food science

To ponder this Pongal: The funny business of sugar

Whether you get natural sugar from fruit or added sugar in processed food, you get the same amount of harmful fructose.

One specific type of sugar, glucose, is the primary energy source of the body although not the only one. Pretty much anything you eat has to be broken down into glucose before it can be used.

Glucose is the most important of the large family of sugars, all of which have names ending in -ose. Glucose is commonly found in nature attached to another sugar, fructose, the two of which form a disaccharide (“two sugars”) named sucrose, also known as table sugar, the stuff that’s in your kitchen.

Fructose is fruit sugar, the stuff that makes honey and fruit taste sweet. It’s the sweetest naturally occurring carbohydrate. Fructose is also the added sugar in many food products. Consider this pair of cereal packages found in your neighbourhood grocery store.

The one on the right makes no bones about containing sugar. The one on the left has a prominent label advertising “No Added Sugar”. It also has a ** against “sugar” in the nutrition facts that the fine print clarifies as “sucrose”. That is, 1.4% of the product is sugar in the form of sucrose.

But go back to the ingredient list. Notice the unspecified quantity of “Apple Juice Concentrate”. The nutrition facts for apple juice say it is 10% sugar. A research study on the exact composition estimates (in grams per litre) 9.30–32.2 glucose, 66.10–96.00 fructose, and 8.5–55.10 sucrose. The range is because multiple varieties of apple were tested. Apple juice is mostly fructose. And fructose is a sugar! Fructose is the sweeter half of the sucrose molecule! In other words, the “no added sugar” claim is a lie because it redefines sugar as sucrose for the purposes of this label, while also refusing to identify exactly how much actual sugar is in this product.

This is not an isolated incident. The sugar industry has spent decades misleading people about sugar and fat. A serendipitous chance for blaming fat was milked for all it is worth.

Conspiracy aside, what exactly is the problem with fructose?

Your muscles and brain are powered by glucose. They cannot do anything with the fructose in your diet until your liver processes it. Fructose taxes your liver similar to how alcohol does.

When you consume sucrose, which is table sugar, it gets as far as the duodenum – the first part of the small intestine – where the enzyme sucrase splits it apart into the constituent glucose and fructose. This is why eating sugar or drinking any sweet juice gives you a rush of energy – the glucose goes into your blood and from there to your brain and muscles. Fructose is absorbed into the bloodstream along with glucose (and galactose), from where it is processed and stored by the liver.

HFCS is “high fructose corn syrup”. (Image: Wikimedia Commons)
HFCS is “high fructose corn syrup”. (Image: Wikimedia Commons)

This idea that different compounds are processed in different manners is called a metabolic pathway. There are multiple pathways around your body for the various components of your diet, and some of them are activated or deactivated based on certain conditions. Starvation, for example, triggers a metabolic state called ketosis wherein your body starts burning its own stored fat, using the produced ketone bodies instead of glucose for energy. This is the evolutionary purpose for which our bodies store fat: as a store for lean times. It is the same reason a camel has a hump, except their metabolism handles it differently.

There is something about the way fructose is metabolised in our bodies that has pretty nasty side effects. Dr Robert Lustig at the University of California has spent nearly two decades studying childhood obesity and is convinced fructose is the culprit.

He’s not alone.

Science author Gary Taubes has joined the fray with his new book The Case Against Sugar.

But do not just read press reports about sugar. Read Dr Robert Lustig’s paper or take out 90 minutes from your weekend to hear him as he takes you into a deep dive of exactly what fructose does to your body.

Play

That was in 2009. In 2013, Lustig delivered another lecture addressing the criticisms of the first lecture.

Play

Finally, we need to address the oft-stated refrain that it is only refined and added sugars that are bad for you while natural sugar is fine. This is false. Whether your fruit happened to be naturally sweet or you sprinkled some sugar on it, how does it matter to your digestive tract? The only distinctions that matter are the ratios of fructose and glucose, plus the role of fiber in slowing down digestion.

  • Fruit: 40–55% fructose (but sometimes significantly higher or lower)
  • Honey: 38–55% fructose 
  • Refined sugar (sucrose): 50% fructose
  • HFCS (used in industrial food products): 42%, 65% or 90%

You are getting about the same amount of fructose no matter where your sugar comes from. Obsessing over added sugar is pointless because the problem is with all sugar. This leads to an inevitable conclusion: don’t drink fruit juice. You’re getting all that fructose as one gulp of a sugar bomb with none of the fiber required to temper it. Eat the whole fruit instead.

Hands-up if you ever felt good about going to a fruit juice stall instead of getting a soda. Fruit juice may be revered as a health food, but you got the same fructose dosage anyway. Do you see how culturally ingrained our sugar habit is, and how hard it will be to lose?

This article was first published on Kilter.

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What hospitals can do to drive entrepreneurship and enhance patient experience

Hospitals can perform better by partnering with entrepreneurs and encouraging a culture of intrapreneurship focused on customer centricity.

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Most of these tech enabled solutions have emerged as hospitals look for better ways to enhance patient experience – one of the top criteria in evaluating hospital performance. Patient experience accounts for 25% of a hospital’s Value-Based Purchasing (VBP) score as per the US government’s Centres for Medicare and Mediaid Services (CMS) programme. As a Mckinsey report says, hospitals need to break down a patient’s journey into various aspects, clinical and non-clinical, and seek ways of improving every touch point in the journey. As hospitals also need to focus on delivering quality healthcare, they are increasingly collaborating with entrepreneurs who offer such patient centric solutions or encouraging innovative intrapreneurship within the organization.

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Getting the best from collaborations

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Meena Ganesh shares a similar view when she says that entrepreneurs offer an outsider’s fresh perspective on the existing gaps in healthcare. They are therefore better equipped to offer disruptive technology solutions that put the customer right at the center. Her own venture, Portea Medical, was born out of a need in the hitherto unaddressed area of patient experience – quality home care.

There are enough examples of hospitals that have gained significantly by partnering with or investing in such ventures. For example, the Children’s Medical Centre in Dallas actively invests in tech startups to offer better care to its patients. One such startup produces sensors smaller than a grain of sand, that can be embedded in pills to alert caregivers if a medication has been taken or not. Another app delivers care givers at customers’ door step for check-ups. Providence St Joseph’s Health, that has medical centres across the U.S., has invested in a range of startups that address different patient needs – from patient feedback and wearable monitoring devices to remote video interpretation and surgical blood loss monitoring. UNC Hospital in North Carolina uses a change management platform developed by a startup in order to improve patient experience at its Emergency and Dermatology departments. The platform essentially comes with a friendly and non-intrusive way to gather patient feedback.

When intrapreneurship can lead to patient centric innovation

Hospitals can also encourage a culture of intrapreneurship within the organization. According to Meena Ganesh, this would mean building a ‘listening organization’ because as she says, listening and being open to new ideas leads to innovation. Santosh Desai, MD& CEO - Future Brands Ltd, who was also part of the panel discussion, feels that most innovations are a result of looking at “large cultural shifts, outside the frame of narrow business”. So hospitals will need to encourage enterprising professionals in the organization to observe behavior trends as part of the ideation process. Also, as Dr Ram Narain, Executive Director, Kokilaben Dhirubhai Ambani Hospital, points out, they will need to tell the employees who have the potential to drive innovative initiatives, “Do not fail, but if you fail, we still back you.” Innovative companies such as Google actively follow this practice, allowing employees to pick projects they are passionate about and work on them to deliver fresh solutions.

Realizing the need to encourage new ideas among employees to enhance patient experience, many healthcare enterprises are instituting innovative strategies. Henry Ford System, for example, began a system of rewarding great employee ideas. One internal contest was around clinical applications for wearable technology. The incentive was particularly attractive – a cash prize of $ 10,000 to the winners. Not surprisingly, the employees came up with some very innovative ideas that included: a system to record mobility of acute care patients through wearable trackers, health reminder system for elderly patients and mobile game interface with activity trackers to encourage children towards exercising. The employees admitted later that the exercise was so interesting that they would have participated in it even without a cash prize incentive.

Another example is Penn Medicine in Philadelphia which launched an ‘innovation tournament’ across the organization as part of its efforts to improve patient care. Participants worked with professors from Wharton Business School to prepare for the ideas challenge. More than 1,750 ideas were submitted by 1,400 participants, out of which 10 were selected. The focus was on getting ideas around the front end and some of the submitted ideas included:

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As Arlen Meyers, MD, President and CEO of the Society of Physician Entrepreneurs, says in a report, although many good ideas come from the front line, physicians must also be encouraged to think innovatively about patient experience. An academic study also builds a strong case to encourage intrapreneurship among nurses. Given they comprise a large part of the front-line staff for healthcare delivery, nurses should also be given the freedom to create and design innovative systems for improving patient experience.

According to a Harvard Business Review article quoted in a university study, employees who have the potential to be intrapreneurs, show some marked characteristics. These include a sense of ownership, perseverance, emotional intelligence and the ability to look at the big picture along with the desire, and ideas, to improve it. But trust and support of the management is essential to bringing out and taking the ideas forward.

Creating an environment conducive to innovation is the first step to bringing about innovation-driven outcomes. These were just some of the insights on healthcare management gleaned from the Hospital Leadership Summit hosted by Abbott. In over 150 countries, Abbott, which is among the top 100 global innovator companies, is working with hospitals and healthcare professionals to improve the quality of health services.

To read more content on best practices for hospital leaders, visit Abbott’s Bringing Health to Life portal here.

This article was produced on behalf of Abbott by the Scroll.in marketing team and not by the Scroll.in editorial staff.