Monday, October 6, 2014

Sugar--Is added sugar always added sugar?

After making breakfast for two girls and packing lunches for three (yes, my darling husband takes lunch to work, but only if I pack it), often I find myself dashing out the door, plastic spoon in hand, for a yogurt breakfast on the way to school.  My preferred choice is Fage 2% Greek Yogurt.  Creamy, filling, yummy.  We buy it by the case, choosing the honey version as I figured honey was better since it is "natural".  But is it really better?  Honey is, after all, added sugar.  Is sugar just sugar, regardless of form?  Or does context and kind matter?
 
What led to my recent re-evaluation of my honey Fage obsession was the arrival of two new flavors, blood orange and key lime.  The blood orange and key lime flavors come from add-in gels, made primarily of cane sugar with fruit pulp and juice.  So the honey flavor--just the addition of honey made by bees--is better, right?  Not necessarily.  A quick evaluation of the added sugar is in order.  Plain 2% Fage Greek yogurt has about 6 grams of sugar from the naturally-occurring sugar in milk.  The new fruit flavors clock in at 16 grams of total sugar, so 10 grams of added sugar (2.5 teaspoons).  The honey version has 29 grams of total sugar, thus a whopping 23 grams of added sugar (almost 6 teaspoons)! 
 
Guideline 1--Added sugar is added sugar.

So which yogurt should I grab on my dash out the door?  I think the answer depends on my day.  A day with dessert at dinner?  Perhaps the blood orange yogurt to save some added sugar for later.    Going for an 8 mile run afterschool drop-off?  A little extra sugar might not be a bad idea, to give me the energy I need for a long run.  In the end, the goal remains to keep added sugars to less than 10% of daily calories (see previous post for details).  For me, this is about 55 grams since I estimate my daily calorie needs at around 2,200 calories. 
 
Guideline 2--Context matters.
 
Remember Pop-tarts from the previous post?  With 16 grams of sugar, they are not very different from the new Fage yogurts.  But the yogurt has more to offer.  A quick comparison:
 



 

Fage 2% honey

Fage 2% key lime

Strawberry Pop-Tart

Serving

5.3 oz container

5.3 oz container

1 pastry

Calories

190

140

200

Total Fat

2.5g

2.5g

5g

Total Carbohydrates

29g

18g

38g

Sugars (subset of total carbs)

29g
  (of which 6 grams are naturally-occurring the yogurt)

16g
  (of which 6 grams are naturally-occurring the yogurt)

16g

Protein

12g

12g

2g

Extras noted in the Nutrition Facts panel

10% of daily calcium

10% of daily calcium

10% of daily vitamin A, thiamin, riboflavin, niacin, and vitamin B6
 
From the Pop-Tarts, you primarily get carbohydrates, with a bit of protein and some fat.  The vitamins are from the enriched flour and, while important, are readily available in other grain products, either enriched flours or whole grains.  However, with the yogurt, the added sugars comes with protein and a good serving of calcium.  In choosing foods with added sugars, it is helpful to ask yourself:
  • What does the food provide beyond added sugars?  Are the added sugars the majority of the food's calories or just part of the equation?
  • Is the food a treat worthy of indulgence?  In in era when you can get any treat at any time, candy corn seems to be a rarity, stocked only in the fall.  I ADORE candy corn (but only the good Brach's kind!).  19 pieces provides 28 grams of sugar.  To answer my own question, yes, the candy corn is worth it.  And, hopefully, I will modify my other foods to take into account the candy corn loveliness. 
  • Is the food a beverage?  Sweet drinks--from soda to 100% fruit juice to Frappuccinos--make it far too easy to exceed the daily recommendation on added sugars.  For example, a vanilla grande Frappuccino (no whip) with a staggering 67 grams of sugar.  Additionally, liquid calories are not satiating as solid calories, meaning that you will be hungry sooner with sugar sweetened beverages and, therefore, likely eating more overall.
Guideline 3--Eat fruit for something sweet.  And avoid HFCS.

In recent years, Dr. Robert Lustig of UCSF has made the argument that while added sugar is bad, it is the fructose component of sugar (sucrose) that is particularly worrying (remember, sucrose is half glucose and half fructose).  In short, he argues that the liver's ability to handle fructose can be overwhelmed and can lead to, among other things, de novo lipogenesis (making fat) and insulin resistance.  Two mediators of this impact are fiber and exercise.  Exercise basically helps negate some of fructose's effects.  Fiber slows the absorption of sucrose and fructose, providing the liver the necessary time to process the fructose.  Additionally, fiber increases satiety and reduces consumption.  Easy way to think of it--an apple is going to be more filling than a bag of fruit chews.  Both have sugar, but the apple provides fiber, not to mention key vitamins and minerals.

I should note that I don't believe the science is completely settled on this issue.  However, I think there is enough basic science data and population studies to suggest something is going on.  Sucrose is half fructose, so, again, limiting added sugars is best.  But some sugars such as agave syrup and high fructose corn syrup (HFCS) have a higher fructose content.  In HFCS, cornstarch has been modified in the lab, converting some glucose to fructose.  Unlike the 50/50 split of sucrose, the percent of fructose in HFCS can vary from 42% to 90%.  When reaching for something sweet with added sugars, choose a chocolate square made with sugar over the fruit chews made with HFCS.

Guideline 4--Kind matters, but only a little.

Sugar Basics--Any substance ended in -ose is a sugar.  The disaccharide sucrose is processed from sugar cane or sugar beets, then crystalized to form the white sugar.  Raw sugar in the United States is not really raw, but has gone through part of the refining process (true raw sugar would have dirt, insect bits, and like--yummy!).  In cooking, the kind of sugar matters.  For example, brown sugar (white sugar with added molasses) makes dense, chewy cookies (check out this link for a great comparison of different ingredients impact on chocolate chip cookies).

Glycemic Index and Sugars--In recent years, there has been some attention on the glycemic index (GI) of foods.  Basically, the GI is a measure of how quickly (and how high) your body's blood glucose level increases and then decreases after eating.  A high GI means the food increases blood glucose quickly, with a rapid decent.  Low GI means a slower, more modest increase and decrease in blood glucose levels.  The GI information can be particularly helpful to diabetics who are trying to manage and monitor blood glucose levels (an index of foods can be found on this Australian website).
 
Sugars like honey and agave, with their high fructose content, have lower GI levels than table sugar (aka sucrose).  Does that make honey and agave better-for-you sugars?  Not really.  They are still added sugars and count toward your daily limit. 

While in general, high GI foods are highly processed with little fiber, there are no hard and fast rules regarding GI, as cooking method, preparation, ripeness, and other factors influence the GI score.  Low GI foods are not necessarily more healthy.  For example, ice cream is low GI by virtue of its fat content (so the sugar is absorbed more slowly).  But if you are looking to feel full longer, a chocolate chip cookie made with whole wheat pastry flour may be slightly better than a cookie made with white flour as the whole wheat flour's fiber should slow the sugar's absorption (just remember--it is still a cookie!).
 
Sugar Alcohols--Sugar alcohols are not related to drinking alcohol, but instead are sweeteners that usually have fewer calories than sucrose.  You may be familiar with glycerol, sorbitol, mannitol, and xylitol.  One thing to remember about these low calorie sweeteners, often found in sugar-free foods, is that they are incompletely absorbed.  Good news?  Blood glucose levels rise more slowly than with sucrose (and, in the case of sugar-free gum made with xylitol, prevents cavities).  Bad news?  Too much sugar alcohol can cause a laxative effect. 

Honey, Maple Syrup, and Molasses--Too much of these sweeteners is still too much added sugar.  However, honey, maple syrup, and molasses do have a few positive attributes.  Depending on the botanical origin, honey and maple syrup contain anti-oxidants, vitamins, and minerals.  My only caution is watch your honey's origin, as too much of the honey sold is stores is not honey at all.  Blackstrap molasses (a by-product of sugar refining) is a good source of iron and calcium.

Zucchini Bread
 
When I started writing this post, I was going to skip the recipe.  We were in the midst of a birthday celebration week and, between a family party and a sleepover with friends, it seemed we were in an added sugar tsunami! 


But now, the crumbs have settled.  I got some great looking local zucchini from the farmers market.  Fall always makes me think of quick breads, so I raided my cookbook shelf for a oldie of my mom's--Gold Medal Century of Success Cookbook (as in Gold Medal Flour).  The recipe does have added sugar (which I decreased slightly), but has the benefit of encouraging the girls think of zucchini as a "good thing".  My adapted version of the book's zucchini bread recipe:
 
Preheat oven to 325 degrees. 

 
Mix ingredients (I stirred after adding each one):
  • 3 cups grated zucchini
  • 3 cups whole wheat pastry flour (not Gold Medal but Bob's Red Mill)
  • 2 cups granulated sugar
  • 1/2 cup of unsweetened apple sauce (the original recipe called for 2.5 cups of sugar, but I just couldn't do it.  The applesauce is still sugar-like, but has some of the benefits of fruit)
  • 1 1/4 cups canola oil
  • 4 eggs, beaten
  • 1 tablespoon, plus 1 teaspoon vanilla
  • 2 teaspoons cinnamon
  • 1 1/2 teaspoons salt
  • 1 1/2 teaspoons baking soda
  • 1/2 teaspoon baking powder
 
Pour into loaf pans treated with cooking spray.  This recipe made one large loaf and 4 mini-loaves.  The mini-loaves baked about 20-25 mins and the large loaf was closer to 40-45 mins.  As always, I used a toothpick to check doneness.

References
All quotes and sources are linked in the above text.  General nutrition information came from Whitney and Rolfes' Understanding Nutrition, 13th ed. and from Nutrition for Sport and Exercise, 2nd ed. by Dunford and Doyle.

 
 
 

Monday, September 22, 2014

Added Sugars--Finding Balance

When I was a kid, one of my favorite breakfasts on a cold morning was cinnamon toast.  My mom would butter slices of bread, sprinkle them with cinnamon and sugar, and then do a quick broil in the oven.  A little slice of heaven.  And on mornings like today, when my youngest announced that she was "feeling un-awesome", warm cinnamon toast and a glass of skim milk helped get her day off to a better start. 

But the larger food environment we live in today is very different from my childhood.  Cinnamon toast was a true treat, as other than some homemade cookies and a very small glass of breakfast OJ, we didn't have a lot of added sugars in our environment.  How do I balance my family's eating in our current sugar-prone environment so I can give them these treats without feeling like I am dooming their health? 
Cinnamon toast
What is Sugar?
Sugars are simple carbohydrates known as mono- or disaccharides.  While a great source of energy and essential for brain function, sugar by itself offers no other nutritional advantages.  However, in fruits, the sugar fructose is packaged with the fruit's fiber, vitamins, minerals, and phytochemicals.  A glass of milk delivers the sugar  lactose along with protein, minerals, and vitamins.
The trouble begins when we move from whole foods like fruits and milk to processed foods.  Even minimally processed foods often have added sugars.  Unfortunately, the current Nutrition Facts panel only gives a total sugar amount.  As a result, a food like chocolate milk is going to have a total sugar amount that includes the naturally-occurring lactose and the added sugars. 
What are Added Sugars?
The list of added sugars can be long, but essentially added sugars are any and all sugars added by a cook or manufacturer to a food. I have complied the list below from USDA MyPlate and the American Heart Association.
agave syrup
anhydrous dextrose
brown rice syrup
brown sugar
confectioner's powdered sugar
corn sweetener
corn syrup
corn syrup solids
dextrose
fructose
fruit juice concentrate
high-fructose corn syrup (HFCS)
honey
invert sugar
lactose
malt sugar
maltose
maple syrup
molasses
nectars (e.g., peach nectar, pear nectar)
pancake syrup
raw sugar
sucrose
sugar
white granulated sugar
A recent Canadian Heart and Stroke Association document also argues that Canadians need to watch their consumption of "free sugars".  By this they mean fruit juices, sugar that has been freed of its fruit form.

Why limited Added Sugar?

The Yale's Rudd Center for Food Policy and Obesity has put together a great summary of studies regarding added sugar and health.  The increased consumption of added sugar has been linked to cardiovascular disease, type 2 diabetes, non-alcoholic fatty liver disease, obesity, and other negative health effects. 
How much Added Sugar?
The current Canadian Heart and Stroke Association recommendation is less than 10% of your daily calories from added sugar.  For a 2,000 calorie diet, this would be about 200 calories from added sugars or about 12 teaspoons.  The American Heart Association general recommendation is 5 teaspoons per day for women (100 calories) and 9 teaspoons for men (150 calories).
Whether you follow the 10% rule or a blanket amount based on gender, both amounts are much lower than current US consumption.  The Canadians are at 13% of daily calories (not including fruit juice).  The 2005–10 National Health and Nutrition Examination Survey puts Americans at 20 teaspoons per day, with teens having the highest consumption at 34 teaspoons per day.

Calculate your Added Sugar Limit.
  • Estimate your daily calorie needs.  MyPlate has a great table to get you started.  For this example, I will use 1800 calories, the general estimate for a woman age 31 to 50.
  • Calculate 10%.  Ten percent of 1800 calories is 180 calories.
  • Calculate grams of sugar.  Sugar, like all carbohydrates is 4 calories per gram.  180 calories divided by 4 calories equals 45 grams.  For this example, the daily limit is 45 grams of added sugar.
  • Convert to teaspoons.  Sometimes it is easier to know the upper limit in teaspoons.  Sugar is about 4 grams per teaspoon.  45 grams divided by 4 grams equals just over 11 teaspoons.
What about my kids?
For my girls, they need around 1600 calories per day.  Ten percent is 160 calories.  Their maximum of added sugars should be 40 grams (carbohydrates are 4 calories per gram) or 10 teaspoons of sugar a day.
I raided my pantry to get a better sense of what added sugar is in our lives. 
Juice--Last year, I stopped buying juice with any regularity.  As I explained to my girls, let's save our sugar for something really fun.  But, we had some leftover OJ from a celebration, so each girl had a 6 oz glass this morning.  Almost 17 grams.  We don't drink soda or sports drinks, but a typical 12 ounce soda has 8 teaspoons of sugar so I probably should have given them a Coke!
Yogurt--One girl is a big fan of Stonyfield's fat free organic lemon.  The container has 27 grams of sugar, but that sugar is a combination of the naturally-occurring lactose and the added sugar.  Using the power of Google, I found the plain version clocks in at 12 grams of sugar, meaning 15 grams of added sugar. 
Pop-Tarts--Yes, we have frosted Strawberry Pop-Tarts and skim milk for some of those dark mornings when we need to be at school at 7:15 am (I often imagine the grass-fed milk screaming in protest in the girls' stomachs).  Pop-Tart ingredients  # 2, 3, and 4 are various forms of sugar, leading to 16 grams of sugar per pastry (yeah, the wheat contributes some, but who are we kidding?).
Yet, these are the easy foods.  Pop-Tarts are never going to be confused with a health food!  And it is easy to balance this morning's OJ with a lunch that is largely added sugar-free.
To me, it is the snack crackers with cane sugar or the pretzels with malt that make life more complicated.  Not to mention, the chicken stock, pasta sauce, and other pantry staples.  While the pretzel and crackers offer a gram or less of sugar on their Nutrition Fact labels, it all adds up. 
Beyond doing calculations like that of the Stonyfield yogurt, some websites do offer short lists of added sugars in common foods like this one from the American Heart Association or this empty calorie chart from MyPlate.
What Did I Learn?
  • ALWAYS read the label.  I almost fell over in Whole Foods when I saw sugar listed on the box of chicken stock.
  • The label is more important than the image.  A health halo around juice, yogurt and other processed foods don't mean their labels match their hype.
  • Cook.  A little less sugar in the cookie (or left out of the stock!) is possible when you control the recipe.
  • Balance your (and your kids) day.  Don't count calories, but keep a mental tally of your added sugar intake.  Maybe skip the extra syrup on your morning pancakes in favor of a cookie at lunch.
  • Cinnamon toast is yummy.  And since I probably put 1/2 teaspoon of sugar on each slice, at three slices per girl, it is WAY better than some of my other options, even with the sugar in the bread itself.
Cinnamon Toast 
Ready for the oven
  • Take white bread (I usually use leftover hot dog buns).
  • Spread with softened butter. 
  • Sprinkle with a mixture of cinnamon and granulated white sugar.
  • Broil for one to two minutes.
  • Eat!
Breakfast time