Sukker – søt forvirringSweet confusion

Kaare R. Norum

Professor emeritus

Energifordeling- WHO og FAO

• Protein– 10-15 % av energien (kaloriene)

• Fett– Total fett 15-30 %– Mettet fett mindre enn 10 %– Flerumettet fett 6-10%, og forholdet mellom de ulike

fettsyrene viktig– Unngå transfett

• Karbohydrater– 55-75 %– Frie Sukkerarter ( Free sugars) mindre enn 10%

Free sugars

WHOs definisjon:

The term ”free sugars” refers to all monosaccharides and disaccharides added to foods by the manufacturer, cook or consumer, plus sugar naturally present in honey, syrups and fruit juices

Litt sukkerhistorie

(4000-2000 år før Kristus)

Hulemalerier i Spania viser mennesker som stjeler honning fra en bikube.

Bruk av daddelpalme og fiken og annet tørket frukt som søtkilde. Sukker brukt som medisin. Etter hvert også som krydder. Sukker betraktes som helsebringende. Thomas Aquinias hevdet blant annet at sukker kunne inntas selv under fasten - det var jo

medisin. Men etter hvert økte også misnøyen mot sukker. Sukker ble holdt ”ansvarlig” for å ha forårsaket skjørbuk og på

samme tid ble en forening mot sukker og slaveri dannet.

Sukker mister sin eksklusive status. Mye negativ omtale om sukker.

Sukker er usunt! asosial adferd blant barn?

8 000 år før kristus

Det 14. århundre

Det 17. århundre

Det 19. Århundre

Det 20. Århundre

Hvorfor sukker?

• Søtt er en positiv smak, den første smak vi møter i livet: laktosen er søtere enn sukrose

• Vi overfører det positive i søtsmaken til andre forhold– Et land av melk og honning– Sukkerungen– Så søt du er– Sweetheart– Honey– Sugarbush

Viktige karbohydrater i kostholdet

• Glukose ): druesukker, et monosakkarid• Fruktose ): fruktsukker, et monosakkarid• Sukrose ): vanlig sukker, et disakkarid• Laktose ): melkesukker, et disakkarid• Stivelse, som er plantenes energilager. Viktigste

forekomst i korn og rotfrukter.Stivelse er polysakkarider bygget av glukoseenheter

• Cellulose, plantenes skjelett, og viktige kostfiber i maten vår. Vesentlig ufordøyelig

Karbohydrater

• Sukker består av glukose og fruktose

• Laktose består av glukose og galaktose

• Stivelse brytes med til maltose og videre til glukose

• Cellulose er bygget opp av glukose-enheter,men kan vanskelig brytes ned i menneskers tynntarm, noe spaltes av bakterier i tykktarm

Absorpsjon av karbohydrater

• Alle karbohydrater må brytes ned til monosakkarider før de passerer tarmveggen.

• Glukose og galaktose med aktiv Na-avhenig transport høyt oppe i tynntarm

• Fruktose med fasilitert diffusjon lengre nede i tynntarmen

• Sukkeralkoholene med passiv diffusjon

Glukose

• Aktiv transport gjennom tynntarmen• Transporteres gjennom cellemembraner via

insulinavhengig glukosetransportør (Glut 4)• Påvirker insulinsekresjon i bukspyttkjertelens

beta-celler• I lever og muskel bygges overskudd av glukose

til glykogen• Kan dannes i kroppen av glykogen, andre

monosakkarider og av flere typer aminosyrer

Fruktose

• Diffusjon gjennom tynntarmen, langsommere absorpsjon enn glukose

• Går gjennom cellemembraner via Glut 5 som ikke finnes i hjerne og bukspyttkjertel, Glut 5 er uavhengig av insulin

• Fruktose påvirker ikke insulinsekresjon, og derved ikke frigjøring av leptin fra fettvev

• Fruktose øker laktat i blodet og kan gi økte mengder fett (triglycerider) i blodet

Glukose

G-6-P

F-6-P

GAP + DAP

Fruktose

F-1-P

DAP+

glyceraldehyde

F-1,6-bis-P

Fruktokinase(lever)

HK/GK

Aldolase BPFK

Omsetning av fruktose

Pyruvat Laktat

Pi

G-6-Pase

Fettsyrer/TG

FDPase

ATP

ADP

2 ATPnetto

2 ADPnetto

Leptin, insulin og appetitt

• Insulin påvirker hjernen direkte, og nedsetter appetitten

• Leptin, som vesentlig dannes i fettvev nedsetter appetitten via områder i hjernen.

• Insulin påvirker frigjøring av leptin fra fettvev

• Fruktose påvirker ikke sekresjon av insulin og leptin og virker derfor ikke nedsettende på appetitten, slik glukose gjør

Glukose versus fruktose

• Fruktose påvirker ikke appetitt-reguleringen, slik glukose gjør

• Fruktose omsettes lettere til fettsyrer enn glukose• Fruktose danner glycerofosfat langt mere effektivt og

hurtigere enn glukose, noe som fører til en mer uttalt triglyceridsyntese fra fruktose enn fra glukose

• Fruktosens glycosylerings-indeks 10 ganger større enn glukosens

• Påstanden om at fruktose er sunnere enn glukose på bakgrunn av glykemisk indeks er å snu metabolske fakta på hodet.

Fruktose i kostholdet

• Viktigste kilde er sukker• Fruktose finnes i honning, bra for bier og

smakfullt for mennesker• Fruktose i en rekke frukter, ikke skadelig• Fruktose brukes mer og mer i søtete

drikker fordi fruktose er søtere enn sukker• ”High fructose corn sweeteners” (HFCS) i

cola og brusdrikker i USA, i softis i Norge(?).

High Fructose Corn Sweetener

• Mais-stivelse hydrolyseres til glukose

• Mye av glukosen isomeriseres til fruktose vha glucose isomerase.

• HFCS meget billigere enn sukker, og søtere (sukker=100,glukose=74 & fruktose=173)

• HFCS-42 og HFCS-55 inneholder henholdsvis 42% og 55% fruktose

Markedføring av fruktose – baksiden av pakningen har følgende tekst:

Erstatt sukker med fruktose og lev bedre.-Fruktose finnes i all frukt, bær og honning-Fruktose har lav glykemisk indeks. Det betyr at

fruktose:• Omsettes langsommere i kroppen• Forebygger svingende blodsukker• Forenkler kroppens fettforbrenning• Er en langvaring energikilde som er spesielt

gunstig under idrettprestasjoner og krevende fysisk eller intellektuelt arbeid

Sukker farlig?

• Det er mengden som er viktigst– Vi trenger ikke sukker i det hele tatt– Uheldige konsekvenser når over 10 energi%– Farlig med mye under svangerskapet

• Dernest når man inntar sukker– Best til måltid, ikke i mellom måltider

• Hvordan sukkeret er i ”maten”– Antagelig mest uheldig i drikke

Sukkerinntak blant 9- og 13-åringer og voksne (g/d).

0

10

20

30

40

50

60

70

80

90

100

110

Jente Gutt Jente Gutt Kvinne Mann

9 år 13-år 16-79 år

Suk

keri

nnta

k g/

d

Brus, saft Godteri Annet

Glykemisk indeks (GI)

• GI er et mål for blodsukkerstigning i løpet av to timer etter inntak av matvarer som inneholder 50 g karbohydrater

• Som standard brukes enten 50 gram glukose (GI=100) eller hvitt brød med 50 gram karbohydrater (GI=100), standardene brukes om hverandre, noe som øker forvirringen, f.eks har hvitt brød GI=70 om glukose er standard.

GI påvirkes av en rekke faktorer

• Tømming av magesekk til tolvfingertarm– Måltidets fettinnhold– Måltidets proteininnhold

• Mengden magesyre• Matens partikkelstørrelse, helkorn vs finmalt mel• Tykkelsen av pasta-produkter• Antall måltider per dag og fysisk aktivitet• Modningsgrad av frukt

Glycemic Index: Predicted versus measured in 14 mixed breakfast

meals

26 2730

4549 51

56 57

63 65

71

81

100

116

91 91

99

74

100

55

96

7477

86

9497

100

76

0

20

40

60

80

100

120

140

Fin-B-C Ger-B-

C

Ref-B-

C

Ita-Cof-

M

Ref-B AB plus-

M

Ref-B-J Oat-

Sug-M

Fros-M AB-M Fre-B-J Corn-M Ref Por-

App

Measured GI

Predicted GI

Flint, Raben, Astrup et al. Br J Nutr 2004;91:979-89.

0

20

40

60

80

100

120

140

0 10 20 30 40 50

Fat in meals (g)

GI

GI = 1/(0.0105 + 0.0008 * Fat in mealR = 0.88, p<0.001

Glycemic Index: The fat content, not CHO, predicts glycemic

index

Flint, Raben, Astrup et al. Br J Nutr 2004;91:979-89.

60

80

100

120

140

0 20 40 60 80 100 120 140

GI

II

p = 0.40, R-square = 0.06

Glycemic Index

No association between GI and Insulinemic index

Flint, Raben, Astrup et al. Br J Nutr 2004;91:979-89.

Conflict of policyConflict of policy

• The World Bank describes sThe World Bank describes sugar as ugar as “one of the most policy-“one of the most policy-

distorted of all commodities” distorted of all commodities” yet provides soft loans to yet provides soft loans to

increase the industry’s production capacity.[i]increase the industry’s production capacity.[i]

• The World Trade Organization would like to end subsidies and The World Trade Organization would like to end subsidies and

controls on sugar to stimulate growth in a global free market.controls on sugar to stimulate growth in a global free market.[ii]

• The World Health Organization would like personal sugar The World Health Organization would like personal sugar

consumption in most countries to be reduced to improve dietary consumption in most countries to be reduced to improve dietary

health.[iiihealth.[iii

[i] Sugar Policies: Opportunity for Change. World Bank Policy Research Working Paper 3222 February Sugar Policies: Opportunity for Change. World Bank Policy Research Working Paper 3222 February

20042004[ii] Panel on European Communities - Export Subsidies on Sugar interim report World Trade [ii] Panel on European Communities - Export Subsidies on Sugar interim report World Trade

Organization (WTO) Sept 2004. Organization (WTO) Sept 2004. [iii] Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert [iii] Diet, Nutrition and the Prevention of Chronic Diseases. Report of a Joint WHO/FAO Expert

Consultation. WHO Technical Report Series No. 916. World Health Organization, Geneva, 2003Consultation. WHO Technical Report Series No. 916. World Health Organization, Geneva, 2003

Sugar output doubled in Sugar output doubled in developing countries developing countries

Source FAS/USDA

2004 World Production/2004 World Production/Consumption of SugarConsumption of Sugar

  Production Consumption

  2002/03 2003/04 2003 2004

  (. . million tonnes, raw value . .)

WORLD 147.7 141.1 139.2 143.1Developing

countries 104.6 99.5 91.9 95.4

Developed countries 43.1 41.7 47.3 47.9

Source: FAO Food Outlook September 2004

Structural price collapseStructural price collapse

Price forecast to 2014Price forecast to 2014

• In 2003/04 price falls under 7¢ In 2003/04 price falls under 7¢ per pound due to excess per pound due to excess capacity.capacity.

• 2013/14 price reaches 9.1¢ per 2013/14 price reaches 9.1¢ per poundpound

World Sugar: Food and Agricultural Policy Research InstituteWorld Sugar: Food and Agricultural Policy Research Institute FAPRI 2004 FAPRI 2004 Agricultural OutlookAgricultural Outlook

Growth forecast to 2014Growth forecast to 2014

• Global sugarcane harvest up 10.4% Global sugarcane harvest up 10.4% (sugar beet down by 3%)(sugar beet down by 3%)

• Total production up 22.4% Total production up 22.4%

• Total consumption up 27%Total consumption up 27%

World Sugar: Food and Agricultural Policy Research InstituteWorld Sugar: Food and Agricultural Policy Research Institute FAPRI 2004 Agricultural OutlookFAPRI 2004 Agricultural Outlook

World Bank Report 2004World Bank Report 2004

A free market in sugar would lead to:A free market in sugar would lead to:

The global welfare gains of …. $4.7 billionThe global welfare gains of …. $4.7 billion

Jobs in developing countries….1 millionJobs in developing countries….1 million

World sugar market price up ….+40%World sugar market price up ….+40%

Sugar Policies: Opportunity for Change. World Bank Policy Research Working Paper 3222 Feb 2004Sugar Policies: Opportunity for Change. World Bank Policy Research Working Paper 3222 Feb 2004

Oxfam attacks EU dumpingOxfam attacks EU dumping

2525¢ ¢ - EU- EU

Approx cost of productioncent/lb

9¢ - India 9¢ - India 8¢ - World price – white8¢ - World price – white

6¢ - World price – raw6¢ - World price – raw5¢ - 5¢ - Zambia, Thailand, MalawiZambia, Thailand, Malawi

4¢ - Brazil4¢ - Brazil

Source Oxfam Briefing Paper March 2004

Sugar and health policySugar and health policy1990 - WHO 797 report on 1990 - WHO 797 report on Diet, Nutrition and the Prevention of Diet, Nutrition and the Prevention of

Chronic Diseases - Chronic Diseases - sugar industry mobilised opposition to sugar industry mobilised opposition to the recommendation of a 10% limit on added sugarsthe recommendation of a 10% limit on added sugars

1992 - 797 Report informed the International Conference on 1992 - 797 Report informed the International Conference on Nutrition and its World Declaration and Plan of Action for Nutrition and its World Declaration and Plan of Action for Nutrition: Nutrition: “....chronic non-communicable diseases related “....chronic non-communicable diseases related to excessive or unbalanced dietary intakes often lead to to excessive or unbalanced dietary intakes often lead to premature deaths in both developed and developing premature deaths in both developed and developing countries.”countries.”

1993 - World Health Assembly 1993 - World Health Assembly ENDORSES in their entirety the ENDORSES in their entirety the World Declaration and Plan of Action for Nutrition adopted World Declaration and Plan of Action for Nutrition adopted by the Conference..…urging members…“to contain and by the Conference..…urging members…“to contain and reduce the rate at which the prevalence of diet-related reduce the rate at which the prevalence of diet-related diseases and of conditions related to them is rising”diseases and of conditions related to them is rising”

The 916 controversyThe 916 controversy

• Jan 2002 - Experts revise draft report on Diet, Jan 2002 - Experts revise draft report on Diet, Nutrition and the Prevention of Chronic DiseasesNutrition and the Prevention of Chronic Diseases

• April 2002 onwards – Sugar, food and drink April 2002 onwards – Sugar, food and drink industries contest draft recommendations in industries contest draft recommendations in consultation and extended dialogueconsultation and extended dialogue

• Sept 2002 – Confusion over IoM 25% figure – a Sept 2002 – Confusion over IoM 25% figure – a nutrient dilution threshold - not a nutrient dilution threshold - not a “recommendation” “recommendation”

• March 2003 – Furore as final draft 916 report put March 2003 – Furore as final draft 916 report put onlineonline

Sweet and Salt reactions to TR 916

The Sugar Association and the Salt Institute said in April 14, 2003 in a letter to the DG of WHO:– TR 916 was drafted by a select group of experts– TR 916 not peer reviewed– TR 916 contains unfounded and misleading

recommendations– ”We will exercise every avenue available to expose

the dubious nature of TR 916, including asking Congressional appropriators to challenge future funding of the US`s 406 million US dollar contribution to the WHO.”

Sweet and Salt reactions to TR 916

• Similar reactions was written to Secretary Tommy Thompson by– Corn Refiners Asscosiation– International Dairy Foods Association– National Corn Growers Association– Snack Food Association– The Sugar Association– Wheat Foods Council– U.S. Council for International Business

• Letters to Tommy Thompson from two United States Senators, Larry E. Craig and John Breaux, supported the industry initiative

Sugar attackSugar attack

““It is difficult to It is difficult to believe the believe the standards standards

of the World of the World Health Health

Organization Organization have slipped to have slipped to

such a low point.”such a low point.”

Threat to WHO fundingThreat to WHO funding

“

”

WHO stands firm WHO stands firm

• March 2003 – Sweetener causus senators ask US March 2003 – Sweetener causus senators ask US government to press WHO/FAO to block the reportgovernment to press WHO/FAO to block the report

• March/April 2003 - WHO gets series of protest March/April 2003 - WHO gets series of protest letters from the Sugar Association with threat to letters from the Sugar Association with threat to challenge US $406m funding to WHO challenge US $406m funding to WHO

• April 2003 – Gro Harlem Brundtland joins with 916 April 2003 – Gro Harlem Brundtland joins with 916 vice chair Prof Shiriki Kumanyika in Rome launch of vice chair Prof Shiriki Kumanyika in Rome launch of 916 report declaring 916 report declaring “The solidity of the work “The solidity of the work done by the experts is well founded and makes done by the experts is well founded and makes these kinds of criticisms [by the sugar industry] these kinds of criticisms [by the sugar industry] unreasonable.” unreasonable.”

May 2003May 2003 - Coca Cola lobbies Coca Cola lobbies health ministershealth ministers

Data Quality Act ‘correction’Data Quality Act ‘correction’

Sept 2003 -Sept 2003 -Jim Tozzi files Jim Tozzi files ‘‘Challenge’Challenge’to 916 under US to 916 under US ‘‘Data Quality Act’Data Quality Act’

Jan 2004 - US letter to WHOJan 2004 - US letter to WHO

US focus on the Data Quality Act US focus on the Data Quality Act – an industry straightjacket on science?– an industry straightjacket on science?

“The consultation process of the development of the WHO/FAO Report and the resulting Report itself would not meet these current US data quality standards” - Steiger

Challenge to Tommy ThompsonChallenge to Tommy Thompson

It is significant that resistance from business interests, which included the sugar industry and soft drinks manufacturers with US government support, was also demonstrated when a previous WHO expert report, based on a scientific consultation in 1990, made similar recommendations intended to prevent diet-related chronic diseases.

In the US you have demonstrated admirable leadership in your support for the WHO framework convention on tobacco control……Therefore I urge you to show equal courage and determination to support global efforts to address another of the biggest public health challenges facing us all in the 21st century.

Sugar accused in mediaSugar accused in media

Big Fish ad campaignBig Fish ad campaign““Sugar has always been associated with weight gain Sugar has always been associated with weight gain and other health problems. We wanted to overcome and other health problems. We wanted to overcome this stigma by developing a series of ads that we this stigma by developing a series of ads that we targeted to moms and children…..”targeted to moms and children…..”

Sugar industry scare tactics

World Sugar Research Organization on implications of 916 recommendations*

– Forecast 3.6-6.5m ton pa fall in production– Focused only on “losers”– Ignored population growth– Ignored technological alternatives e.g. growth

in demand for “flex-fuel”

* Impact of the WHO Dietary Recommendations on World Sugar Consumption, Production and Trade. Dr Xavier Irz, University of Reading. April 2003

Sugar consumption increases with the incomes

•

The developing economies in Asia, including China, are predicted to consume considerably more sugar as the per capita income in these countries improves.

   In parts of China such as Shenzen, where the conversion to a Western economy is nearly complete, per capita gross domestic product has risen to a Western level. This means that people have enough disposable income to buy mass-produced goods such as candy bars, soda, ketchup and other consumer goods containing sugar. As incomes improve across all of China, sugar consumption will rise in other regions as well. As these nations reach the level of OECD (Organization for Economic Cooperation and Development) economies, sugar consumption will parallel that growth.

Alfa Laval – Sugar Industry Equipment Manufacturer 2002

February 2004 – FAO RomeFebruary 2004 – FAO Rome

• Sugar bid to ambush Sugar bid to ambush 916 and global 916 and global strategy at FAO strategy at FAO Committee on Committee on AgricultureAgriculture

• G-77 group ‘bloc’ voteG-77 group ‘bloc’ vote• ISO urges members ISO urges members

to lobby health to lobby health ministers against 916ministers against 916

USDA recommends <10%USDA recommends <10%

US sugar consumption up 20%US sugar consumption up 20%

17.3

31.4

USDA Dietary Guidelines USDA Dietary Guidelines on sugaron sugar

Age-adjusted* Age-adjusted* prevalence of prevalence of

overweight and overweight and obesity obesity

among U.S. among U.S. adults, age 20-74 adults, age 20-74 years NHANES years NHANES

III (1988-94)III (1988-94)

Age-adjusted* Age-adjusted* prevalence of prevalence of

overweight and overweight and obesity obesity

among U.S. among U.S. adults, age 20-adults, age 20-

74 years 74 years NHANES 1999-NHANES 1999-

20002000

1980/1985 - Avoid too much sugar1980/1985 - Avoid too much sugar

1990 - Use sugars only in moderation1990 - Use sugars only in moderation

1995 - Choose a diet moderate in sugars1995 - Choose a diet moderate in sugars

2000 - Choose beverages and foods to moderate 2000 - Choose beverages and foods to moderate your intake of sugarsyour intake of sugars

BMIBMI>>30 – 23%30 – 23%BMIBMI>>25 – 56%25 – 56%BMIBMI>>30 – 31%30 – 31%BMIBMI>>25 – 64%25 – 64%

2005 - 2005 - Choose carbohydrates Choose carbohydrates

wisely for good health?wisely for good health?

BMIBMI>>30 30 - 50%?- 50%?

Sugar accused of influencing Sugar accused of influencing latest US draft dietary guidelineslatest US draft dietary guidelines

• "This curious avoidance of the growing evidence about "This curious avoidance of the growing evidence about the dangers of added sugar would be inexplicable but for the dangers of added sugar would be inexplicable but for the fact that the fact that seven seven members of the panel - which was members of the panel - which was chosen by the Health and Human Services Department - chosen by the Health and Human Services Department - have major financial and organizational connections to have major financial and organizational connections to the food, drug and dietary supplement industries.the food, drug and dietary supplement industries.

It strains the imagination to believe that the It strains the imagination to believe that the sugar industry did not have undue influence sugar industry did not have undue influence this time around."this time around."[i]

[i] Sugar and new Dietary Guidelines The Food Pyramid Scheme. Sugar and new Dietary Guidelines The Food Pyramid Scheme. New York Times New York Times editorial. September 1 2004editorial. September 1 2004

Sugar bidding to buy NGO statusSugar bidding to buy NGO status

In conclusionIn conclusion

• The evidence implicating sugar in health is now The evidence implicating sugar in health is now too great to ignoretoo great to ignore• Attempts continue to manipulate messages and the Attempts continue to manipulate messages and the

overall health agendaoverall health agenda• Government agriculture departments should re-focus Government agriculture departments should re-focus

policies towards health-promoting food productionpolicies towards health-promoting food production• The food and beverage industry could play a key role in The food and beverage industry could play a key role in

ensuring sugar consumption is aligned to strategic public ensuring sugar consumption is aligned to strategic public health goalshealth goals

• The public, media and even shareholders are getting The public, media and even shareholders are getting wisewise

• It is time for the industry to wise up tooIt is time for the industry to wise up too

Takk for meg ;-)