Question 2
A client wants to know why added sugars are “bad” since 1 gram of added
sugar has the same number of calories as 1 gram of intrinsically occurring
sugar. How would you respond to this client?
posted by Unknown @ 4:59 AM
13 comments
13 Comments:
I would start by explaining to the client that intrinsically occurring sugar often comes along with benefits of added nutrients. For example, 100% fruit juice has the added benefit of vitamin C while SSB often do not. A grey area is fortification. We see products like vitamin waters that are fortified with nutrients that may have higher nutrient levels than 100% juices. I would suggest the client to choose the natural source if possible, because we know exactly what is in it and why it has vitamin C.
I would explain that sugar is sugar and the same amount of calories are present in both options, but there are benefits to consuming foods with natural sugars and limited added sugars. Added sugars are increasing calories to a product without any additional benefits. One way to go about explaining this to a client is basing it not only on vitamins present in foods with naturally occurring sugars, but also on fiber content. It is kind of the whole foods approach and the limiting of processed foods.
Tessa, I like how you use the fruit juice example, because I remember doing grocery store tours and explaining the natural/added sugars of fruit juice concentrate and 100% juice, which was a shock to many people. Consumers may think any juice is a good choice, when in fact certain juices (100% juice) provide more health benefits.
In explaining to a client the difference between added sugar and natural sugar I would begin by stating that sugar is sugar; however, the source of the sugar is still something of importance. While naturally occurring sugar will provide one with the same calories as added sugar, naturally occurring sugars also include added benefits of vitamins and minerals. Alternatively, added sugars is simply adding in refined sugar that is strip of any nutritional value and simple put, empty calories. As an example, by sweetening ones tea with honey (which naturally contains sugar), you will also see trace amounts of additional nutrients; however, sweetening ones tea with cane sugar will not have these trace amounts of nutritional value.
I would respond by saying that he or she is correct, added sugars and natural sugars have the same number calories gram for gram (not including artificial sweeteners and sugar alcohols). Then I would go into how added sugars are often considered “bad” because they provide extra calories to products with minimal nutrition, such as soda or fruit punch. As compared to products with intrinsic sugar that are often higher in vitamins, minerals, and fiber, such as natural unsweetened applesauce or 100% pure orange juice with pulp.
I would respectfully provide the client with objective information based on current research. I would explain that there are different types of sugar, but that they all provide the same amount of calories per serving. However, naturally occurring sugar is found in fruits. While fruit juice should be consumed in moderation, the sugar found in whole fruits is much more than empty calories (vs. sugar-sweetened soda). When sugars occur naturally, they are packaged with vitamins, minerals, and fiber. If the client were interested, I would further explain how fiber can provide satiety and keep blood sugar levels steady.
Tessa, I think you provided a really great example! Vitamin water may have a fortified vitamin/mineral content, but this can be used as an education opportunity on the other benefits of whole foods.
It would first be necessary to acknowledge the fact that sugar is sugar gram for gram, and does have the same caloric impact regardless of source. However, like many have mentioned already, it would then be necessary to address the importance of considering the source of sugar. Fruit is the key example of natural sugar when discussing sugar sources. I would tell the client that sugar in itself is not “bad” and is actually the primary fuel source in our bodies. I would then elaborate on how sugars are added to a long list of items as a flavor enhancement, thus increasing calories but not nutritional value. Next, I would mention that fruit is a source of sugar but also comes with a wide array of nutrient including fiber, vitamins, minerals, and phytochemicals not found elsewhere. Focusing on a whole food approach to sugar would be needed to educate that the whole food, including its sugar, is nutritional overall. Looking at the nutrients associated with the source of sugar is important. If discussing sugar-sweetened fortified items like Tessa mentioned, I would also mention that vitamins and minerals may be added to an item but the phytochemical content of fruits or other plant foods are too complex to be understood and replicated through fortification. Every fruit and vegetable has a unique combination of phytochemicals that do different things in the body, which are not fully researched and understood in the science world yet. This phytochemical argument is another piece of evidence supporting eating a variety of whole foods, and not just a combination of different processed items that may meet macro- and micro-nutrient requirements.
See this article for more about natural combinations of phytochemicals vs supplements/fortification.
http://ajcn.nutrition.org/content/78/3/517S.full.pdf+html
Excerpt from article at http://ajcn.nutrition.org/content/78/3/517S.full.pdf+html.
"We proposed that the additive and synergistic
effects of phytochemicals in fruit and vegetables are
responsible for their potent antioxidant and anticancer activities,
and that the benefit of a diet rich in fruit and vegetables is attributed
to the complex mixture of phytochemicals present in whole
foods (31–33). This partially explains why no single antioxidant
can replace the combination of natural phytochemicals in fruit
and vegetables in achieving the health benefits. There are 8000
phytochemicals present in whole foods. These compounds differ
in molecular size, polarity, and solubility, and these differences
may affect the bioavailability and distribution of each phytochemical
in different macromolecules, subcellular organelles,
cells, organs, and tissues. Pills or tablets simply cannot mimic this
balanced natural combination of phytochemicals present in fruit
and vegetables."
Not all sugars are equal the same way not all calories are equal. One hundred calories of carrots is much different than 100 calories of fast food french fries. They have different compositions, nutrient profiles, and health effects. Added sugars versus natural sugars are similar. Natural sugars are consumed in the context of other natural nutrients such as fiber, antioxidants, vitamins, minerals, and phytochemicals that are present in fruits with natural sugars. You do not get these added health benefits from a soda or candy with equal amounts of added sugars. This also changes the digestive process and release of sugar into the bloodstream and consequently to storage. I would reinforce the importance of a balanced diet and explain it is alright to eat added sugars in small quantities and frequencies, but there are a lot more health benefits associated with consuming sugars in their natural forms.
Tessa, I like your example of fruit juices. Not all juices on the market are 100% and so they have a different composition and nutrient profile. Like Nikki said, people are shocked to learn this fact. It is one instance where choosing the more natural sugar option is an easy switch people can make to reduce the amount of added sugars they consume.
"Even as both contain similar kcalorie, energy density values, the body operates off of more than electricity alone. As a car requires not just gas, but oil, anti-freeze, and wipe fluid; our bodies require many supporting nutrients beyond raw energy. In selecting foods with less added sugars, we build more 'supportive fuel' into diet. Without engine oil a car will overheat, despite adding more and more gas, the engine can operate long without oil. Our bodies fall into disrepair, 'illness' when a balance of nutrients are not provided. Natural sugars are associated with foods rich in 'supportive fuels'. Consider added sugars on the label as a flag to look for a better choice. Not all foods with added sugars are bad, but the majority of your diet you be included natural sugar 'supportive fuel' foods."
Justine, I like your specific examples of a 100 kcal of French fries vs. carrots. Specific applicable examples and explanations appears to be beneficial to most clinical patients.
I think everyone agrees on this questions and Kirsten, I appreciate your use of exert from ajcn.nutrition.org. After reviewing everyone's comments I have realized while we as nutrition professionals know not all sugar is created equal, the ability to transfer this concept to our clients is rather tricky. Justine brings up a great example using carrots and french fries. By using simple concepts such as these that the everyday consumer can relate too, I believe we as dietitians can get sound nutrition advice across to the public.
Kirsten, you brought up a good point about the different phytochemicals found in foods. We often focus much of our attention and education on macronutrients, vitamins, minerals, and fiber, often not mentioning the other benefits of whole foods such as phytochemicals.
Justine and Rachel, you both brought up a good point about the added benefits of whole foods on digestion, absorption and storage/usage of nutrients by the body; and your provided examples are a good way to convey the message to clients.
I would explain that although the client is correct there are more benefits of naturally occurring sugars. Then I would explain that naturally occurring sugars are healthier for you then added sugars and that added sugars lack the vitamins, minerals and fiber that natural sugars have. I would give a few examples and then ask the client if he/she had any questions!
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