Ministry of Health’s response to article by pharmacist Matthew Thomas

by Dr Rosmond Adams

As a local physician, lecturer of medicine, epide-miologist and a regional public health researcher, I feel compelled to write to dispel arguments put forward by one Mr Matthew Thomas in Tuesday’s publication of the SEARCHLIGHT newspaper, stating boldly that diabetes and hypertension are not caused by, nor are they linked to increased sugar and salt consumption, respectively.{{more}}

Mr Matthew Thomas made these arguments in response to a statement by Mr Jomo Thomas, in which Jomo stated that marijuana is less dangerous than sugar, owing to the number of persons who are suffering from amputations as a result of uncontrolled diabetes.

I will not enter into the marijuana discussion here, as I already addressed the issue of medical marijuana over a year ago in my weekly column in SEARCHLIGHT called ‘Health Wise’.

In St Vincent and the Grenadines (SVG), diabetes and hypertension are among the leading causes of death. In fact, these two diseases are part of what we call Chronic Non-communicable Diseases (CNCDs) that have reached epidemic proportion here at home and globally. In fact, there are calls at the highest level, including at the World Health Organization (WHO), to tackle this epidemic, due to the premature mortality and the socio-economic burden that these diseases have caused and will continue to cause.

Mr Matthew Thomas’ statement is not based on science and in my opinion constitutes professional irresponsibility. As a member of an allied health profession and one who is responsible for dispensing medication and advising patients, for him to make such a bold statement without any sound scientific evidence is misleading and can threaten the work that public health officials in this country are doing. His statement goes against what health promotion is saying and against the World Health Organization (WHO). The WHO is pushing for countries to impose taxes on sweetened drinks and on certain unhealthy foods, so that people would buy and consume less, with the hope that this would lessen their risks from these diseases. It is understood that in order to tackle these CNCDs, behaviour changes, such as quitting smoking, decreasing alcohol consumption, taking part in physical activity and eating healthy are the best options. However, we know of the difficulty in doing so and as such, by imposing higher taxes on these products, we can then decrease access to them and thus lead to healthier living.

I must say that I understand and I agree with Mr Matthew Thomas’ basic physiological analysis that the body needs sugar for cells to survive and that the cells also need salt (sodium) for many biological processes. However, what Mr Matthew Thomas failed to explain is what will happen when we consume excess of what the body requires.

Numerous studies in the region and in the developed world have pointed to the negative impact on health due to excessive intake of sugar and salt. One study published in the JAMA – The Journal of American Medical Association – in 2014 concluded that US adults consume more added sugar than is recommended for a healthy diet. It was observed that there was a significant relationship between added sugar consumption and increased risk for death from cardiovascular (heart) diseases.

In fact, excess sugar consumption increases the risk of many diseases. The liver metabolizes sugar the same way as it metabolizes alcohol, as both serve as substrates for converting dietary carbohydrate into fat. This promotes insulin resistance, fatty liver, and dyslipidemia (abnormal fat levels in your blood). This in turn can lead to diabetes and heart problems.

Fructose, a form of sugar, undergoes the Maillard reaction with proteins. This causes superoxide free radicals to form, resulting in inflammation. Fructose can directly and indirectly stimulate the brain’s “hedonic pathway,” creating habituation and dependence; this then creates a craving for sugar. Therefore, the more sugar a person consumes, the more he or she will want. This excessive sugar consumption can have far reaching health implications, ranging from dental caries to obesity and ultimately death.

But these are not the only ways consuming too much sugar wreaks havoc on the body. Research now confirms that sugar is a primary dietary factor that drives obesity and chronic disease development. One study found that fructose is readily used by cancer cells to increase their proliferation – it “feeds” the cancer cells, promoting cell division and speeding their growth, which allow the cancer to spread faster.

Alzheimer’s disease is another deadly illness that can arise from too much sugar consumption. A growing body of research found a powerful connection between a high-fructose diet and the risk of developing Alzheimer’s disease, through the same pathway that causes type 2 diabetes. According to some experts, Alzheimer’s and other brain disorders may be caused by the constant burning of glucose for fuel by the brain.

It must be noted that in countries such as Barbados, the business sector is taking responsibility to warn consumers that excess sugar and salt can affect their health. Supermarkets have placed signs close to these products, so that customers are aware of the health implications.

The effects of salt on the body are also numerous. Salt works on the kidneys to make the body hold on to more water. This extra stored water raises the blood pressure and puts strain on the kidneys, arteries, heart and brain.

Eating salt raises the amount of sodium in the bloodstream and wrecks the delicate balance, reducing the ability of the kidneys to remove the water.

The result is a higher blood pressure, due to the extra fluid and extra strain on the delicate blood vessels leading to the kidneys.

Over time, this extra strain can damage the kidneys – known as kidney disease. This reduces their ability to filter out unwanted and toxic waste products, which then starts to build up in the body.

If kidney disease is left untreated and the blood pressure isn’t lowered, the damage can lead to kidney failure. This is when the kidneys are no longer able to filter the blood and the body slowly becomes poisoned by its own toxic waste products.

The raised blood pressure caused by eating too much salt may damage the arteries leading to the heart. At first, it may cause a slight reduction in the amount of blood reaching the heart. This may lead to angina (sharp pains in the chest when being active). With this condition, the cells in the heart don’t work as well as they should, because they are not receiving enough oxygen and nutrients. However, lowering blood pressure may help to alleviate some of the problems and reduce the risk of greater damage.

I can go on and on outlining the negative health effects of these two products when they are used excessively. However, I will close by encouraging Vincentians to embrace healthy lifestyles by avoiding the four major risk factors for these chronic diseases. Quit smoking, if you smoke; do not consume excessive alcohol; avoid physical inactivity; and exercise regularly and eat healthily.

Remember your health is your responsibility.

Note: Dr Rosmond Adams is a local physician. He is the epidemiologist in the Ministry of Health, Wellness and the Environment. He served previously as the Focal Point for Chronic Non-communicable Diseases and is a member of the World Health Organization (WHO) Global coordinating Mechanism on Non-communicable Diseases. Dr Adams has been recently appointed as the head of Communicable Diseases, Health Information and Emergency Response at the Caribbean Public Health Agency (CARPHA).