The David Gillespie Blog

If you change nothing, nothing will change
October 25, 2013
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The Gig is Up

By | Sugar | 3 Comments

Last month Credit Suisse issued a blunt warning to the processed food industry in general and the beverage industry in particular. The gig is up. Well, they didn’t say that exactly, but there can be no other way to read their pragmatic financial assessment of the state of play in the sugar wars.

The processed food industry has done their best to muddy the waters on the science linking sugar to heart disease, obesity and type II diabetes, but it doesn’t fool the team of 20 financial analysts for one second. You see, financial folks don’t need to worry about the prevailing nutritional dogma or whether they will get the next research grant. All they worry about is money and whether their clients are making enough of the stuff.

They ask if it could possibly be coincidence that Mexico is the third largest consumer of sugary soft-drink and ranked second for obesity. They speculate that maybe, just maybe, the same coincidence could explain Italy at #35 for soft-drink and #25 for obesity. But they are convinced that coincidence can’t be further stretched to explain how in every US State, obesity levels correlate exactly with the total sugar consumed from soft-drink (it varies quite a bit because the denizens of richer states consumer more diet soda and aren’t quite as fat as those which inhabit the poorer states).

Realising that the proving anything in human nutrition is virtually impossible (especially when folks making billions out of sugar are funding a lot of it), the financial wingnuts decide to ask doctors what they think. This is a world first as far as I am aware. They actually asked the doctors treating these diseases at the coal-face what they reckon the cause is. And the results confirm that if sugar’s role in disease is a mere coincidence, it’s got the medicos fooled too.

Eighty Six per cent of EU doctors (and 98% of US doctors) are convinced that sugar makes us fat. Ninety two per cent are convinced it causes Type II diabetes (96% in the US). Four out of five doctors also believe that sugar is addictive. And that’s a bit of a shame because less than 40% of them say they have anything more than minimal training in nutrition. Since they are spectacularly unqualified to help, fully 90 per cent of EU doctors think the government should do something to reduce sugar consumption (but only half of them think it will).

Bringing all this back to money (as is their wont), the bean counters then tally up the winners and losers. They point out that, at $140 billion per annum, the cost of type II diabetes to the US health system is already more than $60 billion per annum higher than for tobacco related costs. Worse than that, it is growing at over $6 billion a year – and that’s just one consequence of sugar consumption. Credit Suisse estimate that up to 40% of the $1 trillion annual US health budget is now being gobbled up in sugar related chronic disease.

Even so, the Swiss number crunchers are fairly certain governments will do absolutely nothing to protect their citizens from the food industry. They point out that sugar is the second most lobbied commodity in the world (after oil). Just growing the stuff employs 350,000 people in Europe (and a further 15 million in China). To them it seems a safe bet that no politician will act to endanger those jobs, let alone the millions of jobs that depend on the down-the-line uses of sugar in soft drinks and processed food.

Unfortunately the victims (that would be us) seem to be getting wise to the link between sugar and disease. And this, Credit Suisse predicts, means that the processed food industry will soon need to ‘self-regulate’ if it is to avoid financial Armageddon (a drop in sales, that is).

In other words, we can expect to see Big Sugar start to behave a lot like Big Tobacco when the alarm bells started ringing about lung cancer. Any reader old enough to remember when the only thing that made a telephone portable was installing it in a car, will surely remember these gems from a forgotten age:

Nicotine is not addictive; the link between lung cancer and smoking is not proven; and the tobacco industry does not target children with its advertising.

They may even feel a nostalgic tear well up as Big Sugar dusts off Big Tobacco’s playbook with these little beauties:

Sugar is not addictive; the link between disease and sugar is not proven; and Big Sugar does not target children with its advertising.

And they’ll no doubt add those tactics to the already ubiquitous ‘blame the consumer’ (it’s all about personal responsibility you see) and ‘disrupt the regulators’ (make sure government committees are stacked with people with strong links to the food industry) which they have already begun to deploy.

Credit Suisse is rather more optimistic about self-regulation than am I. They imagine a future consisting of Big Sugar voluntarily removing sugar and then dancing into the sunset arm in arm with a thin and healthy consumer. But I think history suggests a different path lies ahead.

Solid science linking tobacco to lung cancer was first published in 1950. In 1994, the CEO’s of all the US tobacco companies were still testifying to congress that there wasn’t a problem. It wasn’t until 46 US States successfully bludgeoned them with overwhelming legal force in 1998 that they agreed to pay for some of the harm they cause. Even so the Tobacco companies remain extremely profitable businesses that continue to destroy the lives of hundreds of millions of addicts worldwide.

The science is now in on the links between sugar and chronic disease. Those diseases are crippling our health system and destroying the lives of billions of people. But if the tobacco precedent is anything to go by, nothing will be done about it until someone with very deep pockets takes up the fight. Got a minute Rupert?

August 21, 2013
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Is the Heart Foundation’s advice killing us?

By | Big Fat Lies, Conflicts of Interest, Sugar, Vegetable Oils | 13 Comments

This week the authors of a major ongoing assessment of our health released their 12 year update. It’s a sobering document. We are all getting fatter and very much sicker at an alarming rate. But the really disturbing thing is that the Australian Heart Foundation’s advice is making things worse not better.

The AusDiab (Australian Diabetes, Obesity and Lifestyle) study has been monitoring the health of a random selection of 11,000 Australian adults since 2000. The results of the 12 year follow-up were published this week.

The update shows that the number of us with Type II Diabetes has increased by 41%; that obesity has increased by 22%; that almost half of us now have chronically high blood pressure (this is despite a 30% increase in the use of medication to control it); and that the average 25 year old gained 7 kg on the scales and 7 cm round the waist; all in just over a decade.

During all of the period of the study (and for many years before that), the Heart Foundation has campaigned for changes to our food supply that they say would combat exactly those problems. They wanted the saturated animal fats removed from our food and replaced with seed oils (described on the label as ‘vegetable oil’, ‘canola oil’, ‘sunflower oil’, ‘safflower oil’, ‘soy oil’, ‘rice bran oil’ or ‘grapeseed oil’). And they have had considerable success. All fast food outlets now fry in seed oils. There are no products on the supermarket shelves which use animal fat. And in every food category there is at least one major brand that has been certified by the Foundation (with a Tick) as being low in saturated fats.

They have won the war on animal fat and ensured that it has been almost completely replaced by oils extracted from seeds. There is just one remaining bastion of saturated fat, butter. But don’t worry, the Foundation has a plan there too, eat more margarine. They reckon that once you overcome the taste of margarine you’ll soon be enjoying the “great benefit” of more “omega 6.” Omega 6 fats are a significant component of seed oils (vegetable oils) but are very rare everywhere else in nature. The only problem is that research is telling us that they the Heart Foundation has gotten it very, very wrong on these fats.

One of the key pieces of research they rely on for the supposed benefits of margarine (and seed oils in general) has recently been reanalysed. This new analysis has turned our understanding of the heart health benefits of margarine (and in particular the omega-6 fats which are a primary ingredient) upside down. The researchers were able to recover lost data about the exact fats fed to the volunteers in the original Study and then apply modern statistical techniques to that data.

What they found was truly disturbing. Not only was there no benefit to the people substituting margarine for butter, doing so significantly increased the risk of death from heart disease (by 70%) because of the huge increase in omega-6 fat consumption in the margarine chomping group.

The margarines used in that trial have similar levels of omega-6 fats to those (and just about everything else) being promoted by the Heart Foundation for the last three decades. Based on this research, the Foundation is actively encouraging people to consume something that almost doubles the risk of death from heart disease. Let me say that again just so it’s clear. The research says that following the Heart Foundation’s advice almost doubles your risk of death from heart disease.

Extraordinary though that is, it is not the worst of it. These are also exactly the same fats that other research has repeatedly shown to double our risk of breast cancer. And I’m not just talking about rat studies here (although there are more than enough of them). I’m talking about at least 7 major human population studies and 2 long term controlled trials (human again) which all come to exactly the same conclusion. The more omega-6 fat (found primarily in vegetable oil) you consume the more likely you are to suffer from breast cancer.

Worse than that, the rat studies are showing up something that (thankfully) no-one dare try on humans. When you feed pregnant mothers this stuff, their female pups have double the rate of breast cancer – even though they don’t consume any vegetable oils after birth.

This makes the heart Foundation’s chosen marketing vehicle especially horrific. You see, rather than simply run an ad telling us to eat margarine, they’ve decided to create a social media storm with the express purpose of getting mums to consume the exact substance that the research resoundingly shows doubles the rate of breast cancer and nearly doubles their risk of death from heart disease. And if the rat studies are right, those mums (trying to do the very best for their families) may be making very dangerous choices for their unborn daughters.

As if this were not bad enough, the Foundation continues to persist with a bizarre stance on the question of sugar. Last Thursday, the ABC’s venerable science program, Catalyst ran a special feature on the dangers of sugar. It detailed the, now well established, evidence that sugar is not only responsible for the obesity epidemic but is also strongly implicated in a long line of chronic disease including Type II Diabetes and Heart Disease.

Part of the program examined the very high levels of sugar embedded in foods which bear the Australian Heart Foundation’s tick of approval. Professor Michael Cowley, a physiologist and obesity researcher from Monash University expressed surprise that the Heart Foundation would endorse breakfast cereals (for example) that were almost a third sugar. In response, the Heart Foundation said that they ignore the sugar content of foods because (despite abundant evidence to the contrary) they believe it doesn’t make us fat or give us diabetes or heart disease.

The Australian Heart Foundation has spent the last 54 years working to gain our trust as an adviser. Our trust is something you can’t buy, but the processed food industry has found a way to rent the Heart Foundation’s healthy halo. It’s called the Tick Program. Processed foods can gain endorsement from the Heart Foundation by doing what they were going to do anyway. They wanted to use seed oils instead of animal fats because they are loads cheaper. Tick. They wanted to use tons of sugar because food with sugar sells better than food without. Tick.

The only problem is that, through the Tick Program, the Heart Foundation now finds itself in the position of having endorsed hundreds of products that the science says are very dangerous to our health. And it receives a nice chunk of change from the program every year ($2.9m in 2011).

That, girls and boys, is what we lawyers call a conflict of interest. When doctors experience a conflict of interest (say by accepting gifts from pharmaceutical companies), the regulators tighten the rules and (no matter how much it hurts the doctors) puts the brakes on the gravy train.

The same thing happens in just about any profession we depend upon for expert knowledge. We have to be able to trust people we pay to know more than us about a specialist subject. And no matter how morally astute they believe they are, we cannot allow them be led into temptation by conflicts of interest. If we do, we can never be sure if they are giving us advice based on the best evidence or on their own financial interest.

There are now very persuasive reasons to worry about the Heart Foundation’s advice that we should consume seed oils (vegetable oils). And there is just as compelling evidence that ignoring sugar is taking a daily toll on the health of all Australians.

I know it’s embarrassing that the Heart Foundation got it wrong on omega-6 fats and sugar. But they need to suck it up and change their position. Because it is much better to admit being wrong and do something about it than let another 40 women contract breast cancer or another 270 people contract Type II diabetes (and that’s just the toll today – the same toll will be exacted tomorrow and the day after that too).

We don’t need the guardians of our health defending the indefensible. We need them, well, guarding our health without fear or favour (especially without favour). This is not about pride. It’s about doing the right thing and stopping the appallingly dangerous advice – now.

While you wait for the Heart Foundation to do the right thing, here is some simple, free, advice for anyone wishing to avoid heart disease, cancer and Type II Diabetes:

  1. Do not eat any processed food (food in a packet) which has a Heart Foundation Tick – it is more than likely full of sugar or seed oils or both
  2. Do not eat anything that has been deep fried unless you know it was done in olive oil, coconut oil, macadamia nut oil or animal fat.
  3. Avoid any other processed food that contains seed oil.
  4. Avoid any other processed food that contains more than 3g per 100g of added sugar

Warning: following this advice may cause you to live to a very old age, so make sure you’ve got some superannuation

March 30, 2013
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We owe our kids more than a future full of transplants

By | Sugar | 10 Comments

According to a report released this week, liver disease now affects more than six million Australians.  The doctors who commissioned the report want the taxpayer to give them more money to manage sufferers.  Fortunately we now know what causes the vast majority of liver disease and that it can be reversed simply by telling people not to eat sugar.  But I won’t be holding my breath waiting for that to become the recommended treatment.

Liver diseases fall into two main groups, those caused by viruses (Hepatitis – currently afflicting about 518,000 Australians), and, accounting for the other 90 odd per cent of cases, those caused by ‘lifestyle’ (5.5 million people).

The lifestyle group is usually further divided into drinkers (who have the same symptoms but have a history of consuming  more than 2 standard drinks per day for women or 3 for men) and everybody else.  According to the report, Alcoholic Fatty Liver Disease now affects 6,203 people but Non-Alcoholic Fatty Liver Disease (NAFLD) afflicts a massive 5,538,677 Australians.  That’s a pretty big number for a disease was first identified just 30 years ago.

As the name suggests, NAFLD starts out as an accumulation of fat in the liver.  It can then progress through various disease stages and ultimately end in cirrhosis requiring a liver transplant (if you’re lucky enough to find a donor).   There are very few symptoms until the later disease stages, so most people are unaware that they have it all.

NAFLD is frequently described as the liver component of the metabolic syndrome (elevated blood fats, insulin resistance and obesity), because it’s rapid growth has paralleled the same runaway growth in each of the diseases which are a consequence of the syndrome.  More than 90% of obese people and up to 70% of people with Type II Diabetes have NAFLD.

The number of people with NAFLD is accelerating at a tremendous rate.  Even worse, the age of onset is declining rapidly.  A study published last week revealed that the number of US teenagers with the disease more than doubled in the last 20 years and now affects almost 11% of US children aged 12-19.  If those rates translate to Australia (and there’s every reason to think they might) this means the average high school classroom now contains three children suffering from chronic liver disease.  Every classroom.  Three kids.

Even though one of the liver’s functions is to make fat from any excess carbohydrates we consume, the fat is normally exported for storage in all the places that make our jeans too tight.  NAFLD starts when the liver’s ability to export fat is overwhelmed.  The excess fat remains in the liver and begins to create the human version of foie gras.  The best way to make this happen in ducks and geese is to overfeed them (by shoving a metal tube down their throat) with carbohydrates (like corn or dried figs).

Humans get a little twitchy if you reach for the tube and corn, so overfeeding us has to be accomplished with a little more finesse.  In people, all but one carbohydrate triggers an insulin response which (unfortunately for those expecting to make a bit of human foie gras) shuts down appetite and stops us eating too much.

The one carbohydrate which subverts this handy appetite control feature is fructose.  So you might expect that a bit of effort has been put into seeing if fructose (and its primary modern delivery vehicle, sugar or sucrose) might be the source of the sudden explosion in NAFLD.

And you wouldn’t be disappointed.  In the last five years research that proves that sugar is the culprit has been pouring in.  Scientists have of course shown that you can give ducks (hmm, I wonder why they chose that experimental animal) and rats NAFLD using fructose.  And a recent series of human studies have also shown that the consumption of soft drinks is strongly associated with the onset of NAFLD (and I don’t think we can blame the water or the bubbles).  But if that wasn’t enough, a pair of very recent trials from Scandinavia have put the icing on the cake.

The first trial involved feeding four groups of people four different drinks (Coke, skim milk, Diet Coke and a still mineral water).  After 6 months of this, the Coke group had massively (140%) increased liver fat (as well as significantly increased blood pressure, cholesterol and blood triglycerides).  The folks knocking back Diet Coke and water were pretty much the way they were at the start (just in case you thought it might be the water or the bubbles) and the milk drinkers had even slightly improved their liver fat status.

A similar story unfolded in the second trial.  Some very unfortunate volunteer humans were put on the path to NAFLD (27% increase in liver fat) in just three weeks by overfeeding them chocolates, pineapple juice, soft drinks and sports drinks.  The good news is that the disease was easily reversed with diet (although it did take 6 months).

The trials are done, the evidence is clear.  Fructose consumption causes NAFLD in exactly the same way that alcohol causes Alcoholic Fatty Liver Disease.  NAFLD’s alcoholic cousin can be usually be reversed by ensuring the patient avoids alcohol.  So are the experts demanding that GPs be told to adopt a similar practice for fructose?  Nup.

No, what they want is for the government to spend more money on, well, them.  This week’s report calls for a $6 million dollar a year program (run by the doctors who commissioned the report) to increase awareness of liver disease and a $7.5 million dollar a year community care program to help people who are suffering with liver disease.

Now I’m sure these are admirable programs and I’m sure they’ll go some way to alleviating a little bit of the suffering caused by the overwhelming epidemic of chronic liver disease.  But when the cause is clear and the solution even clearer, we can do much better than throw a bit of cash at some liver doctors.

NAFLD currently has at least a quarter of the population on an expressway to a liver transplant (if the rest of the metabolic syndrome doesn’t get us first).  Yet it can be easily and effectively reversed with a pathetically simple piece of advice – don’t eat sugar.  Those charged with keeping us well, need to immediately start giving that advice rather than lobbying for a better ambulance  to park at the bottom of the cliff.

January 31, 2013
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A day late and a dollar short? – Australia’s peak health bodies decide sugar is unhealthy (but only when added to fizzy water).

By | Conflicts of Interest, Sugar | 20 Comments

The week before last the Heart Foundation, Cancer Council and Diabetes Australia declared war on sugar. But before you break out the party poppers you should know that it wasn’t so much an all-out assault as a slap with a wet tram ticket. And the Dietitians Association couldn’t even be bothered getting out the tram ticket, moist or otherwise.

Don’t get me wrong, it’s great to see such august bodies uniting behind an anti-sugar campaign. It’s just a pity the message is so riddled with caveats, exceptions and contradictions as to render it almost completely ineffective. Or was that the point?

The campaigning trio called for action on sugary drinks by “governments, schools and non-government organisations such as sports centres.”

Kellie-Ann Jolly, acting CEO of the Heart Foundation urged the Federal Government to “implement restrictions to reduce children’s exposure to marketing of sugary drinks.” She went on to suggest that State governments should also limit the sale of sugary drinks in schools and sporting grounds.

The CEO of Diabetes Australia, Greg Johnson, wanted even more direct action, calling for a tax on sugar-sweetened beverages.  The call to action was because these drinks are “associated with a range of serious health issues including weight gain and obesity, which in turn are risk factors for diabetes, cardiovascular (heart) disease and cancer.”

The sugar in soft drinks must be magic. You see when it’s mixed with water it apparently makes you fat and gives you diabetes, heart disease and cancer. But when the very same sugar constitutes 72% of a children’s lunch box snack it is so healthful that it deserves a great big Heart Foundation Tick of approval. And when it makes up almost a third of Uncle Toby’s Oat Gourmet Selections or Kellogg’s Just Right breakfast cereal it gets a tick as well.

But the real sign of its magicness is that it is not always dangerous even when the only other significant ingredient is still just water. Fruit Juice is sugar and water but that is not on the radar of the newly minted crusaders against sugary drinks. Apparently sugar molecules that were once part of a piece of fruit are not evil but those that were once part of a piece of sugar cane (despite being chemically identical) are deserving of taxation and prohibition.

Soft drink is an easy target. No-one is suffering under the impression that a can of Pepsi is health food and not even the Beverage Association at its most brazen would attempt to convince us that it is.

Confected rage on the part of the magnificent three is token (at best) for as long as they continue to ignore (or endorse, in the Heart Foundation’s case) the vast majority of sugar we are sold under the label ‘health food’.
Sugar is sugar. It’s just as dangerous when it’s the primary ingredient in a Heart Foundation approved children’s snack as it is when it’s sloshing around in a bottle of Coke. The Heart Foundation in particular robs this campaign of any shred of credibility for as long as it accepts payment from the processed food industry to endorse their sugar filled ‘health’ food.

The evidence supporting the campaign has been available to these organisations since at least 2007. Despite this, the Heart Foundation in particular has publicly and actively denied that sugar presented any health problem at all. Indeed as recently as 2011 they said“based on the current level of evidence, sugar is not directly linked to [heart disease], diabetes, or obesity.” That’s right, the exact opposite of what they now say about the sugar in soft drinks.

They must have found their library card because now it appears they’ve finally caught up with decades of research and mustered the gumption to acknowledge (some of) that evidence – albeit in half-hearted and non-revenue-endangering fashion.

The research on dietary sugar intake is just as damning as the evidence that has now convinced them to act on soft drink. Sugar doesn’t suddenly become dangerous when combined with water and bubbles. It’s dangerous all the time.
How many people million more people need to suffer from the lifelong debilitation (of Type II Diabetes) caused by the sugar added to everything we eat before Diabetes Australia is prepared to accept that evidence. How many more deaths from Heart Disease need to occur before the Heart Foundation is prepared to bite the corporate hand that feeds it?

Until those who are supposed to care, stand up and acknowledge the obvious, the suffering will continue. Until the Heart Foundation are prepared to say no to corporate sponsorship and demand action on all sugar, their gormless flailing at the easy targets will render them less and less relevant. In this age of profit driven, processed food we need real, independent advocates not corporate flunkies.

Image courtesy of Paul / FreeDigitalPhotos.net

July 10, 2012
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The Australian Diabetes Council needs to clean up its act.

By | Conflicts of Interest, Sugar | 15 Comments

It’s Diabetes Awareness Week.  But the Australian Diabetes Council continues to advocate a solution that the science shows will make the disease worse rather than better.  Is their position mere negligent incompetence or is there something more sinister afoot?  Either way it is ordinary people who will pay the price.

Type II Diabetes (90 per cent of all diabetes is Type II) is a disease of carbohydrate metabolism.  Sufferers can no longer properly convert the carbohydrates they consume into energy.  The result is that their blood glucose level is permanently too high.

A permanently high blood glucose level leads to damage to the fine capillaries of the eyes and kidneys as well as the blood vessels transporting food and oxygen to our lower limbs.  Uncontrolled Diabetes will eventually lead to blindness, kidney disease and lower limb amputation.

Every day in Australia nine limbs are amputated because of this disease. Worse than that, it affects more than twice as many people today as it did in the nineties.  And that number is likely to triple in next fifteen years.

You don’t need to be a scientist to figure out that if a person has trouble dealing with carbohydrates they should eat less carbohydrates.  After all that is exactly the approach taken with other similar problems.  For example people who can’t properly digest fats (because their gall bladder is compromised) are advised to eat a lot less fat.

And if that was your hunch you wouldn’t need to look too far for science to back you up.  In 2010 the Harvard School of Public Health published the results of its meta-analysis of the research on the relationship between sugar sweetened drinks and diabetes. They reviewed eight high quality studies which involved 310,819 participants and 15,043 cases of Type 2 diabetes. Each of the underlying studies was significant in its own right and all had been concluded between 2004 and 2010.

All but one of the studies revealed a strong (and significant) association between sugar and diabetes. Taken together they showed that consuming one or more soft drinks (or fruit drinks or vitamin waters) per day would increase your chance of contracting type 2 diabetes by 26 per cent.As convincing as this meta-analysis is, it just confirms what a very strong series of studies (on the link between soft drinks and diabetes) have been saying for the last decade, sugar consumption significantly increases the incidence of type II Diabetes.

Two decades ago (when there were half the number of sufferers there are today) reducing carbohydrates in general and sugar in particular was exactly the advice given.  But strangely the Australian Diabetes Council’s  (ADC) advice to Type II Diabetes sufferers today amounts to advocacy for increasing the amount of carbohydrate.

Yesterday, their Chief Research Officer Dr Alan Barclay told the Today program that Australians hoping to prevent the onset of this terrible disease should eat less fat, less salt and more fish.  He gave no advice about sugar either during that interview or in the similar one he also gave to Alan Jones.  Neither does a word about sugar appear in the detailed booklet on preventing diabetes published by the ADC yesterday.

The official position of the ADC on sugar is that it has nothing to do with Diabetes.  Indeed it “want[s] to end the myth that sugar causes diabetes.” It’s a position which is (strangely) almost identical to the one maintained by CSR Sugar and Nestle Australia.  The ADC instead recommends “that people with diabetes choose at least one serve of a low G.I. food at each meal and snack.”

Sugar is a moderate to low GI food and pure fructose (which is one half of sugar) is the lowest GI carbohydrate available.  It shouldn’t therefore come as much of a surprise that foods high in sugar feature heavily in lists of processed food awarded Low GI certifications.  One type of pure sugar (made by CSR) has even managed to have itself certified as being low GI.

Besides being ADC’s Chief Research Officer (and oft-quoted spokesperson), Alan Barclay has some other strings to his bow. He is also a director and vice-president of the Glycemic Index Foundation (GIF). GIF exists to dispense GI Symbols.

Prospective supplicants submit their fare for testing, pay the ‘testing fee’ and, if adjudged worthy, receive a little blue G that they can display on their labels.  They can leave the proclamation of healthiness on the label for as long as they continue to pay for the privilege with a percentage of their product sales.   Some currently certified foods include, Nestle Milo (46% sugar), a range of Nestle muesli bars (around 25% sugar), USANA Meal replacement shakes (around 27% sugar), CSR’s Low GI Sugar (100% sugar) and of course Danisco pure fructose (100% fructose).

When the ADC exonerates sugar and steers sufferers in the direction of Low-GI foods, they are driving demand for the services of GIF, and the products certified by them.  Doctor Barclay’s involvement in both organisations is a clear conflict of interest (which should, at the very least, be disclosed with every appearance he makes on behalf of the ADC).

The studies linking sugar and diabetes are large, well conducted and reliable yet they are ignored on both the ADC website and in Dr Barclay’s most recent public advice to those seeking to avoid diabetes.

People with type II Diabetes will heed the ADC’s advice.  They will seek out low fat foods (which are usually high in sugar).  They will ignore the sugar content of foods and they will look for foods which bear a Low-GI certification.  This will inevitably increase their sugar intake and the science says they will significantly increase their risks by doing so.

If this was about increasing the risk of your fingernails going green then I would say, so what.    But far more is at stake in this game.  Almost 300 Australians will contract an appalling, life destroying, disease today.  And they’ll be joined by another 300 tomorrow, and another 300 the next day. They will suffer every remaining day of their (foreshortened) life even though the science on how to avoid it has been clear for at least a decade.

I don’t pretend to know ADC’s motivations, but telling at-risk people that it is ok to eat sugar is an extraordinary abuse of a position of trust.  Real people are suffering because of the ADC’s incompetent advice. It needs to clean up its act and it needs to do it now.Type II Diabetes is not a game.

Image courtesy of pat138241 / FreeDigitalPhotos.net

February 14, 2012
2

Why eating sugar impairs your ability to conceive.

By | Sugar | 11 Comments

Female infertility is increasing at an astounding rate in Australia.  The rate of increase of Type II diabetes is strapped to the same rocket.  Now a series of new studies suggest the cause for both is the humble fructose molecule found in every teaspoon of sugar added to your food by your local processed food conglomerate.

As many as one in five Australian women of reproductive age now have PolyCystic Ovary Syndrome (PCOS). Exact data on the numbers affected are hard to come by because up to 70 percent of PCOS cases have not been medically diagnosed.

The symptoms usually include acne, the appearance of male patterns of hair growth (and male baldness) and irregular or absent periods.  Ok so it’s not pleasant, but the big impact is on fertility.  PCOS is the primary cause of female infertility in Australia today.  The reason that doctors suspect that the syndrome goes largely undiagnosed is that pretty much the only time it’s tested for is when a woman seeks fertility treatment.

A recent Swedish evaluation concluded that women with PCOS were 9 times as likely to need access to IVF as women without the syndrome.  IVF is the last resort in fertility treatment.  It is used when everything else has failed.  And it is being used increasingly frequently.  In Australia today approximately one in every 30 children is born as a result of IVF.

IVF is not a path women choose lightly.  It’s an experience that comes bundled with significant psychological and emotional costs.  And at a monetary cost of approximately $32,000 per birth it’s an increasingly expensive burden on mothers, families and the public health system as well.  The number of IVF treatments grew by 50% between 2004 and 2009 and is currently increasing by about 14% every year.

As you might expect from a glance at the symptoms, PCOS is a result of there being too much testosterone (the male sex hormone) in circulation.  Testosterone is not an exclusively male hormone.  Women have it too, but generally circulating at about 10 percent of the male level.

Doctors have long known that women with PCOS not only have higher circulating testosterone, but they also have extremely low levels of very important protein, the charmingly named Sex Hormone-Binding Globulin (SHBG).

One of SHBG’s jobs is to keep testosterone out of circulation.  By binding to testosterone, SHBG controls the amount of free (and therefore active) testosterone in our bloodstream.  Having low levels of SHBG seems to result in there being too much free testosterone in women.

It’s also well established that people who are obese or who have insulin resistance or Type II Diabetes have extremely low levels of SHBG.  In fact low SHBG is such a reliable indicator of insulin resistance that SHBG testing is being proposed as a good early indicator of the development of Type II Diabetes.

Hormones are complex things (and that’s an understatement) and sex hormones are the big daddy of complexity.  Because they are constantly produced and their actions depend on the presence or absence of other sex hormones and what sex you are, it’s very hard to tease out the cause and the effect.

For a long time researchers have believed that insulin resistance is the cause of the low levels of SHBG.  That would mean that PCOS is a consequence of being insulin resistant but a January 2012 study has shown that is not the case.  It turns out that insulin levels do not affect the level of SHBG, but the presence of fat around the liver affects both the insulin level and the SHBG level.

One really sure way to create a fatty liver is to consume large amounts of fructose.  Because fructose is (directly and immediately) converted to fat (by our liver) it’s the single most efficient way to get the job done.

The best way to prove that theory is of course to try feeding a healthy person high quantities of fructose and see if they develop fatty liver, insulin resistance and PCOS.  Because volunteers for that kind of fun might be a bit thin on the ground researchers have had to resort to rats as the model.

You can’t use any old garden variety rats.  To be certain you need to use rats that have been bred with the human gene for the production of SHBG.  Before you get out the rat breeding equipment (whatever that might be) you might like to know it’s already been done.

In 2007 a group of Canadian researchers tried feeding so-called transgenic rats glucose and fructose to see what happened.  They found both sugars suppressed SHBG production but fructose was twice as effective (glucose 40%, fructose 80% suppression) and fructose was especially quick, causing its damage after just three days.  They found the SHBG effect was caused by the accumulation of the fats created as a result of processing the fructose.

Joining some dots here it does not seem like a big leap to say that insulin resistance, Type II Diabetes, fatty liver disease and PCOS are all part of the same bunch of joy you can expect from consuming fructose.

Fructose directly increases the amount of circulating testosterone in women.  More testosterone directly impairs a woman’s ability to conceive.  The single most effective way for a woman to increase her chances of having a baby is for her to stop eating fructose.

When fructose is removed, hormone levels return to normal, PCOS symptoms disappear and fertility is restored.  It really is that simple.  There is no reason (other than financial) that the first words out of a fertility doctor’s mouth shouldn’t be “Stop eating sugar.”

 

Photo by Ⅿeagan. Distributed under the Creative Commons License.

October 31, 2011
0

Let those who cause the pain, pay the tax

By | Sugar | 8 Comments

Sugar causes tooth decay. No sane scientist would argue that simple statement. It is about as controversial as saying day follows night. But treating tooth decay costs Australians $7.7 billion a year. Why are we not looking to the folks who sell sugar to help pay for that?

Certainty is a hard thing to come by in science. It is very rare indeed to find a group of scientists agreeing without exception to a cause and effect relationship. But there are some examples. You will not get a fight from anyone if you say that antibiotics cure most bacterial infections. And you’ll encounter even less resistance if you say that smoking causes lung cancer.

The statement that sugar causes tooth decay is even more certain. The statistics are clear. Populations exposed to sugar for the first time go from ‘background’ levels of decay (of around 4 cavities per 100 teeth) to ‘modern’ levels of around 24 cavities per 100 teeth. The mechanism is known and the science is uncontroversial. Not even Coca-Cola dares deny that sugar and tooth decay go together like peas and carrots.

Researchers have known since the 60s that tooth decay is caused by a little chap called Streptococcus Mutans (S. Mutans). It is one of the two to three hundred species of bacteria that inhabit our mouths.

Like most bacteria, S. Mutans loves a good feed of sugar. As it chomps down on the sugar molecules it produces lactic acid as a waste product. It’s that lactic acid that does the damage to our teeth. But under normal circumstances we are up to the task of protecting ourselves and avoiding tooth decay. Our saliva quickly neutralizes the acid and we regenerate any damaged enamel.

This is fine if the only sugar in our diet is glucose or carbohydrates that are converted to glucose (which is almost all of them). But, if there is some fructose available as well as glucose (oh, such as in table sugar – half glucose and half fructose), then through a quirk of evolutionary biology, S. Mutans has the upper hand.

S. Mutans can build itself a saliva proof home if fructose is also present. We call this little anti-saliva shield, plaque. Plaque binds S. Mutans to each other and to the tooth enamel. It traps the lactic acid against the tooth surface, protects it against the waves of saliva and gives it time to eat through the enamel.

If you really want to rot teeth, the most effective way is to give S. Mutans a constant wash of sugar solution (like soft drink or fruit juice) between meals. Eating sugar at mealtimes still works but it is nowhere near as effective.

S. Mutans has really enjoyed our change in diet in the last few decades. The amount of fructose laden, soft drink, juice and flavoured milk we drink has risen from virtually nothing prior to the Second World War to almost 1 litre per person per day. Consumption of soft drink alone has more than doubled in the last 30 years. And with this our need for dental services has also risen exponentially.

Every now and then politicians bow to public anger over the rising cost of dental services and mumble indistinctly about perhaps fixing the problem. Do they suggest limiting sugar consumption? Don’t be silly. How about asking the sugar purveyors to pick up the bill? Think again.

No, the politician’s answer is to make it our problem. First they try the chemical band-aid of dosing us all with fluoride, then, when that barely dents the costs, they reach for our wallet. The most recent go-round was Kevin Rudd’s ill-fated Denticare scheme, which suggested increasing the medicare levy by 50%. Heaven forbid a processed food manufacturer be presented with the bill.

Sugar rots teeth. The evidence is abundantly clear that, but for a constant wash of sugar between meals (topped up with some nice sticky fruit snacks), we would barely need to visit a dentist at all. So why are we not asking the folks who cause the problem to pay the bill? Or better still, stop creating the problem?

We have no difficulty asking the purveyors of cigarettes to kick in for the costs of treating the disease they cause. So why is the political response to the cost of dentistry a tug of the forelock and a scurry to collect more tax from us (whether we consume sugar or not)?

To be sure, $7.7 billion is a large bill to present to anyone. It represents about two and a half times the entire annual revenue of the Australian sweetened beverage industry. But it is also about 30 times the income tax they paid. Is it really fair that an industry contribute so pathetically to the cost of the damage they cause?

This is not a sin tax in disguise. It is repugnant for food nannies to attempt to make us healthy using the blunt instrument of taxation. If sugar is bad enough to require (at least) $7.7 billion of reparation every year then we should be removing it from the food supply. The level of harm it does is out of all proportion to its utility (is there any?).

But our governments clearly don’t have the moral and intellectual steel to bite that bullet. So let us at least insist that the most obvious part of the damage being caused (the part about which there can be no argument) be paid for by those profiting from our misery.

September 15, 2011
6

It’s time to stop drinking the Kool-Aid of Public Health Dogma

By | Sugar | 11 Comments

One of the big complaints about research on fructose (the dangerous half of ordinary table sugar) is that many of the studies are done on rats, not humans.  But a pair of recent studies have shown that sugar is just as dangerous for primates (including us) as it is for rats.

People defending our right to continue eating sugar (‘in moderation’ of course) frequently waggle their fingers at the studies and say just because it kills a rat doesn’t mean it will harm a human.  One defender of the white stuff, Dr Jennie Brand-Miller, recently went so far as to suggest that sugar doesn’t do us any direct harm at all.

There’s a good ethical (and legal) reason that human studies are few and far between.  The ones that have been done have inevitably resulted in immediate harm to the human subjects.  A study where the expected outcome is to harm the participants makes lawyers nervous.  I guess that’s why you don’t tend to see studies on what happens if you don’t open the parachute.

But the science needs to be done.  There really is no other way to combat the incessant ‘sugar in moderation’ chant of the processed food industry and its toadies.  Thankfully a few US Universities are prepared to push the envelope.

Just last week a team from Vanderbilt University’s paediatrics department published the results of their year-long study into the effects of fructose on Rhesus Monkeys.  Their stated aim was to “induce insulin resistance” (the first step on the path to Type II Diabetes) in a primate using the same methods which are so successful in rodents.

The Vanderbilt folks chose Rhesus monkeys because they are physiologically similar to us and they develop the same chronic diseases that we do (and they are far less picky than humans about being locked in cages for 12 months).  Dr Bremer and his team studied a group of 29 adult male monkeys aged from 12-20 years (approximately equivalent to human ages of 36-60).

At the start of the study, all the monkeys had perfectly normal blood glucose levels and were otherwise fit and healthy.  The diet for the duration of the study was standard monkey lab chow (designed to give them all the nutrients they need in a healthy mix which is 59% Carbohydrate, 30% Protein and 11% Fat).  They were also given access to up to 500ml per day of Kool-Aid.  The monkeys could consume as much (or as little) of the food and Kool-Aid as they wanted.

Kool-Aid is a fruit flavoured powdered sugar drink mix sold in the US.  The closest Australian equivalent is Tang (which is really just Kool-Aid with a multi-vitamin chucked in).  The Kool-Aid delivered up to 75g of pure fructose a day to the monkeys.  I say ‘up to’ but the reality was that the monkeys drank the Kool-Aid and then topped up their calories with chow.  They weren’t going to leave any of the good stuff in the tin.

Unfortunately for our furry friends, they were never healthier than when they hadn’t drunk the Kool-Aid.  Four of them developed Type II diabetes between 6 and 12 months after starting.  The rest of them were well on their way to the same destination (with blood glucose and insulin readings that would have had them on the latest anti-diabetes drugs if they had been humans).

They put on weight (an average of 9% of their starting weight), the percentage of their body which was fat increased by 15%, they ate more of everything, exercised less and their blood lipids were a mess.

Their fasting triglycerides (a strong risk factor for heart disease) increased by a whopping 87%, HDL (good) cholesterol decreased and LDL (bad) cholesterol increased (by 14% each).  In other words these critters were also on the fast track to a heart attack.

The experiment would have been better if they’d had 29 monkeys eating nothing but chow to compare the results to.  But there is no evidence to suggest that monkeys on a standard lab chow diet ordinarily develop these symptoms (and certainly not in less than a year).The researchers set out to give diabetes to a group of primates (with an almost identical metabolism to ours).  All they did was allow them access to a sugar which is plentiful in our food supply.  They didn’t test chemicals on them.  They didn’t inject them with drugs.  They just fed them with the same stuff we give our kids.  And they achieved their aim – four had diabetes and the rest were on their way – in less than a year!

Still not enough to get you to step away from the Froot Loops?  Still not ready to believe, ‘till they do this to humans?  Then you’re in luck, because a human study has also just been released.

This time, a team at the University of California convinced 48 healthy (human) adults to consume four cans of soft drink a day for two weeks (about the same as one in 20 Americans do every day of their lives).    Some of the soft drinks were sweetened with glucose, some with fructose (the two halves of sugar) and some with High Fructose Corn Syrup (55% fructose, 45% glucose).

And guess what?  That’s right, the result was exactly the same as for the monkeys.  The blood fat measurements (which point to heart disease) started going in the wrong direction for the fructose and HFCS groups (and nothing happened to the glucose group).  No-one was given diabetes, but it was just a 2 week study.

Try as they might, researchers have never been able to get results like these by feeding people fat or stopping them from exercising.  But these latest studies could barely be more definitive on whether there is danger in that thar can of soda.

Eat fructose and the only question is when you will develop diabetes and heart disease.  If you happen to be a Rhesus Monkey (well done, you, for being able to read this) you have as little as six months, if not, you might get a bit longer.  But have no doubt, it will happen.

July 13, 2011
0

The Glycemic Index has passed its use-by date

By | Big Fat Lies, Sugar | 16 Comments

The glycemic index (GI) is not just bad science, it has a dangerous loophole big enough to drive an ice-cream truck through. Its time it went to the place where old (and wrong) public health messages go to die.

Wendy’s Chocollo (with waffle cone), Bulla Light vanilla ice-cream, Nestle Milo, Uncle Toby’s Choc Chip Crunchy Muesli Bar and CSR LoGiCane Sugar all have something in common. Yes, they’d all look pretty good on the dessert menu, but they also share something else. The owners of each of these products (and almost a hundred others like them) have paid for the right to display a GI Symbol.

Much like its more famous cousin (the Heart Foundation tick), the GI Symbol is designed to guide confused consumers towards “healthier choices” in the supermarket.

The symbol alerts us to foods which have a low glycemic index. The GI is a measure of the amount that a food affects our blood sugar levels. Our body converts most of the carbohydrates in our food to blood glucose. This causes a spike and then a decline in the amount of glucose we have in circulation.

But not all foods are equal. Some (like glucose) spike our blood sugar levels more quickly than others (like potatoes). This is because the carbohydrates in some foods are more quickly converted to blood sugar than others.

The glycemic index of a food is measured by comparing the way a healthy person’s blood sugar level responds (over a 2 hour period) to 50g of glucose and how they respond to 50g of carbohydrate in the food being tested (let’s say boiled potatoes). If the tested food produces an effect which is 70% of the one measured for the glucose then it is said to have a GI of 70. A low GI food is one which has a GI of 55 or less (meaning that the blood sugar response is 55% of that of pure glucose over a two hour period).

The theory goes that if we could make sure we were eating just the foods which have a low impact on our blood sugar, then we would keep our blood sugar levels more even (and presumably somehow be more healthy as a result). I say presumably because there is a real scarcity of credible evidence that the GI of a food has any measurable (positive) health impact.

GI may be a pointless academic exercise but it is not a harmless one. It has a hidden danger in that the carbohydrate it assigns the lowest (and therefore the best) rating is fructose (it has a GI of 19). Fructose is a very sweet tasting (almost twice as sweet as sugar) carbohydrate that does not produce a significant blood sugar response.

When this little quirk of fructose was first discovered (in the early 1980’s) it was pronounced a miracle sugar for people with diabetes. They could have sweets just like everyone else and their blood sugar would never spike as long as the sweets were made with fructose. Even some sugar was ok too (because, being half fructose, it also has a low(ish) GI).

Diabetes organisations the world over happily advised diabetics they could eat sugar or, even better, pure fructose. Unfortunately for sweet tooths everywhere, by about 2001, it was becoming abundantly clear that the ‘no free lunch’ rule applied (or was it no free pudding?). Fructose was even more dangerous for diabetics than sugar.

It turned out that the reason fructose didn’t have a big glycemic index was because it is converted to fat (by our liver) and not circulating blood sugar (like just about every other carbohydrate). Telling diabetics (or anyone else, but particularly diabetics) to consume a substance that was immediately converted to fat was a very bad idea (verging on the culpably negligent).

The American Diabetes Association quietly withdrew its recommendation in 2002, but the message never got through to Australia. The Australian Diabetes Council tell us they “want to end the myth that sugar causes diabetes”, apparently because sugar-free diets aren’t “much fun.”

And the folks selling the Low-GI stickers (the GI Foundation – a collaboration of University of Sydney, Diabetes Australia and the Juvenile Diabetes Research Foundation) still tell us it is “best to ignore the sugar content of a food and instead focus on the food’s GI.” A director of the GI Foundation (Sydney University nutritionist Jennie Brand-Miller) even went so far as to say recently that “Unlike saturated fats, trans fats, salt and alcohol, sugar doesn’t actually do any direct harm to the human body.”

For the last decade (at least), the research on fructose (and sugar) has shown again and again that exactly the opposite is true. Fructose consumption is a causal factor in obesity, heart disease, hypertension and Type II Diabetes. It is implicated strongly in cancer growth and it is highly likely to be behind the explosion in the number of cases of chronic kidney disease and fatty liver disease.

That all sounds pretty harmful to me. So perhaps that is why the American Heart Association recommended (after reviewing all the evidence in 2009) that Americans needed to dramatically reduce their sugar consumption. Men should consume no more than 9 teaspoons of sugar a day (about a can of soft drink’s worth). That’s less than half the current (vague) Australian recommendation (of about 23 teaspoons a day).

Just like skinny leather ties and big hair, the glycemic Index seemed like a good idea in the eighties. It held out hope (for a dessert filled future) to millions of diabetics everywhere. But science eventually found out what was really going on (as it usually does) and the world moved on.

In Australia we got stuck on the notion that GI should work (and to this day stubbornly refuse to acknowledge the fructose loophole). The food industry leapt on the marketing power of a ‘healthy label’ that meant they could still use as much sugar as they wanted. Positions became entrenched. Reputations were built. And as a result we now have folks like the GI Foundation and the Australian Diabetes Council telling us there’s nothing wrong with eating sugar.

This would all be mildly entertaining if we weren’t talking about real people with very real (and very life-threatening) problems. Every day in Australia nine people lose a limb to Type II diabetes (and 275 more people develop the disease). Every day the number of obese children grows like never before in human history. Every day the number of new cases of chronic kidney disease sets a new benchmark.

The science says all of this misery (and lots more) can be traced back to eating sugar. So how about we stop playing ducks and drakes with quaint scientific notions (that protect the processed food industry from having to face reality). How about we start caring about the people who follow the advice they see on a packet of food. How about we face the truth about sugar and demand that those we pay to care – do.

June 1, 2011
3

How Fructose makes us Unhappy.

By | Sugar | 16 Comments

We don’t know what causes depression and we certainly don’t know how to cure it. But some interesting new research suggests that there may be a very strong link between depression and what we shove in our gobs.

Depression is a catch-all diagnosis for a spectrum of illness affecting our mood. The spectrum covers everything from a mild bout of feeling down through to the most severe Major Depressive Disorder.

We can become depressed because things aren’t going well. If having your cat run over doesn’t alter your mood (one way or the other depending on how you feel about cats I guess) then you were probably built by aliens. But the science suggests how long we stay depressed has more to do with biochemistry than the state of Fluffy’s road-safety skills.

Food makes us happy (I know, you’re shocked at this revelation). Even seeing food improves our mood. This is because the anticipation of a feed, fires up the hormones responsible for how we feel.

The sight (or smell) of food gives us a squirt of the pleasure hormone, dopamine. Dopamine focuses our attention, makes us think more clearly and helps us move faster and more effectively. It’s an important signal to our body that we are in for something good and we need to pay attention. And that was probably pretty handy in times gone by (when dinner was on the hoof rather than in the burger box).

Once we actually start eating, serotonin kicks in. The serotonin makes us feel happier and less stressed. We relax, our mood improves (Fluffy will still be road kill, but we’ll feel better about it) and our minds can turn to less important things than eating (such as sex – the anticipation of which will give us another dopamine hit and the aftermath of which will give us a nice relaxing serotonin hit). While the cliché that the way to a man’s heart is through his stomach may be the G-rated version – it is largely accurate.

Researchers have known for a long time that severe depression is strongly associated with an inability to properly absorb serotonin in the brain. No (or low) serotonin absorption makes it much harder for us to come back from unhappiness. And this can translate into anxiety and depression if it’s sustained for long enough.

The primary anti-depressant drugs available in Australia (Cipramil, Luvox, Prozac, Lovan, Aropax and Zoloft) all work by targeting the serotonin system. They give the brain more time to absorb the serotonin. Some other drugs (Ecstasy, Amphetamines and LSD) work by enhancing the amount of serotonin we produce (but you might find it tricky to get a prescription for them).

If all is well with our hormone system then severe depression should be an extremely rare disease. But it’s not. Most studies suggest that one in ten of us is suffering some form of depression at any given time. So it won’t come as too much of a surprise to discover that one in every 30 GP consultations in Australia is now about depression.

Depression is a major chronic health problem and it is getting much worse at a very rapid rate. Something is messing with our serotonin system and the evidence is starting to mount that the something is fructose.

Fructose is the only carbohydrate which produces a significant spike in our cortisol levels. Cortisol is our stress hormone. It’s terribly handy for confrontations with unexpected bears (for example) because it ramps up dopamine (to focus the mind and sharpen the movements). It also rapidly increases the amount of dopamine we can absorb. But it does so at the expense of our ability to absorb serotonin.

We like dopamine. It is our reward drug. Frequent hits of fructose mean frequent hits of dopamine. This leads inevitably to fructose addiction and that is exactly the mechanism used by other man-made opiods (like nicotine and cocaine). The trouble is that it seems the upregulating of dopamine at the expense of serotonin can become hard-wired if we allow it to go on for long enough. And once we’re addicted, we cant help but let it go on for long enough.

We don’t run into that many bears on a daily basis (well, I don’t). Fructose was once about as common as a bear encounter, but is now embedded in almost every processed food we buy. And it has an addictive quality as powerful as nicotine (so it isn’t exactly going to harm sales now is it?).

We are now on a constant drip of fructose. That means we are on a constant cortisol (and therefore dopamine) high. This in turn continuously impairs our ability to absorb serotonin, the one substance that can turn our mood around.

Fluffy will still become a bumper sticker if he chooses an inopportune moment to cross the freeway and that will probably be a downer. But the science is suggesting that how quickly (or if) we bounce back from that may depend (to a large extent) on how much fructose we are eating.

In an environment of non-stop fructose infusion, the wonder is not that one in ten of us is depressed, it’s that nine in ten of us aren’t (yet).

Image courtesy of David Castillo Dominici / FreeDigitalPhotos.net