Op-Ed: Councilman Jeff Ritterman explains his support for a Richmond soda tax

Dr. Wendel Bruner, the Public Health Director for Contra Costa County, had made it painfully clear: Fully one-third of Richmond’s African American and Latino fifth and seventh graders are obese.  Another 20 percent in each group are overweight. Without a successful intervention, Dr. Bruner warned that most of these children would suffer the ravages of diabetes and premature coronary heart disease, and many would simply not live as long as their parents.

What would a successful intervention look like?  Dr. Thomas Frieden, the director of the Centers for Disease Control and Prevention, has said a one-cent per ounce sugar-sweetened beverage tax might be “the single most effective measure to reverse the obesity epidemic.”

The American Heart Association, the Institute of Medicine, the American Public Health Association, the American Academy of Pediatrics and the United Nations all endorsed the idea.

But why single out sugar-sweetened beverages? Can’t any food or beverage be a part of a balanced diet?  You know, have the cola with dinner but skip the chocolate cake for dessert.

That seems reasonable, but that’s based on the old science. What the new science is telling us is that our bodies actually work a bit differently than that. We are not equipped by nature to metabolize large fructose loads without severe adverse health consequences.

You see, this kind of thing has never happened before in human history. In nature, sucrose or fructose is always bound to fiber and that prevents us from taking in too much at once and our livers can easily handle what’s in an apple (or two or three).

But when we concentrate huge doses of fructose, either from high fructose corn syrup or from sucrose, in water and chug it down, we present the liver with more than it can safely handle. The liver has no storage mechanism for fructose. It can’t just put the excess fructose on the shelf and come back to it later. What the liver cannot metabolize by the usual pathway – the Krebs cycle – it shunts to the DNL pathway. DNL? De novo lipogenesis, literally, new fat making. The liver converts the excess fructose to fat.

Some of the fat ends up around our waistlines. That’s the fat we see. It’s the fat we don’t see that hurts us.  Our livers get packed with fat and begin to malfunction. The fatty livers become “deaf” to the hormone insulin, which regulates sugar and fat metabolism. The pancreas responds by going into overdrive and making high doses of insulin. The overworked pancreas eventually poops out and diabetes results.

The fatty livers also make unhealthy cholesterol, specifically small dense LDL (low density lipoprotein) particles. This unhealthy cholesterol causes the arteries of the heart to plug up. The heart muscle downstream from the blockage dies off due to lack of oxygen.  That’s what we call a heart attack or a coronary.

I’ve been on the treatment end of many heart attacks in my thirty-year career as a cardiologist.  It’s not a pretty sight, the crushing chest pain, the look of sheer terror, the struggling for breath. It’s something to prevent, whenever possible.  If drinking sugar-sweetened beverages increases our heart risk, which it does by 20 percent, we ought to avoid them and pass that knowledge on to our children.

Dr. Kimber Stanhope replaced the toast and crackers that healthy 18-24-year-old volunteers had been eating, calorie for calorie, with a sugar-sweetened beverage. Within two weeks, these healthy volunteers were producing alarmingly high levels of small dense LDL particles. It made Dr. Stanhope decrease her fructose consumption and it did the same for me. Drink a cola and have small dense LDL particles circulating and starting to clog up my heart’s arteries. No, thanks!

The pieces of the puzzle are beginning to fit together.  We Americans have drastically increased our intake of sugar during the past generation. More than half of that added sugar has come in the form of sugar-sweetened beverages. Estimates are that at least 20% of the weight gained by Americans in the last generation was due to sugar-sweetened beverages.

The new science is saying that too many sugary drinks is the main culprit in weight gain, diabetes, premature heart attacks and even some cancers. So why not just educate folks and leave it at that?

It turns out that the public health literature has lots to say about this too. Perhaps it’s no big surprise, but we humans are a stubborn lot. Just educating us was not enough to curtail tobacco use, to get us to put on our seatbelts, nor to designate a safe driver when we had too much to drink. We needed a little “stick” to go along with the carrot.

Cigarette taxes, and penalties for drunk driving and not buckling up moved us to behave in healthier ways. That’s what we plan to do in Richmond with the sugar-sweetened beverage tax.  And we can do even more, because we can direct the tax revenue to programs and projects that promote healthy eating and active living.

We know from our work in the Richmond community that the overwhelming number of residents will support the sugar-sweetened beverage tax if the tax revenue is used to create more after school sports programs; making programs less expensive; providing adequate sports fields; allowing schools to provide healthier school meals, nutrition classes and cooking classes; and providing medical care for children with diabetes who can’t afford care.

We can guarantee enough votes on the future city council to make that package a certainty if the ballot measure passes. We will have $3 million to invest in our children’s well being and we will have made history.  Because of this campaign, many more folks in Richmond will know and understand the new science than probably anywhere else in the United States.

Help us beat Big Soda. Help us make history.

Let’s do it for our children.

Learn more at www.fit-for-life.org

Dr. Jeff Ritterman is a member of the Richmond City Council. This op-ed originally appeared in California City News.

Filed under: First Person, Front

3 Comments

  1. Charles T. Smith

    RICHMOND LIBERALS LOSE THEIR WAY
    When Richmond residents stood up to Chevron several years ago they made national news. Richmond voters taxed Chevron and stopped them from processing heavy crude without adequate environmental protections. Today Richmond is again making national news with a proposed regressive tax on sugar drinks. On the surface, considering the obesity rate among economically challenged residents, this may look like an attempt to help people develop healthier lifestyles by slowing down their consumption of sugar drinks. Under closer inspection, however, it reveals a callous middle class bias against the poor.
    The tax was authored and promoted by Richmond Council Member Dr. Jeff Ritterman, the former head of the Richmond Kaiser Cardiology Department. It is Dr. Ritterman’s current position that sugar drinks are responsible for the high rate of obesity in Richmond’s minority community and, therefore, it is in the community’s interest to discourage the consumption of such drinks by adding a hefty City tax. Interestingly enough, in a 2008 National Geographic Special, “Stress: Portrait of a Killer,” Dr. Ritterman expressed a broader view, stating that the daily stress of being poor is what leads to health problems. The relationship between the stress of poverty and obesity was one of the primary points in the documentary. So what could change in four years that would lead Dr. Ritterman to change his emphasis and focus exclusively on the issue of sugar drinks? I would suggest that he is leading his middle class constituency to take the reactionary position of blaming the victims and he is doing so for political reasons.
    Where the poorest members of Richmond live there are no supermarkets but only liquor stores and quick-stops. This has been the case for years. Richmond has a very high rate of unemployment particularly amongst its minority population. Richmond has a high rate of drive-by shootings and homicides. Its schools are not known for their high academic performance and they have been cash-strapped for years. These are many of the daily stressors under which the poorest members of Richmond must live. As a result of these and other stressors they suffer from serious stress-related health problems. The abuse of sugar drinks is a symptom, not the cause, of these health issues which affect a large portion of Richmond’s residents. There is a proven correlation between poverty and serious health problems including obesity. You don’t need to be a scientist or a doctor to Google “what states have the highest rates of obesity?” and then Google “which are the poorest states in the US?” to see that the results indicate the very same states. Clearly, the relationship between serious health problems and rates of poverty is glaring. Health issues are class issues.
    So then, why would these obvious social facts lead “progressives” to support a regressive sugar tax in the first place? The answer is that capitalism teaches us to attribute our economic problems to our own inadequacies rather than to the economic system itself. Rather than fight capitalism we blame the most oppressed members of our society. We blame them for the consequences of being poor as if it were their fault. This is the reactionary response to our problems which creates the cynicism that leads well-intentioned people to support regressive taxes.
    This is precisely the same strategy that is currently being used by the media to blame public workers’ pensions and benefits for the failure of state and local governments to balance their budgets. The attacks on public workers’ benefits are merely distractions so that citizens forget the impacts of non-stop wars and the largest theft of public funds in the history of the world which we, the tax payers, are paying for.
    This strategy is so effective that even the most liberal citizens are falling for it.
    People who are still comfortable understand that their economic situation is changing fast. They are getting caught up in the downward economic spiral. When they are told that the increased cost of their health insurance is due to other people’s unhealthy lifestyles, they quickly support a regressive sugar drinks tax. They support increasing the health insurance rates for obese people or smokers or just denying them health care altogether. The same attitude is being applied to public workers who have paid into their retirement plans but are now under attack for having a retirement plan at all. Politicians and the media clamor for the reduction of their benefits while advocating for them to work longer before retirement. Voters who have fewer benefits or none at all are now supporting these shortsighted attacks. They don’t understand the causes of their own current economic situation. The easy answer for them is to attack their neighbor. We need to stop these mean-spirited, divisive, reactionary attacks on our friends and neighbors, focus instead on the real problem: work to defeat capitalism before it crushes all of us. Progressives should never support regressive taxes.
    Charles T. Smith

  2. Tony Suggs

    Children are getting fatter because they are sitting on the butts more than they go out and play. Secondly, look at their parents and you will see that most will also be fat.

    So, does anyone eally believe that these same “stubborn” people the doctor mentions is going to all of a sudden start getting more execise simply because of a new a playground is built?

    I doubt it.

    Besides, when all is said and done, this money will be siphoned off to pay for something else, as the budget problems for Richmond, Contra Costa County and the State will still be here for the next 5 to 10 years.

    So, instead of buying my groceries at Target, which includes those evil soft drinks, I will just do all my shopping now in El Cerrito at Safeway. Adding to the air pollution, traffic and loss of tax dollars to Richmond.

    Thanks Doc!

  3. Jeff Ritterman

    From Phoebe Ann Sorgen

    Sugary, acidic soda rots teeth worse than anything. A most delicious and inexpensive beverage is water with sliced strawberries, lemon, and fresh mint leaves in it. Especially if the water is carbonated, soda drinkers would come to like it as much as unhealthy soda. Before breaking free of the sweet addiction, it could be sweetened with XYLITOL, a natural sweetener that is good for teeth, as sweet as table sugar w/ about 40% fewer calories and 75% fewer carbohydrates. http://www.xylitol.org/questions-about-xylitol

    STEVIA, AGAVE and natural FRUIT JUICES are other sweeteners that are not unhealthy like sugar, corn syrup, or aspartame. (The latter 2 are genetically modified, as is much sugar from beets.) Stevia grows like a weed. The minced leaves are sweeter than sugar.

    Consuming unhealthy sodas is both a symptom and a cause of poor health and stress. I blame Big Soda corporations, not the consumers, for getting people hooked on all-American dangerous sodas that are so heavily advertised from infancy on. Soda only makes our probs and stress worse, wasting money and health. Artificial colors and flavors in sodas have been associated with children’s ADHD and other probs, too.

    It only takes 15 days of substituting a healthier beverage for the cravings to go away. 15 days to break a bad habit, get free of that monkey on our backs, and start losing weight and feeling great.

    Progressives and radicals who want to defeat capitalism before it crushes all of us will vote for breaking free of poor health by boycotting Big Soda, a perfect example of capitalism run amok and killing us like Big Tobacco. YAY, Richmond! Go, Richmond! Lead the way! May it become a trend.

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