Type II diabetes....this is ridiculous

OK, so now I hear that diabetes is costing the NHS an absurd amount of money (£760m per year) accounting for 40 million or so prescriptions of drugs to control diabetes per year (1). This, of course, is now set to rise to some unmentionable sum in the next 20 years, and it seems that no amount of nagging is going to stop us.

What is so wrong about this is how completely avoidable this condition is (type II diabetes, that is, which is very different from type I). Even the NHS will tell you that you can by and large avoid having to endure this condition by keeping fit and eating well (2). Now why is it so hard for people to achieve this? Well there are many reasons, but a key indicator is sugar consumption. In fact research has shown that excess sugar consumption can lead to a fatty liver, which in turn promotes insulin resistance and eventually type II diabetes (3).

And yet where is the campaign to tax sugar? Why is sugar added to everything, from juices to cereals, bread, pasta, pasta sauces, almost all ready meals, meat products, heck, even table salt has sugar. When even the "health" foods that are sold to us are nutrient poor and have added sugar, it's no wonder people struggle to control their consumption - if you eat empty calories, your body will ask for more food because calories won't necessarily give you nutrients.

And yet we seem content to merely tell people, vaguely, to exercise, control their weight, diet, without recognising the role that added sugar and processed food play in creating this problem. We "treat" the condition with drugs, which don't address the underlying reason a person has the disease in the first place. Drugs which have serious side effects, which, by the way, only seem to get picked up only after millions of people are already taking them and the pharmaceutical company has already made a hansom profit - like thiazolidinedione, which increases your risk of developing bladder cancer (4). Goodness knows what you'd find with concerted looking!

Want to save money for the NHS? Follow my three step plan:

1. Stop eating sugar
2. Stop eating refined flours and overly processed foods.
3. Pat yourself on the back - you've just helped solve a funding crisis in the NHS.

Will governments ever warn people to avoid sugar? Will there be a public awareness campaign to educate people about the known hazardous effects of processed foods? Or will they just tell people to reduce their calories, under the nonsensical modern idea that it's the calories that count (cue TV presenter telling us that a smoothie has more calories than a soda), and keep paying for more drugs? I'm no fortune teller, but I haven't been hearing about the lobbying power of vegetable producers recently.

(1) Number of diabetes prescriptions tops 40 million

(2) Preventing type 2 diabetes
(3) Research links sugar consumption, fat production and diabetes
(4) Very Common Diabetes Drug Raises Risk Of Bladder Cancer

More good news for bees, at last

Last week saw the banning in France of the insecticide thiamethoxam, which is a neonicotinoid or "nerve-agent" pesticide. I have written about these previously as research has been showing that this type of highly effective pesticide is linked to a decline in bee populations, with serious consequences not just for honey lovers, but for our food security.

© Twilite | Stock Free Images & Dreamstime Stock Photos

Unfortunately, the UK government has yet to take any action in response the these latest, or for that matter any of the earlier findings, although the Department of Environment, Food and Rural Affairs (Defra) is looking into the evidence and assure us that the UK has a "robust" pesticide safety policy.

One thing that really interested me in all of this was how in carefully assessing the risk that this and similar products present, the relevant scientific panels which advise governments produce comprehensive, well informed and complex risk assessments which failed to notice the rather obvious risk that a pesticide that is highly effective against insects generally is likely to be highly effective on other types of non-pest insects too - like bees.

This type of thinking is, sadly, not new. Incidentally it is the 50th anniversary since the publication of Silent Spring by Rachel Carson, which also pointed out the devastation that the blanket application of poisonous pesticides were causing to ecosystems. They were eliminating populations of some pests, but also of song birds and many other animals who were either harmless, or actually necessary for the continued sustainability of the ecosystem. She imagined a world which was silent, where song birds would no longer be heard.

We think we are further along, but it would seem that we might be hurdling towards a world where the buzz of bees is no longer heard, and where we will have to wander around, hand-pollinating plants to keep our food supplies going.

You might think I am exaggerating, but if Defra tells us that it has a "robust" pesticide safety policy, which approved this pesticide in the first place, and then reviews this research, which is merely pointing out what has been suspected for many years, and acts upon it, then how valid is this "robust" safety policy? Considering how important bees are to our food security (crops which rely on bees include tomatoes, cucumbers, cranberries, blueberries, melons, soybeans and avocados to name but a very few) I find this level of oversight just a tad alarming. What other interesting chemicals are being put through this "robust policy"? I guess we'll have to wait for the French to ban them to find out if they might have actually been dangerous.

If you are interested in keeping up the pressure, here are links to a couple of campaigns which might be of interest:

Neals Yard Bee Lovely Campaign Petition

Buglife Ban Neonicotinoids Campaign

Just take this pill.....

A new study has just been published in the latest edition of The Lancet Medical Journal, which has concluded that over 50s would benefit from taking a daily dose of statins, which are used to reduce cholesterol and can prevent heart attacks.

What is unusual here is that normally only those with an elevated risk of heart attack are eligible for this therapy, but the authors of this study are advocating that everyone over 50 should be given this as a matter of course on the basis that it would prevent a large number of heart attacks and be cheaper. In the words of the authors: "This benefit [of reduced risk of heart attacks] greatly exceeds any known hazards of statin therapy." Note the use of known.

Now, I don't really have a problem with drugs being used to help people reduce their risk of heart disease when other options aren't available, but this is another example of a pattern I've noticed in how we use medicine today: masking. By which I mean, we are happily using drugs to mask our symptoms, rather than treat the underlying cause. "Now hang on!" I hear you cry... "Surely this is just a disease of old age? Doctors wouldn't prescribe a drug if it wasn't necessary....would they?"

They would, and they do. Not intentionally you understand, but they do.

By way of example, consider how a diet based programme which has been scientifically proven to reverse heart disease (developed by Dr Dean Ornish, follow this link to study: http://dx.doi.org/10.1016/0140-6736(90)91656-U) has been approved and funded by Medicare in the United States since 2010. Note that this diet can reverse this condition in people already suffering from severe heart disease, and was shown to be more effective than medication. In fact, in the trials, people on standard treatments actually carried on getting worse, not better. So if you are offered statins, there is a chance that you could do the same or better with a change in diet, plus you'd have the benefits of an improved lifestyle. Will you be offered this programme instead of medication here in the UK? Nope. Much cheaper to give you some pills - only £18 a year in fact! Plus, there are no known hazards, right?

Maybe this is a good suggestion. Maybe it is foolish to think that we should be telling people about the real effects of their diets and of the difference this could make. But the reality is that the conclusions being taken by these doctors are misleading. They are implying that there is something unavoidable about the elevated risk of a heart attack. In fact they say that, as most people over 50 will have at least a 10% risk of a heart attack or stroke, you may as well just use age as the sole determining factor of whether to use the therapy. But the fact is that age is only a factor because of how we choose to live. I remember reading in The China Study that if the US had the same rates of heart disease as found in rural China, 80% of all heart units in America would have to close. And those Chinese didn't need statin therapy, they just needed the absence of a Western diet.

By taking pills, you aren't actually changing the factors which give you an elevated risk of a heart attack or stroke, you're just masking them. It may be harder, but I would rather have doctors tell people what they can do to deal with the root cause of heart disease, rather than have them give up and rely on mass medication of people with pills to hide the symptoms and cut their costs.

Why is no one addressing the true cause of obesity?

The last week has seen yet another bout of worry about the state of the nation's waistline with the launch of a campaign by surgeons, psychiatrists, paediatricians and GPs at the Academy of Medical Royal Colleges to battle our ‘single greatest public health threat’ (1) - obesity. Cue lots of advice, finger wagging and commentary which can generally be summarised as "just eat less calories and exercise". The argument is that it is all about personal lifestyle choices and if only we'd eat fewer calories and exercise more then we'd all be thin and happy.

But something is missing.

Sure, there are a lot of people out there who are obese due to lifestyle choices, but there are also a lot of people who are trying to eat well and still struggling to lose weight. Is it always a case of a lack of discipline?

No, it isn't. In fact a big part of the reason we find it difficult to control our calorie intake is that the totality of how we eat and how that relates to our health and weight seems to have been reduced to a simple equation: food = calories. Now, I know that on one, simple, level this is true and that if you eat too many calories you will put on weight. But it doesn't account for everything that food is and how it affects us. Allow me to illustrate this with a rather cruel, but illuminating experiment carried out in 1960:

In 1960, researchers at Ann Arbor University performed an interesting experiment on laboratory rats. Eighteen rats were divided into three groups. One group received cornflakes and water; a second group was given the cardboard box that the cornflakes came in and water; and the control group received rat chow and water. The rats in the control group remained in good health throughout the experiment. The rats receiving the box became lethargic and eventually died of malnutrition. But the rats receiving cornflakes and water died before the rats who were given the box....(2)

What this shows us, other than the fact that researchers at Ann Arbor in the 1960s had empathy issues, is that there is clearly more to food than how many calories it has. Which is why we often still feel hungry an hour or two after eating an average breakfast cereal; we are getting calories, but not the nutrition we need. This is the real reason so many put on weight even while carefully calorie counting: if you measure out your food intake to ensure you only consume 2,000 calories a day, but 500 of those are from a chocolate bar and a coke (which I can assure you, have a worse nutritional profile than even the cornflakes fed to those unfortunate rats) then we shouldn't be surprised when we still fancy a midnight snack. At first you might lose weight, but as research has shown time and again, eventually most are likely to put the weight back on, plus a couple of extra pounds for good measure. In essence when you lose weight by calorie counting without accounting for the nutritional profile of the food you are consuming, you are starving the body of nutrition, and it will make you crave more food until you change what you eat or simply give in.

What is truly interesting about this is that everyone more or less already knows this. We know that coke and most chocolate bars are bad and that greens are good. In fact, most people have an idea that they should be eating whole grains over heavily refined foods. But despite this, I continue to see calories from very different types of food equated with each other more or less every time I read about food in the media. If you are in any doubt have a look at this quote from a recent article about the hidden risk presented by the high quantity of sugar found in many fruit juices:

Half of people who admitted to drinking three or more sugary drinks in a day said they did not compensate by reducing the calorie intake of their food while nearly a quarter of those surveyed did not take into consideration their liquid sugar or calorie intake when they were last on a diet. (see 3, my emphasis)

Note that the problem isn't that you are having sugary drinks, but that you aren't reducing your calorie intake from elsewhere in your diet to compensate for those sugary drinks; after all, what matters is the number of calories, not where they come from, right? Wrong. Very wrong in fact. In the 17th century there are tales of sailors who were shipwrecked on islands for months and lived on nothing but water. Alarmingly, there are also stories of sailors who were marooned with water and a shipment of sugar - they all died within two weeks (4). It would seem it is better to eat nothing than sugar, and yet we are being told not only that we can incorporate this into our diet, but that we should actually replace other calories to accommodate it!

It is interesting how eager we seem to be to replace everything we understand about food with a simplistic and abstract model, which at best distorts the true impact of our eating decisions, and which potentially does considerable damage to the health of our society. I believe that until we understand that what we eat is far more important than how much we eat, we will not see an end to this obesity problem.


1. Academy of Medical Royal Collages: http://www.aomrc.org.uk/item/medical-profession-united-in-fight-to-defuse-obesity-time-bomb.html
2. Fallon S. and Enig, M. G. 1999 Nourishing Traditions
3. http://www.independent.co.uk/life-style/health-and-families/health-news/sugar-warning-for-healthy-drinks-7654017.html
4. Dufty W 1975 Sugar Blues

Good news for bees?

Anyone with an interest in the environment will no doubt know that bee colonies across the world have been in trouble for a number of years now. Colony Collapse Disorder, as it is known, has been on the increase worldwide and has been attributed to any number of causes from pesticides to mobile phone masts.

For anyone who is not aware, bees play a critical role in agriculture by pollinating crops for us. There are now examples where fruit trees in China are having to be pollinated by hand, because the overuse of pesticides has eliminated the bees that once did this for them for free (1). One group of pesticides in particular seem to have a devastating effect on bee colonies: neonicotinoids. These are a relatively recent type of pesticide which affect the nervous systems of insects and do not seem to affect mammals and have become one of the more widely used pesticides worldwide. Neonicotinoids have been implicated in Colony Collapse Disorder by a number of studies (Buglife have a very informative website for more information: http://www.buglife.org.uk) and there have been a number of calls on the government to ban this pesticide, following bans in France and number of other European countries (2).

Sadly, the government in the UK has so far refused to ban this substance, but it seems that a recent study linking Colony Collapse Disorder with neonicotinoids (3)(due for release in June this year) may have changed the government's stance (4).

Now I am clearly very happy that there is a chance that this substance might finally be banned, but what I found interesting in reviewing the various reports and government responses into this was the level of abstraction and reliance on risk assessment models present throughout the documents I have seen (see 5, 6 and 7 below for examples). This was in sharp contrast with the short, reliable and highly persuasive chat I had this morning with our local beekeeper, who did not hesitate to condemn this (and other) type of pesticide.

Now, I am aware that generic medical and product risk assessments are a necessary part of our lives, but I was very interested that very comprehensive risk assessments compiled by a number of highly regarded and specialised scientists in a number of countries, using some fairly complex and well established mathematics failed to predict what our local beekeeper knew by instinct - that using pesticides which are highly effective at targeting insects generally would have the potential to seriously affect the insects that we depend on to pollinate our crops. I am further mystified when one considers that pollinators (i.e. bees) would be in as much contact with this pesticide as the pests we are trying to eliminate. Perhaps in their focus to produce a pesticide that only targets insects and not mammals they forgot how interconnected we all are.

So what lesson is there in all of this?

Well, for me it highlights the loss of context once again (surprise, surprise), with highly complex systems (i.e. the "risk assessments") taking the place of reality and instinct for decision makers. As we should know by now, human devised systems rarely have the ability to fully predict reality, and when they are able to approximate reality they encourage us to over-rely on them, potentially increasing the longer term risk as illustrated by the example above. To put it another way, it would seem that governments, manufacturers and their scientists are finding out the hard way what any expert local bee keeper could have told them for free: that the overuse of pesticides, in particular those as effective as Neonicotinoid, would have a detrimental effect on the health of bees, and ultimately undermine the purpose of pesticides, which is to protect crops.

Again, it isn't that people want to destroy bee colonies - in fact this will be the last thing any of the decision makers and other protagonists would want. It would seem that the world is now structured in a way which makes us think in this way: breaking a problem down into a multitude of disciplines and creating a system or complex procedure, which then forms the basis of further systems. Assumptions are passed from one to the next and eventually it becomes too big and complex for a single person or even a small group of people to handle and context is lost.

I'll be exploring this topic in more detail in future, but if you want to put pressure on the UK government to ban this here are a couple campaigns which might be of interest:

Neals Yard Bee Lovely Campaign Petition

Buglife Ban NeonicotinoidsCampaign


1. http://www.thedailybeast.com/newsweek/2008/06/14/stung-by-bees.html
2. http://www.epa.gov/pesticides/about/intheworks/ccd-european-ban.html
3. http://www.independent.co.uk/environment/nature/new-pesticide-link-to-sudden-decline-in-bee-population-7622263.html
4. http://www.independent.co.uk/environment/nature/government-to-reconsider-nerve-agent-pesticides-7604121.html
5. http://www.buglife.org.uk/Resources/Buglife/Documents/PDF/REVISED%20Buglife%20Neonicotinoid%20Report.pdf
6. https://secure.fera.defra.gov.uk/beebase/downloadNews.cfm?id=47
7. http://www.buglife.org.uk/Resources/Buglife/Documents/PDF/Reply%20to%20FERA%20response%20on%20Buglifes%20neonics%20report.pdf

I'm not a vegetarian, but.....

The other day I had a confluence of news stories that got me thinking about the role meat has in our society. Now I should clarify that I am really not a vegetarian, or vegan, and I don't have a problem with the principle of eating animal products. But you see, there is that word, the principle of eating animal products. "What", I wondered, "is the reality?".

I should mention the news stories that got me thinking about this; the first is an article I saw in the Independent where Michael Mansfield argues that humans should abolish eating meat. This got me thinking of a TV show I once saw which had one of our many celebrity TV chefs in an abattoir looking distinctly uncomfortable with the situation their producer had landed them in. I then recalled the look on the face of the abattoir worker who was with the chef - I remember thinking how unwell he looked. Then, while driving home from work the next day, I heard on a radio panel show that humans consume 52 billion chickens a year. 52 billion! The presenter of the panel show laughed...so did I, both of us quite nervously. I don't think dying chickens are funny - perhaps I (and the presenter) felt that this statistic was telling us something rather big about ourselves and we couldn't really get our heads around it and dealt with it by using a childish giggle. That is what convinced me to have a closer look at this issue.

On researching this, I have seen three angles which consistently come up when talking about human consumption of meat:

1. The health angle
2. The animal welfare angle
3. The sustainability angle

Anyone who has a read of Michael Mansfield's article for instance, will see that the thrust of his argument is coming from the animal welfare angle. Now I am not really interested in rehearsing these here as there are plenty of other people out there doing that - I wanted to have a look at this from another angle. Is it possible to contemplate what meat consumption is doing to our society in a more measured, yet more human way? I thought back to the abattoir worker I saw on TV, and reflected on the vast numbers of animals who meet their end in these institutions. We can't ask the animals how they feel, but how do humans feel doing this work?

I came across an interesting publication which has allowed me to look at this in this way: A Slaughterhouse Nightmare: Psychological Harm Suffered by Slaughterhouse Employees and the Possibility of Redress through Legal Reform, by Jennifer Dillard (see below for full citation). There are a number of interesting findings, but two key themes emerged for me. The first is the connection between slaughterhouse work and violence. There are plenty of stories of workers, either under instruction or by their own volition, ripping off the heads of chickens and throwing around dying birds 'for fun', actions that in any other context would surely have the perpetrator being examined by men in white coats very quickly. In fact, the report states that while the connection between 'general' animal abuse and violent crime has been well documented, the link between what the report calls 'institutional' animal abuse and violence has not received as much academic attention. It describes, however, a study which demonstrated that US counties with slaugtherhouses have: "higher arrest levels for sex offences and more frequent reports of murder, rape, robbery, aggravated assault, burglary, larceny, motor vehicle theft, and arson". It also found that the presence of slaughterhouses had a higher effect on crime levels than the presence of any other industry.

On an individual level, the report found that the impact of working in a slaughterhouse gave rise to measurable psychological harm in the individuals involved. They were found to be exhibiting signs of Perpetration Induced Traumatic Stress, a form of post traumatic stress disorder which results from being an active participant in an event which would cause the victim to have post traumatic stress disorder. The most intriguing trait of this disorder displayed by slaughterhouse workers is that of 'doubling', which is usually used to describe the behaviour of executioners, soldiers and Nazi doctors. Basically, doubling is when an individual 'splits' their character into two, a situation which allows them to switch between being a normal human outside of work, but then switching back to another character capable of contributing to the gruesome requirements of their work. Slaughterhouse workers clearly manifest this trait, which is aptly encapsulated by this quote from one of them:

The worst thing, worse than the physical danger, is the emotional toll. If you work in the stick pit [where the hogs are killed] for any period of time, you develop an attitude that lets you kill things but doesn’t let you care. You may look a hog in the eye that’s walking around down in the blood pit with you and think, God, that really isn’t a bad- looking animal. You may want to pet it. Pigs down on the kill floor have come up and nuzzled me like a puppy. Two minutes later I had to kill them—beat them to death with a pipe. I can’t care.

I was struck by how you had to look for situations experienced by executioners and soldiers to explain the mindset brought about by working in this environment.

I realise that this is an American study which specifically deals with the situation in the US - I couldn't readily find similar studies specifically about this from the UK or the EU. I should note however, that a quick google search of "abattoir animal abuse uk" will give you the unpleasant sense that this is likely to apply here as well.

So what can this tell us about our society now and the role meat consumption plays? Well, the first thing that came to my mind when I reviewed this was the contrast with the long lived societies I recently read about. While no known society has sustained itself exclusively on plants alone, on average these long lived societies consumed far less meat (between 1% and 10% of overall diet from animal products - the exception was the Okinawans at 16%, though this was due to high levels of fish consumption which accounts for 2/3rds of this), and crucially were not, by and large, traditionally separated from the context in which that meat was obtained. For example, the Abkhasians would very occasionally slaughter an animal, but this would be from a herd kept by the community (Robbins 2006). The very low amount of meat consumed meant that large quantities of animals are not killed in a single episode, and communities can be selective in how and which animal they choose. In fact, these societies traditionally saw all of the food they consumed grow in front of them, always understanding the impact their eating decisions have on the land and the animals they raise. I can't but contrast this with how we live now in the West, where I would say the food we eat is decontextualised for the vast majority of us, in particular the meat products, with one group of people mass breeding, another mass killing and another mass consuming.

My conclusion upon reviewing this is that these slaughterhouse workers shouldn't really be doing this to animals. I am not making a judgement here about the merits of consuming animal products. I am just stating that, given the clear suffering this type of work inflicts on those who make their living from it, and to those around them, they shouldn't really be doing it - it would seem to force them to think and act in ways which are by and large contrary to their, and by extension our, that is human, nature. Maybe this is what the panel show presenter and I were nervously giggling at: 52 billion chickens a year aren't 'produced' and consumed without some serious mechanisation. Mechanisation which you would normally associate with the production of something like pens, or hair clips. The juxtaposition of that level mechanisation with the fact that chickens are living animals just caught my unconscious mind, pointing me to the enormity of human action which that figure represents and, now that I have thought about it, I find this disturbing.

Now, I am not saying that we, as a society, want to be so devoid of empathy as to treat animals as abstracted commodities, whose suffering we will happily delegate to low paid workers, who can for their efforts suffer the psychological consequences of this gruesome work. Generally we think we like animals, just look at all of those pampered cats and dogs out there. I think that the very structure of our society - the 'market', the drive for efficiency - is making this happen whether we really want it to or not. Choices are being made with reference to principles and ideas ("profit", "consumption", "commodities", "feeding the hungry", "demand from China for a Western diet"), but not with reference to the underlying reality, part of which is so poignantly described by Dillard's report.

I am not going to pretend I have an answer to this - but perhaps we need to think more carefully about the wider ramifications of meat consumption. After all it is not only the animals who suffer, but people are suffering, sometimes being dehumanised by their actions. This can't be acceptable.

Dillard, Jennifer, A Slaughterhouse Nightmare: Psychological Harm Suffered by Slaughterhouse Employees and the Possibility of Redress through Legal Reform. Georgetown Journal on Poverty Law & Policy, Forthcoming. Available at SSRN: http://ssrn.com/abstract=1016401

Robbins, John  2006 Healthy at 100: How you can - at any age - dramatically increase your life span and your health span