An open-access paper appeared on the American Heart Association
web site this month (Aug 2016):
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
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:
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,”
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
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):
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
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