Author: Nina Evans, Researcher & Trainer in Public Health/31 May 2018
I just wanted to start off with a warm hello to everyone reading this blog, my name is Nina and I am one of the new members of the Clinical Team at X-PERT Health. I am working as a Researcher and Trainer in Public Health to help deliver educator training courses, patient courses, expand our research and (hopefully!) write thought provoking and informative blogs for you all! So, with my hello and without further ado, let’s talk sugar!
Let’s Talk Sugar – First Measure of Industry Progress
In August 2016 the government published ‘Childhood Obesity: A Plan for Action’ which included Public Health England (PHE) overseeing the sugar reduction programme as a commitment to tackle childhood obesity. PHE challenged all sectors of the food industry to reduce the level of sugar in the foods that contribute most to the sugar intakes of children, ambitiously by 20% by 2020. Last week they published a report on the food industry’s progress towards the proposed reduction of sugar by 5% within the first year .
Why was the programme brought in?
To cut a long story short, childhood obesity is upon us as one the of the leading public health concerns. In England one in three children are overweight or obese by the time they leave primary school and this, of course, increases the risk of becoming an overweight adult, ill health and premature mortality in adult life.
Ultimately, consuming too many foods and drinks high in sugar has been linked to weight gain and related health problems as well as tooth decay. Children and adults are currently consuming more than double the recommended amount of sugar daily, which is thought to be one of the leading factors of the obesity epidemic .
What were the results?
Overall, the food industry were unable to cut sugar by 5% in all categories that contribute most to the sugar intakes of children. Those categories are yogurts and fromage frais, biscuits, cakes, morning goods (e.g. pastries and buns), puddings, ice cream, lollies and sorbets, breakfast cereals, confectionery (sweet and chocolate) and sweet spreads and sauces. Cakes and morning goods’ progress were not reported due to limitations with the data. The headline results were as follows ;
* 2% reduction in total sugar per 100g by retailers and manufacturers
* 5 out of the 8 food categories reported had a sugar reduction (breakfast cereals, ice cream, lollies and sorbets, sweet spreads and sauces, sweet confectionary, yogurts and fromage frais)
* 1% increase in the sugar levels of puddings
* 2% reduction of calories in products consumed on a single occasion
* 11% reduction in sugar levels per 100ml for retailers own brand and manufacturer branded drinks included in the Soft Drink Industry Levy (SDIL)
What does this mean?
As there is currently a voluntary approach to reach a reduction of 20% by 2020, suggestions have been made that the government needs to apply a different strategy, such as mandatory targets. Similarly to the previous year, businesses have again been encouraged to focus their efforts on their products which contribute the most sugar to diets. Three options have been provided to help them with this; reformulating products to lower sugar levels, reducing portion size of products which are likely to be consumed in one sitting and directing consumers towards lower/no added sugar products . But, what is used as a sugar substitute during reformulation and what is our opinion on them?
Nutritive vs. Non-Nutritive Sweeteners
Nutritive and non-nutritive sweeteners can both be used as a sugar substitute and are added to food and drinks to enhance sweetness. Non-nutritive sweeteners or artificial sweeteners (such as aspartame, saccharin and sucralose) are often a key ingredient in dieting products as they can provide a significant sweetening effect without adding carbohydrates. Nutritive sweeteners such as polyols (often referred to as sugar alcohols) have also been used as an alternative to sugar for decades. Erythritol, isomalt and maltitol are all examples of polyols which have a similar chemical structure to sugar and are able to activate the sweet receptors on the tongue.
It has been concluded that the use of artificial sweeteners are safe in the short-term, however there is a need for further research to fully characterise long-term risks and benefits. Multiple randomised controlled trials have shown that non-nutritive sweeteners are beneficial for weight and fat loss . However, inconsistent results have been seen on their impact on metabolic health and appetite. Some RCT’s show an increase in cravings, subjective hunger, cardiovascular and metabolic risk whereas some show a decrease. This further identifies the need for future research on their long-term impacts, ideally on individual sweeteners [5-6].
Some sweeteners may be better than others, the lower GI and insulinaemic index of polyols (in comparison to glucose) suggests they can be an effective substitute for those with impaired glucose intolerance or diabetes. In addition to offering a reduced carbohydrate intake polyols are lower in energy and do not raise blood glucose or insulin levels like other nutritive sweeteners [7-8]. Polyols have been studied extensively regarding their role on dental health, concluding they are effective in significantly reducing caries rates . A potential side effect has been identified (which seems to be individualised) is that they can have a possible laxative effect. Some individuals seems to tolerate up to 70g/day with no issues, whilst in some as little as 20g/day elicit these effects .
Essentially, as a nation we need to cut down on our sugar intakes. How this is achieved is down to the individual, whether this is through sugar substitutions (using artificial sweeteners or polyols), shifting to lower/no added sugar products or simply, avoidance. So, if you’re making a conscious effort to cut down on your sugar consumption, let us know how you’re achieving this and how you’re getting on!
As with all our blogs and other work we’d love to hear your thoughts and feedback, so feel free to comment below, drop me an e-mail at email@example.com, message us on Facebook, tweet us at @XPERTHealth or follow us on Instagram @XPERThealth.
1. Public Health England. 2018. Sugar reduction and wider reformulation programme: Report on progress towards the first 5% reduction and next steps. [Online]. London: PHE Publications. [Accessed 23 May 2018]. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/709008/Sugar_reduction_progress_report.pdf
2. Tedstone, A. 2018. The world’s first sugar reduction programme: Data challenges. 22 May. Public Health Matters. [Online]. [Accessed 23 May 2018]. Available from: https://publichealthmatters.blog.gov.uk/2018/05/22/the-worlds-first-sugar-reduction-programme-data-challenges/
3. Public Health England. 2018. First measure of industry progress to cut sugar unveiled. [Press release]. [Accessed 24 May 2018]. Available from: https://www.gov.uk/government/news/first-measure-of-industry-progress-to-cut-sugar-unveiled
4. Miller, P.E. and Perez, V. 2014. Low-calorie sweeteners and body weight and composition: a meta-analysis of randomised controlled trials and prospective cohort studies. The American Journal of Clinical Nutrition. [Online]. 100(3), 765-777. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135487/
5. Sathyapalan, T., Thatcher, N.J., Hammersley, R., Rigby, A.S., Courts, F.L., Pechlivanis, A., Gooderham, N.J., Holmes, E., Le Roux, C.W. and Atkin, S.L. 2015. Aspartame sensitivity? A double blind randomised crossover study. PLoS One. [Online]. 10(3). [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/25786106
6. Swithers, S.E. 2014. Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends in Endocrinology & Metabolism. [Online]. 24(9), 431-41. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772345/
7. Salminen, S., Salminen, E. and Marks, V. 1982. The effects of xylitol on secretion of insulin and gastric inhibitory polypeptide in man and rats. [Online]. 22(6), 480-2. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/7049804
8. Noda, K., Nakayama, K. and Oku, T. 1994. Serum glucose and insulin levels amd erythritol balance after oral administration of erythritol in healthy subjects. European Journal of Clinical Nutrition. [Online]. 48(4), 286-92. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8039489
9. Mäkinen, K.K., Bennett, C.A., Hujoel, P.P., Isokangas, P.J., Isotupa, K.P., Pape, H.R. Jr. and Mäkinen, P.L. 1995. Xylitol chewing gums and caries rates: a 40-month cohort study. Journal of Dental Research. [Online]. 74(12), 1904-13. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8600188
11. Koutsou, G.A., Storey, D.M., Lee, A., Zumbe, A., Flourie, B., leBot, Y. and Olivier Ph. 1996. Dose-related gastrointestinal response to the ingestion of either isomalt, lactitol or maltitol in milk chocolate. European Journal of Clinical Nutrition. [Online]. 50(1), 17-21. [Accessed 29 May 2018]. Available from: https://www.ncbi.nlm.nih.gov/pubmed/8617186