1. Added Sugar Friend or Foe?
Jim Painter, PhD, RD Adjunct Professor, School of Public Health, University of
Added Sugar Friend or Foe?

2. Speaker Disclosure Jim Painter Board Member/Advisory Panel Consultant
California Raisin Marketing Board, Sun-Maid Growers of California, the Wonderful Company, American Heart Association Eat Well Task Force
Consultant
Davison’s Safest Choice, National Dairy Council
Speaker’s Bureau
- Abbott Nutrition
Other
Speaker honorarium underwritten by MO WIC
Honoraria for talks: Dietitians of Canada, Exxon Mobil, Frito Lay, Pennsylvania Nutrition Network, California Raisin Marketing Board, Alaska Tanker Company, Dairy Max, Texas AND, California AND, Florida AND, MINK, NY AND, South Carolina AND, Iowa AND, Nebraska AND, Manitoba Dairy Farmers, Dairy Farmers of Canada.

3. Speaker Credentials

4. ENVIRONMENTAL ELEMENTS
Health vs Disease
ENVIRONMENTAL ELEMENTS
Health
Supporting
Diet
RICH FOOD
Primary Element:
Secondary
Elements:
Clean Air & Water
Exercise
Peace of Mind
Spiritual Contentment
Polluted Air & Water
Sedentary lifestyle
Psychological “Stress”
Pride, fear, Anxiety
HEREDITY
Determines range of health

5. Added Sugar Friend or Foe
Dietary recommendations for added sugar
1. Sugar as a friend encouraging nutrient dense foods:
Dressing on salads, Sweetened milk
2. Sugar as a foe
When added to nutrient devoid foods
When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit

6. Added Sugar
“Although a UL is not set for sugars, a maximal intake level of 25 percent or less of energy from added sugars is suggested based on the decreased intake of some micronutrients of American subpopulations exceeding the level.”
Institute of Medicine of the National Academies , Food and Nutrition Board (2005). Dietary reference intakes for energy, carbohydrate, fiber, fat, fatty acids, cholesterol, protein, and amino acids. Washington, D.C. : The National Academies Press.

7. 2015 Dietary Guidelines for Americans

8. May 2016, FDA issued a final rule;
Added Sugar Labeling
May 2016, FDA issued a final rule;
that would require declaration of the percent daily value (%DV) for added sugars
Set intake limit to no more than 10% of daily total calories

9. Guideline: Sugars intake for adults and children (2015)
- Reduce intake of free sugars throughout the life cycle
- Reduce intake of added sugars to less than 10% of total energy intake
A further reduction of the intake of added sugars to below 5% of total energy intake is beneficial
1 WHO, Draft Guideline: Sugars intake for adults and children
Recommendations do not apply to “intrinsic” sugars

10. Sugars naturally present in honey, syrups, fruit
Added sugars:
Monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer
Sugars naturally present in honey, syrups, fruit
juices and fruit juice concentrates
Natural/Intrinsic sugars:
Those incorporated within the structure of intact fruit and vegetables; sugars from milk (lactose and galactose)

11. Raisins are intact fruit. Sugars in raisins are intrinsic sugars
Traditional dried fruits are an integral part of healthy dietary patterns worldwide, and the WHO’s definition of intrinsic sugars is a key aspect to emphasize as the sugar debate intensifies.

12. Reduction in Nutrients as Added Sugar Increases
Marriott, B. P., Olsho, L., Hadden, L., & Connor, P. (2010). Intake of added sugars and selected nutrients in the united   states, national health and nutrition examination survey (nhanes) Critical Reviews in Food   Science and   Nutrition,50,

13. Reduction in Nutrients as Added Sugar Increases
Marriott, B. P., Olsho, L., Hadden, L., & Connor, P. (2010). Intake of added sugars and selected nutrients in the united   states, national health and nutrition examination survey (nhanes) Critical Reviews in Food   Science and   Nutrition,50,

15. Hazard Ratios of CVD Mortality According to Usual % of Calories from Added Sugar

17. Add pop out of conclusion from previous slide

18. Added Sugar Friend or Foe
Dietary recommendations for added sugar
1. Sugar as a friend encouraging nutrient dense foods:
Dressing on salads, Sweetened milk
2. Sugar as a foe
When added to nutrient devoid foods
When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit

19. Sugar as a Friend Encouraging Salad and Veggie Consumption

20. Vegetable % RDA in 1 NLEA Serving Tomato (148 g) Vitamin A: 25%
Vitamin K: 14%
Vitamin C: 31%
Carrot (85 g)
Fiber: 10%
Vitamin K: 10%
Vitamin A: 234%
Broccoli (148 g)
Fiber: 15%
Vitamin A: 18%
Vitamin K: 158%
Vitamin C: 220%
Riboflavin: 10%
B6: 13%
Folate: 23%
Phosphorus: 10%
Manganese: 16%
Potassium: 10%

21. Potato (Baked with skin, 148 g) Fiber: 13% Vitamin C: 24% Niacin: 10%
Vegetable
% RDA in 1 NLEA Serving
Potato (Baked with skin, 148 g)
Fiber: 13%
Vitamin C: 24%
Niacin: 10%
B6: 23%
Folate: 10%
Manganese: 16%
Phosphorus: 10%
Magnesium: 16%
Potassium: 17%
Romaine Lettuce (85g)
Vitamin A: 99%
Vitamin K: 107%
Vitamin C: 33%
Folate: 29%

22. Fruit
% RDA in 1 NLEA Serving
Pear (166 g)
Fiber: 21%
Vitamin C: 12%
Strawberry (147 g)
Fiber: 12%
Vitamin C: 143%
Manganese: 28%

23. Meat
% RDA
Beef (3 oz, 95% lean, ground, crumbles, pan cooked)
Protein: 50%
Riboflavin: 10%
Niacin: 31%
B6: 18%
B12: 37%
Iron: 15%
Phosphorus: 23%
Zinc: 40%
Selenium: 26%

24. Meat
% RDA
Chicken (4 oz, Breast, Baked, or Broiled)
Protein: 70%
Niacin: 38%
B6: 34%
Phosphorus: 26%
Selenium: 45%
Pork (1 chop , 150g, lean only, bone in, broiled)
Protein: 38%
Thiamin: 46%
Riboflavin: 15%
Niacin: 16%
B6: 20%
Phosphorus: 17%
Zinc: 12%
Selenium: 51%

25. 1% Chocolate Milk

26. Milk Consumption

27. Mass school system

28. Mass school system

29. 1

30. Added Sugar Friend or Foe
Dietary recommendations for added sugar
1. Sugar as a friend encouraging nutrient dense foods:
Dressing on salads, Sweetened milk
2. Sugar as a foe
When added to nutrient devoid foods
When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit

34. Added Sugar Friend or Foe
Dietary recommendations for added sugar
1. Sugar as a friend encouraging nutrient dense foods:
Dressing on salads, Sweetened milk
2. Sugar as a foe
When added to nutrient devoid foods
When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit

52. Added Sugar Friend or Foe
Dietary recommendations for added sugar
1. Sugar as a friend encouraging nutrient dense foods:
Dressing on salads, Sweetened milk
2. Sugar as a foe
When added to nutrient devoid foods
When it replaces nutrients, Juices, Dried fruits
3. What about Fructose?
4. An answer, use fruit

53. Gone Bananas (100g) 70 60 50 40 30
Banana 20
Banana Chips 10

54. Air Crisped Banana Chips

55. Calcium

56. Iron

57. Phosphorus

58. Vitamin C

59. Potassium

60. Added Sugar (g)

61. NuVal Comparison Raisins Dried Cranberries 100 90 80 70 60 50 40 30 20
Raisins
Dried Cranberries

62. Guiding Star Comparison
Raisins
Dried Cranberries

63. Sugar: When does it change from a friend to a foe?

65. High-Fructose Corn Syrup: Harmless Sweetener or Liquid Death?

66. Sugar the Bitter Truth?
Pediatric endocrinologist Dr. Robert Lustig, whose YouTube video -- entitled "Sugar: The Bitter Truth"
"Fructose is the cause of the current epidemic," insists Dr. Lustig
Fructose is toxic in large quantities, because it is metabolized in the liver in the same way as alcohol, which drives fat storage and makes the brain think it is hungry
HuffPost Healthy Living Sugar Hits the News, Thanks to Dr. Lustig's YouTube Video and Nightline (VIDEO). Retrieved from

67. ABC NightLine Sugar Wars

68. Lustig’s Findings
Countries have experienced a rise in sugar supply from:
1960: 218 kilocalories/person/day
2013: 280+ kilocalories/person/day today, with an acceleration in the rate of supply over the past decade.
Diabetes prevalence rates rose 27% on average from to 2010, with just over ¼ of the increase explained by a rise in sugar availability
Basu, S., Yoffe, P., Hills, N., & Lustig, R. H. (2013). The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data. PloS one, 8(2), e57873.

69. Ludwig
Ludwig, a childhood obesity expert, cited sugar as the key source of an American public health crisis
“Tobacco and alcohol are perfect examples. We have made a conscious choice that we’re not going to get rid of them, but we are going to limit their consumption. I think sugar belongs in this exact same wastebasket,”' he said.
MailOnline Is sugar actually poisonous? Researchers say the sweet stuff is fatal for our health. Retrieved from

71. The effects of fructose overfeeding on Intra-Hepatic Lipid (IHCL)* *
IHCL (mmol/kg)
g/d fructose added to weight-maintenance diet
% % %
daily energy requirements as fructose
Lecoultre et al, Obesity 2013 (In Press)

72. Comparison of HFCS, sucrose, and honey
Sugar
Honey
HFCS
How sweet is it?
Sugar is the benchmark
Honey is as sweet as sugar
There are two types: HFCS-55 as sweet as sugar; HFCS-42
How many calories per gram?
4/gram
What's in it?
50% fructose 50% glucose
48% fructose 52% glucose
HFCS-55: 55% fructose
45% glucose
HFCS-42: 42% fructose
58% glucose
Similarities:
Similar components (fructose and glucose)
All considered natural
Differences:
HFCS is not naturally occurring
HFCS is the least expensive to produce
Corn Refiners Association 2009

73. = HFCS = Obesity
Bray et al. 2004

74. The Difference in Added vs Natural Sugar

75. The Difference in Added vs Natural Sugar

76. The Difference in Added vs Natural Sugar

77. Coco Cocoa Nut Torte Directions:
Ingredients:
1 c. almond meal/flour
½ c. unsweetened coconut
½ c. cocoa powder
1 tsp baking soda
¼ tsp salt
1 cup raisins
½ cup pitted dates
¾ c. water
3 Eggs
2 T coconut oil
2 tsp vanilla
Directions:
Preheat oven to 325 F. Grease an 8” round cake pan.
Mix together almond meal, cocoa powder, baking soda, and salt in a bowl and set aside.
In a blender, food processor, or an immersion blender, blend the raisins, dates, and water until smooth.
Add the eggs, coconut oil, and vanilla to the blended mixture and mix until smooth.
Add the wet ingredients to the dry ingredients and mix just until incorporated. Pour batter into greased cake pan and spread evenly.
Bake for minutes or until toothpick comes out clean. Let cool minutes.

79. Wafer vs. Torte

80. Wafer vs. Torte

81. Thanks…

82. Conclusion Sugar is a friend if it encourages whole foods
Sugar is a foe if it:
Encourages nutrient poor foods
Replaces nutrients, ex juice & dried cranberries
Fructose is the same as table sugar
Limit both to 10-5% of calories
The answer!
Use real fruit
Select higher nutrient sweeteners
Non nutritive sweeteners and sugar alcohols
Government health agencies recognize that dried fruits make a positive contribution to overall health.
This is carried over to food regulations but a distinction is sometimes made between fresh, frozen and canned forms of fruit and dried fruit.
Carbohydrates in dried fruit are healthy: research shows dried fruit have a beneficial effect on glycemic and insulin response, may be protective against diabetes, may help maintain healthy weight among school age children and may promote healthy blood pressure.
As research is progressing and the awareness of health benefits of dried fruit is increasing so is the perception of their value in helping people and populations around the world have healthier diets.