IT’S hard to escape sugar, not only in what we eat and drink, but also in the daily news and views that seep into so many corners of our lives.

There’s nothing new about concern over sugar. I can trace my own fights with the sugar industry back to the 1960s, and since their inception in 1981, the Australian Dietary Guidelines have advised limiting sugary foods and drinks. The current emphasis in many articles in newspapers, magazines, popular books and online blogs, however, go further and recommend eliminating every grain of the stuff from the daily diet.

Taking an academic approach to the topic, the George Institute for Global Health has published data based on the analysis of 34 135 packaged foods currently listed in their Australian FoodSwitch database. They found added sugar in 87% of discretionary food products (known as junk foods in common parlance) and also in 52% of packaged foods that can be described as basic or core foods.

The George Institute’s analysis is particularly pertinent to the Department of Health’s Health Star Rating System, and found that some of the anomalies in the scheme could be eliminated by penalising foods for their content of added sugars rather than using total sugars in the product, as is currently the case.

The definition of “added sugars” used in Australia also needs attention, a topic that has been stressed in the World Health Organization’s guidelines. I will return to this later.

In Australia, the nutrition information panel on the label of packaged foods must include the total sugars present. This includes sugars that have been added (known as extrinsic sugars) as well as any sugars present naturally in ingredients such as milk, fruit or vegetables (intrinsic sugars).

There is no medical evidence to suggest that intrinsic sugars are a problem – at least not if they occur in “intact” ingredients. If you consume fruit, for example, the natural dietary fibre and the bulk of the fruit will limit the amount of the fruit’s intrinsic sugars you consume. However, if the sugar is extracted from the structure of the fruit, it becomes easy to consume much larger quantities. Few people could munch their way through five apples, but if you extract their juice, the drink would let you take in all the sugar and kilojoules of five apples in less than a minute.

The Australian Dietary Guidelines do not include advice to restrict fruit itself because there is high level evidence of its health value. The guidelines do, however, recommend that dried fruit and fruit juice be restricted – the equivalent of four dried apricot halves or 125 mL juice consumed only occasionally.

Contrary to the belief of some bloggers, Australia’s dietary guidelines have never suggested replacing fat with sugar. That was a tactic of some food companies who marketed many “low” or “reduced” fat foods where the fat was replaced with sugars or some kind of refined starch.

The wording of Australia’s guideline on sugar has changed. The initial advice to “avoid too much sugar” led to the sugar industry’s multimillion dollar campaign “Sugar, a natural part of life”. This included distributing “educational” material to the general public, politicians, doctors, dentists, pharmacists and other health professionals discussing the importance of a “balanced diet”.

In spite of fierce lobbying by the sugar industry, the next revision of the guidelines retained a sugar guideline, although it was watered down to “eat only moderate amounts of sugars”. Some school canteen operators reported that they had been confronted by sweet-talking sellers of junk foods omitting the word “only” from this guideline.

The evidence for sugar’s adverse effects on dental health have long been known, but the evidence against sugar and its potential role in obesity and, consequently, in type 2 diabetes and other health problems has grown stronger. The most recent revision of the National Health and Medical Research Council’s Dietary Guidelines, therefore, emphasises the need to “limit” added sugars and lists the foods that need particular attention.

Sugary drinks have been specifically targeted because the evidence against them is strong and extends beyond epidemiological studies. Double-blind trials now clearly link sugary drinks with weight gain, the only exceptions being a few trials funded by the food industry.

Added sugar is not the only topic for public health concern, and hence the government’s Health Star Rating System was set up to introduce a simple front-of-pack labelling scheme to assist Australians reduce their intake of saturated fat, salt and sugars from packaged foods.

A specially commissioned independent report (Evaluation of scientific evidence relating to Front of Pack Labelling by Dr Jimmy Chun Yu Louie and Professor Linda Tapsell of the School of Health Sciences, University of Wollongong) found that added sugars were the real problem, but the food industry argued that the scheme should include total sugars because this was already a mandatory inclusion on food labels and routine chemical analysis couldn’t determine the source of sugars.

This was a strange argument since food manufacturers know exactly how much sugar they add to any product, just as they know how many “offset” points the Health Star Rating System allows for the inclusion of fruit, vegetable, nuts or legumes. The content of these ingredients is only disclosed on the food label if used in the product’s name.

The Health Star Rating System has been marred by anomalies. Milo powder (44% sugar) increased its basic 1.5 Stars to 4.5 by assuming it will be added to skim milk. About one in every seven products bearing health stars goes against the Department of Health’s own recommendations. Those of us working in public health question why obvious junk foods get any stars at all. How can caramel topping or various types of confectionery, such as strawberry flavoured liquorice, each get 2.5 stars? Why do some chocolates sport 3.5 stars, while worthy products such as Greek yoghurt without any added sugars get 1.5 and a breakfast cereal with 27% sugar gets four stars?

The fact that over a third of Australian’s energy intake comes from discretionary products (40% for children) is the elephant in the room for excess weight. We need to reduce consumption of these products and allotting them health stars is not helping.

It’s clearly time to follow our dietary guidelines and limit both discretionary products and added sugar. Of the nutrients used in the current algorithm for health stars, the George Institute’s analysis shows that counting added rather than total sugars has the greatest individual capacity to discriminate between core and discretionary foods.

However, in moving to mandate added sugars on food labels and using added sugars in health stars, it’s vital to define these sugars. The World Health Organization has done so: “Free sugars refer to monosaccharides (such as glucose, fructose) and disaccharides (such as sucrose or table sugar) added to foods and drinks by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates”.

Regular sugar in Australia could be described as cane juice concentrate. It has no nutrients other than its carbohydrate. Fruit juice concentrates are also just sugars with no nutrients other than carbohydrates. At present the Health Star Rating System allows products using apple or pear juice concentrate to be counted as “fruit” and used to offset the total sugars. This is nonsense, and gives rise to confectionery, toppings and some breakfast cereals scoring stars they do not deserve.

Other ways to boost health stars also need attention. Food technologists boast they can manipulate foods to gain extra stars (Health Star Rating Stakeholders workshop, Sydney, 4 August 2016). For example, adding wheat, milk, soy or other protein powder, concentrated fruit purees or a laboratory-based source of fibre such as inulin will all give extra “offset” points to reduce adverse points from saturated fat, sugar or salt. Indeed, some food technologists have even suggested they could revert to using the especially nasty trans (but technically unsaturated) fatty acid from partially hydrogenated vegetable oils to replace naturally occurring saturated fat.

My alternative is to go for fresh foods and minimise packaged foods. If the stars look too good to be true, check the ingredient list. But remember that Choice found sugar may go by more than 40 different names. Buyer beware!

Dr Rosemary Stanton, OAM, is a leading Australian nutritionist.


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The Health Star Rating System allows for misleading labelling
  • Strongly agree (83%, 91 Votes)
  • Agree (14%, 15 Votes)
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  • Strongly disagree (2%, 2 Votes)
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Total Voters: 110

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7 thoughts on “Sugar, sugar everywhere

  1. Christina Pollard says:

    With 97% agreeing that the health star rating allows for misleading labeling it’s a good job the government is conducting its 5 year review. The HSR has potential to assist consumers to make healthier food choices, but not without major reforms. A great piece Rosemary

  2. Robert Tucker says:


  3. Dr Rosemary Stanton says:

    To comment 4
    The dietary guidelines look at many issues, not just sugar. Indeed this has always been the case. It was the processed food industry that decided to push low fat foods with sugar or refined starches replacing the fat, not the guidelines.

    The most recent version of the guidelines is based on foods and so talk about the need to limit discretionary foods, including sweet drinks and confectionery as well as a list of foods that are high in any of added sugar, saturated fats or salt. Where anyone does choose to add discretionary foods, portion sizes are recommended. Appropriate quantities of other foods are also listed since too much of most foods will contribute to excess weight.

  4. Anonymous says:

    The more we bang on about sugar, the greater the smokescreen around the big elephant in the room which is ridiculous portion sizes of discretionary foods eaten anytime..only some of which contain sugar.
    Have we really learnt nothing from the fat phobias of the past to know that hunting down one nutrient is a misguided path. All that results is coconut oil laden high kilojoule “sugar free” bliss balls and refined grain “sugar free” cereals and snacks which have little nutritional advantage…and the sugar label hunters who discard an innocent tin of tomato as it has a few specs of sugar to balance the flavour.
    We have really missed the boat by further upbeating the sugar drum as we remain oblivious to the truths staring us in the mouth.

  5. Randal Williams says:

    my simplistic approach is; Don’t drink soft drinks;
    eat the fruit ,don’t drink the juice;
    don’t add sugar to your food or drink.

  6. Anonymous says:

    This is the era of marketing. Used to be just billboards and newspapers now it’s on the Internet ,on food labels.
    Miss information or fake information is very powerful
    The general population do not know / understand /go unprotected from what is happening in food marketing .
    the tobacco industry is still working hard
    The food industry has a similar way of marketing food.It is profit at all cost for the food industry to make a lot of money at the expense of the general public.
    The government needs to set up a body with people like Rosemary Stanton , Professor Jennie Brand Miller ,and other nutritionists with an excellent education and with good reputations,
    This website could help people find their way through the maze of labelling in all of the big shops it’s very hard labelling is so tiny you need sometimes a magnifying glass . The general public are being led astray just for profit for big companies .
    The government will medical care for people dying early of multiple diseases if they don’t address this problem very seriously.

    A healthy long life is governed by what you eat and how you exercise .

  7. Roy Hoevenaars (PhD) says:

    I commend Dr Stanton on the clear, evidence-based summary she has provided of the current issues pertaining to the increasing presence of refined sugars in discretionary foods in Australia. She has been able to provide, both health professionals and consumers, with a well-reasoned summary of the current anomalies with the Health Star Rating System, and where some the lobby influences are coming from. Those of us who work in health
    promotion, should use her valuable summary resource in our own workplaces and in our social connections, to encourage improved nutritional intakes for all Australians – but particularly for people who are confused by the present system, and those at risk of food insecurity.

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