28th April 2018

England recently introduced a sugar tax, making it more expensive to buy food and drink that contains sugar. We are mainly talking about soft drinks here, such as Coke and Irn Bru and concentrated orange juice and suchlike. Many people celebrated this as a great step forward in tackling obesity. Including many people that I like, and get on with, and agree with on most things.

Not, on this however. Firstly, on principle, I do not like the idea of using the state machinery of law making, banning, taxing and suchlike to enforce social controls. It is an attack on personal liberty and represents an unpleasant form of the nanny state. Where does it end?

Don’t climb mountains because you might fall and hurt yourself. Don’t swim in the sea, you may drown. Only state approved ‘healthy’ activities are to be allowed. Hmmmm. No thanks. I would rather make my own choices thanks very much.

Aside from this, you must be absolutely one hundred per cent certain that if you are going to use lumbering, soul destroying, personal freedom crushing, state machinery, that you are going to do a lot more good than harm. Indeed, you should do no harm at all.

Especially when it comes to dietary interventions, which will affect every single person in the country. As readers of this blog know, the dietary guidelines introduced in the US and UK in the late 1970s, early 1980s have almost certainly been the main driving force behind the modern epidemics of both obesity and diabetes. Eat less fat and more carbohydrates was the cry. Yes, and look what happened.

These guidelines were not turned into laws and taxes, in most countries, but Denmark did go as far as introducing a fat tax, in 2011. Luckily, they dropped it fairly rapidly. The Netherlands too have considered it, and it may happen:

‘Although the Netherlands has refrained from introducing a "fat tax", support for such a tax is gaining momentum in several EU member states, thus raising the question whether the EU should consider stepping in so as to adopt an EU-wide "fat tax" scheme that is to be applied in all EU member states.’ 1

Things have gone a bit quiet on this front. Although it was interesting if we had both a fat tax and a sugar tax. Sugar is just the simplest form of carbohydrate, so you could argue we may shortly have both fat and carbohydrate taxes. What would that leave us to eat? Protein.

If I have seen one macronutrient that can cause major health issues, if eaten to excess, it is protein.

‘Protein poisoning (also referred to colloquially as rabbit starvation, mal de caribou, or fat starvation) is a rare form of acute malnutrition thought to be caused by a complete absence of fat in the diet.

Excess protein is sometimes cited as the cause of this issue; when meat and fat are consumed in the correct ratio, such as that found in pemmican (which is 50% fat by volume), the diet is considered nutritionally complete and can support humans for months or more.

Other stressors, such as severe cold or a dry environment, may intensify symptoms or decrease time to onset. Symptoms include diarrhoea, headache, fatigue, low blood pressure, slow heart rate, and a vague discomfort and hunger (very similar to a food craving) that can be satisfied only by the consumption of fat.

 Protein poisoning was first noted as a consequence of eating rabbit meat exclusively, hence the term, "rabbit starvation". Rabbit meat is very lean; commercial rabbit meat has 50–100 g dissectable fat per 2 kg (live weight). Based on a carcass yield of 60%, rabbit meat is around 8.3% fat while beef and pork are 32% fat and lamb 28%.’2

In my practice I have seen two young super-enthusiastic body-builders who ate virtually nothing but protein and protein shakes and suchlike who became very ill indeed. Only when they cut out the protein did they recover. Now, this is not common, but there are only three macronutrients. Fat, carbohydrate and protein, and we are thinking of taxing two of them? Maybe we should just tax protein as well and be done with it.

‘All food found to be unhealthy, and to be taxed, by order of HM Govt.’

Anyway, to return to the sugar tax. What possible downside could there be to this, you may ask? Apart from infantilising the entire population. ‘You are too thick to make decisions about your life, so we will make them for you.’

Well, if you tax drinks containing sugar, more and more people are likely to shift to drinking zero carb alternatives. Coke zero and suchlike. These drinks contain artificial sweeteners, and so the consumption of artificial sweeteners is bound to rise pretty dramatically. Could this do more harm than good? Well, last year a paper came out in the journal Stroke. Called ‘Sugar and artificially sweetened beverages and the risks of incident stroke and dementia - A prospective Cohort Study.’

The main findings were, as follows:

‘Results—After adjustments for age, sex, education (for analysis of dementia), caloric intake, diet quality, physical activity, and smoking, higher recent and higher cumulative intake of artificially sweetened soft drinks were associated with an increased risk of ischemic stroke, all-cause dementia, and Alzheimer’s disease dementia.

When comparing daily cumulative intake to 0 per week (reference), the hazard ratios were 2.96 (95% confidence interval, 1.26–6.97) for ischemic stroke and 2.89 (95% confidence interval, 1.18–7.07) for Alzheimer’s disease. Sugar-sweetened beverages were not associated with stroke or dementia.’3

In short, those who drank more artificially sweetened soft drinks were nearly three-fold more likely to have a stroke. In addition, they were very nearly three times as likely to suffer from Alzheimer’s disease. This, most certainly, does not come under my definition of ‘first do no harm.’

If I want a soft drink, I shall be paying the sugar tax. I do not want to end up with Alzheimer’s, thank you very much. I would be interested to know if the sugar tax will help pay for the millions of extra people who will now, very likely, develop dementia over the next few years.

1: https://www.twobirds.com/en/news/articles/2013/uk/no-fat-tax-in-the...

2: https://en.wikipedia.org/wiki/Protein_poisoning

3: Stroke. 2017;48:1139-1146. DOI: 10.1161/STROKEAHA.116.016027