Children and sugar: American Heart Association guidelines
No sugar for children under 2 years: this is the warning issued by the American Heart Association. Sugar has always been under the close scrutiny of nutritionists and scholars, and at the core of debate and controversy. The publication of the AHA report of Emory University of Atlanta’s pediatric nutritionist Miriam Vos focuses on child nutrition but brings attention to adolescent eating as well. Youngsters under 18 years, in fact, should not consume more than 25 grams of sugar a day (approximately 6 scant teaspoons). Before understanding sugar’s full impact on child nutrition and before reaching hasty conclusions completely eliminating sugar from our children’s diet, it’s necessary to learn a little more on how sugar influences our organism.
Glucose and fructose
As specified by the AHA study, the directive does not take into account natural fruit sugars, rather exclusively sucrose, which is the combination of monosaccharides glucose and fructose. But the certainty that fruit sugar is less damaging is not completely exact. “From a caloric point of view the sugars don’t present substantial differences”, explains nutritionist Andrea Ghiselli of CREA, Rome’s research center for food and nutrition. “Glucose and fructose, two of the main sugars”, adds the professor, “behave similarly in our organism. In fact 1 gram of glucose brings the same caloric input as 1 gram of fructose”.
The difference resides in the impact that these two elements have on metabolism: “Glucose increases the glycemic index, while fructose does not. Or rather it does equally transform into glucose over time, but it’s a very slow modification, hence the blood sugar increases gradually and does not pose a threat to the organism”.
High blood sugar from a diet rich in sugars causes a continuous and copious pancreatic insulin release, which in turn causes a number of health concerns. For example, stored triglycerides in fat cells as well as insulin resistance. Over time the latter, in turn, fosters the pancreas’ reduced insulin production, the consequence of this being Type 2 diabetes. In addition, the constant presence of high blood sugar is connected to arteriosclerosis, because it forms glucose-rich molecules in the blood bind themselves to protein build-up in the inner artery walls.
It would therefore appear that glucose acts in a more detrimental way on our organism. But there is, as always, something else to consider. “Fructose that does not end in the bloodstream starts to spontaneously create triglycerides. Between sugars and triglycerides, the former are better, because they can be burned by muscular activity”.
Professor Fausto Aufieri at Vis Sanatrix Naturae, a biotherapy center in Rome further explains: “Glucose is the only sugar that our brain is capable of utilizing as fuel for cells, therefore fructose is fine but cannot be considered as the only valid sugar, because brain functions would be affected negatively by the exclusion”.
Which then are the sugars we have to absolutely avoid? It’s the added sugars, which are contained in processed foods, especially snacks and sweetened beverages. But there are other foods that contain added sugars. “Added sugars are often hidden in savory foods and employed as preservatives, like in ham or crackers”, explains Aufiero. This is more so in packaged foods. How about those labeled as ‘not containing added sugars’, are those exempt? Ghiselli replies: “the absence of added sugars is not necessarily synonymous with healthy food. These products can be suitable for diabetics, but can however contain vegetable or animal fats plus calories in other ingredients, making said foods therefore not diet-friendly. A food product need to be analyzed fully in its entirety and taking into consideration all the elements that compose it”. The real problem with added sugars? “The delay with which our organism perceives them. Added calories are recognized by our bodies in longer time frames, and for this reason we tend to make a larger use of these products”.
Other risks: cavities and addiction
The reason behind the AHA’s alert does not therefore concern adult weight gain alone – and the health issues associated with it – rather also the possible consequences like dental cavities. “Tooth caries effect highly depends on oral hygiene, but it’s clear that in the case of a child – less aware of oral hygiene – risks are higher”. The other problem connected to elevated sugar intake in children is the risk of developing a kind of habit-forming inclination towards sweet tastes, “Let’s be clear, we’re not talking addiction per se”, specifies the nutritionist, “rather more of a quest for sweetness. In this case it’s what sweet food chosen that makes all the difference. If the child chooses to eat an apple (approximately 10 grams of fructose sugar and even less sucrose in each 100-gram apple) or a glass of sweetened soft drink the ingested calorie count will be the same. The difference being that after eating the apple the child will be sated, while after drinking the soft drink, the child will continue seeking more sweet food”.
Whether it’s fructose or glucose, the result is therefore not much different. Same goes for granulated vs. raw sugar, and goes as far as including honey, explains Ghiselli: “There’s this belief according to which honey – as a natural product – can be eaten freely. As always it all depends on quantities. The advantage of honey is that it contains diluted quantities of sugar, in a 70% ratio”, meaning that in 10 grams of honey there are approximately 7 grams of sugar. “This means that obviously with honey there is a slight lower intake, but 7 grams of sugar contained in honey or 7 grams of granulated sugar are absolutely equivalent in the diet”.
There are then products like stevia, panela – a sweetener obtained from sugar cane – coconut sugar and many other alternatives on the market to substitute sucrose. All valid, but only in the rare case of manufacturers processing the product properly. According to Aufiero, “It’s true that in South America – where all these plants grow – there’s lower number of diabetes cases, but it’s equally true that we don’t have control over storing, transportation and the entire supply chain that these products go through before reaching us. In the instances where the producers are sustainable and attentive to health, these products can be eaten without reserve”. It’s important to avoid interrupting the sucrose intake, rather integrating it wisely.
Purchased the quality sugar and keeping quantities in check, the next step is integrating it in a well-balanced diet – for both children and adults. A good starting point is conscious pairings “Sugars should always counterbalance proteins and lipids in order to be best absorbed by our organism. For example, a boiled, unseasoned potato is metabolized and turned into energy very quickly. The same boiled potato drizzled with a serving of quality olive oil is metabolized three times slower; even slower if the potato is paired with cured meat like prosciutto, for example.” This happens because the effect of the triglycerides contained in the olive oil is to modulate the speed at which the glucose enters our intestinal cells, and hence a lower glycemic response (blood sugar velocity). “This slowing down allows blood sugar to remain in check, increasing at a slower pace. As a reflection of this the pancreas is subjected to less effort and stress”. In addition to this, the feeling of a full stomach lasts longer. This happens because simple sugars (ones that are absorbed more rapidly) like the ones present in fruit and vegetables determine an increase in insulin, a hormone produced by the pancreas. “Insulin comes with a secondary decrease of blood sugar, hypoglycemia – the proverbial blood sugar drop – which makes us feel the need for another meal”.
Coming to a conclusion is not easy, and naturally each child (and adult) should receive specific and personalized treatment and diagnostics. By nature however, the basic guidelines are: contained quantities and avoid excess. “The AHA study is valid, but needs context. Alarmism in any case is never the right approach. In correct measure, everything is allowed”, according to Aufieri, and Ghiselli agrees, adding: “Denying a cookie to a child is not the right solution against child obesity. The first rule is parents setting a good example who should never trespass the threshold of varied sugars and calories, and by the same token not eliminating them tout court. It’s compromise rather than sacrifice”.
by Michela Becchi
translated by Eleonora Baldwin