Action on Sugar: A spoon full of evidence would help the medicine go down

Hidden Sugar or Total Sugar?

Action on Sugar launched yesterday, and ignoring the awful hyperbole which accompanied it I thought it was worth looking at what they are actually proposing in detail because the press release poses more questions than it answers. Fresh from ‘dealing’ with salt CASH state

A similar programme can be developed to gradually reduce the amount of added sugar with no substitution in food and soft drinks by setting targets for all foods and soft drinks where sugar has been added.

They published a high street food ‘Survey’ to illustrate this. I say survey but its actually a very small list, cherry picked to including some extreme examples of foods which by their nature and formulation may have high sugar levels. Does it really take over a dozen Professors and Doctors to point out that Frosties Coca-a-cola, Pepsi and Mars contain a lot of sugar?

Also if Action on Sugar are aiming to highlight the issue of unnecessary added sugars why on earth have they chose to illustrate it using the figures for total sugar content?  Probably because they have jumped the gun and set targets for “added sugar”  despite food labelling being inadequate to monitor such targets.

There are also practical issues can something made mainly of sugar contain “added sugar”? Should there be an arbitrary decision on what is necessary, who would decide this?

Well Action on Sugars proposals go much further than targeting hidden sugar in pasta sauce, as this article shows they also want confectionary and high sugar items to meet an overall 20-30% reduction target as well. This is despite the fact that these are products well know by consumers to be high in sugar, they are clearly labelled as such and the prevailing advice is to consume these in moderation.

Finally why is it so important to remove rather than to substitute? If the ultimate aim is to reduce calories why preclude for example, the use of artificial sweeteners on day one?

The Numbers Don’t Add Up

Action On Sugar has calculated that a 20 to 30% reduction in sugar added by the food industry which, given a reasonable timeframe (3-5 years) is easily achievable, would result in a reduction in calorie intake of approximately 100kcal/day and more in those people who are particularly prone to obesity.

Its good to know that a bunch of academics have deemed that reformulating every food and drink product in the UK containing added sugar is easily achievable within 3-5 years from their ivory towers. If they get their way I may retrain as a food scientist because there will certainly be a lot of work to go round. Monitoring compliance of such major changes would I imagine be equally easy and cheap.

This reduction in calorie intake is predicted to reverse or halt the obesity epidemic

For such major change the outcomes appears uncertain. Reverse or halt?

Sarcasm aside, its worth thinking about what these figures actually mean in practice. Using Sucrose (table sugar) as an example to achieve a 100 kcal per day reduction this would require a reduction in the consumption of added sugar of approximately 25g/day. Working backwards using their assumption that this can be generated by a 20-30% reduction at source we can see that Action on Sugar believe that the average person unwittingly consumes 86-129g of added sugar per day in processed food.

Is this realistic? We can get an idea from the National Diet & Nutrition Survey (NDNS) because this has survey data on Non Milk Extrinsic Sugars (NMES) – basically all the added sugar, honey, syrup and fruit juices in the diet. Although these figures are based on a small survey (and probably include a degree of under reporting) it becomes clear that there are major differences in the NMES intake by gender and age group, and only one group (males aged 11-18) are likely to come anywhere near achieving a 100kcal/day saving based on a 30% reduction in total NMES.

[Edit: Please see additional note below which provides another source of UK data on NMES].

I say total NMES because these figures I mention would make an underlying assumption that all added sugar in the diet comes in the form of ‘hidden sugar’ which we eat unwittingly in processed food and which can be removed without anyone noticing. What about the added sugar people knowingly choose to consume? There is no way of controlling this – I like a Tunnocks Caramel and a drizzle of honey on my Weetabix after all. What about sugar people add to hot drinks themselves?

In simple terms, reducing the sugar in soup or pasta at source cannot stop people eating too many Mars Bars, even if Action on Sugar got their way and they were made with 20-30% less sugar.

The failure to acknowledge obesity as multi-faceted issue by this group which also requires behavioural change and the insistence on this being as simple as cutting supply is staggeringly out of touch.

Errors, Misinformation and Poor Logic

There are a lot of errors, obvious misinformation and poor logic in the press release. While these are not significant in themselves they are indicative of people with shoddy reasoning

No other mammal eats added sugar…

Totally irrelevant.

I hadn’t ever considered whether other mammals eat added sugar in their diet before, probably because most of them are yet to invent processed food. If however they mean no mammal eats sugar they are quite wrong: bears, racoons are opportunist feeders who will undoubtedly exploit calorie rich food sources like honey when available. Eating sugar is not a unique human activity.

…and there is no requirement for added sugar in the human diet.

Firstly, its not required in the sense that you can choose what to eat. The real question though is whether it is harmful and if so in what amounts.

This sugar is a totally unnecessary source of calories…

Again meaningless assertion about necessity without any context.

….gives no feeling of fullness…

Good god Milky Way’s USP was a lie – all sugary snacks can be eaten without ruining your appetite!!

I’m joking of course, this statement which Dr Aseem Malhotra made repeatedly yesterday is blatantly false (sugar does have a satiating effect however small) and is one good example of why appointing him as Science Director when he has no experience in the field and has published no research is a really bad idea.

Where is the research and evidence?

The above is not the only issue with evidence, Malhotra again…

… and is acknowledged to be a major factor in causing obesity and diabetes both in the UK and worldwide.

You read that right. Dr Malhotra appears to be claiming a causal relationship between sugar and type 2 diabetes. Yes it is associated with obesity and this is a risk factor in type 2 diabetes but no direct causal relationship has been established. I think its telling that Action on Sugar have sections on their temporary website for ‘press’ but nothing for ‘research’ and ‘evidence’. Is this the standard of evidence we can expect?

Conclusion

These appear to be poorly thought out proposals which would have uncertain benefits and the campaign seems to be more about misinformation and winning hearts and minds via the daybreak sofa than driving change through robust evidence. I will be putting some of these issues to Action on Sugar and will add their response, if any below.

In the meantime, ask them for evidence yourself.

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Update 12/01/2014

Via twitter another source of data for UK NMES was provided (big thanks to Phil Thompson @UKLowCarb) which is the Department for Environment, Food & Rural Affairs Family Food Datasets. These are presented as averages per person per day and helpfully include both household and eating out energy and nutrient intakes.

Apart from showing a general downward trend in NMES from 92g/person/day in 2001-2 to 77g/person/day in 2012 these would also suggest that a 20-30% reduction is unlikely to provide a 100kcal/person/day reduction in calories. This may explain why one day after launching with these numbers in their press release, Dr Aseem Malholtra is now referring to  a 40% reduction to achieve this target.

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3 thoughts on “Action on Sugar: A spoon full of evidence would help the medicine go down

  1. “No other mammal eats added sugar…”

    No other mammal has hospitals either. Should we demolish all hospitals on the grounds that monkeys (our closet relatives) don’t have them? Wouldn’t that rather put Dr Malhotra out of a job?

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