The bitter truths of sugar
There is such a thing as too much of a good thing, especially when it comes to sugar.
Photo by Charlie Wollborg / Unsplash
The history of sugar in Indonesia began when the Dutch colonies established sugarcane plantations on the island of Java through the ‘Cultivation System’ or, less accurately the ‘Culture System’ (Dutch: cultuurstelsel; Bahasa: Sistem Tanam Paksa), where Javanese peasant farmers were forced to reserve forty-percent of their harvests for the export market at an inadequate price to the market value.
This system introduced novel practices to Java and Indonesian agriculture, such as the extensification of coffee, tea, tobacco, indigo, and sugar as monoculture cash crops (ie, crops grown to make profit) and the double cropping of rice with sugar as opposed to to other staple crops common under the Indonesian ancient monarchies (eg, cassava, sweet potatoes, corn, purple yams, peanuts). In comparison to coffee, which increased approximately a thousand-fold, Indonesian sugar production was documented to rise as much as 2,500% from 1800 to 1850. Together with Cuba, Java was the largest sugar exporter in the world, supplying more than half of the available sugar on the world market by 1870.
Sugar: a socially accepted stimulant
Part of the carbohydrate family, sugar is an organic chemical produced by plants through photosynthesis. It can be sourced from various plants, including corn, palm trees (taken from the sap or nectar), and sugarcane, among others.
Naturally, sugar is found in different food products in various forms of molecules. For example, fructose and glucose (monosaccharides) can be found in fruits and vegetables, and lactose (disaccharide) in milk. When consumed as whole foods, sugars are an integral part of a healthy diet as they contain essential nutrients like vitamins, minerals, and fiber.
However, our food system has enabled a world where refined sugar habit is normalized.
Many of the foods we encounter daily today come in the form of packaged, instant foods that contain excess sugars. Currently accounting for 50-60% of the daily energy intake worldwide, an increase in the availability of high-sugar ultra-processed foods (UPFs) means an enabling food environment for more of these foods and ultimately overconsumption of sugar.
When we consume sugar, it triggers the release of dopamine, a hormone that controls feelings of pleasure, satisfaction, and motivation. This creates a reward sensation, which creates a positive feedback loop between sugar consumption and cravings.
In short, the more we consume high-sugar foods, the more our brain craves them.
This sugar habit raises concern regarding the increased consumption of sugar-sweetened beverages (SSBs)–an example of an ultra-processed beverage containing free sugars–which reaches over a third (69%) of added sugars in our diet and has contributed to various health concerns.
Sugar-sweetened beverages and human health
SSBs available today are notably sweeter than in the past and have become increasingly diverse since the 2000s.
Initially limited to soft drinks, sweet teas, and juices, the SSBs market has expanded to include ready-to-drink coffees and lattes, flavored water, energy drinks, honey drinks, bubble tea, and powdered drinks. These beverages vary widely in brand, volume, sugar content, price, packaging, and targeted customer groups. For example, 600 ml of soda contains 15 teaspoons of sugar (63 grams); 200 ml of flavored milk contains 11 grams of added sugar; and 1 liter of sweet tea contains 65 grams of added sugar.
In Indonesia, the availability of SSBs is facilitated by over 60% of street vendors and retail businesses that cater to various customer preferences, lifestyles, and purchasing power. Today, Indonesia ranks the third highest SSB consumption in Southeast Asia, with an average of 20.23 liters per person per year.
SSBs are consumed at least once a week by 62% of children, 72% of adolescents, and 61% of adults, with ready-to-drink tea being the most frequently consumed.
A typical Indonesian minimart provides up to 91 types of SBBs, ranging from carbonated drinks, coffee, juice, milk, sports drinks, supplement drinks, tea, yogurt, and energy drinks. These unhealthy drinks are widely available in schools and even some hospitals, contributing to a large and rapidly growing market for SSBs in the country.
This growing consumption goes hand in hand with an increase in non-communicable diseases (NCDs), as shown by the growing NCD-related mortality that reached 69% in 2019.
A 2020 cross-sectional study on the elderly population in a health center in Manado, North Sulawesi, showed a significant correlation between SSB consumption (sodas) and the incidence of diabetes mellitus (p = 0.05).
This is not surprising as excessive sugar intake contributes to weight gain and obesity by providing empty calories that lead to an energy imbalance, and increases the risk of developing type 2 diabetes.
High sugar consumption also leads to increased triglyceride levels, inflammation, and high blood pressure–all of which are risk factors for cardiovascular diseases such as stroke. It has been reported that the prevalence of diabetes mellitus rose from 0.9% to 9.19% from 2013 to 2020, likely due to the direct effect of high sugar intake on blood glucose levels and insulin resistance.
Sugar-sweetened beverages and planetary health
Our planet also suffers from sugar.
While sugars can be sourced from various plants, sugarcane is the most produced source of sugar worldwide, with a production of 1.92 billion tons in 2022.
Sugarcane production generates 3.2 kg of greenhouse gas emissions (GHGEs) per kilogram, resulting in a total emission of 6.14 billion tons of GHGEs in 2022 alone. In comparison, sugar beet and corn emit about half of the GHGEs produced by sugarcane (1.81 kg and 1.7 kg, respectively).
Sugarcane production also requires 2.04 m²/kg of land and 620 liters of water per kg, whereas sugar beet uses relatively less water at around 216 liters per kilogram. This extensive land use has resulted in soil erosion, where land is often stripped of protective cover during planting preparation and causes soil degradation. Continuous removal of sugarcane also reduces soil fertility, necessitates increased fertilizer use, and generates industrial waste from wastewater, emissions, to solid waste.
Combating a high-sugar diet while safeguarding the planet
Though it has yet to be implemented in Indonesia, many countries have implemented taxes on SSBs as a way to decrease the consumption of sugar in beverages.
Implementing taxation policies on unhealthy products, eg, a 10% tax on sugar-sweetened beverages (SSBs), can lead to an 8-10% reduction in their purchase and consumption.
In Mexico, for example, an SSB tax significantly decreased SSB consumption, especially among households with children, and increased water purchases in low- and middle-income households and urban areas. Similarly, Thailand saw the greatest decrease in SSB consumption among children aged 6-14 after implementing such a tax.
The trend consistently shows positive health impacts, with a 20% tax on SSBs reducing overweight and obesity rates (by 1-3% and 1-4%, respectively), and significantly lowering the prevalence of type 2 diabetes, heart disease, stroke, and early death.
Indonesian sugary drinks taxation and other mitigation strategies
A policy brief investigating the health and economic impact of SSB taxes on the future diabetes type 2 burden in Indonesia found that implementing a 20% tax on SBB is projected to positively impact public health. The model estimated that taxation on sugary drinks could reduce BMI, potentially prevent 253,527 cases of overweight and 502,576 cases of obesity within a year, as well as prevent new cases of diabetes mellitus annually, with cumulative prevention of 3.1 million new cases by 2033.
While policy regulates and changes behavior most efficiently, change also begins at the household and individual levels.
A good starting point is to choose whole foods first. In some cases when high-sugar UPF products are most convenient, remember that the limit for added sugars is 10% of the total daily calories for adults. This means learning food labels carefully and paying attention to the ingredients list and the nutrition facts.
How about choosing non-sugar sweeteners?
More information on non-sugar sweeteners will follow shortly.
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