Sugar, alcohol, health and society

by | Last updated May 2, 2020 | Published on May 2, 2020 | Odds & Ends

Summary

The more easily available ‘foods’ are, the greater is the likelihood that we will consume more of them. That is such a banal observation that its profound implications and impact often escape attention: thus, the changes in our lives that such awareness might promote are overlooked.

Alcohol and sugar are paramount examples of the ‘availability factor’: lower unit price and more ready availability, and in more concentrated forms, leads to higher average per capita consumption. That translates inexorably into an increased proportion of people who are negatively affected because of increased consumption.

Despite centuries of use, it has only become apparent recently that the fructose part of sugar (chemical name sucrose — composed of glucose + fructose) may have a similar adverse biochemical profile to alcohol. I enumerate other examples of our delayed recognition of the toxicity of natural substances that we ingest — with perhaps more, yet to be discovered.

The facts demonstrating that greater availability increases consumption are denied by governments. Government representatives may be insufficiently educated about science to understand complex issues, and easily manipulated by powerful self-interested lobby groups. Thus, they are readily dissuaded from the policy action of increasing the price, and reducing the availability, of alcohol, or sugar.

Taking such action would probably save society much ill-health, harm, and money. Alcohol causes more such harms than all illicit drugs added together. It is hard not to regard this as an example of the ignorance, narrow-mindedness, ineptitude, and senselessness of government, interacting with the undue influence of pressure groups.

Plants have evolved over hundreds of millions of years to manipulate animals in many ways, thus enhancing their own survival (e.g. by being more, or less, tasty, or toxic — think sugar, tannin, atropine, and nicotine). This process has moulded animal and human biochemistry and behaviour in complex and subtle ways over the course of evolutionary time.

Never mind ‘No man is an island’ (Donne), no organism is an island.

The extensive science that informs us about these issues, touched on in this commentary, can be harnessed both by individuals, and government, to increase general public good — something many people consider to be a primary duty of good government, but a duty that has been all but abandoned.

It is possible that smart device apps could bypass the [lack of] government action and allow grass-roots democracy to directly influence such issues.

Introduction

The factors that influence us to eat and drink greater quantities of things which increase the chances of ill-health are all around us, and, with scientific knowledge, can be manipulated both by individuals, and by society, and by government.

This commentary gives a broad-based overview of the influences, including evolution, that encourage the excessive and harmful consumption of dietary substances such as sugar and alcohol: plants have been manipulating animals with tasty treats, like sugar, for around 100 million years.

A key consideration is the way evolution has panned out — the way that plants interact with all animals, both invertebrates and vertebrates, including humans, by producing chemicals that alter their behaviour and physiology. Think caffeine, tannin, nicotine, atropine, the opium poppy, cannabis, and 1000 other things you don’t even know about. Alcohol and sugar are the foremost examples dealt with here.

A recent book, the follow-on to a conference at the British Academy in Sept 2018, titled ‘Alcohol and Humans: A Long and Social Affair’ [1], was published as I was recensing* this commentary (from a previously posted version — as I often do with the material on my website).

* A term for the process of (critical) revision of texts is ‘recension’.

This book has much interesting material, some, like the chapter ‘Hominoid Adaptation to Dietary Ethanol’ [2] that expands on what I had previously written. Dunbar cites Dobzhansky, ‘Nothing in biology makes sense except in the light of evolution’ [3]. That statement by Theodosius Dobzhansky has echoed down the years: Dobzhansky was a major figure and influence in genetics and evolution, his 1937 work ‘Genetics and the Origin of Species’ was influential and has been cited thousands of times. He was awarded the US National Medal of Science in 1964 and the Franklin Medal in 1973 — a towering figure in the field.

The book makes the point — that I think the medical profession might take more account off — that the general social and psychological benefits of alcohol in society are somewhat greater than is generally appreciated (at least by some elements of the medical profession). A balanced approach for individuals in making decisions about hedonic life choices is preferably based on sound analysis of the facts (of the real medical disadvantages, or harms, of alcohol) and a broad understanding of the place of alcohol in society. Hopefully those reading this commentary will come a little nearer achieving that.

Such an understanding may enable people to balance the views, attitudes, and information that they receive from the medical profession which can sometimes be authoritarian and with a narrow perspective: that may owe something to a deeply embedded puritan philosophy.

Definition: Puritanism; the haunting fear that someone somewhere may be happy (H L Menchen, A Mencken Chrestomathy).

I am sure Dobzhansky would endorse the view that not only does nothing in biology makes sense except in the light of evolution, nor do most things in medicine.

Medical matters relating to alcohol, sugar, and obesity are prominent examples of that idea.

Another key part of this ‘big picture’, the political, cultural, and social dimension, can be understood as a continuance of the types of policies and devices of the decades-old tobacco lobby’s impedance of anti-tobacco legislation. Interest groups, and lobbyists (with their evil twin, ‘spin-doctors’), have refined and expanded these fact-obscuring and anti-democratic techniques, which are now routinely employed by organisations that wish to influence nations’ policies to their own selfish advantage.

The following discussion is intended to offer a broad perspective: furthermore, this perspective is straightforward and follows the precept of ‘Occam’s razor’, which states that the simplest explanation that accounts for the facts is likely to be correct.

The notion of an alcoholic, or alcoholism as a disease, dates to the beginning of the 20th century, and was formally adopted in medical terminology in the middle of the 20th century. However, it has always been a dubious and poorly founded notion. A writer whom I respected — I tried to read everything he wrote — was the professor of psychiatry at Edinburgh, Robert Kendall. He published an article in the BMJ in 1979 [4] called ‘Alcholism: a medical or a political problem?’, in which he criticised the concept of alcoholism as a disease. It is an excellent example of clear thinking. What he wrote was prescient and fits well with much recent research.

Context and influence

For those who might think this is straying too far from my expertise as a pharmacologist, into politics and sociology, let me make a connection to contextualize this commentary, because political and social influences are inextricably woven into the warp and weft of science: it does not happen in a vacuum. A recent book analyses the immense amount spent on the Human Genome project, and how that owed more to politics than sensible expenditure on science, The Postgenomic Condition, by Jenny Reardon: see review.

Many of the points and illustrations below also apply to drugs and the pharmaceutical industry, and are fundamental to the problems with biased science, about which I have written extensively.

Bad science and general misinformation are serious impediments to everyone’s ability to ascertain facts that have profound effects on their everyday lives — like which drugs actually work, and what foods are bad for you. What is defined as a ‘drug’ and what is thought of as ‘food’ is to some extent an accident of history — as illustrated by the universal unregulated use of alcohol, which is a drug like benzodiazepines (like Valium).

There is a separate commentary discussing and analysing the latest data on the health effects of alcohol and interpreting these in the light of other factors which affect lifespan. It is relevant to understand these in relative terms, so as not to over emphasise the adverse health effects of alcohol, e.g. compared to driving motor-vehicles, whilst at the same time underestimating the central, some would say essential, part that alcohol plays in the general improvement of peoples hedonic, social, and psychological experience. This is something that some elements of the medical profession are understandably accused of doing — it is something that may represent individual doctors need for authority, status, and control; those factors are related to personality, character, and beliefs, rather than science.

I have alluded to the various scientific texts and critiques germane to this discussion concerning the extraneous influences on science in various previous commentaries [5-7]. The heart of the matter, in my view, is that we are represented in our ‘democracies’, both in the bureaucracy, and even more so by our political representatives, by a substantial proportion of people who are neither ‘scientifically’ educated or literate, nor adequately equipped, by virtue of their intellect, education, or experience, to make a critical analysis of scientific issues.

Indeed, there are many prominent representatives on the world political stage who have had trouble extemporaneously constructing a meaningful, grammatical, logical, and coherent sentence in the English language — that ability is a reliable measure of general intellectual capacity. Some, perhaps most, administrations seem to proudly wear the badge that declares they are ignorant, and without qualifications.

Their denigration of knowledge and expertise has become a belligerently entrenched stance.

Politicians are a prominent important group in society who are not generally required to have qualifications. The words ‘politician’ and ‘professional’ do not fit in the same sentence: ‘A qualified and professional politician’ would be an oxymoron — saying it highlights their lack of qualifications, because we all expect professionals, like engineers, architects, doctors, pharmacists, nurses, podiatrists, lawyers, as well as electricians, builders, train & truck drivers, to have passed exams, demonstrate ongoing competency, be sober, have a code of conduct etc.

A politician could be illiterate, innumerate and have no education (not even up to the legal school-leaving age), not understand principles like the separation of church and state, the independence of the judiciary etc. There have been recent examples of politicians exhibiting just such astonishing ignorance. There are no real requirements or standards governing ongoing competency, or even sanity. There are usually no standards governing sobriety, or drug taking (drug screening of workers is required in many jobs now), nor even any fixed hours for attendance at their place of work. One could go on.

How many workplaces have an in-house pub like the British House of Commons — a blatant anachronism?

In a modern technology and science dependant society, permitting low levels of competency and knowledge (especially about technology and science) in those who govern is producing undesirable outcomes. This question deserves to be a more prominent subject of debate.

*** Good morning, I am Dr Gillman. I will be taking your appendix out today — I left school at 15 and worked in an abattoir for a couple of years, I’m really good with knives, and I have a certificate from the Mongolian Institute of podiatry. Just sign the consent form here please.

That is how crazy things are — such representatives make decisions about nuclear reactors, even if they cannot even spell the words ‘physics’ or ‘nuclear’ (or pronounce it!).

Not only is such people’s ability to understand what constitutes good, rational, and fact-based policy inadequate, but also, such people are ill-equipped to recognise and critically asses the biased views and false information with which they are bombarded by the omnipresent lobbyists. The financial muscle of the businesses and organisations that employ these lobbyists ensure they gain a disproportionate influence over government policy and decisions.

To cap it all, they sack or ignore their scientific advisors (like my old associate professor Nutt), if they even had any such advisors in the first place. A paucity of qualifications in politicians would be of lesser consequence if proper advice was taken from experts — but this is simply not happening: indeed, expertise is denigrated. Hence the suicidal lunacy of climate change non-policy — one must be afraid for the younger generation(s) who will suffer the outcomes.

That is not good democracy, good policy, or good anything. The politicization of science advisors is a cancer at the heart of government decision-making.

It is hardly democracy at all — it is closer to plutocracy.

This less-than-ideal standard of government policy-making is further exacerbated by the distortion of the democratic process, in many countries, caused by the way political parties are organised and funded (e.g. the party ‘whip’ in the UK — see Jay’s monograph — which means representatives do the party’s bidding, not their constituents’ bidding), that gives even more leverage to the disproportionate influence that lobbyists, and media moguls, have over these imperfect government decision-making processes.

One of the two savvy and politically well-informed men who wrote the classic comedy series (perhaps the best-disguised ‘black’ comedy ever written) Yes Prime Minister was Sir Antony Jay. He also wrote an excellent monograph tracing the history of the development of democracy in the UK, from the Great Reform Act of 1832, to its accidental distortion and degradation, with the help of the media (thank you Mr Murdoch) into the pseudo-democratic facade that most people are beguiled by today — Jay’s monograph can be found here: http://www.cps.org.uk/files/reports/original/111027115304-20090711PublicServicesANewGreatReformAct.pdf

If you think you live in a real democracy, be disabused of that idea.

The oldest battle on the planet

The oldest battle on the planet is the battle between plants and animals. Just because plants do not leap up and attack us, that does not mean they are not engaged in an ongoing war to manipulate us, harm us, and protect themselves. They have been producing chemicals (and spikey bits) to combat all the other organisms, with which they compete on the planet, since the beginning of evolution, hundreds of millions of years ago. There are many examples of chemicals produced by plants — which modern pharmacology has yet to replicate and synthesise — that have multitudinous effects on the functioning and behaviour of animals. Many are toxic. However, the effects can be subtle, and many compounds produced by plants manipulate the behaviour of animals, to the advantage of one, and sometimes both, parties.

There might be a book about this by now [postscript, here is a relevant contribution [8]], but I will give illustrations from my own knowledge to make my point.

Foods: safe or toxic?

It has long been my view that some aspects of medicine are illuminated by considering them with an evolutionary perspective, and that ‘Evolutionary Medicine’ is undervalued. It is a view Dobzhansky would have espoused [3].

There are many interesting and revealing examples concerning evolution, and how plants influence many aspects and characteristics of animals, including humans — like why we have such large livers.

Why the human liver is large

The human liver is large because we are omnivores. Being able to get nutrition from so many diverse sources, both plant and animal, inevitably exposes us to a greater number of potentially toxic substances. As discussed here, many of these are produced by plants (and animals) to deter predators, or even to kill them. Therefore, to be a successful omnivore requires the evolution of many enzymes, which are in the liver, that can break down these toxins into harmless substances. That requires space and energy. A big liver.

How do we know that the plants we consider safe to eat, really are safe to eat? The answer is we do not know, it is little more than ‘folklore’ — it is entirely possible that, unbeknownst to us, long-term consumption of some may lead to the accumulation of toxins that cause disease.

Fruit flies and alcohol

It was recently discovered that fruit flies preferentially deposit their larvae on fruits which have undergone alcoholic fermentation, which confers protection against parasites [9]. That evolutionary adaption must have occurred some 200 million years ago. We might also suppose that this influenced the ‘co-evolution’ of taste receptors and receptors in the CNS, and that these adaptions flowed through the genetic tree into early vertebrates, and then mammals.

These sorts of observations suggest that the dopamine reward pathways in insects, then vertebrates and primates, evolved in tandem with these traits that were related to the benefits of alcohol, and not just by chance.

The fact that alcohol releases dopamine in the reward pathways is the result of tens of millions of years of evolution.

Colour vision and sugar

Primates are different from other mammals in having three types of retinal cone cells (trichromacy), not two. One explanation for the evolution of this trait is that trichromacy enabled better recognition of red-ripe fruit. This has been debated for some time, and recent findings further support the theory: observations now suggest that dichromatic individuals (i.e. ‘colour-blind’ monkeys) are slower to find fruit in the forest, which this puts them at a disadvantage [10-12].

As Melin et al. state in their most recent paper ‘These results provide some of the first behavioural evidence of how wild frugivorous mammals use the chemical properties of food to inform their foraging decisions, and are consistent with recent research reporting that lemurs increase their reliance on olfaction when feeding on fruits whose scent changes with ripeness, and that primates are highly sensitive and attentive to some odorants.’

Wine drinkers may be interested to understand that this selection pressure for the ability to smell different compounds in fruit of varying degrees of ripeness was probably a factor that made this ability more pronounced in Homo sapiens (cf. ADH evolution below).

Those capuchin monkeys that are dichromatic rely more on their sense of smell — this leads to the fascinating speculation that colour-blind wine aficionados may learn to develop their sense of smell more than those with normal colour vision (just as blind people who read Braille develop a greater acuity of the touch sense).

It seems that our ancestors evolved trichromatic colour vision, and the attendant ability to more easily find ripe fruit which contains sugar and odiferous compounds, and alcohol, because finding nutritious ripe fruit was essential for survival [13]. There is a great deal more about this fascinating story, and the evolution of alcohol metabolism in apes versus monkeys, in a book that was published following a recent conference at the British Academy [8].

In short, apes on the forest floor were more likely to encounter over-ripe fermenting fruit, which contains 1-4% of alcohol, and so there was ‘selection pressure’ for the more active form of the alcohol metabolising gene, ADH, as discussed below. The monkeys who stayed up in the trees did not develop the ability to metabolise alcohol; they become intoxicated easily.

This convincingly links fruit, colour vision, olfaction, and the ability to metabolise alcohol together; it explains how they were selected for by the evolutionary pressure to ingest sufficient calories for survival.

Neolithic brewers

An interesting speculation is that alcohol has moulded the evolution of the animal nervous system (cf. fruit flies) continuing through mammalian evolution, influencing CNS receptors and brain reward pathways; both sugar and alcohol release dopamine in the CNS reward centres.

A major difference between the monkeys and the apes was that the apes, when they descended to the forest floor approximately 4 million years ago, evolved a form of the alcohol metabolising enzyme that was 40 times more active. This was possibly because they encountered alcoholic fermented fruit on the forest floor and this may have been another step in the co-evolution of man and alcohol [1].

As Dudley [13] suggested some 15years ago; ‘behavioral responses to ethanol may have been the target of natural selection for all frugivorous species, including many primates and the hominoid lineages ancestral to modern humans.

It may be that homo sapiens evolution-generated predilection for alcohol motivated the cultivation of cereals in the early- or pre- Neolithic period (around 10-12,000 years ago). Such cultivation seems to have been to do with producing alcohol, not just for dietary carbohydrate needs [14]. Indeed, evidence from Mozambique suggests the tantalizing possibility that Sorghum may have been fermented as long as 100,000 y ago [15].

Two strands of evidence indicate that Neolithic cereals may have been used in brewing: first, genetic studies of the human alcohol metabolising genes, especially ADH4, indicate that the 40x more active mutation of the ADH gene spread in the population around then [16]. That coincidence may be explained by the fact that there was selection pressure to metabolise increased quantities of dietary alcohol, compared to that ingested just by eating natural fermented fruit. Second: the genetics of the yeast S. cerevisiae may also have diversified around 12,000 y ago, and the two oldest strains show evidence of ‘domestication’, i.e. they may have been selected by early Neolithic ‘brewers’ for fermenting grain [14, 17].

Weak (1-4%) beer is an effective way of sterilizing water of harmful bacteria — the production of ‘small beer’ for this purpose existed when the Egyptian Pyramids were built and continued into the 19th century. A typical ‘allowance’ for workers was a couple of litres per day, which is not a great deal of alcohol: at 2% it would be only 40 mls, just clean water and a few grams of carbohydrate, with the anxiolytic effect of a few mg of ‘valium’. Rather good popular self ‘mass-medication’ of the population!

The effect of alcohol on reducing anxiety and facilitating social interaction in humans may well be more than mere coincidence. It would have facilitated social interaction in emerging post-neolithic, more densely populated, permanent communities, by reducing social anxiety and reducing water-born infections. A useful public-health measure.

So, pause a moment before you judge somebody who feels they need a drink before they can go to a party (a common phenomenon — how many friends do you have who regularly go to a social function without having a drink first?). It may be innate to our evolutionary heritage.

Parkinson’s disease

Rotenone is a plant derived toxin used to control both insects and fish. It is produced by several families of plants. Experimental and epidemiological research has shown there is both a possible mechanism, and a clear association, between rotenone exposure and a higher risk of PD [18-20].

As a ‘proof-of-concept’ example this clearly shows that plants can produce substances with long-term toxicity to the human nervous system — even if it is not causal in human cases of Parkinson’s disease, it illustrates that we simply do not know how much of this substance is produced by different plants in nature, and how much we are ingesting. This is because nobody has ever screamed all edible plants, at all stages of their growth, for concentrations of Rotenone — we simply do not know. Needless to say, there have been no long-term human studies of the degree of toxicity of low-level ingestion.

Lathyrism

Epidemics of Lathyrism have occurred in humans (and animals) caused by quite modest amounts of chickpea-like legumes (Lathyrus sativa). Lathyrism is a late-onset spastic ataxic paraplegia [21-24]. It is quite probable that many other related plants produce similar toxins, perhaps at levels that have so far evaded detection [24-26]. After all, limited toxicological screening of plants has been carried out, so we have inadequate information [27]. It may just be that low or undetected levels of such compounds in these plants accumulate over decades and cause CNS damage.

You might well think that if a plant has been used for 2,000 years that it would be obvious if it was causing a problem.

You would be wrong — spectacularly wrong.

Aristolochia

Here is a recent example of a natural (must be good) age-old Chinese health supplement/treatment: its deadly effects only emerged recently. It is the vine Aristolochia [28, 29].

There is a complex story to this, about which I have written elsewhere. It is fascinating because it involves one of the largest and most beautiful butterflies in the world, the Cairns Bird-wing, native to our area of north Queensland. The caterpillars feed on the [poisonous] Aristolochia vine. The poison they ingest (aristolochic acid) is passed on to the adult butterfly, which is thus protected from attack by birds, who very quickly learn to avoid them. The plant has been used since antiquity in various civilisations across the globe, for its supposed health benefits, being especially popular with the ‘Han’ Chinese.

The toxic effects (renal carcinoma and renal failure) were first recognised and called Balkan endemic nephropathy in 1956, but was not till the 1990s that full recognition of aristolochic acid’s toxicity started to be more widely understood — amazingly, it is still consumed in Taiwan (whose population is predominantly Han Chinese) because a naïve faith in ancient Chinese medicine remains wide-spread. Taiwan has, as a result of this superstitious ignorance (aka ‘folklore’, or ‘ancient wisdom’), the highest incidence of renal failure and urinary-tract cancers in the world [29].

These deaths are all caused by Aristolochia, used for two thousand years, and still causing innumerable deaths. Natural, safe? Nature fights back and cannot be wished away with magical beliefs. So much for ‘ancient wisdom’.

Anti-oestrogen compounds

Some grasses produce anti-oestrogen compounds, but only in their early-spring shoots. That suppress the ovulation of some grazing animals, until the grass has reached a certain stage of maturity. This mutually benefits both the grass and the animals by making sure that the animals do not breed until the grass is fully established in the early growing season, such that it is not over-grazed. This avoids the denudation of the landscape and erosion and lessens the chance of the offspring of the animals starving through lack of food.

Laxatives: ‘Senokot’

Since the ‘information-environment’ that most people are exposed to is so full of execrably poor material, let us have an example related to excretion. Why do you think so many plant-based extracts act to increase the speed of bowel action in mammals, including humans (think of the laxative ‘senokot’, extract of the senna pod). It is sometimes because of a dynamic relationship with the plants eaten, and some plants produce compounds which maximise the chance of the animal excreting their seeds in an advantageous location.

Toxoplasma gondii and car accidents

Toxoplasmosis is caused by the Toxoplasma gondii parasite: rodents infected with toxoplasma show diminished reaction times and a reduced fear-response to predation by felines, including domestic cats. This is caused by a chemical produced by the Toxoplasma parasite that affects the nervous system. Thus, such rodents are more likely to be caught and eaten, and the likelihood of Toxoplasma maintaining itself in the population is increased [30, 31].

Toxoplasma also infects 20-60% of humans, via domestic cats (how many reasons are there for not having cats?): so, here is an example of a profound effect on human physiology and behaviour (reaction times) that has only recently been elucidated [32]. Humans who are RhD-positive are protected against latent toxoplasma-induced impairment of reaction times which, however, affects everyone else, who suffer slowed reactions, and are therefore more likely to have road traffic accidents, and probably other misfortunes as well [31, 33, 34].

This interesting example of host/parasite evolution may explain the otherwise puzzling perpetuation of the Rh blood group variant in the human population, because it causes occasionally fatal haemolytic disease of the newborn [35-37]. Sickle-cell disease and Malaria show a similar inter-relationship.

In summary

An accumulation of many similar observations to those above illustrates that there are extensive interactions, many unexplored or unknown, between a myriad of compounds produced by plants, and the behaviour and functioning of vertebrates, including humans.

Such are the fascinating implications of contemplating health and medicine with an evolutionary perspective. I have only just learned that I am in the esteemed company of Theodosius Dobzhansky [3] in espousing such views.

Perspective

I have chosen to include sugar because it is topical, it is the precursor to alcohol, and the stories of both share much with medical drugs, and because this illustrates the negative social consequences of incompetent government.

It is interesting to understand the metabolic parallels between excess sugar and excess alcohol, and their similar effect on health. There is not space to detail those here, but to learn more, read Lustig’s summary [38, 39]. This also inter-leaves with another commentary in preparation about the misuse of labelling-words in psychiatry — like alcoholic. Why do we talk about an alcoholic, but not a sugar-holic? It makes little sense.

The following discussion is intended to offer a broad perspective: furthermore, this perspective is straightforward and follows the precept of ‘Occam’s razor’, which states that the simplest explanation that accounts for the facts is likely to be correct.

The notion of an alcoholic, or alcoholism as a disease, dates to the beginning of the 20th century, and was formally adopted in medical terminology in the middle of the 20th century. However, it has always been a dubious and poorly founded notion. A writer whom I respected — I tried to read everything he wrote — was the professor of psychiatry at Edinburgh, Robert Kendall. He published an article in the BMJ in 1979 [4] called ‘Alcholism: a medical or a political problem?’, in which he criticised the concept of alcoholism as a disease. It is an excellent example of clear thinking. What he wrote was prescient and fits well with much recent research.

Milieu and availability

Environment powerfully shapes behaviour.

If there is a jar of sweets kept on the coffee-table, and a stash of soft-drink in the fridge, your children will eat more sweets and drink more soft-drink and probably be more obese and unhealthier (and so will you). If you have larger dinner plates, and larger wine glasses, you will likely serve larger helpings and eat and drink more. Obvious really. Obvious enough to be over-looked.

Back to professor Kendall [4]. He marshalled the evidence that the main determinant of the number of people who suffered harm from alcohol was the average level of alcohol consumption in the population. The data strongly support that. Would it not be surprising if it were otherwise?

The key factor determining consumption of alcohol is ‘availability’.

‘Availability’ has several components: e.g. the actual cost (per capita income/unit price), the ‘physical’ ease of access to it (the numbers of points of sale and ease of access to them), and the hours during which sale and consumption are permitted. Societal and peer-relationship factors are also relevant. All these factors are part of the broad concept of ‘availability’.

The wealthier we are, and the cheaper alcohol is, and the more easily available and accepted it is, the more of it we are likely to consume. Simple.

History makes it clear that labelling alcoholism as a disease has made it easier to ignore the political, social, and economic dimensions, determinants and realities of the problem, and to provide excuses for inaction, as well as the psychological comfort of enabling most people to think that alcohol is all right for ‘us’, and that it is just some unfortunate people who react badly to it.

Evolution has moulded as into creatures who are well able rapidly to achieve satiety: we can take-in a days-worth of food in a few minutes (our dogs can do it in a few seconds!).

There is great evolutionary advantage in not exerting oneself when there are no short-term imperatives for survival-enhancing action. That is a biological way of saying, rephrased in everyday language, that we are lazy and greedy. Since that is the case, there is a tendency for us to eat food if it is available and close at hand, and to exert ourselves minimally, unless there are imperatives to do otherwise.

Whilst those traits had survival advantage in our evolutionary past, in modern civilisation they are disadvantageous. Eating too much, being overweight, and being insufficiently active, are indisputably things which impair long-term health.

Too rich, too greedy, too lazy.

Invoking the nebulous concept of ‘self-control’ is not a sufficient, or smart, solution.

It is not surprising to learn that there are many other cues that compound these fundamental variables: these are the raison d’être of the advertising world.

The above facts constitute a convincing argument that simple environmental factors and cues have a profound effect on our behaviour, including on how much we consume.

Fructose

There are putative adverse metabolic effects of fructose, which may bring about changes in metabolism similar those produced by alcohol: e.g. promotion of insulin resistance, hyper-insulinemia, dyslipidaemia, increased uric acid (gout), and enhanced inflammatory responses.

There is some debate about the extent of the ill-effects, and their relevance to humans (some of the research has been done on rats); nonetheless, sugar is nutritionally marginal and it is clearly worth considering minimising its intake, especially high-fructose corn syrup HFCS drinks, until the evidence is clarified, particularly if you are already overweight [40-43].

The unfortunate (if one is a wine-lover) and brutal reality is that anything more than small quantities of alcohol (~50 ml/d) or sugar (~40 mg/d) are nutritionally unnecessary, and probably contribute impairment of health.

‘Sugar’ is sucrose, which is a dimer formed from one molecule of glucose and one of fructose (cane-sugar is therefore glucose 50% & fructose 50% — whereas HFCS is usually glucose 40% & fructose 60%). The metabolism of glucose is different to that of fructose: all cells in the body can use glucose as an energy source, but they cannot all use fructose, which the body handles differently. Sugar sources with higher fructose percentages, like HFCS, may be ‘worse’ health-wise. Hence the concern over the increase in per capita sugar consumption, and especially HFCS. For further details see Lustig’s paper The Fructose Epidemic [38, 44]. Most HFCS soft drinks have 20% more fructose vs drinks made with ‘ordinary’ sugar — thus justifying ‘HF’ part of their epithet [45].

The increased use of HFCS owes much to the lobby-group-influenced political process of granting subsidies to corn producers to convert their product into cheaper sugar, to add to processed foods.

Not good policy, not good government. Not even good agriculture.

Promoting health without Government action

There are various pitfalls that can prevent us from making healthy eating choices. Plants themselves manipulate us into making unhealthy choices, by tempting us with sugars, and other psycho-active compounds, manipulating our behaviour and appetite.

Government fails to educate people and protect them from misleading information and practices by industry and lobby groups who wish to promote their partisan agenda. Lax regulation regarding food additives and labelling, and unscrupulous advertising, even to children, further exacerbates the problem.

It remains difficult, sometimes impossible, to easily ascertain the amount of salt, or sugar etc., in processed foods, or even bread. Labelling is such, even when it exists, that people with anything but a proficient level of knowledge, education — and a magnifying-glass — are unlikely to be able to make optimum choices.

In effect, the ability of government to carry out education and good policy enactment on behalf of the people has been hampered by incompetence and distorted by biased interests and lobbyists.

Policies to reduce sugar and alcohol consumption have been effectively blocked by industry, just like they did with tobacco.

There are currently various attempts to bypass the problem of poor government regulations and decisions using smart apps. Such strategies could be expanded and made more successful. This would enable people to use their smart devices to quickly reveal the amount of undesirable ingredients in things they are considering purchasing. For instance, there is currently an app in Australia called ‘CluckAR’, which tells you whether the eggs on display are really free-range, by an ‘independent’ definition of that term. This is because governments have approved regulations and labelling systems that have been so influenced by industry lobbyists that their definition of ‘free-range’ is quite different from independent authorities (like 10,000 hens/Ha, rather than the CSIRO/RSPCA figure of 1,500). Technology is such that an expansion of such apps is straightforward, and could be assisted by the various community organisations, environmental groups, and consumer organisations (such as ‘Choice’ in Australia).

I have heard it said that not enough people would adopt such applications to make much difference (see Postscript). However, it may be noted that competition in retail is such that only a small proportion of people need to cease purchasing a particular product, say with palm-oil in it, or excess sugar etc., and sales will soon decrease sufficiently so that red lights will start flashing on the headquarters computer of retail chain in question.

If such apps gained traction that would influence the situation, without government doing anything at all. Indeed, since government is mainly about popularity and ‘follow-ship’, it is probable that politicians would then jump on the bandwagon, and claim it was their idea. Such is the weakness of their principle, vision, and resolve.

Talking of principles, we have room for an 18th c quotation of uncertain origin (it is so delightfully witty, who cares who 1st said it — possibly an interlocutor of Lord Sandwich, but recycled many times since): banter about principles, “Sir you will either die of the pox, or on the gallows”; to which the response was “that depends on whether I embrace your mistress or your principles”.

And finally

I have tried to weave together a number of disparate threads having to do with evolution, society and politics and link these to drugs, eating, metabolism, and health, in such a way as to increase understanding of the big picture of what influences us to eat as we do, and how the category ‘food’ is not as clear-cut and many imagine, and how easily ‘food’ can cause harm.

An evolutionary perspective on the relationship between the plants we eat, and their effect on us, will continue to produce interesting insights. These effects are both powerful and nuanced, as exemplified by the hundreds of millions of tonnes of sugar that plants have manipulated us into growing, to say nothing of heroin.

Obesity in the Western world is a prominent and expensive health problem — the plants are winning!

Changes to our environment and eating behaviour can combat these influences. Even minor changes in the physical layout of one’s kitchen may make a useful difference to eating behaviour.

Individuals can act, even if good government in the interests of the people fails us, having been subverted by industry-interests and lobbyists.

It is a fascinating subject that involves an understanding of evolution, chemistry, pharmacology, psychology, sociology, and politics. It doesn’t get much bigger than that.

Postscript

Whilst I was editing this commentary a news story was reported. It reinforces the comments above concerning consumer buying-habits and their influence on businesses and retail. A large egg-producing company in Australia has announced a big investment considerably increasing free-range egg production, using the lower stocking density of 1500 hens per hectare. They are responding to the shifting preferences of consumers purchasing such eggs, rather than ones called free-range under the government’s less stringent labelling laws. The CluckAR app may have played a part in this change.

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