The David Gillespie Blog

Why is the Australian Heart Foundation handing out ‘ticks’ to confectionary?

Over the last few weeks I’ve been having a bit of a go at Nestle. I’ve been worried that when they tell children that their Fruit Fix confectionary is equivalent to ‘1 Serve of Fruit’, they may be misleading the little dears (and their mummies and daddies). The product is almost three quarters sugar and while that makes it a candidate for lolly of the year, I think it’s a bit of stretch to market it as ‘natural and nutritious’.

When Nestle wrote back and protested their innocence, I was a little surprised that they didn’t wheel out the one obvious defence they did have to my assertions. Surely they could accuse me of outrageous plundering of public sensibilities by simply pointing to the little red tick on the front of the box? You see, our little fruit flavoured friends have been ‘tick approved’.

That’s right, none other than the Australian Heart Foundation has certified Fruit Fix as tick worthy.

I immediately dashed off an email to the heart foundation to check that it was true (you can’t be too careful in these days of dodgy emails and made-up utes – or was that made-up emails and dodgy utes?). And blow me down if it wasn’t so. They explained that the reason that Fruit Fix had earned their stamp of approval was that:

“Fruity [sic] Fix’s sugar content comes entirely from sugars that occur naturally in fruit – they are not added sugars. In order to earn the Tick on this type of food, the product must be at least 95% fruit. [their emphasis]”

Now, I suspect (like a lot of consumers), you’ve never really looked into what a heart foundation tick means. I’ve just assumed that they are hard to get and a product that has one must be really good for me. I mean if the heart foundation gives it a tick, it must mean it’s good for (at least) my heart, right?

The heart foundation website does certainly encourage that perception. They proudly report that ‘The Tick is the Heart Foundation’s guide to help people make healthier food choices quickly and easily’ and ‘Tick foods offer not only a healthier choice but truth in food labelling too.’

They’ve also done quite a bit of research on how we perceive the tick. The data tells them that they’ve been very successful in promoting the tick as a brand that consumers respect and value as a stamp of approval for healthy foods. Thirty percent of us actively look for products with a tick and 78 percent regularly or sometimes use the tick when shopping for food.

With that kind of marketing firepower behind it, you can be sure that any manufacturer aiming at the kiddy market would give their left arm, leg, well anything, to have the tick stamped on the label. A mother that walked past a tick certified snack for little Johnny and chose a plain ol’ unticked bar instead would have to be certifiable herself, surely?

But that kind of power brings a truckload of responsibility. We trust the heart foundation to guide us through the maze of food labels and health enhancing claims (from ‘iron man food’ to ‘50 % more calciYUM’). We believe the Australian Heart Foundation when they tell us a food is ‘a healthier choice’. We pay that bit extra based entirely on their assurance that we can do no better for Muffy and Geronimo. All we ask in return is that they be right.

When the heart foundation started handing out ticks twenty years ago, science knew very little about how our bodies process sugar. One of the core hormones involved wouldn’t even be discovered for another five years and many of the critical studies were not even a gleam in the researcher’s eyes. The evidence linking sugar to heart disease was still thin on the ground. So it’s easy to understand how the criteria for the allocation of a tick might not pay too much attention to sugars.

But today, the science is done, the evidence is in and it’s unequivocal. Sugar consumption is the most significant factor in the accelerating incidence of heart disease, diabetes, obesity and a raft of associated illnesses. In that context, to certify as safe, a product which is almost three quarters sugar is outrageous. This is even more so, when the certifying organisation knows how much we rely on their stamp of approval.

There is no ‘added sugar’ in Fruit Fix, but that does not mean there is no sugar. Sugar is sugar is sugar. No sane chemist would argue that a sugar molecule that once formed part of a piece of sugar cane is any more or less ‘sugar’ than one which was part of an apple or a banana or a strawberry. It doesn’t come as too much of a shock if a marketer (with a product to sell) is deliberately misleading when they justify high-sugar products on the basis that fruit was in some way involved in their construction. It comes as a mighty big surprise (and somewhat of a disappointment) when a self-appointed watchdog does the same.

I had always believed (like most of us, I suspect) that the Australian Heart Foundation was a powerful force for good in ensuring we are all eating better. But, for the tick program to retain any relevance, the heart foundation must ensure that it is up with the latest science. And it must guard against abuse of the program by those skilled in making semantic arguments. Whacking a tick on a children’s food product that has more sugar than a Mars Bar (simply because its sugar came from fruit rather than cane) is at best irresponsible and at worst, child abuse.

I’m nothing if not responsive to reader requests. Richard Andersen has written to express some concerns about my recent post on Uncle Toby’s Fruit Fix bar. Richard is General Counsel (a lawyer) for Nestle Australia Ltd and he says that Nestle is worried that you might have misunderstood some things in my post. So in the interests of clarity and fairness, in this post, I’ll go through each of Nestle’s concerns and correct the record.

Righto, off we go – Nestle says that I “represent[ed] … that the Fruit Fix Strawberry variant contains only strawberries … The front of pack clearly describes the product as ‘… apple, strawberry and grape snack’, which you have failed to mention in your post.”

Well true enuff Richard, you’ve got me there mate. I didn’t recite the front label of the pack. I just went ahead and referred to the product by the name Uncle Toby’s used to describe it on their site (I didn’t actually buy a packet of the stuff!). So for the record folks, Fruit Fix Strawberry is an apple, strawberry and grape snack. It does not under any circumstances contain just strawberries, so don’t go thinking it does.

Richard then says that Nestle is concerned that comparing the sugar content of a strawberry to a fruit fix is misleading because Fruit Fix also contains apples and grapes. I don’t want anyone being mislead so here is the full comparison (including apples and grapes – SFF is Strawberry Fruit Fix):

Protein: Strawberry 1% Apple 0% Grape 1% SFF 1.3%

Fat: Strawberry 0% Apple 0% Grape 0% SFF .5%

Sugar: Strawberry 4.6% Apple 10.4% Grape 15.5% SFF 72.7%

Fibre: Strawberry 2% Apple 2.4% Grape .9% SFF 7.3%

The highest sugar concentration is 15.5% which is still a long way from 72.7% so I’m not sure what point Nestle is trying to make. Even if Strawberry Fruit Fix contained nothing but grapes, you’d still need to eat almost half a kilo of them to get as much sugar as 100g of Fruit Fix, but there you go, full disclosure.

Next Nestle was concerned that I “… make an inference that additional sugar has been added to the product … The product uses fruit puree and juice, which are inherently high in natural fruit sugars”. Notice how they underlined the word natural, I think it must be a magic word. Lawyers always underline magic lawyer words.

I can’t see where I have suggested that sugar is ‘added’ in the original post. But just in case anyone is confused, I unequivocally state that I don’t think any ‘additional sugar has been added to the product’. There’d be barely any room for anything else if they did, given all the sugar that’s already there.

No, I’m happy to accept Nestle’s word that the sugar in Fruit Fix comes entirely from fruit. Nestle seems to think that a molecule of sugar that was in some way associated with a piece of fruit in a prior life is an entirely different kettle of fish than one which found its genesis in a piece of sugar cane (like grapes, sugar cane is about 15% sugar in its natural state). I think this must be some sort of grass-ism (sugar cane is a grass). Nestle appear to believe that fructose molecules from fruit come from a better neighbourhood than those from grass. Apparently once being part of a piece fruit earns them the special label ‘natural’ as opposed to those (I guess) unnatural ones which were once part of a piece of sugar cane.

Nestle also takes exception to me suggesting that they are telling lies by emblazoning their product with ‘1 Serve of Fruit’ and advertising the product as a healthy and nutritious snack. They point out that unlike me, Nestle have carefully ensured they know the legal definition of the word ‘fruit’.

Silly old me. You see when someone says ‘1 Serve of Fruit’, I think of an apple or maybe a banana. But that’s where I’ve gone wrong according to Nestle. No, what I should be doing is reaching for my handy copy of The Australian Guide to Healthy Eating where I will discover (once I drill down to the fine print) that fruit juice and fruit puree are also considered to fit the definition of ‘fruit’. Since Fruit Fix is made from both of those ingredients, it is therefore ‘fruit’.

So when you define the words just the right way, Nestle is telling God’s honest. Personally I think it would be more honest to emblazon the box with ‘Five to Sixteen equivalent serves of sugars that were once part of a piece of fruit’ but I can see how the Nestle marketing people might not go for that.

Unfortunately Nestle didn’t give me their definition of ‘healthy and nutritious’ so I’ll just have to rely on common sense for that one. I take the phrase to mean the food will promote good health (or at least not bad health). And this is where Nestle and I will have to disagree on the ‘truth’. Nestle maintains that a food which is almost three quarters sugar (and the majority of that, fructose) promotes good health. But there over 3,000 published studies which say exactly the opposite.

The latest one (published just last month in the Journal of Clinical Investigation) reported on a study at the University of California where 32 overweight and obese people were persuaded to try a 10 week diet which was either 25 percent fructose or 25 percent glucose. Fructose and glucose are the two sugars that bind together to make table sugar. So ‘sugar’ is half fructose and half glucose (yes, even when it comes from fruit rather than cane).

The people on the fructose diet ended up with increased (1.5kg) abdominal fat, higher triglyceride levels (which leads to heart disease) and 20 percent higher insulin resistance (which leads to Type II Diabetes) after just 10 weeks! None of this happened to the group on glucose.

The University of California research is just the latest in a long line of studies which say the same thing. Sugar (or at least the fructose half or it) is highly dangerous to humans. And there is no shortage of research which shows that fat in the blood (the higher triglyceride levels) from fructose leads to obesity, heart disease and type II diabetes.

The ‘sugar’ in the Fruit Fix is likely to contain significantly more fructose than table sugar, coming as it does from condensed fruit juices. So Nestle are telling parents that it’s good to feed their kids something which consists of large amount of a substance which has been proven to cause obesity, heart disease and diabetes (to name a few of the problems). That does not fit my definition of ‘healthy and nutritious’, so in that sense I believe Nestle is lying when it says that Fruit Fix is a ‘healthy and nutritious’ alternative to fruit.

I guess to lie you must know that what you’re saying is not true. And I have assumed that Nestle would be aware of the research on fructose. I do sincerely hope that their defence (as one of our biggest food suppliers) is not that they weren’t aware of the dangers of sugar.

It’s a free country. Nestle has just as much right to sell high sugar, fruit flavoured confectionary as the next guy (actually a Mars Bar, for example, has considerably less sugar – ‘just’ 55.3%). What they should not do is tell us that it is a healthy and nutritious snack while they’re at it.

I must admit to being a bit of rowing tragic.  I don’t actually row, but rather like former PM John Howard (with cricket), I talk a good game.  So as I meander through the online world of sugar research, papers about rowers naturally attract my attention. And when I see one that seems to provide a magic bullet for off-the-scale performance improvement, I’m very interested.

You might have missed it but the January 2006 edition of the Journal of Sport Science carried an interesting little study on US female college rowers.  The study was trying to see if there was any truth to the old wives tale doing the round of ‘sports nutritionists’ that ribose supplements would enhance athletic performance.

For a while, researchers have known that giving a simple sugar called ribose to heart patients after surgery can help with their recovery, but studies on healthy people had shown no particular benefit (and sometimes quite a bit of danger, but that’s a story for another day).

The rowing study decided to test out the theory on rowers by giving them 10g of ribose dissolved in one cup of water (250ml) before and after training for an eight week season.  Like all good studies they had a control group which they decided to give the same amount of glucose instead.

The researchers then recorded the racing times for the crews over 2,000 metres (a standard race distance for that level of rower).  The ribose group’s performance did improve (by 5.2 seconds) over the season.  But that’s about what you’d expect from 8 weeks of training.  So bad news for the ribose supplement crowd. 

The really interesting news was in the control group (on glucose).  They improved on average 15.2 seconds over the distance.  Three times as much!  Just by giving them a bit of glucose in water.  Now if you don’t think that sounds like much you’ve obviously never sat and waited that long for your crew to finish after the first boat crosses the line.

To give some perspective on that time difference, a different study on US female college rowers looked at what difference a rower’s experience made to how well she rowed.  They concluded that someone with 3 years of rowing experience at college level would on average row 2,000 metres 32 seconds faster than a girl with no experience.  Against that background, over 15 seconds from a glass of glucose water before and after training looks like a very big deal. 

A different study (not about rowers, so I almost missed it) out of Greece (to be published in the June 2009 edition of International Journal of Clinical Practice) suggests that the fructose in traditional sports drinks may lead to low potassium levels (particularly if caffeine is also present such as in cola and guarana drinks) and this in turn could lead to muscle wasting.  This is on top of all the other great things the fructose does for you.

Drinking sugar water before and after sport is not a new invention, but what these studies suggest is that if that drink is 2 teaspoons of glucose (dextrose) in a cup of water, then significant performance improvements could be expected.  Athletes (and tragics) of all types should take note.

Walt Disney once said “The way to get started is to quit talking and begin doing.”  And that is the point we have arrived at in this series on how to break a sugar addiction.

In the book I tell of the ‘cold turkey’ approach I took.  At the time I wrote that I was basing it on a case study of one. Me.  Now thousands of people of broken the sugar habit and hundreds of them have written to tell me of their experiences.  And none of it has changed my mind.

Every person that has told me of going cold turkey has ultimately managed to kick the habit.  There’s nothing fun about the withdrawal period but it does end.  And once it does they are completely free from the desire to eat sugar ever again.  A plate of Bikkies holds all the attraction of a plate of raw broccoli.

Those that try to ‘eat sugar in moderation’ find the going much harder.  They find the cravings just as strong for months on end.  They feel deprived every time someone else is eating sugar.  They barely lose any weight and they feel pretty awful pretty much all the time.  Sounds like fun doesn’t it?

Addiction works by developing a reward and punishment system.  As soon as you stop taking the addictive substance its euphoric effect begins to decline, creating a mild depression in the process.  It feels like an emptiness (or even a boredom).  It doesn’t hurt but as it accumulates it makes you crave the hit that you know will relieve it.

Eating sugar in moderation is the worst of all worlds.  You’re not eating enough to truly relieve the craving (and so no reward for you).  But you are eating enough to maintain the dopamine response that keeps the addiction circuit alive in your brain.

They don’t get heroin addicts off the ‘gear’ by giving them smaller doses of heroin and you won’t get unaddicted to sugar by eating smaller doses either.  I stand in awe of pharmaceutical companies that have convinced smokers to become addicted to lifelong supplies of their nicotine patches rather than lifelong supplies of cigarettes – that is truly a marketing miracle – But I guess technically they are cured of smoking.

No, the way to become unaddicted to sugar is to start today.  I suggest a last supper of your favourite sugary treat.  Go on.  Get that Mars Bar or that can of coke.  Sit down and consciously enjoy the very last time in your life that you will eat (or drink) sugar.  Really enjoy it, right down to the last morsel.  Enjoy the hit.  Enjoy the pleasure of a full blown addiction response as the dopamine and the endorphins course through your brain.

Now stop.  You will henceforth not touch a food containing sugar.  This will not be fun.  But starting is half the battle.  Hold the line.  There is no moderation.  You have stopped poisoning yourself.  If you can just get past the next few weeks of danger, you will enjoy the health Big Sugar has sucked from your life to date. 

Then.  All of a sudden.  The desire will vanish.  I know it sounds strange, but it just plain goes.  Bang.  Just like that.  And you will never want the stuff again.  It’s hard to make it sound believable until you yourself have experienced it (you have after all spent your life addicted to this substance and known no other reality), but it really does happen.

I know this all comes across a little evangelical – but honestly you are taking the most life changing decision you will ever make – you need a little preaching for that.  Good Luck!

If you’re not from Brisbane (or don’t plan going there just to hear me blather on), then feel free to ignore this post.

When I decided sugar was no longer going to be part of my life, I went cold turkey on it.  Well, actually I didn’t.  I did indeed stop eating (and more particularly in my case, drinking) sugar, but I couldn’t bring myself to pay good money for a bottle of water instead of my traditional Pepsi (or 6) a day.

I switched to Pepsi Max because it was the one that tasted (to me) the most like sugar.  I didn’t make this decision based on science.  I couldn’t find any that conclusively proved that sugar was addictive (this was 2004) let alone that substituting sucralose (the active ingredient in Pepsi Max) was any less addictive. 

I just knew that I had to stop drinking sugar but that I just couldn’t get out of the habit of wanting a sweet drink, so Pepsi Max it was.

What I found was that swigging the Pepsi Max was only partially satisfying.  It did nothing for how dreadful I was feeling – I was in the depths of sugar withdrawal and had the whole works -headaches, hunger and cravings.  But what it did do was satisfy the habit part of my addiction.  I was in the habit of having a sweet drink whenever I spotted a vending machine or when relaxing on a hot day.  The ‘Max took care of the habit part of things. 

I could still have my sweet drink as per my habit.  It was nowhere near as satisfying, but it was enough to get me through withdrawal.  The habit kept going, but it didn’t make me consume fructose.  After the withdrawal period ended, the habit itself slowly died.  The ‘Max started tasting more and more metallic as my previously fructose-blasted taste buds returned to working order.  After about two months, I just switched to water when I was thirsty.  And by then, the water was actually more refreshing than the (by then) strange tasting ‘Max.

So for me at least, I didn’t trade one addiction for another.  The substitute was not addictive, despite what some particularly excitable websites maintained.  But gee, it would have been nice to have some science to point to before suggesting my experiment was able to be generalised. 

A great little experiment would be to get a group of people and remove their tongues (so you could be certain it wasn’t the sweet taste that was stimulating the dopamine response).  Then give them unlimited access to solutions which were either sugar or sucralose based and note if they developed a preference for either (while measuring the dopamine levels).

Well the good news is that some researchers at Duke University in North Carolina have done just that.  Ok they chickened out on the tongue removing thing and preferred mice over men, but they did manage to obtain a breed of mice that were genetically unable to taste anything.  And guess what – they did in fact develop an addiction to the sugar solution but not the sucralose solution, even though (to them), they both tasted like water.

For me this study confirms that you can safely substitute (at least one) artificial sweetener(s) for sugar to help overcome habit driven access to sugar (see Part 4).  Reassuringly, this backs up my own experience.  But with the good news comes a caution.  Not all artificial sweeteners are created equal.  

Some of them follow exactly the same metabolic pathways as fructose and are therefore likely to be just as addictive.  Some may not be addictive but do damage in other ways.  In fact I can’t rule any out of the ones in this category altogether but there are some which I can definitely say should be avoided.

To help navigate the minefield, I’ve prepared some lists (as always, these are qualified by the weasel words to the effect that this is what I think the science supports at the moment, but it may be subject to new news):

Not addictive and not damaging (but also not sweet until you have broken your addiction):

• Dextrose
• Glucose

Probably not addictive but possibly damaging in other ways (your best bet for substitution to break habits if glucose tastes bland to you):

• Acesulphame potassium (#950)
• Alitame (#956)
• Aspartame (#951)
• Aspartame-acesuphame (#962)
• Cyclamates (#952)
• Erythritol (#968)
• Neotame (#961)
• Saccharin (#954)
• Stevia (#960)
• Sucralose (#955)
• Thaumatin (#957)
• Xylitol (#967)

Probably not addictive but definitely damaging in other ways (see post on inulins):

• Inulin
• Litesse
• Maltodextrin
• Maltodextrose
• Polydextrose
• Wheat dextrin

Likely to be just as addictive as sugar (and therefore to be completely avoided):

• Agave Syrup
• Corn Syrup
• Fructose
• Fruit Juice Extract
• Fruit Sugar
• Golden Syrup
• High Fructose Corn Syrup
• Honey
• Isomalt (#953)
• Lactitol (#966)
• Maltitol (#965)
• Mannitol (#421)
• Maple Syrup
• Molasses
• Sorbitol (#420)
• And, of course, Sucrose

Next Week – How to start withdrawal.

In 1932, May Donoghue made legal history. She didn’t mean to. All she wanted was a nice drink of Ginger Beer on a warm August night. Unfortunately her chosen refreshment at the Wellmeadow Cafe in Paisley, Scotland came with a free decomposed snail.

The snail enhanced beverage was manufactured by David Stevenson of Paisley. Snails were not a normal part of his range of aerated waters. And Mrs Donoghue came over quite ill, requiring immediate medical attention. She sought £500 restitution and the case of Donoghue (a pauper) v Stevenson eventually found itself before the House of Lords.

If Ms Donoghue’s beverage were served in a clear glass bottle, a legal rule called caveat emptor (buyer beware) would have kicked into to save Mr Stevenson. But her bottle was opaque and it was impossible to see the snail before drinking the putrefied contents. The result was the birth of new legal principle derived from the Golden Rule (love thy neighbour as you love yourself – the rule is common to most religions). Their Lordships said ‘You must take reasonable care to avoid acts or omissions which you can reasonably foresee would be likely to injure your neighbour.’

Clearly the amount of care that the average punter is owed is dependent on how much he knows versus how much the vendor of the product or service knows (or should know).

As we meander through the local shops, we don’t expect most of the people we encounter on the other side of the cash register to hold any particular expertise in health and medicine. Because of this they are unlikely to owe us a duty of care. If I purchase more aspirin than I need in the supermarket, it’s up to me to read the label and if unsure, seek medical advice. Suing Coles, Woolworths or their employees wouldn’t get me very far.

There is however one shop where we rightly have a different expectation. Pharmacies have increasingly set themselves up as drive-by medicos, where we can get the drugs without having to put on a backless gown and engage the stirrups. We like the convenience of access to professional expertise without having to reach for the medicare card.

Our expectations are higher for pharmacists and rightly so. They are not spotty teens barely qualified to drive a checkout. They are university trained, highly skilled professionals. When they tell us we need to take drug X to cure our cold, we believe them without question. In return for our trust, they owe us a duty of care. They owe us a duty to be fully informed about the latest research on everything they offer. They owe us a duty not to sell us any bum steers. Because it is much easier for them to sell us steers of any kind.

In the olden days, the only thing a pharmacist sold you was the stuff your doctor told him to sell you. The only duty the pharmacist owed was not to get the amount wrong (and act as an informal double check on the doctor). When the franchise was extended to over the counter medicines the duty was to ensure we understood what we were buying and how to use it safely. That’s why you get twenty questions when you try to buy aspirin at the chemist.

Now pharmacies are looking more and more like a supermarket. They sell all manner of allied products. Clearly their duty of care for toilet paper or shampoo is no higher than their supermarket rivals. But what about products which are specifically targeted at our health? Is it different when a pharmacist recommends a product to help us lose weight? Of course it is. That is exactly why weightloss products are sold in pharmacies. They sell much better with the implied (or in some case actual) endorsement of a trained health professional.

These “nutritionally balanced” powdered drinks are intended to replace two meals a day for people wanting to carry a few less spare tyres. The shakes can generally only be purchased from pharmacies and some only after a ‘consultation’ with a ‘weight-loss professional’. But there are very few pharmacies which don’t sell shakes of some description with or without the consultation.

The shakes are usually about half fructose, a low GI sweetener. Those in the know have been quietly distancing themselves from fructose for a while now. In 2002 the American Diabetes Association (ADA) reversed its previous advice to diabetics that they should consume fructose. And just last week, a compelling study surfaced in the Journal of Clinical Investigation.

The UC Davis team persuaded 33 overweight and obese people to try a 10 week diet which was either 25% fructose or 25% glucose. The people on the fructose diet ended up with increased (1.5kg) tummy fat, higher fatty triglycerides (which leads to heart disease) and 20% higher insulin resistance (which leads to Type II Diabetes). None of this happened to the group on glucose.

In other words, Australian pharmacists are leveraging our trust in them to sell a weight-loss ‘solution’ based on feeding overweight people a substance that research shows will make them obese, give them heart disease and encourage diabetes. If that’s not a powdered snail in a packet, I don’t know what is. 

I can hear the class action lawyers warming their briefs already.