Sugar – what’s the evidence?

Sugar has been a key focus in our diets for several years now. Everywhere you look are articles on sugar, celebrities claiming to have quit sugar, media reporting on the health risks of sugar and new government legalisation around sugar. With the recent tax on sugary drinks coming into force, the focus has intensified. But what are the nutritional facts? How does sugar fit into a healthy diet? And are the many recently reformulated sugary drinks now healthy?

What is sugar?

Sugar is the generic name for sweet tasting carbohydrates found in our diet.

Free sugars are sugars added to food such as sucrose or glucose or those naturally present in honey, syrups and unsweetened fruit juices.

Naturally occurring sugars are those found within food such as milk and milk products and those that are contained within fruit that is still intact (not juice or extracted fruit sugar).

How much sugar should we eat?

In 2015 the Government’s Scientific Advisory Committee on Nutrition (SACN) published an extensive review on sugar and made recommendations to halve the intake of free sugars to no more than 5% of our daily energy intake. In more everyday terms, SACN have said that adults (and children over 11) should be consuming no more than 30 grams (7 cubes) of sugar each day, with recommendations for 7-10 year olds at no more than 24g of sugar a day and for 4-6 year olds at no more than 19g a day.(1)

Picture from – https://publichealthmatters.blog.gov.uk/2015/07/17/expert-interview-new-sugar-recommendations/

How much sugar are we currently eating?

A 2014 National Diet and Nutrition Survey highlighted that we are consuming too much sugar across all age/sex groups, most notably among children aged 4 to 10 years and 11 to 18 years where mean consumption made up 14.7% and 15.6% of all food energy intake, respectively. For children, the main source of free sugars was fruit juices and soft drinks. Soft drinks alone were providing 30% of free sugar intake in the 11 to 18 years age group. Other major sources of sugar included cereals, cakes and biscuits for children and table sugar & confectionery, soft drinks & fruit juices and cereals & cereal products (mainly cakes and biscuits) for adults.(2)

Health risks of sugar – what’s the evidence?

High intake of sugar has been associated with greater risk of obesity in various studies. The Scientific Advisory Committee on Nutrition (SACN) report on Carbohydrates and Health in 2015 found a positive correlation between sugar intake and the likelihood of exceeding the estimated average requirement for energy in participants.(1,3)

Sugar-sweetened drinks in particular have been shown to increase Body Mass Index (BMI) in teenagers (4). Other research suggests that excess consumption of sugar-sweetened beverages increases the risk of type 2 diabetes.(5,6)

Prospective cohort studies’ findings suggest that higher consumption of sugars and food/beverages containing sugars is associated with a greater risk of dental caries. A greater frequency of consumption was also found to be associated with higher incidences of dental caries.(1)

Sugar and food labelling

Food labels currently do not distinguish between free sugars and naturally occurring ones, such as lactose in milk. For example, the label on a yoghurt would not distinguish between added sugar and sugars found naturally in the milk. As ingredients are listed in descending order by weight, one way to help make healthier decisions would be to look at how high up on the list sugar is in the product. When doing so, it is worth being mindful of occurrences of combinations of different forms of free sugar in ingredient lists, with various types including: sucrose, glucose, syrup, dextrose, honey, fructose, treacle, molasses, corn syrup and fruit juice concentrates.

If a beverage product does not contain any milk or fruit, any sugar content is likely to be all free sugars.

Are the sugar drinks exempt from the sugar tax healthy?

As highlighted in allmanhall’s recent blog on the UK Soft Drinks Industry Levy (“the sugar tax”), the two-year period between announcing and implementing the sugar tax has seen most big soft drinks manufacturers going through a period of portfolio reformulation. With products containing less than 5g added sugar per 100ml, many soft drinks have reformulated their sugar-sweetened drinks to sit just under this threshold.

With so many well-known brands exempt from the tax, this poses the question: are these drinks now healthy?

Many soft drinks have been reformulated to now contain a combination of sugar and artificial sweeteners. Many drinks will still contain added flavours and preservatives. Furthermore, certain drinks (including no added sugar fruit juices and milk-based drinks) fall out of the sugar tax scope and are therefore exempt from the levy.

Fruit juices and smoothies with no added sugars contain sugars classified as ‘free sugar’ and therefore count towards the total amount of sugar in the diet.

Brand Size Calories Sugar Comments
Irn Bru (reformulated) 330ml 66kcal 15.5g Has less than half the sugar than before but still has more than 50% of an adult’s recommended daily limit. Also contains the colouring ‘Sunset Yellow FCF’ – previously linked to hyperactivity in children
Flavoured sparkling water (typical product) 250ml 5kcal 0.5g Contains artificial sweeteners. Even though this is a low-calorie option, it still contains acid which damages teeth over time
Fanta Orange (reformulated) 330ml 63kcal 15g Now contains both sweeteners and sugar. Similarly to Irn Bru, this product still has more than 50% of an adult’s reference intake of sugar.
Cawston Press Apple (reformulated) 330ml 92kcal 20g No added sugars – all sugars are from the fruits in the product. This product will contain beneficial vitamins and minerals, but the sugar in this form is still classified as free sugar and should be limited
Lilt Zero 330ml 10kcal 0g Contains artificial sweeteners. Even though this is a low-calorie option, it still contains acid which damages teeth over time

Artificial sweeteners

Most reformulated soft drinks now contain sweeteners, of which some people are wary. Over the years, many reviews have focused on the safety of sweeteners.

According to the European Food Safety Authority, the European Commission, Parliament and Council regulate the use of food additives. Each sweetener undergoes stringent testing prior to approval for the use in food products. Currently approved non-nutritive sweeteners have shown no ill effects on human health.

Some studies suggest that artificial sweeteners can increase our desire for sweet foods, with artificial sweeteners being considerably sweeter than sugar. On the other hand, evidence shows that replacing sweeteners with sugar will reduce overall energy consumption. A review of 16 randomised controlled trials of switching sugar for low-calorie sweeteners saw a reduced average daily calorie intake by 10% along with a statistically significant weight loss of 0.2kg per week.(7) Another study suggested that low-calorie sweeteners significantly reduced body weight, BMI and weight circumference.(8)

Whilst some people remain unsure about sweeteners, the risks associated with a high-sugar diet are certain. Therefore, replacing sugary drinks with low-calorie, artificially sweetened drinks would be the preferable option if you are not prepared to give up your soft drink altogether. However, whilst diet drinks contain little or no sugar, most, however, will still be acidic and will cause harm to teeth and contribute to tooth decay over time. Water, milk or unsweetened tea and coffee are the best choices for drinks between meals.

Summary

A small amount of sugar as part of a healthy diet is not harmful. However, many people in the UK consume too much sugar in their diets which, in excess, can contribute to weight gain, dental decay and may increase the risk of diabetes.

It is important to look at diet in an holistic way and sugar consumption is just one aspect of a diet. Some foods that contain sugar come with added nutrients or micronutrients which may form an important part of the diet. For example, a yoghurt will deliver protein and calcium. Similarly, a fruit and vegetable smoothie will provide fibre and potassium.

Sugary foods such as carbonated soft drinks, cakes and chocolate, however, tend to provide little in the way of useful nutrition and do not contribute to a balanced diet. These foods should therefore not be considered everyday foods but enjoyed as occasional treats.

References

  1. SACN report, (2015), Carbohydrates and Health, [online], Available at: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf [Accessed 29/08/2015]
  2. Public Health England & Food Standards Agency (2014) National Diet and Nutrition Survey. Results from Years 1-4 (combined) of the Rolling Programme (2008/2009 – 2011/12) REVISED FEBRUARY 2017 Accessed online https://www.gov.uk/government/statistics/national-diet-and-nutrition-survey-results-from-years-1-to-4-combined-of-the-rolling-programme-for-2008-and-2009-to-2011-and-2012
  3. Ludwig, D.S., Peters, K.E. and Gortmaker, S.L., (2001) Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis Lancet 357 pp505–08
  4. Malik, V.S., Pan, A., Willett, W.C. and Hu, F.B., (2013) Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis Am J Clin Nutr 98 pp1084–102
  5. Montonen, J., Järvinen, R., Knekt, P., Heliövaara , M. and Reunanen, A., (2007) Consumption of sweetened beverages and intakes of fructose and glucose predict Type 2 Diabetes occurrence J. Nutr. 137: pp1447–1454
  6. Malik V S et al. (2010) Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes – A meta-analysis: Diabetes Care, Volume 33, Number 11. pp 2477-248
  7. De La Hunty (2006) Nutrition Bulletin 31: 115-128
  8. Miller PE & Perez V (2014) Am J Clin Nutr 100(3):765-77
By |2018-04-30T09:48:55+00:00April 24, 2018|Food Trends, Nutrition and Dietetics|