Search results: added sugar

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.

At last, the American Heart Association (AHA) has done something useful.  It advises eating less sugar.  Americans eat way too much, it says, a whopping 22 teaspoons a day on average.  Let’s work this out.  A teaspoon is 4 grams.  A gram is 4 calories.  So the 275 calories in that default 20-ounce soda you picked up from a vending machine come from nearly 17 teaspoons of sugar – close to the average right there.  If you have trouble maintaining weight, soft drinks are an obvious candidate for “eat less” advice.  Neither the Wall Street Journal (in which I am quoted) nor the New York Times say much about how soft drink manufacturers are reacting to this recommendation, but it isn’t hard to guess.

Here, for example, is what the industry-sponsored American Council on Science and Health (ACSH) has to say:

The study targets added sugars as the main culprit of dietary excess, but since “U.S. labels on packaged foods do not distinguish between naturally occurring or added sugars,” it is difficult to tell the difference. However, “our bodies can’t tell the difference either,” says ACSH’s Jeff Stier. “Natural and added sugars are nutritionally the same. Added sugar causes obesity as much as the orange juice promoted by the American Heart Association causes obesity [e-mail newsletter, August 25, 2009].

This is the first time the AHA has seriously weighed in on sugar.  I find this especially interesting because the AHA has a long history of endorsing sugary cereals (as I discuss in Food Politics and also in What to Eat).  In this example, the AHA’s endorsement is in the lower left corner.  This product has sugars of one kind or another listed 9 times in the ingredient list.

The AHA gets paid for such endorsements.  Let’s hope the new recommendation encourages the AHA to stop doing this.

Update August 27: I really don’t know what to say about the ACSH’s Jeff Stier.  he is acting more like the Center for Consumer Freedom’s Rick Berman every day.   Today’s e-mail newsletter from ACSH contains this statement:

In her blog in The Atlantic, NYU Professor of Nutrition Dr. Marion Nestle has fallen into the habit of suggesting that ACSH is incapable of objective analysis of public health concerns because we are, in her distorted view, “thoroughly industry-sponsored.”

ACSH’s Jeff Stier wrote to her editors: “Like many of the country’s top non-profits, Dr. Nestle’s NYU included, we accept corporate donations, with no strings attached. But we also receive significant support from individuals and foundations. Her misleading description of us suggests that we represent industry. We do not. We are advised by some of the nation’s leading scientists and represent consumers.

“By way of this email, I ask for a conspicuous and fair correction. We are happy to engage on the issues Dr. Nestle writes about, but her attacks on us are below someone of her stature. We’d prefer an informed and enlightening discussion of the issues, not underhanded and unfounded attacks on credibility.”

“Apparently, Dr. Nestle believes that your opinions are irrelevant, since they diverge from her ideological agenda,” says Stier. “We represent you, consumers, who want science rather than ideology informing public health decisionmaking. Does she really think that consumers are so monolithic that they either agree with her or are put up to it by some sinister entity?”

Readers: Does anyone know what is going on with this group?  It sounds so much like the Center for Consumer Freedom that I can’t help but wonder.

You may recall my previous posts about the new Smart Choices program.  This program was developed by food processors to identify products that are ostensibly “better for you”  because they supposedly contain more good nutrients and fewer bad ones.  This program is about marketing processed foods and I wouldn’t ordinarily take it seriously except that several nutrition professional associations are involved in this program and the American Society of Nutrition is managing it.  In effect, this means that nutritionists are endorsing products that bear the Smart Choices logo.

So what products are nutritionists endorsing?  I went grocery shopping last week and bought my first Smart Choice product: Froot Loops!

Froot Loops

Look for the check mark in the upper right of the package.  Frosted Flakes also qualifies for this logo, and do take a look at what else is on the approved list.

A close look a the Nutrition Facts label of Froot Loops shows that it has 12 grams of added sugars in a 110-calorie serving.  That’s 44% of the calories (12 times 4 calories per gram divided by 110).  The usual program maximum for sugar is 25% of calories but it makes an exception for sugary breakfast cereals.  Note that the fiber content is less than one gram per serving, which makes this an especially low-fiber cereal.

OK.  I understand that companies want to market their processed foods, but I cannot understand why nutrition societies thought it would be a good idea to get involved with this marketing scheme.  It isn’t.  The American Society of Nutrition gets paid to manage this program.  It should not be doing this.

But, you may well ask, where is the FDA in regulating what goes on package labels?

Good news: I am happy to report that our new FDA is on the job!  FDA officials have written a letter to the manager of the program.  Although the letter is worded gently, I interpret its language as putting the program on high alert:

FDA and FSIS would be concerned if any FOP [Front of Package] labeling systems used criteria that were not stringent enough to protect consumers against misleading claims; were inconsistent with the Dietary Guidelines for Americans; or had the effect of encouraging consumers to choose highly processed foods and refined grains instead of fruits, vegetables, and whole grains [my emphasis].

Update August 25: I received an interesting e-mail message from a member of the Keystone group that developed the Smart Choices program.  The message confirms that this program is a scheme to make junk foods look healthy.  It says:

Glad to see your posting about Froot Loops! The negotiations over criteria were interesting. Lots of good debate on various points, but when the companies put their foot down, that was it; end of discussion. And sugar in cereals was one such point. Others included the non-necessity for breads, etc. to contain half or more whole grains and the acceptance of fortification to meet the nutrient requirement.

In other words, some people in the group argued that breads needed to contain at least half a serving of whole grains to quality and that added vitamins and minerals should not count toward qualification.  Too bad for them.  I guess the companies put down feet.  But why didn’t they speak up then?  And why aren’t they speaking up now?

Last week, the USDA issued new rules for the nutrient content of school meals and also child care programs.

These apply to sugar and sodium (nutrients), whole grains (ingredient or food),  and milk (food).

The New York Times report on this cut right to the chase

The Agriculture Department announced on Wednesday that it had finalized the regulation it had first proposed in February 2023, having weakened several provisions after feedback from food companies, school nutrition professionals and over 136,000 public comments.

The Update to the standards describes the changes and compares them to USDA’s original proposals.

• Sugars: For the first time (I’m not kidding), the USDA set limits on sugars, starting with breakfast cereals (6 grams per ounce), yogurt (12 grams per 6-ounce serving), and milk (10 grams per 8-ounce serving).  This allows chocolate and other flavored milks if companies get the sugar down to 10 grams.
• Sodium: beginning July 2027, sodium will be reduced by 15% for lunch and 10% for breakfast from current limits (USDA proposed 3 consecutive reductions of 10% over the next five years.
• Whole grains: no change from current standard (USDA proposed that 80% of grains be whole).
• Milk: Allows flavored fat-free and low-fat.

Comment: The sugar rule is an improvement, even though products still are sweetened.  The weakening of the sodium proposal is troubling.  We badly need to reduce sodium in processed and restaurant foods and need federal leadership for doing so.  USDA caved to political pressure here.  The USDA has a long history of captivity by Big Ag.  Now it looks captured by Big Food.

The food industry complaint is that its products won’t meet these standards.  The school food complaint is that the standards are too hard to meet, the kids won’t eat the food, and it will be wasted.

I have a lot of sympathy for school foodservice.  It’s the only thing going on in schools that has to be self-supporting, and school food programs are hugely underfunded.  And lots of schools don’t have kitchens to must rely on food products rather than real food.

But from what I’ve observed, two kinds of skills are needed for successful school meal programs: the ability (1) to prepare and serve edible healthy food, and (2) to get the kids to eat it.  I’ve seen every permutation.

1. Good food, kids eat it
2. Good food, kids won’t eat it
3. So-so food, kids eat it
4. So-so food, kids won’t eat it

Whenever I hear “the kids won’t eat it,” I wonder where the adults are. From what I’ve seen, if adults care that kids are fed, the kids will eat the food—not all, necessarily, but most.

School food is not just about the food.  It’s about the interactions of school food personnel, teachers, and the principal with the kids.  If the adults think it important and necessary to feed kids healthy food, the program has a good chance of success.  The new USDA standards are a step in the right direction but still have a way to go.

Wouldn’t it be nice if we had food standards rather than nutrition standards?  How about mandating numbers of servings of real foods instead of worrying about grams of sugar and milligrams of sodium.

A thought,

Additional Resources

• Comparison Chart: 2023 Proposed Standards vs. 2024 Final Standards
• Implementation Timeline – School Meals
• Implementation Timeline – CACFP & SFSP
• Media Toolkit
  • Infographic: Final Rule for School Meal Standards
  • Infographic: Implementation Timeline
  • Infographic: How We Got Here
  • Video: Rule Overview
  • Video: Added Sugars
• Federal Register notice 

Thanks to everyone who flooded my mailbox with this piece from The Guardian: She was fired after not endorsing Splenda-filled salads to people with diabetes. Why?

According to a lawsuit {Elizabeth] Hanna recently filed against the ADA, the organization – which endorses recipes and food plans on its websiteand on the websites of “partner” food brands – tried to get her to greenlight recipes that she believedflew in the face of the ADA’s mission. These included recipes like a “cucumber and onion salad” made with a third of a cup of Splenda granulated artificial sweetener, “autumnal sheet-pan veggies” with a quarter cup of Splenda monk fruit sweetener and a “cranberry almond spinach salad” with a quarter cup of Splenda monkfruit sweetener.

Guess which company gave more than $1m to the ADA in 2022? Splenda.

I also was sent an email from Georgia Warren, the  Guardian’s Interim membership editor: The link between investigative reporting, some nightmarish recipes and the diabetes epidemic.

Why would a public health charity promote a product that its own science shows contributes to the disease it is fighting? Well, as Neil Barsky reported for us this week, the ADA took more than $1m from Splenda in 2022 – and then fired their chief nutritionist when, according to a lawsuit she recently filed, she refused to sign-off on the Splenda-based recipes that her bosses wanted the ADA to publicly endorse.

Neil – creator of our new series ‘Death by diabetes: America’s preventable epidemic’ – told me…“The ADA has bought into a system that requires them to raise money from corporations to fund their research. I don’t for a second doubt that every single person who works there cares about people with diabetes and wants to do the right thing, but being beholden to these groups distorts your judgment.”

..And what else is pharma funding? The ADA. The organization – whose guidance doctors rely on when treating their diabetes patients – boasts a $100m annual budget. Between 2017 and 2024, pharmaceutical and device manufacturers contributed over $134m to the organization – or roughly 20% of its total funding.

Comment: The ADA has long appeared to be in thrall the the drug industry.  I well remember the talk I gave at one of its annual conventions years ago.  I was one of two speakers about diet and diabetes (the other was a session on the role of sugar in diabetes sponsored by Coca-Cola—truly you can’t make this stuff up).  The other talks, hundreds of them, were about drugs.  At that time, the ADA said virtually nothing about diet on its website.

It’s gotten much better.  Here’s what it says about carbohydrates:

• Try to eat less of these: refined, highly processed carbohydrate foods and those with added sugar. These include sugary drinks like soda, sweet tea and juice, refined grains like white bread, white rice and sugary cereal, and sweets and snack foods like cake, cookies, candy and chips.

And here’s what the ADA says about artificial sweeteners:

It’s also important to know that at this time, there is no clear evidence to suggest that using sugar substitutes will help with managing blood sugar or weight or improving cardiometabolic health in the long run. So here’s the bottom line:

• Sugar substitutes are effective alternatives to sugar for some people, but not a perfect fit for all—it’s a personal choice.
• If you’re looking to reduce your intake of sugar or sugar substitutes, start slowly. For example, start by replacing one soda or juice with water or a no-calorie drink at a time.
• Water will always be a great choice! If you start feeling yourself get bored with just water, you can always spruce it up with fruits or herbs like this sparkling strawberry mint infused water.

And, finally for now, here are the ADA’s corporate sponsors, and its national sponsors.

Conflicted?  Sure looks like it.

I subscribe to Jerry Hagstrom’s Hagstrom Report because he gets to go to things in Washington, D.C. and elsewere that I can’t get to but wish I could.

He reported last week (December 7) on the Food As Medicine Summit, and wrote about it in the National Journal — “Food as medicine’ on the table”.  This notes, among other things, that the minimum fee for attending was $399.

So what is the food-as-medicine movement? Advocates believe changing Americans’ diets away from the fat, sodium, and added sugars that have led to high levels of obesity and instead toward fruits, vegetables, fiber, and lean protein can reduce the need for prescription drugs and hospitalizations. The advocates want Medicare, Medicaid, and private insurers to pay for diet interventions like produce prescriptions.

He also reported on the accompanying Trade Show.

Food as Medicine is still an emerging concept, but there was a small trade show on the sidelines of the Food as Medicine Policy Summit that showed the range of companies that believe the food and health care industries need their products.

I was particularly interested in the trade show because the monetization of Food Is Medicine is a big concern.

Also last week, JAMA published a critique of the concept: “A “Food Is Medicine” Approach to Disease PreventionLimitations and Alternatives,” arguing that “the medical and public health communities’ enthusiasm for food is medicine seems unjustified by its likely benefit.”

The authors argue (my paraphrasing):

• Evidence in support of FIM’s ability to improve health is weak.
• Existing studies do not differential FIM from the effects of standard care.
• FIM requires enrollment in the health care system (overburdened, dysfunctional, difficult to access).
• Patient adherence to interventions is low (unless they are provided intact and paid for).
• Existing federal food and nutrition programs are already known to work; they deserve more support.
• The main beneficiary is the food industry, which gets to shift responsibility to the health care system.
• Food companies will also benefit from sales of FIM products [hence the Summit Trade Show].

Count me as an FIM skeptic.  It’s nice for people who can get it; it is not likely to scale up enough to address chronic disease in any significant way.

Hagstrom lists these resources:▪
▪ USDA National Institute of Food and Agriculture — Gus Schumacher Nutrition Incentive Program
▪ Grey Green Media — Events
▪ Food is Medicine Coalition

FoodNavigator–Asia, a newsletter I subscribe to, publishes articles on reformulation and has now collected them in one place.

Reformulation is what happens when companies change the mix of food product ingredients to make them healthier—or at least to appear healthier-.  This is a highly effective sales strategy.

But reformulation raises philosophical questions:

• Is a slightly better-for-you food product necessarily a good choice?
• Does reformulation convert an unhealthy ultra-processed food product into a healthy one?
• Is a food product with a gram or two less of sugar or salt likely to make any difference to your health?

Never mind.  Here’s what food companies are doing these days, at least in Asia.

Special Edition: Reformulation: Sugar, Salts, Fats and Oils

Governments across the region are continuing to enforce policies to reduce sugar, salts, fats, and certain oils. In this special edition, we’ll showcase the companies providing the most innovative solutions and brands at the forefront of this charge.

• Level up: Singapore’s Gryphon Tea Company reformulates RTD teas to meet better-for-you demand, raises Nutri-grade rating:  Singapore-based Gryphon Tea Company has updated its cold-brewed tea range with “no added sugar” formulations, which the firm says has helped it keep up with the better-for-you trend and reach out to a bigger pool of health-conscious consumers… Read
• ‘Prioritising indulgence’: Cargill-owned Aalst Chocolate investing in consumer-driven innovation to solidify market position:  Cargill-owned Aalst Chocolate is putting “substantial investment” into insights-driven R&D, customised products, and strengthening of its bean-to-bar supply chain to push growth in Asia and beyond… Read
• Hitting the sweet spot: India’s The Brooklyn Creamery winning over Middle East consumers with better-for-you options and novel flavours:  India-based The Brooklyn Creamery is making headway in the Middle East by catering to the buying behaviours and eating habits of consumers in the region, including healthier options and innovative flavours… Read
• Slash the salt: High sodium content in condiments poses public health concern in China:  There is an urgent need for government-backed comprehensive reformulation programmes for high-sodium condiments in China, experts claim… Read
• Thai UPF warning: Products routinely exceed fat, sugar, salt RDIs – new data:  New data from Thailand claims almost all ultra-processed food (UPF) products exceed the recommended daily amount of sodium and lack essential nutrients and minerals… Read
• Innovation challenge: How can firms meet reformulation and fortification demands while remaining cost competitive?  Food firms need to be increasingly savvy when it comes to meeting growing consumer demands for fortified and reformulated products, in order to remain cost competitive in the current economic environment… Read
• Magic marination: World-first liquid shio koji brand hopes to ride ASEAN umami and health trends:  World-first liquid shio koji brand Hanamaruki has big plans to ride on the growing umami and wellness trends in South East Asia, after seeing success in western and East Asian markets… Read
• Bull fighters: How Thailand’s Hippo Energy Drink is taking on the big-name competition:  Thailand-based Hippo Energy Drink believes that its combination of health, natural ingredients and low sugar offerings can help it build on its initial success in South East Asia and take on major brand competitors in the category… Read

Hand Cardullo writes in Forbes: 87% Of Sweetened Products Contain Added Sugars Only, Study Finds.   

That seemed interesting.  But then I got to the sub-headline: New Georgetown University report cites need for more low- and no-calorie sweeteners.

As public health officials clamor to remove added sugars from food and beverage products, a new study published by the Georgetown University Business for Impact Center signals that there is much heavy lifing ahead (full disclosure: I served as an author of the paper). The report noted that added sugars dominate products containing sweeteners, with 87% of items formulated this way. Only 8% of sweetened items contain low- or no-calorie sweeteners (LNCS) only, with 5% consisting of a combination of the two. The paper concluded that increased use of LNCS was necessary to eliminate meaningful amounts of added sugars and that LNCS offered effective and safe ways to do so.

Cardullo says: “Here are some things to consider:

• If public health organizations want to achieve their added sugar reduction goals, they must step up and communicate the efficacy and safety of LNCS in helping consumers manage and lose weight. This will go a long way in helping to clear up consumer confusion.
• The evidence suggests that the public health community must use only the best studies to advance firm points of view on the use of LNCS.
• To help reduce added sugars, food and beverage companies should incorporate LNCS into more of their products.”

Really?  My usual question: Who paid for this?

The paper: Moving Towards Healthier Eating Habits: Why Low- and No-Calorie Sweeteners Play a Critical Role

The funder: “Funding for this paper was provided by the Calorie Control Council” [an international association representing the low- and reduced-calorie food and beverage industry].

Comment: Here is one of the figures from the paper.

This shows that 24% of added sugars come from sugar-sweetened beverages, and another 19% come from desserts and snacks.

Cutting down on both is a good idea on its own, and one that does not require the addition or substitution of artificial sweetneners.