Search results: added 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.

According to FoodProductionDaily, my newsletter source for information about food and nutrition in Europe, the U.K. Food Standards agency is changing its red-yellow-green labeling system to distinguish added sugars from those naturally present in foods. This is a good idea and I wish the FDA would do the same thing, but one of the reasons given doesn’t make a whole lot of sense. According to this report, the Food Standards Agency agreed to do this because “sugars derived from fruit, such as fructose, are generally lower in calories, while added sugars are perceived as unhealthier.” Added sugars may be perceived as unhealthier, but sugars are sugars and they all–sucrose, fructose, glucose, maltose, lactose, and all the rest–have the same number of calories, roughly 4 per gram. I think there is a better reason: naturally occurring sugars come with everything else that’s in fruits and vegetables, and added sugars don’t.

An investigative report from Public Eye and the International Baby Food Action Network (IBFAN): “How Nestlé gets children hooked on sugar in lower-income countries.”

Nestlé’s leading baby-food brands, promoted in low- and middle-income countries as healthy and key to supporting young children’s development, contain high levels of added sugar. In Switzerland, where Nestlé is headquartered, such products are sold with no added sugar. These are the main findings of a new investigation by Public Eye and the International Baby Food Action Network (IBFAN), which shed light on Nestlé’s hypocrisy and the deceptive marketing strategies deployed by the Swiss food giant.

The report points out that Nestlé (no relation) “currently controls 20 percent of the baby-food market, valued at nearly $70 billion.”

Nestlé promotes Cerelac and Nido as brands whose aim is to help children “live healthier lives”. Fortified with vitamins, minerals and other micronutrients, these products are, according to the multinational, tailored to the needs of babies and young children and help to strengthen their growth, immune system and cognitive development….

Spoiler alert: Our investigation shows that, for Nestlé, not all babies are equal when it comes to added sugar. While in Switzerland, where the company is headquartered, the main infant cereals and formula brands sold by the multinational come without added sugar, most Cerelac and Nido products marketed in lower-income countries do contain added sugar, often at high levels.

For example, in Switzerland, Nestlé promotes its biscuit-flavoured cereals for babies aged from six months with the claim “no added sugar”, while in Senegal and South Africa, Cerelac cereals with the same flavour contain 6 grams of added sugar per serving….

Similarly, in Germany, France and the UK – Nestlé’s main European markets – all formulas for young children aged 12-36 months sold by the company contain no added sugar. And while some infant cereals for young children over one year old contain added sugar, cereals for babies aged six months do not.

Do small amounts of sugar like these make any difference to babies’ health?  After all, 6 gram is just a bit more than a teaspoon.

They might make a big difference:

• They get kids hooked on sugars.
• The sugars can add up quickly.

For sure, this report shows is that sugar is not really necessary.  It is there to encourage sales, not health.

The report is getting international publicity:

• The Guardian: Nestlé adds sugar to infant milk sold in poorer countries, report finds
• DE: https://stories.publiceye.ch/nestle-babyfood
• FR: https://stories.publiceye.ch/nestle-bebes
• SP: https://stories.publiceye.ch/nestle-ninos
• PO: https://stories.publiceye.ch/nestle-criancas

The FDA Announces Qualified Health Claim for Yogurt and Reduced Risk of Type 2 Diabetes.

FDA intends to consider exercising its enforcement discretion for the following qualified health claims:

“Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes. FDA has concluded that there is limited information supporting this claim.”

“Eating yogurt regularly, at least 2 cups (3 servings) per week, may reduce the risk of type 2 diabetes according to limited scientific evidence.”

FDA intends to consider exercising enforcement discretion for the above qualified health claims for when all other factors for enforcement discretion identified in Section IV of this letter are met.

All I can do is laugh.  As I told CNN,

Qualified Health Claims are ridiculous on their face.

Why would any sensible person think that all you have to do to prevent type 2 diabetes is eat 2 cups of yogurt a week?…All we can hope is that the yogurt is at least unsweetened, but since it’s really hard to find unsweetened yogurt [in small cups], this is telling people who want to avoid type 2 diabetes that sweetened yogurts are good for them…According to the FDA’s review of the studies, the amount of sugar in the yogurt made no difference to the results…Therefore, according to the FDA, sugar is a non-issue.”

The reason for my amusement?  Limited evidence.  Translation: if you want to believe this, go ahead, but it’s not on the basis of compelling evidence.

Take a look at the Danone petition.  The company asked for—and got—the qualified claim on the basis of observational evidence along with consumption data indicating that Americans currently do not eat much yogurt.

Given this low consumption, such a QHC is important to encourage food companies to increase yogurt in the food supply and inform consumers of current evidence in order to help them make informed choices.

It’s not that the FDA is ignoring the sugar issue despite its allowing the claim no matter how much sugar the yogurt contains.  In its letter of acceptance of Danone’s petition, the FDA said,

we are concerned that the use of a qualified health claim on yogurts that contain a significant amount of added sugars could contribute empty calories to the diet. The Dietary Guidelines for Americans, 2020-2025 recommend limiting added sugars to less than 10 percent of total calories and note that added sugars account on average for almost 270 calories, or more than 13 percent of total calories per day in the U.S. population.

…Consequently, while there is currently no disqualifying level for added sugars, given that Americans are exceeding recommended limits on added sugars, and some yogurts on the market are high in added sugars, FDA encourages careful consideration of whether to use the claim on products that could contribute significant amounts of added sugars to the diet.

Is this a warning to Danone to avoid using the claim on sugary yogurts?  We shall have to wait and see.

In the meantime, Danone is delighted: Danone North America Announces the FDA’s Decision on Their Petition for the First-Ever Qualified Health Claim for Yogurt, Linking This Dairy Aisle Staple to a Reduced Risk of Type 2 Diabetes

In response to efforts led by Danone North America, the new claim states that “eating yogurt regularly, at least 2 cups (3 servings) per week” may reduce the risk of developing type 2 diabetes, a condition 1.4 million Americans are diagnosed with every year.

Qualified Health Claims are about selling food products, not science.

I like sweet foods as much as anyone (maybe more), but I do try to keep sugar intake within reasonable limits.

For one thing, sugars have no nutritional value beyond calories (which hardly anyone needs more of).  For another, it encourages overeating whatever foods in comes with, many of them ultra-processed.

Thus, I cannot understand why my nutrition colleagues would do anything to imply that eating more sugar is OK.

But, thanks to Ricardo Salvador at the Union of Concerned Scientists who forwarded the study to me, we here have: Risk assessment of nutrients: There must be a threshold for their effects.

Its authors argue that because no firm threshold has been established for harm from excessive sugar intake, guidance to keep sugars “as low as possible in the context of a nutritionally adequate diet” is inappropriate.

The most appropriate interpretation from the vast amount of data is that currently no definitive conclusion can be drawn on the tolerable upper intake level for dietary sugars. Therefore, EFSA’s [European Food Safety Authority’s] own guidance would lead to the conclusion that the available data do not allow the setting of an upper limit for added sugars and hence, that more robust data are required to identify the threshold value for intake of sugars.

Sigh.  Who paid for this?

Funding: “Cosun Nutrition Center (Hilversum, The Netherlands) provided financial support for some of the cost for the preparation of this paper. This support was unrestricted, and Cosun Nutrition Center had no influence on or input to the content of this paper” [yeah, right].

And what, pray tell, is the Cosun Nutrition Center?

The Cosun Nutrition Center conducts research and acquires scientific information on plant-based foods in relation to health and sustainability…The Cosun Nutrition Center is funded by Royal Cosun.

Sounds legit.  But what is Royal Cosum?

Founded 125 years ago, Royal Cosun has developed into a leading international agricultural cooperative with more than 8,100 sugar beet growers.

Sugar beet growers?  Oh.

I won’t bother to list the authors’ conflicts of interest, except to assure you that some include affiliations with sugar companies.

Conflicted?  Absolutely.

Caveat lector.

While producers of sugar cane celebrated National Real Sugar Day on October 14, the New York City Council voted to require chain restaurants to post warning labels on sodas and other menu items that exceed to-be-defined limits on added sugars.

Mayor Eric Adams signed the Sweet Truth Act, which gives the city until 2024 to set standards and design the icon, and gives chain restaurants until 2025 to comply.

Meals at fast food and fast casual restaurants can be exceedingly high in added sugars, amounts that far exceed the FDA’s daily recommendation for consumption of 50 grams per day. Even most “small” fountain sodas sold at leading fast food chains contain more than a day’s worth of added sugars. Added sugars have been linked to weight gain in children and adults. Sugary drinks may also contribute to type 2 diabetes and heart disease.

In a video, New York City Health Commissioner, Dr. Ashwin Vasan, explains why sugar redction is a good idea.

Where is the FDA in all this?  It held a public meeting on the need for sugar reduction.  What it will do as a result remains to be seen, but the New York City action is surely a nudge.

In the meantime, the Government Accountability Office has some things to say about the U.S. Sugar Program.  It sums up the issues concisely.

The Department of Agriculture administers the U.S. sugar program to support domestic sugar production through tools such as limiting the supply of sugar.

The program creates higher sugar prices, which cost consumers more than producers benefit, at an annual cost to the economy of around $1 billion per year.

The program also restricts the amount of sugar entering the U.S. at a low tariff. The tariff restrictions are applied using a method based on 40-year-old data that doesn’t reflect current market conditions. This has led to fewer sugar imports than expected.

We recommended that USDA evaluate its method for restricting imports.

Comment: Here is a situation in which policies for sugar production and import intersect with policies for sugar and health in peculiar ways.  The objective of import policies is to restrict them in order to keep prices higher as a means to protect domestic sugar producers.

Ordinarily, food policies are designed to keep prices low—but not in this case (chalk this up to effective lobbying by cane and beet sugar producers, and the power of lobbyists in sugar-producing states).

Also ordinarily, higher prices would reduce demand, but sugar prices are nowhere near high enough to influence demand, which is one reason why this system continues.

Current policies are estimated to cost the public as much as $3.5 billion a year; divided by 350 million Americans means that the policies cost you an extra $10 per year for the sugar you buy—nowhere near enough to affect consumption.

Disparate goals for sugar are yet another reason why a single food agency overseeing the entire food system would be useful for reconciling these kinds of problems.

My thanks to Paola Baratto for sending this one.

The study: . Intakes of Added Sugars, with a Focus on Beverages and the Associations with Micronutrient Adequacy in US Children, Adolescents, and Teens (NHANES 2003–2018).  Ricciuto L, Fulgoni VL III, Gaine PC, Scott MO, DiFrancesco L.   Nutrients. 2023; 15(15):3285. https://doi.org/10.3390/nu15153285.

Method: This is an analysis of links between added sugars from different kinds of drinks and nutrient adequacy in children using combined data from 8 consecutive NHANES surveys (2003-2018).

Results: I found the results hard to understand because they are presented selectively by age, and they compare nutrient intakes to estimated average requirements.  Here is what I think they mean:

• 2 to 8 year olds: If they got their sugar from flavored milk, they had better calcium intake.
• 9 to 18 year olds: If they got their sugar from soft drinks, coffee, or tea, thei had worse intakes of magnesium and vitamins A and C.  But if they got their sugars from fruit drinks or flavored milk, they had better intake of vitamin C (from the fruit drinks), and of calcium, magnesium, phosphorus, vitamin A, and potassium (from the flavored milk).
• 9 to 18 year olds: Higher intake of added sugars in the overall diet was associated with bettter intake of vitamins and minerals.

Conclusion: The results suggest that the relationship between added sugars intake and micronutrient adequacy depends on the added sugar sources and their nutrient composition.

Funding: The funding for this research was provided by The Sugar Association, Inc. P.C.G. and M.O.S. are employed by The Sugar Association Inc., had input in the study design, and reviewed and edited the manuscript.

Comment: The Sugar Association’s purpose in sponsoring this study is to buttress its argument that sugary drinks and foods have nutrients and, therefore, do not warrant restrictions.  If you get the idea from this study that the more sugary foods you eat, the more nutrients you and your kids get, the Association will be even happier.  Sorry Sugar Association, but it is quite possible to consume adequate intakes of vitamins and minerals without eating sugary foods and doing so will make calories easier to control.  With this study, the Sugar Association got what it paid for.

The latest review of sugars and health has created quite a stir.

• The study:  Dietary sugar consumption and health: umbrella review.  BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-071609 (Published 05 April 2023).
• Method:  The authors evaluated 73 meta-analyses that included 8601 studies, most of them observational (meaning they indicate associations but not necessarily causation).
• Findings: Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected.
• Implications: Low-quality evidence linked each additional serving of a sugar-sweetened beverage per week with a 4% higher risk of gout. Each extra cup per day of a sugar-sweetened drink was associated with a 17% and a 4% higher risk of coronary heart disease and all-cause mortality, respectively.
• Recommendations: (1) Reduce the consumption of free sugars or added sugars to below 25 g/day (this translates to about 6 teaspoons daily). (2) Limit sugar-sweetened beverages to less than 1 a week.

Here’s the headline about the stir:

Experts recommend 6-teapsoon limit to added sugar following BMJ review, industry weighs in:  Recently published research in The BMJ is providing fresh concerns about sugar consumption levels, as some industry stakeholders disagree with the conclusion and CPG brand look to innovate in the low- and no-sugar space…. Read more

And one of the quotes from an industry representative:

…This is a review of existing evidence, and even a well-executed systematic review is only as good as the studies that are inputted. Essentially, garbage in equals garbage out, and it is known that added sugars literature suffers from significant variability when it comes to definitions, intake measurements and control of energy and other diet and lifestyle variables.

Comment: The six-teaspoon recommendation is consistent with World Health Organization guidelines to reduce daily intake of free sugar to less than 10% of their total energy intake, and preferably 5 percent.  The authors admit the evidence is not strong.  But there’s just so much of it, and it’s not going away.

When it comes to sugars, less is better, alas.

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