Why You Should Worry About Coca-Cola More Than Opioids

The opioid epidemic has received a lot of media and political attention recently, much more than food-related diseases such as diabetes. Axios recently
reported that “U.S. life expectancy was steadily rising since 1970 but stopped in 2014, mostly because of drug-related deaths.” They based this on a new CDC letter in JAMA. Similarly, the Washington Post alleged last year that the “Drug crisis is pushing up death rates for almost all groups of Americans.”

The media’s focus on opioid deaths is highly misleading. Opioids remain a relatively minor cause of death in America. By far and away, the main culprit is food-related chronic disease: a category that includes diabetes, strokes, heart attacks and cancer. These are all related to junk food.

Drug overdoses killed 52,400 Americans in 2015. Heart disease alone killed 633,842, over 12 times the amount killed by drugs. Add to that diabetes, cancer and Alzheimer’s, and you get 1,419,868 dead Americans. That’s 27 times the amount killed by drug overdoses. And keep in mind that many of those overdoses did not result from opioids.

Screen Shot 2017-09-20 at 8.24.11 AM.png

Heart disease and cancer are the top two causes of death. Drugs are nowhere close. Source.

You may object that these chronic diseases are the inevitable result of old age, but they’re increasingly appearing in kids and teens. You may also object that drug-related deaths are growing, whereas food-related deaths are holding steady or even declining. That is true for some food-related causes of death, to be sure. It’s not, however, true for at least two of them: Alzheimer’s disease and strokes.

First, let’s look at mortality from drug overdoses. This is a broad category that includes opioid and heroin overdoses as well as deaths from other drugs. Over the most recent three-year period for which we have full data, the age-adjusted death rate for drug overdoses increased by roughly 4.3 per 100,000 Americans:

Drug Overdose Death Rate, Past 12 Months, Age-Adjusted

Q3 2014: 14.3

Q3 2015: 16.1

Q3 2016: 18.6

Now let’s look at what’s happened to stroke mortality during the same time frame:

Stroke Death Rate, Past 12 Months, Age-Adjusted

Q3 2014: 35.9

Q3 2015: 37.8

Q3 2016: 37.1

Meanwhile, the age-adjusted death rate for Alzheimer’s increased remarkably:

Alzheimer’s Death Rate, Past 12 Months, Age-Adjusted

Q3 2014: 24.2

Q3 2015: 29.3

Q3 2016: 29.8

(Source for all 2014 data. Source for all 2015 and 2016 data.)

Alzheimer’s disease and strokes combined caused an additional 6.8 deaths per 100,000 over this three-year period, significantly more than the additional 4.3 per 100,000 caused by drug overdoses. And both Alzheimer’s disease and strokes are closely related to junk food.

Why are ~55,000 drug overdose deaths causing a nationwide state of alarm, while we’ve all come to accept the 1.9 million Americans dying yearly from preventable chronic diseases?

Well, we seem to be taking our cues from our leadership. The CDC recently called the increase in the stroke death rate “nonsignificant.” Congress has held hearings on the opioid crisis but granted chronic disease prevention considerably less attention. Donald Trump announced he will declare opioids a state of emergency. He has not expressed any such concern about soda and junk food. The health care debate in Washington has largely ignored the true causes of chronic disease. And the CDC’s own chronic disease efforts are laughably out-of-date.

Now, is any of this dramatic under-reaction to chronic disease possibly related to the fact that the food and beverage industry has long partnered with the U.S. government’s public health efforts? You have to ask.


    • Russ Greene

      Dr. Feinman,

      Do you dispute the connection between nutrition and chronic diseases such as strokes, heart disease, cancer and Alzheimer’s disease? Or the connection specifically between sugar-sweetened beverages and chronic disease?

      • Drug overdose is due to drugs. While there are cases where people with diabetes or other metabolic disease might die from an overdose of sugar, there are also cases where sugar will save their lives. And for people with diabetes, starch is worse than sugar. That sugar may be involved in cause of metabolic disease is likely but without scientific understanding of where it actually fits in, the stuff you wrote is propaganda. You know it and I know it. It may well be that like most propagandists you think the end justifies the means but you don’t know what the ends are. People grow up with sugar. They know if you eat a lot you will get fat. They know that if you have diabetes you can’t eat much if any at all. That may allow them to see through the propaganda and then they won’t trust you and, if they think you are representing what experts think, they won’t trust experts. Not on carbohydrates, not on vaccinations. Maybe not on smoking.

      • Russ Greene

        Thank you for your lengthier response, Dr. Feinman. Allow me to address your points, please.

        “While there are cases where people with diabetes or other metabolic disease might die from an overdose of sugar, there are also cases where sugar will save their lives.”

        While there are cases where pharmaceuticals kill you, there are also cases where they will save your lives, or in the case of opioids make them more bearable in cases of extreme pain and distress.

        “That sugar may be involved in cause of metabolic disease is likely but without scientific understanding of where it actually fits in, the stuff you wrote is propaganda.”

        I understand perfectly that sugar-sweetened beverage consumption correlates with increased chronic disease rates, even controlling for weight gain, that substituting starches for added sugar isocalorically in children improves their blood markers even over two weeks, and that sugar sweetened beverage consumption has significant negative effects on blood markers even over two weeks as well. Do you disagree? I also understand that even John Sievenpiper and Richard Kahn recommend that anyone looking to subtract something from their diet begin with added sugar.

        Does any of this mean that sugar is the only cause of chronic disease? Of course not. And opioids aren’t the only cause of drug overdoses.

        Does that mean that everyone who eats sugar eats it to the point of overconsumption and dies from chronic disease? Of course not. And millions have been prescribed opioids but didn’t become addicted, or became addicted but didn’t die from them. Billions have consumed alcohol without becoming addicted or dying from liver disease. Many smoke cigars or even cigarettes but don’t become addicted, or if they become addicted do not develop lung cancer.

        “It may well be that like most propagandists you think the end justifies the means but you don’t know what the ends are”

        Are you accusing me of not knowing what my own intention is behind writing? That’s quite an existentialist, post-modern critique. I’m reminded of Camus.

        “People grow up with sugar. They know if you eat a lot you will get fat. They know that if you have diabetes you can’t eat much if any at all.”

        How many people are indeed aware that there is a direct link between nutritional consumption and chronic disease that bypasses obesity? Sure, they know if you consume too much of anything you get fat. But how many people are thinking that chronic soda consumption can engender fatal chronic diseases even if you’re normal weight, and that these chronic diseases may even be more deadly at normal weight, or at least equally deadly? I can guarantee you that not everyone understands this because I meet well-educated people on a regular basis still confused by it. The dominant paradigm in the media is that of excess calories -> weight gain -> obesity -> obesity-related diseases such as diabetes, alzheimer’s, strokes, etc. Verify this for yourself if you please.

        Lastly, if you are accusing me of calling on the public to critically, even skeptically evaluate expert opinions on chronic disease, then I am guilty as charged. And proudly so. In fact I’d argue the burden is on your to demonstrate why the public should “trust experts” who have denied that food is related to obesity (Steven Blair), promoted 60%+ carbohydrate diets for the general population and denied the relationship between sugar and diabetes (US Dietary Guidelines), promoted fatally excessive hydration guidelines (ACSM, NATA), and suppressed the right of anyone to promote an alternative paradigm (as they did with Cooksey, Noakes, Fettke, etc.)

        Good luck demonstrating that, Dr. Feinman.

  1. Sorry for giving you a hard time. Probably over-reaction because people who have more influence than you or I take this exaggerated approach. It is not science and has the effects that I cited. If you don’t think there’s a difference between what’s known about effects of opioids and effect of sugar, we are in disagreement but we probably both have bigger disagreements with the experts..

    • Russ Greene

      No problem. I thought it was fairly clear that I was evaluating the effects of both on the macro, not micro scale. Let’s do a thought experiment.

      If you could wave a magic wand and make all opioids or added sugar disappear (with no one left suffering from withdrawals), which would you pick to maximize the overall health of Americans?

      Keep in mind that added sugars constitute 13% of the daily caloric intake of Americans and nearly 1/4 of total carbohydrate intake.

  2. Your own source for the number of overdose deaths indicates “During that period (2000-2015), decreased death rates due to stroke, cancer, heart disease and other conditions increased life expectancy by 2.25 years”. When standardized by population, deaths due to stroke and heart attacks are decreasing, significantly… While the same cannot be said for drug overdoses (mortality rate increased 247% for opioid overdoses during the same period)

    Sure, more people die from poor lifestyle choices than synthetic opioid abuse, but one is trending up, drastically, and the other is trending down. Don’t forget no one will die from junk food/soda (baring some underline condition) in the short term. Decades of poor dietary and exercise choices result in increased risk for stroke/heart disease. Even so, these are just contributing factors with no one being the only cause. Opioid abuse, particularly fentanyl and other new synthetic opioids, can kill an otherwise healthy individual in less than 10 mins.

    So, which is more alarming?
    One takes decades to kill and is decreasing OR
    The other kills young and healthy people overnight at a drastically growing rate

    • Russ Greene

      Stroke and alzheimer’s deaths are both up in recent years, and as I showed their contribution to the death rate exceeds that of drug overdoses during the same period.

      Second, type-two diabetes is up noticeably in children, as is non-alcoholic fatty liver disease. These chronic diseases don’t just kill over a long period time – they are extremely painful, debilitating, and expensive.

      For example, diabetic amputations for example increased 27 percent between 2010 and 2014:

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