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Tag Archives: sugary beverages
Pharmacy Sugary Drink Withdrawal and the New WHO Sugar Guidelines
In response to my decision to remove sugary drinks from my pharmacy in September of 2014, there seem to be the odd lingering claim that “…targeting the sale of one particular category is not going to have a significant impact [on obesity]”, and that “information – not restriction – is key.”
While we agree with the point that obesity is a complex, multifactorial problem, it is completely baseless, in fact hovering on outright deception, that extra calorie intake does not increase your weight. In 2013, the journal PLOS Medicine published a systematic review of systematic reviews, which are the most comprehensive forms of evidence that we have. This review by Bes-Rastrollo and colleagues found that 83% of reviews not funded by the beverage industry a relationship between sugar-sweetened beverage consumption and weight gain. On the other hand, 83% of the reviews that were funded by the industry found insufficient evidence to support a positive association between sugar-sweetened beverage consumption and weight gain or obesity.
Also keep in mind metabolic disease which has also been shown to increase with consumption of these drinks and is one of the main reasons we pharmacists see our customers (high blood pressure, increased cholesterol, increased abdominal obesity, and insulin resistance). For example, a 2010 meta analysis in the Journal of Diabetes Care of over 300,000 subjects found that those that consumed the most sugary drinks, one or two per day (pop, juice, vitamin water, iced tea and energy drinks) had a 26% greater chance of developing type 2 diabetes than those that drank none or 1 serving per month. They concluded that weight gain and metabolic syndrome correlates positively with consumption of these drinks. The New England Journal of Medicine published a study in 2011 which followed over 120,000 people and concluded that one 12 ounce sugary beverage serving a day increased their weight more than those that did not consume this beverage. Finally, a 2012 study in Circulation followed 40,000 men and found a 20% higher chance of having a heart attack or dying from a heart attack when one can of sugary beverage per day was consumed compared to men that didn’t. This was verified by a second study.
Calorie consumption from all sugary beverages combined has continued to climb each decade, especially among children and teens. By coincidence, today, the World Health Organization is changing its recommendation for daily total consumption of sugar to 6-12 teaspoons daily. This would be exceeded by consuming even one can of soda. Finally, we are seeing revised recommendations on sugar that follows science. The new recommendation now recommends free sugars being as low as 5% of total calories, meaning a serving of orange juice is off limits – imagine, a recommendation that pushes you to eat the fruit instead of drinking the juice. Brilliant! There is now a separation of total sugars and free sugars. The total sugar concept meant you could gobble up your calories with juice and pop, but now it’s considered free sugar.
The withdrawal of sugary beverages from Stone’s Pharmasave in Baddeck was not meant to “ban” pop sales, and I certainly do not expect to see a drastic change in obesity levels in my town as a result of my decision. I made this decision to help educate my customers on the effects of sugary drinks. I therefore agree that education is an important component of healthy eating. However, in keeping with recommendations from world experts in obesity research (see the 2015 Lancet Obesity Series), I am also aiming to move beyond education by starting to create an environment in my store that is supportive of healthy food choices. As a pharmacist, I know I shouldn’t sell tobacco, no matter what the industry claims. I don’t feel I should sell sugary beverages, either.
Individual attempts at large scale health outcomes
I find it amusing, especially in the world of preventative therapies, the cut-throat competitive atmosphere in what works and what doesn’t; what is a waste of money and what is positively proven. Unfortunately, virtually all of these claims (positive or negative) come from a claim or conclusion from the latest study. The study might or might not be well designed, it may or may not have the power to come to the conclusion that it does, and it may be just an opinion.
I am a firm believer in the concept that the sum of what we know is a result of all of the studies we have, not just from one or two studies. When I stopped selling sugary drinks last year at my pharmacy or as some reported it, “banned sugary drinks”, some claimed I thought I could lower the weight of those in the village of Baddeck by “controlling” if they consumed these beverages. Of course this is quite impossible an expectation and was never the intent. Just last week a report of no change in obesity trends after a ban on new openings of fast food restaurants in South Los Angeles may have given many the impression that it didn’t matter if you ate there or not. You were still going to stay obese anyway.
The messages that are lost on this are manifold. First, there are people out there with good intentions that want to make a start or make some sort of statement if not to just remind you of the need to be healthier, even if there is no immediate measurable outcome. Second, and perhaps more importantly, maybe the “measurable outcome” is that it spurs someone else to do something with the same intention. Perhaps it isn’t directly related to the event that inspired the first act. It could be that someone sees a ban on something and then they start a walking club because they want to be part of a solution to a problem that the first person wanted to fix. Thirdly, no one is trying to control your lifestyle, regardless of how unhealthy it may be by taking these small steps. These decisions that are being made are not micromanaging obscure trends, they are trying to apply general proven concepts of good diet and exercise to as large a group as possible.
It is easy to find fault with small measures when they don’t have the results we think they should have. On their own however, individual changes do very little. It just depends on how far back you step when you measure results. One individual in my town getting healthy by my sugary drinks removal is huge. You may not notice a significant difference when this is spread out over the entire population of the town. A recent article in Science Daily had the title, “From soda bans to bike lanes: Which ‘natural experiments’ really reduce obesity”. Being a part of a natural experiment with the Propel Centre at the University of Waterloo with the sugary beverage withdrawal this grabbed my interest. The article stated that without before and after weight measurements of the population these studies may not have the rigor to come to meaningful conclusions on obesity related outcomes. While this is probably true, it is difficult to argue the fact that a good diet helps to bring good health. It is not rocket science at all to determine what diet gives you good health. Of all of the scientific studies done today, there are very little out there that argue against the fact that calorie restriction and eating whole foods will improve your health. Will the construction of a hiking trail in a community lower the obesity rate in that community, maybe or maybe not. The only question is what is the tipping point that cumulative measures like this have a measurable effect. What we should care about more is that it spurs others to push for ways that make others healthy, not just themselves.
There is a reason why many people don’t litter. Not only was it driven into our heads as children and adults, but many get the fact that it is a cumulative measure in order to work. It’s like the sand bag on the pile keeping a flood back. Some bags aren’t even touching the water, but they all work to accomplish the job together.