Not so sweet

Common sugar or sucrose consists of one molecule each of glucose and fructose. Glucose is the primary source of the body’s energy but is less than half as sweet as fructose. Being a primary energy source,glucose can be metabolised in every cell of the body. Not fructose though.

Fructose is broken down in the liver. Sweetened drinks have started inviting medical wrath because absorption is faster in the liquid form. This means that at any given instant,the liver has to metabolise a far greater load than when sugar enters the body in solid form (like whole fruits,etc.). This is also why alcohol happens to be associated with fatty liver – greater load pushing liver cells to hypertrophy and then leads to the liver completely giving up one day.

The Nature article says that much like the role taxes have played in the reduction of smoking and drinking,there should be taxes on any processed food items containing added sugars,including sweetened fizzy drinks,juice,sugared cereal and other sweetened beverages like sweets,sports drinks and chocolate milk. The ultimate goal being to force manufacturers to reduce the use of sugar.

The study says that the harmful effects of sugar – especially fructose – go beyond its calorific value and link to obesity. The range of diseases that sugar induces include “hypertension (higher uric acid raises blood pressure),high triglycerides and insulin resistance through synthesis of fat in the liver,diabetes from increased liver glucose production along with insulin resistance,” and the damage fructose causes to lipids,proteins and DNA in the body through its non-enzymatic binding. Thus,the toxic effects of fructose are similar to that of alcohol.

“Sugar also has clear potential for abuse. Like tobacco and alcohol,it acts on the brain to encourage subsequent intake. There are numerous studies examining the dependence producing properties of sugar in humans. Specifically sugar dampens the suppression of the hormone ghrelin which signals hunger to the brain. It also interferes with the normal transport and signalling of the hormone leptin which helps to produce a feeling of satiety. And it reduces dopamine signalling in the brain’s reward centre thereby decreasing the pleasure derived from food and compelling the individual to consume more,” the article says.

India is one of the first countries in the world to have a national programme for prevention of non-communicable diseases but the importance of diet,say public health experts,has not been explored sufficiently. This is more so because in terms of health policy,the country is caught between rampant malnutrition on one side and lifestyle diseases on the other. Some of them say it is time for higher taxes at least on sugary drinks including fruit juices.

Cardiologist Dr K Srinath Reddy,formerly of the All India Institute of Medical Sciences (AIIMS) and currently president of the Public Health Foundation of India,says: “The area of nutrition has been neglected in the country. I am in favour of taxing unhealthy food items and subsidising healthy options but the problem of regulation is that it has to be acceptable to the public. There is enough evidence of all the damage beyond obesity that sugary drinks do but these things have never been dealt with at the policy level.”

Others feel that it is a concept well ahead of its time and difficult to implement in a country like India where exchange of sweets is an established mode of greeting. “There are many other things that India needs to do first like labelling of food products,salt restriction,a law on trans fatty acids. The Nature article has put forward a new concept. Maybe India will be ready for it in the next few years,” says Dr Anoop Misra,director and head,department of diabetes and metabolic diseases,Fortis Hospital and former professor of medicine at AIIMS.

Interestingly,there is a move to tax foods which are harmful but the villain identified is not sugar. Sources in the health ministry say that the consultative expert working group of the World Health Organisation is in the process of finalising a report that says that to increase R&D expenditure on drugs of non-communicable diseases,food products high in fat should be taxed. The report will be discussed in the WHO General Assembly in May.

Know the new ‘villain’ on the block

Common sugar or sucrose consists of one molecule each of glucose and fructose. Glucose can be metabolised in every cell of the body,but fructose is broken down in the liver. Absorption is faster in the liquid form. Increased load pushes liver cells to hypertrophy and ends with the liver giving up completely one day.Thus,the toxic effects of fructose are similar to that of alcohol.

What the experts may do about it: taxing food products high in fat

A recent study in the American Journal of Clinical Nutrition concluded that replacing sugary drinks in the diet with water causes a weight loss of 2-2.5 per cent.There is a move to tax harmful foods but the villain identified is not sugar. Sources in the Health ministry say that the consultative expert working group of the World Health Organisation is finalising a report which says that food products high in fat should be taxed. Some of them say it is time for higher taxes at least on sugary drinks including fruit juices.