Australian Health Survey: the facts about sugar intake

Following the publication of the latest national dietary survey it is clear that sugar intake has fallen since 1995. But mere facts are unlikely shake the resolve of the non-nutritionists driving the lucrative sugar scare.

The trend in sugar consumption in Australia has been a contentious issue in recent years, especially as nutritionists and lay people have sought dietary explanations for the obesity epidemic. On one side of the argument is the view that the intake of sugar, or perhaps fructose, has increased in recent decades and that this has been the driving force behind the epidemic. This argument emerged in the United States where sugar intakes are undoubtedly high.

In the Australian context it has been argued that sugar intake hasn’t increased at all and is actually in steady decline. Proponents of this argument include Dr Alan Barclay and Professor Jennie Brand-Miller who published an assessment of trends in intakes of sugars and obesity rates in Australia, the United Kingdom and the United States between 1980 and 2003. In this paper the authors identified an ‘Australian Paradox’ – increased rates of obesity despite an apparent fall in sugar intake.

The recent publication of new data from the Australian Health Survey (AHS) has provided some clarity on this issue.

Sugar data from the Australian Health Survey

The AHS was conducted by the Australian Bureau of Statistics, which also conducted Australia’s last national dietary survey of adults and children in 1995, so now we have insights into how the diet of Australians has changed over the intervening period of approximately 16 years. Here are some of the top-line results relating to sugar.

• Intake of total sugars has fallen in men, women and children.
• The percentage of dietary energy from total sugars has also fallen.
• Carbohydrate intake has fallen, both in absolute terms and as a percentage of energy. Total energy intake has also fallen.

Sugar from soft drinks

The percentage of sugar from coming from soft drinks has fallen substantially:

• In men it fell from 15.5% of the total in 1995 to 11.4% in 2011 – a fall of 26%.
• In women it fell from 9.3% to 7.6% – a fall of 18%.
• The proportion of sugar from fruit drinks, vegetable drinks and cordial was up marginally in men but down substantially in women.

Sugar from other food groups

• Milk products provided over 17% of total sugar intake.
• Fruit provided about 16% of sugar intake (or 23% if fruit drinks are included). The percentage of sugar coming from fruit has increased.
• Breakfast cereals provided just 2.8% of sugar intake. The percentage of sugar coming from breakfast cereals has fallen.
• The proportion of sugar coming from cakes, muffins, pastries, biscuits, etc has increased. It’s the same story with confectionery.

Image: source

Sugary drinks

I was particularly interested in the data on sugary drinks, having recently published a paper on the topic. Our dataset was very different to that of the AHS, comprising sales data from industry, but the timeframes were similar. In our study we found a fall in the sugar contribution from carbonated soft drinks from 8.4 kg per person in 1997 to 6.2 kg per person in 2011. In relation to the broader category of sugar-sweetened beverages, per capita sugar contribution fell over the 15-year period from 9.2 kg to 7.6 kg. These results are consistent with the large falls in the percentage of sugar from coming from soft drinks observed in the AHS.

Calories from ‘discretionary’ drinks

The AHS also provided data on how many calories came from ‘discretionary’ foods and drinks i.e. those that are not providing many essential nutrients. Here are some figures for beverages:

Soft drinks 1.8%
Fruit drinks, cordials 1.2%.
Alcoholic beverages 6.0%

It makes you wonder why so much of the current anti-obesity effort is being invested in relation to nutrient-poor soft drinks and so little attention is being applied to the much bigger issue of nutrient-poor alcoholic beverages. The percentage of calories coming from alcohol increased between 1995 and 2011.

Is there a Paradox?

The argument about whether sugar intake in Australia is going up or down is now resolved – sugar intake has clearly fallen since 1995. Whether declining sugar intake coinciding with rising obesity prevalence represents a paradox or not depends on your beliefs. If you are convinced that sugar intake is the primary driver of obesity then indeed there is a paradox that you will need to explain somehow. According to your thesis obesity rates should be falling not rising. But arguing that the data on sugar consumption are all wrong is no longer good enough.

The sugar scare: driven by non-nutritionists

The current sugar scare may have had its genesis in the American experience and the credible hypotheses it generated. But before these hypotheses could even be adequately tested in good scientific studies the agenda was hijacked by opportunists, self-serving activists, book-sellers, B grade celebrities and shameless self-promoters, aided and abetted by a media that cares a lot about ratings but little for facts or science. In Australia, the whole premise of the scare – that sugar intake is rising – has been shown to be false. Consequently, the community has been alarmed about a major problem that doesn’t actually exist.

Unfortunately, non-nutritionists operating in the lucrative dietary advice business don’t understand the potential for negative nutritional outcomes from the simplistic solutions they offer. A scientifically-trained dietitian or nutritionist would understand that a sizable proportion of sugar in the diet comes from nutrient-rich fruits and milk products and would offer nuanced advice around sugar, aimed at lowering intake of nutrient-poor foods. In their wilful ignorance the non-nutritionists just target sugar wherever it can be found and sod the consequences.

In the United Kingdom, Professor Graham MacGregor, Chairman of Action on Sugar, recently lamented that the field had been overtaken by ‘nutters’ whose exaggerated claims were generating hysterical headlines. It’s a familiar scenario.

The question for dietitians and nutritionists is how to take back control of the agenda from the nutters. Any ideas?

Image: source


13 thoughts on “Australian Health Survey: the facts about sugar intake

  1. I obeyed ‘conventional wisdom’ for years, following the advice of my doctor and standard dietary regulations and I found myself very ill. A trip to the naturopath turned my life around and I had resolution of half a dozen unpleasant symptoms and also rapid healing of a broken bone. So I’m going to keep hanging out with the ‘nutters’. Because on low carb high fat paleo (I’m actually following The Wahls Protocol at the moment) I am never sick, have no rashes, no digestive issues, good energy levels and great brain function. My personal sugar/carb levels have plummeted and I do believe that for me at least sugar, carbs and gluten (I am diagnosed coeliac) were the problem.

    • Jenny, no doubt you feel better from your experience. However this article is talking about population obesity rates, not IBS nor autoimmune conditions like coeliac as you have described. People with known conditions are not nutters. Science has proven following a gluten free diet for coeliacs aids recovery and fructose malabsorption is the cause of IBS symptoms in some people. Nutters are referred to here as those that claim sugar is the sole cause of obesity, which we know it’s a contributing factor BUT not the sole cause.
      So even though your story may be true for you, it is not true for the “nutters” who claim sugar made them fat or thats its killing the entire population. No, in fact inactivity, medical conditions, genetics, medications, eating too much etc are one of many causes.

      • I appreciate your point Gabrielle and agree to some extent. There are certainly a numbers of ’causes’ in the obesity scenario. I’m commenting because I’m convinced that ‘sugar’ and ‘low fat dogma’ are 2 of the major players and because the ‘everything in moderation’ and ‘blame the obese they are obviously lazy gluttons’ perspectives that are often evident from some nutritionists and doctors are unhelpful and wrong.

    • Hello Jenny. I wasn’t defending carbohydrates. My view is that official recommendations for carbohydrate intakes are too high. Less would be better, especially if we replace some carbs with unsaturated fats.
      But the evidence doesn’t support ‘eat less sugar’ in isolation. There are many aspects to this. It is very hard to distinguish between the health effects of refined sugars and refined starches. However, if we cut the lot out then we also cut out the nutrients that are present in some sugar-rich and starch-rich foods.
      So a balance needs to be struck and to achieve that balance we need advice that preserves the better carb-rich foods in our diet and limits those that provide few nutrients and send blood glucose sky-high.
      Good nutrition is never at the extremes – it’s always in the middle somewhere. Regards, Bill

      • I appreciate your position Bill and think that is probably generally helpful. I’m just very thankful that my doctor is sufficiently aware of the spectrum of symptoms and of the need to be ‘extreme’ in certain situations. She put me on a ketogenic diet to reverse my diabetes and it worked and I am maintaining my health being generally low carb.

    • I find that when people change there diets significantly they often come more into line with the healthy eating guidelines without really knowing it . They reduce sugar and often processed carbohydrate ( and in your case gluten because you have coeliac disease) and replace these with foods we are encouraging people to eat more of like fresh fruit and vegetables, dried beans and legumes which all have carbohydrate but in a much better form. Also there is more mindful planning of meals and snacks rather than grabbing quick processed food/snacks which are often marketed as being healthy. As they say -”It is what you put in your mouth which is important, not what you leave out!”

  2. Yes Gabrielle I agree. I am commenting because I think that sugar is a major part of the problem, not just for me but for lots of people who have struggled with their weight and health.

  3. I eat everything in moderation and exercise. This includes (predominantly limited, because nobody is perfect) sugar and (appropriately portioned sized) carbohydrates. I manage a healthy weight. I reduce my weight when I limit my calories, usually achieved by limiting nutrient deficient, energy dense food, (no targeting of any particular macro-nutrient required). I don’t experience rashes, digestive issues, sickness and I have great energy levels and brain function. And while I have been fortunate to not break a bone, I am confident it will heal (although I will see a ‘conventional’ doctor, with training, to ensure it sets properly).

    Perhaps Bill we could start educating the public why scientific evidence isn’t made up of only anecdotal evidence, no matter the conviction or credibility of the individual behind the claims.

    • Hello Kate. I think part of the problem at present is that the general public has little exposure to or understanding of the world of science. So they rely on others to interpret evidence and present it to them in a way they can understand. This is partly our job and most of us do our best as we have a vested interest in the science.
      It’s also the media’s job and, with notable exceptions, they do a pretty poor job. I had a recent experience with an ABC journalist who had no interest in the facts at all – she just wanted to tell a pre-determined story. If I had supported the story I would have been quoted, but because I argued against it on scientific grounds she attempted to discredit me. I’ve never experienced anything like it.
      One problem with the media is they are not interested in consensus. Their vested interest is in an argument – that’s what generates readership. So, minority views are often given emphasis and the majority position of scientists is played down. Or even attacked – witness last year’s Catalyst programs!
      And the internet is worse as there is no need to present an opposing view at all. Who knows what the vested interests are.
      No simple solutions to this one. Regards, Bill

      • :) That’s why I said ‘start with’. Improved knowledge of science and scientific evidence would obviously follow.

  4. Hi Bill,
    OK so sugar consumption has gone down in toto, but who is consuming the sugar, is it the obese or non-obese; both to an equal extent? Can we be sure the effects of high sugar consumption 20 years ago has “dissipated”, what about the potential effect of sugar intake on genetic programming in utero, and the effect on the infants of 20 years ago? I think the issue complex and not yet put to rest.
    Also, note the comments, at the end of the AHS about under-reporting.
    I think methodological problems are a significant issue in nutrition research, eg self(under)-reporting of diet; or the approach where some nutrient (in this case sugar) goes into a “black box” (the community), “something happens”, and something comes out (obesity), ie what is happening in the black box (remember that cartoon?).
    Also, should milk-sugar (lactose) be considered the same way as sugar (sucrose)?

    • Hello Rick. You have asked lots of good questions, all worthy of investigation.
      You will have seen from my comments elsewhere in this blog that I have wider concerns about carbohydrate. But hopefully this post will serve two purposes. Firstly, it pushes back against the baseless notion that sugar intakes are increasing. There is no point basing public health action on fairy stories.
      Secondly, I hope it encourages some people to step back from the all-eggs-in-one-basket approach to addressing obesity. I argued against the fat-causes-obesity mantra for 15 years because the evidence simply didn’t support it. I suspect I’ll be arguing against the sugar-causes-obesity mantra for the next 15 years. Targeting just one source of calories didn’t work in the past but we didn’t learn the lesson – we just repeated the error with sugar.
      Hopefully research will ultimately illuminate the way forward for us. Regards, Bill

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