63. The Current Debate about Sugar

Sugar is definitely in the news these days. The “Action on Sugar” campaign has certainly hit the airwaves but has been challenged by The Grocer with various articles including one with the headline “Action on Sugar Case is ‘pretty weak’ “. Hence there is great interest in the forthcoming report from the Scientific Advisory Committee on Nutrition currently being prepared by a Group under the chairmanship of Professor Ian MacDonald. This is due to be released next summer.

First of all there are questions about the “independence” of the chairman and several members of the group because of their association with the food industry. Professor MacDonald has links with Mars and Coca Cola but as these have been declared the Department of Health is satisfied that there is no conflict of interest. Not everyone would agree. However what concerns me much more is some of his views on information which is highly relevant to the conclusions and recommendations expected in the report.

In The Grocer he has stated that:

“Certain people have said that people should no longer be concerned about their intake of satfats and that it is about reducing sugar .That’s nonsense and utterly condemns the work that has been done to reduce the satfat intake.”(1)

In fact the case for reducing saturated fat (SFA) has been discredited as demonstrated by the recent article in the British Medical Journal (2). In a comment on that article I pointed out that according to the National Food Survey the intake of SFA had fallen from 56.7 g/day in 1969 to 29.2 g/day in 2000(3).

In 1984 the official Committee on Medical Aspects of Food Policy (COMA) recommended that the SFA intake should be reduced from 20% of food energy to 15% as part of a strategy to reduce cardiovascular disease (4). This target was reached by 2000(5). Currently the amount of SFA in the British diet is 12.7% of energy. Over this period the incidence of obesity has continued to increase. In men it has doubled since 1993, which is when detailed information was first collected (6). What is especially disturbing is that since 1994 the incidence of diabetes has more than doubled for both men and women (7).

The government Responsibility Deal with the food industry aims to reduce the SFA level even more to 11% of energy in the hope and expectation that there will be a reduction in “ the risk of premature avoidable mortality from cardiovascular and coronary heart disease”(8). As it is evident that reducing saturated fat in the past has not delivered the expected results in the past, is it really credible that the same strategy will work in the future?

It is worth mentioning that Albert Einstein has defined insanity as doing the same thing over and over again and expecting a different result!

In fact a recent meta-analysis of numerous investigations has concluded that there was

“no significant evidence to conclude that dietary saturated fat(SFA) is associated with an increased risk of CHD, stroke or CVD”(9).

In the Responsibility Deal website (8) it is somewhat ironic that many of the comments are highly critical. Examples include:

• How about you prove first to us citizens that saturated fat is bad. There is absolutely NO STUDY proving this ‘hypothesis’. People are getting fat because of SUGAR and CARBS!
• I can’t believe that government websites are advocating this information…. Sugar and carbs are the most likely causes ……..Why is the population fooled over and over by false information?!!?
• This has to be a joke, right? Its starches, sugar and carbs that are making people fat and sick. NOT the saturated fats. Now people will eat more sugar, carbs and starches because they will be more hungry – ultimately making them fatter, sicker have more cravings for even more sickening starches, suger and carbs. Please do some serious research

• Sugary carbohydrates cause weight gain and diabetes NOT saturated fats

These views indicate that there is growing awareness that one of the key problems with the current pattern of consumption in this country is excessive sugar and carbohydrates not SFA.

It is crucial to recognise that the term “saturated fat” consists of a range of chemical entities which usually contain an even number of carbon atoms the smallest being butyric acid with 4 and behenic acid with 22. Here is a brief selection of some of the functions/benefits of SFA (11):

• Cell membranes require SFA to be “waterproof” in order to function properly
• The heart prefers the long chain fatty acids palmitic acid(16 Cs) and stearic acid (18 Cs) to carbohydrates to carbohydrates as a source of energy
• Bones need SFA in order to assimilate calcium effectively.
• The short and medium chain length fatty acids, which have up to 12 carbon atoms do not need to be emulsified by bile salts and so are rapidly absorbed into the blood stream from the small intestine. They are especially valuable because they boost the immune system and possess anti-microbial, anti-viral and anti-tumour properties. Lauric acid (C12) is particularly effective
• It is now known that the LDL cholesterol exists in particles which vary in size. At one end of the extreme they are densely packed and it is now believed that these particular ones initiate the damage which ultimately results in coronary heart disease. At the other end are the large fluffy particles which are relatively benign. SFA in the diet favours the formation of the large particles.

There is now a very large volume of sound research which leads to the inevitable conclusion that those who are attempting to comply with the official advice to reduce SFA are not improving their health and are almost certainly damaging it. Not only are they missing out on valuable nutrients they are also increasing omega-6 polyunsaturated fats. This pushes up the omega-6:omega-3 ratio thereby increasing the requirement for omega-3s(12) but they are also increasing intake of carbohydrates which contributes to the development of obesity and a range of chronic diseases.

Sources of SFA such as butter and various meats also contain a selection of other key nutrients such as vitamins which will be lost to the diet by those who take steps to limit their intake of SFA.

With reference to sugar Professor MacDonald has claimed that:

“The consumption rates are a bit higher than they were in the 1960s, but not excessively so. Consumption hasn’t trebled.”(13). How on earth can he justify this statement?

The graphs below show that how the increase in sugar consumption based on data from the UK and the USA relates to the increase in obesity which appeared in the paper by Richard Johnson and colleagues(14).

FIGURE 1

Sugar intake per capita in the United Kingdom from 1700 to 1978  and in the United States from 1975 to 2000 compared with obesity rates in the United States in non-Hispanic white men aged 60–69y. Values for 1880-1910 are based on studies conducted in male Civil War veterans aged 50–59 y.

Subsequently data for Great Britain shows that between 1975 and 2000 there has been a 5-fold increase in the amount of soft drinks purchased for consumption in the home (Table 1). The National Food Survey did not collect comprehensive information on purchases such as snacks which were consumed outside the home so the total consumption of soft drinks would have been higher than the figures indicate. Soft drinks are a major source of sugar and there can be no doubt that this huge increase in consumption must have resulted in a substantial increase in the intake of sugar.

TABLE 1 CHANGING DEMAND FOR SOFT DRINKS

Source: National Food Survey

Over the same period, consumption of processed foods, many of which contain sugar has increased. With the demonization of fat, especially SFA in the mid-eighties, numerous new “low fat” versions of foods were developed. It was extremely common for the fat to be replaced by sugar. Yoghurt is a good example. It is inevitable that these trends contributed even further to the amount of sugar being consumed.

Confirmation is provided by the phenomenal increase in diabetes. The fact that the incidence of this disease has doubled in the last 15 years simply cannot be ignored (7). Type 2 diabetes is caused by excessive sugar and refined carbohydrates in the diet.

Those with diabetes have an increased risk of developing obesity, hypertension, heart disease and even Alzheimer’s Disease so the rapid rise (not to mention the projections into the future) must be regarded as the major contemporary public health issue. If the review does not accept that this is caused by the current level of sugar consumption and that there must be a concerted effort to achieve very considerable reductions then it must recommend an alternative strategy which will deal with this issue effectively.

Finally the distinguished German scientist Otto Warburg discovered that cancer cells can only survive with sugar as the source of energy. There are numerous case studies of cancer patients who have recovered by eliminating sugar from their diet!

REFERENCES

1. http://www.thegrocer.co.uk/topics/anti-sugar-mood-change-is-perilous/353683.article
2. http://www.bmj.com/content/347/bmj.f6340
3. http://webarchive.nationalarchives.gov.uk/20130103014432/http://www.defra.gov.uk
4. Department of Health and Social Security (1984) “Diet and Cardiovascular Disease” London: HMSO
5. http://webarchive.nationalarchives.gov.uk/20130103014432/http://www.defra.gov.uk
6. Health Survey of England 2010 Adult Trend Tables
7. Health Survey for England 2009
8. https://responsibilitydeal.dh.gov.uk/new-saturated-fat-pledge/
9. P. Siri-Tarino (2010) American Journal of Clinical Nutrition 91 (3) pp. 535-546
10. http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD002137.pub3/full
11. Mary Enig(2000) “The Skinny on Fats” http://www.westonaprice.org/know-your-fats/skinny-on-fats?
12. https://vernerwheelock.com/?p=153
13. http://www.theguardian.com/lifeandstyle/2013/sep/07/sugar-diet-who-uk-experts
14. R J Johnson et al (2007) American Journal of Clinical Nutrition 86 (4) pp899-906