By Jerome Burne
The sugar tax is obviously a very sensible idea but it’s much more than that. It’s prophetic, it’s a sign of a major change, it’s the swallow that could be heralding a medical summer. The tax is shorthand for a long running battle around what is a healthy diet, which turns out to be about a lot more than just diet.
The fact it is being discussed at all says that something very important has changed because the ideas behind the tax fly in the face of everything that dietitians and the establishment responsible for healthy eating guidelines have been telling us for decades.
Having the tax on the agenda is a victory for a group of nutrition-rebels and suggests the old guard are facing an uncomfortable U-turn. The fact the rebels are now challenging the Prime Minister highlights just what a political issue this has become. That’s because it raises a lot of very big questions.
Do we want to allow the big food companies to continue damaging our health? Shouldn’t they be made to pay considerably more for the collateral damage they are causing? If changing our diet by cutting down on sugar and carbohydrates makes senses, how big an impact could the new diet have on the risk of chronic disease in general?
Need for medical profession to get serious about nutrition
There’s growing evidence that reversing the established low fat high carbohydrate advice could make a major difference to the way diabetes, Alzheimer’s and even cancer are prevented and treated. In the case of diabetes that is just beginning to happen.
And if this is true, then the medical establishment will have to get serious about keeping people healthy rather than remaining lamentably ignorant about nutrition and then handing out pills when a chronic disease has taken hold. Trying to prevent chronic disease without any serious knowledge of nutrition, as doctors do now, will seem as unacceptable as being unable to read an X-ray.
But none of these changes are going to happen without a major shift in the way both big food companies and big pharma are regulated. The relentless opposition by the processed food industry to such relatively minor change as a sugar tax show the need for much tougher controls on what sort of products it’s acceptable to bring to market.
Meanwhile the drug companies’ huge financial clout means that the vast bulk of the money spent on research and subsequent clinical trials goes on potential drugs. As a result promising non-drug forms of prevention and treatment struggle for funds and recognition because they are regarded as the poor, and largely ineffectual, relation of real drug medicine.
Need for non-commercial drug testing
The very fact we need a sugar tax points to a much bigger need. We aren’t going to halt the epidemic of chronic disease by relying almost exclusively on companies driven by a commercial agenda to tackle it. We need a body devoted to public health that gets no commercial funding and derives no income from patented drugs that runs trials whose aim is only to discover if a product will genuinely benefit patients.
Now much of that may sound both wildly speculative and pie-in the-sky when faced with a neo-liberal government wedded to privatisation. But the current system has delivered a cash-strapped NHS, an inexorably rising bill for drugs that are of dubious benefit or safety and a surfeit of unhealthy foods. Dramatic change is needed and the sugar tax is a small but significant step in the right direction.
So let’s put a bit more flesh on the bones of these wild-eyed claims and proposals.
1. Do we really know that low carb diets are such a disaster?
Ever since the book Pure White and Deadly came out in the 1970’s there’s been an informed critique, ignored by the establishment, that said it’s not saturated fat that makes us fat and gives us heart disease but sugar and refined carbohydrates. Mounting evidence now suggests that the low fat idea is wrong in theory and fails in practice.
The latest blow to official dogma comes from a study by an expert on the effects of sugar – Professor Robert Lustig. Sugar defenders claim that the benefits from cutting out sugar could be due to the drop in calories. So Lustig reduced the added sugar in the normal diet of processed food eaten by 43 obese children, lowering it from 28% of total calories to 10%. But the sugar was replaced by starch so their calorie count stayed the same.
In just ten days the kids’ metabolic markers dramatically improved. Their blood fat levels, blood pressure and fasting glucose all dropped significantly. Their insulin level fell by 50%., It wasn’t the calories, it wasn’t the fat, it was the sugar that was making them sick. Imagine the further improvement if they were also moved on to real food. This is food as powerful medicine.
2. But haven’t dietitians been trying to encourage food companies to reduce the amount of sugar in their food?
It’s true there is something called the Responsibility Deal involving both dietitians and representatives of the big food and drink companies sitting together to work out how to reduce ‘the promotion of food high in fat, salt and sugar levels in processed foods. What do you think the results have been?
A brilliant investigation by the BMJ earlier this year showed that although the companies agreed this was all a good idea, when the senior dietitian heading the Board asked them to actually do something about it they simply said no. After a year the food bought by British households was 11.7% higher in calories than it had been the previous year.’
Given the extensive financial connections between the food companies and the dietitians who were supposed to be encouraging them to change their ways, this was hardly surprising.
The investigation found that over a million had been paid by food companies to the lab of one top researcher while a dietitian heading a top government committee charged with ensuring there was no undue industry influence on official dietary advice, was found to have: ‘a declared an involvement with 179 commercial organisations and non-personal interests’ in 34 separate food or drink companies.’
3. But even if the dietitians are cosy with the food companies that doesn’t mean a low carb diet could prevent chronic disease
But it’s not an unreasonable idea. A pattern of problems such as high blood pressure, high blood glucose, excess weight tend to show up in people with diabetes and heart problems and sometimes Alzheimer’s. They are known as metabolic syndrome and that’s what Professor Lustig improved just by removing sugar from the obese boys’ diet. Keeping carbohydrates low has the same effect.
Metabolic syndrome is classically an early sign of diabetes which is why a growing number of diabetic patients are using it to successfully control their blood glucose and insulin levels. This is the point where conventional dietitians advice to diabetics (eat a low fat diet with lots of potatoes, rice, bread and even puddings as a treat) is increasingly coming into conflict with both patients and a few pioneering GPs.
What’s important here is that there are studies, still small, showing that the low carb diet can produce impressive weight loss and reverse the markers of diabetes in a few months, something drug treatment can’t do. That’s strongly suggests that it’s time to stop regarding diet as a handmaiden to real medicine and that means big changes for the medical school curriculum.
4. Are you saying that we just have to cut out carbs and we can cure everything?
No but it does show that a specific diet can make a big difference to both preventing and treating one of the big chronic diseases facing us and very likely others as well. One of these could be Alzheimer’s. Certainly people with high blood sugar and insulin, such as diabetics, are more likely to develop it and researchers are experimenting with delivering insulin to the brain as a treatment.
What the Alzheimer’s example shows is the hugely damaging effect doctors’ common dismissal of the clinical relevance of diet and nutrition when there is a drug available or even the promise of a drug. The estimated spend on the failed search for an Alzheimer’s drug is 40 billion dollars.
Meanwhile the amount spent on possible dietary and nutritional treatments has been infinitesimal. Yet there is promising research to suggest that combinations of high doses of B vitamins, omega 3 and exercise can make a difference. Rather than investigating these links, however, the establishment response has been to run several badly flawed trials that claimed to disprove the claims but did nothing of the sort.
5. So more fat plus more vitamins has a better chance of fighting cancer, Alzheimer’s and heart disease than the combined research and expertise of the drug industry?
Well it would be very interesting see the result of spending the drugs’ budget on researching promising non-drug approaches and in making good quality food plus informed lifestyle education and practical support available at every GP’s surgery. The incidence of chronic disease would certainly plummet.
Meanwhile the safety, effectiveness and cost of drugs could be massively improved if they were subject to a proper patient-oriented regulatory system. New ones would have to show they were better than the best existing treatment rather than nothing (a placebo); they would also be subject to the kind of massive costs and social disapproval that Volkswagen has suffered when they fudged, cheated or hid unfavourable test results.
The idea that relying on the drugs industry as it is set up at the moment is the best way to tackle the growing epidemic of chronic disease is simply ludicrous. Anything indicates the emergence of a “polluter pays” approach to food and drug companies and implies that food can be a powerful clinical tool has to be warmly welcomed.