Currently browsing posts about: Sugars

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.

Artificial sweeteners are a terrific example of why correlation does not necessarily mean causation (see previous post).

Their use has increased in parallel—is highly correlated—with rising rates of obesity.  But could artificial sweeteners cause obesity?

Unlikely as that idea may seem, Brazilian researchers thought  it was worth careful investigation.

They did a preliminary study of sweeteners and weight gain in rats.

They report: although total calorie intake was similar in all rats, the rats fed artificial sweeteners gained more weight than those fed sucrose (table sugar).

The investigators fed the rats yogurt containing either sucrose, aspartame, or saccharin along with unlimited amounts of rat chow.

The rats must not have liked the taste of the artificial sweeteners because they ate more of the sucrose-containing yogurt than the kind with artificial sweeteners. They compensated for less yogurt by eating more rat chow.

Although saccharin and aspartame promoted relatively fewer calories from yogurt intake when compared to sucrose, increases in calories from chow intake effectively compensated for decreases in calories from yogurt, in such a way that there was a similar total caloric intake among all groups after the 12-week period of the experiment.

As they put it, “Possible explanations for weight-gain in saccharin and aspartame groups without increasing energy intake are still widely speculative.”  They suggest that artificial sweeteners might induce:

• Reduced energy expenditure.
• Excessive insulin secretion.
• Increased fluid intake and retention.

What are we to make of this?

This is a small, preliminary study using only 10 rats in each of the three groups.

The differences in calorie intake were small and small calorie differences are difficult to measure.

Bottom line: this is an interesting result that needs to be repeated with greater numbers of rats and even more careful calorie measurements.

Reference: Fernanda de Matos Feijó et al.  Saccharin and aspartame, compared with sucrose, induce greater weight gain in adult Wistar rats, at similar total caloric intake levels.  Appetite 2012; 60:203-207. doi: 10.1016/j.appet.2012.10.009

The latest study on the evils of High Fructose Corn Syrup (HFCS) so annoys the Corn Refiners Association that it broke the study’s embargo.

Reporters were not supposed to write about the study until today, but the Corn Refiners issued a press release yesterday: “Caution: New Study Alleging HFCS-Diabetes Link is Flawed and Misleading.”

The New York Times quickly posted its own pre-embargo account.

Why the fuss?  The study reports that countries with the highest levels of HFCS in their food supplies also have a 20% higher prevalence of diabetes in their populations.  This is a correlation between HFCS and diabetes.  It does not mean that HFCS causes diabetes—an important distinction.

But the authors’ press release (sent to me in an e-mail message) makes it sound like causation.  They say (also see Dr. Goran’s comments added to this post below):

HFCS appears to pose a serious public health problem on a global scale,” said principal study author Michael I. Goran…The study adds to a growing body of scientific literature that indicates HFCS consumption may result in negative health consequences distinct from and more deleterious than natural sugar.

This conclusion is based on their observations that the amounts of other sugars in the food supplies of countries with high and low HFCS are about the same.  But HFCS is a form of sugars that adds to total sugar availability.

The authors obtained information about diabetes and obesity prevalence and HFCS and other dietary factors in the food supply from existing sources of data, all of them questionable.   The data do not distinguish between type 1 and type 2 diabetes, for example, and the two different sources of data on diabetes prevalence give different results.

Inconsistencies abound.  For example, Mexico has more diabetes than does the U.S., but rather low HFCS availability (Mexicans prefer sucrose in their sodas).  Some countries with high diabetes rates report no HFCS availability at all.

As with all correlational studies, something else could be going on that causes HFCS, sugars of all types, and diabetes to increase.

That was the point I was trying to make when I spoke to Stephanie Strom of the New York Times:

 “I think it’s a stretch to say the study shows high-fructose corn syrup has anything special to do with diabetes,” Dr. Nestle said. “Diabetes is a function of development. The more cars, more TVs, more cellphones, more sugar, more meat, more fat, more calories, more obesity, the more diabetes you have.”

She noted that the study “falls right in the middle of the Corn Refiners fight with the Sugar Association,” a reference to the legal war being waged between the two industry groups over the marketing of high-fructose corn syrup.

The Corn Refiners press release quotes its president, Audrae Erickson:

This latest article by Dr. Goran is severely flawed, misleading and risks setting off unfounded alarm about a safe and proven food and beverage ingredient.  There is broad scientific consensus that table sugar and high fructose corn syrup are nutritionally and metabolically equivalent…The bottom line is this is a poorly conducted analysis, based on a well-known statistical fallacy, by a known detractor of HFCS whose previous attack on the ingredient was deeply flawed and roundly criticized.

Whew.

Yes, HFCS is sugar(s)—glucose and fructose.  So is table sugar (sucrose).

But the bottom line goes for both: Everyone would be better off eating less sugar(s).

Addition to post: Dr. Goren wrote two e-mails to me in response.  With his permission, they follow.

Hi Marion,

I saw your comments in the NYT article that was published about our global HFCS paper.

You say that: “Diabetes is a function of development. The more cars, more TVs, more cellphones, more sugar, more meat, more fat, more calories, more obesity, the more diabetes you have.”

I wanted to mention that an often overlooked issue is that obesity is not the only factor contributing to type 2 diabetes and even the causal link between obesity and type 2 diabetes is unknown. Other factors include inflammation, oxidative stress, insulin resistance etc. In the study that was done with my colleague at the University of Oxford, the countries with high and low/zero HFCS were matched for obesity levels as well as total calorie and sugar availability. In essence this allowed us to isolate the effects of HFCS as a contributing factor, independent of obesity and the other factors that you mention that are related to obesity. I agree, as stated in the paper, that the ecological type analysis has its limitations, but in the case of HFCS it provided an opportunity to study its effects at the broader macro level. We did this because it is impossible to evaluate individual levels of HFCS consumption because we don’t know specifically how much is added to food/beverages.

The main critique of our study from the corn refiners association is based on their assertion that fructose and glucose are the same when in fact its textbook knowledge that their metabolic fate/pathways are very different. The CRA now says that sucrose and HFCS are “almost identical”. Almost identical acknowledges that they are different in some way which they are. Its a fact that HFCS-55 has at least 10% more fructose than sucrose and our prior study in which we analyzed popular beverages showed this was on average 20% and in some cases as much as 30% higher fructose. The key question in my mind is whether the additional fructose in HFCS is enough (even if its only 10% higher) to tip the balance towards the negative metabolic effects of fructose on health. This is at the heart of the issue and should be the focus of investigation. Our study, with its accepted limitations, adds to the growing body of evidence that the additional fructose coming from HFCS may indeed be enough to tip this balance.

His second message:

Thanks for responding, and yes, I’d be pleased if you added this to your blog –  – I think this will be a good addition. The question of whether the extra 10% fructose matters is indeed critical.

We also by the way did analyze total sugars versus diabetes in a much larger data set of 200 countries but the reviewers asked for that to be taken out which we did because we also thought the focus on HFCS would be unique. We also did see a clear relationship between total sugar and diabetes – some of that relationship was mediated by obesity but there also was an independent association between total sugars and diabetes. So, I agree – – both obesity and total sugars contribute to diabetes – – but I also believe, as shown in our paper, that HFCS has a separate link, and that this is probably due to the higher fructose content in HFCS.

Also, you mentioned in your blog that the different estimates of diabetes gave different results. That’s not really correct. The estimates of diabetes were different from each other, but regardless of which diabetes estimate we used, we still found a consistent association between HFCS and the 2 prevalence estimates of diabetes as well as fasting glucose. So in essence the results were validated using different prevalence estimates of type 2 diabetes.

Not to worry.  This is just a proposal.

A French Senator wants the country to impose a 300% increase in the tax on palm oil imports, thereby raising the price of products containing it—like Nutella, the chocolate-hazelnut spread beloved by European children (and adults).

Of course they love it.  The first ingredient is sugar.

But the second ingredient is palm oil, high in saturated fats.  Palm oil production, again alas, is strongly linked to deforestation and other environmental problems in Malasia and Indonesia.

The proposed tax distresses Malasian palm oil producers:

The action…to propose onerous new burdens on palm oil producers, is irresponsible, badly-informed and ignores the primary source of saturated fats in the French diet [referring to trans fats].

The proposed tax also distresses the makers of Nutella, as well it should.  Most Nutella eaters probably think they are eating hazelnuts and chocolate.  It must come as an unpleasant surprise to learn that the first two ingredients are sugar and palm oil.

At a meeting in Boston this week, Joe O’Toole, the president of Lucullus, a French specialty food company, brought me the November 16 edition of Le Figaro.  He knew I’d want to see the two-page ad defending Nutella’s use of palm oil.

My rather loose translation:

Nutella, you are delicious but why do you have palm oil?

Let’s talk about palm oil.

For 50 years, the French have trusted us to be an important brand.  This is an important responsibility.  This is why we have always made responsible choices in our selection of ingredients.

Today, Nutella finds itself in an unjust position at the heart of a debate about palm oil….Palm oil gives smoothness (“l’onctuosité”) and stability to the recipe.

…Contrary to certain ideas and opportunistic communications…palm oil is not dangerous to health. Nutritionists say…Nutella contains less saturated fat than most snacks or breakfasts.

At the bottom of both pages, the ad says: “For your health, eat at least five fruits and vegetables per day.”

Oh.  OK. [It turns out that the French government requires this statement on all food ads.]

Nutella’s website has a Q and A.  For example:

How can Nutella® help moms at breakfast time?

It can be difficult to persuade children to eat breakfast. When used in moderation with complementary foods, Nutella® is a quick and easy tool to encourage kids to eat whole grains, such as whole wheat toast, English muffins, toaster waffles and bagels.

The chocolate milk argument!  It sounds better in French, no doubt.

Update, November 23: Thanks to Lucie for finding this annotated, alternative version of the ad.

One of the great ironies of food politics these days is this: while journalists and scientists are increasingly documenting the health consequences of diets way too high in added sugars, the producers of two forms of those sugars—sucrose and high fructose corn syrup (HFCS)—are doing everything they can to decrease their rivals’ market shares.

Once the election is over, I will write about the ugly legal battles between the producers of sugar cane and beets (sucrose) and the corn refiners who produce HFCS.  But in the meantime, don’t miss the current issue of Mother Jones.

It has just published an investigative report by journalist Gary Taubes and dental health administrator Cristen Kearns Couzens:  Big Sugar’s Sweet Little Lies: How the industry kept scientists from asking: Does sugar kill?

Their report is a detailed account of how the sugar industry manipulated scientists and government officials into overlooking the health problems caused by overconsumption of sugars and instead focusing on overconsumption of dietary fat (both removed from their caloric context, alas).

Their winning campaign, crafted with the help of the prestigious public relations firm Carl Byoir & Associates, had been prompted by a poll showing that consumers had come to see sugar as fattening, and that most doctors suspected it might exacerbate, if not cause, heart disease and diabetes.

With an initial annual budget of nearly $800,000 ($3.4 million today) collected from the makers of Dixie Crystals, Domino, C&H, Great Western, and other sugar brands, the association recruited a stable of medical and nutritional professionals to allay the public’s fears, brought snack and beverage companies into the fold, and bankrolled scientific papers that contributed to a “highly supportive” FDA ruling, which, the Silver Anvil application boasted, made it “unlikely that sugar will be subject to legislative restriction in coming years.”

The report is accompanied by riveting background information, examples of sugar advertisements, and formerly confidential documents:

Curl up with Mother Jones over the weekend , hopefully one free of hurricanes (I, along with many others, am still waiting for electricity, water, and heat).

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?

I’ve been trying to keep track of the legal dispute between the Corn Refiners (representing manufacturers of high fructose corn syrup—HFCS) and the Sugar Association, which represents growers of sugar beets and cane (sucrose).

Recall: HFCS is glucose and fructose separated, whereas sucrose is glucose and fructose stuck together.  Because they are biochemically pretty much the same (enzymes that split sucrose act quickly), they have the same effects in the body.

So the dispute is about market share, not science.

First, the Corn Refiners tried to change the name of HFCS to “corn sugar.”  The FDA turned this down (as well it should).

Then, the Sugar makers sued the Corn Refiners, claiming that the Corn Refiners’ public education marketing campaign was false and misleading because it promoted HFCS as “natural” (It’s not, in my opinion) and nutritionally and metabolically equivalent to other forms of sugar (which it is).

Then, the Corn Refiners countersued on the basis that Sugar lobbying groups are tricking the public into believing that sucrose is healthier than HFCS (it’s not) and trying to create a “health halo” for sucrose (absurd).

As Food Navigator puts it, the two associations are “trading insults.”

While all this is going on, a group called Citizens for Health has filed a petition with FDA to put the concentration of fructose in HFCS on package labels.  HFCS is usually 42% or 55% fructose (it is 50% in sucrose).  These forms of HFCS are considered by FDA to be generally recognized as safe (GRAS).

The petition argues that some products have more fructose—65% or 90%—and should say so.

All sugars should be consumed in small quantities, but fructose especially so.

The Corn Refiners say that Citizens for Health, which sponsors a website called foodidentitytheft.com, is funded by the Sugar Association.

Also in the meantime, a new study says HFCS has nothing whatsoever to do with obesity.  Guess who sponsored the study.

Advice for today: eat less sugar(s), meaning sucrose, glucose, fructose, table sugar, HFCS, corn sugar, and all the other euphemisms food companies use to deflect attention from how much their products contain.

Yesterday, New York City Mayor Michael Bloomberg announced a ban on sales of sugary drinks larger than 16 ounces in restaurants, delis, sports arenas, and movie theaters.

The reactions have been ferocious, and not only from the soda industry, which placed this ad in today’s Times.

The New York Times also weighed in with an editorial arguing that the mayor has now gone too far and should be sticking to educational strategies.

Alas.  If only educational strategies worked.  But they do not.

We know this from what it took to discourage people from smoking cigarettes.  We also know this from research on eating behavior.  This shows that it doesn’t take much to get people to eat too much.

Just barrage us with advertising, put food within arm’s reach, make food available 24/7, make it cheap, and serve it in enormous portions.

Faced with this kind of food environment, education doesn’t stand a chance.

That’s the point the Mayor’s proposal is trying to address, however clumsily.  After all, a 16-ounce soda is two servings.

Sugary drinks—especially large ones—make sense as a target for a portion size intervention.

• They have calories but no nutrients (“liquid candy”).
• The larger the serving size, the more calories they contain.
• They are widely consumed, often to the extent of hundreds and sometimes thousands of calories a day.
• Research links them to obesity (people who habitually consume sugary drinks tend to have worse diets and weigh more than those who don’t).
• People tend to drink the amount that is in the container.

The sugary drink industries have much to answer for their role in obesity promotion.

• They put billions of dollars into advertising, much of it directed to children and minority groups.
• They lobby Congress and federal agencies to prevent laws and regulations that might affect sales.
• They co-opt health organizations to neutralize criticism (hence: the Academy of Nutrition and Dietetics’ advice to focus on “education and moderation”)
• They attack public health professionals who advise “don’t drink your calories.”
• They attack the science and make it appear confusing (see the above ad which does not mention studies that show otherwise).
• They price drinks to favor the largest size servings; an 8-ounce soft drink costs much more per ounce than a 2-liter bottle.

If the Beverage Association really wanted to help Americans eat more healthfully, it could change all of those practices.

The Mayor is committed to improving the health of New Yorkers and is trying to figure out ways to do that.

Beverage companies are interested in one thing and one thing only: the financial health of beverage companies.  And they have convinced many Americans that the financial health of beverage companies trumps public health.

Education?  I’m for it if it’s focused on educating the public how beverage companies really operate.

Addition: The New York City Health Department has been collecting endorsements from public officials and health advocates and is posting them online. I’m in good company.