Sixty seconds on . . . the war on sugar
BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m636 (Published 18 February 2020) Cite this as: BMJ 2020;368:m636All rapid responses
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In an effort to move attention off the proven causes of coronary artery disease (CAD) [1-3] onto something else – viz. SUGAR – which can sell books; proponents of the LowCarb and Ketogenic diets have been attempting to misdirect people to buy their diet books for decades by convincing them that the problem is SUGAR.
While proponents of the LowCarb-KETO diets – who are happy to sell you their latest diet book(s) – focus on the health risks associated with non-insulin dependent diabetes mellitus; their suggestion that it is the elevated insulin resulting from diabetes, caused by too much SUGAR in the diet, which is the sole cause of the inflammation causing CAD, demonstrates either a complete lack of understanding of the “Inflammation and Heart Disease Theory” [1] itself or a complete disrespect for the people they are misleading - cavēre ēmptor. No one has ever suggested that a diet high in SUGAR is a way to improve your health [4] – particularly heart health.
By focusing on SUGAR alone, people are being told that if they simply avoid SUGAR and associated carbohydrates, they will lose weight. From a merely biological perspective, the concept of excluding the primary pathway, which has evolved for energy metabolism from food in humans, is gravely unconscionable and from a medical perspective arguably malpractice.
The simple perspective that losing weight is all one needs to do – the primary focus of too many who think that merely losing weight will reduce their heart disease and associated comorbidities like type 2 diabetes - would invoke the continued use of The Tapeworm Diet.
Yes, the over consumption of SUGAR and refined carbohydrates is not nutritionally beneficial for humans; however, it has never been recommended by serious physicians and scientists studying the health consequences of our diets [5-7] – merely those selling LowCarb-KETO diets.
References:
1. Fleming RM. Chapter 64. The Pathogenesis of Vascular Disease. Textbook of Angiology. John C. Chang Editor, Springer-Verlag New York, NY. 1999, pp. 787-798.
2. Fleming RM. Chapter 29. Atherosclerosis: Understanding the relationship between coronary artery disease and stenosis flow reserve. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999. pp. 381-387.
3. Fleming RM. Chapter 30. Cholesterol, Triglycerides and the treatment of hyperlipidemias. Textbook of Angiology. John C. Chang Editor, Springer-Verlag, New York, NY. 1999, pp. 388-396.
4. Fleming RM, Fleming MR, Chaudhuri TK. What Can Santa Claus Teach Us About Diet and Lifestyle? Int J Dz Rev and Prev. 2020;2(1):1-4. DOI:10.22230/ijdrp.2019v2n1a133. https://ijdrp.org/index.php/ijdrp/article/view/133/101
5. Fleming RM, Fleming MR, Chaudhuri TK, Harrington GM. Cardiovascular Outcomes of Diet Counseling. Edel J Biomed Res Rev. 2019;1(1):20-29. http://edelweisspublications.com/articles/48/531/cardiovascular-outcomes... counseling
6. Fleming RM, Fleming MR, Chaudhuri TK. Do LowCarb Diets Cause Heart Disease or Cancer? LOJ Heal Car. 2019;2(3):229-232. DOI: 10.32474/SJFN.2019.02.000138.
7. Fleming RM, Fleming MR, Chaudhuri TK. Are we prescribing the right diets and drugs for CAD, T2D, Cancer and Obesity? Int J Nuclear Med Radioactive Subs 2019;2(2):000115.
Competing interests: FMTVDM is issued to first author.
Re: Sixty seconds on . . . the war on sugar
Dear Editor
With markets getting integrated day by day and rising globalization, trade flow between two countries has been ever-expanding. While trade flow is known to generate positive externalities for health like reducing communicable disease, increasing life expectancy and an overall increase in standards of living, it is also generating lots of negative externalities like rising prevalence of non-communicable diseases, obesity, and chronic conditions. This can be attributed to trade liberalization, transnational food corporations and global food advertising and promotion [1,2].
Due to increasing trade, the flow of food rich in sugar, sodium, and saturated fat has also been entering, proliferating and thriving in developing countries. Such types of food lead to an increase in the incidence of many non-communicable diseases like Diabetes, cardiovascular disease and obesity [3]. While there is a decline in the consumption of sweetened beverages in developed countries, the pattern of consumption in developing countries has been rising [4,5].
Thus the problem runs deeper and the tax regulations regarding the sale and consumption of sugar products will not solve the problem. This calls for a more systematic approach of global dialogue at multiple levels like World Health Organization (WHO), World Trade Organization (WTO), United Nations System Standing Committee on Nutrition (UNSCN), etc. An international consortium should be established exclusively for sugar, sodium, saturated fat and refined carbohydrate that exceed strict nutrient or calorie threshold. In order to curb the negative externalities of globalization, trade flow should not be restricted, rather a way to limiting and countering the adverse effects while preserving the positive effects should be adopted [2].
References:
1) Lin T, Teymourian Y, Tursini M. The effect of sugar and processed food imports on the prevalence of overweight and obesity in 172 countries. Globalization and Health. 2018;14(1):35
2) Goryakin Y, Lobstein T, James W, Suhrcke M. The impact of economic, political and social globalization on overweight and obesity in the 56 low and middle income countries. Social Science & Medicine. 2015;133:67-76
3) Hawkes C. Uneven dietary development: linking the policies and processes of globalization with the nutrition transition, obesity and diet-related chronic diseases. Globalization and Health. 2006;2(1):4
4) Jensen B, Nichols M, Allender S, et. al. Consumption patterns of sweet drinks in a population of Australian children and adolescents (2003–2008). BMC Public Health. 2012;12(1):771
5) Welsh J. Sharma A, Grellinger L. Consumption of added sugars is decreasing in the United States. American Journal of Clinical Nutrition. 2011; 94(3):726-734
Competing interests: No competing interests