India has more than 65 million diabetics. Experts are now asking Indians to cut sugar consumption to less than 10 percent of the daily energy intake. Will it stop the looming health crisis?
By Shobha John
Juicy jalebis, plump rasgullas, delicious kheer, delectable chutneys…it’s easy to get a sugar high in India. And with numerous festivals and traditions where sweets are the norm, the possibilities of not indulging in your sweet tooth are remote. No wonder India is the largest consumer of sugar and has more than 65 million diabetics, second only to China.
Experts say that if the consumption of sugar-sweetened beverages (SSBs) such as aerated drinks, fruit drinks, and energy and vitamin drinks containing added sugars continues at the present rate, then the percentage of Indian overweight and obese people could increase from 39 percent to 49 percent and the incidence of Type 2 diabetes (T2DM) could rise from 319 to 336 per 100,000 annually from 2014 to 2023.
In fact, recent WHO guidelines warn that the world is eating too much sugar and people should slash their sugar intake to just 5 to 10 percent of overall calories. The guidelines especially focus on added sugars in processed food and those in honey, syrups and fruit juices as against naturally occurring sugars in fruits, vegetables and milk.
In addition, there have been global calls recently for the ban on “addictive” energy drinks to children, which, in some cases contain up to 10 teaspoons of sugar per 250ml—more than three times the maximum an adult should consume daily.
Action on Sugar, a UK health campaign group, asked for the ban on these drinks to youngsters, with the worst offender being Sainsbury’s Orange Energy Drink (it had 15.9g per 100ml of sugar) among 197 drinks surveyed from supermarkets and online. It said that children were being deceived into drinking this stuff, thinking it would improve their performance in school and during sports, when, in fact, they were increasing their risk of developing obesity or Type 2 diabetes by drinking them. Action on Sugar has called for strict limits on added sugars, saying the body can generate the energy it needs from other sources such as fruits, vegetable and starch.
So what exactly does sugar do to the body? It leads to the accrual of body fat. These fatty acids, in turn, can impair critical functioning of the liver, pancreas, and cellular functions. And with Indians having higher fatty acids and insulin resistance than white Caucasians, it is better to be safe than sorry.
Sweets fall into many categories, be it traditional sources such as jaggery and khandsari, processed sugars and SSBs. Along with decreased physical activity, this has led to Indians developing insulin resistance, abdominal adiposity, “epidemic” T2DM and cardiovascular diseases.
And that is why we should heed calls from various international medical associations asking us to cut sugar consumption to less than 10 percent of the total energy intake daily. After all, sugar leads to “empty” calories (1g of sugar gives 4 kcal). While the WHO expert panel had recommended decreasing sugar intake to 5 percent of total calorie intake, the American Diabetes Association said that the consumption of sucrose should be minimized to avoid displacing nutrient-dense food choices. The panel specifically said that one should avoid sugary drinks, sweet tea and fruit juices, as these raise blood glucose and provide several hundred calories in just one serving. The Institute of Medicine, a US NGO, has even suggested increased access to free, safe drinking water in public places to encourage water consumption instead of SSBs.
Devotees pleasing Lord Ganesh with ladoos, his favorite delicacy
A research paper brought out recently by Dr Anoop Misra and Dr Seema Gulati of the Delhi-based National Diabetes, Obesity, and Cholesterol Disorders Foundation (N-DOC) and Diabetes Foundation, has thrown light on why India, of all countries, is so sugar-laden. Much of it has to do with numerous festivals and the Indian culture of “sweetening the mouth” after every meal or during auspicious occasions. This, together with SSBs and western sugar-loaded food items, has led to Indians being sitting ducks for many lifestyle diseases.
What is scary is that increased calorie intake, which leads to obesity, is increasing at a rapid pace in India. “Increased purchasing power and availability of high fat, energy-dense foods, along with reduction in the energy expenditure consequent to urbanization and mechanization, has led to a parallel rise in overweight individuals, obesity and T2DM,” says Dr Misra.
The research paper says that sugars come under three subgroups, as defined by the WHO and FAO:
- Monosaccharides: Glucose, fructose and galactose
- Disaccharides: Sucrose (glucose and fructose), lactose (glucose and galactose), maltose (glucose and glucose), trehalose (glucose and glucose)
- Free sugars: All monosaccharides anddisaccharides added to foods by the manufacturer or consumer; sugars naturally present in honey, syrups, and fruit juices
Consumers spoilt for choices at a sweet shop
Trials have shown that fructose more than glucose may increase total cholesterol, uric acid, and postprandial triglycerides, says Misra. Then, there are SSBs, many of which are sweetened with high fructose corn syrup, the most common added sweetener in processed foods and beverages, and some with sucrose or fruit juice concentrates.
However, a distinction has to be made between “sugar” which means white sugar, honey or brown sugar and “traditional sugars” such as jaggery and khandsari, which are produced from sugarcane. Jaggery is obtained by boiling clarified sugarcane juice until a solid residue is left after evaporation and usually contains 65-85 percent sucrose. It is a source of calcium, potassium, and iron. Khandsari is finely granulated crystallized sugar that contains 94-98 percent sucrose and retains some calcium.
The report also shows that while the per capita consumption of jaggery and khandsari was 8.72 kg per annum in 2001, it dropped to about 5 kg per annum in 2011. Indian sugar production, meanwhile, exceeded 27 million tons during 2012–2013, a jump from 15 million tons in 2005. The increase was mainly due to the intake of SSBs, making the total sugar intake among Indians higher than the average global per capita consumption. Shockingly, SSBs have attracted direct foreign investment of over $1 billion in recent years. While the production of SSBs was about 6.6 billion bottles in 2001–2002 in India, it increased by 13 percent per year, exceeding 11 liters per capita per year.
—Dr Anoop Misra, Chairman, Diabetes, Obesity and Cholesterol Disorders Foundation
NO KIDS’ STUFF
Sadly, the higher consumption of sugar has also affected children. Misra says that the easy availability of SSBs and other sugar-containing high calorie foods within and around schools has made matters worse. “A study conducted by our group of 1,800 school children between 9-18 years and their mothers from Delhi, Bangalore, Pune and Agra in 2013, showed high consumption of sweetened food among them. It highlighted the role of mothers in deciding food choices of children and showed that surprisingly, mothers considered any food ‘healthy’ if it was ‘hygienically’ prepared,” says Misra. “Another study by our group recorded the consumption of colas among children at approximately 1.8 cans per week (1 can of 300 ml is equivalent to 132 kcal and 33-40g sugar), and could result in nearly 1.3 kg of weight gain per child per year.”
The deleterious effects of sugar can be reduced, say experts, by a 20 percent soda tax, which could lead to a reduction of 3 percent in obesity (or prevent 11.2 million new cases), and a 1.6 percent decline in T2DM, (or prevent 4,00,000 cases) from 2014–2023.
After all, too much sugar can lead to a bitter end.