Canada’s Food and Drugs Act, RSC 1985, c F-27 (“FDA”) says “food includes any article manufactured, sold or represented for use as food or drink for human beings, chewing gum, and any ingredient that may be mixed with food for any purpose whatever,” though no one may sell “food that has in it any… harmful substance”(emphasis added).

Dr. Robert Lustig, who is probably the world’s best known anti-sugar advocate, says in his article “Fructose: it’s ‘alcohol without the buzz’” that there are two types of sugar: glucose, which isn’t particularly sweet and fructose, which is.¹ Lustig says that the dietary fibre that accompanies natural (non-additive) fructose (in an apple, for example) renders the fructose more-or-less safe, but he opposes additive fructose through table sugar (which is a combination of glucose and fructose) and other high-fructose additives, saying that they have detrimental, even devastating, health consequences.

The following discussion concerns whether fructose is a harmful substance whose addition to foods ought to be regulated. By implication, it also concerns a broad set of societal issues, which concern the tension between regulation and freedom. More particularly, where should the line be drawn between things like alcohol and soda pop, tobacco and cocaine, methamphetamine and marijuana? Why? What do the choices we make (or fail to make) say about us as a society? Are there matters of human nature which cannot be reliably overcome through willpower and common sense, such that regulation is the correct mechanism by which to improve the lives of all citizens? Did the FDA, in fact, correctly codify the values we want to have, and if it did, should consumer goods containing added fructose be considered a food at all?

Dr. Lustig says that there are four generally accepted criteria for regulation of a substance as a drug: ubiquity, toxicity, abuse, and [negative] externalities. It’s hard to find these four criteria mentioned in a publication not somehow associated with Lustig’s name, though apparently they originated in a 2003 book discussing the regulation of alcohol.² Nonetheless, these criteria appear sensible, and so form the basis of our discussion of the need (or lack thereof) for the regulation of fructose.

Ubiquity

Candy, chocolate milk and soda pop are all foods you might expect to have a high amount of fructose. Fructose, however, is also often present in many foods that aren’t generally considered sweet, including peanut butter, bread, barbecue sauce, yogurt, ketchup and spaghetti sauce. As well, there are 152 different ways to say “sugar” on a nutrition label.³ As a result, fructose is ubiquitous, and it is hard to get away from added fructose even if you’re careful. As is discussed later, fructose may also be addictive, which would make its unexpected presence nothing short of insidious.

Toxicity

A strict textual interpretation of the FDA would not allow the sale of anything containing a “harmful substance” as food – this is clearly overbroad, as many food items could contain at least somewhat harmful substances. The important question for our purposes, though, is whether fructose is toxic enough to the average person that it ought to be regulated.

Fructose, as a source of calories with no nutritional benefit, is thought to have strongly contributed to the obesity epidemic. Dr. Lustig argues that fructose consumption creates liver fat, insulin resistance and metabolic disease, including type-2 diabetes, heart disease and fatty liver disease. He further argues that links are emerging between excess fructose consumption and cancer and dementia.

Dr. Richard Kahn, formerly of the American Diabetes Association, agrees with Lustig that obesity and diabetes are serious and epidemic conditions. Conditions which, incidentally, are now prevalent in Europe and Asia in addition to North America. Kahn also agrees the we don’t have to rely on sugar to get sufficient food energy; that sugar itself does not come along with any other essential nutrients, vitamins or minerals; and that the first step to losing weight is to cut out dietary sugar. However, Dr. Kahn believes that the studies which link fructose to negative health effects and diabetes are not as robust as other studies in the biological sciences, and concludes that there is an insufficient link between fructose and negative health impacts to determine that it should be regulated.

While there may not be a definitive link between excess fructose consumption and negative health impacts, experts agree that fructose is at best unnecessary, and at worst deadly. 

Negative externalities

The easiest way to explain negative externalities is to say they are negative effects, not paid for by the person creating them. Do you dump toxic waste without a permit? That probably creates negative externalities. Do you dump toxic waste and pay for a permit to do so? Not an externality.

In terms of substance-related issues: drunk driving and smoking create what are, in present day, obvious negative externalities. The argument that fructose creates negative externalities in society thus rests on the impact of one person’s disease on all other members of that society.

Health care is the largest budget item for every province, and Canadians spent $228.1 billion ($6,299 per person) on health care in 2016.⁴ This is up from $5,911 in 2012.⁵ Canada spends roughly $33.7 billion annually on treating obesity, diabetes, heart disease and related illnesses,⁶ and the proportion of obese Canadians is expected to rise by another 5% by 2030.⁷ Meanwhile, Canadians between one and 65 years old are taking a greater proportion of health care expenditures.⁸ In addition to health care costs, there are other costs associated with sick citizens, including lost productivity due to absenteeism and a more backed-up healthcare system (which in turn creates more healthcare issues).

Abuse

The Diagnostic and Statistical Manual of Mental Disorders (“DSM”) says that a person is addicted to a substance if they exhibit a maladaptive combination of the following indicators: impaired control, social impairment, risky use, and pharmacological indicators like tolerance and withdrawal.

Dr. Nicole Avena, from the Mount Sinai School of Medicine in New York, has found evidence for sugar addiction, including bingeing, withdrawal, craving, and physiological changes in the brain.⁹ Similar findings have been made by other researchers, and the strength of the addictive effect of sugar has been said to be equal to, or stronger, than that of cocaine.¹⁰ | ¹¹ | ¹² | ¹³

Conclusion

The next time you’re in a grocery store, consider comparing the price of sugary foods to non-sugary foods. Consider their cost of production and the nutritional value they provide; think about whether sugary foods might be marked-up because they are addictive; think about the effects that might have on society; and consider whether regulation, or freedom to choose, is a more important value. Incidentally, Canada is changing its labelling requirements to make the contents of food less opaque.¹⁴

Those changes, which may make it easier to avoid unnecessary fructose, won’t be fully required until 2021. 

---

1. ncbi.nlm.nih.gov | ↩
2. Babor T, Caetano R, Casswell S, Edwards G, Geisbrecht N, Graham Ketal. Alcohol: No ordinary commodity — Research and public policy. Oxford: Oxford University Press; 2003. | ↩
3. CBC.ca | ↩
4. Fraser Institute | ↩
5. cihi.ca | ↩
6. GlobalNews.ca | ↩
7. ncbi.nlm.nih.gov | ↩
8. cihi.ca | ↩
9. ncbi.nlm.nih.gov | ↩
10. theguardian.com | ↩
11. huffingtonpost.com | ↩
12. youtube.com | ↩
13. youtube.com | ↩
14. CBC.ca | ↩
15. freakonomica.com | ↩