Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Disclosures*
Consultant, Heartland Food Products Group, manufacturer of SPLENDA® Sweetener Products
*Related to this presentation
LCS: Rationale for Use
Replace added sugars
Offer sweet, good tasting lower calorie foods, beverages, sweeteners to satisfy innate desire for sweetness
Added sugars: 270 kcals/day (13% total calories/day) 1
1. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance. http://www.health.gov/dietaryguidelines/2015-scientific-report/11-chapter-6/d6-3.asp
2. Dietary Guidelines for Americans 2015-2020, 8th ed: http://health.gov/dietaryguidelines/2015/guidelines/
Dietary Guidelines: Reduce Added Sugars
Dietary Guidelines 2015-2020: reduce/limit added sugars1,2
Growing evidence health concerns:1
Strong: Risk of overweight/obesity, type 2 diabetes (adults)
Moderate: high blood pressure, stroke, heart disease, high triglycerides
DG Advisory Committee recommendations (2/15):1
Reduce added sugars < 10% of total calories1
Revise Nutrition Facts label:
Include added sugars (total g), % Daily Value2
1. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance. http://www.health.gov/dietaryguidelines/2015-scientific-report/11-chapter-6/d6-3.asp
2. Dietary Guidelines for Americans 2015-2020, 8th ed: http://health.gov/dietaryguidelines/2015/guidelines/3. Changes to the Nutrition Facts Label: (final regulations, published 5/20/16)
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm
Final Regulations for NEW Nutrition Facts Label1,2
1. Changes to the Nutrition Facts Label: (final regulations, published 5/20/16) http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm385663.htm
2. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance. http://www.health.gov/dietaryguidelines/2015-scientific-report/11-chapter-6/d6-3.asp
When can you expect to see the
new label?2018 - 2019
Topics
• Safety regulations, review
• Benefits: weight control, diet quality
• Practical advice for use
Topics
• Safety regulations, review
• Benefits: weight control, diet quality
• Practical advice for use
Approval of Low Calorie Sweeteners by U.S. FDA
U.S. FDA regulates, approves ingredients as food additive or Generally Recognized As Safe (GRAS)1,2
Follows established rigorous protocols for safety/safety review2
Standard of safety: “…reasonable certainty of no harm…”
Approved for entire population
1. Rulis, AM, Levitt JA: FDA’s food ingredient approval process. Safety assurance based on scientific assessment. Regulatory Toxicology and Pharmacology. 2009; 53:20-31.
2. Guidance for industry and other stakeholders toxicological principles for the safety assessment of food ingredients see http://www.fda.gov/food/guidancecomplianceregulatoryinformation/guidancedocuments/foodingredientsandpackaging/redbook/default/htm
Major LCS in Use in U.S. Today1
NNS Name Initial Approval/Use+ FDA Approval Route
Saccharin U.S. use in early 1900’s GRAS2
Aspartame 1981 Food additive
Acesulfame-K 1988 Food additive
Sucralose 1998 Food additive
Neotame 2002 Food additive
Stevia extracts 2008 - 2015 GRAS2,3
Monkfruit extract (luo han guo)
2009 GRAS 2,4,5
Allulose (psicose) 2015 GRAS6
1. Academy Nutrition and Dietetics. Use of nutritive and nonnutritive sweeteners (position paper). J Acad Nutr Diet. 2012; 112(5):739-757. 2. GRAS notices are submitted to FDA under its proposed rule of April 17, 1997, published in the Federal Register at 62 FR 18938-18964. 3. What refined Stevia preparations have been evaluated by FDA to be used as a sweetener? http://www.fda.gov/AboutFDA/Transparency/Basics/ucm214865.htm4. GRAS notice no. GRN 000301 (self-affirmation notification to FDA)
http://www.accessdata.fda.gov/scripts/fcn/gras_notices/grn000301.pdf 7/23/20095. FDA. Agency response letter GRAS notice no. GRN 000301.
http://www.fda.gov/Food/FoodIngredientsPackaging/GenerallyRecognizedasSafeGRAS/GRASListings/ucm253511.htm, 4/11/20116. Agency Response Letter GRAS Notice No. GRN 000498 http://www.fda.gov/Food/IngredientsPackagingLabeling/GRAS/NoticeInventory/ucm406210.htm
+Listed in chronological order of availability in U.S. marketplace.
FDA has found all of these LCS to be safe for their intended and permitted uses.
FDA’s Definition of “Natural”, Changes?
“From a food science perspective, it is difficult to define a food product that is 'natural' because the food has probably been processed and is no longer the product of the earth. That said, FDA has not developed a definition for use of the term natural or its derivatives. However, the agency has not objected to the use of the term if the food does not contain added color, artificial flavors, or synthetic substances.1”
Update 5/9/16: “Because of the changing landscape of food ingredients and production, and in direct response to consumers who have requested that the FDA explore the use of the term “natural,” the agency asked the public [11/15] to provide information and comments on the use of this term in the labeling of human food products.”2
1. What is the meaning of ‘Natural’ on the label of food: http://www.fda.gov/aboutfda/transparency/basics/ucm214868.htm2. “Natural” on Food Labeling:
http://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm456090.htm
Organizations’ Statements Support Safety
American Cancer Society1
Nat’l Cancer Institute2
American Diabetes Association/American Heart Association3
Academy Nutrition & Dietetics4
American Diabetes Association5
American Academy of Pediatrics6
1. American Cancer Society: http://www.cancer.org/healthy/eathealthygetactive/acsguidelinesonnutritionphysicalactivityforcancerprevention/acs-guidelines-on-nutrition-and-physical-activity-for-cancer-prevention-common-questions, last revised 2016
2. National Cancer Institute: http://www.cancer.gov/about-cancer/causes-prevention/risk/myths, last revised 2014 3. Nonnutritive Sweeteners: Current Use and Health Perspectives. Scientific statement from American Diabetes Association (ADA) in Diabetes Care:
http://care.diabetesjournals.org/content/early/2012/07/06/dc12-9002.full.pdf+html) and American Heart Association in Circulation: http://circ.ahajournals.org/content/early/2012/07/09/CIR.0b013e31825c42ee. (Published simultaneously)
4. Academy of Nutrition and Dietetics. Use of nutritive and nonnutritive sweeteners (position paper). J Acad Nutr Diet. 2012; 112(5):739-757.5. Evert A, Boucher J, et al. Nutrition therapy recommendations for the management of adults with diabetes (position statement). Diabetes Care:
2013;36(11):3821-3842.6. American Academy of Pediatrics Policy Statement. Snacks, Sweetened Beverages, Added Sugars, and Schools. Pediatrics. 2015;135(3):575-583.
ADA: Nutrition Therapy for Adults: 20121
“Use of nonnutritive sweeteners (NNSs) has the potential to reduce overall calorie and carbohydrate intake if substituted for caloric sweeteners without compensation by intake of additional calories from other sources.”
Safety: statement refers to the reviews and approvals by FDA.
Glycemic effect: statement concludes research supports that NNS [LCS] do not produce a glycemic effect unless other calorie containing ingredients are in the product.
1. Evert A, Boucher J, et al. Nutrition therapy recommendations for the management of adults with diabetes. Diabetes Care: 2013;36(11):3821-3842.
Please Don’t Eat the Media Headlines*
Which studies do or don’t YOU hear about?
The third-party trademarks used herein are registered trademarks of their respective owners.
*Slide title adopted from David Katz, MD, MPH, Director of Yale University’s Yale-Griffin Prevention Research Center
Original research, go beyond press releases, spin and media headlines
On new research. Consider within existing body of evidence, government regulatory review, association recommendations and position papers
On the vast body of scientific research, not just one new study
1. Read…
2. Reflect…
3. Rely…
Don’t Eat the Media Headlines: Read, Reflect, Rely
Topics
• Safety regulations, review
• Benefits: weight control, diet quality
• Practical advice for use
LCS Use and Weight Control1
Summary: Randomized control studies done in humans consistently show that
simple behavior changes made to control weight can overcome any proposed mechanism that might
promote an increase in calories and weight gain.
1. Peters JC, Beck J: LCS use and energy balance. Physiology & Behavior. 2016. http://dx.doi.org/ 10.1016/j.physbeh.2016.03.024
LCS for Successful Weight Control: NWCR
National Weight Control Registry: largest and longest study observing the experiences of successful wt losers1
Entry: >30 lbs and kept off >1 yr
Random sample (N=434) NWCR participants Achieved mean wt loss: 34.2 + 18.5 kg maintained for 7.8 + 5.2 yrs Responded to online survey about consumption of low/no calorie
beverages
1. Thomas J. Graham, Dale S. Bond, Suzanne Phelan, et al. Weight-loss maintenance for 10 yrs in NWCR. Am J Prev Med. 2014;46(1):17-23.2. Catenacci VA, Pan Z, et al: Low/No Calorie Sweetened Beverage Consumption in National Weight Control Registry. Obesity.
2014;22(10):2244-2251.
Results:
53% regularly consume low-and no-calorie sweetened beverages daily
78% of low- and no-calorie sweetened beverage drinkers say diet beverages help them control total calorie intake
Top 5 reasons:
1. taste (54%)2. thirst (40%)3. part of routine (27%)4. reduce calories (22%)5. go with meals (21%)
LCS and Diet Quality/Healthy Eating
Drewnowski1: 5 cycles NHANES data (1999-2008), diet quality assessed* LCS consumers ate more vegetables, whole grains and low-fat dairy
Piernas2: Secondary analysis of CHOICE, 3 groups (control, water and diet beverage), 6 mos Both study groups (diet beverage, water) reduced total energy, carbohydrates, total sugar,
added sugars and other calorie containing nutrients (protein, fat)
DB: > reduction of desserts compared to water drinkers
Gibson3: Adults in UK National Diet and Nutrition Survey, 4 groups: SSB, LCS-B, non-consumers of soft drinks (NC) and consumers BB LCS-B and NC consumed less calories and sugars than consumers of SSB or BB
NC and LCS-B consumers had higher quality diets compared to SSB and BB consumers
*HEI/Healthy Eating Index was developed by USDA to measure compliance with U.S. dietary recommendations and guidelines.**Solid Fats, Alcoholic Beverages and Added Sugars. 1. Drewnowski A, Rehm CD: Consumption of LCS among U.S. adults Is associated with higher healthy eating index (HEI 2005) scores and more physical
activity. Nutrients. 2014;6:4389-4403. Infographic: http://depts.washington.edu/uwcphn/reports/lcs_infographic.pdf 2. Piernas C, et al. Dietary Consumption Patterns? Results from the Choose Healthy Options Consciously Everyday (CHOICE) Randomized Clinical Trial.
Am J Clin Nutr. 2013;97:604-611. 3. Gibson SA, et al. Low Calorie Beverage Consumption Is Associated with Energy and Nutrient Intakes and Diet Quality in British Adults. Nutrients.
2016; http://www.mdpi.com/2072-6643/8/1/9
Topics
• Trends in use
• Safety regulations, review
• Efficacy: metabolic and weight control, diet quality
• Practical advice for use
LCS: Not a Magic Bullet to Achieve Diabetes/Health Goals in the Face of Overeating and/or Unhealthy Eating
LCS: A Tool in Your Toolbox to Ease, Improve Adherence, Potentially Achieve Your Nutrition, Diabetes Goals
Weight Control3
BP Control
Lipid Control3
Glycemic Control
Diet Quality
LCS Use within Healthy Eating Plan1,2,3
1. 2015-2020 Dietary Guidelines: http://health.gov/dietaryguidelines/20152. Fernstrom JD: Nonnutritive Sweeteners and Obesity. Ann Rev Food Sci Technol. 2015;6:119-136.3. Peters JC, Beck J: LCS use and energy balance. Physiology & Behavior. 2016. http://dx.doi.org/ 10.1016/j.physbeh.2016.03.024
“Think Before You Drink”
Reduce added sugars from sugar-sweetened beverages1 (47% of added sugars from beverages2)
Water is the preferred beverage choice1
Drink sparkling water, flavored seltzer, club soda
Flavor water/seltzer with juice, lemon, lime, vegetables, dry powder mix without sugar
Choose diet soda over regular soda
Select other zero calorie beverages made with LCS
Sweeten hot or cold drinks with preferred LCS
Make your own ice tea, fruit punch, drinks with dry powder mix without sugar with preferred LCS
1. Dietary Guidelines for Americans 2015-2020, 8th ed: http://health.gov/dietaryguidelines/2015/guidelines/2. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance.
http://www.health.gov/dietaryguidelines/2015-scientific-report/11-chapter-6/d6-3.asp
Reduce Added Sugars, Satisfy Desire for Sweet Taste/Sweets
Sugar-free means added sugars free, not calorie-free
Review “natural” term
Clarify agave, honey contain calories, raise BG
Product categories: Diet soda/beverages = 0 calories
Tabletop sweeteners = negligible calories*
Sugar-free foods/beverages with calorie-containing ingredients**
Learn to cook and bake with LCS
How to replace LCS, save calories, carbohydrate and NOT compensate (replace calories) from other foods
*Calories from bulking ingredients dextrin, maltodextrin; ADA define free food <20 cal/svg**Glycemic effect: statement concludes research supports that NNS [LCS] do not produce a glycemic effect unless other calorie containing ingredients are in the product.