Is it possible to control sugar consumption?

Ice cream and fried bananas. (Dr. Noorali Bharwani)
Ice cream and fried bananas. (Dr. Noorali Bharwani)

I call sugar a sweet slow poison, a weapon of mass destruction. We use the poison on ourselves, our families and our friends, but not on our enemies.

It is reported the North American diet contains about 20 per cent sugar. This is equivalent to 30 teaspoons a day! Most of it is hidden in different kinds of juices and food. The major sources of added sugars are in beverages, desserts, sweet snacks, sweetened coffee, sweetened tea and candy.

Like alcohol, sugar has no nutritional value. It has no vitamins, minerals or fiber.

North American children’s consumption of sugar per day is reported to be between 25 to 35 per cent of total calories. The World Health Organization recommends daily dietary sugar intake of no more than 10 per cent of total calories.

Consumption of excess sugar raises blood pressure and makes us overweight. Our risk of becoming diabetic increases and it damages our liver by causing fatty liver. There is increased risk for heart attack and stroke.

Several provinces in Canada have imposed extra tax on sweetened beverages. A new tax on sugary drinks sold in Newfoundland and Labrador has come into effect since September. This is Canada’s first per litre sugar sweetened beverage tax.

In Ontario, anyone who buys sugar-sweetened beverages including energy drinks, iced teas and pop will pay an extra 20 cents per litre in sales tax. Quebec has some laws as well. Around the world about 40 nations have imposed beverage tax.

Should Canada have nationwide beverage tax?

A new University of Alberta study suggests Canada could save $2.5 billion a year if everyone followed international guidelines for sugar intake. That would mean eating the equivalent of 2.2 Kit-Kats of sugar a day instead of our current three (The economic burden of excessive sugar consumption in Canada: should the scope of preventive action be broadened? By Liu et al Canadian Journal of Public Health volume 113, pages 331–340, 2022).

The article suggests increasing tax on sweetened beverages is not going to solve the problem. It says, “Public health interventions to reduce sugar consumption should therefore consider going beyond taxation of sugar-sweetened beverages to target a broader set of products, in order to more effectively reduce the public health and economic burden of chronic diseases.”

Is this possible? Sugar is hidden (for taste and preservation) in so many products that it makes the task of controlling sugar consumption almost humanly impossible. Just like controlling smoking, alcohol consumption, drug abuse, over-eating and obesity.

What’s the solution? Self-control is the only way. Here is a collection of some ideas. There is nothing new in the list. These are the things we all think about and talk about but forget to implement.

  1. Eat a healthy balanced diet with lots of fruits, vegetables, whole grains and proteins.
  2. Replace juice and sweetened drinks with sugar free options.
  3. Do not give kids pop or juice outside of meal times (stick with water).
  4. Check nutrition labels.
  5. Government should tax all sugar-containing foods and use the funds to promote healthy eating and good health.

Sugar is one temptation we should do without! Do you think taxing sugar containing drinks and foods will change much?

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What do we know about vitamin B12 deficiency?

Victoria, British Columbia by night. (Dr. Noorali Bharwani)
Victoria, British Columbia by night. (Dr. Noorali Bharwani)

Even after more than 100 years, vitamin B12 (cobalamin) is still the subject of intense research.

Vitamin B12 plays an important role in red blood cell formation, cell metabolism, nerve function and the production of DNA. As we know, the function of DNA is to store all of the genetic information that a person needs to develop, function, and reproduce.

Vitamin B12 is also necessary for normal bone marrow and central nervous system function. The vitamin is absorbed in the distal ileum (where the small bowel joins the large bowel). Its absorption in the distal ileum requires intrinsic factor.

Where can you find intrinsic factor?

Intrinsic factor is a natural substance normally found in the stomach. Lack of intrinsic factor leads to vitamin B12 deficiency and pernicious anemia, and can cause brain and nervous system problems. There may be cognitive decline. There may be peripheral neuropathy. Quite often the presentation can be very suttle and potentially serious.

Vitamin B-12 deficiency is associated with dementia and low cognitive function, but it’s not clear whether vitamin B-12 supplements might help prevent or treat dementia.

The discovery of vitamin B12

“The discovery of vitamin B12, the elucidation of its role in metabolism, and the effects and treatment of its deficiency occurred in distinct phases over more than 100 years, and it was the subject of two separate Nobel Prizes,” says an article in Ann Nutr Metab 2012 (The discovery of vitamin B12 – authors Scott and Molloy).

The next advance was made with the discovery that a gastric component, which was named intrinsic factor, was missing in pernicious anemia. Many years later, intrinsic factor was found to be a glycoprotein that formed a complex with vitamin B12, promoting its absorption through ileal receptors.

The article says vitamin B12 is still the subject of intense research and, in particular, its role in preventing some irreversible neurological lesions remains unclear.

The incidence of vitamin B12 deficiency increases with age. The condition affects five to 20 per cent of adults older than 60 years.

The main source of vitamin B12 is animal-based foods such as meat, fish, eggs, and dairy products. In addition, some vegetable-based foods have been fortified with vitamin B12.

Individuals who do not consume these foods are more susceptible to vitamin B12 deficiency.

Other common causes include autoimmune gastritis (which causes pernicious anemia), malabsorptive states (e.g., pos-gastrointestinal surgery), and certain medications like metformin, proton pump inhibitors and histamine-2 receptor antagonists.

Managing B12 deficiency

The recommended daily amount of vitamin B12 for adults is 2.4 micrograms. Most people get enough of it from a balanced diet.

But it is important to recognize that certain segment of the population is vulnerable to be B12 deficient. If left untreated, vitamin B12 deficiency can lead to anemia, fatigue, muscle weakness, intestinal problems, nerve damage and mood disturbances.

All people over 65 years of age who are malnourished, all people in institutions or psychiatric hospitals, and all people with hematological or neuropsychiatric symptom should have their serum B12 levels measured.

Older adults, vegetarians, vegans and people who have conditions that affect their ability to absorb vitamin B12 from foods might benefit from the use of oral supplements.

Vitamin B12 supplements also are recommended for women who are pregnant or breastfeeding. Vitamin B12 is transferred through the placenta to the fetus during pregnancy and through breast milk after birth. Infants who drink breast milk from a mother who consumes adequate amounts of vitamin B12 or infants who drink infant formula, will receive enough vitamin B12.

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Why is PSA test so controversial?

Echo Dale Regional Park in Medicine Hat, AB. (Dr. Noorali Bharwani)
Echo Dale Regional Park in Medicine Hat, AB. (Dr. Noorali Bharwani)

Prostate cancer remains the most commonly diagnosed non-skin cancer among Canadian men and is the third leading cause of cancer-related death.

The natural history of prostate cancer ranges from a potentially inconsequential course to a fatal disease. Doctors continue to grapple with the question of how to identify those with clinically important disease while avoiding overdiagnosis and overtreatment, says an article in the Canadian Medical Association Journal (CMAJ October 24, 2022 194) written by Kikachukwu et al.

History of PSA (prostate-specific antigen) test

T. Ming Chu, PhD, DSc, Chair Emeritus of Diagnostic Immunology Research and Professor Emeritus of Urologic Oncology, led the research in the 1970s that resulted in the discovery of PSA and the development of the PSA test.

PSA test was originally approved by the FDA (Food and Drug Administration in U.S.) in 1986 to monitor the progression of prostate cancer in men who had already been diagnosed with the disease. FDA approved PSA as a screening test seven years later.

Even after 30-years, why is PSA screening test controversial?

Using the PSA test to screen men for prostate cancer is controversial because it is not yet known for certain whether this test actually saves lives. Moreover, it is not clear that the benefits of PSA screening outweighs the risks of follow-up diagnostic tests and cancer treatments.

The Canadian Task Force on Preventive Health Care (CTFPHC) recommends against routine PSA screening for men of all ages, but states that the greatest benefit from screening is likely in those aged 55–69 years.

The guideline identifies and reports the increased risk of prostate cancer among Black people, but does not provide specific guidance on managing this increased risk. The new guideline was published online on October 27, 2022 in the Canadian Medical Association Journal (CMAJ).

Research from the United States and Europe has shown the incidence and lifetime risk of developing prostate cancer among Black people are more than double than among their white counterparts (CMAJ October 24, 2022 194).

There is no doubt prostate cancer screening can help identify cancer early on, when treatment is most effective. But some prostate cancers are slow growing and never spread beyond the prostate gland. This is where the dilemma is.

Some other points about PSA test

  1. False positive results and overdiagnosis. This happens quite often with PSA testing and only about 1 in 4 abnormal results is due to cancer. A false-positive result can lead to unnecessary testing that is more invasive, such as repeated biopsies. It can cause unnecessary anxiety and distress. (CCS – Canadian Cancer Society website).
  2. A false-negative result means that the test shows the PSA level is normal even though prostate cancer is present. Not all prostate cancers cause a high PSA level. PSA testing misses about 15 per cent of prostate cancers (CCS).
  3. Most medical organizations encourage men in their 50s, men age 45 who have family history of prostate cancer or are Black individuals to discuss the pros and cons of prostate cancer screening with their doctors.
  4. Most organizations recommend stopping PSA tests around age 70. Men at age 70 and over have the highest incidence of prostate cancer over-diagnosis and several studies have suggested that screening in this age group is likely not beneficial.
  5. In most men with prostate cancer, the tumour grows slowly, and they’re likely to die of another cause before the prostate tumour causes any symptoms. The prognosis for most prostate cancers is good, with a 10-year survival rate of 95 per cent.

Questions remain – Who should get PSA test, at what age to start (45, 50 or 55) and how to manage patients with elevated PSA test results?

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Photo Quiz: Scalp Lumps

Dermatofibrosarcoma Protuberans (Dr. Noorali Bharwani)

This is a 34-yr-old male with a history of scalp lumps. Is this a case of…
Dermatofibrosarcoma? or
Sebaceous Cyst?

Correct Answer
Dermatofibrosarcoma Protuberans. This is a rare neoplasm of the dermis layer of the skin, and is classified as a sarcoma. It usually occurs in the trunk or extremities but can involve the head and neck particularly the scalp. In many respects, the disease behaves as a benign tumour, but in 2%-to-5% of cases it can metastasize, so it should be considered to have malignant potential.

This photo quiz was published on the Canadian Healthcare Network website.

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