How sick do we have to get?

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.

Where’s the F word … err fructose … in healthy children debate?

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

Attack of the Chocolatier

On Sunday, ABC’s Ockham’s Razor program aired a piece by a chap called Chris Forbes- Ewan. Chris is a nutritionist who works for the Defence Science and Technology Organisation (DSTO) in Tasmania. He has spent the last few years making high melting point chocolate for DSTO. This stuff allows Aussie troops to still enjoy a choccy even when sitting in the hot Arabian sun.

DSTO says they “work closely with industry ... through a range of ... mutually beneficial arrangements.” Interestingly they have been ‘working closely’ with Nestle on Chris’s project. DSTO explain “Nestlé’s transformation from a general food company into a health, nutrition and wellness company meant that they were more closely aligned to DSTO in the area of nutrition.”

Nestle has been transformed into a health and wellness company? I must have missed the memo. I’m sure DSTO (and Chris) are not in any way influenced by ‘closely working’ with Nestle for years, but it would have been nice to disclose the relationship so we could make up our own mind.

It’s true I have no formal qualifications in nutrition. But apparently none are necessary, beyond being a human that eats. And I understand that to someone (like Chris) who has worked in this area for ‘more than two decades’ it could be a little confronting to deal with someone qualified by nothing more than a thirst for knowledge.

After reading 208 pages of summarised research in Sweet Poison, he decides the thing worthy of attack (beyond my credentials) is my claim that we now get almost 20% of our calories from fructose.

For the record the average Aussie consumes about 50 kg of sugar a year. On top of that, they gulp down approximately 10 kg of sugar in fruit juice concentrate (used to sweeten ‘healthy’ food like Nestle’s fruit fix), honey and fruit juice. The fructose half of this equates to 16.4 percent of the recommended adult male’s diet (2,000 Calories per day) or 18.2 percent of an adult female diet of 1,800 Calories. To me, that looks like ‘almost 20 percent’ and a lot more than the 6 percent Chris calculates.

But even if he were absolutely right, it wouldn’t change my argument one little bit. Unlike Chris (and coincidentally Big Sugar), I don’t believe (and there is no credible research to suggest) that there is any safe level of fructose consumption (beyond that which is contained in two pieces of fruit per day).

Even Chris concedes that “many Australians do eat excessive amounts of sugar, and would do themselves (and their waistlines) a favour by reducing sugar intake.” His real concern seems to be that people won’t voluntarily give up sugar, reducing his argument to: I know it’s bad but people won’t change, so let’s not worry about it.

His only other concern was about a human trial (of fructose feeding) I mentioned in the book. It had to be abandoned due to some of the participants suffering heart problems.

I mentioned the study to make the (I thought, rather amusing) point that humans have better lawyers than rats which is why (perhaps) there are less human studies on fructose. But Chris claims that I completely misinterpreted the study’s findings. He implies that the heart problems were no more attributable to fructose than to starch (the two diets used in the trial).

I didn’t do the study, so I have to rely on what the researchers themselves concluded. They say that even though the link between the fructose and the heart attacks could not be proven, the probability that it “was due to chance was < .0005” (less than five hundredths of a percent).

Sweet Poison is stuffed to the brim with examples from the (over 3,000) studies that show the damage being done by fructose, but Chris doesn’t have problems with any of the rest. This one (somewhat oblique) reference is the only one he questions.

He has however personally found 12 studies which show feeding people fructose has no effect or is beneficial (no less). He doesn’t cite (or describe) any of them, so we’ll just have to take his word on that. Perhaps next time Chris, you could give us some clues? Maybe even mention the name of the researchers? Ockham’s Razor is a science show after all.

Despite his newly discovered (and unnamed) studies, Chris finishes his piece by saying that “recent studies suggest that high fructose intake may increase the risk of conditions such as gout, kidney stones, non-alcoholic fatty liver disease, high blood pressure and diabetes, and may also lead to blood lipid profiles associated with greater risk of heart disease.” Oh ok, so we agree then?

And that’s it. That’s all he had. The End.

I’ve put the evidence out there and the best a chocolatier-come-critic can come up with (after six months) is (incorrectly) suggesting I misinterpreted an abandoned study from 1984?

Sugar purveyors (including the DSTO’s partner, Nestle) have billions in revenue and resources coming out their ears. Sweet Poison cites endless studies and there are even more on my blog. But so far not one study has been cited which contradicts any of it.

If the science is wrong and fructose is harmless (as Chris starts to imply but then changes his mind), then surely it can’t be that hard to prove. Just cite some credible studies.

Coke offers me a job (sort of)

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.

Pass the Salt

A study published in last week’s British Medical Journal (BMJ) seemed to confirm what our health gurus already know. Apparently salt is not good for you.

The paper reviewed a series of studies on salt intake conducted between 1985 and 2007. The results were all over the map. But the authors said if you looked at them just the right way, they showed that if you ate more salt your risks of stroke and heart disease were much higher than otherwise.

The theory goes that if you eat less salt, less water will be drawn into your bloodstream and you will have lower blood pressure. And blood pressure is a known risk factor for heart disease and stroke. So they concluded we should all continue to try harder to reduce our salt intake.

Huh? Didn’t we already know this? Isn’t this old news? Why on earth would anyone need to confirm something that we’ve been told since at least 1979? Well it seems the dangers of salt are nowhere near as certain as we have been led to believe.

According to the salt industry, the results are questionable because two of the study’s authors are members of a strident anti-salt group, but didn’t disclose this to the BMJ. And it doesn’t take long to find major studies which flat out contradict those results. Just last year, a significant study showed that (at least in the US), low salt levels actually increase your risk of death from heart disease.

Some small salt studies have shown that decreasing salt will lower blood pressure (and quite a few haven’t). But the favourable results (of less than 2% decrease) are hardly earth shattering. In fact, it’s possible to get similar effects just by decreasing the amount of water someone drinks prior to having their blood pressure taken.

Whether salt really increases (or reduces) your risk of death from a heart attack is clearly far from settled. But that hasn’t stopped nutritionists, Food Standards Australia and the Heart Foundation lobbying furiously for decreases in our daily salt allowance.

Meanwhile the link between sugar (well, at least the fructose half of sugar anyway) and high blood pressure has been growing stronger by the day. A study released last month confirmed that fructose directly causes high blood pressure. The researchers were able to raise participants’ blood pressure by 5 percent in just two weeks by giving them the amount of fructose contained in 3.5 litres of softdrink per day (about 3 times the American average).

The blood pressures returned to normal after two months off the high sugar diet. The study is clearly not a real world example but the effect was pronounced and very, very quick. No study of salt intervention has ever produced anything like it.

Another study released last month backs up the link. In that one, the soft-drink consumption habits of 4,528 people were analysed. Participants who consumed more than 74g of fructose a day (about the same as in 1.3 litres of soft drink and bang on the American average) significantly (87%) increased their risk of having dangerously high blood pressure. Once again, no salt study has ever shown anything like that effect.

But while the Heart Foundation campaigns against salt, it hands out ‘ticks’ to high sugar products like fruit bars and fruit juices. And when salt concerns are put to food processors they respond with good intentions – oh dear, yes there is too much salt in food – we must do better. But try saying that kind of thing about sugar and you get letters from the legal department.

I wonder why that is? Perhaps it’s got something to do with the fact that reducing salt (from anything to anything) is a great marketing claim and it probably won’t affect the sales of the product. But reducing sugar (when your competitors don’t) will probably cost you serious money. Unlike salt, sugar is highly addictive.

It’s time we suspended the phoney war on salt and started a real war on the real culprit: sugar.

Just say No to Sugary Cereal.

We know kids shouldn’t eat high sugar cereals. But actually implementing a ban is likely to defeat all but the most determined of parents. A very recent study out of Yale University in the US may give some hope to timid parents.

The researchers tried a tactic most parents would be reluctant to attempt. Instead of educating children, they just removed sugar-filled food as an option.

The researchers looked at a group of 89 kids (aged 5-12) and what they ate when they were away at summer camp. Half the group were offered only low-sugar cereals (the American equivalent of Weet-bix etc) and the other half were offered only high sugar cereals. Both groups had access to as much table sugar, strawberries and bananas and fruit juice as they wanted.

The Yale team wanted to know firstly if the kids offered low sugar cereals would protest and refuse breakfast. Perhaps surprisingly, 100 percent of the low-sugar group just ate what was on offer (1 percent of the high sugar group refused – obviously some aberrant child snuck in).

The interesting thing is that they ate alot less, in fact they ate half as much. The low-sugar group on average ate the recommended serving of the cereal (one cup). But the high sugar group ate on average two cups. The low sugar group compensated for less cereal by adding table sugar to their cereal and drinking more juice, but even when that was included in the calculations, they ate significantly less sugar than the kids munching on the high sugar cereal.

The researchers didn’t do it, but an interesting extension to this study would be to remove the table sugar and juice, but make sure there was plenty of cold milk to drink. I rather suspect the result would be even more impressive. My guess would be that the kids would once again just eat what was on offer, and perhaps eat less cereal and drink more milk, but their sugar consumption would be insignificant.

The researchers also asked the children to rate their breakfasts out of five (1 being the best and 5 being the worst). The high-sugar kids rated theirs 1.5 on average (no surprises there). They thought their breakfasts were just swell.

The low-sugar kids were of course, nowhere near as happy. Their average was 1.6. In other words, they had no problems with their brekkie’s either.

The interesting thing about this study is that it did what many parents find very difficult. It just removed the option. There was no attempt at moderation or education. The option was simply not there. The kids weren’t unhappy. And they didn’t starve. They just moved on with the new reality.

FYI: I will be giving two public lectures in Brisbane in the upcoming week. There’s more info on both at www.sweetpoison.com.au.

Time to smash juice's health halo

Drinking fruit juice is a nutritious way to get extremely fat. But juice marketers have us convinced that sugar that was once part of fruit is much healthier than sugar that was once part of sugar cane. We’re not entirely convinced. We still drink 3 litres of soft drink for every litre of juice. But that’s still 700ml of juice a week and growing at about 1.5 litres a year.

We love juice because it seems to defy mum’s first law of food: If it tastes good it can’t be good for you. And that’s because even though it’s yummy, it is stuffed with loads of vitamin C. Even the thickest nutritionist knows we all need that vitamin C, right?

Most plants and animals can produce all the Vitamin C they need. Unfortunately humans and other apes descended from tree-swingers never bothered to develop the necessary enzyme. This is probably because our prehistoric diet had plenty of fresh fruit and veg.

If you run low on Vitamin C, you will eventually die of scurvy. And if we are to believe the juice purveyors, we are all on the verge of expiring from lack of Vitamin C.

But do you know anyone that has died of scurvy? Me neither. That’s because it’s extraordinarily difficult to deplete your stores of vitamin C enough to achieve it. Pretty much the only way you’ll do it will be to lock yourself up on a sailing ship for 6 months. Even then you’d be pushing it. Captain Cook didn’t lose anyone to scurvy on his way over here and all he fed his men was pickled cabbage and salted meat. There were no stops at the mid-pacific juice bar for that lot.

According to the World Health Organisation, you would need to be totally deprived of Vitamin C for two months before you showed the first signs of scurvy. And even then all you would need to fix the problem would the amount of Vitamin C found in half a small bag of hot chips.

The other major nutritional claims for fruit juices are that they are good sources of folate and potassium. And while both are important, anyone who eats bread, nuts, meat, fresh fruit or vegetables (well just about anything really) will be getting more than any fruit juice would ever deliver.

A glass of apple juice is no better for you than a glass of Coke. The average soft drink is 10% sugar and so is the average juice. And while the nutritional content claims are (vaguely) true, they are about as relevant as slapping “Asbestos Free” on the front of a bottle of Coke (no, this is not a suggestion).

Big Sugar is green with envy at people queuing round the block to buy sugar water from juice bars. Coca-cola tried to get in on the act and buy Berri, our biggest juice purveyor by a country mile. But the ACCC decided that wouldn’t be good for competition (it is, however, ok for a Japanese Brewer to own it).

And earlier this year, Coke got knocked back again when it tried to buy half the Chinese fruit juice market. I don’t know why they’re bothering. All they need to do is source their sugar molecules from fruit juice concentrate rather than cane, chuck in some multivitamins and, voila, healthy sugar water – oh wait – they’ve already thought of that: Glaceau Vitamin Water.

None of this is secret, so why does the government endorse juice as an alternative to fresh fruit? Why does the heart foundation hand out ticks to fruit juice makers? And why is juice promoted as a “green food” in school canteens?

In July, I asked the Queensland Deputy Premier and Minister for Health, Paul Lucas, why juice was endorsed as health food in schools. A flunkey immediately responded (at the end of September) letting me know that the Minister’s reply was awaiting signature and so, of course, I am still waiting. Maybe he forgot how to sign his name?

It’s time to knock the health halo off the head of the juice makers and place them firmly in the sugar-water category they have so successfully evaded. It’s time for governments to stop aiding and abetting the deception and its time kids were fed water at school instead of sugar-water dressed up as health food.