On the first day of October, 2008, the city of San Francisco became the first US government to ban the sale of cigarettes in pharmacies. The mayor explained the ban by saying "Pharmacies should be places where people go to get better, not where people go to get cancer". And there’s certainly a straightforward appeal to his sentiment but not, of course, if you are Big Tobacco. Philip Morris (the world’s largest tobacco company) has already commenced litigation to have this outrageous affront to free trade struck from the statute books.
We in Australia, have no need for such comical goings on. Our far more sensible Pharmacy Society has long espoused a policy of not selling tobacco from places designed for the promotion of good health. And while the policy is voluntary, compliance is almost universal. Few Australians would suggest that a pharmacy is an appropriate place for the sale of a substance that undoubtedly can cause significant disease and untimely death.
Which makes me wonder why pharmacies in Australia are quite happy to endorse and sell weight-loss shakes. Only people who had recently joined a monastery could fail to be aware of the concoctions being spruiked by various “shake peddlers”. These “nutritionally balanced” powdered drinks are intended to replace two meals a day for people wanting to carry a few less spare tyres. The shakes can generally only be purchased from pharmacies and some only after a “consultation” with a “weight-loss professional”. But there are very few pharmacies which don’t sell shakes of some description with or without the consultation.
The recipe varies a little between brands but the typical shake is one third protein and almost half sugar with just a smidgeon of fat for taste (pretty much powdered milk plus sugar plus multivitamins). Mixed in accordance with the directions, one meal replacement shake will often contain up to 25g of sugar.
Many powdered milk purveyors proudly proclaim that their high sugar shakes are good for dieters because of their low GI rating. A low GI food is one that does not cause the spikes in insulin which some nutritionists believe contribute to weight gain. They achieve this low GI status by using fructose as the sugar rather than ordinary old common or garden variety table sugar (which is half glucose and half fructose).
Astute readers of New Scientist magazine will have immediately spotted a problem with this. The June 28, 2008, issue reported on a study at the University of California where 33 overweight and obese people were persuaded to try a 10-week diet which was either 25 per cent fructose or 25 per cent glucose.
The people on the fructose diet ended up with increased (1.5kg) abdominal fat, higher triglyceride levels (which leads to heart disease) and 20 per cent higher insulin resistance (which leads to Type II Diabetes) than the other group. None of this happened to the group on glucose. The sponsor of the study, PepsiCo tried to spin its way out of the result by pointing out that none of their products contain pure fructose. I guess it’s lucky for the shake peddlers that none of them paid for the study because even that feeble attempt wouldn’t have been available to them.
The University of California research is just the latest in a long line of studies which say the same thing. Those in the know have been quietly distancing themselves from previous recommendations on fructose for a while now. In 2002 the American Diabetes Association (ADA) reversed its previous advice to diabetics that they should consume fructose.
The ADA’s new position is that added fructose should be completely avoided. They explain their change of heart by saying that notwithstanding its proven lack of insulin response, “fructose may adversely effect [sic] plasma lipids”. That’s doctor-speak for eating fructose may increase the amount of fat you have circulating in your bloodstream. Additionally, there is no shortage of research which shows that fat in the blood from fructose leads to obesity, heart disease and diabetes.
But what are we to make of the claim that these products have helped hundreds of thousands of Australians successfully lose weight? The shakes are intended as meal replacements but there are precious few Calories in them. On average they provide just 200-odd Calories. This is about the same as a 300ml chocolate milk and about one third of the Calories most people would eat in a meal. The combined effect of replacing two meals a day with the shakes would therefore be to halve the number of Calories the average person would eat.
I suspect if any of us replaced two meals a day with a small chocolate milk we might also lose quite a bit of weight, but the extreme calorie restriction would make it a very hard regimen to stick to. This suspicion is borne out by recent research published in the journal of the American Psychological Association. The meta-study analysed the outcomes of 31 long-term studies of calorie restricting diets. They found that most people initially lost 5 per cent to 10 per cent of their body weight. However, “the majority of people regained all the weight, plus more. Sustained weight loss was found only in a small minority of participants, while complete weight regain was found in the majority.”
In other words, Australian pharmacists are now selling a weight-loss “solution” based on feeding overweight people a substance that research consistently shows will make them obese, give them heart disease and encourage diabetes.
A serving of Coca-Cola the same size as one of these shakes contains about the same amount of sugar. But because Coke uses table sugar (only half fructose) rather than pure fructose like the miracle powders, they might find themselves in the unusual position of being the healthier alternative. You would need to drink almost twice as much Coke to get the same amount of fructose as is in the average weight-loss shake.
Hopefully Coke will spare us the prospect of Kerry Armstrong flogging Coca-Cola as a weight-loss aid, but it is no less ridiculous than pharmacists selling fructose-laden shakes. Big Tobacco liked to try it on in the heyday of smoking, but not even they would have had the chutzpah to suggest that cigarettes were a cure to lung cancer. Yet that’s what is being perpetrated by the shake makers every time they suggest drinking fructose will cure obesity.
The evidence of fructose is in, and it’s unequivocal. It’s time for Australia’s pharmacists to stand back from commercial interest and extend their ban on tobacco sales to include fructose shakes.
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