Currently browsing posts about: Sugars

I’ve had so many requests to comment on Michelle Obama’s new PLEZi food business—reduced sugar but ultraprocessed artificially sweetened drinks for kids—that I feel obliged to write about them, unhappy as I am as having to consider this enterprise so ill advised.

In case you missed it, the former First Lady—a public health hero of mine for her efforts to improve school food and feed kids more healthfully—announced these drinks as having 75% less sugar than Coke and Pepsi.

The press materials say PLEZi’s mission is:

to create higher standards for how the U.S. makes and markets food and beverages for kids, leading with nutrition, taste, and truth…PLEZi Nutrition was created to give parents a helping hand by offering healthier, great-tasting products that parents can feel good about giving their kids and that kids actually want. The company is focused on lowering sugar content and lowering sweetness to help adjust kids’ palates to crave less sweetness overall. In addition to reducing the sugar and sweetness, they are adding in nutrients kids need, all with the aim to replace sugary drinks and snacks.

Here’s what’s good about all this.

• Michelle Obama is eloquent on the need for kids to eat more healthfully.
• PLEZi is established as a benefit corporation meaning that its stockholders have agreed to have social values as part of its mission, not just profits (although those count too, evidently).
• It has donated $1 million to Food Corps, which teaches school kids about food—a cause well worth supporting.
• It has a distinguished “kitchen cabinet” advisory committee of people who care about kids’ health.

Why my dismay? 

Take a look at the PLEZi Blueberry Blast drink’s nutrition information and ingredient list.

This product has a lot less sugar than Coke or Pepsi and contains zero added sugars, but it has five sweeteners:

• Apple juice concentrate (Translation: sugar derived from apples)
• Watermelon juice concentrate (ditto from watermelons)
• Blueberry juice concentrate (ditto from blueberries)
• Stevia leaf extract
• Monk fruit extract

These, plus “natural flavors” (don’t get me started) and some of the other ingredients put this squarely in the category of ultraprocessed products, now strongly associated with poor health and promotion of excessive calorie intake.

These drinks do not meet my idea of a “higher standard,” alas.

Instead, I see PLEZi as a direct competitor of existing drinks—Kraft’s Capri Sun and Kool-Aid Jammers among them—both with less sugar than Coke or Pepsi, and neither what I would consider a health food.

I found PLEZi shelved right with other sweetened drinks aimed at kids  at the Target in Ithaca, New York.

PLEZi’s cost

Target has PLEZi,on special sale at for $3.50 for 32 ounces (four 8-ounce bottles).  This makes it almost twice as expensive as Capri Sun ($3.19 for 60 ounces—ten 6-ounce pouches).

The competition

PLEZi’s nutritional profile isn’t all that different from that of “half the sugar” Capri Sun.  Here’s Capri Sun Strawberry Kiwi:

Capri Sun has the same kinds of ingredients as PLEZi, but less fruit juice, and a little more overall sugar.  To me, they don’t look all that different.

What about taste?

I bought packages of PLEZi Blueberry Blast, Orange Smash, and Capri Sun ‘s “half the sugar” Strawberry Kiwi.

OK, I  am not these products’ core customer.   They are not aimed at me.  I thought the PLEZi drinks were oddly colored and watery, and had undistinguishable flavors and the slight off-taste of monk fruit sweetener.

Capri Sun is noticably sweeter, which is not surprising: it has 7 grams of sugar in 6 ounces, whereas PLEZi has 6 grams of sugar in 8 ounces.

But all of these drinks raise the same question: Is a somewhat less sugary, sweetened, “better-for-you” drink necessarily a good choice?

Many healthier drinks are available for kids.

I would like to know:

• Why anyone would think kids need another drink like this.
• Why someone didn’t identify PLEZi drinks as ultraprocessed.
• Why someone didn’t intervene to protect Mrs. Obama from getting involved in this dubious enterprise.

My business and health questions:

• Will PLEZi sell?
• Will it cut into sales of Kool-Aid Jammers and Capri Sun, let alone Coke and Pepsi?
• Will it accustom kids to less sweet tastes?
• Will it encourage kids to eat more healthfully?

I sure hope the Kitchen Cabinet insists on a serious evaluation.

I was surprised to see a press release from the American Society for Nutrition (ASN—of which I am a member) announcing publication of a research paper the Society had commissioned and published on sugars and body weight: Important food sources of fructose-containing sugars and adiposity: a systematic review and meta-analysis of controlled feeding trials.

The paper, the press release said, “Illustrate[s] The Need for Nuance in Public Health Guidance Related to Consumption of Sugars: Findings call into question recommendations that imply all sources of fructose-containing sugars carry the same risk.”

The press release notes that “this comprehensive review is timely as the 2025 Dietary Guidelines Advisory Committee currently assesses the latest science to inform updated evidence-based recommendations,” and it quotes the lead author: “There is an opportunity for more food-based guidance around sugars to help ensure Americans don’t inadvertently eat less health-promoting foods containing fructose – especially at a time when most people don’t eat enough of all forms of fruit, which offer significant health benefits.”

Uh oh.  This is an easily misinterpreted message.

My immediate question:  Who wrote the paper ?

No surprise.: authors with extensive conflicts of interest.

I’ve written about some of these authors’ conflicts of interest disclosures previously.  See, for example. this, this, and this.

Just for fun, I’ll post this particular statement of the conflicted interests at the end of this post.

Basically, these authors do not understand the difference between a conflict of interest (financial ties, which are discretionary) and non-discretionary viewpoints (all researchers have them).  In this case, consulting for a sugar company is a conflict; being a vegan or avoiding sugar-sweetened beverages is not.

My second question: Why did ASN commission this paper, and from these particular authors no less?

I contacted John Courtney, the long-time executive director of the ASN.  He said this was a leftover from an initiative started ten years ago.  Since then, the ASN has decided not to commission papers on controversial topics and this will not happen again.

Good.  It shouldn’t.  Commissioning papers like these make the ASN look like an arm of the food industry.  The ASN should avoid even teh appearance of conflicts of interest as much as it possibly can.

You don’t believe this is a problem?  Take a look at this conflict of interest statement.  Enjoy!

Conflict of Interest

JLS is a member of the Journal’s Editorial Board and played no role in the Journal’s evaluation of the manuscript.

LC was a Mitacs-Elevate postdoctoral fellow jointly funded by the Government of Canada and the Canadian Sugar Institute (September 2019–August 2021). She was previously (2010–2018) employed as a casual clinical coordinator at INQUIS Clinical Research, Ltd. (formerly Glycemic Index Laboratories, Inc.), a contract research organization.

AC and AA have received funding from a Toronto 3D MSc Scholarship award.

SA-C was funded by a Canadian Institutes of Health Research (CIHR) Canadian Graduate Scholarships Master’s Award, the Loblaw Food as Medicine Graduate Award, the Ontario Graduate Scholarship, and the CIHR Canadian Graduate Scholarship Doctoral Award. She avoids consuming NSBs and SSBs and has received an honorarium from the international food information council (IFIC) for a talk on artificial sweeteners, the gut microbiome, and the risk for diabetes.

NM was a former employee of Loblaw Companies Limited and current employee of Enhanced Medical Nutrition. She has completed consulting work for contract research organizations, restaurants, start-ups, the International Food Information Council, and the American Beverage Association, all of which occurred outside of the submitted work.

TAK has received research support from the Canadian Institutes of Health Research (CIHR), the International Life Science Institute (ILSI), and the National Honey Board. He has taken honorarium for lectures from International Food Information Council (IFIC) and Institute for the Advancement of Food and Nutrition Sciences (IAFNS; formerly ILSI North America).

FA-Y is a part-time Research Assistant at INQUIS Clinical Research, Ltd., a contract research organization.

DL reports receiving a stipend from the University of Toronto Department of Nutritional Sciences Graduate Student Fellowship, University of Toronto Fellowship in Nutritional Sciences, University of Toronto Supervisor’s Research Grant—Early Researcher Awards, and Dairy Farmers of Canada Graduate Student Fellowships; a scholarship from St. Michael’s Hospital Research Training Centre, and a University of Toronto School of Graduate Studies Conference Grant.

AZ is a part-time Research Associate at INQUIS Clinical Research, Ltd., a contract research organization, and has received funding from a BBDC Postdoctoral Fellowship. She has received consulting fees from the GI found.

RJdS has served as an external resource person to the World Health Organization’s Nutrition Guidelines Advisory Group on transfats, saturated fats, and polyunsaturated fats. The WHO paid for his travel and accommodation to attend meetings from 2012–2017 to present and discuss this work. He has also performed contract research for the CIHR’s Institute of Nutrition, Metabolism, and Diabetes, Health Canada, and the World Health Organization for which he received remuneration. He has received speaker’s fees from the University of Toronto and McMaster Children’s Hospital. He has held grants from the Canadian Foundation for Dietetic Research, Population Health Research Institute, and Hamilton Health Sciences Corporation as a principal investigator and is a co-investigator on several funded team grants from the CIHR. He has served as an independent director of the Helderleigh Foundation (Canada). He serves as a member of the Nutrition Science Advisory Committee to Health Canada (Government of Canada) and is a co-opted member of the Scientific Advisory Committee on Nutrition Subgroup on the Framework for the Evaluation of Evidence (Public Health England).

TMSW was previously a part owner and now is an employee of INQUIS and received an honorarium from Springer/Nature for being an Associate Editor of the European Journal of Clinical Nutrition.

CWCK has received grants or research support from the Advanced Food Materials Network, Agriculture and Agri-Foods Canada, Almond Board of California, Barilla, CIHR, Canola Council of Canada, International Nut and Dried Fruit Council, International Tree Nut Council Research and Education Foundation, Loblaw Brands Ltd, the Peanut Institute, Pulse Canada, and Unilever. He has received in-kind research support from the Almond Board of California, Barilla, California Walnut Commission, Kellogg Canada, Loblaw Companies, Nutrartis, Quaker (PepsiCo), the Peanut Institute, Primo, Unico, Unilever, and WhiteWave Foods/Danone. He has received travel support and/or honoraria from the Barilla, California Walnut Commission, Canola Council of Canada, General Mills, International Nut and Dried Fruit Council, International Pasta Organization, Lantmannen, Loblaw Brands, Ltd., the Nutrition Foundation of Italy, Oldways Preservation Trust, Paramount Farms, the Peanut Institute, Pulse Canada, Sun-Maid, Tate & Lyle, Unilever, and White Wave Foods/Danone. He has served on the scientific advisory board for the International Tree Nut Council, the International Pasta Organization, McCormick Science Institute, and Oldways Preservation Trust. He is a founding member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, is on the Clinical Practice Guidelines Expert Committee for Nutrition Therapy of the EASD and is a Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation.

DJAJ has received research grants from Saskatchewan & Alberta Pulse Growers Associations, the Agricultural Bioproducts Innovation Program through the Pulse Research Network, the Advanced Foods and Material Network, Loblaw Companies, Ltd., Unilever Canada and Netherlands, Barilla, the Almond Board of California, Agriculture and Agri-food Canada, Pulse Canada, Kellogg’s Company, Canada, Quaker Oats, Canada, Procter & Gamble Technical Centre, Ltd., Bayer Consumer Care, Pepsi/Quaker, International Nut & Dried Fruit Council, Soy Foods Association of North America, the Coca-Cola Company (investigator initiated, unrestricted grant), Solae, Haine Celestial, the Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Soy Nutrition Institute (SNI), the Canola and Flax Councils of Canada, the Calorie Control Council, the CIHR, the Canada Foundation for Innovation and the Ontario Research Fund. He has received in-kind supplies for trials as a research support from the Almond Board of California, Walnut Council of California, the Peanut Institute, Barilla, Unilever, Unico, Primo, Loblaw Companies, Quaker (Pepsico), Pristine Gourmet, Bunge Limited, Kellogg Canada, and WhiteWave Foods. He has been on the speaker’s panel, served on the scientific advisory board and/or received travel support and/or honoraria from Nutritional Fundamentals for Health (NFH)-Nutramedica, Saint Barnabas Medical Center, The University of Chicago, 2020 China Glycemic Index International Conference, Atlantic Pain Conference, Academy of Life Long Learning, the Almond Board of California, Canadian Agriculture Policy Institute, Loblaw Companies, Ltd., the Griffin Hospital (for the development of the NuVal scoring system), the Coca-Cola Company, Epicure, Danone, Diet Quality Photo Navigation, Better Therapeutics (FareWell), Verywell, True Health Initiative, Heali AI Corp, Institute of Food Technologists, SNI, Herbalife Nutrition Institute, Saskatchewan & Alberta Pulse Growers Associations, Sanitarium Company, Orafti, the International Tree Nut Council Nutrition Research and Education Foundation, the Peanut Institute, Herbalife International, Pacific Health Laboratories, Barilla, Metagenics, Bayer Consumer Care, Unilever Canada and Netherlands, Solae, Kellogg, Quaker Oats, Procter & Gamble, Abbott Laboratories, Dean Foods, the California Strawberry Commission, Haine Celestial, PepsiCo, the Alpro Foundation, Pioneer Hi-Bred International, DuPont Nutrition and Health, Spherix Consulting and WhiteWave Foods, the Advanced Foods and Material Network, the Canola and Flax Councils of Canada, Agri-Culture and Agri-Food Canada, the Canadian Agri-Food Policy Institute, Pulse Canada, the Soy Foods Association of North America, the Nutrition Foundation of Italy, Nutra-Source Diagnostics, the McDougall Program, the Toronto Knowledge Translation Group (St. Michael’s Hospital), the Canadian College of Naturopathic Medicine, The Hospital for Sick Children, the Canadian Nutrition Society, the American Society of Nutrition, Arizona State University, Paolo Sorbini Foundation, and the Institute of Nutrition, Metabolism and Diabetes. He received an honorarium from the United States Department of Agriculture to present the 2013 W.O. Atwater Memorial Lecture. He received the 2013 Award for Excellence in Research from the International Nut and Dried Fruit Council. He received funding and travel support from the Canadian Society of Endocrinology and Metabolism to produce mini cases for the Canadian Diabetes Association. He is a member of the ICQC. His wife, Alexandra L Jenkins, is a director and partner of INQUIS Clinical Research for the Food Industry. His 2 daughters, Wendy Jenkins and Amy Jenkins, have published a vegetarian book that promotes the use of the foods described in this study, The Portfolio Diet for Cardiovascular Risk Reduction (Academic Press/Elsevier 2020 ISBN:978-0-12-810510-8). His sister, Caroline Brydson, received funding through a grant from St. Michael’s Hospital Foundation to develop a cookbook for 1 of his studies. He is also a vegan. JLS has received research support from the Canadian Foundation for Innovation, Ontario Research Fund, Province of Ontario Ministry of Research and Innovation and Science, Canadian Institutes of health Research (CIHR), Diabetes Canada, American Society for Nutrition (ASN), International Nut and Dried Fruit Council (INC) Foundation, National Honey Board [the US Department of Agriculture (USDA) honey “Checkoff” program], Institute for the Advancement of Food and Nutrition Sciences (IAFNS), Pulse Canada, Quaker Oats Center of Excellence, The United Soybean Board (the USDA soy “Checkoff” program), The Tate and Lyle Nutritional Research Fund at the University of Toronto, The Glycemic Control and Cardiovascular Disease in Type 2 Diabetes Fund at the University of Toronto (a fund established by the Alberta Pulse Growers), The Plant Protein Fund at the University of Toronto (a fund that has received contributions from IFF), and The Nutrition Trialists Fund at the University of Toronto (a fund established by an inaugural donation from the Calorie Control Council). He has received food donations to support randomized controlled trials from the Almond Board of California, California Walnut Commission, Peanut Institute, Barilla, Unilever/Upfield, Unico/Primo, Loblaw Companies, Quaker, Kellogg Canada, WhiteWave Foods/Danone, Nutrartis, Soylent, and Dairy Farmers of Canada. He has received travel support, speaker fees, and/or honoraria from ASN, Danone, Dairy Farmers of Canada, FoodMinds LLC, Nestlé, Abbott, General Mills, Comité Européen des Fabricants de Sucre, Nutrition Communications, International Food Information Council, Calorie Control Council, the International Sweeteners Association, the International Glutamate Technical Committee, Phynova, and Brightseed. He has or has had ad hoc consulting arrangements with Perkins Coie LLP, Tate & Lyle, Phynova, and INQUIS Clinical Research. He is a former member of the European Fruit Juice Association Scientific Expert Panel and a former member of the Soy Nutrition Institute (SNI) Scientific Advisory Committee. He is on the Clinical Practice Guidelines Expert Committees of Diabetes Canada, European Association for the study of Diabetes, Canadian Cardiovascular Society, and Obesity Canada/Canadian Association of Bariatric Physicians and Surgeons. He serves or has served as an unpaid member of the Board of Trustees and an unpaid scientific advisor for the Carbohydrates Committee of IAFNS. He is a member of the International Carbohydrate Quality Consortium (ICQC), Executive Board Member of the Diabetes and Nutrition Study Group of the EASD, and Director of the Toronto 3D Knowledge Synthesis and Clinical Trials foundation. His spouse is an employee of AB InBev.

XYQ, SB, NM, VH, EL, SBM, VLC, and LAL declare no competing interests.

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Thanks to Jill Richardson who spotted this at the Sugarcane Juice Bar, St Louis Galleria.

Sugarcane juice is delicious but, as I keep saying, you can’t make this stuff up.

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The latest review of sugars and health has created quite a stir.

• The study:  Dietary sugar consumption and health: umbrella review.  BMJ 2023; 381 doi: https://doi.org/10.1136/bmj-2022-071609 (Published 05 April 2023).
• Method:  The authors evaluated 73 meta-analyses that included 8601 studies, most of them observational (meaning they indicate associations but not necessarily causation).
• Findings: Significant harmful associations between dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, seven cancer outcomes, and 10 other outcomes (neuropsychiatric, dental, hepatic, osteal, and allergic) were detected.
• Implications: Low-quality evidence linked each additional serving of a sugar-sweetened beverage per week with a 4% higher risk of gout. Each extra cup per day of a sugar-sweetened drink was associated with a 17% and a 4% higher risk of coronary heart disease and all-cause mortality, respectively.
• Recommendations: (1) Reduce the consumption of free sugars or added sugars to below 25 g/day (this translates to about 6 teaspoons daily). (2) Limit sugar-sweetened beverages to less than 1 a week.

Here’s the headline about the stir:

Experts recommend 6-teapsoon limit to added sugar following BMJ review, industry weighs in:  Recently published research in The BMJ is providing fresh concerns about sugar consumption levels, as some industry stakeholders disagree with the conclusion and CPG brand look to innovate in the low- and no-sugar space…. Read more

And one of the quotes from an industry representative:

…This is a review of existing evidence, and even a well-executed systematic review is only as good as the studies that are inputted. Essentially, garbage in equals garbage out, and it is known that added sugars literature suffers from significant variability when it comes to definitions, intake measurements and control of energy and other diet and lifestyle variables.

Comment: The six-teaspoon recommendation is consistent with World Health Organization guidelines to reduce daily intake of free sugar to less than 10% of their total energy intake, and preferably 5 percent.  The authors admit the evidence is not strong.  But there’s just so much of it, and it’s not going away.

When it comes to sugars, less is better, alas.

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Every now and then the USDA puts out a collection of its latest charts.

These provide lots of information at a glance.  Here are three quick examples:

1.  What’s happened to farms in the US over the past 200 years.  The number of farms has gone way down; the size has gone way up.

2. This one is about sweeteners in the food supply (not amounts actually eaten).The peak year was around 2000. The overall trend tracks with corn sweeteners.

3. More than half of food expenditures are now on food eaten in restaurants or institutions—where meals are higher in calories.

Enjoy!

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Really, I can’t make this stuff up.

Thanks to Jim Krieger of HealthyFoodAmerica.org for sending me to Food Navigator-USA: Post launches the first-ever cereal designed to promote sleep.

A cereal meant to be consumed at bedtime?  I wanted it for my cereal box collection, and there hasn’t been a good one like this for a long time since the FDA started discouraging ridiculous health claims.  I went straight to the Ithaca Walmart and scored a box.

Sweet Dreams, the box tells you, is “part of a healthy sleep routine.”

The front-of-package claims:

• Made with whole grains
• Supports natural melatonin production with zinc, folic acid, and B vitamins
• Excellent source of Vitamin E for neuroprotection

The back-of-package claims:

• Sleep…We want to help you enjoy it.  With delicious wholesome ingredients, curated vitamins and minerals, and a specially formulated night-time herbal blend, our dreamy cereal is part of a healthy sleep routine.
• Made with a night-time herbal blend containing a touch of lavender and chamomile

I looked up the website:

For 130 million American adults, a good night’s sleep is elusive. You deserve good sleep, and we want to help you enjoy it! So, we made Sweet Dreams cereal, the first ready-to-eat cereal specially designed to support a good sleep routine and a fresh start to the next day…Available in Blueberry Midnight and Honey Moonglow flavors, make Sweet Dreams cereal a part of your bedtime routine and enable a better sleep cycle while satisfying those nighttime food cravings.

Comment:

I hardly know where to begin: “curated vitamins and minerals”?  “Supports natural melatonin production”?

This last is a structure/function claim like those for supplements.  It requires only the barest hint of scientific substantiation.

Reader, I ate it.

The cereal is crunchy, with occasionally visible almonds, but is cloyingly sweet (to my taste): A cup of cereal has nearly a tablespoon (13 grams) of added sugar– 24% of a day’s total sugar allowance.

No wonder it’s so sweet.  Sugars appear seven times on the ingredient list.

Whole Grain Wheat, Rice, Cane Sugar, Almonds, Whole Grain Rolled Oats, Canola and/or Soybean Oil, Flavor Clusters (Sugar, Corn Syrup, Degermed Corn, Palm Oil, Natural Flavor, Cocoa (processed with alkali)(for color), Blueberry and Carrot Concentrates (for color)), Salt, Honey, Corn Syrup, Barley Malt Extract, Molasses, Tocopherols (Vitamin E) to maintain freshness, Natural Flavor.

Post must be trying to sell more cereal.  Eat cereal at night?  Well, if you have sleep problems I suppose you can give it a try.

I ate this cereal in the morning.  It did not make me feel sleepy.

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I received an emailed announcement alerting me to today’s big event: It’s National Peanut Brittle Day, “a day dedicated to honoring one of our favorite uniquely American treats.”

Who knew?

The press release continues with some not-so-sweet news:  peanut brittle is yet another victim of inflation.

The chart shows the cost of the raw ingredients in peanut brittle has increased by nearly 18% — from just under $0.38 per pound in early 2021 to nearly $0.46 cents today.

Other cost increases: transportation, energy, labor add up to “a recipe for expensive candy!”

A strange press release, but an interesting commentary on what’s happening with prices.

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I was sent a note from the University of California Research Consortium on Beverages and Health about its new fact sheets on sugar-sweetened beverages done in collaboration with the American Heart Association.  The Consortium includes faculty who work on some aspect of sugar science on all ten UC campuses.

Factsheets and Infographics on the UC Research Consortium on Beverages and Health webpage:

• Factsheet: What Are Sugary Drinks?
• Factsheet: 7 Reasons to Skip Sugary Drinks.
• Factsheet: Health Harms of Sugary Drinks.
• Factsheet: The Heavy Environmental Impact of Sugary Drinks.
• Factsheet: Sugary Drinks and COVID.
• Factsheet: How Four Cities in California Are Using Sugary Drink Tax Revenues. UC Research Consortium on Beverages and Health.

They also can be accessed from UC’s Nutrition Policy Institute publications page.

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