There is a new disease stalking the developed world. Not ebola, or anti-biotic resistant tuberculosis, or MERS ( a new respiratory disease that emerged in Saudi Arabia). They are bad enough. This one is called NASH, and has an even more tongue-twisting actual name: non-alcoholic steatohepatitis. Or in plain English, non-alcoholic fatty liver syndrome.
In NASH, the liver swells up from excess fat deposits, rather like the liver in a goose stuffed to develop into foie gras. The result is virtually the same as alcohol-produced cirrhosis of the liver. There is no cure, and in severe cases the only treatment is a liver transplant.
Thirty years ago, this condition was so rare in the United States it did not even have a name. Now it is suspected to be occurring in 5 million Americans. In 2001 cases of NASH were responsible for only 1 percent of liver transplants in the U.S.; by 2009 it had reached 10 percent, and by 2020 NASH is expected to be the leading reason for liver transplants.
Where did this epidemic come from? Apparently, like smoking and drinking, we did it to ourselves. NASH is linked to obesity and type-II diabetes, both of which stem from excessive intake of sugar and fats. It is normally a progressive disease, striking people over 50, but in recent years we have seen a sharp upsurge of NASH in children and adolescents, just like type-II diabetes. Today the US performs about six to seven thousand liver transplants per year. Yet if no treatment is found and current rates of NASH continue, by 2025 — just ten years from now — the demand for transplants from people with failing livers could reach 5 million per year.
Now if 3D printers can print replacement livers for us by then, all may be fine. But right now, it seems that millions would die for lack of available organs for transplant.
How did this happen? Heroin is dangerous, so illegal. Cigarettes and alcohol are dangerous, so they are illegal for teens and heavily taxed and regulated. Sugar is just as deadly, when consumed in the quantities we now routinely make available in giant-sized sugary drinks at fast food restaurants, theaters, and convenience stores.
When I was a kid, we drank Coca-Cola in six ounce bottles, got our sugar rush, and that was it (we also turned in the bottle for a recycle fee if we could). Today’s kids routinely drink 32 ounce sugary drinks. At McDonald’s the “child-size” Coke is 12 oz., large is 32 ounces and “super-size” is 42 ounces. That is almost a half-gallon of soda, containing literally one-quarter pound of sugar! (113 grams)
I won’t go into fats here. I know that a certain amount of sugar and fat is necessary and healthy, just like drinking wine in moderation is good for you. But with almost any other substance sold in the marketplace that is dangerous when over-consumed, we regulate it, limit access for minors, and sharply limit marketing. Yet with sugar, we have no limits! We accept advertising, huge portions, and access for kids at every vending machine and cafeteria and corner store; when we make sugar consumption so attractive and so easy it’s no wonder we have problems linked to overconsumption.
Of course, just because we see a problem, have good scientific information on how to halt it, and care about children, doesn’t mean we will do a damn thing. We saw that when Mayor Bloomburg tried to limit the sale of super-large portions of sugary drinks in New York.
So very likely we will have another problem causing the unnecessary loss of millions of lives, children succumbing to a preventable maladies, and billions of dollars of health care costs added to our health insurance load — in short, another major public policy failure.
It may be impossible to stop hundreds of thousands of people from being killed in Syria and Iraq. But we can easily stop millions of our own children and adults being killed right here at home — we just have to ban (or punitively tax) portions larger than 12 oz. for sugary drinks, limit the size and number of candy bars that children can purchase without an adult, and change the marketing of sugar-rich products to include health warnings.
But will we do it? Or in ten years will we wring our hands over another challenge we faced and ignored?