On the basis of all of the details in these published papers, the conclusion, and attendant headlines, might have been: “very poor people with barely anything to eat get sick and die more often than affluent people with access to both ample diets, and hospitals.” One certainly understands why the media did NOT choose that! It is, however, true- and entirely consistent with the data.
Also, by way of reminder: the HIGHEST levels of both total fat, and saturated fat intake observed in the PURE data were still LOWER then prevailing levels in the U.S. and much of Europe, providing no basis whatsoever for headlines encouraging people already exceeding these levels to add yet more meat, butter, and cheese to their diets. Absolutely none.
Currently browsing posts about: Sugars
Is sugar under siege?
The sugar industry must think so.
Take a look at these recent industry reports:
- International Sugar Organization: An Evaluation of the Global Sugar Market Environment
- American Sugar Alliance: Sugar Market Outlook
- Sosland Publishing: Consumer Trends and Industry Response
- Mintel: Trends in sugar, sugar reduction, and sweeteners
- Rabobank: Sweetness and Lite: How Vulnerable is Global Sugar Consumption to Food & Beverage Trends?
- The Sugar Association: The New State of Play for Sugar: Trends, Policy, Consumption and Activism
Here’s what the sugar industry is worried about, according to The Sugar Association:
I love getting notes like this one from a reader:
Why aren’t you saying anything about the PURE study. Doesn’t it prove that everything you’ve been saying about eating more fruits and vegetables and about saturated fat is wrong, wrong, wrong. Admit it.
Not this time. Whenever I hear the claim that “everything you thought about nutrition is wrong,” I know that skepticism is in order. Science rarely works that way; it usually progresses incrementally.
What the PURE study is about: The PURE (Prospective Urban Rural Epidemiology) study was designed to examine, among other things, the effects of lifestyle behaviors on the health of about 135,000 people in 18 countries over up to 10 years. Its results have just been published in Lancet journals.
What the headlines say: “Study challenges conventional wisdom on fats, fruits and vegetables.”
What the studies say: Three papers report results:
Higher fruit, vegetable, and legume consumption was associated with a lower risk of non-cardiovascular, and total mortality. Benefits appear to be maximum for both non-cardiovascular mortality and total mortality at three to four servings per day (equivalent to 375–500 g/day).
High carbohydrate intake was associated with higher risk of total mortality, whereas total fat and individual types of fat were related to lower total mortality. Total fat and types of fat were not associated with cardiovascular disease, myocardial infarction, or cardiovascular disease mortality, whereas saturated fat had an inverse association with stroke. Global dietary guidelines should be reconsidered in light of these findings. [Note: the data do not distinguish types of carbohydrate.]
Our data are at odds with current recommendations to reduce total fat and saturated fats. Reducing saturated fatty acid intake and replacing it with carbohydrate has an adverse effect on blood lipids. Substituting saturated fatty acids with unsaturated fats might improve some risk markers, but might worsen others.
Why the need for skepticism:
I like the way James Hamblin explains the problem in The Atlantic:
The practically important findings were that the healthiest people in the world had diets that are full of fruits, beans, seeds, vegetables, and whole grains, and low in refined carbohydrates and sugar.
As a writer and a reader, though, this is very boring. If I pitched that to my editor, he would laugh at me. What is new here? Why is this interesting? You know what would be novel? You getting fired! Now get out there and find me a story, dammit!
Why did they do this study?
I looked immediately to see who paid for it. The list of funders is very long (it must have been extremely expensive). The list begins:
The PURE Study is an investigator initiated study funded by the Population Health Research Institute, the Canadian Institutes of Health Research (CIHR), Heart and Stroke Foundation of Ontario, support from CIHR’s Strategy for Patient Oriented Research (SPOR) through the Ontario SPOR Support Unit, as well as the Ontario Ministry of Health and LongTerm Care and through unrestricted grants from several pharmaceutical companies, with major contributions from AstraZeneca (Canada), SanofiAventis (France and Canada), Boehringer Ingelheim (Germany and Canada), Servier, and GlaxoSmithkline, and additional contributions from Novartis and King Pharma and from various national or local organisations in participating countries [the funders that follow are mainly government and private research bodies along with a sugar trade association and more drug companies—the list takes up more than half a column].
Drug companies have a big interest in this topic, especially if dietary approaches to heart disease prevention aren’t proven.
What the PURE study really tells us: For this, I am going to quote from David Katz’s lengthy analysis:
My translation: This study confirms that the single most important risk factor for poor health is poverty. The study results are consistent with the idea that largely plant-based diets are good for health. No single study can settle the fat vs. carbohydrate debate because people eat complicated combinations of foods and diets containing those nutrients. What we really need are well designed studies of dietary patterns—the ones done to date suggest that largely plant-based diets are associated with excellent health and longevity.
I cannot understand the revisionist attack on the work of Ancel Keys, who died at the age of 100 in 2004. Most scientists are lucky to have made important contributions in one area. Keys produced outstanding work in several:
- High altitude physiology
- The physiology of starvation (for this alone, he should be honored)
- Mediterranean diet benefits
- Heart disease epidemiology
The fuss, of course, is over this last one, particularly his role in the Seven Countries Study. The arguments falls right into today’s absurd debate about sugar vs. fat as a cause of disease (absurd, because we don’t eat sugar or fat; we eat foods and diets that provide energy measured as calories).
What started off this most recent fuss is Ian Leslie’s The Sugar Conspiracy, which begins with the question “How did the world’s top nutrition scientists get it so wrong for so long?” This alone is a red flag. “Everything you thought you knew about nutrition is wrong” is a sure signal for caution; that’s not how science works.
The attack on Keys’ work induced the True Health Initiative to develop a White Paper in defense (here’s its press release). Its authors: Katherine Pett (who had written a blog post in defense), Joel Kahn (who also wrote a blog post) Walter Willet (long a champion of Mediterranean diets), and David Katz (who wrote about it in his own blog post).
In response, Michael Joyner pointed out that R.A. Stallones (a professor of mine at the School of Public Health at Berkeley) had made the same arguments years ago.
Another defense of Keys’ work comes from Kevin Klatt, a nutrition biochemistry PhD student at Cornell.
Sarah Tracy, a science historian at the University of Oklahoma, has been working on a biography of Ancel Keys for years. I can’t wait for it to come out. We need to have Keys’ life and work put in reasonable perspective.
While waiting for the fat v. sugar debate to resolve (I’m predicting it won’t), eat a healthy diet, enjoy what you eat, and be skeptical when writers write about nutrients, not food.
As a result of yesterday’s post, readers asked questions about sugar. Here’s one:
Q: Is there a difference between cane and beet sugar?
A: It depends.
Both are 99.95% sucrose.
But the plants are different. Sugar cane is grassy; sugar beets are a root vegetable.
The sucrose is extracted and refined by different methods.
And that remaining 0.05%: chefs say it makes a difference in cooking properties.
The San Francisco Chronicle did some comparative baking and then ran blind taste tests.
These showed big differences, with cane sugar a clear winner.
Just for fun, here’s another difference: sugar beets are about 95% GMO; sugar cane is non-GMO.
Also for fun, here’s cane-plus-beet versus high fructose corn syrup:
You know the drill. Everyone would be healthier eating less sugar—no matter whether it comes from cane, beets, or corn.
I am a faithful subscriber to Jerry Hagstrom’s Hagstrom Report on issues having to do with agriculture. He attended the International Sweetener Symposium in San Diego and took notes. If you want to know how the sugar industry is dealing with the “eat less sugar” message, here are some hints (wish I’d been there):
From José Orive, executive director of the London-based International Sugar Organization:
There is “sugar diarrhea” in the media, Orive said, referring to the many articles urging reductions in sweetener consumption. “We need to talk the bull by the horns in pointing out the role of sugar in human nutrition” and talking about the importance of exercise.
From Craig Ruffolo, an analyst with McKeany-Flavell in Oakland, CA:
We need to get back to positivity, not negativity. The sugar industry has a really great message. It starts with 15 calories per teaspoon.
From Courtney Gaine, president and CEO of the Sugar Association:
“We have this obesity crisis that has become a massive economic problem,” Gaine said. The pressures on governments to address the human and economic costs of obesity have combined with “a public health community that does not trust industry” she said.
A lot of the food companies “who should be our friends” are instead reformulating products and advertising they are using less sugar, she said. Coca-Cola is replacing its “Coke Zero” with a label that reads “Coke No Sugar” and is already supplying Delta Air Lines with napkins bearing that slogan.
From Lynn Dornblaser, director of innovation and insight at Mintel, a Chicago market research firm:
“Products making low sugar claims won’t be going away anytime soon”…The “no high-fructose corn syrup” claim “is not losing its power.”
Hagstrom’s summary comes with references:
▪ American Sugar Alliance – “An Evaluation of the Global Sugar Market Environment” by José Orive
▪ “Sugar Market Outlook” by Craig Ruffolo
▪ “The New State of Play for Sugar: Trends, Policy, Consumption and Activism” by Courtney Gaine
▪ “Consumer Trends and Industry Response” by Ron Sterk
▪ “Trends in sugar, sugar reduction, and sweeteners” by Lynn Dornblaser
Healthy Food America is relatively new on the food advocacy scene but I am always impressed by the useful resources it produces.
It is my go-to place for information about soda taxes and other ways to reduce sugars and sugary drinks.
It offers, for example:
- Soda tax maps
- Report with Ninjas for Health on Coca-Cola’s involvement with researchers and reporters
- Toolkit for advocates working to reduce sugars
- Research Watch summaries
- Daily news feed
I can’t believe that I am writing about sugar policy again. The Trump Administration has just gotten a preliminary agreement with Mexico about the sugar it exports to us.
Mexico says OK, (1) it won’t make us pay as much for it, and (2) it will restrict how much refined (white) sugar it sends.
This is great for U.S. sugar processors who turn raw sugar into white. They want Mexico to send raw sugar so U.S. processing plants stay busy.
But food and beverage companies making products will have to pay more for sugar. They belong to the Coalition for Sugar Reform, which is not happy about the agreement.
Under NAFTA, Mexico could sell unlimited amounts of sugar to us. But our domestic sugar producers complained the Mexicans were “dumping” subsidized sugar and undercutting their prices. In retaliation,
- We threatened to impose tariffs.
- Mexico threatened to stop buying our high-fructose corn syrup (it currently buys 80% of our HFCS).
Three years ago, we got Mexico to agree to set minimum prices and limit the amount of sugar it sells to us. The new arrangement confirms that deal, at least for the moment.
As for us public health types, sugar policy is endlessly weird. Domestically, we don’t produce enough sugar to meet demands so we have to import sugar from other countries. We keep domestic prices high through quotas, buy-backs and price-support loans. This ought to discourage consumption, but does not.
How come? Because the higher price, amounting to billions a year overall, works out to only about $10 per year per capita.
This is not high enough to:
- Reduce sugar consumption
- Improve health
- Generate outrage
Want to read more about this?
- The US International Trade Commission did a report in 2011 stating that a liberalized sugar trade policy would increase food sales.
- The American Enterprise Institute says higher sugar prices cost Americans almost $3 billion a year.
- Reuters: Coke, Cargill enter fray as sugar dispute threatens Mexico trade
- Nasdaq: U.S., Mexico closer to sugar trade deal: Mexican economy minister
- Mexican News Daily: US sugar industry accused of lying