Friday, March 14, 2014

Sugar: the sweet enemy

ONE IN FIVE FILIPINOS is overweight and one in five overweight Filipinos is obese.

This statistic from the Philippine National Nutrition Health Evaluation and Survey of 2003 seems as fantastic at first sight as it was when it was first released years ago. Obesity in the Philippines?

It becomes all the more eye-popping when one remembers that 26% of Filipinos—one in four— live below the national poverty line.

That line was P7,017 monthly for a family of five in 2009, the year of the government’s latest poverty data. It’s tougher in Metro Manila: a family of five needed to earn P8,300 a month to escape being labeled poor.

One could surmise the overweight belong to the three in four Filipinos who aren’t poor. That would seem logical.

But there are children who belong to families officially classified as poor who are overweight and obese. How does one explain that?

Fast food and junk food
The 2005 Nutritional Status for Filipino Children conducted by the Department of Science and Technology’s Food and Nutrition Research Institute said a major reason for obesity among youngsters is their unparalleled access to cheap,widely available, high-calorie and appetizing food, otherwise known as fast food and junk food.

This is a valid reason but it still doesn’t completely answer the question: If one in four Filipinos is poor, why is one in five Filipinos overweight?

A recent study published in the New England Journal of Medicine may shed light on a probable reason why. This study showed that poor families in Ohio that moved to lower poverty areas were less likely to become obese and less likely to have glucose levels typical of diabetes compared to families that stayed in poor neighborhoods.

Previous U.S. studies have shown that poor neighborhoods tend to lack good sources of nutritious food and this contributes to obesity and ill health in residents. That means the poor are becoming obese also by eating junk food and fast food.

Whether or not we can draw the same conclusion about poor Filipino families is debatable. But this U.S. finding is food for thought.

The sweet common link
Is there a single reason why a growing number of persons worldwide, including Filipinos, across all economic classes are becoming too fat for their own health?

Yes, there is a common link, according to Dr. Robert Lustig, Professor of Pediatrics in the Division of Endocrinology at the University of California, San Francisco (UCSF).

It’s sugar. Or, more precisely, two kinds of sugar: sucrose and high-fructose corn syrup (HFCS).

Dr. Lustig and two fellow doctors ignited a maelstrom of controversy this February by declaring that sugar and other sweeteners are poisons that should be regulated.

It’s not the first time a medical doctor has called sugar a poison but the research by Dr. Lustig and his team was so widely covered by traditional print media and on the Internet as to spark emotional debates in the medical and non-medical communities worldwide. One of the first works by a doctor calling sugar a poison dates back to 1972.

In a research paper published in the scientific journal, Nature, Dr. Lustig and his team proposed that governments levy a tax on all foods and drinks that include added sugar to discourage consumption. He called on governments worldwide to regulate soft drinks and other products with sugar as strictly as beer and alcoholic beverages.

The alcohol in beer, by the way, is made by fermenting sugar.

More controversially, Dr. Lustig asked that sales of sugar-enhanced food and drinks be banned in or near schools. He would also restrict the purchase of sugared products to a certain age limit similar to the 18-year old age limit on alcohol purchases in the USA.

Dr. Lustig loudly advocates this severe regulation of sugar because sugar is a poison in the medical sense of that term.

More specifically, Dr. Lustig and his team zeroed in on two specific types of sugars as poisons: sucrose (or table sugar) and HFCS (the most popular sweetener used in soft drinks worldwide).

He cited a widely used medical definition of a poison as any substance applied to the body, ingested or developed within the body, which causes or may cause disease.

The physical definition of a poison is any substance that inhibits the activity of a catalyst, which is a minor substance, chemical or enzyme that activates a reaction.

Based on these definitions, Dr. William Coda Martin classified refined sugar as poison in 1957 because all the vitamins, minerals, salts, fibers and proteins that make sugar useful to the body are removed during the process of sugar refining.What is left after processing is a substance full of empty calories that becomes toxic when consumed in excess.

Dr. Lustig agrees with this definition of sugar as a poison.

He does not, however, include naturally occurring sugars such as glucose in his crusade against sugar. Glucose is a sugar naturally found in all foods that have carbohydrates.

Dr. Lustig’s findings in his research paper echo his views at a symposium in 2009 entitled, Sugar: the Bitter Truth. The video of this symposium remains on YouTube and has had over two million hits.

In this video, he described glucose, which is the primary energy source for human cells, as the “energy of life.” Glucose is also known by much of the general public, especially by diabetics, as “blood sugar.”

HFCS: most dangerous of all
Soft drinks or carbonated beverages are the main sources of HFCS, the most dangerous sugar, in the diet of Filipinos or anyone else in any country where soft drinks are sold. And that’s practically all the 196 countries on Earth.

HFCS is a sweetener added to soft drinks and processed foods such as cereals, some meats, yoghurt and sauces. It’s much cheaper than sucrose and this accounts for the widespread popularity of HFCS among beverage and processed food makers.

In the USA, more than 450 calories of an American’s daily calories come from beverages and 40% from soft drinks or fruit juices.

HFCS is dangerous because it attacks the liver, said Dr. Lustig, since only the liver can metabolize fructose. He described fructose as a chronic hepatotoxin or a toxic substance that damages the liver.

“Fructose is a poison by itself,” he declared.

Among the liver's many vital functions is detoxification or the removal of toxins from the body. Fructose is metabolized by the liver unlike glucose, which is safely metabolized by cells throughout the body from complex carbohydrates.

The strain HFCS places on the liver starts a process that can lead to fatty liver disease and liver failure. The liver metabolizes fructose as a fat, hence the key role of fructose in encouraging obesity.

Dr. Lustig said 30% of fructose ends up as fat. Therefore, a high sugar diet equals a high fat diet.

“A low fat diet isn’t really low fat because the fructose/sucrose doubles as fat. That’s why diets don’t work.”

Fructose can also trigger the development of Type 2 diabetes since the high levels of sugar in the blood from un-metabolized fructose mean the pancreas has to produce more insulin, the hormone that helps control and keep stable blood sugar levels.

The increased demands on the liver caused by HFCS may ultimately lead to insulin resistance, which is the underlying cause of obesity and diabetes.

Dr. Lustig pointed out that acute fructose ingestion does not stimulate insulin to combat rising sugar levels, neither does fructose suppress the hunger hormone, ghrelin. The result is that the brain does not signal the body to stop ingesting fructose.

“Chronic fructose exposure alone causes metabolic syndrome,” said Dr. Lustig.

He described metabolic syndrome as a conglomerate of phenomena that includes obesity, Type 2 diabetes, lipid problems, hypertension and cardiovascular disease.

“Fructose triggers all of these,” he said. In this sense, fructose can be considered a poison.

He also said the high level of HFCS in some infant formulas was contributing to the epidemic of overweight babies in the USA and in other countries. One infant formula (also available in the Philippines) he cited had a 10.3% sucrose content versus the 10.5% sucrose content in a leading soft drink brand.

He also said there is no difference between HFCS and sucrose or table sugar.

“They’re both really bad. They’re both dangerous. They’re both poison.”

Differences of opinion
Although Dr. Lustig’s attacks on sugar are severe, the medical community in the USA has not unanimously drawn the same conclusions, however. The jury’s still out on whether sugar really is a poison or not.

The American Medical Association in 2009 voiced the conventional wisdom by saying that high fructose corn syrup does not appear to contribute more to obesity than other caloric sweeteners.

Other skeptics say more Americans are overweight because they’re eating more. The average American’s daily caloric intake has jumped 24% since 1970. Still others say sugary beverages (not specifically HFCS) are the culprit, and whatever form the sugar is in does not matter.

Some researchers contend that saturated fat and not sugar is the basic cause of obesity and chronic disease. Still others argue that it is a lack of physical exercise.

Defenders of sucrose and HFCS say that to date, research suggests that HFCS and table sugar aren’t that different. They’re both processed sweeteners our bodies seem to treat them the same way.

Dr. Lemuel M. Tocjayao, a diabetologist and Chairman, Department of Internal Medicine at De Los Santos-STI Medical Center, believes that an excessive intake of table sugar can be toxic and can indirectly cause diabetes.

“As far as I know, there have been no extensive studies to prove sugar is toxic, especially when sugar is taken in moderation,” he said. “Sugar is only one factor in diabetes.”

He noted that the American Diabetes Association does not regulate sugar, nor has sugar been banned for diabetics.

He cautioned, however, that sugar should be taken in small amounts or just enough to sweeten your food and drink. That small amount, he said, is one teaspoon for a cup of coffee.

(Published in Enrich magazine, 2012)

Sunday, March 2, 2014

Order, diplomacy and Philippine coffee

THE FACE OF PHILIPPINE DIPLOMACY is a woman who can speak her mind in seven languages. That directness is probably the German in her. Or is it the Filipino in her?

"My husband always tells me I preach like a schoolteacher," says Delia Domingo-Albert, our ambassador to Germany and one of the country's most accomplished diplomats.
Ambassador Delia Domingo Albert

Among her singular achievements: chairmanship of the United Nations Security Council during the Philippines' presidency of this body in June 2004 and Secretary of Foreign Affairs, the first woman to hold this high rank in the Philippines and in the ASEAN (Association of Southeast Asian Nations) region.

She talks about German directness and Filipino casualness in a lively tour d' horizon that focused on effective diplomacy, organic Philippine coffee as a trade tool and the changes wrought in her character by exposure to things foreign.

Her husband, by the way, is a German who loves the Philippines. They have a home in Wiesbaden where their daughter was born. She was second-in-command of the Philippine embassy (then in Bonn) for eight years.

Consequently, Ambassador Albert has a powerful interest in German culture, dotes on Maultaschen (pasta squares filled with meat and spinach) and Rote Gruetze (a pudding made from different fresh red berries, eaten with vanilla sauce) and, not unsurprisingly, is now quite German in her dedication to efficiency.

That virtue is a resounding advantage when it comes to running an embassy in a country where relentless efficiency is the norm.

"Ordnung muss sein! (There must be order)," she says in flawless German. "I run a very well organized embassy. I expect the staff to know what they are doing... I expect them to speak German and expect them to work hard.

"I am known to be very demanding, but if you look at my curriculum vitae, I have run through all the departments. That is very rare in an ambassador. I know exactly what I can expect from everyone because I have done the job myself, so I think I am reasonable (with my demands). I like efficiency. My work ethic has produced good results.

"Puenktlichkeit (punctuality) is another of my standards. My husband has taught me that it is very inconsiderate of another person to be late and I always try to be on time."

Severe as these remarks may sound to the average Pinoy, these embody qualities demanded of any professional diplomat.

Her new posting to Germany will give her ample opportunities to practice the ambassador's art in a country no longer a stranger to her.

"I feel it is important to have a focus in order to be an effective ambassador. That is the way I like to work. It is a waste of possibilities if you use your position to simply represent," she points out.

"During my appointment as second in command in the 1980s, it was relatively easy to connect Germany to Asia due to the fact that Eastern Europe was still closed. I remember Foreign Minister Hans Dieter Genscher being very pro-Asia. It will be a challenge now to enhance that connection to Asia again.

"The competition (for investments) is fiercer as Eastern Europe has been able to cater to many of Germany's needs since its opening up to the West. My focus will be on bringing the Philippines back into the picture in terms of investment opportunity and as a reliable trading partner."

Her efforts towards this end is not confined to her work in the embassy in Berlin. Diplomacy, after all, is a two-way exchange.

"I've also suggested to German Ambassador (to the Philippines) Axel Weishaupt to gather Philippine and German individuals and look at what has transpired during our 50 years of diplomatic, business and cultural relations to help identify the strong points within this relationship, and to use these findings to formulate objectives for the next 50 years to create a roadmap based on the experiences of the past," she explains.

"The Philippines and Germany have a very good relationship and I am grateful for that. Yet this needs to be translated into economic cooperation," she continues.

She points out that Philippine companies should concentrate on finding niches that can translate into mutually beneficial economic activities. She is particularly keen on seeing partnerships in environmentally acceptable or "green" processes made possible by German technology.

She admits the "lively" political situation in the Philippines poses a challenge to marketing the country in Germany. She points out, however, that all countries go through periods of change.

"I remind them that we, as a country, have already been through a lot and are still standing. The fundamental laws of democracy do exist here and are not altered.

With the embassy as the frontline in the push to sell the Philippines, Ambassador Albert aims to showcase the best of the country in all aspects. For one thing, she will introduce organically grown Philippine coffee to Germany.

"We will be serving only Philippine coffee in the embassy to make it a tradition with our guests," she notes. "I plan to have an open house one day a week where anybody can come in to the embassy. I have always done that. I want to serve Philippine coffee, maybe with moscovado and bibingka."

She recounts her experience heading our embassy in Australia. "I remember in Canberra we used to open the embassy to groups of Australian school kids and we would serve them macaroons. And I would tell them, "You must always eat macaroons because they are made from coconuts that we sell to your country."

She intends to have other items on her plate. "Another thing is Philippine tablea chocolate. My mother used to make that and I just love it! In the same way that I was able to penetrate the Australian market with Philippine mangoes, I would like to promote organically grown Philippine coffee in Germany."

Ambassador Albert comes to her new job toting one of the most formidable resumes in the Philippine diplomatic service. She speaks Filipino, English, German, French, Romanian, Spanish and Japanese. She has represented the Philippines in nine countries.

In 1992, she was awarded the Knights Commanders Cross of the Order of Merit with Star by the Federal Republic of Germany for promoting Philippine relations with Germany, as well as relations between ASEAN and the European Union. In January 2004, President Gloria Macapagal-Arroyo conferred on her the Order of Sikatuna, rank of Datu, for her exceptional service to the Philippines.

The Philippine Women's University in 2003 conferred on her the degree of Doctor of Humanities, honoris causa, in recognition of her contribution towards building a gender-fair society as the first woman Secretary of Foreign Affairs in the Philippines and in the ASEAN.

She returns to a Germany far different from the Cold War front line state she knew in the 1980s. She looks forward to seeing the former East Germany, especially Leipzig, Dresden and Magdeburg.

"I now have the chance to witness the impact of the unification, which I literally watched from the front row. I saw the beginnings, I witnessed the unbelievable downfall of the Berlin Wall and I know of the hopes that were attached to those events at the time. I am curious to see what has become of it.

"Berlin is an important player in Europe. It will be a challenging job and I am very much looking forward to rediscover this country that I have only known as a divided country," she notes.

A career diplomat, Ambassador Albert has discovered that it does help kindle your professionalism if you love your job. "I've always wanted to become a diplomat. I've always loved history and I like to travel. It was the perfect match for me," she explains.

(Published in Starweek Magazine of The Philippine Star, Sept. 11, 2005)