June 2014


Sugar town

By Gail Bell
A sugar-cube replica of Rachel Whiteread’s Embankment (2005) © The Art Fund

A sugar-cube replica of Rachel Whiteread’s Embankment (2005) © The Art Fund

Have we lost control of what we eat?

As a young wife in the early ’70s, cooking coq au vin from The Margaret Fulton Cookbook to impress dinner guests, I bought my ingredients village-style: the bacon and whole roasting chicken from the butcher; garlic cloves, fresh parsley, button mushrooms and small white onions from the green-grocer; red wine and brandy from the bottle shop; and basics like plain flour and butter from the corner shop. The dried ingredients – marjoram and bay leaves – lived in my cupboard in a smug wooden wedding-present herb stand. Looking at the recipe today, I realise that getting this dish and its accompaniments to the table must have taken me the best part of a day. “Place chicken pieces [which I would have cut up myself] in a china or glass bowl with wine, sprinkle with garlic and marjoram. Allow to stand 2 hours, stirring occasionally.”

I don’t do coq au vin anymore, but if I did, it would be achieved with a quick whip around Woolworths. I would throw in a tray of ready-to-cook chicken pieces and give up on trying to find small white onions. Quite possibly, if I were pressed for time, or, as is more likely, annoyed by the unnecessary multiplication of choice as I ripped down the aisles, I might pick up a bottle of ready-made sauce.

The shopping landscape has changed in 40 years and we are hardly the better for it, health-wise. My hypothetical ready-made coq au vin sauce is likely to contain a lot of salt, or sodium, as the nutritional information on the back of the bottle has it, which will in turn have been masked by the addition of sugar and other non-specified carbohydrates, a little like the MasterFoods Beef and Red Wine Casserole Slow Cooker Sauce with the Heart Foundation Tick I bought on special this week for $2 each. I bought three.

Trained to worry about excessive salt and fat in food, I hadn’t really noticed the sugar creeping in. I equated the overweight shoppers around me with the “Big Mac, fries and Coke” generation who knew no better; in my head-in-the-clouds way, I considered my own increasing quick grabs for ready-to-eat, ready-to-serve meals to be of a different order. I was trading in expediency for the sake of getting back to my work at the writing desk, not sitting in front of a giant plasma screen with a bucket of chicken nuggets on my lap.

And this, folks, as added-sugar’s greatest negative campaigner and biggest noise, Dr Robert Lustig, says, is why I need to be recruited to a new idea.

“We all weigh 25 pounds [11 kg] more today than we did 25 years ago – all of us,” he says in his now famous 2009 address at the University of California. Lustig is a professor of clinical paediatrics and an endocrinologist. His subject is the obesity epidemic and how we got there.

“Our genetic pool did not change in the last 30 years, but boy oh boy has our environment changed.”

He asks and answers his own questions. Why are we all eating more? Because leptin, the satiety messenger to the brain, isn’t working. Leptin comes from fat cells and it tells the brain, “I don’t need to eat any more. I’m done.” We are consuming more calories than ever. Are the extra calories coming from the fat in our food? No. His PowerPoint presentation flashes up the stats and graphs. The extra calories are coming from carbohydrates, and one particularly bad carb called fructose.

Robert Lustig is an interesting character. The YouTube video of his lecture ‘Sugar: The Bitter Truth’, now viewed more than 4.5 million times, has prompted many to see him as the public face of hard science shaping up to the government (the US Food and Drug Administration and the US Department of Agriculture) and Big Food, which includes Big Sugar. He has impressive credentials, he’s a media natural (Oprah Winfrey and Alec Baldwin court him), he writes books and gives lectures, and as Gary Taubes, an award-winning science journalist who has been researching sugar for a decade, writes, he “doesn’t dabble in shades of grey”.

Lustig sucks up information, statistics, graphs, empirical research and complicated scientific papers, metabolises them all with a spruiker’s talent for the selling points, and gets those out to the audience in a fast-paced delivery, peppered with asides like “how am I doing?”, “just follow the arrows”, and “you’re joking me”.

Lustig is here to tell us why we are fatter and more prone to type 2 diabetes, heart disease and fatty livers, and he begins his story with “the Coca-Cola conspiracy”.

“Anybody here [in the audience] work for Coke? Pepsi? Okay, good … What’s in Coke?” he asks. The joke is that only two people on the planet know and they aren’t allowed to fly in the same plane. What can be known is that a can of Coke contains 55 milligrams of salt. The salt, he says, is there to make you thirstier. To disguise the salt they add sugar. “It’s like drinking a pizza.”

If you drank a small original Coke every day for a year you’d gain 8 pounds of fat, says Lustig. Today, Coke sells in a 44-ounce plastic bottle (our 1.25-litre bottle), and one per day of these would produce 57 pounds, or nearly 26 kilograms, of fat. The fat, he promises to explain later in his talk, derives from overloading our bodies with the sugar that makes Coke taste good.

Too much sugar makes you fat – his science proves that point. But worse, sugar is addictive. In a later interview, he likens hidden sugar in cereal to having your breakfast “laced … with morphine”. Worse still, the fructose component of sugar is a poison – his definition of a poison being a substance that can only be metabolised by the liver.

I stayed for the whole 89 minutes of the YouTube pitch. Lustig’s “perfect storm” metaphor made me think. He marries the fears about three major industrial changes that hit the United States in the ’70s and ’80s: cheap food, high-fructose corn syrup and low-fat diet food.

The story of high-fructose corn syrup (HFCS) needed a little explaining to my Australian ears. I found a compelling narrative in Michael Pollan’s book The Omnivore’s Dilemma, published in 2006, which is like a trail of breadcrumbs leading us from the over-production of corn by farmers to the obesity epidemic of today’s US. Where cheap corn once was turned into corn liquor, or fed to pigs and cattle (to fatten them quickly), since the ’80s “the cleverest thing to do with a bushel of corn”, writes Pollan, “is to refine it into 33 pounds of high-fructose corn syrup”. Read the labels on the food in your kitchen, Pollan says, “and you’ll find that HFCS has insinuated itself into every corner of the pantry: not just into our soft drinks and snack foods, where you would expect to find it, but into the ketchup and mustard, the breads and cereals, the relishes and crackers, the hot dogs and hams”.

In the US, HFCS is “the leading source of sweetness in our diet”. In Australia our high-density sweetener is sucrose (derived from cane sugar), which is composed at the molecular level of glucose and sucrose.

As for low-fat diet food, the third element in Lustig’s perfect storm, my own pantry and refrigerator bear out his assertion. Nearly everything that isn’t a whole food has “low-fat” stamped on its packaging. I don’t spoon granulated sugar into beverages or onto cereal, yet I’ve been caught in the passive sugar consumption vortex for more years than I care to think about. Based on Lustig’s figures, I’m ingesting almost five times as much fructose as my grandparents, who lived through the Great Depression on milk and butter from their cow, fruit from their trees, vegetables from their garden, and eggs and meat from their chickens. It’s an awkward thought to sit with, considering my Big Mac theories about overweight kids at the mall.

The relationship between corn, alcohol and sugary drinks is given the business by Lustig when he crunches the calories on a Coke and a beer and arrives at 90 and 92 respectively. “Bottom line? No difference,” he says. A beer belly equals a soda belly. Would you “think twice” about giving your kid a Budweiser? What about a Coke?

Misguided interventions are also on his radar. “If you get your breakfast through the national school breakfast program, which 25% of school kids do, guess what you’re getting: a bowl of Froot Loops and an eight-ounce glass of orange juice,” he said in an interview for the New York Times’s Well blog earlier this year. “That’s 11 teaspoons of added sugar. This is what we have to fix.”

In a piece he wrote for the Atlantic, Lustig draws his map of society like one of his neat biochemical pathways, with no fuzzy lines or inconvenient anomalies. “Long-term stimulation of the pleasure centre drives the process of addiction. Rich people are addicted to money, power, gambling; middle-class people are addicted to cocaine, amphetamine, caffeine, nicotine, alcohol, heroin. The poor, well, all they’ve got is sugar.”

Human appetite, it turns out, is surprisingly elastic. As Michael Pollan explains, “our evolutionary ancestors [would] feast whenever the opportunity presented itself, allowing them to build up reserves of fat against future famine … and while [this] represents a useful adaptation in an environment of food scarcity and unpredictability, it’s a disaster in an environment of fast food abundance, when the opportunity to feast presents itself 24/7”. It’s not just what we eat, in other words; how much and how often we eat also has to be factored in.

We have an abundance of foods in Australia, over 30 times as many choices on the shelves as we had 50 years ago. But our whole society is set up to ensure we avoid feeling “full”. Following Lustig’s arrows in their dizzying circuits through the metabolic landscape, we learn that by consuming too much sugar for too long, we develop insulin resistance and leptin resistance. When hunger is appeased, a feedback mechanism kicks in, and we stop eating. Leptin, the satiety hormone (so named from the Greek lepto for thin), turns off hunger by feeding messages back to the brain. Leptin resistance means the brain can’t read those messages; instead it reads that the body is starving, no matter how much you continue to eat. Sugar triggers a spike in insulin, insulin blocks leptin’s signals, a sense of being “full” isn’t achieved, and we eat another Tim Tam.

On the subject of resistance, my inner sceptic can’t help scanning the onscreen Lustig for signs of celebrity fever. I am, after all, the granddaughter of a snake oil salesman and faith healer who peddled patent medicines with memorable panache.

Five years after the UC lecture, and many interviews and much fame later, Lustig is asked in the New York Times interview: “Your lecture on sugar spread quickly and was viewed by millions of people. Were you surprised?”

“It blows my mind,” he answers. “I didn’t even know it was being taped. If I had, I would’ve worn a better tie.” Which is disingenuous, considering he invited the UC audience to ask further questions after the cameras were turned off. He might mean he didn’t know the lecture would be posted on YouTube, but to my eye, the aw-shucks appeal to audience sympathies is a bigger mindblower than his choice of tie.

There is a book on the history of medicine that I love to read: The Greatest Benefit to Mankind, written in 1997 by the late Roy Porter. Its section on Biochemistry and Nutrition begins, “Chemistry became a powerful tool in the 19th century for explaining the phenomena of life.” Further along he traces the science of nutrition through the two world wars and the Depression in between, noting that the science “developed in many directions, broadcast many messages and served many masters … while the involvement of food science with the food processing industry has been, to say the least, a mixed blessing”. He cites the examples of sugar consumption doubling between 1860 and 1960, and fibre consumption declining by 90% in British diets owing to “the growing consumption of milled white bread”.

My mother’s generation didn’t pay as much attention to the mixed blessing of science’s messages as we did, possibly because they’d been through the Depression and war rationing. Thinness was a worry to be overcome, by regular mealtimes and whole foods – plenty of them. Baby boomers, on the other hand, embraced new foods, diet trends (good and bad) and more flexible dining schedules. Increasingly, sitting down to regular meals evolved into eating on the run.

“[Boomers] were skipping breakfast when they had early-morning meetings … They skipped dinner when their kids stayed out late or grew up and moved out of the house,” wrote Michael Moss, an investigative reporter for the New York Times. “And when they skipped these meals, they replaced them with snacks.”

Burning sugarcane in Brazil. © Eskinder Debebe / UN Photo

My generation and those that followed knew about the dangers of too much salt, fat and sugar and yet held on to a dreamy faith in the science behind the nutritional information printed on our food. Moss, after interviewing some 300 players involved with processed foods, uncovered the antidote to this dreamy faith. “What I found, over four years of research and reporting, was a conscious effort – taking place in labs and marketing meetings and grocery-store aisles – to get people hooked on foods that are convenient and inexpensive.”

One of his finds was the master wizard behind “optimising” food. Howard Moskowitz has a PhD in experimental psychology with a strong background in mathematics. He has “optimised” soups, pizzas, salad dressings, pickles, pasta sauces and sweet fizzy drinks for Kraft, PepsiCo, General Foods, Campbell and Cadbury Schweppes. Using food engineers, volunteer tasters and mathematical modelling, Horowitz can deduce the “bliss point” at which a consumer will say yes. “In making [sauces, for instance], Campbell supplied ingredients, including the salt, sugar and, for some versions, fat, while Moskowitz supplied the optimisation.” Questioned by Moss about the obesity epidemic, Moskowitz replied, “There’s no moral issue for me. I did the best science I could. I was struggling to survive and didn’t have the luxury of being a moral creature. As a researcher, I was ahead of my time.”

We used to lag behind the US in trends but in a global world where the “fear of not knowing” hastens and intensifies the uptake of ideas, the sugar wars have come crashing onto our shores. Australia’s own anti-sugar campaigner is Sarah Wilson, a journalist, blogger and TV presenter whose book I Quit Sugar is consistently in the bestseller lists. Wilson, who has an autoimmune disease that she believes is exacerbated by sugar, began her journey towards giving up sugar during a weekend fast for a magazine article. An e-book, based on her blog, earnt her a prominent position on the anti-sugar bandwagon.

It may be that celebrity bestsellers like Wilson, who makes no claim to medical expertise, serve a bell-ringing role in our engagement with the obesity crisis.

Dr Rosemary Stanton, our best-known nutritionist, put our consumer habits into perspective in an ABC radio interview: “Australians are not eating well at the moment. And whereas when I started working back in the ’60s we had between 600 and 800 foods available, the average supermarket now stocks something in the order of 30,000 different foods, including almost 2000 snack foods.”

The World Health Organization has suggested that there would be “additional benefits” in reducing a daily intake of 10 teaspoons of sugar a day per person down to six, which equates roughly to the austerity sugar ration per person in the UK at the end of World War Two. So why not aim to cut it all out?

Stanton, who supports eating less sugar, also acknowledges the social need to share sweet food on special occasions, like birthdays. In her experience, too, completely quitting sugar never works in the long term. I checked to see how hardline Lustig and Wilson are about having the occasional sugar treat. In his interview in the New York Times, Lustig says his wife bakes cookies once a week, using two-thirds the sugar in the recipe. “If you go down by half, then it [ruins the texture]. But if you go down by a third, the cookies come out just as good. And you can taste the chocolate, the nuts, the oatmeal … So we’re not militant.” Wilson will eat a bite of someone else’s dessert but claims to have collapsed after eating two chocolate croissants while on holiday in Sardinia.

Because so much of the anti-sugar story is compelling, we have to ask ourselves, “Are we being sold a pup?” Those who recall the grapefruit diet that swept the developed world in the ’70s may also remember the permission it gave to generous helpings of bacon and eggs for breakfast as long as the meal began with half a grapefruit. Each subsequent meal (preceded by grapefruit) was high in meat and drastically low in vegetables and fruit. The Mayo Clinic disavowed connection with the diet (it was erroneously referred to as the Mayo Clinic Diet), and it sank to fad status. In the late ’90s, “Weird Al” Yankovic wrote a parody song: “Who’s that waddlin’ down the street / It’s just me ’cause I love to eat / … / There’s one thing left to do / Grapefruit diet (Diet!)” It was left to filmmakers striving for period authenticity to put half a grapefruit back on the breakfast plate.

But worse things than parodies have come out of the mounting sucrophobe climate. Sydney nutritionist Cassie Platt eagerly took up the I Quit Sugar plan with dire results. Her hair fell out, her menstrual cycle went haywire, and she watched her body “slowly deteriorate”. In retaliation, she wrote her own book, Don’t Quit Sugar, in which she advocates a return to natural sources of sugar like sweet root vegetables, whole fruit and honey, while keeping a sensible distance from sugared soft drinks and the “daily candy fix”.

Australia’s peak body for processed foods, the Australian Food and Grocery Council (AFGC), is understandably irritable about the links being made between their products and obesity, type 2 diabetes, heart attacks and shortened lives. In the wake of the Australia and New Zealand Food Regulation Ministerial Council’s review of food labelling, which incorporated extensive public consultation, there was support for the introduction of a streamlined way for consumers to navigate the current confusing system of too much information in a too-small font on the backs of food packets. The new system would award processed food a star rating (1 to 5, like hotels, movies and white goods), and the rating would be on the front of the pack. One popular product with the weight conscious – 98% fat-free yoghurt, laced with sugar – would score 2 stars, for instance.

Two years ago, when the Labor government was in power, the food industry and consumer health advocates came together to consider the front-of-packaging labels. Both sides had marshalled their arguments, backed by data. Michael Moore (not the American documentary-maker) from the Public Health Association became co-chair of the technical design working group and asked Rosemary Stanton to take part. Moore told Ann Arnold of ABC Radio National’s Background Briefing: “At the very start of the process she said to me, ‘Michael, yes, I’ll do it, but I am concerned because of the number of times that I have been through this sort of process and it looks good and then the Food and Grocery Council reneges.’”

In the interview with Arnold, Moore says that good faith prevailed in the early stages. Although he was aware of the warnings published in the Lancet by two academics who claimed that “you simply can’t negotiate with the tobacco, alcohol and the junk food industry”, he was prepared to deal with the leopards across the table.

The committee took its recommendations to the joint state and federal ministerial forum in June 2013, and here the first intimations of trouble from the AFGC surfaced. Questions were raised about anomalies in the reports, as might be expected in a system based on nutrient value. Where does water fit, for example? Dairy? What about the Daily Intake Guide currently printed on packaging? Should we have both?

The ministers of the time, including Coalition ministers, decided to recommend a date for voluntary labelling to begin. They then took it a step further, indicating a move towards mandatory labelling in the future. At this point, still in June 2013, the AFGC issued a press release citing “serious flaws” in the scheme. Gary Dawson, its CEO, estimated that star labelling would cost the industry $200 million in a declining profit climate.

In December 2013, three months after the Liberal government came to power, the new assistant health minister, National Party senator Fiona Nash, announced a cost–benefit study analysis. On 5 February 2014, the new star rating information website went live. Hours later, Nash’s chief of staff, Alastair Furnival, rang the Department of Health and ordered the website be taken down – only to have his own reputation taken down when it was revealed that he had vested interests in Big Food. He was a former chief economist for Cadbury (the beneficiary of a $16 million Liberal government allocation) and held shares in Australian Public Affairs, a company that worked closely with major food and grocery companies.

Mike Daube, a public health specialist, attended one of the committee’s forums after the cost–benefit analysis was announced in December. He has doubts about the perceived co-operation guaranteed by the AFGC. “Of course they’re wide open to discussion … they want to be discussing till kingdom comes, they’ll discuss, they’ll negotiate, they’ll come out with more and more work that needs to be done,” he told Arnold. “It can be cost–benefit analysis today, it can be more testing tomorrow. The bottom line is that they will keep discussing until 2064 if it stops anything from happening.”

Kevin Buckett, the current chair of the oversight committee charged with implementing the health star rating system, believes that the food industry should seize the opportunity to embrace the ratings. He told Background Briefing: “if your food is healthy you will get a [good] star rating … a highly credible government-sanctioned label which … will be accepted and trusted by the consumer to indicate that your product is healthy. If it isn’t healthy, stop telling people it is.”

Many will recognise the tactics of Big Tobacco and Big Pharma in our own AFGC’s manoeuvres. First, commission your own scientists to produce studies that refute claims that your product is hurting anyone. Then bury evidence that points the wrong way. Keep talking, stalling, seed the public discourse with doubts, discredit your opponents, and get the government of the day in your pocket.

Lustig, in his usual unambiguous way, told the Guardian, “The White House is in bed with the food industry and Congress apologises for the food industry.” Michelle Obama, he claims, has been “muzzled”. In 2010 the First Lady launched her ‘Let’s Move’ initiative to an audience at the Grocery Manufacturers Association of America. “She took it straight to them and said, ‘You’re the problem. You’re the solution.’ She hasn’t said it since. Now it’s all about exercise.”

I thought about something I read many years ago as an undergraduate, an off-label study in abnormal psychology that was more interesting than what I was supposed to be reading. This was before the pathways to obesity and the hormones – with their Doctor Who names, leptin and ghrelin – had been fully identified. Fat lab rats that had to work for their food (by moving a weighted lid off the feed tin, for instance) “will not lift a paw if they have to work to get food”. Scientists had altered these rats’ brains by creating a lesion in the ventromedial nucleus of the hypothalamus (the part that responds to rising glucose levels and signals satiety). In an informal follow-up experiment on humans, two groups of obese subjects were invited to help themselves to a bag of nuts while filling in questionnaires. One bag of nuts was pre-shelled, the other bag was not. One out of 20 obese patients ate the nuts if they had to be broken out of their shells; 19 out of 20 ate the pre-shelled nuts.

Even if this old story has only anecdotal status, it speaks to the power of suggestion in ready-to-eat, ready-to-serve food choices. Midweek I find myself reaching for the Dolmio Extra Spicy Peppers pasta sauce and dumping the lot in the pan, despite the fresh herbs on my balcony and fresh tomatoes in the fridge. If I could be bothered to read the back (I just did), I’d find that it contains more sugar than I need, as well as other indecipherable ingredients and nutritional information. How can a consumer navigate food shopping with any confidence? Is the Heart Foundation Tick the best endorsement? With a little digging you can discover that the Heart Foundation takes corporate sponsorship money from Big Sugar and Nestlé, while denying any conflict of interest. Are we meant to believe that these partnerships are all about helping us make wise decisions in the food aisles?

Jamie Oliver recently entered an arranged marriage with Woolworths. Its managing director, Tjeerd Jegen, said he was looking forward to working with Australia’s favourite chef and cookbook author. “This partnership is a natural fit – Jamie is world famous for his passion for fresh food, and Woolworths is Australia’s fresh food people.” Oliver said, “I’m incredibly proud and excited to be working with Woolies – Australia’s fresh food people. Together our aim is to inspire Aussies to cook more fresh food from scratch and to have fun with it, all safe in the knowledge that they’re feeding themselves and their families with quality, affordable and local ingredients they can trust.”

So it’s out with the caged eggs, and in with RSPCA-approved (or equivalent standard) fresh chicken. Not a word about the aisles bulging with processed foods, sweet fizzy drinks and snacks.

There are losers in every public argument. The director-general of the WHO, Margaret Chan, has said that global obesity “is not a failure of individual willpower … but a failure of political will to take on big business. Public Health must also contend with Big Food, Big Soda and Big Alcohol.” Squeezed between individual willpower and big business in the sugar wars are farmers, potential losers in the battle of wills.

I read a report from the Townsville Bulletin, ‘Cane Farmers Feel Demonised by Health Lobby Over Sugar’. “Farmers … are being maligned,” it says. “Farmers today [are] being made to look like drug dealers, the same as tobacco growers in the 1980s … Like anything else, sugar [has] to be consumed in moderation.”

I was reminded momentarily of Ray Lawler’s play Summer of the Seventeenth Doll. Perhaps it was just nostalgia for simple human dramas and less complicated times, the idea of lanky blokes like Barney and Roo, stripped to their shorts, machetes in hand, sweating in the blackened rows of sugar cane. It’s the same kind of nostalgia “optimised” in Woolworths’ fresh-food-straight-from-the-farm commercials.

“Sugar may be the new alcohol or tobacco to some,” writes Nick Cater in the Australian. “To [sugar growers], [it] may be the new live cattle.”

Lustig ends his lecture with a sad but true fact: the FDA and the USDA are not going to do anything about high-fructose corn syrup. “The FDA isn’t touching this … That would mean an admission to the world that our food is a problem.” From what we’ve seen since the star rating website was pulled down here, our own legislators share the same resistance.

As a veteran of many fad diets since my coq au vin days, I am listening to the arguments with half an ear. I will always say yes to the social pleasures of bespoke shortbread and birthday cake. But at the same time, I remind myself that although there is no village nearby there is always the possibility to shop village-style, even if it’s within the confines of a giant supermarket trying to tempt me with “mouth feel”.

And there it is, in a nutshell. We push the trolleys around. We make the choices. All the rest is Big Selling.

Gail Bell
Gail Bell has worked as a pharmacist, educator and writer. Her books include The Poison Principle and Shot: A Personal Response to Guns and Trauma.

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