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About Sickkids
About SickKids

March 14, 2014

Cut back on sugar – should your double-double be a single-double?

There is no good news about sugar. Earlier this month, a study in JAMA Internal Medicine concluded that “most US adults consume more added sugar than is recommended for a healthy diet” and said there is a significant relationship between added sugar consumption and increased risk for cardiovascular disease mortality.

Days later, the World Health Organization launched a public consultation on its draft guideline on sugars intake. The document urges people to lower the amount of sugar they eat.

Daina Kalnins, Director of Clinical Dietetics at SickKids, provides some insight.

Q: Can you summarize WHO’s advice on sugar?
A: The guidelines, which are still in the consultation phase, propose to reduce further the recommendations for how much sugar should be a part of our diet. The guidelines do not include the sugars naturally found in fruits/vegetables, for example, as these foods have significant nutritional value other than the carbohydrates.

WHO’s current recommendation, from 2002, is that sugars should make up less than 10 per cent of total energy intake per day. The new draft guideline suggests that a reduction to below five per cent of total energy intake per day would have additional benefits. Five per cent of total energy intake is equivalent to around 25 grams (around six teaspoons) of sugar per day for an adult of normal Body Mass Index (BMI). For children, this would translate to a four-year old limiting intake to about 4-5 teaspoons per day.

Daina Kalnins

Q: Why is sugar dangerous?
A: Sugar in itself is not dangerous, it is the excess calories that sugar provides that contribute to excess energy intake, which is associated with obesity and associated illnesses in both adults and children. In addition, sweetened beverages and sweets may displace healthier, more nutritious foods, and this is especially an issue for children.

I want to emphasize that physical activity cannot be ignored when discussing obesity and excess energy  intake, as inadequate activity plays a key role in obesity.

Q: Does this mean we should use honey instead of sugar?
A: Honey is also a sugar, and is therefore included in the limits. The suggested limits on intake of sugars in WHO’s draft guideline apply to all monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) that are added to food by the manufacturer, the cook or the consumer, as well as sugars that are naturally present in honey, syrups, fruit juices and fruit concentrates.

Q: Should we eat less fruit?
A: Absolutely not. Fruits contain more than just sugar; they are full of nutrients and fibre that are an important part of a balanced diet.

Q: How do we control our sugar intake when there’s sugar in almost everything we eat?
A: A balanced diet that includes fresh or freshly prepared foods from all foods groups and is limited in prepared or processed foods helps to ensure that nutrient needs are being met and that added sugar is limited. Labels provide information on ingredients in foods, which can help to identify contribution of sugar to a packaged food.

Limiting sweetened beverages is also a great way to reduce sugar intake. Children should be encouraged early on to have milk and water as their beverages of choice, and parents can help by quenching their own thirst with water instead of sweetened drinks. Education around content of sugar in various foods from various health organizations will help consumers understand where “hidden” sugars are found.

Read Daina Kalnins' books on infant and child nutrition. See the links to Better Food for Kids in Recommended Reading.

Learn more about WHO’s public consultation on its draft guideline on sugars intake. When finalized, the guideline will provide recommendations on limiting the consumption of sugars to reduce public health problems like obesity and tooth decay. Comments on the draft will be accepted via the WHO web site until March 31, 2014.