Sugary Drinks Linked to High Death Tolls Worldwide

Consumption of sugary drinks may lead to an estimated 184,000 adult deaths each year worldwide, according to research published today in the journal Circulation and previously presented as an abstract at the American Heart Association Council on Epidemiology and Prevention in 2013.

“Many countries in the world have a significant number of deaths occurring from a single dietary factor, sugar-sweetened beverages. It should be a global priority to substantially reduce or eliminate sugar-sweetened beverages from the diet,” said Dariush Mozaffarian, M.D., Dr.P.H., senior author of the study and dean of the Friedman School of Nutrition Science & Policy at Tufts University in Boston.

In the first detailed global report on the impact of sugar-sweetened beverages, researchers estimated deaths and disabilities from diabetes, heart disease, and cancers in 2010. In this analysis, sugar sweetened beverages were defined as any sugar- sweetened sodas, fruit drinks, sports/energy drinks, sweetened iced teas, or homemade sugary drinks such as frescas, that contained at least 50 kcal per 8oz serving. 100 percent fruit juice was excluded.

Estimates of consumption were made from 62 dietary surveys including 611,971 individuals conducted between 1980 and 2010 across 51 countries, along with data on national availability of sugar in 187 countries and other information. This allowed capture of geographical, gender and age variation in consumption levels of sugar- sweetened beverages in different populations. Based on meta-analyses of other published evidence on health harms of sugar-sweetened beverages, the investigators calculated the direct impact on diabetes and the obesity-related effects on cardiovascular disease, diabetes and cancer.

In 2010, the researchers estimate that sugar-sweetened beverages consumption may have been responsible for approximately:

133,000 deaths from diabetes
 

45,000 deaths from cardiovascular disease

6,450 deaths from cancer

“Some population dietary changes, such as increasing fruits and vegetables, can be challenging due to agriculture, costs, storage, and other complexities. This is not complicated. There are no health benefits from sugar-sweetened beverages, and the potential impact of reducing consumption is saving tens of thousands of deaths each year,” Mozaffarian said.

Overall, in younger adults, the percent of chronic disease attributed to sugar-sweetened beverages was higher than the percent in older adults.

The health impact of sugar-sweetened beverage intake on the young is important because younger adults form a large sector of the workforce in many countries, so the economic impact of sugar-sweetened beverage-related deaths and disability in this age group can be significant. It also raises concerns about the future. If these young people continue to consume high levels as they age, the effects of high consumption will be compounded by the effects of aging, leading to even higher death and disability rates from heart disease and diabetes than we are seeing now.

Singh GM, Micha R, Khatibzadek S, Lim S, Ezzati M, and Mozaffarian, D. “Estimated global, regional, and national disease burdens related to sugar-sweetened beverage consumption in 2010.” Circulation. Published online ahead of print 06-29-15. doi:10.1161/CIRCULATIONAHA.114.010636

The greatest dietary mistake of the 20th century....was NOT saturated fat.

No it was the wrecked balance of Omega-3 and Omega-6 intake. 

Dietary fats have become completely deranged in the last 100 years. Enter trans fats. Enter concentrated animal farming operations and feeding soybeans and corn to fatten up beef, pork and chickens. We've run amok. and it is time to correct things.

We have a tendency to obsess about fat in our culture. We’ve recently seen an about face in recommendations regarding saturated fat. Saturated fat was the dietary bogeyman for the last few decades and now research is suggesting that it may not be as harmful as we thought. Really? So butter is ok now? Yes and it always has been. Margarine was a health scam perpetrated by greedy oil companies. Greed...oil... sound familiar? But in all of this back and forth on fats in our diet one point remains painfully obvious.

Today, people are eating way too many Omega-6 fatty acids. Mostly from corn and soybeans and their oils that dominate the western diet.

At the same time, consumption of animal foods high in Omega-3 is the lowest it has ever been. To make matters worse the animals we eat are no longer roaming free on the range eating omega-3 rich grass, they are raised on feed lots and fattened up with omega-6 loaded (you guessed it) corn and soybeans.

The net effect is we now consume a grossly distorted ratio of these polyunsaturated fatty acids. Setting our sugar insanity aside for the moment, this is arguably one of the most damaging aspects of the modern Western diet.

Omega-3 and Omega-6 fats are essential components of the human diet. Our bodies don’t have the ability to manufacture them and therefore we must get them from the foods we eat everyday. Allow me to introduce you to the Omegas.

If the Omega-3s and Omega-6s are missing from our diet, we develop a deficiency and become sick. That is why they are termed the “essential” fatty acids.

However, these fatty acids are different than most other fats. They are not simply used for energy or stored in tissue; they are biologically active and play crucial roles in survival events like blood clotting and inflammation, brain cell communication, and even regulation of heart rhythm.

But here is a problem. Omega-6s and Omega-3s don’t have the same effects. Omega-6s are pro-inflammatory, while Omega-3s have an anti-inflammatory effect. Omega-6s promote unhealthy clotting and narrowing of blood vessels while Omega-3s have the opposite effect.

Don’t get me wrong. Omega-6s are not all bad. In the body inflammation is essential for our survival. It helps our bodies fight infection and recover from trauma, but inflammation allowed to go unresolved can also cause severe damage and contribute to disease when the inflammatory response is exaggerated or excessive.

Today we realize that unresolved, chronic inflammation may be setting the biochemical stage allowing the development of the most challenging diseases we face today, including heart disease, obesity and metabolic syndrome, diabetes, arthritis, Alzheimer’s, asthma and many types of cancer.

Put simply, a diet that is high in Omega-6 but low in Omega-3 increases inflammation, while a diet that includes balanced amounts of these fats governs inflammation appropriately.

So again, the issue is that people who eat a typical Western diet are eating way too many Omega-6s relative to Omega-3s.

A good way to figure out what is healthy for humans, is to look at populations that are healthy and don’t have all these Western diseases.

Good luck finding developed countries that fit that description. The sad truth is, every country that eats an industrial diet gets sick. Our food practices today erode our health and send our health care costs skyrocketing upward. Bully for hospitals and drug companies, but not so great for you and me.

Therefore, to find dietary guidance we must look at non-industrial populations like the most recent hunter-gatherers.

Hunter-gatherers who eat mostly deer, elk, and other land dwelling animals have a. Omega-6 to Omega-3 3 ratio of 2:1 to 4:1, while the Inuit, who ate mostly Omega-3 rich seafoods, had a ratio of 1:4.

All of these populations enjoyed good health. They did not suffer from the chronic diseases we face today.

Keep in mind that none of these populations were eating a lot of Omega-6. We need to consider that we will not fix our own health by continuing to consume high levels of omega-6 and simply adding omega-3. Getting a daily small balanced amount of both is probably best. Emphasis on balanced.

Anthropological evidence also suggests that the ratio of Omegas human beings evolved with is closer to 1:1, while the ratio today is around 22:1 or worse. Meaning 22 times more omega-6 than what we are genetically programmed to handle.

Not only are modern people eating much less Omega-3 from animal sources, they are eating huge amounts of processed seed and vegetable oils which provide ridiculously high levels of Omega-6.

The technology to extract seed and vegetable oils is twentieth century technology.  Evolutionarily speaking we simply have had no time to genetically adapt to these high amounts of Omega-6.

Soy is the major culprit here. Here is a chart that shows the dramatic increase in soybean oil consumption in the USA, from zero to 11 kilograms (24 pounds) per person per year.

Soybean oil is currently the biggest source of Omega-6 fatty acids in the USA, because it is abundant and dirt cheap. Don’t even get me started on government subsidies for soy and corn.  Thus soy oil, and to a slightly lesser extent corn oil are used in all manner of processed foods. Unfortunately processed foods make up an ever-increasing part of daily food intake in developed countries, so we are literally stuffing our cells and tissues with excessive omega-6.

The amount of Omega-6 fatty acids found in body fat stores has increased by more than 200% in the past 50 years alone.

So the unbalanced fats that we are eating are leading to structural changes, in our body fat stores, cell membranes, tissues and organs everywhere in the body. Continuing on this path is suicidal.

A high amount of Omega-6 in cell membranes is strongly associated with the risk of cardiovascular disease, partly due to the pro-inflammatory effects, but also due to lipid imbalances and unwarranted clotting.

There have been several controlled trials where people were directed to replace saturated fats like butter with Omega-6 rich vegetable oils. Instead of having healthier hearts, the dietary changes backfired and they had a significantly increased risk of heart disease.

A high Omega-6 intake is also associated with violence and depression, while Omega-3s improve all sorts of mental disorders like depression, schizophrenia and bipolar disorder.

Consumption of vegetable oils high in Omega-6, and a precipitous drop in omega-3 levels is simply the reality of food policy and production changes over the past 100 years. There is a tsunami of evidence that this is causing serious harm.

Fortunately, optimizing your intake of the most important Omega-3 fatty acids is relatively simple.

The single most important thing you can do to reduce your Omega-6 intake is to avoid processed seed and vegetable oils high in Omega-6, as well as the processed foods that contain them.

Here is a chart with some common fats and oils. This is why I prefer using olive oil in the kitchen. To reduce your intake of Omega-6 you need to avoid all of these oils that have a high proportion of Omega-6 (blue bars).

You can see that all of these plant oils are much higher in Omega-6, relative to Omega-3. In fact Omega-3 in plant oils is virtually non-existent. Mind you I said to reduce Omega-6 not eliminate it. Omega-6 is essential for health, it is the overconsumption, the loss of balance that is the issue.

Animal foods are the best sources of the preformed Omega-3 fatty acids, EPA and DHA. And they provide omega-6 too. Think fish and grass fed beef and pork.

The problem is that commercially raised animals are fattened up with grain-based feeds of mainly soy and corn. If those grains fatten up cows what must they be doing to us?

Feeding soy and corn to cows, pigs and chickens reduces the Omega-3 content, so the fats in the meat are mostly Omega-6. Therefore, if you can afford it, grass fed or wild meat is definitely optimal. However, occasional consumption of conventionally raised meat is healthy, as long as it is not processed.

It is also best to buy pastured or omega-3 eggs, which are much healthier than eggs from hens that were fed grain-based feeds.

By far the best and healthiest way to increase your Omega-3 intake is to eat seafood at least twice per week or ideally, even more often. Fatty fish like salmon is a particularly good source. Sardines, mackerel, herring and tuna are good choices too. Wild caught fish is best, but eating farmed fish is much better than eating no fish at all.

If you eat a lot of conventionally raised meats and/or don’t eat much seafood, then I strongly suggest you take a fish oil supplement.

And when you are choosing supplements, please be aware of this. There are some plant sources of Omega-3, like flax and chia seeds. However, these contain a type of Omega-3 called ALA. ALA does not confer the heart, eye and brain benefits of its longer cousins EPA and DHA. And humans are inefficient converters of ALA into the active forms, EPA and DHA. So be sure you either eat fish or take a supplement that provides EPA and DHA. Adults need between 1000 and 4000 mg EPA/DHA daily and children under the age of 10 need 200-1000 mg EPA/DHA daily for best results. Teenagers should be dosed as adults.

And finally for the geeks in the room, here is a nifty chart showing the metabolic pathways of Omega-6 and Omega-3s.

~enjoy!

Fish oils and prostate cancer. Are supplements dangerous?

I have been asked to explain the reported “findings” of the SELECT study. This is the study generating new headlines claiming that fish oil supplements are linked to an increased risk of aggressive prostate cancer. 

For starters, the men in the SELECT study were not given fish oil supplements. What the results were reporting were levels of EPA, DPA and DHA omega-3s in blood, and cancer risk. And it is very important to note that the difference of omega-3 levels when comparing the healthy (control) group and the combined cancers group was nearly insignificant.

That difference is 4.66% in the combined cancer group versus 4.48% in the control group. It is a minute variance. Eating one additional serving of fish compared to the control group could result in that difference. Again no fish oil supplements were given in the study, so to blame omega-3 supplements for the reported findings is totally irresponsible.

Another point to consider is this. The reported omega-3 levels in any of the SELECT participants are not high levels. They are only slightly higher than the levels in those who consume a western diet typically average. Therefore any country that consumes a diet based on fish would have incredibly high levels of aggressive prostate cancer, and that is not the case.

What does the science really say about fish consumption or omega-3 levels and risk of prostate cancer?

The studies almost uniformly show that eating fish or having higher plasma levels of omega-3 is protective.  Several large scale epidemiological studies, including those looking at native Japanese men, Inuit men and people that live in South America, have shown that a high intake of fish and a high omega-3 status is linked to a lower incidence of many cancers including prostate cancer.

In a 2010 meta-analysis published in the American Journal of Clinical Nutrition by Szymanski et al, the authors pooled data from four studies on fish consumption and death from prostate cancer and found a 63% decrease in risk for high fish consumption.

One must be very careful with making decisions based on the latest headlines. People do have a tendency to make decisions based on the last study or news advertised, rather than the sum of evidence of many studies published on a specific topic. But we must not do this. We must take into consideration the totality of evidence that we have on a topic, not just the latest headline on CNN.

In addition, studies should be read critically – there are inherent flaws in most of them.

The findings from this most recently reported study: Brasky et al. 2013 ( SELECT) are from an observational study (looking back in time) and observational studies do not prove cause and effect.

Scientific studies that are prospective in design are considered more important in weighing total evidence and give us more useful guidance in our choices on diet or supplements that might improve our health.

Are there more useful, prospective studies that demonstrate protective benefits of omega 3 fatty acids against prostate cancer?

Yes there are quite a few. Lets consider some of those.

Researchers investigated the effect of dietary fish intake amongst 6272 Swedish men who were followed-up for 30 years. That study reported that men who ate no fish had a two to three-fold increase in the risk of developing prostate cancer compared with those who consumed large amounts of fish in their diet.

TerryP, Lichtenstein P, Feychting M, Ahlbom A, Wolk A. Fatty fish consumption andrisk of prostate cancer. Lancet 2001; 357: 1764–6

Another prospective cohort study based on the Physician’s Health Study found that fish consumption (≥5 times per week) was not related to prostate cancer risk but was protective of prostate cancer–specific death.

ChavarroJE et al. A 22-y prospective study of fish intake in relation to prostatecancer incidence and mortality. Am J ClinNutr 2008; 88: 1297–303.

Other studies have suggested lower prostate cancer risk with Omega 3 fatty acids from fish in Swedish men.

NorrishAE, Skeaff CM, Arribas GLB, et al. Prostate cancer risk and consumption of fishoils: A dietary biomarker-based case-control study. Br J Cancer. 1999;81:1238–42.

And this study showed lower prostate cancer risk with Omega 3 fatty acids from fish in Japanese and Brazilian men..

KobayashiM, et al, Serum n-3 fatty acids, fishconsumption and cancer mortality in six Japanese populations in Japan andBrazil Japan J Cancer Res.1999 Sep;90(9):914-21.

A large prospective cohort established in 1986 looked at 51,529 American men, 40 – 75 years of age, completed a mailed questionnaire about demographic and medical information found that a high intake of fish was associated with a lower risk of metastatic prostate cancer. A similar association was also found for dietary marine fatty acids from food.

Leitzmann MF, Stampfer MJ, et al, Dietary intake of n-3 and n-6 fatty acids and the risk of prostatecancer. Am J Clin Nutr. 2004 Jul;80(1):204-16.

An important clinical study published by a group at the Harvard School of Public Health examined the link between dietary fish consumption and the risk of metastatic prostate cancer. This paper reported results from the Health Professionals Follow-up Study that involved 47,882 men over twelve years. During the twelve years, 2,483 cases of prostate cancer were identified. Of these, 617 were advanced and 278 were metastatic. Eating fish more than three times a week reduced the risk of prostate cancer but had an even greater impact on the risk of metastatic prostate cancer. For each additional 500 mg of marine omega-3 consumed, the risk of metastatic disease decreased by 24%!

Augustsson,K., et al., A prospective study of intake of fish and marine fatty acids andprostate cancer. Cancer EpidemiolBiomarkers Prev, 12(1): p. 64-7, 2003.

And again, in the 2010 meta-analysis (an analysis of multiple studies) Szymanski and his team found that a significant 63% reduction in prostate cancer-specific mortality in those that consumed fish but no link between eating lots of fish and men’s risk of developing prostate cancer.

SzymanskiKM, Wheeler DC, Mucci LA. Fish consumption and prostate cancer risk: a reviewand meta-analysis. Am J Clin Nutr.2010 Nov;92(5):1223-33.

When one considers the larger picture, the headlines claiming that men who consume omega-3 supplements are at increased risk of prostate cancer, based on one study where no one used omega-3 supplements, and where levels of omega-3s were only 0.02% in variance among cancer cases and healthy cases, seem preposterous.

Study: Soda and Sugar Drive Obesity

New research powerfully implicates soda and other sugary drinks as culprits in the obesity epidemic.

A huge, decades-long study involving more than 33,000 Americans has yielded the first clear proof that drinking sugary beverages interacts with genes that affect weight, amplifying a person’s risk of obesity beyond what it would be from heredity alone.

This means that such drinks are especially harmful to people with genes that predispose them to weight gain. And most of us have at least some of these genes.

In addition, two other major experiments have found that giving children and teens calorie-free alternatives to the sugary drinks they usually consume leads to less weight gain.

Collectively, the results strongly suggest that sugary drinks cause people to pack on the pounds, independent of other unhealthy behavior such as overeating and getting too little exercise, scientists say.

That adds weight to the push for taxes, portion limits like the one just adopted in New York City, and other policies to curb consumption of soda, juice drinks and sports beverages sweetened with sugar.

Soda lovers do get some good news: Sugar-free drinks did not raise the risk of obesity in these studies.

“You may be able to fool the taste” and satisfy a sweet tooth without paying a price in weight, said an obesity researcher with no role in the studies, Rudy Leibel of Columbia University.

The studies were being presented Friday at an obesity conference in San Antonio and were published online by the New England Journal of Medicine.

The gene research in particular fills a major gap in what we know about obesity. It was a huge undertaking, involving three long-running studies that separately and collectively reached the same conclusions. It shows how behavior combines with heredity to affect how fat we become.

Having many of these genes does not guarantee people will become obese, but if they drink a lot of sugary beverages, “they fulfill that fate,” said an expert with no role in the research, Jules Hirsch of Rockefeller University in New York. “The sweet drinking and the fatness are going together, and it’s more evident in the genetic predisposition people.”

Sugary drinks are the single biggest source of calories in the American diet, and they are increasingly blamed for the fact that a third of U.S. children and teens and more than two-thirds of adults are obese or overweight.

Consumption of sugary drinks and obesity rates have risen in tandem —both have more than doubled since the 1970s in the U.S.

In one study, researchers randomly assigned 224 overweight or obese high schoolers in the Boston area to receive shipments every two weeks of either the sugary drinks they usually consumed or sugar-free alternatives, including bottled water. No efforts were made to change the youngsters’ exercise habits or give nutrition advice, and the kids knew what type of beverages they were getting.

After one year, the sugar-free group weighed more than 4 pounds less on average than those who kept drinking sugary beverages.

“I know of no other single food product whose elimination can produce this degree of weight change,” said the study’s leader, Dr. David Ludwig of Boston Children’s Hospital and the Harvard School of Public Health.

The weight difference between the two groups narrowed to 2 pounds in the second year of the study, when drinks were no longer being provided. That showed at least some lasting beneficial effect on kids’ habits. The study was funded mostly by government grants.

A second study involved 641 normal-weight children ages 4 to 12 in the Netherlands who regularly drank sugar-sweetened beverages. They were randomly assigned to get either a sugary drink or a sugar-free one during morning break at their schools, and were not told what kind they were given.

The studies “provide strong impetus” for policies urged by the Institute of Medicine, the American Heart Association and others to limit sugary drink consumption.

The genetic research was part of a much larger set of health studies that have gone on for decades across the U.S., led by the Harvard School of Public Health.

Researchers checked for 32 gene variants that have previously been tied to weight. Because we inherit two copies of each gene, everyone has 64 opportunities for these risk genes. The study participants had 29 on average.

Every four years, these people answered detailed surveys about their eating and drinking habits as well as things like smoking and exercise. Researchers analyzed these over several decades.

A clear pattern emerged: The more sugary drinks someone consumed, the greater the impact of the genes on the person’s weight and risk of becoming obese.

For every 10 risk genes someone had, the risk of obesity rose in proportion to how many sweet drinks the person regularly consumed. Overall calorie intake and lifestyle factors such as exercise did not account for the differences researchers saw.

This means that people with genes that predispose them to be obese are more susceptible to the harmful effects of sugary drinks on their weight, said one of the study leaders, Harvard’s Dr. Frank Hu. The opposite also was true — avoiding these drinks can minimize the effect of obesity genes.

“Two bad things can act together and their combined effects are even greater than either effect alone,” Hu said. “The flip side of this is everyone has some genetic risk of obesity, but the genetic effects can be offset by healthier beverage choices. It’s certainly not our destiny” to be fat, even if we carry genes that raise this risk.