These few words still bring to my mind fond childhood memories of Mary Poppins singing to Jane and Michael about how a “spoonful of sugar helps the medicine go down, in a most delightful way” as they tidied up their room. However, now that I have grown, I know that the relation between sugar and medicine is not as harmless as the merry nanny made us believe as children. Over the last decades, there have been many studies proving the close relation between sugars and several conditions; such as obesity, diabetes, cardiovascular disease (CVD), and dental caries (1-4).
However, the issue at hand is trickier than it may seem at first glance.
Firstly, the definition of sugar itself has been a source of confusion both for the consumer and the scientific community. Several nutritional guides, such as the Nordic Nutritional Recommendation 2012 (5), specific for the Nordic populations, use the term added sugars as a reference value for their recommendations. Added sugars is defined according to the FDA as “sugars and syrups that are added to foods during processing or preparation”, meaning that sugars found naturally in food, for instance, fruits, vegetables and dairy products, are excluded from this definition (2). However, the World health Organisation (WHO) favours the term free sugars for their guidelines, which also include natural sugars present in fruit, fruit juices and juice concentrates (2, 6). Furthermore, the sugar industry has gotten almost ridiculously creative in the use of synonyms for sugar on food labels, which only adds to the bewilderment of the consumer.
Secondly, the strong influence that the sugar industry exerts when regulation and policy making is needed, as well as on the funding of research studies on the topic. I have been involved in researching within the topic of added sugars for a few months now and it has been a challenge to find studies, particularly systematic reviews, not funded by one branch or another of the sugar industry (see for example Gibson et al.7 or Rennie et al.8). Furthermore, a good example of the influence of the food industry on a policy level is the abolishment of both the sugar and fat taxation introduced in Denmark (9, 10).
Lastly, the ubiquitous presence of sugars (almost everything that comes in a jar, a can or a packet contains sugar) makes reducing or eliminating the consumption of added sugars almost impossible for the consumer.
However, there is light at the end of the tunnel. International Organisations such as the WHO, have started to promote the implementation of harsher techniques to tackle the current obesity pandemia through, among others, limiting the maximum amount of sugars recommended with the diet, promoting healthy behaviours and diets, and encouraging economic measures, such as excise taxes (11).
A particularly good example is the taxation on sugar-sweetened beverages (SSBs) implemented by British chef Jamie Oliver on his Italian restaurants. Twelve weeks after the introduction of a 10p tax on SSBs, the purchase of soft drinks had decreased by 11%. After 6 months, a 9.3% decrease in purchase is still significantly lower than before the introduction of the tax (1). The success of this initiative has made headlines both on mass and scientific media (1, 12-13). However, this is not Jamie Oliver’s first incursion into healthy eating he has championed and supported many programmes to promote healthy eating habits among children to improve their academic results through his School Dinners Programme (14), among his audience via books and TV shows, and many others through his Food Revolution initiative. Most notably he helped to push forward the approval of a policy soon to be adopted by the United Kingdom’s Government named Childhood Obesity: a Plan for Action (15). This plan intends to implement harsher strategies to prevent obesity among British children by promoting healthy eating and taxing unhealthy habits (15).
This should be a call to scientists and researcher, as well as, global institutions to prompt them to reach an agreement so that we can present a unified front when designing dietary recommendations and changing food policies. In coclusion, the topic of sugar is not exempt of intricate issues. However, what a remains perfectly clear is that the excessive consumption of, particularly, added sugars is closely related to numerous chronic diseases. Therefore we need to remember that having that spoonful of sugar could definitely keep us on the fast track to make (many) medicines go down, although definitely not in “a most delightful way”.
- Cornelsen L, Mytton OT, Adams J, et al. Change in non-alcoholic beverage sales following a 10-pence levy on sugar-sweetened beverages within a national chain of restaurants in the UK: interrupted time series analysis of a natural experiment. J Epidemiol Community Health 2017;71:1107-1112.
- Erickson J, Slavin J. Total, Added, and Free Sugars: Are Restrictive Guidelines Science-Based or Achievable? Nutrients 2015, 7, 2866-2878; doi:10.3390/nu7042866
- Bray, G.A.; Poopkin, B.M. Dietary sugar and body weight: Have we reached a crisis in the epidemic of obesity and diabetes? Health be damned! Pour on the sugar. Diabetes Care. 2014, 37, 950–956.
- Welsh, J.A.; Cunningham, S.A. The role of added sugars in pediatric obesity. Pediatr. Clin. North. Am. 2011, 58, 1455–1466.
- Nordic Nutrition Recommendations 2012. Integrating nutrition and physical activity. 2012. Available at: https://www.norden.org/en/theme/former-themes/themes-2016/nordic-nutrition-recommendation/nordic-nutrition-recommendations-2012. [Last Accessed: 24 October 2017].
- World Health organization. Guideline: Sugars Intake for Adults and Children 2015. Available at: http://www.who.int/nutrition/publications/guidelines/sugars_intake/en/. [Last Accessed: 24 October 2017].
- Gibson SA. Dietary sugars intake and micronutrient adequacy: a systematic review of the evidence. Nutr Res Rev. 2007 Dec;20(2):121-131.
- Rennie KL, Livingstone MB. Associations between dietary added sugar intake and micronutrient intake: a systematic review. Br J Nutr. 2007 May;97(5):832-841.
- Jensen J, Smed S. The Danish tax on saturated fat – Short run effects on consumption, substitution patterns and consumer prices of fats. Food Policy. 2013;42:18-31.
- Bodker M, Pisinger C, Toft U, Jorgensen T. The rise and fall of the world’s first fat tax. Health Policy. 2015 Jun;119(6):737-742.
- World Health Organization. Using price policies to promote healthier diets. 2015. Available at http://www.euro.who.int/__data/assets/pdf_file/0008/273662/Using-price-policies-to-promote-healthier-diets.pdf. [Last Accessed: 24 October 2017].
- Boseley S. Will a sugar tax work? Well, it did at Jamie Oliver’s Italian restaurants. The Guardian 17 October 2017. Available at: https://www.theguardian.com/society/2017/oct/17/will-a-sugar-tax-work-well-it-did-at-jamie-olivers-italian-restaurants. [Last Accessed: 24 October 2017].
- London School of Hygiene and Tropical Medicine. Sales of sugar-sweetened drinks in Jamie’s Italian restaurants fall by 11% after 10p levy. 17 October 2017. Available at: https://www.lshtm.ac.uk/newsevents/news/2017/sales-sugar-sweetened-drinks-jamies-italian-restaurants-fall-11-after-10p-levy. [Last Accessed: 24 October 2017].
- Williams R. Jamie Oliver’s school dinners shown to have improved academic results. The Guardian. 29 March 2010. Available at: https://www.theguardian.com/education/2010/mar/29/jamie-oliver-school-dinners-meals. [Last Accessed: 24 October 2017].
- HM Government. Childhood Obesity: A Plan for Action. 2016. Available at: https://www.gov.uk/government/publications/childhood-obesity-a-plan-for-action. [Last Accessed: 24 October 2017].