Search results: added sugar

Nutrition labels may seem self-evident but it takes volumes of Federal Register notices to explain how every word works.  When it comes to food labels, the devil is in those details.

Take “Added Sugars,” coming soon to a food label near you.

How does the term apply to honey and maple syrup or, for that matter, sugar itself.  These are sugars ready to add.

Pure honey and maple syrup producers are worried that when you see grams of Added Sugars on their labels, you will think that these natural products have been adulterated with—gasp—High Fructose Corn Syrup.

The producers of sugar-sweetened cranberry products are also concerned.  They worry that the added sugars will discourage you from buying cranberries.

Here is how the FDA suggests dealing with these “problems,” in quotes because they are problems for producers, not you and me—we know what “added” means.

The purpose of this draft guidance is to advise food manufacturers of our intent to exercise enforcement discretion related to the use in the Nutrition Facts label of a symbol “†” immediately after the added sugars percent Daily Value information on single ingredient packages and/or containers of pure honey or pure maple syrup and on certain dried cranberry and cranberry juice products that are sweetened with added sugars and that contain total sugars at levels no greater than comparable products with endogenous (inherent) sugars, but no added sugars.

Got that?

Pure honey and maple syrup get a “†” indicating that they have no more sugar than any other comparable sugar.

Cranberries are more complicated:

With respect to the labeling of certain cranberry products, cranberries are a naturally tart fruit, and certain dried cranberries and cranberry juice products have added sugars added to them to bring the total sugars per serving up to levels comparable to the levels of non-cranberry competitor products that contain equivalent amounts of total sugars, but whose labels list zero “added sugars” because their fruit products are inherently sweet.

Did you get that?

If I read this FDA-speak correctly, the FDA is making an exception for cranberries.  It agrees that the Added Sugars in cranberries also deserve a “†”.

Why is FDA allowing this?  The Draft Guidance explains:

We received comments from the cranberry industry to the final rule and subsequent correspondence that the added sugars declaration would be detrimental to the cranberry industry by implying that cranberry products are less nutritious than competitive products that have similar amounts of total sugars and nutrients.

These comments were similar to those we received which noted that grape juice contains 36 grams of total sugar with no added sugars while cranberry cocktail, with sugars added for palatability because cranberries are naturally tart, generally contains 28 grams of total sugars including 25 grams of added sugars and has 30 fewer calories per serving than 100% grape juice.

Likewise, comments explained that sweetened dried cranberries contain 29 grams of total sugars including 25 grams of added sugars per serving while raisins contain 29 grams of total sugars with no added sugars per serving. Both sweetened dried cranberries and raisins have the same number of calories per serving and a similar nutrient profile.

In translation, you are not supposed to be concerned about the Added Sugars in cranberries.

But couldn’t you could buy real cranberries and add a whole lot less sugar than that?

Chalk this as a win for cranberry lobbyists.

The documents

• Download the Draft Guidance 
• Federal Register Notice
• Constituent Update
• Changes to the Nutrition Facts Label
• Additional Labeling Guidance

 

Just in the nick of time, the FDA has released rules on labeling added sugars.  and re-adjusting serving sizes, documents aimed at helping food manufacturers prepare for the sweeping update to Nutrition Facts labels set for 2018.

The FDA also released draft guidance for complying with the rules.  Here is one example from this Q and A:

7. How should I calculate the amount of added sugars in a fruit juice blend containing the juices of multiple fruits that have not been reconstituted to 100 percent (full-strength)?

If the juice blend is reconstituted such that the sugar concentration is less than what would be expected in the same amount of the same type of single strength juice (e.g., less than 100% juice), the added sugar declaration would be zero. If the juice blend is reconstituted such that the sugar concentration is greater than what would be expected in the same amount of the same type of single strength juice, the amount of sugar that is in excess of what would be expected in the same amount of the same type of single strength juice must be declared as added sugars on the label.

A separate draft guidance explains changes in serving sizes that also go into effect.

When does all this happen?  The rules became final in May but they do not have to be implemented until July 26, 2018.  Businesses with annual food sales below $10 million get an additional year to comply.

The elephant in the room?  Will the new administration step in and repeal the whole thing?

The relevant documents

• Draft Guidance for Industry: Questions and Answers on the Nutrition and Supplement Facts Labels Related to the Compliance Date, Added Sugars, and Declaration of Quantitative Amounts of Vitamins and Minerals
• Federal Register Notice for the Draft Guidance on Questions and Answers
• Draft Guidance for Industry: Reference Amounts Customarily Consumed: List of Products for Each Product Category
• Federal Register Notice for the Draft Guidance on Reference Amounts
• Changes to the Nutrition Facts Label

 

The FDA announced this morning that it is proposing a Daily Value (the maximum) for Added Sugars on food labels—10% of calories.

Susan Mayne, FDA’s Director of the Center for Food Safety and Applied Nutrition, explains the rationale: this is the percentage recommended by the Dietary Guidelines and practically every other health authority that has examined the evidence on sugars and health.

Ten percent of calories means 200 calories on a 2000 calorie daily diet, or 50 grams, or 12 teaspoons—the amount in one 16-ounce soda.

If you drink a 16-ounce soda, you have done your added sugars for the day.

If this seems abstemious, consider that 10% of calories is more generous than the amount recommended by the UK’s Scientific Advisory Committee on Nutrition:

It is recommended that the average population intake of free sugars should not exceed 5% of total dietary energy for age groups from 2 years upwards.

The World Health Organization’s recent report on sugars and health also views 10% as the absolute maximum:

• In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation).
• WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation).

The WHO report explains:

The recommendation to further limit free sugars intake to less than 5% of total energy intake, which is also supported by other recent analyses, is based on the recognition that the negative health effects of dental caries are cumulative, tracking from childhood to adulthood…No evidence for harm associated with reducing the intake of free sugars to less than 5% of total energy intake was identified.

Americans, on average, consume way more than 10% of calories from added sugars, so this recommendation means a sharp restriction.

It means consuming less of sugary products: sodas, baked goods, and all those packaged foods with added sugars.

The proposal is up for comment.

You can bet that there will be plenty.

Congratulations to the FDA for this one.  Let’s hope it sticks.

How to Comment

To comment on the proposed changes to the Nutrition Facts Label:

1. Read the proposed changes.
2. Starting Monday, July 27, 2015, go to Regulations.gov to submit comments.

Dr. Yoni Freedhoff sent me Canada’s Heart and Stroke Foundation’s  new position statement on Sugar, Heart Disease, and Stroke.

Its major recommendation is just like the one from the World Health Organization:

The Heart and Stroke Foundation recommends that an individual’s total intake of free sugars not exceed 10% of total daily calorie (energy) intake,and ideally less than 5%.

The Canadian government, the Foundation says, should:

• Ensure clear and comprehensive nutrition labelling of the free sugars content in the Nutrition Facts table of all packaged foods, grouping all sugars together when listingingredients on product packaging, and standardized serving sizes on the Nutrition Facts table.
• Restrict the marketing of all foods and beverages to children.
• Educate Canadians about the risks associated with free sugars consumption through public awareness and education campaigns.

Shouldn’t we be doing that too?

As Dr. Freedhoff puts it, it’s “Amazing how forceful and sweeping public health organizations can be when they don’t need to worry about upsetting their industry partners.”

August 1 is the deadline for filing comments on FDA’s food label proposals.

Two were released yesterday, one for and one against.

The Union of Concerned Scientists (UCS) organized a statement in support of listing added sugars signed by 280 scientists, physicians, and public health officials (including me).

The press release says:

In a letter submitted as a public comment for the agency’s first label update since 1994, the signatories point out that sugar overconsumption contributes to diabetes, cardiovascular disease and other ailments….Many food and beverage manufacturers add excessive amounts of sugar to their products, including those that they market as healthy options. In our current food environment, many people are unknowingly and unavoidably consuming excess sugar. Given our soaring rates of chronic diseases and the link between sugar and these diseases, citizens have a right to know how much sugar has been added to their foods.

People who signed the letter include many from Healthy Food Action, a national network of health professionals founded by Dr. David Wallinga.  I am a co-author of the statement with UCS staff and Dr. Robert Lustig.

In contrast, the American Society for Nutrition (ASN), an organization of nutrition scientists to which I belong, produced a strong statement against labeling added sugars.

ASN also has concerns that the inclusion of added sugars on the label may divert attention away from total calories and other important contributors to weight gain. The inclusion of added sugars on the label may confuse consumers and create the perception that naturally occurring sugars are somehow more beneficial because they are “natural” and do not have health effects similar to added sugars…There is no supporting evidence that indicates that the inclusion of added sugars on the food label will translate into the American public reducing caloric intake from added or total sugars or total energy intake…it is important to consider potential unintended consequences of  reformulation as well. When sugar is removed from a solid food product…The replacement is often fat and/or starch which could lead to a product with higher calories per serving. ASN encourages FDA to carefully consider potential adverse consequences of this proposed determination, including gaining input from food scientists…An investment in consumer education… is likely to be most productive for consumer understanding relative to added sugars, and would assure that consumers do not experience increased confusion, which they may encounter if added sugars are declared on the Nutrition Facts label.

These comments, which read as though written by sugar trade association groups, were signed by the president of ASN.  Although the statement letter gives no indication of the process by which these comments were developed, I’m told it was prepared by ASN’s public policy committee.

If so, it would help to know whether members of the committee have financial ties to the sugar industry or to food companies that use sugar in their products.

I wonder how much of the ASN membership agrees with this position on Added Sugars.   I certainly don’t.

 

The FDA is taking comments on its proposals to revamp the food label until August 1, 2014.

It has two sets of proposed changes:

• Nutrition and Supplement Facts Labels
• Serving Sizes

Here is the first of my comments on several food label items.  Feel free to copy, edit, or file your own (see directions below).

July 16, 2014

TO:  FDA

FROM:  Marion Nestle, Professor, New York University

RE:  Nutrition Facts panel: ADDED SUGARS

1.  Retain the line for Sugars but call it Total Sugars

2.  Add a line for Added Sugars

Rationale:

• Excessive intake of dietary sugars is well established to raise the risk of obesity and type-2 diabetes.[i]
• Americans on average twice as much as is generally recommended.[ii]
• The amount typically consumed comes close to the upper limit recommended by the Institute of Medicine on the basis of increased risk of nutrient deficiencies.[iii]
• Sugars intrinsic to foods are accompanied by nutrients; added sugars are not.
• Although there is no biochemical difference between intrinsic and added sugars, food and beverage companies know exactly how much sugar they add as part of the recipes for their products.
• Listing the amount of added sugars on food labels would inform consumers about how much sugars are added to the foods they buy.
• Randomized, controlled clinical trials to test the hypothesis that added sugars increase disease risk would violate ethical standards and, therefore, are impossible to conduct.

3.  Establish a Daily Reference Value for Added Sugars of 10% of total calories

Rationale:

• Since the 1977 Dietary Goals, health officials have consistently recommended an upper limit of 10 percent of calories from added sugars.[iv]
• The 1992 USDA Food Guide Pyramid suggested an upper limit of 6, 12, and 18 teaspoons of sugars, respectively, for daily diets of 1,600, 2,200, and 2,800 calories, respectively.  This works out to 7, 10, and 13 percent of calorie intake, respectively, for an average of 10 percent.[v]
• By 1992, health officials in several European countries had recommended much the same.[vi]
• The Institute of Medicine’s 2002 upper safety limit of 25% of calories was based on risk for nutrient deficiencies, not obesity and chronic disease.[vii]
• In 2009, the American Heart Association recommended that women consume no more than 100 calories per day from added sugars (25 grams), and men no more than 150 calories per day (38 grams).  These come to 5 percent and 7.5 percent, respectively, of a 2000-calorie daily diet.[viii]
• The 2010 Dietary Guidelines for Americans state that no more than 5 to 15 percent of calories should come from a combination of solid fats and added sugars.  This implies that added sugars should be less than 10% of calories.^[ix]
• Dr. Robert Lustig says that a “dose” of added sugars up to 50 grams a day poses little risk for metabolic or chronic disease.  This amounts to 200 sugar calories and 10% of a 2,000-calorie daily diet (he says twice that much, the amount commonly consumed by Americans, is toxic.[x]
• The World Health Organization in 2014 said that added sugars should make up less than 10 percent of total calories per day, and less than 5 percent would be even better,[xi] based on two research reviews, one on sugars and obesity[xii]  and one on sugars and tooth decay.[xiii]
• Added sugars as 10% of calories represents about half the amounts currently consumed and comes close to consensus.

References

[i] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohttp://steinhardt.nyu.edu/nutrition/hort studies. BMJ 2012;345:e7492.  doi: 10.1136/bmj.e7492.

[ii] USDA.  Loss-adjusted food availability documentation.  March 11, 2014.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/loss-adjusted-food-availability-documentation.aspx#.UzlzcfldU6w.   USDA.  Food availability documentation: added sugar and sweeteners.  http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/food-availability-documentation.aspx#sugar.   The tables used to construct figure 3D are at: Refined Sugar, Corn Syrup, Other Sweeteners.

[iii] Institute of Medicine (IOM) of the National Academies. “Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids (Macronutrients), Chapter 6: Dietary Carbohydrates: Sugars and Starches”, Washington, DC: National Academies Press; 2002.

[iv] U.S. Senate Committee on Nutrition and Human Needs.  Dietary Goals for the United States, December 1977.

[v] USDA.  Food Guide Pyramid, 1992.

[vi] Cannon G:  Food and Health: The Experts Agree.  London:  Consumers’ Association, 1992.

[vii] USDA.  Is intake of added sugars associated with diet quality?  Nutrition Insights, Insight 21, October 2000.

[viii] Johnson RK, Appel LJ, Brands M, et al.  Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.  Circulation. 2009;120(11):1011-1120.  doi: 10.1161/CirculationAHA.109.192627.

[ix] USDA and USDHHS.  Dietary guidelines for Americans, 2010.  http://www.cnpp.usda.gov/dgas2010-policydocument.htm.

[x] Lustig RH.  Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity, and Disease.  Hudson Street Press, 2012.

[xi] WHO.  Draft guideline: Sugars intake for adults and children, March 2014. http://www.who.int/nutrition/sugars_public_consultation/en/.

[xii] Te Morenga L, Mallard S, Mann J. Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ 2012;345:e7492 doi: 10.1136/bmj.e7492.

[xiii] Moynihan PJ, Kelly SAM.  Effect on Caries of Restricting Sugars Intake. Systematic Review to Inform WHO Guidelines.  JDR 2014;93:8-18.  doi:10.1177/0022034513508954.

 

The FDA makes it easy to file comments. It provides:

• All necessary information in one place.
• A short guide and checklist
• Nutrition and Supplement Facts Label: Docket FDA-2012-N-1210  Comment here now
• Serving Sizes: Docket FDA-2004-N-0258  Comment here now

While I’m on the topic of sugars (see yesterday’s post), the World Health Organization (WHO) has just called for public comment on proposed new guidelines for intake of “free” (added) sugars:

• Added sugar intake should be less than 10% of total calories per day (50 grams for a 2000 calorie-a-day diet)
• Intake below 5% of calories would confer additional benefits (25 grams)

Although the announcement casually mentions that the draft guidelines reaffirm a previous WHO sugar guideline from 2002, it just as casually fails to mention what happened to that guideline.

I, however, have perfect recall, particularly because I wrote about these events in the Afterword to the 2013 edition of Food Politics:

In the early 2000s, the World Health Organization (WHO) began work on a global strategy to reduce risk factors for chronic disease, obesity among them. In 2003, it published a research report that advised restricting intake of “free” (added) sugars to 10% or less of daily calories. Although this percentage was similar to that embedded in the USDA’s 1992 Pyramid (7–13% of calories, depending on total intake), sugar industry groups strenuously objected, enlisted senators from sugar-growing states to pressure the DHHS secretary to withdraw funding from WHO, and induced the DHHS chief counsel to send a critique of the report to WHO that had essentially been written by industry lobbyists. When released in 2004, WHO’s Global Strategy on Diet, Physical Activity, and Health omitted any mention of the background report or the 10% sugar recommendation.

“Strenuously objected” vastly understates what happened.

Why was the sugar industry so concerned?  One 12-ounce Coke or Pepsi contains about 40 grams of sugars.  Have one, and you’ve just about done your added sugars for the day.

WHO must either think that the research basis of the 10% sugar guideline is much stronger now (see references below), or that the political landscape has shifted so far in the direction of reducing sugar intake that governments will ignore industry groups this time.

I’m not so sure.  I think WHO needs all the help it can get with this one.

Submit comments here.  Now!

References

Reports commissioned by WHO

• Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies
• Effect on caries of restricting sugars intake: Systematic review to inform WHO guidelines

What happened to the previous guideline

• Waxman A. The WHO Global Strategy on Diet, Physical Activity and Health: the controversy on sugar. Development 2004;47:75–82
• Zarocostas J. WHO waters down draft strategy on diet and health. Lancet 2004;363:1373.
• Kaiser J.  The man behind the memos.  Science 2004;305:1552-1553.

After my post earlier this week about the USDA’s final rules for the WIC program, I heard from Tracy Fox, who heads a food and nutrition policy consulting firm in Washington, DC.

She wrote: “Did you see the amount of total sugar they are allowing in the yogurt provision?  Up to 40 grams per 8 ounces.”

Oops.  She’s right.

The sugar rules for WIC yogurt

The rules say:

As recommended by the IOM, yogurt must conform to the standard of identity for yogurt as listed in Table 4 of 7 CFR 246.10(e)(12) and may be plain or flavored with ≤ 40 grams of total sugar per 1 cup of yogurt.

The IOM reference is to the Institute of Medicine’s 2005 report, WIC Food Packages: Time for a Change.  On page 221, this report says:

Yogurt (must conform to FDA standard of identity…plain or flavored with ≤ 17 g of total sugars per 100 g yogurt.

Let’s do the math

The standard serving size for yogurt in these rules is 8 ounces, or 226 grams.  At 17 grams of sugar per 100 grams, this allows for 38.4 grams of sugar per 8 ounces.  USDA must have rounded this up to 40.

But plain yogurt is already sweet.  It contains 16 grams of lactose sugar in 8 ounces.

The rules allow for an additional 24 grams of sugar per 8 ounces—6 teaspoons!

But most yogurt comes in 6 ounces containers

In 2003, yogurt makers shrunk the package size to 6 ounces as a cost-saving measure.

A 6-ounce yogurt contains 12 grams of lactose. 

So the rules allow for 18 grams of added sugars in 6 ounces—4.5 teaspoons.

The new Nutrition Facts label may help

• It requires listing the amount of added sugars.
• This may discourage government agencies from buying highly sweetened yogurts.
• It may encourage yogurt makers to cut the sugar.

In the meantime, what to do?

• Encourage the WIC program to buy plain yogurt.
• Ask USDA to amend the regulations.
• Make sure added sugars stays on the FDA’s proposed rules (file comments here)