Food Politics

Last week, I wrote about the dairy industry’s petition to avoid having to follow FDA rules about labeling artificial sweeteners on the front of milk cartons.

Cara Wilking, Senior Staff Attorney at the Public Health Advocacy Institute at Northeastern University points out that the Sugar Association, the trade association for producers of cane and beet sugar, is right on top of this issue.

To assist consumers in making informed choices about what is sweetening the products they purchase, the Sugar Association petitioned the Food and Drug Administration (FDA) requesting changes to labeling regulations on sugar and alternative sweeteners.

In this petition we asked that artificial sweeteners and sugar alcohols be identified on the front of the package along with the amounts, similar to what is required in Canada.

If it is important to you to know if the product you purchase contains artificial sweeteners, let your congressional representatives know that FDA needs to take action on this important consumer issue.

The Sugar Association, obviously, represents the producers of cane and beet sugar. It wants to sell more sugar.  It doesn’t like artificial sweeteners much.  [Recall: it doesn't like me much either---go to Media and scroll down to the bottom to read the Sugar Association's letter threatening to sue me].

In contrast, the dairy industry wants to sell more milk.  Sweetened milk, no matter with what, sells to kids.  School kids are a big market for the dairy industry.  This market, however, is not doing well these days, according to the dairy industry’s August 2012 School Channel Survey.

Schools and processors are realizing 59% of current potential…Milk potential stands at 6.29 milks per student each week…Actual usage is 3.74 milks per student each week.  Elementary schools: 70% of potential being realized, down 1 point Secondary schools: 50%, down 1 point over last year.

Achieving ‘a milk with every meal’ translates into nearly 300 million incremental gallons….

Of course artificial sweeteners should be prominently labeled.  The Sugar Association has this one right.

Whatever your opinion, you can file comments at www.regulations.gov. Search for docket number FDA-2009-P-0147.

My post yesterday about the increase in sugars in certain Stonyfield yogurts elicited this e-mail from Stonyfield’s Vice President for Communications and Social Media. I’m posting it here with her permission:

Hi Marion,

Alice Markowitz here…I read your blog post today–and wanted to give you an update on our yogurt and company.

Happy to say, that as Chairman of the Stonyfield Board, Gary [Hirshberg] is still wholeheartedly and irrepressibly involved with the company and our direction. Likewise, Stonyfield is actively engaged in the labeling issue, as we continually try to communicate the importance of knowing where your food comes from and how it’s produced.

I also wanted to clarify that we’ve shared the parent company Groupe Danone with Dannon since 2003, and we’ve always operated our company independently. That includes making our own decisions about the recipes we use for our yogurts.

In 2011, we replaced some of the sugar in our Smooth and Creamy style nonfat yogurts with organic stevia. Our fans didn’t like the switch, so we went back to using just organic sugar with our new Blends. So, while there’s more sugar in those yogurts now than when we used stevia, the amount is about the same as our pre-stevia recipe. In fact, the slight increase is due primarily to an increase in milk in the product, resulting in more protein, more milk sugar.   As with many of our products, Blends has a mix of naturally-occurring sugars from milk and fruit and some added sugars.

We are concerned about the amount of sugar in our yogurts. In fact, almost half of the sugar listed in the nutritional info is what’s found naturally in the milk and fruit – which is why you see different sugar amounts in different flavors. The sugar we do add is organic sugar used to create the flavors that our yogurt lovers prefer the most.

Ultimately though we offer the choice to the consumer, and offer 98 different organic products. If yogurt eaters prefer to restrict their sugar intake, we offer plain versions of our nonfat, lowfat, whole milk and Greek yogurt without any added sugar. Turns out we’re also the only company that offers a plain yogurt for babies (with naturally-occurring milk sugars only) so parents have a choice if they prefer no sugar.

Probably more info than you ever wanted but hope this clarifies things a bit.

All the best,

Alice

Maybe it’s a coincidence but now that Gary Hirshberg has left Stonyfield to work on Just Label It!, its parent company, Dannon, is sweetening up its “Blends” yogurts.  

Or so writes a reader:

Yes it’s more sugar!  In the French Vanilla (6 oz cup), they added 10 g (from 17 – 27g)! 

In the Peach (also 6 oz cup) they added 6g (from 20 -26). 

It’s so bad that kids are fighting over it.  

We have noticed that they are eating less fruit because they want that sugar in the yogurts.

As I wrote of the competition between Dannon and Yoplait (owned by General Mills) in the yogurt chapter of What to Eat, 

The chief weapon in the yogurt battles is sugar.  Both brands are desserts.  Sugars constitute 55 percent of the 80 calories in Go-GURT, 67 percent of the 90 calories in Danimals Drinkable, and 68 of the 170 calories in Danimals XL.  Even in Stonyfield’s YoBaby organic yogurts…53% of the 120 calories come from added sugars.  Some of Stonyfield’s yogurts for older kids appear berry-flavored, but they have no fruit at all….

The book was published in 2006.  In this instance, I’m sorry that it’s holding up so well.

I spent a lot of time last week talking to reporters about the widely publicized study in PloS One that correlates sugar and diabetes.

The study is based on an econometric model of data food availability and diabetes prevalence in many countries.  Such data are not particularly reliable, but the authors did the best they could with what they had.  They are quite forthcoming about the limitations of their model and the data on which it is based [see addition below].

Their principal conclusion: for every 150 kcal/person/day increase in sugar availability (about one can of soda/day), diabetes prevalence increases by about 1%.

Because no other dietary, weight, or behavioral factor shows this kind of effect in their model, it is tempting to interpret the study as demonstrating that sugar is a risk factor for diabetes independent of calorie intake or body weight.

I’m not so sure.  Take a look at the summary figures and decide for yourself.

Figure 1.  Relationship between obesity and worldwide prevalence of diabetes.

Despite outliers, this figure shows an obvious and strong correlation between obesity and diabetes.  Compare this to Figure 2.

Figure 2.  Relationship of sugar availability to worldwide diabetes prevalence.

The correlation here is much less obvious.  Without statistical tests, you could just as easily draw the line straight across the graph.  The statistical significance is much weaker than that in Figure 1.

This means that these data cannot easily distinguish between several possibilities:

(a) Calories –> Obesity –> Diabetes

(b) Sugar –> Diabetes

(c) Sugar –> Calories –> Obesity –> Diabetes

While waiting for science to clarify these distinctions, the bottom line is the same for all of them.

As I explained in yesterday’s post, everyone would be healthier eating less sugar.

Addition: The authors have posted detailed comments about their methods.

Here’s another one of those occasional queries from Kerry Trueman.  This one, posted at Huffington, is about FDA regulations for labeling sugars.

Trueman: I’ve just begun to sink my teeth into Michael Moss’s extraordinary food industry exposé, Salt Sugar Fat: How the Food Giants Hooked Us, a book you’ve rightly lauded as a “breathtaking feat of reporting.” As Moss points out, the FDA is happy to give us guidelines on how much salt and fat to include in our daily diets, but–as a glance at any nutritional label shows–they’ve declined to make any recommendation at all about sugar.

Does this mean that:

(a) It’s OK to eat as much sugar as you like, or:

(b) There may be an unsafe level of sugar consumption, but the FDA just doesn’t have the resources to figure out what that level is, or:

(c) The FDA knows how much sugar we can eat without harming our health, but the food industry won’t let them tell us.

How is the average American supposed to interpret this absence of information?

Nestle: Whoa. Slow down. Let’s back up a minute. The FDA sets nutritional standards for food labels, but the Institute of Medicine (IOM) sets nutritional standards for dietary intake. To understand what’s happening with the FDA and food labels, we have to talk about what the IOM used to call the Recommended Dietary Allowances (RDAs) but now calls Dietary Reference Intakes (which, confusingly, include RDAs and other standards, such as Upper Limits).

In 2002, the IOM set standards for total carbohydrates–sugars and starches (which are converted to sugars in the body). In its review of the evidence, the IOM set the RDA for total carbohydrates at 130 grams a day (roughly 4 ounces) to meet the needs of the brain for fuel. This amount is much less than typically consumed by adults.

As for sugars, the IOM noted that the average intake of sugars among adolescent males was 143 grams per day, and that the heaviest users were consuming 208 grams per day–much more than the amount of total carbohydrate needed.

Since sugars are not required nutrients, the IOM could not set an RDA. And although it did not have enough evidence to set an Upper Limit, the IOM suggested that the maximum level of intake of added sugars (as opposed to those naturally present in foods) should be a whopping 25% or less of calories.

Americans typically consume around 20% of calories from added sugars. Taken at face value, the IOM suggestion made it sound as if current intake levels were just fine. The sugar industry happily viewed 25% as a recommendation, not a maximum.

Before the sugar industry got after them, many countries recommended an upper level of sugar intake at 10% of calories. That’s what the U.S. Pyramid did in 1992.

The sugar industry does not like the 10% recommendation. It means, for example, that just one of Mayor Bloomberg’s 16-ounce sodas takes care of recommended sugar intake for the day.

Robert Lustig, who is largely concerned about what too much fructose does to us, thinks that 50 grams of sugar (sucrose or HFCS) is a reasonable Upper Limit for most people. This would provide 25 grams of fructose, which the body can handle with relative ease. What’s interesting about his cut point is that it means 200 calories a day, or 10% of calories for a 2000 calorie diet. So there we are at 10% of calories again.

If the FDA wanted to be helpful, it could do two things.

1. Require companies to list added sugars under the carbohydrate category on food labels.

2. Set a DV for sugars at 50 grams.

In the meantime, everyone would be healthier eating less sugar. 

Center for Science in the Public Interest (CSPI) held a press conference this morning to announce that 10 health departments, 20 health and consumer organizations, and 41 health professionals (including me) have signed a letter in support of its petition asking the FDA to:

Our letter of support begins:

The undersigned scientists and organizations are concerned about Americans’ excess consumption of added sugars…Every edition of the Dietary Guidelines for Americans (going back to 1980) has recommended reducing consumption of added sugars, but Americans are consuming more added sugars (including sucrose, high-fructose corn syrup, corn syrup, and other caloric sweeteners) now than they did in 1980. And that high level of consumption…is contributing to serious health problems.

If the situation with trans fats was any indication, the food industry will reduce the sugars in its products if it has to disclose them.

This is not the first time that CSPI has tried to get added sugars labeled (see petition from 1999).  I’m hoping the letter of support will encourage the FDA to take action this time.

Maybe it will even put sugars on front-of-package labels, as the Institute of Medicine suggested in 2011.

Artificial sweeteners are a terrific example of why correlation does not necessarily mean causation (see previous post).

Their use has increased in parallel—is highly correlated—with rising rates of obesity.  But could artificial sweeteners cause obesity?

Unlikely as that idea may seem, Brazilian researchers thought  it was worth careful investigation.

They did a preliminary study of sweeteners and weight gain in rats.

They report: although total calorie intake was similar in all rats, the rats fed artificial sweeteners gained more weight than those fed sucrose (table sugar).

The investigators fed the rats yogurt containing either sucrose, aspartame, or saccharin along with unlimited amounts of rat chow.

The rats must not have liked the taste of the artificial sweeteners because they ate more of the sucrose-containing yogurt than the kind with artificial sweeteners. They compensated for less yogurt by eating more rat chow.

Although saccharin and aspartame promoted relatively fewer calories from yogurt intake when compared to sucrose, increases in calories from chow intake effectively compensated for decreases in calories from yogurt, in such a way that there was a similar total caloric intake among all groups after the 12-week period of the experiment.

As they put it, “Possible explanations for weight-gain in saccharin and aspartame groups without increasing energy intake are still widely speculative.”  They suggest that artificial sweeteners might induce:

• Reduced energy expenditure.
• Excessive insulin secretion.
• Increased fluid intake and retention.

What are we to make of this?

This is a small, preliminary study using only 10 rats in each of the three groups.

The differences in calorie intake were small and small calorie differences are difficult to measure.

Bottom line: this is an interesting result that needs to be repeated with greater numbers of rats and even more careful calorie measurements.

Reference: Fernanda de Matos Feijó et al.  Saccharin and aspartame, compared with sucrose, induce greater weight gain in adult Wistar rats, at similar total caloric intake levels.  Appetite 2012; 60:203-207. doi: 10.1016/j.appet.2012.10.009

The latest study on the evils of High Fructose Corn Syrup (HFCS) so annoys the Corn Refiners Association that it broke the study’s embargo.

Reporters were not supposed to write about the study until today, but the Corn Refiners issued a press release yesterday: “Caution: New Study Alleging HFCS-Diabetes Link is Flawed and Misleading.”

The New York Times quickly posted its own pre-embargo account.

Why the fuss?  The study reports that countries with the highest levels of HFCS in their food supplies also have a 20% higher prevalence of diabetes in their populations.  This is a correlation between HFCS and diabetes.  It does not mean that HFCS causes diabetes—an important distinction.

But the authors’ press release (sent to me in an e-mail message) makes it sound like causation.  They say (also see Dr. Goran’s comments added to this post below):

HFCS appears to pose a serious public health problem on a global scale,” said principal study author Michael I. Goran…The study adds to a growing body of scientific literature that indicates HFCS consumption may result in negative health consequences distinct from and more deleterious than natural sugar.

This conclusion is based on their observations that the amounts of other sugars in the food supplies of countries with high and low HFCS are about the same.  But HFCS is a form of sugars that adds to total sugar availability.

The authors obtained information about diabetes and obesity prevalence and HFCS and other dietary factors in the food supply from existing sources of data, all of them questionable.   The data do not distinguish between type 1 and type 2 diabetes, for example, and the two different sources of data on diabetes prevalence give different results.

Inconsistencies abound.  For example, Mexico has more diabetes than does the U.S., but rather low HFCS availability (Mexicans prefer sucrose in their sodas).  Some countries with high diabetes rates report no HFCS availability at all.

As with all correlational studies, something else could be going on that causes HFCS, sugars of all types, and diabetes to increase.

That was the point I was trying to make when I spoke to Stephanie Strom of the New York Times:

 “I think it’s a stretch to say the study shows high-fructose corn syrup has anything special to do with diabetes,” Dr. Nestle said. “Diabetes is a function of development. The more cars, more TVs, more cellphones, more sugar, more meat, more fat, more calories, more obesity, the more diabetes you have.”

She noted that the study “falls right in the middle of the Corn Refiners fight with the Sugar Association,” a reference to the legal war being waged between the two industry groups over the marketing of high-fructose corn syrup.

The Corn Refiners press release quotes its president, Audrae Erickson:

This latest article by Dr. Goran is severely flawed, misleading and risks setting off unfounded alarm about a safe and proven food and beverage ingredient.  There is broad scientific consensus that table sugar and high fructose corn syrup are nutritionally and metabolically equivalent…The bottom line is this is a poorly conducted analysis, based on a well-known statistical fallacy, by a known detractor of HFCS whose previous attack on the ingredient was deeply flawed and roundly criticized.

Whew.

Yes, HFCS is sugar(s)—glucose and fructose.  So is table sugar (sucrose).

But the bottom line goes for both: Everyone would be better off eating less sugar(s).

Addition to post: Dr. Goren wrote two e-mails to me in response.  With his permission, they follow.

Hi Marion,

I saw your comments in the NYT article that was published about our global HFCS paper.

You say that: “Diabetes is a function of development. The more cars, more TVs, more cellphones, more sugar, more meat, more fat, more calories, more obesity, the more diabetes you have.”

I wanted to mention that an often overlooked issue is that obesity is not the only factor contributing to type 2 diabetes and even the causal link between obesity and type 2 diabetes is unknown. Other factors include inflammation, oxidative stress, insulin resistance etc. In the study that was done with my colleague at the University of Oxford, the countries with high and low/zero HFCS were matched for obesity levels as well as total calorie and sugar availability. In essence this allowed us to isolate the effects of HFCS as a contributing factor, independent of obesity and the other factors that you mention that are related to obesity. I agree, as stated in the paper, that the ecological type analysis has its limitations, but in the case of HFCS it provided an opportunity to study its effects at the broader macro level. We did this because it is impossible to evaluate individual levels of HFCS consumption because we don’t know specifically how much is added to food/beverages.

The main critique of our study from the corn refiners association is based on their assertion that fructose and glucose are the same when in fact its textbook knowledge that their metabolic fate/pathways are very different. The CRA now says that sucrose and HFCS are “almost identical”. Almost identical acknowledges that they are different in some way which they are. Its a fact that HFCS-55 has at least 10% more fructose than sucrose and our prior study in which we analyzed popular beverages showed this was on average 20% and in some cases as much as 30% higher fructose. The key question in my mind is whether the additional fructose in HFCS is enough (even if its only 10% higher) to tip the balance towards the negative metabolic effects of fructose on health. This is at the heart of the issue and should be the focus of investigation. Our study, with its accepted limitations, adds to the growing body of evidence that the additional fructose coming from HFCS may indeed be enough to tip this balance.

His second message:

Thanks for responding, and yes, I’d be pleased if you added this to your blog –  - I think this will be a good addition. The question of whether the extra 10% fructose matters is indeed critical.

We also by the way did analyze total sugars versus diabetes in a much larger data set of 200 countries but the reviewers asked for that to be taken out which we did because we also thought the focus on HFCS would be unique. We also did see a clear relationship between total sugar and diabetes – some of that relationship was mediated by obesity but there also was an independent association between total sugars and diabetes. So, I agree – - both obesity and total sugars contribute to diabetes – - but I also believe, as shown in our paper, that HFCS has a separate link, and that this is probably due to the higher fructose content in HFCS.

Also, you mentioned in your blog that the different estimates of diabetes gave different results. That’s not really correct. The estimates of diabetes were different from each other, but regardless of which diabetes estimate we used, we still found a consistent association between HFCS and the 2 prevalence estimates of diabetes as well as fasting glucose. So in essence the results were validated using different prevalence estimates of type 2 diabetes.