[HN Gopher] Type 2 Diabetes and cardiovascular disease attributa...
       ___________________________________________________________________
        
       Type 2 Diabetes and cardiovascular disease attributable to sugar
       beverages
        
       Author : tchalla
       Score  : 122 points
       Date   : 2025-01-07 17:51 UTC (5 hours ago)
        
 (HTM) web link (www.nature.com)
 (TXT) w3m dump (www.nature.com)
        
       | sitkack wrote:
       | > Burdens of type 2 diabetes and cardiovascular disease
       | attributable to sugar-sweetened beverages in 184 countries
       | 
       | https://www.nature.com/articles/s41591-024-03345-4.pdf
       | 
       | The data and the code used for the analysis appears to be
       | available.
       | 
       | ----
       | 
       | One of the reasons that we don't have Universal Healthcare in the
       | US is that things that are categorically unhealthy would be
       | prohibited from being sold. Afterall, it would benefit not only
       | the receivers of care but also the people funding the healthcare
       | system. The sellers of those things will fight (to their death)
       | to prevent that environment from existing.
       | 
       | Not allowing something to be mass produced, marketed and sold is
       | different than banning it outright.
       | 
       | I personally think mass scale tobacco and soda should not be
       | sold, at the same time I think people can hand roll and pack a
       | pipe into the grave. Same for their at home bathtub soda.
        
         | malux85 wrote:
         | I think you strike a good balance between personal freedoms and
         | health of the population.
         | 
         | You're right in that availability is the problem.
         | 
         | If I go across the road to the store, there's a whole WALL
         | covered in hundreds, maybe thousands, of sugar drinks, all very
         | very cheap.
         | 
         | You know what there isn't any of in the whole store? Something
         | healthy and low sugar / high protein.
         | 
         | I have the luxury of time and a little bit of money so I can
         | choose, but what about the busy parent who just needs energy?
         | The busy office worker with a bunch of projects due, or just
         | the poor individual with not much money, I don't think it's
         | fair to setup these kind of situations and then blame the
         | individuals for their choices, we have to step in at a
         | governmental level
        
           | firesteelrain wrote:
           | FWIW - the convenient stores near me sell the Core Power
           | Elite Protein drinks. I have picked them up and it helps make
           | my protein goals on days where I come up short. They do taste
           | pretty good but more expensive than a soda.
           | 
           | It's possible people are depressed and looking for the most
           | tasty option.
        
             | ElevenLathe wrote:
             | One thing 7-11s have started stocking in recent years is
             | packaged hard boiled eggs. The price is insane if you
             | compare it to boiling your own, and they are a bit
             | tasteless, but you don't have to peel them and the price is
             | reasonable compared to other stuff there if you're stuck
             | eating lunch from 7-11.
        
               | firesteelrain wrote:
               | It is more than twice the price of Wal-Mart! Well, I
               | guess that's the price of convenience.
               | 
               | 2/hard boiled eggs - $2.09 @ 7/11
               | 
               | 6/hard boiled eggs - $2.96 @ Wal-Mart
               | 
               | 6/raw eggs - $2.62 @ Wal-Mart
        
               | lithocarpus wrote:
               | Next compare the price of a donut vs the price of a bag
               | of flour and sugar ;)
        
               | arcticbull wrote:
               | You're paying for footprint. There's 320 Walmarts in
               | California and almost 2000 7-Elevens. There's zero
               | Walmarts in SF and San Mateo county, and at least
               | 50-Elevens. Those 7-Elevens are often in premium
               | locations downtown.
        
               | firesteelrain wrote:
               | I am not sure I follow the discussion and its tie into
               | California - I am in the South US
        
               | arcticbull wrote:
               | I just picked a market.
        
               | hilux wrote:
               | Nice. "Tea eggs" are big in East Asian corner stores.
        
               | SoftTalker wrote:
               | Two hard-boiled eggs and an apple is a pretty nutritious
               | lunch for about $2-$3 tops.
        
           | nnurmanov wrote:
           | I went little further. I could not find low or no sugar
           | Nestle cereals at the local supermarket, then I asked their
           | support if they have something with low sugar. Their rep
           | wrote that they have lowered the sugar amount by 34% from
           | 2000 to 2010, but it is still not clear if those amount are
           | OK, when I taste the sugar amount is definitely high. I do
           | think the government should step in and promote healthy food
           | and habits
        
             | cogman10 wrote:
             | So many of these "we lowered X" things are simply "We cut
             | the portion size down by 34% to hit calorie/sugar goals".
             | 
             | That's where you get dumb things like "Here's a candy bar
             | with 3.5 servings" to try and trick a consumer into
             | thinking it's not as calorie dense as it is.
        
             | samaltmanfried wrote:
             | It's really tragic that lots of Americans think this kind
             | of garbage is a healthier alternative to other kinds of
             | breakfast. It may actually have less sugar than pancakes
             | drenched in some disgusting syrup, but it's still garbage.
             | There's a real problem with nutritional literacy in this
             | country. The manufacturers of these products really aren't
             | helping here either. Cheerios have a big 'CAN LOWER
             | CHOLERSTEROL' plastered on the front of the pack, but the
             | contents are still literally 24% added sugar.
        
               | zargon wrote:
               | From the Cheerios box in my cupboard: 140 calories per
               | serving, 1g added sugar per serving. 1g carb = 4
               | calories. 4 / 140 = 3%.
               | 
               | I would not be at all surprised if some flavor of
               | Cheerios is 24% added sugar, but regular Cheerios are not
               | so bad in the sugar department.
        
               | JumpCrisscross wrote:
               | > _1g added sugar per serving_
               | 
               | That is still a good amount of sugar given it's every day
               | and setting your morning baseline. If taken with _e.g._ a
               | refined juice or sweetened coffee, that's probably
               | setting one up for sugar cravings in a few hours.
        
               | zargon wrote:
               | A slice of bread (in the U.S.) has more than 1g of added
               | sugar (and less than 140 calories). (If you know of any
               | besides Ezekiel that have less sugar, I would like to
               | hear about it.) I don't think it is fair to villainize
               | Cheerios when it is one of the least offensive options
               | among ultraprocessed breakfast cereals. Especially based
               | on... other things that aren't Cheerios? Juice (20+ g
               | sugar) and coffee sweetener (4+ g sugar) would be the
               | villains in this scenario.
        
               | JumpCrisscross wrote:
               | > _don 't think it is fair to villainize Cheerios when it
               | is one of the least offensive options among
               | ultraprocessed breakfast cereals_
               | 
               | You're correct. I'm damning the whole category within the
               | context of this discussion.
        
               | Xeronate wrote:
               | 1g of sugar per serving is hardly anything. You are
               | weakening your argument by being hyperbolic.
        
               | JumpCrisscross wrote:
               | > _1g of sugar per serving is hardly anything_
               | 
               | I'll stand by it being "a good amount" given it's
               | incorporated into a daily ritual.
        
               | bluGill wrote:
               | What is the serving size and more importantly how does
               | the serving size compare to what people actually eat?
        
               | zargon wrote:
               | Serving size is 1.5 cups. Regardless of how much people
               | eat, it's still only 3% added sugar.
        
               | hombre_fatal wrote:
               | There's nothing wrong with the "can lower cholesterol"
               | banner on it because it's a source of whole grains and it
               | has no saturated fat. That combo generally does lower
               | cholesterol when put to the test, and it probably is one
               | of the best cereals in the aisle.
               | 
               | Directing people towards better alternatives is a good
               | thing.
        
               | SoftTalker wrote:
               | Is this regular Cheerios, or Honey Nut?
               | 
               | The Honey Nut Cheerios are glazed in sugar, but the plain
               | Cheerios (to my taste) don't have much if any. Don't have
               | any here to check the ingredients though. If I want
               | cereal for breakfast I generally make plain oatmeal.
        
         | Wytwwww wrote:
         | Can you not buy more or less as unhealthy products in countries
         | with universal healthcare as in US?
         | 
         | e.g. smoking rate is considerably higher in France or even in
         | Spain
         | 
         | Sugar consumption isn't relatively that high either compared to
         | most European countries:
         | 
         | https://www.who.int/data/gho/data/indicators/indicator-detai...
        
           | JumpinJack_Cash wrote:
           | > > smoking rate is considerably higher in France or even in
           | Spain
           | 
           | But they somehow compensate with other good habits
           | considering that lifespan and healthspan is greater than the
           | US.
           | 
           | Then we can get into a whole different conversation about the
           | intensity of one's life in the US v. Europe not just the
           | lenght, but that is a whole different conversation.
        
           | Eumenes wrote:
           | America's poor use EBT/food stamps to buy massive amounts of
           | junk food, including billions on soda. Those same people are
           | almost 100% on ACA or state health insurance plans and
           | milking the tax payer on treatment for obesity, diabetes, and
           | cardiovascular disease. There is no way, in my mind, it is
           | feasible to fund these lifestyles and provide the treatment
           | for it. Its absolutely insane.
        
             | HappySweeney wrote:
             | The soda is not consumed by the food stamp holder. It's
             | used as a medium to convert the balance to cash.
        
             | bluGill wrote:
             | Do they? Food stamps in most states have restrictions on
             | what you can buy with them. My impression is soda is not on
             | the list. Of course this is (mostly?) the states and every
             | state has different rules so you probably need to cite 50
             | different state rules to verify this and thus an exception
             | state is likely.
        
               | mtalantikite wrote:
               | This is an ongoing debate, but afaik you can use them for
               | soda [1].
               | 
               | [1] https://www.nytimes.com/2017/01/13/well/eat/food-
               | stamp-snap-...
        
           | sitkack wrote:
           | That isn't the argument I made. Processed food industries
           | actively block healthcare reforms because they fear being
           | regulated for the now obvious public good.
        
         | tanaros wrote:
         | > One of the reasons that we don't have Universal Healthcare in
         | the US is that things that are categorically unhealthy would be
         | prohibited from being sold. Afterall, it would benefit not only
         | the receivers of care but also the people funding the
         | healthcare system. The sellers of those things will fight (to
         | their death) to prevent that environment from existing.
         | 
         | Perhaps you're implying something unique about the US, but
         | those products are still sold in other countries that have
         | state-funded universal health care.
        
           | Mistletoe wrote:
           | It's just your normal run-of-the-mill HN posting that makes
           | no sense and doesn't match reality.
        
           | sitkack wrote:
           | This argument by massive processed food industries, that if
           | we get Universal Healthcare, that their products and
           | practices will be curtailed because it will be for the actual
           | monetary public good says nothing about what is sold in
           | countries with public healthcare.
           | 
           | Are you saying that corporate processed food manufacturers
           | are not making that statement?
           | 
           | Clearly there is a problem with soda consumption leading to
           | obesity in countries with Universal Healthcare, but that
           | isn't the argument I am making.
        
         | cogman10 wrote:
         | > One of the reasons that we don't have Universal Healthcare in
         | the US is that things that are categorically unhealthy would be
         | prohibited from being sold.
         | 
         | For the most unhealthy class of people that are most affected
         | by things like T2 diabetes, we have universal healthcare. At 65
         | you get Medicare which covers diabetes treatment.
         | 
         | We have yet to ban sodas despite the added cost to the
         | taxpayers.
         | 
         | > I personally think mass scale tobacco and soda should not be
         | sold, at the same time I think people can hand roll and pack a
         | pipe into the grave. Same for their at home bathtub soda.
         | 
         | For tobacco, the age restriction has been the thing that has
         | limited use more than anything. People don't tend to pick up
         | smoking once they hit 21. Millennials by and large do not smoke
         | and the anti-tobacco legislation in the 90s is a large part of
         | that.
         | 
         | Unfortunately, because the legislation didn't target all
         | nicotine products that left the door open for vape companies to
         | come in and get Gen Z and Alpha addicted to nicotine all over
         | again.
         | 
         | A broad ban on the sale of nicotine products to minors should
         | be in place. It certainly shouldn't be sold over the internet.
         | 
         | Soda is trickier. I don't think an outright ban would be right
         | (though it would have a fair number of positive health
         | benefits). A sin tax would likely be ineffective and age checks
         | seems like it would be somewhat burdensome.
        
         | asdff wrote:
         | I don't think people realize the scale of soda consumption that
         | needs to happen to have health issues. By and large the people
         | in these affected studies are not drinking water at all. They
         | are getting all their thirst needs met by a sugary drink. That
         | is so overboard. You can have a can of coke every now and then
         | and not have your enamel slough off.
        
           | ElCapitanMarkla wrote:
           | We had a family friend who is in her late 50s stay for a
           | couple of days over Christmas, all she drunk was Diet Coke.
           | Even going to bed at night she took a bottle of Diet Coke
           | with her. The thought of waking up through the night for a
           | swig of Coke grosses me out a bit. And yes, she is the
           | absolute picture of health...
        
             | neom wrote:
             | eh, Diet Coke is primarily water, aspartame, phosphoric
             | acid and caffeine. I drink 5/6 of them a day (don't like
             | water much). The paper linked actually says short term
             | effects of diet soda are less problematic, but recent
             | evidence suggests that aspartame may have harms on the
             | microbiome and glucose tolerance generally.
             | 
             | That said, the idea of drinking anything either sweet or
             | carbonated before bed, during the night, or in the morning,
             | mind boggling to me, that does sound really gross.
        
               | SoftTalker wrote:
               | Have you ever tried plain carbonated water? It's more
               | interesting than still water, and for me more thirst
               | quenching. Easy to make at home with a Soda Stream or
               | similar, just don't add any of their syrup.
        
             | KittenInABox wrote:
             | I mean, diet coke explicitly doesn't have the kind of sugar
             | in this study.
        
           | ozim wrote:
           | Mostly from own experience I know poor people drink sodas and
           | as you get used to the taste you don't like taste of plain
           | water - even when you have decent tap water.
           | 
           | As an adult I started drinking tap water and now I don't like
           | taste of sodas anymore. I am happy that I got over with it
           | but still have some people I know stuck on sodas and
           | disliking plain water taste.
        
         | lithocarpus wrote:
         | I don't know that that's true. Most healthcare is subsidized.
         | And so is the sugar. There's very little movement to restrict
         | the sugar. There are profits to be made on both ends (selling
         | the sugar and the insulin for example) by those who have
         | captured the relevant parts of the government.
        
         | bagels wrote:
         | Canada has universal healthcare and they drink plenty of sugary
         | drinks there too.
        
         | officeplant wrote:
         | >I personally think mass scale tobacco and soda should not be
         | sold, at the same time I think people can hand roll and pack a
         | pipe into the grave. Same for their at home bathtub soda.
         | 
         | I'd be fine with that to be honest. I'd drink soda water going
         | forward just to not have to smell cigarettes, but be fine with
         | people backyarding some tobacco to make their own cigars.
         | 
         | It would probably even be healthier to force people to make
         | their own syrup for soda at home vs the ease of obtaining it
         | now.
        
         | bluGill wrote:
         | Before we go here, what is the alternative. If restrict soda
         | and people switch to beer even if they will be driving that
         | could be much worse. (I don't otherwise know how the effects of
         | alcohol vs soda come up but that too is a question worth
         | asking)
        
           | JumpCrisscross wrote:
           | > _what is the alternative_
           | 
           | Shrubs [1]!
           | 
           | [1] https://en.m.wikipedia.org/wiki/Shrub_(drink)
        
             | bluGill wrote:
             | There are many alternatives, but what is important here
             | isn't what you recommend, it is what people choose.
        
               | JumpCrisscross wrote:
               | > _what is important here isn 't what you recommend, it
               | is what people choose_
               | 
               | Do we have any evidence soda drinkers sub Coke for
               | alcohol? I'd have guessed artifically-sweetened soft
               | drinks would have been the substitute.
        
       | tomcar288 wrote:
       | It's good to see more studies come on this but it's not exactly
       | news. Researchers have known for quite some time now that there's
       | an entire constellation of diseases (diabetes, stroke, certain
       | cancers, fatty liver disease, heart disease, etc, etc) known as
       | metabolic syndrome that are all caused by diet and lifestyle.
        
         | interestica wrote:
         | > It's good to see more studies come on this but it's not
         | exactly news. Researchers have known for quite some time now
         | 
         | A growing body of studies signals consensus - that's
         | newsworthy. This ties two specific factors together rather than
         | any general metabolic syndrome.
        
         | arcticbull wrote:
         | Just to clarify metabolic syndrome isn't the umbrella term for
         | all of these things.
         | 
         | Metabolic syndrome is when you have 3 or more of: central
         | adiposity, high blood pressure, high blood sugar, high
         | triglycerides and low HDL.
         | 
         | You can have any of these independently, it becomes metabolic
         | syndrome when you hit the bingo.
        
         | toomuchtodo wrote:
         | Also good that GLP-1s have been found to help people patch the
         | reward center around unhealthy diet demand signals. We know
         | these things are bad, we know will power isn't a solution, and
         | we have a fix we can deploy at scale relatively inexpensively.
         | 
         | https://news.ycombinator.com/item?id=41988285 ("HN: GLP-1 for
         | Everything")
         | 
         | https://news.ycombinator.com/item?id=42579445 ("HN: Weight loss
         | drugs seem to be driving down grocery bills")
         | 
         | https://papers.ssrn.com/sol3/papers.cfm?abstract_id=5073929 |
         | https://dx.doi.org/10.2139/ssrn.5073929 ("The No-Hunger Games:
         | How GLP-1 Medication Adoption is Changing Consumer Food
         | Purchases")
        
           | bitmasher9 wrote:
           | Saying will power isn't a solution is insulting to everyone
           | that successfully made lifestyle and diet changes to become
           | healthier without pharmaceutical intervention.
           | 
           | It may not work for everyone all the time, but I know a lot
           | of people that have made these changes.
        
             | hombre_fatal wrote:
             | This is just an uncharitable / strawman interpretation of
             | what they said. They are concerned with all the people left
             | over once you remove the people that just had to muster up
             | "willpower". And they are concerned for the people who
             | weren't dealt the same hand of traits that us fit people
             | have.
        
             | lazyasciiart wrote:
             | Their willpower doesn't appear to have solved the issue on
             | a societal level, and it is not an insult to say that.
        
             | toomuchtodo wrote:
             | If one is insulted, they should revisit their mental model
             | and emotional state. There is no gold star for will power
             | because someone lucked out with genetics and brain
             | chemistry/structure. "Be more lucky" is not actionable for
             | the body you are issued.
             | 
             | We can patch bugs in the human, and we should whenever
             | possible and desired by the person. This helps them make
             | their own luck.
        
               | jacobgkau wrote:
               | You are transferring the problem from the foods industry
               | to the pharmaceutical industry. I hope "one" knows that.
               | 
               | The "bugs" are not in "the human," they're in the food
               | industry. Fixing our food supply would be far better for
               | individuals and society than fighting fire with fire by
               | leaving our food broken and using drugs to work around
               | it.
               | 
               | In the meantime, doing what you can to unbreak your diet
               | without using drugs is still far smarter than relying on
               | an artificial "fix" for the "machine" that is literally
               | you (and can't be tossed and replaced when you find out
               | your "fix" caused other issues, which happens almost
               | every time the pharma industry provides shortcuts for
               | people). Doing it this way also moves your demand as a
               | consumer to the unbroken parts of the food supply, which
               | will help everyone else as food companies are
               | incentivized to cater to that instead of continuing on
               | with what they're doing.
        
               | toomuchtodo wrote:
               | If this is your belief, then you do not understand the
               | mechanisms by which GLP-1 agonists work. They silence the
               | signals in the brain craving the unhealthy foods in
               | question. You will never win against your brain
               | chemistry.
        
               | jacobgkau wrote:
               | "You will never win against your brain chemistry" is a
               | defeatist way to dismiss taking basically any action,
               | ever. People _selling_ you artificial solutions will, of
               | course, be incentivized to convince you that it 's true.
               | 
               | Humans lived for thousands of years (without the
               | widespread diet-related ailments we're seeing epidemics
               | of today) without artificially "fixing" their own brain
               | chemistry. This is not an internal medicine problem, it's
               | an external food supply and societal lifestyle problem.
               | 
               | If you want to say it's _too hard_ for you (you, only) to
               | do what 's required to not get sick and you'd rather rely
               | on medicine, fine. But it is actually insulting to
               | pretend like everyone needs a crutch just because you do.
               | The main thing is that the crutch should be a last
               | resort, and "willpower isn't a solution" should not be a
               | common mantra to push the crutch as the first option.
        
               | toomuchtodo wrote:
               | Is this why GLP-1s are so effective at scale and your
               | theory is not? We tried the silly will power way, that
               | did not work. We tried GLP-1s, and they clearly work
               | because industries are shifting because of it. If you
               | want to ignore data out of a belief system, that's a
               | choice. You believe the intervention is inferior to will.
               | But the evidence clearly shows the vast majority of
               | humans are assisted by an intervention versus "will
               | power" which does not work (gold stars to those who need
               | to feel better about themselves they don't need an
               | intervention).
               | 
               | I don't take GLP-1s, but I support getting them to
               | everyone who wants them and ignoring anyone who tries to
               | stop that, or says that is a lesser path for lesser
               | people. I hope you learn to give grace, because lucky
               | people are just lucky, not special.
        
               | jacobgkau wrote:
               | > We tried the silly will power way, that did not work.
               | 
               | They still work for plenty of people, just not you. They
               | _can_ work for more if we enable healthy diets and
               | lifestyles as a society.
               | 
               | And no, that's not a "gold star" to the people who were
               | able to literally have their "machine" work as designed.
               | It's rather a gold star for you to not acknowledge if you
               | needed artificial assistance to exist.
               | 
               | > Is this why GLP-1s are so effective at scale... We
               | tried GLP-1s, and they clearly work because industries
               | are shifting because of it.
               | 
               | None of the articles you cited in your earlier comment
               | address "scale" at all, nor provide evidence of "shifting
               | industries." Two of them address changes in the spending
               | patterns of high-income consumers who are already using
               | the drug (unrelated to the proportion of the total
               | population using the drug), and the third is a blog post
               | by a doctor literally selling GLP-1s as a miracle drug
               | ("It's getting to the point of wondering what GLP-1
               | agonists _aren 't_ good for"-- yikes).
               | 
               | Your most recent KFF link (which it looks like you
               | removed) claims 12% of adults have taken GLP-1 drugs
               | (going off of a single poll taken by a health-tracking
               | organization-- probably biased towards people actively
               | working on their health). If that number was true, it
               | would be alarming that over 10% of humans needed an
               | artificial fix for a problem created by the food industry
               | and socially sanctioned sedentary lifestyles, not
               | something to parade around like you've actually fixed the
               | underlying problem.
        
               | SoftTalker wrote:
               | Pharmaceutical companies would love for you to believe
               | that. They salivate over the idea that they can convince
               | you that you need their products for the rest of your
               | life. They aren't any different from the common street
               | dealer in many ways. They don't really care about your
               | health, only that you keep coming back.
        
             | KittenInABox wrote:
             | By this logic I, a person who has never been at risk of
             | financial insolvency partially due to my lack of consumer
             | addiction/upbringing with financial literacy, should be
             | insulted by someone who says that budgeting isn't a
             | solution to systemic poverty.
        
               | jacobgkau wrote:
               | No, by this logic, you _should_ be insulted by someone
               | saying paid professional accountants managing all of your
               | money is the _only_ way for society to avoid widespread
               | debt because  "most people" haven't managed to bring
               | themselves to do the basic at-home budgeting that you're
               | used to.
        
       | dotcoma wrote:
       | Really? I thought it was salad's fault.
        
       | siliconc0w wrote:
       | I'd bet a dollar per gram additive sugar tax in excess of 5g
       | would immediately flatten the chronic disease curve. Maybe double
       | that if it's marketed towards kids. There are a lot of problems
       | besides sugar/HFCS but it's easily towards the top of the list.
        
         | jopsen wrote:
         | Shops will just sell the sugar and the soda separately, mix it
         | yourself :)
         | 
         | Or people will pay more.
        
           | bitmasher9 wrote:
           | I bet adding the sugar yourself would reduce consumption
           | considerably. Which would be the goal of the tax.
        
             | llamaimperative wrote:
             | Unfortunately Internet people like to point out the
             | hypothetical 99th percentile person who would evade/be
             | immune to such incentives and suggest that therefore, it
             | would not be worth doing.
             | 
             | It's such a common and lazy pattern on HN :(
        
               | Someone1234 wrote:
               | When I read those, I don't actually think those people
               | believe their own arguments. They started with a
               | conclusion, like "sugar taxes are bad," and then worked
               | backwards to find an argument to fit it. That's why when
               | you challenge them they just shift the goalposts.
        
           | PaulRobinson wrote:
           | Not what has happened in the UK, where sugar tax has been a
           | thing since 2018. It's now actually quite hard to find a
           | sweetened drink - almost all soda-style beverages now are
           | "zero sugar", sweetened with artificial sweeteners. Nobody is
           | buying sugar and pouring it in. Nobody.
           | 
           | It's a little too early to determine if this has slowed the
           | prevalence of diabetes in the population. One problem is that
           | other studies have shown that drinking artificially sweetened
           | beverages with foods means many people end up eating more
           | calories of food - the brain is looking for calories
           | indicated by the sweet taste its not getting from the
           | beverage, so compensates.
           | 
           | It's a complex picture, but sugar taxes seem to be a
           | reasonable way to get sugary drinks off the shelves.
        
             | Melting_Harps wrote:
             | > It's a complex picture, but sugar taxes seem to be a
             | reasonable way to get sugary drinks off the shelves.
             | 
             | As a person who is indifferent to the prospect, I fail to
             | see why?
             | 
             | When I lived in the UK a lot of people who couldn't afford
             | real juice would buy 'squash' and drink it as a replacement
             | for juice. I personally found it entirely revolting and way
             | too sugary but on occasion used it in my teas to flavor
             | them: I just can't see why the consumer should be punished
             | with less options, or worse those made with things like
             | aspertame, then simply rely on the consumer to use said
             | product responsibly. I guess one can say with things like
             | the NHS the consequences are socialized, but even that is a
             | stretch as the British diet is a near mirror image of it's
             | American counterpart in it's wide use of highly processed
             | and refined foodstuff.
             | 
             | Besides, if you go to the smaller shops run by non-Anglo
             | merchants you will find every conceivable item you can
             | imagine: I personally think Turkish food has way too much
             | sugar in it's diet, but as I found out from our baker they
             | make the most amazing fruit syrups to make deserts with,
             | which incidentally make for good tea enhancers as well!
             | 
             | Again, maybe I'm just too biased given my lived experience
             | in this space, but nothing has yet to convince me that
             | price alone serves as a real deterrent to really solve this
             | issue, only an improved lifestyle choice where those
             | calories get effectively used end up really solving the
             | core issue.
        
               | frameset wrote:
               | > When I lived in the UK a lot of people who couldn't
               | afford real juice would buy 'squash' and drink it as a
               | replacement for juice. I personally found it entirely
               | revolting and way too sugary
               | 
               | Are you aware that you're supposed to dilute squash to
               | taste? It's just concentrated juice. If it's too sweet,
               | you haven't added enough water.
        
             | protimewaster wrote:
             | Last time I was in the UK, nearly everywhere that sold soda
             | offered the full calorie, full sugar version of Coke. Pepsi
             | and other drinks were often only available in lower or zero
             | sugar, but Coke was almost always available in the full
             | sugar version, for some reason.
        
               | Someone1234 wrote:
               | It is a choice manufacturers made.
               | 
               | Pepsi and Dr. Pepper decided to go lower sugar with
               | supplemental artificial sweeteners to keep their price
               | down, whereas Coca-Cola kept the original formula, but it
               | costs more.
               | 
               | To put figures to this:
               | 
               | - Pepsi (11g sugar per 250 ml): 8.8p/100ml
               | 
               | - Dr. Pepper (11g sugar per 250 ml): 10.0p/100ml
               | 
               | - Coca-Cola (27g sugar per 250 ml): 14.2p/100ml
               | 
               | "full sugar" Dr. Pepper also contains: Aspartame,
               | Acesulfame K
               | 
               | "full sugar" Pepsi contains: Sucralose, Acesulfame K
               | 
               | So after the sugar tax some people moved to these hybrid
               | drinks whereas others just moved whole-hog to Pepsi Max
               | and Diet Dr. Pepper which are commonly cheaper and have
               | the same aftertaste as their "full sugar" variants.
        
             | amluto wrote:
             | It would be interesting to see the effect of a _sweetness_
             | tax. See if the manufacturers can make desirable beverages
             | that don't taste so sweet (and don't have whatever effect
             | triggering sweetness receptors so intensely has).
        
               | scotty79 wrote:
               | In Poland there's a tax for both sugary and artificially
               | sweetened drinks since 2021. Also caffeine and taurine.
               | 
               | In one year the effect for beverages over all was 36%
               | raise in proce and 20% drop in sales. Surprisingly sales
               | of energy drinks rose by 4%.
               | 
               | In two years 60% of beverages altered their ingredients.
               | Tax income was less than you expected.
        
           | skeeter2020 wrote:
           | they'll optimize the packaging to help you out. My mom tells
           | me about how margarine used to come with a yellow color
           | packet to mix into your white spread. The dairy board lobbied
           | to make it illegal to sell yellow margarine because "it looks
           | like butter". Didn't seem to hurt Oleo much...
           | 
           | https://www.cbc.ca/archives/when-consumers-had-to-diy-for-
           | th...
        
           | sushid wrote:
           | Both would reduce demand so a sharp drop off would still be
           | fairly realistic. Of course, getting anything done at the
           | federal would be impossible in the US today.
        
         | Melting_Harps wrote:
         | > I'd bet a dollar per gram additive sugar tax in excess of 5g
         | would immediately flatten the chronic disease curve. Maybe
         | double that if it's marketed towards kids. There are a lot of
         | problems besides sugar/HFCS but it's easily towards the top of
         | the list.
         | 
         | It doesn't, it doesn't even discourage the purchases unless
         | (perhaps?) universally adopted: Boulder, CO has had a sugar tax
         | for a while now, and all it does is punish not curtail the
         | consumer: often the poorer ones most as it accounts for a
         | larger part of their income/wages. If they are so motivated
         | they continue to buy said sugary drink at an inflated price
         | with no benefit, or simply go 6 miles out of town and purchase
         | in bulk if they are committed to said behaviour. I've seen it
         | all too often,and have even managed to 'hack' the system by
         | buying things that contain sugar but somehow flew under the
         | radar (San Peligrino fruit flavored sodas).
         | 
         | It's all just window dressing and shows just how poorly
         | educated the average consumer is in measuring the necessary
         | caloric intake relative to their lifestyle(s), but perhaps more
         | importantly how food has been weaponized, mainly in the US,
         | which has a direct correlation to type 2 diabetes being so
         | prevalent in the first place.
         | 
         | It's hard to blame either or entirely, but I'd saw its a 30:70
         | with the former and latter respectively.
         | 
         | The truth is I stopped drinking soda after peaking in my early
         | 20s to late teens, I still have a relatively fast metabolism
         | and an active lifestyle to supplement it, but the feeling you
         | get from the sugar high of continued use has gone from
         | energizing back then to feeling ill for hours now.
         | 
         | I occasionally drink soda with specific meals, often for
         | nostalgia to this day, but its hardly a daily or even weekly
         | thing for me anymore.
         | 
         | Ultimately, if your reasoning/logic were true we would see a
         | dramatic drop in fast food consumption due to the higher prices
         | but that simply isn't the case and corps in the fast food
         | industry are reporting record profits YoY in this market
         | despite the increase in price.
         | 
         | I see food the same way I see drugs at this point, both in
         | excess or when misused can be incredibly dangerous, the best a
         | Society can do is to safely regulate and educate it's populace
         | in the pros/cons usage of both: nothing will stop a person from
         | seeking or abusing either if they so desire. And its is a
         | larger loss in agency for said Society to pretend it can as it
         | often leads to draconian measures with no meaningful or
         | effective outcome (eg sugar tax).
         | 
         | In fact having worked in all aspects of the food industry from
         | farm to table for a significant portion of my life, restaurant
         | culture and the art of cuisine/gastronomy wouldn't even be a
         | thing if it weren't for the debauchery and the unruly excess of
         | the clientele who were ready and willing to drop up to a day's
         | wage on a meal(s) and accompanying alcohol were it not for the
         | 'uninhibited decadence'a of the consumer.
        
           | adamc wrote:
           | I would expect it to work badly whenever a person could
           | easily cross a boundary. In larger cities -- say, New York --
           | it would suffer similar, but fewer, problems simply because
           | the average effort of getting outside the city would be
           | higher.
           | 
           | You see this between states when tax regimes differ. Sure,
           | those who live near the border "cheat". But most people live
           | far enough away that they are affected by the tax.
           | 
           | There is lots of counter-evidence to your propositions,
           | notably involving the effect of raising prices on cigarettes,
           | which _does_ discourage smoking.
        
           | taeric wrote:
           | I'm curious if you have data showing this? Last I heard,
           | which a quick google seems to back up, is that Seattle's
           | similar tax had modest benefits.
           | (https://sph.washington.edu/news-events/sph-blog/sugar-
           | sweete...) Took a brief look to see if there were strong
           | challenges to this, but I didn't find anything.
        
       | caseyy wrote:
       | If A causes diabetes, then it causes C outcome of diabetes. It's
       | a tautology.
       | 
       | ((A - B) [?] (B - C)) - (A - C)
        
       | neom wrote:
       | Interesting. I think folks in the comments here maybe missed this
       | paper is way more about the beverages part making it important.
       | The research is around sugar sweetened beverages (SSBs). If I'm
       | reading it right, the SSBs have a differentmetabolic effect.
       | 
       | "Due to their liquid form, SSBs are rapidly consumed and
       | digested, resulting in lower satiety, higher caloric intake and
       | weight gain. High doses of rapidly digested glucose also activate
       | insulin and other regulatory pathways, which can result in
       | visceral fat production, hepatic and skeletal muscle insulin
       | resistance and weight gain. High doses of rapidly digested
       | fructose directly activate hepatic fat synthesis, leading to
       | ectopic fat deposition and metabolic dysfunction in liver and
       | muscle"
       | 
       | Unfortunately I can't find where they define high dose, but if
       | you look at what they say is high elsewhere, it seems to be
       | around 9 servings a week of "any beverage with added sugars and
       | >50 kcal per 8 oz serving, including commercial or homemade
       | beverages, soft drinks, energy drinks, fruit drinks, punch,
       | lemonade and aguas frescas." - A can of coke is 12oz I believe?
        
         | KittenInABox wrote:
         | I'm curious what is the number of added sugars and above 50kcal
         | peer 8 oz serving. You can get away with saying fruit drinks
         | have no added sugar and still be insanely sugary.
        
           | athenot wrote:
           | Fruit drinks have a neat trick to increase sugar content.
           | Take apple juice for example: you can evaporate water out of
           | it till it's a sugary syrup, then add it to regular apple
           | juice, and it's still called "100% pure apple juice no sugar
           | added".
           | 
           | (This is also done with various flavor essences from the
           | juice, so they can recombine them in such a way as to produce
           | a uniform flavor all throughout the year regardless of where
           | the fruits are coming from.)
        
             | ricardobeat wrote:
             | Not in the EU:
             | 
             | > It should be clearly indicated when a product is a
             | mixture of fruit juice and fruit juice from concentrate
             | 
             | https://eur-lex.europa.eu/legal-
             | content/EN/TXT/?uri=celex%3A...
        
               | criddell wrote:
               | Are you saying that they couldn't say "100% fruit juice
               | and no sugar added" on the label when the drink is a
               | mixture of fruit juice and fruit juice from concentrate?
               | What part of the regulation would prohibit this?
        
               | pjerem wrote:
               | You can say "no added sugar" but you are forced to write
               | it's from a concentrate and it must be in the front of
               | the product, not hidden somewhere.
               | 
               | Not perfect but at least you can't just say it's fruit
               | juice.
        
         | trod1234 wrote:
         | All carbohydrates eventually break down into sugars. Some quite
         | a bit faster than others.
         | 
         | What people and scientists haven't been saying in any
         | meaningful way is the truth that carbohydrate poisoning is a
         | real thing. If you eat too much, its harmful.
         | 
         | Its common knowledge that medicines may become poisons when
         | taken in too high amounts. This applies to most things in this
         | area.
         | 
         | Protein poisoning is fairly easily discovered in the scientific
         | literature, why isn't carbohydrate poisoning? Its a conundrum.
        
           | fwip wrote:
           | Scientists aren't saying it because it's not true.
        
           | hombre_fatal wrote:
           | You don't think the scientific literature has anything to say
           | about sugar surplus or junk food surplus?
           | 
           | Carbohydrate poisoning sounds nonsensical though. Too many
           | potatoes and whole grains, for example, aren't poisoning you.
           | More people should be replacing junk food with those things.
           | 
           | It's just a fad to use "carbs" as a euphemism for "junk food"
           | and it only further confuses the discourse about nutrition.
        
             | bityard wrote:
             | I've noticed that people who want to deny that the
             | extremely high carbohydrate content of the typical western
             | diet is the major factor for runaway rates of diabetes and
             | cardiovascular disease like to label the "bad" food as
             | "junk food" or "ultra-processed food." But we never get an
             | explanation from them as to what exactly is IN the junk
             | food or ultra-processed food that causes the disease.
        
               | hombre_fatal wrote:
               | Well, I can answer that.
               | 
               | It's not always about a certain boogeyman inside it, but
               | whether it makes it easy to overeat and whether it pays
               | its rent in nutritional content.
               | 
               | Consider potato chips. Even if they have zero saturated
               | fat, the issue most people have with them is that they
               | are hyperpalatable and low nutritional value compared to
               | their calorie density. Combine fat and salt and certain
               | textures, and we can't stop ourselves. Trying to blame a
               | macronutrient like carbs doesn't make much sense to me.
               | 
               | Add in bad ingredients like saturated fat and the problem
               | becomes multifaceted, but it's not necessary for
               | individual ingredients to be bad for us for a food to
               | have its downsides.
        
           | nonameiguess wrote:
           | Protein poisoning happens because your body has a limited
           | capacity to process protein. It's very high and you're
           | unlikely to hit it, but it's happened to people living off
           | the land and eating nothing but lean meat. Carbohydate
           | processing is not inherently rate-limited like that. How much
           | you need is dictated by how much you use. Even the stated
           | numbers here about 9 weekly 8 oz drinks with 50 kcals or more
           | per serving is comically miniscule compared to what is
           | ingested with no ill effects by any serious endurance athlete
           | who actually needs and uses that much energy. Carbohydrate
           | only has a deleterious effect when you ingest more than you
           | use, which is not characteristic of a poison.
        
         | athenot wrote:
         | About 15 years ago, I stopped drinking soda. Not out of a
         | desire to be healthy or loose weight but simply because it
         | dawned on me that for the same amount of sugar in one soft
         | drink that I drink without any afterthought, I could enjoy a
         | really good pastry that I can slowly savor.
         | 
         | I do the same for fats. The way I look at it, I want to
         | maximize the "enjoyment per kcalorie". :)
         | 
         | More recently, I'm starting to apply this to meat as well. I
         | really enjoy meat, but I'm not one for quantity since I'm on
         | the skinnier side. So I'm trying to enjoy meat more, and in
         | doing so, get better quality, prepare it better, etc. while at
         | the same time eating less of it. This is still a work in
         | progress, and eating in restaurants can be challenging as they
         | usually favor quantity over quality--except for the very high-
         | end & costly places.
        
         | exhilaration wrote:
         | So taking myself as an example: I drink 12 oz of coffee daily
         | (7 days per week), and I add exactly 12 grams of table sugar to
         | my coffee each day (equivalent to 3 sugar packets), which is 45
         | calories. Seems like I don't have much wiggle room and should
         | continue avoiding soda and juice.
        
           | brailsafe wrote:
           | I'll be the guy that I assume most people are sick of by this
           | point, and recommend experimenting with dropping the
           | additives in exchange for higher quality coffee if you can
           | afford it (it's usually not much more per cup). At
           | effectively zero calories, after some period of time you'll
           | get used to it and recalibrate your sense of sweetness to the
           | point where sugary drinks and coffee are much less palatable
        
             | SoftTalker wrote:
             | I honestly can't tell much difference between expensive
             | coffee and Maxwell House. But in general I've never nerded
             | out over coffee, wine, bread, cheese, whiskey, or any other
             | food or beverage.
             | 
             | I don't add sugar to my coffee either.
        
               | cwbrandsma wrote:
               | I can easily tell the difference between the two, but I
               | really don't care so long as the coffee is brewed well. I
               | still like Maxwell House Black Silk, but at home I grind
               | my own beans and brew in a French Press.
               | 
               | What I don't like is "Church Coffee", where it has brewed
               | within an inch of its life and is the darkest, most
               | bitter/burned flavor that ever existed.
        
               | znpy wrote:
               | Cheese is worth it, a bit. First because it's way leas of
               | a bullshit industry when compared to wine for example,
               | and also because (particularly if you're in europe) there
               | is so much variety of cheese at overall an affordable
               | price. And you largely don't need tools or fancy
               | accessories. If anything, you could get something nice to
               | paid it with :)
        
             | vasco wrote:
             | You can either get better coffee or you can also just get
             | used to the flavor. I didn't like it and after about a year
             | it became fine, now I have a lifetime of no sugar coffee
             | unlocked.
        
             | wil421 wrote:
             | Just to add a bit, we bought a Breville espresso and
             | grinder. I only use some whole milk to make my coffee and
             | no sugar. My wife uses a little agave syrup and skips most
             | of the milk.
        
             | GeekyBear wrote:
             | I'll chime in to agree that it does take some time to get
             | used to it, but after the transition period you don't miss
             | it.
             | 
             | Giving up sweetened drinks and learning to cook healthy
             | foods from scratch have been my most effective lifestyle
             | changes.
        
           | m3kw9 wrote:
           | Learn to drink it black, it's good. But I do get beans and
           | grind them so the brew is much higher quality. I'm assuming
           | you drink that can of grinds for 3 bucks or instant. Those
           | suck
        
         | dfltr wrote:
         | "Sugar: The Bitter Truth" (https://robertlustig.com/sugar-the-
         | bitter-truth/) is a pretty long watch, but it's incredibly eye-
         | opening in terms of explaining in detail exactly why our
         | current dietary sugar intake is so damaging to our bodies.
         | 
         | Note: Robert Lustig is a professor of pediatric endocrinology
         | at UCSF, I promise I wouldn't ask you (the reader) to watch a
         | long-ass youtube video unless it contained extremely relevant
         | science about how you (the biological machine) work.
        
         | xboxnolifes wrote:
         | I'm always glad for more hard evidence, but this exact
         | reasoning has been "common sense", or something to that tune,
         | my entire life. Maybe not every individual resulting issue, but
         | that liquid sugar absorbs more rapidly and as such is worse
         | that an equivalent amount of sugar in a more solid meal.
        
         | Hilift wrote:
         | Orange juice is high in sugars. Drinking any alternative
         | beverage with a lot of sugar is bad for your health. I believe
         | a 12 ounce glass of orange juice is 100% of maximum sugar
         | intake for one day. If you drank orange juice the same way you
         | drank soda with added sugar, the health effect would be equally
         | detrimental.
        
       | busyant wrote:
       | I know several people who've undergone bariatric surgery.
       | 
       | One of the post-surgery 'rules' is ... "Don't drink your
       | calories."
        
       | pelagicAustral wrote:
       | I only ever drink coke when I'm mixing with whisky... not sure
       | which one is worse...
        
         | hilux wrote:
         | The Coke is definitely worse, unless you're flying an airliner,
         | of course.
        
         | schroeding wrote:
         | Same, but with rum. Just doesn't work as well with the diet
         | stuff for some reason, too.
         | 
         | Classic coke + Cuban rum + lime == very good time. :D
        
       | hilux wrote:
       | It's "good" that this is in Nature, but does any health-aware
       | person not already know this?
       | 
       | Our real problem is that most people aren't health-aware, and
       | advertising (including the pharma-funded healthcare system)
       | absolutely overwhelms common-sense truths about health.
       | 
       | Over the past few years I have improved my own health by greatly
       | limiting my intake of sugars, including by cutting out "healthy"
       | smoothies, but I learned all this from Dr Internet, and NOT from
       | any physician who was being paid to treat me. US physicians'
       | knowledge of nutrition is stuck at whatever they were taught in
       | med school, which was probably 20+ years behind the research _at
       | that time_.
        
         | pama wrote:
         | The HN title shortening is a bit misleading. The paper
         | systematically analyzes the burden of this known effect on 184
         | countries.
        
       | xnx wrote:
       | There is almost nothing* like sugar drinks in the natural world
       | our bodies evolved in. Sugar drinks are about as different as tea
       | leaves and pure cocaine. It's is no coincidence that both are
       | refined white powders.
       | 
       | *honey
        
         | ricardobeat wrote:
         | I take it you haven't tried a nice ripe mango from subtropical
         | regions, or a pineapple, white grapes (or grape juice),
         | watermelon, navel oranges? They can be sweeter than Dr. Pepper.
         | 
         | Sugarcane also exists and you can chew it.
         | 
         | They just tended to 1) come with fiber, 2) not be as easy to
         | acquire or eat in large quantities 3) not available all year,
         | or all at once
        
           | Ensorceled wrote:
           | This is nonsense:
           | 
           | 100g of mango has 14g of sugar
           | 
           | 100g of watermelon has 6.2g of sugar
           | 
           | 100g of navel orange has 12g of sugar
           | 
           | 100g of sugar has 100g of sugar, 1 can of Dr Pepper has 40g
           | of sugar
           | 
           | It's both pure sugar AND more sugar. You have to eat more
           | than half a pound of mango to get to the same sugar as a Dr
           | Pepper.
        
       | tpoacher wrote:
       | "Tendency to manifest consumption of sugar beverages attributable
       | to predisposition to type 2 diabetes and cardiovascular disease."
       | 
       | Hm. I thought the "switcheroo test" would create an obviously
       | false "what if" statement in this case, but not so sure.
        
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