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  Jeff Ritterman Op-Ed in Chronicle - Soda-tax Wars are Ground Zero of Obesity Fight
December 3, 2013

Soda-tax wars are ground zero of obesity fight
Jeff Ritterman
Published 5:03 pm, Monday, December 2, 2013
As San Francisco debates the merits of a soda tax, it makes sense to understand the science of sugar consumption and its health impacts. Opponents of soda taxes argue that eating cake with sugary frosting is just as bad as drinking a big gulp. Science says otherwise.
Our bodies respond differently to sugar, depending on the form it comes in. Cake makes us feel full and we reduce the amount we subsequently eat. Digestion takes hours, allowing our bodies time to deal with the sugar load. This doesn't happen when we drink a soda.
For millennia, humans quenched their thirst with water. As a result, unlike solid foods, liquid calories don't trigger our sense of feeling "full." We take in excess liquid calories without being aware of it. These unregistered calories, however, are not just empty calories. They are harmful calories.
When we drink soda, two sugars (glucose and fructose) are immediately absorbed. The glucose enters the bloodstream, signaling the pancreas to churn out insulin. The fructose - the sweet part - goes to the liver, where much of it gets converted into fat.
The overworked pancreas eventually poops out from exhaustion. Diabetes is the result, with its risks of amputations, blindness, kidney dialysis, heart attacks and strokes. Meanwhile, the fructose is converted into fats that infiltrate our organs and clog the heart's arteries, causing heart attacks early in life. The liver itself gets packed with fat. Before reaching the breakdown point, the liver goes deaf to the insulin signal, in medicine known as "insulin resistance." The pancreas has no choice but to shout, i.e., make more insulin, thus hastening the pancreatic exhaustion and the onset of diabetes.
Both the developed and the developing worlds are suffering a pandemic of "metabolic syndrome," the medical term for the combination of obesity, high blood pressure, diabetes and high risk of heart attack. The only way to reverse this worldwide calamity will be to kick the liquid sugar habit. How do we change direction?
By taxing soda, as a response to the pandemic of metabolic syndrome. Imposing soda taxes is now an international movement.
I led a soda tax campaign in my city, Richmond, in 2012. We were beaten at the polls, but it was a victory. Never before had people in Richmond debated the health impacts of sugary drinks. When we started I, a cardiologist for 30 years, realized I knew very little about the metabolism of fructose. Go ask your doctor "where in the body is fructose metabolized?" Chances are your doc doesn't know.
The soda tax campaign gives us a chance to change all of that, and to bring this science into the mainstream for discussion and debate. The future health of our children may depend on it.
Dr. Jeff Ritterman is the retired chief of cardiology, Kaiser Richmond Medical Center and a former Richmond City Council member. While serving on the Richmond City Council, he led the 2012 Richmond Soda Tax Campaign (Yes on N).

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