Sugar and vice

The metal tab pulls back with a familiar click-click-hissssss as bubbles rush to the top of the can. The alluring scent of faux orange or grape or berries wafts through the air, a familiar smell that hints at what’s to come.

What’s to come tastes good. It’s a reminder of summer, or of a childhood treat, of a sporting event or a beach day with friends. It’s OK to indulge yourself, the advertising says. You’ve earned it.

If you’re drinking a 20-ounce Mountain Dew, you’re earning the equivalent of 18 teaspoons of sugar. A same-sized Pepsi equals 16 teaspoons and a Coke comes out to 15. A 16-ounce Rockstar Energy Drink slams more than 15 teaspoons of its own.

Here’s the problem with what you’re drinking, some scientists say: Humans are not biologically designed to deal with that much liquid sugar at once. Since there’s no digestion involved, it enters the bloodstream and is absorbed more quickly than food.

As it does, the sugar overwhelms the pancreas, the organ tasked with regulating blood sugar, and over time wears it out. Welcome to Type 2 diabetes. That much sugar hits the liver like a freight train—the liver doesn’t know what to do with it all, other than convert it into fat, leading to higher rates of fatty liver disease. That’s a condition that used to be seen mostly in alcoholics.

Davis-based doctor of public health Harold Goldstein offers up the statistics on the amount of sugar in the most popular drinks off the top of his head—and then he sends a chart. Goldstein is the founding executive director of the California Center for Public Health Advocacy in Davis and whose mission is to look for solutions to what scientists say is an alarming increase in diabetes and obesity in California.

About five years ago, the CCPHA commissioned a study by the UC Berkeley Center for Weight and Health to see if there was a correlation between obesity and sugary beverage consumption. The study found that between 1977 and 2001, Americans on average were consuming 278 more calories a day than before, with 43 percent of those calories defined as new beverage calories.

“I had no idea what the answer was going to be, but what they came up with was simple and compelling,” Goldstein said. “I was stunned. It was twice as much as I guessed.”

We weren’t just eating more. We were drinking more.

And mostly, we were drinking more sugar, a phenomenon that coincided with the “soda wars” of the ’70s and ’80s, where Coca-Cola and Pepsi went head-to-head on television advertising campaigns to win the hearts, tastebuds and dollars of consumers. It also coincided with an increase in portion sizes: In the ’70s and ’80s, a 12-ounce can was the norm. Now fast-food restaurants offer 32-ounce cups with free refills, and thirsty consumers can find sugar-sweetened drinks everywhere, from corner markets to vending machines in airport parking garages.

Another surprising statistic, this from the National Institutes of Health via Goldstein: A quarter of teenagers, or 23 percent, have prediabetes, an increase from 9 percent just 10 years ago.

“These beverages are tricking the body,” Goldstein said. “The pancreas goes wild and the liver says, ‘Look at all this. I better save it for a rainy day and turn it into fat.’ There is a cohort of teens that will be entering the health care system with higher rates of diabetes than ever.”

The grim statistics are why state Sen. Bill Monning (D-Carmel), backed by CCPHA and the Sacramento-based Health Officers Association of California, has been at battle with the beverage industry. Earlier this year, Monning introduced Senate Bill 203, which would have required a warning label to be placed on the packaging of sugar-sweetened beverages including sodas, sweet teas, sports drinks and energy drinks.

The label would have been required on drinks with 75 or more calories per 12 ounces and would read as follows: “STATE OF CALIFORNIA SAFETY WARNING—Drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.” State Sen. Richard Pan (D-Sacramento), a pediatrician, supported the bill and is also listed as a co-author.

Monning introduced a similar bill last year, but it didn’t make it to the governor’s desk. And, once again, just a few weeks ago, this year’s bill died, this time in the Senate Health Committee, an outcome showing that the beverage industry is willing not only to put a lot of muscle and money behind the effort to stop Monning, but also to try to stop information they deem harmful to their industry from reaching the public in the first place.

But the soda industry has bigger problems besides one California legislator: More and more studies are being released every year on sugar-sweetened beverages, and how they’re not so good for you.

For instance, a Monterey County Health Department study, which was delayed for more than two years because someone higher up the food chain brought down pressure, finally was released this past March. Which adds even more fizz to the pop drama.

The report was based on research conducted between 2011-2012 by a tri-county organization—San Benito, Santa Cruz and Monterey counties—called the Nutrition & Fitness Collaborative of the Central Coast, as part of the nationwide initiative called “Rethink Your Drink.” The aim is straightforward: getting people to reduce their consumption of sugary drinks.

Christine Moss is a staffer to the collaborative and knows what she’s talking about. She also knows about pressure from the American Beverage Association, a representative of whom called her while the collaborative was gathering its data.

“He wanted to make sure we weren’t doing anything silly like pushing for a soda tax,” she said. “I explained to him we couldn’t work on something like that, because our funders wouldn’t allow it.”

Epidemiologists began the survey in 2011, seeking to track the sugary-beverage-consumption habits of 250 people in each of the three counties. They found participants at health clinics and in laundromats waiting for their clothes to dry. In the end, they collected 1,053 surveys and completed the work by late 2012.

“Any place we could get a group together, we did a survey,” Moss said. “That way we could get a nice representative group of people. That was important to us.” The aim was to release the survey a few months into 2013.

Yes, that means it is a full two years late. What happened?

“We were touchingly naïve,” Moss said. “We started to realize this was very controversial. We got lots of pushback. Our state funder, the California Department of Public Health, had lots of questions and cautions.”

She says she would send in surveys and the Department of Public Health would send them back asking for very precise changes. “I wasn’t quite sure of the intent, but the approvals each step took a lot of time. It pushed back our timeline a long way,” she said.

Examples of that pushback: Moss says she was not allowed to use imagery people might think of as a specific soda can—no red backgrounds with silver swirls, or blue backgrounds with red and white imagery. And she was actually discouraged from using the word “soda” in the report (it may have slipped in, she says, in at least one instance, but the report mostly references sugar-sweetened beverages).

“I expect it’s a trigger word for certain special interests,” Moss said, “but we found it’s much broader than soda.”

Moss says the research revealed what she calls “two big shockers.” First, as soda sales have started to plateau, companies have ramped up their advertising for energy and sports drinks, specifically targeting 11- to 17-year-olds.

“The numbers will knock your socks off. For every second-grade teacher wondering why kids are so hopped up, caffeinated drinks are big,” Moss said.

The other big shocker: Nobody’s drinking much water.

The California Department of Public Health did not respond to questions about the report’s delay.

That brings us to the money and influence the beverage industry wields throughout the state. Here are just a few examples.

Last June, on the same day Monning’s previous labeling bill died in the state Assembly Health Committee, PepsiCo spent $2,200 on a catered event for 13 legislators and more than three dozen legislative staff members from the Latino Legislative Caucus, as The Sacramento Bee reported. Of the legislators who attended, two voted against Senate Bill 1000, the previous iteration of the labeling bill.

Later that day, the Bee reported that PepsiCo representatives took Assemblymen Luis Alejo and Freddie Rodriguez to dinner. Alejo, who this year became head of the Latino Legislative Caucus, didn’t vote on the bill because he’s not a member of the Assembly Health Committee. Rodriguez, who is a committee member, abstained.

Assemblywoman Lorena Gonzalez voted against it. She said at the time that a decline in soda sales would lead to the loss of too many jobs in her district.

Alejo says the timing was coincidental. The PepsiCo event had been planned for more than a month and featured a book signing by Richard Montanez, a former janitor who became a PepsiCo executive—and the inventor of Flamin’ Hot Cheetos.

In 2014, the American Beverage Association California Political Action Committee, also known as the American Beverage Association Strategic Advocacy Fund, spent $11.8 million on various candidates and measures. Of that, $9.24 million went to the successful opposition of a soda tax floated before San Francisco voters. The group also spent $2.43 million to defeat a Berkeley soda tax, which passed despite fierce industry opposition.

The PAC donated $4,100 to Alejo for Assembly, and the same to the Senate campaign of Ben Hueso, the San Diego Democrat who is vice chair of the Latino Legislative Caucus.

It put $27,200 into Gov. Jerry Brown’s campaign and $3,000 into Attorney General Kamala Harris’ too. It gave $46,000 to the Democratic State Central Committee of California and $10,000 to the California Republican Party. (For more information, see box at left.)

Fast forward to this year. The PAC started 2015 with $504,000 in the bank. The spokesman for the Latino Legislative Caucus PAC and foundation, local political strategist Roger Salazar, is now the spokesman for CalBev, also known as the California-Nevada Beverage Association, the trade association representing the non-alcoholic beverage industry in California and Nevada.

The Cal-Nev Soft Drink Association PAC spent $37,371 on various campaigns in 2014, mostly as $1,000 contributions to individual legislators.

In the hours and days that followed Monning’s announcement of his latest labeling bill, SB 203, CalBev went on the offensive.

In a written statement, CalBev Executive Director Bob Achermann says obesity and diabetes are more complicated than a warning label. Monning’s bill is “misguided,” singles out soft drinks while ignoring sugar-rich cupcakes, donuts and processed foods, and is riddled with loopholes that will confuse consumers, according to the statement.

For example, the release says, fountain sodas purchased at restaurants with table service will be exempt from labeling. The release also calls out milk-based products like Frappuccinos and lattes, which contain as much sugar and more calories than soft drinks.

Salazar says the industry has taken on an initiative to reduce sugar-sweetened beverage consumption 20 percent by 2025.

“There are ways you can have a collaborative effort, but bills like this seek to demonize an industry with a shocking label when there are other, broader causes to obesity and diabetes we should be looking at,” Salazar said. “It’s about balancing calories, and there’s no question we support programs that educate people about nutrition and exercise.”

But the statement that there could be a collaborative effort came as news to Monning.

“Their position on labeling is, they provide caloric information on the label and consumers have that at their fingertips,” he said.

He acknowledges other sources of sugar are out there, but says none are as dangerous.

“While sugar is in other foods,” he said, “medical evidence is clear that liquid consumption of sugar is more immediately damaging. When you eat it, more is eliminated through digestion.”

Achermann contends it’s counterproductive to suggest legislation impacting only some beverages will be effective.

“If consumption of sugar- sweetened beverages is going down and diabetes is going up, then how are soda and other sweetened beverages driving the problem?” he writes.

Goldstein agrees on one point: Soda consumption is going down. Americans now drink an average of 44 gallons of soda a year, a 17 percent drop from the peak in 1998, he says. But the percentage of adolescents drinking sports, energy or sweetened fruit drinks is on the rise, from 31 percent in 2009 to 38 percent in 2012.

The ultimate question might be, “Will a warning label work?” The fact that the industry fought so hard against it indicates it might.

Monning says that the more the labeling issue is in the public eye, the more it’s likely to resonate, and he remains committed to seeing the issue through.

“This will not deter me from my fight against the leading contributor of diabetes and other chronic illnesses,” Monning said in a statement after the latest bill failed during a 4-to-1 vote. “The scientific evidence of the proven adverse health impacts of sugar-sweetened beverages demands a health warning label, and it is only a matter of time before California enacts legislation that informs individuals about healthful beverage choices.”

Goldstein, the Davis-based public-health doctor, isn’t sure what’s so controversial about a warning label. His center’s polling research shows that 74 percent of California voters support labeling, and that includes 63 percent of Republican voters, 86 percent of Latino voters and 80 percent of African-American voters.

“In some ways, labeling is the most Libertarian of all public policies,” Goldstein said. “It says consumers have the right to know and should be able to decide for themselves on the truth. The beverage industry wants to continue hiding behind a marketing message.”

A different kind of persistence, Moss thinks, proves the very power of a warning label.

“The statistic I hear about getting people’s attention is that you need to hear a message 11 to 13 times before it sinks in,” she said. “If you have to look at it every time, maybe that’s the loading dose. Maybe it will lead to the question, ‘Is this the best choice I can make?’”