The fight is on over sugar

ScientistIt is difficult even for experienced scientists to agree on the interpretation of their findings. Add to that external research funding linked to commercial interests and it is even more difficult to know what to believe.

A case in point. If you thought excessive sugar intake is the root of the evil obesity epidemic you might have to think again.

Or not….

Sugar advice questioned

There has been a scathing attack on global health advice to eat less sugar. Through industry proxies, a scientific review now claims that warnings to cut sugar are based on weak evidence and cannot be trusted.

The review identified 9 guidelines that offered 12 recommendations, all indicating a suggested decrease in the consumption of foods containing nonintrinsic sugars (that is added sugar to you and me). The recommendations were based on various health concerns, including nutrient displacement, dental caries, and weight gain. However, the reviewers claimed that no guideline met criteria for trustworthy recommendations and were all based on low-quality evidence.

The review was paid for by the International Life Sciences Institute, a scientific group funded by multinational food and agrochemical companies.

Tainted from the beginning. When will industry ever learn.

The review findings immediately questioned

Predictably, the review quickly received sharp criticism from public health experts. It was but the latest effort of the food industry to influence global nutrition advice by supporting prominent academics questioning the role of sugary food and beverages in causing obesity and other health problems.

The review was seen as an attempt to undermine sugar guidelines from the World Health Organization (WHO) to consume fewer products with added sugar, such as soft drinks, candy and sweetened cereals. It is a classic example of how industry funding is used to influence opinion.

To be fair to the review team, they wanted their results to be used to promote improvement in the development of trustworthy guidelines on sugar intake. They also emphasised that the review findings should not be used to justify higher intake of sugary foods and beverages.

Still, nutrition experts say that the review team ignored the hundreds of randomised controlled trials that have documented the harms of sugar. There are strong scientific evidence that sugar contribute to adverse health conditions like weight gain and Type 2 diabetes. The view is that the review team ignored the real data, created false scores, and somehow got through a peer review system difficult to understand from a reputable journal like Annals of Internal Medicine.

The WHO contrary point of view

soda

So until we have the general scientific opinion swinging over to supporting sugar, it is clearly best to stick to the WHO recommendations.

A WHO guideline of 2015 recommends that adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. WHO also believes that a further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits.

Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. But the guideline does not refer to the sugars in fresh fruits and vegetables, and sugars naturally present in milk.

Contrary to the above review findings, WHO states that they have solid evidence that keeping intake of free sugars to less than 10% of total energy intake reduces the risk of overweight, obesity and tooth decay. Based on the quality of supporting evidence, these recommendations are ranked by WHO as “strong”.

So there you have it. And if you embark on reducing your sugar intake remember that much of the sugars consumed today are “hidden” in processed foods that are not usually seen as sweets.

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A bathtub of sugary soft drinks

bathtub

Consumption of sugar sweetened beverages equal a bathtub worth per year.

Can you believe it, when analysing data collected through the UK National Diet and Nutrition Survey, Cancer Research UK found that teenagers aged between 11 and 18 drink almost a bathtub full of sugary drinks on average in a year. To be more precise the average soft drink consumption for this group equalled 77L per year. That is actually a very small bathtub as they normally vary in size from 77L to say 170L. However, when taking a bath the water volume is most often just half that so drinking a bathtub of soft drinks per year is a fairly accurate estimate.

The figures shed light on the extreme sugar consumption of UK teenagers in that they eat and drink three times the recommended limit, with sugary drinks being their main source of added sugar. This contributes to the development of overweight and obesity and obese children are around five times more likely to grow into obese adults. The situation is similar in many other countries. Sales of sugar sweetened beverages in Australia equates to 75L per year for every adult and child, while overall consumption of sugar sweetened beverages per person in the USA has been estimated at 115L per year.

And on it goes. So what can be done?

Taxing sugar in soft drinks

In an effort to reduce the detrimental effects of consuming excessive volumes of sugary drinks, a tax has been suggested similar to the tax on tobacco. Several countries have already imposed a tax while others are in the process to do so.

Norway has had a generalised sugar tax on refined sugar products, including soft drinks, in more than 35 years. Hungary’s tax introduced in 2011 has seen 22% of people reduce energy drink consumption and 19% of people reduce their intake of sugary-sweetened soft drinks. France introduced a targeted tax on sugary drinks at a national level in 2012 and found that sales of soft drinks declined in the year following the introduction of the tax, following several years of annual growth. Annual sales of soft drinks in Mexico declined 6% in 2014 after the introduction of a tax in 2013.

South Africa, Ireland and the United Kingdom have all decided to introduce soft drink taxes in 2017-2018. The United States does not have a nation-wide soft drink tax, but a number of cities have or will soon introduce their own taxes. There has been a growing debate around taxing soft drinks in various cities, states and even in congress in recent years. This debate alone has raised awareness of the problem and soft drink consumption is on the way down.

Other countries are still debating the benefits of a sugar tax. In Australia there is an expert group proposal to introduce a tax of 40 cents per 100 grams of sugar, which would lift the price of a two-litre bottle of soft drink by about 80 cents.

What about diet beverages?

dietsodadrinker

Diet beverages might not be the solution to reduce the incidence of obesity.

The reduction in the consumption of sugar sweetened beverages is all good if it is replaced by water. But what about diet beverages? Sugar substitutes like aspartame are supposed to promote weight loss, but a number of clinical and epidemiologic studies have suggested that these products don’t work very well and may actually make things worse. This is quite confusing as energy intake is reduced. However, there has been some evidence that artificial sweeteners actually can make you more hungry and thus may be associated with increased energy consumption.

Now a research team has found a possible mechanism explaining why use of the sugar substitute aspartame might not promote weight loss. Their report show how the aspartame breakdown product phenylalanine blocks a gut enzyme called intestinal alkaline phosphatase (IAP). And IAP is normally protective in that it has been shown to prevent obesity, diabetes and metabolic syndrome.

The researchers also showed that mice receiving aspartame in their drinking water gained more weight, had higher blood sugar levels, which indicates glucose intolerance, and higher levels of the inflammatory protein TNF-alpha in their blood, which suggests the kind of systemic inflammation associated with metabolic syndrome.

So what to do?

It is quite clear that just a debate around the detrimental effects of excessive consumption of sugar sweetened beverages can have an effect. Add to that an increase in the price and the benefits are obvious as shown already in several countries.

But it is equally important that the new choice of beverage doesn’t add to the problem. The use of artificial sweeteners might not be as innocent as could be expected.

Too much fat or too much sugar

Added sugar cause more problem than high fat (Photo: Health Gauge)

Replacing fat with sugar is a bad choice (Photo: Health Gauge).

New research findings justifies another look at this topic we have covered before, but this is not easy with very polarised views. It used to be simple in the past. What’s now considered flawed research stated that fat, particularly saturated fat, was bad for our health. It increased cholesterol levels and caused heart disease with early death. Low-fat diets were in vogue and industry produced plenty of low-fat alternatives for the proselytes.

Unfortunately, industry substituted fat with sugar and that didn’t help the situation much. Actually, it now seems to have made what was considered a bad situation even worse.

Fight between old and new science

In a previous blog I put my toe into the sugar debate, an issue that has recently turned nutrition on its head. Now overindulgence in sugar is the culprit behind several diseases and increased mortality. So in the one corner we have the old die-hard supporters of the low-fat diet, while in the other corner we have the fresh newcomers daring to promote a low-carb high-fat diet.

Although the low-fat supporters have lost considerable ground the umpire seems to still be sitting on the fence. The 2015-2020 Dietary Guidelines for Americans target both saturated fats and added sugars as nutrients to limit and seem to give them equal weight in their advice:

  • Consume less than 10% of calories per day from added sugars, and also
  • Consume less than 10% of calories per day from saturated fats.

Let’s just pause for a moment to consider this new advice. The energy stored in our food is measured in terms of calories. Technically, one calorie is the amount of energy required to raise the temperature of 1 gram of water 1º Celsius. However, in the food area a calorie is actually 1000 technical calories. Although the technical calorie unit is part of the metric system, it has been superseded in the International System of Units by the joule and used in some countries as the new energy measure. A food calorie is approximately 4.2 kilojoules. Confused, I thought so. So for convenience let’s stick to the common use of calorie in the food area and forget that technically it is actually kilocalories.

Now to be clear, sugar contains less than 4 calories, whilst fat contains 9 calories per gram. Thus, according to the above recommendations you could consume double the amount of added sugar compared to saturated fat to keep within the given proportion of energy allocated to each of the two nutrients. So although the recommendation looks evenhanded in reality it is not.

New studies support the low-carb camp

New scientific findings

New scientific findings give further support to the low-carb camp.

Back to the science. With the tables turning, low-fat diets are out and high-fat diets are very much in. Since the eat-less-saturated-fat advice has been around for decades, there should be proof around either way you would think. However, it took quite some time to disprove the fat hypothesis since it was considered heresy.

This has changed and a new article cites several meta-analyses of randomised controlled trials that did not find a connection between saturated fats and heart disease or overall death rates.

But it goes further with low-carb comparisons. A recent study suggested that low-fat diets might not be the way to go after placing about 150 adults on either a low-carb or a low-fat diet for a year. Participants on the low-carb diet lost more weight and lowered their risk for heart disease more than participants who followed a low-fat diet.

Another study involved 17 people at risk for heart disease and diabetes. They were put on a low-carb, high-fat diet for three weeks. Then, they turned the table and increased carb intake while reducing total fat and saturated fat intake every three weeks for 18 weeks, keeping total caloric intake the same. The more carbs and less fat in the diet resulted in an increase in markers linked to obesity, type 2 diabetes, and heart disease. I know, a very small group of people, but anyway.

So is the fight over?

No, we are still waiting for the knock-out blow. Life is never that simple.

As for saturated fats, these fats are a diverse class of compounds. Some saturated fats elevate bad cholesterol, others have no effect, and some actually increase good cholesterol. Fats in foods are always a mixture. While some foods high in saturated fats, such as processed meats, might be connected to heart disease, other foods high in saturated fat such as dairy have no such effect. And there is also the supposition that some polyunsaturated fats might induce inflammation that in turn can influence the heart disease rate.

And similarly to fats, not all carbs are equal. The monosaccharide, fructose, and the disaccharide sucrose, common table sugar, with half fructose (together with glucose), produce greater degrees of metabolic abnormalities than does glucose alone found in long chains of starch in certain foods and cellulose in plant walls.

If you need to lose weight science is pretty clear. If you eat too little fat, your metabolism won’t be as efficient and will create some waste because of an excess of carbs and/or protein. A slower metabolism and a higher load of waste will interfere with weight loss. On the other hand, high-fat food dampens appetite and can help you eat less and thus lose weight.

Sugar can be fattening indirectly by causing you to eat more. Eating too much sugar will encourage insulin production. If you produce too much insulin it actually causes blood sugar to dip and you feel tired. As you need an energy boost you eat more, and you tend to give in to cravings for more sugar. Of course, that only makes the whole cycle happen again.

But we don’t eat fat or carbohydrates in isolation, we eat them in the form of complex foods with a lot of other necessary components. If you forget weight loss and just want to maintain a healthy diet there is room for good forms of both fat and carbohydrates. With fat you get important fat-soluble vitamins and essential fatty acids, and with complex carbohydrate foods you get minerals, water-soluble vitamins and antioxidants like flavonoids.

What about everything in moderation?

Find the right balance for healthy eating (Photo: Mauro Cateb).

Find the right balance for healthy eating (Photo: Mauro Cateb).

We have said it before, why not everything in moderation as the saying goes. Or did go!

Even that has now been criticised as being too vague and difficult to measure. ‘There are no good or bad foods,” and “all foods can fit into a healthy diet” are variations on the moderation theme. But what exactly is moderation? A new study found that definitions of moderate consumption were related to personal consumption behaviours. Results suggest that the endorsement of moderation messages allows for a wide range of interpretations of moderate consumption.

Healthy eating is about finding a balance between two extremes – deprivation and overindulgence. It is about adhering to strategies and habits that can be maintained long term as part of a lifestyle to avoid a yoyo effect between these extremes.

Call it what you like as long as you don’t give in to your ghrelin urge too often. An occasional binge can be justified to keep you happy. That’s what life is all about, isn’t it?

The war on sugar

The sweetness of ice cream can be overwhelming.

The sweetness of ice-cream can be overwhelming.

The sweet tooth seems to require a treat now and then. But why are most food manufacturers overdoing the sweetness thingy. You have an ice-cream treat and although it initially tastes nice, after half is consumed you feel the sugar molecules crawling in your mouth with the sugar taste lingering for several hours. The same with a blueberry cheesecake. The sweetness is just overwhelming.

I could go on and on. I am not after sugar replacements, I just want the sweetness to be toned down.

Trend to reduce sugar intake

Actually, reducing sugar intake has become a key concern amongst many consumers. In a recent 2,500-strong European consumer survey, a quarter of those asked preferred low sugar food products, findings that seem to confirm the continuing shift in consumer efforts to reduce sugar intake. They also found that more than 60% of those surveyed actively monitored their dietary sugar intake. This might be influenced by the World Health Organisation recommendation to reduce sugar intake to less than 10% of total energy intake, or the more extreme aim to get down to less than 5% for improved health.

Excessive sugar consumption continues to be criticised by the media and health professionals alike, resulting in today’s sugar backlash. This has led to sugar replacing fat and salt as the new dietary pariah in many countries. There is thus a key opportunity for companies to address consumer preferences and adapt their products to carry a low or reduced sugar level. But food manufacturers aren’t listening. Of course, taste differences that consumers are not used to can make or break a popular product – something manufacturers are hesitant to risk. However, why not give us some alternatives?

But still a persistent problem

In reality we seem to go backwards in many respects and the USA is a horror example not to follow. In the last 40 years, fructose, a simple sugar derived from fruit and vegetables, has been on the increase in American diets. Because of the addition of high-fructose corn syrup to many soft drinks and processed baked goods, fructose alone now accounts for 10% of caloric intake for US citizens. But note that this is the average with peaks much beyond this especially in adolescents.

Fructose in soft drinks a culprit.

Fructose in soft drinks a culprit.

And then you should know that a recent study found that, matched calorie for calorie with the simple sugar glucose, fructose causes significant weight gain, physical inactivity, and body fat deposition. The link between increases in sugar intake, particularly fructose, and the rising obesity epidemic has been debated for many years with no clear conclusions as people are not only consuming more fructose through their diets, but also consuming more calories in general.

Thus researchers studied two groups of mice, one group was fed a diet in which 18% of the calories came from fructose, mimicking the intake of adolescents in the USA, and the other was fed 18% from glucose, while both groups had exactly the same amount of calories derived from sugar. The only difference was the type of sugar, either fructose or glucose. The results showed conclusively that the fructose-fed mice displayed significantly increased body weight, liver mass, and fat mass in comparison to the glucose-fed mice.

Given the dramatic increase in obesity among young people and the severe negative effects that this can have on health throughout life, it is important to consider what foods are providing our calories.

More ill effects from too much sugar

A new study highlights one more reason to avoid sugary beverages, processed foods and other energy-dense carbohydrate-containing foods. Regular consumption of sugary beverages was shown to be associated with a 3 times greater risk of prostate cancer. By contrast, healthy carbohydrate-containing foods like legumes, non-starchy vegetables, fruits and whole grains were collectively associated with a 67% lower risk for breast cancer.

A common warning though for these type of studies, the results point only to associations, not necessarily to cause-and-effect, but at least the findings are in line with previous studies. Malignant cancer cells seem to feed on sugar, and diets high in refined carbohydrates may lead to a range of adverse health effects primarily due to their impacts on body fatness and on the dysregulation of insulin and glucose, both of which are factors that may increase cancer risk.

Better control of your brain

So what to do about the sweet tooth. Well, actually it has nothing to do with our teeth per se but rather brain chemistry. Excess sugar consumption has been shown to repeatedly elevate dopamine levels which control the brain’s reward and pleasure centres in a way that is similar to many drugs of abuse including tobacco, cocaine and morphine.

Go for a pill or healthy food? (Photo: Chris de Rham)

Go for a pill or healthy food, your choice (Photo: Chris de Rham).

An Australian research team even went further in showing that if sugar is consumed at current levels in the modern western diet, it can induce structural changes in the brain that impact behaviour by influencing how neurons communicate.

Now you could try medication as the Australian research team observed that the smoking cessation drug varenicline, which is FDA approved, had a similar effect in reducing sugar consumption. Or you could go the more natural way.

Some hope in the war on sugar

There are some tentative steps in industry product reformulation through the development of new sugar-reduced products that you could go for. Or you could just reduce the portion size.

There are also potential government action that might provide future help. A few governments have taken the bold move to introduce a sugar tax as recent years have brought more attention to the role of carbohydrates in our diets and the differences between healthy and unhealthy carbs.

As usual it is your choice.

Is sugar a public health enemy?

Popular low-fat products (Photo: Barry Ennor)

Popular low-fat products (Photo: Barry Ennor)

You have probably picked low-fat food products over full-fat products for quite some time since high fat consumption was claimed to be linked to heart disease. And now it’s time to cut back on your sugar consumption as well. What pleasures are left in life? Problem is that sugar consumption is on the increase. By the start of the 1970s, supermarket shelves were full of low-fat yogurts, spreads, and even desserts and biscuits. When creating their low-fat products, manufacturers needed a fat substitute to stop the food tasting like cardboard, and they picked sugar.

However, it has long been questioned whether a diet high in sugars, especially refined sugars, is bad for human health. In 1972, John Yudkin, founder of the nutrition department at the University of London’s Queen Elizabeth College, published a book called “Pure, White and Deadly” where he questioned the link between fat and heart disease and instead put the blame on sugar. After all, he wrote, we had been eating substances like butter for centuries, while sugar, had, up until the 1850s, been something of a rare treat for most people. This was not what the low-fat proponents wanted to hear and as a result there was a concerted campaign mounted to discredit the work of Yudkin.

More evidence that excessive sugar intake is bad for health

Now there is a mounting pile of evidence suggesting that Yudkin was right and that excessive sugar intake is worse for the body than we ever suspected. Many studies have linked high sugar consumption to obesity, and a possible contributor to diabetes, cardiovascular disease, dementia, macular degeneration and tooth decay. Mind you, these are observational studies, which can prove association but not cause and effect.

Still it might pay off to heed the advice. It is clear that most of us should cut back on the sweet stuff. The World Health Organization (WHO) recommends that less than 10% of our energy should come from free sugars. Free sugars are defined by the WHO as all sugars “added to foods by the manufacturer, cook, or consumer, plus sugars naturally present in honey, syrups and fruit juices”. That is a stretch target for most of us. And if that is not enough, now there are rumours in the press that this target might be reduced to 5%, which is equivalent to five teaspoons or 20 g. This is not going to be easy.

Let’s look at some facts. The world produced about 168 million tonnes of sugar in 2011. The United Nation’s Food and Agriculture Organization estimates that average global added sugar consumption is about 24 kg a year – equivalent to 65 g or about 260 kcal a day. Of course this is not evenly spread around the world. Consumers in the United States of America is at the top of the per capita total consumption of sugar (including high-fructose corn syrup used in only a handful of countries) with about 64 kg per year, while China is close to the bottom with about 6 kg per year. I have borrowed a graph from the blog of the Conversable Economist to illustrate the spread in energy intake from sugar in different countries. The orange bit is the high-fructose corn syrup.

Calory sweetener

But how do you reduce sugar intake

It is useful to know that a single can of cola contains ten teaspoons of sugar, a Mars bar has five, a bowl of Coco Pops has about four and there are eight in some ready meals. If the ingredient list for a food includes words like sucrose, glucose, fructose, high-fructose corn syrup, honey, agave syrup, fruit juice concentrates, invert sugar, cane sweetener, maltose, malt syrup, dextrose and dehydrated cane juice, you will know that part or all of the sugars listed on the nutrition label come from added sugars. That’s when it is time to react.

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