who fund us: tax payers.

We may get to a point where we feel that we’ve helped the public awareness and knowledge about why sugar is harmful to health (and in what quantities). Then we can start talking to people about behavior change. For now, we don’t believe that we’re at that place.

Synapse: What has been the public’s response so far?

LS: We’ve been launched for a month, and in that time we’ve had over six million Twitter encounters and 62,000 website page views. A feature of our website is Ask the SugarScientists. We originally thought we would get 25 questions from the public between our launch and April. In our first month, we’ve gotten 630!

People ask really good questions: how do I know if I’m consuming added sugar as opposed to total sugar? How do I get this information from nutrition labels? What are the differences between consuming honey and table sugar? Why is liver the main organ that processes fructose? These are sophisticated questions. We’ve had to do additional PubMed searches. Sometimes the answer is: we don’t know!

There has been an enormous outpouring of volunteer support. People from the UCSF Medical Center have volunteered their time to help answer questions. The San Francisco Brigade of Code for America called us – they’re an organization of volunteers in the tech industry, and said they were looking for a good cause and picked us – we’ve partnered with them to develop new functionalities for our website, such as an interactive map that would allow people to identify sugar consumption and diabetes rates in their communities.

One of the main audiences for using our resource materials are clinicians. People in the medical profession see high rates of obesity, metabolic disease and diabetes. Their patients deal with complications. It’s a hard thing to see. This is something that health professionals can do: download our little pocket card, give it to a patient, and tell them to think about it. It’s like a health information campaign in a box.

The SugarScience website is: SugarScience.org