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Latest Review on Sugar Intake Comes Under Fire

Dietary sugar is making headlines again following the publication of an industry-funded review examining health guidelines on sugar intake and the development of a heated debate surrounding the findings. On average, adults in the United States consume a total of 22 teaspoons of sugar per day, mainly from sources such as soft drinks, candy, cookies, and fruit drinks. That’s more than twice the American Heart Association’s recommended daily intake and part of an increasing global trend in sugar intake. In the midst of calls by the World Health Organization (WHO), the FDA and Public Health England to reduce sugar intake, the new systematic review questions the scientific basis underlying these guidelines, arguing that they are based on weak evidence and do not meet the criteria for trustworthy recommendations.

Systematic Review of Current Guidelines

In the review published in the Annals of Internal Medicine last month, the authors, Jennifer Erikson, Behnam Sadeghirad, Lyubov Lytvyn, Joanne Slavin and Bradley C. Johnston, examined nine sugar-intake guidelines (both quantitative and qualitative) from around the globe, including those from the WHO, United States Department of Agriculture, and the Institute of Medicine. The team of researchers then collected and evaluated the evidence used to formulate each recommendation. While they found that these public health organizations were in general agreement suggesting that the consumption of free sugars should be reduced in the diet, the authors of the review rated the quality of evidence linking sugar with health outcomes as low to very low and argue that current guidelines need to be revisited and improved. Although the authors believe that the public should be given guidance on dietary sugar consumption, they conclude, “At present there seems to be no reliable evidence indicating that any of the recommended daily caloric thresholds for sugar intake are strongly associated with health effects.”

The Backlash and Controversy

This conclusion has now come under heavy fire from multiple angles, as scientists and public health officials weigh in. One of the main criticisms is aimed at the industry funding behind the research. The review was sponsored by the International Life Sciences Institute (ILSI) which in turn is funded by many big-name food manufacturers like Coca-Cola, General Mills, Hershey’s, and Kraft. In addition, one of the authors is on the scientific advisory board of one of the world’s largest producers of high-fructose corn syrup.

Critics Respond

Critics such as Dean Schillinger, a physician at the University of California, San Francisco and co-author of an accompanying editorial published in the same issue, think that the paper is politicizing the science and that nearly all the scientific evidence shows a clear cause-and-effect relationship of sugar consumption to obesity and type-2 diabetes.  Barry Popkin, a nutrition professor at the University of North Carolina at Chapel Hill agrees, and told the New York Times that Erikson et al. “ignored the hundreds of randomized controlled trials” documenting the adverse effects of excess sugar intake, adding that he was astounded that the paper made it through peer-review. Marion Nestle, a nutrition professor at New York University, says in a NYT interview that “This comes right out of the tobacco industry’s playbook…” calling the paper a “shameful” attempt by the food and beverage industry to undermine the scientific consensus on limiting sugar. 

Their fear is that this latest review could be used to cast doubt among the public and weaken the public health efforts to combat diseases linked to sugar consumption. ArsTechnica went so far as to call the sugar industry’s attempts “gas-lighting” and Schillinger also compared the industry’s efforts to what Big Tobacco did to cover up the effects of secondhand smoking on health.  This current controversy comes on the heels of the recent report published by Cristin Kearns et al. uncovering the sugar industry’s role in manipulating dietary policy since the 1950’s and ‘60’s, whereby they downplayed the link between dietary sugar and coronary heart disease ( covered in the September issue of EpiMonitor ).

Interestingly, the Associated Press (AP) reported that the Mars corporation (also affiliated with ILSI) bucked the general industry stance and also denounced the recent paper, saying that it undermined the science and threatened the reputation of industry-funded science. Somewhat alarmingly, the AP also reported that there was an issue with the original disclosure statement on the manuscript which claimed that the protocol and study were conducted independently; however, after the AP found evidence that the group had input on the proposal, the disclosure was later corrected.

In Defense of the Review

Christine Laine, Editor-in-Chief of the Annals of Internal Medicine, said in a written statement to the press that they decided to publish the review along with a critical editorial because of its “great interest” to their audience. In ILSI’s defense, Eric Hentges (Executive Director) states that the paper focuses on the quality of the methods and evidence used to determine the current recommendations and “is not an industry attempt to undermine the science”. One of the study’s lead authors Bradley Johnston, clinical epidemiologist at the Hospital for Sick Children in Toronto, concludes that current guidelines which were reviewed are simply “not trustworthy” due to the large amount of uncertainty in the underlying science used to derive them. Johnston told the NYT, “We hope that the results from this review can be used to promote improvement in the development of trustworthy guidelines on sugar intake”, adding that the review “should not be used to justify higher intake of sugary foods and beverages.”

Details of how the team evaluated each of the recommendations and guidelines is available in the Erickson et al. manuscript:

The accompanying editorial can be seen here:

Recent EpiMonitor coverage of dietary sugar debate:

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