America’s losing battle against diabetes
reuters.com
reuters.com
There is the inherited kind, and then there is the "earned" kind. One is genetically unavoidable, the other is mostly preventable.
It is not even the food, or fats, or carbs, or sugars, it's too many calories over extended time frames and all the fizzy drinks with sugar and lattes with more calories than a pizza are what transfers people to diabetes city.
The body has ok ish prevention systems when it comes to food via ghrelin feedback loop and stomach size, but the body cannot cope with too much fast absorbed fluid calories.
The rise of zero calorie drinks is a decent first step, some people say these can make you fat as well, but that is entirely physically impossible, they contain zero energy and they do not cause blood sugar level volatility , else diabetics drinking them could drop dead within minutes.
Many people have very poor education on food matters and are falling to all kinds of marketing tricks, like bio(doesn't make it healthy) , no fat(replaced by sugar), natural ingredients or juice(how much and still, fluid fruit sugar is not good for you if you drink a bottle).
Sure, a basketball professional can have a Gatorade after a training when he is depleted of glycogen, but the Avery joe whos daily exercise is grabbing the beer and tv remote and constantly being saturated with carbs? Will not end well.
I didn't look up historical data but the self caused diabetes will certainly be more wide spread in nations with more obesity problems than nations with slimmer people.
And diabetes and blood sugar levels are just the start, there are many more undesired side effects.
Source, ex gf has masters in nutrition.
I'd tread lightly here. Some initial research is showing that artificial sweeteners can stress your gut bacteria, which is a not well understood area of human metabolism.
Realistically it's very hard to avoid sugar altogether, it's in everything in one way or another from bread to milk. Misinformation is also a big issue for example we grew up thinking fruit juice is good for you...
I think gp covered this?
>they do not cause blood sugar level volatility , else diabetics drinking them could drop dead within minutes.
If it actually released insulin and there was no corresponding rise in blood sugar (from the drink), you'd expect them to get low blood sugar and pass out.
If someone has the genetic disposition for Type 2 diabetes in younger, more fit people they are still extremely likely to start seeing the effects as they age and lose activity (even if they do not become overweight/obese).
Overweight is a factor that accelerates this process.
And the reason why that matters is that getting the causality wrong might promote incorrect conclusions about how best to address the problem, and that that in turn might lead to ineffective or even harmful recommendations. Which I don't think is a mere academic concern; it seems that that's a mistake that health researchers (or at least health pundits) just keep making over and over and over again.
If there is some kind of direct damage occuring to hormonal systems then it doesn't really have to correlate to weight and exercise related T2.
The roads of my childhood were definitely included higher polluting diesel trucks, but kids and pregnant women did spend a lot less time traveling and usually didn't ride in diesel vehicles themselves, there was that fine leaded gas..
My sister spent the first 36 years of her life without diabetes or symptoms of diabetes. 5'3", 130 pounds. Then she had her second child, and whatever happened during that time eradicated her ability to deal with sugar. She had been perfectly healthy aside from an ovarian cyst which was removed before she was pregnant with the second child.
So now she's a type 1 diabetic, complete with a blood glucose monitor and an insulin pump.
Interestingly, there is a stronger genetic component to type 1 diabetes than there is to type 2 diabetes. We can analyse a set of 30 or so locations in the genome and give you a score, which is how likely you are to trigger type 1 diabetes. Most of the score is based on just one region in the genome, the HLA region which controls the way your immune system distinguishes between self and enemy. A person with a low score can still get type 1 diabetes, but it is much less likely.
We know that to get type 1 diabetes, you need to be susceptible (that we can measure with the genetic test) but also there needs to be some kind of trigger. I don't think having a second child was the trigger, but something was.
The mechanisms for viruses causing adult-onset type 1 diabetes have perhaps not been well understood, but there's now little doubt that it happens. I don't know how long it's been a subject of active study but researchers talked to my father about his adult-onset type 1 diabetes, which followed a bad case of the mumps, in the early eighties.
I think it's just very, very tough to prove something like this in a way that is technically beyond doubt. My dad was part of a cluster of cases but, you know, that's not proof of causation, even if you find a lot of them. Interesting field.
We have too much time and temptations around. When you're busy and can only have veggies fruits and a bit of meat/fish the whole problem evaporates. Bonus point if your daily activity involves good physical exercise and relaxed relations.
Perhaps you mean leptin? Ghrelin is for hunger while leptin is for satiety, so the latter is really more the limiting factory.
Thanks for the addition, I have just always held the opinion that ghrelin has more effects. Another example would be on a binge, no matter if people eat slow or fast(important for leptin trigger), the appetite keeps being a bit higher than the satiety sensation for some reason.
Btw, I wanted to add that I did not intend to just point fingers at the US, was just because the title is us centric. Europe is mostly no better, nor are most LATAM countries.
As long the sweeteners do not have calories, they will not directly make anyone gain weight. The taste might cause a desire for more sweet things and eventually people will give in, but that's tangential/collateral.
On the other side, it's proven beyond doubt that sugar directly, the fructose component in sugar causes dysregulation of lipid and carbohydrate metabolism. Indirectly, sugar promotes positive energy balance, thus body weight and fat gain, which also cause dysregulation of lipid and carbohydrate metabolism
There might be more to weight gain than just a straight calorie count https://www.sciencedirect.com/science/article/abs/pii/S01956...
It could be the hormonal response, could be the gut bacteria, could be consumption time window, circadian rhythms, or a combo thereof.
Here is one of my favorite videos on the subject [2], a talk by Dr Pradip Jamnadas who is one of the top cardiologists in Florida.
There is no industry that profits on you being healthier through fasting. Consequently it doesn't get the attention or consideration that it should given the supporting evidence. However it has an advantage over every other solution suggested here - everyone can start reaping the benefits immediately. No legislation, no taxation, etc.
Eating healthy and natural foods is still a critical part of the solution. Perhaps most importantly, we need to properly educate the youth and show them the benefits and consequences of their choices when it comes to diet and exercise.
[1] Fasting: Molecular Mechanisms and Clinical Applications https://www.sciencedirect.com/science/article/pii/S155041311...
[2] Fasting For Survival Lecture by Dr Pradip Jamnadas https://www.youtube.com/watch?v=RuOvn4UqznU
I tried for months. My sleep as disrupted, I felt awful, and I had no energy. But more to the point, _nothing happened at all_ in terms of weight loss. Just thinking about it makes me angry!
I have no idea what the hell is going on with my metabolism and why I am the pure opposite case. I'm genuinely curious.
Right now, I lift heavy 3x a week and do moderate cardio 3x a week (run, bike, swim, etc). I feel great! And I get to eat like an insane teenager. My blood chemistry is perfect and my resting heart rate is in the high 40s.
It's more than a little frustrating at times that I have to do all that _work_ when I personally know people who dropped a bunch of weight with almost no effort via fasting. I feel great, though, and at this point I'm used to the program.
all diets are just hunger management tools.
This is a pretty dismissive comment, here are some excerpts from the abstract of my previous citation [1]:
> In lower eukaryotes, chronic fasting extends longevity, in part, by reprogramming metabolic and stress resistance pathways.
> In rodents intermittent or periodic fasting protects against diabetes, cancers, heart disease, and neurodegeneration, while in humans it helps reduce obesity, hypertension, asthma, and rheumatoid arthritis.
> Thus, fasting has the potential to delay aging and help prevent and treat diseases while minimizing the side effects caused by chronic dietary interventions.
Really we should start teaching people the value of IF.
It’s obvious that obesity is correlated, especially since losing weight often makes symptoms disappear. I think we need to better understand precisely what the metabolic pathway is. Losing weight obviously is the best intervention, but the statistics I’ve seen indicate that for people needing to lose in excess of 30 lbs the success rate of keeping the weight off is <10%. So while it’s the best intervention, it’s not a particularly effective one.
An interesting note, bariatric procedures have had mixed results in this arena, laparoscopic banding has basically been abandoned as ineffective over the long term, in favor of vertical sleeve gastrectomy (restrictive) and gastric bypass (restrictive and malabsorptive). Paired feeding research indicates that the greater weight loss from bypass vs. sleeve does not just come from malabsorption, but from an as yet unknown metabolic change.
If we cared, we'd address the culture that is making us miserable.
We can try to address diabetes, obesity, depression, and suicide by passing bills and popping pills, but it doesn't actually address anything.
People are miserable whether they know it consciously or not. Many Americans believe they are happy and yet are spiritually devoid. They know deep down that the reward they're getting for their effort is break-even most of the time. The more aware can see this reflected as stagnant wages. American society is that of decreasing trust and we've never been more divided. What do people do when they feel alienated? They seek out escape. What kind of escape can most people afford? Comforting, cheap, and addictive food and vicarious living through mainstream mass entertainment.
Yeah, no shit they're getting fat and sick.
Many people do care, the real question is how do we change this culture? Where do we even begin?
Obviously we must teach the youth about the relationships between diet, exercise, and mental health - which science has unveiled over the past decades.
How do you help people fill their spiritual void? Historically religion has served that function. Now science is the new religion, and the world is slowly being reduced to mechanistic and predictable processes which displace the wonder and awe humanity once held.
> Yeah, no shit they're getting fat and sick.
Just about everyone can see the problems, yet no one seems to have solutions.
Note: I got tired of others profiting from my pain so I try to share this link with everyone to show just how f&$^@#d up healthcare is in the USA. I'm not the creator, but they are also diabetic.
From the study: "Population obesity prevalence exhibits a positive relationship with national income and there is no evidence that the relationship, while weakening, actually turns negative at higher income levels (“obesity Kuznets curve”)."
and: "In terms of the strength of the income-obesity relationship across our analyzed countries, we find that a 1% increase in per capita income was on average associated with a 1.23% and a 1.01% increase in the prevalence of obesity among adult males and females, respectively."
[0]https://journals.plos.org/plosone/article?id=10.1371/journal...
Exactly. There's also the chorus of people who sing lies about how things are better than ever and we should be so lucky to live in the USA. It all rings hollow against the lived experience of so many people. Capitalism profits from people being tired and afraid, which is why capital fights against any improvement to the lives of individuals (universal healthcare, higher wages, education, etc).
I had been referred to my local hospital's diabetes department and was prescribed Metformin. On my second appointment I was given "the talk" and told I would definitely end up on insulin - everyone does - and will probably have all kinds of nasty complications.
Then we looked at my most recent HbA1c result. "The metformin is working well for now", he said. "Your a1c is back to normal".
"No, I haven't been taking it. I've done that through diet alone."
I was discharged from their care on the spot and haven't been back.
Repeat this process within grocery stores for produce and processed foods.
Peoples taste becomes so attuned to it that they don't even realize that almost everything they eat is a desert.
It takes attention and effort to get off of that soft addiction. The first several months things will taste bland. But, once you reset your taste buds, you will have a hard time believing you used to eat all that sugar. And you will experience all of those other flavors that the sugar was drowning out.
And the addiction is real. A friend who is a nurse has seen people sneaking in sugary foods to people who are in the facility due to diabetes, and in danger of losing limbs or going blind. They won't stop.
Seriously. It's such a pain to shop. I've, thankfully, managed to find one brand of 100% whole wheat bread that has <1g added sugar. All the rest were crazy levels for bread imo.
And protein bars, despite being labeled as 'healthy', usually contain tons of added sugar, sadly. Or, just as bad, they have sugar alcohols to make them sweeter. It'd be nice to just find one that only has sugar from what's in it, without all the added stuff. Closest I've gotten to zero is one with 2g sugar and 2g sugar alcohols.
As for the addiction, you're 100% right. I used to drink way too much sweet tea a day. I went without for only a week and the first one I drank after that was just not flavorful. It was quite disgusting. I've since added it back in from time to time, but mostly I just drink unsweet anymore.
This poor lady was given such bad advice. Groceries can be delivered too, diabetes+fast food is a recipe for disaster.
That said, I'm curious how reporters find these stories. A poor diabetic who lived alone and died from diabetes complications during covid because it stopped her from eating well and getting regular blood tests is a very specific story.
I'll reproduce the list here, like a top-10 list the most effective is at the bottom (but it's also the hardest to accomplish):
12. Constants, parameters, numbers (such as subsidies, taxes, standards).
11. The sizes of buffers and other stabilizing stocks, relative to their flows.
10. The structure of material stocks and flows (such as transport networks, population age structures).
9. The lengths of delays, relative to the rate of system change.
8. The strength of negative feedback loops, relative to the impacts they are trying to correct against.
7. The gain around driving positive feedback loops.
6. The structure of information flows (who does and does not have access to information).
5. The rules of the system (such as incentives, punishments, constraints).
4. The power to add, change, evolve, or self-organize system structure.
3. The goals of the system.
2. The mindset or paradigm out of which the system — its goals, structure, rules, delays, parameters — arises.
1. The power to transcend paradigms.
Why I think this is relevant: Taxation is #12. It is not at all the most effective way, and is highly unlikely to provide us with a solution. #11 & #10 are related to another idea here, outright banning sugars or HFCS. It can work, but there are other issues (like portion size at restaurants) beyond just sugars. This isn't to say these can't be used, but they're unlikely to be effective. They also miss a major part of the diabetes epidemic which is the relatively sedentary nature of people in the US, and that requires more of a culture change. Sugars are the low hanging fruit, it'll help some, but it's far from a solution.
#6 has been applied for over a decade now in the US as restaurants have increasingly placed caloric values on their menus. And caloric values have been listed on food packaging for decades. But just having the information is not itself that useful unless people understand what to do with it or have the discipline to track and make use of it (or at least say, "Maybe I don't need that 2000 calorie hamburger and the 500 calorie fries and the 300 calorie drink.").
[0] https://donellameadows.org/archives/leverage-points-places-t...
Easiest solution to climate change: Carbon tax.
If we havn't used these solutions, someone high up in the food chain is placing a greater emphasis on profits from the status quo instead of the wellbeing of the population.
In many western countries, no one is willing to eat a plate of barely seasoned boiled potatoes, or of barely seasoned pulses, etc
Everything is meaty, savory, rich.
Edit: I see I caused a reaction. I will explain. We are training our taste, and our children's tastes, to expect an explosion of flavor in every bite. This is not healthy. It promotes ordering take-out food, buying ready-meals, etc. Food doesn't need to be complex. We have fallen to "recipe book" diets. For example, I am mediterranean. When I read mediterranean recipe books, I see the same meals we eat, but turbo-charged with flavor. You can see the same thing in Chinese take-outs, where you will rarely see the owner eat the loaded meals he sells. He'll sautee some bean sprouts and mix them with boiled rice
Our stomachs aren't nuclear reactors, but in the western world, they are trained to be
Recipe book meals are ok to eat twice a week. The rest of the week should include steamed veggies with olive oil and salt, boiled apple puree, lentil soup, chick peas with carrots, mash with cabbage and til, leek and potato cream, etc
Those products all have brand names and each one has a product manager who wants to grow sales so they add sugar, salt, and fat to manipulate you into craving more.
Healthy food is simple to understand - fresh vegetables, fresh fruits, nuts, grains, pulses, and meat.
That’s it.
It takes time to prepare and cook and the ingredients don’t stay fresh very long so you have to synchronise your shopping day by day.
Who does that? Hardly any couples with kids and a full work schedule, particularly those working three minimum wages jobs. They buy convenience foods in boxes and jars from the supermarket, or fast foods from a drive through.
Convenience ——> Diabetes
And there's certainly nothing wrong with seasoning. Healthy food doesn't need to be bland.
I think other commenters have it right when they say there's a culture problem. In Niagara Falls, for example, it's a fairly common occurrence for Americans going into the Canadian side to get into arguments with Starbucks employees because they think they're being scammed/ripped off, when the reality is simply that canadian sizes are smaller than the american ones. Japanese snack sizes look minuscule in comparison with american ones. Take out food in many places is pretty much restricted to just burgers and pizza, (compare to Japan selling oden at 7-eleven). "Healthy" food like salads is often drizzled with oily, high sodium dressings, the list goes on.
I don't think it's fair to call it a moral failing of consumers. We've been set up to fail.
But also, that's kinda abdicating responsibility a bit, don't you think? My in-laws live in North America, but cook traditional homemade chinese food (and they were teachers by trade in China, so the "low income peeps don't have time" argument doesn't exactly fly either).
It costs them something to the tune of $150 a month in groceries to feed 6 lavishly when we go visit (probably even less otherwise because they're even thriftier when cooking for themselves). The fact that the vast majority of americans don't know how to cook rice in a regular pot, or pickle their own radishes is largely due to its culinary culture (or rather, a lack of it).
In Japan, there's the concept of Yamato Nadeshiko, a desirable set of traits in a romantic partner which involves among other things being excellent at home cooking. I'm not aware of this kind of intertwining between cooking and other aspects of life in the US. IME, cooking is mostly just seen as an annoying chore, or associated with snobbishness.
Another example: there's animes/mangas portraying cooking in home economics class in school (like cutting veggies and making rice). The closest I've seen in the US so far is third graders making homemade ice cream (which is basically just dumping cream in a bag of ice).
Point being, I think there's more than just corporate narratives when it comes to culture.
It sounds all good and well, until you realize it's essentially just a tax on the least wealthy people. Cheap food is typically high in sugar, so all you're doing is removing cheap food.
I offer the alternative of subsidizing healthy food, use the carrot and not the stick. Subsidizing healthy food also has the added bonus of supporting local farmers and manufacturing of food.
> If we havn't used these solutions, someone high up in the food chain is placing a greater emphasis on profits from the status quo instead of the wellbeing of the population.
I think the fundamental assumption here is a lack of agency of the individual. The answer isn't to 'tax the plebs until they do what we want' - we need to understand exactly why people are making the decisions they do.
I have some theories of my own about this, but it's an actively ongoing investigation. I spoke to a friend in Biology just the other day, and they had a completely different perspective from their field about why people are becoming more obese.
You could in theory offset that by changing the mix of products qualified for SNAP program. 20% of food stamp money is spent on sugary stuff https://fns-prod.azureedge.net/sites/default/files/ops/SNAPF...
I think the idea of a government dictating what you get to eat is still insane. How long till some politician gets paid off to pass some specific food? Such power should always be setup under the assumption that a bad actor will eventually corrupt it.
And then of course you get the blind thinking "the government put it on the healthy list, so it must be healthy"...
The better solution (in my opinion) is to educate people - to the point where they choose to make the right choices. Diet and exercise is just as important as Math and English when teaching kids to be productive members of the work force. This will massively pay off in the long run, as such habits usually get passed down for generations.
The real problem is two fold. tons of people are negligently ignorant about what they eat and how it affects them. Lots of people’s livelihoods depend upon most people having terrible diets. Like seafood? You’re probably eating multiple times the safe limit of heavy metals. Like live events with popup food services? Would you like it as much if the only affordable foods were vegetable and fiber rich options without the large servings of carbs and sugars? Want cirrhosis with your alcohol? Want diabetes warnings on your ice cream and coffees?
To solve the diabetes epidemic we must get structure the parts of society that rely on people actively eating themselves too expensive and early deaths.
We've got now the hydrogen thing (aka fossil fuel with a ton of steps before you actually run an electric motor). We're going to have billions in special interest for this in the dems new bill.
http://dx.doi.org/10.1002/ese3.956
We've got the ethanol thing
https://cfpub.epa.gov/si/si_public_record_report.cfm?dirEntr...
I could go on endlessly.
And, yes, it’s just as bad for you as soda.
Don’t forget that we'll be needing a flour tax too…
My personal opinion, based on nothing more than my experiences, and probably not worth much:
How did we reduce smoking, another addictive, pleasurable activity with negative health consequences? We taxed it, sure, but we also had aggressive public health campaigns, provided medical assistance, and developed harm-reducing substitutes. Most importantly, we changed the culture, marketing and image of smoking. We didn't simply tax cigarettes and get smoking rates to appreciably fall.
Food is even more difficult. Everyone needs to eat. No one needs to smoke. People with unhealthy attitudes towards food can't just give up eating. We have a culture that celebrates overconsumption. We have holidays seemingly dedicated to it. Advertising and the media are constantly promoting unhealthy eating.. Unhealthy eating is an easily accessible pleasure to many in the lower economic classes thanks to subsidies combined with the inherently low cost of production. With such a low starting price, you'd have to have crushing taxes to cause a meaningful shift in habits. Such taxes would be unfair to the people who can safely consume those products. Does it help if we tax, say, sweetened, carbonated beverages while excluding fruit juices or sugary fruits? Honey has even more fructose than "high fructose" corn syrup. Should we tax that too?
Economists have studied Pigovian taxes a lot. There are answers to most of the obvious objections (and answers to those answers, and so on). I happen to think most of macroeconomics is pseudoscientific nonsense. Unfortunately, in cases like this, pseudoscientific nonsense is the best we have.
Putting tariffs on Chinese goods isn't exactly an unpopular idea either.
Insofar as the atmosphere doesn't confine itself to political boundaries, it certainly seems to me like that would be the sensible way to attempt such a thing. Why faff around?
Companies that don't want to pay this tax would, of course, be free to simply not sell their products in the USA. But I doubt that every participant in, e.g., China's consumer product manufacturing industry would be able to stomach such a course of action.
It would be similar for a hypothetical sugar tax. Which, of course, the US already has something like that, but of course it's currently being used to favor domestic sugar production over international sugar production, so it's not applied consistently to all sugar. But still, I think we can see from that that it's not a question of practicalities. If we can do it for the sake of economic protectionism, then I'm sure it would also work when the motivation is to mold people's diets.
(In case I need to put a finer point on it, I'm speaking here about the feasibility of actually implementing an excise tax policy; I'll refrain from speculating about its ability to achieve its stated goals.)
Long story short, I think that this sort of thing is probably less a question of practicalities than it is a question of political will. If you have political reasons to like this idea, it's very easy to come up with motivated reasoning for why it would be something approaching a panacea. If you have political reasons to dislike it, it's very easy to come up with motivated reasoning for why it could never work.
I'd say it's harder to create a measure of carbon output for a given finished product that is remotely accurate. It really depends where each part of the pencil was manufactured, what specific materials are used, what manufacturing processes were applied, how each raw material was shipped, etc. Take that multiply it by a billion products and you have a huge mess.
If you want a good explanation for what excise taxation's about, albeit one that uses stodgy, old-fashioned language, you need look no further than Adam Smith's writings on the subject in The Wealth of Nations.
Mandate A1C checks bi-yearly for insurance providers or have them pass along the penalty.
HbA1C is effectively a measure of the average amount of sugar that has been in your blood over the last couple of months.
A spot sugar level is the amount of sugar in your blood right now, and can vary a huge amount, depending on when you last ate, what you ate, and what exercise you have just done. It's less useful. You can do a fasting blood glucose, and a glucose challenge, but these tests are much more inconvenient for the patient.
Outside the US, most testing has switched to HbA1C for these reasons.
The same is true of carbon taxes, they don’t extract money from the economy they move it around within the same economy.
Diet choices are not a problem of policy.
People choose to eat high-sugar foods because they're cheap. A tax will help make them less-cheap.
T2D is insulin resistance, what causes the body to release insulin and why does the body become resistant?
In another comment You stated obesity causes T2D. As I previously stated there are obese people that do not get T2D, but more importantly there are skinny people who get T2D.
In response you replied to another comment claiming there are medical cases where people who do not eat carbs get T2D in attempt to disprove my position. Again I ask you to link a single case of T2D where the patient did not consume carbs/sugars. It would be the same as trying to find a case of non alcoholic fatty liver disease where the patient does not consume carbs/sugars, another chronic condition that is linked to obesity but not cause by obesity, it is cause by chronic damage to the liver by way of processing sugar, like T2D it just doesn’t happen without carbs/sugars.
Consider that in many - not all - cases of pre-diabetes and even full T2D, patients can make dietary/lifestyle changes to reverse their insulin resistance and even get off medication entirely. Reversing T2D is successfully done by reduction of sugar/carb consumption, it can be but doesn’t need to be a ketogenic diet. But I have never heard of any case where a patient successfully reversed T2D with weight loss alone without reduction of carb/sugar intake.
Sugar has a relatively high caloric density and can be addictive, leading to obesity. However, you can eat large amounts of sugar if you do a lot of sport, for example, and then burn off the calories again. Then you don't get diabetes from it either.
> mdbug: Insulin resistance and type 2 diabetes is mostly caused by obesity.
Your statements are misleading. Sugar can be addictive. Sugar can also cause obesity. Sugar can also cause insulin resistance. Sugar can also cause diabetes. These concepts are not mutually exclusive.
2007: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2235907/
The reviewed evidence supports the theory that, in some circumstances, intermittent access to sugar can lead to behavior and neurochemical changes that resemble the effects of a substance of abuse.
2010: https://pubmed.ncbi.nlm.nih.gov/20138901/
It is thought that SSBs contribute to weight gain in part by incomplete compensation for energy at subsequent meals following intake of liquid calories. They may also increase risk of T2DM and CVD as a contributor to a high dietary glycemic load leading to inflammation, insulin resistance and impaired beta-cell function.
2012: https://pubmed.ncbi.nlm.nih.gov/22289979/
Temporal patterns over the past three to four decades have shown a close parallel between the rise in added sugar intake and the global obesity and type 2 diabetes (T2D) epidemics.
2013: https://pubmed.ncbi.nlm.nih.gov/23657152/
The incidence of T2D increased dramatically over the last decades mainly due to Western lifestyle factors such as lack of exercise and high calorie diets. In fact, high-sugar diets are thought to promote weight gain and insulin resistance predisposing to T2D
2015: https://pubmed.ncbi.nlm.nih.gov/26376619/
There are plausible mechanisms and research evidence that supports the suggestion that consumption of excess sugar promotes the development of cardiovascular disease (CVD) and type 2 diabetes (T2DM) both directly and indirectly.
I'll just stop looking there.
Blood sugar triggers the release of insulin to clear it from the blood. Insulin is a hormone that puts the body into an anabolic state so all cells and in particular fat cells begin to store the sugar from the blood. There is a correlation between obesity and T2D, but not causation.
This is why not all T2D patients are obese, rather in every case of T2D you will find someone that regularly consumed sugar/carbs.
If a patient consumes no carbs, there would be no high levels of blood sugar, no need for insulin to clear excess sugar from the blood…so I’d really like to see what the medical treatment would be for such a patient.
Wrong. You should BAN High-fructose corn syrup. https://en.wikipedia.org/wiki/High-fructose_corn_syrup
It is way more harmful than natural sugar.
It is not banned yet because:
- It is made from corn, and corn is heavily substituted by US government.
- It is super cheap (high volume of corn available)
- It is not only slightly sweet but also prevents spoilage (that's why they add it to US "bread" !)
- It is good anti-oxidizer
- It is good and cheap liaison
At some point it was marketed as a more "natural" alternative to plain sugar. Then it became the villain and people said you should use normal sugar.
The truth is: HFCS is not much different from normal sugar. They're both calorie dense and not very healthy.
> It is way more harmful than natural sugar.
When the Wikipedia page doesn't agree with your assertion.
Sugar, carbon, and land are things that we move quickly to implement and bring it to more and more externalities.
With sugar I could at most harm myself, not others. A tax on sugar but not on fat would be discrimination of one diet form or even lifestyle over another. I can offset a lot of sugar with a lot of sport myself.
But, it's still significantly better than taxing productive work (the current system), which is why I support it so strongly. In my mind, it's not a question of whether the sugar tax is a great idea, it's a question of whether it's better than current taxes (due to the incentives it fixes). Unless externality taxes can fund the whole budget, we will need to branch out.
I don't like the contrast with fat since fat isn't known to be bad. See studies on olive oil consumption, or see studies on how the keto diet might help with chronic disease. Sugar is bad. Taxing sugar will save lives. I'd say the same for alcohol and cigarettes.
I also view this as somewhat important for a functioning society. Even though sugar isn't an externality per se, having a society full of sick people isn't conducive to its flourishing, and might have pretty bad unintended downstream consequences. If everyone is depressed and sick, might they vote for a populist autocrat, after being unable to put their finger on what exactly is wrong? See Hitler's 10x explosion of popularity one year into the Great Depression. This is a broad view of externalities which I pay mind to.
One problem with taxes on addictive substances is that they have little effect on consumption behavior. A higher tobacco tax makes smokers poorer, but only very few will smoke less as a result.
Has this been studied? I get that we expect a lot of price inelasticity due to the nature of addiction, but I wonder how true that is.
One study[1] I'm reading now about a natural experiment on cigarette taxes. It worked a bit. There was an immediate decrease of 0.75% after the 25% tax was implemented, and it continued to decrease by 0.02% month-on-month afterwards (although part of that 0.75% decrease might be the existence of untaxed substitutes, and part of that 0.02% monthly decrease might be a global trend).
This[2] seems quite optimistic about taxes' ability to reduce demand. However, the data they share is not a nice natural experiment, so I don't put too much weight into it.
This one[3] is saying demand isn't inelastic at all.
This one[4] on sugar is saying a 10% price increase leads to a 13% reduction in demand.
> A higher tobacco tax makes smokers poorer
Yes, but an income tax makes workers poorer. I'd rather tax destructive behavior than productive behavior, as long as demand isn't too inelastic, given that we literally have to choose between them in order to raise sufficient revenue for the state. I admit that I should read more studies on exactly how inelastic it is before coming to a conclusion on that, though, but my cursory reading seems to support that it isn't overly inelastic.
> large amounts of saturated fats are known to be unhealthy
I wouldn't mind taxing that as well. I'm aware there's a point at which it becomes a bit too complicated, though. Start simple with sugar, alcohol and tobacco, and add other things like saturated fats based on the weight of evidence and whether it can be done simply and easily.
> In small amounts, sugar can even be healthy, e.g. after exercise.
Yeah. Similar to how alcohol might be healthy for people with heart disease. These are edge cases, and the tax will distort the market for these edge cases. But taxation is always a blunt instrument, and the broad alignment of incentives 99% of the time with a sugar tax is correct, unlike with a property tax (not a land tax) or an income tax where you get a misalignment almost all the time.
[1] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...
[2] https://www.who.int/tobacco/mpower/publications/en_tfi_mpowe...
[3] https://iris.paho.org/bitstream/handle/10665.2/31303/v40n4a0....
[4] https://bmcpublichealth.biomedcentral.com/articles/10.1186/s...
Mostly those being "you cannot accurately predict how taxing will play out."
But "poor or middle class" people choosing $2 soda over $3 orange juice... might choose $3 orange juice over $2 soda that has a $2 tax slapped on it. You cannot argue "they'll just keep buying the same thing when it's taxed all to hell."
(Orange juice probably isn't much better than soda, but that's not the point of my argument.)
Sugar is not "literally in everything." Not for the dictionary meanings of "literally" and "everything." Though it does seem that yes - the corn industry, especially HFCS should not be subsidized... the exact opposite of taxing! So repeal those subsidies, and maybe put taxes on HFCS at the industry level (rather than the consumer level). If industry, rather than the government, want to foot the bill for HFCS and sell it at a loss, then at least we've shifted the problem.
I think you know what he meant. I remember having a similar discussion with my dad. He was surprised to learn his peanut butter and bread both had sugar as one of the top ingredients. Sauces in a lot of restaurants have it in high quantities. Even things like beef jerky can have twenty grams of sugar per serving.
> 2 : in effect : virtually —used in an exaggerated way to emphasize a statement or description that is not literally true or possible
How about we first find out what actually causes diabetes. Not what correlates with it, but what really causes it. And then how we can stop that.
You can tax or forbid sugar all you want, but is it gonna stop diabetes? Will people who eat tons of other "empty carbs" really not get diabetes?
I'm not so sure. Instead of restricting peoples lifes, I would much rather opt for giving them opportunities. Such as providing discounts for gyms or other ways of working out.
Now, some people will change their life through incentives and some people won't. The nice thing about a sugar tax is that if the funds are appropriated for health care funding or UBI for low income individuals, then you can provide more of the opportunities you were talking about for people to get healthy (gym discounts, nutrition consults, etc.). The tax is two parts. Disincentivize the purchasing of high sugar content food and fund discounts or incentives that improve health outcomes.
There is no debate that there is a correlation, but that's not a causation.
Also, what is it now, sugar or obesity? Because if it is obesity, then shouldn't we (by your logic) tax everything that leads to obesity and not just sugar?
> People gain weight because they consume too many calories and then eventually overweight people develop diabetes.
But why do they consume too many calories?
There was a post here on HN not long ago that claimed that the micro-nutritions (like minerals) of many vegetables have declined over the years. Maybe that contributes much more to "eating too much" than anything else. That's something to research first, before taxing stuff based on our gutfeeling imho.
No, I'm saying that it is the cause. People consume food that contains sugar. Because the food contains all that added sugar the number of calories in the food is higher than it would otherwise be. This constant caloric surplus is what leads to obesity, which in turn leads to diabetes. (at least of the non-genetic variety)
> Also, what is it now, sugar or obesity? Because if it is obesity, then shouldn't we (by your logic) tax everything that leads to obesity and not just sugar?
The added sugar is why the food contains so many calories. If you remove the sugar you remove the additional calories. You don't need to tax everything. Just the sugar.
> But why do they consume too many calories?
Because people eat until they are satiated and unfortunately sugar does not make you feel full, but it does add a lot of calories; therefore, people end up consuming more calories than they should, since they are always eating until they are full.
> There was a post here on HN not long ago that claimed that the micro-nutritions (like minerals) of many vegetables have declined over the years. Maybe that contributes much more to "eating too much" than anything else. That's something to research first, before taxing stuff based on our gutfeeling imho.
This is not a gut feeling. Sugar is a high caloric food and the consumption of too much of it causes spikes in insulin that can lead to insulin resistance that in turn causes the pancreas to produce more insulin. High levels of insulin in the body cause more fat to be stored in cells and prevents the breakdown of fat. If we can deter people from consuming lots of sugar, then you can prevent this whole process from starting.
Well, then I disagree. There's people getting no diabetes even though eating a lot of sugar and I bet there's also a lot of people getting or having diabetes without eating any sugar.
> This constant caloric surplus is what leads to obesity
I don't think that's how it works. Point in case: if I eat two same things, once having sugar, the other one not, then I feel full quicker and longer by the one that contains sugar. That does not mean that sugar is healthy, I believe it's the opposite, but you can't just say that sugar is _the_ thing that leads to obesity. If anything, it is a surplus of calories in general, but that can happen without sugar and it also doesn't explain how it even comes to this surplus.
To me it honestly feels as if you are just trying to make your life easy by finding an "easy" solution.
> The added sugar is why the food contains so many calories. If you remove the sugar you remove the additional calories. You don't need to tax everything. Just the sugar.
Replace sugar with fat and the same is true, no? So tax added fat as well? How about protein then?
> Because people eat until they are satiated and unfortunately sugar does not make you feel full
Oh, as I said, it definitely makes _me_ feel full though. Maybe you meant "doesn't make you feel as full as other things"? Well then I might agree, but here it becomes complicated - if you are actually consequent, you would not tax sugar, but things that "make you not feel as full", don't you agree?
> This is not a gut feeling. Sugar is a high caloric food and the consumption of too much of it causes spikes in insulin that can lead to insulin resistance that in turn causes the pancreas to produce more insulin
You just said something very important: "too much". But what is too much? That question can't even be answered in general, because, for example, it is different for someone lying on their couch the whole day and someone doing extreme sports.
The only people getting diabetes without eating sugar are the ones that are genetically predisposed to it. (i.e. Type 1 Diabetes) We are not talking about those people. We are talking about the people who get diabetes because of insulin resistance due to being obese (Type 2 Diabetes). Sure there are lots of foods that don't contain sugar like chicken breasts, vegetables, legumes, etc; however, these are not the foods people are eating that is causing them to become obese. It's really hard to overeat those kinds of foods only, because you will become full and stop eating before you have consumed way too many calories.
> I don't think that's how it works.
I mean you can think anything you want, but you thinking something is not going to change the basic science. People can only gain weight by consuming more calories than they use. The majority of people are losing most of their calories by just breathing every day. Even if they introduce regular exercise they won't significantly change the calories out number, so the only choice left is to shrink the calories in number and the easiest way to do that is remove foods from your diet that contain a lot less added sugar.
> If anything, it is a surplus of calories in general, but that can happen without sugar and it also doesn't explain how it even comes to this surplus.
> To me it honestly feels as if you are just trying to make your life easy by finding an "easy" solution.
Sure, in principle obesity can happen with any food or additive, but in practice the leading contributor is sugar. You don't need to believe me you can DYOR on this subject. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6959843/) There are other foods that should be limited besides sugar, but the way you start tackling a problem like obesity/diabetes is eliminate the biggest contributors first and then work your way down.
> Replace sugar with fat and the same is true, no? So tax added fat as well? How about protein then?
In fact, the food industry did the opposite. They replaced all the added fat with sugar and that is why there is so much sugar in everything now. The other thing though we haven't talked about is the fact that foods with sugar tend to have a high glycemic index. A high GI value causes blood sugar levels and insulin to increase quickly, which in turn causes insulin to be overproduced and more fat to be stored. In effect, the sugar that replaced fat turned out to be worse, because of biochemical processes within the human body. Perhaps if the industry starts adding lots of fat back into food if sugar was eliminated, then there would need to be a fat tax. You'd get no argument from me there, but it is not such a big problem currently. As for protein, try and consume your daily caloric intake just eating chicken breasts some time. You'll probably throw up before you get there.
> Maybe you meant "doesn't make you feel as full as other things"? Well then I might agree, but here it becomes complicated - if you are actually consequent, you would not tax sugar, but things that "make you not feel as full", don't you agree?
No, it's not about taxing something that doesn't make you feel full. It's about taxing the biggest contributor that is adding lots of excess calories into your diet and effecting the chemical processes in your body to store more fat.
> You just said something very important: "too much". But what is too much? That question can't even be answered in general, because, for example, it is different for someone lying on their couch the whole day and someone doing extreme sports.
While the threshold for how much sugar can be consumed safely may vary from person to person, it is quite obvious that on the aggregate the majority of people in the world are consuming way more than they should. The AHA recommends an added sugar limit of no more than 36 grams per day for men. (https://www.hsph.harvard.edu/nutritionsource/carbohydrates/a...) That means if you consume one can of regular coke you have already exceeded your limit for the day. You set public policy and pass laws based on the population at large and most people are not doing extreme sports. Also, for those that are doing extreme sports sugar consumption is best targeted pre-workout or during the workout for a quick boost of energy. They will still though get a lot of their glucose intake from natural sources of sugar and so even athletes should limit the amount of added sugar they consume.
> It is important to not single out sugars as the enemy to be avoided at all costs. Sugars are a naturally-occurring, integral component of many unprocessed foods.
> A positive correlation between sugar consumption and obesity is only apparent when sugar is overconsumed, which is the topic of this review. It is worth recapitulating that obesity is a multifactorial disease. This review focuses on the association between sugar consumption trends and obesity prevalence. However, for a holistic understanding of the causes of obesity, we must also take into account such factors as physical activity, economic status, and consumption of other macronutrients, i.e. fat, and micronutrients, among others.
Yeah, I don't think we will come to an agreement here.
Seems you really want to do something against obesity and you are ready to accept quite a lot of collateral damage by punishing people with extra tax who don't need to be protected/helped at all.
I on the other hand believe that the sugar itself is a minor problem, the bigger problem is the lack of physical activity and micro-nutritients. There is some overlap here, because added sugar has zero good micro-nutritients, but I personally believe that low-carb is great not because of the lack of carbs but because it's easier to get your body satisfied with everything besides calories when eating ingredients rich in fat and protein than those rich in carbs - but even here there are exceptions (such as pumpkin).
But that's my personal assessment and as your study says, we don't know enough yet how much impact the different factors really have, so no one really knows. However, increasing bureaucracy based on not well understood concepts is probably a fairly bad idea.
Oh, one more thing:
> It's about taxing the biggest contributor that is adding lots of excess calories into your diet
Sorry that doesn't make any sense. If I ate 2500 calories today and 500 of them were "excess" (because daily I burn only 2000), then which of the 2500 are now your so-called "excess calories"?
Actually, quite the opposite. People who don't consume foods with lots of added sugar are already healthier and wouldn't end up paying a lot more for their food. The people who are consuming lots of added sugar are contributing to the growing problem of chronic diabetes. Right now we are all being punished with higher health insurance premiums and reduced benefits, because more and more people are having to go on insulin, alpha-glucosidase inhibitors, metformin, etc. You know how you reduce health care costs and help people? You prevent disease from starting in the first place, but that means instituting programs and incentives that actually change people's behavior. If you have a sugar tax whose funds go into programs to encourage healthy eating, working out, etc., then that is a net win for society, since over time less and less people will develop type 2 diabetes and other illnesses caused by obesity. This is not a new concept and has been successful before. Most notably in the form of cigarette taxes. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228562/)
> I on the other hand believe that the sugar itself is a minor problem, the bigger problem is the lack of physical activity and micro-nutritients.(sic)
Increasing physical activity and micro-nutrients are great goals, but do not play a large part in the obesity epidemic. The over-consumption of high caloric food is the root cause. It takes a lot of time to lose weight through physical activity. Run 30 minutes on treadmill and maybe you will lose 300 calories? That probably won't even offset half of many people's lunch calories. Again, the majority of calories are lost through just breathing out. (https://www.youtube.com/watch?v=nM-ySWyID9o) It's a much easier and more effective strategy to reduce the amount of calories coming in. That's why intermittent fasting has become so popular.
> But that's my personal assessment and as your study says, we don't know enough yet how much impact the different factors really have, so no one really knows. However, increasing bureaucracy based on not well understood concepts is probably a fairly bad idea.
Just because we don't fully understand the role of all the biochemical processes involved in insulin resistance, obesity, etc. doesn't mean we don't understand the broader causes and the changes that should be made to diets to improve health outcomes. Your argument is similar to saying just because we don't understand all the mechanisms that cause the earth to heat up we shouldn't try and reduce CO2 emissions. It's nonsensical.
> Sorry that doesn't make any sense. If I ate 2500 calories today and 500 of them were "excess" (because daily I burn only 2000), then which of the 2500 are now your so-called "excess calories"?
Sure, it does. As you yourself stated "added sugar has zero good micro-nutrients", by definition these are excess calories that you don't need. If we need to reduce people's consumption of calories then the first to go should be the ones that aren't providing any benefit.
Not "the opposite". Exactly as I said: a lot of people would end up paying more, for no health benefit.
> Increasing physical activity and micro-nutrients are great goals, but do not play a large part in the obesity epidemic.
That is merely your own opinion, but you seem to think that this is a fact. If you are so sure, I'm sure you have some good sources for that? I mean, the first study you linked actually doesn't speak in your favor.
> Sure, it does. As you yourself stated "added sugar has zero good micro-nutrients", by definition these are excess calories that you don't need.
Wait what? That's not how "excess" is commonly defined. Here's how this term is usually used:
> When you eat more calories than you need, your body stores the extra calories as body fat. Even a fat-free food can have a lot of calories. Excess calories in any form can be stored as body fat. (https://my.clevelandclinic.org/health/articles/4182-fat-and-...)
or
> “Excess calories per day” is simply an arbitrary measure over an arbitrary unit of time to better calculate and plan your diet and calorie deficit/surplus (depending on your goals). (https://www.forbes.com/sites/quora/2017/07/27/how-long-does-...)
So this term is used simply for surplus calories. Sure, sugars can be surplus calories, but if I eat 2500kcal of protein in a day and my body only burns 2000kcal, then 500 of these are excess calories. But I could have left out 500 of any of these 2500kcal to avoid excess calories. So my point still stands.
No, what happens is this money eventually flows back in terms of lower healthcare costs overall.
> That is merely your own opinion, but you seem to think that this is a fact. If you are so sure, I'm sure you have some good sources for that? I mean, the first study you linked actually doesn't speak in your favor.
It actually did. Unfortunately, you can only lead a horse to water.
> So this term is used simply for surplus calories. Sure, sugars can be surplus calories, but if I eat 2500kcal of protein in a day and my body only burns 2000kcal, then 500 of these are excess calories. But I could have left out 500 of any of these 2500kcal to avoid excess calories. So my point still stands.
I'm glad we agree sugar can be considered surplus calories. The point is when we are trying to reduce people's overall number of calories from their diet we could eliminate any calories, but we should try and eliminate the ones that don't provide any benefit and in fact have negative consequences first.
Only if that really happens - just because obesity goes down doesn't mean that we experience cost savings. People might just live longer then and get other sicknesses instead, require more pension etc - who knows how it plays out. Can you backup your claim?
And even then, there might be better solutions that lower the healthcore costs as much or more, without imposing a partially unfair tax.
> It actually did. Unfortunately, you can only lead a horse to water.
Lol, I already quoted the relevant parts from your study and you just ignored it.
> The point is when we are trying to reduce people's overall number of calories from their diet we could eliminate any calories, but we should try and eliminate the ones that don't provide any benefit and in fact have negative consequences first.
As I already said, that is your personal opinion and I believe different. I suspect physical activity, micro-nutritions (where sugar is part of, but really only part) and also gut-bacteria and stress-levels are major factors. Sugar is probably not the easiest thing to realistically fix and introduces a lot of collateral damage if you generally tax sugars.
But I know you believe different for some reason and I think a discussion is pointless. I would be interested to see a study (and a quote from there) that really says "sugars are the (main) cause and here is why", but I doubt you can show my something, because it most likely just doesn't exist.
For example, Scotland is one of the few countries in the world where Coca-Cola is not the most popular fizzy drink. Irn Bru is.
Following the sugar tax, Irn Bru changed the recipe to use alternative sweeteners.
Some people complained, and there is an original version, but it is far more common to see the sugar free version used.
In this case, the tax works.
Trouble is that too few people understand this and therefore politicians present taxes as fair/unfair
The war against salt, also.