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Sugar and Diabetes

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Sugar and Diabetes Sugar and Diabetes Position Statement Diabetes Canada recommends Canadians: Organization (WHO) set of • Limit their intake of free sugars1 to less recommendations to prevent the than 10% of total daily calorie (energy) marketing of foods and beverages to intake. This is approximately 50 grams children. (12 teaspoons) of free sugars • A Federal, Provincial, and Territorial consumption per day based on a 2000- Working Group on Food and Beverage calorie diet2. Marketing to Children is convened to • Limit intake of sugar sweetened develop, implement and monitor beverages (SSB) and drink water in their policies to restrict food and beverage place. marketing to children. • Promote the intake of whole foods and • Federal, provincial, and territorial reduce the intake of free sugars governments support improved access throughout life for overall health. to and affordability of nutritious foods in all regions. Diabetes Canada recommends that federal, • The Government of Canada implement provincial/territorial, and municipal legislation to require labeling of free governments: sugars on menu labels in restaurants so • The Government of Canada introduce a Canadians can make more informed tax on SSBs and use the revenues choices about the foods they eat. generated to promote the health of • Recreational events, schools, recreation Canadians. facilities, and government spaces not • The Government of Canada ensures offer SSBs for purchase. clear nutrition labelling for packaged • Recreational events, schools, recreation foods including the amount of free facilities, and government spaces sugars on the Nutrition Facts Table. provide free water for consumption. • Federal, provincial, and territorial • Retailers and food manufacturers governments immediately voluntarily cease marketing food and operationalize the World Health beverages to children until legislation is enacted. 1 Free sugars are those sugars that are removed from their original source and added to foods as a sweetener or as a preservative. 2 As per the WHO Sugars Intake Guideline, Canadians may benefit from limiting free sugar intake to less than 5% of total daily calorie intake based on a 2,000-calorie diet per day (approximately 26 g or 6 teaspoons). Diabetes Canada, recognizing its responsibility intake of sugars by adults and children are as a health leader and employer will: provided. This statement can inform policy- • Remove SSBs at Diabetes Canada makers and program managers in their events. assessment of consumption of free sugars • Offer free water at all Diabetes Canada within their jurisdictions and influence a events and venues. reduction of consumption, as necessary, • Continue to encourage Canadians to through a range of public health and public limit consumption of SSBs. policy interventions. • Encourage Canadians to limit consumption of foods high in free Diabetes Canada developed the present sugars in preference to whole natural evidence-informed recommendations using a foods. systematic and deliberative approach. The • Serve foods that are healthy and steps in this process included: nutritious at Diabetes Canada events. • Identification of priority questions and • Expand and promote food preparation outcomes; programs to encourage consumption of • Retrieval of the evidence; whole foods throughout the community. • Assessment and synthesis of the • Work with partners with similar values evidence; and goals to promote health and health • Formulation of recommendations; policies to create healthy food • Review and input from experts; and environments in Canada. • Planning for communication, • Not partner with companies whose dissemination, implementation, products are harmful to health and/or evaluation and updating of the linked to the development or risk of recommendations. diabetes, consistent with Diabetes Canada’s corporate partnership policy. Diabetes • Promote additional research on the direct impact of free sugars From 2000 to 2010, the prevalence of consumption on diabetes and other diabetes in Canada doubled from 1.3 million chronic conditions. to 2.5 million people (1). Today, more than one in four Canadians — or over ten million Why is the Consumption of Sugars people —lives with diabetes or prediabetes; if Important to Diabetes Canada? nothing is done, by 2020, it will be almost one in three. Diabetes will cost an estimated $14 This position statement is based on a review billion in 2015. The Canadian economy and all of the evidence published between 1995-2015 Canadians are paying the cost of treating about the role of free sugars in the diet of diabetes-related complications. people living with diabetes and those at risk for type 2 diabetes. Recommendations for Diabetes is a condition characterized by an developing type 2 diabetes for mother and elevation in blood glucose (blood sugar) levels child in the future (2). due to either a lack of insulin or a reduced effectiveness of one’s own insulin. People with Overweight and obesity are risk factors for diabetes need to manage their glucose level in the development of prediabetes4, type 2 an effort to achieve their target blood diabetes and gestational diabetes (2). glucose3. Diabetes is a leading cause of Approximately 60% of adult Canadians (3) and blindness, end-stage renal disease, heart one-third of children and youth aged 5 to 17 disease, stroke, and non-traumatic years are overweight or obese (4). Children amputation in Canadian adults (2). who are obese are at increased risk of remaining overweight or obese as adults (5,6). There are three common types of diabetes. Type 2 diabetes is being diagnosed earlier Type 1 diabetes occurs in people when their than ever before, and more frequently in beta cells, located in the pancreas, no longer children (6,7). function. Consequently, very little or no insulin is released into the circulation. As a Behaviour modification, including dietary result, glucose builds up in the blood instead management for people at-risk of type 2 of entering the cells to be used as energy. diabetes, attempts to reduce the likelihood of About five to 10 per cent of people with progression to diabetes. Dietary management diabetes have type 1 diabetes. Type 1 may target weight loss, but also promotes the diabetes generally develops in childhood or consumption of healthy foods. For people adolescence but can develop in adulthood. diagnosed with diabetes, adhering to a healthy diet optimizes glycemic control and Type 2 diabetes occurs when the body cannot reduces the risk of developing complications. properly use the insulin that is released or does not make enough insulin. Glucose builds World Health Organization Sugars up in the blood instead of being used as Intake Guideline energy. Over 90% of people with diabetes have type 2 diabetes. Type 2 diabetes In 2015 the WHO released guidelines on the develops in adulthood most commonly, but intake of free sugars for adults and children children can be affected. (7). These guidelines recommend: • Reduced intake of free sugars A third type of diabetes, gestational diabetes, throughout the life-course (strong is a temporary condition that occurs during recommendation); pregnancy. It affects up to 18% cent of all pregnancies and increases the risk of 4 Prediabetes occurs when there is impaired fasting 3 Goals for target blood glucose are set for individuals glucose, impaired glucose tolerance, or A1C of 6-6.4%; depending on age, treatment methods and other co- 50% of people with prediabetes will transition to type 2 existing health problems. diabetes. • In both adults and children, intake of Sugars in our Food Supply free sugars not exceed 10% of total energy (strong recommendation); and Sugars are ubiquitous in our food supply and • Further reduction to below 5% of total are consumed as a naturally-occurring energy (conditional recommendation). component of many foods including milk, yogurt, fruits, and vegetables. It is also The WHO states that the first two frequently added during food preparation, at recommendations are based on the health the table and during food processing. risks of free sugars consumption in predisposing those who consume them to Sugars come in many forms. Glucose, overweight and obesity, and dental caries. fructose, and sucrose are commonly used WHO’s third recommendation states that a sugars. Glucose occurs naturally in fruits and further reduction of free sugars to below 5% plant juices. Most ingested carbohydrates are (about 6 teaspoons) of total energy intake per converted into glucose during digestion and it day would provide additional benefits. The is the form of sugar that is found in our blood. limits would apply to all sugars added to food, Fructose is found in fruits, some vegetables, as well as sugars naturally present in honey, cane sugar, and honey. It is one of the syrups, fruit juices and fruit concentrates. components of table sugar (fructose combined with glucose forms the Diabetes Canada supports these disaccharide sucrose). It is also consumed as a recommendations for Canadians and high-fructose syrup. Sucrose is found in the acknowledges the importance of the stems of sugar cane and roots of sugar beet. outcomes described by the WHO. Diabetes It also occurs naturally with fructose and Canada recommends reducing free sugars glucose in fruits and some roots vegetables consumption by the general population to such as squash. Maltose is found in certain promote dental health and decrease the risk grains (e.g. barley) and is less sweet than overweight and obesity and subsequent glucose, fructose or sucrose. Lactose is found illnesses. Furthermore, for people living with in milk and other dairy products (8). diabetes, limiting sucrose intake to 10% or less of total daily energy is recommended by Free sugars are those sugars that are the 2013 Clinical Practice Guidelines for the removed from their original source and added Prevention and Management of Diabetes in to foods as a sweetener or as a preservative. Canada. Intake of sucrose >10% of total daily There are many different forms of 'free energy may increase blood glucose and sugars' including cane juice, corn syrup, triglyceride concentrations in some brown rice syrup, barley malt, agave nectar, individuals with type 2 diabetes (3).
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