Sugar, the New Nutrition Facts Label, and the American Consumer: Do Added Sugars Really “Add” Up?

Love it or hate it, Americas eat a lot of sugar--upwards of 150 lbs a year per person!

Source: http://www.attn.com/stories/131/how-sugar-similar-cocaine

Ah, sugar.  America’s love-hate relationship with the sometimes-naturally-occurring-but-more-often-than-not-refined substance is controversial at best (as in the eternal debate over the safety of high fructose corn syrup) and criminal at worst (like when New York City tried to ban the sale of sugar-sweetened drinks larger than 16 ounces). While it sure seems like we can’t get enough of the stuff (given the variety of sugary products that are available in our grocery stores and the fact that diabetes is more rampant than ever), low carb diets & ketogenic diets are also more popular than ever.  Given its notoriety, its hard to imagine Americans are somehow unaware that sugar is an ingredient to watch out for and avoid in excess, yet Americans are constantly being told through advertising to give in to our desires and reward ourselves with indulgent desserts.  Given this dichotomy, what are we to do as a country?!

One change being proposed, thanks in part to First Lady Michelle Obama’s campaign against childhood obesity, is the FDA proposing the first update in 20 years to the Nutrition Facts Label that graces the side of every food product sold in this country.  You know, this guy!

Source: http://www.fda.gov/Food/IngredientsPackagingLabeling/LabelingNutrition/ucm275438.htm

The recommended changes include updated serving size information, clearer daily percentages, and (perhaps unsurprisingly controversial) an "added sugars" category (see below).

Source: http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm

So why is this little guy and his little added sugar subheading so controversial?  Well, to quote those clickbait ads you see everywhere, "corporations HATE him!"  That's right, Campbell Soup Co., the cranberry industry as a whole (turns out that stuff is pretty bitter without sugar), Kellogg, Roman Meal Co. (a whole-grain bread company), and Dannon all have called to have the proposed nutrition label change scrapped.  Why?  Probably because Americans would be shocked by how much added sugar is in the products, which might just affect their purchasing habits.  

To many consumers, its not always obvious which products naturally contain sugar and which have sugar added (sometimes in surprising amounts)
Source: http://healthtipsdailybasis.blogspot.com/2015/06/alison-lost-10-pounds-by-cutting-this_23.html

One wonders what this means for the relationship between government regulation, consumer rights, and corporate interests.  It begs the question of what the consumer deserves to know about their food they are purchasing and consuming.  Should consumers be able to identify the origin of where their beef comes from?  Should consumers have the right to know whether a product contains GMOs?  Should the consumer be hidden from the fact that a milk product has had aspartame added to its ingredients?  These are all valid questions, and the issues behind them are not always as cut and dry as you might think...

To be fair, however, another valid concern worth looking at is over the average consumer's ability to read a nutrition label correctly.  Let's take a look at the labels below, for instance.  A recent study published in the Journal of the Academy of Nutrition & Dietetics looked at this very issue, specifically how well consumers could decipher what "added sugars" means.  Take a look at the labels below:

From left to right: the current nutrition facts labeling system listing only “sugars” (version s), a proposed label listing both “sugars” and a subheading of “added sugars”(version s+a), and another proposed label listing “total sugars” and a subheading of “added sugars” (version ts+a)

Source: http://www.andjrnl.org/article/S2212-2672(15)00505-5/fulltext

Sugars (on the left label) clearly includes all sugars, right?  92% of those interviewed were able to figure that out.  But did 8g of "added sugars" mean it was in addition to the 21g of "sugars" listed on the middle label?  52% of those interviewed mistakenly thought so.  However, only 33% of those interviewed misunderstood the label on the right, with 67% correctly determining that "added sugars" was already included in the "total sugars" category.  This just goes to show how important research is to figuring out better ways to convey information to the public!  

So what does this mean for the new nutrition facts label?  The FDA has got its work cut out for it! These messages might seem straightforward to the nutrition professional, but that's because we work with this information day in and day out.  Not everyone else is so fortunate as to be surrounded by food and nutritional knowledge as we are. But in all seriousness, its not easy to distill information so that as many people as possible can easily understand it.  That's why we RDNs and other nutritional professionals have to constantly be honing and perfecting our message to reach as many people as effectively possible.  

"Get back to the part about sugar!" you say?  Well, here's a quick rundown of the evidence-based facts we have on sugar:  

• As mentioned earlier, sugar is best enjoyed in moderation (the WHO recommends <25g of sugar a day)
• As far as we know now, there is no scientifically significant difference between the way our bodies process the different types of sugars (i.e. honey vs. HFCS vs. fructose vs. sucrose) 
• Sugar may be addictive in large, frequent quantities, lending an interesting point to the obesity debate, but the research is still lacking
• It does, however, lend well to the idea that sugar is best enjoyed in moderation as previously recommended
• The same advice is given to artificial sweeteners: use in moderation to ensure safety (which most Americans already do)
• Sugar does not cause hyperactivity in children, but it can displace desperately needed essential nutrients in a child's diet that could be obtained from healthier foods

So what's the moral of the story?  Just as we've heard since the dawn of civilization: all things in moderation (sugar included).  

Main Article:

Laquatra, I., Sollid, K., Smith Edge, M., Pelzel, J., & Turner, J. (2015). Including “Added Sugars” on the Nutrition Facts Panel: How Consumers Perceive the Proposed Change. Journal of the Academy of Nutrition & Dietetics, 115(11), 1758-1763. doi:10.1016/j.jand.2015.04.017

Other References and Links:

http://www.diabetes.org/diabetes-basics/statistics/

http://www.todaysdietitian.com/newarchives/100112p28.shtml

http://www.hsph.harvard.edu/nutritionsource/carbohydrates/added-sugar-in-the-diet/

Rethink Your Drink in 2016

By: Donna T.

When we hear “new year,” our bodies are typically the first thought that comes to mind. Americans spend beaucoup money on gym memberships and imagine themselves a completely different person by the time the next new year comes around. I would be lying if I said I haven’t done this and saw my goal self as the next Victoria Secret model. However, the majority of these and similar resolutions go out the window, many by February! This is partially due to creating unrealistic goals that become overwhelming and discouraging. If that happens to you this year, I challenge you to try a tiny daily change instead. It may not seem like much, but if you make this simple change a habit, you can make another tiny change, and so forth. Just as the ocean is made up of droplets of water, serious change is made up of tiny changes. Rather than have the overwhelming goal of being the next Adriana Lima looming over your head, try a goal you will hardly notice, making it so much easier. The example I would like to focus on is switching just one of your less healthy beverages for a healthier one, preferably water. Just one per day! That doesn’t seem so bad for starters and may even save some money!

So why beverages? I would like for you to ponder what comes to mind when anyone mentions nutrition, diet, weight loss or maintenance, etc. Most people will think of mainly food. We tend to forget that beverages are a part of our diet, yet the “majority of Americans consume beverages and discretionary foods … high in sugar, sodium, fats, and cholesterol as part of their daily diets” (An, 2016).

Before I go any further, I would like to clarify some terms, such as discretionary foods. These are the foods that do not fit in the main food groups because they are not essential to a healthy diet and are high in fats, sugar, sodium, and usually too high in calories, while low in good nutrients like fiber. They are referred to as energy-dense foods, which means they contain a high concentration of calories, or energy, per unit (for our purposes, a bite). The danger with energy-dense foods, such as processed items, is that they provide many calories and reach or exceed our daily limit without supplying critical nutrients. Opposite energy density is nutrient density, seen in foods like fruits and vegetables. These foods have a high concentration of health-promoting nutrients per bite and less calories.

The majority of the beverages Americans consume on a daily basis, and usually in excess, are considered energy-dense and are just as threatening as those processed, discretionary foods. A recent study examined the relationship between such beverage consumption, discretionary food intake, and quality of diet among US adults. It found that there was in fact an observable relationship between beverage consumption and overall dietary behavior.

Some of the specifics included that more educated adults had higher intakes of diet beverages, while those with a lower education level and lower socioeconomic status consumed more of the sugar-sweetened beverages (SSB). Oddly enough, those consuming higher amounts of diet drinks had higher overall caloric intakes and were typically obese, while more normal-weight individuals were drinking the SSBs.

My theory on the above oddity is that the diet beverage drinkers have the mentality (whether they are aware of this or not) that they have saved calories so they can eat more. They may not make a point of going for unhealthy choices, but because those energy-dense types of foods are already a part of their diet, simply eating more means making unhealthy choices that ultimately far outweigh the potential benefits of drinking diet. Now that I have shared my thought on the matter, I would like to know if you have any other theories or more to add to this one. 

The study’s findings led to the conclusion that more research needs to be done that looks at not just beverage consumption alone, but associated dietary behaviors. So when you go to create your resolutions list and sitting there in the number one position is some form of changing your body, wouldn’t it be worth it to devote some time and energy to look at your every day health and dietary behaviors? While exercise is important, simply signing up for a gym membership will only take you so far. What about all those days you are just too tired to work out? That may be a good indication to look at your diet patterns. Why? Those energy-dense and discretionary foods I mentioned earlier – they can negatively affect energy levels and nutritional status, leading to a lack of energy and strength, two important things for all those awesome workouts you planned ... or found on Pinterest (if you're me, that is).

Before your resolution of getting fit bites the dust, grab some white out, and then simply write “get healthier.” To bring this full circle, the way to get healthier is to be realistic and start small, like with our beverages. Take a look at the images below. Just replacing one of those drinks with water will save your body from all that sugar (several teaspoons, actually). Think about it like this: You wouldn’t eat 20 packets or more of sugar. Why are you drinking it then? Another way I have heard a registered dietitian nutritionist put it is to pretend you own a prized racehorse. Would you give it energy drinks and the like, especially close to race day? Probably not. If you wouldn’t give it to your horse, how much more important do you think your body and your life are to you? Now, I am not saying just one, tiny change should be an ultimate goal, but for someone who has drank 6 sodas per day for the last 10 years, drinking only four per day is a wonderfully huge change for the body, yet gradual enough not to throw it out of whack. Remember, with each minor goal we accomplish, we are that much closer to major change.

(http://i.imgur.com/EgVny.jpg)

(http://bitsandpieces.us/wp-content/uploads/2013/05/rethink-your-drink.jpg)

I want to know some simple changes that you could make in your daily routine – changes that you could really see yourself succeeding at because they are that simple, especially any related to beverages. Also feel free to make suggestions for others to try.

Additionally, I would like to encourage all of you to do some searching on your own for information on the effects of drinking sodas and energy drinks over a long period of time. If more people were aware of these scary effects, especially those on children, they may be less likely to consume energy drinks. For those of you who do venture out and explore this, please come back and educate the rest of us because, honestly, I’d rather if Red Bull did not give anyone wings … if you get my drift.

To start it off: I chose to transition from sweet tea to unsweetened, and if you are from the south, you know the agony associated with this. It was hard at first, but I began just by mixing half sweetened tea and half unsweetened. After some time of slowly tweaking the ratio to more and more unsweetened tea, I finally reached my goal. Now when I try to drink, say McDonald’s sweet tea, I gag because it is like drinking syrup, which tells me that I have trained my body to not crave as much sugar. Our bodies will change, but we have to do it gradually. Remember: Inch by inch, it's a cinch. Yard by yard, it's too hard. 

Now it is your turn!

Referenced Article: 
An, R. (2016). Beverage consumption in relation to discretionary food intake and diet quality among US adults, 2003 to 2012. Journal of the Academy of Nutrition and Dietetics, 116(1), 28-36. http://dx.doi.org/10.1016/j.jand.2015.08.009