Healey on Health

Our family was enjoying an all-inclusive Caribbean resort vacation when Austin, our youngest at about 7 years at the time, walked by me on the pool deck with a coke at about 9:30 AM. “Whoa, whoa, whoa, whoa, whoa”, I said(five whoas being perfect, four seldom enough and six always too many), “what are you doing drinking a coke at this hour of the day?” Austin pointed out that the cokes were free and we were on vacation to which I replied that the beer was free too and I wasn’t drinking beer at 9:30 AM. Ultimately we agreed that we would both begin imbibing at noon, Austin watching me like a hawk the entire rest of the vacation. This is why one should not negotiate with children. The point of this story is that we were, each of us, tempting fate, our health and our future patterns of addiction with our pact, so adroitly negotiated on that sunny pool deck. You see, both alcohol and fructose, which forms 50% of sucrose (sugar), tend to be transformed by the body into liver fat rather than to be used for cellular energy. But Austin had the advantage over me. While the alcohol in my beer was going to be transformed into liver fat, the fructose in his drink might actually be used for energy if Austin maintained a high enough energy output. Back then he did, but as times have changed so have our children’s activity levels. The combination of higher levels of fructose in our children’s diets with lower levels of physical activity produces similar metabolic effects as high beer consumption in a middle aged man, fat bellies, fatter livers and even type 2 diabetes! I see this in my own practice with children as young as five having diabetes and as young as ten with abnormal liver functions tests related to fatty liver. Sugar, or sucrose, is 50% glucose and 50% fructose. High fructose corn syrup (HFCS), which has now replaced sucrose in American soft drinks, is 55% fructose. While glucose tends to be used for energy, fructose, like alcohol, is handled differently by the body, often going directly to fat. Historically, most of the carbs in our diets came from starches in grains and vegetables which are exclusively glucose, some from dairy which has glucose and galactose, the latter quickly converted to glucose by the liver, and a little bit from fruits which contain glucose and fructose, but with a lot of fiber as well. Manufactured forms of sugar(sucrose) did not become widely available until the development of the slave trade allowed large plantations in the New World to cheaply produce sugar. Sugar consumption in developed countries soared from a few pounds per person per year in the 1700’s to over 130 pounds by the late twentieth century! Sugar or HFCS finds its way into everything from breakfast cereal to peanut butter to ketchup to low-fat salad dressings. We eat it in baked goods, confections, granola bars and energy drinks. We add it to condiments, sauces, fruit, salads, jams, jellies, desserts, coffee and tea. We are bewitched, beguiled and besotted by it. I was often asked by my patients if eating sugar caused sugar diabetes. I used to reassure them that eating sugar might lead to obesity thereby indirectly increasing their risk of diabetes but recent evidence suggests that there is, in fact, a direct linear relationship between a society’s sugar consumption and the rate of type 2 diabetes! The more pounds of sugar or high fructose corn syrup in our diets the higher the likelihood of developing diabetes. Both obesity and diabetes are now rampant in the developed world. These conditions create not only enormous personal burdens but also a huge societal burden for the health care system to bear. The incidence of both is alarmingly high and growing quickly. Diabetes vastly increases the risk of premature heart disease and stroke, and is now the leading reason for kidney dialysis. Sugar has become a far more effective killer than alcohol ever hoped to be! Next week I’ll talk about the macro effects of sugar on society, both historically and now. As far as our long ago deal on that poolside deck goes, Austin is doing fine. Our household has never been an all-inclusive resort despite the expectations of our children. But on the way home from work on Fridays I will pick up a pack of soda and a six-pack of beer in the spirit of our agreement, the Dominican Détente. Unfortunately, Austin had neither the wisdom nor the temerity to include my wine or whiskey in the negotiations. As a result, while the wretched child remains slender, I do not.