The Sugar Crisis

This past week Public Health England (PHE) launched an app which informs parents about the sugar levels of common foods. The Sugar Smart app scans bar codes of thousands of food and drink products and displays the sugar content in cubes and grams. This app is part of a United Kingdom government-backed campaign to encourage the nation to cut down on excessive sugar intake which is contributing to obesity, diabetes and tooth decay.

 

The cynics amongst us may say that this is another move typical of a nanny state forever telling the public what to do, whilst simultaneously jumping into bed with some private techno conglomerate that in turn gets a gigantic tax break for doing some alleged good.

Whilst I tend to err on the side of cynicism on anything remotely related to any government, in this case, this may be one move worthy of applause. See if this backstory convinces you!

First of all who is Public Health England?

PHE was established in April 2013 to bring together public health specialists from more than 70 organisations into a single public health service. PHE’s job is to basically make the public healthier. It does this by researching ways to improve how the public understands health, come up with solutions to public health problems and advise the government on what to do to put these solutions in place. PHE publishes a range of documents that are available to the public, on various health issues and how they can be tackled.

What is PHE’s issue with sugar?

In October 2015, PHE published a 48-page report called ‘Sugar Reduction – The evidence for action.’ The report was put together by a group of experts on nutrition called the Scientific Advisory Committee on Nutrition.

Their research showed that as a nation we are eating around twice as much sugar as we should be. Excess sugar in our diet contributes to and in some cases, directly causes a multitude of health problems such as:

Obesity – about 1 in every 4 adults, 1 in every 10 of 4-5 year olds, and 1 in every 5 of 10-11 year olds are obese

Diabetes – and its many complications including heart disease, high blood pressure and stroke

Tooth decay – half of 8 year olds have tooth decay

Personally my heart breaks when I see an obese child – not one that’s a little chubby – but obese, because I think of all the health problems lying in wait for them as an adult. Obesity costs the National Health Service (NHS) £5.1bn every year – money that can potentially be spent on unavoidable health problems. If we can reduce our intake of sugar by at least half of what we are taking in now within 10 years, that would improve our quality of life and save the NHS £500m every year.

What exactly is sugar?

Sugar is a carbohydrate that provides the body with energy. It is found naturally in fruits, some vegetables and honey as fructose, in plants as glucose, and in milk as galactose. Sucrose, the name given to sugar that is refined is made up of glucose and fructose, and is called ‘added’ sugar.

In foods, sugar may also be referred to as maltose, corn syrup, molasses, invert sugar and hydrolysed starch. Don’t be fooled by the different terminology – it’s all sugar.

What’s so bad about sugar anyway?

Like most foods, sugar itself does not need to be shamed. The problem is the quantities in which we consume it, especially the added sugars. Sugar is added to a range of foods and drinks to make them taste better and in some cases preserve them.

What happens to your body when you eat too much sugar?

The adult human body is not made to deal with excessive amounts of sugar; it can cope with no more than 7 cubes per day. When we eat more sugar than we need, it’s converted to fat leading to weight gain. Sugar also confuses our metabolism causing high cholesterol, high blood pressure and insensitivity to insulin, a hormone that controls sugar levels. High cholesterol and high blood pressure can lead to heart problems like heart attacks, and strokes. Insensitivity to insulin leads to diabetes.

How much excess sugar are we eating?

A National Diet and Nutrition Survey showed that school children and teenagers are eating 3 times, and adults 2 times more sugar than they should be. For the average 4-6 year old this is the same as 22kg of sugar – equivalent to 10 of those 2.2kg bags of sugar we buy, or 5, 500 cubes per year. Mindboggling when put in those terms, right?

Steps such as making the Sugar Smart app available to families to help cut down their children’s intake makes sense because they are the group that are eating far more sugar than they should. Secondly, a lot of the health consequences like diabetes and heart disease develop over time, so it makes sense to target children before these illnesses set in – ‘prevention is better than cure.’

How much sugar is ‘safe’?

Per day, children aged 4-6 years old need the equivalent of 5 cubes or 19 grams, those aged 7-10 years can make do with 6 cubes or 24 grams and anyone aged 11 and over needs no more than 7 cubes or 30 grams. Note that there is no recommendation for children younger than 4 years, which in my mind means that added sugar is a ‘no-no’ for this age group. This is a really important message that I don’t think has been stressed enough.sugar-app-645x645

Where is all this excess sugar coming from?

 

The main sources of sugar are soft drinks especially fizzy drinks and cordials (drinks that need to be diluted), table sugar, juices, sweets, biscuits, cakes, pastries, breakfast cereals and alcoholic drinks. You can also find added sugar in the unlikeliest of places such as  bread, yoghurt, flavoured water and soups.

How do we cut down our sugar intake?

The first step is education – we should all aim to know roughly the recommended daily amount of sugar, why too much sugar is harmful, and which foods are high in sugar. You don’t need to have ‘Google’ levels of information to know what to do: the basic facts as outlined in this article, and many others, is a good enough start.

There are some practical things we can do without waiting to be advised by PHE. One thing I did when I had my child was to not have fizzy drinks and sweets in the house – I just didn’t buy them. So he grew up knowing that we don’t eat or drink these products. However, at parties, he is allowed to have them, because I feel it is important for children to get to know different foods, safely. We do have other sweet treats like desserts, ice-creams and biscuits but these are limited to no more than 2-3 times per week, and importantly, in small quantities. Now that he is 8, he is so accustomed to his diet that he isn’t a big fan of sweet things. Though his cousin has a sweet tooth, being raised the same way, she’s not hot on sweet drinks at all. And one of my son’s besties also raised the same way, doesn’t like juice and only drinks water. We have to remember that children will follow whatever precedent we as adults set.

Another rule of thumb in our house is that neither adults nor children drink anything that is any shade of blue, green, purple, or pink unless it has been blended in the house with identifiable ingredients – not that we blend much anyway – no time for that! That pretty much rules out blue drinks, reduces sugar and a whole load of artificial gunk.

It’s not going to be easy for everyone to cut down their sugar intake – what else is PHE doing to help us?

PHE knows that it’s not easy for everyone to get, understand and act on this information or any information on health and lifestyle changes. It’s also known that the highest levels of sugar are consumed by poorer, deprived families who are more likely to have limited access to this information. The creation and availability of the Sugar Smart app is just one step to help the public. PHE recommends that a range of actions are required such as:

  • Reducing price promotions on high sugar foods
  • Reducing the levels of advertisements of high sugar foods to children
  • Introducing a tax on high sugar foods; this has been done in some countries with good effect
  • Introducing recognised training in diet and nutrition to people who can influence the public such as those that work in catering, fitness and leisure industries
  • Controlling portion sizes of meals

 How can I get the sugar app?

You can download the app onto your smart phone from Google Play or the App Store.

How does it work?

Sugar AppThe app tells you the recommended daily amount of sugar for each age group.

  1. Open the app
  2. Allow the app access to your camera when prompted
  3. Pick a product with a barcode
  4. Scan the barcode with the app camera
  5. Line the barcode up with the red line and wait for a beep
  6. The app will then read out the amount of sugar in the product

Although about 75, 000 products are loaded into the app, there are still more to be added. If your product is not in the app, a pop-up message will tell you. So, I scanned 5 products and only 2 came up, but it worked perfectly and kids love it.

The menu tab in the app gives more information on the sugar content of food, your scan history and direction to the app’s website: http://www.nhs.uk/change4life/Pages/change-for-life.aspx

Is this app necessary?

For some people, no. But others may find it helpful when you take into consideration the age-group they fall in and the lifestyle they lead.

There is a panel on the packaging of most foods that tells us the exact amounts of fat, protein and sugars contained in that product. However, the amounts are given in grams which I find difficult to interpret because I am of the generation that worked in ounces. The Sugar Smart app uses images of sugar cubes so anyone from any era can understand the results. It’s also great for engaging children and young adults who have grown up with apps, and children are after all the primary target of this part of the campaign.

Let’s give it a try – one more app on your phone won’t hurt, and we may actually use it!

 

For more discussions on topical health (and life) issues listen to Matters of Life and Health on the online radio station PowerXtra Radio www.powerxtraradio.co.uk or via the TuneIn radio app, Tuesdays 7-830pm GMT.

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In memoriam: Jonah Lomu

 

_86786152_jonah_lomu1_getty[1]One week ago today, we woke up to the news that one of the greatest, if not the greatest, rugby players of modern times, Jonah Lomu, had died in his sleep at the tender age of 40. His death came nearly 3 weeks after his native New Zealand national team, the All Blacks, won Rugby World Cup (2015) for a 2nd consecutive year. During the tournament, Jonah was promoting and commentating, and even led the All Blacks in a display of the haka in London’s Covent Garden a few days before the games started. So for his family, friends, team-mates, rugby fans the world over, and probably anyone who knew his story, his death came from the rear, unseen, unexpected, like a side-blow. As I take my obsessive-rugby-fan-in-awe-of-excellence-superhero-loving hat off, and replace it with my MD cap, his unexpected death was sadly, a real possibility. Let me explain why.

 

A bulldozer, a bullet, and a ballerina

Jonah Lomu exploded on the international rugby scene when I was in my final year at medical school. I’d been living in England for about 7 years and up until that time, I have to be honest, I’d tried but failed miserably to engage with the sport. Growing up in the Caribbean, we were all raised on a staple diet of fast and furious American sports. If a game didn’t feature scores in double and triple figures like basketball, I wasn’t interested. If the pace wasn’t fast and furious and agile like American football, don’t even bother me. So with the ‘real’ football, where at the end of a 90 minute game the score could easily be 0-0, I often had to ask the question, ‘what was the point of all that?’ And as for rugby, with its heavy sluggish players where it was very possible that a game could be won without a touchdown, I mean a try, well…

But in that summer of 1995, as I was just coming out on the other side of my final year exams, this superstar giant of a man captured the world’s, and my imagination, at the World Cup in South Africa. That summer, because of that one man, I fell in love with rugby. Though built like a bulldozer, on the pitch, he displayed bullet-like speed and at times the daintiness of a ballerina. When you watch the playbacks of his tries that year, you can easily forget that the All Blacks didn’t even win the Cup in ’95.

 

A new journey

Later that year, when the news broke that he had been diagnosed with a kidney disorder known as Nephrotic Syndrome (NS), I grieved, because I knew what that meant – theoretically anyway. The grief lasted but a split second, because not having done practical training in the kidney diseases as a junior doctor yet, I hadn’t seen first-hand what the real consequences were. So my optimism kicked in, and I felt reassured that he would continue to take rugby to dizzying new heights, higher than those of the ‘fake one-country world championship of American football’; you see I kid you not when I say that I fell head-over-heels in love with rugby. I was fully converted.

About 8 years later, when it emerged that he was on dialysis, it was hard to remain optimistic, even though in the intervening years he’d continued his rise the upper echelons of global sporting superstardom. By then I had completed 9 months of training on a kidney unit specialising in the care of patients with kidney failure, so my knowledge was no longer just theoretical. I had met so many patients with NS – from the newly diagnosed, to those on dialysis, to those fortunate enough to get a 1st kidney transplant to those even more fortunate enough to get a 2nd transplant, and to those who had sadly died along that journey. And what struck me the most, was how this was truly a disease of the young, and of young men in particular. You see in most of the other adult medical specialities, it feels like the average age of patients is near 70; but in the kidney unit, it felt like 30 – it really did, though in reality it’s probably in the mid-50s – itself still young. We medics always have patients we remember vividly: I will never forget the first patient I saw with NS. He was a white man, in his early 40s, who was running his own business up until the day before he came into the unit, swollen like a Michelin man from head to toe. He spent weeks in hospital undergoing treatment. His life was transformed forever. Seventeen years later I still wonder how he fared…for sure.

Jonah received a kidney transplant from a live unrelated donor in 2004, but his body rejected the kidney 7 years later, a somewhat typical scenario; and so, he went back on to dialysis. Though he retired in 2007, he still lived life to the full, becoming a young statesman of and ambassador for the sport. At the World Cup this year, he looked a picture of health to many, but to ‘us’ the signs of kidney failure were there – complexion a little off colour, grey even, big but not as bulky, and looking older than a 40 year old should. The extraordinary effort, on all levels, from so many people, that would have gone into accommodating a trip half-way round the world when he needed to be connected up to a dialysis machine for up to 6 hours 3 times per week cannot be underestimated. It seems unfair that even after the military precision behind that planning, he still died, cheating himself, his family and us, out of another 30 years of his sparkle and dazzle.

 

But this is where the tragedy of NS and kidney failure in young people lies. These patients and their families and their doctors and nurses know that they won’t live as long a life as they should, but many still die too young. The week before Jonah died, I interviewed another giant of a young man with the same illness, on a weekly online radio show* I host on health and medicine. He is now on dialysis, and like Jonah he lives purposefully, as he awaits a kidney transplant. He spoke about the uncertainty of his future, and because of that he wastes no time. To say it’s not easy to live with this fact is an understatement, and one cannot imagine the will and strength and faith that goes into taking on that purposeful mind-set when faced with your own mortality – a mortality that can come from the rear, unseen like a side blow.

 

Twelve facts about Nephrotic Syndrome

  • Nephrotic Syndrome (NS) is a combination of signs and symptoms that indicate kidney damage. The damage is in the filters of the kidney. These tiny filters normally get rid of excess salts and fluid, but in NS, they become very leaky and so huge amounts of protein leak into the urine.

 

  • It can come on suddenly.

 

  • The symptoms of NS are weight gain, tiredness and poor appetite.

 

  • The signs of NS are swelling around the eyes, or of the whole body which starts from the feet and moves upwards, frothy urine because of the protein, low protein in the blood because it’s all leaking out into the urine, high blood pressure and high cholesterol as the kidneys aren’t working properly.

 

  • It can affect both children and adults and is the cause of kidney failure in about 12% of adults (about 1 in 10 adults with kidney failure) and 20% of children (about 1 in 5 children with kidney failure).

 

  • Males are more commonly affected than females.

 

  • NS is caused by specific diseases of the kidneys. For some reason the immune system decides to attack the kidneys but no one really knows why. This is the type that Jonah Lomu had, though it is rare.

 

  • Other conditions like diabetes, cancer and lupus, as well as some medications, can also cause NS. Diabetes is the most common avoidable cause of NS in adults.

 

  • Some types of NS are more common in those of African, Indian and Asian descent.

 

  • It is treated with drugs like steroids to dampen down the immune system.

 

  • People with NS are more likely to get blood clots as their blood tends to be thicker. A blood clot can lodge in the lungs suddenly and if this clot is big or blocks a major blood vessel, it can cause the person’s heart to go into cardiac arrest. It’s possible that this is what happened to Jonah Lomu.

 

  • If the kidneys fail altogether, people with NS need to have dialysis. They are connected to a machine, and their blood is diverted into this machine through a tube connected to one of their big veins. The machine does the work of the kidneys by filtering the blood before it is diverted back into their body.

 

*Matters of Life and Health airs online @Powerxtra Radio via Tune In radio app, Tuesdays 7-9pm GMT