Dr Aseem Malhotra is an interventional
cardiologist and the founding member and science director of Action On
Sugar, a group of specialists concerned with sugar and its effects on
health. Action on Sugar has been campaigning to reduce population
consumption of sugar by 40% over the next few years to reverse the
obesity epidemic. Dr Malhotra, one of the most vocal campaigners against
sugar industry and Big Food, tells Rema Nagarajan why sugar is the new tobacco.
Is it true that sugar kills more than tobacco?
Non-communicable disease contributes to 35 million deaths worldwide for
which poor diet is a major contributor. According to the Lancet's
Global Burden of disease report, poor diet is responsible for more
disease than physical inactivity, alcohol and smoking combined. What is
more important is the increasing years of disability, chronic suffering
and impact on health care resources of people living with these diseases
as opposed to dying of old age. Combating this now poses the greatest
challenge to health worldwide.
Why do you say Big Sugar is the new Big Tobacco and that it is worse?
There are many comparisons to be made with the sugar and tobacco industry. Both are financially and politically very powerful and as we are learning the sugar industry is using tactics similar to the tobacco industry in resisting any control or regulation to reduce population consumption. We mustn't forget that It took 50 years from when the first studies linking smoking and lung cancer were made before any effective regulation was introduced because Big Tobacco engaged in a corporate strategy that involved planting denial, planting doubt, confusing the public and even buying the loyalty of scientists. But Tobacco was avoidable and they didn't target children unlike the food industry that spends billions in marketing targeting the most vulnerable members of society.
How does Big Sugar target children? How can this be regulated/stopped?
The government should introduce regulation to ban junk food advertising to children including the internet.These mult-billion dollar companies are able to over-power positive health messages, with the odds stacked very much against public health. Their ONLY interest is profit. Doctors' interest is to protect your health. For every £1 the World Health Organisation spends in preventing diseases caused by unhealthy eating, the food industry spends £500 in marketing junk food.
The sugar industry says sugar is not harmful when part of a varied diet and that what you eat is your choice. You can choose to eat in moderation and exercise more to prevent obesity. How true is that?
There is absolutely no role for added sugar to be part of a balanced diet. There is no nutritional value and the body does not require any energy from added sugar. Of course there's nothing wrong with the occasional treat. I have a sweet tooth as much as anyone else and enjoy chocolate and ice cream but consume it very seldom now as a treat.
Regular exercise has many benefits but has very little to do with obesity. Independent scientific evidence reveals that over the past 30 years as obesity has rocketed in the western world, exercise levels haven't changed very much and may have actually increased placing the blame directly on calories consumed. The food industry has promoted this belief to deflect culpability for the obesity epidemic onto the individual. By sponsoring sporting events, companies such as MacDonald's and Coca-Cola increases the acceptability of the consumption of junk food at the expense of our children's health. I was very disturbed to hear a respected Indian doctor on NDTV recently giving out a message that it's OK for kids to consume junk food as long as you exercise. This is not only ignorant but gives out a very harmful message contrary to scientific evidence. A recent very large 175 country study conducted from Stanford University in America looked at sugar availability and consumption worldwide and revealed that for every 150 excess sugar calories consumed (typical of a can of cola) compared to 150 calories from another source there was a staggering eleven fold increase in the prevalence of type 2 diabetes that was independent of body weight and independent of physical activity.
Essentially you are still vulnerable to increasing your risk of health problems if you're normal weight and exercise if you regularly consume such products. And the scientific evidence supports this as 40% of normal weight individuals will develop the diseases of the metabolic syndrome. Indians are particularly vulnerable to the TOFI (Thin on the outside, fat on the inside) phenotype. Increased waist circumference is a particularly good marker for this.
There are many comparisons to be made with the sugar and tobacco industry. Both are financially and politically very powerful and as we are learning the sugar industry is using tactics similar to the tobacco industry in resisting any control or regulation to reduce population consumption. We mustn't forget that It took 50 years from when the first studies linking smoking and lung cancer were made before any effective regulation was introduced because Big Tobacco engaged in a corporate strategy that involved planting denial, planting doubt, confusing the public and even buying the loyalty of scientists. But Tobacco was avoidable and they didn't target children unlike the food industry that spends billions in marketing targeting the most vulnerable members of society.
How does Big Sugar target children? How can this be regulated/stopped?
The government should introduce regulation to ban junk food advertising to children including the internet.These mult-billion dollar companies are able to over-power positive health messages, with the odds stacked very much against public health. Their ONLY interest is profit. Doctors' interest is to protect your health. For every £1 the World Health Organisation spends in preventing diseases caused by unhealthy eating, the food industry spends £500 in marketing junk food.
The sugar industry says sugar is not harmful when part of a varied diet and that what you eat is your choice. You can choose to eat in moderation and exercise more to prevent obesity. How true is that?
There is absolutely no role for added sugar to be part of a balanced diet. There is no nutritional value and the body does not require any energy from added sugar. Of course there's nothing wrong with the occasional treat. I have a sweet tooth as much as anyone else and enjoy chocolate and ice cream but consume it very seldom now as a treat.
Regular exercise has many benefits but has very little to do with obesity. Independent scientific evidence reveals that over the past 30 years as obesity has rocketed in the western world, exercise levels haven't changed very much and may have actually increased placing the blame directly on calories consumed. The food industry has promoted this belief to deflect culpability for the obesity epidemic onto the individual. By sponsoring sporting events, companies such as MacDonald's and Coca-Cola increases the acceptability of the consumption of junk food at the expense of our children's health. I was very disturbed to hear a respected Indian doctor on NDTV recently giving out a message that it's OK for kids to consume junk food as long as you exercise. This is not only ignorant but gives out a very harmful message contrary to scientific evidence. A recent very large 175 country study conducted from Stanford University in America looked at sugar availability and consumption worldwide and revealed that for every 150 excess sugar calories consumed (typical of a can of cola) compared to 150 calories from another source there was a staggering eleven fold increase in the prevalence of type 2 diabetes that was independent of body weight and independent of physical activity.
Essentially you are still vulnerable to increasing your risk of health problems if you're normal weight and exercise if you regularly consume such products. And the scientific evidence supports this as 40% of normal weight individuals will develop the diseases of the metabolic syndrome. Indians are particularly vulnerable to the TOFI (Thin on the outside, fat on the inside) phenotype. Increased waist circumference is a particularly good marker for this.
Is all sugar bad?All sugars aren't bad. The cells of the body require glucose for energy
which is intrinsically present in whole fruit and vegetables. But
regular sugar which is added to sweeten various foods is bad as the body
does not require any carbohydrate from added sugar. High levels of
added sugar are present in chocolates, ice cream, cakes, biscuits and
Indian mithai. One regular can of coke contains a staggering 9 tea
spoons of added sugar. This is triple the limit recommended by American
Dietary guidelines for the average 4 to 8 year old child. A Mars bar has
8 tea spoons of added sugar! Responsible parents should be wary of
allowing their small children to consume a can of coke more than once
every few weeks. Added sugar comes under the umbrella of non-milk
extrinsic sugars which includes fruit juice. Contrary to common wisdom,
fruit juice is not healthy because it contains liquid sugar and without
the fibre of the whole fruit. A very large observational study recently
published in the BMJ revealed that fruit juice consumption was
associated with and increased risk of type 2 diabetes.
http://articles.timesofindia.indiatimes.com/2014-01-24/science/46562061_1_sugar-industry-big-sugar-big-tobacco
When
you say sugar do you mean regular sugar or things like dextrose,
glucose, sucrose, fructose and high-fructose corn syrup etc which are
added to processed food?
Fructose fulfills all the criteria that suggest it should be regulated. But even regular sugar is made up of 50% fructose and 50% glucose. It is the fructose component that has been implicated in causing the metabolic syndrome namely type 2 diabetes, hypertension, dyslipidaemia and increased waist circumference. Fructose is toxic to the liver, it's unavoidable as it is added to most processed foods, has the potential for abuse and has a negative impact on society through increasing health care costs. It also gets converted to liver fat that causes insulin resistance which drives type-2 diabetes and inflammation in the body which increases the risk of a heart attack and stroke. It also interferes with hormones that control appetite stopping us from feeling full, and as a result we eat more and get fat.
As a Cardiologist who deals with and treats patients with type 2 diabetes on a daily basis I am extremely concerned about its rocketing prevalence especially in India which has the second highest incidence of type 2 diabetes in the world. This is a multi-organ, multi-system condition associated with increasing the risk of heart attack, stroke, kidney failure, blindness, depression, amputation. 70% of type 2 diabetics will ultimately develop dementia. This is an entirely preventable disease which causes so much unspeakable suffering worldwide.
How do you say sugar is more to blame than fats in our diet for obesity?
It depends which kinds of fat one is referring to. Trans-fats found in fast food is particularly harmful but non-processed foods that contain more fat such as eggs, milk and cheese have great nutritional value. We need fat to survive but we don't need any added sugar.
If sugar is so bad why are food regulators not doing more to regulate the sugar used by the food industry?
Many of the people and organisations that give out nutritional advice have been co-opted by the industry. Last week, investigative journalists from Channel 4's Dispatches programme uncovered that several members of the UK's Scientific Advisory Committee on Nutrition are on the payroll of the food industry with the chief scientist Professor Ian MacDonald taking considerable amounts of money, both personal and for research from companies such as Coca Cola and Mars.
What is a reasonable amount of sugar to have in a day? How much in excess are we having?
Scientists have recently advised the World Health Organisation to suggest a limit to a maximum of 6 tea spoons per day for the average adult female and 8 for the average male or 5% of total energy. It's important to note that this is a LIMIT. You do not need any added sugar in your diet. In the United states 1/3 of sugar consumption comes from sugary drinks including juice, 1/6 from foods such as chocolates, ice cream, cakes and biscuits and up to a half comes from foods that people don't normally know as having added sugar such as bread, low fat yoghurts and ketchup.
Sugar consumption per person has supposedly been declining over a long term say from the 1940s to now. Is that true?
This is incorrect. Sugar consumption has trebled worldwide in the past 50 years. There has been a very slight drop in the past 10 years but the consumption is still staggeringly high.
Fructose fulfills all the criteria that suggest it should be regulated. But even regular sugar is made up of 50% fructose and 50% glucose. It is the fructose component that has been implicated in causing the metabolic syndrome namely type 2 diabetes, hypertension, dyslipidaemia and increased waist circumference. Fructose is toxic to the liver, it's unavoidable as it is added to most processed foods, has the potential for abuse and has a negative impact on society through increasing health care costs. It also gets converted to liver fat that causes insulin resistance which drives type-2 diabetes and inflammation in the body which increases the risk of a heart attack and stroke. It also interferes with hormones that control appetite stopping us from feeling full, and as a result we eat more and get fat.
As a Cardiologist who deals with and treats patients with type 2 diabetes on a daily basis I am extremely concerned about its rocketing prevalence especially in India which has the second highest incidence of type 2 diabetes in the world. This is a multi-organ, multi-system condition associated with increasing the risk of heart attack, stroke, kidney failure, blindness, depression, amputation. 70% of type 2 diabetics will ultimately develop dementia. This is an entirely preventable disease which causes so much unspeakable suffering worldwide.
How do you say sugar is more to blame than fats in our diet for obesity?
It depends which kinds of fat one is referring to. Trans-fats found in fast food is particularly harmful but non-processed foods that contain more fat such as eggs, milk and cheese have great nutritional value. We need fat to survive but we don't need any added sugar.
If sugar is so bad why are food regulators not doing more to regulate the sugar used by the food industry?
Many of the people and organisations that give out nutritional advice have been co-opted by the industry. Last week, investigative journalists from Channel 4's Dispatches programme uncovered that several members of the UK's Scientific Advisory Committee on Nutrition are on the payroll of the food industry with the chief scientist Professor Ian MacDonald taking considerable amounts of money, both personal and for research from companies such as Coca Cola and Mars.
What is a reasonable amount of sugar to have in a day? How much in excess are we having?
Scientists have recently advised the World Health Organisation to suggest a limit to a maximum of 6 tea spoons per day for the average adult female and 8 for the average male or 5% of total energy. It's important to note that this is a LIMIT. You do not need any added sugar in your diet. In the United states 1/3 of sugar consumption comes from sugary drinks including juice, 1/6 from foods such as chocolates, ice cream, cakes and biscuits and up to a half comes from foods that people don't normally know as having added sugar such as bread, low fat yoghurts and ketchup.
Sugar consumption per person has supposedly been declining over a long term say from the 1940s to now. Is that true?
This is incorrect. Sugar consumption has trebled worldwide in the past 50 years. There has been a very slight drop in the past 10 years but the consumption is still staggeringly high.
