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糖真的有害健康嗎?

Is sugar really bad for you?
糖真的有害健康嗎?

It’s hard to imagine now, but there was a time when humans only had access to sugar for a few months a year when fruit was in season. Some 80,000 years ago, hunter-gatherers ate fruit sporadically and infrequently, since they were competing with birds.

雖然現在難以想象,但曾幾何時,人類只能在水果成熟的幾個月里吃到糖。大約8萬年前,從事狩獵和采集活動的人類只能偶爾吃到少量水果,還要跟鳥搶著吃。

Now, our sugar hits come all year round, often with less nutritional value and far more easily – by simply opening a soft drink or cereal box. It doesn’t take an expert to see that our modern sugar intake is less healthy than it was in our foraging days. Today, sugar has become public health enemy number one: governments are taxing it, schools and hospitals are removing it from vending machines and experts are advising that we remove it completely from our diets.

現在,我們全年都能吃到大量的糖,糖的營養意義降低,吃到糖的難度也大大下降,開瓶汽水或者開盒麥片即可。不是專家也知道,現代人糖的攝入量不及以前四處找糖的時期健康。如今,糖已經成了公共健康的頭號敵人:政府對糖征稅,學校和醫院不在自動售貨機里賣糖,專家建議在飲食中完全不攝入糖。

“糖”一詞涵蓋了多種甜味劑,也包括水果中的天然果糖

But so far, scientists have had a difficult time proving how it affects our health, independent of a diet too high in calories.

但到目前為止,科學家還難以證明糖如何獨立于高熱量飲食之外影響著我們的健康。

Meanwhile, there is also a growing argument that demonising a single food is dangerous – and causes confusion that risks us cutting out vital foods.

也有越來越多的聲音認為,將某種食物妖魔化十分危險,并且會造成困惑,可能導致我們停止食用至關重要的食物。

Sugar, otherwise known as ‘added sugar’, includes table sugar, sweeteners, honey and fruit juices, and is extracted, refined and added to food and drink to improve taste.

糖,又名“添加糖”,包括蔗糖、甜味劑、蜂蜜和果汁,經提取和精煉后加入食品和飲料中,以改善口味。

But both complex and simple carbohydrates are made up of sugar molecules, which are broken down by digestion into glucose and used by every cell in the body to generate energy and fuel the brain. Complex carbohydrates include wholegrains and vegetables. Simple carbohydrates are more easily digested and quickly release sugar into the bloodstream. They include sugars found naturally in the foods we eat, such as fructose, lactose, sucrose and glucose and others, like high fructose corn syrup, which are manmade.

但糖其實是一個廣義概念,包括了成分或復雜或簡單的碳水化合物。碳水化合物經由人體消化分解成葡萄糖,幫助人體細胞產生能量,并維持大腦運轉。復雜的碳水化合物包括全谷物和蔬菜。簡單的碳水化合物更容易消化,會迅速將糖釋放到血液中,包括天然存在于食物中的糖,譬如果糖、乳糖、蔗糖和葡萄糖,以及其他人造糖,比如高果糖玉米糖漿。

Before the 16th Century only the rich could afford sugar. But it became more available with colonial trade.

在16世紀之前,只有富人才吃得起糖。但隨著殖民貿易,糖變得越來越普遍。

Then, in the 1960s, the development of large-scale conversion of glucose into fructose led to the creation of high fructose corn syrup, a concentrate of glucose and fructose.

上世紀60年代,葡萄糖開始能夠被大規模地轉化為果糖,促生了高果糖玉米糖漿,一種葡萄糖和果糖的濃縮物。

This potent combination, above any other single type of sugar, is the one many public health advocates consider the most lethal – and it is the one that many people think of when they think of ‘sugar’.

很多倡導公共健康的人士認為,這種味道濃烈的混合物比其他任何單一糖類都危險。而很多人想到“糖”時,想到的就是高果糖玉米糖漿。

Sugar rush

高糖熱潮


Consumption of high fructose corn syrup in the US increased tenfold between 1970 and 1990, more than any other food group. Researchers have pointed out that this mirrors the increase in obesity across the country.

從1970年到1990年,美國的高果糖玉米糖漿消耗量增加了10倍,增幅比其他任何食品都高。研究人員指出,這也反映在了全美肥胖現象越來越多。這可能是因為高果糖玉米糖漿不同于其他食物,它不會增加瘦素。瘦素是一種激素,有助于我們產生飽腹感。

Meanwhile, sugary drinks, which usually use high fructose corn syrup, have been central to research examining the effects of sugar on our health. One meta-analysis of 88 studies found a link between sugary drinks consumption and body weight. In other words, people don’t fully compensate for getting energy from soft drinks by consuming less of other foods – possibly because these drinks increase hunger or decrease satiety.

含糖飲料一般會使用高果糖玉米糖漿,在研究糖對人體健康的影響中一直是個重要對象。對88項研究進行的一項薈萃分析發現,飲用含糖飲料與體重高低相關。換句話說,人們不會因為喝了汽水獲得了熱量就少吃其他食物,可能因為這些飲料增加了饑餓感,或減少了飽腹感。

But the researchers concluded that while the intake of soft drinks and added sugars has increased alongside obesity in the US, the data only represents broad correlations.

但研究人員認為,雖然美國汽水和添加糖的攝入量連同肥胖現象一起增加了,但數據只表示兩者大致相關。

And not everyone agrees that high fructose corn syrup is the driving factor in the obesity crisis. Some experts point out that consumption of the sugar has been declining for the past 10 years in countries including the US, even while obesity levels have been rising. There also are epidemics of obesity and diabetes in areas where there is little or no high fructose corn syrup available, such as Australia and Europe.

不是所有人都認同高果糖玉米糖漿造成了肥胖危機。一些專家指出,過去10年中,包括美國在內的一些國家,糖消耗量持續下降,但肥胖水平卻一直上升。在澳大利亞和歐洲等幾乎或完全不使用高果糖玉米糖漿的地區,也出現了大量肥胖癥和糖尿病。

High fructose corn syrup isn’t the only kind of sugar seen as problematic. Added sugar, particularly fructose, is blamed for a variety of problems.

高果糖玉米糖漿不是唯一被認為會引起健康問題的糖。添加糖,尤其是果糖,被認為是各種問題的罪魁禍首。

For one, it’s said to cause heart disease. When liver cells break down fructose, one of the end products is triglyceride – a form of fat – which can build up in liver cells over time. When it is released into the bloodstream, it can contribute to the growth of fat-filled plaque inside artery walls.

比如認為果糖會引起心臟病。肝細胞在分解果糖時,有個最終產物是甘油三酯。甘油三酯是一種脂肪,會不斷在肝細胞中累積。當甘油三酯進入血液,可能會導致動脈血管內部形成富含脂肪的斑塊。

One 15-year study seemed to back this up: it found that people who consumed 25% or more of their daily calories as added sugar were more than twice as likely to die from heart disease than those who consumed less than 10%. Type 2 diabetes also is attributed to added sugar intake. Two large studies in the 1990s found that women who consumed more than one soft drink or fruit juice per day were twice as likely to develop diabetes as those who rarely did so.

一項為期15年的研究似乎證實了這一點:研究發現,每天攝入的熱量中,添加糖的比例占25%或以上的人,死于心臟病的幾率是占比低于10%的人的兩倍多。食用添加糖還會引發2型糖尿病。上世紀90年代的兩項大型研究發現,相比于幾乎不喝汽水及果汁的女性,每天飲用超過一杯的女性患糖尿病的幾率會高出一倍。

Sweet nothings?

糖是無辜的?


But again, it’s unclear if that means sugar actually causes heart disease or diabetes. Luc Tappy, professor of physiology at the University of Lausanne, is one of many scientists who argue that the main cause of diabetes, obesity and high blood pressure is excess calorie intake, and that sugar is simply one component of this.

但目前還不清楚糖是否真的導致了心臟病或糖尿病。包括瑞士洛桑大學生理學教授塔皮(Luc Tappy)在內的很多科學家認為,造成糖尿病、肥胖癥和高血壓的主要原因是熱量攝入過量,糖只是熱量的一種。

“More energy intake than energy expenditure will, in the long term, lead to fat deposition, insulin resistance and a fatty liver, whatever the diet composition,” he says. “In people with a high energy output and a matched energy intake, even a high fructose/sugar diet will be well tolerated.”

“長遠來看,無論何種飲食結構,只要能量攝入多于消耗,就會導致脂肪堆積、胰島素抵抗和脂肪肝,”他說,“而能量消耗和攝入相匹配的人,即使是高果糖/高糖飲食也完全沒問題。”

Tappy points out that athletes, for example, often have higher sugar consumption but lower rates of cardiovascular disease: high fructose intake can be metabolised during exercise to increase performance.

塔皮指出,比如運動員的糖消耗量往往更高,但患心血管疾病的幾率卻更低,為了提高成績他們會進行運動,能將攝入的大量果糖代謝掉。

Overall, evidence that added sugar directly causes type 2 diabetes, heart disease, obesity or cancer is thin. Yes, higher intakes are associated with these conditions. But clinical trials have yet to establish that it causes them.

總的來說,添加糖直接導致2型糖尿病、心臟病、肥胖癥或癌癥的證據不足。添加糖攝入量較高確實與這些疾病有關,但臨床試驗還沒有證實是糖導致了這些疾病。

Sugar also has been associated with addiction… but this finding, too, may not be what it seems. A review published in the British Journal of Sports Medicine in 2017 cited findings that mice can experience sugar withdrawal and argued that sugar produces similar effects to cocaine, such as craving. But the paper was widely accused of misinterpreting the evidence. One key criticism was that the animals were restricted to having sugar for two hours a day: if you allow them to have it whenever they want it, which reflects how we consume it, they don’t show addiction-like behaviours.

常常還說糖會上癮,但這可能也并非如此?!队\動醫學雜志》2017年發表的一篇文章提到,多項研究發現老鼠可能會出現糖分戒斷癥狀,并認為糖會產生與可卡因類似的作用,比如渴求感。但這篇文章飽受詬病,被認為誤解了相關證據。一種批評認為,動物吃糖的時間被限制在一天兩小時,如果允許它們像人類一樣想吃就吃,就不會出現類似上癮的行為。

Still, studies have demonstrated other ways in which sugar affects our brains. Matthew Pase, research fellow at Swinburne’s Centre for Human Psychopharmacology in Australia, examined the association between self-reported sugary beverage consumption and markers of brain health determined by MRI scans. Those who drank soft drinks and fruit juices more frequently displayed smaller average brain volumes and poorer memory function. Consuming two sugary drinks per day aged the brain two years compared to those who didn’t drink any at all. But Pase explains that since he only measured fruit juice intake, he can’t be sure that sugar alone is what affects brain health.

但還有很多研究表明,糖會以其他方式影響我們的大腦。澳大利亞斯威本大學人類精神藥理學中心的研究員帕塞(Matthew Pase)請被試對象報告他們喝了多少含糖飲料,并用核磁共振掃描他們大腦的健康狀況,研究了攝入量與大腦健康的關系。喝汽水和果汁頻率更高的人,平均腦容量更小,記憶力更差。每天喝兩杯含糖飲料的人大腦比完全不喝的人老兩歲。但帕塞說,他只測算了果汁的攝入量,因此無法確定影響大腦健康的是不是只有糖。

“People who drink more fruit juice or soft drinks may share other dietary or lifestyle habits that relate to brain health. For example, they may also exercise less,” Pase says.

帕塞說:“喝果汁或汽水較多的人可能都有其他影響大腦健康的飲食或生活習慣。比如,可能鍛煉得也少。”

One recent study found that sugar may even help improve memory and performance in older adults. Researchers gave participants a drink containing a small amount of glucose and asked them to perform various memory tasks. Other participants were given a drink containing artificial sweetener as a control. They measured the participants' levels of engagement, their memory score, and their own perception of how much effort they’d applied.

最近的一項研究發現,糖甚至可能有助于改善老年人的記憶力和表現。研究人員給參試者一杯含少量葡萄糖的飲料,并請他們完成各種各樣的記憶任務,另外一些參試者作為參照喝的是含人工甜味劑的飲料。研究人員檢測了參試者的投入程度、記憶分數和他們自認為付出了多少努力。

The results suggested that consuming sugar can make older people more motivated to perform difficult tasks at full capacity – without them feeling as if they tried harder. Increased blood sugar levels also made them feel happier during the task.

結果表明,攝入糖分能夠讓老年人更積極地去全力完成困難的任務,同時不覺得自己付出了更多努力。血糖水平升高還會讓他們在完成任務的過程中更加快樂。

Younger adults showed increased energy after consuming the glucose drink, but it didn’t affect their mood or memory.

年輕人喝了葡萄糖飲料后會增加能量,但不會影響他們的情緒或記憶力。

Teaspoon of sugar

稍來點糖


While current guidelines advise that added sugars shouldn't make up more than 5% of our daily calorie intake, dietitian Renee McGregor says it’s important to understand that a healthy, balanced diet is different for everyone.

盡管目前的指南建議添加糖不應超過每日熱量攝取的5%,但營養學家麥格雷戈(Renee McGregor)說,重要的是要明白健康和均衡的飲食因人而異。

“I work with athletes who need to take on more sugar when doing a hard session because it’s easily digestible. But they worry they’re going over the guidelines,” she says.

“我指導的運動員在進行艱苦的訓練時必須增加糖的攝入量,因為糖容易消化。但他們擔心會超過指南規定的量。”她說。

For most of us non-athletes, it’s true that added sugar isn’t crucial for a healthy diet. But some experts warn we shouldn’t single it out as toxic.

對我們大部分普通人來說,添加糖確實不是健康飲食的關鍵。但一些專家警告說,我們不該認為只有添加糖有害健康。

McGregor, whose clients include those with orthorexia, a fixation with eating healthily, says that it isn’t healthy to label foods as ‘good’ or ‘bad’. And turning sugar into a taboo may only make it more tempting. “As soon as you say you can’t have something, you want it,” she says. “That’s why I never say anything is off-limits. I’ll say a food has no nutritional value. But sometimes foods have other values.”

麥格雷戈的客戶包括健康食品癥患者,會對健康飲食過度迷戀。她說,給食物貼上“好”或“壞”的標簽是不合理的。禁止吃糖只會增加它的吸引力。“一旦你說不能吃什么,你就越想吃什么,”她說,“所以我從不說禁止吃某種食物,我會說它沒有營養價值。但有時,食物也有其他價值。”

Associate professor at James Madison University Alan Levinovitz studies the relationship between religion and science. He says there’s a simple reason we look at sugar as evil: throughout history, we’ve demonised the things we find hardest to resist (think of sexual pleasure in the Victorian times).

美國詹姆斯麥迪遜大學副教授列文諾維茨(Alan Levinovitz)研究的是宗教與科學的關系。他說,我們認為糖邪惡的原因很簡單:縱觀歷史,我們總是把最難抗拒的東西妖魔化(譬如維多利亞時代將性快感妖魔化)。

Today, we do this with sugar to gain control over cravings.

如今,我們對糖這么做是為了控制渴望。

“Sugar is intensely pleasurable, so we have to see it as a cardinal sin. When we see things in simple good and evil binaries, it becomes unthinkable that this evil thing can exist in moderation. This is happening with sugar,” he says.

“糖能給人帶來極大的愉悅,所以我們必須把它看成是頭等大罪。當我們用簡單的好壞二元論來看待事物時,想到邪惡的東西居然可以適量存在就會感到不可思議。對糖的看法就是這樣。”他說。

He argues that that seeing food in such extremes can make us anxious about what we’re eating – and add a moral judgment onto something as necessary, and as everyday, as deciding what to eat.

他認為,用如此極端的態度對待食物可能會讓我們擔心吃的東西,并在每天決定吃什么時進行一場道德判斷,思考是否有必要吃。

Taking sugar out of our diets can even be counterproductive: it can mean replacing it with something potentially more calorific, such as if you substitute a fat for a sugar in a recipe.

在飲食中去掉糖甚至可能適得其反:可能意味著用熱量更高的東西取代糖,比如做菜時用脂肪代替糖。

And amid the rising debate around sugar, we risk confusing those foods and drinks with added sugar that lack other essential nutrients, like soft drinks, with healthy foods that have sugars, like fruit.

有關糖的爭論越來越激烈,我們可能會將類似汽水這種含添加糖但缺少其他必需營養物質的食品和飲料,與水果等含糖的健康食品相混淆。

One person who struggled with this distinction is 28-year-old Tina Grundin of Sweden, who says she used to think all sugars were unhealthy. She pursued a high-protein, high-fat vegan diet, which she says led to an undiagnosed eating disorder.

28歲的瑞典人格倫?。═ina Grundin)就一度難以區分這兩者,她說過去以為所有的糖都不健康。她遵循高蛋白、高脂肪的純素飲食,導致患上了一種尚未確診的飲食失調。

“When I started throwing up after eating, I knew I couldn’t go on much longer. I’d grown up fearing sugar in all forms,” she says. “Then I realised there was a difference between added sugar and sugar as a carbohydrate and I adopted a high-fructose, high-starch diet with natural sugars found in fruit, vegetables, starches and legumes.

“當我開始在飯后嘔吐時,我知道不能再這樣了。我從小到大一直害怕各種形式的糖,”她說,“后來我意識到,添加糖和碳水化合物中的糖是有區別的,于是我開始進行高果糖、高淀粉的飲食,接受水果、蔬菜、淀粉和豆類中的天然糖分。”

“From the first day, it was like the fog lifted and I could see clearly. I finally gave my cells fuel, found in glucose, from carbohydrates, from sugars.”

“從第一天開始,就像大霧散去,我終于看清了。我終于讓體內的細胞得到了能量,這些能量來自葡萄糖、碳水化合物和糖類。”

While there’s disagreement around how different types of sugars affect our health, the irony is we might be better off thinking about it less.

不同糖類對人體健康的影響還沒有定論,但可能考慮得越少越好。

“We’ve really overcomplicated nutrition because, fundamentally, what everyone is searching for is a need to feel complete, to feel perfect and successful,” says McGregor. “But that doesn’t exist.”

麥格雷戈說:“我們真的把營養過分復雜化了,從根本上說,所有人都在尋找圓滿、完美和成功的感覺,但這其實并不存在。”
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