Sugar reduction: from evidence into action | Hacker News Reader

Sugar reduction: from evidence into action

gov.uk

64 pointsDanBC85 comments

  > The Scientific Advisory Committee on Nutrition (SACN)
  > has concluded that the recommended average population
  > maximum intake of sugar should be halved: it should 
  > not exceed 5% of total dietary energy.

If we say that an average man has nutritional requirements of 2500kcal per day, then these recommendations imply he should not consume more than 125kcal of sugar per day, which is 31.25 grams of sugar.

A ~350ml can of Coke contains 39 grams of sugar [1]. A ~600ml 'Vitamin water' drink has 31 grams of sugar. A single McDonalds 'McFlurry' dessert has 64 grams of sugar [2].

Even something 'healthy' like a 250ml 'pomegranates, blueberries & acai' smoothie from 'innocent drinks' has 35 grams of sugar [4].

I guess my point is that we want people to reduce their sugar intake to recommended levels, there needs to be a sea change in what's seen as a normal diet. No one thinks that a 'McFlurry' is a health food, but in my experience they're not seen as a huge indulgence, despite being more than two-days worth of sugar-allowance for an average man, and more for an average woman.

  [1] http://www.coca-colaproductfacts.com/en/coca-cola-products/coca-cola/

  [2] http://www.mcdonalds.com/us/en/food/product_nutrition.dessertsshakes.3832.mcflurry-with-oreo-cookies-12-fl-oz-cup.html

  [3] http://vitaminwater.com/files/vitaminwater_2014_NutritionFacts.pdf

  [4] https://www.innocentdrinks.co.uk/things-we-make/our-smoothies/smoothies/pomegranates-blueberries-acai

Is that total sugar or "added/free" sugar? Because for a 2000kcal diet, that'd be about 100kcal of sugar or ~25 grams. That's equivalent to a single NLEA serving of apple.

https://www.nutritionix.com/i/usda/apple-1-nlea-serving/513f...

When it comes to processed foods, surely the human body doesn't care whether or not the sugar was "added" or was sourced from the primary listed ingredient on the package.

The fibre in whole fruit and vegetables blunts the rise in blood sugar level.

Which is why I specifically said processed food.

Here's a similar recommendation from the World Health Organization:

> A new WHO guideline recommends adults and children reduce their daily intake of free sugars to less than 10% of their total energy intake. A further reduction to below 5% or roughly 25 grams (6 teaspoons) per day would provide additional health benefits.

> Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

> The WHO guideline does not refer to the sugars in fresh fruits and vegetables, and sugars naturally present in milk, because there is no reported evidence of adverse effects of consuming these sugars.

> Reducing free sugars intake to less than 10% of total daily energy intake was recommended by the WHO Study Group for the first time in 1989 and was further elaborated by a joint WHO/FAO Expert Consultation in 2002. This new updated WHO guideline calls for further reduction of free sugars intake to less than 5% of total energy intake if possible.

http://www.who.int/mediacentre/news/releases/2015/sugar-guid...

Public health tends to ignore the sugars in fruit if you eat the whole fruit. As soon as you juice it or blend it or sometimes cook it they want you to count it as sugar.

Why do you consider the smoothies from Innocent Drinks as healthy? I've always considered those as something bad for the health and I'm not sure they are marketing it as healthy.

Is this sarcastic? Look at the name of the brand, fer chrissakes

I'm a non-english speaker so it was not so obvious for me.

The general public sees fruit juices and smoothies as healthy. Public Health England had to issue advice asking people to limit their juice consumption and telling them not to count it as more than one of their "five a day".

They market themselves as healthy.

  > our quest to make natural, delicious, healthy drinks that help people
  > live well and die old. [1]

  > They're healthy and they're all absolutely delicious. [2]

  > As fruit and veg experts, we make tasty, healthy, convenient ways to
  > help people get more fruit and veg into their diet. [3]

  [1] http://www.innocentdrinks.co.uk/us/our-story

  [2] http://www.innocentdrinks.co.uk/super-smoothies

  [3] http://www.innocentdrinks.co.uk/us/nutrition

Yes, we need a radical change of diet if we want to live healthier, for example to fight type-2 diabetes.

Unfortunately my whole life I see the opposite trend. Everything gets low-fat or even "zero-fat" at the same time being rich with carbs (usually mostly sugar).

Doesn't help that even latest "trendy" eats (e.g. vegan fad) are in general based on carbs as an energy source.

There isn't any need to villainize carbohydrates. In their unadulterated form, derived from whole plant-based foods, it's perfectly reasonable to consume the majority of calories from "carbs". The trouble comes when these sugars are extracted, refined and added to processed foods.

> Carbohydrate provides the majority of energy in the diets of most people. There are many reasons why this is desirable. In addition to providing easily available energy for oxidative metabolism, carbohydrate-containing foods are vehicles for important micronutrients and phytochemicals. Dietary carbohydrate is important to maintain glycemic homeostasis and for gastrointestinal integrity and function. Unlike fat and protein, high levels of dietary carbohydrate, provided it is obtained from a variety of sources, is not associated with adverse health effects. Finally, diets high in carbohydrate as compared to those high in fat, reduce the likelihood of developing obesity and its co-morbid conditions. An optimum diet should consist of at least 55% of total energy coming from carbohydrate obtained from a variety of food sources.

> The bulk of carbohydrate-containing foods consumed [are recommended to] be those rich in non-starch polysaccharides and with a low glycemic index. Appropriately processed cereals, vegetables, legumes, and fruits are particularly good food choices.

http://www.fao.org/docrep/W8079E/w8079e08.htm

A ~350ml can of Coke contains 39 grams of sugar [1]. A ~600ml 'Vitamin water' drink has 31 grams of sugar. A single McDonalds 'McFlurry' dessert has 64 grams of sugar [2].

Yes, you should not consume these. Drink water instead and have a small ball of real Italian ice cream when available.

You probably should also not eat all of your French fries too as starch is also easily turned into sugar inside your body.

Problem is that they also add syrup inside your burger and white bread turns into sugar inside your body.

TL;DR Avoid McDonalds.

There's nothing wrong with starch (a complex carbohydrate of plant origin), nor its metabolization into sugar in the body. After all - sugar is the body's preferred energy source. A plain baked or boiled potato, especially sweet potato, is actually quite a healthful food. Just ask the traditional Okinawans, the longest living cohort documented.

Now, this is definitely not a recommendation to eat McShit's, but your fear should be directed at the oil (fat) the fries are coated in, as well as the added salt, added sugar, and deep frying method of cooking.

There's nothing wrong with starch (a complex carbohydrate of plant origin), nor its metabolization into sugar in the body.

Starch, for example, is a polymer of glucose units and is typically broken down to glucose.

The most important carbohydrate is glucose, a simple sugar (monosaccharide) that is metabolized by nearly all known organisms.

Doctors and scientists once believed that eating complex carbohydrates instead of sugars would help maintain lower blood glucose. Numerous studies suggest, however, that both sugars and starches produce an unpredictable range of glycemic and insulinemic responses.

https://en.wikipedia.org/wiki/Carbohydrate_metabolism

"Actions to take" section:

1. Reduce and rebalance the number and type of price promotions in all retail outlets including supermarkets and convenience stores and the out of home sector (including restaurants, cafes and takeaways)

2. Significantly reduce opportunities to market and advertise high sugar food and drink products to children and adults across all media including digital platforms and through sponsorship

3. The setting of a clear definition for high sugar foods to aid with actions 1 and 2 above. Currently the only regulatory framework for doing this is via the Ofcom nutrient profiling model, which would benefit from being reviewed and strengthened

4. Introduction of a broad, structured and transparently monitored programme of gradual sugar reduction in everyday food and drink products, combined with reductions in portion size

5. Introduction of a price increase of a minimum of 10-20% on high sugar products through the use of a tax or levy such as on full sugar soft drinks, based on the emerging evidence of the impact of such measures in other countries

6. Adopt, implement and monitor the government buying standards for food and catering services (GBSF) across the public sector, including national and local government and the NHS to ensure provision and sale of healthier food and drinks in hospitals, leisure centres etc

7. Ensure that accredited training in diet and health is routinely delivered to all of those who have opportunities to influence food choices in the catering, fitness and leisure sectors and others within local authorities

8. Continue to raise awareness of concerns around sugar levels in the diet to the public as well as health professionals, employers, the food industry etc, encourage action to reduce intakes and provide practical steps to help people lower their own and their families sugar intake

A "sugar tax" is not a bad idea if it is ringfenced to creating a healthier environment and funding NHS obesity-related treatments.

The problem is that this type of tax will be subsumed within general taxation.

what about a "healthy food tax" ringfenced for funding the costs of end of life care for people with longer life expectancy??

<sarcasm>Isn't this a very cynical pov? On the same grounds I could argue for trolls to be euthanized instead of feed. </sarcasm>

Yes, Minister made a similar joke that people who died from smoking tobacco are doing society a favor by limiting the need to spend money on elderly care and pensions.

Except it's not a joke, it's probably true [0] :

Research by the Institute of Economic Affairs argues that a tax on fatty food could actually increase the burden on the health system and unfairly penalise the poor.

Dr Barrie Craven from the Department for Education at the University of Newcastle, who co-wrote the IEA report, said: "It is commonly assumed that obese people are a disproportionate burden on the NHS.

"By 56, the obese are the most expensive but not over their lifetime.

"We have to remember that the obese and smokers tend to die earlier and the healthy incur very expensive 24 hour care later in life for diseases such as dementia."

[0] http://www.telegraph.co.uk/news/health/news/9359212/Obese-an...

Why do you think it is important that the use of the tax be ringfenced? My view would be that the aim of the tax would be to nudge people into changing their behaviours, and it will do this whether the resulting income goes into funding obesity related treatments or just into the general taxation pot.

Also, hypothecation doesn't really seem to me to rise above the level of a PR labelling exercise -- if sugar tax income is all spent on NHS obesity programmes, then the government will simply reduce the amount of NHS funding from the general pot correspondingly. Further, you get awkward effects if peoples' behaviour really does change where obesity programmes could end up underfunded because the sugar tax income falls. Better to just fund them to the right level from the general pot, I think.

The issue is that if the tax is successful, and revenues start to fall from that particular source due to fewer sugary foods, there may be an instinct on the part of politicians to make up that money elsewhere.

A good example in the US is cigarette taxes - while originally designed to fund cancer treatment and anti-smoking initiatives, a lot of states have come to depend on the revenue from those taxes. As more people switch to e-cigs, which are not taxed and offer big cost savings, states are talking about taxing e-cigarettes similarly.

If the goal of the cigarette tax was harm reduction, presumably there's some incentive to have people smoke e-cigarettes instead of regular tobacco - but the real concern is the loss of the tax revenue the state has come to depend on. Ringfencing (theoretically) discourages this.

One of the big issues is that councils "fund" public realm changes from the central government grants.

I do a lot of work with my local council to deliver better child safe cycle infrastructure. The Local Sustainable Transport Fund is coming to an end in 2016. Cycle City Ambition Grant money is an ad-hoc grant that only impacts 8 cities and many transport ideas would take years to deliver.

Providing a national "fund" that councils could put together projects and then "bid" for funding with a focus on delivering healthy transport options (walking/cycling/public transport) would enable the delivery of huge long-term health benefits.

One of the reasons London does so well with some of the cycling schemes is that there is a committed 10-year plan to invest in cycling. Without this type of financial commitment you don't get a good safe network. You get little bitty pieces of ad-hoc infrastructure that the council hopes to connect together eventually IF future grants become available.

Yup, UK doesn't do hypothecated taxes. In any case, if they do this correctly it should be revenue neutral because the only possible justification for this - the one used by all the public health activists - is there are negative externalities which need to be compensated for, which makes this a Pigouvian tax [0] and PTs are supposed to be revenue neutral (though see the wiki for the huge amount of complications in making this so).

[0] https://en.m.wikipedia.org/wiki/Pigovian_tax

I'm not in favour of such a tax, but even if I were I would object to much of that. 1 through 4 and 6 through 8 fall somewhere on a spectrum from redundant to positively Orwellian.

What the hell? Educating people on healthy eating is Orwellian? How...

It isn't. Manipulating 60+ million people's choice architecture (as per e.g. 7) on the other hand certainly is. YMMV but either way it's still redundant if adding a tax as a market correction functions as expected. If it doesn't, there isn't a market solution so the tax is redundant.

And if there turns out to be no negative externalities as per the IEA, then the whole thing is just one big Orwellian exercise in public health authoritarianism. But don't concern yourself, it's for your own good and won't someone think of the children ?

We stopped buying raw sugar as well as things with added sugar at the grocery store. We also stopped buying juice and obvious junk food like potato chips. We still buy whole milk and bacon and cheese and pasta.

It was hard at first, but we still have sugar in various forms around the home to use on occasion. We're buying more fruit now too, but eat less than it takes to make the juice we eliminated.

We're losing about one pound per week, with no change in activity levels. So that's crudely about 500 calories per day, each. We have sweet things for social reasons, or to celebrate. The trick is just to avoid buying them so you can't eat them when you get hungry. Once we get down to our target weights I imagine we'll buy more.

It's really quite shocking when you stop buying sugar, just how many of your usual purchases you end up putting back on the shelf.

Sugar is an odd substance. It's made up of glucose and fructose. Glucose tells your body to store fat and "use me" while your liver is converting the fructose to fat.

At least where I come from, domestic use sugar is almost entirely sucrose. Glucose and fructose are available but they're very much specialist products (for baking, jam-making, etc). They're certainly not something you put into tea.

Sucrose breaks down into glucose and fructose. https://en.wikipedia.org/wiki/Sucrose

sucrose is an 50/50 glucose/fructose combination: https://en.wikipedia.org/wiki/Sucrose

But yeah, it's all sucrose except for 'dextro energy' (glucose==grape sugar) or baking.

Sucrose is composed of glucose and fructose, connected by a single chemical bond. That bond is quickly broken after the sucrose enters your body. As a result your body reacts to sucrose in broadly the same way as it would to a 50-50 mixture of glucose and fructose.

So cutting down on the sugar should tell the body to use more fat as an energy source, yes? In your opinion, where can I read about this stuff without resorting to websites that make extraordinary claims about crazy diets without any scientific basis? Or do I have to stick to publications?

This is probably a good start http://thatsugarfilm.com/

I suggest some of Lyle McDonalds articles for a start, for example

http://www.bodyrecomposition.com/fat-loss/how-we-get-fat.htm...

http://www.bodyrecomposition.com/fat-loss/the-fundamentals-o...

In case you like his writing, he's the author of a couple of high quality books.

So cutting down on the sugar should tell the body to use more fat as an energy source, yes?

Actually, he answers that almost directly here:

http://www.bodyrecomposition.com/nutrition/nutrient-intake-n...

They should probably just copy whatever we've been doing in the US. Our sugar consumption has been falling since the late 90's.

https://pbs.twimg.com/media/CUsIUgdVAAA-pu3.jpg

(Obesity has continually increased, however.)

Does that chart include the corn syrup and other substitutes?

Yes. Jozan also just posted a link to a more detailed breakdown:

https://upload.wikimedia.org/wikipedia/commons/3/39/US_Sweet...

HFCS article [0] on Wikipedia has a bit more detailed graph [0] about sugar usage in comparison with other sweeteners (high fructose corn syrup etc.) in the US.

[0] https://en.wikipedia.org/wiki/High_fructose_corn_syrup

[1] https://upload.wikimedia.org/wikipedia/commons/3/39/US_Sweet...

Average consumption at least. It's still the poorer layers of society who suffer the most obesity problems, so it would be interesting to see a graph of their average consumption.

The highly-refined super-sugary foods are typically the cheap stuff, so intuitively a sugar-tax and advertising ban should help target those most vulnerable to obesity.

Maybe your sugar consumption dropped but remember many food companies started to sweeten things with concentrated fruit syrup, HFCS, honey, agave nectar etc. It's still all sugar.

As it has in the UK [0][3] and most of the developed world [1]. In the UK official data shows per capita calorie consumption has also fallen since the 1970s [0]. Obesity, similarly is on the rise. Something we have seen a rise in over the same time is heating in homes and other places [2]. I'm unable to quickly locate reliable data for calories burned by exercise or work but it seems a reasonable hypothesis that in the UK being cosy and sedentary is making up for the big drop in calorific intake.

Anticipating down votes for sources but do please study the data and where it's taken from.

[0]http://www.iea.org.uk/sites/default/files/in-the-media/files...

[1]http://www.comitesucre.org/site/the-inconvenient-truth-about...

[2]https://www.gov.uk/government/uploads/system/uploads/attachm...

[3] http://www.ifs.org.uk/bns/bn142.pdf

Note that sugar consumption has been falling since the 1970s in the UK. Strangely this "evidence" is not mentioned.

Note that our environment has changed significantly since the 1970s, with a propensity for many people to go from A to B by car and generally exercise less.

I see a sugar tax as a way of creating a fund to enable councils to implement healthy travel options (protected cycle to school networks, discounted public transport, public transport networks) and mitigate the cost of obesity-related diseases to the NHS.

Except it won't - it will end up in the general taxation pool, and spent on anything, including foreign aid, unemployment, defense

God forbid we get healthier as a nation and help those less fortunate than us at the same time!

why introduce a financial penalty on sugar consumption itself if it is not a major factor in rising obesity and other health problems?

I agree that this would be a good use of new funds. But perhaps a deeper problem is that these areas are so underfunded as it is. We treat road transport as "essential infrastructure" whilst provision for healthy options are treated as an expensive luxury.

Public transport isn't a "healthy travel option". This just goes to support the worry of another commenter that this will just go into the general taxation pool to support various programs that may or may not have anything to do with sugar and/or health.

Public transport usually involves a short walk to a stop, making it a healthier option than private cars.

While what you say is true, taking public transport makes people move around more: going to/from the bus-stop, changing at connections, standing up in the metro instead of sitting etc.

Here is a study on this subject: http://www.bmj.com/content/349/bmj.g4887 Its conclusion: "Men and women who commuted to work by active and public modes of transport had significantly lower BMI and percentage body fat than their counterparts who used private transport."

Public transport is recognised as a "healthy" travel option as it contains a walking/cycling element. If it replaces your car use, then it also impacts pollution/congestion.

Do you have link to evidence to backup that claim?

In my view sugar has been used more and more as an extra ingredient in other foods. Additionally, there are different kinds of sugar, which may influence your statistic: http://thatsugarfilm.com/blog/2015/03/16/added-sugar-vs-natu...

I thoroughly recommend watching That Sugar Film.

Could you provide sources? I am interested in this topic and would love to read more then just a stated "fact" as an answer to missing "evidence".

See "Household food expenditure and consumption and nutrient intake – 1974-2000" on the following page:

http://webarchive.nationalarchives.gov.uk/20130103014432/htt...

The statistic points at an average of 100grams of sugar per person per week in 2000. Considering that a single can of coke already contains 30 grams of sugar, the statistic seems to indicate raw sugar intake, and not added sugar or other sugars.

Still not convinced reducing sugar is going to stop childhood or adult obesity. The large part of it is simply because food is too convenient. With many foods having no preparation requirements it becomes easy for food to fill idle time.

The easiest route to reducing over eating of foods that don't complement a sedentary diet would be to restrict food assistance programs. Instead of just saying "No" to certain purchases it should instead reward specific food type purchases. You could put a punitive value on some allowed but not good for you foods in necessary but rewarding good choices is better than punishing bad.

Still their 25g is less than one ounce... how do you do that on a normal day?

What a surprise: a Government-appointed committee recommends increasing taxes.

It's a specific consumption tax. It's not like they are proposing a 2% hike on income tax.

Even worse - in addition to it being more tax, it's in a form that disproportionately harms poor people.

If making more nutritionally balanced foods cheaper relatively to foods with a lot of associated health problems is taken as "harm", then yes.

If a family is struggling financially, a sugar tax could easily push them over the edge. This strikes me as an increase in taxes for the poor as the impact relative to their income (as a %) would be significantly higher. So, the financial strain and stress would likely offset any benefit from reduced sugar for the poor. There were good posts about people on the poverty line on HN yesterday as a case in point.

If the tax is restricted to "high sugar soft drinks"[0] do you still think that there wouldn't be alternatives for a struggling family to purchase?

0 - https://www.gov.uk/government/uploads/system/uploads/attachm...

So you really think it's ethical to use taxation and the threat of bankruptcy to coerce people to change their sugar habits? Honestly?

Just checking: Are you talking about the UK?

Me? Not really - I don't think the morality of compulsory taxation is dependent upon geography.

No, not you. Rustynails.

Well, no argument here about consumption taxes on "food" being regressive. :)

Edit: adding scare quotes because coke may not be food, but bread is!

Out of curiosity, are you against higher taxes on alcohol? It's definitely regressive, but there is also a more definite link to harmful effects (side-stepping somewhat the issue of taxes on necessary items like food).

I'm against compulsory taxes in general, and especially so called 'sin taxes' on alcohol, tobacco and gambling.

"Harm" here defined by making those poor people buy more expensive but much healthier food.

It is indeed harmful from some point of view. But reducing it into an unconditional label is too much unidimensional thinking.

I don't drink, smoke nor do any type drugs (caffeine exempted). I am addicted to soda! I have gotten better but for a good 12 years I bet I drank 1.5 gallons of soda a day. I am down to 1 gallon a week or less. Hard to beat this consumption of sugar.

Try substituting sugary drinks with a serving or several of whole fruit.

One idea is to unceremoniously slam down a glass of water before you drink the sugary drink. Don't use sugar water to quench a thirst.

I drink 32 oz of water in the morning and 40 oz of tea before lunch.

Why not drink diet/zero versions of your soda then?

One good reason to avoid "diet" soda is they contain artificial sweeteners, such as aspartame, which encourage sugar craving and sugar dependence - the opposite effect desired by the parent.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/pdf/yjbm...

It's still better than drinking the "normal" versions.

Well "Science" says differently. I was drinking diet soda instead and my Doctor told me to just go back to soda and cut back (I did by like 90% but that 10% is still to high):

> Conclusion :These results suggest that diet soda has adverse effect on the cerebellum of adult female albino Wistar rats. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3824455/

It actually is the de-sweetening not the abstinence of sugar: > In light of these findings, a similar approach might be used to reduce sugar intake. Unsweetening the world’s diet [15] may be the key to reversing the obesity epidemic. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2892765/

Their experiments showed that artificial sweeteners can alter the mix of bacteria in the guts of mice and people in a way that can lead some to become glucose intolerant. http://www.npr.org/sections/thesalt/2014/09/17/349270927/die...

More bureaucracy. If they really wanted to decrease sugar usage, they could require poison labels on fruits, and any product with more than 5 grams of sugar, as well as any ads for these products.

Why can't they just leave us alone?

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