Professor warns how excess sugar makes us sick: 'Sugar had an evolutionary function for humans'

We humans have a natural system that makes us sugar lovers. Although that had a function in evolutionary terms, our current society is messing up that system and we are now getting sick from all that sugar. But instead of continuing to satisfy that sugar craving, professor Martijn Brouwers advocates that we put a stop to the industry and take measures.

More than half of the Dutch population is overweight and obese. In addition, 17 percent of the Dutch population is now obese. And although it seems that these numbers continue to rise, medicines such as Ozempic are emerging. Metro previously explained the difference between obesity and 'ordinary' overweight.

Martijn Brouwers (47) is a professor and internist-endocrinologist at Maastricht UMC+. His field of expertise focuses on hormones and metabolism. "I treat many patients with hormone problems, diabetes and metabolic diseases. I have always been fascinated by what happens in our body and what can go wrong. All kinds of chemical processes take place there. If something goes wrong in such a process? Then you can become ill."

In his book Sugar in Abundance he sounds the alarm, as the title suggests, about the abundance of sugar in our society. (Fruit) sugar, also known as fructose, is naturally found mainly in fruit and honey. But nowadays you also find fructose frequently as a sweetener in all kinds of (ultra)processed food in our supermarkets. Earlier, a general practitioner told Metro how ultra-processed food makes us sick.

The aforementioned fascination with the chemical processes in the body was also one of the reasons for writing the book. “We have done a lot of scientific research into diabetes and cardiovascular diseases. We think that the liver plays a major role in this. People with fatty liver disease in particular are at risk for these diseases. We also did research into fructose and the role of that fat. Fructose does all sorts of special things in the body and I then asked myself: 'But why?' Evolution gives us the answer.”

Our sugar cravings can be explained if we go back tens of thousands of years. “Nature has ‘invented’ that our body works in a certain way. Our system is originally set up for fructose, but in a different way than we use it now. Tens of thousands of years ago, for example, there was fruit on the trees in the summer and there was a lot of food available. As a result, fructose has a signal function in our body. As in: ‘Hey, there is a lot of food available now, eat it’. But nowadays fructose is available in abundance and causes all kinds of diseases.”

The professor explains that fructose, based on that natural mechanism, has all kinds of useful functions. "For example, the intestines can absorb more food through fructose and ensure that sugars are stored as fat in the liver. Beneficial if you had to ration and store for the seasons when there was less food available. Fructose also has an effect on testosterone levels and reproduction. The signal that there was a lot of food available makes it a good time to reproduce. Our body still works that way. For example, with an eating disorder like anorexia nervosa you see that women who eat little do not have a period. In other words, little food does not mean a good time to reproduce. Eating a lot does mean reproduction and that the child can survive. Fructose gives that signal of: 'This is the right time'."

According to Brouwers, approaching our current sugar cravings from an evolutionary perspective explains a lot. "Tens of thousands of years ago, food was scarce. Our body is equipped with all kinds of mechanisms that stimulate the desire for food and sweets. Sweet means calories and there used to be few of those. In other words: the need for sweets is in our genes."

But our brains have given this a clever twist in this modern consumer society. “We bend our environment to what we need. That is a need for sweet and high-calorie food and as little exercise as possible. For the latter, we have come up with all kinds of devices, such as dishwashers, lawn mowers or e-bikes. And we have also arranged our food in a 'smart' way. We have become so good at making food that is focused on our primary needs that our body is not at all set up for it. Our body still functions from that 'rationing and scarcity cycle'. But that cycle is no longer there and there is constant abundance. The body cannot handle that.”

All those originally beneficial effects of fructose that Brouwers listed above are having an unfavorable effect in this society. “We can now translate those evolutionary effects into diseases. For example, we see a relationship between fructose, for example in soft drinks, and colon cancer . Excessive fructose can also lead to liver inflammation, liver failure or liver cancer. In addition, we see an increased risk of diabetes and cardiovascular diseases if you have a lot of fat in your liver . And the effect of fructose on testosterone and reproduction now also has a negative effect. For example, in hormonal disorders in women, such as polycystic ovary syndrome ( PCOS ).”

According to the professor, these are all functions that were once useful, but now lead to diseases of affluence. "We created that environment ourselves. But our system is not properly adjusted to the current environment."

According to the professor, all of this also makes it so difficult to lose weight. “We have created an environment that feeds us as much as possible in what we want. Although food producers and supermarkets naturally have a responsibility in this, it is too simplistic to put all the blame on them. They offer what we want. Why don’t you see cones of carrots and cauliflower passing by in the city centre? Because we prefer French fries. The streetscape is what we want as people.”

How does the internist-endocrinologist himself move through the supermarket? Does he quickly walk past something? “I walk past sugary soft drinks . But I am also human and supermarkets are designed in such a way that you first walk past the vegetables and fruit and later encounter all kinds of temptations. I, like many people, also like chips and chocolate.”

How do you deal with that as a person? How do you moderate that sugar craving? “Our environment constantly tempts us to buy these products. It is a challenge to resist that. I think it is best to avoid snacking and skip sugary products, especially soft drinks.”

According to the professor, it is therefore important to name the scientific findings about sugar and lifestyle diseases. "You can develop all kinds of pills, but I think that measures are needed for our excessive eating and our fructose cravings."

According to the professor, you can't blame the individual for everything. With his book, he also sounds the alarm towards the government. "Because people are naturally predisposed to this, it is difficult to stay away from sweets. It is our environment that makes it difficult for us. But the food industry and supermarkets are not going to change that. That leaves one more player: the government. They can ensure that our living environment becomes healthier. We live in a time with major health problems, in which the government must do its bit."

And Brouwers does have his ideas about that. "One way to do that is to provide good information. Cutting back on the Food Centre, for example, which the government did, is not good. In addition, it is important to know what is on the packaging. Reading labels is quite difficult. Information such as the Nutri-Score makes that easier."

Incidentally, the professor emphasizes that there is also considerable discussion about the Nutri-Score. "There is certainly still room for improvement. But you can see at a glance that water has a green score and cola has a red score. The Nutri-Score is not mandatory. Although private labels often put it on their products, you will not find a Nutri-Score with A-brands such as Coca Cola or Pepsi. A government could make that mandatory."

Brouwers continues: “But you can also ban advertising for unhealthy food for children, or child marketing. So that you don’t continually tempt children to eat unhealthy food. You can also do that by not allowing fast food restaurants around schools, for example. You can also make healthy food cheaper and unhealthy food a bit more expensive. You can come up with all kinds of measures for that. Look at the smoking policy, for example. There are pictures on cigarette packets, there is a lot of information available about the health effects, it is more expensive and you are not allowed to smoke everywhere. I think you can do something similar for unhealthy food. Although people still smoke , those numbers have dropped considerably. The only complicated thing is that food is a basic need and smoking is not. But I think it is necessary to implement measures.”

And if you consider Brouwers' plea as patronizing, the professor has something to say about that too. "People are patronized all day long to do unhealthy things. By the supply, commercials, packaging and other enticements of the industry. That is also patronizing, but we call it marketing."

Now that more than half of the Dutch population is overweight and there is a real obesity epidemic, Brouwers fears that if nothing is done, these figures will only increase. "What is worrying is that more and more young people are overweight and also develop lifestyle diseases at a young age. They are ill for the rest of their lives. In addition to being unpleasant for the patient, it also puts pressure on healthcare and society."

Nowadays, there are drugs like Ozempic on the market to temper things. But the professor wonders whether drugs are the solution. "You can give Ozempic to half of society. But at the same time, that also creates an ethical discussion. Because how do we want to organize our society? People tend to solve problems with innovation. As a scientist, I am an advocate of that. But I do have a problem with it if we as a society live unhealthy lives and then take a pill for it."

He continues: "We don't just eat and drink too much, we consume too much in many areas. We just want more, more, more. But what do we want as a society? We can continue as we are doing now or we can think together about how to put a stop to it. Then you have to tackle the cause and that is the design of food in society. Instead of tackling the consequences with a pill. It now seems that that pill is a more obvious option than, for example, prevention. I hope that a new cabinet will pay more attention to that in the future."

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