Comments on: Sugar and health: the expert view

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By: Bill

Bill — Tue, 01 May 2012 21:30:38 +0000

Hi Robert. Your fruit and dairy examples throw up some interesting contradictions. When nutritionists are asked why they are concerned about the added sugar in Food X but not the sugar in fruit the usual answer is that fruit comes in a package with plenty of nutrients. But as you point out many fruits are not that nutrient-rich e.g. apples, pears and grapes. Take away vitamin C (drying of grapes to make sultanas) or fibre (to make apple juice) and nutrient density becomes very low. Apple juice is a high sugar, nutrient-poor beverage that is little better than cordial but it is seldom described as such. The dietetic mind-set won’t permit it.
Calorie for calorie, dairy products are generally more nutrient-rich than fruits, irrespective of their sugar content. Yet dairy products with added sugar get targeted. There is no logic to it.
The focus on sugar is a distraction that sometimes leads to illogical dietary advice. We need OBJECTIVE measures of carbohydrate quality that can be applied universally. Nutrient density is such a measure. Regards, Bill.

By: Robert

Robert — Tue, 01 May 2012 10:25:02 +0000

Bill, I have to agree about nutrient density. I am not a nutritionist. However, basic calculations show that dairy is not particularly nutrient dense, even before sucrose is added. Some fruits are not either, but they come with all sorts of vitamins, fibre and phytochemicals. In responding to the dietary guidelines, and using nutrient databases, I learned that generous amounts of leafy greens are a great way to get nutrients. That’s why the guidelines modellers had to restrict their model to two serves of greens per day. Then they made another downward adjustment to one serve per day, presumably for further “cultural acceptability”.

By: Bill

Bill — Mon, 30 Apr 2012 22:58:59 +0000

Hello Robert. Your comment highlights some of the issues when considering carbohydrate quality. How should we measure the nutritional quality of a carbohydrate-rich food? Should we focus on the sugar content or nutrient density? In Frank Hu’s (Harvard) recent presentation in Sydney he used solid/liquid form as a measure of carbohydrate quality.
The meta-analysis that you cite highlights a problem, but what’s driving the problem? Is it high sugar consumption or high carbohydrate consumption? If people ate vast amounts of high GI starch, I suspect you would see similar links with metabolic syndrome.
Personally, I think the sugar content of a food is a poor measure of carbohydrate quality. Firstly, because it’s not used universally – nutritionists won’t assess fruit on the basis of its sugar content. ‘Added sugar’ is no better as some foods with added sugar are nutrient-rich and make a very useful contribution to the diet. How can one say the lactose in chocolate milk is OK but the sucrose isn’t? And is the liquid form of chocolate milk a problem? I don’t think so. Milk-based liquid meal replacements are effective for weight management.
I like nutrient density as a measure of carbohydrate quality. It bumps out soft drinks, confectionery, biscuits, cakes and pastries, and also some nutrient-poor cereal products like white rice and pasta. Regards, Bill.

By: Robert

Robert — Mon, 30 Apr 2012 13:21:59 +0000

Bill, a crucial point is whether the studies mentioned adjusted for energy intake. As you mentioned, sugar generally makes the diet less nutrient dense. This means that more energy intake may be needed to meet essential nutrient requirements. The apparent risk could be well less if they adjusted for energy. (It’s a bit like those studies that adjust for serum cholesterol and subsequently find no risk associated with saturated fat intake.)
Nevertheless, the following meta-analysis found that sugar sweetened beverages raise risk of metabolic syndrome even *after* correcting for energy intake.
http://www.ncbi.nlm.nih.gov/pubmed/20693348