The David Gillespie Blog

Yesterday the US Centers for Disease Control published an interesting study they’d been doing on heart disease risk factors. They divided a group of 6,113 American adults into five groups and measured all the traditional stuff. You know, waist circumference, fat consumption, weight, etc.

The people in all five groups had about the same body mass index (a measure of weight for height where 25-29.9 is considered overweight – they were all about 28) and had about the same waist circumference (95 cm). And I guess those stats are interesting right there, given these were average Americans, not specifically selected for being overweight.

But one of the groups was a standout on many of the measures. They had the lowest fat consumption (just 28.9% of total calories). They had the lowest saturated fat consumption (just 9.7%). And they had the lowest cholesterol intake by a country mile (only 238mg).

This group were poster children for the low-fat lifestyle we are all encouraged to pursue. There was just one little problem, their blood work was awful. On average the folks in the low-fat group had by far the worst blood cholesterol and triglyceride (blood lipid) readings of all five groups. And they weren’t just bad, they were time-to-order-some-drugs bad.

The groupings had been done on the basis of how much added sugar was in each person’s diet (from less than 5% of calories through to 25% or more). The group that had those lousy blood results were the ones who also ate the most sugar. On average, they (1,135 people) were each eating 192 g (46 teaspoons) of added sugar per day. ‘Added sugar’ does not include the sugar in fruit, dried fruit or juices, so total sugar was likely to be appreciably higher than that.

And it wasn’t just a coincidence. As you look down the results, the amount of sugar consumed by each group directly correlated with their cholesterol and triglyceride levels. The group (893 people) that ate the least sugar (13.6 g or 3 teaspoons) had blood work right where it should be for minimal (to non-existent) heart disease risk. The high sugar folks had gained 1.27 kg in the last year. Again, weight gain consistently correlated with sugar (and not fat) consumption.

The researchers discounted the possibility that high sugar intake was just a marker for someone who ate a lot of bad food anyway. The association between sugar intake and blood lipids was independent of the fat and cholesterol components of processed foods. The link also persisted when the researchers took into account smoking, drinking and levels of physical activity. The study leaves no room for doubt that what they were observing was all down to the sugar (and the sugar alone).

The American Heart Association (AHA) is no doubt feeling pretty pleased with itself. It came out last August and told Americans they needed to dramatically reduce their sugar intake. This study backs up their advice in spades. People in the study who consume added sugar at the maximum levels recommended by the AHA (9 teaspoons per day for an adult male) ended up in the second lowest group for badness with blood fats. Not perfect, but an awful lot better than the boys and girls slugging down 46 teaspoons a day.

So what is the Australian Heart Foundation’s position on sugar? Well, not much really. They mention that “A high sugar content doesn’t necessarily make a food ‘bad’”, but point out that it isn’t so much the sugar content that’s bad as whether or not the food has other nutrients.

To our Heart Foundation, sugar is just another carbohydrate and not a particularly harmful one at that. In response to one of my earlier rants) Susan Anderson, National Director, Healthy Weight at the Australian Heart Foundation told Cardiology Update “Although associated with tooth decay… eating sugar itself is not clearly associated with other health problems.”

Surely this latest (large cohort) study finally puts a pin in that notion? Yep, sugar will definitely make your swimming togs shrink by the time summer comes around (and the odd tooth fall out), but (much more dangerously) it will also really put you on the path to death-by-heart-attack (with serious symptoms by age 38 according to these figures).

No study on fat has ever produced a result like this – ever! Not even close. So will the message on heart disease be changing here in Australia? Will we stop bagging fat and start going after the real culprit? I’m not a betting man, but I reckon the odds are slightly higher that the Storm will win the grand final – what do you think?

What do you do when a strategy you’ve been executing for almost 30 years is plainly not working? If you’re the nutrition hierarchy in Australia, apparently the answer is you just keep doing what you’ve always done.

In 1981, the National Health and Medical Research Council (NHMRC) published the very first set of guidelines aimed at making Australians healthier. They had published guides on what to eat since 1954 but these had been focused on the nutrients we need just to stay alive (rather than attempting to improve us).

The 1981 guidelines were different. For the first time they were aimed at preventing chronic diseases. Fat was blamed for the increasing rates of obesity and heart disease, so just like the American version (released a year earlier) our guidelines were focused on fat consumption, recommending we should ‘Avoid eating too much fat’.

And that’s pretty much how the guide has read for the last three decades. In short, fat makes you fat and sick and you should eat a lot less of it.

I very much doubt that anyone actually pores over the guidelines while they fill their shopping trolley, but many of us use them without realising it. They are the basis for the nutrition (daily intake) recommendations on every packaged food we buy. They form the foundation for every piece of advice any government agency or nutritionist gives us (from school canteens to hospitals). And every meal for our military forces is created using a policy based on the guidelines.

Because of this, the eat-less-fat message got through to us loud and clear. Between 1980 and 1995, the average Australian successfully decreased the amount of fat they were eating by 5% and the amount of cholesterol by a whopping 18%. We replaced the fat with carbohydrates (bread, cereals and sugar), increasing our consumption by 16.5%.

Unfortunately the obesity statistics went in exactly the opposite direction to our fat consumption. In 1980, two in five (39%) Australian Adults were either overweight or obese. By 2008, only two in five weren’t (62% were overweight or obese). In just 28 years, all that low-fat eating (or was it the high-carbohydrate eating?) had managed to increase the number people with a weight problem by 58 percent!

Heart disease sufferers didn’t fare much better. The number of people afflicted increased by 12% between 1989 and 1995 (despite significant advances in health care for heart patients in that period).

Evidence that fat makes you fat and sick was suspiciously lacking by the time the revised guidelines came out in 1992. And the proof that the theory was nonsense was there in spades by the time the third release hit the streets in 2003.

A comprehensive review of the evidence had been published in the British Medical Journal in 2001. It concluded that despite decades of research (and thousands of people participating in randomized trials), there was “still only limited and inconclusive evidence” that the amount or type of fat you eat makes any difference to your chances of death by heart attack.

The guidelines are currently being reviewed ahead of publication of new version (hopefully next year). So can we expect a sudden change of heart from the nutrition elite? The US experience suggests pigs may be approaching the runway before that happens.

The US guidelines are being reviewed this year as well, but they won’t be changing much because (according to Meir Stampfer, a Harvard professor of nutrition and epidemiology who worked on the 2000 guidelines) scientists on this year’s committee know perfectly well what the evidence says, but few researchers want to shake the status quo or risk confusing the public.

Here in Australia, status quo is definitely the name of the game as well. The draft update to the new NHMRC dietary guideline released this week takes 678 pages to tell us that not much will be changing.

And you don’t have to look too far to see why. The NHMRC is heavily dependent on the Australian Heart Foundation for scientific review of the evidence on fat and heart health.

Despite the fact that Heart foundation researchers have been publishing scientific reviews since 2003 that say things like:

• “Dietary fat is not an independent risk factor for the development and progression of overweight and obesity”;
• “Eating patterns low in fat and high in carbohydrate may not be beneficial for lowering [heart disease] risk”; and
• “There is no direct relationship between total fat intake and the incidence of [heart disease]”,

none of that science has stopped them plastering their website with messages imploring us to eat less fat (or stopped them jumping into bed with margarine manufacturers and sugary snack makers). Maybe they’re scared the public (yep, you) will get confused by all that science?

For the last three decades the NHMRC and the Heart Foundation have been spending our hard earned tax dollars telling us to eat less fat (and by implication, more carbohydrate). For at least the last 10 years, that message has been demonstrably wrong.

Now I guess that would be merely irritating if they’d been telling us that parting your hair on the left caused bad breath (it doesn’t). But millions of real people have made daily decisions about what to shove in their mouth based on this advice (whether they knew it or not) with the direct result that they are significantly fatter and sicker than they were the day before.

Its time those we trust with our health stopped worrying about confusing our pretty little heads and started worrying about the fact that their advice is killing us. I’d rather be confused than dead. How about you?

One of the primary motivators for Kevin and Nicola’s proposed ‘reform’ of the health system is the explosion in health costs predicted in the Intergenerational Report released in February.

Kevin explains “If we do not change the system, the state and territory budgets will be overwhelmed entirely by health costs over the next 20 or 30 years to the point that their ability to do anything else would be removed,” and Nicola backs him up by pointing out that the direct cost of treating diabetes alone is projected to increase 436 percent (!) from $1.6 billion to $8.6 billion by 2032-33.

According to Diabetes Australia, those numbers are likely to be a vast underestimate. They reckon almost 15 percent of the population already suffer from diabetes (or pre-diabetes). Worse still, those numbers are going in only one direction – up, big time – because according to them, “there is no cure for diabetes”.

Diabetes is currently the sixth biggest killer of Australians, but headed for number one with a bullet. And before it kills us (and this is why Kevin and Nicola are worried), we will each probably consume hundreds of thousands of public health dollars (primarily as drugs) being treated (and not being cured).

There are three main types of diabetes (Type I, Type II and Gestational) and they are all on the increase, but the one everyone is worried about (when it comes to health dollars) is Type II Diabetes.

Type II Diabetes is variously called Non-insulin Dependent, Lifestyle or (less and less now) Late Onset, Diabetes and it currently accounts for around 95 percent of all diabetes diagnosed in Australia. It’s been a national health priority since 1996. Since then, the prevalence of the disease has doubled, so whatever we’ve been doing it aint been working too well so far.

Type II Diabetes is the end stage of a disease which starts out as failure of our ability to process carbohydrates (about 60 percent of our food). Our bodies convert most carbohydrates to glucose. In healthy people that glucose is pumped out to the cells that need energy via our bloodstream. Cells that need energy, signal their desires by moving glucose receptors to the cell surface (kinda like hanging out the “this room needs servicing” sign in a hotel).

In people who ultimately become (Type II) diabetic, something goes wrong with the “room needs servicing sign”. The receptors never get to the cell surface (or if they do, it’s in smaller numbers). The result is that the glucose goes sailing by. The maid doesn’t know the room needs her.

Because the glucose doesn’t get used by the cells (or not as many of them), it stays in the bloodstream longer and the result is a longer than normal high blood sugar concentration. People in this early stage fail 2-hour after-meal blood sugar tests but do ok on fasting blood sugar tests. If they’ve been fasting (haven’t eaten) for a while then blood sugar will have returned to normal. These people are often diagnosed as being “pre-diabetic”.

We can be pre-diabetic for decades. Eventually though, we lose the ability to clear the glucose at all and that’s when we officially have Type II Diabetes. It’s the point where we can no longer get our blood sugar levels back to normal even after fasting.

Doctors will tell you that there are all sorts of risk factors associated with Type II Diabetes. If you’ve got a high BMI, thick waist or high total body fat (all different ways of saying you’re fat), you’re in the gun. But one symptom has a much higher correlation than any of those, yet strangely it is never spoken of (probably because it’s a tad bit hard to measure). The one thing that almost always means you are on your way to Type II Diabetes is the amount of fat stored in your muscles (whether you look fat or not).

That accumulated fat in the muscles is an indication of persistent high levels of circulating fat. And it has been shown to directly interfere with the ability of cells (that need energy) to get the receptors to the cell surface. It’s like some fat guy is standing between you and the door when you want to hang out the ‘room needs a service’ sign.

So if you want to do some experiments on diabetic rats and you don’t have any handy, you can give normal rats diabetes by increasing the amount of circulating fat in their bloodstream. And the best way to do that is to feed the rats sugar. The fructose half of sugar (sugar is a 50/50 mix of glucose and fructose) is converted directly to the kinds of fats necessary to create diabetes as soon as it is eaten.

The latest in a line of studies that have tried this on humans got the expected results last year. The researchers at the University of California fed volunteers diets supplemented with fructose (at around twice the level consumed by the average American). The result was a 20 percent decrease in the effectiveness of clearing the glucose out of the bloodstream – step one on the Type II Diabetes treadmill. Other recent studies have shown that when carbohydrates (including sugar) are pulled out of the diet, Type II Diabetes symptoms are reversed.

The Californian study lasted just 10 weeks (and clearly longer term studies are needed) but red flags are waving all over the place. Sugar consumption creates exactly the kind of fat needed to turn us all into Type II Diabetics. It shouldn’t come as much of a surprise then that as our per person sugar consumption soars past 1 kg per week, Type II Diabetics are being minted at the rate of 275 per day (and counting).

But you won’t find any warnings about not eating fructose on the Diabetes Australia website. In the face of a deadly epidemic (accelerating at epic proportions) why are we not being told what the research says about sugar? Why is the government response restricted to rearranging the funding deckchairs on the titanic? And why do our healthy eating guidelines persist in advising that there’s nothing wrong with a diet that’s 20 percent sugar?

Unlike death and taxes, Type II Diabetes is not inevitable. It can be stamped out and it can probably be done easily by eliminating added fructose (sugar) from our diet. But first, those we trust with our health need to stop fighting about who pays for the amputation of our gangrenous limbs and start reading the research on sugar.

A study published this week says that we are 87 percent more likely to contract pancreatic cancer if we have two cans of soft drink a week (about 10 grams of sugar a day on average). But the current Australian healthy eating guidelines say it’s perfectly fine to slurp up more than ten times that much sugar. Is there a problem here?

In the study, 60,524 Singapore Chinese were followed for 14 years (not literally, they were surveyed on their dietary habits). Their names were cross-matched with health records. Those that drank two or more soft drinks a week were much more likely to be among the 140 that had contracted pancreatic cancer in the intervening years.

Clearly the study doesn’t prove anything. You could drive a truck through it with questions like “What else did they eat?” “Did they smoke as well?” and so on. But it’s not the only recent study coming up with similar results.

A 2006 study published by the Karolinska Institute in Sweden also decided soft drinkers were in significant jeopardy, and had warnings for anyone eating sugar at all. The Swedish study began in 1997 when scientists ran a dietary survey of almost 80,000 healthy people, who were subsequently monitored until June 2005. According to the cancer registry, 131 people from this group had developed cancer of the pancreas.

The researchers were able to demonstrate that the risk of developing pancreatic cancer was directly related to the amount of sugar in the diet. The people who said that they drank soft drinks twice a day or more were 90 per cent more likely to develop pancreatic cancer than those who never drank them.

It won’t shock you to discover soft drinks are not health food, but the study went on to report that people who added sugar to food or drinks (like tea and coffee) at least five times a day were at 70 per cent greater risk than those who did not. People who ate fruit jams at least once a day also ran a higher risk – they developed the disease 50 per cent more often than those who never ate them.

As far as our bodies are concerned, a soft drink is a combination of just three things, water, glucose and fructose (the two halves of sugar). If water or glucose is the problem then we should all give up now. Water is critical to survival (if you like living more than three days) and if we were cars then glucose would be our petrol. A 2002 a study tried to tease out which food element had the greatest association with pancreatic cancer, and fructose got first prize.

The study conducted by the US National Cancer Institute identified 180 cases of pancreatic cancer from among 88,802 women who were monitored for 18 years as part of the Nurses’ Health Study. Women who were overweight and sedentary and had a high fructose intake were shown to have a 317 percent greater chance of developing pancreatic cancer.

Big Sugar’s response to the most recent study was as predictable as death and taxes. Richard Adamson, a consultant to the American Beverage Association (ABA) said in a statement “… soft drinks do not cause cancer … You can be a healthy person and enjoy soft drinks. The key to a healthy lifestyle is balance — eating a variety of foods and beverages in moderation along with getting regular physical activity.”

Well, he would say that wouldn’t he. You canna blame a man for trying (it on). After all, the ABA is in the business of selling soft drinks. The fact that he could have been reading from the current Dietary Guidelines for Australian Adults is of much more concern.

The Australian guidelines say “Consume only moderate amounts of sugars and foods containing added sugars.” They go on to explain that what that means is up to 20 percent of energy intake. For an adult male eating a 2,200 calorie diet, that is 110 grams of sugar (about three cans of soft drink) a day.

In Australia, pancreatic cancer is the fifth most lethal cancer for both men and women. Every year it kills almost twice as many Australians as Melanoma and the numbers are steadily increasing. It is also the least treatable cancer. More than 95 percent of sufferers are dead within five years of diagnosis (compared with just 7 percent for Melanoma).

None of the studies on sugar and pancreatic cancer are conclusive on their own. But taken together, there is cause for serious concern. Sugar consumption is clearly implicated in a disease which (every year) kills almost one and a half times the number of Australians as die on the nation’s highways. And yet the people we rely on for nutrition advice tell us that it’s perfectly fine to consume sugar at ten times the level which was a problem in the most recent study.

It’s time to wake up, smell the (unsweetened) coffee and act on sugar before we sentence even more Australians to death by pancreatic cancer.

Governments are often criticised for not putting in the hard yards when it comes to forward planning. They start building desalination plants after we run out of water. They start adding lanes to freeways after traffic is at a standstill. They build more power stations after the black-outs start.

But there’s no way you could accuse Paul Lucas (Queensland’s Health Minister) of such poor planning. He’s already building the infrastructure necessary to treat the victims of childhood obesity in 2014.

Back in 2007, the Queensland government implemented a series of initiatives aimed at reducing childhood obesity by 33 % by 2020. Smart Choices would force children to eat healthy food at school and Smart Moves would force children to exercise for at least half an hour during school time.

The policies are very similar to programs for healthy eating and exercise implemented as part of the UK’s Healthy Schools initiative. Those programs were kicked off in 1999 because surveys in 1995 had shown that a quarter of British kids were overweight or obese. In Queensland we took until 2006 to reach that particular milestone, hence the delay (I guess).

The British programs have met with resounding failure. Now almost a third of English kids are overweight or obese. And the prediction is that the numbers will be truly diabolical by 2050.

The presumption underlying the Smart Moves program is that sport prevents obesity in children. But an extended study of the UK program to be released this week suggests that is likely to be nonsense.

After a decade long study of children in the UK, the researchers have concluded that increased physical activity is unlikely to reduce a child’s weight. For years nutritionists have told us that kids are fat because they don’t exercise. But the study concludes that the opposite is in fact the case.

Overweight children eat more and exercise less because they are fat, not the other way round. When you think about it that has a certain logic to it. We are perfectly happy to accept that when children grow taller they demand more food, so why wouldn’t we accept that when they grow fatter they do the same.

We are also happy to accept that a pregnant woman puts on weight (and eats more) because she’s preggers. And just like a pregnant woman, an overweight child, exercises less because it is much harder to move when you are carrying extra weight. Less exercise is a side effect of weight gain not the cause of it.

Growing taller happens because of the work of growth hormones in the child’s body. Pregnancy happens … well, you know why … and also involves hormones. Growing fatter also happens because of the work of hormones.

Appetite control hormones precisely regulate the amount of additional weight gained, but sugar (or more precisely, the fructose half sugar) has been shown to disrupt the operations of those hormones. But fructose limitation is not on the menu for the Queensland government any more than it is in Ole Blighty.

Just like its British equivalent, Queensland’s healthy eating in schools program focuses on the anti-fat dogma trotted out by nutritionists for the last five decades. It has little concern for sugar unless it has been added. Soft drinks are coded ‘red’ because of the added sugar and can only be consumed twice per term (maximum). But juices with identical (or higher) sugar content are coded ‘amber’ and can be consumed every day.

I asked Paul Lucas about that contradiction in July last year. In my request I supplied him with references to many of the recent studies on the damage done by the fructose half of sugar. Paul finally got around to having a minion reply to me in the New Year.

The minion agreed that diets high in added (his emphasis) fructose were indeed undesirable because fructose promotes weight increase, chronic disease and increased circulating fatty acids. But he points out that fruit juice is high in naturally occurring (my emphasis) fructose not added fructose. As such there is no need to change the policy.

Ah, I see. So somehow the very act of adding fructose to water rather than removing the fruit from the fructose and water (juice) must magically transmogrify the fructose from a healthy substance to a dangerous substance. I’m glad that’s been cleared up.

As much as Paul is having his minion trot out the party line, it would seem that he has one eye on the ‘success’ of the British programs. On Sunday he announced that in 2014 Queensland will have its very own childhood obesity treatment clinic. When Smart Moves and Smart Choices produce the inevitable increase in childhood obesity, Paul will be there ready with the ambulance parked at the bottom of the chronic disease cliff face.

How many children need to be sacrificed to nutritional dogma before the science on fructose crosses into the political domain. Do all our kids need to be overweight or suffering from diabetes before we acknowledge that the ‘fat makes you fat and exercise makes you thin’ advice is just plain wrong? Or can we start doing something about it now? Maybe, just maybe, if we did, by the time that brand new clinic is open for business, they won’t be needed.

Also published in Crikey

I’ve got some very exciting news to share. I’ve been offered a job! And it’s not just any job, its diplomatic post.

I didn’t have to schmooze Kevin or even be a ‘successful’ liberal ex-politician. All I had to do was ‘enjoy talking to others’ and love ‘sharing thoughts and information on how they can make a positive difference to the environment, the community and the people around them.’

Obviously my interest in sharing information preceded me (who knew so many powerful people read Crikey?). Because when the diplomatic corps needed help with their environmental community sharing messaging, my name was clearly at the top of the list.

They’ve even noticed (I’m not sure how) that I am renown for being the ‘guardian of the household’ and the maker ‘of family decisions’, so kudos to them and their thorough information gathering. Although to be honest it would have been good not to mention that so publicly. It has gotten me in a bit of bother with her indoors.

My personally engraved invitation arrived just yesterday (copy below). Now some (clearly envious) folks have suggested that it might have been sent to more than just me. But that can’t be true, it is addressed to me personally (it says ‘Dear David’). They are clearly aware of my love of sharing information. And they practically plead with me – signing off with “we would love to hear from you.”

No, naysayers be buggered. Coca-Cola has clearly turned over a new leaf. They have decided to be an environmental saviour of some description (with a diplomatic corps – it’s an ambassador they want). And they need an excellent communicator (oh, say, like me) to help convince people how wrong they’ve been to think of them as just a purveyor of sugar (and water).

Oh there’s some i dotting and t crossing to do, but I’ve filled out their little online form. So I’ll no doubt be taking up my new posting any day now. I wonder if it will be based in the Maldives? I hear they are nice (although prone to flooding due to global warming now – hey maybe they’ll send me straight to Copenhagen).

I can’t wait to start sharing information on how other people can make a positive difference. Maybe I should start now. Ahem – People (that’s you) can make a positive difference to the environment by buying sugar sweetened beverages. The drinks will make you fat, which means not all the sugar is turned into energy. Less energy, less CO2 out of your mouth. So drink up, the planet will thank you!

How am I doing? I reckon I’m made for this corporate spin ambassadoring lark.

Also published in Crikey.