Map of life expectancy at birth from Global Education Project.

Thursday, September 17, 2009

Breaking news! Mass poisoning of children

You may not be reading it here first that a bunch of people with long strings of letters after their names -- specifically Kelly D. Brownell, Ph.D., Thomas Farley, M.D., M.P.H., Walter C. Willett, M.D., Dr.P.H., Barry M. Popkin, Ph.D., Frank J. Chaloupka, Ph.D., Joseph W. Thompson, M.D., M.P.H., and David S. Ludwig, M.D., Ph.D. -- have written an essay now posted on the NEJM website urging a tax on sugary beverages. They figure a tax of a penny an ounce -- applied not only to soda but also so-called "sports drinks" and beverages sold as fruit juice but aggressively sweetened with mutant high sugar grape juice -- would raise $14.9 billion for the federal government in the first year.

That would obviously help pay for universal health care (although I'm cynical enough to believe it would just get sucked up by the insurance industry with a little help from their best buddy Max), but more important, it would discourage people from consuming the stuff. It's not just that the empty calories make you fat, which they do. Oh no, it's worse than that. The best summary I know of is by David S. Ludwig, in JAMA, May 8 2002 (v. 287 p. 2414), but you aren't allowed to read it. So I'll tell you what it says.

Some carbohydrates, among them refined sugars but also potatoes and white rice, among others, get converted to blood glucose very quickly. When you eat them, your blood sugar shoots up, an event called a glycemic spike, hence these foods are said to have a high glycemic index. That forces your pancreas to pump out a whole lot of insulin. Then, as the blood sugar declines, the insulin is still around, which means you get hungry again. Sugar consumed in beverages has little or no satiating effect; on the contrary, it actually makes you hungrier a couple of hours later. It has been found that kids who are given sugary soda with meals actually eat more later on than kids who are not.

Just as bad, if not worse, repeated insulin spikes over the years cause your cells to become insulin resistant and also wear out the pancreatic beta cells that make insulin, in other words you start to develop Type 2 diabetes. They also seem to have a direct effect on atherosclerosis, but the worst part is that diabetes puts you at risk for heart disease, kidney disease, blindness, loss of limbs -- it's one of the very worst things that can happen to you. Or, as Ludwig himself sums it up,

The rate of carbohydrate absorption after a meal, as quantified by glycemic index, has significant effects on postprandial hormonal and metabolic responses. High–glycemic index meals produce an initial period of high blood glucose and insulin levels, followed in many individuals by reactive hypoglycemia, counterregulatory hormone secretion, and elevated serum free fatty acid concentrations. These events may promote excessive food intake, beta cell dysfunction, dyslipidemia, and endothelial dysfunction. Thus, the habitual consumption of high–glycemic index foods may increase risk for obesity, type 2 diabetes, and heart disease, a hypothesis that derives considerable support from laboratory studies, clinical trials, and epidemiological analyses.

(The American Diabetes Association, by the way, having accepted millions of dollars from the sugar industry, works very hard to downplay this inconvenient truth. They even want to tell you that it's a "myth" that consuming sugar causes diabetes. It is not a myth, it is a fact. For shame.)

By the way, while potatoes and rice do have a high glycemic index, they are typically eaten as part of a complete meal. Consuming high glycemic index foods with a meal that also includes fiber and fat damps down the glycemic spike. So you don't have to give up potatoes but what you definitely don't want to do is eat french fries by themselves as a snack, or even worse, make a meal of fries and soda. Fruit, by the way, has a low glycemic index because it contains fiber. The GI for instant rice is 91; for an apple, 36. Beans, fruits, vegetables, whole grains -- that's the way to go. But you already knew that.

The excise tax would be imposed at the manufacturing stage, so it would be no problem to implement and manufacturers could simply lower their tax burden by lowering the sugar content of their beverages. It would be regressive in the sense that low income people consume more sugary drinks, but of course anyone can avoid the tax altogether by choosing other beverages. And by so doing, they will avoid the much greater price of a horrific, early death; and all of us will avoid the enormous cost of medical care for people with diabetes and its complications, including chronic kidney disease, heart disease, neuropathy, retinopathy . . .

There are enormously powerful forces arrayed against it, from Archer-Daniels-Midland to Coke and Pepsi and McDonald's, who will spend hundreds of millions to defend their God-given right to murder our children. Is there any possibility the people can be more powerful than them?


RayPublicHealth said...

Have you seen this Newsweek article?

C. Corax said...

Gov. Patrick wanted to help balance the state budget with a sin tax. That got shot down real quick.

Funny how hysteria about vaccination makes front page news over and over, but murder by diet is acknowledged in only the most cursory manner by the media before it moves on to two-page spreads about the latest dietary fad.

Cervantes said...

Interesting Ray -- still in the early hypothesis stage, I would say, but we'll see where it goes.