THE BLOG
03/05/2014 02:24 pm ET Updated May 05, 2014

Added Sugar Replaces Fat as Ingredient to Watch For

Michelle Obama unveiled a series of proposed changes to the food label last Thursday. These changes, she said, will help consumers make better, more informed decisions.

The nutrition label was due for an update, as the way we eat and nutrition science have moved along quite a bit, and a revision has been in the works for a decade, but given how difficult it is to change anything in the food industry, most expected little tweaks rather than bold changes.

Instead, the proposal surprised with a few very meaningful modifications. The new suggested label updates the serving sizes, admitting that people don't drink just half a bottle of soda, leave a bagel half eaten, or serve just half a cup of ice cream. Calories will be displayed loud and clear, grabbing our attention as the largest, most prominent item on the label. But the most audacious part of the proposal: food companies will have to list how much sugar they add to a product. Up until now, when a kid had flavored milk a parent could only know the total sugar in the drink -- the sugar naturally occurring in milk, and the sugar added as sucrose, high-fructose corn syrup (HFCS) or the many other sugar forms. This extra line on the food label is especially important for products that contain fruits and dairy, both of which have innate sugars, but to which manufacturers can add sweeteners for taste and appeal, and up until now we had no way of knowing how much.
nutrition facts label proposed revision

Nutrition facts label proposed revision. Source: Food and Drug Administration. Red highlights are my addition.

Why is added sugar targeted?
Sugar makes food taste good. That's why sugar is added to everything. Does sugar just make us consume too many calories or is there something inherently fattening and unhealthy about added sugar?

Evidence is now mounting, connecting too much sugar directly to high blood pressure, high triglycerides (blood fats, a risk for heart disease), fatty liver and insulin resistance.

A recent study in JAMA Internal Medicine found that Americans who consume more added sugar have a higher risk of death from heart disease. A study in Public Health Nutrition, found that sugar consumption around the world was directly associated with overweight, obesity and high blood pressure. While low intake of cereals and physical inactivity were also contributors, nothing predicted how fat a country would be as much as how much sugar it consumes. Another recent article published in PLoS One looked at the relationship between sugar availability and diabetes prevalence in 175 countries. After accounting for many factors, such as obesity, exercise, poverty, age, etc., the study found that the higher the added sugar in the countries' food supply, the higher the diabetes rates. The authors' conclusion: "Every 150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1 percent."

The World Health Organization recommended in 2003 that "added sugar" be limited to 10 percent of a person's caloric intake. The American Heart Association (AHA) limited further, and recommended that women should consume no more than 100 calories of added sugars per day (6 teaspoons), and most men, no more than 150 calories (9 teaspoons). One 12-ounce can of Coke contains 130 calories in added sugars, which puts women over the AHA upper limit -- no room for bread, sweetened yogurt, and just forget about dessert.

Yet the average American consumes about 16 percent of his daily calories in added sugar.

Fruit juice concentrate and honey are added sugar:
Many consumers look for sugar in the ingredient list and HFCS is on many people's list of undesirables. The new label proposal will require listing all the forms of sugars consumers don't think about under the added sugar rubric.

Names for added sugars include: Brown sugar, corn sweetener, corn syrup, dextrose, fructose, fruit juice concentrates, glucose, high-fructose corn syrup, honey, invert sugar, lactose, maltose, malt sugar, molasses, raw sugar, turbinado, sugar, trehalose, and sucrose.

Fruit juice concentrate might sound good to eat, but when you strip a fruit juice of everything, all that's left is sugar, and it really is no different from sucrose derived from cane or beets.

Another trick food makers can apply to "healthify" the ingredient list is using several different sugars, each in small amounts, and since ingredient lists are ordered by weight, a product which is mostly added sugars -- of several kinds -- might list sugar as the third or fourth ingredient. The proposed label change will help consumers identify all added sugars as one entity, and enable us to understand what proportion of the food is sugar.

Our changing eating habits and our understanding of nutrition and health are shifting the focus from fats in the diet -- we now understand that the type of fat matters more than the total fat -- to added sugar. Note that "calories from fat" is omitted in the new label. Don't get me wrong: fat, with its 9 calories per gram, is a nutrient to watch for, but that doesn't mean that added sugar, which is the other ingredient that can make food super desirable, should get a free pass. This one line for added sugar in the new label is a big step forward.

Dr. Ayala
 
Full disclosure: I'm vice president of product development for Herbal Water. I'm also a pediatrician and have been promoting good nutrition and healthy lifestyle for many years

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