Where’s the F word … err fructose … in healthy thinking debate?
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Governments are often criticised for not putting in the hard yards when it comes to planning. They start building desalination plants after we run out of water. They start adding lanes to freeways after traffic is at a standstill. They build more power stations after the black-outs start. But there’s no way you could accuse Paul Lucas (Queensland’s Health Minister) of such poor planning. He’s already building the infrastructure necessary to treat the victims of childhood obesity in 2014. In 2007, the Queensland government implemented initiatives aimed at reducing childhood obesity by 33% by 2020. Smart Choices would force children to eat healthy food at school and Smart Moves would force children to exercise for at least half an hour during school time. The policies are very similar to programs for healthy eating and exercise implemented as part of the UK’s Healthy Schools initiative. Those programs were kicked off in 1999 because surveys in 1995 had shown that a quarter of British kids were overweight or obese. In Queensland, we took until 2006 to reach that milestone, hence the delay (I guess). The British programs have met with resounding failure. Now almost a third of English kids are overweight or obese. And the prediction is that the numbers will be truly diabolical by 2050. The presumption underlying the Smart Moves program is that sport prevents obesity in children. But an extended study of the UK program to be released this week suggests that is likely to be nonsense. After a decade-long study of children in the UK, the researchers have concluded that increased physical activity is unlikely to reduce a child’s weight. For years nutritionists have told us that kids are fat because they don’t exercise. But the study concludes that the opposite is in fact the case. Overweight children eat more and exercise less because they are fat, not the other way round. When you think about it, that has a certain logic to it. We are happy to accept that when children grow taller they demand more food, so why wouldn’t we accept that when they grow fatter they do the same. We also accept that a pregnant woman puts on weight (and eats more) because she’s preggers. And just like a pregnant woman an overweight child exercises less because it is much harder to move when you are carrying extra weight. Less exercise is a side effect of weight gain not the cause of it. Growing taller happens because of the work of growth hormones in the child’s body. Pregnancy happens … well, you know why … and also involves hormones. Growing fatter also happens because of the work of hormones. Appetite control hormones precisely regulate the amount of additional weight gained, but sugar (or more precisely, the fructose half sugar) has been shown to disrupt the operations of those hormones. But fructose limitation is not on the menu for the Queensland government any more than it is in Ole Blighty. Just like its British equivalent, Queensland’s healthy eating in schools program focuses on the anti-fat dogma trotted out by nutritionists for the past five decades. It has little concern for sugar unless it has been added. Soft drinks are coded “red” because of the added sugar and can only be consumed twice per term (maximum). But juices with identical (or higher) sugar content are coded “amber” and can be consumed every day. I asked Lucas about that contradiction in July last year. In my request I supplied him with references to many of the recent studies on the damage done by the fructose half of sugar. He finally got around to having a minion reply to me in the new year. The minion agreed that diets high in added (his emphasis) fructose were indeed undesirable because fructose promotes weight increase, chronic disease and increased circulating fatty acids. But he points out that fruit juice is high in naturally occurring (my emphasis) fructose not added fructose. As such there is no need to change the policy. Ah, I see. So somehow the very act of adding fructose to water rather than removing the fruit from the fructose and water (juice) must magically transmogrify the fructose from a healthy substance to a dangerous substance. I’m glad that’s been cleared up. As much as Lucas is having his minion trot out the party line, it would seem that he has one eye on the “success” of the British programs. On Sunday he announced that in 2014 Queensland will have its very own childhood obesity treatment clinic. When Smart Moves and Smart Choices produce the inevitable increase in childhood obesity, Lucas will be there ready with the ambulance parked at the bottom of the chronic disease cliff face. How many children need to be sacrificed to nutritional dogma before the science on fructose crosses into the political domain. Do all our kids need to be overweight or suffering from diabetes before we acknowledge that the “fat makes you fat and exercise makes you thin” advice is just plain wrong? Or can we start doing something about it now? Maybe, just maybe, if we did, by the time that brand new clinic is open for business, they won’t be needed. |
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8 Comments
Surely the positive effect of the vitamins and minerals contained in fruit juice outweigh the negative sugar component?
I think the science needs to cross into the public domain, because it is not as represented here or in David’s book.
From my (admittedly brief) reading, the study isn’t saying that an increase in activity would not reduce obesity. It is saying that it is difficult to produce an actual overall increase in activity in children: “The most likely cause of such weight gain seems to be over-nutrition, insofar as physical activity is unstructured before 5y, and attempts to structure it thereafter may be unsuccessful because an ‘activitystat’ operates to defend the child’s activity set-point.” That is, if you increase their activity for half an hour they will correspondingly reduce their activity during another part of the day.
So overeating during the first 5 years of life will set a trend towards obesity that will continue through childhood.
I must have missed the part where they commented on the special role of fructose in all this. I’m a pretty terrible reader.
Another interesting excerpt: “The BMI of children who exercise more than 60 minutes per day is no different, but their metabolic risk is substantially less.” That would suggest to me that there is at least some benefit to enforcing physical activity at school.
In conclusion, I don’t see how a program of healthier eating (yes, even if it includes evil fruit juice) and activity could be a bad thing, but it appears that the diets of children < 5 years need to be addressed as a part of the big picture.
I’m sorry, I don’t want to be unkind, but this article is crap! The claims are based on one study done in rats and the reasoning is misrepresentative to say the least. Even the study cited states that weight gain “caused” by fructose occurs only in the face of a “high fat, calorie dense” diet. Weight gain does not occur simply because of “hormones”. It requires an energy balance in which input is greater than output. This is why Lucas differentiates diets high in added fructose and natural fructose. Diets high in added fructose are more likely to be high in energy and low in fibre and nutrients. They consequently tend to have negative health effects. Diets high in natural fructose are more likely to be low in energy and high in fibre and nutrients. They consequently tend to have less negative health effects. Furthermore, he is talking about overall diet, not some contrived smackdown of soft drink vs. juice.
My understanding of the contribution of fructose to the development of obesity is that its role is controversial. I would bet my right arm that for every reference the author sent to Queensland, I could provide him with two stating that fructose’s role in the development of obesity is unknown or neutral. To start, search;
http://www.ncbi.nlm.nih.gov/pubmed or have a look at
http://www.obesitymyths.com/myth9.1.htm
Additionally, on a practical note, if you hysterically demonise and restrict any one component of a child’s diet you are asking for trouble. At best you’ll foster frustration and resentment and the child will end up eating whatever it likes whenever it can get its chubby little hands on it. At worst you’ll promote an eating disorder.
Cheers.
There were two talks on Ockham’s Razor, one by David Gillespie and one, outlining
why Gillespie’s point of view was unsound, by Chris Forbes-Ewan, a nutritionist with the Defence Science and Technology Organisation:
http://www.abc.net.au/rn/ockhamsrazor/stories/2009/2621415.htm
http://www.abc.net.au/rn/ockhamsrazor/stories/2010/2770728.htm
There is also a long discussion here:
http://www.raisin-hell.com/2010_01_01_archive.html
On balance, I think I conclude that Gillespie’s ideas are interesting, but largely over-stated and so are probably not based in science.
I think Chris Forbes-Ewan ought to be invited to write an article on fructose for Crikey.
Yes! Better still, get him to write on the broader topic of obesity as well. It would bs interesting, and we might learn that there is more to good nutrition than eliminating one ingredient.
I tried to send the following comment last week, but it doesn’t seem to have been delivered, so here is a second attempt.
Readers of David Gillespie’s blogs may be interested to know that it is now more than two weeks since I first attempted to get David to reply to a series of questions in a comment about his blog entry titled ‘Attack of the Chocolatier’.
My questions cut to the core of David’s treatment (or rather mistreatment) of the science that he claims underpins his book ‘Sweet Poison’. David hasn’t answered any of my questions.
By refusing (or perhaps more appropriately not being able) to answer those questions, David is tacitly admitting that the science behind his book ‘Sweet Poison’ is fatally flawed.
As I have demonstrated in other comments on ‘Attack of the Chocolatier’ and in my Ockham’s Razor program (ABC Radio National) of 10 Jan 10, David Gillespie is not a reliable source of information on the health effects of fructose.
The questions are:
(i) In light of the evidence provided by Rosemary Stanton that there has either been no increase or a slight decline in food intake in the last 30 years (see my comment sent on January 29, 2010 at 8:48 PM), do you still believe that food intake has increased by 30% in Australia in the last three decades?
(ii) Taking into account your claim that average Australian intake of fructose is about two-thirds the average intake in the US, and that the US intake accounts for 9-10% of total energy intake (references provided in my comment sent on January 29, 2010 at 10:10 PM) do you still claim that almost 20% of our energy intake is now derived from fructose?
(iii) Noting that the authors of the 1985 paper by Reiser et al. [Am J Clin Nutr. 1985 Aug;42(2):242-51] refer (more than once) to a ‘… lack of relationship between the onset of the abnormalities and the type of dietary carbohydrate’, do you still claim that fructose consumption was the cause of severe heart conditions in four participants in that study?
(iv) Noting that at least 19 human fructose-feeding studies were conducted after 1985 (references provided in my comment of January 30, 2010 at 6:02 PM) do you still claim that no further human studies were conducted following that date?
(v) Noting that the World Health Organisation recommends that the maximum safe intake of added sugars is 10% of total energy (or rather just short of 10%); that the NHMRC dietary guideline is to ‘consume only moderate levels of sugars and foods containing added sugars’; that the American Heart Association sets safe upper levels of intake of 35 g of added sugar for men and 25 g for women, and that 12 of the 19 references to human studies conducted in the period 1985-2007 reported positive or, at worst, neutral effects attributable to fructose, do you still believe that added fructose is a poison in the diet at any dose?
(vi) Given that the NHMRC in Australia and ACSM in the US (and other national health authorities) recognise the value of physical activity in weight control, do you still believe that physical activity has no role to play in weight control?
(vii) Noting that the conclusion of the most recent meta-analysis (in the December 26 edition of Clinical Nutrition) concludes that ‘There is no support from the human literature for the hypothesis that sucrose may be physically addictive …’, do you still insist that fructose—the relevant component of sucrose in this context—is addictive in humans?
Joal suggested that I write something about the possible causes of the obesity epidemic.
Although it is nearly nine years old, I believe that my Ockham’s Razor program from 2001 is still appropriate. The URL for the transcipt is:
http://www.abc.net.au/rn/ockhamsrazor/stories/2001/343941.htm
Also, one of my comments on David Gillespie’s blog entry ‘Attack of the Chocolatier’ (www.raisin-hell.com) included:
‘There is a long list of purported causes of, or contributing factors to the obesity epidemic. They include, but are not limited to:
‘High intakes of total fat, of saturated fat, of a particular kind of saturated fat known as palmitic acid, of a type of polyunsaturated fat called linoleic acid; high intakes of carbohydrate and/or alcohol; low intakes of protein; skipping breakfast; ‘grazing’ rather than eating three square meals; eating fast food rather than home-cooked meals; using artificial sweeteners; reduced physical activity; insufficient sleep; exposure to environmental chemicals such as insecticides … even a virus has been implicated as a cause of obesity in some circumstances.
‘At the Annual Scientific Meeting of the Nutrition Society of Australia last December, a prominent Australian nutritionist stated that the correlation coefficient for the association between fructose intake and the obesity epidemic is something like 0.8 (i.e. there is a strong correlation). A prominent American nutritionist immediately countered with: ‘The correlation coefficient for linoleic acid and obesity is 0.85’. (Linoleic acid is a fatty acid found in large quantities in vegetable oils, e.g. soybean and canola).
‘I also suspect that reduced physical activity plays a major role in the obesity epidemic, which is most likely multifactorial (i.e. there are many contributing factors).
‘The cause (or more likely causes) of the obesity epidemic remain unresolved. It is not appropriate to claim, as David does, that fructose is indisputably the sole cause, and that it is harmful in any dose.’
BTW, the President of the Australian Skeptics, Eran Segev, requested that I write an article for their magazine. It will be published in the March issue.
Finally, you may be interested in a comment by Eran Segev about David Gillespie’s approach to the science of fructose metabolism in humans. Go to http://www.raisin-hell.com, scroll down to ‘Attack of the Chocolatier’ and read the comment dated February 17, 2010 10:50 AM.
Eran is far more direct than I am, and goes further in his comment than I am prepared to go. However, to paraphrase the character played by Ian Richardson in the superb BBC TV series ‘The House of Cards’ and ‘To Play the King’:
‘Eran might very well think that; I couldn’t possibly comment’.