As a medical specialist who deals with diseases of the digestive tract and liver, a big part of my assessment is asking my patients what they eat or drink. Food and drink choices have a big impact on how people feel and on their risk of developing chronic diseases.
When I counsel people for their “fatty liver disease,” they are quite surprised when I tell them it is not the result of them eating fatty food. This is a common misperception. Fat in the liver is primarily produced following ingestion of excessive sugar or fructose by pathways in our bodies designed to store excess energy for future use in the event of starvation. This fact has been known for hundreds of years.
Where are people getting that excessive sugar and fructose from? My first question to patients is, “do you drink coffee, tea, juice, smoothies or sweetened beverages? If so, how much sugar do you add?”
For simplicity’s sake, I will review only coffee. But there are many more dietary contributors. While many say they add one to two teaspoons of sugar to their coffee at home, most people buy their daily coffee. And if the barista of the day is Tim Hortons, it’s very often a ‘double double’ or even a ‘triple triple.’ The size is often medium or large. Do people know how much sugar they are actually getting? And how much sugar is too much?
First, it is paramount to know that four grams of sugar is one teaspoon or one sugar cube. Second, it is important to acknowledge that in 2015, the World Health Organization made a statement on sugar intake and advised that men and women consume less than five to 10 teaspoons (25-50 grams) of sugar a day. The American Heart Association recommends children consume less than six teaspoons (25 grams) of added sugars in a day. Most people are unaware of this measurement because nutritional labels list items in grams.
Large Tim Hortons Original Blend Coffee triple triple nutritional information (2020,March, 03). https://company.timhortons.com/ca/en/menu/nutrition-and-wellness.php#?
A medium double double contains 14 grams of sugar (3.5 teaspoons) plus four grams of sugar from cream. A large double double contains 24 grams of sugar (six teaspoons) plus more sugar from the milk or cream. A large triple triple has 48 grams of sugar plus six grams of sugar from the cream, which equals 54 grams sugar (13.5 teaspoons).
Canada’s largest coffee retailer does not offer their products with “added teaspoons” of sugar, it is a “shot” of sugar that contains more sugar that one would assume given its labeling. The sugar content of each shot also varies depending on the size of drink ordered. This is very confusing for consumers because the offer of single, double, or triple suggests one, two or three teaspoons of sugar, but this is not the reality.
Every single patient I have asked confirms my thoughts on this mis-perception of sugar content. Do not think I am against this large Canadian brand. I do purchase their coffee but I stay away from sugar.
My mission has been to educate my patients and to have them consider enjoying their drinks without sugar. If they learn what’s in a ‘double double’ or ‘triple triple,’ my hope is that this education leads to practice change when they leave my office.
For those I see in follow up months later, many have improved symptoms, success with weight loss and some even have improvement or reversal of their disease attributed to sugar intake (fatty liver, type-2 diabetes etc.).
I do hope that large brands take more responsibility to make this very important information clear to consumers. The epidemic of obesity, type-2 diabetes, and poor metabolic health did not develop mysteriously over the last three decades. It is certainly contributed to by poor or misinformed food and drink choices in conjunction with sedentary lifestyles.
Are the shots in a medium double double equivalent to the two teaspoons of sugar the consumer is expecting? No. It has 18 grams of sugar, which is 4.5 teaspoons. This lack of clarity needs to end if we have any hope in improving the health of Canadians and preventing metabolic disorders. Tim Hortons, as a Canadian giant, I’m talking to you.
*A version of this article was first published in The Toronto Star
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Excellent, and I hope Tim’s listens to you and its customers, and takes some responsibility for societal health and not just their profits.