Sugar Shysters

The Sugar Shysters: A day in the life of a South African endocrinologist

With up to 10-million South Africans either suffering from type 2 diabetes or in the pre-diabetic stage, a wholly preventable epidemic is about to swamp our already strained public healthcare system. Kevin bloom spent a day at the diabetes clinic of a major public hospital, where he learnt a brand-new word: ‘Coca-Colanisation’.

1. Dr Energy Balance

At the top of the escalators that lead from the third-floor parking lot in the Charlotte Maxeke Johannesburg Academic Hospital to the fifth-floor foyer you are faced, as you turn right through the entrance, with a Coke dispenser. You don’t register it because your brain is hardwired to filter out all background noise and a Coke machine, whatever else it is, is about as background as the hum in your ears.

You wait five minutes, checking your phone, stealing glances at the poor bloke in the slippers and gown who’s sucking on a cigarette in the outdoor atrium. Your contact, Dr Sundeep Ruder, comes striding down the corridor to fetch you. “Sometimes I’ll just put an ‘out of order’ sign on there,” he says.

Huh? Aah, he means the Coke machine, not the dude out of daytime television central casting. You associate freely from the mistake: if tobacco is estimated to have caused 100-million deaths in the 20th century, processed sugar is all set to sail past that harvest well before the middle of the 21st.

The seven-fold increase in the worldwide incidence of type 2 diabetes between 1975 and 2005; the doubling in the worldwide incidence of obesity since 1980; the fact that the latter (due in part to the global food trade) is no longer confined to rich countries; the fact that up to one in five South Africans is either a confirmed type 2 diabetic or in the pre-diabetic stage — why is it, you wonder, that you aren’t legally obliged to consume your Coke in a room safely quarantined from society?

One of only 50 working endocrinologists in the country (the US, at around six times South Africa’s population, has between 6,500 and 7,000), Ruder has made it his life’s mission to expose and correct the structural fault in the diet of the postmodern human.

He uses phrases like “absolute positive energy balance”, which is less about having a sufficient energy store to get through your day than it is about a conscious and sustained conversation with your best volitional self: “What is my intention for the day? How do I apply the energy balance I need?”

A highly trained specialist in the functioning of a select network of hormone-secreting organs – “endocrine” comes from two Greek words meaning “to separate within” – there are few South Africans better placed to tell us why, as a nation, we are failing to regulate our metabolisms.

“The human body evolved a mechanism to store energy easily in anticipation of scarcity,” Ruder says of our early history as a species, when we would stumble across the odd fruit tree on the prehistoric African veld. “Fast forward to 2015, the same evolutionary physiological advantage in the setting of an energy-rich environment, which is also sedentary, causes things like obesity and type 2 diabetes.”

And so here we are, a Thursday morning in the diabetes clinic of the Charlotte Maxeke Johannesburg Academic, where the patients who came late don’t have a place to sit, and where energy levels are sagging. Into the consulting room steps Mr Botha, 49, who was diagnosed with diabetes in 2000.

“You know, I’m on the road a lot,” he admits sheepishly to the doc. “I’m drinking Tab, a burger here, chips there.” His sugar-monitoring diary has been stolen, he says, before lamenting that healthy food is near impossible to find outside the big cities, and that anyway it’s “hellish expensive”.

2. ‘Buy the World’

Purveyors of high-fructose corn syrup, which was developed in the 1970s as a cheap replacement for sugar and which can currently be found in everything from salad dressing to bread to cereals to chips (Coca-Cola uses it in their recipes in some countries, in others it uses sucrose), all have their procedures for dealing with dissent.

Since these procedures also have their pet names, and since these pet names don’t necessarily apply industry-wide, we at Daily Maverick have decided to lump the most common defensive manoeuvre under the epithet “couch potato counterattack”. It goes thusly.

If you, dear diabetic or obese person, can’t deal with the fact that you ingest too many calories and that your exercise regimen stretches about as far as the recliner handle on your Lay-Z-Boy, how convenient for you that we are here to take the blame. What Big Corporate is doing with this reverse piece of psychological espionage is nothing short of genius, mainly because it lays the emphasis on the sugar addict’s version of the alcoholic’s (eternally dubious) ‘disease’, self-justification: I was born this way, genetically predisposed to be a sufferer, and my only chance would’ve been if the drink wasn’t there.

In other words, for endocrinologists and activists and the anti-sugar lobby in general, it’s a tough one to beat.

As my morning on the ward with Ruder demonstrated, even amongst people in the acute stages of type 2 diabetes, people who have no doubt that the onset of blindness they’re experiencing is directly related to their past and present intake of processed junk, there’s a tendency to indulge in futile self-recrimination. “Yes doctor, I’m sorry doctor, I couldn’t help it doctor.”

But to go no further than the agency and free choice of the consumer is to risk falling prey to willful obfuscation. Would these sufferers have stood a better chance if the Coca-Cola Company really wasn’t there? That, it would appear, is the $50-billion question.

Not only do we have the abovementioned seven-fold increase in the worldwide incidence of type 2 diabetes between 1975 and 2005 – a 30-year period, incidentally, when certain American brands came to be associated with smiles and happiness across the entire planet – we also have the fact that Big Corporate, when confronted in 1999 with their culpability by one of their own and offered a chance to repent, chose to stick with the profits. Why?

Because, as New York Times journalist Michael Moss wrote in 2013 in a groundbreaking investigative feature entitled ‘Junk Food America’: “What I found, over four years of research and reporting, was a conscious effort – taking place in labs and marketing meetings and grocery-store aisles – to get people hooked on foods that are convenient and inexpensive.”…..

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