SUGAR AND HEALTH ALLEN W. KNEHANS, PHD DAVID ROSS BOYD PROFESSOR OF NUTRITIONAL SCIENCES DEAN, COLLEGE OF ALLIED HEALTH OU HEALTH SCIENCES CENTER
WHAT IS SUGAR? • Not so simple a question • Nutritionist/Dietitian – any mono or disaccharide • Layperson – Sucrose, a specific disaccharide • FDA Labeling: Sugars (plural) as component of Total Carbohydrate – All mono and disaccharides combined
WHAT ARE ADDED SUGARS? • Added sugars are distinct from naturally occurring sugars • Naturally occurring: dairy, fruit, 100% fruit/veggie juice, vegetables • Added sugars: added during processing, high fructose corn syrup in many soft drinks, include syrup and honey • Added sugars: dairy desserts (ice cream), grain-based desserts (cake, cookies), sugar- sweetened beverages (soft drinks, sweet tea), sweets (candies, syrups) • Foods of Minimal Nutritional Value for federal regulations: soda water (soft drinks), water ices (popsicles), chewing gum, some candies (hard candy, jelly beans, marshmallows, candy corn)
CONCERN ABOUT ADDED SUGARS • Over past 30-40 years, total caloric intake has increased by 150-300 calories per day, and about half of that increase comes from sugar- sweetened beverages • Average intake of added sugars in US is about 15% of calories, an increase • Added sugars add no nutritional value; no vitamins, minerals, or protein, only add calories (many get too many calories in US) • Data from NHANES III indicate a reduced intake of calcium, vitamin A, iron, and zinc when added sugar intake was above 25% of total energy intake
ADDED SUGARS AND HEART DISEASE • Those consuming above 25% of calories as added sugars almost 3X greater risk of death from heart disease • Those above 10% of calories as added sugars have 30% greater risk • High sugar diets lead to high blood triglyceride levels and high LDL- cholesterol levels, both risk factors for heart disease (evidence is excellent)
ADDED SUGARS AND OBESITY • Intake of sugar-sweetened beverages/soft drinks is associated with a higher body weight • Reducing sugar-sweetened beverage intake is associated with weight loss • Given complexity of obesity, difficult to say added sugar intake causes obesity, but significant evidence argues an association
ADDED SUGARS MAY HAVE OTHER EFFECTS • Type 2 diabetes • Fatty liver disease • Increased inflammation, which increases risk of most chronic diseases including heart disease and diabetes
RECOMMENDATIONS FOR ADDED SUGARS • 2015-2020 Dietary Guidelines for Americans recommend that Americans limit calories from added sugars to less than 10 percent of calories per day • Food labeling laws require added sugars be listed on labels, being phased in • American Heart Association (AHA) recommends a daily upper limit of about 5 teaspoons of added sugars for an average adult woman and 9 teaspoons for an average adult man • For reference, one 12-ounce soda contains about 8 teaspoons of added sugar
POLICY APPROACHES • Menu labeling at chain restaurants – limited effect, many saw, few used • Improved food infrastructure – programs to increase mobile vendors of fruits and vegetables into disadvantaged neighborhoods, no effect on intake • Subsidies for health foods – matching funds for SNAP benefits, has increased fruit and vegetable purchases at farmers’ markets • Taxation of unhealthy foods/beverages – more common in Europe, successful, AMA supports • Labeling codes at point of sale – “red-coded” soft drinks in vending machines, city-wide only at public buildings, successful
PREVIOUS APPROACHES TO RESTRICT SNAP USE • In 2008 US Congress rejected the restriction of buying sugar sweetened beverages with SNAP benefits as part of 2008 Farm Bill • Multiple states (Maine, Minnesota, New York) have attempted to restrict SNAP benefit use but have not been approved • Since 2010 Healthy Hunger-Free Kids Act passed, USDA has revised nutrition standards for nearly all federal food programs to align with Dietary Guidelines for Americans, exception is SNAP
ARGUMENTS FOR/AGAINST RESTRICTION OF SNAP BENEFITS • Feasibility – could use barcodes to designate which foods can be purchased • Justification – SNAP participants have a lower Healthy Eating Index • Effectiveness – participants can use own money to purchase high sugar items • Slippery slope – if approve restricting high sugar, what is next? • Consistency – USDA states should drink water instead of sugary drinks • Dignity – would feel singled out • Distrust – Beverage industry has funded “anti-hunger” centers that oppose restrictions
MY OPINIONS • No question that consumption of high sugar foods is unhealthy • So government funds should not go to purchase foods of minimal nutrition value (sugar sweetened beverages primarily) • If a waiver is not possible, then alternatives such as a food tax on high sugar foods or incentive program to purchase fruits and vegetables could be implemented • Could be a combination, those who accept limits on SNAP would receive incentives for fruits and vegetables • A recent study found that 2/3 of SNAP participants asked would prefer this policy
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