Search results: sugar policy

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)

As part of an interactive case study and point-counterpoint on regulation of sugar-sweetened beverages, the New England Journal of Medicine (NEJM) conducted a poll of its U.S. and international readers.  The poll elicited responses from 1290 readers from 75 countries.

Overall, 68% of respondents favored government regulation.

High as this percentage is, the average is much lower than percentages from most countries as a result of one outlier—the United States.

Only 58% of U.S. voters in the poll favored regulation.  Everywhere else in the world, the percent in favor averaged 84%.

These results reminded me of change-in-sales figures from a few years ago:

Americans have reduced soft drink consumption, causing soda companies to focus their marketing efforts overseas.  Trends like these explain Coca-Cola’s new obesity ad campaign and Pepsi’s $50 million deal with Beyoncé. 

In America these days, 58% is an impressive majority.  NEJM readers are likely to be physicians, scientists, and health and health policy professionals. I suspect we will be hearing more about this idea.  Stay tuned for this one too.

If I weren’t so concerned about USDA’s dropping its data on calories in the food supply (see previous post), I might not have become so alarmed about the New York Times report on the sudden drop in estimates of sugar consumption.

USDA provides data on amounts reported as consumed, from 1970 to 2011.

• Refined Sugar
• Corn Syrup
• Other Sweeteners

These have declined, not necessarily because people are eating less but because USDA changed its methods.

According to the Times account:

In e-mails the center obtained through a Freedom of Information request, officials at sugar industry trade groups discussed the benefits of the lower estimate and how they might persuade the U.S.D.A. to make a change that would reduce it even more.

“We perceive it to be in our interest to see as low a per-capita sweetener consumption estimate as possible,” Jack Roney, director of economics and policy analysis at the American Sugar Alliance, wrote in an e-mail on March 30, 2011.

These figures are for reported intake—always an underestimate.

Reported intake is much lower than amounts of sugars available for consumption—amounts produced, less exports, plus imports—always an overestimate (the truth lies somewhere in between).

Food availability figures also indicate declines, but suggest that Americans have access to about 65 pounds a year each of table sugar and corn syrup for more than 130 pounds per year total.

None of these figures is precise.  But if the methods for calculation are the same every year, trends should be discernible.

Adjusting for waste introduces new sources of error and makes trends impossible to determine.

The USDA used to re-correct the entire food availability series when making changes in methods.  Why aren’t its data collectors doing that now?

We neeed USDA to be keeping up with food availability data.  What to do?

 The New England Journal of Medicine has just published a series of articles on sugar-sweetened beverages to  coincide with presentations at The Obesity Society’s annual meeting.  Here are links to the articles.  I’ve extracted brief quotes from some of them.  And here’s a summary in the New York Times.

Perspective: J.L. Pomeranz and K.D. Brownell, Portion Sizes and Beyond — Government’s Legal Authority to Regulate Food-Industry Practices.

Regulations that affect “ordinary commercial transactions” (such as the sale of a product) are presumed to be constitutional if they have a rational basis and if the government body enacting them has the appropriate knowledge and experience to do so.

In the case of New York City’s portion-size restrictions, for example, the health department is an expert public health body that reviewed relevant scientific evidence on the health hazards associated with consumption of sugar-sweetened beverages and the effect of portion sizes on consumption patterns. The proposed policy thus has a rational basis….

Original Article: Q. Qi and Others, Sugar-Sweetened Beverages and Genetic Risk of Obesity

The study concludes: “the genetic association with adiposity appeared to be more pronounced with greater intake of sugar-sweetened beverages.”

Original Article: J.C. de Ruyter and Others,  A Trial of Sugar-free or Sugar-Sweetened Beverages and Body Weight in Children

We conducted an 18-month trial involving 641 primarily normal-weight children from 4 years 10 months to 11 years 11 months of age. Participants were randomly assigned to receive 250 ml (8 oz) per day of a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage that provided 104 kcal (sugar group). Beverages were distributed through schools….Masked replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in normal-weight children.

Original Article: C.B. Ebbeling and Others, A Randomized Trial of Sugar-Sweetened Beverages and Adolescent Body Weight

We randomly assigned 224 overweight and obese adolescents who regularly consumed sugar-sweetened beverages to experimental and control groups. The experimental group received a 1-year intervention designed to decrease consumption of sugar-sweetened beverages, with follow-up for an additional year without intervention….Among overweight and obese adolescents, the increase in BMI was smaller in the experimental group than in the control group after a 1-year intervention designed to reduce consumption of sugar-sweetened beverages, but not at the 2-year follow-up

Editorial: S. Caprio, Calories from Soft Drinks — Do They Matter?

These randomized, controlled studies — in particular, the study by de Ruyter et al. — provide a strong impetus to develop recommendations and policy decisions to limit consumption of sugar-sweetened beverages, especially those served at low cost and in excessive portions, to attempt to reverse the increase in childhood obesity.

Clinical Decisions: T. Farley, D.R. Just, and B. Wansink, Regulation of Sugar-Sweetened Beverages

This one is a point/counterpoint.  On the basis of the evidence just presented, should government regulate sugary drinks?

New York City Health Commissioner Tom Farley says yes:

If a harmful chemical in schools were causing our children to get sick, people would demand government regulation to protect them. It is therefore difficult to argue against a government response to an epidemic of obesity that kills more than 100,000 persons a year in the United States and has an environmental origin.7

Federal, state, and local governments already regulate the food system, from farm to retail, in many ways and for many purposes, ranging from support of agriculture to prevention of foodborne illness. The question is not whether we should regulate food, but rather whether we should update food regulations to address this new epidemic.

David Just and Brian Wansink say no:

We must also recognize that the universe of foods that contribute to childhood obesity is much larger than sugar-sweetened beverages. Such a narrowly defined approach would have minimal chance for overall success. Rather, we must consider approaches that will involve parents, schools, and pediatricians in leading children toward more healthful eating habits and increased physical activity. In truth, we cannot hope to create regulations that restrict behavior holistically.

I’d say we now have plenty of evidence that habitual use of soft drinks raises risks for obesity, and plenty of evidence for the need for regulation.

Yes, it would be nice if “leading children to eat better” worked, but parents, teachers, and everyone else needs lots of help in coping with today’s food environment.

The New England Journal has done a great public service in publishing these papers as a series, and the authors all deserve much praise for taking on these difficult research projects.

OK city agencies: get to work!

Cheers to the FDA.  It just said a firm no to the Corn Refiners’ petition to be allowed to call High Fructose Corn Syrup (HFCS) “corn sugar.”

The FDA’ s rationale:

• Sugar is solid, dried, and crystallized.  Syrup is liquid.  HFCS is liquid.  Therefore, it is syrup, not sugar.
• Corn sugar already has a regulatory definition: dextrose (glucose).  HFCS contains fructose as well as glucose.  Therefore, it is not corn sugar.

As I mentioned earlier, I filed comments to the FDA on the Corn Refiners’ petition:

The [Corn Refiners’] website quotes comments I have made to the effect that HFCS is biochemically equivalent to sucrose. It is. But I do not believe that biochemical equivalence is a good reason for the FDA to agree to a name change at this point.

It is highly unlikely that public misunderstanding of nutritional biochemistry and the differential physiological effects of glucose vs. fructose will be addressed and corrected by changing the name of HFCS to corn sugar.

…the name change is not in the public interest. Its only purpose is to further the commercial interests of members of the Corn Refiners, and that is not one the FDA should be concerned about.

I was referring here to the legal and public relations wrangling between the Sugar Association, which represents the growers of cane and beet sugar (sucrose), and the Corn Refiners.

I have complained previously about the in-your-face behavior of the Corn Refiners in attempting to protect its share of the sweetener market: its strange advertisements; its use of my quotes (they told me the quotes are in the public domain and if I don’t like it I can sue them); its aggressive lobbying; its stated intention to use the term “corn sugar” whether the FDA approves it or not.

The Sugar Association’s behavior is not much better.  It has taken the Corn Refiners to court over the naming issue.

I was amused to receive two e-mails this week from its public relations firm complaining about the Corn Refiners’ clumsy PR response to a UCLA  study ostensibly showing that HFCS makes rats “fat and stupid.”  This study, however, did not compare the effects of sucrose and HFCS and its results, even if confirmed, could apply to any source of fructose.

The second e-mail sent links to the FDA’s decision and the Sugar Association’s response.

The FDA’s ruling represents a victory for American consumers,” said Dan Callister, an attorney for the plaintiffs in the ongoing litigation. “It reaffirms what most consumer advocates, health experts and policy officials have been saying all along: only sugar is sugar. HFCS is not sugar. The next step is for the federal court to end the CRA’s misleading propaganda campaign.

Sugars, plural, are sugars.  Sucrose is glucose and fructose.  So is HFCS.

Everyone would be better off eating a lot less of both.

And that brings me to New York City Mayor Michael Bloomberg’s latest attempt to promote the health of his constituents: banning any sugary drink larger than 16 ounces from restaurants, movie theaters, and street carts.

I can’t wait to see how the Beverage Association deals with this one.

Addition June 1: Rosie Mestel of the L.A. Times has an excellent account of this in which she quotes from these comments.  Her story is accompanied by a PR photo from the Corn Refiners Association.  What are these people thinking?

Two articles I’ve written are in journals this week: a short one in Newsweek (!) and my monthly Food Matters column in the San Francisco Chronicle.

New York’s Calorie Counts: A Good National Model (Newsweek, April 30 online and May 10 in print)

The new health-care law contains an overlooked boost for nutritionists like me: by next year, all national chains with more than 20 locations must offer “clear and conspicuous” calorie information. It’s the most important obesity-related public policy since the USDA’s food pyramid. But reception to the new mandate has been muted so far, largely because the benefits of New York City’s similar 2008 law seem minor: one study found just 15 fewer calories were consumed per meal; another reported it was 30; and a third found that people ate more.

The problem with these studies is that they focus on Starbucks customers and fast-food goers in low-income neighborhoods—patrons who often care about convenience and value above all. They also fail to capture the long-term benefits of calorie counting, namely education and social pressure. Labels will offer case-by-case lessons in exactly what 1,000 calories looks like, and they may even spur restaurants to ease up on sugar and fat. (Denny’s, McDonald’s, and Cosi, among others, have debuted lighter fare in New York City.) Of course, much depends on the definition of “clear and conspicuous.” Still, the country’s nutritional literacy is about to improve—making my job a lot easier.

Sugary school meals hit lobbyists’ sweet spot (San Francisco Chronicle, Sunday, May 2)

Nutrition and public policy expert Marion Nestle answers readers’ questions in this monthly column written exclusively for The Chronicle. E-mail your questions to food@sfchronicle.com, with “Marion Nestle” in the subject line.

Q: I’m stunned by the amount of sugar my daughter is served routinely in school: candied cereals, flavored milk, Pop Tarts, breakfast cookies, fruit juice – 15 teaspoons of sugar, just in breakfast. Why no standards for regulating sugar in school meals, especially when obesity and diabetes are such concerns?

A: Politics, of course. The U.S. Department of Agriculture spends $12 billion a year on school meals. Kids buy foods from snack carts and vending machines. Food companies fight fiercely to protect their shares in that bounty.

If you watched “Jamie Oliver’s Food Revolution,” you witnessed the struggle to get sugary foods out of schools. Fifteen teaspoons – 60 grams and 240 calories – is a lot for breakfast, but kids get even more sugar from snacks, treats from teachers and birthday cupcakes.

Sugars were never a problem when we supported school lunch programs decently. That changed when schools ran out of money, sought vending contracts with soft drink companies and encouraged kids to buy sodas and snacks. Schools evaded restrictions on snack sales during lunch periods. Nobody paid much attention to what kids ate in schools – until kids began getting fatter.

Why no standards? Nobody wants to take on the sugar lobbyists.

In 1977, a Senate committee recommended an upper limit of 10 percent of calories from added sugars. This was so controversial that from 1980 to 2000, the Dietary Guidelines gave no percentages when they said “eat less sugar.” The 1992 food pyramid said “Use sugars only in moderation.” It defined moderation in teaspoons – for example, 12 a day in a diet of 2,200 calories, which comes to less than 10 percent of calories. By then, health officials in at least 30 countries had adopted the 10 percent sugar guideline.

A committee of the Institute of Medicine undermined that consensus. Because science provides only circumstantial evidence for the effects of sugars on obesity and other health problems, the committee suggested a safe maximum of 25 percent of calories. Sugar trade associations happily interpreted this percentage as a recommendation.

In 2003, the World Health Organization issued a research report restating the 10 percent guideline. Using the IOM report as evidence, sugar trade associations enlisted senators from sugar-growing states to lobby U.S. government officials to withdraw funding from WHO. They also lobbied governments of sugar-growing countries to oppose the 10 percent guideline. WHO dropped the 10 percent sugar guideline.

Dietary guidelines are the basis of federal nutrition policy. The 2005 guidelines advised limits on sugars without stating a percentage. In a footnote, the guidelines said that sugars could be part of a day’s “discretionary calories,” defined as 2 to 8 teaspoons a day. This is less than 10 percent of calories, but the guidelines do not say so explicitly.

Neither does the USDA’s 2005 pyramid, which personalizes diet plans based on age, activity level and gender. I, for example, am allowed 195 discretionary calories for added fats and sugars. If I use them all for sugars, I get to eat 12 teaspoons – about 10 percent of my daily calories. This is less than the amount your daughter ate for breakfast or the sugars in a 20-ounce soda. Hence: lobbying.

Will we get an explicit sugar policy when Congress gets around to reauthorizing the Child Nutrition Act? The draft bill says nothing about sugars but does require school foods to adhere to “science-based” nutrition standards based on the dietary guidelines. If so, this means a maximum of 10 percent of calories from added sugars.

The IOM has just released a “School Meals” report. This says that with careful planning, 10 percent should provide enough sugar discretionary calories to permit sweetened low-fat milk, yogurt and breakfast cereals. The IOM warns that without these sweetened foods, student participation rates and nutrient intakes might decline.

Sorry, but I don’t buy the “kids won’t eat it” argument. I’ve seen plenty of schools where kids eat unsweetened foods. Somehow, they survive. Kids will eat healthier foods when meals are prepared by adults who care what kids eat, as Oliver has demonstrated.

As for legislation, California led the way with the 2007 school food nutrition standards bill, which regulated soda sales and the amount of sugar in snacks. Companies responded by reducing the sugars in their products. Passing the Child Nutrition Act will help, but its big drawback is funding. The draft bill increases school reimbursements by only about 6 cents per meal, not enough to meet costs in many school districts and much less than the $1 increase that many believe necessary.

But with luck, 2010 will bring us national legislation and improved editions of the dietary guidelines and pyramid. Let’s hope these make it easier for schools to help kids cut down on sugars.

Note: Nestle and Malden Nesheim will speak about their new book, “Feed Your Pet Right,” at 3 p.m. May 22 at Omnivore Books in San Francisco and at 3 p.m. May 23 at Point Reyes Books in Point Reyes Station.  Addition: Holistic Hound, Berkeley, Tuesday, May 18, 6:30 p.m.

Marion Nestle is the author of “Food Politics,” “Safe Food” and “What to Eat,” and is a professor in the nutrition, food studies and public health department at New York University. E-mail her at food@sfchronicle.com and read her previous columns at sfgate.com/food.  This article appeared on page K – 8.

I got a comment this morning from Eric who asks whether I had seen the article in yesterday’s New York Times about Florida’s bailout of Big Sugar in the Everglades.  I could hardly miss it.  The story starts on the front page and continues over two full inside pages.

Titled “Deal to save Everglades may help sugar firm,” the article explains how Florida politicians engineered a taxpayer-supported buyout of United States Sugar for nearly $2 billion in 2008, ostensibly to restore a waterway through the Everglades.  Now, it seems, the restoration projects have stopped for lack of money and U.S. Sugar gets to keep using the land.

U.S. Sugar is or was the largest sugar producer in Florida.  Founded by Charles Stewart Mott in 1931, it owned mills and a railroad as well as land.

Sugar policy, as I explained in a post last September, is special.  Alone among commodities, it is supported by an arcane system of quotas and tariffs designed to ensure that domestic sugar producers get prices for their crops that are higher than values on the world market.  The result?  Taxpayers pay more for sugar than they should.

I suppose I could argue that higher prices for sugar are a good thing.  High prices discourage consumption.   Fortunately or unfortunately (depending on how you look at it), sugar prices are not high enough to do that.

So chalk this one up to politics in action, replete with lobbyists, lawyers, and corporate heads with cozy ties to government officials.   As is all too often the case, the corporation came out ahead.  Whether the Everglades will ever benefit remains to be seen.

First, the “Nutrifluff,” my term for research with results that are intriguing but of unknown clinical significance.  I thank everyone who sent me links to the New York Times account of the new study linking chocolate milk to reduced inflammation.  It quotes the lead author:  “Since atherosclerosis is a low-grade inflammatory disease of the arteries, regular cocoa intake seems to prevent or reduce [it].”   But the giveaway is the next magic words that cover all bases: “more studies needed.”

The study suggests – but in no way proves – that drinking chocolate milk reduces the risk of coronary artery disease.  Inflammation is an intermediate marker of suggestive but unconfirmed clinical implications.  More research is needed, indeed.

Next, policy.  Recall the fuss over chocolate milk (see previous post on the topic)?   Marlene Schwartz of the Rudd Center at Yale has posted an explanation of her views on the matter.

The “chocolate milk controversy” story this week is not about nutrition; it’s about marketing…They explain that “more than half of all flavored milk is sold in schools,” and “the importance of flavored milk goes beyond the school market because it is a key growth area for milk processors.”

They are trying to sell their product. There is nothing wrong with that as long as their marketing efforts are not misleading. Chocolate milk is not the nutritional equivalent of regular milk. It is significantly higher in calories, sugar (often high fructose corn syrup), sodium, and usually contains artificial colors and flavors.

In the promotional video on YouTube, expert dieticians acknowledged that chocolate milk has about 60 more calories per serving than regular milk, but then quickly added that “in the grand scheme of things, that’s nothing compared to the amount of nutrients they are going to be getting.”

That sounded really familiar.

“In the grand scheme of things, these calories don’t count” is exactly what we heard from David Mackay, the CEO of Kellogg in his defense of marketing his company’s high-sugar cereals: “Twelve grams of sugar is 50 calories. A presweetened cereal as part of a regular diet for kids is not a bad thing.”

50 calories here, 60 calories there, and pretty soon we are talking about real weight gain.

Our research has found that children will eat low-sugar cereals and drink white milk when these are the foods that are served. We also found that most children will also eat a piece of fruit if you prompt them to take it. School cafeterias are the perfect place to reinforce the nutrition lessons that begin at home and promote nutrient-dense foods.

If chocolate milk were the only treat children were exposed to in schools, it would not be nearly as much of a problem.  But it is not.  In many schools, kids are offered sweet treats all day long (birthday celebrations, rewards from teachers, etc) or exposed to those readily available from vending machines.  So sweet foods have become the norm.  Norms are hard to change, but let’s at least not make them worse.