Tuesday, October 04, 2011

The rotten truth: Why 'fruit sugar' is one of the most damaging ingredients in our food (?)

There is a rehash of the old fructose scare below but most of the research appears to be epidemiological. I can see no evidence of harm from double-blind studies. That the most naturally-occurring form of sugar is bad for you seems crazy. It's amusing the number of bad things it is said to cause. See here, here and here for some skeptical articles

Sweet, cheap and natural — fructose sounds like the ideal ‘healthy’ sweetener. However, the sugar, which is found naturally in fruit but is now added to many processed foods, may hide a range of deadly secrets.

Scientists are discovering that fructose appears to be linked to serious modern epidemics such as cancers, heart disease, hypertension, kidney damage and even dementia.

The latest fears were raised last week by research that found people who consume lots of fructose by drinking fruit juice have an increased risk of rectal cancer. The research, published in the Journal of the American Dietetic Association, suggests that the high content of fructose in processed fruit juice may be the trigger.

The problem, the researchers say, is that many substances found in fruit which help protect against bowel cancer — such as fibre, vitamin C and other antioxidants — are lost during processing.

There have been other concerns about the fructose content of fruit juice. Earlier this year, scientists at Bangor University warned that even freshly-squeezed juice contains up to five teaspoons of fructose per glass, which may lead to weight gain or even diabetes.

The British Dietetic Association says that because of this we should drink only one 150ml glass of juice a day. It warns: ‘Although fruit juice is natural, it has had all the fibre squeezed out of it and so the fructose is easily absorbed into the bloodstream.’

If only keeping one’s consumption of fructose down to safe daily levels were that straightforward. Nowadays, fructose is cropping up not just in fruit juice, where it occurs naturally, but in all sorts of foods and drinks — from biscuits to ice cream.

Most consumers wouldn’t know: it can be listed in the ingredients under a variety of names. The most common name for industrially produced versions is high-fructose corn syrup. It is a processed form of fructose derived basically from corn.

In the UK, it is replacing beet and cane sugar, because it’s cheap and keeps foods moist, boosting shelf life. It adds texture to food such as cereal bars and biscuits, making them chewy, and thickens ice cream and yoghurt drinks.

High-fructose-corn syrup is used in frozen products, too, as it reduces crystallisation. Another benefit is that it turns baked products an appetising brown, so you can often find it in cakes, pastries and bread rolls, crackers and cereals.

It’s easy to see why manufacturers of food and drink love corn syrup — and are using so much of it. A low-fat, fruit-flavoured yoghurt, for instance, can harbour ten teaspoons of the fructose-based sweetener in one pot. A can of soft drink can contain as much as 13 teaspoons.

Scientists are now growing increasingly worried about fructose syrup’s health effects, because although it contains around the same number of calories as cane sugar, the body does not metabolise fructose syrup in the same way. It places a far greater load on the liver, which, in turn, prompts a range of problems, including raised levels of fat in the bloodstream.

In August, a U.S. study published in the Journal of Clinical Endocrinology & Metabolism found that adults who consumed high fructose corn syrup in fizzy drinks for two weeks as 25 per cent of their daily calorie requirement had increased blood levels of cholesterol and fats called triglycerides, which are linked to an increased risk of heart disease.

Fructose may also cause liver damage, the U.S. study found. As Dr Kimber Stanhope, who led the study, explains: ‘Fructose overloads the liver. It then gets turned into liver fat, which then increases blood triglycerides, cholesterol and the risk of cardiovascular disease.’

She adds that fructose may also increase the risk of diabetes in this way. ‘The extra liver fat may cause the increased insulin resistance we see in people consuming fructose.’ Insulin resistance is linked to a higher risk of diabetes.

Fructose may also make you more prone to obesity. For example, laboratory research by Princeton University this year concluded that ‘long-term consumption of high-fructose corn syrup resulted in abnormal increases in body fat, especially in the abdomen’. Such abdominal fat may raise your risk of heart disease and stroke.

Professor Bart Hoebel, who led the study, says: ‘Some people have claimed that high-fructose corn syrup is no different to other sweeteners when it comes to weight gain and obesity, but our results make it clear that this just isn’t true.’

High blood pressure is another danger, say researchers at Imperial College, London. The study, published in the journal Hypertension earlier this year, showed that people’s blood pressure rose significantly for every extra sweetened drink they consumed per day.

Dr Ian Brown, one of the researchers, says fructose may reduce nitric oxide levels in the bloodstream. This chemical is vital for keeping blood vessels healthily dilated.

Professor Richard Johnson, who led the University of Colorado study, was moved by the seriousness of this result to declare: ‘Excessive fructose intake should be considered an environmental toxin with major health implications.’

Perhaps even more worrying, research by Cambridge University suggests fructose may be helping to fuel rising levels of dementia.

Laboratory studies have linked high intakes of fructose with the formation of beta-amyloid plaques in the brains of animals. These plaques are frequently seen in people with Alzheimer’s.

In the U.S., concerns over risks of high fructose corn syrup have led to it being branded ‘the devil’s candy’ — even Michelle Obama has declared she doesn’t want her daughters eating it.

In response, its makers, the Corn Refiners Association, are trying to rebrand high fructose corn syrup as ‘corn sugar’. This attempt to camouflage the product has prompted a high-level legal case in the U.S. courts —launched by makers of traditional cane-sugar sucrose who don’t want to be sullied by high-fructose corn syrup’s worsening reputation.

However, British health authorities seem unworried and unwilling to accept responsibility. The Food Standards Agency says: ‘The syrup is not classed as an additive. It’s just thick sugar. It’s not even classed as a novel food, so it is an issue about nutrition rather than food safety.’ The agency says any food-safety concerns should be the Department of Health’s responsibility. But the latter says the former should be regulating it.


Is an obsession with natural birth putting mothers and babies in danger?

There is no doubt that for most women in this country, childbirth remains a safe and happy experience. But it is also true that for too many, it is a highly risky and frankly horrific experience.

Stories abound of mothers-to-be left alone in labour, sometimes refused pain relief or surgical intervention, putting their babies’ health or even lives in danger.

The statistics make grisly reading: an average of 11 babies are stillborn every day in NHS hospitals, according to research published recently in The Lancet.

Unlike other high-income countries, it’s a figure that has remained largely unchanged over the past ten years — putting Britain on a par with Belarus and Estonia.

More than £27 million in compensation was paid in 2008 by London hospitals alone for childbirth cases. Indeed, a shocking 60 per cent of all payments made by the NHS Litigation Authority relate to obstetrics.

In June this year, an unprecedented police investigation was launched into the deaths of five babies and two mothers at Furness General Hospital in Cumbria. And last weekend it was revealed another baby’s death at the hospital is also to be looked into. So what is going on?

Midwives point to an understaffed, overstretched system dealing with both a rising birth rate and a growing number of more complicated deliveries as a result of obesity, older mothers and multiple births.

The Royal College of Midwives warned last week that existing ‘massive midwife shortages’ will soon worsen as maternity hospitals face ‘falling budgets and pressure to cut staff further, despite a rapidly rising birth rate’.

Yet experts are far from convinced that falling budgets and staff shortages are the only reason for the obstetric scandals that have mired the reputation of UK maternity healthcare. Take the tragic case of 26-year-old health care assistant Liza Brady, whose son Alex was delivered in September 2008 stillborn at Furness General with the umbilical cord wrapped tightly around his neck.

At 11lb 13oz, Alex was exceptionally large, yet midwives refused her request for a Caesarean — despite this having been suggested by a consultant obstetrician whom she saw during her pregnancy. During a long and painful labour, the midwives persistently refused her plea to be seen by a doctor and delayed the delivery even though the machine monitoring the baby’s heart showed he was in distress. ‘A doctor offered to help as he came on duty, but he was shooed away by the midwives who said he wasn’t needed,’ recalls Liza.

Prabas Misra, an obstetrician and gynaecologist at the hospital, was so appalled by Liza’s care that he expressed ‘grave concerns’ about her case in a letter to hospital colleagues. He condemned as ‘indefensible’ the midwives’ claim that the foetal heart rate had been normal, since they’d admitted being unable to pick up the heart rate because of positioning of the monitor.

Summing up, Mr Misra wrote of ‘the risk of trying to make every labour and delivery normal and natural, and not thinking laterally (about) possible complications. I am all for having a natural childbirth — but not at any cost’.

Although talking about a specific case, Mr Misra has put his finger on an issue at the root of the problems in obstetrics today: the dangerous myth, promulgated by some midwives, that natural childbirth is not only the kindest form of delivery but also invariably the safest.

For years, the prevailing view among some leading figures in midwifery was that obstetricians were little better than trouble-makers. They were seen as over medicalising the natural process of childbirth, slowing down labour with their foetal heart rate monitors, and so increasing the risk of complications. It became something of a turf war.

‘These people need a job to do — and, too often, it’s taking over from the midwives and reducing their autonomy,’ said Professor Caroline Flint, a former president of the Royal College of Midwives as she opened a new midwife-led unit in 1997.

Yet while public attitudes might have changed — as seen in the rise in the numbers of women asking for Caesareans — this view that natural delivery is the only way is still influential in the midwifery world.

The NHS Institute for Innovation & Improvement’s guidance for midwives, for instance, instructs them to ‘focus on normal birth and reduce the Caesarean rate’. Doctors, it says, should ‘only enter the room of a labouring woman when asked to review (the patient) by a midwife’.

And despite objections from obstetricians, the RCM’s high-profile Campaign For Normal Birth has the slogan: ‘Intervention and Caesarean shouldn’t be the first choice — they should be the last.’

James Drife, a retired obstetrician and Professor of Obstetrics and Gynaecology at Leeds University, comments: ‘It’s difficult to see exactly who the RCM is campaigning against. Every woman would like a normal birth, but the real fear is of a bad outcome.

‘To prevent that happening, we need co-operation between all the professionals in the obstetric team, rather than campaigns about which treatment is best. Without such co-operation, there is a far greater risk of mistakes being made.’

Gill Edwards, a leading clinical negligence solicitor with the firm Pannone, is in no doubt why these fatal mistakes continue. ‘Too often, we see a desire for autonomy, sometimes verging on arrogance, on the part of some midwives,’ she says. ‘It leads them to ignore National Midwifery Council rules that require them to call on the skills of other health professionals whenever something happens which is outside their sphere of practice.’

Of course, the vast majority of midwives do a superb job and their professionalism is not comprised by rivalry with doctors or dogmatic views about natural birth. However, for a minority this is not always the case.

‘Some of our worst cases occur because the drive to achieve a “normal” delivery clouds the judgment of midwives about when to call in specialist help from an obstetrician, or for a paediatrician to be present at the birth to assist with resuscitation when there are signs of foetal distress during labour,’ says Ms Edwards.

Last month, NHS watchdog the Care Quality Commission highlighted the lack of ‘a joined-up approach to working together’ as a major risk factor at Furness General Hospital. The coroner who looked at Alex Brady’s death put it more simply: ‘I don’t believe the doctors integrated. The midwives ran the show.’

The criminal investigation into the hospital was launched after a coroner’s report on the death of ten-day-old Joshua Titcombe in July 2008 as a result of a serious lung infection.

The inquest had heard that his parents, Hoa and James, had urged midwives to treat their son for an infection for which Hoa had been given antibiotics — but were told there was no need for the baby to see a doctor.

The coroner’s report was damning, finding ‘no integration between the midwifery and paediatric teams’, alongside ‘a failure to record fully or at all many of the factors which, taken together, might have led to a greater degree of suspicion or a referral to a paediatrician’.

It wasn’t the first such case. In July 2008, Nittaya Henrickson and her newborn son, Chester, both died at the hospital after she suffered an amniotic fluid embolism, where fluid from the amniotic sac escapes into the mother’s bloodstream. It’s a leading cause of maternal death, but the baby normally survives provided it is delivered promptly by Caesarean.

At an inquest in July 2009, Chester’s father, Carl, described how he pleaded with the midwives to get a doctor after he felt his wife die in his arms — but was told she had only fainted and that no doctors were needed to deliver the baby.

But while the scale of the problems at Furness are unprecedented, the evidence suggests the nature of the problems is far from unique. Last month, Laura Newman, 21, told how her baby died, aged nine days, after being starved of oxygen during the birth at Sandwell Hospital in the West Midlands last December.

‘Not only was the midwife extremely rude and dismissive to Laura and her family, but when it was clear that something was wrong and the baby needed to be urgently delivered, the midwife ignored the warning signs,’ says Jenna Harris, of Irwin Mitchell solicitors, who is representing Laura.

Laura herself has urged ‘every expectant woman to make sure the midwife makes regular checks during labour. It doesn’t make any difference whether you had a healthy pregnancy or not; things can go wrong at the last minute.’

The failure by some midwives not to monitor the baby correctly is another major factor in baby injury and death. Some midwives are resistant to monitoring in the belief it is another step to over-medicalising birth.

Electronic foetal monitoring is designed to provide healthcare professionals with continuous information on the foetal heartbeat and uterine contractions. It is seen as a major defence against stillbirth or neurological damage.

Yet mistakes made in the use of the technology are a major contributing factor to babies being damaged during birth (leading to cerebral palsy and other problems) or dying, says Edwin Chandraharan, senior consultant obstetrician at St George’s Healthcare NHS Trust, London.

Mr Chandraharan recently pointed out: ‘A 1997 report highlighted that substandard care, especially with regard to CTG (cardiotocography or fetal monitoring) contributed to over 50 per cent of deaths during labour and birth. Unfortunately, more than decade later, (there is) a continuing problem of CTG misinterpretation.’

Last year, the Birth Trauma Association made a Freedom of Information request about obstetric cases going through the courts, and found that of 1,040 cases a large proportion related to failure to monitor the baby properly during labour.

‘While there are excellent maternity services, there are also some that are fragmented, dysfunctional and occasionally unsafe,’ says the association’s Maureen Treadwell. ‘For instance, despite evidence to the contrary, some midwives still believe using electronic monitoring on women considered to be at risk during childbirth is unhelpful because it makes medical intervention more likely. Simply having more midwives won’t change that.’

So what will? A start could be universal acknowledgement that no matter how much a woman longs for a normal delivery, ‘things can go wrong at the last minute’ — as Laura Newman put it.

And that recognition needs to start with antenatal information provided by midwives, which, according to Mrs Treadwell, is too often too rosy. ‘Women have the right to honest, objective information of what can go wrong, and what their choices are, and midwives have an ethical duty to provide that information,’ she says.

Such assessments have to be evidence-based. ‘Some midwives still suggest it’s equally safe to have a normal delivery with a breech baby, even though the evidence Caesareans are safest for breech births is overwhelming.’

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