Sugar revisited -- again.

For at least a thousand years sugar has been valued for its organoleptic and preservative properties and as an important trading commodity. The furore surrounding the report from WHO and FAO (1) which included a recommended upper limit for intake of free sugars, suggests that sugar is still of huge importance in the global economy. The article by Steyn and colleagues (pp. 599–608) explains a guideline to restrict intake of sugar in South Africa. More than 20 countries are known to have similar guidelines. Yet representatives of the sugar industry claim that other authoritative reports do not provide evidence of adverse health effects to the extent that warrants appreciable reductions in sugar intake. It is therefore important to examine these apparent discrepancies. The term " sugar " was previously understood to be more or less synonymous with sucrose derived from sugar cane or beet. In the United States and other countries high fructose corn syrup is increasingly used in manufactured foods so that while intake of sucrose may be decreasing, the total amount of sugars is not. From the perspective of human health, sugars are generally divided into two main groups: those incorporated within the structure of intact fruit and vegetables (sometimes labelled " intrinsic " sugars) and those saccharides which are added to foods and drinks by manufacturer , cook or consumer (added sugars). Dietary guidelines do not recommend restriction of intrinsic sugars or milk sugars (lactose, galactose) since these are not considered to have adverse health outcomes. However, added sugars plus concentrated sugars in honey, syrups and fruit juices (collectively described as " free sugars ") are believed to be broadly comparable when it comes to considering untoward effects and are therefore considered as a group. A report issued in September 2002 by the Institute of Medicine (IOM) on dietary reference intakes (2) has been interpreted as suggesting that intake of added sugars may be as high as 25% of total energy without detrimental effect. This is misleading since this maximal intake level is based on ensuring sufficient US intakes of certain essential micronutrients not present in foods and beverages that contain added sugars. It in no way implies that this is an acceptable level of intake in other respects. An earlier FAO/WHO report (3) has also been cited by critics as failing to confirm a link between intake of sugars and chronic disease. It acknowledges that there …