1 About sugar
1.1 What is sugar?
Sugar is a sweet crystalline substance obtained from various plants, especially sugar cane and sugar beet, consisting of sucrose. It is used as a sweetener in food and drink and also to add texture, flavour and increase shelf life.1 Sugar is a carbohydrate along with starch.2
There are two main types of sugar, those that are contained in the cellular structure of foods and drinks and naturally present in dairy products (these are intrinsic sugars and you don’t need to limit them), and those that are ‘free’ or ‘added sugars’ such as the sugar added to food, and the sugars naturally present in honey, fruit juice and syrups. These should be limited to no more than 5% of energy intake 3
1.2 What are “free sugars”?
Free sugars are the sugars that the World Health Organization says need to be limited to no more than 5% of total calories. These are the sugars added to foods, and the sugars naturally present in honey, fruit juice and syrups. There are surprisingly large amounts of free sugars in everyday foods and drinks, which are either added by manufacturers (such as fructose, sucrose, glucose and corn sugar) or added at home; for example, on cereal, hot drinks and whilst cooking.
While fruit juices count towards your 5-a-day the sugars in them are free sugars that should be limited to 5% of energy intake. Raising awareness is needed of the free sugars in juices. A typical orange juice has more free sugars in it than a cola, but an orange eaten whole has no free sugars because the sugars it has in it are tied to the fruit, fibre and so on and are therefore not “free”.
1.3 What is the worst type of sugar for our health?
According to the World Health Organization these are “free sugars”.
We do not need to worry about sugars that occur naturally in fruit, vegetables, milk and yoghurt. It’s the sugars added to things by manufacturers (breakfast cereals, chilled desserts, lower fat lower sugar yoghurt, sweets, cakes, biscuits, chocolate, and some fizzy drinks) as well as sugar added at home (on cereal, hot drinks and whilst cooking), and the sugar naturally in fruit juice, honey and syrups (such as agave and maple syrup) that we should cut down on.3
1.4 What are the dfferences between… :
- added sugar and natural sugar?
Naturally occurring sugar is the sugar found in whole, unprocessed foods, such as milk, fruit, vegetables and some grains. The most common natural sugars are fructose, which is found in fruit, and lactose, which is found in milk products.4
Added sugar is the sugar added to processed food and drinks when they are being made, as well as sugar you may add to your food at home.3
Food manufacturers may add both natural sugars (such as fructose) and processed sugars (such as tA) to processed food and drinks.
- intrinsic and extrinsic sugars?
Intrinsic sugars are those that present naturally within the cellular structure of food, these sugars are mainly found in fruits and vegetables. Extrinsic sugars are those that are added to food5
- hidden and added sugars?
Hidden sugar is the sugar found naturally in most foods. On the other hand, ‘added sugar’ is the sugar added to many foods to make them taste nicer.5
1.5 What types of sugar is the World Health Organization trying to get people to cut down on?
It’s the sugars that are added to things such as breakfast cereals, chilled desserts, yoghurts, sweets, cakes, biscuits, chocolate, and some fizzy drinks that we should cut down on as well as the sugar naturally present in honey, fruit juice and syrup.
1.6 Are you suggesting that people should cut fruit out of their diet?
No. Fruit does contain sugar as part of its structure, and therefore does not contain any free sugars. It’s a healthier choice because it also contains fibre, vitamins and minerals.6
1.7 What is the guidance from the World Health Organization about drinking fruit juice?
The sugars in fruit juice are all free sugars and therefore should be limited to 5% of calories a day along with any other free sugars.
1.8 What is the issue with fizzy drinks?
There is no problem with fizzy drinks as long as they are sugar free. Soft drinks, including fruit juice are the largest single source of sugar for teenagers. Some flavoured waters also contain large quantities of added sugar even though they may present as a healthier alternative. There are significant health benefits to switching from a sugary drink or a juice to a diet drink or sugar free version. Following the World Health Organization diet drinks are far healthier than juices and other sugar sweetened drinks and do not contain free sugars.
1.9 Aspartame has been documented in the media as causing cancer, is this true?
In December 2014 the European Food Safety Authority (EFSA) completed a full risk assessment on aspartame, taking into account all available scientific research and concluded it is safe at current levels of exposure. Research has shown that many people find it hard to make long term changes if they have to cut out their favourite foods or drinks, in which case swapping to sugar free versions can help them to do this, whilst still having significant benefits over eating sugar.
1.10 What are the health implications of consuming too much sugar?
According to recently published data from the UK National Child Measurement Programme (NCMP), almost one in ten children aged 4-5 years is obese, rising to one in five children aged 10-11 years. Even more are overweight. Evidence shows that eating too much sugar results is linked to fat build up inside the body, which can lead to weight gain and obesity. Children who are overweight or obese are more likely to develop illnesses such as type 2 diabetes, go onto experience weight and health problems in adolescence, and are more likely to become overweight or obese adults.
If an individual is overweight or obese they are more prone to a range of serious health problems. These include cardiovascular disease; type 2 diabetes; endometrial, breast and colon cancer; as well as psychological and social problems such as stress, low self-esteem, depression, stigma, prejudice and bullying.
1.11 How confident is the World Health Organization about the evidence behind sugar causing tooth decay?
There is clear evidence to support the connection between sugar and tooth decay and recent estimates suggest poor dental health costs the NHS in the UK alone £3.4 billion a year.12 In 2012, almost one-third of five year olds in England had tooth decay with stark inequalities across the country.1 A systematic review commissioned by the World Health Organization found that when less than 10% of total energy (calorie) intake is made up of free sugar there are much lower levels of cavities. Dental decay progresses with age and the effects from sugars on teeth are lifelong.13
1.12 How confident is the World Health Organization about the evidence behind sugar causing obesity and deadly/chronic diseases?
In the UK alone, NHS costs attributable to being overweight and obese are projected to reach £9.7 billion by 2050, with wider costs to society estimated to reach £49.9 billion per year.15 If people choose, cook and eat within the 5% guidelines on sugar this will lead to longer, healthier lives.
- Sugar guidelines and consumption
2.1 What is the recommended daily allowance for sugar for adults and children?
No more than 5% of people’s (from 2 years old and above) daily energy intake should come from free sugars. This is a new recommendation announced by the World Health Organization in March 2015. The Scientific Advisory Committee on Nutrition (SACN) later issued the same recommendation 14
- So what does that really mean?
- Children aged 4 to 6 should have no more than 19g or 5 teaspoons of free sugars per day
- Children aged 7 to 10 should have no more than 24g or 6 teaspoons of free sugars per day
- Children aged 11 years and upwards, as well as adults, should have no more than 30g or 7 teaspoons of free sugar per day
To put this into perspective, a typical 330ml can of fizzy drink can contain up to 35g or 9 teaspoons of free sugar.
2.2 Why can we only eat 5% free sugars of our daily energy intake?
The UK Government’s advice on sugar intake is based on robust evidence compiled by an independent expert body – the Scientific Advisory Committee on Nutrition (SACN). The evidence considered by SACN shows that reducing free sugars intake to below 5% of total energy intake reduces the risk of eating too many calories.14
SACN have proposed a recommendation of around 5% of total energy intake from total sugars on the bases that it could help reduce obesity, and tooth decay. They have also taken into account evidence on type 2 diabetes. A diet where sugars intake is 5% of daily energy intake approximately equates to 30g or 7 cubes of sugar per day on average.14
2.3 When do we expect to achieve the 5% sugar intake figure? Is it realistic?
The new recommendations on sugar pose a significant challenge but are achievable in the long-term. The scientific evidence shows that we all have to reduce our sugar consumption in order to protect our health. This is why a broad range of measures is needed in response – there is no single solution. We need to change our environment to help the nation make healthier choices.
Current estimates of UK sugar intakes from the National Diet and Nutrition Survey programme (NDNS), show that average intakes are three times higher than the 5% maximum recommended level in school-aged children and teenagers (15% of energy intake) and around twice the maximum recommended level in adults (12% of energy intake).
2.4 Currently how much sugar does the average person consume in the UK?
The average person in Britain consumes 700g of sugar a week – equivalent to 175 cubes of sugar!
2.5 Does this differ between age groups?
The below shows a breakdown of daily total sugar intake14
- Children aged 1 and a half to 3 consume on average 36.1g of sugar (11.9%)
- Children aged 4-10 consume on average 60.8g of sugar (23.8%)
- Teenagers aged 11 – 18 consume on average 74.2g of sugar (15.4%)
- Adults aged 19 – 64 consume on average 58.8g of sugar (12.1%)
- Adults aged 65+ consume on average 51.6g of sugar (11.5%)
2.6 Which foods and drinks consumed by 4-10 year olds in England contain the most sugar?
Children’s sugar consumption, as a percentage of energy intake, is up to 55% greater than the current SACN recommendation. The highest contributor to added sugar in the diet 4 to 10 year olds is:
- 30% drinks (including 17% from soft drinks). These are not the low calorie drinks
- 29% cereals (mainly from biscuits, cakes and breakfast cereals)
- 22% sugar, preserves and confectionery
- 12% milk and milk products
2.7 Why are people in England eating and drinking too much sugar?
There does not seem to be one definitive reason for people in England eating too much sugar. However, the reasons could include, but are not limited to:
- A lack of availability of lower sugar options, especially in favourite foods such as cakes and biscuits
- Unpopularity of artificial sweeteners, and lack of availability and understanding of these as viable alternatives to sugar
- Confusion over the levels of free sugars and need to limit these in fruit juices, honey and syrups
- Sugar addiction
To complement the government health campaigns that aim to raise awareness of what is considered an acceptable level of sugar consumption and illustrate how consumption builds up throughout the day – our campaign seeks to drive the demand for and availability of more options that are within the guidelines on sugar.
- Nutrition labels
3.1 How do people know if they are buying foods with too much free sugars?
Nutrition labels do not tell you how much free sugars there are in the product. You can only tell if the food contains free sugars by checking the ingredients list. Or a Sugarwise certified product, all of which are within the guidelines on free sugars. A food containing lots of fruit or milk may not have any free sugars in it and therefore be a healthier choice than one that contains lots of added free sugars in the form of sugar, honey or juice. In this case the two products may contain the same total amount of sugars.
3.2 What is classified as a sugar on nutrition labels?
The sugars figure in the nutrition label is the total amount of sugars in the food. It includes sugars from fruit and milk, as well as the sugars that have been added.
4.2 Why are you only focusing on sugar?
It’s our job, as the campaigning and certification body for sugar. It’s the same reason the Vegan Society focusses just on vegan foods, or OK Kosher on kosher foods! We’re just the first to apply the same principle to sugar. Certification schemes have the effect of increasing both demand for and availability of what is being certified. By applying that to sugar we might just get more sugar free and lower sugar options out there. If people have choices available to them that are within the guidelines, education makes a lot more sense. Cooking from scratch can be helpful but is not convenient for everyone or all the time, and it would be useful to have more store bought ready foods within the guidelines on sugar as well.
4.3 Sugar has received increased amounts of attention from the media and political environment, has this influenced your decision to focus on sugar once again?
No. This campaign was started by Rend Platings at the start of 2015, when there was hardly any media attention on sugar! In fact it was then difficult to persuade people to take any notice of sugar. Rend went to the Parliament and submitted her daughter’s nursery menu as evidence, and contacted Change4Life in August telling them about her ideas for “Sugar Smart” certification. She feels very lucky that they took notice and helped get retailers and others behind sugar reduction!
4.4 What is the aim of the Sugarwise campaign?
Unlike other campaigns that are educational over the amount of sugars in foods, the Sugarwise campaign seeks to bring to market more foods that are lower in sugar and free of added sugar so people shopping have more choices. The campaign will make it more viable and convenient for families to reduce the amount of sugar they consume; while the government’s campaign will more broadly stimulate the desire for a change.
4.5 Who will the campaign target?
The Sugarwise campaign targets everyone in the UK, and through partners, elsewhere in the world, particularly families who wish to reduce the amount of sugars their children consume.
4.6 Why have you decided to launch this campaign?
Something needs to be done about increasing the amount of Sugarwise choices out there. Education has limited value if everything sold still has a lot of sugar in it.
4.7 How do you plan to help families reduce their sugar intake? How does that fit in with Change4Life?
The Change4Life campaigns will raise awareness of the high levels of sugar consumed and the health harms of sugar. It does this by encouraging families to download their Sugar Swaps app and find out exactly how much sugar is in everyday food and drink. The Sugarwise campaign then supports them in making the changes needed to protect their kids by ensuring that options within the guidelines are readily and easily available for them.
4.8 How long will the campaign run?
5 Sugarwise partners
5.1 How can Local Authorities get involved?
Local authorities are invited to contact us to discuss their interest in becoming a Sugarwise City/County etc., Our certification for local authorities is comprehensive and we will guide you through all the stages you need to go through for a credible certification that is of a high standard that people can trust.
5.2 How can schools help deliver this campaign?
We can provide guidance and information that fits with the curriculum and helps to facilitate the educational process in making children and their families eat lower sugar. Our pack for schools includes resources and ideas for including healthy eating messages across the curriculum.
Schools are invited to contact us to discuss their interest in becoming a Sugarwise Nursery/School etc., Our certification for education is comprehensive and we will guide you through all the stages you need to go through for a credible certification that is of a high standard that parents can trust.
5.3 How can charities get involved?
We are reaching out to a range of charities which promote healthier eating. But please don’t wait for us to get in touch. You can help right away by promoting the campaign messages through your channels as well as distributing the campaign literature. In return we will promote your charity. Get in touch to find out more. It is a great campaign to be involved with for publicity and we are continuing to attract significant media attention.
6.1 Have you got references for your recommendations?
Yes we do. We are hoping to be able to work towards linking to all the articles listed, and also making sure free copies are made available for all the articles where relevant. In the meantime, though, here is the list of our references to date.
6.2 References for this FAQ
- Oxford Dictionaries Sugar Definition (2015) http://www.oxforddictionaries.com/definition/english/sugar
- Simple vs Complex Carbs. http://www.diabetes.co.uk/nutrition/simple-carbs-vs-complex-carbs.html (2015)
- Karim David. The Difference Between Natural Sugar & Added Sugar? http://www.karimdavid.com/the-difference-between-natural-sugar-added-sugar/
- Family Doctor. Added Sugar: What You Need To Know. http://familydoctor.org/familydoctor/en/prevention-wellness/food-nutrition/sugar-and-substitutes/added-sugar-what-you-need-to-know.html
- European Food Information Council. http://www.eufic.org/page/en/page/FAQ/faqid/extrinsic-intrinsic-sugars/
- NHS Choices. Water, drinks and your health. http://www.nhs.uk/Livewell/Goodfood/Pages/water-drinks.aspx
- NHS Choices. 5 A DAY: what counts? http://www.nhs.uk/Livewell/5ADAY/Pages/Whatcounts.aspx
- Public Health England. Sugar reduction. Responding to the challenge. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/324043/
- England 2014-2015. Available at http://www.hscic.gov.uk/article/2021/Website-Search?productid=19405&q=OBESITY&sort=Relevance&size=10&page=1&area=both#top
- Singh AS, Mulder C, Twisk JW, van Mechelen W, Chinapaw MJ. (2008) Tracking of childhood overweight into adulthood: a systematic review of the literature. Obesity Review; 9(5): 474-88
- Public health England Economics of Obesity. Available at http://www.noo.org.uk/NOO_about_obesity/economics [Accessed December 2015]
- NHS England, (2014) Improving dental care and Oral Health – A Call to Action
- Moynihan, P. J. and Kelly, S.A.M. (2013) effect on caries of restricting sugar intake: Systematic review to inform WHO guidelines. Journal of Dental Research. DOI:10.1177/0022034513508954
- SACN 2015 Report. Available at https://www.gov.uk/government/publications/sacn-carbohydrates-and-health-report
- Government Office for Science, Foresight (2007) Tackling Obesity: future choices summary of key messages. https://www.gov.uk/government/publications/reducing-obesity-future-choices