Sugar in Food: Soda and Stones – Nutrition Action


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“Aged Brie & sun dried figs create a flavor that would make even Mona Lisa smile,” gushes the label of the frozen gourmet “grown-up” Good Tastes Brie and Fig Mac & Cheese, which is sold at stores like Whole Foods.

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Smile? Chances are, she’d laugh at the tiny 1¹∕³-cup portion that’s supposed to serve two. (She might also chuckle at some of the “wholesome, gourmet, exhaustively sourced” ingredients, like the maltodextrin, xanthan gum, and natural cheese flavor.)

How many people will notice that the Nutrition Facts apply to just half the box? Probably not many. After all, who would ever think that just over a cup of mac & cheese could have up to 640 calories and 16 grams of saturated fat?

Amy’s Cheese Enchilada may seem like a 240- calorie bargain (though its 6 grams of saturated fat and 440 milligrams of sodium aren’t exactly low).

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Look again. The Nutrition Facts on the box are for just one of the two small enchiladas that are inside. Eat them both and your bargain morphs into about a quarter of a day’s calories and half a day’s sodium and sat fat.

The FDA’s serving size for enchilada-plus-sauce is about 7 ounces. Each of Amy’s enchiladas weighs 4.5 ounces. But thanks to a loophole in the labeling rules for foods that come in “small discrete units,” Amy’s can pretend that one enchilada is a serving.

You’re not fooling us, kiddo.

Coffee has been linked to a lower risk of dying of mouth and throat cancer in the largest study to look for a connection.

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The American Cancer Society’s Cancer Prevention Study II followed nearly 1 million participants for 26 years. Those who reported drinking more than four cups of caffeinated coffee a day had a 50 percent lower risk of dying of mouth and throat cancer than those who drank coffee occasionally or never. (One cup is 8 ounces, so a 16 oz. Starbucks grande is equal to two cups.)

The researchers found a hint that people who drank decaf had a lower risk of dying of mouth and throat cancer. However, tea wasn’t linked to a lower risk.

What to do: This study doesn’t prove that coffee lowers the risk of mouth and throat cancer (and four cups could keep you up at night and make you jittery). But coffee does contain compounds that protect against DNA damage in animals. Tobacco and alcohol are the strongest risk factors for mouth and throat cancer.

Source: Am. J. Epidemiol. 177: 50, 2013.

Drinking more fluids is thought to prevent kidney stones. But that may not apply to sugar-sweetened soda.

Researchers tracked more than 194,000 people for roughly eight years. Those who drank at least one serving of sugar-sweetened cola a day had a 23 percent higher risk of kidney stones than those who drank less than one serving a week. Likewise, those who drank at least one serving of sugar-sweetened non-cola a day had a 33 percent higher risk than those who drank less than one serving a week.

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In contrast, people who drank regular coffee, decaf, or tea at least once a day had a 16 to 26 percent lower risk of kidney stones than people who drank those beverages less than once a week. The risk was 30 to 40 percent lower in people who had at least one serving of red or white wine or beer daily, and 12 percent lower in those who drank orange juice, but not other juices, at least once a day.

What to do: Minimize sugar-sweetened sodas. Researchers suggest that their fructose may raise the risk of kidney stones by making kidneys excrete more calcium, oxalate, and uric acid. (Most kidney stones are made of calcium oxalate.)

Source: Clin. J. Am. Soc. Nephrol. 2013. doi:10.2215/ CJN.11661112.

“Institute of Medicine: Lowering daily sodium intake below 2,300 milligrams may do more harm than good,” reported CBS News in May 2013. “No benefit in sharply restricting salt, panel finds,” said The New York Times. “Is eating too little salt risky?” asked National Public Radio. “New report raises questions.”

Questions, indeed. But not so much about salt as about what the IOM was asked, what it concluded, and whether it relied on discredited data.

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When the Centers for Disease Control and Prevention asked the Institute of Medicine to quickly review the impact of very-low-sodium diets on health last year, the CDC expected to clear up some confusion. Instead, the report caused more. Here’s what the IOM did—and didn’t—say.

The report wasn’t about whether we eat too much salt. The question wasn’t whether typical U.S. sodium intakes —at least 3,400 mg a day, not including what we get from the salt shaker—are healthy. They’re not.

Instead, the CDC wanted to know what happens at 1,500 mg to 2,300 mg a day.

While that matters for setting daily sodium targets, it applies to few people, since only about 5 percent of adults get less than 2,300 mg of sodium a day (not counting what comes from the salt shaker).

The report found no harm for most people. There’s “insufficient and inconsistent” evidence that very-low-sodium diets cause harm in the “general population,” the IOM concluded.

Why insufficient? Studies that have observed a higher risk of disease or death in people who eat very-low-sodium diets have weaknesses.

One example: “People who report eating very little sodium are more likely to be ill,” explains Stephen Havas of the Northwestern University Feinberg School of Medicine. Odds are, it’s illness that raises their risk of disease and death and makes them eat so little salt (and food).

Since all the evidence of harm in the general population was based on studies that had that or some other weakness, it added up to “insufficient,” said the IOM.

The report found evidence of harm in people with heart failure, but that’s irrelevant, and the evidence is suspect. The most persuasive evidence of harm came from a group of Italian researchers who randomly assigned patients with heart failure to normal or very-low-sodium diets. Those restricting sodium were more likely to be readmitted to the hospital or to die.

Alarming? Not quite. First, the researchers restricted not just salt, but also how much water the patients could consume. And they put them on high doses of diuretics. That regimen isn’t used here.

“This hyper-aggressive treatment may have caused severe depletion of blood volume,” explains Frank Sacks of the Harvard School of Public Health.

More troubling, in June 2013 the journal Heart retracted a meta-analysis on sodium and heart failure by one of the Italian researchers, Pietro Di Pasquale of the University of Palermo. Each of the six studies in the meta-analysis was done by his research group.

In March 2013 Heart’s editor warned that two of the studies had duplicate data. In June Heart explained that when its ethics committee asked to see the raw data, the researchers said it was “lost as a result of computer failure.” The IOM didn’t cite the meta-analysis, but it did cite the two studies with duplicate data.

“It’s hard to believe that data can be lost from two trials,” says Lawrence Appel of Johns Hopkins University in Baltimore.

“The editors from the journals that published these papers should ask for the data and conduct an independent analysis of all trials from this research group.”

Sources: www.iom.edu/Reports/2013/ Sodium-Intake-in- Populations-Assessment-of-Evidence.aspx; MMWR 60: 1413, 2011; Clin. Sci. 114: 221, 2008; Heart 99: 820, 2013.