The current fad is no exception.  I took this photo in my local book shop this week, and you’ll see that the recurring silver bullet today is cutting out sugar. It seems we’re lining up in droves to buy these books, judging by the amounts stocked in bookshops.

As a dietitian who works with food industry clients, including a sugar company*, I know quite a bit about the role of sugars in our diet, our intake of sugars in New Zealand, and the evolving scientific consensus involving sugars and health. So this diet fad is keeping me pretty busy as I try to inject some New Zealand context and scientific evidence into the space.

Let’s be clear, I’m not advocating for unrestricted sugar consumption, or arguing that sugar is particularly good for you.  Advice relating to sugars is, and always has been, relevant to strategies to reduce the high risk of overweight and obesity in many countries. However, a singular focus on sugars is unwarranted and would be ineffective for the wider population, when there is nothing metabolically special about sugars (over any other energy source) to cause weight gain.  This singular focus also distracts from the importance of a person’s whole diet, and may unintentionally reduce diet quality by reducing intake of nutritious foods such as fruit, vegetables and milk, and increasing intake of saturated fats.

In 2010 an Australian nutritionist, Dr Chris Forbes-Ewan, provided this useful and balanced feedback on one of the books pictured above.  The points he made are still just as relevant today, and I could not put them better myself.

My own personal advice on sugars is pretty simple – ideally items high in sugars should either; also contain a lot of other essential nutrients (vitamins, minerals, fibre, phytonutrients) to justify their regular consumption; or be enjoyed in small amounts.

I used the word enjoyed deliberately. Food is more than a collection of nutrients. We are social beings who interact, share, love and dream over food.  Without the ability to enjoy food (responsibly) life just isn’t much fun.

To justify their investment, some of those on these fad diets claim all sorts of short term health gains. I’ve even been approached by “believers” suggesting that all dietitians should provide this advice to their clients, because a number of general practitioners are promoting it.  With all due respect to general practitioners, nutritional science isn’t generally their area of expertise.

While I applaud the “believers” for changing their lives, there is no evidence that the responsible consumption of sugar caused their initial health problems.  Frankly, cutting any common source of dietary energy from  your diet altogether will drastically reduce overall energy intake.  Simply being conscious of (and thereby restricting) what you’re putting into your mouth is known to result in weight loss to start with.

Unfortunately the long term results on weight and micronutrient status are unknown – generally because people can’t stomach fad diets for very long.  That’s what makes them fad diets.  But not to worry – the astute authors will have dreamed up another fad diet to make their money from by then, and so the rollercoaster devoid of common sense continues…

*this blog represents my own personal views, not those of my clients.

It was a great opportunity to show what is happening in NZ and how we as a nation are faring in these tricky times and what the food industry and health sector are doing to address a global issue.

Not surprisingly, but no less disappointingly the piece was fairly one dimensional and single-mindedly focused on sugar and soft drinks.  What it did highlight, once again, was the limited lens through which so many people choose to examine the link between food and health, or rather food and disease as appears to be the main focus.

While I commend Sunday for attempting to help New Zealanders think about what they choose to eat (or in this case drink), the facts do not warrant the dramatic way in which this, and many other stories are presented.

It certainly makes for good TV to show a wheelbarrow full of sugar to represent how much we each consume annually, but this is somewhat misleading.  Likewise we each consume several Olympic-sized swimming pools of water annually, which also looks frightening.  In fact on a daily basis our median intake of sucrose when last measured in 2008/09 was just 48g.  And it’s on the decline (it was 53g in 1997).

Also, only 5% of our energy (as measured in 2008/09) came from non-alcoholic beverages.  And just 1.4% of energy was contributed by the sucrose in all non-alcoholic beverages (only part of which is sugary soft drink).  The rest, presumably, is contributed by fat, lactose, fructose, glucose and protein (remembering this group includes all non-alcoholic beverages other than plain milk).  So are the other foods and drinks which contribute 98-99% of our energy intake unimportant?  I think not.

In New Zealand, our intake of sugar (and particularly sugary soft drinks) differs significantly from countries like the United States, where much of the concern about sugar intakes stems from.

I don’t wish to trivialise the issue, as clearly the above figures are population medians, and some New Zealanders do over-consume.  I would like to propose however, that these individuals are unlikely to be over-consuming on sugary soft drinks alone, and are more likely to be part of the growing number of food-illiterate people who don’t understand what over-consumption is.

To Professor Rush’s point, there is some evidence that we feel less satiated when we drink kilojoules, compared with when we eat them (because our stomachs empty more quickly), but I think the issue of satiation is far broader than just blaming drinks for our obesity problem.  More and more New Zealanders seem to have become so accustomed to constant grazing on food and drink, to the point that many do not recognise the feeling of satiation, let alone the feeling of hunger.

What drives us to this?  Economic, cultural and social issues that shape the environment we live in and the choices we make.  Recently I read some research which found that most people no longer know what a calorie/kilojoule is.  Yes, sugar and sugary drinks provide kilojoules, but so does everything we eat.  In order to improve our health as a nation, individuals need a basic understanding of their own diet and how it relates to their own health; they need tools to help them make the best choices for them individually and they need to accept some individual responsibility for what they feed themselves and their families on a daily basis.

Yes, I do provide independent nutrition advice to a range of food companies, including NZ Sugar and Coca-Cola Oceania, so you may think my opinion is biased.  As a result though, I’ve been following this issue closely and am aware of the evidence, plus lack of evidence, surrounding it.  In my experience, it’s hard to get those without a vested interest in this issue to speak up – at least in New Zealand.  My personal view is to stick to the facts, and to address all of the issues with practical solutions, rather than pinpoint one possible contributor alone.  If there was a single silver bullet to address obesity, we would have found it my now, and we’d all be an ideal BMI.

The interface between science and journalistic endeavour is an area of constant tension. Rarely does a singular study change the course of knowledge. This comes about by the gradual accumulation of a body of evidence, each study with its own strengths and flaws.  And for every five studies that prove a point there are bound to be at least four which disprove it, or vice versa.

It’s an unfortunate truth that cumulative evidence over long periods of time is just not attention-grabbing material.  Nevertheless that’s what forms the basis of evidence-based recommendations such as the food and nutrition guidelines.

Meanwhile it’s frequently opinion, and our propensity for storytelling which creates human interest and media attention.  Regrettably at times it is presented as fact.

By way of example, I’d like to share a recent frustration with one of our daily papers.  A few weeks ago there was a large, well-meaning, colourful feature about the sugar content of popular children’s breakfast cereals.  The headline  described them as junk food.  My concerns about this article were multiple:
1.    The sugar content of cereals is hardly news, when every single packet, by law, displays the sugar content per 100g.
2.    The sugar content per 100g is really only useful when comparing between cereals in the supermarket.  It does not equate to the sugar content per serve, which in this particular case would have been about a third of that colourfully highlighted.
3.    A public health advisor contributed: “cereal manufacturers use layers of sugar on fat on salt on more sugar to get people hooked on the product”.  So,  you could be forgiven for thinking that breakfast cereal – surely a good product to develop a life long habit for – is less preferable than sending little Johnny off to school on an empty stomach, or with a belly full of bacon and eggs.
4.    There wasn’t any information which would help the average person to put the sugar content of these possible breakfast options into context with other possible breakfast options.  I don’t know any children who’d be happy to eat weetbix or porridge without sugar or fruit, which would essentially render either of these options equivalent in total sugar to most of the cereals listed in the article.  Unfortunately the other recommended option,  “homemade bircher muesli” requires a luxury of time that most of us don’t have, not to mention it being made with fruit juice, grated apple and yoghurt, adding a substantial amount of sugar.

So the average Mum (household shopper) is left feeling guilty (yet again) for feeding her children something they will actually eat for breakfast, and has no idea what she should replace it with.

But she only has to wait a week before another article from the same paper gives her a solution.  This extols the health benefits of maple syrup and encourages parents to drizzle it over their children’s breakfasts for “nutritive value”.

And we wonder why people get confused….

If you have any similar examples to share I’d love to hear them! Just submit a comment below.