Americans Eating More Processed Sugar, Study Finds

The other day I was "interviewed" for a magazine article. The author emailed me questions. Most of them were asking about my opinion of high fructose corn syrup (HFCS) and childhood obesity. One can usually tell the slant of the author by the wording of the questions. This author seemed bent on getting a nutrition expert to blame HFCS for the rising weight of American children/teens.

In my opinion, the problem isn't HFCS. If you look at the big picture, American kids are eating more CALORIES overall (and a lot of them from fried foods as well as sugar-sweetened beverages & processed baked sweets) and using less CALORIES with increasingly sedentary lifestyles (more tv/video/computer and less physical activity). Intake of sugar-sweetened beverages is ridiculously high (soda, sport drinks, energy drinks and juice). Yes, even juice! I've always considered juice to be "soda without the bubbles" since it is just sugar & water - only very little micronutrients (vitamins/minerals/phytonutrients) compared to EATING the fruit. But the popularity of sport & energy drinks is growing. Add to this the newest sugared beverage, the "nutrient waters" and what lessons are children getting from parents & the media? Apparently there is something wrong with drinking regular, plain, natural water.

This press release from Emory University shows another affect of increased soda/processed food consumption - high fructose consumption in 'empty' calories from these beverages is contributing to more than American waistlines:
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Americans are getting more than 10 percent of their daily calories from fructose, used mainly in sugar-sweetened beverages and processed foods, a new study finds.
The study, analyzing the amount and sources of dietary fructose consumption among U.S. children and adults from 1988 to 1994, was published in the July 9, 2008 issue of The Medscape Journal of Medicine.

Fructose occurs naturally in fruits and vegetables, however, it is added to many processed foods as table sugar (sucrose) and high-fructose corn syrup.

"Measurement of fructose consumption is important because growing evidence suggests that it may play a role in health outcomes," says lead study author Miriam Vos, MD, MSPH, assistant professor of pediatrics, Emory University School of Medicine.

Vos and colleagues examined fructose consumption patterns by sex, age group, race/ethnicity, socioeconomic status and body mass index for 21,483 U.S. children and adults. They used a single 24-hour dietary recall administered in the third National Health and Examination Survey (NHANES), the only nationally representative survey in the past 20 years to include fructose content as a reported variable.

The study found that U.S. children and adults consumed 54.7 grams of fructose per day, an almost 50 percent increase from a national study sample conducted in 1977-1978, which estimated mean consumption of fructose at 37 grams per day.

Fructose consumption was highest among adolescents ages 12 to18 at 72.8 grams per day. Among racial and ethnic groups, non-Hispanic blacks consumed the most fructose at 57.7 grams per day, or 11 percent of total calories. Normal-weight participants (56.2 grams) consumed more fructose than obese persons (51.1 grams). And those in the highest-income category consumed less of their total calories from fructose than those in the lowest-income category.

The largest source of fructose was sugar-sweetened beverages (30.1 percent), followed by grains, which include processed foods such as cakes, pies and snacks, breads and cereals (21.5 percent), and fruit or fruit juices (19.4 percent).

"Short-term studies have shown that fructose can elevate plasma triglycerides," says Vos. "Further surveillance and research are needed to assess trends in fructose consumption and to develop a better understanding of the health impact of this common additive in the food supply."

In addition to Vos, study authors were Jean Welsh, MPH, RN, of the Graduate Division of Biological and Biomedical Sciences, Nutrition and Health Science Program, Emory University; and Joel Kimmons, PhD, Cathleen Gillespie, MS, and Heidi Blanck, PhD, all of the Division of Nutrition, Physical Activity, and Obesity, Centers for Disease Control and Prevention.

Dr. Vos was supported by the Joseph W. Crooks Faculty Development Award.

Reference: The Medscape Journal of Medicine, eJournal, Clinical Nutrition & Obesity, July 9, 2008

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A follow up Systemic Reviews issue of the Medscape Journal of Medicine on 8/12/2008 asked the question "Soft Drinks and Weight Gain: How Strong Is the Link?" It's free to register at Medscape to read the article, here is the abstract:
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Emily Wolff, MPH; Michael L. Dansinger, MD, MS

Context: Soft drink consumption in the United States has tripled in recent decades, paralleling the dramatic increases in obesity prevalence. The purpose of this clinical review is to evaluate the extent to which current scientific evidence supports a causal link between sugar-sweetened soft drink consumption and weight gain.
Evidence acquisition: MEDLINE search of articles published in all languages between 1966 and December 2006 containing key words or medical subheadings, such as "soft drinks" and "weight." Additional articles were obtained by reviewing references of retrieved articles, including a recent systematic review. All reports with cross-sectional, prospective cohort, or clinical trial data in humans were considered.
Evidence synthesis: Six of 15 cross-sectional and 6 of 10 prospective cohort studies identified statistically significant associations between soft drink consumption and increased body weight. There were 5 clinical trials; the two that involved adolescents indicated that efforts to reduce sugar-sweetened soft drinks slowed weight gain. In adults, 3 small experimental studies suggested that consumption of sugar-sweetened soft drinks caused weight gain; however, no trial in adults was longer than 10 weeks or included more than 41 participants. No trial reported the effects on lipids.
Conclusions: Although observational studies support the hypothesis that sugar-sweetened soft drinks cause weight gain, a paucity of hypothesis-confirming clinical trial data has left the issue open to debate. Given the magnitude of the public health concern, larger and longer intervention trials should be considered to clarify the specific effects of sugar-sweetened soft drinks on body weight and other cardiovascular risk factors.

Exerpt from the article:

Mechanisms by Which Soft Drinks May Promote Obesity and Related Diseases

There are 4 main mechanisms by which soft drinks may promote obesity and cardiovascular risk factors: direct caloric increases, appetite stimulation, adverse metabolic effects of high-fructose corn syrup consumption, and replacement of milk and other beneficial dietary intake.

Sugar-sweetened soft drinks typically contain 140-150 calories per 12-oz serving. If normal dietary intake decreased by an equivalent amount of calories per serving, then weight change would not be expected. However, as noted above, DiMeglio and Mattes[6] found that there was no decrease in usual dietary intake in response to 450 calories per day from sucrose-sweetened soda. (The daily caloric intake was equal to baseline intake plus the caloric intake attributed to the soda.) In the same study subjects, a solid sucrose supplement in the form of jelly beans was associated with a caloric reduction from baseline dietary intake that perfectly compensated for the caloric load provided by the jelly beans, such that the daily caloric intake remained unchanged. Others have reported similar findings.[38,39] Hypothetically, sugar solutions may fail to trigger satiety in the same way that solid preparations do; however, the physiologic mechanisms have not been fully determined.

Appetite stimulation associated with rapidly changing glucose and/or insulin levels may be caused by rapidly absorbed, high glycemic carbohydrates, including those found in sugar-sweetened soft drinks. A rapidly falling serum glucose level is a well-known appetite stimulant, and carefully conducted human studies have attributed increased hunger and caloric intake to differences in glycemic index or glycemic load intake, and associated differences in glucose and insulin levels.[40,41] The DiMeglio data described above may not support this hypothesis because the glycemic load of the jelly beans vs the soda was probably similar.[6]

Fructose, found in similar amounts in both sucrose and high-fructose corn syrup, may hypothetically promote obesity more than an equivalent amount of glucose. A study by Elliott and coworkers[42] examined the relationship between fructose, weight gain, and the insulin resistance syndrome and found that fructose, compared with glucose, is preferentially metabolized to lipid in the liver. In animal studies, fructose consumption induces insulin resistance, impaired glucose tolerance, hyperinsulinemia, hypertriacylglycerolemia, and hypertension, although data in humans are less clear.[42] Because fructose has limited insulin-stimulating effects, the consumption of foods and beverages that contain fructose produce smaller amounts of insulin than glucose-containing carbohydrates. In addition, because leptin production is regulated by insulin responses to meals, circulating leptin concentrations are reduced by the consumption of fructose. Bray and coworkers[13] have also found that the digestion, absorption, and metabolism of fructose differ from those of glucose, noting that when large amounts of fructose are ingested, the fructose provides a relatively unregulated source of carbon precursors for hepatic lipogenesis. Furthermore, a recent study conducted in mice suggested that the consumption of fructose-sweetened beverages increases adiposity more than the consumption of either sucrose-sweetened or artificially sweetened beverages.[43]

The consumption of milk has greatly decreased over the past few decades, whereas sugar-sweetened soft drink consumption has greatly increased. Energy intake from milk decreased by 38% between 1977 and 2001.[12] It has been shown that this trade-off between sweetened drinks and milk has led to a lower daily intake of protein, calcium, phosphorous, magnesium, zinc, and vitamin A at the highest level of sweetened drink consumption (> 2 glasses or 12 oz/day).[44] Harnack and colleagues[45] found similar results in children and adolescents, particularly at high levels of soft drink consumption. French and coworkers[4] also noted that soft drinks may affect the dietary quality of youth by displacing milk consumption, which can reduce calcium intake among children and increase their risk for osteoporosis and bone fracture. Nielsen and Popkin[12] have hypothesized that because dairy products may have a favorable effect on weight, reducing milk intake may be associated with increased weight gain, especially if the milk is being replaced with drinks of a higher caloric value. Popkin and colleagues,[46] however, citing the 2005 Dietary Guidelines for Americans, noted that there was no sufficient evidence that milk consumption reduced, or prevented, weight gain.

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Healthy Fast Food?

If you sell it, will people buy it?

Many "fast food" chains tried those options a few years ago (when you are a Registered Dietitian, you get samples at the annual Food Expo every year) but the public wasn't ready. Do you remember McDonald Salad Shakers? Not a big seller. Even I didn't like the McLean (honestly, I haven't eaten a McD's burger in 10 years, but that's another story).

A few years later, Wendy's closed their in-restaurant salad bar (yes, they used to have a real salad bar) and just premade them and WOW! They were a hit! The timing was right for salad-to-go. And the rest jump aboard.

Warning: Many of these salads pack just as much fat & calories as the burgers. However, if you choose the grilled chicken and the fat-free dressing, take off half the cheese & bacon, you've got a decent meal.

Men's Health published a great article about the newest trend in fast food: Healthy options. If you are a patron of fast food, I hope this helps you make better choices. And lets hope that the public increases their purchase of these items so the chains will keep them on the menu. Remember, the companies aren't trying to help us be healthier, they are trying to make $$$. If it doesn't sell, they will stop serving it.

Eat This Not That: America's Best - and Worst - Restaurants

Posted Thu, Jul 31, 2008, 3:29 pm PDT

Eating out invariably raises a number of tricky questions: sit-down or drive-thru? Burgers or pizza? Thin or stuffed crust? And if you're dining with your family, add the biggest question of all: Will the food we eat today bring a fatter tomorrow for our kids? And fewer tomorrows for the rest of us?

So the choice between McDonald’s and Burger King shouldn’t be based solely on whether you're more terrified by the scary clown Ronald McDonald or that creepy masked Burger King. Choosing one over the other could be the difference of hundreds of calories in a meal, more than 10 unnecessary pounds over the course of a year, and countless health woes over the course of a lifetime.

During more than a year of research, my coauthor and I discovered vast dietary discrepancies between many of the places Americans love to eat most. So to help you separate the commendable from the deplorable, we put 43 major chain restaurants under the nutritional microscope — both for your benefit, and that of your family.

How did we judge the restaurants? We started by calculating the average number of calories per kid entrée, then rewarded restaurants for having healthy adult options that would appeal to the young palette, and for providing healthy vegetable sides and non-soda drink options. Finally, we docked points for those restaurants still harboring nasty trans fats.

The result is a Restaurant Report Card that holds each eating establishment fully accountable for the fare they’re serving up to all of us — moms, dads, kids, teens, and twentysomethings — along with a survival strategy for making it through any meal unscathed.

Did your favorite restaurant make the grade?

A Chick-fil-A
Chick-fil-A excels in every category we tested for. With a slew of low-calorie sandwiches, the country’s “healthiest” chicken nugget, a variety of solid sides like fresh fruit and soup that can be substituted into any meal, and nutritional brochures readily available for perusing at each location, Chick-fil-A earns the award for America’s Healthiest Chain Restaurant (for kids, for the adults who drive them there, plus anybody else wise enough to make it their fast food choice).

Your Survival Strategy: Even the smartest kid in the class can still fail a test, so be on your toes at all times, even at Chik-fil-A. Skip salads with ranch or Caesar dressings, any sandwich with bacon, and avoid milkshakes at all costs.

A- Subway
A menu based on lean protein and vegetables is always going to score well in our book. With more than half a dozen sandwiches under 300 calories, plus a slew of soups and healthy sides to boot, Subway can satisfy even the pickiest eater without breaking the caloric bank.

But, despite what Jared may want you to believe, Subway is not nutritionally infallible: Those rosy calorie counts posted on the menu boards include neither cheese nor mayo (add 160 calories per 6-inch sub) and some of the toasted subs, like the Meatball Marinara, contain hefty doses of calories, saturated fat, and sodium.

Your Survival Strategy: Cornell researchers have discovered a “health halo” at Subway, which refers to the tendency to reward yourself or your kid with chips, cookies, and large soft drinks because the entrée is healthy. Avoid the halo, and all will be well.

B+ Boston Market
With more than a dozen healthy vegetable sides and lean meats like turkey and roast sirloin on the menu, the low-cal, high-nutrient possibilities at Boston Market are endless. But with nearly a dozen calorie-packed sides and fatty meats like dark meat chicken and meat loaf, it’s almost as easy to construct a lousy meal.

Your Survival Strategy: There are three simple steps to nutritional salvation: 1) Start with turkey, sirloin, or rotisserie chicken. 2) Add two noncreamy, nonstarchy vegetable sides. 3) Ignore all special items, such as pot pie and nearly all of the sandwiches.

B McDonald’s
Though not blessed with an abundance of healthy options, Mickey D’s isn’t burdened with any major calorie bombs, either. Kid standards like McNuggets and cheeseburgers are both in the acceptable 300-calorie range.

Your Survival Strategy: Apple Dippers and 2% milk with a small entrée makes for a pretty decent meal-on-the-go. McDonald’s quintessential Happy Meal® makes this possible — just beware the usual French fries and soda pitfalls. Adults should go for a Quarter Pounder without cheese.

C+ Domino’s
Domino’s suffers the same pitfalls of any other pizza purveyor: too much cheese, bread, and greasy toppings. If you don’t order carefully, you might bag your child a pizza with more than 350 calories per slice. To its credit, Domino’s does keep the trans fat off the pizza, and it also offers the lowest-calorie thin crust option out there.

Your Survival Strategy: Stick with the Crunchy Thin Crust pizzas sans sausage and pepperoni. If your must order meat, make sure it's ham. And whenever possible, try to sneak on a vegetable or two per pie.

C Burger King
BK has only four legitimate kids’ entrées on the menu, and none of them — French Toast Sticks, hamburger, mac and cheese, chicken tenders — are particularly healthy. And while the recent addition of Apple Fries provides a much-needed healthy side alternative for kids, the menu is still sullied with trans fats.

BK pledged to follow in the wake of nearly every other chain restaurant and remove trans fats from the menu by the end of 2008, but so far, we’ve seen little action.

Your Survival Strategy: Adults can sign on for the Whopper Junior and a Garden Salad, and escape with only 365 calories. The best kids’ meal? A 4-piece Chicken Tenders®, applesauce or Apple Fries, and water or milk. Beyond that, there is little hope of escaping unscathed.

D Chipotle
We applaud Chipotle’s commitment to high-quality produce and fresh meats, but even the most pristine ingredients can’t dampen the damage wrought by the massive portion sizes served up here. The lack of options for kids means young eaters are forced to tussle with one of Chipotle’s massive burritos or taco platters, which can easily top 1,000 calories.

Your Survival Strategy: Stick to the crispy tacos or burrito bowls, or saw a burrito in half.

F Applebee’s, IHOP, Olive Garden, Outback, Red Lobster, T.G.I. Friday’s
These titans of the restaurant industry are among the last national chains to not provide nutritional information on their dishes. Even after years of communication with their representatives, we still here the same old excuses: it’s too pricey, it’s too time-consuming, it’s impossible to do accurately because their food is so fresh. Our response is simple: If every other chain restaurant in the country can do it, then why can’t they?

Your Survival Strategy: Write letters, make phone calls, beg, scream, and plead for these restaurants to provide nutritional information on all of their products. Here are the phone numbers for each of the restaurants that refuse to tell us the truth!

Applebees: email, 888-59APPLE; IHOP: email, 888-240-6055 (press 1 for Guest Visit issues); Olive Garden: email, 800-331-2729; Outback: email, 757-493-7662; Red Lobster: email, 800-LOBSTER.

For a comprehensive A-to-F breakdown from Men's Health on 30 other chain restaurants, see the complete Eat This, Not That! For Kids Restaurant Report Card. Or check out the adult versions of the Restaurant Report Cards here.