#210 A Sweet Tooth
The Exposome
Is the sugar I ate as a small infant affecting my health today?
A Five-Minute Read
I was sorting out some family papers the other day. I found my ration card. It was issued by the Ministry of Food no: AE950893.
As an island, Great Britain had a food problem during the Second World War. It needed to import many types of food through the blockade of the Atlantic. The Government therefore introduced rationing. Ration cards contained coupons which entitled people to buy the designated weekly amount of scarce food. If they could find them in the shops. Everyone therefore had a ration card. My ration card still contained one coupon made out for butter. The ration was designed to ensure a healthy diet.
I am a baby boomer. Even infants were given a ration. One of the big shortages was sugar. It was rationed in 1940. Sweets were rationed in 1942. The sugar restriction was 40g of sugar per day. (This led to a revival in carrot cakes. Carrots have always been used as a sweetener).
After the second world the UK remained under sugar rationing until September 1953. Immediately after the rationing was removed consumption doubled within a year. There are stories of riots at the sweet shops on the day the rationing of sugar ended. I was conceived when sugar was restricted, and my infant years were loving but less sweet.
Sugar and Future Health
A researcher from California used my ration card and many others like it to look at the impact of this natural experiment. An entire country had their diet radically changed over a long period. Something that could never be created deliberately. It would mean delberately manipulating sugar intake for a large group of people over a long period of time.
They combined aggregate sugar consumption data with medical histories. Rationing was released at different times for different food stuff. No other food, for example butter, doubled its consumption immediately after the removal. Other changes in diet were not likely to impact health as much.
I am a member of the UK Biobank. This captures my medical history and makes it available (anonymously) for researchers. The California team were able to assemble 39,000 people who had a reduced sugar intake either in the womb or in infancy. They could then looked out 60 or 70 years of their lives. They looked for the incidence of disease, compared with those who never lived under rationing. The found associations with Type 2 Diabetes and hypertension.
The results confirm the exposome (#106 "The Genome and the Exposome"). The fact that our health is the cumulative result of our life experiences and environments. That starts before we are born. A person’s likelihood of having either condition depended directly on how many of their first 1000 days fell during rationing. That is from conception onwards. The more days the bigger the effect.
Those of us who reached the age of 1.5 before the end of rationing have “won”. Our incidence of diabetes is down by 35% compared to those who never suffered rationing. Not only that but if we get it, it arrives 4 years later. Hypertension is reduced by 20% and comes two years later. The sensitivity to sugar is demonstrated by the last group that could be included in the sample. They were conceived during rationing but were born after September 1953. They got some benefit but not as much. Diabetes was only reduced by 15% and hypertension by only 5%.
The Impact of Childhood Diseases
A separate US study looked at diabetes from a different perspective. They studied the health of the Millennials and the Baby Boomers. They were trying to understand an apparent decline in health. In the UK, the US and Europe studies have shown the same thing. Each pre-war generation showed health improvement over previous generations. This was measured using the main chronic diseases. Starting with Baby Boomers the rate of improvement either slowed down or went into reverse.
They too used a large longitudinal survey. They looked for associations between these health measures and individuals’ life journeys. About half of the variation could be explained with only three things. The first was the incidence of childhood diseases. These were not the contagious diseases such as measles and mumps. The used 12 health related problems. They included asthma, allergies, epilepsy, migraines and things like that. The more diseases you had before the age of 17 the more likely you had chronic diseases in later life. The second big variable was obesity. This returns us the sugar and exposure in early life. The third was job tenure or how frequently those individuals had to change jobs.The hypothesis was this was stressing and and may have caused inflamation.
Sugar and Young Children
Do children develop a taste for sugar in the womb or during breast feeding? Certainly, public health authorities recommend no added sugar. This for the first 1000 days from conception, not birth, and is a critical window for development. The average pregnant person in the United States consumes more than 80 grams of added sugar daily. While more than 80% of babies and toddlers have foods with added sugar on any given day. This means that babies are exposed to larger amounts of sugar than recommended.
The Impact on Health-span and Life Expectancy
We cannot wind back our lives to the moment of conception. We cannot change our exposome. We can’t change what our mother ate when we were in the womb. Therefore, we live in a world where chronic diseases are increasing at a given age. However, we are able to better manage those diseases today than ever before. We can stop them interfering with everyday life. The price is an ever growing individual and national health bill. It will take time, but prevention could reduce future health costs
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