Upload
others
View
0
Download
0
Embed Size (px)
Citation preview
March 2018 Issue
FREE
excessive sugar consumption
in AfricaShould we stop it now or
wait for the sour end?
The romantic tragedy of
1
2
9
6
10
8
12
FROM THE DOCTOR’S OFFICE
By Melissa Owoaje
MYTH BUSTER
CASE STUDY
EDITOR’S PIECE
QUIZ
BODY OF EVIDENCE
By Gabriel Oludare
FOOD FOR THOUGHT
By Emmanuel Ose
Contents
1
Children love sweet things. Almost every child
gets excited when they hear that something
sweet is coming their way. Children do not
possess the information or judgement to know
that eating sweet things may be enjoyable but
excessive sugar consumption is not good for their
health. Unfortunately, many adults are aware of
all the information available about the dangers
of excessive sugar consumption but have not
changed the way that they consume sugar.
Free sugars is so ubiquitous in foods and drinks
that avoiding excessive sugar consumption
cannot happen unconsciously. It takes vigilance
and care to monitor what is being consumed
daily to be able to achieve healthy levels of sugar
consumption. With education and good discipline,
over time, the World Health Organisation (WHO)
recommended limit for daily free sugar intake can
be achieved.
This fight back on sugar intake is not as optional
as it may appear because the rate of obesity-
related illnesses is on the rise and excessive sugar
is implicated in the rise of obesity. One mark of a
responsible generation is how well they set up the
next generation to succeed. As one of the most
informed generations of all time, it will be criminal
if we do not intervene to save the next generation
from obesity-related illnesses. This edition of
First Class Health provides a good insight into the
damage that excessive sugar intake can cause and
how changes in lifestyle can avert ill health. The
one message that comes through clearly is that
the story needs to be rewritten; sugar intake has
to be reduced to healthy levels as there is nothing
sweet about excessive sugar consumption.
Emmanuel Ose
Emmanuel Ose is a pharmacist with
experience in both hospital and
community pharmacy.
Emmanuel OseEditor
Dr Gabriel Oludare
Gabriel Oludare is a physiologist
and university lecturer. He has a
keen interest in the effects of food
on the functioning of the body.
Dr Melissa Owoaje
Melissa Owoaje is a medical
doctor with a particular interest in
education and writing.
There is nothing sweet about excessive sugar consumption
Editor’s Piece
Follow us @1stC1assHealth
Contributors
2
BODY OF EVIDENCEThe consequences of excessive sugar intake
By Gabriel Oludare
Sugar is an important part of the human
diet as it makes food more palatable and
provides energy. However, since the latter
part of the twentieth century, there have
been questions about the benefits of sugar,
especially refined sugars. People began to
wonder whether high sugar diets are good
for human health. According to the Food
and Agricultural Organization, an average
of 24 kilograms of sugar, equivalent to over
260 food calories per day, was consumed
annually per person of all ages in the world
as at 1999 with estimates rising to 25.1kg
in 2015.
In March 2015, the World Health Organization
(WHO) published a recommendation
that, in order to avoid a negative impact
on health, people should obtain no more
than 10% of their daily calorie intake from
free sugars. A majority of people exceed
the 10% recommended threshold in many
countries, with exceptions in Asia and Sub-
Saharan Africa. Although Sub-Saharan
Africa consumes a lower percentage of
dietary free sugars, the greater load of
sugar from cereals consumed and hidden
sugars in food substances are of great
concern. After cereals and vegetable oils,
sugar derived from sugarcane and beet
provides more kilocalories per capita per
day on average than other food groups.
Over-consumption of sugar has been
implicated in the occurrence of obesity,
diabetes, cardiovascular disease, dementia
and tooth decay - all of which are on the
rise in Africa. South Africans consume the
largest amount of sugar in Africa. They
consume between 12 and 24 teaspoons
of sugar per day - four to eight teaspoons
are from sugar sweetened beverages -
which is above the WHO guideline of a
total limit of 6 teaspoons of sugar per
day. Legislation on sugar tax by the South
African government which was effected in
April of 2017 was targeted at curbing the
rising rates of obesity, diabetes and heart
related diseases. South Africa follows the
footsteps of Mexico, France, Hungary and
the state of New York in the USA that
have pioneered the strategy. The sugar
tax by South Africa is one of the ambitious
strategies to reduce obesity by 10% by
2020 and includes other legislation such
as the salt reduction legislation, trans-
fat regulations and stricter label and
advertising regulations.
Overview of sugar intake in Africa
3
Sugar and recommended limits
Sugar is the generic name for sweet, soluble
carbohydrates, many of which are used in food.
Sugars can be classified as monosaccharides,
disaccharides and polysaccharides. Simple
sugars which are called monosaccharides include
glucose (also known as dextrose), fructose,
and galactose. Disaccharides include sucrose,
maltose (from malted grains) and lactose (from
milk). Polysaccharides include starch, glycogen
and cellulose.
The granulated sugar most commonly used as
food is sucrose - a disaccharide comprising of
glucose and fructose. In the body, sucrose is
broken down into the simple sugars fructose and
glucose. These simple sugars are absorbed into
the bloodstream and circulated by the arteries
to the body’s cells to provide energy. The excess
of this glucose can be stored as glycogen in the
liver and muscles and can be called upon when
required like during exercise or periods of fasting.
Excessive simple sugars in the body can also be
converted into fat and stored.
Table 1: Classification of sugars
Classes of sugar Sugars within the class
MonosaccharidesGlucose (aka dextrose), fructose and galactose
DisaccharidesSucrose, maltose
and lactose
PolysaccharidesStarch, glycogen
and cellulose
The World Health Organization recommends that
both adults and children reduce their intake of
free sugars to less than 10% of total energy intake.
A further reduction to below 5% of total energy
intake brings additional health benefits. Free
sugars are all monosaccharides and disaccharides
added to foods by the manufacturer, cook or
consumer plus sugars naturally present in honey
syrups and fruit juices.
Also, the American Heart Association recently
proposed an upper limit for added sugar in
the diet of 100 calories (420 kJ, 25 g) per day
for women or 150 calories (630 kJ, 37.5 g) for
men. This is equivalent to approximately 5-6%
of dietary energy. This can be viewed as an
ideal upper limit but is probably too low to be
accepted by the majority of people. For that
reason, an appropriate upper limit for the intake
of added sugar is 10% of energy. However, for
people who are at increased risk of the negative
health consequences of sugar, an intake of <6%
of energy is advisable. This applies to people who
are overweight or obese who have pre-diabetes
or who live in areas where the drinking water is
not fluoridated.
For illustration, a 355-ml can (33.5cL) of a sugar
sweetened beverage (one serving) contains
approximately 40g of sugar (150 calories, 630
kJ). Drinking one can per day translates to
approximately 6-8% of the daily recommended
calorie intake. Therefore, ideally, both adults
and children should limit the consumption of
sugar sweetened beverages to one can per day,
or the equivalent amount of added sugar from
other foods. An additional recommendation is
that infants and young children should not be
given beverages with added sugar. As children
grow, they demand sweetened foods and drinks.
In order to help to prevent dental caries, the
frequency of sugar intake should be limited and
sugar-rich foods should be consumed only with
meals, where possible
4
Erizanu P (2017) South Africa plans to fight obesity with a sugar tax http://edition.cnn.com/2017/03/02/health/south-africa-sugar-tax/index.html last accessed 7th November 2017.
FAO (2007). Food Balance Sheets. Food and Agriculture Organization of the United Nations.
Frank B.H. and Vasanti S.M. (2010) Sugar-sweetened beverages and risk of obesity and type 2 diabetes: Epidemiologic evidence Physiol Behav. 100(1): 47–54.
Papier K, Este C.D., Bain C, Banwell C, Seubsman S, Sleigh A, and Jorda S (2017) Consumption of sugar-sweetened beverages and type 2 diabetes incidence in Thai adults: results from an 8-year prospective study Nutr Diabetes. 2017 Jun; 7(6): e283
Steyn, N.P., Temple N.J. (2012) Evidence to support a food-based dietary guideline on sugar consumption in South Africa. BMC Public Health. 12:502
Sugar and the liver
An abundance of added sugar may cause the
liver to become resistant to insulin, an important
hormone that helps turn sugar in the bloodstream
into energy. This means that the body isn’t able to
control blood sugar levels as well as it should and
this can lead to type 2 diabetes. Also, fructose (a
component of table sugar and high-fructose corn
syrup) in added sugars triggers the liver to store
fat more efficiently and in unusual places. Over
time, a diet high in fructose could lead to globules
of fat building up around the liver - a precursor to
nonalcoholic fatty liver disease.
Sugar and the heart
A well known study with 4301 participants
showed that sugar is associated with higher levels
of bad cholesterol (LDL) and low levels of good
cholesterol (HDL). This can damage the arteries
which help circulate blood and lead to heart
disease, heart attacks and strokes. Heart disease
and stroke are the number one causes of death
among people with type 2 diabetes, accounting
for 65% of those deaths. Research also suggests
that eating less sugar can help lower blood
pressure - a major risk factor for heart disease.
In addition, people who eat a lot of added sugar
(where at least 25% of their calories come from
added sugar) are twice as likely to die of heart
disease as those whose diets include less than
10% of total calories from added sugar.
Sugar and the pancreas
The pancreas pumps out insulin into the blood
after a meal to process the high levels of sugar
and move them into energy stores in body cells.
The consumption of excessive sugar will cause
the pancreas to pump out higher levels of insulin
to process the sugar in the blood. The high levels
of insulin in the blood can lead to low blood sugar
which is unsafe. Over time, high blood insulin levels
may cause body cells to have poor sensitivity to
insulin and affect the removal of glucose from the
blood. The body will then resort to converting
blood glucose into fat. Excess body fat can lead to
obesity which is a risk factor for several illnesses
including type 2 diabetes.
Medical consequences of excessive sugar intake
References
5
The GBD 2013 Obesity Collaboration, Marie N.G et al (2014) Global, regional and national prevalence of overweight and obesity in children and adults 1980-2013: A systematic analysis Lancet. 2014 Aug 30; 384(9945): 766–781.
Weeratung P, Jayasinghe S, Perera Y., Jayasena G. and Jayasinghe S (2014) Per capita sugar consumption and prevalence of diabetes mellitus – global and regional associations BMC Public Health201414:186
Welsh, J.A., Andrea J.S., Lisa G, Miriam B.V. (2011). Consumption of added sugars is decreasing in the United States. American Journal of Clinical Nutrition. American Society for Nutrition. 94: 726–734.
WHO (2015) See Guideline: Sugars intake for adults and children. Geneva: World Health Organization.
Wikipedia (2017) Sugar https://en.wikipedia.org/wiki/Sugar#Consumption last accessed 7th November 2017.
Sugar and the kidneys
In a diabetic patient, too much sugar can lead to
kidney damage. The kidneys play an important
role in filtering blood. Once blood sugar levels
reach a certain amount, the kidney starts to let
excess sugar into the urine. If left uncontrolled,
diabetes can damage the kidneys, which prevents
them from doing their job in filtering out waste in
the blood. This can lead to kidney failure.
Sugar and body weight
The more sugar you eat, the more you’ll weigh.
Emerging research suggests that regularly eating
too much sugar impairs your body’s ability to tell
your brain you are full. The possible role of sugar in
the causation of excessive weight gain has focused
mainly on Sugar Sweetened Beverages (SSBs).
Very compelling evidence on the consumption
of SSBs in weight gain came from the recent
findings of two large studies that were carried out
in the USA. The investigators tracked 121 000 men
and women for a period of 20 years. The pooled
results indicated that the intake of SSBs could
explain almost one third of weight gain. (Subjects
gained an average of 1.52 kg during each four-
year period, of which 0.45 kg was linked to SSB).
Other foods strongly associated with weight gain
were potatoes, read meat and processed meat.
Sugar and the brain
Eating sugar gives the brain a huge surge of
a feel-good chemical called dopamine, which
explains why one is more likely to crave a candy
bar than a fruit. Because whole foods like fruits
and vegetables don’t cause the brain to release as
much dopamine, the brain starts to need more and
more sugar to get that same feeling of pleasure
leading to a craving for sugary food items such
as ice cream or sweets. In rat studies looking at
sugar addiction, when animals binge on sugar,
they experience chattering teeth, tremors, shakes
and anxiety when it’s taken away.
Sugar and the skin
Sugar in the bloodstream attaches to proteins
to form harmful new molecules called Advanced
Glycation End products or AGEs. AGEs attack
nearby proteins and damage them. The proteins
at risk include protein fibres in collagen and
elastin - these keep the skin firm and elastic. The
damage done by AGEs can result in dry, brittle
protein fibres that lead to wrinkles and saggy skin.
Sugar and the teeth
Sugar indirectly causes tooth decay due to
bacterial action on the sugar residues in the
mouth. Candy can rot the teeth because the
bacteria that causes cavities love to eat sugar
lingering in the mouth after one has eaten
something sweet. The bacteria’s waste product
which is acidic is responsible for decalcification
and demineralization of the tooth which results in
tooth decay.
6
1.9adults in the world
billion
FROM THE DR’S OFFICETackling excessive sugar consumption
By Melissa Owoaje
As a society we consume too much sugar. There is extensive research on the relationship between
sugar consumption and health. Eating too much sugar can contribute to weight gain and obesity.
Being overweight increases the risk of health problems including heart disease, type 2 diabetes, high
cholesterol, high blood pressure and certain cancers by four to eight times. Obesity-related diseases
are among the top 10 causes of death – this prevalence is only rivalled by HIV/AIDS. Consuming too
much sugar can also cause tooth decay.
7
So how much sugar should we be consuming?
The World Health Organisation (WHO) has
recommendations for maximum free sugar
intake. The ‘strong’ recommendation is that free
sugars should not make up more than 10 percent
of the energy (calories) we consume per day.
However, for additional benefits, the ‘conditional’
recommendation is that free sugars should not
make up more than 5 percent of the energy
(calories) we consume per day. This is about 30g
of sugar a day for those aged 11 and over (roughly
equivalent to seven sugar cubes). Children aged 7
to 10 should have no more than 24g of free sugars
a day (six sugar cubes). Children aged 4 to 6
should have no more than 19g of free sugars a day
(five sugar cubes).There is no guideline limit for
children under the age of 4 but it is recommended
they avoid sugar-sweetened drinks and food with
sugar added to it. On average, all age groups
consume over double the recommended intake.
To reduce the chances of suffering from diseases
such as heart disease, type 2 diabetes and tooth
decay one should try to reduce the intake of free
sugars.
As already defined, free sugars are all
monosaccharides and disaccharides added to
foods by the manufacturer, cook or consumer
plus sugars naturally present in honey syrups and
fruit juices. Common free sugars can be found
in sweets, cakes, biscuits, juices and fizzy drinks.
These foods and drinks can be very detrimental
to health. Free sugars are different from the
other kind of sugars - naturally occurring sugars.
Naturally occurring sugars are not considered to
be harmful in normal dietary quantities and can
be found in milk, whole fruit and vegetables.
Sugar, obesity and type 2 diabetes
Obesity has increased tremendously in all
divisions of society. The WHO has estimated that
there are 1.9 billion overweight adults in the world,
600 million of which were obese. People who
eat more sugar are more likely to be obese than
those who eat less. It is very important to take
steps to tackle obesity as it can lead to serious
and potentially life threatening conditions such
as type 2 diabetes, coronary heart disease, some
types of cancer and stroke.
Type 2 diabetes is a condition that leads to high
blood sugar levels. Although we know that sugar
does not directly cause type 2 diabetes, we
know that it leads to obesity. Obesity is the most
potent risk factor, accounting for 80-85% of the
total risk of developing type 2 diabetes. Sugar
contains many calories which can lead to obesity
and increase the risk of type 2 diabetes. There are
further health complications associated with type
2 diabetes including blindness, kidney disease,
amputation, sexual dysfunction, nerve problems,
complications in pregnancy and dementia.
8
Mrs RN is a 65 year old lady who came to see
her doctor with increased thirst and fatigue.
A urine test showed a high sugar content in her
urine. Blood pressure during consultation was
170/90mmHg (this is very high as normal blood
pressure should be 120/80mmHg). Her Body
Mass Index (BMI) based on her weight divided
by her height was 35, classifying her as clinically
obese (see previous edition – heavy weight but
no paunch - for a detailed description of BMI). Mrs
RN was sent for a blood glucose test. The results
confirmed that she had type 2 diabetes (she had
a HbA1c level of 7.8%).
Mrs RN was advised that she had 3 new diagnoses
1. High blood pressure 2. Type 2 diabetes 3.
Obesity. She was advised of the health risks
associated with all 3 diagnoses and agreed a
management plan with her doctor. She declined
blood pressure lowering medication in an attempt
to tackle her blood pressure with a change in
her diet. By changing her diet she would be also
addressing her diabetes and weight. She agreed
with her doctor to try to lose weight and return
for a review in 4 months.
Mrs RN sought advice from a nutritional expert
who analysed her diet. The analysis revealed
that Mrs RN was consuming 70g of sugar a day
through her diet. This is more than double the
recommended amount suggested by the WHO.
Mrs RN decided to pursue a low calorie, low sugar
diet for the next 4 months in an attempt to tackle
her 3 health problems.
After 4-5 months Mrs RN was reviewed by
her doctor. Her blood pressure had improved
significantly to 147/78. She had lost 12kg, making
her new BMI = 30. Furthermore, her blood sugar
had reduced significantly to a HbA1c of 5.5%. The
target blood sugar for a person with diabetes is
an HbA1c of 6.5%. Although she was still in the
obese range she was not far off the overweight
range and was making good progress. Mrs RN
agreed to continue on this plan so as to stabilise
her blood sugar levels and continue lowering her
blood pressure. The low calorie, low sugar diet
will also help her continue to lose weight. Mrs
RN reported feeling stronger, healthier and less
lethargic.
CASE STUDY
References
Johnson, R. J., Segal, M. S., Sautin, Y., Nakagawa, T., Feig, D, I., Kang, D., Gersch, M. S., Benner, S. and Sanchez-Lozada, L. G. 2007. “Potential role of sugar (fructose) in the epidemic of hypertension, obesity and the metabolic syndrome, diabetes, kidney disease, and cardiovascular disease.” American Journal of Clinical Nutrition. URL: <http://ajcn.nutrition.org/content/86/4/899.full>.
World Health Organisation, 2015. “Obesity and Overweight,” URL: http://www.who.int/mediacentre/factsheets/fs311/en/
British Dental Health Foundation, nd. “Dental Decay,” URL: https://www.dentalhealth.org/tell-me-about/topic/mouth-conditions/dental-decay
NHS Choices. 2016 “Diabetes.” URL: <http://www.nhs.uk/conditions/diabetes/pages/diabetes.aspx>
9
There is a TV programme that shows the life
of truckers in Australia and the journeys they
embark on to deliver very expensive cargo. As you
know, Australia is a very vast country. It has a land
area of 7.7 million square km. Just to appreciate
its vastness, the country with the largest land area
in Africa is Algeria with 2.4 million square km.
Anyway, this programme is interesting because
a camera follows these truckers to record their
trials and tribulations as they try to get heavy
expensive cargo from one part of the country to
another.
On one very interesting edition of the programme,
a company was trying to transport a power
station, worth several million dollars, to a place
that was hundreds of miles into the middle of the
country. The power station was very heavy and
could have been easier to carry in 3 separate
trips. If transported in 3 separate parts, the driver
would be able to take the fastest route, enjoy the
journey and do so without much extra assistance.
However, the decision was reached to transport
the power station in one journey. This decision
made the journey very difficult indeed. Firstly,
the power station was too heavy for one truck
so it needed one truck to drag it and another
to push it. Both drivers had to keep in constant
communication on a radio device. Secondly, they
had to have an engineer follow then in a separate
van. The engineer had to carry out checks at
certain intervals and move sharp stones out of
the way when needed. Thirdly, the drivers had
to use a tarred road as much as possible and
drive slowly because small dips in the road could
present serious problems. The trucks as well
as the driving team were under a lot of stress
throughout the journey.
What is sugar doing to you?
Sugar is clearly a source of enjoyment as it
improves the taste of food and drinks. The global
annual sugar production is over 170m metric tons
and has been over this threshold for most of the
last 5 years. This shows that people clearly enjoy
their sweet confectioneries and other sweet foods.
So what is the harm in eating sugar? Well, eaten
in moderation, sugar may be easily processed by
the body to provide energy but the continuous
overloading of the body with sugar can only have
the same effect on the body that the heavy power
station was having on the trucks transporting it.
Excessive sugar consumption causes a number of
challenges, including obesity and obesity is a risk
factor for many illnesses.
What kind of journey do you want?
Just like trucks used to transport heavy goods,
the body is like a vehicle that we have been issued
with to help us get to our lifes’ destination. We
have a lot of evidence now that shows without
doubt that the load we are carrying in our bodies
can determine how enjoyable the journey will be.
Those who take care of their bodies can expect
to minimise their risk of illnesses that can make
the journey very stressful. However, like the
truckers in the Australian programme, if you make
decisions that lead to excessive demands on your
vehicle, you may make it to the destination but
the journey may not be very enjoyable for you
or those closest to you. It is therefore worth
considering carefully what kind of life journey you
would like to have. You will know what decision
you have made by how you respond when you
next go to see a friend and you are asked the
question – ‘what would you like to drink’?
FOOD FOR THOUGHT“Welcome to our home… what would you like to drink”
By Emmanuel Ose
10
No sugar in diet is healthier than some sugar.
Natural sugar is better for you than processed sugar.
Humans need sugar to survive. Eliminating all sugar from diet is almost impossible since fruits, potatoes, and other starchy foods all have high sugar contents. That doesn’t mean you shouldn’t avoid foods with super-high sugar concentrations. A 20-ounce bottle of soda (about 60cL), for example, has roughly 65 grams (about 16 teaspoons) of sugar, which is more than twice the amount of sugar the World Health Organization advises that adults and children consume in a whole day. A low dose of sugar is not harmful but a high dose can be dangerous
Natural sugars consumed at normal dietary quantities are not considered to be harmful. However, some sugars in natural products like fruit and synthetic products like candy are the same. The difference is that candy and other related products usually have more sugar per serving, which means more calories per serving. Also, free sugars are metabolised quickly and cause blood sugar to rise quickly while natural sugars can come with fibre and therefore are metabolized slowly.
All “types” of added sugar have the same effect on your body. Some schools of thought believe that brown sugar is healthier than white sugar. Brown sugar is the sugar crystals that have retained a sticky syrup substance called molasses during sugar cane refining. This molasses give it its brown colour. In fact, brown sugar is mostly white sugar with some molasses so if you could refine it further, you would get your standard white, table sugar.
Some types of added sugar are better for you than others
Myth Buster
Myth Fact
11
Sugar directly causes cavities
If drinks have artificial sweeteners instead of sugar, you can drink as much as you like
Eating too much sugar is the direct cause of type 2 diabetes
Sugar is as addictive as heroin.
Cavities are actually caused by acidic foods and drinks that wear away the enamel on the teeth. Sugar indirectly causes tooth decay due to bacterial action on the sugar residues in the mouth. When one eats something with sugar, bacteria that naturally reside in the mouth consume this sugar as well. Bacteria’s waste product is acidic, which decalcifies or demineralizes tooth enamel, creating tooth decay.”
Some artificial sweeteners can be just as harmful to your body as sugar. Although artificial sweeteners like stevia, truvia, and aspartame (as found in diet sodas) have fewer calories than their sugary counterparts, research shows that people who drink diet soda are twice as likely to be obese than those who do not.
Diabetes is caused by a mix of genetics and environmental factors so a high sugar diet alone cannot directly cause diabetes. You are more likely to develop diabetes if you are overweight or obese because excess body fat can lead to insulin resistance. This makes a diet heavy in sugar an indirect, rather than a direct cause of type 2 diabetes
There are multiple conflicting studies concerning the subject of sugar addiction. One French study published in 2013 links cravings for sweets with the “reward” centre of our brains that are induced by addictive drugs. The study concluded that sugar can be even more addictive than cocaine. This finding is highly contested due to the fact that addiction-like behaviour in rodents occurred when the animals were restricted to eating sugar during a certain time period each day. However, when the test subjects were allowed to eat sugar whenever they wanted like in humans, the addictive behaviour vanished.
QUIZ1
43
6
2
5 7
How many calories is contained in 1 cube of sugar?
Which of the following actions does not help to
reduce weight gain?
Which organ in the body produces insulin
to remove excess sugar from the blood?
What is the WHO recommended daily
maximum consumption of free sugars for an adult who wants to achieve increased health benefits?
What is the daily recommended calorie
intake for a man?
What is the daily recommended calorie intake for a woman?
Which of these conditions is not
directly or indirectly linked to excessive
sugar consumption?
3% of daily calorie intake
5% of daily calorie intake
7% of daily calorie intake
11% of daily calorie intake
The liver
The kidneys
The pancreas
The heart
10 calories
15 calories
16 calories
20 calories
100 calories
1000 calories
1500 calories
2000 calories
Type 1 diabetes
Type 2 diabetes
Obesity
Tooth decay
Reduction in sugar consumption
Reduction in salt consumption
Reduction in alcohol consumption
Increase in physical activity and exercise
1050 calories
1500 calories
1800 calories
2500 calories
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
A
B
C
D
13
Readers response
Take the quiz online and get your result!
Have you enjoyed the magazine and would like to test your knowledge? You
can take the quiz online by going to our website (www.firstclass-health.com)
and clicking on the quiz button. You will get your results instantly on the
website as soon as you complete the quiz!
Get future editions sent to your email
Would you like to receive future editions of First Class Health? You
can subscribe to the magazine on our website and we will send you
future editions directly to your email. You can subscribe by going to
www.firstclass-health.com and clicking on the subscribe button.
Tell your friends about us
We would like to continue to provide First Class Health as a health resource
to anyone that wants it, anywhere, at anytime, free of charge to the
reader. Please follow us on Twitter @1stC1assHealth and ask your friends
and followers to follows us as well. You can also find us on Facebook by
searching for First Class Health. You will be the first to know when our
next edition is published and ready to be accessed for free.
Get answers to your questions
Have you read something in the magazine and have questions that you
would like to be answered? You can ask your question on our website
by going to www.firstclass-health.com and clicking on ‘ask the doctor’.
For Enquiries and Distributorship call: 070 339 231 08
Boost yourhealth with
good food