A decade after the World Health Organization faced enormous pressure — and a threatened withdrawal of U.S. funding — for recommending that people limit added sugars to 10 per cent of their caloric intake, the international public health agency announced Monday it is going to issue updated advice on prudent levels of sugar consumption.
The WHO said it would reveal its latest recommendations on Wednesday, opening up a short consultation period for the public — which will undoubtedly include the food lobby — to try to influence the final position. The expectation is the agency is going to lower the bar further. After all, news conferences aren't generally called to announce no change.
In Canada, the Heart and Stroke Foundation this week kicks off a process aimed at determining whether it should follow the lead of the American Heart Association and issue sugar limit recommendations of its own.
Heart and Stroke hosted the first meeting Monday of an international advisory panel it has convened to look at whether the organization should produce an added sugar limit recommendation and, if yes, what that recommendation should be.
In the past few decades, the percentage of the population that is overweight and obese has soared. A study published Monday in the journal CMAJ Open reported that obesity rates in Canada tripled between 1985 and 2011, rising to 18 per cent from six per cent. It projects that by 2019, nearly 21 per cent of Canadian adults will be obese.
Nutritional experts have been warning we eat too much, and in particular too much sugar. But they also acknowledge people need help figuring out how much sugar they actually eat.
"People need to understand what they're consuming, and I don't think we currently do as a society," says Dr. Yoni Freedhoff, an Ottawa-based weight loss expert and author of "The Diet Fix: Why Diets Fail and How to Make Yours Work."
"I don't think that's true for the average person out there."
Experts aren't so concerned about naturally occurring sugars, the stuff built into the foods Mother Nature concocted — things like apples, figs, corn and yams. The problem is the sugars that are added to processed and prepared foods. Those sugars are ubiquitous: in breakfast cereals, condiments, baked goods and pasta sauces.
"At least when you're eating fruits, yes, you're taking in ... some naturally occurring sugar, but there's a heck of a lot of other nutrients and fibre in there that's good for your health," says Manuel Arango, director of health policy for the Heart and Stroke Foundation.
"But the added sugars are worse because products that have added sugars generally don't have ... any other nutrients. So there's only health risks, no nutritional benefits."
In the past, it was generally assumed that the risk from added sugars was an indirect one. Sugars contain a lot of calories and the more calories you eat, the greater the risk your calories in will exceed calories out, and weight gain will result. It is well established that being overweight raises your risk of developing heart disease, diabetes and some cancers.
But another school of thought is emerging, one that suggests sugar poses a more direct risk. The idea is that there is something about calories from sugar that increases your risk of developing disease, even if you maintain a healthy weight.
A study published last month in the journal JAMA Internal Medicine suggested the risk of dying of heart disease is higher among people who consume a greater percentage of calories from added sugars. And the risk was also higher for people who consumed seven servings or more of sweetened beverages a week.
Still, currently there is little in the way of clear guidance about how few of your daily intake of calories should come from added sugars.
One of the rare organizations that offers spelled-out guidance is the American Heart Association, which suggests that added sugars make up no more than half of your daily discretionary caloric allowance, which it says would be no more than 100 calories or six teaspoons (30 millilitres) a day for most American women and 150 calories a day or about nine teaspoons (45 ml) of sugar for men. To put that in context, a can of regular soda — not artificially sweetened — contains about 140 calories.
From most sources of nutritional guidance, there is advice on how many calories you should consume, and how those calories ought to be divvied up among proteins, produce and carbohydrates. But on the issue of added sugar, generally the message is: The less, the better.
The most recent iteration of Canada's Food Guide, for instance, urges Canadians to limit their consumption of added sugars. But the guidance is that vague; there is no recommended daily limit. And where the label of a breakfast cereal, for instance, will tell you what proportion of your recommended daily intake of fibre or sodium a bowl will contain, it won't list that for sugars.
In addition to being ubiquitous, added sugars come in many guises, so spotting exactly how much added sugar there is in prepared foods is no easy thing. Molasses, sucrose, fructose, anhydrous dextrose, malt syrup and honey — these are just some of the names sugar goes by.
Back in the early 2000s, the WHO came under extraordinary pressure when it recommended that added sugars make up no more than 10 per cent of a person's daily calories. The sugar industry successfully lobbied the U.S. Congress, which threatened to withdraw American funding for the UN's health agency, if it proceeded with the recommendation.
"It was really hard to understand what all the fuss was about," says leading nutrition expert Marion Nestle. (Her name is pronounced like the verb "to nestle" and she is not connected with the Swiss food conglomerate.)
Nestle, who is a professor at New York University, says the 10 per cent figure was essentially U.S. policy at the time. Embedded in the 1992 version of the U.S. food pyramid was the recommendation that added sugars make up no more than seven to 13 per cent of daily calories.
"It's pretty low, compared to what people actually eat. You can hit 10 per cent quickly, if you drink sodas at all," says Nestle, who expects the food industry to again go into battle when the WHO releases its new sugar intake recommendation.
"There's going to be fierce lobbying. Fierce, fierce, fierce," he says.
But both Nestle and Freedhoff think social media — which didn't exist in 2003 to the degree it does now — will make it harder for the food industry to fight new recommendations this time, especially given widespread concerns about rising obesity rates.
"I think what's different this time — hopefully — is that there is sufficient concern among the populace that politicians will be able to stand up to the sugar lobby and say, 'We can't get away with this,'" Freedhoff says.
"Politicians can only act in the public health's best interest when not doing so would be worse than their own political interests. And I think that a politician today standing up and saying that they are going to cut off aid, for instance, to the WHO if they make a suggestion that we should eat less sugar, that would not fly very well."
Follow @HelenBranswell on Twitter.