Sukker

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Sukker søt forvirringSweet confusion

• Kaare R. Norum
• Professor emeritus

2
Energifordeling- WHO og FAO

• Protein
• 10-15 av energien (kaloriene)
• Fett
• Total fett 15-30
• Mettet fett mindre enn 10
• Flerumettet fett 6-10, og forholdet mellom de
  ulike fettsyrene viktig
• Unngå transfett
• Karbohydrater
• 55-75
• Frie Sukkerarter ( Free sugars) mindre enn 10

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Free sugars

• WHOs definisjon
• The term free sugars refers to all
  monosaccharides and disaccharides added to foods
  by the manufacturer, cook or consumer, plus sugar
  naturally present in honey, syrups and fruit
  juices

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Litt sukkerhistorie
Hulemalerier i Spania viser mennesker som stjeler
honning fra en bikube. Bruk av daddelpalme og
fiken og annet tørket frukt som søtkilde. Sukker
brukt som medisin. Etter hvert også som krydder.
Sukker betraktes som helsebringende. Thomas
Aquinias hevdet blant annet at sukker kunne
inntas selv under fasten - det var jo medisin.
Men etter hvert økte også misnøyen mot sukker.
Sukker ble holdt ansvarlig for å ha forårsaket
skjørbuk og på samme tid ble en forening mot
sukker og slaveri dannet. Sukker mister sin
eksklusive status. Mye negativ omtale om
sukker. Sukker er usunt! asosial adferd blant
barn?
8 000 år før kristus
(4000-2000 år før Kristus)
Det 14. århundre
Det 17. århundre
Det 19. Århundre Det 20. Århundre
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Hvorfor sukker?

• Søtt er en positiv smak, den første smak vi
  møter i livet laktosen er søtere enn sukrose
• Vi overfører det positive i søtsmaken til andre
  forhold
• Et land av melk og honning
• Sukkerungen
• Så søt du er
• Sweetheart
• Honey
• Sugarbush

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Viktige karbohydrater i kostholdet

• Glukose ) druesukker, et monosakkarid
• Fruktose ) fruktsukker, et monosakkarid
• Sukrose ) vanlig sukker, et disakkarid
• Laktose ) melkesukker, et disakkarid
• Stivelse, som er plantenes energilager. Viktigste
  forekomst i korn og rotfrukter.Stivelse er
  polysakkarider bygget av glukoseenheter
• Cellulose, plantenes skjelett, og viktige
  kostfiber i maten vår. Vesentlig ufordøyelig

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Karbohydrater

• Sukker består av glukose og fruktose
• Laktose består av glukose og galaktose
• Stivelse brytes med til maltose og videre til
  glukose
• Cellulose er bygget opp av glukose-enheter,men
  kan vanskelig brytes ned i menneskers tynntarm,
  noe spaltes av bakterier i tykktarm

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Absorpsjon av karbohydrater

• Alle karbohydrater må brytes ned til
  monosakkarider før de passerer tarmveggen.
• Glukose og galaktose med aktiv Na-avhenig
  transport høyt oppe i tynntarm
• Fruktose med fasilitert diffusjon lengre nede i
  tynntarmen
• Sukkeralkoholene med passiv diffusjon

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Glukose

• Aktiv transport gjennom tynntarmen
• Transporteres gjennom cellemembraner via
  insulinavhengig glukosetransportør (Glut 4)
• Påvirker insulinsekresjon i bukspyttkjertelens
  beta-celler
• I lever og muskel bygges overskudd av glukose til
  glykogen
• Kan dannes i kroppen av glykogen, andre
  monosakkarider og av flere typer aminosyrer

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Fruktose

• Diffusjon gjennom tynntarmen, langsommere
  absorpsjon enn glukose
• Går gjennom cellemembraner via Glut 5 som ikke
  finnes i hjerne og bukspyttkjertel, Glut 5 er
  uavhengig av insulin
• Fruktose påvirker ikke insulinsekresjon, og
  derved ikke frigjøring av leptin fra fettvev
• Fruktose øker laktat i blodet og kan gi økte
  mengder fett (triglycerider) i blodet

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Omsetning av heksoser
Glukose
Fruktose
Galaktose
Pi
Fruktokinase
HK/GK
Galaktokinase
G-6-Pase
(lever)
(lever)
G-6-P
Gal-1-
P


F-6-P
UDPG
Aldolase B
FDPase
Gal-1-P UDPG
PFK
transferase
F-1,6-bis-P
G-1-P
DAP
GAP DAP


UDP-Galaktose
glyceraldehyde
UDPGal-UDPG
Isomerase
UDPG
Pyruvat Laktat
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Omsetning av fruktose
Glukose
Fruktose
Pi
ATP
Fruktokinase
HK/GK
G-6-Pase
(lever)
ADP
G-6-P
F-1-P
F-6-P
Aldolase B
FDPase
PFK
F-1,6-bis-P
DAP
GAP DAP

glyceraldehyde
Pyruvat Laktat
Fettsyrer/TG
13
Leptin, insulin og appetitt

• Insulin påvirker hjernen direkte, og nedsetter
  appetitten
• Leptin, som vesentlig dannes i fettvev nedsetter
  appetitten via områder i hjernen.
• Insulin påvirker frigjøring av leptin fra fettvev
• Fruktose påvirker ikke sekresjon av insulin og
  leptin og virker derfor ikke nedsettende på
  appetitten, slik glukose gjør

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Glukose versus fruktose

• Fruktose påvirker ikke appetitt-reguleringen,
  slik glukose gjør
• Fruktose omsettes lettere til fettsyrer enn
  glukose
• Fruktose danner glycerofosfat langt mere
  effektivt og hurtigere enn glukose, noe som
  fører til en mer uttalt triglyceridsyntese fra
  fruktose enn fra glukose
• Fruktosens glycosylerings-indeks 10 ganger større
  enn glukosens
• Påstanden om at fruktose er sunnere enn glukose
  på bakgrunn av glykemisk indeks er å snu
  metabolske fakta på hodet.

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Fruktose i kostholdet

• Viktigste kilde er sukker
• Fruktose finnes i honning, bra for bier og
  smakfullt for mennesker
• Fruktose i en rekke frukter, ikke skadelig
• Fruktose brukes mer og mer i søtete drikker fordi
  fruktose er søtere enn sukker
• High fructose corn sweeteners (HFCS) i cola og
  brusdrikker i USA, i softis i Norge(?).

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High Fructose Corn Sweetener

• Mais-stivelse hydrolyseres til glukose
• Mye av glukosen isomeriseres til fruktose vha
  glucose isomerase.
• HFCS meget billigere enn sukker, og søtere
  (sukker100,glukose74 fruktose173)
• HFCS-42 og HFCS-55 inneholder henholdsvis 42 og
  55 fruktose

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Markedføring av fruktose baksiden av pakningen
har følgende tekst

• Erstatt sukker med fruktose og lev bedre.
• -Fruktose finnes i all frukt, bær og honning
• -Fruktose har lav glykemisk indeks. Det betyr at
  fruktose
• Omsettes langsommere i kroppen
• Forebygger svingende blodsukker
• Forenkler kroppens fettforbrenning
• Er en langvaring energikilde som er spesielt
  gunstig under idrettprestasjoner og krevende
  fysisk eller intellektuelt arbeid

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Sukker farlig?

• Det er mengden som er viktigst
• Vi trenger ikke sukker i det hele tatt
• Uheldige konsekvenser når over 10 energi
• Farlig med mye under svangerskapet
• Dernest når man inntar sukker
• Best til måltid, ikke i mellom måltider
• Hvordan sukkeret er i maten
• Antagelig mest uheldig i drikke

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Sukkerinntak blant 9- og 13-åringer og voksne
(g/d).
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Glykemisk indeks (GI)

• GI er et mål for blodsukkerstigning i løpet av to
  timer etter inntak av matvarer som inneholder 50
  g karbohydrater
• Som standard brukes enten 50 gram glukose
  (GI100) eller hvitt brød med 50 gram
  karbohydrater (GI100), standardene brukes om
  hverandre, noe som øker forvirringen, f.eks har
  hvitt brød GI70 om glukose er standard.

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GI påvirkes av en rekke faktorer

• Tømming av magesekk til tolvfingertarm
• Måltidets fettinnhold
• Måltidets proteininnhold
• Mengden magesyre
• Matens partikkelstørrelse, helkorn vs finmalt mel
• Tykkelsen av pasta-produkter
• Antall måltider per dag og fysisk aktivitet
• Modningsgrad av frukt

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Glycemic Index Predicted versus measured in 14
mixed breakfast meals
Flint, Raben, Astrup et al. Br J Nutr
200491979-89.
25
Glycemic Index The fat content, not CHO,
predicts glycemic index
Flint, Raben, Astrup et al. Br J Nutr
200491979-89.
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Glycemic Index
No association between GI and Insulinemic index
Flint, Raben, Astrup et al. Br J Nutr
200491979-89.
27
Conflict of policy

• The World Bank describes sugar as one of the
  most policy-distorted of all commodities yet
  provides soft loans to increase the industrys
  production capacity.i
• The World Trade Organization would like to end
  subsidies and controls on sugar to stimulate
  growth in a global free market.ii
• The World Health Organization would like personal
  sugar consumption in most countries to be reduced
  to improve dietary health.iii
• i Sugar Policies Opportunity for Change. World
  Bank Policy Research Working Paper 3222 February
  2004
• ii Panel on European Communities - Export
  Subsidies on Sugar interim report World Trade
  Organization (WTO) Sept 2004. 
• iii Diet, Nutrition and the Prevention of
  Chronic Diseases. Report of a Joint WHO/FAO
  Expert Consultation. WHO Technical Report Series
  No. 916. World Health Organization, Geneva, 2003

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Sugar output doubled in developing countries
Source FAS/USDA
29
2004 World Production/Consumption of Sugar
  Production Production Production Consumption Consumption
  2002/03 2002/03 2003/04 2003 2004
  (. . million tonnes, raw value . .) (. . million tonnes, raw value . .) (. . million tonnes, raw value . .) (. . million tonnes, raw value . .) (. . million tonnes, raw value . .)
WORLD 147.7 141.1 141.1 139.2 143.1
Developing countries 104.6 99.5 99.5 91.9 95.4
Developed countries 43.1 41.7 41.7 47.3 47.9
Source FAO Food Outlook September 2004 Source FAO Food Outlook September 2004 Source FAO Food Outlook September 2004 Source FAO Food Outlook September 2004 Source FAO Food Outlook September 2004
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Structural price collapse
31
Price forecast to 2014

• In 2003/04 price falls under 7 per pound due to
  excess capacity.
• 2013/14 price reaches 9.1 per pound
• World Sugar Food and Agricultural Policy
  Research Institute FAPRI 2004 Agricultural Outlook

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Growth forecast to 2014

• Global sugarcane harvest up 10.4 (sugar beet
  down by 3)
• Total production up 22.4
• Total consumption up 27
• World Sugar Food and Agricultural Policy
  Research Institute FAPRI 2004 Agricultural
  Outlook

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World Bank Report 2004

• A free market in sugar would lead to
• The global welfare gains of . 4.7 billion
• Jobs in developing countries.1 million
• World sugar market price up .40
• Sugar Policies Opportunity for Change. World
  Bank Policy Research Working Paper 3222 Feb 2004

34
Oxfam attacks EU dumping
25 - EU Approx cost of production cent/lb 9
- India 8 - World price white 6 - World
price raw 5 - Zambia, Thailand, Malawi 4 -
Brazil Source Oxfam Briefing Paper March 2004
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Sugar and health policy

• 1990 - WHO 797 report on Diet, Nutrition and the
  Prevention of Chronic Diseases - sugar industry
  mobilised opposition to the recommendation of a
  10 limit on added sugars
• 1992 - 797 Report informed the International
  Conference on Nutrition and its World Declaration
  and Plan of Action for Nutrition ....chronic
  non-communicable diseases related to excessive or
  unbalanced dietary intakes often lead to
  premature deaths in both developed and developing
  countries.
• 1993 - World Health Assembly ENDORSES in their
  entirety the World Declaration and Plan of Action
  for Nutrition adopted by the Conference..urging
  membersto contain and reduce the rate at which
  the prevalence of diet-related diseases and of
  conditions related to them is rising

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The 916 controversy

• Jan 2002 - Experts revise draft report on Diet,
  Nutrition and the Prevention of Chronic Diseases
• April 2002 onwards Sugar, food and drink
  industries contest draft recommendations in
  consultation and extended dialogue
• Sept 2002 Confusion over IoM 25 figure a
  nutrient dilution threshold - not a
  recommendation
• March 2003 Furore as final draft 916 report put
  online

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WHO challenges food industry
BMJ 2003326515-
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Sweet and Salt reactions to TR 916

• The Sugar Association and the Salt Institute
  said in April 14, 2003 in a letter to the DG of
  WHO
• TR 916 was drafted by a select group of experts
• TR 916 not peer reviewed
• TR 916 contains unfounded and misleading
  recommendations
• We will exercise every avenue available to
  expose the dubious nature of TR 916, including
  asking Congressional appropriators to challenge
  future funding of the USs 406 million US dollar
  contribution to the WHO.

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Sweet and Salt reactions to TR 916

• Similar reactions was written to Secretary Tommy
  Thompson by
• Corn Refiners Asscosiation
• International Dairy Foods Association
• National Corn Growers Association
• Snack Food Association
• The Sugar Association
• Wheat Foods Council
• U.S. Council for International Business
• Letters to Tommy Thompson from two United States
  Senators, Larry E. Craig and John Breaux,
  supported the industry initiative

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Sugar attack
It is difficult to believe the standards of the
World Health Organization have slipped to such a
low point.
41
Threat to WHO funding


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WHO stands firm

• March 2003 Sweetener causus senators ask US
  government to press WHO/FAO to block the report
• March/April 2003 - WHO gets series of protest
  letters from the Sugar Association with threat to
  challenge US 406m funding to WHO
• April 2003 Gro Harlem Brundtland joins with 916
  vice chair Prof Shiriki Kumanyika in Rome launch
  of 916 report declaring The solidity of the work
  done by the experts is well founded and makes
  these kinds of criticisms by the sugar industry
  unreasonable.

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May 2003 - Coca Cola lobbies health ministers
44
Data Quality Act correction
Sept 2003 - Jim Tozzi files Challenge to 916
under US Data Quality Act
45
Jan 2004 - US letter to WHO
46
US focus on the Data Quality Act an industry
straightjacket on science?
The consultation process of the development of
the WHO/FAO Report and the resulting Report
itself would not meet these current US data
quality standards - Steiger
47
Challenge to Tommy Thompson
It is significant that resistance from business
interests, which included the sugar industry and
soft drinks manufacturers with US government
support, was also demonstrated when a previous
WHO expert report, based on a scientific
consultation in 1990, made similar
recommendations intended to prevent diet-related
chronic diseases. In the US you have
demonstrated admirable leadership in your support
for the WHO framework convention on tobacco
controlTherefore I urge you to show equal
courage and determination to support global
efforts to address another of the biggest public
health challenges facing us all in the 21st
century.
48
Sugar accused in media
49
Big Fish ad campaign
Sugar has always been associated with weight
gain and other health problems. We wanted to
overcome this stigma by developing a series of
ads that we targeted to moms and children..
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Sugar industry scare tactics

• World Sugar Research Organization on
  implications of 916 recommendations
• Forecast 3.6-6.5m ton pa fall in production
• Focused only on losers
• Ignored population growth
• Ignored technological alternatives e.g. growth in
  demand for flex-fuel
• Impact of the WHO Dietary Recommendations on
  World Sugar Consumption, Production and Trade. Dr
  Xavier Irz, University of Reading. April 2003

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Sugar consumption increases with the incomes

• The developing economies in Asia, including
  China, are predicted to consume considerably more
  sugar as the per capita income in these countries
  improves.
•    In parts of China such as Shenzen, where the
  conversion to a Western economy is nearly
  complete, per capita gross domestic product has
  risen to a Western level. This means that people
  have enough disposable income to buy
  mass-produced goods such as candy bars, soda,
  ketchup and other consumer goods containing
  sugar. As incomes improve across all of China,
  sugar consumption will rise in other regions as
  well. As these nations reach the level of OECD
  (Organization for Economic Cooperation and
  Development) economies, sugar consumption will
  parallel that growth.
• Alfa Laval Sugar Industry Equipment
  Manufacturer 2002

52
February 2004 FAO Rome

• Sugar bid to ambush 916 and global strategy at
  FAO Committee on Agriculture
• G-77 group bloc vote
• ISO urges members to lobby health ministers
  against 916

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USDA recommends lt10
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US sugar consumption up 20
31.4
17.3
55
USDA Dietary Guidelines on sugar
1980/1985 - Avoid too much sugar 1990 - Use
sugars only in moderation 1995 - Choose a diet
moderate in sugars 2000 - Choose beverages and
foods to moderate your intake of sugars
BMIgt30 31 BMIgt25 64
BMIgt30 23 BMIgt25 56
Age-adjusted prevalence of overweight and
obesity among U.S. adults, age 20-74 years
NHANES III (1988-94)
Age-adjusted prevalence of overweight and
obesity among U.S. adults, age 20-74 years
NHANES 1999-2000
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2005 - Choose carbohydrates wisely for good
health?
?
BMIgt30 - 50?
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Sugar accused of influencing latest US draft
dietary guidelines

• "This curious avoidance of the growing evidence
  about the dangers of added sugar would be
  inexplicable but for the fact that seven members
  of the panel - which was chosen by the Health and
  Human Services Department - have major financial
  and organizational connections to the food, drug
  and dietary supplement industries.
• It strains the imagination to believe that
  the sugar industry did not have undue influence
  this time around."i
• i Sugar and new Dietary Guidelines The Food
  Pyramid Scheme. New York Times editorial.
  September 1 2004

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Sugar bidding to buy NGO status
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In conclusion

• The evidence implicating sugar in health is now
• too great to ignore
• Attempts continue to manipulate messages and the
  overall health agenda
• Government agriculture departments should
  re-focus policies towards health-promoting food
  production
• The food and beverage industry could play a key
  role in ensuring sugar consumption is aligned to
  strategic public health goals
• The public, media and even shareholders are
  getting wise
• It is time for the industry to wise up too

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Takk for meg -)