Saturday, 11 January 2014

Action on Sugar

This week saw Consensus Action on Salt and Health (CASH) morph into Action on Sugar. Perhaps this was a recognition that the panic over salt "has little basis in science" and the real money now lies in the anti-sugar crusade. In a few years they will be called Action on Cheese.

CASH's abrupt change of direction has meant that we have been able to watch campaigners switch between bandwagons in real time. The screenshot below shows the CASH website at that awkward halfway house between the salt shaker and the sugar bowl




Fortunately for Action on Sugar, their new enemy is also a white crystal so they can keep most of their images. All they need is a web designer to delete the word 'salt' and replace it with 'sugar'.

As I mentioned on Wednesday, Action on Sugar got proceedings underway with a frenzied media blitz that revolved around their claim that "sugar is the new tobacco". Within 24 hours, scientists were lining up to criticise this absurd hyperbole—calling it "nuts", "inaccurate" and "quite crazy"—but the damage had been done and Aseem Malhotra (for it is he) had got his smug little face on television countless times.

Malhotra is Action on Sugar's Science Director. Says it all, really. As Slipp Digby notes in a must-read post that fisks the group's erroneous claims, "appointing him as Science Director when he has no experience in the field and has published no research is a really bad idea."

It has been less than three years since Malhotra burst onto the scene. I had him down as a know-nothing wannabe celebrity on the make from his very first Observer articles. He made incredible schoolboy errors on very basic facts from the outset, although it is interesting to note that his early articles about Big Food did not mention sugar and his ideas appeared to have evolved by reading sensationalist anti-sugar books and becoming a disciple of Robert Lustig.

Lustig's theories focus on High Fructose Corn Syrup, which he thinks is the primary cause of obesity in the USA. This has no relevance to the UK because there is hardly any High Fructose Corn Syrup in the EU (as usual, Malhotra seems to be unaware of this fact). Lustig might have a point or he might not, but at least he is a scientist who has put forward a testable hypothesis. Malhotra is not a scientist, he is a medic, and whilst that is enough for him to play the 'trust me, I'm a doctor' card, he is a prime example of why trusting medics on issues that are outside their immediate field of competence ends in tears.

If you don't believe me, take a look at this interview with him on Sky News this week.



Let's leave aside his usual claim that sugar has "no nutritional value whatsoever". People don't drink Coca-Cola because they think it's nutritious, they drink it because they like it. Let's also leave aside his claim that "poor diet is responsible for more disease than smoking, alcohol and physical inactivity combined" because I've written about that little fib before.

Instead, let's look at this nugget:

"Even if you are of normal weight and you have excess sugar in your diet, and you exercise, you are still increasing your risk potentially of getting Type 2 diabetes".

What Malhotra has done here is mangle the results from a controversial and tentative study by Robert Lustig (there's a good discussion about it here) that found that sugar availability correlates with diabetes. That is not terribly surprising, perhaps, and it is even less surprising that obesity correlates with diabetes.

The obvious explanation for both these findings is that excessive sugar consumption can lead to obesity and obesity can lead to diabetes. However, Lustig suggests that sugar consumption may have an effect on diabetes that is independent of its effect on obesity. In other words, he hypothesises that sugar consumption adds to diabetes risk of being obese. Whilst that is not impossible, the evidence he has presented so far is far from compelling.  That's only my opinion, but it also happens to be the opinion of Diabetes UK, who put out a statement in response to Action on Sugar's media blitz.

“... it is important to be clear that we want to reduce sugar consumption because having too much can easily lead to weight gain, as is true with foods high in fat. So reducing the amount of sugar in our diets is not all that we need to do to reduce our risk of Type 2 diabetes.

"The evidence that sugar has a specific further role in causing Type 2 diabetes, other than by increasing our weight, is not clear. We look forward to the conclusions of the Scientific Advisory Committee on Nutrition, which is due to report this year.”


Malhotra presents Lustig's theory as if it were proven fact and then further embellishes it by asserting that slim, physically active people are at greater risk of developing diabetes if they consume sugar. This goes beyond even Lustig's theory and enters the realm of outright quackery.

And then there is this gob-smacking comment...

"Intrinsic sugars within food like fruit and vegetables: not a problem, that's glucose. But what added sugar has is fructose and that is completely unnecessary in your diet."

Malhotra has fallen for the naturalistic fallacy, implying that "intrinsic sugars" are healthy because they are "natural" whereas added sugars are not. In fact, there is no reason to think that 200 calories from a smoothie are any less fattening than 200 calories from a Coke.

More incredibly, Malhotra thinks that glucose is the main sugar in fruit. Of course it isn't. Fructose is the main "intrinsic" sugar in most fruit (and some vegetables), hence the word fructose.



This howler of Malhotra's is equivalent to a temperance campaigner thinking that beer is stronger than whisky. It is like an anti-smoking campaigner not knowing the difference between a pipe and a cigarette. It does not bode well for Action on Sugar that their Science Director doesn't have even a GCSE-level understanding of the subject about which he claims to be an expert.

I foresee entertaining times ahead.

8 comments:

Unknown said...

If you remove sweet and salty, all that's left is sour and bitter.

Neil said...

Lustig's research and conclusions were as ridiculous as those of Ancel Keys. For poor political reasons, Keys' results were adopted by the US government (and thence spread globally) whilst Lustig's were swept away by Keys' hostility.

Keys is probably responsible for far more ill health on this planet than Lustig might have been if his studies were given the same credit as Keys' bogus "fat kills you" nonsense did.

g said...

Fructose isn't the main sugar in most fruit and veg.

http://en.wikipedia.org/wiki/Fructose#Food_sources

If you're going to sneer at the errors of others then it helps if your own statements are accurate.

Also, the notion of 'empty' calories is also relevant. A smoothie and a coke may contain similar numbers of calories, but the former has fibre, complex carbohydrates and vitamins that the latter does not have.

Although, you'd be better eating 200 calories worth of fruit anyway, much more filling.

Finally, when sugar was compared to tobacco, it was not in the context of the health effects, but in terms of the business strategy of the tobacco industry, as is clear from the original press release, which was misreported by the Daily Mail (see press releases here http://www.actiononsugar.org/ )

slippdigby said...

Seasoned Malhotra watchers will know that he had a go at making that Basu et al cohort study fly with Diabetes UK back in July 2013.

They of course refused to endorse any direct links between sugar and diabetes due to insufficient evidence, so he poisoned the well by claiming they had a conflict of interest between policy and corporate sponsorship.

It turns out - as Diabetes UK later explained - that a company which makes baby formula which he deems to be high in sugar once bought some exhibition space from them.

These are classy moves.

http://www.bmj.com/content/346/bmj.f3199?tab=responses

Ivan D said...

@g

I checked your reference which lists 9 fruits, 5 of which have a fructose:glucose ratio of >1. In two cases it is >= 2. Perhaps the word majority might be more appropriate but most is accurate and therefore in marked contrast to what Malhotra said about intrinsic sugars. Snowdon is not claiming to be a scientist but he has exposed a typical blunder made by someone who is.

He has also raised an important point in that thanks largely to the ignorance of the media, many people don't recognize the distinction between scientists and medics. The training, discipline and in my view personality profile required to excel at either profession are very different. Most scientists understand that and don't pretend to be medics. Sadly, some medics do not extend similar courtesy to science and society.

Medics also know very little about industry or economics so why they presume the expertise to make comparisons and pontificate about marketing is beyond me and speaks volumes about the arrogance of their profession.

Times have moved on, science has become more specialized and it is no longer possible for most people to have a true grasp of subjects outside their immediate field of expertise. Unfortunately, nobody has explained this to the medical establishment, which continues to churn out people who would benefit from a few lessons in humility and respect for others.

Christopher Snowdon said...

g,

Fructose is the main intrinsic sugar in most fruit, as your link shows. There is fructose and glucose in all fruit and veg. Conversely, there is a large amount of glucose in 'added sugar', including High Fructose Corn Syrup (45% glucose, 55% fructose) http://en.wikipedia.org/wiki/High-fructose_corn_syrup

Claiming that fruit/veg = glucose, and 'added sugar' = fructose' - as Malhotra does - is plain wrong.

I don't think this was a slip of the tongue by Malhotra. His twin beliefs that (a) 'natural' is good, and (b) fructose is evil, means that he cannot accept the idea that fructose occurs naturally.



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Ben said...

"In previous short- and long-term studies, we showed that consumption of fructose-sweetened beverages with 3 meals results in lower 24-h plasma concentrations of glucose, insulin, and leptin in humans than does consumption of glucose-sweetened beverages."
http://ajcn.nutrition.org/content/88/6/1733S.short