The bitter taste of capitalism
James Linney reviews Robert Lustig's 'Fat chance: the hidden truth about sugar, obesity and disease,' Forthestate, 2013, pp320, £8.99
Once upon a time, advice on how to lose weight and lead a healthy life ran something like this: ‘Eat less fat and exercise more.’ Sugar got a mention - mainly as a warning to get kids to brush their teeth - but it was certainly not the evil queen of the story.
Robert Lustig’s book about the obesity pandemic makes the case that this advice, like any fairy tale, is based partly on a distorted reality and mostly on a fantasy. The mantra of ‘Eat less, move more’, he claims, has contributed to the huge obesity problem we are facing. Today more people die of the complications of obesity than of undernutrition. In 2008 there were more than 1.4 billion overweight adults worldwide and the prevalence of obesity has more than doubled since 1990.1 In America about a third of adults are now obese and the rates show no sign of slowing down. Yet in no way is this just a US and European problem: the rates of obesity are sky-rocketing globally and the problem has no respect for borders or level of economic development.
Lustig is an American paediatrician who specialises in endocrinology and this book is the result of his years of seeing, treating and researching obese children. Such children are now commonly presenting with type-2 diabetes, high blood pressure and cardiovascular disease: conditions previously only seen in adults.
In the first part of the book the author attempts to myth-bust some long and commonly held beliefs in science regarding obesity - beliefs that have been partly assimilated and echoed by the food industry.
Myth number 1: A “calorie is a calorie” and to maintain a healthy weight you simply have to balance calories in with calories out. This is a favourite argument of the fast-food industry: it claims that its products can form part of any healthy diet, as long as the consumer’s calorie in/out levels are roughly equal. In other words, it does not matter whether you consume your 2,000 daily calories in two Big Mac meals or 100 carrots (not something I would recommend in either case, by the way): if you don’t use up the energy your body will store it - at least that is the claim.
However, studies of the effect of different food types on the metabolic processes of the body makes it clear that quality is more important that quantity. Certain foods (no prizes for guessing which ones) stimulate hormonal changes that have devastating pathological consequences. Hormones are the carrier-pigeons of the body: they race through the blood sending messages to your organs, stimulating or inhibiting metabolic pathways.
The main one we are interested in here is insulin. Insulin is often described as the body’s ‘energy storage hormone’. The higher the level of insulin, the more energy (in the form of fat) is stored. Chronically raised levels of insulin lead to an increase in insulin resistance and eventually to type-2 diabetes. Insulin’s fat-storing properties have an evolutionary basis: for most of our history we were hunter-gatherers and would often face long periods of food scarcity - for example, during winter. It was therefore very important that we had the ability to store as much as we could in times of abundance.
Myth number 2: It is our behaviour - ie, ‘sloth’ and ‘gluttony’ - that results in our poor metabolic outlook. Another convenient assumption for the fast-food capitalists - it is not their fault people are lazy, after all. In fact they can point to all the good they do by encouraging people to get active: for instance, Coca-Cola and Macdonald’s are among the biggest sponsors of sporting events.
In the book this theory is turned on its head. By studying the actions of large amounts of insulin, we discover that another hormone - leptin - is inhibited. Leptin can convey the message to fat cells that they do not need to store any more energy. The result is a chronic, false state of starvation, which in turn leads to energy seeking and energy conservation: in other words, you feel more hungry, generally awful and much less likely to want to go jogging. Which brings us to the final myth.
Myth number 3: To overcome obesity we can simple exercise our way out of a problem. A solution favoured by the medical profession, politicians and the food industry alike. This fails on many levels - one being that processed food has become increasingly energy-dense. For example, to burn off a 250ml glass of orange juice a 68kg man would have to jog for more than 30 minutes. The conclusion is that exercise, although good for health, will not effectively counter obesity.
In the second part of the book Lustig turns to the real bad guy in his story - sugar, or more specifically fructose syrup. This is a food sweetener made from corn that can be processed to convert some of its glucose into extra fructose.
Fructose is unique amongst other carbohydrates because it can only be metabolised in the liver. If the liver has more fructose than it can deal with, it converts it into liver fat and triggers several metabolic processes, collectively known as metabolic syndrome, that lead to diabetes, high cholesterol, liver dysfunction and cardiovascular disease.
Sugar, the author says, is a chronic, dose-dependent poison. It is also addictive, triggering the same dopamine reward receptors in the brain as other addictive chemicals, presenting the classical symptoms of addiction - withdrawal, guilt, binging and continued ingestion, despite the negative effects. Sugar is the most common of all food additives and is found in more than 80% of all processed food products. It is not always clearly labelled and hides behind a mask of different names: for example, dextrose, blackstrap molasses, maltodextrine, etc.
Food manufacturers not only add large quantities of sugar: they also extract fibre, as fibre reduces the longevity of food, does not freeze well and decreases the sugar high that brings consumers back. Fibre (soluble and insoluble) is not digestible by the body and acts as a protective cover around sugars and results in a slower release of sugar in the intestine, thus avoiding the spikes in insulin that are so harmful. This is why eating fruit is so much better than drinking it. Without the fibre (destroyed by juicing) fruit juice ‘from concentrate’ - yes, even the ‘all natural’, ‘no added sugar’ type - is worse for you than the equivalent amount of Coca-Cola because it is more sugar-concentrated.
After establishing a very comprehensive argument for the destructive effects of sugar in our bodies the author now turns towards the political and individual solutions for reversing the damage. Let us look first at his advice for the changes we can make on an individual level. These can be and are summarised by the author himself as: “eat real food”. In supermarkets, restaurants and the home he advises avoiding processed food. Hmm. This may benefit some people - people who are very motivated and whose diet is probably already much better than those who are really suffering from obesity. But clearly it is no solution.
Now I am not saying that there is no point in educating people about the harms of sugar and giving them practical advice on how to make better choices, but, given the realities of the way most food is produced and marketed to us from infancy, this advice is of little use. The advertising industry has spent decades and countless amounts of money on perfecting its ability to sell poisonous food with no nutritional value. They like to target kids: as with cigarettes, the prize money comes with getting them hooked on a favoured brand early. Hence the cartoon monkeys, tigers and clowns recruited to sell toxins.
The other lie here comes with the idea of choice. The author himself admits that the idea of personal food choice is based on an illusion: “approximately 80% of the 600,000 consumer-packaged foods in the US have added caloric sweeteners. The only way you can avoid it is if you grow your own” (p257). This brings us to the crux of why any individual solution is going to fail. Firstly, it is no surprise that, the poorer you are in an industrial country, the more likely you are to be obese. But the working class on the whole has less leisure time, more stressful lives and less money to spend on expensive ‘real foods’. The reality is that they have very little choice regarding foods that are affordable and available - not least because of the alienation that affects their understanding of all products.
The power and choice is in the hands of the food manufacturers and not surprisingly they favour nutritionally worthless and in fact harmful foods, because they are cheap and they help to propagate a continuous conveyor belt of new products. Even when they are pressured to change food products because, say, they are high in fat, they simply take out fat, label the product as a ‘health food’, but add hidden sugar (and inflate the price).
This brings us to the “public health solution” section of the book. Lustig begins by arguing that the food industry’s claim against government interference - ie, that this would be a move toward a “nanny state” - is a fallacy. The author admits that the American obsession with free consumer choice is actually a smokescreen, behind which lies monopoly capitalism. He points out: “90% of the food produced in the US is sold to you by a total of 10 conglomerates …” (p234). With great market control comes great government influence.
To his credit, Lustig does admit to the huge influence that the food industry has over the government and he references two examples worth highlighting. Firstly, the dependence on fructose as a food additive largely comes from the American Farmer’s Bill of the 1930s. This established a system of huge subsidies for farmers who produced large amounts of corn. The government was aware that food scarcity produced social unrest and they needed a cheap, abundant source of calories that could be added to many foods.
The second example given relates to the World Health Organisation’s attempt in 2002 to publish a report entitled Diet, nutrition and the prevention of chronic diseases.2 In this report - ‘technical report series 916’ - it was concluded that sugar is a major risk to global health and should constitute no more than 10% of a person’s daily intake. This threatening document caused panic in the food manufacturers’ organisations and their lobbying went into overdrive - they soon had top officials in the Bush government on their side. Secretary of health Tommy Thompson even threatened to withhold the $406 million annual US contribution to the WHO unless TRS 916 was withdrawn.
Despite this obvious collusion between food industry and government, Robert Lustig thinks help will come in the form of the ever fair and balanced justice system. He is of the deluded belief that “lawsuits are a great way to get the food industry and government’s attention, and maybe even get them to do the right thing …” (p25). Yes, sure, legal cases against companies with billions of pounds to spend on armies of lawyers, judges with close ties to the government and often the food companies in their constituency … Good luck with that one.
Amongst the other solutions suggested is sugar taxation. Despite the fact that such “regressive” taxes put more economic burden on the poorest in society, Lustig feels this is justified because the adverse effects of sugar on health are disproportionately felt by the poorest. A strange logic, to say the least. But a sugar tax is something that has gained support in the UK, with the British Medical Association recently calling for its introduction. However, there is no evidence that taxing a very small proportion of foods - sugary drinks, say - will reduce overall sugar intake; and secondly it is no substitute for a healthy, affordable alternative. Sugar-free soft drinks often contain a long list of miscellaneous chemical ingredients, which often just scrape past the food regulators. There is no evidence that they help and there is a risk that they simply propagate the body’s sugar addiction, which it seeks from other sources. Forty percent of Coca-Cola’s sales now come in sugar-free drinks, so why are people not getting thinner?
The author offers, rather half-heartedly, a few other sugar-limiting proposals, all of which are not new - many are at best a distraction: for example, an age limit on buying sugary drinks, a ban on fast-food restaurants close to schools and tighter restrictions on vending machine licences. The bottom line is that the author considers sugar should be treated in the same way as alcohol and tobacco, and he feels that this can be achieved by lobbying governments. After all, “in a democracy, the public have the power”. However, as a communist I have a very different idea of what democracy is - governments in states like the US and UK are first and foremost political representatives of capitalism. As with recreational drugs, more policing and regulation will not help. It will only distract from the real problems.
This book certainly contains very useful information about the devastating effects of the modern, capitalist-controlled diet: information that should be available to those who suffer the consequences more than anyone else - the working class. But we should not try to make out that this is a problem simply of one bad ingredient or the food manufacturers alone. The global obesity problem results from the mode of food production as a whole. It affects everyone not just agricultural workers in developing countries, factory workers in advanced countries or the millions of fatally obese children worldwide. The fight for a healthy diet has to go hand in hand with the fight for a healthy mode of production under working class control.
Having said that, let me end with two pieces of advice I frequently offer to my patients: don’t drink your fruit - eat it; and if the label says “low in fat”, be suspicious.