Crushed can

Shock swept through the industry last week after the Scientific Advisory Committee on Nutrition called for ministers to slash the recommended daily intake for sugar by half and “minimise” consumption of fizzy drinks.

As the consultation over SACN’s recommendations gets under way - alongside Public Health England’s launch of a wide-ranging sugar reduction strategy - we tackle 10 of the biggest questions it poses to the industry.

1. So. Is sugar now officially bad and fat off the hook?

SACN claims there is a clear, direct link between high sugar intake and obesity and heart disease, prompting a major new clampdown on sugar by Public Health England. But Dr Alison Tedstone, PHE director of diet and obesity, admits excessive concentration on one ingredient is risky. “It would be very difficult for public health if the focus on sugar were to lead to an increase in satfat intake or increase in salt intake,” she says.

“To deal with obesity we need to cut calories, and sugar in the diet is an obvious target,” says Susan Jebb, professor of diet and population health at the University of Oxford. “Research has clearly shown there is a link between diets high in sugar and weight gain. But what the data also tells us is that [weight gain] effect is mediated through calories. It is not something miraculous or unusual about sugar.”

The PHE strategy is more unequivocal. “Without saying so explicitly, PHE effectively proposes important changes in the Responsibility Deal on calorie reduction,” claims Professor Jack Winkler, former professor of nutrition policy at London Metropolitan University. “Most importantly, it suggests adopting the organisational structure that was so important to the success of the salt reduction programme,” by taking it one sku at a time.

“To suggest 5% for population but 10% individually is not helpful”

2. How significant is SACN’s recommendation to halve free sugar intake (including added and naturally occurring sugars) from 10% of daily energy intake to just 5%?

It’s huge. A March draft report by WHO suggested a 5% limit could be beneficial, despite admitting there was a limited evidence base, and concentrated its findings around dental health. Although SACN’s definition for sugars has changed (see 9) the new targets are a massive challenge to the nation’s diet. All age groups currently fail to hit the existing target (children aged 11-18 are on average consuming in excess of 50% more than recommended). The new figure works out at five teaspoons or 25g a day for women, up to eight teaspoons or 35g for men. The average fizzy drink contains about seven. 

3. Is it true SACN has issued conflicting targets?

Yes. SACN says a level of 10% of dietary energy from free sugars (70g/day for men and 50g/day for women) is an “acceptable” upper limit at an “individual level,” but it is urging ministers to keep this message away from consumers. On a population level, SACN is aiming for 5%, not least because some individuals may not eat any sugars, therefore skewing the figures. But this is already confusing leading health experts, let alone the public. “SACN clearly distinguish population and individual level recommendations, so while individuals should ensure they don’t exceed 10% of their daily energy intake from free sugars, the aim at the population level is to achieve an average of 5% to help reduce tooth decay and lower the amount of energy consumed,” says Dr Nita Forouhi, programme leader at the MRC Epidemiology Unit, University of Cambridge. But Professor Ian Macdonald, chair of the SACN nutrition committee, which produced the report, says this is not the case.

“The thing about 10% is we regard it as an acceptable upper limit but we don’t think it should be published because it would be confusing,” he admits.

Suppliers are certainly scratching their heads. “There is massive potential for confusion,” says Dr Julian Cooper, head food science at British Sugar.

“What the consumer needs is clear information. To suggest a 5% limit of daily energy intake across the population while also suggesting 10% for the individual is hardly helpful,” adds British Soft Drinks Association director general Gavin Partington.


4. Is there still a place for sugar-sweetened beverages in a balanced diet?

Just one 350ml can of an estimated 80% of all sugary fizzy drinks on shelves would take up almost the entire daily recommended sugar allowance suggested by SACN. “Yes, it is all about calories but there seems to be something about fizzy drinks that means you are more likely to consume excess calories and put on weight,” says Professor Macdonald. Yet SACN admits it hasn’t identified the exact causes of the unwanted special relationship - it has found no evidence, for example, of any specific metabolic effect of fructose. “It’s either a hidden effect or that the calories are somehow not detected by the body, which doesn’t feel full as a result,” adds Macdonald.

“The recommendation that consumption of sugar-sweetened beverages should be minimised is grounded in high quality evidence, adds Dr Forouhi. “Our evidence from an eight-country study across Europe shows a strong positive link between habitual intake of sugary drinks and the risk of developing diabetes, even after controlling for obesity,”

Dr Jebb, who is also chair of the Responsibility Deal food network, says there is no longer any doubting a “specific link” between sugar-sweetened beverages and weight gain contributing to the obesity crisis. “It’s not just carbonated drinks but energy drinks, sports drinks,” she adds.

Winkler claims the extent of the contribution of fizzy drinks to obesity may in fact be vastly underestimated. “In one recent article by Mytton et al, they found that the amount of soft drinks people claim to be drinking in the National Diet & Nutrition Survey (NDNS) is barely a quarter of the amount that members of the British Soft Drinks Association reported they were selling,” he says.

Yet if fizzy drinks are to blame for rising levels obesity, how does that marry with falling levels of sugar across the category and a massive boom in advertising around diet and zero calorie alternatives? Kantar Worldpanel claims sugar in carbonates has fallen 3.5% since 2012, while new figures released by soft drinks companies last month predict ad spend on low and no-calorie drinks will have risen by 70% in two years by the end of 2014. “It is frankly shocking that the one area singled out for action by SACN and PHE is soft drinks - a category where 60% of products are no added sugar and where a huge amount of investment is already going in to growing that percentage further,” says one leading soft drinks source. “What about the huge amount of calories in alcohol? Nobody is talking about that.”

Sugar Cane Commodities

5. What will be the impact on juices and smoothies?

Fruit juice, according to the latest National Diet & Nutrition Survey figures quoted in the SACN report, comes in 13th in the list of most consumed carbohydrates by 11-18 year olds, well behind fizzy drinks, chips, biscuits, pizza and chocolate, providing around a 10th of their non-milk extrinsic sugars.

Yet PHE has already earmarked juices (along with smoothies, which are not mentioned in the SACN report) for action. It is “reconsidering” whether fruit juice and smoothies should be included as part of 5 a day. Current advice recommends one 150ml glass of unsweetened 100% fruit or veg juice counting towards one portion, with smoothies able to count for up to two portions if they pack in enough whole fruit. And many scientists believe drinking juice should not be lumped in with sugary fizzy drinks. “The key message is we should get our fluid intake mainly from drinking water not fizzy pop or fruit juice,” says Professor Tom Sanders, head of the diabetes and nutritional sciences division at King’s College London,” but he adds: “The thing about sugary drinks is that they are empty calories. That’s the slight advantage of fruit juice.”

“I disagree with the pressure groups keen to decry pure juice as being as devilish as a full sugar cola,” adds Catherine Collins, principal dietitian at St George’s Hospital NHS Trust

Last week Innocent revealed independent research showing that smoothies contain comparable fibre to that contained in whole fruit. “A wealth” of beneficial antioxidants are low GI, meaning the naturally found sugars are absorbed slowly by the body.

“The average person in the UK drinks just 45ml of fruit juice a day: 1% of the calories in the average British diet,” says Partington.

6. What other products could be affected?

Only fizzy drinks and squash are singled out for action by SACN but the menu of products on PHE’s list of shame is huge. As well as immediately launching a digital drive to urge families to cut down on sugar, it identified soft drinks, biscuits, breakfast goods, puddings, preserves, confectionery, fruit juice, alcohol and cereals as the biggest contributors to intake and called for both voluntary and regulatory measures. It remains to be seen if voluntary moves such as the FDF’s announcement last week of a 250g portion cap across single-serve confectionery products will any longer go far enough.

“We need to think about reducing the portion sizes of those foods that contribute to overconsumption of energy and contribute to chronic heart disease,” says Professor Macdonald.

As well as calling for measures across all high sugar drinks, including taxation, Susan Jebb, professor of diet and population health at the University of Oxford identifies confectionery as “the big one”.

PHE’s plans include tighter advertising controls both online and in traditional media, a bogof ban, a drive to reduce portion sizes and changes to in-store promotions. Documents leaked to The Grocer show it has also considered setting binding targets for reformulation and carrying health warnings, similar to cigarettes, on pack.

“My view is that it would be best to focus on reducing the major contributors of added sugar, soft drinks and confectionery, rather than having across the broad reductions as was done for salt,” says Professor Sanders.

7. What about overall carbohydrate intake?

SACN sticks to current guidelines that 50% of the population’s energy intake should come from carbohydrates. There is “no association between total carbohydrate intake and BMI or body fatness. Carbohydrates are a good source of energy on which diets should continue to be based. Concern has been raised that high intake of carbohydrates are harmful to health but this report concludes that intakes at the current recommended levels show no association with the incidence of cardiovascular disease, type 2 diabetes, glycaemia or colo-rectal cancer,” it says.

8. What do the changes in advice on fibre mean?

SACN calls for a significant increase in the nation’s fibre intake, recommending products such as fruit & veg, wholemeal bread, high fibre cereals and whole wheat pasta. It has also recommended a broader definition of fibre. Although cutting sugar grabbed the headlines the gap between current levels of fibre intake (24g per day) and what SACN recommends (30g) is a not insubstantial 25%. 

9. Are these new definitions of sugar and fibre practical?

SACN proposes the term ‘free sugars’ to encompass added sugars and those naturally present in syrups and unsweetened fruit juice, but excludes lactose in milk and dairy. Some scientists warn there is a major disconnect between SACN and PHE’s drive to reduce sugar, and existing labels. The DH’s front-of-pack traffic-light hybrid system is based - under EU regulations - on the term total sugars. “We currently have no way of analysing ‘free sugar’,” says Professor Tom Sanders, head of the diabetes and nutritional sciences division at King’s College London. “It also gets very confusing with products like fruit yoghurt where there is a significant contribution of lactose, which while being in the free form, is not classified as ‘free sugars’. Researchers also warn that cutting down on products such as sugar sweetened beverages and confectionery and replacing sugary snacks such as biscuits with fruit and nuts will not necessarily reduce total sugar intake as the added sugar will be replaced by sugar in fruit.

The move to increase fibre intake looks to be even more daunting when it comes to labelling, as fibre is not even included as one of the EU’s accepted front of pack labelling components. “The new definitions will not alter the nutrition information on the label, as this is determined by European regulation,” says Dr Glenys Jones, nutritionist at Sugar Nutrition UK.

“It’s going to be a very big challenge for the DH to communicate to people how much free sugar and fibre is in their food, ” adds Bridget Benelam, a nutritionist at the British Nutrition Foundation. 

10. What are the chances of a sugar tax? Despite the DH repeatedly ruling it out, PHE seems determined to push the idea of a sugar tax, despite toning down the language from its draft proposals which identified fizzy drinks as the “low hanging fruit” on which it could be tested. But it admits there is no evidence that taxes, such as those already tried in places like France and Denmark, actually work. Even prominent members of Action on Sugar, which campaigns for such a tax, aren’t in favour. “It would be astounding if the government reversed that position,” says Professor Winkler. “Especially in the light of the pasty tax revolt only two years ago and the subsequent introduction and repeal of a fat tax in Denmark - one of the more tax-tolerant nations on Earth.

“Especially also because the PHE report explicitly recognises that the price of foods and drinks is a key issue for the poor families that eat the most unhealthy diets.”