THE RISK OF A SWEET TOOTH

Our voracious appetite for sweets poses serious health questions. How safe is sugar? How safe the substitutes? Despite the dangers, the passion continues to grow. From cookies to yogurt, consumers are on a binge with no end in sight. Picture this: a Neanderthal man deep in the forest gorges on the yummies of his time fruits, berries, anything sweet and pluckable. A prehistoric example of what would become a modern public-health problem? Not quite. For the Neanderthal, a sweet tooth was, in pop sociospeak, a life enhancer-the bitter-tasting stuff, early man learned, often led to sickness or even death. But today, man's voracious appetite for goodies poses a serious medical dilemma. Some nutritionists blame sugar for scores of ills, ranging from cavities and diabetes to hyperactivity and violent crime. Others argue that artificial sweeteners are just as risky-or more so-because they may cause cancer, chromosome damage and neurological problems.

Yet despite the simmering controversy, Americans show little inclination to resist their passion for sweets. Outlets such as David's Cookies and Haagen-Dazs ice cream parlors have broken out across the country like acne to name just one other disorder associated with sweets. In the last 10 years U.S. citizens have increased their annual consumption of sugar in its multitude of crackly, crunchy, syrupy and other forms from 118.1 to 126.8 pounds per person. The increasing intake of foods containing sugar substitutes-saccharin and aspartame-is even more impressive, although the numbers are considerably lower: 15.8 pounds per capita last year, compared with 6.1 pounds in 197 5. Overall, the average American now consumes about 11 more pounds of sugar, or its equivalent, than he did a decade ago.

When you've got a sweet tooth, the abandon can be reckless whether you make it sugar or one of the substitutes. Lisa Skolnik, the 30-year-old public-relations director of Chicago's Museum of Contemporary Art, will have fruit salad and a chocolate-chip cookie for breakfast, yogurt with raisins for lunch and top off her dinner of fresh vegetables and a bagel with two scoops of fudge brownie ice cream. A balanced diet is very important, but I could never stop eating sugar, she says. Debbie Mohr, a 22-yearold project director for a Denver marketing firm, prefers a low-calorie sweetener. She puts aspartame on her cereal in the morning and in her yogurt at lunch and, between meals, sips Diet Pepsi, which is also flavored with NutraSweet, the trademark for aspartame. "It makes it sweet, but without the calories, she explains.

But some people can't consume sweets of either the natural or artificial kind without dire consequences. About a year ago Betty Johnson, 44, of Atlanta started walking lopsidely and losing her balance after eating pastries. Her doctor diagnosed her condition as sugar intolerance. If I eat a candy bar, it's like I've had a fifth of liquor, she says. Edith Johnson of Bethesda, Md., blames hot cocoa faced with aspartame for causing her to collapse and go temporarily blind one night last January. I loved the way it tasted but I also knew it was doing something to me, she recalls. It was like my head was being emptied.

Empty Calories: Experts are divided over the relative merits-and demerits-of sugar versus its substitutes. Sugar, notes Bonnie Liebman of the consumerist Center for Science in the Public Interest, constitutes empty calories that keep more useful nutrients out of the diet. A sedentary, overweight population can't afford to waste those calories, she says. But Dr. Charles McElroy, an associate professor of medicine at the University of California, Los Angeles, sees no problem with sugar in moderation. It always amazes me, he says, that people would choose to drink a diet soda when there is a tremendous uncertainty as to whether or not it is a health risk.

Chemically speaking, sugar takes a variety of forms. Common table sugar is sucrose, refined from sugar cane or sugar beets. Lactose is the sugar that naturally occurs in milk; maltose is the sugar from malt that flavors milk shakes, and fructose is what sweetens fruit and honey. When consumed by humans, all these sugars are ultimately turned into another sugar, glucose, which supplies energy.

COWS AND RATS.

Animal species vary widely in their response to sweets. Xylose, a sugar that comes from wood, makes chickens wipe their beaks and walk backward in revulsion, says Monely Care of Philadelphia's Monell Chemical Senses Center. Cows, on the other hand, like xylose but are indifferent to maltose. Rats like maltose but are indifferent To-lactose, which possums love. Meat-eating lions, tigers and domestic cats don't react to sugars at all. Then there is man, who seems to be programmed to like sweet-tasting things from birth. In one study, for example, newborns were offered bottles of plain water or sucrose solutions at different concentrations. All clearly preferred the sweet drinks. In hospitals, in fact, infants are often given sweetened water even before they breast-feed to encourage them to drink more liquid. And given a choice of foods, children between 6 months and 11/2 years of age showed a preference for the naturally sweet items, milk and fruit. There is no proof, however, that a baby's exposure to sugar will necessarily determine how fond he is of sweets as an adult. Freud said during the first six years you form your basic personality, but we see no evidence that food preferences are formed then more than at any other time, says psychologist Paul Rozin of the University of Pennsylvania.

Nor apparently do genetics have much to do with whether a child develops a sweet tooth. In one study, for example, sets of identical twins tested for their perceptions and preferences for sweets showed no closer match than did fraternal twins. The degree to which individuals like sweets appears to be unpredictable. Food scientist Rose Marie Pangborn of the University of California, Davis, gave a lemonade-sugar mixture to a group of volunteers and found that they liked concentrations of sugar ranging all the way from 4 percent to 36 percent. There was nothing systematic to explain this, no differences male to female, by age or foreign born versus native born, she says. It's just the variability of the species.

Variable or not, many members of the species feel helpless when they go eyeball to-eyeball with a confectioner. Do I like sweets? We're talking addiction, says Bobby Buich, a mother of four from Tiburon, Calif If I got yelled at, grandma would come out of the kitchen and comfort me with a cookie, recalls Gene Braun, a 55-year-old Las Vegas community-college counselor. That started a sweet kick that I've never been able to curb. People come in here wanting something totally sinful, says Lynn Anderson, owner of The Truffle Chocolate in Denver's Larimer Square. The venial temptations she offers include truffles that cost $24 a pound, molded chocolate telephones or various animals at $16 a pound, chocolate champagne magnums at $60 and, for only $1, a large strawberry dipped first in white, then dark chocolate.

Scientists haven't fully figured out how humans perceive sweetness. According to the most common view, the taste buds of the tongue are equipped with sweet receptors, chemical structures that fit like a lock and key with molecules of sugar or other sweeteners. The link triggers nerve impulses that travel to the brain. The brain, in turn, assesses the nature of the sweet impulses-whether they're intense or mild or whether they're combined with some other nerve signals, such as those for sourness.

CHEWY CARAMELS

But the larger question is what dangers actually lurk in the sugar bowl or in those packets of artificial sweetener. There are some physicians specializing in clinical ecology who maintain that sugar can trigger allergic reactions leading to severe mental problems, including violent behavior. In a celebrated case, former San Francisco City Supervisor Dan White was found guilty of manslaughter, rather than murder, in killing Mayor George Moscone and Supervisor Harvey Milk six years ago after pleading what became known as a Twinkie defense. His lawyer used the diminished mental capacity defense based, in part, on White's addiction to junk food, including candy bars. But most experts argue that there is little scientific evidence that sugar causes severe psychological syndromes.

There is no question, however, that sugar causes cavities. Sugar interacts with bacteria in the mouth to produce acids that eventually bore holes in the hard enamel of the teeth. Widespread addition to drinking water of fluoride-which strengthens dental enamel-has vastly reduced the overall incidence of cavities. But the American Dental Association still advises parents to keep sugar-rich products to a minimum in the diets of children. Dental experts point out that sweets that tend to stick in the mouthlike raisins, chewy caramels and granola bars-can be more cavity producing than soft drinks, which are quickly swallowed. The experts also advise anyone who eats sugary foods to wash them down with water as quickly as possible.

Sugar also can be dangerous for diabetics, who simply cannot adequately metabolize carbohydrates in the diet. But there is universal agreement that excessive sugar intake does not cause diabetes, says Dr. Lester B. Salans of New York's Mount Sinai School of Medicine. One form of diabetes occurs because the pancreas fails to produce sufficient insulin, the hormone essential for the body's utilization of sugar and other carbohydrates. Another form results primarily from a shortage of receptor molecules on body cells for insulin to attach to. Researchers link this type of diabetes to obesity; in most cases elevated blood-sugar levels drop when the patient simply loses weight. There is also some preliminary research indicating that fructose may be safer for diabetics than sucrose.

DIETERY CULPRIT

The most important sugar related health issue concerns the role it plays in obesity. Recent evidence suggests a smaller part than most people suppose. Joel Grinker of the University of Michigan School of Public Health found that the babies of obese parents, who genetically are at risk of becoming obese themselves, showed no more affinity for sugar-and water solutions than other infants. Whatever inclines people to obesity, she concluded, it is not an early taste for sweetness. Nor does a liking for sweets seem to be involved in adult obesity. Dr. Jules Hirsch of New York's Rockefeller University studied some fat people and found they actually craved less sugar than their normal-weight counterparts.

The real dietary culprit in obesity is fat, which contains nine calories per gram compared with sugar's four. M. R. C. Greenwood, a Vassar College biologist, and Adam Drewnowski of the University of Michigan asked obese and nonobese people to rate various combinations of sugar and fat given to them in the form of whipped cream. The overweight individuals tended to prefer a mixture that was 34.4 percent fat and 4 percent sucrose, while the normal-weight group liked a combination of only 7.7 percent fat and 20.7 percent sugar. On the other hand, switching to sugar substitutes is at best a partial aid to weight control. Dr. Theodore Van Itallie and Katherine Porikos of New York's St. Luke's-Roosevelt Hospital Center put some obese volunteers on a high-sugar diet and then substituted aspartame for sugar (without telling them), theoretically reducing their caloric intake by 25 percent. As time went on, however, Van Itallie found that the actual caloric loss amounted to 15 percent, rather than 25 percent. The subjects, he concluded, defended their weight by spontaneously consuming 10 percent more calories from unsugared foods. Still, says Van Itallie, this study suggests that low-calorie sweeteners may have some use in weight control.

Originally, artificial sweeteners were largely used by diabetics. But the Calorie Control Council estimates that about 69 million Americans 18 and over now consume products containing sugar substitutes, an increase of more than 60 percent since 1978, and the estimate would be dramatically higher if youngsters under 18 had been included. Diet soft drinks, first introduced in the 1950s, account for most of the increase. Kathryn M. Kolasa, head of the food and nutrition department at East Carolina University in Greenville, N.C.,surveyed 131 families and found that 88 percent bought diet beverages. Many of the mothers said they purchased them because they thought sugar is bad for kids. And the reason children and adults enjoy diet drinks is that the sweeteners have improved in flavor over the years. Nonetheless, all sweeteners are embroiled in medical controversy and no resolution is in sight. A look at the rocky history of each of the three major sugar substitutes:

SACCHARIN

A petroleum derivative discovered in 1879, saccharin was introduced as a sweetener early in this century. Some countries banned the substance early on because of suspicions that it might be dangerous, and in 1912 a panel of U.S. scientists put through a regulation that saccharin should be used only in foods intended for invalids. The recommendation was put aside, however, because of the sugar shortage during World War 1. Some consumers have always objected to saccharin because it produced a bitter aftertaste. In the 1960s, however, this problem was overcome when the sweetener was combined with another artificial sweetener, cyclamate.

The question of safety was revived when several studies linked saccharin to cancer in experimental animals. The major study, performed by Canada's Health Protection Branch, showed that rats and their offspring fed large amounts of the substance the equivalent of 800 cans of diet soda per day, according to critics of the study-developed bladder cancer. Since federal law prohibits the use of any additive found to cause cancer, the FDA proposed an immediate ban on saccharin in 1977. But protests from consumers and scientists led Congress to adopt a succession of moratoriums on enforcement while the safety of saccharin was given further study.

Subsequent experiments have upheld the finding that saccharin causes bladder cancer-but only in male rats whose mothers also were fed saccharin throughout their lives. To date, there is no firm evidence that the chemical causes cancer in man. Dr. Irving Kessler at the Johns Hopkins University School of Medicine examined the cancer mortality of more than 20,000 diabetics and found that deaths from bladder cancer were actually 29 percent fewer than would be expected in a group that size. For the time being, saccharin remains on the market, albeit with a warning label.

CYCLAMATE

This substance dominated the sweetener market-in combination with saccharin-through the 1960s. But after a 1969 study showed that cyclamate (mixed with saccharin) might cause cancer in animals, the FDA imposed a total ban in 1970, which its manufacturer, Abbott Laboratories, has been fighting ever since. At the FDA's request, a committee of the National Academy of Sciences reviewed all the published data on the safety of cyclamate and issued a report last June. The committee found that the additive doesn't seem to cause cancer by itself but might when combined with other substances and that, in humans, cyclamate-saccharin mixtures may be associated with a small increase in the risk of bladder cancer.

Cancer isn't the only issue, however. Some early animal studies suggested that cyclamate might also cause testicular atrophy and damage to chromosomes in laboratory animals. Consumer groups, therefore, fear that the NAS report that focused on cancer might encourage the FDA to permit the reintroduction of cyclamate. It was banned because of a combination of reasons, only one of which was carcinogenicity, notes Dr. Sidney Wolfe, director of the Health Research Group. Exasperated Abbott spokesmen, however, cite a 15-year study showing that cyclamate has no effect on the reproductive function of primates. Meanwhile, the substance is available around the world, except in the United States and Great Britain. Among its advantages are the fact that it is cheaper than either saccharin or aspartame and is especially effective as a sweetener when combined with either.

ASPARTAME

Approved for use as a tabletop sweetener in 1981 and for beverages in 1983, aspartame has stirred up more controversy than either of its predecessors. It is not, technically, an artificial sweetener since it is composed of two amino acids, phenylalanine and aspartic acid, which are natural constituents of proteins in such foods as milk, eggs and meat. Just by sheer coincidence, the combination happens to be sweet, says Dr. Alan Forbes of the FDA. Both the FDA and the American Medical Association assert that aspartame is safe except for those who suffer from PKU, an inherited inability to metabolize phenylalanine that leads to severe retardation. The outcry comes from a growing number of consumers who claim, like Edith Johnson, that aspartame causes a galaxy of disorders, ranging from nausea and headaches to seizures, blindness, rashes and brain damage. Mrs. Jacqueline Hausler of Olney, Md., filed the first aspartame suit last May, for $2 million, claiming that her five-year-old son suffered permanent neurological and psychiatric injury from the substance.

Critics charge that the FDA approved aspartame even though the manufacturer, G.D. Searle & Co., had failed to produce adequate evidence that it was safe. The case, says consumerist attorney James Turner, reveals a fundamental flaw in the whole regulatory process at FDA. Democratic Sen. Howard M. Metzenbaum of Ohio, who has made sweeteners a legislative crusade, introduced a bill that would require an independent agency, rather than the manufacturer, to test aspartame-as is the case with all other products submitted for FDA approval.

The scientific case against aspartame is hardly airtight, resting largely on anecdotes and some animal data. But there are theoretical reasons for concern. Dr. Richard Wurtman of the Massachusetts Institute of Technology, an expert in brain chemistry, worries that the large quantity of phenylalanine in the sweetener could interfere with the chemical neurotransmitters that normally conduct nerve impulses within the brain and "transiently affect a whole range of behaviors and other brain functions. This would be especially possible for a child who consumed a two-liter bottle of a diet drink on a hot day. For this reason he joins Metzenbaum in urging that diet-drink labels list the quantity, and not just the presence, of aspartame. Other experts have argued that aspartame might impair brain development in fetal life and have blamed the eye problems reported by some aspartame users on the fact that the sweetener contains methyl, or wood, alcohol.

In response, Searle spokesmen note that the amount of methyl alcohol in aspartame is less than would be consumed in a glass of orange juice. The FDA's Forbes concedes that there may be a small number of people who are sensitive to aspartame but says, "I really feel a strong sense of confidence that it is safe." He adds that there have been virtually no complaints about aspartame to drug authorities in either Canada or Great Britain. Meanwhile, a number of additional studies are planned to further pin down the effects of aspartame on the human brain.

As the controversy over artificial sweeteners continues, the chemical industry, of course, is busily searching for new and better substances to satisfy the craving for sweets. We still haven't found the ideal sweetener, says Keith Keeney of the Calorie Control Council. That's why we need so many different ones. One substance, called hernandulcin, has a long-lasting aftertaste that would make it especially suitable for chewing gum. So-called L-sugars are promising candidates. They might provide a sweet taste, but because they are the reverse in the chemical structure of the sugars people normally consume, they aren't digestible and wouldn't add calories. Acesulfame K is currently awaiting FDA approval; it is about 200 times sweeter than sugar, leaves no aftertaste and apparently is calorie-free. Researchers note that once the structure of the human sweetness receptor has been worked out, they should be able to synthesize a host of sweeteners to fit them. This is the long-term goal, says Marcos Hatada, a chemist at the University of California, San Diego.

Whether the taste comes from the natural product of the sugar cane or the chemical laboratory, history and culture tell us that man is permanently endowed with a sweet tooth. Knights returning from the Crusades brought back little pieces of sugar for their ladies. In India a banquet begins with a taste of the sweet dessert. And the Chinese, as always, have a proverb on the subject: In times of stress, sweeten the tea.

THE RAP AGAINST SWEETENERS

The search for the perfect sweetener has thus far been futile. The problems range from cavities to cancer.

SUGARS

The main health arguments against sugar, whether raw, brown, refined or in the form of high-fructose corn syrup, are that it can increase cavities and that it supplies empty calories 1 16 per teaspoon-that are virtually devoid of vitamins and minerals.

SACCHARIN

It contains no calories and is about 300 times sweeter than sugar. Since 1977 the FDA has threatened a ban because of evidence linking it to bladder cancer in rats. Warning labels now advise consumers of those findings.

ASPARTAME

It contains four calories a gram-the same as sugar but aspartame is about 200 times sweeter, so it's used in much smaller amounts. Some users have complained of problems ranging from headaches to seizures.

CYCLAMATE

A ban was imposed in 1970 after evidence was found that it caused cancer in laboratory animals. But a manufacturer claims the evidence was based on flawed studies and has petitioned the FDA to reintroduce the product. Cyclamate is 30 times sweeter than sugar and has no calories.

CALORIES AND CASH

Marketing battles between food ingredients aren't usually the sort of thing the public can get its teeth into. But this one's got plenty of intriguing elements: calories, cavities, cancer and, of course, cash. The fight to feed the national sweet tooth has never been more competitive, the market never more lucrative. Sugar and sugar substitutes go into everything from breakfast cereal to laxatives, and account for more than $8 billion in sales annually, a toothsome total, indeed.

Vying for sweet supremacy are two newcomers and two old standbys. In what is sometimes called the sugar segment, high fructose corn syrup (HFCS), introduced around 1970, has posed a real challenge to sugar's market leadership. In the low-calorie segment-by far the smaller of the two-aspartame has swamped saccharin since receiving FDA approval in 1981.

LOW COST

There is no secret to the appeal of HFCS: it's cheap-about 20 cents a pound, compared with 27 cents a pound for sugar. In 1972 products made from sugar beets or sugar cane accounted for 80 percent of the total sweetener market; sweeteners made from corn held a 15 percent share. By 19 84 HFCS alone had captured a full 30 percent of the market and the total share of all corn sweeteners had surpassed sugar for the first time. The ultimate prize came last year, when HFCS became the only sweetener used in almost all of Coca-Cola's and Pepsi's nondiet bottled and canned products. The clear reason why we made the change was economics, says Roger Berdoulay, vice president for marketing at PepsiCo Inc. "The cost savings [equals] $400 million to the total soft-drink industry. Having won over the soda makers, HFCS may find it hard to make any dramatic new gains. Some products require a dry sweetener, and there are some situations where sugar is needed for its bulk or other characteristics. Future growth will be much slower, says Robert Kinnee, director of marketing for the corn-products unit of CPC International, an HFCS producer.

If sugar makers have their way, any future growth for HFCS will be negative. Why Did the 'Old Cola Drinkers of America 'Turn Up Their Noses at Classic Coke? asked the Sugar Association, Inc., in a full-page ad that appeared in newspapers around the country last week. The ad contends that the loss of market share Coke has suffered since 1979 was due to its gradual substitution of HFCS for sugar. Most industry analysts, however, believe that it is impossible to distinguish between sugar and HFCS in processed foods and drinks. And they doubt that the Sugar Association campaign, which will cost $2 million this year, will have any effect. "The economics are so much more favorable for high fructose that you can have marketing battles from now until doomsday but there is no way the bottler is going to change," says Emanuel Goldman of Montgomery Securities.

SNOB APPEAL

The Sugar Association hopes to capitalize on the high cost of its product, however, using snob appeal. People will seek out the best chocolatechip cookies, the best candy, says association spokesman Sarah Setten. We think if there were a sugar-sweetened beverage people would seek it out and would be willing to pay somewhat more for it. The Sugar Association has been waging a separate ad campaign aimed at abolishing its image as a public-health menace. The ads stress sugar's safety and the fact that it contains only 16 calories per teaspoon.

Both sugar and HFCS are threatened by America's increasing appetite for diet foods. The success of aspartame has helped boost the low-calorie sweetener share of the total sweetener market from 4 percent in 1972 to 9 percent today. Aspartame owes its success to taste-it does not leave the metallic aftertaste that many people complain of in saccharin-and to clever marketing. G.D. Searle & Co., developer of aspartame, gave the compound a catchy name, NutraSweet, and launched the first consumer-oriented marketing campaign for a food ingredient. The ads touted NutraSweet as an amazing substance that was totally natural, nonfattening and didn't promote cavities, like you know what.

Preselling NutraSweet to the public helped Searle to make the product irresistible to its primary target: food and beverage makers. Aspartame has all but replaced saccharin in the national beverage market (Dr Pepper is one significant exception). But the old standby has remained dominant on the table top, where the two compete as Sweet 'n Low (saccharin) and Equal (aspartame). Marvin Eisenstadt, president of Cumberland Packing Corp., the makers of Sweet 'n Low, attributes his product's staying power to the fact that people have gotten used to it and see no reason to switch.

SALES TONIC

Aspartame has proved to be the elixir of life for Searle, just acquired by Monsanto Co. in a friendly buyout. Last year sales of NutraSweet and Equal totaled $585 million, outstripping the company's pharmaceutical revenues by $45 million. Growth will continue as aspartame begins to flavor new products, including ice cream, juices and jams. But Searle's U.S. patent on the compound will expire in 1992, throwing the domestic market open to competition. Searle may soon have to contend with another rival. Abbott Laboratories is petitioning the FDA to be allowed to resume sales of cyclamate, the sweetener that was ordered off the market in 1970 when it seemed to cause cancer in rats; a decision is expected before the end of next year. Used in a blend with saccharin, cyclamate produces a good-tasting sweetener that is far cheaper than aspartame.

More threatening is the possibility someone will come up with a new product that will be good tasting, sweet, cheap and proven safe beyond challenge. Such a compound would not only threaten aspartame and saccharin but would undoubt edly help diet foods make further, even more dramatic inroads into the overall food and beverage markets. No one is working harder than Searle.

If anyone is going to put aspartame out of business, it's going to be us, says Searle vice president Bertram Shelton. But scientists at dozens of other companies are also busy blending chemicals and bending molecules in the search for the perfect sweetener. The incentive is obvious: the company that gets there first will be able to live off the fat of the land for years to come.