Jamie’s UNJUST CRUSADE AGAINsT SUGAR
As Jamie admits on his website, his team started looking into sugar consumption and decided they had enough to film a TV documentary. Now do not get me wrong, he may have been well meaning, but the fact that he sees these devastating effects of sugar and decides to make a TV show just makes me think one thing, money, fame and attention. However lets play the game and imagine it was all for our benefit to scare us into becoming sugar-phobic like Davina McCall.
Jamie pushed heavily for a tax on sugary drinks, not the tax you already paid on many foods and beverages but another one just on drinks that contain added sugar which would be paid for by producers who then either raised prices, altered recipes or made smaller portion sizes to evade taxation. He was not asking that you be taxed for indulging in his delicious sugary desserts, just drinks as far as I am aware.
You can read this 'courageous, forward-thinking' document here Public Health England - Sugar Reduction, The Evidence for Action. Sadly this great document does not really contain anything new and just refers to The Scientific Advisory Committee on Nutrition (SACN) report, Carbohydrate and Health which we will cover in more detail.
As you can see above, the WHO recommendations are based upon low quality and moderate quality evidence in relation to body weight, and very low and moderate quality evidence for dental caries. Basically it's not evidence that any self respecting scientist would dare use to make such bold statements. Although in a post-covid era do we even have any self respecting scientists left? As you may know, despite the lack of evidence the sugar tax policy went through in the UK and people still talk about it as a valid scientific concept via the rose tinted glasses supplied by low carb/ketosis fantasists.
Jamie used the SACN guidance for his campaign. So lets review it and see what the evidence looked like.
The Science Behind SACN’s review contains the “evidence” on page 15-18 and it makes for an interesting read. For the full review click the link above.
SACN’s claim the review was comprehensive and includes systematic reviews of the literature in order to identify “relevant” studies.
Their “objective was to identify the best quality evidence” so they restricted it to “evidence” from randomised controlled trials (which have the potential to demonstrate a causal relationship, e.g. between an aspect of diet and a risk factor for disease) and prospective cohort studies (which reveal associations, e.g. between an aspect of diet and a disease risk factor or endpoint) as these are considered the most robust study designs for diet and health research.'
Here are a few gems taken from this comprehensive review about the dangers of sugar. I'll leave you to draw your own conclusions about the quality of evidence upon which Mr Oliver based his campaign.
“Very few studies on the effects of individual sugars, such as glucose, fructose or sucrose, met the inclusion criteria. There was also insufficient evidence of appropriate quality to draw conclusions on the impact of sugars intake on the majority of cardio- metabolic outcomes in adults, including body weight.”
“Few trials on fructose met the inclusion criteria for the SACN report because many were either not randomised or they were of insufficient duration. No studies specifically investigating the effects of high fructose corn syrup were identified that met the inclusion criteria. However, as concern has been expressed around fructose consumption and its implications for cardio-metabolic health, evidence from trials that did not meet the inclusion criteria for SACN’s report were considered. It was concluded that, on balance, there was insufficient evidence to demonstrate that fructose intake, at levels consumed in the normal UK diet, leads to adverse health outcomes independently of any effects related to fructose’s presence as a component of total and free sugars.”
“There was a lack of evidence to assess the impact of sugars intake on oral health in adults; evidence for a relationship comes from studies in children and adolescents. Most of the evidence on sugars and on sugars-sweetened foods and beverages considered in SACN’s report is derived from prospective cohort studies.”
“Prospective cohort studies are observational in nature rather than involving an intervention and so cannot demonstrate a causal relationship, only an association. Generally, evidence from three or more such studies was used to judge whether an association existed, where possible supported by a meta-analysis of the combined data.”
“Expert judgement was also applied and where an association appeared to exist, the evidence was graded as adequate, moderate or limited (details of the evidence grading system used by SACN can be found in Annex 2 of the SACN report).”
The evidence for a relationship between sugars intake and tooth decay comes from mainly prospective cohort studies and some trials, conducted in children and adolescents. Studies that adjusted results for tooth brushing frequency were given more weight during the assessment because oral hygiene practices may have affected results. SACN concluded that decreased consumption of free sugars would help to lower the risk of dental decay, which continues to be a problem in the UK.
In children and adolescents:
Cardiovascular disease, colorectal cancer and type 2 diabetes
The findings from prospective studies were:
there is insufficient evidence to enable conclusions to be drawn in relation to cardiovascular disease risk factors or endpoints (events) (see paragraphs 6.6-6.17 of the SACN report)
sugars or sugars-sweetened beverage intake are not associated with the incidence of colorectal cancer (see paragraphs 6.38-6.39 of the SACN report)
there is no association between the incidence of type 2 diabetes and total or individual sugars intake (see paragraphs 6.23-6.34 of the SACN report)
But a greater risk of type 2 diabetes is associated with a higher intake of sugars- sweetened beverages. This finding was not supported by the limited evidence from randomised trials, which showed no effect of diets differing in sugars content on blood sugar and insulin levels or on insulin resistance (see paragraphs 6.25-6.28 of the SACN report)
SACN comments that the reason for this discrepancy with type 2 diabetes, between the results of prospective studies and randomised controlled trials, is not clear. Presumably the increased risk might reflect higher energy intakes among those with higher intakes of sugars-sweetened drinks. In a meta-analysis of prospective (observational) cohort studies, incidence of type 2 diabetes increased by 23% for each additional 330ml/day of sugars- sweetened drinks consumed (see paragraphs 6.35-6.37 of the SACN report).
Randomised controlled trials
Although most of the evidence available that met SACN’s inclusion criteria came from prospective, observational cohort studies, some randomised controlled trials also met the inclusion criteria. Randomised controlled trials can provide evidence of causal relationships rather than associations. Generally, there needed to be three or more randomised controlled trials to determine whether or not there was evidence of an effect. Where an effect appeared to be present, the evidence was graded by SACN as adequate, moderate or limited.
Cardio-metabolic outcomes
“Randomised controlled trials examining cardiovascular risk factors, body weight, inflammatory markers and risk factors for type 2 diabetes demonstrate no effects of increasing sugars intake.
There is also insufficient evidence to assess the link between individual sugars and sugars-sweetened foods and drinks and cardio-metabolic outcomes.”
I am not totally against Jamie's desire to shift people towards a more wholesome diet, but his demonisation of sugar leaves me with a bitter taste in my mouth. As I have stated before, sugar is neither toxic (unless consumed in massive doses, which applies to most substances) or addictive. It is essential, (especially for brain function it would appear) and pretty disgusting if consumed alone (take the sugar challenge and see how many spoonfuls of table sugar you want to consume). I admit that when food processors get their hands on sugar and fat they are able to induce sometimes uncontrollable cravings, but as a chef surely that is or was Jamie's role in society? To create dishes that entice our tastebuds and leave us desiring more?
So was it a “courageous, forward-thinking” document with evidence for action....or a cowardly, backward-thinking attack with action without evidence that Jamie nor the government fully understand but forced it through anyway.
