Will Sugar Bankrupt Healthcare?

Your doctor should be contacting the hospital nutritionist to update the diet stroke protocol. But that won't occur unless YOU contact the hospital to get it done. Please pay it forward.
http://www.medpagetoday.com/PrimaryCare/DietNutrition/53768?xid=nl_mpt_DHE_2015-09-29&eun=g424561d0r
With apologies to Pogo, we have met the enemy and it is sugar.
That message may now be playing in a theater near you, so consider skipping the super size drink at the concession stand.

Here's the trailer: Sugar -- not dietary fat, not cholesterol, not sodium, not red meat, not carbohydrates -- that is the fundamental threat to good health in this country. It drives obesity, which promotes type 2 diabetes, which leads to heart disease. Oh, and yes, there is always tooth decay.
Yet, for more than four decades now, almost the entire nutritional community has been focused on dietary fat. Nutrition fell prey to the vices of politics and popularity, and it is only now barely starting to recover.
This isn't just a minor problem requiring a small course correction. It is a scandal, and the whole field must be overturned.
That, at least, is how some people see nutritional science. It's a view that was recently propagated in two films: That Sugar Film, from Australia, and Sugar Coated, from Canada. In a third film -- sugar is clearly having its day in the spotlight as the culprit in a whole host of chronic diseases -- titled Sugar Rush, British celebrity chef Jamie Oliver shows the toll sugar is taking in Great Britain and urges the country to adopt a sugar tax and use the proceeds for health education.
That Sugar Film

Of the three movies, That Sugar Film is most entertaining. It is the lightest on the science, but it's also the funnest and most watchable. Its strength is visual: It is one thing to hear that the average child in the U.S. eats about 32 teaspoons of sugar per day, but it's stunning to see on the screen just how much sugar that actually is.
Like the influential 2004 documentary Super Size Me -- in which the filmmaker eats nothing but McDonald's for 30 days -- That Sugar Film consists of one man doing disgusting things for entertainment. Only this time, the culprit is sugar: 40 teaspoons of it per day for 60 days, to be precise. But the catch in the film is that filmmaker Damon Gameau isn't eating candy or ice cream, or even drinking soda. He's consuming only foods that are marketed as healthy, like juices, yogurts, and granola bars. In one sequence, he forgoes snacks and eats the corresponding amount of sugar instead.
And the results weren't pretty. By the end of the experiment, his skin is noticeably worse, he's gained weight, he has trouble finding the motivation to exercise, he has mood swings, and his doctors say he's well on the path to diabetes.
But the problem with a film like this, of course, is that it is essentially a study with an "n of one": the filmmaker himself. The film is, though, bolstered by interviews with experts -- playfully replayed on packages of sugar or juice cartons -- and actors explaining the history or the effects of sugar that are all woven together into a highly entertaining package.
And by that measure, it's a success.
Sugar Coated
If That Sugar Film is the most entertaining, Sugar Coated is its somber, determined, and moody avatar.
In the film, we learn -- through numerous interviews with experts, which constitute nearly the entire documentary -- that sugar is a threat to society. We learn that were it not for the fact that money talks, in this case in the form of dollars (and lots of them) from industry to politicians, sugar would have been declared a culprit long ago. And we learn that if we don't do something soon, sugar will break our healthcare system.
In both of these films, the narrative is the same: In the 1970s, the researchers and even policy-makers started to consider the possibility that excess sugar consumption was really unhealthy. But the sugar industry, having taken lessons from their cousins in tobacco, proved masterful with public relations and did everything in their power to obscure answers about the unhealthiness of sugar. And perhaps even more importantly, they gave considerable funds to scientists who found that sugar played no role in the emerging problem of obesity and other health problems; rather, people simply ate too many calories or too much fat.
"A calorie is a calorie," is something heard often, and implicitly criticized, in the films. There is some evidence that the blame was placed unfairly on dietary fat, leading to a "low-fat" craze that made up for worse taste by adding more sugar.

Also, the same in the films is the presence of Gary Taubes, a contrarian journalist who, even long ago, was warning of the dangers of sugar. In a controversial 2002 New York Times Magazine article criticizing low-fat diets, he began: "If the members of the American medical establishment were to have a collective find-yourself-standing-naked-in-Times-Square-type nightmare, this might be it."
In Sugar Coated, another contrarian makes an appearance: Robert Lustig, MD, of the University of California San Francisco. He's accused in an interview with a reporter of "taking everything we've learned about healthy eating over the last 30 years and turning it upside down." Lustig answered: "Well it deserves to be turned upside down because it didn't work, did it?"
Another heavy presence in the film is Yoni Freedhoff, MD, an obesity doctor in Ottawa, Canada, who has also been pointing out for years the high toll sugar has been taking on our bodies. Freedhoff openly criticizes the Canadian Obesity Network in the film for taking funding from fast food and soft drink companies, and he said that the Heart & Stroke Foundation -- the Canadian version of the American Heart Association -- committed an "abuse of public trust" when they put their health check endorsement on sugary products.
But there's good news at the end of Sugar Coated: the Heart & Stroke Foundation took note, apparently, as we learn that they did away with their endorsement program. This fits the narrative of the films perfectly: nutritionists were wrong, but thanks to people who were not afraid to push an unpopular idea, now we know the Truth, and it's only a matter of time before things change.
Contrarian Crusaders

One of the problems with that narrative as it's presented is that it doesn't feel like the people in these films are doing what we think good scientists should do -- forming cautious theories around the data they look at. Taubes, Lustig, and Freedhoff, rather, are crusaders.
They have evidence, to be sure. But they're also seeing that evidence from a rigid set of glasses: in a field that is so convoluted that nearly every food it studies has been found to be associated with cancer, it's relatively easy to pick a theory and to stick with it.
Sugar causes cancer? There's some evidence for that. Sugar causes obesity? Yup. Diabetes? Almost definitely.
But there are plenty of studies showing the opposite; that's the nature of nutritional research -- and of imperfect science. And so it is up to the person approaching the evidence to decide with whom they want to set up camp. Some researchers shop around before eventually deciding. But some make a name for themselves and become advocates, and they wield media and politics to get their message out.
They are not bought by drug companies, but they may be accused of a less-discussed bias: holding on to a theory so tightly that virtually no new evidence could make them change their mind.

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Hell Hath No Fury Like Industry Scorned
Nonetheless, the data are piling up, and it increasingly looks like critics of sugar got it right.
There are signs that the critics of sugar may soon be moving from contrarian to mainline status: the upcoming U.S. Dietary Guidelines are expected to take a much harsher stand against added sugars. It appears that the medical establishment is no longer standing naked in Times Square.
From here, it looks as if the contrarian view made sense all along, and we should laud the writers and the researchers that warned us long ago. But to think that way is to forget what a difficult fight against sugar it has been, and in some ways still is. And it is also to forget that the early scientists that fought for their viewpoint were often viewed as crackpots, were personally smeared, and their research was discounted.
In this sense, the films are a good reminder that science is a thoroughly human endeavor.
To do science is to do politics. And politics, like nutrition, is messy.