World Health Organisation: Should we Halve Sugar Consumption?

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Offline evan_au

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A new report from WHO proposes halving recommended maximum sugar consumption from 10% to 5% of calories.
  • Is refined sugar as dangerous as they suggest?
  • How would you encourage such a radical dietary change?
  • Is reducing sugar consumption a more cost-effective public health measure than the government subsidising the latest end-stage cancer drug?

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Offline alancalverd

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Two things can kill you: not enough of what you need, or too much of what you like. The former is rightly considered a problem for society. The latter is nobody's damn business.

If you don't drink alcohol, smoke, eat fried Mars bars, or sleep around, you can live to be 120. But why would anyone want to? If you read the Daily Mail and suchlike garbage, an irrational fear of dying can be rationalised into a paralysing fear of living.   

Yes, an excess of some food and drink can shorten your life, and it behoves us to inform our children of the facts. But what adults eat is no more the business of others than whether they choose to go skiing or skydiving.

Unlike tobacco and alcohol, heart disease and diabetes don't inconvenience or kill third parties: so why should any third party worry if they are selfinflicted? The elimination of infectious disease just means that we die from cancer, heart disease or dementia, and if we cure any or all of these, something else will end our lives slowly and painfully.

The best song that the BBC ever banned was "Live fast, love hard, die young" - a better slogan than anything the Department of Health ever put out.
« Last Edit: 31/12/2013 00:44:12 by alancalverd »
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Offline CliffordK

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Diabetes, of course, does cost society as a component of our high health care costs, and driving up our costs of health insurance, or subsidized health care. 

However, looking at sugar and diabetes, the results are a bit more ambiguous.

Sok-Ja Janket prospective cohort study that failed to find a positive correlation between sugar intake and the development of diabetes.  In fact, those individuals with the highest sugar intake had a slightly lower risk of diabetes, as well as a slightly lower BMI.  Dietary information was self-reported.

Sanjay Basu study analyzing food supply data, and found a moderate correlation between countries with higher sugar intake per capita, and diabetes.  They do not look at individuals with diabetes.

Here is a review article about sugar intake and cardiovascular disease.  The results seem to be ambiguous, with any correlation being weak at best.  Fat intake may be a bigger indication of cardiovascular disease.

There is some debate on whether diet sodas in fact are beneficial for weight loss.  The sodas are in fact low in sugar and calories, but they don't curb hunger.

Anyway, the correlation between sugar and diabetes, obesity, or heart disease is complicated.  A healthy diet is prudent.  But sugar isn't necessarily "evil".  Personally I choose to limit my access to candy and soft drinks.  However, I do consume some other sugar sweetened beverages, and will use sugar as a sweetener as needed.

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Offline CliffordK

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Your "table sugar" is sucrose, or a glucose/fructose disaccharide. 

The body is very good at converting between different types of sugar, glucose, fructose, lactose, galactose, maltose, and sucrose.  There really is no benefit of one over the other.  Starches are also broken down to simple sugars, but it can take longer to do so.

However, one complaint about our refined sugars is that they are "empty calories", and have not additional vitamins or nutrition.

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Offline RD

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The body is very good at converting between different types of sugar, glucose, fructose, lactose, galactose, maltose, and sucrose.  There really is no benefit of one over the other.

Fructose isn't absorbed well ... http://www.ncbi.nlm.nih.gov/pubmed/16183355

Eating a big bag of "diabetic" sweets (candy), [which are made using fructose], in a few hours is not recommended.
« Last Edit: 31/12/2013 09:12:52 by RD »

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Offline Ethos_

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The best song that the BBC ever banned was "Live fast, love hard, die young" - a better slogan than anything the Department of Health ever put out.
I agree whole heartedly alan,

GET OUT OF MY BUSINESS AND MY DIET BIG BROTHER!!!
"The more things change, the more they remain the same."

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Offline evan_au

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heart disease and diabetes don't inconvenience or kill third parties
A study found that obesity is contagious; since the food we eat and the exercise we take contribute to obesity, and obesity is a major contributor to diabetes and heart disease, shouldn't we treat it as seriously as any contagious disease?

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Offline alancalverd

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Am I alone in objecting to this perversion of medical language?

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A contagious disease is a subset category of infectious diseases (or communicable diseases), which are easily transmitted by physical contact (hence the name-origin) with the person suffering the disease, or by their secretions or objects touched by them.

Obesity is not a disease. It may result (rarely) from a disease condition but is mostly a lifestyle choice. Contagious diseases of all kinds were rife in concentration camps throughout Europe and Africa in the 20th century, but there is no record of any prisoner dying of obesity, or even living with it. 
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Offline evan_au

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Quote from: OED
Disease (Noun): a disorder of structure or function in a human, animal, or plant, especially one that produces specific symptoms or that affects a specific location and is not simply a direct result of physical injury

I would argue that obesity fits the description of a disease, and results in impairment of structure and function in humans. It is one of the major causes of disability & death in Western countries (now that retrospectively-more-obvious risks like smoking have declined over the past 20 years).

For a medical assessment of the impact of sugar consumption on health, you must look at the correlation of sugar consumption with public health. This can apply to individual consumption in experiments with volunteers, consumption within a particular country, or by comparing consumption between different countries.

Concentration Camps were not reknowned for their luxurious menu or their care for the wellbeing of inmates; in fact, initial obesity could assist survival in such an extreme environment.

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Offline Ethos_

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I would argue that obesity fits the description of a disease, and results in impairment of structure and function in humans.

Depends upon who's defining the word. If I choose to gain 50 lbs. you're telling me that the STATE has the right to declare me disease ridden? I think my liberty is at stake when I allow the state to tell me what I can and can not eat. I'll make those choices for myself and I believe everyone else should as well.
"The more things change, the more they remain the same."

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Offline CliffordK

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Perhaps life is a disease, and humanity is a plague upon the Earth.  [:o]

It is pointless to argue whether obesity or addictions are diseases.  One of the hardest things to break about addictions such as smoking is the social aspects.  People often like to hang out and smoke with their friends.

One might say that obesity is self inflicted.  But diseases can also be self inflicted.  Were there ever really chicken pox parties?  Some aspects, however, of the obesity may be easier to consider as an illness.  Certainly one might treat disability caused by obesity as an illness.  Type 2 diabetes?

One may prescribe diet and exercise for treatment.

The point of Evan's article is that social groups are extremely important with many addictions including obesity. 

Perhaps there is a way to encourage less sugar in diets rather than government mandates.  I.E.  low sugar cereals.  EDUCATION (beyond TV ad spots).

After a hot day of hard work, a 32 oz soda can hit the spot, and the calories may not be a problem.

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Offline alancalverd

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    Disease (Noun): a disorder of structure or function

Nothing disordered about lifestyle obesity. Eat too much, get fat. Eat too little, get thin. Proper order and correct function of all animals. "Too fat" depends on your intentions: the optimum is quite different for a hibernating dormouse or a sumo wrestler compared with a greyhound or a marathon runner.

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[obestity] results in impairment of structure and function in humans.


True (except for sumo rikishi) but that puts it into the same class as trauma, not disease. And as with many traumatic injuries, the cure is "do nothing and avoid further trauma".
 
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It is one of the major causes of disability & death in Western countries (now that retrospectively-more-obvious risks like smoking have declined over the past 20 years).

So what? Death is essential. Having eliminated many of the traditional causes of death and disability thanks to improved hygeine and agriculture, we now have the choice of cancer, cardiovascular disease, dementia, or selfinflicted death. My choice is hypothermia or possibly nitrogen hypoxia, both of which are fairly quick and pleasant. Overeating is slow and pleasant. Who am I to criticise those who choose the latter?

Interestingly, the UK population now consumes fewer calories per capita than we did 60 years ago. What has changed, AFAIK, is that we are never cold, consequently we don't burn off the calories we do consume. 
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Offline CliffordK

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Interestingly, the UK population now consumes fewer calories per capita than we did 60 years ago. What has changed, AFAIK, is that we are never cold, consequently we don't burn off the calories we do consume. 

Or that as a population one has more of a sedentary lifestyle than eons of the past.

Escalators, Elevators, Cars, etc.  Too much time sitting in front of a computer.  Even a factory worker may be more inclined to sit at a computer pushing buttons than moving heavy stuff by hand.

Around the house, washing machines, dish washers, dryers, etc, all to lend a helping hand.

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Offline evan_au

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The relationship between the quantity of "calories consumed in food" vs "calories burnt by exercise" is an important one in public & personal health.

However, this tentative WHO recommendation is about the sources of our calories. They are recommending a reduction in the proportion coming from simple sugars, and a greater proportion coming from other sources like complex carbohydrates, fats and meat.

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Offline alancalverd

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1 Calorie (nutritional) = 1000 calories (physics) = 1 kcal = 4200 joules.

If you weigh 60 kg you expend 1500 joules (0.3 Calories) climbing a flight of stairs.

Adult male normal daily intake at constant weight is about 2500 Calories, say 10,000,000 joule.

You'd have to do a hell of a lot of exercise to burn off 1,000 extra Calories (4.2 MJ) per day! Professional athletes and some labourers do so, but nearly all the energy you consume is used to maintain your body temperature.

UK consumption has decreased by about 500 Calories per day in the last 60 years. Are we really all doing 2.1 megajoules less useful work each day than previously? 60 years ago elevators, escalators, tractors and power tools were commonplace, and home washing machines were the norm in North America  if not the UK (most middle class families used highly automated laundry services and did even less manual handling of wet clothes than we do today!). True, we still had farms, mines and factories in the UK, but truck drivers, retail and office workers weren't overweight, even in London where the public transport system was affordable. And the decrease in manual labour doesn't explain the increase in child obesity - 5-year-olds left the mining industry well over 100 years ago.     
« Last Edit: 03/01/2014 14:00:57 by alancalverd »
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Offline dlorde

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I saw an article based on a recent study that suggested diet drinks (artificially sweetened) tended to cause an increase in overall calorie consumption. The hypothesis was that this occurs because of an unexpected 'priming' response to the sweetness which is unfulfilled by the calorific content of the drink...

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Offline evan_au

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The Australian Dietary Guidelines 2013 (page 15/16)
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In adults, energy intake increased by 34% in the decade to 1995, equivalent to an additional 350 kilojoules per day. Greater increases were seen in children and adolescents, with energy intake increasing by 11% for 1015 year-old girls (equivalent to an additional 900 kilojoules per day) and by 15% for 1015 year-old boys (equivalent to an additional 1,400 kilojoules per day) (see Figure 1.2). Without compensatory increases in physical activity, these changes are enough to have resulted in the significant observed increase in mean body weight

The Australian government is now promoting 8700kJ per day as a dietary target for the average adult: http://www.8700.com.au/

Dr Karl says:
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A calorie is not a calorie...It costs your body different amounts of energy to digest different foods. So fats need only two or three per cent of their inherent energy to digest them; while carbohydrates need five to 10 per cent; and proteins need a massive 25 per cent to unravel the tightly wound amino acids that make them up.
Presumably, amongst carbohydrates, simple disaccharides need even less energy to digest than complex polysaccharides.
We are eating more processed food these days - reportedly eating minced meat in a hamburger pattie makes more energy bio-available than chewing a slab of steak with equal mass.
We are discovering much more today about the impact of our microflora on health, nutrition & energy extraction - but you would still have to say that this is still a very murky area...

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Offline alancalverd

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I saw an article based on a recent study that suggested diet drinks (artificially sweetened) tended to cause an increase in overall calorie consumption.

A few years ago my weight-conscious daughter ordered "Double bacon cheeseburger with extra fries and a diet Coke".  Cold and hungry, but still a teenager!
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Offline evan_au

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Quote from: alancalverd
UK consumption has decreased by about 500 Calories per day in the last 60 years.

Could you show where these figures came from, Alan?

By 1953, the last of wartime rationing in the UK would have been relaxed, and perhaps people were trying to make up for 10+ years of rationing? (Plus the impact of rationing during WW1, and the Great Depression which filled much of the time up to WW2.)

I have heard that the current UK regulations on food advertising require that food meet certain nutritional requirements before it can be advertised. Perhaps this has had an impact in the past couple of years? It has reportedly impacted the food being sold, as manufacturers have adjusted their UK recipes to come in just under the minimum nutritional content threshold.

So the question for those administering the UK advertising guidelines will be: "Will we add a new rule about maximum 5% of calories coming from simple sugars?"

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Offline alancalverd

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I'm still searching for my original source of 1950's statistics but http://www.ifbb.org.uk/changing-diet gives some fascinating details of the Victorian diet of 3500 - 7000 Cal/day.
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Offline Alan McDougall

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A new report from WHO proposes halving recommended maximum sugar consumption from 10% to 5% of calories.
  • Is refined sugar as dangerous as they suggest?
  • How would you encourage such a radical dietary change?
  • Is reducing sugar consumption a more cost-effective public health measure than the government subsidising the latest end-stage cancer drug?

I am a diabetic type 2 and many of my teeth are gone, all this due to excess sugar consumption. Everything in moderation should be our motto. George Washington is an example of sugar damage to the teeth, look at a painting of him, with his very bad fitting ivory false teeth, heck he looks uncomfortable.
The Truth remains the Truth regardless of our beliefs or opinions the Truth is always the Truth even if we know it or do not know it (The Truth remains the Truth)

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Offline Atomic-S

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Ithink that the form in which the sugar appears may be significant. If it is in the form of candy, the eater gets a strong dose all at once, which may not be good; and also it may linger in the mouth and throat so as to promote bacterial growth, causing dental decay, upper respiratory infections, etc.  If the same sugar is included in something like a muffin, these problems would likely be reduced.
 

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Offline evan_au

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Australia is currently reporting an increase in limb amputations. A major cause of this is uncontrolled diabetes. A major cause of this is excess sugar consumption.

Better sugar controls could impact a number of unexpected areas.

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Offline dlorde

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There was an interesting programme on TV here last night asking whether sugar was 'the new tobacco', in as much as excess can lead to obesity, diabetes, and even death, and it's promoted and controlled by a powerful industry lobby. A group called 'Action on Sugar' suggested that the added sugar in food products could be incrementally reduced without the customer noticing in much the same way as it has been done for added salt in the UK.

Much of the unnecessary extra sugar was attributed to fizzy drinks, 'enhanced' water, and as a flavour enhancer for 'reduced fat' food products.

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Offline dlorde

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I'm still searching for my original source of 1950's statistics but http://www.ifbb.org.uk/changing-diet gives some fascinating details of the Victorian diet of 3500 - 7000 Cal/day.
The TV programme I saw the other night mentioned that overall calorie intake has reduced over the last 50 years, but that we've become a more sedentary population, and the reduction in exercise more than compensates for the reduction in calories.

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Offline alancalverd

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The numbers still don't add up. You need to do a hell of a lot of exercise to burn a few calories. As I said in reply #14 above, climbing a flight of stairs burns 0.3 kcal. If you ran upstairs every 10 minutes for a working day, you would burn 14.5 Calories (one tenth of a slice of bread) more than if you spent the entire day sitting in an office.

Maximum useful output of a manual worker is about 75 watts for an 8 hour day - about 500 Calories. The guys who fly manpowered aircraft are racing cyclists who can manage 200W for a couple of hours.

Body heat loss increases rapidly if the ambient temperature drops below 20 deg C, from about 100 Cal/hr to as much as 2000 Cal/hr with an effective wind chill of -30 deg C. 50 years ago the average ambient temperature experienced by UK citizens was about 12 deg C: 2-4 degrees above the  mean outdoor temperature for the whole year. Calorific intake was particularly high in Scotland (the home of the fried Mars bar) but obesity was little different from England because the mean experienced ambient temperature (MEAT) was lower. MEAT is now above 15 deg C and many people never experience an ambient below 17 deg C during the working week, nor expose themselves to outside air temperatures during the winter. So we get fat.

Obesity in schoolchildren is not directly due to lack of exercise, but to lack of exposure to cold air. My cohort all remember outdoor PT lessons and lunch breaks continuing in falling snow, and everyone walked or cycled up to 3 miles to school every day (bus passes were strictly limited to 1.5 miles for primary and 3 miles for secondary schools, and nobody's mum had a car). Walking 3 miles on a warm day won't burn up a slice of bread, but spending two hours in the rain will account for a lunch of cottage pie and spotted dick.     
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Offline CliffordK

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Is it possible that there are errors in the calorie calculations. 
Perhaps modern man is eating "better calories".

It is hard to quantify, but say if people were eating 100% whole wheat bread 100 years ago.
And today they are eating white bread.

If the products have the same calories, perhaps there is better bio-availability of the white bread.  In fact, the choice of foods with higher bio-availability may be the source of the obesity problem.  Say your body is conditioned to getting large volumes of bran, fiber, etc.  Suddenly you take that out of the diet.  The food is absorbed quicker, and one gets more calories out of the food that is eaten.  So, one gets less full, and feels hungry quicker.

The problem may not be sugar, but rather starch (simple carbs).

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Offline Ethos_

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Is it possible that there are errors in the calorie calculations. 
Perhaps modern man is eating "better calories".

It is hard to quantify, but say if people were eating 100% whole wheat bread 100 years ago.
And today they are eating white bread.

If the products have the same calories, perhaps there is better bio-availability of the white bread.  In fact, the choice of foods with higher bio-availability may be the source of the obesity problem.  Say your body is conditioned to getting large volumes of bran, fiber, etc.  Suddenly you take that out of the diet.  The food is absorbed quicker, and one gets more calories out of the food that is eaten.  So, one gets less full, and feels hungry quicker.

The problem may not be sugar, but rather starch (simple carbs).
Important observations Cliff and surely, the starch content of just about everything we eat has increased over the years. But the problem is not only public consumption of needless calories, what ever their source. The push being generated by progressive politicians is assuming the authority to prescribe their own brand of diet for each and every citizen. The agenda has nothing to do with any concern they may have about our welfare, it's all about control.

I'm fairly conscious about my calorie intake, but there are others who choose to be less diligent. A persons health is a very personal matter and should remain under the control of those persons without BIG BROTHER's attempt at total control.

Liberty is much too precious to abandon it to the Nanny State regulating our calorie count.
"The more things change, the more they remain the same."

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Offline alancalverd

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I cannot understand why people look for complicated solutions to simple problems. Nearly all the food you eat is used to maintain your body temperature, so if your ambient temperature increases, you burn less food to keep warm.

Starch and sugar consumption in Northern Europe have actually decreased over the last 50 years, and people have been eating white bread for at last 200 years.
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Offline CliffordK

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Nearly all the food you eat is used to maintain your body temperature

Is that true?

When you look at a body at rest (me sitting in front of the computer), then one can look at an energy conversion.  Ultimately being released as heat.

But, the brain is churning away.  The heart is pumping.  Kidneys are functioning, etc.  Ultimately I have to wear a sweater to keep warm.  But there are complex functions of the superficial veins to maintain warm core body temperatures while not overheating.

I find it is easier to gain weight in the winter and loose weight in the summer.  But, I don't keep my house at 70F in the winter (usually closer to 50F).  And, the house rarely reaches 98.6 in the summer.

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Offline alancalverd

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OK, let's be pedantic. Nearly all the food you eat is used to keep you alive - basal metabolism.

http://www.scientificamerican.com/article.cfm?id=thinking-hard-calories discusses the metabolism of the brain, which surprisingly accounts for around 10 - 12% of your total power consumption, but there is no proven difference in brain wattage between sleeping and hard thinking: it's nearly all "dynamic RAM" so cannot be equated to useful work.

Thus whilst you are contributing to society by searching for rude pictures, curmudgeonly old scientists, or invading alien hordes, the rest of your body is feeding and cooling the brain (and doing quite a lot of work in keeping it above your hips) so the entire 120 watts of resting power simply ends up as heat with no mechanical output - or what we curmudgeons call useful work.
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Offline evan_au

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A persons health is a very personal matter and should remain under the control of those persons

People are responsible for Personal health.
Governments are responsible for Public health.
What is Public health but the aggregate of many Personal health decisions?

So people can still make Personal decisions, but government is responsible to guide the aggregate of those decisions (as has been done for tobacco consumption).
Sounds like a grey area to me...

One thing is clear - it is not in the interests of the sugar industry (or tobacco industry) to provide the public with fair and unbiased information about consumption of their products; however, it is in their interests to ensure that you are addicted to their products!
« Last Edit: 12/01/2014 07:30:19 by evan_au »

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Offline alancalverd

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If governments took responsibility for public health they would ban the sale of tobacco and alcohol, but they would lose  a lot of votes and a lot of money. So they make it an offence to injure other people by smoking in public places or driving whilst inebriated.  Seems like a fair balance between public safety and private pleasure.

Eating sugar won't kill third parties so it is no business of government beyond whatever statutory education syllabus it may lay down.

I never worried much about my kids' consumption of sugar but I made sure they got plenty of artificial coloring agents, so I could blame their bad behavior on the food industry rather than crap parenting. Oddly, the two who smoked as teenagers grew up to be a chef and a wine merchant, whilst the two who didn't, seem quite unconcerned about the finer aspects of food and drink.
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Offline dlorde

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It's a tricky question how far the government should get involved - how much should it curtail individual freedoms to reduce costs for everyone?

However, it's quite an easy and simple choice to avoid alcohol or smoking; the problem with added sugar is that it's in so many food products, such as ready meals, that many people don't realise how much they're consuming, and it's not nearly as easy to avoid.

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Offline alancalverd

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It's a tricky question how far the government should get involved - how much should it curtail individual freedoms to reduce costs for everyone?

You'd save a lot more by banning skiing. IMHO not every smoker gets a smoking-related disease, but the sole point of downhill skiing seems to be to go faster and faster until you break something.

Golf is equally pointless but the endpoint seems to be to have a heart attack or to be struck by lightning on the golf course, neither of which imposes much cost on the taxpayer.

I used to coach junior rugby. One Sunday when I was assigned to the "hospital run" I took a sprained ankle to the local casualty department where there were two other rugby lads, six soccer boys, and ten girls who had fallen off horses. "Ladies first" was a clinical necessity as they were all potential spine and brain injuries compared with the stitch and bandage treatment for clumsy footballers. About half of my female friends over the years have had spinal surgery or treatment for brain trauma from equitation. Should the government ban horseriding?
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Offline Ethos_

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 About half of my female friends over the years have had spinal surgery or treatment for brain trauma from equitation. Should the government ban horseriding?
Truly, and what about water sports? Maybe we should ban swimming, just total the drowning deaths that occur every year. And while we're at it, maybe we should close all the beaches where Man of War jelly fish attacks are on the rise. And we haven't even considered the shark attacks that happen in these very dangerous locals either. And for Heavens sake, let's put an end to vehicle transport, especially private automobiles. I think we should all stay at home, locked up in our houses and allow absolutely no visitors because they may be carrying some dreadful virus.

Get a grip people, life is dangerous..................Live it to the fullest!
"The more things change, the more they remain the same."

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Offline dlorde

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.. About half of my female friends over the years have had spinal surgery or treatment for brain trauma from equitation. Should the government ban horseriding?
That's an interesting question - for example, there's clearly a difference in the perception of the dangers of recreational sport and those of recreational drugs. Professor David Nutt upset the government by comparing the danger of horse riding with that of taking ecstasy, and was eventually sacked as chairman of the  Advisory Council on the Misuse of Drugs for publicly rating drugs realistically by the harm they caused; ironic, eh? The powers-that-be didn't like having their biases exposed, nor did they think the public would either...

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Offline evan_au

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Diabetes is a major cause of vision loss in Western countries (behind Age-related Macular Degeneration).

In Australia, it is estimated that over 10% of the population have diabetes or pre-diabetes; perhaps half of these do not know that they have a problem.
Around 90% of diabetes cases are the potentially preventable Type 2 diabetes, caused by excess glucose levels (rather than the somewhat mysterious Type 1 diabetes).

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Offline dlorde

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Diabetes is a major cause of vision loss in Western countries (behind Age-related Macular Degeneration).
There's also a possible link between type II diabetes and Alzheimer's.

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Offline alancalverd

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Hey! Whatever happened to herpes, AIDS, asthma, SARS, and avian flu, each of which was destined to wipe us out within 5 years? Who decides what ailment is to be fashionable this year?   
helping to stem the tide of ignorance

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Offline CliffordK

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Hey! Whatever happened to herpes, AIDS, asthma, SARS, and avian flu, each of which was destined to wipe us out within 5 years? Who decides what ailment is to be fashionable this year?   

Rather than just chugging along with the status quo, it isn't bad to bring forward potential health issues.
Obesity.  Perhaps sugar & starches, etc.  Don't mandate the size of a "Super Big Gulp", or what can be put in it.  Hmmm...  perhaps a Surgeon General Warning. 

Quote
The Surgeon General Considers a Super Big Gulp to be hazardous to your health

AIDS.  In many senses with multi-drug therapy, it is being treated as a chronic disease in the USA.  It does affect about 1% of the population in the USA.  However, the disease is still in epidemic proportions in Sub-Saharan Africa with as high as 25% prevalence rate, and no money to pay for treatment.  They talked about it on the radio the other day with some African countries where well-off men would have multiple very young sex partners, vertically spreading the disease throughout the population.

Asthma.  Generally not a lethal condition, but may require chronic treatment.  The prevalence in the USA does seem to be slowly increasing.  Some risk factors include smoking, and C-Section Birth.  It will still be discussed off and on for some time.

SARS???  It seems to have had a boom and bust, perhaps like the Swine Flu.  Variants could return.

Avian flu, is still a risk, and a few cases pop up from time to time, however, so far it hasn't made the leap to rapid human to human transmission.  If one considers how rapidly the swine flu spread around the world, we could still be slammed by the avian flu, or another livestock derived flu.  We are now coming up on the century anniversary of the 1918 flu.  Are we better prepared now?  There still is a significant delay between the identification of an epidemic, and the availability of the vaccine.

West Nile Virus is likely here to stay.

Of course, perhaps the disease that has been in epidemic proportions since the beginning of time is Malaria.  Largely ignored because it is uncommon in the USA and Europe.

Anyway, there are many diseases out there.  Some such as STDs are potentially preventable.  Others such as mosquito borne vectors may be difficult to prevent.  I find it perfectly reasonable to consider public health recommendations to extend to diet, smoking, and drinking.