(Condensed article published October 29, 2017 in the Davis Enterprise)
Our Children Are Bleeding. What Are We Going to Do?
What would you do if your child got hurt right now? If he or she was bleeding, had a fever, or broke a bone? We generally know how to react to an acute health concern with our children- the symptoms are apparent and either we know what to do or where to take them for someone else to help. Conversely, it is much harder to recognize the longer-term health effects that seemingly innocent daily actions have on our children. What would you do if you knew your child might slowly be developing a chronic disease?
When our kids are not bleeding, don’t have a fever, and no bones are broken, it’s easy to believe they are healthy (and our health care system has been pretty good about reassuring us of this too). But, there is a startling statistic from the Centers for Disease Control and Prevention that approximately one in every three kids born in the United States will eventually develop type 2 diabetes. Type 2 diabetes is a metabolic disorder in which the body is unable to properly regulate the hormone insulin. It develops in large part over years of improper nutrition. It is now considered one of the leading causes of chronic diseases, including heart disease, high blood pressure, stroke, cancer, and dementia.
While multifactorial, a large part of the rise of type 2 diabetes is due to the huge amount of sugar that is part of the average American diet. Estimating sugar consumption is difficult, however it has been estimated from Department of Commerce and Department of Agriculture statistics that Americans’ consumption of sugar is 10-15 times higher than it was in the early 1800s (before the modern candy and soft drink industries emerged in the mid to late 1800s). And, just in the past three decades, the consumption of added sugars rose about 20% for the average American child and 30% for the average American adult.
The problem is not that we enjoy sugar (I enjoy sugar)- the problem is a diet, over months and years, of way too much sugar. Our kids are enjoying sugar and sweetened foods and drinks all day long, day after day, year after year. A diet high in sugar has become normalized in our society today.
Many of us may be aware of this situation and know a lot about how to prevent it. Many of us may not. I hope to illuminate why this normalization of high sugar consumption is harmful, to raise awareness and call us to action- to our community here in Davis, to all of us helping to raise the next generation. If we all become more aware, and work together, we can change the alarming trend that is decreasing our kids’ life expectancy. My kid and your kid may not be bleeding at the moment, but as a group, they are becoming sicker. The good news is that we can do something about this. We really can help our kids- especially if we all work together.
How Did We Get Here?
Sugar used to be hard to come by (nature was smart in this way), so it used to be a rare treat. But we’ve developed farming practices and technologies to easily extract and refine many forms of sugar. Additionally, many political and financial forces have made it even easier to provide us with unlimited sugar. The food and beverage industry and their lobbyists have a huge amount of money and power, and therefore influence, in politics and policy. The industry has made it easy for all of us to consume large amounts of sugar, both through the development and production of high sugar processed foods and drinks as well as through their influence on nutrition research and policy. In fact, reminiscent of Big Tobacco, the sugar industry (via the Sugar Research Foundation) began a campaign in the early 1960s, via their research, publicity, and legislative work, to vilify fat with the goal of getting us to eat less fat and more sugar. This campaign has been very successful.
And, Big Sugar wants us to know that we, and our kids, deserve sugar…. all day long. We parents have been caught in the middle of this slow but steady tide of sugar invasion into our breakfasts, lunches, snacks, dinners, desserts, and drinks. We buy and consume a lot of sugar products. Because they are so yummy! And our kids love them. And they make life easier. It has been a slow, insidious rise, over time, until it’s become so normal we don’t even realize it. It’s like how you don’t know how much your child has grown until someone else who hasn’t seen them in a while points it out- he’s so tall! So I will point it out- most of us eat a lot of sugar. And it has come at a price. Some of us do realize it, but… since the kids aren’t bleeding….
Why We Should Care – Health Consequences
Based on research in the March 17, 2005 issue of The New England Journal of Medicine, the National Institutes of Health stated that: “The U.S. could be facing its first sustained drop in life expectancy in the modern era… Over the next few decades, life expectancy for the average American could decline by as much as 5 years.” As Dr. Mark Hyman, author of The Blood Sugar Solution, says, “We are raising the first generation of Americans to live sicker and die younger than their parents.”
Type 2 diabetes is an inability to properly regulate insulin in the body, leading to insulin resistance. From mild insulin resistance to full-blown type 2 diabetes, this spectrum of metabolic disorders is one of the leading causes of chronic diseases, including heart disease, high blood pressure, stroke, cancer, and dementia. People with type 2 diabetes also suffer from other complications such as liver failure, failing eyesight, amputations, nerve damage, and tooth decay.
A large part of the rise of type 2 diabetes is due to the large amount of sugar that is part of our standard American diet. A large epidemiological study published Feb. 27, 2013 in PLOS ONE suggests sugar may have a direct link to diabetes, independent of obesity. The Stanford School of Medicine’s website summarizes the study’s findings: “After accounting for obesity and a large array of other factors, the researchers found that increased sugar in a population’s food supply was linked to higher diabetes rates, independent of obesity rates… Specifically, more sugar was correlated with more diabetes… Not only was sugar availability correlated to diabetes risk, but the longer a population was exposed to excess sugar, the higher its diabetes rate after controlling for obesity and other factors. In addition, diabetes rates dropped over time when sugar availability dropped, independent of changes to consumption of other calories and physical activity or obesity rates.”
A sugar-rich, nutrient-poor diet does its damage slowly over the course of many years.
Consumption Guidelines
The World Health Organization (WHO) released guidelines in 2015, recommending that “adults and children reduce their daily intake of free sugars to less than 10% of their total energy [caloric] intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons, also equal to 100 calories) per day would provide additional health benefits.” WHO issued these guidelines in response to the increase in chronic diseases (such as type 2 diabetes and heart disease), obesity, and tooth decay. Free sugars refers to all sugars present in foods, excluding the natural sugars found in whole fresh fruits and vegetables and milk. Free sugars include all sugars “added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.”
The American Heart Association has similar guidelines, but uses the term added sugars. Added sugars are the same as free sugars except don’t include sugars from fruit juice. They recommend that women and children limit their added sugar intake to 6 teaspoons per day (25 grams) and men to 9 teaspoons (38 grams) per day. They also recommend avoiding any added sugars for children less than 2 years of age.
While fruit juice does contain some vitamins and minerals, it still has an unhealthy effect on blood sugar, just like sugar-sweetened beverages. A recent 2013 study by the Harvard School of Public Health revealed that while eating more whole fruits is associated with a lower risk of type 2 diabetes, greater consumption of fruit juice is associated with a higher risk. The bottom line is that we should eat, not drink, our fruit. Consequently, I believe the WHO guidelines are more appropriate. Unfortunately, the term added sugar is used more frequently in this country.
Children in the United States consume approximately 19 teaspoons of added sugar per day. This is three times more than what is recommended. In our current diets, the recommendation of 6 teaspoons per day is often exceeded before breakfast is over. Most sugar-sweetened breakfast cereals contain at least 4 teaspoons of sugar per serving (and check how many servings you actually eat!). A typical 6-ounce yogurt has 2 teaspoons of added sugar. An 8-ounce glass of orange juice contains 6 teaspoons of sugar. Similarly, a person can drink their entire sugar budget (and more) from one sugar-sweetened beverage: A 12-oz can of Coke has 39 g or roughly 9 teaspoons of sugar. A 591 mL (about 20 ounce) bottle of Thirst Quencher Gatorade has 35 grams or roughly 8 grams of sugar. A small pouch of Capri Sun Fruit Punch (177 mL or about 6 ounce) ranges has 13 grams or 3 teaspoons of sugar.
Sugar: Here, There, and Everywhere
Many people may not be aware of how much sugar they and their kids are consuming every day. There are many ways sugar can make its way into our kids’ diets. Below I discuss some of the many pathways- of course, not all of these apply to every child; they are just some of the pathways.
While we are all aware of obvious forms of sugar (cakes, cookies, donuts, candy, syrup), sugar is also found in so many of our other everyday food choices: breakfast cereals, granola, yogurt, bread, packaged foods, drinks, condiments (dressings, sauces, ketchup, etc.), tomato sauce, peanut butter, and protein and energy bars. Sugar is usually added to low-fat products to make them taste better (remember the Sugar Research Foundation).
In addition to a lot of sugar being “hidden” in foods, sugar can also be a helpful parenting tool. When we feel like congratulating our kids or encouraging them to do something we want them to do, we often turn to sugar (I know these from experience). Also, the more we purchase pre-made food, or eat out or get take out, the more likely we are to consume higher amounts of sugar than if we cooked our own food. Remember, the sugar industry has purposefully made it really easy for us to consume large amounts of sugar.
Sugary foods can also be found daily at school, whether from birthday celebrations, holiday celebrations, fundraisers, class parties, or rewards for good behavior. And the “Second Breakfast” that we provide our lower-income students unfortunately consists of many sugar-laden processed foods.
Our children find a lot of sugar when they play sports, too. In our sports culture, our children receive contradictory messages about health. We encourage our kids to be active, but then we give them sports drinks and often junk food at halftime and/or after the game. There are also a lot of unhealthy snacks at the baseball snack shack, and at the school fundraiser food table during sports games.
In our community, it seems commonplace for kids to get sodas, juice, even sugary coffee drinks. Many community and social gatherings center around serving sugary foods and drinks. We also find candy on the counter at many businesses, or given to kids as a reward after a haircut or appointment.
The bottom line is that there are many individual choices that are made each day at home, school, sports, and social gatherings about what to eat and drink, and the sugar load in each of these choices adds up, day after day, month after month, year after year.
What We Can Do
The good news here is that we can change our habits if we want to. It is definitely not easy, but when we understand why a change is important, and we help to support each other in this change (in our families, our schools, our sports teams, and our community), we can make small, incremental changes over time to add up to big change. Maybe one or two of the ideas below will feel like something you’d like to try.
· Educate yourself and your kids about the effects of sugar, and where sugar is found in their diet. Look up information about sugar on websites such as the World Health Organization and American Heart Association. Watch Fed Up (fedupmovie.com) and read books (such as Gary Taubes’ The Case Against Sugar, Mark Hyman’s The Blood Sugar Solution, and Robert Lustig’s Fat Chance).
· Learn to read food labels and practice doing this with your kids. See how many grams of sugar are in the items you eat daily. (A good rule of thumb: if any type of sugar is in the first five ingredients, it’s a dessert.)Track your daily sugar consumption. How does your consumption compare to the World Health Organization’s recommended guidelines mentioned earlier?
· Try to buy more food items that don’t require labels.
· Think about your values. Your values around health may come into conflict with competing priorities, such as convenience and time. Think about what is important to you.
· Make water the default drink in your home. Consider eliminating soft drinks, sports drinks, energy drinks, teas, fruit drinks, juice, and sugared milks in your home. Consider reducing or avoiding sugary coffee drinks.
· For teachers and parents, consider encouraging non-food items to celebrate a child’s birthday or have the kids in the class write or say something they appreciate about the birthday child. (This also helps avoid the problem that those kids with food allergies face when snack food is provided at school. It is more inclusive, and cheaper.)
· For teachers and parents, when your class plans a celebration, encourage non-food celebrations, or encourage healthy food options such as whole fruits and vegetables.
· Send kids to sports practices and games with a big container of water (or two), or possibly a homemade electrolyte drink (you can Google this), rather than a sports drink that has added sugar.
· For coaches and parents (AYSO soccer, anyone?), consider eliminating the habit of parents providing treats at half time or after the game, and just let parents provide their own kids with food, if they choose to do so. Or, just encourage whole fruits for a half-time snack (sliced oranges, watermelon, grapes, etc.). (This also helps avoid the problem that those kids with food allergies face when snack food is provided, so it is more inclusive.)
· Make your own homemade treats- that way you are in control of how much sugar you use. And play with recipes- you can often reduce the sugar and still have it taste great.
· Try cooking one more meal at home per week. Choose whole food ingredients and experiment with a couple new recipes. Cooking at home helps to cut down on sugar consumption.
· Consider a 10-day sugar free challenge (see fedupmovie.com) to detox your body from sugar dependence and cravings.
· Think about how you can “treat” your kids- show your love- without giving them sugar.
· Consider asking your doctor and pediatrician to check your and your child’s blood sugar levels (fasting glucose and hemoglobin A1C), to see how well your body is handling sugar right now. Consider checking every year.
· Enlist help and support as you make changes. As a health coach, I realize the critical importance of support during times of change. The more support you have from those around you, the easier it will be to make changes. So include your family in your discussions, encourage other parents on your children’s sports teams and in your children’s schools to support each other, and encourage those in our community to work towards change.
· Once you implement some healthier habits, enjoy the times you do enjoy a delicious sweet treat! Maybe it will actually feel special.
Besides the individual behavioral changes listed above, we can also support policy changes, proper nutrition labeling, and getting the food and beverage industry out of health research and the development of health guidelines. For example, I support a local city tax on sugary drinks. As many others have already stated, I think we need to start looking at this issue as we finally did with cigarettes. While we don’t want to take away people’s free choice, we must acknowledge that this is a serious health issue with long-term consequences that also costs us billions of dollars every year in health care expenditures.
When sugar becomes the rule rather than the exception, it is no longer a “treat”. It becomes an expectation. As a community, let’s support each other in making changes to what is considered “normal” in terms of everyday sugar consumption. Let’s not let the greed of the food and beverage industry compromise the health of our children. Let’s rise up together and take action. Let’s save our kids from their fate that has been forecast- that one in three of them will end up with type 2 diabetes and the myriad of health impairments it can entail. Metaphorically, our kids are bleeding. Let’s love and celebrate our children and keep them healthy at the same time.