Today’s interview with Dr. Franz-Werner Dippel focuses on the effects of too much sugar on health. What does the research say? Which diseases are becoming more common when sugar consumption is too high? And what is the recommended maximum daily intake?
Comorbidities, i.e., other diseases, lead to a more rapid deterioration of multiple sclerosis and often limit the choice of medication options. Since sugar is permanently overrepresented in our society today, I felt it was worth contributing to the discussion, even though the studies refer to the entire population and not just MS patients.
I conducted the interview in German and translated it.
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Introduction Dr. Franz-Werner Dippel
I am a certified biologist and medical scientist with more than 30 years of experience in nutrition-related metabolic disorders (diabetes, high blood pressure, lipid metabolism disorders, arteriosclerosis, fatty liver, morbid obesity, metabolic syndrome, etc.) in various research roles.
I currently work as a freelance lecturer on nutrition and health for various educational institutions and several commercial clients (occupational health services).
In addition, I am a visiting scientist in the field of nutrition and health at the Technical University of Berlin, Germany.
Personal motivation for the job
Due to severe acne during puberty, my family doctor recommended that I give up sugar. After six months, I was “cured.” Since then, I have been aware that nutrition has a decisive influence on health. That is why I studied biology and medical science.
When raising my two daughters, I made sure they had a healthy, low-sugar diet from the start. It paid off. Both are slim and fit and are also interested in health and nutrition. My eldest daughter is studying medical education, and my younger daughter is studying medicine.
Evaluation of 73 high-quality meta-analyses on sugar consumption
What does their summary in the article “Sugar: Sweet, white, and deadly?” refer to?
We know from numerous studies that sugar is one of the biggest health risks in our diet (WHO). In a recent mega study, Chinese and American scientists have now systematically investigated the health risks of sugar. The new publication is the most comprehensive study ever conducted on the health risks of sugar consumption. It summarizes the current state of scientific knowledge.
For how many and what types of diseases was there a statistically significant correlation? And can you explain what statistically significant means?
Sugar promotes obesity and thus contributes to the development of numerous secondary diseases (WHO). For 45 of the 83 medical endpoints (diseases) examined, the link between sugar consumption and harmful health effects was statistically significant in the current publication. These include 18 endocrine or metabolic diseases (e.g., obesity, fatty liver, type 2 diabetes, gout, high cholesterol), 10 cardiovascular diseases (e.g., high blood pressure, coronary heart disease, heart attack, stroke), 7 cancers (e.g., liver, pancreatic, breast, and prostate cancer) and 10 other diseases affecting various organ systems (e.g., asthma, ADHD, depression, and tooth decay). The data for four endpoints was inconsistent. For the remaining 34 endpoints, the association between sugar consumption and disease was not statistically significant.
A statistically significant association is always said to exist when the result is very unlikely to be due to chance. There are scientifically defined probability thresholds for significance.
Is the amount of sugar directly related to its harmful effects on health?
That’s a safe bet! For some diseases, a linear dose-response relationship has been found. For others, a clear dose effect was seen when comparing the highest and lowest amounts of sugar consumed. These findings suggest a causal link. However, this isn’t proof in the strict scientific sense. But it’s the best evidence we have right now. For methodological reasons, a conclusive (confirmatory) study is unfortunately not feasible. The situation is comparable to studies on alcohol and nicotine consumption. Here, too, definitive proof is lacking. However, the chain of evidence is overwhelming.
Which metabolic disorders occur more frequently when consuming sugary drinks on a regular basis?
Overweight, obesity (adiposity), diabetes, lipid metabolism disorders (elevated cholesterol or triglyceride levels), non-alcoholic fatty liver disease.
How does sugar intake affect cardiovascular disease?
Put simply, sugar leads to overweight and obesity and, as a result, to deposits in the large and small blood vessels (arteriosclerosis). This leads to narrowing of the vessels or complete blockage. If deposits break loose and travel with the bloodstream, this can lead to heart attacks, strokes, pulmonary embolisms or thromboses.
Is there any evidence of a link between excessive sugar consumption and cancer?
Cancer usually develops over very long periods of time. According to current scientific knowledge, sugar appears to promote the development of certain types of cancer. These include liver, pancreatic, breast, and prostate cancer in particular. However, the exact mechanism of action is not known. The situation is similar with alcohol and nicotine. Here, too, the exact mechanism linking the amount consumed to the development of liver and lung cancer is not fully understood. Nevertheless, no one today doubts the link between alcohol and liver cancer or between smoking and lung cancer. Of course, there are alcoholics and smokers who do not develop cancer. However, they are in the minority.
What other diseases are negatively affected by high sugar consumption?
The first disease for which a link to sugar consumption has been proven is tooth decay. Bacteria in dental plaque feed on sugar and starch breakdown products. They release organic acids that dissolve tooth enamel and cause cavities. Without proper oral hygiene, this process leads to painful inflammation and, in the medium to long term, tooth loss.
ADHD, depression, and asthma are also suspected of being linked to high sugar consumption. Sometimes it is not possible to clearly distinguish between cause and effect. It could also be, for example, that people who are depressed tend to consume more sugar. Along with other luxury foods, sugar is one of the ultimate mood enhancers.
Varieties of sugar
Which types of sugar are particularly common, and does it make a difference to my health if I consume too much of a certain type of sugar?
The most common sugar in our diet is glucose (grape sugar). It makes up 50 percent of table sugar (sucrose) and milk sugar (lactose). It is found in 100 percent of starch (flour, pasta, rice, potatoes) and starch breakdown products (maltose, maltodextrin).
Glucose is also found in varying concentrations in honey, maple and agave syrup, thick juices, corn syrup, and coconut blossom sugar.
The second most common sugar is fructose (fruit sugar). It also makes up 50% of table sugar and is found in varying concentrations in corn syrup, honey, and other plant sugars.
The third most common sugar is galactose (mucilage sugar). It makes up 50% of milk sugar.
All three types of sugar (glucose, fructose, and galactose) contribute equally to the development of obesity, fatty liver, and type 2 diabetes.
Industrially processed foods contain more than 70 different names for added sugar, including dextrose, barley malt extract, invertose, isoglucose, isomerose, levulose, skimmed milk powder, whey powder, refined sugar, sucanat, etc. This is completely overwhelming for consumers.
Why are sugary drinks particularly bad for your health?
In beverages, sugar is present in dissolved form, either as table sugar (sucrose) or as glucose-fructose syrup (corn syrup). In the first case, table sugar simply has to be broken down into its two components, glucose (grape sugar) and fructose (fruit sugar). This happens within a few minutes in the small intestine. The sugar molecules are then absorbed into the blood and transported to the liver. In the second case, glucose and fructose are already present as monomers. Enzymatic breakdown is not necessary.
In both cases, there is an explosive increase in blood sugar and an excessive insulin response from the pancreas. The excess energy (blood sugar) is converted into fat and stored in the liver, muscles, and abdominal cavity. Over time, these repetitive processes overwhelm the body’s regulatory systems. Insulin resistance develops (the cells no longer absorb sugar) and secretion failure (the pancreas no longer produces enough insulin). This leads to the full onset of type 2 diabetes.
In contrast, the sugar from an apple is absorbed much more slowly.
Why should you also be careful with fruit juices, which appear to be healthier than carbonated soft drinks?
Sugar is also present in fruit juices and fruit smoothies in dissolved form. The cells of the fruit are broken down during processing (juicer, blender) and the fiber is removed (fruit juice) or broken down to such an extent (smoothie) that it can no longer delay the absorption of sugar into the blood. This has the same consequences as consuming soft drinks.
How much sugar is in processed foods, and why should you avoid them?
Industrially produced foods contain varying amounts of sugar. There are hardly any ready-made products that do not contain added sugar. Soft drinks and fruit juices contain between 10 and 15% sugar, breakfast cereals and spreads between 30 and 50%. Sweets consist mainly of sugar (e.g. candies, gummy bears, marshmallows).
Unlike some essential amino acids and omega-3 fatty acids (ALA, EPA, DHA), sugar (glucose) is not a vital nutrient. Our bodies are able to produce all the sugar they need from other nutrients (gluconeogenesis).
Humans are not evolutionarily adapted to such large amounts of sugar. Our ancestors had no access to sugar for thousands of years. It was not until the beginning of the 19th century that sugar became a small part of our diet. Since the end of World War II, sugar has been a mass-produced product.
Recommendations for sugar consumption
What is the current sugar consumption per capita in Germany, and what is the WHO's recommended limit?
Annual per capita consumption is around 36 kg. This corresponds to 3 kg of pure sugar per month and approx. 100 grams per day. However, official statistics only record the consumption of table sugar from sugar beets and sugar cane. This does not include consumption of sugar from other sugar plants (e.g., corn syrup, maple syrup, coconut blossom sugar, etc.) or honey and dairy products.
The WHO guideline of March 4, 2015 recommends consuming a maximum of 5% of daily energy intake in the form of added sugar. With an average energy requirement of 2,000 kcal, this would correspond to about 25 g of sugar. This amount is already reached with one glass (250 ml) of a sweetened soft drink.
Aditional note from Nele: Annual per capita sugar consumption varies significantly by country, but it remains well above healthy limits. In the United States, people consume on average about 46 kilograms of sugar per year. That’s roughly 3.8 kilograms per month, or about 126 grams every day. In the United Kingdom, the average is around 34 kilograms annually, which equals about 2.8 kilograms per month or 93 grams a day. In Canada, annual consumption is approximately 30 kilograms, translating to about 2.5 kilograms per month and 83 grams per day.
What does this mean specifically for the consumption of sweetened soft drinks?
Sweetened soft drinks and so-called energy drinks are pure sugar bombs. Avoiding them is the first step out of the sugar trap.
How can you identify sugar on packaging labels?
Sugar is one of the food ingredients that must be listed on the label of finished products. The nutritional information table lists all types of sugar and shows the total sugar content in grams and as a percentage. The list of ingredients provides information about the type of sugar used. Finished products containing more than 5% added sugar should not be purchased.
Is sugar addictive, and if so, how difficult is it to quit?
Sugar creates psychological and physical dependence. Anyone who has ever tried to give up sugar knows this. There is no magic formula for kicking the industrial sugar habit. Like nicotine and alcohol withdrawal, it requires self-discipline and willpower. If you can’t do it on your own, psychotherapy is recommended.
What tips do they have for returning to a healthy level of sugar intake?
Unlike our early ancestors, we now have access to numerous types of fruit that are high in sugar. Berries (strawberries, raspberries, currants, gooseberries, etc.) are low in sugar but still very sweet. There is also nothing wrong with eating one apple a day. Bananas, sweet cherries, grapes, and dried fruits of all kinds should be avoided. On special occasions (birthdays, passing exams, weddings, etc.), a piece of cake is of course allowed. It’s best to bake it yourself, then you know how much sugar it contains. Vanilla, cinnamon, and cocoa are also suitable natural sweeteners.
Is there any empirical evidence as to what works better—gradually reducing sugar intake or cutting it out completely?
I am not aware of any studies on this. We know from smoking and drinking that the zero-point method is more effective than gradual nicotine or alcohol withdrawal.
Where can you find support and further information if you want to reduce your sugar consumption?
You can break your sugar addiction through medical fasting under a doctor’s supervision. But your health insurance won’t cover the costs.
What developments would you like to see in society's approach to sugar over the next five years?
I fear that the way modern food is produced is irreversible. A sugar tax would probably only lead to the industry replacing sugar with substitutes (e.g., xylitol, erythritol) or synthetic sweeteners (e.g., stevia, aspartame). In my opinion, this would achieve nothing, as we are just as unaccustomed to these substances as we are to sugar. Two-thirds of the German population is now overweight, and a quarter of that is obese. The trend is rising. Politicians have so far looked on helplessly as this development has unfolded. Perhaps the draft law to ban advertising for unhealthy children’s foods will mark the beginning of a turnaround.
Farewell
Where can people find you and your information online?
I do not maintain a personal website, as I pursue neither commercial nor business interests.
Since 2018, I have been giving seminars on sugar-related topics at various adult education centers in Germany.
You can search for my course titled “Sugar – A Heavy Problem?” or enter my name in the nationwide German adult education course finder: https://www.volkshochschule.de/kursfinder.php
In addition to sugar, I offer seminars on the following topics: weight reduction, intermittent fasting, low-carb diets, superfoods, dietary supplements, dairy products, plant-based nutrition, food allergies, the gut microbiome, immune system support, and more.
I have also written a publication on the topic of sugar, which is available for download as a PDF.
For those interested in documentaries, I highly recommend the excellent ARTE film titled “The Big Sugar Lie” (original title: Die große Zuckerlüge):
👉 Watch it here on YouTube
There are also many insightful books available in English that cover similar themes. Some highly recommended titles include:
Robert Lustig: Fat Chance: The Bitter Truth About Sugar (Hudson Street Press, 2013)
John Yudkin: Pure, White and Deadly: How Sugar is Killing Us and What We Can Do to Stop It (Penguin Books, reissued 2012)
Gary Taubes: The Case Against Sugar (Knopf, 2016)
Michael Moss: Salt Sugar Fat: How the Food Giants Hooked Us (Random House, 2013) — a good alternative to consumer guides like Achtung, Zucker!
These resources provide an excellent foundation for understanding the complex role of sugar in our health and society.
Is there anything else you would like to share with our listeners?
When it comes to sugar, you are largely on your own. However, every individual can do something themselves. Avoid purchasing sweetened beverages and processed foods. Cook and bake more often.
Many thanks to Dr. Franz-Werner Dippel for the excellent overview on the topic of sugar. I’ve realized that I definitely consume too much sugar, and starting today, I’m going to make a serious effort to cut back. After all, neither you nor I need any additional health complications—especially not alongside multiple sclerosis (MS).
Sugar also promotes inflammation, which can directly worsen MS. I wish you all the best on your journey to reduce sugar. Take it seriously—as seriously as you would any addictive substance—because sugar, like any other, will try to stay part of your life.
More content on this topic will follow soon, but in the meantime, I recommend checking out the twin study discussed by Dr. Lisa-Ann Gerdes, which is already available and offers fascinating insights.
See you soon and try to make the best out of your life,
Nele
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