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Sugar, alcohol allowances remain in U.S. dietary guidelines, but watch it, local health leaders say

Spokesman-Review - 2/4/2021

Feb. 4—A majority of Americans fall short of a healthy diet, including too many calories from sugar. Battling U.S. obesity rates, experts warn against such heavy sweetened consumption.

Dieticians have long urged curbing "added sugars" typically from drinks, processed foods, sweeteners and desserts. That doesn't include natural sugars such as from fruits and milk, but many people don't come close to following suggested daily limits on added sugars from packaged products and sweeteners, say Spokane health leaders.

In December, the federal government issued new dietary guidelines that kept the same daily allowances for sugar and alcoholic drinks — despite advised reductions. The action reported on those issues but rejected a scientific panel's call to make significant cuts, citing that the advice to change lacked the "preponderance of the evidence" standard required.

However, the update did adopt the scientific group's recommended "no added sugars at all" for children ages 2 and younger.

The scientific group, with 20 academics and doctors, advised cutting the added sugars limit to 6% of daily calories, from the current 10%, and new limits for alcoholic beverages, citing U.S. obesity rates and health issues such as diabetes, heart disease and cancer. That lower goal is more ideal, but it's a challenging message, a local nutritionist said.

"I see patients daily, and they don't know how many calories they need. They don't know what 6% or 10% added sugar is, so giving them a percentage doesn't help people in general," said Lisa Randall, a Spokane Providence Health Services registered dietician nutritionist and diabetes educator. "Reading the guidelines and understanding why we shouldn't eat any added sugar is more important."

"The thing about added sugars is that our diet in this country is so out of sync — not even close to that 6% or 10%. It's more like in the 20%."

Randall said for better health, a focus should be on a diet rich in fresh fruits, vegetables and whole grains while limiting added sugars.

The American Heart Association and the World Health Organization already have moved their guidance closer to 6% added sugars for daily diets, said April Davis, a Washington State University clinical assistant professor and registered dietician in Spokane.

The AHA advises that for most American women to consume no more than 100 calories per day of sugar, about 6 teaspoons or 24 grams. For men, it's 150 calories per day, or about 9 teaspoons. Davis said she sides with the 6% guidance after scientific members "spent a lot of time looking at a plethora of evidence," although more research is needed.

"But they looked at everything they could," Davis said. "I do think status quo is not the way to go at this point with such an increase with diet-related disease states and conditions that are affecting the health of our population."

Generally, the risk of obesity is that it changes how the hormonal system and metabolism function, she said, "so thinking about the liver, the heart, the digestive tract." That organ system adaptability is detrimental when overconsuming calories, especially excess sugar, Davis added.

There also are genetic components — how people put on weight — that's called the apple or pear shape, she said. A body that's more apple-shaped genetically is more at risk with obesity because fat cells are surrounding organs and then impacting their function and changing some of the pathways, "to the detriment of a person's health."

"Just in general, that's why obesity lends itself to these chronic conditions because the organs don't function as well when exposed to that environment."

There are two sides to the dietary debate, added Glen Duncan at WSU's Elson S. Floyd College of Medicine. He is a professor and chairman of its department of Nutrition and Exercise Physiology, where Davis also works. He said there is a lack of specific, evidence-based studies testing the 6% guideline.

"I do agree with them that the evidence is difficult to get," Duncan said. "You have to remember that all dietary research is subjective. It's difficult to measure diets validly and reliably. We do have some good tools, but they're prone to measurement biases."

But he'd like to see the 6% bar, citing that the other side of the debate centers on junk calories that don't add nutritional value.

"That's where people like me, April and largely the scientific advisory committee would say is, 'Well, guess what? The guidelines you've been using the last several years have done nothing to impact the obesity problem, so we need to be way more aggressive.' "

"It really reframes the issue to more a prevention model. Unfortunately, the current guidelines just are not robust enough for prevention and health promotion."

Randall said compromise was likely a factor, comparing to advice years ago that urged Americans to eat at least five fruits and vegetables a day.

"It was really nine fruits and vegetables a day, but Americans ate one to two a day," she said. "You can't go from one or two a day to nine, so they compromised."

"I look at this sugar thing similarly in that 6% is far better than 10% for sure, but if you consume 20%, you're not going to go to 6%. If we got to 10%, I would celebrate."

Calories come from carbohydrates, protein and fat. Eating more sugar, people typically don't consume what's needed from nutrient-dense fruits and vegetables providing vitamins, minerals, phytochemicals and antioxidants.

Whole grains rich in fiber have antioxidants and fight inflammation, Randall said, while processed grains such as white flour become inflammatory and are more calorie-dense, with the vitamins and minerals removed from the germ. But that makes such products shelf-stable for a wider food supply.

Added sugars, which also help preserve food, go by many names including dextrose, fructose, sucrose, high-fructose corn syrup, glucose, lactose, maltose, malt syrup, brown sugar, molasses, honey and raw sugar.

Newer food labels list total sugar grams to track, but examples add up quickly: a 12-ounce Coca-Cola, 39 grams of added sugar; Starbucks 16-ounce café latte, 18 grams; 12-inch square of angel food cake, 15 grams; half a cup of ice cream, 12 to 24 grams depending on varieties; and one cup of Honey Nut Cheerios, 12 grams.

Generally, added sugar in foods are associated with higher calories, Randall added. "When we have a lot of sugar in our diet, we have too many calories. This is contributing to the obesity problem and overweight problem."

For people who don't have trouble with carbohydrate metabolism, the body can take care of added sugar and adapt, she said, but it's an issue if there's diabetes or prediabetes. "We're talking about half the population in this country right now. If you add in insulin resistance, it is the majority of the population."

While Duncan said it's critical for U.S. residents overall to reduce sugar consumption, he added that everyone is different as far as dietary responses. One person responds well to a low-carb diet, for example, while another doesn't.

Adults also need to limit alcohol, Davis and Randall said, and they agree with "no added sugars" for kids 2 and under. Adults should pay attention, as well, for health gains.

"We're overconsuming calories, and a lot of that is due to these added sugars," Davis said.

"The 6% was actually derived by looking at, in order to meet all our nutrient needs, what is that junk or empty-calorie amount available left over for people in general ... whereas for under 2 years old, you don't even have that 6%" to meet a growing child's nutritional needs, she said.


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