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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