Scientists say potential damage from naturally occurring fructose in apparently healthy drinks is being overlooked by Sarah Boseley
Fruit juices and smoothies represent a new risk to our health because of the
amount of sugar the apparently healthy drinks contain, warn the US
scientists who blew the whistle on corn syrup in soft drinks a decade ago.
Barry
Popkin and George Bray pointed the finger at high fructose corn syrup
in soft drinks in 2004, causing a huge headache for the big
manufacturers, including Coca-Cola and Pepsi.
"Smoothies and fruit juice are the new danger," said Popkin, a distinguished professor at the department of nutrition at the University of North Carolina, in an interview with the Guardian. He
added: "It's kind of the next step in the evolution of the battle. And
it's a really big part of it because in every country they've been
replacing soft drinks with fruit juice and smoothies as the new healthy
beverage. So you will find that Coke and Pepsi have bought dozens [of
fruit juice companies] around the globe."
In the UK, Coca-Cola owns Innocent smoothies while PepsiCo
has Tropicana. Launching Tropicana smoothies in 2008, Pepsi's sales
pitch was that the drink would help the nation to reach its five a day
fruit and vegetable target. "Smoothies are one of the easiest ways to
boost daily fruit intake as each 250ml portion contains the equivalent
of 2 fruit portions," it said at the time.
However, Popkin says
the five a day advice needs to change. Drink vegetable juice, he says,
but not fruit juice. "Think of eating one orange or two and getting
filled," he said. "Now think of drinking a smoothie with six oranges and
two hours later it does not affect how much you eat. The entire
literature shows that we feel full from drinking beverages like
smoothies but it does not affect our overall food intake, whereas eating
an orange does. So pulped-up smoothies do nothing good for us but do
give us the same amount of sugar as four to six oranges or a large coke.
It is deceiving."
Nine years ago the two scientists had
identified sugar-sweetened soft drinks, full of calories and consumed
between meals, as a major cause of soaring obesity
in developed countries. But they argue that as people change their
drinking habits to avoid carbonated soft drinks, the potential damage
from naturally occurring fructose in fruit juices and smoothies is being
overlooked.
All sugars are equal in their bad effects, says
Popkin – even those described on cereal snack bars sold in health food
shops as containing "completely natural" sweeteners. "The most important
issue about added sugar is that everybody thinks it's cane sugar or
maybe beet sugar or HFC syrup or all the other syrups but globally the
cheapest thing on the market almost is fruit juice concentrate coming
out of China.
It has created an overwhelming supply of apple juice concentrate. It is
being used everywhere and it also gets around the sugar quotas that
lots of countries have."
In a survey of sweeteners in US food
products between 2005 and 2009 for a paper published in 2012, Popkin and
colleagues found that fruit juice concentrate was the fifth most common
sugar overall and the second most common, after corn syrup, in soft
drinks and in babies' formula milk.
More studies need to be done
before governments and health bodies around the world will take notice.
There are only two really good long-term trials – one in Singapore and
one by Harvard, he says. "But all the long term studies on fruit juice
in anything show the same kind of effect whether it's a smoothie or
natural [juice] and whether it's a diabetes or weight gain effect," Popkin added.
Further
evidence supporting the theory came last week from a study published by
the British Medical Association. Researchers from the UK, USA and
Singapore found that, in large-scale studies involving nurses, people
who ate whole fruit, especially blueberries, grapes and apples, were
less likely to get type 2 diabetes, which is obesity-related, but those
who drank fruit juice were at increased risk. People who swapped their
fruit juice for whole fruits three times a week cut their risk by 7%.
Most of the attention from those concerned about growing obesity levels among children
is still on soft drinks with added sugar, such as colas and lemonade,
which are consumed in enormous quantities. In 2012 we drank nearly 227
litres of liquid each in the UK, according to the industry, which says
61% of those had no added sugar. Excluding water brings the "no added
sugar" total to 54%. Fruit juices and smoothies are also included in the
total. We each drank 17.6 litres of those.
British health
campaigners are calling for a soft drinks tax in the UK. In January
Sustain published its Children's Future Fund report, saying that £1bn a
year could be raised from a tax of 20p a litre and invested in
children's health programmes. It has been backed by more than 60
organisations and the first children's commissioner, Al Aynsley-Green,
gave his support. In February the Academy of Medical Royal Colleges also
called for the tax in its obesity report.
The British Soft Drinks
Association says that consumption of soft drinks containing added sugar
has fallen by 9% over the last 10 years, while the incidence of obesity
has risen by 15%. "Obesity is a serious and complex problem requiring
concerted action by a wide range of organisations as well as by people
themselves. Soft drinks companies recognize the role they have to play,"
it said. Companies were reducing the calorie content of their drinks.
PepsiCo, it said, had only advertised the no added sugar variants of its
soft drinks since 2005.
Innocent Smoothies claims that people who
drink juice have better diets and lower rates of obesity than others,
although the studies it cited had funding from the juice industry.
"Smoothies
are made entirely from fruit and therefore contain the same amount of
sugars that you would find in an equivalent amount of whole fruit," it
said in a statement.
Meanwhile, efforts by the soft drinks
companies to grow the market continue. Coca-Cola in the UK this year
declared its ambition to increase the market by £2.1bn by 2017,
identifying six "moments" in the day when we could be persuaded to buy
more soft drinks, including fruit juice and smoothies for breakfast and
soft drinks for children when they come home from school. Sales of
sweetened Coca-Cola, containing nine teaspoons of sugar in a standard
can, still outstrip those of Diet Coke and Zero Coke combined.
"Unless
Coca-Cola drastically reduces its marketing for sugary drinks, its
strategy to reach more people more often will mean that it pumps record
levels of sugar into our diets," said Charlie Powell, campaigns director
of Sustain.
"This is a business model that is unhealthy and
unsustainable, perfectly highlighting the 'profit versus public health'
conflict of interest endemic in the sugary drinks industry."
Coca-Cola
argues that taxes do not change behaviour and that sugar should not be
vilified. In a statement, it said: "We believe that rather than single
out any ingredient, it is more helpful for people to look at their total
energy balance. This is because obesity and weight gain are caused by
an imbalance in calories consumed and burnt off. Our products should be
enjoyed as part of a sensible, balanced diet and healthy lifestyle that
includes regular physical activity. For those that are watching
their calorie intake, we offer a wide range of low or no calorie
options, which represent more than one third of our sales."
In an
article this year in the journal Pediatric Obesity, Bray and Popkin
review the issue 10 years on from their famous paper. "The concern with
HFCS in our diet has led to a reduced proportion of HFCS in beverages
compared to other sugars," they say, but add "this is a misplaced shift …
fructose remains a major component of our global diet. To date, to the
best of our knowledge every added amount of fructose – be it from fruit
juice, sugar-sweetened beverages or any other beverage or even from
foods with high sugar content – adds equally to our health concerns
linked with this food component."
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