Edition: 2016-08-24

An open-access paper appeared on the American Heart Association web site this month (Aug 2016):
Added Sugars and Cardiovascular Disease Risk in Children.

It's worth a read by anyone who might still harbor illusions that the AHA is actually interested in materially reducing cardiovascular disease.

They propose that children over age 2 be limited to 25 grams of “added sugars” per day, and that those under 2 get no added sugars.

There's little actual progress here, as you can see from the AHA spin quotes in the medical press, such as:
MPT: AHA: Restrict Kids to 25 Grams or Less of Daily Added Sugar
“Until then, the best way to avoid added sugars in your child's diet is to serve mostly foods that are high in nutrition, such as fruits, vegetables, whole grains, low-fat dairy products, lean meat, poultry and fish, and to limit food with little nutritional value,” Vos said.

The paper is a meta analysis. No new trials were run. They did keyword searches on PubMed. Although many of the papers they relied on may be presumed to be intellectual junk food, valid data supporting an added-sugar hypothesis would be easy enough to find. Their population consumption data was from NHANES, which they admit is iffy (PDF p5):
“These estimates may be conservatively low because it is well established that self-reported dietary assessments underreport.”

Significantly, the phrases “blood glucose” (or BG) and “blood sugar” appear exactly nowhere in the paper. “insulin resistance” was considered in the searches, but the general issue of insulin provocation was largely ignored. This is not entirely due to ignorance. They showed some awareness of actual metabolism (PDF p5):
“Increased glucose in the portal blood stimulates insulin secretion, leading to increased uptake of glucose into muscle and adipose, increased synthesis of glycogen, increased fatty acid synthesis in the adipose, increased amino acid uptake, and induction of lipoprotein lipase into muscle and adipose. Fructose does not stimulate secretion of insulin to the same extent and is absorbed primarily into the liver where it stimulates de novo lipogenesis.”.

They spend a page defining different sugars (PDF p2&3), but entirely ignore the elephant in the room: available carbohydrates that promptly become BG. Table 2 on PDF page 2 specifies added-sugars for various foods, including grain-based foods, but is blissfully silent about the fact that the grains themselves are usually 60% glucose polymers that become BG as fast if not faster than table sugar.

Paid by the word? Many pages were squandered on analysis of associations, solids v.s liquids, satiety factors, vague markers like BMI, what fructose does (including words about a preposterous trial in which glucose was substituted for fructose), how the papers they examined were inconclusive on diabetes, and the expected frequent hang-wringing about the need for more research.

It's hard to tell what explains this train wreck. The adverse health trends are unmistakable, so the AHA must at least pretend to be deeply concerned and taking action. Possibilities include but are not limited to:

• They might have some dim awareness that excess carbs are a problem, and are looking for a scapegoat (“added sugars”). Somebody's gotta take the fall, and it looks like Big Sugar drew the short straw.
   
• Perhaps they know full well what the problem is, but face-saving and liability management require moving away from carbs very cautiously. They need many more retirements and funerals before they can take a posture of: go low carb, just like we've always said.
   
• These people are merely hopelessly incompetent. Whatever the real explanation, I consider this organization, and many of the people who scribble for it to be a clear and present danger to public health.

Two co-authors disclosed relevant relationships with the Milk Processor Education Program and the Sugar Board (added sugar intake among toddlers). The AHA itself has rather more industry conflicts of interest.

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Bob Niland [disclosures] [topics]