SUGAR DECEPTION = TOBACCO DECEPTION?

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Previously I had presented information demonstrating how sugar has negative health consequences, often denied—for obvious reasons—by the sugar industry.

Now it has been brought to light how the sugar industry paid for and was closely involved in development of an influential literature review, published by the New England Journal of Medicine in 1967, that downplayed dietary sugar’s links to coronary heart disease while pointing the finger at fat and cholesterol intake, according to a report published September 12, 2016 in JAMA Internal Medicine.

The sugar industry’s funding and other participation were not disclosed in the 1967 articles, which had a major influence on dietary recommendations for sugar in the following decades, notes Dr C. E Kearns (University of California, San Francisco).

The literature review from almost 50 years ago—when conflicts of interest were not required—served as a lobbying tool for the industry and likely influenced the first dietary guidelines of the 1980s. It put the focus on dietary cholesterol and deflected sugar intake as a risk factor for heart disease. If the evidence had been fairly presented, the recommendations would have been to reduce both fat and sugar, not just saturated fat. Even today, the sugar industry, led by the Sugar Association, the industry’s Washington, DC–based trade association, steadfastly denies that there is a relationship between added sugar consumption and cardiovascular disease risk.

The present group (Kearns) analyzed previous internal documents from the Sugar Research Foundation (SRF), the precursor to the Sugar Association, that had become available in academic libraries and other publicly accessible locations. They also reviewed historical reports and statements made in early debates about health effects of sugar. According to those documents, the SRF set the journal’s review’s objective, contributed articles for inclusion, and received drafts. Kearns and colleagues describe finding documentation that the SRF paid two nutrition researchers, Dr D Mark Hegsted and Dr Robert McGandy (Harvard School of Public Health, Boston, MA), to conduct the literature review; the payments amounted to about $48,900 in 2016 dollars.

Also among the evidence of influence, they write, is correspondence from July 30, 1965, to Hegsted from SRF vice president John Hickson. In it, they report, Hickson emphasized the SRF’s objective for funding the review: “Our particular interest had to do with that part of nutrition in which there are claims that carbohydrates in the form of sucrose (table sugar) make an inordinate contribution to the metabolic condition, hitherto ascribed to aberrations called fat metabolism. I will be disappointed if this aspect is drowned out in a cascade of review and general interpretation.” Hegsted, the current report states, responded “We are well aware of your particular interest in carbohydrate and will cover this as well as we can”.

The Sugar Association responded to the recent report from Kearns and colleagues on September 12, 2016 with a statement: “We acknowledge that the Sugar Research Foundation should have exercised greater transparency in all of its research activities; however, when the studies in question were published, funding disclosures and transparency standards were not the norm they are today. Beyond this, it is challenging for us to comment on events that allegedly occurred 50 years ago and on documents we have never seen.”

I believe that Kearns and colleagues have found the “smoking gun,” having produced compelling evidence that a sugar trade association not only paid for but also initiated and influenced research expressly to exonerate sugar as a major risk factor for coronary heart disease.

The consequences of this deception are deeply disturbing.

First–and most obvious–is the misdirection of subsequent research and government efforts to improve heart health. Thanks largely to the reputation of Harvard and its research faculty, the publications sent other medical researchers down different paths, and retarded accurate evaluation of the role sugar plays in heart disease. These, and similar, research reports led to the belief that fat, not sugar, was the culprit, and Americans went on a low-and-no fat binge. What was particularly pernicious about the hundreds of new products designed to meet the goal of lowering fat content was the food industry’s preferred method of making low-fat offerings taste good: the addition of sugar—lots of sugar.

The discovery of the sugar industry’s role in twisting nutritional research results joins what we now know about the similar machinations of cigarette companies and fossil fuel industries.

Unfortunately, this type of subterfuge gives science itself a black eye. In the long-run, however, science is usually a self-correcting process, as evidenced by the recent investigation. But I must admit, 50 years is far too long!

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UNDETECTED SUGAR MAY BE LURKING IN YOUR DIET BEYOND JUST SOFT DRINKS AND DONUTS

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   All research indicates that excess sugar in the diet is unhealthy, increasing one’s risk of type 2 diabetes, heart disease, and obesity. For instance, a recent study disclosed that people who got 17 to 21 percent of their calories from added sugars had a 38% higher risk of dying from cardiovascular disease than those who kept their intake of sugar at or below 8%. Results of this type have prompted the American Heart Association to recommend that sugar intake be kept in this latter range, amounting to a daily intake in women of to more than 6 teaspoons (24 gms) daily, and in men, 9 teaspoons (36 gms).

But at this time, achieving these targets is challenging. For example a frozen stir-fry dinner can contain the same amount of sugar as 16 gummi bears (5 teaspoons). Or even whole-wheat bread can have almost a teaspoon of sugar per slice. As a matter of fact, food companies add sugar to almost three-quarters of all packaged products, including nutritious-sounding items such as instant oatmeal and peanut butter, or even into apparently “unsweetened” items such as tomato sauce and crackers.

Some Guidelines

 In general, the sugars found in dairy products and fruits such as sweet potatoes and beets come in small doses and are packaged with fiber, protein, vitamins, and minerals and they don’t affect one’s blood sugar greatly, and, when consumed in moderation, they are not of great concern.

The main challenge, however, is to try to avoid those unnecessary added sugars.  Usually nutrition facts on labels designate added and naturally occurring sugars together under “total sugars.”  But, unfortunately, the amount of undesirable added sugar is usually not clearly indicated. In the effort to ease this burden, the FDA has proposed that added sugars have their own line on food label, similar to the way total fat and saturated fat are listed separately. This should also include the percent contributing to the total daily limit. But until food labels change, we can make some suggestions: 1) Know the code words for sugar. Ingredients on the list that end in “ose”, i.e., fructose, maltose, and sucrose, are added sugars that should be minimized or avoided. Even healthier-sounding sugars such as brown rice syrup or honey aren’t any better than other types. 2) Scan the entire ingredients list. Since ingredients are usually listed in order of weight, the higher up a substance is, the more sugar it is likely to contain. But many manufacturers use more than one type of sugar in a product, allowing them to list them separately, leading to the false impression that a food possesses less sugar than it actually contains. 3) Compare nutrition labels.  Find the “plain” version of foods such as yogurt or oatmeal and compare the nutrition facts label against the same brand’s sweetened versions. The difference in the amount of sugar between the two products is almost always added sugar. So, instead of purchasing the “sweetened” version, opt for the plain version and, for sweetness, add fresh fruit.

For more information and a general lowdown on the best and worst natural sugars, the reader should consult the Consumer Reports website: ConsumerReports.org/naturalsugar2015.

 

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SUGARY DRINKS AND OBESITY: A MEDICAL OPINION

                      

     Everyone acknowledges that we have a serious epidemic of obesity in the U.S.A. Sugary drinks play an important role in this problem, especially the large sizes (16 ounces and more). So beyond exhorting individuals to cut back on these products—which has little chance for success—what can we, as a society do to help stem this unhealthy tide?

       First, how much does consumption of sugary drinks contribute to our current obesity? On average, beverages with added sugar constitute over 10% of caloric intake nationwide, and they supply little of nutritional value. Thus any effective means to curb this intake would be welcome indeed. Despite the complexity of this issue, two possible societal approaches have been advocated: 1) Increase that tax rate on all these concentrated caloric products or 2) Banish the large drinks entirely in restaurants, movie theaters and delis, as was attempted (unsuccessfully) in New York City. This latter approach is likely doomed, if for no other reason that its legality is highly questionable.   

      From my perspective, raising tax rates on such drinks makes some sense. Since 2009, 19 states and eight cities have proposed such taxes on these drinks, according to the Rudd Center for Food Policy and Obesity. The advantage of raising such taxes can be taken from that of tobacco products. Cigarettes are clearly the cause of numerous diseases, costly in both human suffering as well as expenses to society at large. Thus heavy taxes provide the dual advantage of discouraging their consumption as well as raising taxes that can aid in the care of these afflicted individuals. In the case of sugary drinks (and other similar products), taxing these products, plus providing healthier alternatives such as fruit juices in public places, would move us in the right direction. A penny-per-ounce excise tax on sugary drinks would effectively raise the shelf price of these drinks by about 20%. According to a number of studies, this would result in a 14 to 20% reduction in the consumption of the taxed beverages. But our obesity epidemic goes far beyond these drinks. Additional measures would obviously be needed to supplement this advantage, as I note below.

     Societal trends require consideration.  For instance, studies showing that the ready availability of foods high in sugar, fat, sodium, and calories increase average body weight. Adults living closer to fast food restaurants consume such food more frequently than those who don’t and, consequently, are heavier. This is especially important for children; schools that serve more unhealthy foods or provide vending machines with unhealthy foods tend to be heavier than children whose schools do not permit such practices. Similarly, adolescents who attend schools near fast food restaurants are more likely to be obese.

    Compounding these problems are other economic forces surrounding foods: The cost per calorie of healthy foods exceeds those of poor nutrient foods. In the past 30 years, this cost disparity has increased; between 1985 and 2000, the prices of healthy foods, like fruits and vegetables, fish, and dairy products increased at more than twice the rate of prices of sugar and sweets, fats and oils, and carbonated beverages.

    Finally, we must consider portion sizes as another contributor to obesity. For children alone, between 1977 and 2006 the average portions of soft drinks, pizza, and Mexican foods increased by 34, 140, and 139 calories, respectively. Sodas, sold originally in 6.5 oz. bottles, are now typically sold in 20 ounce containers. Studies have shown in general that increased portion sizes lead to rises in calorie intake: as a result, US adults now consume 500 calories more per day in 2006 than they did in 1977. This trend has been further exacerbated by our increased eating away from home, for in 2008, Americans spent 49% of their food budget on food away from home compared with 33% in 1970. On average, each meal eaten outside the home increases that day’s consumption by about 134 calories, while, at the same time shifts the content toward less nutritious ingredients such as saturated fat and added sugar.

    This problem extends well beyond the United States to include Europe. For instance, the nation of Hungary, notorious for relatively short life spans, has, in the past 18 months imposed taxes on salt, sugar and the ingredients in other unhealthy foods.  Their dual purpose is to raise revenues and to force healthier eating habits. Although commendable, whether this strategy accomplishes anything more than raising tax rates is uncertain at present.

   Obviously, stemming the rising tide of obesity will require a milti-pronged attack that will probably include some governmental intervention—at both the local and federal levels. Education of the public about these issues will be needed, including proper and widespread food labeling.  Unfortunately, those who are solemnly opposed to such “big brother” governmental directives will likely require much convincing. Hopefully this will occur before many of those same individuals wind up requiring expensive obesity induced medical attention!