We Malaysians love our sugar, we put it in our drinks and we use it to make our kuih. But that love is slowly killing us.
According to the Malaysian Adult Nutrition Survey (MANS) 2002/2003, the average adult in Malaysia consumes 7 teaspoons of sugar a day. The average sugar intake comprises 4 teaspoons of table sugar (16.74grams) and 3 teaspoons of sweetened condensed milk (19.13grams) added into beverages[1].
The average intake is about 50grams of sugar a day but Malaysians consume 125gm daily. That is about two-and-a-half times more than the norm. – Dr Chua Soi Lek, Health Minister[3]
And amongst the ethnicities that make up our nation, Malays have the highest sugar consumption, averaging 74.2grams per day, per person, with Indians coming very close at 73.9grams per day, per person.
This overconsumption of sugar has consequences; according to the National Health and Morbidity Survey 2019 (NHMS 2019):
One in five adults in Malaysia has type 2 diabetes, with an estimated 3.9 million adults in Malaysia aged 18 and above being diagnosed with diabetes as of 2019, higher than the 3.5 million in 2015[2].
The NHMS survey also found that 49% of people with diabetes had never been examined or diagnosed with the chronic disease[4].
With World Diabetes Day coming on 14 November 2022, it is time we learn about our unhealthy relationship with sugar.
Too Much Sugar Is Not Very Sweet
As of 2019, sugar consumption per capita reached 42.4 kg, according to the Food and Agriculture Organisation of the United Nations[5].
So why do Malaysians like to consume so much sugar in the first place?
Maybe, it is because of the mentality that a host is sweet according to how much sugar he gives his guests. – Datuk Seri Dr Chua Soi Lek, former Health Minister[3]
A sweet tooth is not the only factor, however.
Current subsidies have made sugar very cheap, with the existing domestic wholesale refined sugar price capping at RM2.69 per kg[5].
Because of this, sugar and sugary foods and beverages are pretty affordable leading many Malaysians to overindulge in such things, with rising incomes from 2004 to 2019 contributing to this increasing consumption[6].
Furthermore, the low price of sugar has enabled its widespread distribution with data indicating a steady increase in the distribution of sugar in Malaysia over the years. Sugar distribution for domestic usage, in particular, has increased from 651,973.12 metric tons in 2004 to 806,381.88 metric tons in 2009[1].
Dr Khairul Hafidz Alkhair says that high-sugar content drinks such as carbonated drinks, juices and cordials are some of the primary culprits behind this overconsumption, especially since carbonated drinks can contain between six and seven teaspoons of sugar per serving[7]. On average, Malaysians consume around 3kg of sugar per year in the form of sugary drinks[6].
We also need to monitor the use of sweetened creamer or condensed milk as they are high in fat and sugar. Each glass of teh tarik has up to three tablespoons of condensed milk which is equivalent to three tablespoons of sugar. Watch out for kuih because they also have high sugar content. – Dr Khairul Hafidz Alkhair[7]
It certainly does not help that there is a general lack of awareness regarding the dangers of excessive sugar consumption.
I knew that sugar caused diabetes but I didn’t realize it caused obesity. – Wan Maznah binti Hamzah, an employee in the public works department[8]
But not all sources of sugar are obvious.
Carbohydrates, The Other Culprit
One of the more common sources of hidden sugar is carbohydrate-heavy foods. And not only do Malaysians love to eat carb-heavy meals such as fried rice, roti canai and mee goreng for breakfast, lunch or dinner, but such foodstuffs are commonly donated to or purchased by low-income households in the Bottom 40% (B40).
A high-carbohydrate diet that consists of rice, noodles, bread, roti canai, etc, whereby the carbohydrate is broken down into sugar in our blood can also cause an increase in the risk of diabetes. – Prof Dr Chan Siew Pheng, senior consultant endocrinologist[9]
Addicted To Sugar
So why are there so many people, particularly youths, indulging in sugar? Perhaps food trends have something to do with it.
Malaysian youngsters are getting into trendy, new food crazes such as cheese-coated banana fritters, boba or bubble iced teas and Milo ais kepal (a concoction of ice cubes, Milo and sweetened creamer sprinkled with crushed peanuts)[10].
We can see for ourselves the popularity of hipster food and beverages among our youths. It’s so easy to find these items… even roadside stalls are promoting them widely on social media. – Dr Feisul Idzwan Mustapha, deputy director of Non-Communicable Diseases (NCDs) at the Disease Control Division, Ministry of Health[10]
In their attempts to get in on the latest popular trends, many of these youths fail to realise just how sugar- or calorie-laden such “trendy” foods are. Dr Feisul Idzwan Mustapha, who is deputy director of Non-Communicable Diseases (NCDs) at the Disease Control Division, Ministry of Health, said that the consumption of the so-called hipster food and beverages is one of the main risk factors for the increase in diabetes cases among young people[10].
Calorie-wise, one glass (500 ml) of boba tea has 300 to 500 kilocalories (kcal). Each serving of rice contains 75 kcal, so (total calories in) one glass of boba tea is equivalent to five servings of rice. As for cheese pisang goreng, each one has 190 kcal. Just imagine the sugar content of these ‘viral’ food items. – Dr Feisul Idzwan Mustapha, deputy director of Non-Communicable Diseases (NCDs) at the Disease Control Division, Ministry of Health[10]
But why is it so hard to say “no” to sugar?
Dr Alan Greene has an answer. A children’s health and wellness expert and the author of books like “Raising Baby Green” and “Feeding Baby Green”, Dr Greene says that the overconsumption of sugar could lead to addiction[11].
In medicine, we use ‘addiction’ to describe a tragic situation where someone’s brain chemistry has been altered to compel them to repeat a substance or activity despite harmful consequences. This is very different from the casual use of ‘addiction’ (‘I’m addicted to “Game of Thrones!”’). – Dr Alan Greene, children’s health and wellness expert[11]
Eating sugar releases dopamine into our bodies; this chemical serves as a neurotransmitter for the “reward circuit” associated with addictive behaviour. When a certain behaviour causes an excess release of dopamine, you feel a pleasurable “high” that you are inclined to re-experience, and so repeat the behaviour[11].
Repeating this behaviour more and more will cause your brain to release less dopamine, and the only way to feel the same “high” as before is to repeat the behaviour in increasing amounts and frequency in a process known as substance misuse[11].
Sugar activates the opiate receptors in our brain and affects the reward centre, which leads to compulsive behaviour, despite the negative consequences like weight gain, headaches, hormone imbalances, and more. Every time we eat sweets, we are reinforcing those neuropathways, causing the brain to become increasingly hardwired to crave sugar, building up a tolerance like any other drug. – Cassie Bjork, RD, LD and founder of Healthy Simple Life[11]
It might be safe to say that sugar is more addictive than cocaine.
Not So Sweet On Our Health
Our sugar addiction has some rather severe consequences for our long-term health.
Senior consultant endocrinologist Prof Dr Chan Siew Pheng says that while high sugar consumption does not directly cause diabetes, high sugar intake leading to weight gain can increase the risk of contracting Type 2 diabetes[9].
Many other factors including your overall diet with excess food intake that results in weight gain, lifestyle and genetics also impact your risk of developing diabetes. This is a common misunderstanding Malaysians have towards sugar and diabetes. – Prof Dr Chan Siew Pheng, senior consultant endocrinologist[9]
Diabetes is not the only health risk that comes from high sugar consumption.
As Dr Chan pointed out, high sugar consumption can lead to weight gain, which will eventually result in obesity. Malaysia is now the fattest nation in Asia according to a study in 2014 and has the second highest child obesity rate among children in ASEAN aged 5 to 19 years, with 7.1% of children under the age of 5 being overweight[6].
Once again, sugary drinks are to blame; more than one-third (36%) of students have sugary drinks at least once a day, and the average daily sugar intake for adolescents has increased from seven teaspoons in 2012 to 10 teaspoons in 2017— than the recommended limit for adults[6].
Besides obesity and diabetes, overconsumption of sugar is found to have an adverse effect on heart health as well[10].
Basically, the higher the intake of added sugar, the higher the risk for heart disease. – Dr Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health[12]
How sugar affects heart health is not completely understood, but it seems to have several indirect connections. For example, high amounts of sugar will overload the liver, causing it to metabolise fat. Over time it will lead to a greater accumulation of fatty tissue, which may turn into fatty liver disease, a contributor to diabetes, which raises your risk for heart disease[12].
The effects of added sugar intake — higher blood pressure, inflammation, weight gain, diabetes, and fatty liver disease — are all linked to an increased risk of heart attack and stroke. – Dr Frank Hu, professor of nutrition at the Harvard T.H. Chan School of Public Health[12]
The Cost Of Non-Communicable Diseases For The Nation
For those living with diabetes and other non-communicable diseases (NCD), life can get very expensive. A report released by the Health Ministry and the World Health Organisation (WHO) shows that Malaysia spent a whopping RM22.53 billion to treat non-communicable diseases among Malaysians in 2017[13].
For overall expenditure, the estimated total healthcare cost for diabetes was RM4.38 billion (45.38%) followed by cardiovascular diseases (CVD) with RM3.93 billion (40.73%) and cancer with RM1.34 billion (13.89%), according to the report. Other expenditures include RM1.72 billion on medications for the three selected NCD categories and RM1.67 billion on medical testing[13].
Malaysia is expected to be an aged nation by 2030, where people of the age of 65 will comprise over 14% of the population. This demographic change means that the health and economic burden of NCDs may increase. – Tan Sri Dr Noor Hisham Abdullah, Health Ministry director-general[13]
What Is the Government Doing To Resolve This?
In 2019, the Malaysian government imposed a Sugar Tax, following the examples of countries like the USA and the Philippines which have similar taxes.
An excise tax of 40 cents per litre is levied on sweetened beverages with more than 5g of sugar or sugar-based sweetener per 100ml. This includes carbonated, flavoured and other non-alcoholic beverages. Juice or vegetable-based drinks with over 12g of sugar per 100ml will also be taxed[14].
While the price raise was intended to curb the overconsumption of sugar by the Malaysian populace, detractors and critics of the tax have opined that it would not be enough to make an impact, with reactions ranging from approval and concern to effectiveness and scepticism[14].
One issue that was brought up is the side effects on the B40 communities, particularly those who sell sweet foods for a living.
Those selling kuih, cakes and other items will be affected. Their profit margins may go down. – Dr Shankaran Nambiar, Senior Research Fellow at the Malaysian Institute of Economic Research[15]
Another issue is restaurants using the sugar price hike as an excuse to raise the price of beverages like teh tarik and other food products[15].
This will make eating out more expensive for many households, particularly the B40. – Dr Shankaran Nambiar, Senior Research Fellow at the Malaysian Institute of Economic Research[15]
Who’s Helping Us Combat Our Sugar Addiction?
Malaysian Society for World Action on Salt, Sugar and Health (MyWASSH)
MyWASSH is a new society registered with the Malaysian Registry of Societies (Number PPM-008-10-10112021) in October 2021. It consists of clinicians, educators, and specialists with a strong interest in reducing salt and sugar intake in Malaysia. The organization is affiliated with the World Action on Salt, Sugar and Health (WASSH) based in the United Kingdom, which is a global group aiming to improve population health throughout the world by achieving a gradual reduction in salt and sugar intake.
MyWASSH seeks to inculcate salt and sugar reduction strategies by engaging with lawmakers, the food industry, the media, healthcare professionals and the general public.
If you need help with reducing your sugar intake, feel free to contact them on Facebook or LinkedIn.
How To Curb Your Sugar Intake
Ultimately, it falls upon you to control your sugar consumption and reduce your risk of obesity, diabetes and other non-communicable diseases.
Try these steps:
- Choose or consciously prepare kuih and cakes with less white sugar;
- Replace sweet desserts such as kuih and cakes with healthier options such as fruits
- Consume foods containing sugar moderately;
- Avoid consuming sugary foods or drinks between meals and close to bedtime;
- Drink more water rather than carbonated and non-carbonated sugary drinks (such as soft drinks, syrup, and cordial);
- Check the nutrition information panel on the labels of beverages for sugar content;
- Limit intake of table sugar or sweetened condensed milk or sweetened condensed filled milk;
- When ordering drinks, ask for less sugar or less sweetened condensed milk or condensed-filled milk;
- Eat more fruits and vegetables, especially low-starch ones such as spinach, broccoli and tomatoes;
- Cut out high-carb foods and choose low-carb alternatives such as rolled or steel-cut oats, whole grain bread, dried beans and legumes; and
- Exercise regularly to ensure that your body is actively burning fat and preventing extra weight gain.
For more information about how you can curb your sugar cravings, visit this website.[7]
Explore our sources:
- MyHealth. Link.
- Dr K.L.K. Kien (2022) #HEALTH: Not the sweetest news for Malaysians. New Straits Times. Link.
- A. Edwards (2007) Most Malaysians have a sweet tooth. The Star. Link.
- CodeBlue (2020) Survey: 1.7 Million Malaysians Risk Three Chronic Conditions. Link.
- The Star (2022) Study underway on whether to raise the cost of sugar. Link.
- M. Clark-Hattingh (2019) Sugary drinks tax important first step, but obesity in Malaysia demands further action. Unicef. Link.
- K. Mustapha (2019) Sweet kills: How overconsumption of sugar is making Malaysians obese, sick. New Straits Times. Link.
- T. Fuller, A. O’Connor & M. Richtel (2017) In Asia’s Fattest Country, Nutritionists Take Money From Food Giants. The New York Times. Link.
- M. Hassandarvish (2021) Is sugar the main cause of diabetes? Not really — Malaysian expert points to factors beyond sugar. Malaymail. Link.
- Bernama (2021) Bad eating habits linked to higher diabetes rates among young Malaysians: Expert. The Sun Daily. Link.
- A. Schaefer & K. Yasin (2020) Experts Agree: Sugar Might Be as Addictive as Cocaine. Healthline. Link.
- Harvard Health Publishing (2022) The sweet danger of sugar. Link.
- M. Carvalho (2022) Malaysia spent RM22.53bil to treat diabetes, cancer and heart disease in 2017. The Star. Link.
- S. Ong (2019) Sugar tax starts today. The Malaysian Reserve. Link.
- F. Zainal, R. Vethasalam & A. Shah (2022) Economists: Expand sugar tax to more items. The Star. Link.
