The World Health Organisation announced that “sugars should be less than 10% of total energy intake per day.” It further advised that “a reduction to below 5% of total energy intake per day would have additional benefits.”[i]
This announcement follows much “Action on Sugar” in 2014 – this being the name of a new organisation launched on 9th January 2014, with the stated aim of targeting added sugar.[ii] Dr Robert Lustig has been telling us “The bitter truth about sugar.”[iii] Dr Assem Malhotra called for the dietary advice on sugar to undergo emergency surgery.[iv] James DiNicolantonio suggests that “the metabolic syndrome is being driven by a diet high in carbohydrate/sugar as opposed to fat.[v]
“The term ‘free sugars’ refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugars naturally present in honey, syrups and fruit juices.”[vi]
The Department of Health Dietary Reference Values remains the basis for UK dietary advice.[vii] It has not been updated in the past 22 years, despite epidemics of obesity and type 2 diabetes having developed in this time. This document recommends that “the population’s average intake of non-milk extrinsic sugars [free sugars] should not exceed about 60 g/day or 10 per cent of total dietary energy.”
Guideline Daily Amounts
In 1996, the Ministry of Agriculture Fisheries and Food (MAFF) published a leaflet to help consumers judge the nutrients in food, in relation to the Daily Guideline Intakes (DGIs).[viii] In 1998, the DGIs became Guideline Daily Amounts (GDAs) – set by a collaboration of UK government, consumer organisations and the food industry, overseen by the Institute of Grocery Distribution (IGD).
The summary table for GDAs for adults is as follows:
Calories (% of daily intake)
Calories (% of daily intake)
This raises some interesting points:
First, GDAs for macronutrients don’t add up. With protein and carbohydrate approximating to four calories per gram and fat approximating to nine, women would consume 1,730 calories per day and men 2,275 if macronutrient recommendations were followed.
Second, the sugar GDA and Dietary Reference Value (DRV) invite confusion. The DRV sets a maximum of 10% of dietary energy for non-milk extrinsic sugars. The GDA can include milk sugar, but we should note how a maximum of 10% has become 18% for women and 19% for men because of the next point…
Third, the food industry treats the sugar GDA as the target for added sugars – those free sugars that experts want to curtail.[ix] It is, in fact, the maximum for total sugars, which brings us to the final and most important point…
Sugars are supposed to be total sugars. A food label for bread informs us that a 40 gram slice has 15 grams of carbohydrate, of which 1.6 grams is listed as sugars.[x] The rest is starch, but this highlights a serious error in our understanding of carbohydrates and sugars.
The big issue
Carbohydrates are, or break down into: monosaccharides (glucose, fructose, galactose); disaccharides (sucrose, lactose, maltose); or polysaccharides (digestible starch or indigestible fibre, insoluble or soluble).
When the food label tells us that there are 15 grams of carbohydrate in bread and 1.6 grams of these are sugar, that will be the “caramelised sugar” listed in the ingredients of this processed product. The remaining 13.4 grams of carbohydrate are also sugar – whether mono, di or poly saccharides. There are 2.7 grams of fibre in the slice of bread (a polysaccharide). Arguably (and there is much debate on this point), this can be ignored, as it is deemed indigestible to the body. This still leaves 10.7 grams of carbohydrate in this one slice of bread, which will break down into sugar in the body. In the case of bread, this will largely break down into glucose – the sugar that goes into the blood stream causing the body to release insulin to return blood glucose levels to a safe range.
The GDAs advise an adult female to have 90 grams of total sugar. The same average woman is told to have 230 grams of carbohydrate, which breaks down into sugars. Even if we generously disregard fibre, this still leaves 206 grams of carbohydrate recommended for consumption on a daily basis. That’s 824 calories of sugars – not the 360 envisaged. To the body, sugar from sucrose (fructose and glucose) or sugar from fruit (fructose and glucose) is still sugar. One comes with vitamins and minerals, the other doesn’t, but the sugar is sugar.
The conflict in advice
In the most recent Food Agricultural Organisation/ World Health Organisation review, recommendations for carbohydrate intake being 55-75% were discussed.[xi] The NHS ‘eatwell’ plate advises an intake of 33% bread, rice, potatoes, pasta and other starchy foods (glucose); 33% fruit and vegetables (fructose/glucose); 15% milk and dairy foods (lactose); 12% non-dairy protein (beans and pulses are sugar/protein combinations); and 8% foods and drinks high in fat and/or sugar (sucrose).[xii]
While the World Health Organisation is consulting on the proposal that sugar consumption should be no more than 5% of total calories, they are overlooking the fact that people are simultaneously being advised to have at least 55% of their food intake in the form of sugars.
[iii] Lustig R. Fat Chance: The bitter truth about sugar. Fourth Estate, 2013.
[iv] Malhotra A. The dietary advice on added sugar needs emergency surgery. BMJ 2013;346 doi: 10.1136/bmj.f3199[published Online First: Epub Date]|.
[v] DiNicolantonio JJ. The cardiometabolic consequences of replacing saturated fats with carbohydrates or Ω-6 polyunsaturated fats: Do the dietary guidelines have it wrong? Open Heart 2014;1(1) doi: 10.1136/openhrt-2013-000032[published Online First: Epub Date]|.
[vi] Joint WHO/FAO Expert Consultation, 2003, “WHO Technical Report Series 916 Diet, Nutrition, and the Prevention of Chronic Diseases”, Geneva.
[vii] Department of Health. Dietary reference values for food energy and nutrients for the United Kingdom: Report on Health and Social Subjects No 41. HMSO, 1991.
[viii] Williams C, Rayner M, Myatt M, Boaz A. Use your Label: Making Sense of Nutritional Information. Foodsense leaflet. MAFF 1996 .
[ix] Malhotra A. The dietary advice on added sugar needs emergency surgery. BMJ 2013;346 doi: 10.1136/bmj.
[xi] Mann J, Cummings JH, Englyst HN, et al. FAO//WHO Scientific Update on carbohydrates in human nutrition: conclusions. Eur. J. Clin. Nutr. 2007;61(S1):S132-S37