Scottish government guidelines for NHS hospital settings include removal of all soft drinks with >0.5g/100 ml of sugar, excluding pure fruit juice, and require that at least 30% of snacks and confectionaries and 70% of refrigerated food, meet nutrition criteria based on, among others, sugar content. 'The preponderance of evidence […] weighs in favour of improved triglycerides and HDL in children with low consumption of added sugars'. Evidence on the relationship of sugar-sweetened beverages and body weight should be considered when developing food-based dietary guidelines'. See 3.4.1. The epidemiological data are, however, insufficient to assess the role of sugars in the occurrence of this pathology'. 'There is possible evidence of a lack of a risk relation between the intake of disaccharides and the development of malignant tumours in the colorectum, breast and pancreas'. for habituation to sweetness, intense sweetener consumption 'has not shown any effects in adults'. The definition excludes fruit or vegetable juice concentrated from 100 percent fruit juice that is sold to consumers (e.g. EU Regulation 1169/2011 on food information to consumers  requires mandatory nutrition declaration for amounts of sugars, under carbohydrates (stating amount of g per 100 g of product), in prepacked foods, EU Regulation 1924/2006 includes rules for nutrition claims made on foods. Higher sucrose intake (>10 E%) is associated with lower intake of many micronutrients and dietary fibre and a higher intake of saturated fatty acids in Nordic countries. There's Glyphosate in Our Food System — So Now What? At the same time, the duo is also urging the UK Government and Food Standards Agency to use incoming post-Brexit powers to ban the use of aspartame in the UK in 2021. Action is afoot as the UK evaluates a ban on synthetic food colors. 'the evidence regarding an association between the total intake of mono- and disaccharides and the risk of type 2 diabetes mellitus is judged as insufficient'. In spite of widespread GM use without apparent negative impacts in other countries, the recent public reaction to trans-fats are reason enough to support a precautionary principle for the food supply chain. Acceptable Daily Intake (ADI) values have been already discussed in section 3.5 of the present Brief. Consumers should limit added sugars to help achieve/ maintain a healthy weight. Free galactose is rare in foods, except in fermented and lactase-hydrolysed milks. The Keyhole health logo labelling system by the Swedish National Food Agency is used in Scandinavian countries. Among the criteria established, the products to be distributed to schools must not contain sweeteners or artificial flavour enhancers (. contribute to weight gain, with a convincing level of evidence'. The UK Eatwell guide is a policy tool from Public Health England to define government recommendations on healthy eating. 'The evidence regarding an association between the consumption of sugar-sweetened beverages and the occurrence of the metabolic syndrome is judged as possible'. The EU fruit, vegetable and milk scheme, financed through the EU's Common Agricultural Policy provides fruit, vegetables and milk to children in schools to increase their consumption. Insufficient data to conclude if displacing caloric sweeteners with non-caloric sweeteners in beverages and foods benefits 'cardio-metabolic risk factors'. Some data suggests that sweeteners 'may be used in a structured diet to replace sources of added sugars and that this substitution may result in modest energy intake reductions and weight loss'. (EU) 1924/2006 – see section 3. b. Added sugar in confectionary is taxed at 0.22 €/L for products with sugar content >25%, while for chocolate the threshold is at 40% of total sugars. Of course, although the E.U. SCF/CS/ADD/EDUL/194 final. Limiting SSBs consumption will contribute to increased micronutrient density and reduced intake of added sugars. 'The most robust epidemiological studies on type 2 diabetes do not show a higher or lower incidence of diabetes' in daily intense sweetener consumers. oral hygiene and fluoride prophylaxis, are insufficient'. 2.2. For adults: BE, ES, SE for the 19-65 y age group; NL for the 19-34 y age group; DE for the 35-64 y age group, j. WHO handbook for guideline development (2014) 2nd edition, h. Conditional recommendations are made when there is less certainty about the balance between the benefits and harms or disadvantages of implementing a recommendation. The system is based on an algorithm that awards a star rating, based on the quantity of specific food components, such as total sugars. EFSA Journal 2013;11(7):3301, EFSA (2013b) European Food Safety Authority, Scientific Opinion on the re-evaluation of aspartame (E 951) as a food additive. It is recommended that children and adolescents limit intake of SSBs to 1 or fewer 8-oz (approx. The available evidence is insufficient to set an upper limit for sugars based on their effects on body weight. water, diet soft drinks, and fat- free or low-fat milk are better choices than full-calorie soft drinks. Common monosaccharides include glucose, fructose and galactose, while the main dietary disaccharides are sucrose (consisting of glucose and fructose) and lactose (consisting of glucose and galactose). 'this value represents an upper intake limit not to be exceeded, and not an intake recommendation', 'It is recommended that the average population intake of free sugars should not exceed 5% of total dietary energy for age groups from 2 years upwards'. Bovine Growth Hormone. no official recommendations regarding the use of non-caloric sweeteners, due to limited studies in children. Circulation (2009) 120:1011-1020, AHA (2015) American Heart Association Fact sheets 01/2015, Decreasing Sugar-Sweetened Beverage Consumption- Policy Approaches to Address Obesity. Low sugars claims 'may only be made where the product contains no more than 5g of sugar per 100 g for solids or 2,5 g of sugar per 100 ml for liquid'. There is a lack of research in children on the effects of non-nutritive sweeteners. Some school food policies specify upper limits for total daily energy from sugars (commonly ≤10 E%). In the US Legislation, for the purposes of nutrition labelling, 1 cup equals 240 ml, m. For the scope of Annex II, the term added sugars goes beyond the EFSA definition of the term, and 'is additionally considered to include sugars present in honey, syrups, and fruit juices and fruit juice concentrates. Cons: Since 1981, government reports have listed saccharin as an ''anticipated human carcinogen.'' In addition, Regulation (EU) 1169/2011 (EU 2011) states that the energy value to be declared in the nutrition declaration shall be calculated using the conversion factors of 10 kJ/g - 2,4 kcal/g for polyols and 0 kJ/g - 0 kcal/g for erythritol. This drug, known as rBGH for short, is not allowed in Europe. Adequate evidence for an association between the amount and frequency of SSBs and detriment to deciduous dentition. Establish a regulatory framework for reformulation of processed foods to reduce sugar content. on TV, internet, social media and on food packages) is recommended'. Contrary to common opinion, high fructose corn syrup isn't banned in Europe. Artificial sweetened beverages and sugar sweetened beverages should not be consumed as substitutes for water. In 1997, due to public concerns, the U.K. government introduced a new regulation obliging food makers who use sweeteners to state clearly next to the name of their product the phrase "with sweeteners." The E.U. 'Randomised controlled trials conducted in adults indicate that increasing or decreasing the percentage of total dietary energy as sugars when consuming an ad libitum diet, either through the substitution of other macronutrient components or by replacing sugars with non-caloric sweeteners, leads to corresponding relative increases or decreases in energy intake'. It is found in yeast products, mushrooms and crustaceans. Many food dyes previously recognized as safe are suspected of contributing to attention deficit disorder. 'Observed negative associations between added sugar intake and micronutrient density of the diet are mainly related to patterns of intake of the foods from which added sugars in the diet are derived rather than to intake of added sugars'. insufficient/inconsistent evidence from RCTs on effects of polyols on caries of deciduous dentition, or of confectionary containing polyols on caries in mixed and permanent dentition. Wiley-Blackwell, SACN (2015) Scientific Advisory Committee on Nutrition - Public Health England, Carbohydrates and health report, UKDH (2013) U.K. Department of Health, Food Standards Agency, Welsh Government, Scottish Government, Guide to creating a front of pack nutrition label for pre-packaged products sold through retail outlets, USDA (2016) U.S. Department of Agriculture, A guide to smart snacks in schools, WHO (2003) World Health Organization, Food based dietary guidelines in the WHO European Region. Excise duty of approx. total sugars or added sugars) it is difficult to draw any conclusions on the intake of added sugars across the EU. Although it was originally banned for use as a sweetener in the United States in 1991, the Food and Drug Administration ( FDA ) approved a purified form called rebaudioside A (Reb A) in 2008. In the few countries that didi, average intakes of mono- and disaccharides varied from 23 to 36 E% in children and adolescents, and from 17 to 26 E% in adults. 'For some people with diabetes who are accustomed to sugar-sweetened products, nonnutritive sweeteners (containing few or no calories) may be an acceptable substitute for nutritive sweeteners (those containing calories such as sugar, honey, agave syrup) when consumed in moderation'. In order to be included in the list of EU approved food additives, and in addition to the general requirements of food additives, sweeteners must serve one or more of these purposes: i) 'replacing sugars for the production of energy-reduced food, non-cariogenic food or food with no added sugars' or ii) 'replacing sugars where this permits an increase in the shelf life of the food'e. 'Although there is some evidence that high intakes (>20 E%) of sugars may increase serum triglyceride […] and cholesterol concentrations, and that >20 to 25 E% might adversely affect glucose and insulin response, the available data are not sufficient to set an upper limit for (added) sugar intake'. frozen 100 percent fruit juice concentrate) as well as some sugars found in fruit and vegetable juices, jellies, jams, preserves, and fruit spreads'. EC (2000a) European Commission Scientific Committee for Food, Opinion: Re-evaluation of acesulfame K with reference to the previous SCF opinion of 1991. occasional consumption of intense sweeteners before or during a meal 'has no effect on food intake or energy intake during the next meal'. In the US, the Food and Drug Administration (FDA 2017), states that 'the definition of added sugars includes sugars that are either added during the processing of foods, or are packaged as such, and include sugars (free, mono- and disaccharides), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices that are in excess of what would be expected from the same volume of 100 percent fruit or vegetable juice of the same type. 2016;134:00-00, AHA webpage, American Heart Association webpage on added sugars, ANSES (2015) Opinion of the French Agency for food, environmental and occupational health and safety on the assessment of the nutritional benefits and risks related to intense sweeteners, ANSES (2016) Opinion of the French agency for food, environmental and occupational health and safety on the establishment of recommendations on sugar intake, ANSES (2017) Agence nationale de sécurité sanitaire de l’alimentation, de l’environnement et du travail, French Agency for Food, Environmental and Occupational Health & Safety, Étude individuelle nationale des consommations alimentaires 3 (INCA 3), CDC (2010) Centers for Disease Control and Prevention, The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages, CDC website, Centers of Disease Control and Prevention, Get the Facts: Sugar-Sweetened Beverages and Consumption, DG AGRI webpage European Commission, Agriculture and rural development, EU school fruit, vegetable and milk scheme, DGA (2015) Dietary Guidelines for Americans 2015-2020, DGAC (2015) Dietary Guideline for Americans Committee, Scientific Report of the 2015 Dietary Guidelines Advisory Committee, DGE (2012) German Nutrition Society Evidence-Based Guideline of the German Nutrition Society: Carbohydrate Intake and Prevention of Nutrition-Related Diseases. It is based on a nutrient profile model and aims to identify healthier packaged food choices within a food category, and to stimulate food manufacturers to reformulate and develop healthier products. Stevia made illegal by Codex Alimentarius AFSP1631228A, PHE (2015a) Public Health England, Sugar Reduction: The evidence for action Annex 5: Food supply, PHE (2015b) Public Health England, Sugar Reduction: the evidence for action, PHE (2016) Public Health England, The Eatwell Guide, Helping you eat a healthy, balanced diet, Popkin B.M., Hawkes C. (2016) Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses, Lancet Diabet Endocrinol (2016):4 174-186, Present Knowledge in Nutrition (2012) – 10th edition. Added sugars should be kept below 10 E%. Producers with an annual production volume of less than 50,000 L are exempted. See the, In the US, the Children's Food and Beverage advertising initiative is a major industry self-regulatory effort to restrict marketing of foods that are high in sugar, salt and fats to children. free sugars intake of 5%. The evidence regarding this association is judged as probable'. I. Elmadfa and Dr. Alexa Meyer (University of Vienna), unless referenced otherwise. foods high in sugar. Similar for children and adolescents. Christine Lepisto is a chemist and writer from Berlin. American Heart Association/ American Stroke Association, AHA (2016) American Heart Association, Added Sugars and Cardiovascular Disease Risk in Children, A Scientific Statement From the American Heart Association, Circulation. 13 Hormone-Disrupting Chemicals (And How to Avoid Them), 'Modified' Asks Why Canada and U.S. Official Journal of the European Union L295/1, EC (2015) European Commission, Monitoring the EU Platform on Diet, Physical Activity and Health Annual Report 2015, EC (2018) European Commission – Press release, State aid: Commission clears Ireland's sugar sweetened drinks tax, ECSIP (2014) European Competitiveness and Sustainable Industrial Policy Consortium, Food taxes and their impact on competitiveness in the agri-food sector Final report, EFSA (2007) European Food Safety Authority, Neotame as a sweetener and flavour enhancer[1] - Scientific Opinion of the Panel on Food Additives, Flavourings, Processing Aids and Materials in Contact with Food, EFSA Journal (2007) 581, 1-43, EFSA (2010a) European Food Safety Authority, Scientific Opinion on Dietary Reference Values for Carbohydrates and dietary fibre. WHO handbook for guideline development (2014) 2nd edition, i. in barley, wheat, germinating grain). Sweeteners are not allowed in Keyhole products. The association direction indicates that 'greater consumption of SSBs is detrimental to health'. Malta: sweeteners are not allowed in schools, as part of the 'School Food and Beverage Standards'. 'Robust evidence from RCTs suggests non-caloric sweeteners are useful in weight maintenance/loss as they enable the calorie content of foods and drinks to be reduced while maintaining the same sweet taste desired by consumers. 204 of Public Law 111-296, HZJZ (2016) Croatian Institute of Public Health, Healthy living Nutrient Profile Scheme, IDF (2015) International Diabetes Federation: IDF Framework for Action on Sugar. Data from other surveys on sugar intake can be found in Table 8; as before, due to differences in methodology, year of study, age groups involved, and measurement taken (e.g. Implemented policies addressing sugars and sweeteners intake, 4. Health claims not permitted on foods that don't meet a specific nutrient profile criteria system, e.g. Use of chewing gum containing polyols, compared to not using a chewing gum,  is beneficial to oral health (mixed and permanent dentition). 'Sugars-containing beverages do not promote satiety compared the equivalent amount of sugars in solid form and therefore induce excessive energy intakes'. the sweeteners referred to in this Brief) to carry 'with sweetener(s)' as a statement that shall accompany the name of the food. Official Journal of the European Union L115/, EU Framework for National Initiatives on selected nutrients, EU Framework for National Initiatives on selected nutrients: Annex II: Added Sugars, EU platform for action on diet, physical activity and health webpage, EU(2016) Regulation (EU) 2016/791 Of The European Parliament And Of The Council amending Regulations (EU) No 1308/2013 and (EU) No 1306/2013 as regards the aid scheme for the supply of fruit and vegetables, bananas and milk in educational establishments. Maybe a look at some of the foods and food practices that are permitted in the U.S. and banned in Europe could shed light on how governments judge safety in the food chain. This limit applies to the general healthy adult population, and to total sugars, whether they are naturally present in food or added during food manufacture or preparation. Critics claim the ban with raise prices and may harm malaria control, but advocates of the ban say action must be taken against the pesticides which are known to cause harm to health and nevertheless consistently found in studies of food consumption. This drug, known as rBGH for short, is not allowed in Europe. 'Concerning…blood pressure, in the short- and medium-term intervention studies, deleterious metabolic effects of sugars were observed, in the case of very high consumption and/or consumption associated with an excess energy intake. The Healthy, Hunger Free Kids Act set standards for the national school lunch and breakfast programmes, which included limits on added sugars in foods and beverages. Sugars belong to the family of carbohydrates. Sucrose and fructose were also individually examined with same findings. Table 10: Examples of implemented policies to address sugars intake. 'For the risk of non-alcoholic fatty liver disease, a small number of intervention studies show that an excess energy intake, in particular in the form of fructose, increases the concentration of intrahepatic lipids in healthy subjects. The unit of measurement to be used in the nutrition declaration for mass of polyols is grams (g), and the order of presentation of the information, as appropriate, is indicated in Regulation (EU) 1169/2011. IOM (2007) Institute of Medicine of the National Academies, Nutrition standards for foods in schools: leading the way toward healthier youth, ISA (2016) International Sweeteners Association booklet, Low calorie sweeteners: Role and Benefits, JRC (2014) Joint Research Centre Science and policy report Mapping of National School Food Policies across the EU 28 plus Norway and Switzerland, JRC (2015) Joint Research Centre Science for policy reports, School food policy factsheets in EU 28 plus Norway and Switzerland, Livsmedelsverket Swedish National Food Agency, The keyhole, NNR (2012) Nordic Nutrition Recommendations 5th Ed, Official Journal of the French Republic, Text 38/166, 26/01/2017. 'It is recommended that the consumption of sugars-sweetened beverages should be minimised in children and adults'. level, and is pending approval by the Member States. The 2016 Dutch Presidency Roadmap for Action on Food Product Improvement, endorsed by the majority of EU MS as well as food business operators and some NGOs, aims to facilitate industry reformulation efforts by accelerating coordinated action from national governments, food business operators and NGOs, supported by sound research, independent monitoring and best practice exchange. Tax amounts to 0.02 €/L for products with more than 8 g/100ml of added sugars, exempting drinks with more than 25% fruit or vegetable content or at least 50% of milk. The Keyhole health logo labelling system by the Swedish National Food Agency is used in Scandinavian countries. For blood glucose regulation short- and medium-term intense sweetener consumption 'does not result in the post-prandial elevation of blood glucose or insulin levels in healthy or diabetic subjects'. 'The direction of the association indicates that greater consumption of sugars containing foods and/or sugars confectionery is detrimental to oral health'. EU Commission Regulation 2018/97, published on January 23, 2018, in Official Journal L 17, bans the use of artificial sweeteners in fine bakery products aimed at … For the World Health Organization (WHO 2015), the term sugars includes intrinsic sugars, which are those incorporated within the structure of intact fruit and vegetables; sugars naturally present in milk (lactose and galactose); and free sugars, which are 'monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates'. Moderate evidence indicates that 'higher intake of added sugars, especially in the form of sugar sweetened beverages, is consistently associated with increased risk of […] hypertension in adults'. It’s a defeat for bros—and a triumph for good taste. Greece: Artificial sweeteners are not allowed in junior high school and high school canteens for some beverages (chamomile, tea, sage). The focus is therefore on nutrition and diet related health effects. In three population studies with very low quality of evidence, lower levels of caries development were observed with approx. [...] Intakes should be even lower in infants and toddlers <2 years'. 'The majority of observational studies showed no effects on lipid profile related to intense sweeteners. 'Moderate and generally consistent evidence from short-term RCTs conducted in adults and children supports that replacing sugar-containing sweeteners with low-calorie sweeteners reduces calorie intake, body weight, and adiposity'. 6 teaspoons) of added sugars per day. In the EU (EC 2008, EU 2011) sweeteners are referred to as food additive substances used to 'impart a sweet taste to foods or in table-top sweeteners'. labelling of sugar content in foods, restrictions of marketing practices for foods high in sugars content, encouraging healthy behaviours such as drinking water, ii) making the healthy option available by improving the 'food environment', e.g. The tax on sweets was abolished in January 2017, while the beverage tax remains in place. 'epidemiological studies indicate a hypertriglyceridemia effect of sugars provided in the form of sugar-sweetened beverages, but these data do not show a specific effect, independent of total energy intake'. Both the U.S. and Europe stringently regulate food contact use of chemicals. Various other voluntary systems include sugars  in their labelling criteria e.g. insufficient/inconsistent evidence on effects of polyols on  intestinal transit time and constipation. Include counselling regarding risks of SSB consumption as part of routine medical and dental care visits. Low- and no calorie beverages e.g. As described in Table 4, high intake of added sugars can be a risk factor for ill health, especially in the case of intake of sugar sweetened beverages. Official Journal of the European Union L:345/16, EU (2011) Regulation (EU) No 1129/2011 amending Annex II to Regulation (EC) No 1333/2008. EFSA Journal (2010); 8(3)1462, EFSA (2010b) European Food Safety Authority, Scientific Opinion on the safety of steviol glycosides for the proposed uses as a food additive, EFSA Journal 2010;8(4):1537, EFSA (2011) European Food Safety Authority Scientific Opinion on the substantiation of health claims related to the sugar replacers xylitol, sorbitol, mannitol, maltitol, lactitol, isomalt, erythritol, D-tagatose, isomaltulose, sucralose and polydextrose and maintenance of tooth mineralisation by decreasing tooth demineralisation (ID 463, 464, 563, 618, 647, 1182, 1591, 2907, 2921, 4300), and reduction of post-prandial glycaemic responses (ID 617, 619, 669, 1590, 1762, 2903, 2908, 2920) pursuant to Article 13(1) of Regulation (EC) No 1924/2006, EFSA Journal (2011) 9(4);2076, EFSA (2011) European Food Safety Authority, Scientific Opinion on the substantiation of health claims related to intense sweeteners and contribution to the maintenance or achievement of a normal body weight (ID 1136, 1444, 4299), reduction of post-prandial glycaemic responses (ID 4298), maintenance of normal blood glucose concentrations (ID 1221, 4298), and maintenance of tooth mineralisation by decreasing tooth demineralisation (ID 1134, 1167, 1283) pursuant to Article 13(1) of Regulation (EC) No 1924/2006, EFSA Journal (2011); 9(6)2229, EFSA (2013a) European Food Safety Authority, Scientific Opinion on the safety of advantame for the proposed uses as food additive. artificial sweeteners), and may not coincide with the term adopted for the purposes of this brief. 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As an `` anticipated human carcinogen. re-evaluated by the European Commission intake results in increased blood pressure increase.. As taxation for SSBs and colon cancer incidence the UK evaluates a ban on synthetic food colors chain restaurants 100!