Don’t buy Prof Mor­ri­son’s sweet talk

Jamaica Gleaner - - OPINION & COMMENTARY - Kwesi Mar­shall

THE PRE­SEN­TA­TION of In­terim Guide­lines seek­ing to re­duce the sugar con­tent of sugar-sweet­ened bev­er­ages (SSBs) sold in schools, by Min­is­ter of Health Christo­pher Tufton, has gar­nered no­table pub­lic at­ten­tion. While much of the con­ver­sa­tion con­cern­ing this ini­tia­tive has been strongly sup­port­ive, some voices – as to be ex­pected in a mat­ter of such na­tional im­por­tance – have been raised in op­po­si­tion.

Per­haps the most sur­pris­ing of these dis­sent­ing voices has been that of Pro­fes­sor Er­rol Mor­ri­son, the pres­i­dent and co-founder of the Di­a­betes As­so­ci­a­tion of Ja­maica (DAJ). As the re­cently ap­pointed chair­man of the Na­tional Food In­dus­try Task Force (suc­ceed­ing the able stew­ard­ship of Pro­fes­sor Fitzroy Henry), I have, of course, at­tended to the pro­fes­sor’s com­ments with some in­ter­est. In this piece, I will de­liver the re­sponse from the Task Force.

Pro­fes­sor Mor­ri­son’s many con­tri­bu­tions over sev­eral decades as a re­spected physi­cian, sci­en­tist, and ad­min­is­tra­tor mean that the ex­plic­itly stated rea­sons be­hind his de­ci­sion war­rant se­ri­ous and fair-minded scru­tiny. It is clear that the pro­fes­sor’s re­marks do not un­set­tle the con­sid­er­able sci­en­tific ra­tio­nale un­der­gird­ing those In­terim Guide­lines and do not, in fact, pro­vide suf­fi­cient sup­port for his de­clared op­po­si­tion to their im­ple­men­ta­tion.

DEEP-RU­RAL CHIL­DREN

Here I fo­cus on spe­cific com­ments Pro­fes­sor Mor­ri­son made dur­ing an in­ter­view on Cliff Hughes On­line on Oc­to­ber 4, 2018. Pro­fes­sor Mor­ri­son cen­tres the rea­son­ing for his op­po­si­tion on a sce­nario in which young chil­dren from “deep, ru­ral set­tings” must walk long dis­tances, without break­fast, to their schools. Hun­gry and in need of nutri­tional sus­te­nance, these chil­dren are greeted by the prover­bial bag juice man, from whom they buy res­cu­ing serv­ings of bag juice. In such sit­u­a­tions, the pro­fes­sor ar­gues, “sug­ary drinks may very well be help­ful”.

In fact, the pro­fes­sor goes fur­ther. “And I’m say­ing that sug­ary drink is of tremen­dous help to them. And that is not a mat­ter of opin­ion. That’s a fact. Be­cause the brain re­quires that sugar and it’s us­ing 50 per cent of it. That’s not giv­ing you an opin­ion, Cliff.” Fur­ther­more, he forthrightly as­serts: “When you’re work­ing hard in phys­i­cal and men­tal ac­tiv­ity, sug­ary drinks have no real ad­verse ef­fects and I don’t know who can take op­po­si­tion to that. It’s not an opin­ion. I’ll say it again. It’s a sci­en­tific fact.”

So, is it a sci­en­tific fact that in cer­tain con­texts, sug­ary drinks “have no real ad­verse ef­fects”? Not quite. In fact, it re­mains a mat­ter of con­sid­er­able de­bate whether sug­ary drinks, in any con­text, are as in­nocu­ous as the pro­fes­sor con­tends, es­pe­cially when their po­ten­tial longterm ef­fects on health are con­sid­ered.

How­ever, is it a sci­en­tific fact that the brain re­quires sugar? Now, the an­swer is quite straight­for­ward. Ex­cept for con­di­tions of pro­longed fast­ing or star­va­tion, glu­cose – sim­ple sugar – is in­deed the pre­ferred fuel for health­ful brain ac­tiv­ity. So, count that as a sci­en­tific fact.

But now we come to a cru­cial ques­tion: Does it then fol­low that SSBs, by them­selves, are suit­able sin­gle-source di­etary choices in sit­u­a­tions de­mand­ing el­e­vated nutri­tional sup­port? One could an­swer this ques­tion in the af­fir­ma­tive only if it were demon­strated that SSBs were suf­fi­ciently com­plete and ac­cept­ably balanced di­etary sources of nu­tri­ents. So, what does the nutri­tional sci­ence say?

The an­swer from that sci­ence is ex­tremely clear here. And the an­swer is an ex­tremely clear and re­sound­ing no. Now and then, you might hear nutri­tion­ists or other health pro­fes­sion­als speak of SSBs as di­etary sup­plies of so-called ‘empty’ calo­ries.

But why would they say such a thing? Well, in nutri­tional terms, a typ­i­cal serv­ing of such a bev­er­age will pro­vide its calo­ries — or en­ergy — in the form of sim­ple sug­ars, some wa­ter for hy­dra­tion and ... that’s just about all. And, yes, that is a sci­en­tific fact. So, bag juices, in par­tic­u­lar, and SSBs, more broadly, ac­tu­ally fall con­sid­er­ably short of be­ing ad­e­quately com­plete or balanced nutri­tional sources.

One can imag­ine that this state­ment of the task force’s po­si­tion on SSBs might raise con­cerns in cer­tain quar­ters, par­tic­u­larly among some food and bev­er­age in­dus­try stake­hold­ers, of a com­plete ban­ning of SSBs from the Ja­maican di­etary land­scape. Might that re­ally be so?

‘SUGAR CAP’

No. Not at all. First, the pro­posed frame­work, which is sched­uled to be­gin im­ple­men­ta­tion in Jan­uary 2019, is de­signed to pro­duce a grad­ual, multi-year, step­wise re­duc­tion in the amount of sugar added to SSBs, lim­ited to school set­tings only. There­fore, rather than talk of a ban or tax on sug­ary drinks, per­haps the term ‘sugar cap’ would be more ap­po­site.

Sec­ond, the very idea of pro­mot­ing sus­tain­able life­style choices, grounded in sen­si­ble and nu­tri­tion­ally balanced di­ets, is based on al­low­ing con­sumers to se­lect freely, without any sem­blance of co­er­cion, their own food and bev­er­age choices, from as broad a di­etary spec­trum as they can af­ford.

So, on oc­ca­sion, SSBs might well be en­joy­ably and per­haps even healthily con­sumed — but con­sumed pru­dently as ex­tremely mi­nor play­ers from among a much larger and more di­verse di­etary cast of char­ac­ters.

So, we have seen the nutri­tional sci­ence clearly rec­om­mends the im­ple­men­ta­tion of the In­terim Guide­lines. The Guide­lines, then, by promis­ing to pro­mote the cur­rent and fu­ture pub­lic health, de­serve the ac­tive sup­port of all well-mean­ing Ja­maicans.

Ac­cord­ingly, on be­half of the mem­bers of the Na­tional Food In­dus­try Task Force, I urge Pro­fes­sor Mor­ri­son to re­con­sider his op­po­si­tion to the pro­posal. I also urge our part­ners in the Ja­maican food and bev­er­age in­dus­try to lend, in good faith, their cru­cial as­sis­tance through­out the im­ple­men­ta­tion process.

And, above all, I urge the peo­ple of Ja­maica, in schools and out of them, to pro­vide their whole­hearted back­ing to this im­por­tant pol­icy ini­tia­tive.

Kwesi Mar­shall, PhD, is chair­man of Na­tional Food In­dus­try Task Force. Email feed­back to columns@glean­erjm.com.

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