Sugar and spice and all things in moderation

*Deep breath*

Sugar Tax.  I don't remember anything that has so divided that diabetes online community.  Sure we all have different views, that's what makes us a community.  Of course we don't all agree - where would the fun be in that?  But the announcement of the Sugar Tax has everyone scrambling for an opinion.

I'll admit a few things from the start.... firstly, I'm pro Sugar Tax (for reasons which I'll explain), and secondly, I'm not sure writing this blog is the best idea I've ever had - experience tells me it could end up with me taking a week off the internet....  It's important to realise that my opinion is no more valid than anyone else's.  I'm not right, but neither am I wrong.  It's just what I 'reckon'.  And who doesn't love a good reckon?

So I'm pro Sugar Tax... light your torches and grab your pitch forks.  Why am I in favour of it?  Incentivisation.  My academic background is in economics (so I'm also generally pro Free Markets too), and I like the theory of how individuals react to incentives.  That theory generally being that when faced with a choice over two 'identical' products, the rational choice is to choose the cheapest one.

Now Coke and Diet Coke aren't quite identical, but they're pretty close.  If one is cheaper than the other - the rational choice is to choose the cheapest one right?  Why pay over the odds for a Coke when Diet Coke is (almost) identical?  Add to that, the differences are that Coke has more sugar (and more calories) then you're almost winning twice.  Changing behaviour is difficult, but people acting rationally, understand the dis-incentive in choosing more expensive Coke, over cheaper Diet Coke - so it should work.

But this is where it gets tricky.  In theory, theory and practice are the same.  In practice, they aren't.

Sugar Tax comes with a whole host of other things to consider.  Is the level of tax going to be big enough to make everyone behave rationally?  Probably not (price elasticity of demand is what you're thinking of there).  Are there socio-economic implications of increasing tax on soft drinks?  Yes of course.  There are loads - too many to even begin to discuss here.

Is Jamie Oliver a bit annoying, and prone to the odd diabetes-related gaffe?  Yes of course.  Isn't it a half measure if it doesn't include sugary milkshakes?    Yeah.   What about my hypo treatment?  Agreed.  There are alternatives, but you need something that works for you.  Thankfully Diabetes UK have our back on that one.   Why not make fruit and veg a load cheaper instead?  Yeah why not?  Completely agree.  Ask a farmer how much he makes off a 20p cucumber...

In my humble opinion (which, remember, counts for no more and no less than yours), I think people hear the announcement of a Sugar Tax and assume it's the only solution being proposed.  I don't think it is, and don't see how it can be.  Affecting the behaviour of a huge number of consumers isn't going to happen overnight, and isn't going to be done by a 7p levy on a can of coke.

I think the majority of people know that being overweight and inactive is bad for you, but they don't change their lifestyle.  Many people also know that smoking is bad for you but people continue to do it.  Though that number continues to fall as tax rises and the number of places you can smoke decreases.  Multiple measures gradually affect behaviour.

We already have a limit on advertising junk food to kids.  Placing sweets near supermarket tills is on its way out.  Evidence shows that indeed in some parts of the world, sugar tax has some effect on changing behaviour.  It won't change the world overnight (not least because you won't see it for two years anyway).

It's easy to be cynical and say it's patronising, pointless, punishing those who are already worse off.  But it's also easy to think that we have a responsibility to ourselves to be healthy, to reduce our risk of cardiovascular disease, strokes and Type 2 diabetes.  And if we don't want to, that's fine, but you'll have to pay a small premium for it.

Anyway - it's just what I reckon...

Cheers.

A little information can be a dangerous thing

Yesterday CrossFit caused what modern media would call a "Twitter storm".  Other people would call it a disagreement, a difference of opinion or simply a mistake.  Modern media loves hyperbole - me, not so much.

It started with this:

It's reasonable to say that this was certainly offensive to many people.  It's equally fair to say that what it's insinuating (Coca Cola causes diabetes) is also untrue.

I saw this shared a few times on Twitter and did so myself, highlighting to friends how inappropriate it was.  All the responses to that tweet were pointing out why the message was wrong, how insulting it could be and how people personally affected by diabetes had taken offence.

You'd expect CrossFit to realise the error of their ways, apologise and everyone could move on.  What they did instead was post a link to an article about how sugar was linked to diabetes.

At this stage it's worth pointing out a few facts, specifically that there are two types of diabetes.  Type 1 diabetes is an auto-immune condition and the cause isn't clearly known.  It typically presents in younger people but can do so in adults.  Type 2 diabetes is generally (but not always) brought on by being overweight and partaking in limited physical activity.  Gender, age, ethnicity and genetics also play a big part in determining if someone is more likely to get Type 2 diabetes.  

As you'd expect, a few people challenged Cross Fit about their link and as you can probably guess, CrossFit didn't really stop to think about what they were saying or how it was perceived.  Their next tweet said:

That's not true.  You can only have Type 1 diabetes or Type 2 diabetes.  You can't have both.  You can become more resistant to insulin over time if you have Type 1, but that doesn't mean you have Type 2 diabetes.

As you can imagine by now, this cycle of posting inaccurate information, only for it to be challenged by the knowledgeable diabetes online community continued.  One such tweet (since deleted by the CrossFit team) said this:

"and yet our point that diabetics shouldn't be drinking liquid sugar remains perfectly valid"

That's an incredibly dangerous and inaccurate thing to say.  It's also fairly irresponsible when you consider that over 293,000 people follow the CrossFit account (and some who aren't as well informed about diabetes are likely to believe it to be true).

For someone like me who has Type 1 diabetes, actually following that "advice" is potentially life threatening.  If I was having an episode of low blood sugar (hypoglycemia), something like Coca Cola would be absolutely necessary to stop me losing consciousness (and possibly my life).

It's easy to jump on the back of CrossFit (or at least whoever was in charge of their Twitter account yesterday) but I think the problem is more wide ranging than one errant social media account.  

The wider media perception of diabetes is that it's not necessarily all that serious, that everyone who has it does so through their own fault, and that by eating less sugar it's all entirely preventable.  For people living with the condition, it's both insulting and intimidating.  Attaching that level of stigma to a chronic illness is very irresponsible and can lead to people withdrawing, being scared to talk about their condition and not managing it correctly.

There's also some sort of implication that diabetes is fair game for jokes.  You don't see the same sort of things for other conditions like cancer (and rightly so I should add) because it's incredibly serious, life threatening and no-one's fault that they have it.  What people don't realise about diabetes is that all these things can apply equally.

At the start of 2015, Jamie Oliver apologised when being pictured next to a giant coke can with "Diabetes" written on the side in the Coca Cola font, stating that he was actually trying to highlight the lack of water in some American schools, where children were picking up sugar laden soft drinks  as there was no other choice.

As someone with diabetes, I don't expect everyone to know as much about it as I do or to understand how difficult it can be to live with.  Before I got diagnosed, I barely knew anything about it, but equally I didn't claim to know anything about it either.

As a person (diabetes or otherwise), I do expect those in a position to influence others (be it newspapers like the Daily Mail, or CrossFit twitter accounts) to report or comment on something serious after they've properly researched the full facts.  Passing off ill-informed opinions can have serious implications for millions of people and ultimately it's irresponsible to do anything other than be crystal clear with the truth.

The irony is that an active lifestyle is one of the best things you can do to help manage diabetes of either kind, and to help prevent Type 2 diabetes.  CrossFit seemed to be in the perfect position to use the facts to highlight how what they offer can benefit a lot of people.  Instead they chose to try and pull off something smug and fortunately it seemed to backfire.

Overnight (in the UK, during the day across the pond), it continued to rumble on.  There's something quite unsettling about watching an organisation who are clearly in the wrong continue to try and justify and defend their behaviour:

Firstly, as you can see above, "offending the sensitive" is apparently a small price to pay to ill-inform people.  For the record, I personally don't believe drinking excess amounts of anything is particularly good for you, not least Coca Cola.  But I also know that obesity is the link to Type 2 diabetes.  Excessive sugar consumption will most likely lead to obesity, in the same way that excessive consumption of anything calorific will do.  Eating sugar does not directly cause diabetes of any type.   Eating (or drinking) 'treat' foods (those higher in fat and sugar) should be done so in moderation.  Eating fresh fruit, vegetables, lean meat and some carbs is a balanced healthy diet.  But I say again, you can't get diabetes from eating sugar.

Next up, (just cut off at the top - sorry) is a triple whammy.  Firstly stating that any apology would be insincere, followed by a confirmation that making jokes about chronic illness is OK, and finished off, perhaps most staggeringly of all, by a tweet expressing disappointment about the "misinformation about diabetes and the role sugar plays in causing it".

If you've made it this far, the irony that CrossFit are the ones presenting misinformation is probably not lost on you.  Also EATING SUGAR DOESN'T GIVE YOU DIABETES.

CrossFit kept on pulling the trigger stating that if they have to insult "the sensitive" they will.  Well they don't have to insult anyone, 'sensitive' or otherwise.  They could just listen, understand and be more accurate in what they say.  Finally, they return to the scene of an earlier crime, stating that people with Type 1 diabetes can develop Type 2 diabetes.  No they can't.  Type 2 diabetes (as discussed way back at the beginning) essentially means your pancreas produces some insulin, even the tiniest amount.  Type 1 diabetes means your pancreas has no functioning beta cells (that produce insulin).  These two conditions are at odds - you can have one or the other, but not both.

At the time of writing this, I've not seen an actual apology from CrossFit for the way they misrepresented the facts.  They did post a few (subsequently deleted) tweets saying it should have been clear  they were only talking about Type 2 diabetes.  It wasn't clear, and it certainly wouldn't really have been any more accurate anyway.

They also posted this on Facebook:

When they say "the link between sugar and Type 2 diabetes is undeniable", they really should be talking about the link between obesity and Type 2 diabetes.

The also posted this on Twitter (highlighting that they absolutely haven't apologised):

I don't need an apology to make me feel better.  I know enough about diabetes to not need their validation or permission to do what I want.  I do want them to apologise for being lazy and irresponsible with their language that perpetuates the stigma of diabetes.

There's a reasonable chance you're reading this because you know me in some way, so you've probably read a lot of the science that distinguishes between Type 1 and Type 2 and nodded along.  Other people with a lot less experience of diabetes (like me 15 years ago!) simply do not know (and we shouldn't necessarily expect them to know) the difference, and are likely to be guided by the 'facts' that companies like CrossFit have misrepresented over the last 24 hours or so.

If you want facts about diabetes in this country, visit the Diabetes UK "Guide to Diabetes" page where you'll get accurate information.  Don't rely on companies with gimmicks to tell you the truth about something complicated.

There's a daily struggle to change that stigma that many people are subjected to that says having diabetes is your fault and you're to blame.  Some diabetes is preventable, but a lot of it (including all Type 1 diabetes) simply is not.  CrossFit haven't helped do anything to change that stigma and stereotyping and I think that's a real shame.

Apologies this has been long winded, but highlighting and disproving 'claims' like the ones CrossFit made today is really the only way that the perception will gradually begin to change and people with diabetes will stop being bullied, stigmatised, stereotyped and blamed about their condition.  We wouldn't put up with it for other long term illnesses, why should we stand by and accept it for diabetes?

CrossFit - #ImNotYourHomie