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New government recommendations on carbohydrates, sugars and fibre published today
Nobody could have escaped the big stories in the media on sugars in the modern diet over the last year. In part, the interest has been fuelled by the Scientific Advisory Committee on Nutrition’s (SACN) Carbohydrates and Health report, the draft of which was published in 2014 and the final report published today.
The report was requested by the Government to provide clarification of the relationship between dietary carbohydrates (which includes starchy carbohydrates, sugars and dietary fibre) and health, and to help inform public health recommendations. To achieve this, the SACN reviewed the evidence for the role of dietary carbohydrates in:
- Colorectal health (like colon cancer and constipation)
- Cardiometabolic health (including cardiovascular disease, type 2 diabetes and obesity)
- Dental health
So what does the report say, and what interest might it have for care homes and dental practices?
SACN have made the following recommendations:
- For the population (from age 2 years upwards) to lower consumption of free sugars to 5% of daily dietary energy intake which is around 25g for women (5-6 tsp) and 35g (7-8 tsp) for men.
- For the population to increase daily total fibre intake to 30g/day for adults (aged 17 and older) from the current recommendation of 24g. Age specific recommendations have also been provided; 15g/day for children aged 2-5 years, 20g/day for 5-11 year-olds, 25g/day for 11-16 year-olds.
SACN has also recommended that the dietary reference value for total carbohydrate should be maintained at an average population intake of approximately 50% of total dietary energy
As the big news stories have concentrated on sugars, let’s deal with this first
Research reviewed in the report looked at the impact of sugars on energy intake, and suggested that by reducing the percentage energy consumed as sugars (for example by replacing sugars with low calories sweeteners) total energy intake could be reduced. Furthermore, randomised controlled trials specifically in children and adolescents indicated that a high consumption of sugar-sweetened beverages, as compared with non-calorically sweetened beverages, results in weight gain. Thus the Committee recommend a reduction in free sugars intake as a useful strategy to decrease the risk of weight gain in the UK population.
We must not disregard the fact that these recommendations are specified for a general healthy UK population though, and not for those with low BMI. For service users in care homes that are overweight, reduction of foods high in free sugars can be part of a healthy eating strategy, and can be replaced with foods such as fruit and vegetables or low fat dairy products. However, for those that may be at risk of malnutrition, these recommendations need to interpreted with caution, and may not be suitable for those people with very limited appetite where reducing such foods may impact on their already poor energy intake.
And what about dental health?
The studies addressed in the report perhaps confirm what we know already, that higher consumption of sugars is associated with a greater risk of dental caries. Indeed, previous government recommendations on reducing sugars in the diet were based on this association. The new recommendations may serve as a timely reminder of the potential impact of both high frequency and amount of sugars in our diet on the increased risk of development of dental caries. But it also raises another interesting issue – oral health shares some of the risk factors, such as diet, as other chronic diseases. This report reminds us that a holistic approach, rather than purely a disease specific one, may be a positive step to tackling these. The link between oral health and diet/nutrition has, for example, supported efforts to improve infant feeding practices and promote preventive dietary interventions – including those delivered in the primary dental care setting – to reduce obesity in young people. Also important to consider are the trends in both dental caries and obesity in lower socioeconomic groups, and their relationship with poorer diets.
Let’s talk about fibre
The report also emphasises the benefits of dietary fibre, particularly for digestive health, and the ability of some types of fibre (notably oat bran and beta-glucan) to reduce risk factors for heart disease such as high cholesterol levels and high blood pressure. There is consistent evidence from observational studies that increased intakes of total dietary fibre, and particularly cereal fibre and wholegrain, are associated with a lower risk of cardiometabolic disease and colorectal cancer. Randomised controlled trials indicate that total dietary fibre, wheat fibre and other cereal fibres, increase faecal mass and decrease intestinal transit times (important for constipation). Randomised controlled trials also indicate that higher intake of beta-glucans, found in oats and barley, leads to lower total cholesterol concentrations and lower blood pressure. Thus we can see that adequate fibre intake may help to lower risk of many common health concerns prevalent in the care home population.
Whilst the report emphasises the benefits of dietary fibre, and provides perhaps the strongest evidence for this, it is regrettable that only sugars have seemed to get media attention. Fibre has been somewhat of a 'Cinderella' nutrient in recent years, having been excluded from the list of those nutrients that can be declared on front of pack food labelling. Perhaps now there will be a greater focus on the importance of raising fibre intakes in the population and a higher profile for this important dietary component going forward. This will need to happen as current intakes are low and many consumers will have to change their diets substantially to achieve the new recommendations. Fibre intake in care home populations may be particularly low.
And finally to ‘Carbs’
Additionally, despite the view favoured by some celebrities and media that ‘carbs are fattening’, this is not supported by the evidence from the high quality, randomised controlled trials considered in this review. Again, perhaps rather than the focus solely on sugars, the lack of evidence for any adverse health effects of including all carbohydrates in the diet may be brought more into public awareness.
The challenge of the new recommendations
The new SACN fibre and free sugars recommendations can be met but it will be a challenge. Current average intakes of free sugars are at least twice the new recommendation in all age groups, with intakes being highest in teenagers. Broadly though, the recommendations continue to reflect general guidance on healthy eating. These emphasise the need to base each meal on starchy foods, such as potatoes, rice, pasta or bread, and encourage a diet that is based on high fibre foods such as wholegrain foods, pulses (such as kidney beans, lentils, haricot beans), potatoes with skins, vegetables and fruits, with limited amounts of foods containing free sugars such as jams, confectionery, biscuits, buns, cakes and sugar-containing soft drinks. Where possible, foods that contain free sugars but are rich in other nutrients, such as low-fat yogurts, breakfast cereals and unsweetened fruit juice, should be selected over less nutrient-dense foods.
 Free sugars are sugars that have been added by a food manufacturer, cook or consumer to a food and those sugars naturally found in fruit juice, honey and syrups. They do not include sugars naturally found in milk and milk products nor in fruit and vegetables.
Ayela Spiro, British Nutrition Foundation – QCS Expert Nutrition Contributor
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