tag:theconversation.com,2011:/uk/topics/health-claims-7630/articlesHealth claims – The Conversation2023-03-05T19:20:24Ztag:theconversation.com,2011:article/2004462023-03-05T19:20:24Z2023-03-05T19:20:24ZSex and lies are used to sell vapes online. Even we were surprised at the marketing tactics we found<figure><img src="https://images.theconversation.com/files/513089/original/file-20230302-22-rpx5kz.jpg?ixlib=rb-1.1.0&rect=0%2C2%2C998%2C745&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/hague-netherlands-march-13-2022-popular-2135784369">oliverdelahaye/Shutterstock</a></span></figcaption></figure><p>It’s easy to buy vapes or e-cigarettes online. When we looked at websites selling them to buyers in Australia and New Zealand, we found a variety of slick, false or misleading marketing claims.</p>
<p>In our <a href="https://www.sciencedirect.com/science/article/pii/S1326020022000139?via%3Dihub">new research</a> we outlined how these included health claims – how vapes contain “zero” carcinogens, are an effective aid for quitting smoking, and lead to improved breathing “in a matter of days”. </p>
<p>Vapes were also marketed as sexy, sleek and environmentally friendly.</p>
<p>We saw a range of products on sale – including several bundled together as “starter kits”. Most vaping liquid contained nicotine. There were price discounts, loyalty schemes and free delivery.</p>
<p>Here’s why this is all such a concern and what we can do about it.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/vaping-related-lung-disease-now-has-a-name-and-a-likely-cause-5-things-you-need-to-know-about-evali-125730">Vaping-related lung disease now has a name – and a likely cause. 5 things you need to know about EVALI</a>
</strong>
</em>
</p>
<hr>
<h2>What we did and what we found</h2>
<p>We investigated 20 Australian and New Zealand online retailers of vapes and vaping products.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Marketing discount for vapes" src="https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=390&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=390&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=390&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=490&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=490&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512448/original/file-20230227-18-ks3a5e.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=490&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Discounts and special offers were common.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>We looked at their product range, how they verified buyers’ ages, as well as their marketing strategies and claims.</p>
<p>Most websites only needed buyers to click on a box to confirm they were 18 years old or over. When buyers clicked through, they could find a range of nicotine and no-nicotine vapes and vaping liquids. Some didn’t ask buyers’ ages at all. Only one site needed buyers to verify their age with formal identification.</p>
<h2>Outlandish marketing claims</h2>
<p>Unsubstantiated or blatantly false health claims were the most common claims we found. These included:</p>
<blockquote>
<p>vaping has been proven to be up to 95% less harmful than smoking cigarettes.</p>
</blockquote>
<p>This statement stems from a study <a href="https://journals.sagepub.com/doi/pdf/10.1177/026119291504300610?casa_token=rjfg5Px-WNcAAAAA:PTechh4LPbk4yXDV15A6MndWRNayULmxMau8WwR6eaN3Y000g7G9rn_dBuEijTNeqmtFL0a_hiw">criticised</a> for its lack of hard evidence, yet it remains a common claim. </p>
<p>Other health claims included:</p>
<blockquote>
<p>you will feel your breathing improve in a matter of days.</p>
</blockquote>
<p>and:</p>
<blockquote>
<p>if you are vaping high quality tested liquids, then you can be puffing on ZERO carcinogens. </p>
</blockquote>
<p>When it came to quitting smoking, websites claimed:</p>
<blockquote>
<p>e-cigarettes are a more effective tool for helping smokers quit than nicotine replacement therapies, including patches and gum.</p>
</blockquote>
<p>These claims are unfounded as the jury remains out as to whether these products help people quit smoking. A major review of the literature found there was <a href="https://openresearch-repository.anu.edu.au/handle/1885/262914">insufficient evidence</a> to promote vapes for this.</p>
<p>Websites also called vaping “sleek”, “stylish” and futuristic. </p>
<p>One website claimed:</p>
<blockquote>
<p>Some people vape because it’s sexy.</p>
</blockquote>
<p>Another site claimed:</p>
<blockquote>
<p>Creative design, advanced technology, [product name] will bring you infinite pleasure.</p>
</blockquote>
<p>There were environmental claims too, such as:</p>
<blockquote>
<p>don’t buy a disposable [e-cigarette] that isn’t fully recyclable – our device is friendly to the planet.</p>
</blockquote>
<p>Marketing vaping products as something creative, innovative, sleek, sexy and environmentally friendly would be particularly appealing to younger buyers.</p>
<p>We found multiple payment methods, price discounts and opportunities to earn loyalty discounts. Delivery options including postal and courier services. Sometimes, delivery was free.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Free shipping marketing tactic" src="https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=136&fit=crop&dpr=1 600w, https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=136&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=136&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=171&fit=crop&dpr=1 754w, https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=171&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/512451/original/file-20230227-20-w04btt.PNG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=171&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Sometimes, delivery was free.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<h2>Why is this an issue?</h2>
<p>Vapes <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-6-the-health-effects-of-e-cigarette-use">are not harmless products</a>. They contain hundreds of chemicals, originating from the e-liquids, from the device and formed by the heating element, many of which are toxic. Risks include addiction, poisoning, seizures, burns and injuries, lung injury, and environmental pollution (from plastics and lithium batteries).</p>
<p>Vaping use almost tripled among Australian adults between <a href="https://www.tobaccoinaustralia.org.au/chapter-18-e-cigarettes/18-3-extent">2013 and 2019</a> and <a href="https://www.abs.gov.au/statistics/health/health-conditions-and-risks/smoking/latest-release">young adults</a> are taking up vaping in droves.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1628942421018169346"}"></div></p>
<p>Buying vapes online is popular. An <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15142-8">Australian study</a> reported adolescents mainly get vapes from “friends”. However, adults (25+ years) tend to buy them online. It’s likely “friends” who provide vapes to adolescents could be buying at least some of these online.</p>
<p>An <a href="https://click.endnote.com/viewer?doi=10.3390%2Fijerph16030338&token=WzMzMDE4ODAsIjEwLjMzOTAvaWplcnBoMTYwMzAzMzgiXQ.PwsYKA6Wl8Peh_VhuDkajiNLdBc">international study</a> also reported Australians mostly (65.2%) bought their vape products online. In fact, the study found Australians were many times more likely to buy them online compared with people in Canada, the United States and England.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/we-asked-over-700-teens-where-they-bought-their-vapes-heres-what-they-said-190669">We asked over 700 teens where they bought their vapes. Here's what they said</a>
</strong>
</em>
</p>
<hr>
<h2>What needs to happen next?</h2>
<p>Nicotine-containing vapes are only <a href="https://www.tga.gov.au/resources/resource/guidance/nicotine-vaping-products-information-prescribers#:%7E:text=From%201%20October%202021%2C%20all,from%20Australian%20pharmacies%20and%20overseas.">legally available</a> to adults in Australia with a doctor’s prescription to help people stop smoking. </p>
<p>In New Zealand, nicotine-containing vapes <a href="https://vapingfacts.health.nz/the-facts-of-vaping/vaping-law-and-policy/">can be legally purchased</a> as a regulated product. However, in both countries, it is illegal for manufacturers or retailers to sell them to those under 18.</p>
<p>Despite these restrictions, it’s clear both nicotine and no-nicotine vapes are being sold to under 18s, and to people without prescriptions.</p>
<p>Australia’s Health Minister Mark Butler has <a href="https://www.abc.net.au/news/2023-02-24/australia-vaping-problem-health-policy-solution/102012768">recently met with</a> state and territory health ministers to discuss vaping regulation. The Therapeutic Goods Administration earlier this year <a href="https://www.tga.gov.au/resources/consultation/consultation-proposed-reforms-regulation-nicotine-vaping-products">finished taking public submissions</a> about proposed vaping reforms.</p>
<p>It’s time we stop the promotion of, and easy access to, vaping products through online retailers. We also need to ban the use of unsubstantiated marketing claims.</p>
<p>This will require improved surveillance, monitoring, and regulations that curb the online sale and importation of vapes, along with improved border controls.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-can-we-reverse-the-vaping-crisis-among-young-australians-enforce-the-rules-185867">How can we reverse the vaping crisis among young Australians? Enforce the rules</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/200446/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jonine Jancey receives funding from the WA Health Promotion Foundation. She is a Board member of the Australian Council on Smoking and Health.</span></em></p>Vapes were marketed as healthy, sexy, sleek and environmentally friendly. It’s time we clamped down on these dodgy claims.Jonine Jancey, Academic and Director Collaboration for Evidence, Research and Impact in Public Health, Curtin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1800352022-05-06T01:35:22Z2022-05-06T01:35:22ZLemon water won’t detox or energise you. But it may affect your body in other ways<figure><img src="https://images.theconversation.com/files/460444/original/file-20220428-25629-p1digh.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/glass-cup-hot-tea-lemon-on-1194702835">Shutterstock</a></span></figcaption></figure><p>If you believe anecdotes <a href="https://www.insider.com/is-drinking-lemon-water-good-for-you-2018-2">online</a>, drinking lukewarm water with a splash of lemon juice is detoxifying, energising and soothing.</p>
<p>Water and lemon juice on their own are healthy. But if you combine them, do they become healthier? The really quick answer is, no!</p>
<p>Could drinking lemon water do you any long-lasting harm? It’s unlikely.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/ive-always-wondered-why-does-lemon-juice-lighten-the-colour-of-tea-91324">I've always wondered: why does lemon juice lighten the colour of tea?</a>
</strong>
</em>
</p>
<hr>
<h2>It contains vitamin C, but do you need extra?</h2>
<p>Lemon juice contains vitamin C, a vital nutrient. We’ve long-known a vitamin C deficiency can lead to <a href="https://theconversation.com/explainer-what-is-scurvy-and-is-it-making-a-comeback-69709">scurvy</a>. This condition is most commonly associated with seafarers in history who had no access to fresh fruit and vegetables on long voyages. </p>
<p>More recently, we have seen low levels of vitamin C in Australia, for instance in people admitted to <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/imj.14030">hospital</a> and <a href="https://www.pathologyjournal.rcpa.edu.au/article/S0031-3025(18)30117-X/pdf">referred for surgery</a>. But this may not represent vitamin C levels more broadly in the community. In this group of people, the factors that led to their ill health could also have impacted their vitamin C intake.</p>
<p>If your intake of vitamin C is low, drinking lemon water may help. Vitamin C <a href="https://www.ijstr.org/final-print/nov2013/Effect-Of-Heating-On-Vitamin-C-Content-Of-Some-Selected-Vegetables.pdf">starts to degrade</a> at 30-40°C, which would have a small impact on levels in your warm lemon water, but nothing too concerning.</p>
<p>If you have enough vitamin C in your diet, anything extra will be excreted as either vitamin C or <a href="https://www.webmd.com/diet/what-is-oxalate-oxalic-acid">oxalate</a> via your urine.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-scurvy-and-is-it-making-a-comeback-69709">Explainer: what is scurvy and is it making a comeback?</a>
</strong>
</em>
</p>
<hr>
<h2>What else can lemon juice do?</h2>
<p>Lemon juice may have other benefits, but research so far has been mixed.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4977979/">One study found</a> people with high blood lipid (cholesterol) levels who drank lemon juice for eight weeks did not see any changes in their blood pressure, weight or blood lipids levels.</p>
<p>However, <a href="https://link.springer.com/article/10.1007/s00394-020-02228-x">in another study</a>, drinking 125mL lemon juice with bread led to a small decrease in blood glucose levels compared to drinking tea or water with the bread. A <a href="https://www.jstage.jst.go.jp/article/gsr/7/2/7_174/_article/-char/ja/">small study</a> found something similar with drinking 30g lemon juice with water before eating rice.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Cutting a baguette with a bread knife on chopping board" src="https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460474/original/file-20220429-9923-1iq0yt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Drinking lemon juice with carbs can affect blood glucose levels.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/whole-grain-bread-put-on-kitchen-1023191101">Shutterstock</a></span>
</figcaption>
</figure>
<p>Researchers suggest the acidity of lemon juice inhibits a particular enzyme in your saliva (salivary amylase), which usually starts to break down starch in your mouth. So it takes longer for starch to break down to glucose lower in the gut and transported across the intestine wall into your blood. For people with diabetes, this may lead to a reduction in the spikes of blood sugar levels, but it has not as yet been tested. </p>
<p>Other <a href="https://www.sciencedirect.com/science/article/pii/S092422442100412X">studies</a> indicate there are other nutrients in lemon that may be beneficial for protecting against developing diabetes.</p>
<p>But it is likely you can get the same benefits by adding lemon juice to your food.</p>
<h2>How about detoxing, energising or soothing?</h2>
<p>Your body already detoxes without the added “help” of lemon water. It breaks down toxins or excess nutrients in the liver and eliminates those molecules via the kidneys and out into the toilet in your urine.</p>
<p>There is no evidence vitamin C helps this. So any claims lemon water detoxes you are untrue. If you really need a detox, you probably need a liver transplant.</p>
<p>Does lemon juice energise you? Aside from the placebo effect of drinking something you feel is good for you, the short answer is no. However, like most nutrients, if you’re not getting enough of them, you could feel sapped of energy.</p>
<p>And as for lemon water being a soothing drink, some people find warm drinks soothing, others prefer cold. The best temperature to drink fluids is the temperature at which you are more likely to drink enough to stay hydrated. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/do-you-really-need-a-detox-52077">Do you really need a detox?</a>
</strong>
</em>
</p>
<hr>
<h2>Any possible harms?</h2>
<p>As lemon water is acidic, there have been some concerns about its ability to erode tooth enamel. But this is a problem for <a href="https://theconversation.com/health-check-whats-eating-your-teeth-37096">any acidic beverages</a>, including fizzy drinks and orange juice.</p>
<p>To minimise the risk of acid erosion, some dentists <a href="https://dentistsatpymble.com.au/lemon-water-and-your-teeth/">recommend</a> measures including:</p>
<ul>
<li><p>rinsing out your mouth with tap water after drinking lemon water</p></li>
<li><p>chewing sugar-free gum afterwards to stimulate saliva production</p></li>
<li><p>avoid brushing your teeth immediately after drinking lemon water</p></li>
<li><p>drinking via a straw to avoid contact with the teeth.</p></li>
</ul>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-whats-eating-your-teeth-37096">Health check: what's eating your teeth?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Man drinking bottle of lemon water with mint through a straw" src="https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/460479/original/file-20220429-26112-kt2bex.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You can always use a straw.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/man-drinks-lemonade-through-straw-glass-1766075933">Shutterstock</a></span>
</figcaption>
</figure>
<p>Some doctors say lemon water may <a href="https://www.wellandgood.com/how-lemon-water-impacts-your-bladder/">irritate the bladder</a> and may make some people feel like they need to urinate more often, particularly at night. If that’s the case, they recommend switching to plain water. </p>
<p>However <a href="https://link.springer.com/article/10.1007/s00192-022-05090-z">one study</a>, which looked at a range of drinks including lemon beverages, found no effects on bladder irritation when people reduced their intake. </p>
<p>Others say lemon water makes <a href="https://www.medicalnewstoday.com/articles/322879#overview">acid reflux</a> (heartburn) worse. But this has not been tested.</p>
<h2>So, should I drink lemon water?</h2>
<p>If you enjoy drinking lemon water, drink it! But if you don’t like drinking it, you’re not missing out.</p>
<p>You can get your vitamin C from other citrus fruits, as well as other fruit and vegetables. You can also squeeze some lemon juice on your meat, salads or vegetables.</p><img src="https://counter.theconversation.com/content/180035/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Evangeline Mantzioris is affiliated with Alliance for Research in Nutrition, Exercise and Activity (ARENA) at the University of South Australia. Evangeline Mantzioris has received funding from the National Health and Medical Research Council, and has been appointed to the National Health and Medical Research Council Dietary Guideline Expert Committee.</span></em></p>Water and lemon juice on their own are healthy. But what if you combine them?Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1170472019-05-16T09:01:16Z2019-05-16T09:01:16ZHow to make health news interesting — without overselling the claims<figure><img src="https://images.theconversation.com/files/274878/original/file-20190516-69209-ny5h9i.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adult-adorable-woman-lady-boss-putting-1131606356?src=aBUUwMMZ2-WnMpgxmhpbwQ-3-4">Roman Samborskyi/Shutterstock</a></span></figcaption></figure><p>Health stories are prolific in the news. Each year, thousands of articles are published claiming to have the latest compelling evidence on how we should eat, drink, exercise, sleep, and which medications we should or shouldn’t be taking – among a host of other things.</p>
<p>Not only is there a deluge of information, it is also often conflicting. Reports on statin use, for example, have stated there are associations between taking them and <a href="https://www.express.co.uk/news/uk/338741/Statins-key-to-a-longer-life">living longer</a>, <a href="https://www.express.co.uk/life-style/health/608210/statins-age-you-faster-new-research-suggests-long-term-use-warning">ageing faster</a>, <a href="https://www.express.co.uk/news/uk/578174/Statins-stroke-experts">reduced stroke risk</a> and <a href="https://www.express.co.uk/news/uk/1036177/diabtetes-risk-statins-health-concerns">increased diabetes risk</a>. </p>
<p>Every day, these reports are read and shared by millions, potentially influencing our decisions and behaviour – but how do we know that the evidence we’re relying on is strong enough? Writers need easy ways to communicate the strength of evidence without reducing interest or readability. But that can sometimes mean the public is over or undersold its relevance.</p>
<p>For <a href="https://doi.org/10.1186/s12916-019-1324-7">our latest research</a>, we wanted to find a way to help writers accurately communicate research evidence, without diminishing reader interest in the claims. To do this, we teamed up with nine UK press offices, from journals, universities and funders, to run a randomised trial with health-related press releases. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-believe-the-daily-express-it-takes-a-lot-more-than-carrots-to-beat-cancer-28357">Don't believe the Daily Express, it takes a lot more than carrots to beat cancer</a>
</strong>
</em>
</p>
<hr>
<p>We focused on press releases because they play a crucial role in science news. When the latest research is published, a press release is used to summarise the study’s most “newsworthy” results. The press release is then sent to journalists who use the material to write the news.</p>
<p>Previous research <a href="https://www.bmj.com/content/349/bmj.g7015">has shown</a> that there is a close correspondence between the content of the press release and the news articles that follow – journalists have little time and tight word limits, so aren’t always able to build a more in-depth piece.</p>
<h2>Mays and mights</h2>
<p>The first aim of our work was to improve the alignment of news claims with the underlying evidence by focusing on the wording of press releases. In the intervention arm of the study, we reserved strong language, such as “causes”, “affects” and “boosts”, for strong causal evidence from trials and experiments.</p>
<p>In observational research, cause and effect is difficult to determine due to uncontrolled variables. For example, an association may exist between ice cream sales and water consumption – not because one causes the other, but because they both increase in sunny weather. So for this type of research we opted for weaker language, such as “may cause”, and “could affect”, in the releases. This distinction is not only easily understood by those who know the convention, but crucially <a href="https://www.ncbi.nlm.nih.gov/pubmed/27808530">also meaningful</a> to all readers whether or not they have heard of correlations or clinical trials. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/274880/original/file-20190516-69169-1bukaar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Journalists use press releases for their stories on a daily basis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/male-journalist-eyeglasses-checking-written-article-644329909?src=GBDGdvHBTeiqP7G2kSswCw-1-51">GaudiLab/Shutterstock</a></span>
</figcaption>
</figure>
<p>We found that the strength with which claims are made in press releases generally carries through into the news. Importantly, there was no detrimental effect on the likelihood of a story making it into the news if the language was softer. Whether or not a press release was picked up did not depend on the strength of the causal claims. When headlines and claims were softer in press releases, they were generally softer in news – despite the received wisdom that news is not interested in “mays” and “mights”. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/from-medical-treatment-to-diet-and-lifestyle-choice-how-to-spot-unreliable-health-research-63572">From medical treatment to diet and lifestyle choice: how to spot unreliable health research</a>
</strong>
</em>
</p>
<hr>
<p>The second aim of our research was to make sure that stories included explicit caveats – such as “this research was observational and cannot show cause and effect” – when needed. Our results showed that these caveats were more likely to appear in the news when they were present in the press release.</p>
<p>A story on liver health and smoking <a href="https://www.dailymail.co.uk/health/article-3701603/How-quitting-smoking-good-LIVER-given-cigarettes-drink-alcohol-too.html">published on MailOnline</a>, for example, used a quote from the press release to state, “Dr Brown stressed this was an observational study and cannot say whether giving up smoking led to a reduction in drinking or vice versa”. The caveats did not appear to reduce news uptake, and were even associated with more news coverage – a result that matches <a href="http://orca.cf.ac.uk/121559/">parallel research</a> showing that caveats do not reduce reader interest.</p>
<p>Most of these findings are based on observational analyses, and although we cannot show the direct effect of press release content on the news, we do know that journalists read press releases before writing the news. We also cannot show how such news content would affect public health. But our findings suggest that there could be a simple way to communicate the strength of evidence to the public without affecting uptake.</p>
<p>Causal inference is just one element of evidence strength, but there are many others that could, and should, be communicated to readers. For example, findings from larger studies repeated over a long period of time are more robust than those from small, single studies. Although the reporting of evidence strength in the media is only one factor in how people make health-related decisions, we believe that providing more easily decoded news is a step in the right direction.</p><img src="https://counter.theconversation.com/content/117047/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Petroc Sumner receives funding from the ESRC and Wellcome Trust</span></em></p><p class="fine-print"><em><span>Rachel Adams receives funding from the European Research Council, and has received funding from the ESRC.</span></em></p>Journalists have to communicate research without reducing interest or readability — but the public needs accuracy.Petroc Sumner, Professor and Head of School, School of Psychology, Cardiff UniversityRachel Adams, Research Associate in Cognition and Neurostimulation, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/443142015-09-04T04:24:00Z2015-09-04T04:24:00ZExpensive running shoes don’t prevent injuries, but comfortable ones might<figure><img src="https://images.theconversation.com/files/92224/original/image-20150818-12389-1xvcora.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many runners opt for expensive footwear - but are they worth it?</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/fotografgruppen/4017135689/">Fotografgruppen Fotografgruppen/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>If you’ve ever sustained an injury from running, you’re not alone; about half of all adults who run regularly will get injured <a href="http://bjsm.bmj.com/content/41/8/469.long">each year</a>. And if that’s not enough to put you off, having a history of previous injuries is one of the strongest risk factors for <a href="http://bjsm.bmj.com/content/41/8/469.long">getting injured again</a>. </p>
<p>So it’s no surprise that avoiding injuries is a priority for runners. </p>
<p>One third of runners are so concerned about this, in fact, that they’ll <a href="http://journals.lww.com/nsca-jscr/Abstract/2012/08000/Primitive_Running___A_Survey_Analysis_of_Runners_.2.aspx">ditch their plain old running shoes</a> for fancier footwear they feel is safer and will improve their performance. But do the promises made by global footwear companies about their expensive running shoes stack up? </p>
<h2>The evidence</h2>
<p>The first thing we need to address is whether the modern running shoe’s extra safety features, such as increased stability or extra cushioning, are protecting people from injury. Not very much, according to <a href="http://bjsm.bmj.com/content/43/3/159.short">a provocative 2009 review</a> that highlighted a lack of research testing exactly this. </p>
<p>More evidence has emerged since, but we’re still none the wiser. </p>
<p>One study that randomly allocated 81 female runners to shoes with different levels of stability based on their foot posture (pronated, neutral, supinated) found <a href="http://bjsm.bmj.com/content/early/2010/06/26/bjsm.2009.069849.short">no difference</a> in injury rates during a 13-week training program. Another, which randomly allocated hard or soft-soled shoes to 247 runners, also found <a href="http://bjsm.bmj.com/content/early/2013/09/16/bjsports-2013-092613.short?rss=1">no difference</a> in injury rates over a five-month period.</p>
<p>But despite the current state of research literature indicating no clear benefits of running shoes with extra safety features, we’re bombarded by claims from global footwear companies about the advantages of their expensive products. </p>
<p>When we dissect the content of the claims made by these manufacturers, we see a recurrence of vague terms, teetering dangerously between the medical and sportswear industries. </p>
<p>Words conjuring imagery of sport and performance such as “zoom”, “fast”, “elite” and “launch pad” are littered among others suggesting direct benefits from their shoes, such as “better” and “safer”. Terms once synonymous with expensive cars are also adopted by global footwear companies, who claim their products offer the most “<a href="http://www.asics.com.au/gel-nimbus">fluid</a>”, “<a href="http://www.mizunousa.com/Running/Products/WAVE-RIDER-18-MENS">smooth</a>” or “<a href="http://www.brooksrunning.com/en_us/Transcend.html">plush</a>” experience for runners. </p>
<h2>Problematic claims</h2>
<p>The problem is compounded by running footwear companies using “surrogate outcomes” to support claims that their newest technology <em>may</em> reduce risk of a running-related injury. But what’s a “<a href="http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=4225188&fileId=S0266462300009594">surrogate outcome</a>”? </p>
<p>If we want to test whether a new model of footwear, or piece of footwear technology, actually protects against injury, we’d measure – in a controlled study – how many people get injured wearing (and not wearing) the product. </p>
<p>But tracking who does and doesn’t get injured over an extended period is a time-consuming and expensive exercise. To circumvent inconvenience and cost, we could instead measure what effect the new footwear has on outcomes that <em>may</em> relate to increasing risk of injury.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/92223/original/image-20150818-12372-if6efg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s no clear evidence to suggest expensive running shoes prevent injury.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/22226011@N02/8080159041/">nprpdx/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>We may, for instance, measure how much they reduce your foot from rolling in (pronating) or soften your impact with the ground (ground reaction forces), as a “surrogate” for measuring injury. But these aren’t strong surrogates because neither foot pronation nor high ground reaction forces are strong <a href="http://bjsm.bmj.com/content/early/2015/07/28/bjsports-2015-095054.short?rss=1">risk factors</a> for running-related injuries. </p>
<p>The reason for measuring surrogate outcomes in place of actual ones then, is that they’re cheaper, more convenient and provide indirect support for marketing claims about new footwear products. </p>
<h2>Inviting controversy</h2>
<p>In the search to gain advantage in an increasingly competitive marketplace, footwear companies are forever pushing the boundaries with their claims. And when they slip up, the results can be disastrous. </p>
<p>In 2012, <a href="http://www.universalhub.com/files/vibram-complaint.pdf">a class-action lawsuit</a> was made against Vibram USA, the company that makes the FiveFingers running shoes, the glove-like footwear at the epicentre of the “natural” or “barefoot” running phenomenon. </p>
<p>The case was based on unsupported and deceptive claims of “strengthened foot and leg muscles”, “reduced risk of injury” and improved “balance and agility” and “spinal posture” from wearing the shoes. Vibram USA settled, offering refunds to customers and discontinuing the use of these claims about its footwear. </p>
<p>Similarly, promises of more <a href="https://www.youtube.com/watch?v=m9ZaAkYEES8">toned buttocks</a> from walking in Reebok’s EasyTone shoes were found to be deceptive and <a href="https://www.ftc.gov/news-events/press-releases/2011/09/reebok-pay-25-million-customer-refunds-settle-ftc-charges">misleading</a> by the US Federal Trade Commission. </p>
<p>Reebok was required to pay US$25 million in customer refunds and banned from making unsubstantiated health and fitness claims relating to its “toning” footwear.</p>
<h2>The solution</h2>
<p>Selecting running shoes based on the purported benefits of certain foot protective features, such as “cushioning” and “motion control”, offers no protection against running-related injuries. In fact, we may have reached a point where running shoes are being over-engineered in order to meet market trends, rather than being designed to make running safer. </p>
<p>But where does that leave people faced with the task of deciding the right shoe for them? Interestingly, the solution may lie in not what you think the shoes may do for you, but how comfortable they feel.</p>
<p>In the absence of strong evidence that modern running shoe features reduce injury rates, <a href="http://bjsm.bmj.com/content/early/2015/07/28/bjsports-2015-095054.full.pdf+html">comfort</a> may be more important than other factors, such as reduced foot pronation and shoe cushioning. </p>
<p>Although footwear comfort is <a href="http://europepmc.org/abstract/med/20216463">difficult to define and quantify</a>, most people are able to sense whether the shoes they’re trying on are comfortable or not. Support, fit and foot alignment are among factors that influence feeling comfortable in a pair of shoes. </p>
<p><a href="https://www.researchgate.net/profile/Annegret_Muendermann2/publication/10658602_Relationship_between_footwear_comfort_of_shoe_inserts_and_anthropometric_and_sensory_factors/links/004635182b4c8cf136000000.pdf">Comfortable running shoes</a> are associated with lower frequency of injuries than uncomfortable shoes. This suggests your body may be the best judge of footwear that’s ideal for you. </p>
<p>The next time you feel bamboozled by the cornucopia of gels, foams and rubbers in running shoes, arm yourself with the knowledge that comfort is one of the best determinants of whether a pair of shoes is right for you. And that may work best for preventing injuries, your wallet and your peace of mind.</p><img src="https://counter.theconversation.com/content/44314/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>John Arnold has received research funding from Sports Medicine Australia.</span></em></p>Since avoiding injuries is a priority for runners, many end up buying expensive footwear for their purported safety features. But do the promises made by global footwear companies stack up?John Arnold, Lecturer in Exercise Science, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/194952013-10-28T06:30:07Z2013-10-28T06:30:07ZEU Fructose ruling means dodgy health claims are easier to make<figure><img src="https://images.theconversation.com/files/33810/original/ss8j7jsx-1382699876.jpg?ixlib=rb-1.1.0&rect=269%2C1%2C754%2C485&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Fructose is associated with US obesity rise but Europe allows health claims.</span> <span class="attribution"><span class="source">Macz_out</span></span></figcaption></figure><p>An EU decision to allow health claims to be made about fructose has angered obesity experts <a href="http://www.theguardian.com/society/2013/oct/17/obesity-experts-appalled-eu-fructose-health-claim-approval">who blame the fruit sugar</a> for rising obesity levels in the US. The decision allows food and drink manufacturers <a href="http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32013R0536:EN:NOT">to claim</a> the “consumption of foods containing fructose leads to a lower blood glucose rise compared to foods containing sucrose or glucose”, where at least 30% of other sugars have been replaced by fructose.</p>
<p>Last December, the EU <a href="http://www.efsa.europa.eu/en/topics/topic/nutrition.htm">restricted food health claims</a> on products to those that had been scientifically substantiated and officially authorised. The fructose claim was allowed because it has a low glycemic index (GI), but there are serious concerns because this <a href="https://theconversation.com/fructose-health-claims-ignores-evidence-of-harm-19476">doesn’t necessarily</a> make it healthy and also whether a health claim should be allowed at all when we should be consuming less sugar — glucose, sucrose or fructose — in our diet.</p>
<h2>Warnings from the science community</h2>
<p>The European Food Safety Authority (EFSA), which advised on the decision, actually <a href="http://www.efsa.europa.eu/en/efsajournal/pub/2223.htm">sounded a note of caution</a> in May 2011. It pointed out that high intakes of fructose could lead to complications such as dyslipidaemia (a higher amount of lipids such as cholesterol in the blood), insulin resistance and an increase in visceral fat: the internal fatty deposits that can accumulate around organs (rather the fat you can pinch under your skin). </p>
<p>Robert Lustig, an American endocrinologist, <a href="http://www.theguardian.com/commentisfree/2013/oct/21/fructose-poison-sugar-industry-pseudoscience">went further</a>. He argued it was pseudoscience to find a health benefit from reducing blood glucose when increasing fructose in the blood directly contributed to heart disease and diabetes and was associated <a href="https://theconversation.com/fructose-health-claims-ignores-evidence-of-harm-19476">with other</a> serious health problems.</p>
<h2>The ‘halo effect’</h2>
<p>A major fear is the so-called halo effect, where a product that is marked as healthy, or has at least some health claims, leads consumers to believe it is a wholly healthy product. The drafters of the <a href="http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32006R1924:EN:NOT">2006 EU Regulation</a> on health and nutrition claims clearly shared this concern and wanted to avoid a situation where “nutrition or health claims mask the overall nutritional status of a food product, which could mislead consumers when trying to make healthy choices in the context of a balanced diet”. For this reason, the regulation required the EC to establish “specific nutrient profiles which food or certain categories of food must comply with in order to bear nutrition or health claims”. </p>
<p>These are the same tools that are used in the UK to determine when food and drink is too high in fat, sugar or salt, to be advertised to some children on TV. <a href="https://www.gov.uk/government/publications/the-nutrient-profiling-model">Nutrient profiles</a> drawn up by the Food Standards Agency, weigh up the amount of fat, sugar and salt in foods against the good nutrients like vitamins and minerals.</p>
<p>But although there was a January 2009 deadline for the EC to produce nutrient profiles according to the regulation, no profiles have been developed to date. This failure means that the EC also has no option to restrict claims on unhealthy foods - it must either authorise or refuse them.</p>
<h2>Refuse or defer</h2>
<p>In the case of fructose, the better path would have been to refuse the fructose claim, or at least defer a decision pending further evidence. Not only would this respect the intention of the regulation to avoid mixed messages but it would also have invoked the “<a href="http://ec.europa.eu/food/food/foodlaw/precautionary/index_en.htm">precautionary principle</a>”, which applies when a danger has been identified but there is no strong evidence of the precise risk involved, and which comes into play in issues of health and consumer protection. </p>
<p>In this case there is mounting scientific evidence of <a href="http://www.nature.com/nature/journal/v502/n7470/full/502181a.html">harm from fructose</a> consumption and uncertainty about a potential increase in consumption from manufacturers re-formulating food and drinks with fructose and promoting them using a health claim. It has been pointed out elsewhere that fructose manufacturers <a href="http://www.nutraingredients.com/Industry/Sweet-sales-future-for-fructose-products">clearly expect</a> a surge in sales.</p>
<p>Instead, the commission chose to authorise the fructose claim rather than taking the approach <a href="http://eur-lex.europa.eu/LexUriServ/LexUriServ.do?uri=CELEX:32013R0536:EN:NOT">used for other claims</a> that involved refusing authorisation or deferring a decision to avoid confusing the consumer (for example, over conflicting national dietary advice on sugars and a potential health claim relating to carbohydrates) or misleading them (because a salt claim relied on compositional levels that were uncertain and therefore may not have been beneficial).</p>
<p>Perhaps this is “incompetence or collusion” as Lustig suggests, or maybe it is one bad decision in the absence of evidence on the effect of a claim.</p>
<p>It could also be that this is the first of several narrow, “technical” health claims that could be applied to products that are high in fat, salt or sugars, as industry gets smarter about the system and the process of authorisation - in which case it is time the European Commission revisited the spirit of the regulation to make sure we avoid these mixed messages. Unfortunately this may not be possible until it fulfils its obligation to develop a set of nutrient profiles that can actually be used to guide health and nutrition claims.</p><img src="https://counter.theconversation.com/content/19495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>An EU decision to allow health claims to be made about fructose has angered obesity experts who blame the fruit sugar for rising obesity levels in the US. The decision allows food and drink manufacturers…Colin Mitchell, Researcher, University of OxfordMike Rayner, Director of the BHF Health Promotion Research Group, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/194762013-10-24T19:44:18Z2013-10-24T19:44:18ZFructose health claims ignores evidence of harm<figure><img src="https://images.theconversation.com/files/33670/original/fx56xf3s-1382586428.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The European food agency has decided to allow health claims for products containing fructose.</span> <span class="attribution"><span class="source">Broken Haiku/Flickr</span></span></figcaption></figure><p>The European Food and Safety Agency (EFSA) has just approved health claims for fructose-sweetened products, in a move that has <a href="http://www.theguardian.com/society/2013/oct/17/obesity-experts-appalled-eu-fructose-health-claim-approval">astonished scientists around the world</a>.</p>
<p>Food and drink manufacturers can now claim that their products are healthier if they replace at least 30% of their glucose or sucrose with fructose.</p>
<p>The rationale provided by the EFSA for the decision is that fructose has a low glycemic index (GI). The glycemic index of a particular food is a measure of the rise in blood glucose levels in response to 50 grams of carbohydrate in that food. </p>
<p>This glucose response drives the subsequent insulin response, and insulin is the major hormone driving fat accumulation. That’s the link with obesity.</p>
<p>But it’s not really as simple as that. Just because a food has a low glycemic index doesn’t mean it’s healthy or that you can eat as much of it as you want.</p>
<p>Processed foods containing fat (such as ice-cream, chocolate, and potato crisps) have a low glycemic index because fat slows gastric emptying (the rate at which food enters the small intestine from the stomach). But most of us would recognise they are not the ideal foods to eat when you want to lose weight.</p>
<p>Fructose has a low glycemic index, which is not surprising since it’s not glucose (recall that glycemic index measures the rise in blood glucose levels). But that doesn’t mean it’s not potentially problematic.</p>
<p>Fructose and glucose are handled very differently by the body. Whereas glucose is used by most tissues as a source of energy, fructose is taken up almost entirely by the liver. </p>
<p>When we are eating more than we need, fructose is converted very efficiently by the liver into fat. Just like excessive alcohol consumption, this can cause fatty liver (non-alcoholic fatty liver), which is now very common among people who are overweight and obese. </p>
<p>Left unchecked, fatty liver can lead to cirrhosis and liver failure. It also contributes to weight gain generally. </p>
<p>Excess consumption of glucose (in the form of starchy foods) can certainly contribute to weight gain, but not fatty liver. </p>
<p>Excessive consumption of fructose (more so than glucose) exacerbates insulin resistance and the metabolic syndrome – and thereby greatly increases the risk of type 2 diabetes and cardiovascular disease.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=430&fit=crop&dpr=1 600w, https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=430&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=430&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=540&fit=crop&dpr=1 754w, https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=540&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/33672/original/pqdb9d6t-1382587851.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=540&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ice-cream’s low glycemic index doesn’t make it a healthy product.</span>
<span class="attribution"><span class="source">Cascadian Farm/Flickr</span></span>
</figcaption>
</figure>
<p>It’s important to note that dietary fructose is not a problem if you’re lean and fit, and not over-eating. Under those circumstances, the fructose will be metabolised as an energy source.</p>
<p>The major sources of glucose are starches (polymers of glucose) and sucrose (which is comprised of one molecule of glucose and one of fructose). </p>
<p>Our major source of fructose in Australia is sucrose. In the United States, high fructose corn syrup is now a major source. </p>
<p>While there’s also fructose in fruit, it’s in a diluted form and present with a range of other healthy nutrients and fibre. And health claims are overwhelming applied to highly-processed foods (think of the last time you saw a health claim on an apple). </p>
<p>But why would the processed food industry want to be able to make health claims for fructose?</p>
<p>Fructose is much sweeter than glucose and significantly sweeter than sucrose. The food industry has conducted very sophisticated research on what stimulates food consumption (the “bliss point”), and found that, together with fat and salt, sweetness is one of the <a href="http://michaelmossbooks.com/">major drivers of excess food intake</a>.</p>
<p>So, sweetness is very good for business.</p>
<p>And interestingly, when we drink calories, particularly watery calories as in soft drinks or alcohol (as opposed to soup), our body does not recognise them as such; it’s as if we were drinking water. </p>
<p>Caloric drinks are particularly problematic because <a href="http://www.ncbi.nlm.nih.gov/pubmed/10878689">they’re added on</a> to what we voluntarily eat. </p>
<p>The European Union’s approach to food regulation, then, is very reductionist. The EFSA has taken one short-term impact of a food component (the glycemic index) to justify a health claim for fructose, and ignored all the science that indicates its adverse impacts on long-term health in relation to over-consumption, weight gain, diabetes, heart disease and liver disease.</p>
<p>This is yet another victory for the powerful processed food and beverage lobbies over advocates for public health.</p><img src="https://counter.theconversation.com/content/19476/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Kerin O'Dea receives funding from the National Health and Medical Research Council and the Australian Research Council.
</span></em></p>The European Food and Safety Agency (EFSA) has just approved health claims for fructose-sweetened products, in a move that has astonished scientists around the world. Food and drink manufacturers can now…Kerin O'Dea, Professor of Population Health and Nutrition, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.