Intended for healthcare professionals

Observations From The Heart

The dietary advice on added sugar needs emergency surgery

BMJ 2013; 346 doi: (Published 21 May 2013) Cite this as: BMJ 2013;346:f3199
  1. Aseem Malhotra, interventional cardiology specialist registrar, Royal Free Hospital, London
  1. aseem_malhotra{at}

Foods that we think of as junk are only half the problem

Are current guideline daily amounts (GDAs) fit for purpose? With a worsening obesity crisis and increasing prevalence of type 2 diabetes, this is a pertinent question. According to Professor Tom Sanders, head of nutritional sciences at King’s College London, “guideline daily amounts enable consumers to make informed choices on balancing their diet by identifying guideline levels for key nutrients and calories consumed each day and how much a portion of a particular food contributes to that allowance.” But do they? Before answering this we need to understand the history of our dietary advice.

In 2003, the World Health Organization, responding to increasing concerns over the rising tide of obesity, stated that “added sugars”—specifically non-milk extrinsic sugar—should contribute no more than 10% of total energy intake.1 This was in line with the UK government’s Committee on Medical Aspects of Food and Nutrition Policy (COMA) recommendations in 1991.2 COMA also recommended that consumption of fruit, vegetables, potatoes, and bread (containing intrinsic sugars) should increase by 50%. Consequently, Rayner et al, although maintaining that “added sugars” contribute no more than 10% of total energy, suggested that total sugars should contribute to 20% of guideline daily amounts.3

This nutritional advice has formed the basis of UK food labelling since 2003 and subsequently influenced European legislation. I believe that not only has this advice been manipulated by the food industry for profit but that added sugar is a risk factor for obesity and diet related disease.

In 2009, the American Heart Association published a scientific statement in Circulation entitled “Dietary sugar intake and cardiovascular health.” …

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