2019 review: Sugar controversies

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2019 review: Sugar controversies

Post by jimmylegs » Thu Feb 21, 2019 9:00 am

no time to read in detail, but here are some snippets:

Controversies about sugars: results from systematic reviews and meta-analyses on obesity, cardiometabolic disease and diabetes (2016)
fft: https://link.springer.com/article/10.10 ... 016-1345-3

"Fructose-containing sugars are a focus of attention as a public health target for their putative role in obesity and cardiometabolic disease including diabetes. The fructose moiety is singled out to be the primary driver for the harms of sugars due to its unique endocrine signal and pathophysiological role. However, this is only supported by ecological studies, animal models of overfeeding and select human intervention studies with supraphysiological doses or lack of control for energy. The highest level of evidence from systematic reviews and meta-analyses of controlled trials has not shown that fructose-containing sugars behave any differently from other forms of digestible carbohydrates. Fructose-containing sugars can only lead to weight gain and other unintended harms on cardiometabolic risk factors insofar as the excess calories they provide. Prospective cohort studies, which provide the strongest observational evidence, have shown an association between fructose-containing sugars and cardiometabolic risk including weight gain, cardiovascular disease outcomes and diabetes only when restricted to sugar-sweetened beverages and not for sugars from other sources. In fact, sugar-sweetened beverages are a marker of an unhealthy lifestyle and their drinkers consume more calories, exercise less, smoke more and have a poor dietary pattern. The potential for overconsumption of sugars in the form of sugary foods and drinks makes targeting sugars, as a source of excess calories, a prudent strategy. However, sugar content should not be the sole determinant of a healthy diet. There are many other factors in the diet—some providing excess calories while others provide beneficial nutrients. Rather than just focusing on one energy source, we should consider the whole diet for health benefits.
A lesson we can learn from the fat paradigm is that there can be unintended consequences of focusing singly on one nutrient. When saturated fat was deemed harmful, the industry responded by producing low-fat products, with no resultant appreciable calorie change, as in these products calories from fat were replaced with calories from other sources, e.g. starches and other sugars like maltodextrins [7]. The public perception changed as ‘low-fat’ products were deemed ‘healthy’, and a concomitant increase in availability on the supermarket shelf likely led to the overconsumption of such ‘low-fat’ products [148]. Not surprisingly, the expected reduction in cardiometabolic disease with the ‘low-fat’ food was not seen, and instead, we saw an unprecedented increase in incidence of overweight/obesity [149] and diabetes [150].

If a similar approach is taken by the industry who producing ‘low-sugar’ food products, a replay of the above scenario looks likely. Furthermore, the unique functional properties of fructose-containing sugars mean that their replacement is not as easy as it sounds. The functions provided in food products by sugars are related to their sensory (sweetness, taste and aroma, texture and appearance), physical (crystallization, viscosity, osmotic pressure, hygroscopicity, consistency/bulk, grain size and distribution), microbial (preservation and fermentation) and chemical (inversion and caramelization) properties [151]. Therefore, reducing or replacing sugar means one has to replace sugars with several ingredients in order to fulfil the above properties which, in many cases, may not result in calorie reduction [106]. Most commonly sugars are replaced with bulking agents, and most of these bulking agents also provide energy as most are carbohydrate-based, e.g. isomaltulose, sugar alcohols, maltodextrins and starch hydrolysates, and some are fat based. Thus, the calorie reduction in ‘low-sugar’ products might be negligible or in some cases might even increase [106]. Another side effect of a drastic reduction in sugars is that even good sources of sugars might be targeted like whole grains. For example, the calories per serving are the same (110 kcal/30 g) in Frosted Flakes and Reduced Sugar Frosted Flakes despite the total sugar content being 11 and versus 8 g, respectively. Despite appearing paradoxical, the replacement of sugars with refined corn starch means that glycaemic index of the flake product increases from 55 to 75 [152], and such an increase of GI at a whole diet level can potentially be associated with higher rates of diabetes [153]. Evidence from National Health and Nutrition Examination Survey (NHANES) data suggests that while at the population level in USA, consumption of added sugars has decreased in past two decades, there has been an increase in calories from other sources including other carbohydrates, protein and fats—such that average daily calories have not reduced [154].

Conflict of interest
JLS has received research support from the Canadian Institutes of health Research (CIHR), Canadian Diabetes Association (CDA), PSI Foundation, Calorie Control Council, Banting and Best Diabetes Centre (BBDC), American Society for Nutrition (ASN), Dr. Pepper Snapple Group (investigator initiated, unrestricted donation), INC International Nut and Dried Fruit Council, and The Tate and Lyle Nutritional Research Fund at the University of Toronto. He has received travel reimbursement, speaker fees, and/or honoraria from the Canadian Diabetes Association (CDA), Canadian Nutrition Society (CNS), University of Alabama at Birmingham, Abbott Laboratories, Canadian Sugar Institute, Dr. Pepper Snapple Group, The Coca-Cola Company, Dairy Farmers of Canada, Nutrition Foundation of Italy (NFI), C3 Collaborating for Health, WhiteWave Foods, Rippe Lifestyle, mdBriefcase, Alberta Milk, FoodMinds LLC, Memac Ogilvy & Mather LLC, PepsiCo, and Pulse Canada. He has ad hoc consulting arrangements with Winston & Strawn LLP, Perkins Coie LLP, and Tate & Lyle. He is a member of the European Fruit Juice Association Scientific Expert Panel. He is on the Clinical Practice Guidelines Expert Committees of the Canadian Diabetes Association (CDA), European Association for the study of Diabetes (EASD), and Canadian Cardiovascular Society (CCS), as well as an expert writing panel of the American Society for Nutrition (ASN). He serves as an unpaid scientific advisor for the Food, Nutrition, and Safety Program (FNSP) and the Technical Committee on Carbohydrates of the International Life Science Institute (ILSI) North America. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group (DNSG) of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His wife is an employee of Unilever Canada. TAK declares no conflicts of interest.

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