Modern Life Is Toxic

There are two narratives we’re being fed at the moment, scare stories that are essentially about how modern life is killing us. Everything we breathe, everything we eat, can either kill us or make us fat or damage our children. There’s an underlying message of nostalgia for ye olden days when food was safe and chemicals were safely confined to the periodic chart on the classroom wall. The days before Brexit and Trump and Facebook and everything going to hell in a hand cart.

A study has found that the chemicals in cleaning products can cause serious lung function decline in women.

It says that ‘According to new research, women who work as cleaners or regularly use cleaning products at home experience a greater decline in lung function over time than women who do not clean.’

And of course the effect is being compared with smoking, because everything is these days, including sugar.

The phrasing is odd: ‘The effect of occupational cleaning was thus comparable to smoking somewhat less than 20 pack-years’. ‘Somewhat less’ is meaningless. Does it mean a bit less or a lot less? The effect of smelling a lovely flower is somewhat less than smoking.

The hydra of chemical versus natural is rearing its ugly heads again. In this vision of the world, natural (ie unprocessed) is always better even though cancer, ricin, deadly nightshade, botulism and many more things are natural. And a chemical is a chemical whether it comes from a lab or from a plant. The cleanest mountain air or spring water are made of chemicals.

The point is not whether these chemicals are harming us, it’s that the reporting is gleefully playing on our fears. At a time of national and global insecurity, people are more vulnerable to scare stories, we’re hyper-alert to yet more things that are threatening Life As We Know It.

The Evil Chemicals narrative ties in with the Ultra-processed Food narrative, the other monster that is crawling out of the night to stalk us.

The report the media has picked up on says that ‘a 10% increase in the proportion of ultra-processed foods in the diet was associated with significant increases of 12% in the risk of overall cancer and 11% in the risk of breast cancer’.

However, Professor Linda Bauld, Cancer Research UK's prevention expert, said: 'It's already known that eating a lot of these foods can lead to weight gain, and being overweight or obese can also increase your risk of cancer, so it's hard to disentangle the effects of diet and weight.'

Dr Ian Johnson, from the Quadram Institute in Norwich, said the study had ‘identified some rather weak associations. The problem is that the definition of ultra-processed foods they have used is so broad and poorly defined that it is impossible to decide exactly what, if any, causal connections have been observed.’

And Professor Tom Sanders at King's College London said that mass-produced bread would be classed as ultra-processed, but a home-made loaf or bread from a posh local bakery would not. 'This classification seems arbitrary and based on the premise that food produced industrially has a different nutritional and chemical composition from that produced in the home or by artisans. This is not the case.'

This study is highly critical of the classifications used for ultra-processed food too.

There's a significant point in Professor Sanders’ comment about bread; there's a lot of food snobbery and smuggery going on, with the foods that are identified as being mostly eaten by lower income people being demonised whereas middle class food is more 'wholesome' and 'virtuous'.

The moral high ground food police probably don't count craft ale or artisan gin as highly processed and don’t seem to have noticed that even porridge made with soya milk and honey counts as 'ultra-processed'.

The smugness is about doing things more simply or more traditionally, buying food that doesn’t come in packaging. Yes, plastics are destroying the environment but food packaging extends the shelf life of products, causing less wastage and less environmental harm from producing (even) more than we need. It’s also a great boon to people too busy to shop for fresh produce and ingredients every day. It’s a complex problem not solved by ill-informed moralising or nostalgia.

Toxins (aka chemicals) have taken the place of diphtheria, polio and smallpox as the Invisible Evil (and plague if you go back further). But never fear, you can buy a detox from a wellness guru because your fear is their marketing opportunity.

It's not like things were any better in ye olden days when people breathed in coal or wood smoke or smog, and lots more people smoked. Sitting around in the cave or wooden houses before chimneys were invented during the long winters didn’t just make people smell like kippers, it caused serious lung damage.

Employment was much more lung-unfriendly too - mining, dyeing and tanning, the cloth industry or industrial scale laundries just to name a few.

Has there ever been a time in human history when our lungs were pink and flawless since we first learnt to make fire? It’s not modern life that’s killing us, being alive has always been dangerous. We just have more media to scare us about it now.

In ye olden days food was full of germs and poo and parasites as well as adulterants – for example alum, plaster of Paris and ash in bread.

In 1872, adulterants in food were found to include ‘strychnine, cocculus inculus (both hallucinogens) and copperas in rum and beer; sulphate of copper in pickles, bottled fruit, wine, and preserves; lead chromate in mustard and snuff; sulphate of iron in tea and beer; ferric ferrocynanide, lime sulphate, and turmeric in chinese tea; copper carbonate, lead sulphate, bisulphate of mercury, and Venetian lead in sugar confectionery and chocolate; lead in wine and cider; all were extensively used and were accumulative in effect, resulting, over a long period, in chronic gastritis, and, indeed, often fatal food poisoning. Red lead gave Gloucester cheese its 'healthy' red hue.’ Ice cream was found to contain ‘cocci, bacilli, torulae, cotton fiber, lice, bed bugs, bug's legs, fleas, straw, human hair, and cat and dog hair’.

Yum. So much for hipster nostalgia.

 Of course we need to avoid harm where we can but we need to separate real harm from hysteria, conspiracy theories and marketing opportunities. Headlines about city air being as bad as smoking don’t help. We’re never going to live some bucolic idyll in the Shires like hobbits.

Fear and guilt make for good headlines and clickbait but things are not getting worse. They’ve always been bad. The history of humanity is about processing, ingesting and inhaling stuff that's bad for us. Sometimes for fun.

…. For I Have Sinned

Why exercise is not an act of contrition

Shirley Cramer, chief executive of the Royal Society for Public Health thinks activity icons on food packaging will help combat obesity. The idea is to use stick people to show how long it would take to run or walk off the calories you’re about to eat.

The RSPH think that people are suffering from information overload in food packaging and that this will help – by giving them even more information as there is no proposal to replace the current labelling. Their research has found that 63% of people would support its introduction, with 53% saying it would cause them to make positive behaviour changes such as choosing healthier products, eating smaller portions or doing more physical exercise.

There are several problems with this approach. Firstly, who are the times based on? Everyone has a different metabolism and burns calories at a different rate depending on gender, height, age, build, lifestyle and so on.

The recommended calorie intake is 2500 a day for men and 2000 for women, based on some mythical average human. Averages can be useful as guidelines but it should be made clear that pretty much no one is ‘average’. I’m certainly not and nor is anyone I know.

Judging by the comments on the BBC article about this initiative, people don’t even understand what calories do. Someone commented on how long they’d have to run to work off 2500 a day, for example. We need calories to survive, they are not the enemy. It makes a big difference what constitutes those calories though – fats, sugars and so on. Eating 2000 a day is not going to keep you healthy if they’re made up of pizza and chocolate no matter how much you exercise.

You don’t just burn off calories while exercising. People who exercise regularly have a higher resting metabolic rate, which means that they burn off more even when they’re doing nothing just to sustain the extra muscle. What’s more, exercise is not just for calorie or weight control. There are many other health benefits, both physical and psychological.

The RSPH press release says that ‘it is hoped that ‘activity equivalent’ calorie labelling would help promote and normalise physical activity’. This is my biggest problem with the proposal – the intention may be to get people to be more active but it very strongly promotes the idea of exercise as punishment or penance rather than ‘normalising’ activity.

It’s like a Catholic approach to health – commit the sin and then do penance. Exercise is not an act of contrition and framing it as such helps no one. If guilt is your motivation and you hate every minute of your workout, you’re much less likely to keep up the exercise. Or, if you think you can exercise away the muffin, you have no reason to stop eating them in a cycle of sin and do penance, sin and do penance. As one woman told me, this approach is ‘reinforcing the notions that food has a moral value based on its calorific content, and that exercise is some kind of punishment for making arbitrarily-determined ‘poor’ nutritional choices’. Exercise does not wash away your sin and restore your moral balance.

A woman at my gym once said to me ‘When I’m as thin as you I can stop coming’. She wasn’t happy when I pointed out that the only reason I stay fit is that I keep coming. Forever. And ever. Amen.

There’s another worrying aspect to this proposed initiative. As a friend has pointed out, ‘This promotes an inherently disordered framing of what food and exercise are ‘for’. The whole idea of exercising simply to compensate for the food you've eaten is so triggering to people in eating disorder recovery who need to unlearn this bullshit in order to have a healthy and moderate relationship with food. This is so harmful, in the sense that it might actually trigger restriction and a return to disordered eating behaviours’.

This proposal comes from a good intention to help empower consumers to make healthier choices and to tackle the obesity crisis. But we already know that some foods are healthier than others. People over-eat for many different and complex reasons. If you buy crisps or chocolate, you know they are not health food. Who looks at how many calories are in a bar of chocolate and then puts it back? No one.

Making people feel guilty about their choices is not going to solve underlying psychological problems, nor is promoting exercise just to balance the scales. It’s not going to change anyone’s relationship with what they put in their mouth or with their bodies. When it comes to obesity, no one-size-fits-all approach is going to work.

As to the 63% who support the introduction of the activity icons – the road to hell is paved with good intentions. Also, the road to gyms making a profit is paved with people who join and then stop going after a couple of months. People often answer health questions based on how they would like to see themselves, how they would like to be, rather than on a realistic self-appraisal.

There is also the issue of practicality. Legislation on the mandatory labelling of food and drink is currently decided at the European level. Even if the political will existed and the food and drink industry was on board, it could take several years to happen. The industry is generally not so keen on ideas that discourage people from eating their products – unless they can sell us other products to counteract their effect. Maybe they should start investing in gyms.

Finally, why is it that articles like this so often have a food porn image at the top? Does the BBC (for example) think that we’ll read anything if there’s a picture of a heap of chocolate at the top? And, as all chocolate-lovers know, there is no such thing as a standard chocolate bar.

Pray for us sinners.

Dangerous Curves Ahead

Barbie now comes in three different shapes: tall, petite and curvy – and her new incarnations have sparked some debate. There have been complaints that curvy Barbie is still thinner than the average woman in the UK and the US. But is this a bad thing?

Scaled up, curvy Barbie would be 167.6cm or 5’6” (slightly taller than average) with a waist measurement of 63cm (24.8in) and hips 91.2cm (35.9in) whereas the average British woman measures 79.5cm (31.3in) and 105cm (41.3in) according to the 2012 Health Survey of England.

In that year, 67% of men and 57% of women were overweight or obese. Overweight and obesity are defined as ‘abnormal or excessive fat accumulation that may impair health’. Being overweight/obese is associated with an increased risk for some common causes of disease and death including diabetes, cardiovascular disease and some cancers.

The cost to the NHS of obesity and obesity-related disease was £2.3 billion in 2007 and is projected to be £7.1 billion by 2050 (assuming we still have an NHS by then). Costs attributed to overweight and obesity taken together are £4.2bn in 2007, projected to be £9.7bn in 2050. This compares with the current cost of smoking-related disease at approximately £2bn (and smokers are heavily taxed).

For some time, Body Mass Index (BMI) has been used as an indicator of obesity but it’s a pretty blunt instrument as it doesn’t distinguish between fat and muscle or take account of how the fat is distributed (fat in the core area or around the organs is worse for health than fat lower down the body, for example). Waist to hip ratio or waist measurement are now considered more accurate with a waist measurement over 102cm (40.2in) in men and 88cm (34.6in) in women taken as the threshold for health concerns. This metric still works best for people of average height and Western ethnicity though.

By these measurements, Curvy Barbie is clearly thinner than the average UK woman. This may not be a bad thing.

Original skinny Barbie has taken a lot of flak over the years for causing girls and young women to be unhappy with their body shape. For example, research done in 2006 found that girls aged between 5.5 years and 7.5 years old were less satisfied with their own body shape after reading a book with pictures of original Barbie. The research was done by Helga Dittmar of Sussex University who found that "The girls said they wanted a thinner body shape than they had. They had lower body-esteems after seeing pictures of Barbie. If we show an effect with a single exposure study it stands to reason that the impact increases as time moves on."

The media is full of images of very thin people that cause a lot of pressure, misery and body dysmorphia in women (and of course, men too). Diet books and products are huge earners. Barbie is just a tiny contributor but even with falling sales, she is a presence in the lives of many young people.

Fat shaming is hateful behaviour. There was a recent case of people handing cards to overweight women on the Tube in London to humiliate them, reducing women (yet again) to just a body to be judged.

Women are of course used to being judged by their appearance – and found wanting both by companies trying to sell products and by society in general. But should Barbie reflect the average woman? If she had a scaled-down version of the average waist and hip size would this make young women feel better about themselves or would it normalise obesity? Even while acknowledging the flaws of BMI, the Health Survey of England found that ‘there was a significant discrepancy between participants’ own assessment and their BMI category, which was greater among men than women. This lends support to the idea that a high prevalence of overweight and obesity in the population has led to a greater bodyweight/size becoming the norm’.

There’s a fine line to be walked here. While it is in no way acceptable to judge anyone by their size, promoting healthy body shape through a balanced diet and exercise can only be a good thing. The message is too complex for some: obesity is not good for health but if fat is bad, it’s too easy to jump to the assumption that fat people are bad/weak/stupid. It’s important that children understand the distinction. There’s also a class/income element to obesity as people in lower income groups are more prevalent in overweight groups.

Children have little or no control over what they eat so education is essential to ensure that, as soon as they have a choice, they make it a healthy one. The recent proposal to tax sugary drinks has its heart in the right place but even if campaigners succeed in getting it done, it won’t work without education and healthy bodies as role models.

Prevention is easier than cure. It’s hard to lose weight and exercise regularly. Evolution has geared us to seek out fats and sugars as they were once in short supply. Now they’re everywhere. The time of food scarcity when a fat baby was thought to be a healthy baby is long gone.

Children don’t know what dress size Curvy Barbie takes, they don’t know that it’s less than the average, they just see that she’s not skinny as a stick. Yes, she is just a doll and is only a tiny part of the way children are influenced. But if Curvy Barbie helps just a little bit to stop children feeling as bad about themselves while at the same time it normalises a healthier shape, that could be a step in the right direction.

Perhaps toy maker Mattel is being more realistic about the shape we’re in or perhaps this is an attempt to boost profits, which are reported to have fallen by 59% with a 14% drop in sales of Barbie.

It seems unlikely that Mattel is being altruistic. The tall and petite versions only look different heights compared with standard Barbie. In isolation, they just look like any other doll – and are still unnaturally thin. Tall Barbie would be 180cm (5ft 11in tall) with a waist measurement of 56.4cm (22.2in) and 78cm (30.7in) hips. Just for comparison with Lanky Barbie, I am 185cm (73in) with a waist of 76cm (30”) and hips 99cm (39”). I weigh 66.5kg (146lb) with more muscle than average. If I were any thinner, I’d be ill.

A sweet solution?

The British Medical Association is calling for a 20% tax on drinks with added sugar in an attempt to stem the increase in obesity, Type 2 diabetes and tooth decay.

Obesity costs the NHS more than £5 billion every year and treating Type 2 diabetes costs £8.8 billion a year, almost 9% of its budget (smoking-related disease costs around £2.7bn)

However, the BMA proposal may not be the simple fix it appears to be.

The BMA cites evidence from other countries that increasing the cost of these drinks leads to a reduction in obesity in the population. A meta-analysis of the link between a sugary drink tax and obesity levels finds that there is some correlation in America, France, Mexico and Brazil where an increase in price was associated with a decrease in the demand for what the analysis calls sugar sweetened beverages (SSBs).

The BMA cites Mexico as an example of a country where a tax has worked in reducing obesity but doesn’t consider if other measures were taking place at the same time – for example, health awareness campaigns and reduction of sugar in other products. In other words, as we so often find, correlation does not equal causation.

In some countries, people drink SSBs because they have little or no access to clean drinking water – in some parts of Mexico and Brazil, for example. This may have influenced the amount of SSBs people were drinking and their choice of alternatives – which makes them less convincing as arguments for a tax on SSBs in the UK. In other words, the BMA is not comparing like with like.

Ironically, in one part of Mexico, the local Coca Cola making plant takes all the fresh water, forcing locals to drink Coke. Diabetes rates are what you'd expect.

The meta-analysis found that, rather than choosing diet versions of SSBs, people switched to juice and milk. One study found that the impact of a tax may be minimal because of this and that the fats and calories in these drinks could reduce the effect of SSB price increases. There are vitamins and calcium in these alternatives but if weight loss is the aim, this is not a good argument.

There are also culture-specific factors that need to be considered in the UK.

Focussing on sugar sidelines the problem of fat consumption. Saturated fats are still a major health problem in the UK even if the current fashion is to demonise sugar and blame it for all our ills. Sat fats often come as part of the sugary package – for example in biscuits and chocolate. The UK is the third largest consumer of chocolate in the world and the second biggest biscuit eater.

According to the NHS, sweet drinks are not the biggest contributor to adult sugar intake. Up to 27% of it comes from table sugar, jams, chocolate and sweets and 20% from cakes, pastries and biscuits. Only 25% of added sugar comes from soft drinks and fruit juice. Note that this includes supposedly healthy fruit juice.

The British also eat more crisps than the rest of Europe put together and a third of UK children eat crisps every day. In addition to the fat content, there is all the salt, too.

So while cutting back on SSBs may help, the fact that a tax may have worked in other countries doesn’t mean it will necessarily work here. The BMA needs stronger evidence tailored to British eating habits and culture to make a convincing argument.

Another objection is that a tax would hit the poorest the hardest. The counter-argument is that lower-income groups have seen the greatest rise in obesity. Several US states introduced a tax on SSBs to raise revenue but are now claiming this is part of their anti-obesity policy, so any comparison of the UK with the US should factor in political capital to be gained from any tax as well as financial interests – and political cowardice.

The sugar lobby in America is very powerful, influencing governments and being highly duplicitous about the effects of sugar and the situation in the UK is not much better.

It is very much easier for governments to penalise the public than the producer.

If the tax raised is spent on providing subsidies for healthier drinks and foods or health awareness campaigns, there could be some justification for it; so far there is no indication that this would be done. But this too would let the sugar producers off the hook.

The Scientific Advisory Committee on Nutrition is releasing a report this week that says sugar should take up no more than 5% of daily intake, down from 10%.

Figures from the national diet and nutrition survey, referenced in the SACN report, found sugary drinks to be the highest contributor of sugars to the diet of 4 to 10 year olds. While reducing children’s sugar intake is undeniably a good idea to prevent disease in the future, it doesn’t tackle current problems and, again, ignores fat intake. Current adult saturated fat intake, at 13.3% of food energy, far exceeds the 11% maximum recommended intakes and this 2.3% is enough to have a significant health impact.

The Government has delayed the release of a detailed assessment by Public Health England of the likely success of a range of measures to reduce our addiction to sugar. If it ever is released, it will make interesting reading.

It’s clear that something has to be done to curb our sweet tooth but it’s a much more complicated issue that the BMA appears to think it is. There needs to be a different approach for adults and children. Other sources of sugar need to be tackled alongside drinks for there to be any hope of success. Political and financial considerations need to be factored in. Fats must be targeted as much as sugars.

It could be argued that the BMA’s proposal is a step in the right direction. But it’s a false step based on insufficient evidence and a failure to address the bigger picture. It’s like putting a sticking plaster on a gaping wound.

UPDATE 1.3.2018

A thorough new report found that "We were unable to find evidence that any sugar tax actually implemented anywhere in the world has led to improvements in health."

UPDATE 13.3.2018

Another strong argument against sugar tax.

Sometimes it's good to be vindicated.