Dr. Ritchie: You know one of the interesting things if you look at the trends in diet over the time period that obesity has increased; and when I say obesity, I refer to both children and adults. Since as you all know, this is not a child-only issue. Within the last 30 years, child obesity has quadrupled and adult obesity has also increased, such that now almost two-thirds to three-quarters, depending on where you live exactly, are overweight or obese as adults. But what we see is that calorie intake has definitely increased and the intake of most things has increased. So we can’t just pinpoint it on sugar; certainly sugar has increased. When we look at the diet quality of children, we see that very few kids meet the dietary guidelines. Right now, the recommendation is that an average person get 10% or less of their calories from sugar. What we see is most people get one-quarter or one-third, much more than 10%, of calories from sugar.S: So you’re saying, Dr. Ritchie, that our children, our youth, are actually getting two or three times as much sugar in their diet than they actually should be.
Dr. Ritchie: Yes, 2-3 times more sugar. And that is not only true among kids but of adults also. But what that trend data shows is just that a lot things have changed. It’s not just the sugar intake. So we’re actually eating a little bit more fruits and vegetables than we used to.
S: Really? Without the syrup?
Dr. Ritchie: Well most of those fruits and vegetables if you look at them there’s just a very few fruits that have increased. It’s mostly apples and bananas, not a wide variety of fruits. Vegetables that have increased are mostly potatoes.
M: Which end up fried.
Dr. Ritchie: Exactly. French fries. Certainly the trends are not anywhere near optimal for anything. About the only thing that has decreased during the time period is milk consumption. And that is actually quite well correlated with the increase in soda consumption. So if you see a kid that has a high soda intake; more than likely they will have a low milk intake. If they have a high milk intake, more than likely they have a low intake of sweetened beverages.
S: So it is an inverse relationship.
Dr. Ritchie: So we have kind of switched to replacing what we would call more healthy beverages, the low-fat or non-fat milk; our kids and adults too have switched and replaced those with sweetened beverages.
S: Well, let’s just talk about sugar for a minute as far as the types. You know you look at what you are eating or drinking and there is sugar in there, but that doesn’t mean that is the only word that says how much sugar is in there. They sneak different words in there that are also sugars. So, let us talk about the sugar types and what to look out for. You want to be careful of your nutrition and daily sugar intake.
M: Yes, especially with the increase in proportion of calories coming from sugars. I understand that it should be down to 10% of total calorie intake; and for some kids it goes as high as one-third or 40% of their total calorie intake. So this is something we really have to watch out – sugars in our kids’ diets.
Dr. Ritchie: Let me just add that that is 10% of added sugar. So in milk, in fruits, in various foods there are natural sugars that are present, but we want to avoid the added sugars.
M: Yes. Well, unfortunately, with nutrition facts labels, we are not able to make a difference between those naturally occurring sugars and added sugars, so we have to look closely at the ingredient list. Sugar is not always indicated as ‘sugar,’ so we have to look for words like, high fructose corn syrup, brown sugar, fructose, corn syrup solids, dehydrated cane juice, honey, dextrose, concentrated fruit juice, concentrated fruit, molasses, maple syrup, rice syrup, inverted sugar, malt, etc. Basically, all these words that end in - ose, syrup, juice end up as sugars on the nutrition panel.
Dr. Ritchie: The sugar that we eat from fruit and from natural foods – as part of the natural foods that we eat – contain some of those very same sugars, so it’s not like the body can really tell if you eat a fruit and get some fructose from that fruit versus a drink that has high fructose corn syrup added and has fructose in it. Your body can’t tell that that fructose was added or whether it was a natural part of that food. But what we want to do when we read labels, we want to avoid things that have those sugar and sugar-related ingredients added to them. When you eat a fruit, it has that sugar packaged naturally and comes with a lot of nutrients whereas a soda just has that sugar but no other nutrients; there is nothing else that is redeemable in it. It’s what we call an empty calorie in that it gives you calories from that sugar but doesn’t give you any other nutrients, no other phytochemicals, no dietary fiber -- nothing else to be healthy. And what we are seeing is that people are getting more and more of their calories from empty calories and less of their calories from nutritious, whole foods. And what that leads to is a lot of consumption of calories and not a lot of nutrient intake.
S: Can it also lead to malnutrition?
Dr. Ritchie: So what we call overnutrition is really a form of malnutrition. In the past, when we talk about malnutrition, we always thought about kids that were starving and not getting very much nutrition. But nowadays, kids that are overconsuming on calories but aren’t getting enough nutrients are also malnourished.
S: Do you have any statistics?
Dr. Ritchie: The U.S. has Dietary Guidelines for Americans and The Food Guide Pyramid have guides for certain food groups. On a national basis, and here I am including adults, is that no one is meeting those recommendations. The statistics are that 2% of kids and maybe 3% of adults are meeting those recommendations. So when we are talking about public health and intervening to prevent obesity, what we are really talking about is intervening on the entire population. Some of us are maybe more or less genetically prone to overweight. But all or most of us are not doing a great job of managing our diets. People are very interested in obesity because it is so visual. You can see it and grasp onto it, but some of the other diseases associated with obesity are much less obvious to us, like cancer, hypertension, cardiovascular disease, diabetes. So even in the absence of obesity, a healthy diet is important for the promotion of health.
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M: The 1980’s started a low fat period in America. Food with less fat means increased carbs. This translated in an increase in sugars and starch fillers, especially in the form of HFCS, in manufactured processed food in the 1980’s in America. In the 1980’s, 35 pounds of HFCS per person per year was consumed, whereas in 2004, the number more than doubled to 78 pounds per person per year.
K: To tie this to the Farm Bill (last week’s topic), the reason why we might be seeing the increase in consumption. The Farm Bill helps to subsidize some of the commodities (such as corn) that help to produce ingredients like HFCS. Because these commodities are so highly subsidized, it is cheaper for manufacturers to use ingredients such as HFCS, especially if we are talking about using sugar in soda and other junk food.
K: There isn’t a set dietary guideline for a safe maximum amount of sugar intake per day but there are some experts that talk about the recommended maximum added sugar in our diet. So added sugar does not mean sugar we get from fruit and natural foods but only added sugar. It is at about less than 10% of your total calorie intake, so if you are at approximately 2000-calorie diet, that is about 40 grams of sugar per day is the recommended max. This is about 10 teaspoons of sugar per day.
Examples of sugar in 20 ounce bottles of sweetened beverages:
Cola = 17 teaspoons of sugar
Cherry flavored cola = 18 teaspoons of sugar
Lemon lime soda = 17 teaspoons of sugar
Examples of sugar in snacks:
Candy bar (2 ounces) = 7.5 teaspoons of sugar
Lemon fruit pie = 11.5 teaspoons of sugar
We need to be careful about the amount of added sweeteners daily.
Dr. Ritchie: For every man, woman, and child, there are approximately two cans of soda produced. This is not counting all the other sweetened beverages like juices, lemonades, and others, so even without the snacks, we are consuming a lot of sugar in just beverages.
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