TorixEdyn

23/02/2022

Poorest Americans drink a lot more sugary drinks than the richest – which is why soda taxes could help reduce gaping health inequalities
Many countries such as the U.K. and Mexico and a handful of U.S. cities such as Philadelphia and San Francisco have imposed soda taxes in an effort to fight rising obesity.

Lots of research shows a link between drinking sugary substances and a whole host of negative health outcomes, including type 2 diabetes, heart disease, liver disease, tooth decay and gout.

As economists who study economic status and health, we wanted to look at this from another perspective: Does how wealthy you are affect how much soda you consume? And could reducing sugary beverage consumption narrow the double-digit life expectancy gap between the richest and poorest Americans?

Wealth and soda
We analyzed data for over 24,000 U.S. adults in two nationally representative random samples from the National Longitudinal Surveys, which follow groups of people over a period of time, asking them hundreds of questions each year on a variety of topics like employment, health and attitudes. Some questions are asked every year, while others are included less frequently.

We looked at two groups of people. The first is referred to as the NLS 1979 cohort and includes people born from 1957 to 1964. They were asked how often they consumed sugary drinks in the previous week every other year from 2008 to 2016, meaning the respondents were in their 40s and 50s when asked the question.

The second group is known as the NLS 1997 cohort and includes people born from 1980 to 1984. They were asked the sugary drink question four times from 2009 to 2015, putting them in their 20s and 30s.

Prior studies have found that consumption of sugary drinks tend to rise as income falls. But few of them controlled for the range of other factors that could also matter, such as gender, race and ethnicity, education, cognitive skills and interest in health and nutrition. Moreover, none of them focused on wealth, which can offer unique insights on the issue.

Wealth represents an accumulation of resources rather than a regular flow of income. Newly graduated doctors have high income and low wealth, while retirees may have high wealth, but little income. The difference between income and wealth means they could affect consumption patterns differently. Wealth is distributed much more unequally. In addition, individuals may signal their membership in the upper economic echelons through the foods they consume.

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We first looked at the share of respondents who reported drinking any sugar-sweetened beverages in the survey week by income and wealth deciles, which divides them into 10 equal groups depending on their income or wealth.

The number of sugar-sweetened beverages consumed generally falls as income rises. We found the same pattern when we looked at wealth, but the differences by wealth are more pronounced. Our analysis suggests that adults living in the richest 10% of families drink about 2.5 fewer sugary drinks a week than those in the poorest 10%.

This decline in sugary drink consumption as income and wealth rise holds up even after taking into account things like education, race, gender, cognitive abilities and interest in nutrition.

What’s the impact of 2.5 more sugar drinks a week? Rough calculations based on the typical sugar amounts in these drinks – about 9.5 teaspoons per 12-ounce can – suggest that it could result in about 5.6 pounds of weight gain over a year, assuming no increase in physical activity or decrease in consumption of calories from other sources.

For richer or poorer
We also wondered whether soda consumption might change as people gain or lose wealth or make more or less money. Would increases in economic status correlate with decreases in sugary drink consumption?

Over the four-year periods we could observe, changes in income and wealth, even large ones, were not correlated to changes in sugary drink intake. We did not observe that adults who had gotten richer tended to report a drop in the number of sugary drinks consumed.

One possible explanation is that while economic status shapes our early drinking habits, those habits don’t much change in adulthood. Another possible explanation is that four years is not enough time for noticeable changes in sugar-sweetened beverage consumption to happen.

Our finding that people who are wealthier or make more money consume fewer sugary drinks supports the idea that soda consumption contributes to health inequities along the economic distribution.

However, that doesn’t mean soda taxes are the best way to reduce these inequities. Since we find that sugary beverage consumption is higher for poorer Americans, these taxes can be regressive – meaning they fall more heavily on those with less income. On the other hand, if people with lower incomes respond to the higher prices caused by “soda taxes” by cutting consumption substantially, they can avoid the tax and improve their health.

A just-published study suggests that some soda taxes may be more effective than others at changing drinking habits. Specifically, it found that taxes based on the quantity of sugar in a drink are more successful than those simply based on volume, which are more common in the U.S.

So well-designed soda taxes can help reduce rich-poor health disparities, but we’ll need a range of strategies to achieve that goal.

21/02/2022

Two glasses of wine might add more sugar to your diet than eating a doughnut
Soft drinks have been the focus of the UK government’s attempts to curb people’s sugar intake in recent years, but the same approach has not yet been applied to the sugar content in alcoholic drinks.

The government introduced “sugar taxes” on soft drinks in 2018, meaning manufacturers are charged a levy of up to 24p per litre of drink if it contains eight grams of sugar per 100 millilitres. This was done in order to attempt to reduce the public’s sugar intake in light of increases in childhood obesity.

But a new report from Alcohol Health Alliance UK has suggested that just two glasses of wine contains enough sugar to meet the maximum recommended daily intake level – even more than a glazed doughnut.

The report found that some bottles of wine contain as much as 59 grams of sugar per bottle. A standard bottle of wine contains 750 millilitres, which is equivalent to three large glasses of wine. This means in some cases a single large glass of wine can contain just under 20 grams of sugar, almost twice the sugar content of that glazed doughnut. So, when it comes to alcoholic drinks, how much sugar do they contain?

Consumption of sugar-sweetened drinks has been linked to an increased risk of weight gain and obesity, and associated conditions such as type 2 diabetes. Most research into sugary drinks has focused on soft drinks, such as colas. Alcohol, or ethanol to give it it’s proper name, is itself calorific.

Alcohol is second only to fats in terms of its calorie content per gram. On top of this potentially significant calorie content is the sugar that is contained in many alcoholic drinks. This includes the non-fermented starches and sugars found in beers and wines, or sugars added to some drinks such as cocktails or mixers to add flavour. It is unsurprising therefore that alcohol consumption has been associated with weight gain.

Sugar levels in cocktails
Surveys have reported that alcoholic drinks account for 10% of daily intake of added sugar in the UK for 29 to 64-year-olds, and 6% for the over 65s. This difference may be explained by the alcoholic drinks chosen by these different age groups.

Four different cocktails of different colours.
Cocktails have high levels of sugar. Cabeca de Marmore/Shutterstock
Near the top of the list of sugary drinks is likely to be the recent phenomenon of pre-made cocktails in a can, with some containing a staggering 49 grams of sugar per serving. Other more traditional cocktails also fare poorly when scrutinised for sugar content, a summer fruit cup cocktail, for example, may contain more than 25g of sugar per serving. This figure could be higher at home, depending on who makes the drink, and what is considered a serving. Having several of these cocktails won’t just make you merry, but will also provide more sugar than eating several chocolate bars.

Wine can vary dramatically in sugar content, with the seemingly healthier lower strength alcohol wines often having more sugar and therefore not necessarily being healthier. In general, dry wines or red wines generally have lower sugar levels.

Read more: The science of sugar: why we're hardwired to love it and what eating too much does to your brain – podcast

For those of us who enjoy beers and ciders, these drinks can contain even more sugar per serving than wine. A pint of cider, for example, contains more than 25g of sugar, with some ciders containing an eye watering 46g of sugar per serving.

Because spirits such as gin, vodka, whisky and rum are highly distilled their sugar content should be negligible. Without mixers, these drinks are clearly the healthiest in terms of both sugar and calorie content. The mixers they come with can however be sugar-sweetened so if you want to avoid sugar, having your gin neat or on the rocks is the best way forward.

Better labelling
It is clear that more can be done to alert people to the sugar content of alcoholic drinks. The first step would be to mandate that alcohol producers accurately label their products, not just with alcohol content by volume, but also sugar and calorie content, so consumers can make informed choices. Equally, altering the sugar levy to target alcoholic drinks more specifically would likely cause drinks manufacturers to alter their recipes to have less sugar content.

The levy on soft drinks has shown this can work, with significant reductions in consumption of sugar-sweetened non-alcoholic drinks since 2018. The government claimed that the tax on soft drinks resulted in more than 50% of manufacturers reducing sugar content in drinks between March 2016, when it was announced, and its introduction in 2018.

In the UK more than 20% of people regularly drink alcohol at levels that increase their health risk. People should also be aware of the less obvious risks posed by drinking alcohol, including the sugar content, and take this into account when choosing their tipple, especially if they are trying to lose weight.

18/02/2022

Sugar detox? Cutting carbs? A doctor explains why you should keep fruit on the menu
One of my patients – who had been struggling with obesity, uncontrolled diabetes and the cost of her medications – agreed in June 2019 to adopt a more whole-food plant-based diet.

Excited by the challenge, she did a remarkable job. She increased her fresh fruit and vegetable intake, stopped eating candy, cookies and cakes and cut down on foods from animal sources. Over six months, she lost 19 pounds and her HbA1c – a measure of her average blood sugar – dropped from 11.5% to 7.6%.

She was doing so well, I expected that her HbA1c would continue to drop and she would be one of our plant-based successes who had reversed diabetes.

Her three-month follow-up visit in March 2020 was canceled because of COVID-19 lockdowns. When I eventually saw her again in May 2021, she’d regained some of the weight and her HbA1c had climbed to 10.4%. She explained that her diabetes doctor and a diabetes nurse educator had told her that she was eating too much “sugar” on the plant-based diet.

She’d been advised to limit carbohydrates by cutting back on fruits and starchy vegetables and eating more fish and chicken. Sugar-free candy, cakes, cookies and artificial sweeteners were encouraged. In the face of conflicting medical advice, she fell back on conventional wisdom that “sugar” is bad and should be avoided whenever possible, especially if you have diabetes.

I’m a physician, board certified in preventive medicine with a lifestyle medicine clinic at Morehouse Healthcare in Atlanta. This emerging medical specialty focuses on helping patients make healthy lifestyle behavior modifications. Patients who adopt whole-food plant-based diets increase carbohydrate intake and often see reversal of chronic diseases including diabetes and hypertension. In my clinical experience, myths about “sugar” and carbohydrates are common among patients and health professionals.

Fruit vs. sugar
Your body runs on glucose. It is the simple sugar that cells use for energy.

molecular diagrams for glucose, fructose and galactose
These molecules are the three kinds of simple sugars, found in starches, fruit and milk. Trinset/ iStock via Getty Images Plus
Glucose is a molecular building block of carbohydrates, one of the three essential macronutrients. The other two are fat and protein. Starches are long, branching chains of glucose.

molecular diagram of chain of glucoses together
Chains of simple sugar molecules linked together form starches and other carbohydrates. Trinset/iStock via Getty Images Plus
Naturally occurring carbohydrates travel in nutrient-dense packages such as fruits, vegetables, whole grains, nuts and seeds.

Humans evolved to crave sweet tastes to get the nutrients needed to survive. A daily supply of vitamins, minerals and fiber is needed because our bodies cannot make them. The best source of these substances for our ancient ancestors was sweet, ripe, delicious fruit. In addition, fruits contain phytonutrients and antioxidants, chemicals produced only by plants. Phytonutrients such as ellagic acid in strawberries have cancer-fighting properties and promote heart health.

Refined sugars, on the other hand, are highly processed and stripped of all nutrients except calories. They’re a concentrated form of carbohydrates. The food industry produces refined sugars in many forms. The most common are sucrose crystals, which you’d recognize as table sugar, and high-fructose corn syrup, which is found in many processed foods and sweetened beverages.

If you continually satisfy your taste for sweet with foods that contain refined sugar – rather than the nutrient-rich fruits at the core of this craving passed on by evolution – you may not get all the nutrients you need. Over time, this deficit may create a vicious cycle of overeating that leads to obesity and obesity-related health problems. Women who eat the most fruit tend to have lower rates of obesity.

Sugar toxicity
Refined sugars are not directly toxic to cells, but they can combine with proteins and fats in food and in the bloodstream to produce toxic substances such as advanced glycation end products (AGEs). High blood glucose levels may produce glycated low-density lipoproteins. High levels of these and other glucose-related toxic substances are associated with an increased risk of a wide range of chronic health problems, including cardiovascular disease and diabetes.

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The disease most commonly associated with sugar is Type 2 diabetes. A surprising number of people, including health professionals, incorrectly believe that eating sugar causes Type 2 diabetes. This myth leads to a focus on lowering blood sugar and “counting carbs” while ignoring the real cause: progressive loss of pancreatic beta cell function. At diagnosis, a patient may have lost between 40% and 60% of their beta cells, which are responsible for producing insulin.

Insulin is a hormone that controls how much glucose is in the bloodstream by blocking glucose production in the liver and driving it into fat and muscle cells. Loss of beta cell function means not enough insulin gets produced, resulting in the high blood glucose levels characteristic of Type 2 diabetes.

Beta cells have low levels of antioxidants and are susceptible to attack by metabolic and dietary oxidized free radicals and AGEs. Antioxidants in fruit can protect beta cells. Researchers have found that eating whole fruit decreases the risk of Type 2 diabetes, with those who eat the most fruit having the lowest risk.

hands pouring sugar into a bowl with strawberries in the background
As you consume less refined sugar, you may notice more nuance in fruits’ flavors. Brianna Soukup/Portland Portland Press Herald via Getty Images
Detoxing from sugar
People interested in losing weight and improving health often ask if they should do a “sugar detox.” In my opinion this is a waste of time, because it is not possible to eliminate sugar from the body. For instance, if you ate only baked chicken breasts, your liver would convert protein to glucose in a process called gluconeogenesis.

Low-carb diets may lead to weight loss, but at the expense of health. Diets that significantly reduce carbohydrates are associated with nutrient deficiencies and higher risk of death from any cause. On low-carbohydrate ketogenic diets the body will break down muscles and turn their protein into glucose. The lack of fiber causes constipation.

Eliminating foods sweetened with refined sugar is a worthy goal. But don’t think of it as a “detox” – it should be a permanent lifestyle change. The safest way to go on a refined sugar “detox” is to increase your intake of nutrient-dense fruits and vegetables. Once you eliminate refined sugar, you’ll likely find that your taste buds become more sensitive to – and appreciative of – the natural sweetness of fruits.

18/02/2022

18/02/2022