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Keeping the sugar debate in context

Author: Courtney Scott, MPH, RD

Registered Dietitian (United States).
Master’s in public health nutrition from the University of California - Berkeley.

Sugar. It’s the nutrition buzz word of 2015. New campaigns are cropping up left, right and centre aimed at lowering sugar consumption, including proposals to label added sugars and new, lower limits for recommended added sugar intake. (1-3) Supermarkets and food manufacturers are pledging to cut the sugar in their products. (4)  And in the past two years we’ve seen the launch of two documentaries on the health effects of sugar. (5, 6) 

This heightened attention follows an increasingly clear scientific evidence base: as a population we are eating too much added sugar and it’s having a negative impact on our health. (2, 3) Sugar contributes so-called ‘empty calories’ to our diets and high sugar consumption has been linked to obesity, diabetes, heart disease, fatty liver disease, dental caries and some cancers. (3, 7-9) There are plenty of compelling reasons to limit added sugar intake.

However, a healthy diet is much more than just a low sugar diet. Diets are complex; a unique mixture of the thousands of foods available to us. And this complexity cannot be boiled down to a single nutrient of concern. Yes, we’re eating too much sugar and would benefit from eating less but research has consistently shown that a healthy dietary pattern is also high in vegetables and fruits and other minimally processed foods, like whole grains. (10)  This type of a diet would be naturally lower in sugar, but the low sugar content is only one reason that such a diet is healthy. It is also high in fibre and a glut of nutrients and compounds, the likes of which we are only just beginning to identify and understand how they improve our health. 

Focusing on a single nutrient, any single nutrient whether it be sugar or fat or salt, is catchy for headlines and advocacy campaigns but can take our collective attention off the overall healthfulness of the diet. If the only objective were to eat a diet low in added sugar, then a diet of crisps and chips, high in fat and salt, would be just fine. However, we know, and the evidence shows, that consuming ultra-processed, high fat and high salt foods isn’t good for us either. (11)  Diet beverages also illustrate the limitations of a singular focus on sugar, as while devoid of caloric sweeteners they do not contribute value to the diet.

While sugar is not the only concern with today’s modern diet, it can be an important marker of foods and beverages that would otherwise be wise to limit. Of particular concern are ultra-processed foods, which usually come with added sugars. (12)  These ultra-processed foods are low in fibre and high in quickly available calories, sugars, salt and fats, and are considered ‘hyperpalatable’ due to being high in fat, sugar and salt. (13-15) This hyperpalatability combines with high availability, affordability and aggressive marketing to make moderate consumption of ultra-processed products a challenge for most consumers. (16)

It is old news that a diet high in vegetables, fruits and other lower-calorie minimally processed foods is good for us. While we may have heard it a hundred times before, it is the soundest nutrition recommendation out there. Yes, we need to reduce sugar intake, but in order to significantly change course on obesity and noncommunicable diseases, our diets and the food system and food environments that produce them need an overhaul, not a tinkering. (17)  As said by Stuckler and Nestle (2012): 

“…food systems are not driven to deliver optimal human diets but to maximize profits. For people living in poverty, this means either exclusion from development (and consequent food insecurity) or eating low-cost, highly processed foods lacking in nutrition and rich in sugar, salt, and saturated fats (and consequent overweight and obesity).” (18)

Efforts to reduce sugar consumption should be fully supported, however we must also undertake broader work to shift the food system and food environment towards providing affordable minimally processed food for everyone.  

References:

1. U.S. Food and Drug Administration. Proposed Changes to the Nutrition Facts Label.  27 July 2015 [cited 2015 12 August]; Available here 
2. UK Scientific Advisory Committee on Nutrition, Carbohydrates and Health. 2015: London.
3. World Health Organization, Guideline: Sugars intake for adults and children. 2015: Geneva.
4. Cooper, C., Tesco announces plans to cut sugar content of its soft drinks by five per cent every year, in The Independent. 2015: UK.
5. Hozer, M., Sugar Coated. 2015.
6. Gameua, D., That Sugar Film. 2014.
7. Yang, Q., et al., Added sugar intake and cardiovascular diseases mortality among us adults. JAMA Internal Medicine, 2014.
8. Morenga, L.T., S. Mallard, and J. Mann, Dietary sugars and body weight: systematic review and meta-analyses of randomised controlled trials and cohort studies. BMJ, 2013. 346.
9. Johnson, R.K., et al., Dietary sugars intake and cardiovascular health a scientific statement from the american heart association. Circulation, 2009. 120(11): p. 1011-1020.
10. U.S. Dietary Guidelines Advisory Committee, Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture. 2015.
11. Monteiro, C.A., et al., Increasing consumption of ultra-processed foods and likely impact on human health: evidence from Brazil. Public Health Nutr, 2011. 14(1): p. 5-13.
12. Monteiro, C.A., Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutr, 2009. 12(5): p. 729-31.
13. Kessler, D.A., The End of Overeating. Taking Control of our Insatiable Appetite. 2009, United States of America: Rodale Books.
14. Moss, M., Salt, sugar, fat : how the food giants hooked us. 2013, New York: Random House.
15. Monteiro, C.A., et al., Ultra-processed products are becoming dominant in the global food system. Obesity Reviews, 2013. 14: p. 21-28.
16. Moodie, R., et al., Profits and pandemics: prevention of harmful effects of tobacco, alcohol, and ultra-processed food and drink industries. The Lancet, 2013. 381(9867): p. 670-679.
17. Roberto, C.A., et al., Patchy progress on obesity prevention: emerging examples, entrenched barriers, and new thinking. The Lancet. 385(9985): p. 2400-2409.
18. Stuckler, D. and M. Nestle, Big Food, Food Systems, and Global Health. PLoS Med, 2012. 9(6): p. e1001242.