Sweeteners Issues and Uncertainties (1975) / Chapter Skim
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SUGAR
SUGAR
Pages 59-118
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From page 59... ...
Table 4 lists production in tons of both cane sugar and beet sugar and shows the gradual rise that occurred from l958 to l973. Table 5 translates sugar consumption of the United States into pounds per person per year for a 25-year period.
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From page 60... ...
The person who thinks he is getting around the problem of obesity by using saccharin or cyclamate and continues to eat pie, cake, ice cream, and everything else, will still put on weight. It is total calories, I think, that is the important problem.
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From page 61... ...
Data on the effect of dietary carbohydrates on enzyme activities is presented in Table l8. This gives you a picture of what sucrose, glucose, and corn starch will do in terms of certain enzyme systems, showing that sucrose apparently magnifies the effect, that it has an accelerating effect on certain liver and blood enzymes when it is administered to the rats.
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From page 62... ...
There are some clinicians who will take issue with that. Indeed, if hypoglycemia is a reality, as many people believe, then what we are dealing with is a lot of people who have aberrant carbohydrate metabolism, and they cannot handle the load or the insult from absorbable sugars such as sucrose.
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From page 63... ...
In Table 2l I have summarized the risk factors of absorbable sugars as I view them. The next two figures illustrate the association of absorbable sugars with allergic manifestations and a hypoglycemic state.
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From page 64... ...
64 FASTlNG PATlENT X APPEARANCE OF SEVERE NASAL AND G.1. ALLERGY NOSE BLOCK AND CRAMPS 0.5 1 2 3 4 5 6 HOURS ON GLUCOSE TOLERANCE TEST FIGURE 2 Hypoglycemia in allergy.
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From page 65... ...
Is there a specific test in the medical profession for hypoglycemia for people who do not suspect an aberrant carbohydrate metabolism? KRAYBILL: The test is one for glucose tolerance.
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From page 66... ...
Edward Rynearson, published in a supplement to Nutrition Reviews, July l974 -- that he had seen very, very rare cases of functional hypoglycemia throughout a lifetime of specialized work in carbohydrate metabolism. I think we have to be quite careful about implying that hypoglycemia is a widespread disease, or that it has anything much to do with sugar consumption.
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From page 67... ...
RALPH NELSON, Mayo Clinic: It is commonplace today to use functional hypoglycemia as a diagnosis to explain symptoms not related to hypoglycemia in persons who otherwise are healthy. But in my experience, healthy people who embrace this diagnosis have been unable to correlate their symptoms with the decrease of blood sugar during the glucose tolerance test.
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From page 68... ...
TABLE 3 Economics of sweets Poorer families use twice as much sucrose/person as higher income groups. The reverse situation is true for total sugars (processed, prepared foods, i.e., jams, jellies, cakes, frozen desserts, etc.)
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From page 69... ...
TABLE 5 U.S. Per Capita Sugar Consumption (Pounds/Person/Year)
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From page 70... ...
l964 5.86 l965 2.l2 l966 l.86 l967 l.99 l968 l.98 l969 3.37 l970 3.75 l97l 4.52 l972 7.4l SOURCE: Licht's World Sugar Statistics, 72/73 TABLE 8 General Benefits of Absorbable Sugars Increases GNP of country Provides employment (farm, factory, transport) Reward feature - satiety value Provides quick energy Calories for low income groups Low cost energy Appetite stimulator Provides consistency and texture to certain foods ^Probably not true in l974-l975.
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From page 71... ...
In weight control, total caloric value of diet is important SOURCE: Vadenstern, E
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From page 72... ...
Low Cholesterol Group (l3) + ll.l t l.6 P < 0.00l TABLE l4 Deaths From Pancreatic Cancers by Time Period (Study of Boston Population: l930-l956)
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From page 73... ...
Pathol., 85:3l8-24, l968. TABLE l7 Effect of Sucrose on Glucose Tolerance in Rats Glucose Levels with Time (ing %)
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From page 74... ...
Species Diet Caries Score (Teeth Development § Maturation) Hamsters Stock + Purified 6.l Rats Stockl + Purified2 0.0 Mice Stockl + Purified2 0.0 Hamsters Purifiedl + Purified 48.0 Rats Purified + Purified 2.7 Mice Purified + Purified 0.5 SOURCE: Sognnaes, R
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From page 75... ...
TABLE 2l General Adverse Effects of Absorbable Sugars (Sucrose) High intakes replace calories from other macronutrients (empty calories)
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From page 76... ...
NUTRITION: SUMMARY OF EVIDENCE Paul M Newberne In conducting nutritional experimental work for over 20 years, I must admit, in company with most other nutritionists, that carbohydrates have usually been the last thing considered in designing the diet.
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From page 77... ...
Animals like it as well. When we consider the amount of sugar consumed by various population groups around the world, we find it to be significant, constituting about l8 percent of the total calories; and the consumption is increasing, particularly in developing countries.
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From page 78... ...
in order to maintain body weight gain. If intake exceeds usage, there will be weight gain.
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From page 79... ...
Each of these can be taken up separately for brief discussions. Sugar and heart disease relationships have usually been associated with the levels of lipids in the blood (cholesterol and triglyceride)
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From page 80... ...
0 Min 22 23 23 22 2l 30 Min 63 86 67 64 64 SOURCE: Szanto and Yudkin , Reference 4 . TABLE 5 Blood Sugar After Consuming Glucose or Sucrose Minutes Post-Ingestion Sugar Basal (mg%)
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From page 81... ...
TABLE 7 Serum Cholesterol Levels (mg/l00 ml) of Twelve Men Diet Mean Glucose Sucrose Lactose fj Glucose Difference l80 ± 6.5 l85 ± 7 -5 ± 3.5 l77 ± 9.7 -l78 ± ll.2 l ± 3.4 _l79 ± ll.l l74 + l0.l 5 ± 4.5
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From page 82... ...
data relative to dietary factors and coronary heart disease from 37 countries. Mortality data from degenerative heart disease and per capita consumption of fat, sucrose, complex carbohydrates, protein and total caloric intake were considered.
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From page 83... ...
Finally, TABLE 9 Effect of Dietary Fructose and Sucrose on Blood Glucose in Untreated Adult-Onset Type Diabetesa Case Starch Fructose^5 Sucrose*
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From page 84... ...
DEATHS-Percent actual of expected CardiovascularRenal Disease Diabetes mellitus Liver Cirrhosis Appendicitis Gallstones Cancer (All) Tuberculosis Peptic Ulcer Suicide Accidents -- Total Sex {Death rate of persons accepted for standard insurance)
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From page 85... ...
Wt. Increase CariesAverage Caries Score Group Treatment Rats M F Free Rats I Entire Ration 8 23l l96 8 0 Stomach Tube II Granular Sucrose l3 232 l82 2 7.5 Orally III Sucrose Sol'n l3 252 208 7 l.2 Orally From Haldi, reference l0.
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From page 86... ...
The underlying thesis has been that if we could identify all of the essential nutrients, obtain reasonable estimates of the dietary requirements for each, and understand their biochemical function, then it should be easy to develop biochemical tests for nutritional status or to evaluate dietary data. Adequate nutrition would be defined as enough of all essential nutrients.
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From page 87... ...
There are, in fact, data indicating effects upon serum lipids that are not observed when either is fed alone. The primary problems possibly associated with sugar consumption have been discussed -- heart disease, diabetes, obesity, and dental caries.
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From page 88... ...
1 1 1 1 1 1 1 1 5 10 15 20 25 30 Saturated Fat Consump., % Calories FIGURE l Correlations between fat and sugar consumption and mortality from coronary heart disease. Taken from McGandy et aZ., N
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From page 89... ...
The experimental studies of Cohen have shown the development of a mild diabetes in rats fed diets containing very large amounts of sugar. However, many people with elevated blood lipids demonstrate abnormalities in glucose tolerance, and diabetics are at high risk of atherosclerosis and heart disease.
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From page 90... ...
We were shown by Sidney Cantor that the sucrose level of consumption had remained essentially constant or slightly decreased, but I thought he also definitively showed that the total sugars had gone up by as much as 30 percent. HEGSTED: I think we are discussing consumption and disappearance, and I do not know how much of the disappearance figures represent consumption.
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From page 91... ...
My understanding is that the development of adipose tissue is still a controversial area. HENRY SEBRELL: I would like to make a brief comment on fat cells, based on the work primarily of Jules Hirsch at Rockefeller and Jerry Knittle at Mount Sinai.
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From page 92... ...
Fat cells without fat in them are a little difficult to identify. FREDERICK STARE, Harvard University: As Jules Hirsch and a few others have pointed out, there may be a second period in development where fat cells are laid down, and that is early in adolescence.
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From page 93... ...
When I checked the caloric value of those snack cakes, I discovered that two of them represented 50 percent of that child's total caloric requirement. I find this particularly appalling because that snack cake gets 50 percent of its calories from fat.
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From page 94... ...
Added vitamins would not compensate for their high sugar and fat content. The other thing we need is sugar consumption information.
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From page 95... ...
I just wonder whether we should encourage, to such an unregulated extent, the consumption of sugar. DISCUSSION ROSS HALL, McMaster University: I was struck by the fact that our speakers have addressed themselves to four health problems as they relate to sugar -- diabetes, dental caries, obesity, and heart disease.
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From page 96... ...
This is when the rats were given distilled water to drink, hypertonic saline, and hypertonic saline sweetened with either glucose or sucrose. The blood pressures follow
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From page 97... ...
But the investigators were not satisfied with this. They wanted to make the animals have higher blood pressures, so they sweetened the hypertonic saline.
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From page 98... ...
Supplemental Sucrose Diastolic Blood Pressure (g/day)
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From page 99... ...
BOWEN: I am with the National Caries Program and can answer part of the question. Some years ago there was a study to compare the effects of refined sugar versus nonrefined sugar in caries causation in rats.
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From page 100... ...
Particularly, you reduce the carbohydrates from starch, increase the carbohydrates from sugar, increase animal fats and separated 3490 Calories per capita per day $us 2600 2000 1500 1 100 800 600 400 300 200 150 & Q * ° "T6 20 30 40 50 60 70 80 ~90 100 100 90 80 70 60 50 40 30 20 10 Percent of total calories p -- 1785 Calories per capita per day -- -j FIGURE l Consumption pattern of countries as a function of income.
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From page 101... ...
So it is difficult, and it may even be impossible, to apply a cause and effect relationship between certain aspects of the life-style, which include heredity, smoking, exercise, and control of blood pressure on the one side and coronary heart disease on the other. How does this information help us to deal with sweeteners?
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From page 102... ...
There are going to have to be changes in our behavior. We are going to continue to be suspicious of being "at the top of the line." We have a Finnish person working with us to whom I always say how grateful I am to the Finns, because they have a higher heart disease rate than we do, and therefore we are number two instead of being number one.
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From page 103... ...
We came out quite clearly with a figure during the wintertime, the cooler months, that approximated 20 percent of their total caloric intake coming from sugars -- I am using that in the plural. During the warmer weather, in the springtime, when more ice cream was consumed, more soft drinks, more iced tea, the percentage of total calories coming from sugars increased to 24 percent.
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From page 104... ...
I cannot quite believe that there are many children who receive half of their total calories from sugar, but I do not know this to be a fact because I do not know of such data. On the question of the Yemenites that was mentioned this morning, we seem to forget that when they left Yemen and went to Tel Aviv, not only did they consume more sugar, but they consumed more food in general, and they all gained weight.
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From page 105... ...
Why some people or why most of us enjoy sweet taste, I just do not know. As for dental caries, as far as I know the children in Grand Rapids, where they have had fluoridation as long as any other place, eat the same amounts of snacks and sweets as the children in Boston, and yet they have 60 to 70 percent less tooth decay.
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From page 106... ...
What I cannot understand is why there is difficulty in this area when you are talking about sucrose or other absorbable sugars. Why is that an exception?
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From page 107... ...
Let us briefly look at what is necessary for dental caries to develop. You must have a caries susceptible tooth, a cariogenic flora, and a suitable dietary substrate.
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From page 108... ...
MARSHA COHEN: In terms of eating up to 25 percent of your calories in refined sugar, wouldn't that present-STARE: I said "sugars" including the sugar out of orange juice and other foods. COHEN: But you are not precluding the fact that under your theory people could choose to eat 25 percent of refined sugars, and you would still approve of their diet.
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From page 109... ...
But I think it is all very premature to say that we must have regulation or legislation that will request stating the percentage of sugar added to a food, when all we have been hearing all day is that none of the broad sweeping allegations of the harmfulness of sugar have really been clearly demonstrated in a cause and effect relationship, with the possible exception of dental caries. It would not be a surprise if the next speaker states that the percentage of sugar has little relationship to the cariogenicity or the caries-producing capability of the food in which it is contained.
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From page 110... ...
For the study, 2 g/kg of sucrose was prescribed; and the increase of sucrose intake from l.5 to 2 g/kg lowered both cholesterol and triglycerides in these men with coronary heart disease. The calorie intake was kept constant to maintain weight, because loss of body weight reduces blood fats rather drastically.
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From page 111... ...
We studied thin, muscular, and obese children and found -- as others have -- that obese children ate about the same amount of calories as did thin children. There were fat children eating a lot of calories, but so were there thin children.
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From page 112... ...
It is also an infectious disease, and investigators at the National Institute of Dental Research, the Forsyth Dental Center, and several other places have identified an organism, namely streptococcus mutans, which is intimately associated with plaque formation and dental caries.
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From page 113... ...
If we feed a rat, let us say, an NIH diet, we can measure most of the parameters that control the rate of fat synthesis. These are really only two -- the Vmax of fatty acid synthase and the concentration of malonyl CoA.
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From page 114... ...
What comes out, leaving aside all the numbers, is that sucrose increases the activity of fatty acid synthase from 0.68 to 2.6 micromoles/min/g in three days. This will really quadruple the capacity of the liver to synthesize fat, and it will in fact quadruple the rate of fat synthesis as measured by 3H uptake from 0.45 ymoles C2 units/min/g liver to 2.6 pmoles/min/g.
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From page 115... ...
But I think we have the tools, and these are questions one can answer. Obviously, the relationship between the rate of fatty acid synthesis and the process of atherosclerosis is a complex one.
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From page 116... ...
ll6 that last little plastic can of pudding, or that last little synthetic bread stick or whatever it is that we are being introduced to, is the straw that broke the nutritional camel's back. We are simply on the defensive, and we have very few weapons.
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