Sweet Talk: Experts Debate Whether to Cut Sugar in Junk Food

March 11, 2015

LONDON — Two experts went head to head today during a debate at the Diabetes UK Professional Conference in London entitled, "It's time to propose further reductions in sugar intake."

On one side of the ring was renowned campaigner Dr Graham MacGregor (Wolfson Institute of Preventive Medicine, London, United Kingdom), a hypertension doctor who has successfully led a movement in the United Kingdom to get the food industry to voluntarily reduce salt in processed foods, which has led to "our salt model now being copied all over the world," he told attendees. Dr MacGregor is chair of the Action Group on Salt, both in the United Kingdom and worldwide.

Dr MacGregor says adopting the same stance with regard to sugar is now necessary and the easiest way to help tackle the global obesity and type 2 diabetes epidemic.

He didn't go so far as to say there is a causal link, however. "There is no hard evidence that sugar per se causes diabetes, I'm not claiming it is directly toxic — unlike salt."

On the other side was Dr Mike Lean (University of Glasgow, Scotland), who argued that "it is the pattern of consumption that is associated with diabetes [and obesity], not sugar." There is no such a thing as "addiction to one nutrient," but "an eating addiction rather than a food addiction," he stressed.

There is no hard evidence that sugar per se causes diabetes; I'm not claiming it is directly toxic.

Furthermore, says Dr Lean, "limiting sugars means fiddling with lots of foods." And "cutting out lactose is a bad idea [it limits dairy food intake], sucrose is only a medium-low glycemic-index [GI] food, there is no evidence for a directly toxic effect of fructose, and we need glucose, it's a fact of life," he noted.

And while he acknowledged that there is "a clear relationship between sugar-sweetened beverages and overweight in children, it's the pattern of consuming more sugar-sweetened beverages," rather than the amount of sugar in each product that is the problem, he said.

Dr Lean cited vegetarians as an example of a group, who — even with sugar consumption levels of up to 7% of daily calorie intake — "do well." The key is in the word "balanced" when combined with "diet," he maintained.

Indeed, said Dr Lean, numerous guidelines designed to help reduce the amount of sugar people consume, starting during the 1980s and culminating in a new WHO report last week, are "very confusing," with different limits cited for sugar intake, and "have had little effect."

The WHO report recommends that people reduce the amount of sugar they consume to less than 10% of their daily energy intake — about 50 g or 12 tsps of sugar for adults — but indicates that a cut to less than 5% would be even better.

In contrast, Dr Lean applauded the approach of Diabetes UK, "which doesn't set a numerical limit" for sugar intake, he explained.

We need to teach people about nutrition rather than talking about one nutrient.

"While I do agree with Graham [MacGregor] that we should have a sensible limit [for daily intake for sugar] of <10% and that we should limit sweetness, we need to teach people about nutrition rather than talking about one nutrient."

UK Plans to Tackle Sugar in Same Way It Has Salt

Dr MacGregor is proposing a gradual, voluntary reduction in the amount of sugar put into processed foods by industry — around a 10% reduction per year, "so we reduce the sensitivity of the sugar taste in the UK population," in the same way that was done with salt.

Indeed, he says an announcement to this end will be made in about 3 months, and "we'd like to get some diabetologists involved."

"We have to look at what it is practical to do. Children get hooked on fast food, and then when their mothers cook them a healthy meal with meat and vegetables, they don't like it."

In some socially deprived areas, 20% of food intake is sugar.

And "in some socially deprived areas, 20% of food intake is sugar. This is the real problem — it's not some scientific debate. Mrs Bloggs, whose husband has just left her and who has five children, is not going to listen to nutritional advice," Dr MacGregor maintained. "Mike [Lean] needs to come up with a plan because this is an emergency. What is he going to do to prevent the whole world becoming obese?

"In the UK, we have reduced salt gradually over 7 years, and we now have the lowest salt [content of food] in the world, and on a population level this has prevented 18,000 strokes and heart attacks. We continuously screwed down the levels, and people didn't notice. But you will notice when you go abroad how salty bread tastes. We can do the same for sugar and [hopefully one day] for fat, especially palm oil," he continued.

Indeed, Dr Lean argues that fat is a bigger culprit than sugar. "We need to reformulate foods — I don't think we have any disagreement with that, but the issue is whether it's sugar, and I think the answer lies in fat, not sugar."

Dr MacGregor does not disagree that fat in processed foods is a huge problem, too, but said that sugar is the easier target for now.

And although there is no causal connection between sugar and diabetes, there is trial evidence suggestive of a "direct relationship between sugar-sweetened beverages and diabetes," not to mention the effect of sugar on dental caries, he asserted.

In fact, a recent review in the Mayo Clinic Proceedings, published in January, concluded there is now a large body of evidence from animal studies and observational and clinical trials in humans to suggest that eating processed foods with added sweeteners, including sugar, is contributing to the growing incidence of type 2 diabetes.

[The food industry] shouldn't be allowed to advertise unhealthy foods; it's exactly the same as tobacco.

"We should regulate/legislate and tax salt, sugar, and fat and restrict availability and reduce portion size," Dr MacGregor asserted. And industry "shouldn't be allowed to advertise unhealthy foods; it's exactly the same as tobacco.

"But the food industry is very powerful and in the pocket of governments so, for now, voluntary reformulation — while legislation is enacted — is the most practical solution for public health," he concluded.

Drs MacGregor and Lean report no relevant financial disclosures.


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