June 24, 2014

Defining Added Sugar

 
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People seem to enjoy foods with sugar because they taste good; or that for decades their taste buds have been retrained to enjoy that taste. Research using brain scans show that sugar releases dopamine in the brain and causes a pleasurable sensation. Currently the Nutritional Facts Label lists all sugars (both naturally occurring and those that have been added - sugar, HFCS, honey, corn syrup, etc) as “Sugars.” The White House has taken the lead on breaking down sugars into two categories: Sugars and Added Sugars as research shows that consumers are confused into believing some products that have healthy naturally occurring sugars may have too much sugar, and avoided them. For example, 100% orange juice can offer a range of nutrients and only contains naturally occurring sugars. 

While the new recommendation of the addition of “Added Sugars” under Sugars will differentiate added and naturally occurring sugars in products, Americans still continue to consume too much sugar of all kinds.  Reduction of sugar intake continues to be an issue of education for consumers (how those sugars are actually metabolized into their bodies) and how to eat a balanced diet.

First off, what is Added Sugar?

Added sugar is any caloric sweetener not naturally found in a food. It can be sugar/sucrose (from sugarcane or sugar beet processings) which is half fructose and half glucose. Sucrose is often used in cold dairy products such as ice cream. Fructose (a monosaccharide or simple sugar) can be used as high fructose corn syrup and although it is made of fructose and glucose like sucrose it is thought to be the most evil of sugars.  

The new regulation of Added Sugar will help people distinguish between the natural sugars found in fruit, vegetables, milk, 100% juice (versus fruit drinks), and sugars added arbitrarily. The proposed nutritional label changes for Sugar will “make it easier than ever to judge a food by its label,” said FDA Commissioner Margaret A Hamburg, M.D. The rule changes may illuminate food content that many consumers may find surprising and it may help us focus more on health and wellness.

“Healthy” Added Sugars:

Some products containing Added Sugar are marketed as “natural” because those sugars come from Agave nectar, raw honey or coconut palm sugar. Agave syrup has 70% fructose which is actually more than high fructose corn syrup. In the Huffington Post’s “Top 10 Food Label Tricks to Avoid in 2012”, Dr. Robert J. Davis states, “Just because a product contains an alternative to HFCS -- whether sugar, fruit juice concentrate, brown rice syrup or agave nectar -- doesn't necessarily make it more healthful.” He concludes, “All caloric sweeteners, if consumed in excess, can contribute to obesity and related health problems.”  

It is important to work with a Registered Dietitian at your local retail market or your personal physician to understand the level of caloric sweetener intake that is right for your body. While the Dietary Guidelines for Americans are updated every five years, the labels that consumers rely upon to inform them about ingredients are less consistent.

Consumer Clarity:

Gail Rampersaud, M.S., R.D.N., L.D.N., University of Florida, Florida Department of Citrus, explains, “Your body doesn’t know the difference between added sugar or natural sugar from a metabolic standpoint. Where the difference comes in is what nutrients and how much of them are traveling with those sugars. You have to look at the total package. I really think that the addition of Added Sugars on the label will help with that confusion and am encouraged that it will help differentiate nutrient dense beverages from others.” Gail points out that we need to “reduce our intake of calories from solid fats and added sugars (emphasis on beverages with added sugars) and eat more nutrient dense foods and beverages. Naturally-occurring sugars like in 100% orange juice will be more obvious to consumers who will start to see what beverages give you nutritious calories.”  

Gail Rampersaud gives five excellent reasons why to drink 100% orange juice in her INTERVIEW HERE. Additionally as a side note, some consumers may think “From Concentrate” orange juice is with more sugar, but that is not the fact. The difference is in how the fruit is processed.

The Context of the Diet:

Kristine Clark, PhD., RD, Director, Sports Nutrition, Assistant Professor, Penn State, spoke with The Food Journal about how sugar can be linked in the minds of consumers to obesity. “Ultimately what the researchers are showing is it’s not sugar that causes weight gain, but excess calorie consumption and inadequate energy expenditure. It’s not a simple one size fits all especially with genetics playing an increasing role. If we took people all overweight by ten pounds, with similar diets, and gave them 16 tablespoons of raw sugar every day to see what happened, if nothing happened, we can’t say sugar is causing something. Say two of the 100 people broke out in hives, could we say sugar cause that?” READ FULL INTERVIEW WITH KRISTINE CLARK HERE

With Added Sugar, it continues to be up to the consumer to take charge of all aspects of their heath as nutrition science expands. According to the FDA's web site on Guidance & Regulation, “The government has no specific recommendation for added sugars. Including added sugars on the new Nutrition Facts label would allow consumers who want to limit their added sugar intake to compare various brands of similar products.”

Interview with Gail Rampersaud, M.S., R.D.N., L.D.N., University of Florida, Florida Department of Citrus

Food Journal:  I would like to open with a discussion about the proposed FDA new labeling of sugar, calling out “Added Sugars”. Will this cause, in your opinion, consumers to shy away from products that are nutritious? 

Gail Rampersaud: I think that the potential change with the declaration of Added Sugars on labels will help consumers.  Naturally-occurring sugars like in 100% orange juice will be more obvious to consumers who will start to see what beverages give you nutritious calories. Generally, beverages or other food products with added sugar do not have the wide range of nutrients that products with natural sugars have. What needs to be done overall is to align the nutrition facts label with dietary guidelines. We need to reduce our intake of calories from solid fats and added sugars (emphasis on beverages with added sugars) and eat more nutrient dense foods and beverages. The Dietary Guidelines for Americans are updated without fail every five years while labels don’t have updates consistently.  

The Food Journal:  Orange juice is particularly in the spotlight in the sugar debate. It has typically 21g of sugar in an 8-ounce serving. What is the breakdown of all natural and added sugars per serving?

Gail Rampersaud:It is really important to understand there is no added sugar in 100% orange juice. All naturally occurring sugar comes from the whole fresh oranges. The grams of sugar may vary somewhat in the USDA database, values on the carton or in other databases. There is consumer confusion because there are so many choices now in the beverage aisle in the grocery store with fruit flavored beverages, drinks or cocktail aids. These beverages typically have added sugar. If the label says 100% orange juice by FDA rule, there is no added sugar. Added sugar also has nothing to do with whether orange juice is from concentrate or not. That is simply the difference in how the fruit is processed (http://www.orangejuicefacts.com/faq.html). If “from concentrate”/ “not from concentrate” confuses consumers, this issue can be cleared up by simply looking for the words “100% fruit juice” or “100% orange juice” on the label to make sure they are choosing a nutritious beverage that is 100% juice.

Food Journal: What are some of the misconceptions about “sugar” in general?  

Gail Rampersaud: My colleagues and I published a paper on research findings for consumer perceptions related to sugar in beverages – how much they knew about natural sugars versus added and artificial sugars – and there is a lot of confusion. A lot of information in the media is also adding to that confusion. Your body doesn’t know the difference between added sugar or natural sugar from a metabolic standpoint. Where the difference comes in is what nutrients and how much of them are traveling with those sugars. You have to look at the total package. I really think that the addition of added sugars on the label will help with that confusion and am encouraged that it will help differentiate nutrient dense beverages from others.  

The Food Journal: Vitamin C is a key component of orange juice that distinguishes it as a nutritional beverage to other fruit juices?  What are the other benefits, and why should orange juice be in the diet?

Gail Rampersaud: I have five reasons: #1. 100 % orange juice counts towards daily fruit intake. Americans don’t eat enough fruit. 8 out of 10 Americans are not getting enough fruit. 8 oz of 100% orange juice is equal to one cup of fruit for the day which can account for about half of the two cups recommended for many adults.  #2.  Nutrient density. I did an analysis a few years ago where I compared nutrient density among seven different commonly 100% fruit juices, and along with orange juice, only grapefruit juice came out on top. A lot of consumers think about the Vitamin C content for orange juice but 8 oz is also a good source of potassium and folate (under consumed in the US) as well as thiamin, while providing in lesser amounts other vitamins and  minerals like Vitamin B6 and magnesium. #3. There is no added sugar. #4. Hesperidin, a phytochemical/flavonoid found in 100% orange juice, is supported by emerging research that says it may provide benefits for healthy blood pressure and blood vessel function. 100% orange juice is the only commonly consumed food that contains a significant amount of hesperidin.  #5. Research suggests that adults and children who consume 100% orange juice have better overall diet quality and intake of some nutrients compared to those who don’t drink 100% orange juice. We don’t have research for that with beverages that contain added sugar .  

Good taste is also important to consumers and orange juice has that. We should recommend that people eat whole fruit first, but people are busy, and orange juice is a convenient way to complement your whole fruit intake.  

The Food Journal: Do you think sugar is addictive?

Gail Rampersaud: Sugar addiction is an intriguing topic and we are hearing more and more about it. As a registered dietitian/nutritionist, I am not at all an expert in this complex research field dealing with the brain. The important thing for consumers is they have to watch serving sizes, serving amounts, and portion sizes. Follow an overall balanced diet, consuming nutrient dense foods, and stay within daily calorie needs.  

Interview with Kristine Clark, PhD., RD, Director, Sports Nutrition, Assistant Professor, Penn State

Food Journal:  Is the new label the FDA has created for ‘Added sugars’ going to confuse consumers?

Kristine Clark: Confusion will happen for a while until there are more lay articles written on line or in regular magazines for the community interested in nutrition. Without Added Sugar identified, it’s always just been Sugar. When we drink a soda, we may know what we are consuming intellectually. First ingredient is water and next is sucrose or high fructose sugar but I guarantee 50% of the users of soda don’t know that. The real question with the new labeling is does that proportion of the population of user really care about calling out Added Sugar?  That is the real outlier. The general consensus is we are trying to educate a group of people who don’t care.  

The confusion about sweetening agents has gone on for decades. What is nutritive and non-nutritive. The FDA’s labeling rule will fuel more confusion but there will be web site material available.  I am very interested how consumers will interpret.  The impression is that sugar is a villainous ingredient that consumers love to eat. The outcry is sugar is an evil doer. People believe it is a disease- causing ingredient, that it upsets the physiological ecosystem, is the underlying reason for obesity, diabetes, cancer or Lupus. Yet there is zero evidence to the truth behind sugar and caloric sweeteners (the word I would use because it encapsulates all sweetening agents) causing any disease. 

Food Journal:  What do consumers not universally think about with sugar in food?

Kristine Clark: One of the most important conditions to focus on is the consumer adding their own sugar versus the company. A consumer that eats yogurt with no added sugar may find it unpalatable so they will add sugar or a non-caloric sweetener like Splenda, or honey. They may think it is a better alternative than leaving it up to the company that makes the yogurt. The consuming population view honey and Agave as healthier agents when in fact Agave sugar is 70% fructose, 30% glucose. To make a comparison, corn sugar is 42% fructose, 58% glucose, yet it is called high fructose corn syrup. That is funny when Agave has more fructose as a sweeting agent!  

Food does not appear in nature with only glucose in it. In food, natural sugars are found in “blends” of fructose and glucose.  The difference, and somewhat the concern, is the amount of fructose versus glucose in sweeteners. But it’s valuable for consumers to know that the blend of fructose and glucose found in foods is a natural blend. Fruits and vegetables contain this blend of fructose and glucose. These are not “added sugars.” When a food manufacturer contributes to the sweetness of a food by adding sugar or, on the other hand adds a sweetener in order to stabilize a product (keep it moist, such as in a granola bar) then it’s fair to say this is “adding sugar.” The FDA’s new label will point this out to consumers. Confusion exists behind simple sugars too. The simplest sugar is glucose, or Blood sugar. Every time we eat something with carbohydrates in it, it is broken into the simplest sugar, glucose. And, glucose is the body’s best source of energy. The brain, muscle cell and other organ systems rely heavily on glucose for energy. On the other hand, sucrose or common table sugar, is a blend of fructose and glucose, similar to other sweeteners that contain calories such as high fructose corn syrup, honey, agave sugar , brown sugar, maple syrup, and others.  All of these sweeteners or “sugars” are blends of fructose and glucose.  Fructose and glucose blends are natural sugars found largely in fruits, vegetables and even nuts.   Added Sugar would essentially be any sweetening agent not found naturally in the food.  Here’s an example:  Buy an apple that has a honey coating.  The apple has sugar naturally found in it, but the honey is obviously added.  Therefore honey  - even though it is a naturally occurring “sugar” is NOW an added sugar since it was “added “ to the apple that normally doesn’t have it.

Food Journal: You work with a lot of athletes.  How do you advise them nutritionally with sugar intake?

Kristine Clark: We have seven dining halls on campus with eleven potential cereals including oatmeal that are choices for students and student athletes.  I consistently promote cereals that are low in added sugars like Special K, Whole Grain Cherrios or Raisin Bran, but we have data to support that the primary popular cereals are the ones with more added sugar like Lucky Charms, Count Chocula and Captain Crunch.   It’s not that the athletes are saying they like sugar.  They just like cereal that is sweeter.  There is no evidence that this added sugar will do anything harmful.  It becomes available glucose, and that makes ATP or energy for physical activity. 

Athletes are drinking natural fruit juice, but they are also drinking chocolate milk, which is highly promoted as a recovery beverage.  They are drinking Gatorade on the fields and in their playing venue, which has added sugar.  As a Registered Dietitian I try hard to promote drinking the right beverage at the right time for all people I counsel.  Sports drinks with added sugar have a purpose during physical activity.  They not only provide fluids, but they provide electrolytes and energy in the form of sugar.  This is a good thing for people who are exercising.  Fruit juices are excellent sources of vitamins, possibly some minerals, and anti-oxidants.  They also provide carbohydrates for energy.  Chocolate milk provides vitamins, minerals, protein, and carbohydrates for both energy and good health.  There are beverages that I don’t promote.  These include any drinks that do not contribute nutritional value but high calories in the form of sugar.  Most people do not need to drink “extra calories.”  But beverage choices including beer, wine, cocktails, soda, energy drinks are available and enjoyed by many.  In a healthy balanced diet having a moderate amount of these typically will not cause a problem.  The problems occur when excess calories from a wide variety of sources start to add up.   

I am a negotiator. An athlete says, “I love soda, and I cannot give it up, so tell me how many I can drink.”  I would advise, “If you are drinking six now, let’s cut back to three.”  I call myself a sales person for good nutrition and a negotiator for bad nutrition.  If I get them to modify bad behavior it is better than nothing.   At the higher echelon of athletes - like competitors in Triathlons, cycling, swimming - these are athletes who deliberately care about their nutritional health.  They go out of their way to consume foods lower in added sugar.  High school and college athletes view themselves as very invincible and take less caution.

Food Journal: What in your opinion is the key factor that prompted FDA to change the labeling of sugar on products?   

Kristine Clark: The FDA has determined the average American is consuming 16% of total calories from added sugars.  It is too much.  The fact is that these added sugars are coming largely from soda, energy drinks and sports drinks, fruit drinks and a lot of desserts, such as cookies, pastries, donuts, cakes.  For the latter, there is not just sugar in those foods but also fat.  It is a very calorie dense choice.   

Consumer concern about the obesity epidemic is tied into this.  Sugar is linked, not from a research standpoint but from the mind of consumers, to obesity.  Ultimately what the researchers are showing is that weight gain is driven by calorie imbalance. Calorie consumption is excessive and/or energy expenditure (calorie burning) is too low. If you and I ate a candy bar every day and drank a regular soda and ate ice cream and did not gain weight because we were in our calorie boundary, would the general consensus be that sugary foods don’t cause weight gain?  Yet, because weight gain is common the general consensus is that something must be causing it!  We know that sugary foods are popular and consumed in excess.  But, ultimately it’s excess calories.  The calorie excess likely is the culprit versus the ingredient, sugar.  If someone changed their calorie intake, consuming an extra 900 calories a day by eating three additional candy bars yet didn’t compensate on the energy balance equation by burning these extra calories through exercise, they would gain weight.  It is not a single ingredient problem; it is a calorie problem.

The Food Journal:  What about the “hidden” sugars in alcohol? Should they be called out, especially for college students and athletes?

Kristine Clark:  Alcohol is a big contributor of calories. What causes weight gain with athletes is the food they eat with the alcohol. Alcohol is a drug. It goes to the liver where it is broken down into the sugar and sugars are used for an energy source. Because it is a drug, the body tries to get rid of it. The body preferentially uses the calories from alcohol. therefore food calories in excess of what someone can use will be stored energy, or body fat. If an athlete eats breakfast at 2AM because they are drunk, those calories are stored as body fat. 

The Food Journal: Do you think added sugar is addictive?

Kristine Clark:  Recently at the American College of Sports Medicine meetings,  relationships between sugar addiction and food was brought up. What researchers feel is that sugar addiction, like food addiction has not yet been proven. But researchers are saying more research is needed. Some studies have shown that when MRI tests are given places in the brain light up when sugar has been given to the subject. Yet, there is not enough evidence to say certain foods containing sugars or even sugar alone cause addictions.  There are too many questions in an individual diet to make claims such as that.  

If we took people all overweight by ten pounds, with similar diets, and gave them 16 tablespoons of raw sugar every day to see what happened, if nothing happened, we can’t say sugar is causing something. Say 2 of the 100 people broke out in hives, could we say sugar caused that?  

What we have to do is look at food in the situation of an entire diet. What does someone eat most days of the week, how and what does that look like? What does their physical activity look like?  It is not a simple one size fits all especially with genetics playing an increasing role.