The Telephone Game, Sugars Edition

Nutrition conversations can be "qwerty" ... I mean, quirky. They’re eerily reminiscent of a favorite game from my youth—the telephone game. Remember it? It was always full of laughs, but it was also eventually full of falsehoods. It taught me valuable lessons about how easily facts can get distorted as information is shared.

A modern version of this game appears to be playing out with nutrition information. To the general public, nutrition advice seems to flip-flop so much that it may seem reasonable to believe whatever you want. The most hard-core believers keep their favorite (science-free) soundbites on speed dial, constantly spamming all of their social contacts. It’s like a horrible game of telephone that just won’t end.

Nutrition science has come a long way in recent decades. But even in this golden age of the smartphone, a post-truth game of telephone about sugar has emerged.

To help make sense of sugars, here are two group texts I often receive, along with my reply on behalf of nutrition science.
 

“Sugar is toxic.”

If I had a dollar for every time I heard this one, I’d be texting everyone I know from this fancy new cell phone (which, sadly, I don’t own). But I digress.

The most frustrating thing about the statement “sugar is toxic” is that it’s partly true. Yes, you heard me right. It’s misleading (without the proper context), but it can be true.

Here’s the context. All chemicals are toxic at some level, and we consume many “chemicals” every day—like water (H2O), salt (NaCl) and sucrose (C12H22O11), aka table sugar. Did you know that even things necessary for human life can be toxic at high levels? It’s true. But it’s the dose that makes the poison.

Too much of anything can be a bad thing, including sugar. But using words like “toxic” to describe foods, nutrients and ingredients isn’t helpful. It’s deceptive, distracting and done for one purpose—to persuade people beyond established scientific evidence. In other words, it’s more story than science.
 

“We’re eating more sugar than ever before.”

Another commonly repeated phrase. But is it true? The short answer is no—well, not if you’re using the most up-to-date data, that is. It can appear true, depending on one’s pre-determined cut-point for the data being referenced. For example, you’ll often see the phrase “we’re eating more sugar than ever before” supported by evidence referencing consumption patterns up until the late 1990s.

Well, we’re done partying like it’s 1999, so here’s a novel 2017 New Year’s resolution for us all: When we hear definitive (but suspect) statements such as this, seek out the data and think critically. Luckily for us, the USDA/ERS has been tracking these numbers since the 1970s. Yes, the amount of sugar (i.e. caloric sweeteners) available in our food supply peaked in 1999. It’s been on the decline ever since—down about 15 percent from 1999 to 2015.

It should be stated that this USDA/ERS dataset tracks trends of estimated total deliveries/availability, not actual human consumption. Still, the data paint a pretty compelling picture that puts this popular argument into perspective.

Self-reporting survey evidence also points to a sugar consumption peak in the late 1990s and subsequent drop-off.

First, the peak: In analyzing multiple USDA surveys between 1977 and 1996, a 2003 study estimated that in 1977-78, added sugars intake was 235 calories per day. By 1994-1996, it rose to 318 calories. A 2011 study analyzed National Health and Nutrition Examination Survey (NHANES) data between 1999 and 2008 and found added sugars intake in 1999-2000 was 401 calories per day.

Now, the subsequent drop-off: By 2007-2008, NHANES shows average added sugar intake had dipped sharply to 308 calories. According to the 2015-2020 Dietary Guidelines for Americans (DGAs), the downward trend continues. The 2007-2010 NHANES found that average added sugars intake is down to 270 calories per day. 

While we eat more sugar than is currently recommended, we are not eating more sugar than ever before. The nutrition community will be keeping a close eye on coming NHANES analyses to see if the downward trend in added sugars is still, well, trendy.
 

Message Sent

As nutrition science evolves, we’ll continue to gain more knowledge about the most important questions in health. Although some have already condemned sugar (in any amount) for good, that perspective is not reflective of the scientific consensus today. Using the best available evidence from randomized controlled trials and systematic reviews and meta-analyses of these trials, nutrition experts around the world agree that, while it’s difficult to pinpoint exactly how much is too much, sugar consumption should be reduced in many cases. There is scholarly debate among credible scientific experts on all things sugars these days, and this is a good thing. This is how you "science."

Credible experts do not blindly advocate eliminating “toxic” sugar from the diet. The 2015-2020 DGAs recommend consuming less than 10 percent of our calories from added sugars and illustrate how added sugars can be part of a healthy eating pattern. I think I’ll trust the DGAs and totality of peer-reviewed literature on this call.

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