Currently browsing posts about: Sugars

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

The FDA also released draft guidance for complying with the rules.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

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

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

A separate draft guidance explains changes in serving sizes that also go into effect.

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

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

The relevant documents

• Draft Guidance for Industry: Questions and Answers on the Nutrition and Supplement Facts Labels Related to the Compliance Date, Added Sugars, and Declaration of Quantitative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• Federal Register Notice for the Draft Guidance on Questions and Answers
• Draft Guidance for Industry: Reference Amounts Customarily Consumed: List of Products for Each Product Category
• Federal Register Notice for the Draft Guidance on Reference Amounts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

Gary Taubes: The Case Against Sugar.  Knopf, 2016.

The title of this book says just what it is: a legal brief arguing that sugar is the cause of just about everything that ails us: obesity, type 2 diabetes, and heart disease, of course, but also cancer, high blood pressure and, therefore, stroke, as well as gout and Alzheimer’s disease.

This book makes a different argument: that sugars like sucrose and high-fructose corn syrup are fundamental causes of diabetes and obesity, using the same simple concept of causality that we employ when we say smoking cigarettes causes lung cancer.  It’s not because we eat too much of these sugars…but because they have unique physiological, metabolic, and endocrinological (i.e. hormonal) effects in the human body that directly trigger these disorders.

Sugar, Taubes says, is the basis of a simple unifying hypothesis—insulin resistance—to explain all of these conditions.  To make this case, he provides vast amounts of evidence: historical, observational, and interventional.

Is he right?  Many of his hypotheses are testable and it is greatly to his credit that he has organized the Nutrition Science Initiative (NuSi) to do just that.

Taubes is an excellent writer, clear and compelling, and he covers an enormous territory here, from slavery to manipulation of research by the sugar industry.

I worry that focusing on one substance—sugar—smacks of “nutritionism,” reducing the complexities of dietary patterns and health risks to just sugar.   I also think questions remain about the dietary context in which we consume sugar, particularly calories but also complex carbohydrates (starch), which gets digested to sugar—glucose.  Should we not be worried about excess glucose on its own?

If I understand the last chapter correctly, Taubes ducks the question of how much sugar is OK to eat.  Or maybe it’s not ducking.  Maybe what he is saying is that the only safe level of sugar is none.

If so, that is well below the 10% of calories recommended as an upper daily limit by the US Dietary Guidelines and the World Health Organization on the basis of those committees’ reviews of the science.

Let’s get those hypotheses tested.

In the meantime, I am all for eating less sugar.

If this book encourages people to cut down on sugar, it’s all to the good.

The Associated Press reporter Candice Choi has a special interest in industry-funded research (as I do) and has been using emails obtained through FOIA requests to document connections between funders and researchers that otherwise would not come to light.

Yesterday, she reported some follow up on the article I was surprised to see published in the Annals of Internal Medicine—the one I wrote about in my last post.

Ms. Choi came up with these delicious tidbits:

• Mars Inc., which is one of the companies that funds ILSI (the International Life Sciences Institute, which funded the study in the Annals charging that dietary guidelines for sugar are based on weak evidence), is now denouncing the study on the grounds that “the paper undermines the work of public health officials and makes all industry-funded research look bad…[and] creates more doubt for consumers rather than helping them make better choices.”
• Mars is saying this even though emails show that two Mars executives knew about the study last year.
• Mars now said it will make clear to ILSI hat it does not support such work.
• ILSI’s executive director says ILSI devised the concept for the study, but the paper originally said that the authors wrote the protocol and conducted the study independently from the funder. Oops.  When confronted with the Associated Press emails “showing the group sent the authors ‘requested revisions’ on the proposal last year,” the journal corrected that statement to make clear that ILSI “reviewed and approved” the protocol.
• One of the authors did not fully disclose her consulting and research agreements with companies that make high-sugar foods.  The AP had emails demonstrating this author’s financial ties to Coca-Cola and to ILSI for a previous grant on the same topic.  The Annals now show a more complete disclosure statement.

The point of all this is that when food companies sponsor research, they sometimes are much more involved in it than they would like to let on.

Mars is right.  These kinds of incidents make all industry-funded research look bad.  Mars should know.  It funds research to make chocolate look like a health food.

I haven’t posted an industry-funded study for a while, but here’s a good one.  This is a systematic review published in the Annals of Internal Medicine attacking dietary advice to eat less sugar on the grounds that such advice is not scientifically justified.

This one doesn’t pass the laugh test.

What are dietary guidelines supposed to do?  Tell people to eat more sugar?

This review is particularly peculiar:

• It was funded by the International Life Sciences Institute (ILSI), a food-industry front group.
• Two of the four authors consult for ILSI, and one of the two is on the scientific advisory board of Tate & Lyle, the British sugar company.
• The authors admit that “given our funding source, our study team has a financial conflict of interest and readers should consider our results carefully.”  No kidding.
• It was published by a prestigious medical journal.  Why?
• It is accompanied by an editorial that thoroughly demolishes every single one of the authors’ arguments.

I can understand why ILSI wanted this review.  Many of its funders make sugary foods and drinks.  They would like to:

• Cast doubt on the vast amounts of research linking excessive sugar intake to poor health.
• Discredit dietary guidelines aimed at reducing sugar consumption.
• Head off regulatory attempts to tax or label added sugars.

In funding this study, ILSI is following the tobacco industry playbook to the letter.  Strategy #1 is to cast doubt on the science.

When the 2015 Dietary Guidelines came out with a recommendation to restrict sugar intake to 10% of calories or less, the Sugar Association called it“agenda-based, not science-based.”  The Annals review says international sugar guidelines do not “meet criteria for trustworthy recommendations and are based on low-quality evidence.”

I detect a theme here.

But I ask again: what are dietary guidelines supposed to do?  We cannot lock up large numbers of people and feed them controlled amounts of sugar for decades and see what happens.  Short of that, we have to do the best we can with observational and intervention studies, none of which can ever meet rigorous standards for proof.  So this review is stating the obvious.

Take a look at the accompanying editorial.  After destroying each of the flawed premises of this review, it concludes:

Industry documents show that the F&B [Food & Beverage] industry has manipulated research on sugars for public relations purposes….Accordingly, high quality journals could refrain from publishing studies on health effects of added sugars funded by entities with commercial interests in the outcome. In summary, our concerns about the funding source and methods of the current review preclude us from accepting its conclusion that recommendations to limit added sugar consumption to less than 10% of calories are not trustworthy. Policymakers, when confronted with claims that sugar guidelines are based on “junk science,” should consider whether “junk food” was the source.

I don’t ever remember seeing a paper accompanied by an invited editorial that trashes it, as this one did, but this incident suggests a useful caution.

Whenever you hear that something isn’t “science-based,” look carefully to see who is paying for it.

The press coverage

• The New York Times: A Food Industry Study Tries to Discredit Advice About Sugar (I’m quoted)
• NPR: How Much Is Too Much? New Study Casts Doubts On Sugar Guidelines (I’m quoted)
• EurekAlert: Dietary sugar guidelines are based on low quality evidence
• WTKR:The debate continues on how much sugar is OK
• Time: Should You Trust the New Research About Sugar?
• CSPI: Industry-funded Study Designed to Cast Doubt on Sugar Advice
• Daily Mail (Reuters): So we CAN eat more sugar? Controversy as top journal publishes Coca Cola-funded study claiming sweets are NOT as bad as feds claim (I’m quoted)

USDA has just released a report on the adoption of these three GM crops in the U.S.  Ordinarily, USDA just tracks corn, soybeans, and cotton.

Here’s a quick summary of trends in alfalfa (green), sugarbeets (red), and canola (blue):

Canola hovers at around 90% of total, sugar beets at 95%, and alfalfa (a perennial) is just getting started at a bit over 10%, but rising.

Why?  According to data summarized by USDA, yields are higher and herbicide use and labor costs are lower.

Aren’t you happy that it’s that sweet, gooey time of year again?

As Julia Belluz of Vox points out

Candy and Halloween didn’t always go hand in hand.  It wasn’t until the 1950s that that candy industry started to push the stuff as a way to boost flagging fall sales.

The candy industry would love you to think:

• We eat so little candy that it makes no difference to our health.
• Kids who eat candy have healthier body weights than kids who don’t.
• Chocolate is a health food.

Kids do love candy, as this marketing report tells us.  I’ll bet these favorites have everything to do with advertising budgets.

Does candy have a place in healthy diets?  Sure, but in very small and occasional amounts.

Good luck getting through tonight’s trick-or-treat.

Happy Halloween, everyone.

PepsiCo, yesterday, announced that it had launched its sustainability report with an agenda for 2025. 

The sustainability promises look good, but reporters called me for comments only on the first goal in its Products agenda:

1. At least two-thirds of Pepsi’s global beverage portfolio volume will have 100 calories or fewer from added sugars per 12-ounce serving.

For the record, the other Product goals are:

2. At least three-quarters of its global foods portfolio volume will not exceed 1.1 grams of saturated fat per 100 calories.

3. At least three-quarters of its global foods portfolio volume will not exceed 1.3 milligrams of sodium per calorie.

The reporters’ questions assumed that Pepsi plans to reduce the sugar in its full-sugar beverages.

Maybe, but that’s not clear from the press release or the report.

Here’s what I want to know:

1. The baseline: What proportion of Pepsi drinks already have fewer than 100 calories per 12 ounces?  Pepsi makes loads of beverages that meet that target—Gatorade, bottled waters, diet sodas.
2. The marketing plan: Will the marketing dollars shift from full-sugar to lower-sugar options?

I ask, because Pepsi’s track record on sugar reduction is not encouraging.  In 2009, Pepsi set a goal to reduce the average amount of added sugars in its drinks by 25% by 2020.

The result?  An increase in average sugars of 4% so far (Pepsi got into trouble with investors who wanted marketing focused on full-sugar beverages).

Pepsi’s sustainability report says the company is working hard to find ways to reduce sugars and “these efforts could yield significant progress.”   Let’s hope they do.

The report also explains how the company plans to reach its lower-sugar goal:

• Reformulating
• Creating new low-and no-calorie drinks
• Making smaller sizes
• Boosting promotion of lower-calorie drinks

I hope the company does these things, despite its unfortunate record on sugar promises.  We need to wait and see whether the company delivers on this one.

But I’m thinking: Surely this announcement must be designed to head off the ongoing soda tax initiatives.  Pepsi is pouring millions of dollars into fighting the taxes directly and through its membership in the American Beverage Association.

Pepsi wants to have things both ways: to appear to promote healthier beverages while it is fighting public health measures to reduce soda intake.

Let’s give the company the benefit of the doubt and hope it delivers on its promises—while doing everything we can to get those taxes passed.

Here’s one of the articles that quotes me:

The last time Pepsi tried to position itself as doing something for health, its investors got very upset,” Marion Nestle, a professor in the Department of Nutrition, Food Studies & Public Health at New York University, said in an email. In 2012, investors got mad at PepsiCo CEO Indra Nooyi for focusing on getting revenue from healthy products, Business Insider reported.

“[PepsiCo] will continue to do everything it can to promote its most profitable products,” Nestle said. “These, alas, tend to be the ones with full sugar.”

I wrote a commentary for a study published this morning in JAMA Internal Medicine: “Food industry funding of nutrition research: The relevance of history for current debates.”

The study, by UCSF investigators Cristin Kearns, Laura Schmidt and Stanton Glantz, is based on their archival research.  They found documentary evidence of shocking manipulation by the sugar industry of a Harvard review of studies on dietary factors and heart disease published in the New England Journal of Medicine in 1967.

Kearns et al. discovered that the sugar industry trade association paid investigators at Harvard an impressive amount of money ($48,000 in today’s dollars) to produce research demonstrating that saturated fat—not sugar—raises the risk of heart disease.

In my commentary, I reproduced a figure from the sugar-funded 1967 reviews.  This summarizes the epidemiology showing that both sugar and saturated fat intake were then indistinguishably associated with increased mortality in 14 countries.

Nevertheless, the reviews exonerated sugars and blamed saturated fat.

Yes, I know that association does not necessarily mean causation, but I’m guessing that the epidemiology still shows that both sugars and saturated fats are associated with increased heart disease risk.

My interpretation: We would all be healthier eating less of sugary foods and fatty meats.

Here are the relevant documents for your reading pleasure:

• The press release from JAMA Internal Medicine
• The press release from UCSF
• The article by Kearns et al.
• Kearns et al.’s online tables analyzing the studies (look for Supplement in their paper)
• The New England Journal of Medicine articles from 1967: Part 1 and Part 2
• My commentary on Kearns et al.’s paper
• NYU’s blog post about my commentary
• JAMA Internal Medicine’s podcast interview with me and Stan Glantz (find it under Related Multimedia on the right side of the page)

The Sugar Association issued a response to today’s article by Kearns et al.:

We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities…Generally speaking, it is not only unfortunate but a disservice that industry-funded research is branded as tainted…We question this author’s continued attempts to reframe historical occurrences to conveniently align with the currently trending anti-sugar narrative, particularly when the last several decades of research have concluded that sugar does not have a unique role in heart disease.  Most concerning is the growing use of headline-baiting articles to trump quality scientific research—we’re disappointed to see a journal of JAMA’s stature being drawn into this trend.

I will post press accounts as they appear (I’m quoted in most of these):

•  Vox 
• New York Times
• STAT (a particularly detailed account)
• CSPI’s comment on Kearns et al.
• Reuters 
• Live Science
• Bloomberg News 
• Healthy Food America comment
• Business Insider
• Associated Press 
• NBC
• Time
• Quartz
• CNN
• Forbes
• United Press International
• Good Food
• Fortune
• Daily Mail
• Helio
• The Guardian
• US News
• CBS News
• Glamour
• Smithsonian
• Huffington Post
• Union of Concerned Scientists