Dr. Wendel Bruner, the Public Health Director for Contra Costa County, had made it painfully clear: Fully one-third of Richmond’s African American and Latino fifth and seventh graders are obese. Another 20 percent in each group are overweight. Without a successful intervention, Dr. Bruner warned that most of these children would suffer the ravages of diabetes and premature coronary heart disease, and many would simply not live as long as their parents.
What would a successful intervention look like? Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, has said a one-cent per ounce sugar-sweetened beverage tax might be “the single most effective measure to reverse the obesity epidemic.”
The American Heart Association, the Institute of Medicine, the American Public Health Association, the American Academy of Pediatrics and the United Nations all endorsed the idea.
But why single out sugar-sweetened beverages? Can’t any food or beverage be a part of a balanced diet? You know, have the cola with dinner but skip the chocolate cake for dessert.
That seems reasonable, but that’s based on the old science. What the new science is telling us is that our bodies actually work a bit differently than that. We are not equipped by nature to metabolize large fructose loads without severe adverse health consequences.
You see, this kind of thing has never happened before in human history. In nature, sucrose or fructose is always bound to fiber and that prevents us from taking in too much at once and our livers can easily handle what’s in an apple (or two or three).
But when we concentrate huge doses of fructose, either from high fructose corn syrup or from sucrose, in water and chug it down, we present the liver with more than it can safely handle. The liver has no storage mechanism for fructose. It can’t just put the excess fructose on the shelf and come back to it later. What the liver cannot metabolize by the usual pathway – the Krebs cycle – it shunts to the DNL pathway. DNL? De novo lipogenesis, literally, new fat making. The liver converts the excess fructose to fat.
Some of the fat ends up around our waistlines. That’s the fat we see. It’s the fat we don’t see that hurts us. Our livers get packed with fat and begin to malfunction. The fatty livers become “deaf” to the hormone insulin, which regulates sugar and fat metabolism. The pancreas responds by going into overdrive and making high doses of insulin. The overworked pancreas eventually poops out and diabetes results.
The fatty livers also make unhealthy cholesterol, specifically small dense LDL (low density lipoprotein) particles. This unhealthy cholesterol causes the arteries of the heart to plug up. The heart muscle downstream from the blockage dies off due to lack of oxygen. That’s what we call a heart attack or a coronary.
I’ve been on the treatment end of many heart attacks in my thirty-year career as a cardiologist. It’s not a pretty sight, the crushing chest pain, the look of sheer terror, the struggling for breath. It’s something to prevent, whenever possible. If drinking sugar-sweetened beverages increases our heart risk, which it does by 20 percent, we ought to avoid them and pass that knowledge on to our children.
Dr. Kimber Stanhope replaced the toast and crackers that healthy 18-24-year-old volunteers had been eating, calorie for calorie, with a sugar-sweetened beverage. Within two weeks, these healthy volunteers were producing alarmingly high levels of small dense LDL particles. It made Dr. Stanhope decrease her fructose consumption and it did the same for me. Drink a cola and have small dense LDL particles circulating and starting to clog up my heart’s arteries. No, thanks!
The pieces of the puzzle are beginning to fit together. We Americans have drastically increased our intake of sugar during the past generation. More than half of that added sugar has come in the form of sugar-sweetened beverages. Estimates are that at least 20% of the weight gained by Americans in the last generation was due to sugar-sweetened beverages.
The new science is saying that too many sugary drinks is the main culprit in weight gain, diabetes, premature heart attacks and even some cancers. So why not just educate folks and leave it at that?
It turns out that the public health literature has lots to say about this too. Perhaps it’s no big surprise, but we humans are a stubborn lot. Just educating us was not enough to curtail tobacco use, to get us to put on our seatbelts, nor to designate a safe driver when we had too much to drink. We needed a little “stick” to go along with the carrot.
Cigarette taxes, and penalties for drunk driving and not buckling up moved us to behave in healthier ways. That’s what we plan to do in Richmond with the sugar-sweetened beverage tax. And we can do even more, because we can direct the tax revenue to programs and projects that promote healthy eating and active living.
We know from our work in the Richmond community that the overwhelming number of residents will support the sugar-sweetened beverage tax if the tax revenue is used to create more after school sports programs; making programs less expensive; providing adequate sports fields; allowing schools to provide healthier school meals, nutrition classes and cooking classes; and providing medical care for children with diabetes who can’t afford care.
We can guarantee enough votes on the future city council to make that package a certainty if the ballot measure passes. We will have $3 million to invest in our children’s well being and we will have made history. Because of this campaign, many more folks in Richmond will know and understand the new science than probably anywhere else in the United States.
Help us beat Big Soda. Help us make history.
Let’s do it for our children.
Dr. Jeff Ritterman is a member of the Richmond City Council. This op-ed originally appeared in California City News.