Talk:Sugar/Archive 3

Health effects

I have some suggestions for how the "Health effects" section could be improved, so I'll list them here for discussion.

• Some of the refs are a bit old. Here are some newer reviews on health effects that we could use:

• the Alzheimer's section needs better refs or deletion. The only solid study I found was a prospective cohort study.
• the bit outside the subsections is odd and not a section lede. Nutritional effects should possibly have their own section.
• some statements are not supported by their refs.

• The 2003 WHO review, which as Jytdog says is a bit old, says nothing about overconsumption of sugar (it uses the term only for overeating, and notes that it happens when the foods are energy-dense), nothing about hyperactivity, and almost nothing about refined carbohydrates (it also does not use the term "(un)refined sugars", for reasons detailed here). It cites a study to say that switching from simple to complex carbs improved the weight and metabolic indicies of people with metabolic syndrome, but that's its only use of the term "metabolic syndrome". It mentions effects on obesity other than just adding to the energy intake, page #57 (p67 of the pdf). So only for the statement about caries is it accurately cited.
• The Malik ref says nothing about "overconsumption" increasing body weight and body fat. Malik says "regular consumption", by which I think "routine" is meant. He mentions water as well as artificially-sweetened beverages.
• The statement "...while other sugars (complex carbohydrate) consumption is normally associated with a lower rate of dental caries" should be removed. The next sentence describes what the ref says ("Although other fermentable carbohydrates may not be totally blameless, epidemiological studies show that consumption of starchy staple foods and fresh fruit are associated with low levels of dental caries") more accurately, although it could be improved.

• some refs are of poor quality. All the refs now in the cardiovascular section have large conflicts of interest. The non-WHO ref in the section on hyperactivity needs evaluating. I'm really leery of the papers from the Rippe Health sponsored supplement, due to COIs and a doubt as to whether they might not be a vanity publication.
• when the "Health effects" section has been updated, the comments on health in the article lede need to be updated too.

HLHJ (talk) 06:34, 23 March 2018 (UTC)

The WHO on recommended sugar consumption reduction measures might also be a good source. HLHJ (talk) 23:39, 25 March 2018 (UTC)

"The science behind the sweetness in our diets" (PDF). Bulletin of the World Health Organization. 92 (11): 780–781. 2014-11-01. doi:10.2471/BLT.14.031114. ISSN 0042-9686. Retrieved 2018-03-23. ...and a WHO interview on the science behind the guidelines. HLHJ (talk) 15:10, 28 March 2018 (UTC)

Jytdog, I know you're busy, and probably won't get to reviewing the funding section above for a while. That's OK. But I'm a bit worried about the health effects section; it has a bunch of serious problems, which I have detailed here. Could you or another editor take a look at it? How would it be appropriate to recruit someone? HLHJ (talk) 15:17, 28 March 2018 (UTC)

Jytdog, since it's been three weeks, I'd like to ask Carl Fredrik, who has taken a neutral interest in this content, if he's able to improve it. Failing that, I hope you will not object to my improving it myself. Carl Fredrik, would you be willing to work on this? HLHJ (talk) 18:55, 6 April 2018 (UTC)

::Thanks to WhatamIdoing for fixing some of this. HLHJ (talk) 23:59, 8 September 2018 (UTC)(misplaced, moved to section below HLHJ (talk) 20:35, 9 September 2018 (UTC))

There is a Cochrane review on the cardiovascular stuff, source 6 above, but it basically says that we are short on good studies. I have tagged the statements that are not supported by the sources they cite, and removed the plural in the "addiction" section to accord with WhatamIdoing's removal of the ref, as these seem like pretty minor edits.

A really interesting population-level study on the correlations between obesity, diabetes, and diet: Basu, Sanjay; Yoffe, Paula; Hills, Nancy; Lustig, Robert H. (2013-02-27). "The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data". PLOS ONE. 8 (2): –57873. doi:10.1371/journal.pone.0057873. ISSN 1932-6203. Retrieved 2018-08-24.{{cite journal}}: CS1 maint: unflagged free DOI (link)

Rippe-sponsored supplement to the European Journal of Nutrition

As mentioned in the section #Funding of health research, above, some sources for this article are from a specific journal supplement:

All three of those refs are from a "supplement sponsored by Rippe Health" (list of European Journal of Nutrition supplements). Rippe Health is in turn sponsored by producers of sugary foods, among others, like the Corn Refiners Association (sic). The editor of the supplement is James M. Rippe, the founder and director of Rippe Health. The lead author of one of the papers on the supplement (listed above) is also James M. Rippe The second is written by John Sievenpiper and his postdoc. Dr. Sievenpiper has received media attention for the support he has received from the sugar industry. The third paper is by a group from the Department of Psychiatry at Addenbrooke’s, and I didn't find any authorial conflicts of interest, but I'm not sure that this paper would have been adequately peer-reviewed.

I took the supplement to Wikipedia talk:MEDWikipedia talk:WikiProject Medicine/Archive 109#Sponsored supplement?, and based on the response, in part:

Eur J Nutrition was by no means the only publisher to issue such sponsored supplements. A number of otherwise very high quality journals did, and they represent a disgraceful cheapening of the medical literature. I do not consider any such publication to be truly peer-reviewed--it has the same status as any other conference papers in a commercially sponsored conference. In many cases these supplements were included only in the issues sent to individual subscribers, not to libraries. Essentially, they were advertisements.

I am amazed and horrified to learn that they are still being published. I do not know how fair it is to stigmatize this particular journal. I know where to ask, and I shall inquire further.

What I am fairly sure about, is that ewe cannot use the material as a RS even in our usual meaning of RS, and certainly not a MEDRS. DGG ( talk ) 03:48, 25 March 2018 (UTC)

I think they should definitely be removed from the article.

HLHJ (talk) 17:40, 25 March 2018 (UTC)

I have removed the papers from the "sponsored supplement" (aka "paid advertisement").

I also removed the section on cardiovascular health, which was entirely taken from that source. WhatamIdoing (talk) 01:52, 6 September 2018 (UTC)

Thanks to WhatamIdoing for fixing some of this. HLHJ (talk) 23:59, 8 September 2018 (UTC)(moved from section above HLHJ (talk) 20:35, 9 September 2018 (UTC))

Industry talking points in the article

I am concerned at seeing sugar-industry talking points being edited into Wikipedia. For instance, in the last edit to the Sugar article, we see:

"Sugar consumption has been implicated in obesity, diabetes, cardiovascular disease, dementia, and tooth decay" → "Excessive consumption of sugar has been implicated in the onset of obesity, diabetes, cardiovascular disease, dementia, and tooth decay."

The 2015 WHO guidelines explicitly say that there is no evidence of harm for reducing sugar intake below 5%. They don't talk about "excessive" sugar consumption; the source never uses the word "excessive". The word seems to be completely unsourced. Then there is:

"In 2015 the World Health Organization recommended that adults and children reduce their intake of free sugars, which is sugar not present in whole, unprocessed foodstuffs besides honey, to less than 10%, and encouraged a reduction to below 5%, of their total energy intake.<ref name="WHO 2015p4"/>" → " In 2015, the World Health Organization recommended that adults and children reduce their intake of free sugars to less than 10%, and encouraged a reduction to below 5%, of their total energy intake.<ref name="WHO 2015p4"/>"

In the second edit, "energy intake" is now wikilinked to Energy homeostasis. The idea that cutting down on energy-dense (inclu. sugary) foods and drinks is a good idea for reducing weight and diabetes seems to be supported by MEDRS; the message that really, obesity is about "energy balance" is an industry talking point with little foundation in medical evidence:

"Health experts say this message is misleading and part of an effort by Coke to deflect criticism about the role sugary drinks have played in the spread of obesity and Type 2 diabetes. They contend that the company is using the new group to convince the public that physical activity can offset a bad diet despite evidence that exercise has only minimal impact on weight compared with what people consume... Critics say Coke has long cast the obesity epidemic as primarily an exercise problem. “The message is that obesity is not about the foods or beverages you’re consuming, it’s that you’re not balancing those foods with exercise,” Dr. Freedhoff of the University of Ottawa said... The [industry-funded] group says there is “strong evidence” that the key to preventing weight gain is not reducing food intake — as many public health experts recommend — “but maintaining an active lifestyle and eating more calories.”"[1]

We need to be careful about neutral, independent sources and information on a topic that has had so much money thrown at confusing it. This sort of campaign seems to work largely by making genuinely independent people accept the information offered in good faith. For clarity, as the issue has been raised, I am not accusing anyone of shilling with this post. I've edited things I later classified as misinformation into articles; I assume my fellow editors can also make such mistakes in good faith. My apologies for the misunderstanding. I suggest undoing the changes to these sentences. HLHJ (talk) 02:52, 20 August 2018 (UTC)

My apologies for not getting back to this sooner. Please see your talk page. Jytdog (talk) 02:57, 20 August 2018 (UTC)

(edit conflict) Seen, and I hadn't intended that. Modified. HLHJ (talk) 03:19, 20 August 2018 (UTC)

Have you clicked on the link to Energy intake? I think you should do. Jytdog (talk) 03:07, 20 August 2018 (UTC)

(edit conflict) Yes, I had. I also checked the WHO source and found it did mention energy balance, but (unsurprisingly, as it is about sugar) not the effects of exercise on it. HLHJ (talk) 03:19, 20 August 2018 (UTC)

I think you misunderstand me. If we want to link to "energy intake", that content in WP is actually in Energy homeostasis and has been for a long time; but above you frame that wikilink like it is some kind of conspiracy. That isn't helpful. This is one of the reasons I haven't wanted to engage with this material; there is too much of this added-on stuff mixed in, that just makes no sense and falls apart and ends up wasting my time, and there is so much work to do. Please just keep things simple. Please. Jytdog (talk) 05:07, 21 August 2018 (UTC)

I've added the NYT source and a brief statement about COIs to the Energy homeostasis article. Separately, I had some source access problems while researching the medical topic, and will try and improve the content when I get around to tracking down the sources. HLHJ (talk) 02:31, 25 August 2018 (UTC)

With regard to the difference between "Sugar consumption has been implicated in obesity, diabetes, cardiovascular disease, dementia, and tooth decay." and "Excessive...."... I am not sure what you are getting at. Nobody including the WHO advocates reducing sugar to zero, unless I am missing something. Like everything it is a "dose makes the poison" thing. If we are being "high level" and not giving the actual numbers, "excessive" is useful as it makes it clear indeed that reduction, not elimination, is the goal. (and it is excessive sugar that causes those ill effects.. so "excessive is correct, not "reduced"). If we were to give more detail, something like "Free sugar intake that is more than 10% of total energy intake has been implicated in..." Jytdog (talk) 03:16, 20 August 2018 (UTC)

The WHO source says "free sugars intake should be as low as possible" for caries reduction, and "Increasing or decreasing free sugars is associated with parallel changes in body weight, and the relationship is present regardless of the level of intake of free sugars". It seems that there is no evidence for a threshold harmless value, but there is some sort of dose-response relationship. The WHO seems to indicate that reducing free sugar intake to zero would not be a concern, and it's recommendation are phrased in terms of "less than". The 5% and 10% seem to be arbitrary cutoff levels used in interventional and observational studies, not motivated by a corresponding level of risk. I think the older phrasing communicated that more succinctly, but I think I put it rather too harshly.

The WHO source doesn't say anything about diabetes and cardiovascular disease except that being overweight is a risk factor, nor anything about dementia; the lede is presumable summarizing cited information later on. I should really take the time to review all the medical sources again, and update the article, if you've no objection. HLHJ (talk) 04:05, 20 August 2018 (UTC)

The WHO report on page 3 says "An analysis of cohort studies in children suggests a positive association between the level of free sugars intake and dental caries. The evidence suggests higher rates of dental caries when the level of free sugars intake is more than 10% of total energy intake compared with it being less than 10% of total energy intake. Furthermore, in three national population studies, lower levels of dental caries development were observed when per capita sugars intake was less than 10 kg/person/year (approximately 5% of total energy intake). Additionally, a positive log-linear dose response relationship between free sugars intake and dental caries was observed across all studies, at free sugars intakes well below 10 kg/person/year (i.e. <5% of total energy intake). The overall quality of the available evidence from cohort studies was considered to be moderate, whereas that from the national population studies was considered to be very low. Based on the entire body of evidence, WHO generated the following recommendations for free sugars intake in adults and children. and they follow with the recommendation to reduce, followed by specific targets of less than 10% of energy intake (strong), and less than 5% supported by weaker evidence. They no where say "eliminate".... Jytdog (talk) 05:07, 21 August 2018 (UTC)

They don't say "eliminate", and I don't think that the article should, either. Sorry if I gave that impression.

I think that the article should be phrased so as not to give the impression that there is some threshold level of sugar consumption, below which there are no harms, as I do not think this reflects the MEDRSs. The word "excessive" seems to me to suggest some limit which has been exceeded. "Excess baggage", for instance, seems to me to imply some non-zero amount of baggage which would not be excess. Obviously this is a judgement call.

Looking at the MEDRS, the relationship between free sugars and caries has been studied down to intakes of less than 200g/year (about 2L of pop, and less than double the average US daily consumption), although the WHO source mentions this only in the very tiny text. The reason the evidence is assessed as low-quality is that it is mostly population-level observational studies, which rank poorly on GRADE. The reviews the WHO cited for the <5% recommendation are this dose-response review and this public-health review. The results section of the first begins "Meticulous Japanese data on caries incidence in two types of teeth show robust log-linear relationships to sugar intakes from 0%E to 10%E sugar". The evidence doesn't suggest a particular level below which sugar consumption is non-cariogenic. People with approximately zero free sugar consumption (ignoring salivary amylase) still get caries, just infrequently; with rising sugar intake, the rate of caries increases exponentially, doubling for every ~6kg sugar/year increase in consumption, as the straight line on the semi-log plot of figure 2 in the dose-response review shows (why do journals publish fitted curves without the equation of the line?). Quoting the sources, "There is no evident threshold for sugars" and "There is no evident threshold for sugars below which there are no adverse effects".

The evidence on obesity is less clear-cut, as the data set is not as good. The relevant review the WHO commissioned and based their paper on is here. It says mostly that drinking sugary drinks, including fruit juice, seems to lead to obesity under ordinary conditions (also that adults are rubbish at following dietary advice to reduce sugar, and kids are worse). The authors suspect this is because the drinks fail to fill people up and make them consume more, largely because under highly controlled conditions, carefully substituting the sugar in diets without changing the energy intake seemed to have no effect on weight (I believe there is some population-level data somewhere suggesting that sugar consumption levels matter less than the form in which the sugar is consumed; soda vs. pre-prepared food vs. home baking, for example; I'd have to hunt). There is no evidence for or against a threshold effect here; as the discussion of the review says, "currently available data did not allow formal dose-response analysis".

I will try and keep things simple, I agree it's a good idea. I've not engaged with this material for ~a couple of months myself. I've recently taken an interest in improving the coverage of COIs and COI-based claims on Wikipedia, and it's the most uncomfortable topic I've ever taken an interest in. Over the past decade I've not really had any conflicts; suddenly I'm causing them, and learning how to use dispute resolution mechanisms, which are necessary but tedious and socially unpleasant. I will try and answer your comments about energy balance and fructose soon. The obesity review does mention fructose in passing on the last page of the body. HLHJ (talk) 04:16, 23 August 2018 (UTC)

I think that the problem with talking about "excessive" sugar consumption is that it's always the other guy whose sugar consumption is excessive. Me, with healthy yogurt (30 g added sugars) and my healthy fruit juice (30 g sugar) for breakfast, and my healthy salad with French dressing (10 g added sugars per serving) for lunch, and my healthy granola bar (25 g added sugars) and my healthy dried cranberries (25 g added sugar) for a snack – my sugar consumption isn't excessive at all. (Hey, how did I eat three times the maximum recommended level of added sugars, and I haven't even had dinner yet?)

If we want to limit the statement about eating sugar being linked to multiple medical conditions, then we should probably be more precise, e.g., "more than 10% of calories" or "more than 25 g per day". Or we could just say that sugar's linked to these diseases, and get into the details later in the article. WhatamIdoing (talk) 04:12, 6 September 2018 (UTC)

I'd favour the latter, as I think the lede would be a bit clumsy with something like "Sugar consumption has been implicated in tooth decay; free sugar consumption above level X has been implicated in obesity, level Y in diabetes, and level Z in cardiovascular disease, but there is only a positive indication of a safe level of consumption for (subselection of diseases and respective thresholds)". But it is entirely possible that this could be phrased better. I am also not sure we could support that much precision with the sources, although where we can, I think it would be a good idea to have this sort of information in the detailed sections later in the article. HLHJ (talk) 20:06, 9 September 2018 (UTC)

The content in the health section still suggests thresholds, which is not supported in the sources cited. Zefr, you recently added some more threshold language to the health section; could you please explain what sourcing supports the thresholds? For instance, you wrote "A review of human studies showed that the incidence of caries is lower when sugar intake is less than 10% of total energy consumed", but it seems to me that the review, in the details, describes observational data giving an exponential dose-response curve for sugar and caries, with no indication of a 10% threshold. There were interventional studies for higher sugar levels, but excellent observational data for low ones. The reviewers only commented on that threshold because they were explicitly asked to do so by the WHO; it reflects the guidelines, not the data, although it is headlined in the abstract. HLHJ (talk) 03:06, 14 September 2018 (UTC)

Read the WHO document, pages 3,4,7,12, and 16. That's clear enough for stating sugar intake should be less than 10% of total energy consumption to lower risk of dental caries and weight gain. This is sufficient evidence for the encyclopedia, as there are no more definitive sources redefining intake levels with disease risk. There's nothing further to say here. --Zefr (talk) 16:17, 14 September 2018 (UTC)

Are you talking about the 2015 WHO review which updates the 2003 one, but is not cited in the article, or the 2003 one in the article? In both cases, I have read it, Zefr, as I thought my posts above implied. I have also read related review papers. The small text, and the reviews commissioned as sources, are more definitive than the executive summary, and they go into more detail. The evidence is clear that there is nothing magic about 10% except that the WHO asked for data about that consumption level; the dose-response curve is not discontinuous there, and the data does not suggest any threshold there. The 2015 WHO review says:

Additionally, a positive log-linear dose-response relationship between free sugars intake and dental caries was observed across all studies, at free sugars intakes well below 10 kg/person/year (i.e. <5% of total energy intake).

10% of energy in an adult is ~47g, or 12 teaspoons of sugar [2], which works out as 17kg/year. That's an intake at which you'd get an average of 30 cavities as opposed to the three you would get with negligable sugar, according to a slight extrapolation of the dose-response curve mentioned above. At 5%, you'd expect ten cavities, which you might think is an acceptable harm, but it's a harm. This is, of course, assuming that you are otherwise eating a Japanese post-war diet, with lots of sticky starches. There are populations where cavities are far rarer (mentioned in the same study:"only 2% of urban and rural Nigerians of all ages including the elderly, whose permanent teeth had been exposed to diets for half a century, had any dental caries when their sugar intakes were about 2 g/day per person (0.4%E)" [3]), so obviously sugar isn't the only factor.

I'm in favour of giving the WHO targets, but as WHO targets. We should make it clear, as the WHO does, that these are not thresholds for harm, and there is no RDA for sugar. I mean, we currently have:

By itself, sugar is not a factor causing obesity and metabolic syndrome, but rather – when over-consumed – is a component of unhealthy dietary behavior.[69] Meta-analyses showed that excessive consumption of sugar-sweetened beverages increased the risk of developing type 2 diabetes and metabolic syndrome – including weight gain and obesity – in adults and children.[71][72]

This sounds contradictory and gives the impression that there is harmless level of consumption for sugar-sweetened beverages, which does not seem to be supported by the evidence.

HLHJ (talk) 00:29, 22 September 2018 (UTC)

RfC on sugar industry influence on health information and guidelines

The consensus is to replace the previous content with the proposed content.

Cunard (talk) 06:00, 18 November 2018 (UTC)

The following discussion is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

---

Should the Sugar#Society and culture section be replaced, and if so, what features of the edits suggested at Talk:Sugar/Archive 2#Funding of health research should and should not be included? Extended for a further thirty days by HLHJ (talk) 02:08, 11 October 2018 (UTC), originally started by HLHJ (talk) 01:37, 6 September 2018 (UTC)

Clarification: Should the Sugar#Society and culture section be replaced, and if so, with what? See discussion for several content suggestions, or make your own. HLHJ (talk) 02:43, 11 September 2018 (UTC)

Should we replace the previous content with the proposed content?

Previous content

Proposed content

Society and culture Manufacturers of sugary products, such as soft drinks and candy, and the Sugar Research Foundation have been accused of trying to influence consumers and medical associations in the 1960s and 1970s by creating doubt about the potential health hazards of sucrose overconsumption, while promoting saturated fat as the main dietary risk factor in cardiovascular diseases. In 2016, the criticism led to recommendations that diet policymakers emphasize the need for high-quality research that accounts for multiple biomarkers on development of cardiovascular diseases. References

Sugar industry funding and health information Main article: Sugar marketing § Influence on health information and guidelines Sugar refiners and manufacturers of sugary foods and drinks have sought to influence medical research and public health recommendations, with substantial spending documented from the 1960s to 2016. The results of research on the health effects of sugary food and drink differ significantly, depending on whether the researcher has financial ties to the food and drink industry. The authors of a 2016 review of funding bias concluded that "This industry seems to be manipulating contemporary scientific processes to create controversy and advance their business interests at the expense of the public's health". A 2013 review concluded that "unhealthy commodity industries should have no role in the formation of national or international NCD [non-communicable disease] policy". There have been similar efforts to steer coverage of sugar-related health information in popular media, including news media and social media. The Sugar Research Foundation, a trade association for the sugar industry, conceived, funded, and participated in an influential 1967 medical review. It was called "SRF Funds Project 226", and published as "Dietary Fats, Carbohydrates and Atherosclerotic Vascular Disease". While this took place in 1965-1967, it was documented in a 2016 JAMA Internal Medicine publication which reviewed industry documents. Taking into account "other recent analyses of sugar industry documents", the review concludes that such actions were part of a wider industry-sponsored research program in the 1960s and 1970s. It also concludes that "Policymaking committees should consider giving less weight to food industry–funded studies". The U.S. National Institute of Dental Research's 1971 National Caries Program was lobbied by the sugar industry, which substantially influenced the types of research the caries program called for. Research on food cariogenicity that could have harmed the sugar industry was omitted from funding priorities. The NIDR's public health task force on caries and an industry task force on caries had almost exactly the same members. The NIDR copied 78% of the industry groups' report into their own, with portions being copied verbatim. Industry groups criticised the evidence behind the World Health Organization 2003 recommended limit on free sugar consumption. When the WHO updated the recommendations, a decade later, it commissioned two reviews, and found support for both the earlier recommendation and a new, stricter one. In 2011, the competing Corn Refiners Association (which makes sugar syrups) and the Sugar Association became involved in a lawsuit against one another, which continued as of 2015. In the course of this lawsuit, numerous internal documents were made public. These revealed funding of over $10 million to James Rippe for health research and media outreach, and a combined $4 million to Citizens for Health and Center for Consumer Freedom, which publicly opposed one another's views on the healthiness of the rival products without acknowledging their funding (such shilling is legal in the US following the Citizens United ruling). In 2015, it was reported that Coca-cola had paid millions to promote controversial health messages related to sweet drinks, ranging from academic research to social media posts, since 2008. The money went to researchers, dietitians, health experts, research organizations, and professional associations, among others. Following this media attention, Coca-cola released information on almost $120 million U.S. dollars given out to medical, health and community organizations between 2010 and 2015. These include $29 million for academic research; the largest donation was $7.5 million to Louisiana State University's Pennington Biomedical Research Center. Coca-cola has now announced that it will "pull back" (reporter's phrasing) from funding health experts and obesity research, in order to improve its transparency. A 2016 investigation of PepsiCo and Coca-cola sponsorship and lobbying found funding going to "63 public health groups, 19 medical organizations, seven health foundations, five government groups and two food supply groups", including the National Institutes of Health, the American Diabetes Association, and professional associations of medical specialists. They found evidence that PepsiCo had funded 14% of the organizations, and Coca-cola had funded 99%. However, the authors suspect this difference is overestimated; Coca-cola had recently released some funding data (see previous paragraph), while, they say, PepsiCo is “known for making its sponsorship data extremely difficult to track”. References

please don't forget breaks for editing convienence

• oppose Sugar#Society and culture section be replaced--Ozzie10aaaa (talk) 11:10, 7 September 2018 (UTC)

Am I right to take this to be a vote for the status quo, Ozzie10aaaa? HLHJ (talk) 22:48, 8 September 2018 (UTC)

yep--Ozzie10aaaa (talk) 22:52, 8 September 2018 (UTC)

• Support. When I learned that there's a section "Sugar#Society and culture", I assumed that it would mention the 18th-century transportation of Africans as slaves to the Caribbean so that Europeans could enjoy refined sugar. The current section, and the much longer version below, probably belong in Wikipedia, but not in this article. This is an article about a substance. Its chemical, culinary, and medical properties, and methods of production, belong here. The strategies used by its lobbyists do not. Maproom (talk) 07:45, 8 September 2018 (UTC)
• Huh? Maformed RfC as question makes no sense. Replaced with what? The same stuff with a few words different? The same-titled section with new content? Or? (It certainly shouldn't be filled with conspiracist twaddle about Big Sugar as can be found at the linked discussion). Alexbrn (talk) 11:04, 10 September 2018 (UTC)
  • Alexbrn, I've rearranged the page to make it easy to find the proposed text. The existing text is two sentences with one ref, and the proposal is nine paragraphs with 20 refs. Both the existing text and the proposal are about the role of the sugar industry in supporting research that is favorable to their product, and if you believe that both amount to "conspiracist twaddle", then I suppose that you could propose removing all of it. WhatamIdoing (talk) 20:27, 10 September 2018 (UTC)
    • Sorry for the slow response. The long section listed as proposed text above by WhatamIdoing is currently available in slightly altered form at Sugar marketing; my most recent suggestion was for a shorter summary and a link. I started out writing a small section, but it grew as I researched it... Alexbrn is right that the RfC question is basically "Replaced with what?", although of course, as Ozzie10aaaa says, the status quo is also an option. Apologies for the unclear phrasing. Suggestions on sourcing and anything else that would improve the quality of the content are welcome. HLHJ (talk) 00:44, 11 September 2018 (UTC)
      • Okay now it's clear, but I think some of the previous responses now don't make sense so I'm not sure of the worth of this RfC. To the specific question now the answer is "no". Alexbrn (talk) 02:16, 11 September 2018 (UTC)
        • Thanks. I have clarified the question with your phrasing above. Ozzie10aaaa's vote for the status quo seems pretty clear. Maproom seems to me to vote for the replacement of the existing section with nothing (in this article). I think, subject to correction, that you favour deleting the existing section, Alexbrn. Perhaps I should have asked "How should conflicts of interest in academic publishing on sugar be covered?", but the material includes shilling in mainstream media, too. Further discussion below. HLHJ (talk) 03:52, 11 September 2018 (UTC)
          • I don't know how you infer that. The question I answered was the simple binary one: should TEXT A be replaced by TEXT B. I have replied no. That the question has now been changed again makes this RfC a clusterfuck. I give up! Alexbrn (talk) 04:05, 11 September 2018 (UTC)
• Support key elements of this proposal. The RfC does not ask a specific enough question to support or oppose as a blanket matter, but it seems self-evident to me that:

1. The existing section's title does not represent its contents, which are about health and lobbying rather than "culture". Industry marketing about health effects should be a subsection under health effects.
2. A "main article" link to Sugar marketing at the top of that subsection is a useful pointer to pertinent information.

However, there's a level of detail in the proposed edit that is WP:COATRACK when it comes to the article on sugar. All of it would live comfortably in the sugar marketing page with a more focused precis here. Rhoark (talk) 16:25, 2 October 2018 (UTC)

• I support an expansion, and much of the material is highly relevant - I'd call it Culture and promotion as a compromise, with a seealso to sugar marketing too. Cas Liber (talk · contribs) 23:43, 14 October 2018 (UTC)
• (Summoned by bot) I support an extension of some type, minor preferably; the suggestion that is currently in the right-hand column, however, in mine opinion is far too detailed for this article ~ surely it should be in Sugar marketing or Sugary claims or Lies by the sweet industry. Yes, the two latter are red (or, at least, as i write i certainly hope they are!); the language in the suggested text is fit for such an article, though, as it seems to pass judgement on the industry in WP's voice, rather than simply reporting what the sources say. Thus, while i support some small changes from the status quo, i do not believe that the suggested substitution is appropriate, either in size or character. Happy days, Lindsay^Hello 10:00, 20 October 2018 (UTC)
• Support proposed change (Summoned by bot)^Thanks, L3X1 ◊distænt write◊ 01:45, 21 October 2018 (UTC)
• Support this proposal. The previous content was a whitewash of the situation. Peter K Burian (talk) 17:01, 26 October 2018 (UTC)
• Support per above comments Seraphim System ^(talk) 20:02, 9 November 2018 (UTC)

Discussion

To editor Maproom: The longer section below is at Sugar marketing, and methods of production and market information are at Sugar industry. It is my view, but not, I think, Zefr's, that both of these articles should be linked to from brief summaries in this article. Sugar plantations in the Caribbean, Triangular trade, and Free produce movement seem the closest matches to what you were thinking of. HLHJ (talk) 22:48, 8 September 2018 (UTC)

Update: I've posted it above, because people will need to review both the previous and proposed versions before they can make a decision. WhatamIdoing (talk) 20:22, 10 September 2018 (UTC)

That makes sense, it gives a better idea of what we are discussing. Thank you. I invite other text suggestions, too, and comments on what should/shouldn't be included. HLHJ (talk) 00:44, 11 September 2018 (UTC)

To editor Alexbrn: I'm not sure this is a conspiracy. Legally, civil conspiracy would apparently involve collusion to defraud, or illegally mislead, but I'm not a lawyer. If clandestine lobbying to influence public health information is a conspiracy (a fascinating question I'd love to hear a lawyer discuss), then there's been multiple little conspiracies by assorted groups. But a functional single conspiracy would not sue itself, and thus be compelled by court orders to reveal large chunks of the information it wished to conceal, triggering extensive coverage in the New York Times and Washington Post et al. (I didn't cite all of it; everyone from The Guardian to Fox News covered it, many of them badly). At best, that's a rather dysfunctional conspiracy. I don't think it is plausible to posit overarching central planning for these actions. Nor do I think that these actions imply anything about the health effects of sugar; even an unlikely lobbyist who didn't care about truth at all might be right by accident (some incautious journalists seem to miss this nuance). On the other hand, I do think that we need to be aware of conflicts of interest in academic publishing. See Talk:Sugar/Archive 3#Rippe-sponsored supplement to the European Journal of Nutrition for a reason for thinking that we need such awareness on Wikipedia. HLHJ (talk) 03:52, 11 September 2018 (UTC)

Not a conspiracy so much as a conspiracy theory. This is covered in RS e.g.[4]. Perhaps we should cover it too. Alexbrn (talk) 04:18, 11 September 2018 (UTC)

I don't have fulltext access right now, but it looks to me as if the article is warning about inferring too much from these documents. I think I have been careful not to imply too much; I've tried to be neutral and factual. Please let me know where I've failed, and I'll fix. We could include content on overinflated claims; it would be good to have a WP:MEDRS source for that, since it will probably involve judging what biomedical claims are unjustified. How would you define the difference between conspiracy theory and reporting on a conspiracy, Alexbrn? HLHJ (talk) 04:57, 11 September 2018 (UTC)

It's not our job to imply anything, just to reflect RS properly. MEDRS would apply to biomedical claims. The overall problem here is that the sphere of food is populated by some zealous tribes and right now the low-carb/sugar-is-the-great-satan tribe is a fashionable silliness. Wikipedia should resist buying into that. Alexbrn (talk) 05:43, 11 September 2018 (UTC)

It's hard to write English that implies nothing; I'm happy if no reasonable person would be likely to read in an implication that isn't supported by reliable sources. I entirely agree with your assessment that there is a great deal of fashionable silliness in nutrition, and Wikipedia should resist it. The logic seems to be that, if the sugar industry has promoted statement X in ways of which one disapproves, not-X must be true. It's just as wrong as the logic that if people make silly claims about not-X, X must be true. I'm happy to cover both the dubious marketing methods and the silly fads, being careful to separate both from our best current assessment of reality. I admit I'm more interested in the former, but I have every respect for editors writing content about the latter (since creating food fads is an industry, I guess they overlap). I wish people would ditch both propaganda and silly fads, reality is enough to occupy us all. But humans being human, I won't hold my breath. HLHJ (talk) 23:39, 11 September 2018 (UTC)

To editor LindsayH: I entirely agree that a shorter summary would be appropriate for this article, with a longer one at Sugar marketing. I'd appreciate criticism and suggestions for improving the neutrality of the proposed text, if you have time. I have not found independent sources publishing favourable coverage of this topic (the WHO one is neutral); if you know of any, please let me know. HLHJ (talk) 04:00, 22 October 2018 (UTC)

Closure

• On October 8, I closed this RfC with a result of "no consensus" per a request for closure submitted on October 7. On October 9, HLHJ requested for the RfC to be reopened to allow for more editors to express their opinions. I've undone the closure, and I'm reopening the RfC now. If consensus emerges, any editor may request another closure at Wikipedia:Administrators' noticeboard/Requests for closure. — Newslinger talk 01:25, 10 October 2018 (UTC)

Thank you, Newslinger. HLHJ (talk) 01:35, 10 October 2018 (UTC)

---

The discussion above is closed. Please do not modify it. Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Diabetes mellitus

Is it true that eating too much sugar gives one Diabetes mellitus? If so, this could go in the article, under health effects. Vorbee (talk) 19:16, 12 June 2019 (UTC) I have done a Google search and found a website - www.medicinetoday.com - that says that Type One diabetes is an auto-immune disease. Vorbee (talk) 19:57, 13 July 2019 (UTC)

You should read about the differences between type II diabetes (potentially diet-related) and type I diabetes (probably genetic). There is no food or ingredient proven to "cause" a disease. Over-consumption of sugar-sweetened beverages is a positive risk factor for type II diabetes, shown here. --Zefr (talk) 20:20, 13 July 2019 (UTC)

Strength of evidence that sugar causes caries

From https://en.wikipedia.org/wiki/Sugar#Tooth_decay:

The 2003 WHO report stated that "Sugars are undoubtedly the most important dietary factor in the development of dental caries.

(emphasis mine)

But from a different paragraph of the same article https://en.wikipedia.org/wiki/Sugar#Recommended_dietary_intake

The World Health Organization recommends that both adults and children reduce the intake of free sugars to less than 10% of total energy intake, and suggests a reduction to below 5%. "Free sugars" include monosaccharides and disaccharides added to foods, and sugars found in fruit juice and concentrates, as well as in honey and syrups. According to the WHO, "[t]hese recommendations were based on the totality of available evidence reviewed regarding the relationship between free sugars intake and body weight (low and moderate quality evidence) and dental caries (very low and moderate quality evidence).

(Again, emphasis mine)

Do the phrases "undoubtedly" and "very low and moderate quality evidence" not contradict each other? — Preceding unsigned comment added by 2A02:A317:2241:7A00:7045:FE41:1909:61A9 (talk) 21:53, 29 January 2020 (UTC)

No, though it certainly looks like it, 2A02:A317:2241:7A00:7045:FE41:1909:61A9. The WHO has "low to moderate quality evidence" that reducing free sugar consumption to <10% of energy intake is good for caries, and somewhat less evidence that reducing it to <5% is good. Actually, they have excellent population-based evidence, but since their formal quality scale privileges controlled trials, other things probably cannot rank higher than "moderate". Population-based evidence goes all the way down to <2grams free sugars/day, levels at which caries becomes a rare disease (~98% of so of people don't get it). There is no evidence that there is a level of sugar intake which does not cause caries, although there is very good evidence that more sugar causes more caries (that is, there is a dose-response relationship with no lower cut-off). So speaking in a manner unconstrained by their formal reporting methods, the WHO can say that sugar undoubtedly causes caries. They probably won't even be sued for saying it. HLHJ (talk) 01:42, 27 February 2020 (UTC)

Update of obesity and metabolic syndrome section

Extended content

Should we replace the previous content with the proposed content? Previous content Proposed content Obesity and metabolic syndrome A 2003 World Health Organization technical report provided evidence that high intake of sugary drinks (including fruit juice) increased the risk of obesity by adding to overall energy intake. By itself, sugar is not a factor causing obesity and metabolic syndrome, but rather – when over-consumed – is a component of unhealthy dietary behavior. Meta-analyses showed that excessive consumption of sugar-sweetened beverages increased the risk of developing type 2 diabetes and metabolic syndrome – including weight gain and obesity – in adults and children. References Obesity and metabolic syndrome Free sugar consumption is a determinant of body weight in people who choose their own food, according to the evidence in a 2013 systematic review commissioned by the World Health Organization (WHO). Adults advised to increase sugar consumption were found to gain weight, with longer studies showing more weight gain ; adults advised to decrease their sugar intake lost weight. This was true regardless of how much free sugar they were eating. Advising children to consume less sugar did not have much effect on what they consumed, and evidence that advice to children had an effect of weight was less consistent. Children who consumed more sugar had a higher risk of becoming overweight. Studies of people on controlled diets, in which sugar intake was changed while energy intake remained the same, do not find an effect on obesity. It is therefore thought that higher sugar consumption increases overalldesired energy intake. A high intake of sugary drinks (including fruit juice) increases the risk of obesity by adding to overall energy intake, likely because drinks cause less satiety than food, according to a 2003 WHO technical report. The risk of obesity in children is estimated to rise by 60% per can or glass of sugary drink per day. The 2013 WHO review confirmed the association. Subsequent reviews including further studies, and prospective cohort studies as well as randomized trials, found the evidence strengthened. Meta-analyses showed that excessive consumption of sugar-sweetened beverages increased the risk of developing type 2 diabetes and metabolic syndrome – including weight gain and obesity – in adults and children. References

I would like to suggest this edit. It updates the existing content by adding more recent sources. The sentence "By itself, sugar is not a factor causing obesity and metabolic syndrome, but rather – when over-consumed – is a component of unhealthy dietary behavior.[cites WHO 2003 report]" was removed as I could not find text in the source to support it, and more recent systematic reviews contradict it. The 2013 WHO review decided not to consider metabolic disease ("Initially, several other outcomes, such as diabetes and cardiovascular disease (CVD), were also considered..."), as these are also linked to obesity, so I've had to retain an older review for that. For the 2013 WHO study, I have additionally cited the summary forest plots for the individual findings, but these findings are also described in the conclusions section.

Zefr, do you have any objections to these edits? I know you have previously reverted similar ones. I will post on your talk page to ensure you see this. If not, I will make them. HLHJ (talk) 03:50, 27 February 2020 (UTC)

Clear from all the sources is 1) overconsumption of sugar, particularly from sugar-sweetened beverages, is a factor for obesity and metabolic syndrome, but 2) the quality of clinical research to nail down the sugar-obesity mechanism is insufficient to say anything more than what we already have in the article (due to few rigorous trials, low subject numbers and weak designs typical of dietary research, as discussed by the authors). The text offered under Proposed content is verbose and unclear, with extensive use of quotes unnecessary. It can be replaced by: Excessive intake of sugary drinks (including fruit juices) increases the risk of obesity by adding to overall energy intake. By itself, sugar is not a factor causing obesity and metabolic syndrome, but rather – when over-consumed – is a component of unhealthy dietary behavior increasing the risk of type 2 diabetes and metabolic syndrome in adults and children. --Zefr (talk) 16:19, 27 February 2020 (UTC)

I took the content of statements directly from the conclusions of the WHO review; if they think the research is sufficient to support these statements, I do. "By itself, sugar is not a factor causing obesity and metabolic syndrome" seems to me to contradict the MEDRS. Separately, I cannot find any indication in the data or reviews that there is an "overconsumption" threshold, and many indications that there is not one ("the relationship is present regardless of the level of intake of free sugars", for instance). Quotes are needed to support controversial content; as I do not see any prospect of us agreeing, I am going to revise this into an RfC question. WhatamIdoing, your revisions were very helpful on the last RfC, and I try to learn from my mistakes ; may I ask your review before I launch this one? Zefr, if you can specify what you find unclear, I will attempt to clarify it. HLHJ (talk) 16:41, 29 February 2020 (UTC)

I think your proposed text needs some work. An encyclopedia article does not normally need an explanation of how much scientific evidence is behind each statement. If all the good sources say something, then we don't add WP:INTEXT attribution like "according to WHO" or "in a meta-analysis". Also, listing out which groups gain and lose weight by changing their sugar consumption is "excessive detail" rather than "encyclopedic summary". I wouldn't restore the "by itself" sentence, which is confusing (do you mean if I eat sugar by itself, rather than as part of a meal?), but I'd shorten the proposed text like this:

Free sugar consumption is a determinant of body weight in people who choose their own food.

A high intake of sugary drinks (including fruit juice) increases the risk of obesity by adding to overall energy intake, likely because drinks cause less satiety than food. The risk of obesity in children is estimated to rise by 60% per can or glass of sugary drink per day. Excessive consumption of sugar-sweetened beverages increases the risk of developing type 2 diabetes and metabolic syndrome – including weight gain and obesity – in adults and children.

It's already going to take someone about half an hour to read this article (aka "an amount of time almost nobody will dedicate to reading this article"). I don't think that adding even more detail is your best proposal. WhatamIdoing (talk) 17:52, 29 February 2020 (UTC)

I take your point; last time I added TMI, I moved most of it to a more specific article. I've linked one from this section. The first paragraph comes across as a bit short and cryptic, and I think the bit about satiety could be generalized to make a statement about sugar in all forms. I'll think on this, and rephrase, trying to maximize the information density while making it easy to understand. HLHJ (talk) 23:45, 29 February 2020 (UTC)

"A cheap source of sugar is corn syrup"

Is it "cheap"? Doesn't corn syrup cost more than real sugar? Isn't the only reason corn syrup exists is because politicians get kickbacks from corn syrup producers to make imports of real sugar more expensive than corn syrup? — Preceding unsigned comment added by 124.170.88.48 (talk) 07:21, 29 March 2021 (UTC)

No- its actually cheaper to produce corn syrup because it doesn't go through near as long of a refinement process. Also, corn syrup has applications that other sugars do not, because it is composed of higher carbohydrates above disaccharides to some degree. 98.178.191.34 (talk) 03:56, 11 June 2021 (UTC)

References to "Strong"

Throughout the references to this page are a number of mentions of "Strong" with page numbers. However, there is no initial listing which gives any details of this book. I did a quick Google search and did not find anything that stood out as an obvious candidate.

These references are meaningless as is, and citing them as support for any of the assertions made herein is meaningless.

Does anyone have any idea what this book is? And if they do, can they please add the details to several of the references herein, in case the first citation is deleted at some point in the future?

MisterSpike (talk) 06:45, 11 October 2021 (UTC)

In an old version of the article https://en.wikipedia.org/w/index.php?title=Sugar&diff=910054556&oldid=909691866 I found Strong, Roy, Feast: A History of Grand Eating, 2002, Jonathan Cape, ISBN 0224061380 as an addition to the references section. JimRenge (talk) 09:28, 11 October 2021 (UTC)

No reliable evidence linking sugar consumption to Alzheimer's disease or dementia

As of 2021, there are no highly-quality evidence based reviews of clinical trials linking sugar consumption to dementia or alzheimer's disease. What does exist is speculative animal based studies done on rats, some weak cohort studies or nonsense pseudoscience published in MPDI. Due to lack of good sourcing any claims about making a "sugar–Alzheimer's disease connection" should be removed until high-quality sources are published. See current discussion at the reliable source noticeboard Psychologist Guy (talk) 00:19, 28 October 2021 (UTC)

I agree, and others do at RSN as well. I've removed the section. Woodroar (talk) 14:22, 30 October 2021 (UTC)

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Nicolevlad. Peer reviewers: Klicausi.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 10:23, 17 January 2022 (UTC)

"Foreign matter in refined sugar" listed at Redirects for discussion

An editor has identified a potential problem with the redirect Foreign matter in refined sugar and has thus listed it for discussion. This discussion will occur at Wikipedia:Redirects for discussion/Log/2022 May 4#Foreign matter in refined sugar until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Steel1943 (talk) 06:02, 4 May 2022 (UTC)