Emerging research suggests that sugar may be linked to deadly diseases, but Health Canada’s current food labelling regulations make it tough for Canadians to get an easy picture of how much of the sweet substance they are consuming — and it doesn’t look like that’s going to change any time soon.
The groundbreaking and controversial research explored by the CBC’s the fifth estate in its season premiere tonight links sugar to diseases ranging from diabetes to cancer and Alzheimer’s.
“Sugar is toxic beyond its calories,” Dr. Robert Lustig, an expert on childhood obesity at the University of California, San Francisco, told the fifth estate’s Gillian Findlay.
While Canadians have become used to warnings about the dangers of consuming too much fat or salt, nutrition labels on food have never included recommended daily limits specifically for sugar.
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One option, and perhaps the most popular, is to eat or drink the sugar-free versions of your favourite sugary foods and beverages, like soda. When it comes to dessert or a snack, sugar-free Jell-O is a “free” food in a type 2 diabetes diet that can give you a little sweetness. However, warns Dr. Hannon, some sugar substitutes might interfere with your ability to control blood sugars, so go easy on these products.
Canned or bottled tomato sauce is a key ingredient in many meals, from pizza to spaghetti, but using store-bought sauce in your dish may add a surprising amount of sugar. The answer is to make your own simple sauce. “Simmer canned, chopped tomatoes on the stove with herbs you like,” says Hannon. “Even if you add a teaspoon or two of sugar, it would still be less than in the bottle.” Another option is to simply blend store-bought sauce with canned tomatoes to reduce the amount of sugar in each portion.
Is a candy jar part of your desk’s decor? What might be a welcoming treat for visitors can become a trap for you and your sugar habit. “If you take one piece in the morning, one later on, and so on, by the end of the day you may have eaten 10 pieces,” Hannon says. Moving the jar or getting rid of it entirely will help you limit your sugar intake and stick to your type 2 diabetes diet.
Sugar-sweetened fruit products like fruit roll-ups, fruit leather, and juice drinks give the illusion of being healthy options for a diabetes diet, but they really aren’t, says Hannon. Replace these choices with one serving of whole fruit to satisfy your sugar cravings with a nutritious, reduced-sugar option. The great thing about fruit is that you can easily eyeball a serving — it’s about the size of a baseball.
Bottled salad dressings are surprisingly high in sugar or high-fructose corn syrup, says Hannon. But for many people, a tasty dressing enhances the pleasure of eating salad. Experiment with making your own dressings to limit the amount of sugar in your salad. By using a homemade dressing, you’ll also be able to control other ingredients that affect your overall health as well as your diabetes, such as the type of oil you use or the amount of salt you add.
Low-fat dairy products are good for people with type 2 diabetes, but skip those strawberry, chocolate, or vanilla varieties. Flavoured milk contains a lot of added sugar, Hannon notes. If you really want milk with a little added sweetness, experiment with mixing in sugar-free syrups or just use the smallest amount of a sugar-based one to get a little added flavor. Likewise, opt for plain yogurt and add your own chopped fresh fruit for a sweet taste.
Granola, a main staple in many trail mixes, could quickly top out your sugar quota for the day, especially if the mix also includes a touch of chocolate or sugary nuts. You can improve your diabetes numbers by making your own trail mix with plain nuts, oats, and some dried fruit — and by sticking to a reasonable serving of your treat.
Even seemingly healthy boxed breakfast cereals may contain sugar that you don’t really need or want in your daily diabetes meal plan. Look for breakfast choices that do not contain refined flours or added sugar. For example, a slice of whole-grain toast with natural peanut butter and some fruit could be a good alternative. Beware of hidden sugar when eating out for breakfast. “Oatmeal at fast-food restaurants can be high in sugar,” warns Hannon.
A simple switch that can improve your diet is choosing whole-grain foods over refined flour ones, such as whole-grain pasta instead of white pasta and whole-grain bread instead of white. Unfortunately, whole-grain alternatives are often costlier. In tight economies, it’s essential to look for supermarket sales that help you maximize food dollars, allowing you to continue to buy the building blocks of your healthy, low-sugar diabetes diet.
Remember that eating one small cookie won't hurt your diabetes diet. The key is to keep the portion small and consider other options available to you, such as fresh fruit or a handful of nuts, before you reach for the cookie. But if you do choose the sugarier treat, just keep the portion reasonable, really savor it, and adjust your diet plan for the day accordingly.
Health Canada does not have a recommended limit for how much sugar Canadians should consume in a day.
A representative of Food and Consumer Products of Canada, an industry organization that represents the largest food companies in the country, says it sees “no need” for a recommended daily limit on sugar intake.
- Check out how much sugar is in popular grocery items
- Watch a medical researcher talk about eating fruit
Health Canada declined numerous requests by the fifth estate for an interview, but former Health Canada employees did speak off the record, and said the department does not think that sugar should be singled out as a major culprit behind chronic diseases.
Stirring up debate
According to Statistics Canada, the average Canadian consumes 26 teaspoons of sugar per day. That works out to 40 kilograms per year —– or 20 bags.
Wile neither the Canadian nor U.S. governments has a recommended daily limit for sugar consumption, one major U.S. medical group is recommending people cut back on the sweet substance.
The American Heart Association is suggesting men consume no more than nine teaspoons a day. For women, the recommendation is a maximum of six teaspoons.
That recommendation comes as research from a small but influential group of medical researchers is stirring up debate on the impact sugar has on health.
One of the most vocal of those researchers is Lustig, an author who has become a YouTube sensation for a 90-minute lecture in which he calls sugar a toxic poison.
“I use those words and I mean them. This is not hyperbole. This is the real deal,” he told Findlay.
“Everyone thinks that the bad effects of sugar are because sugar has empty calories. What I’m saying is no, there are a lot of things that do have empty calories that are not necessarily poisonous.”
Breaking down the sugar
Lustig says that sugar, which is made up of glucose and fructose molecules, is a poison because of the way our bodies break it down.
“When you metabolize fructose in excess, your liver has no choice but to turn that energy into liver fat and that liver fat causes all of the downstream metabolic diseases.”
But not everyone agrees with Lustig’s theory, including other doctors and food industry representatives.
Dr. John Sievenpiper, a researcher at St. Michael’s Hospital in Toronto, questions Lustig’s methodology and his view that "sugar and only sugar" is the prime factor in the international food supply that “predicts [the] diabetes rate worldwide."
Sievenpiper notes that during the same time period when Lustig points to increasing sugar consumption and rising rates of obesity —– something that has been linked to diabetes — there was also increasing consumption of bottled water.
“But there's no real biological plausibility in the link between bottled water and [being] overweight and obesity. We have to be careful in putting too much of the biological plausibility in wanting to believe patterns that we see.”
Sievenpiper isn’t recommending people eat a lot of sugar, but he does suggest we should be careful about saying fructose is largely responsible for various health problems.
“As long as you match for calories, fructose does not behave differently than does any other form of carbohydrate, namely starches or fine starches and glucose. And that's not to say that they're benign, because I don't think we should be having a lot of refined starch or glucose. But it's not behaving any differently.”
A representative of Canada’s largest food industry association is also skeptical of Lustig’s research.
Phyllis Tanaka, vice-president of scientific and regulatory affairs for Food and Consumer Products of Canada, isn’t worried about Lustig’s claims about one of her industry’s key ingredients and doesn’t think consumers should be either.
“I think it’s important that we step back and look for ways to educate and help consumers fit sugar into a healthy dietary pattern,” she said.
But current food labelling regulation can make it difficult for consumers who want to avoid sugar.
On Canadian nutrition labels, manufacturers are required to list ingredients in order from greatest to least volume. But many labels list multiple kinds of sweeteners with different names. For example, honey, barley malt syrup and evaporated cane juice could all be listed separately, even though the human body treats them all as sugar.
Also, sugar is measured in grams on labels, instead of more consumer-friendly teaspoons. For someone trying to keep track of intake, four grams of sugar equals one teaspoon.
In a can of Coke, for example, there are more than 10 teaspoons of sugar. The popular “Healthy Choice” microwave chicken dinner has 5½ teaspoons.
Tanaka says her group has worked with Health Canada over the last few years on how to help consumers make “informed choices,” and that for those who want to avoid sugar, all the information they need is already on the label.
“At this point in time, I’m comfortable in saying the science just isn’t there to support a role in chronic disease.”
Watch The Secrets of Sugar on the fifth estate on CBC-TV tonight at 9 p.m.