Download Jim Painter, PhD, RD Adjunct Professor, School of Public Health

Jim Painter, PhD, RD
Adjunct Professor, School of Public Health,
University of Texas-Houston
@DrJimPainter
Added Sugar Friend or Foe?
Speaker Disclosure
Jim Painter

Board Member/Advisory Panel


Consultant


California Raisin Marketing Board, Sun-Maid Growers of California, the Wonderful Company, American Heart Association
Eat Well Task Force
Davison’s Safest Choice, National Dairy Council
Speaker’s Bureau
- Abbott Nutrition

Other

Speaker honorarium underwritten by MO WIC

Honoraria for talks: Dietitians of Canada, Exxon Mobil, Frito Lay, Pennsylvania Nutrition Network, California Raisin
Marketing Board, Alaska Tanker Company, Dairy Max, Texas AND, California AND, Florida AND, MINK, NY AND, South
Carolina AND, Iowa AND, Nebraska AND, Manitoba Dairy Farmers, Dairy Farmers of Canada.
Speaker Credentials
Health vs Disease
ENVIRONMENTAL ELEMENTS
Health
Supporting
Diet
Primary Element:
Clean Air & Water
Exercise
Peace of Mind
Spiritual Contentment
Secondary
Elements:
RICH FOOD
Polluted Air & Water
Sedentary lifestyle
Psychological “Stress”
Pride, fear, Anxiety
HEREDITY
Determines range of health
Added Sugar Friend or Foe
Dietary recommendations for added sugar

1. Sugar as a friend encouraging nutrient dense foods:

Dressing on salads, Sweetened milk
2. Sugar as a foe

When added to nutrient devoid foods

When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit
5
Added Sugar
“Although a UL is not set for sugars, a
maximal intake level of 25 percent or less of
energy from added sugars is suggested based
on the decreased intake of some
micronutrients of American subpopulations
exceeding the level.”
Institute of Medicine of the National Academies , Food and Nutrition Board (2005). Dietary reference intakes for
energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, D.C. : The
National Academies Press.
2015 Dietary Guidelines for Americans
Added Sugar Labeling
May
2016, FDA issued a final rule;
that would require declaration of the percent
daily value (%DV) for added sugars

Set intake limit to no more than 10% of daily
total calories

8
Guideline: Sugars intake for adults and children (2015)
- Reduce intake of free sugars throughout the life cycle
- Reduce intake of added sugars to less than 10% of
total energy intake
- A further reduction of the intake of added sugars to
below 5% of total energy intake is beneficial
Recommendations do not apply to “intrinsic” sugars
Added sugars:
- Monosaccharides and disaccharides added to foods
and beverages by the manufacturer, cook or
consumer
- Sugars naturally present in honey, syrups, fruit
juices and fruit juice concentrates
Natural/Intrinsic sugars:
- Those incorporated within the structure of intact fruit
and vegetables; sugars from milk (lactose and
galactose)
http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1
Raisins are intact fruit.
Sugars in raisins are intrinsic sugars
Traditional dried fruits are an integral part of
healthy dietary patterns worldwide, and the WHO’s
definition of intrinsic sugars is a key aspect to
emphasize as the sugar debate intensifies.
http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf?ua=1
Reduction in Nutrients as Added Sugar
Increases
Marriott, B. P., Olsho, L., Hadden, L., & Connor, P. (2010). Intake of added sugars and selected
nutrients in the united states, national health and nutrition examination survey (nhanes) 20032006.Critical Reviews in Food Science and Nutrition,50, 228-258.
12
Reduction in Nutrients as Added Sugar
Increases
Marriott, B. P., Olsho, L., Hadden, L., & Connor, P. (2010). Intake of added sugars and selected
nutrients in the united states, national health and nutrition examination survey (nhanes) 20032006.Critical Reviews in Food Science and Nutrition,50, 228-258.
13
Hazard Ratios of CVD Mortality
According to Usual % of Calories from
Added Sugar
3
2.43
2.5
2
1.49
1.5
1
1
1.09
1.23
0.5
0
Adjusted Hazard Ratios of CVD Mortality
7.40%
11.40%
14.80%
18.70%
25.20%
Add pop out of conclusion from
previous slide
Added Sugar Friend or Foe
Dietary recommendations for added sugar

1. Sugar as a friend encouraging nutrient dense foods:

Dressing on salads, Sweetened milk
2. Sugar as a foe

When added to nutrient devoid foods

When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit
18
Sugar as a Friend Encouraging Salad
and Veggie Consumption
Ceasar Salad w/ Creamy Ceasar
Dressing
Ceasar Salad Plain
Calories
Side Salad w/ Creamy Ranch
Dressing
Side Salad Plain
0
100
200
300
Vegetable
% RDA in 1 NLEA Serving
Tomato (148 g)
Vitamin A: 25%
Vitamin K: 14%
Vitamin C: 31%
Carrot (85 g)
Fiber: 10%
Vitamin K: 10%
Vitamin A: 234%
Broccoli (148 g)
Fiber: 15%
Vitamin A: 18%
Vitamin K: 158%
Vitamin C: 220%
Riboflavin: 10%
B6: 13%
Folate: 23%
Phosphorus: 10%
Manganese: 16%
Potassium: 10%
Vegetable
% RDA in 1 NLEA Serving
Potato (Baked with skin, 148 g) Fiber: 13%
Vitamin C: 24%
Niacin: 10%
B6: 23%
Folate: 10%
Manganese: 16%
Phosphorus: 10%
Magnesium: 16%
Potassium: 17%
Romaine Lettuce (85g)
Vitamin A: 99%
Vitamin K: 107%
Vitamin C: 33%
Folate: 29%
Fruit
% RDA in 1 NLEA Serving
Pear (166 g)
Fiber: 21%
Vitamin C: 12%
Strawberry (147 g)
Fiber: 12%
Vitamin C: 143%
Manganese: 28%
Meat
% RDA
Beef (3 oz, 95% lean,
ground, crumbles, pan
cooked)
Protein: 50%
Riboflavin: 10%
Niacin: 31%
B6: 18%
B12: 37%
Iron: 15%
Phosphorus: 23%
Zinc: 40%
Selenium: 26%
Meat
% RDA
Chicken (4 oz, Breast,
Baked, or Broiled)
Protein: 70%
Niacin: 38%
B6: 34%
Phosphorus: 26%
Selenium: 45%
Pork (1 chop , 150g, lean
only, bone in, broiled)
Protein: 38%
Thiamin: 46%
Riboflavin: 15%
Niacin: 16%
B6: 20%
Phosphorus: 17%
Zinc: 12%
Selenium: 51%
1% Chocolate Milk
Milk Consumption
1
Added Sugar Friend or Foe
Dietary recommendations for added sugar

1. Sugar as a friend encouraging nutrient dense foods:

Dressing on salads, Sweetened milk
2. Sugar as a foe

When added to nutrient devoid foods

When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit
30
Added Sugar Friend or Foe
Dietary recommendations for added sugar

1. Sugar as a friend encouraging nutrient dense foods:

Dressing on salads, Sweetened milk
2. Sugar as a foe

When added to nutrient devoid foods

When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit
34
Added Sugar Friend or Foe
Dietary recommendations for added sugar

1. Sugar as a friend encouraging nutrient dense foods:

Dressing on salads, Sweetened milk
2. Sugar as a foe

When added to nutrient devoid foods

When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit
52
Gone Bananas (100g)
70
60
50
40
30
20
10
0
Banana
Banana Chips
Air Crisped Banana Chips
180
160
mg/100g
140
120
100
80
60
40
20
0
Calcium
4.5
4
3.5
3
mg/100 g
2.5
2
1.5
1
0.5
0
Iron
Phosphorus
140
120
mg/100g
100
80
60
40
20
0
Vitamin C
8
7
mg/100g
6
5
4
3
2
1
0
Potassium
1400
1200
mg/100g
1000
800
600
400
200
0
Added Sugar (g)
70
60
50
40
30
20
10
0
NuVal Comparison
100
90
80
70
60
50
40
30
20
10
0
Raisins
Dried Cranberries
Guiding Star
Comparison
Raisins
Dried Cranberries
Sugar: When does it
change from a friend to a
foe?
% of Calories from Sugar
50%
45%
40%
35%
30%
25%
20%
15%
10%
5%
0%
Oatmeal
(Plain)
Cheereos
Multi-grain Honey Nut
Cheereos
Cheereos
Froot
Loops
Apple
Jacks
High-Fructose Corn Syrup: Harmless
Sweetener or Liquid Death?
Sugar the Bitter Truth?
 Pediatric
endocrinologist Dr. Robert Lustig,
whose YouTube video -- entitled "Sugar: The
Bitter Truth"
 "Fructose
is the cause of the current epidemic,"
insists Dr. Lustig
 Fructose
is toxic in large quantities, because it
is metabolized in the liver in the same way as
alcohol, which drives fat storage and makes the
brain think it is hungry
HuffPost Healthy Living. 2010. Sugar Hits the News, Thanks to Dr. Lustig's YouTube Video and Nightline (VIDEO).
Retrieved from http://www.huffingtonpost.com/connie-bennett/sugar-hits-the-news-thank_b_506517.html
ABC NightLine Sugar Wars
http://www.hulu.com/watch/136085
Lustig’s Findings

Countries have experienced a rise in sugar supply
from:
 1960:
218 kilocalories/person/day
 2013:
280+ kilocalories/person/day today, with an
acceleration in the rate of supply over the past decade.

Diabetes prevalence rates rose 27% on average from
2000 to 2010, with just over ¼ of the increase
explained by a rise in sugar availability
Basu, S., Yoffe, P., Hills, N., & Lustig, R. H. (2013). The Relationship of Sugar to Population-Level Diabetes
Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PloS one, 8(2), e57873.
Ludwig

Ludwig, a childhood obesity expert, cited sugar as
the key source of an American public health crisis

“Tobacco and alcohol are perfect examples. We
have made a conscious choice that we’re not going
to get rid of them, but we are going to limit their
consumption. I think sugar belongs in this exact
same wastebasket,”' he said.
MailOnline. 2012. Is sugar actually poisonous? Researchers say the sweet
stuff is fatal for our health. Retrieved from
http://www.dailymail.co.uk/news/article-2124212/Is-sugar-actuallypoisonous-Researchers-say-sweet-stuff-fatal-health.html
The effects of fructose overfeeding
on Intra-Hepatic Lipid (IHCL)
Fructose intake (% energy)
25
*
IHCL (mmol/kg)
25
*
20
20
15
10
15
5
10
0
5
0
0
1.5
3
4
g/d fructose added to
0
+15%
+30%
+40% weight-maintenance diet
daily energy requirements as fructose
Lecoultre et al, Obesity 2013 (In Press)
Comparison of HFCS, sucrose, and honey
How sweet is
it?
How many
calories per
gram?
What's in it?
Sugar
Honey
HFCS
Sugar is the
benchmark
Honey is as
sweet as
sugar
There are two types:
HFCS-55 as sweet as
sugar; HFCS-42
4/gram
4/gram
4/gram
50% fructose
50% glucose
48% fructose
52% glucose
Corn Refiners Association 2009
HFCS-55: 55%
fructose
45% glucose
HFCS-42: 42%
fructose
58% glucose
= HFCS
= Obesity
Bray et al. 2004
The Difference in Added vs
Natural Sugar
calories/100g
500
450
400
350
300
250
200
150
100
50
0
74
The Difference in Added vs
Natural Sugar
Potassium, mg/100g
Potassium, mg/100g
1600
1400
1200
1000
800
600
400
200
0
75
The Difference in Added vs
Natural Sugar
Fiber g/100g
Fiber g/100g
4
3.5
3
2.5
2
1.5
1
0.5
0
76
Coco Cocoa Nut Torte
Ingredients:
•
1 c. almond meal/flour
•
½ c. unsweetened coconut
•
½ c. cocoa powder
•
1 tsp baking soda
•
¼ tsp salt
•
1 cup raisins
•
½ cup pitted dates
•
¾ c. water
•
3 Eggs
•
2 T coconut oil
•
2 tsp vanilla
Directions:
Preheat oven to 325 F. Grease an 8” round
cake pan.
Mix together almond meal, cocoa powder,
baking soda, and salt in a bowl and set aside.
In a blender, food processor, or an immersion
blender, blend the raisins, dates, and water
until smooth.
Add the eggs, coconut oil, and vanilla to the
blended mixture and mix until smooth.
Add the wet ingredients to the dry
ingredients and mix just until incorporated.
Pour batter into greased cake pan and spread
evenly.
Bake for 25-30 minutes or until toothpick
comes out clean. Let cool 10-15 minutes.
Wafer vs. Torte
300
250
200
GF Wafers
GF Torte
150
100
50
0
Calcium
Magnesium
Potassium
Wafer vs. Torte
2
1.8
1.6
1.4
1.2
GF Wafer
GF Torte
1
0.8
0.6
0.4
0.2
0
Zinc
Iron
Vit B1
Vit B2
Vit B6
Thanks…
Conclusion
•
Sugar is a friend if it encourages whole foods
•
Sugar is a foe if it:
•
•
Encourages nutrient poor foods
•
Replaces nutrients, ex juice & dried cranberries
Fructose is the same as table sugar
•
•
Limit both to 10-5% of calories
The answer!
•
Use real fruit
•
Select higher nutrient sweeteners
•
Non nutritive sweeteners and sugar alcohols