The rise of sugar is a fascinating piece of our social history – from its discovery in India to an expensive luxury added in small quantities to some foods and drinks and now to the astronomical amounts we consume today. Its story includes establishing it as a crop in the New World, the development of slavery to fulfil the market in Europe, blockades in the Napoleonic War preventing its transatlantic shipment and the development of rival sugar beet manufacture in Europe. Is the latest part of the story that it is making us ill?

It’s uncommon to find someone who doesn’t like sugar. Although people vary in how much sweetness they enjoy, most of us gain pleasure from sweet foods and drinks. Sugar is quickly absorbed and the sweetness triggers the “reward centre” in our brain, making us feel good. Many of us turn to sweet things when we feel a bit low and in need of comfort or perking up; and sweet snacks such as chocolates or biscuits are often shared amongst friends or given as gifts.

But recently sugar has been getting some bad press. You have probably seen the headline accusation that sugar is “the new tobacco”, suggesting that sugar, like smoking, is the cause of widespread disease. Certainly, a large part of the population is now designated “obese”, which is worrying as a large amount of body fat increases the chance of major diseases such as diabetes, heart disease and stroke.

Others have countered by saying that it’s not specifically sugar that has led to the current levels of obesity and diabetes, but people eating too many calories from all types of food and drink.

So does our sugar consumption matter? The simple and straight answer is “yes”.

In fact, the subject has become so important that a consortium of Britain’s leading doctors and scientists have formed a group – Action on Sugar – to publicise the problem and what’s to be done about it.

Although defenders of sugar are right that there is no decisive evidence yet that sugar alone leads to obesity and disease, there can be no doubt it is a major contributing factor. The attractive taste of sweet food and drinks makes it easy to consume too many calories. And it is possible, as some doctors think, that fructose – which makes up half of the main type of sugar we eat – is not handled well by our bodies and is turned into fat that is linked with diseases*.

These days sugar seems to be in everything. The amount of sugar sold each year is truly stunning. It’s not just the sugar we buy for home use and the sugar you’d expect to find in desserts and confectionary. Processed food often sells more on taste than on nutritional quality, and added sweetness can make all sorts of food seem more appetising. This means sugar can be found in a huge variety of savoury foods, from ham to curries, soups to ready meals, pizzas to tins of beans. And there’s the large quantities of sugar that go into soft drinks, particularly fizzy drinks and so-called “sports drinks”, where one can may contain the equivalent of many teaspoons of sugar. Many people see these drinks as a major health hazard, and several states in the USA are taking steps to limit their sales.

Our bodies do not need sugar – however much we want it! It fulfils no nutritional need, and cutting back on added sugar makes a lot of sense. (Most nutritionists agree that there is no need to worry about the sugar naturally occurring in whole fruit and vegetables.) Reducing the sugar in your diet is a great help to achieving and maintaining a healthy body weight, and the health advantages of doing so are immense.

For all our sakes let’s wish Action on Sugar every success.

 

*We explain how your body processes fructose in our book, How to Live to 110: Your comprehensive guide to a healthy life

 

Microbes have a bad name. Most people just think of them as carriers of disease. Indeed, bacteria and other microscopic organisms are often pictured in TV adverts as tiny evil humans that every home-loving person should buy powerful antiseptics to eradicate.

Of course, a few microbes are the cause of major diseases, and some others bring less serious upsets. But it’s unfair of us to think of all microbes as harmful. Many of them fulfil useful purposes in the environment, such as breaking down waste to release chemicals for plants and animals to re-use. And some are vital for our health.

Each of us carries around a whole personal environment of different microbes ¬¬ –on our skin and inside our body. Researchers have coined the term ‘Human Microbiome’ for this, and recently they have been showing how individual it can be and exploring how it affects our health.

We acquire our first microbes as we are born, and our exposure to them increases rapidly over the first few years of life and continues into adulthood. As adults we carry around 10 microbial cells for every one of our own cells. That’s about 100 trillion microbe cells! Our gut alone contains about 2 kg of microbes.

These are not causing us any harm, and many are more than just passive passengers, coming along for the ride. We have learned a lot about the gut microbes, for example. They produce anti-inflammatories, pain killers and some vitamins as well as beneficial antioxidants. Recent research* has shown that people with cancer developing in their colons have a different microbial makeup in their colons to healthy people, which suggests some microbes may be protective against this. And fascinating laboratory work in mice** has suggested that some microbes might be implicated in body fatness, with other interesting work*** opening up about their association with metabolic changes related to type 2 diabetes.
With much of this work it’s far too early to suggest that actively changing gut microbes might be beneficial for humans. But these are interesting findings, and they undermine the simplistic view that microbes are there to be eradicated.

*Link to study on the Human Gut Microbiome and Risk of Colorectal Cancer  http://dx.doi:10.1093/jnci/djt300

**Link to study on the gut microbiome and obesity in mice  http://dx.doi.org/10.1126/science.1241214

***Link to study of the human gut microbiome and metabolic markers  http://dx.doi.org/10.1038/nature12506

Link to study on dietary intervention impact on gut microbial gene richness  http://dx.doi.org/10.1038/nature12480

 

So many enjoyable things seem to be bad for us. But here’s some welcome good news – if you like nuts!

Some of the strongest evidence yet of the health benefits of eating nuts has come from two large US research studies*. These followed 76,000 women and 42,000 men over periods of 30 years and 24 years respectively. The participants were all health professionals, and periodically they were asked to fill in questionnaires about their lifestyle and what they were eating. These studies have produced a lot of good evidence about the health risks and benefits of different foods and aspects of lifestyle.

Recently, researchers have focused on what these studies show about eating nuts**. They found that the more times a person ate nuts each week, the less likely he or she was, on average, to have died during the study period or to have suffered cancer, heart disease or lung disease. Those who said they ate nuts every day did best, but even eating nuts once a week seemed to be associated with health benefits.

Unfortunately, the studies did not record what types of nuts people ate, nor how these were prepared – salted, spiced, roasted or whatever. It is likely, though, that most of the participants, as health professionals, would have been aware of the risks of eating too many salted products.

Interestingly, the frequent nut eaters tended not to be overweight. This does not automatically mean that eating nuts helps you keep slim: for example, the people who ate nuts might have led healthier lifestyles. The researchers therefore carefully took into account all the other factors that might have contributed to the health results they found with nuts, using statistical techniques to tease out what was associated with nut eating. It does indeed seem that eating nuts is associated with lower risk of the major diseases.

This is consistent with a range of earlier, smaller-scale studies, and with the widely supported Mediterranean Diet, which encourages eating 30g of nuts a day and has been shown to be effective at reducing the risk of those diseases.
Nuts contain vitamins, minerals and vegetable nutrients, unsaturated fat (oil) and proteins, and they contribute to dietary fibre.

If you are thinking of adding nuts to your diet, try to avoid added salt and be cautious about the calories in nuts. Because of the oil they contain, some types of nuts have quite a lot of calories for their size, and if you start eating nuts daily, you may need to cut back on the other calories you eat.

*The studies are the Nurses Health Study and the Health Professionals Follow Up Study.
** Link to nuts study: http://dx.doi.org/10.1056/NEJMoa1307352

 

We’re told the NHS is strapped for cash and it might get worse before it gets better. So, is there anything we can do as individuals? Actually, yes there is. Better still, it may even bring us financial benefits too.

A recent report* from Nuffield Health and the London School of Economics called “12 minutes more…” makes a strong economic case for taking more exercise. It is an approachable document well worth browsing through.

The health benefits of activity have been shown repeatedly: increased physical activity reduces the risk of heart disease and stroke, helps control type 2 diabetes, reduces blood pressure and body fat, improves aspects of mental health and much more. As a result, governments around the world – including our own – have recommended we all do at least 150 minutes of moderately physical activity a week.

Unfortunately, the report concludes that the majority of us don’t achieve this level. But it goes a stage further by looking at what this means economically for individuals and for the country.

First, there’s the personal burden when someone contracts one of the long-term diseases that physical activity might have helped prevent. Quite apart from the unpleasantness of the disease itself, there is the potential for loss of earnings and the impact this has on one’s own life and the lives of family members.

Secondly, there’s the less obvious but even greater burden illness puts on society as a whole through the loss of economic activity and the demands placed on the NHS and other organisations. The sums involved are quite staggering. If everyone did the recommended amount of exercise, the report authors calculate this would save the NHS £257 million per year. Mental health savings – taking account of savings for the NHS, earnings and welfare – would be over £6.3 billion.

On an individual level, the report estimates that the average household income of those that do moderate sports is more than £6,500 a year higher than inactive households. These people are also more likely to be employed.

This report contains a lot of detail establishing how all these figures were calculated. But even if only a proportion of these staggering amounts could be saved it shows that we can all do our bit by increasing our activity levels.

Many economists believe that if something doesn’t hit our own pocket directly we tend to ignore it – and that certainly seems true for physical activity. It’s only when a report like this spells it out to us that we can see clearly the enormous cost inactivity is having.

And the solution is hardly a drastic one. The report’s title “12 minutes more…” comes from its bottom line finding: that all it would take to improve our health and personal finances, and to relieve the financial pressure on the NHS, is an increase in the amount of activity we do on average of just 12 minutes a day.

 

 

*Link to the report: http://www.nuffieldhealth.com/sites/default/files/inline/Nuffield%20Health_%20LSE_Low-Fitness_Report.pdf

 

Just when most of us have got it fixed in our heads that being overweight is bad for us, along comes a major scientific paper* suggesting that being somewhat overweight actually reduces our risk of dying. What’s going on?

The researchers looked systematically at around 100 previous studies that together involved 2.88 million participants (of whom around 270,000 died during the study period). Each study divided the participants up according to their Body Mass Index (BMI), putting them into the standard categories of “underweight”, “normal weight”, “overweight” and three levels of “obesity”. The studies then worked out how likely it was – compared with people in the normal weight category – that people in each of the categories would die within a given period of time (such as one year or five years). In statistics this likelihood is referred to as the “hazard ratio”.

For a long time it was thought that the normal weight people would be the least likely to die in a given period. But when the data from all the studies were pooled together, the people with the lowest risks of dying turned out to be those in the overweight category and the lowest level of obesity category!

The effect is quite a small one – it’s only about a 5% lower risk. And the risk of dying climbs steeply for the level 2 and 3 obesity categories, where it is about 30% higher than for normal weight people.

Nevertheless, this result seems surprising. It’s sometimes referred to as the “obesity paradox”. What should we make of it?

The most important point, as most scientists would agree, is not to conclude that we should all start piling on the pounds. There is strong evidence that increasing levels of body fat can lead to all sorts of potentially harmful changes in the body. Diseases such as heart disease and diabetes become more likely. These may not result in death, but they can still be disabling and unpleasant. And once you start to build up body fat, it becomes harder to get rid of, so it is wise to take action straightaway to avoid any possibility of ending up in the high-risk obese categories.

But how do scientists explain the slightly lower risk of dying among those who are overweight? So far, there is no clear explanation, although several factors may contribute.

Firstly, the measure used – the BMI – is less than ideal. It is a simple calculation of your body weight (in kilograms) divided by your height (in metres) squared. “Normal weight” is agreed internationally to be a BMI score of 18.5 to 25, while “overweight” is 25 to 30. One big problem with this is that people with a lot of muscle but not much fat – such as men who get fit through weight training – end up being classed as “overweight”, even though they are in great shape. Highly muscular sportsmen can even be classed as “obese” by this measure! Having some fit, healthy people in the overweight category could well affect the results.

Many of the studies focused on older people, and the finding is even stronger among the over-65s. Being in the overweight category makes it around 10% less likely an older person will die in a given period compared with older people in the normal weight zone. It is possible that some extra body fat could help older people survive serious illnesses.

It is quite likely there are other processes going on as well. People’s bodies may perhaps handle excess fat in different ways. Or it might be that something like fitness is ultimately a more important factor than body weight. And some of the people in the overweight category may well have been taking action to lose body fat, which has been shown to bring health benefits. There’s plenty still to explore. For example, the lower end of the normal BMI range is associated with higher mortality than the upper part. There’s no clear explanation for this.

This study has certainly raised intriguing questions. Hopefully, future research will start to answer some of the questions and provide a better indication of the dangers and benefits of body fat. Until then, though, the basic advice doesn’t change. To stay healthy and avoid future disease, watch your weight!

 

 

*Link to the study:  http://jama.jamanetwork.com/article.aspx?articleid=1555137

 

The story about sugary drinks continues.

A recent study* recorded the weight of more than 600 children over an 18 month period. Half were given the equivalent of just one can of sugary drink a day, while the others received a similar drink but without the sugar. The study showed that the children with the sugary drink put on significantly more weight.

This was not a surprise, but it is important confirmation of what was expected – that cans of sugary drinks are a significant source of excessive calories contributing to children putting on fat. A can of a sugary soft drink such as some types of cola can contain as much as 40 grams of sugar or roughly 10 teaspoons. Over the course of a year, drinking just one can a day adds up to an astonishing 14 kg (or 30 lbs) of sugar. And remember that many kids drink more than one can a day.

So what’s to be done?

Substituting artificial sweeteners is one way. These have been extensively tested but we need to ask whether their more extensive use is sensible.

New York City has been bolder. An initiative there aims to control the sale of large (16oz) measures of soft drinks. This will not do away with the problem: the regulation will only affect some sales outlets and, of course, anyone can buy multiple drinks in a café or shop. Nonetheless, it has achieved its objective in raising public awareness of the problem.

Not surprisingly, the soft drinks industry sees itself as losing out if this regulation passes legal scrutiny. But rather than opposing it, surely the industry should be seeking to take a lead and bring out healthier drinks. Evidence – such as from the study described – is making it harder and harder for them to deny that sugary drinks are contributing to the obesity epidemic.

 

*Link to the study: http://www.nejm.org/doi/full/10.1056/NEJMoa1203034

 

 

‘Low carb’ diets are a popular way to lose weight, and millions of people have used them to shed some unwanted body fat. These diets go under various names, but essentially they involve cutting right back on starchy foods such as potatoes, bread, rice and cereals and instead eating more protein as a source of calories (as well as fats and oils to varying degrees).

Many health professionals have been uneasy about the possible health effects of these diets over the long term. Now a comprehensive study* suggests their concerns may be justified.

The study followed 43,000 Swedish women for nearly 16 years. At the start, they were aged between 30 and 49. The study looked at what they ate and noted who developed coronary heart disease, stroke or other diseases of the arteries. Researchers were particularly careful to rule out alternative explanations of their findings.

They concluded that reducing carbohydrate intake and increasing protein intake was associated with an increase in diseases of the arteries. A 20 g reduction in daily carbohydrate intake and a 5 g increase in daily protein intake corresponded with a 5% increase in the overall risk of cardiovascular disease.

This may be down to two reasons. People on these diets tended to eat less fruit, vegetables, cereals and legumes, all of which have benefits in reducing heart and blood vessel disease. At the same time, many were eating more red meat, associated with increases in these diseases.

The conclusion is these ‘low carb’ diets may result in short-term weight loss, but continuing with them over the longer term carries a risk.

If you choose to follow a ‘low-carb’ diet for any length of time, try to make sure you are still eating a good range of vegetables, fruit and wholegrains. And think about getting your protein from plenty of sources other than red meat – such as beans, soya, fish, chicken and dairy products.

*Link to the study:  http://www.bmj.com/content/344/bmj.e4026

 

Professor Brian Kirby, Author of How to Live to 110: Your comprehensive guide to a healthy life.

 

Do you eat breakfast? Many people don’t, but they could be putting themselves at greater risk of diabetes, heart disease and increased body fat.

Surveys vary in the number of people who don’t eat breakfast. Part of the problem, of course, is defining what counts as a ‘breakfast’. Assuming it to be a meal rather than a snack taken on the run to work, then somewhere between 30% and 40% regularly skip it.

Thankfully, parents and teachers – whatever they do themselves – usually insist that children eat something. Past studies have shown the importance of breakfast for learning, and some schools even provide breakfast for pupils.

Two recent studies have now reinforced the benefits of breakfast for adolescents and adults.

In a study of nearly 3,000 European adolescents*, those that ate breakfast regularly had less body fat, were fitter and showed fewer of the risk factors for heart disease – especially in the boys.

The other study** looked at more than 29,000 adult men, following them for 16 years. After taking account of other factors, those who regularly skipped breakfast were 21% more likely to get type 2 diabetes, a serious disease that is increasing rapidly among adults and young people.

These findings have considerable significance in confirming and adding to earlier work.

Nutritionists have long suggested that we should eat something at the beginning of the day. Food that releases energy slowly can stave off feelings of hunger and reduce the amount of snacking through the morning. Debate will continue about what makes the ideal breakfast – although most nutritionists won’t be suggesting a daily fry-up!

 

Professor Brian Kirby, Author of How to Live to 110: Your comprehensive guide to a healthy life

 

*Link to the study of adolescents: http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8536196

**Link to the study of adult men: http://www.ajcn.org/content/early/2012/03/27/ajcn.111.028209.abstract

 

 

 

Two recent studies have provided evidence that some foods may be addictive – at least for some people.

Maintaining a healthy body weight throughout your life is important. People who have too much body fat are more likely to suffer heart disease, cancer and other diseases. But, despite knowing this, some people find it difficult to stop themselves eating lots of high-calorie foods such as ice cream and chocolate.

Often, this is described as a sort of “addiction”. Those people feel like they are hooked on food, as if it were a drug. And it has long been known that some foods – particularly ones that are sweet, fatty or salty – can produce a pleasurable response in the brain similar to that produced by recreational drugs.

But that doesn’t mean those foods actually are addictive. Addiction means more than getting pleasure from something and wanting to keep doing it. According to one of the standard books used by psychologists around the world (the “DSM-IV”), addiction to a substance needs to include at least three of the following:

  • large amounts of the substance consumed over a long period
  • unsuccessful efforts to cut down
  • continued use despite adverse consequences
  • neglecting aspects of life in pursuit of the substance
  • tolerance (i.e. over time you need more of the substance to get the same effect)
  • withdrawal.

Now there is some evidence that people can truly be addicted to food in this strict sense.

In America, researchers set up a social network website for overweight children and teenagers. To join the site, you had to give details of your age, height and weight. You could then interact with others through chat rooms, or express your feelings in forums.

The original aim of the website was to encourage and help young people to lose weight. The thought behind it was that teenagers may be more willing to express their true feelings online than face to face.

Researchers studied all the comments and looked for patterns. Much of what was written made hard reading, as the young people expressed their anxiety and deep struggles with food. (Many of the comments are quoted in the published paper.) It became clear that many of the young people met three or more of the criteria listed above, particularly the first four. This suggests they actually were addicted to food.

Now a completely different study suggests that repeatedly eating ice cream can result in “tolerance”, the fifth of the criteria.

Study participants were given milkshakes based on ice cream – making this one of the best ever studies to volunteer for! Their brains were scanned as they drank them to measure their pleasure response. As you’d expect, the ice cream milkshakes produced a highly pleasurable response in the brain. But what was interesting was that the response got less over time when the people had frequent ice cream milkshakes. The researchers described this change as “paralleling the tolerance observed in drug addiction”.

So, food may actually be addictive for some people. That raises all sorts of issues related to helping people lose weight, stopping young people from gaining unhealthy amounts of fat and even in how food is sold.

And when somebody is properly addicted to food, what do you do then? The approach with drug or alcohol addiction is to cut out the substance entirely. Clearly, that’s not something you can do with food.

It will be interesting to see where research such as this leads in the coming years.

 

Tim Kirby, author of How to Live to 110: Your comprehensive guide to a healthy life.

 

The teen study: http://www.tandfonline.com/doi/full/10.1080/10640266.2011.584803#tabModule

The ice cream study: http://www.ajcn.org/content/early/2012/02/14/ajcn.111.027003.abstract

 

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