Friday July 17 2015
Sugar can cause tooth decay in children
"Sugar intake 'should be halved'," BBC News reports. The headline is prompted by a government report that recommends no more than 5% of our calorie intake should come from "free sugars". The previous recommendation was 10%.
The new advice says children aged 11 or over and adults should consume no more than seven teaspoons of added sugar a day – 30g, equal to less than a single can of Coca-Cola, which contains 39g.
Children should consume much less than that. The report recommends no more than 19g for children aged four to six (around the amount of sugar in a pouch of Capri Sun) and no more than 24g for children aged seven to 10 (around the amount of sugar in a Snickers bar).
The BBC tells us "all age groups in the UK consume twice as much as this limit" (in fact it's at least twice as much), so the gulf between what is good for our health and what we actually do is now wider than ever. The main sources of free sugars are sugar-sweetened drinks, cereal, chocolate, sweets, fruit juice and added sugar at the table.
The Mail Online said that, "Hitting [this] new target will mean cutting out almost all fizzy drinks from diet" and that, "Crisps and chocolate bars will need to become [a] once or twice-week luxury".
Experts generally welcomed the new recommendations, considering them evidence-based and balanced. But some cautioned against too much of a focus on sugar, warning fat is also an important source of calories and should not be overlooked.
The government has accepted the new recommendations, which will be used as part of a wider strategy to tackle obesity.
This report confirms most of us are consuming way too much sugar and it is damaging our health and our kids' health. But it is one thing setting out what people should aspire to eat to be healthy and quite another making it happen.
Read more about practical ways to lower your free sugars to meet the new recommendations.
What is the basis for these reports?
The story follows new recommendations from the Scientific Advisory Committee on Nutrition (SACN).
The SACN advises Public Health England, and other government agencies and departments on nutrition and related health issues.
Dietary carbohydrates, which include sugar and fibre, and their role in health were last considered in reports published in the 1980s and 1990s. Since then considerable new evidence has emerged, SACN says.
In 2008, the Food Standards Agency and the Department of Health asked SACN to provide clarification on the relationship between dietary carbohydrates and health and make public health recommendations. The new report was prepared in response to this request.
How did SACN decide on the new advice?
SACN considered evidence on whether intakes of specific carbohydrates – such as starch, free sugars and fibre – are a factor in the risk for cardiovascular disease, obesity, type 2 diabetes mellitus and bowel cancers. The effect on oral health was also discussed.
The report systematically reviewed evidence from prospective cohort studies and randomised controlled trials – the more high-quality end of the evidence. This gives us confidence the recommendations and advice are based on the best available evidence.
What are 'free sugars'?
SACN used a new term, "free sugars", to describe the types of sugar most of us need to reduce to meet these new recommendations. This term has also recently been adopted by the World Health Organization (WHO).
It replaces the arguably more confusing term "non-milk extrinsic sugars", which has been used for decades but means little to most people outside the nutritional field.
Free sugar means all the different types of sugar we have in our diet, excluding the sugars found naturally in "intact" fruit and vegetables, in milk and milk products. Importantly, most of our free sugar intake comes from sugar added to food and drink by manufacturers.
Free sugars can be found in products you may not expect, including savoury ready meals where sugars are added by the food manufacturer. That is why it is always important to check food and drink labels for nutritional information. Free sugars also include syrups, honey and juice, but not fruit or sweeteners.
PHE's response to the SACN report usefully highlights some differences in the total sugar and free sugar of foods, allowing us to see how we might reduce our intake.
- A typical 330ml can of fizzy cola drink contains 36g of total sugar, all of it free sugars, but the same size can of diet cola contains no sugar, free or otherwise.
- A 125g fruit yoghurt contains 15.9g of total sugar, most of it as free sugar. By contrast, 125g of plain yoghurt with some whole strawberries contains the same total sugar, but none of it as free sugars.
Making these types of swaps can help minimise free sugars and is the way to go.
What are the health risks associated with free sugars?
Since carbohydrate recommendations were last considered in 1991, the evidence that a high intake of free sugars is detrimental to several health outcomes has strengthened.
Something that didn't hit the news was the evidence that total carbohydrate intake has no positive or negative effects on weight gain, heart health, bowel cancer or oral health. The more important issue was the amount of free sugars and fibre in the diet.
Increasing the amount of total calories coming from free sugars in food or sugar-sweetened drinks was linked to:
Eating more fibre, particularly cereal fibre and wholegrain, was linked to:
There were added benefits of eating more bran and isolated beta-glucans, which improved many markers of heart health, including reducing:
- total cholesterol
- LDL ("bad") cholesterol
- triacylglycerol concentrations (another blood fat)
- blood pressure
Free sugars should not exceed 5% of our total dietary energy intake. This applies to all age groups from two years upwards. This halves the old recommendations, which used to advise 10%. In real terms, this means:
- no more than 19g a day of free sugars for children aged four to six
- no more than 24g a day for seven to 10-year-olds
- no more than 30g a day for children from age 11 and adults
No specific recommendations are made for children under the age of two because of an absence of information. But from about six months of age, a gradual change to a more diverse diet that includes more wholegrains, pulses, fruit and vegetables is encouraged.
The SACN says current average intakes in all age groups are at least twice the new sugar recommendations, and three times higher in 11 to 18-year-olds.
The main sources are:
- sugar-sweetened drinks – including carbonated drinks, juice drinks, energy drinks, squashes and cordials
- cereal-based products – biscuits, cakes, pastries and sweetened breakfast cereals
- table sugar
- fruit juice
The SACN advises that consumption of sugar-sweetened drinks should be minimised in children and adults. These new recommendations aim to reduce the risk of obesity and improve dental health.
How has the report been received?
Reactions from experts in nutrition were generally positive, welcoming the new recommendations. Many highlighted how the real challenge lay ahead, concerning how best to help people achieve a lower sugar intake. As we know, people already consume a lot more sugar than the old recommendations.