IN this report, Olugbenga Adanikin examines the health implication of consuming Sugar-Sweetened Beverages (SSB), with special emphasis on energy drinks, weak regulations, and the opacity in implementing the 10 per cent SSB Tax meant to discourage Nigerians from excessive consumption of the products.
What is the fuss about energy drinks?
Sugar-Sweetened Beverages (SSB), according to the United States Center for Disease Control and Prevention (CDC), is any liquid sweetened with various forms of added sugars like brown sugar, corn sweetener, honey, raw sugar, sucrose, dextrose, fructose and other similar sweeteners.
Research revealed these drinks could be soda, fruit, sports, energy drink, sweetened waters, and coffee and tea beverages with added sugars.
On July 4, 2014, the National Agency for Food and Drug Administration and Control (NAFDAC), in a statement posted on its verified Facebook page, established energy drinks as having caffeine and sugar as components, which “are known to cause a variety of adverse health effects.”
This raised other safety concerns, including how energy drinks can increase heart rate and blood pressure when consumed arbitrarily.
“Now that you know people, be WISE!!!” The warning stated after indicating the inherent dangers of consuming SSB products.
These are diseases “…not spread through infection or other people, but are typically caused by unhealthy behaviours.”
They include type 2 diabetes, heart disease, kidney diseases, stroke, obesity, tooth decay and cavities, gout and even arthritis.
According to the World Health Organisation (WHO), NCDs kill 41 million people annually, accounting for 74 per cent of deaths globally.
Furthermore, the global health body said, “of all the NCD deaths, 77 per cent are in low-income and middle-income countries.”
Though not peculiar to Africa, the spike in NCBs has remained a global issue but is worst in a developing nation like Nigeria.
Reports say at least one in every 10 adults in Nigeria, accounting for six million adults, is suffering from diabetes, one of the multiple diseases associated with the consumption of SSBs.
In 2022, a consultant endocrinologist at the University of Port Harcourt Teaching Hospital, Sunny Chinenye, said the figure had risen to 11.2 million people.
Worse still, experts continued to express concern about the shortage of insulin, while patients spend between N20,000 to N150,000 monthly on Insulin as it helps regulate blood sugar (glucose) in the body.
“Diabetes is a very costly condition. In Nigeria, a typical patient will spend N20,000 to N30,000 to control it properly. This is the minimum, covering medications, blood tests, and clinic attendance.
“When complications like kidney disease come into the picture, some patients have a monthly expenditure of N100,000 to N150,000,” A professor and a chief clinical coordinator at the NSIA-Lagos State University Teaching Hospital (LUTH), Olufemi Fasanmade, told Punch.
The shortage of endocrinologists in Nigeria is another nightmare.
A Medical Practioner and Consultant Physician Endocrinologist at Ladoke Akintola University Teaching Hospital (LAUTECH), Michael Olamoyegun, further alluded to this shortage when he said the country could only boast of less than 200 endocrinologists. Still, the country lacks a systematic screening approach to recording diabetes patients. He suggested telemonitoring as a great approach to diabetes management.
NAFDAC’s weak or no regulation
The Act establishing NAFDAC prohibits the sale of “counterfeit, fake drugs and unwholesome processed foods.” Mojisola Adeyeye is NAFDAC’s Director-General (DG).
This implies it is largely NAFDAC’s mandate to regulate the consumption of local or imported drinks, especially those with additives, including energy drinks.
In other words, adding additives to food or drinks make it ‘processed food.’ Still, NAFDAC has not achieved much with particular reference to the SSB.
The Food Additives Regulations, enacted on July 7, 2021, for instance, attempts to reflect SSB in its definition of food as “any substance, whether processed, semi-processed or raw, which is intended for human consumption and includes water and other drinks….and any substance which has been used in the preparation or treatment of food….”
This further positioned NAFDAC as the supposed regulator of SSB products because energy drinks contain additives.
Regardless, with reference to food additives regulation, the emphasis was more on food and not the SSB.
On Tuesday, March 14, The ICIR visited NAFDAC headquarters and randomly asked the officials which agency of the federal government should regulate the drinks such as energy drinks, and the response was NAFDAC. It was the same response when The ICIR visited the Federal Ministry of Health. The reporter was directed to the Food and Drugs Department and later to Food Safety Unit within the department.
Again, these field findings pointed to popular submissions that NAFDAC should regulate SSB products in Nigeria.
The ICIR further contacted NAFDAC Head of Media Department, Abubakar Jimoh, a doctor, to verify how the agency has been able to regulate sugar-sweetened beverages and if there is an existing NAFDAC regulation to regulate SSB products in Nigeria. The ICIR also asked him to point at one if such exists.
He promised to ‘revert’, but the official is yet to respond as of the time of filing this report.
Two days later, Friday, March 17, at about 11:17am, The ICIR further reached out to remind Jimoh. But he never responded.
As such, to a large extent, and based on field findings, NAFDAC currently has no direct regulation on sugar-sweetened beverages, which might have implications for the public.
Dissecting the soft drinks regulations and linkage with SSB
The ICIR, in the course of these findings, studied the NAFDAC regulations. It showed that the Soft Drinks Regulations gazetted on September 15, 2021, at the moment, is the closest to checkmating production, sales, or importation of SSB. This is because it classified soft drinks into nine groups, which also recognised “carbonated beverage” and “drink”.
Findings would later reveal soft drinks in this context would also mean non-alcoholic carbonated or non-carbonated ready-to-drink beverages.
They include flavoured crush, flavoured squash or cordial, comminute drinks, fruit crush, fruit squash and fruit cordial.
Others are carbonated soft drinks, added substances for carbonated soft drinks, and names of carbonated soft drinks and non-carbonated soft drinks.
For instance, Section two (2) of the soft drink regulation addressed Prohibition, and Section three (3) dealt with the Labelling of soft drinks, Fruit squash, cordial or Fruit crush. In contrast, Sections four (4) and five (5) addressed ‘Offences and Penalties’, Forfeiture after conviction.
It forbids anyone from “manufacturing, importing, exporting, distributing, advertising, display for sale, offer for sale, sell or use soft drinks specified in the Schedule to these Regulations unless it has been registered in accordance with the provisions of these Regulations.”
Again, the Schedule referenced in Section 2 pointed at the nine classifications of soft drinks mentioned above. This implies that sugar-sweetened beverage is regulated by multiple guidelines such as food additives, soft drinks, wine regulations, etc.; thus, there is no particular guideline for SSB.
For instance, in the case of Carbonated Soft Drinks, which Energy Drinks are also classified, it was merely described as the “class of beverages made by absorbing carbon dioxide in potable water with or without various added substances.”
Also, Carbonated Soft Drinks with Added Substances such as nutritive sweeteners – “dry or liquid form of sugar, invert sugar, dextrose, glucose syrup…, or any combination of food flavours, colours and other food additives” should adhere strictly to the right quantity Food CODEX approved by the agency (NAFDAC).
However, these are controlled through the food additives regulations and somehow implied on SSBs.
The guideline discouraged false, misleading descriptions of additives on product labels. It also emphasised that the “food additives with a shelf life of not exceeding 18 months shall carry the date of minimum durability using words such as “will keep at least until…..”
The inscription “for food use” or a statement expressing similar context is expected to appear prominently on the label. And most essentially, the use of synthetic colours and a mixture of colours in the food item should visibly display the “lot number of the mixture, the food grade colour and the common name of the individual colours, either synthetic or inorganic in the mixture.”
Other items highlighted in the soft drinks guideline, which, if breached, could harm the public are quinine, stannous chloride, and caffeine, among other chemical preservatives.
According to the Standard Organisation of Nigeria (SON), the acceptable sugar content in soft drinks is between 7 – 14 grams per 100 ml. The ICIR could not establish NAFDAC’s specification on sugar content, but the maximum gram in wine, according to the Wine Regulations (2019), is 45 grams per litre.
Quinine, Stannous chloride, Caffeine – should Nigerians be worried?
Quinine, for instance, can be used to treat malaria, according to findings. It is considered toxic to yeasts and trypanosomes but could cause dizziness, diarrhoea, vomiting, abnormal heartbeat, and kidney damage in the worst scenarios.
The U.S Food and Drug Administration (FDA), in 2007, banned its use and warned against its purchase from vendors outside of the US.
A search on stannous chloride, another item flagged by NAFDAC, could be used to conserve soft drinks. Also described as Tin Chloride, Meghachem, an India-based chemical firm, highlighted how the chemical has remained an essential item in the steel industry, used to make Tin Cans.
“Direct exposure to the Stannous Chloride can be hazardous to human health. Any contact with the skin or respiratory system can lead to severe injuries and death,” it stated, emphasising the chemical could also release toxic gases when exposed to overheating.
Incidentally, most soft and energy drink-producing firms have adopted tin cans. And this can imply that excessive exposure of the can drinks to warm temperatures could cause more harm than good.
As for Caffeine in SSB is expected to range between 14.5mg/100ml and 32mg/100ml. NAFDAC maintained anything beyond 32mg/100ml might be harmful.
The agency particularly emphasised the compulsory declaration of other composing nutrients and boldly written inscriptions that should read – Not Suitable for Pregnant Women, Children and People Sensitive to Caffeine.
The ICIR bought three different brands of energy drinks in the course of these findings. The essence was to verify the sugar levels and the caffeine contents. One of the products was imported, and the other two were locally produced.
They all complied with the caffeine and sugar level guidelines. For instance, one of the local brands had 30mg/100ml of caffeine rather than the maximum of 32mg/100ml. The foreign brand had 32mg/100ml. Its total sugar was 11 grams per 100 ml against a maximum of 14 grams per 100 ml. Regardless, they all issued the inscription “High Caffeine Content.”
The SSB producers also warned against excessive product consumption and the need for pregnant women, lactating mothers, and those sensitive to caffeine or diabetes.
“High caffeine content. Not recommended for children, pregnant women, lactating mothers, people sensitive to caffeine or diabetics (30mg/100ml). Consume responsibly – limit daily intake to one bottle. Do not mix with alcohol,” the inscription read.
A medical practioner at the department of internal medicine, General Hospital, Orile-Agege, Lagos State, Rokibat Giwa-Ayedun, was among the experts who buttressed the implication of consuming caffeine and sugar in SSB products.
She said consuming caffeine products arbitrarily could lead to abnormal heart rhythm, insomnia, and palpitation, which could lead to sudden death and other fatal health conditions.
She explained that excessive sugar consumption would often make the body store the item (sugar) as fat, “and it will increase your chances of gaining weight, and could block the blood vessels, which eventually could cause a heart attack.”
In a 2020 study on the “Assessment of Sugar Content from Different Soft Drinks Sold in Nigeria” by Abass Ohilebo of the Redeemers University and Blessing Odudu, the researchers did a comparative analysis of 10 licensed soft drinks produced in Nigeria.
The drinks were tested, and the result revealed a range of between 0.036g/100ml (Limca) to 3.88g/100ml (Teem Bitter Lemon). The study arrived at low sugar contents from all drinks subjected to the test.
Regardless, The ICIR can confirm that the highest an offender can get is a maximum jail term of one (1) year or a fine not beyond N800,000 or both. And the maximum fine a corporate organisation could attract is N5 million.
But considering the inflation and depreciating value of the local currency, some have argued the sanction is ineffective enough to deter erring firms or individuals from breaching the relevant guidelines.
Meanwhile, The ICIR can confirm that the Federal Ministry of Health is yet to capture SSB products in its food safety policy. The food safety policy, as of the time of this finding, is currently being reviewed to capture the new realities posed by the consumption of SSB products.
The SSB Tax to the rescue
The Federal Government (FG) approved the SSB Tax to curb non-communicable diseases in the country. The tax was also part of the 2021 Finance Act and became operational in 2022.
The idea of taxing SSB products as a form of deterrent was largely due to consistent efforts from a group called National Action on Sugar Reduction (NASR).
The group, through the National Assembly (NASS), successfully pushed the advocacy for sugar reduction in the diet of Nigerians through a 10-per cent tax on sugary and carbonated drinks.
Ultimately, the vision of the coalition (NASR), which includes the Diabetes Association of Nigeria (DAS) and the Nigeria Cancer Society (NCS), is to increase taxes on SSB to the point that it will discourage Nigerians from excessively consuming sugary drinks and beverages for their health benefits.
The 10 per cent SSB tax later met contention from the Manufacturers Association of Nigeria (MAN). Meanwhile, relevant stakeholders were already asking for an increment in the excise tax from 10 to 20 per cent of the final retail price of the SSB products.
Part III, Section 21 of the Customs, Excise Tariffs (Consolidation) Act elucidates the non-alcoholic drinks – SSB.
It stated, “Excise duty on non-alcoholic, carbonated and sweetened beverages shall be charged at a specific rate of N10 per litre.”
Efforts are being made to ensure the tariff is diverted to the health fund as part of moves to fund the health sector and provide support for victims of SSB-related ailments.
This is more important because, for over two decades, Nigeria has been unable to meet its commitment to setting aside 15 per cent of its annual budget for the health sector. The commitment was from the Abuja Declaration on health, where member nations of the African Union (AU) agreed to earmark 15 per cent of their annual budget to the health sector.
Infographics show Nigeria’s annual budget for the health sector in the last 10 years
Sadly, managing NCBs, amidst the declining government revenue has worsened the plight of the victims to get the right treatment. Basically, the tax would come in handy in bridging the funding gap.
Thus, the Nigerian Customs Service (NCS), since July 2022, has been collecting the SSB Tax. It has feasted on the opportunity to drive more money into the government’s coffers. Still, how much has been collected via the tariff and the current utilisation level is not sure, and not currently in the public space.
On Thursday, March 2, The ICIR wrote a Freedom of Information (FOI) request to the Nigeria Customs Service (NCS) to establish how much has been recovered from the SSB Tax since its implementation and possible utilisation. But as of the time of filing this report, the Service is yet to respond to the FOI.
According to the freedom of information law, failure to respond to FOI requests attracts stiff punishment, such as a jail term or N500, 000 fine.
“It is a criminal offence punishable on conviction by the Court with a minimum of 1-year imprisonment for any officer or head of any government or public institution to which this Act applies to willfully destroy any records kept in his custody or attempt to doctor or otherwise alter same before they are released to any person, entity or community applying for it,” Section 10 read.
Is the tariff from SSB channelled to the Health Fund?
The ICIR also attempted to verify from the health ministry how much of the tariff from the SSB has been collected and if it was rightly channelled to the health fund as stipulated by the law. And especially the utilisation of the funds? But the Director of Information at the Federal Ministry of Health, Ahmadu Chindaya, told The ICIR reporter to meet with the Director, Food and Drugs, as he was “not in the best position to speak on these issues.”
The director in charge of food and drugs, to which he referred this reporter, was unwilling to speak to The ICIR. After being briefed on the journalist’s purpose of the visit, she asked that the reporter be taken to another unit, the Food and Safety.
At the food and safety unit of the ministry, the head, Olugbemiga Atanda, advised that Femi Stephen, one of his colleagues, attend to the reporter. After brief questions on the SSB, The ICIR was asked to send its questions to Stephen.
On Tuesday, March 14, the questions were sent. It was acknowledged, but no feedback.
Another reminder was sent days after. The respondent apologised and promised to respond as soon as possible. Stephen replied by Wednesday, March 22, confirming issues regulating the SSB did now emanate from the ministry.
“In responding to your questions, please note that the SSB tax did not originate from the federal health ministry. It originated from the Federal Ministry of Finance, Budget and National Planning.”
He disclosed that implementing the tax would be within the mandate of the finance ministry. The official also confirmed, “SSBs are linked to certain Non-communicable diseases such as diabetes.”
While apologising for the delayed response, he provided data on diabetes prevalence in Nigeria.
Experts’ opinion on managing non-communicable diseases caused by SSBs
The medical practitioner from the department of internal medicine, General Hospital, Orile-Agege, Lagos State, Giwa-Ayedun, while proffering solutions, advised the public to stay away from SSB products and obey medical counsel. She explained that though some medical conditions might be hereditary, and few others could emanate due to age, lifestyles also contribute to NCDs, such as diabetes.
According to her, the Federal Ministry of Health has an important role, especially regarding awareness creation, to protect the public from health challenges that could arise from the intake of SSB products. Though she disclosed the responsibility lies with multiple stakeholders, the medical expert emphasised the cardinal role of NAFDAC in regulating what people consume.
Justifying why serious attention is required to manage the situation, she said the pancreas ordinarily produces hormones that regulate the blood sugar, which is insulin, but as “the body ages, the ability to produce enough insulin to manage the blood sugar wanes.”
A medical doctor, Solomon Chidiebere, also tasked NAFDAC to stand up to its duties. He said, “Many carbonated drinks are filled with sweeteners, and some are unhealthy for the body…”
He cited instances where people who consume carbonated drinks often complain of belching. “That is because they (the energy drinks) contain gas. The word carbonated means there is the presence of carbon. And carbon is used as a preservative.”
Chidiebere, a general physician at Pinecrest Specialist Hospital, Lagos, advised an optimum SSB consumption. He said those with a family history of diabetes or vulnerable to being diabetic should stay-off the SSB products.
“Usually, the body needs to take time to metabolise it (sweeteners), unlike when you take natural products such as carbohydrates like rice. The body tries to synthesise them naturally, but this (sweetener) is not in its natural form, so the body does not thrive well with unnatural products.”
“You must also be mindful that the producer is not selling with the mindset that you are in good health. His first interest is to make profits…”
During this report, The ICIR sought input from a professor and a Consultant Physician and Endocrinologist at the College of Health Sciences, University of Abuja, Anumah Felicia. She revealed the country currently lacks specific guidelines for regulating SSB products.
But, the medical practitioner affirmed the existence of a National Action Group, comprising the NAFDAC and Non-Governmental Organisations (NGOs). The group, she disclosed, were able to push for a 10 per cent levy as part of measures to checkmate SSB products in the country.
“It is not NAFDAC’s responsibility per se; a National Action Group in Nigeria is driving that process,” she said. “But NAFDAC is still part of the secretariat. It is like a coalition of NGOs. I am even a member, and we have achieved something. Some 10 per cent, which is not enough. We are looking at 20 per cent recommendation made by the WHO.”
A top source in the health ministry also disclosed efforts by the ministry to review its food safety policy to incorporate SSB products.
“We have a policy on food safety already, but all those things were not covered, so we are reviewing it to incorporate SSB”.