A pharmacist's perspective on health and metabolic disease
On Monday, the 2017 FIZZ (fighting sugar in soft-drinks) symposium was held in Auckland. There was an overwhelming support for New Zealand to tax sugar-sweetened beverages.
Today, this opinion piece by economist Mac Mckenna was published in the New Zealand Herald. In summary Mr McKenna stated “To use a rugby analogy, blaming soft drinks for the obesity problem is like blaming a missed penalty for losing 50-0.”
Prof. Boyd Swinburn has written an excellent response exposing the alternative facts.
Here is my response:
I am one of your “so-called public health ‘experts’“ who is supporting a tax on sugar sweetened beverages. I am a pharmacist with more than 20 years experience working in New Zealand. Recently I completed a PhD in public health (AUT) focusing on a common precursor of many different non-communicable diseases.
Your assertation that “the evidence does not support the [sugar-tax] crusade” has overlooked other effects of sugar-sweetened beverages on health. I agree with you that the sugar tax is unlikely to make a significant dent in obesity statistics, but there is more to the sugar tax than simply managing obesity.
When I started my pharmacy practice 20 years type 2 diabetes was rare in people under the age of 40 years. Now I am aware of 9 years olds being diagnosed with what was known as “adult onset diabetes”. In fact, in many countries, children being diagnosed with type 2 diabetes have been increasing since the 1980s¹. Globally, other medical conditions including gout, dental decay, cardiovascular disease and dementia are increasingly prevalent.
What is common to all these conditions? Fructose consumption. Especially the fructose found in table sugar (sucrose) and high fructose corn syrup, found in many processed foods. Increased fructose consumption is associated with all the medical conditions mentioned above. Yes – there are other environmental factors, better diagnostic methods and people living longer to be able to be diagnosed with these conditions. But high fructose levels in the diet are exacerbating these conditions.
Fructose has become increasingly common in the diet, especially after the introduction of high fructose corn syrup about 40 years ago. Thirty years ago, my family might buy a 1.25 litre bottle of “Sparkling Duet” to share on Friday nights with our fish and chips. These days we see children going to school drinking from an individual 1.25 litre bottle of soda and the same again on the way home.
Since then, excessive fructose is well established as being linked to increased tooth decay, and high uric acid levels. Dental cavities are the leading cause for children needing to be admitted to hospital to have a general anaesthetic. The high uric acid level is then associated with gout and with fatty liver disease, with the latter leading to insulin resistance and high triglyceride levels. These conditions lead to type 2 diabetes and cardiovascular disease. Type 2 diabetes is becoming increasing recognised as a leading risk factor for the development of many cancers and dementias. Scarily, you do not need to be obese to develop fatty liver disease or type 2 diabetes.
All of these conditions are associated with reduced length and quality of life, and increased pain and suffering. This leads to people taking time off work, or leaving employment due to pain, other illnesses or doctor’s visits – and not just their own, but in order to look after family members. Type 2 diabetes is a leading cause of blindness and kidney disease in New Zealand, placing considerable strain on our healthcare systems and the economy in general.
You claim that “If people still choose to consume “unhealthy” products in spite of these health warnings then what right does the Government have telling people they are making the wrong choice.” Except that the insidiously addictive nature of fructose and sweet-foods have been overlooked. We should start looking at sugar-sweetened products in the same way that we have considered tobacco. We need to consider the overall message going out about sweetened foods and beverages. Just as when we recognised tobacco was unhealthy, we changed the way it was represented in our communities. We now need to do the same with sugary drinks and consider the advertising within our community, who is sponsoring our national sports teams, or events, and other factors influencing our decision making – especially our children. Although advertising may not be directly targeting children, they still notice them : Just ask any teacher after a new advertising campaign.
Taxing sugar-sweetened beverages – and not just fizzy drinks, but also sugar sweetened juices, milks, energy drinks, and sports drinks is not going to be a panacea and instantly improve health. However, it will be a step in the right direction, but only if the revenue gets targeted to health initiatives: Either to empower communities to make better decisions, or to fix the damage that has already occurred.
Yes – there is the risk that a tax on sugar-sweetened beverage may further disadvantage those on a low income, but data from Mexico showed that there was a 17% decrease in spending on sugar sweetened beverages from people in the lower socioeconomic demographics. This was after they took into account purchases of cheaper products. It is also estimated that the overall cost to many households household would be less than $1 per week. Is this really a significant risk?
Ideally, I would like to see a sugar tax, not just a tax on sugar-sweetened beverages. Yes, sugary drinks only comprise a small part of the average sugar intake. But when you consider that, as according to the World Health Organisation, we should consume no more than three, six or nine teaspoons of added sugars per day (depending on whether you are a child, woman, or man). Considering that a can of soda can have between 8-12 teaspoons of sugar, this means that one can of soda exceeds the recommended daily intake for both children and women and leaves little leeway for men. If we can reduce sugary drink consumption we can make a dent in sugar consumption. Maybe if the price on sugar-sweetened beverages goes up, more people will switch to healthier alternatives.
Taxing sugar-sweetened beverages, if done well, can send a clear message to industry. It says that we as a nation recognise that excessive consumption of these products lead to harm and this is one step on a long-road to the nation’s health recovery.
*Just to make it clear – although fructose is found in many fruits, consumption of fructose as part of a piece of whole fruit (not juice) is unlikely to have negative effects on health – unless you eat a lot of fruit very quickly.
¹Rosenbloom, A. L., Joe, J. R., Young, R. S., & Winter, W. E. (1999). Emerging epidemic of type 2 diabetes in youth. Diabetes Care, 22(2), 345-354. doi:10.2337/diacare.22.2.345