Stop singling out sugar

Acg67

Nods head and as for epidemiological evidence driving policy, points at Willett and his ilk

http://evolvinghealth.wordpress.com/2014/04/27/stop-singling-out-sugar/#more-1196

It’s been called “deadly,” “toxic,” and “poison”. Today there’s no shortage of books, news articles, and journal articles singling out the sweet substance as the scapegoat for all of society’s ills. These include obesity, metabolic syndrome factors such as high blood pressure, non-alcoholic fatty liver disease (NAFLD), type-2 diabetes, and cardiovascular disease.

Providing the most recent fodder for anti-sugar headlines in several media channels was the World Health Organization (WHO) recommendation to halve intake of sugar in draft guidelines released on March 5 for public consultation (now closed). It provided strong recommendations to reduce intake of free sugars and to limit intake of free sugars to less than 10 percent of calories per day, as well as a conditional recommendation to further reduce free sugars to below 5 percent of calories for additional benefits for body weight and dental caries.

But what does the evidence really say about sugar’s impact on health to warrant such low doses? How does it really compare with other sources of carbohydrates and calories in foods and beverages? And, is the focus on fructose as a monosaccharide warranted in finding a real answer to improving public health? Challenging the WHO and others for spreading fears about sugar unfairly were scientists in a symposium on Saturday, April 26. The event, supported and sponsored by the Corn Refiners Association, took place during the American Society for Nutrition 2014 Scientific Sessions and Annual Meeting at Experimental Biology in San Diego.

Dr. John Sievenpiper, of St. Michael’s Hospital in Toronto, compared all the attention surrounding sugar to that of fat consumption in the 1950s. Like with fat in those earlier years, he said it’s difficult to separate out how fructose-containing sugars contribute to obesity and cardiometabolic disease. A lot of the reason is due to small effects and lack of demonstrated harm of sucrose, high-fructose corn syrup, or fructose over other sources of excess calories in the diet.

“There are many pathways to overconsumption leading to weight gain,” Dr. Sievenpiper said. “Attention needs to remain focused on reducing overconsumption. We need to get away from a single nutrient approach and focus on total diet and dietary patterns to improve health.”

When interpreting results of trial designs relating to sugar, Dr. Sievenpiper said, it’s important to “follow the energy.” For example: Isocaloric or “substitution” trials are those where energy from sugars are substituted for other sources of energy in the diet; hypercaloric or “addition trials” are where energy from sugars are added to the diet; while hypocaloric or “substraction” trials are where energy from sugars are substracted from the diet.

It shouldn’t be surprising that the addition of excess energy from sugars in hypercaloric trials would lead to increased weight gain. There is consistent evidence, Sievenpiper said, that hypercaloric feeding of sugar and fructose promotes weight gain, fasting and postprandial dyslipidemia, raised uric acid levels, and NAFLD. But these effects all are attributable to the excess energy rather than the fructose itself.

The WHO draft recommendations, Dr. Sievenpiper pointed out, were based mainly on evidence that addition of excess energy from sugars increased body weight, which reinforced their current recommendation of 10 percent (Morenga et al 2013). But the recommendation to reduce sugar intake to less than 10 percent and, further, to 5 percent was solely based evidence in reduction of dental caries (Moynihan and Kelly 2012).

On the other hand, Dr. Sievenpiper cited the work of Sigrid Gibson and colleagues showing that a moderate dietary sucrose intake at levels up to 25 percent of energy appear to have no significant adverse effects on metabolism when substituted for starch, at least in the medium term.In addition, reviews published by Dr. Sievenpiper’s lab using controlled feeding trials with fructose at low to moderate doses (in doses normally found in fruit) does not harm body weight, serum fasting or postprandial lipids, uric acid, and NAFLD. At these levels in humans, he said, the evidence even suggests a benefit to blood pressure and glycemic control.

Fructose-Fatty Liver Hypothesis

One of the major sources of controversy surrounding fructose is that because, unlike glucose and other sugars, it’s metabolized primarily by the liver. This fact along with evidence from animal trials has led to concerns that fructose may have a greater likelihood of being converted into fat through de novo lipogenesis. However, Luc Tappy and Kim-Anne Le previously demonstrated that generally less than 3 percent of fructose ends up being converted to fat in typical diets, while the rest ends up burned up as energy or stored as liver glycogen in humans.

But this evidence hasn’t kept the belief that fructose is uniquely harmful from reaching the mainstream, largely because of perpetuation by Dr. Robert Lustig (and his famous YouTube video), as well as others, who have championed the idea and have even likened fructose to ethanol and suggested it contributes to NAFLD. These misguided views are “becoming doctrine,” Dr. Sievenpiper said. And it can lead to confusion about whether or not fruits, which contain varying levels of fructose, should be avoided.

Through a systematic review of published literature, Mei Chung, Ph.D., a research assistant professor at Tufts University School of Medicine, sought to evaluate the effects of different levels and forms of dietary fructose on the incidence or prevalence of NAFLD and on indices of liver health in humans.

Chung provided a summary of the evidence that included five observational studies and 19 interventional studies that investigated a variety of clinical outcomes. The study found that both hypercaloric fructose and glucose diets (excess energy) had similar effects on liver fat and liver enzymes in healthy adults. She said there was “insufficient evidence to draw a conclusion” on liver de novo lipogenesis from the limited amount of intervention studies.

“Based on the indirect comparisons across study findings, the apparent association between indices of liver health and fructose or sucrose intake appear to be confounded by excessive energy intake,” Chung said. She expects the full findings to be published in a peer-reviewed journal soon.

Sweet Policy

Roger Clemens, DrPh, chief science officer of E.T. Horn, discussed matters of policy surrounding sugar intake. He highlighted that there were global efforts to reduce prevalence of obesity through approaches in dietary guidelines, taxation on sugar-sweetened beverages, and restricted access to these products. Approximately 60 countries now recommend limiting intake of added sugar and sugar-sweetened beverages in diverse ways, he said. But these efforts have inconsistent results relative to changes to body weight in targeted populations.

Clemens also warned that what’s driving the policy is epidemiological evidence that can’t establish causation, while the evidence from randomized controlled trials is largely being ignored, although they show that when sugars are isoenergetically exchanged with other carbohydrates they are not associated with weight change. “What evidence do you want to accept?” he charged.

Criticizing the proposed changes to nutrition facts panels by the U.S. Food and Drug Administration, Clemens also said listing “added sugars” was wrong-headed. “It’s silly and impractical,” he said considering that there are no analytical methods for added sugars, so food producers would have to provide information and maintain records for two years.

There are really no signs that suspicions about sugar are abating among the public. The belief that sugar is “addictive” (similar to illicit drugs) is now becoming pervasive. The major challenge for the scientific community, Clemens said, is how to get the word out about evaluating topics like sugar through the lens of evidence. Through social media, the public has been largely sold that sugar is uniquely harmful, he said. “How can we compete?”

Part of the reason why sugar remains in the spotlight is that “it’s a low hanging fruit,” Dr. Sievenpiper said after the event. He also hedged that by no means does he advice against limiting amounts of sugar or sugar-sweetened beverages in a person’s diet, so long as it’s part of a total dietary pattern designed to yield results in terms of reducing overall energy intake.

It’s advice reminiscent of the old adage of “losing sight of the forest from the trees”—demonizing one nutrient distracts from the overall dietary pattern (with many contributing factors) that deserve attention.

ndj1979

in …to track this and to read later….

SunofaBeach14

Well reasoned, but I guarantee that several will attack this because the Corn Refiners Association was involved and therefore it must be wrong . . .

rejectuf

Valid points raised, but yes the sponsorship of those points is troubling.

I think added sugar is an issue, and it does lead to excess calories/energy intake in individuals. How often do we see HFCS in foods and wonder why there is any sugar in there? It's important to note that they still advise reducing sugar intake as part of reducing calories, but not doing that in isolation.

For me, controlling sugar was the domino which led to all my other macros staying in line and my weight to start dropping.

32sami

Opinions vary

chrisdavey

books about eating in moderation don't sell too well

Good article mate.

psych101

Nice article!

Serah87

:flowerforyou:

Railr0aderTony

Just kidding, without Sugar there would be no RUM

lemonsnowdrop

This is my favorite post today (especially after all the people demonizing sugar lately).

snikkins

Just kidding, without Sugar there would be no RUM

The most valid of points. :drinker:

neanderthin

The main champion of this diatribe was a Dr. from Toronto......what the hell do Dr's from Canada know anyway.:happy:

FoxyLifter

Thank you! :drinker:

32sami

The main champion of this diatribe was a Dr. from Toronto......what the hell do Dr's from Canada know anyway.:happy:

Not all doctors in Canada are stupid, but I guess it takes one **** to recognize another. :laugh:

psuLemon

In to read later and possibly more based on experience.

Shropshire1959

First they came for my Fat, and I did not speak out-- Because I did not eat meat..

Then they came for my Flour, and I did not speak out-- Because I did not eat breads

Then they came for my sugar , and I did not speak out-- Because I did not eat sweets..

Then they came for my Alcohol --and I shouted "Wait one cotton picking minute .. that's a step too far".



'They' don't care about your health - they just have something to SELL and bolster their bank balance.

Ever few years 'They' pick on another duty victim food stuff .. they cry wolf so many times, no one really listens any more.

yarwell

Challenging the WHO and others for spreading fears about sugar unfairly were scientists in a symposium on Saturday, April 26. The event, supported and sponsored by the Corn Refiners Association, took place during the American Society for Nutrition 2014 Scientific Sessions and Annual Meeting at Experimental Biology in San Diego.

The presence of sponsorship $ always casts a long shadow.

A previous version of this debate was interesting where Robert Lustig was attacked in the Q&A. Is this year's on line anywhere ?

kuolo

Not sure a symposium organised and paid for by the Corn Refiners Association is where you should be getting your 'scientific' info on sugar!

Any non-bought-and-paid-for research out there?

Honeycat89

I sugar

Joanne_Moniz

Valid points raised, but yes the sponsorship of those points is troubling.

I think added sugar is an issue, and it does lead to excess calories/energy intake in individuals. How often do we see HFCS in foods and wonder why there is any sugar in there? It's important to note that they still advise reducing sugar intake as part of reducing calories, but not doing that in isolation.

For me, controlling sugar was the domino which led to all my other macros staying in line and my weight to start dropping.

That's right!! Reducing sugar is the key to weight loss... Quality calories. One does not have to eliminate it but needs to reduce it. Our bodies cannot process all the sugar the average person is eating. It is converted to fat!!!

Joanne Moniz
The Skinny on Obesity Group

neanderthin

Valid points raised, but yes the sponsorship of those points is troubling.

I think added sugar is an issue, and it does lead to excess calories/energy intake in individuals. How often do we see HFCS in foods and wonder why there is any sugar in there? It's important to note that they still advise reducing sugar intake as part of reducing calories, but not doing that in isolation.

For me, controlling sugar was the domino which led to all my other macros staying in line and my weight to start dropping.

That's right!! Reducing sugar is the key to weight loss... Quality calories. One does not have to eliminate it but needs to reduce it. Our bodies cannot process all the sugar the average person is eating. It is converted to fat!!!

Joanne Moniz
The Skinny on Obesity Group

More nonsense..............if the body didn't or couldn't process all the sugar we consumed it wouldn't have ended up in fat reserves.....you will never understand this, but thought I'd let others that may read this understand that what your saying makes no sense at all. It's you inability to understand that is fueling your particular fear mongering and you probably don't even know your doing it.

neanderthin

Challenging the WHO and others for spreading fears about sugar unfairly were scientists in a symposium on Saturday, April 26. The event, supported and sponsored by the Corn Refiners Association, took place during the American Society for Nutrition 2014 Scientific Sessions and Annual Meeting at Experimental Biology in San Diego.

The presence of sponsorship $ always casts a long shadow.

A previous version of this debate was interesting where Robert Lustig was attacked in the Q&A. Is this year's on line anywhere ?

. At least Dr's with a motivated sponsor and all the studies you could possibly want pretty much made Lustig appear kinda fanatical, and a few Dr's challenged him directly......making fun of him really. Science is never boring.

SunofaBeach14

Not sure a symposium organised and paid for by the Corn Refiners Association is where you should be getting your 'scientific' info on sugar!

Any non-bought-and-paid-for research out there?

Actually, no, there isn't. Research costs money and that money has to come from somewhere. Major sponsors include the private sector, government, and universities, each of which will bring it's own biases. This is why research is published, data supplied, and the peer review process is so important. So . . . any actual criticism of the reasoning and research?

SunofaBeach14

Challenging the WHO and others for spreading fears about sugar unfairly were scientists in a symposium on Saturday, April 26. The event, supported and sponsored by the Corn Refiners Association, took place during the American Society for Nutrition 2014 Scientific Sessions and Annual Meeting at Experimental Biology in San Diego.

The presence of sponsorship $ always casts a long shadow.

A previous version of this debate was interesting where Robert Lustig was attacked in the Q&A. Is this year's on line anywhere ?

. At least Dr's with a motivated sponsor and all the studies you could possibly want pretty much made Lustig appear kinda fanatical, and a few Dr's challenged him directly......making fun of him really. Science is never boring.

Lustig has all but been written off by the serious minded. I find it interesting that people will find bias in where the money comes from but will shrug off demonstrated fanaticism by the researcher himself.

Unknown

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ndj1979

Valid points raised, but yes the sponsorship of those points is troubling.

I think added sugar is an issue, and it does lead to excess calories/energy intake in individuals. How often do we see HFCS in foods and wonder why there is any sugar in there? It's important to note that they still advise reducing sugar intake as part of reducing calories, but not doing that in isolation.

For me, controlling sugar was the domino which led to all my other macros staying in line and my weight to start dropping.

That's right!! Reducing sugar is the key to weight loss... Quality calories. One does not have to eliminate it but needs to reduce it. Our bodies cannot process all the sugar the average person is eating. It is converted to fat!!!

Joanne Moniz
The Skinny on Obesity Group

and along came joanne…that train is never late…

sorry, reducing overall calorie intake is the key to weight loss. …quality calories and sugar has nothing to do with it..

Unknown

This content has been removed.

Jestinia

Just woke up, not enough caffeine in my bloodstream yet. Did I miss the part where this article addresses sugar's potential effects on satiety? Because that is what does me in when I eat a lot of sugar. Including sugar from fruit. It's like the reverse of eating low carb for me. Yet naysayers go off on low carb because it has no magical fat burning properties while ignoring its satiety effects. This article seems to be ignoring sugar's satiety affecting properties as well.

Yeah, if you eat too much you will get fat. If you eat less calories than you burn in a day you will lose weight. But what foods make different people eat too much or more easily stick to a deficit or maintenance? This article, unless I read it sloppily, seems to be missing a huge piece of the puzzle, and therefore, the point.

shapefitter

Our bodies don't process artificial sweeteners so well, either.

Joanne_Moniz

Our bodies don't process artificial sweeteners so well, either.

That's right; it is important not to replace sugar with artificial sugar ingredients... The jury is still out on which is worse!!

Acg67

Our bodies don't process artificial sweeteners so well, either.

Proof?