The Low Down on South Africa’s Sugar Tax

Chat Leave a comment January 17, 2017 nutritionadsa

The Minister of Finance announced in the February 2016 National Budget a decision to introduce a tax on sugar-sweetened beverages (SSBs), with effect from 1 April 2017, to help reduce excessive sugar intake by South Africans. The Association for Dietetics in South Africa (ADSA) welcomes this step as one part of the solution to address the obesity problem and improve the health of South Africans.

How much sugar do South Africans really consume?

When you think of sugar-sweetened beverages, the first thing that comes to mind is the regular fizzy drink, but the term encompasses far more than that. SSBs are beverages containing added sweeteners that provide energy (‘calories’ or kilojoules) such as sucrose, high-fructose corn syrup or fruit-juice concentrates. This includes carbonated drinks (fizzy soft drinks and energy drinks), non-carbonated drinks (sports drinks, iced teas, vitamin water drinks and juice concentrates), sweetened milk drinks and sweetened fruit juices. And many of us do not realise just how much sugar is found in these drinks. For example, a 330 ml bottle of iced tea has a little over 6 teaspoons of sugar!

ADSA is concerned that the intake of added sugars (sugars added to foods and drinks during processing by the food manufacturing companies, cook or consumer) is increasing in South Africa, both in adults and children. Some estimate that children typically consume approximately 40-60 g/day of added sugar, possibly rising to as much as 100 g/day in adolescents. High intakes of added sugar, particularly as SSBs, has been shown to lead to weight gain and cause dental caries. The added sugar in these drinks makes them high in energy (kilojoules). Because these drinks don’t make us feel full in the same way that eating food does, most of us don’t reduce our food intake to compensate, making it easy to consume too many kilojoules. Over time, these extra kilojoules can cause one to become overweight, putting us at risk for diabetes, heart disease and certain cancers. Obesity is already a massive problem in South Africa, with 2 in 3 women and 1 in 3 men being overweight or obese, as well as almost 1 in 4 children.

What is ADSA’s recommendation for sugar intake?

ADSA supports the recommendations by the World Health Organization (WHO) and the South African Food-Based Dietary Guidelines that we need to reduce the intake of beverages and foods that contain added sugars, such as sugar-sweetened beverages, sweetened yoghurts, frozen desserts, some breakfast cereals, ready-to-use sauces, cereal bars, health, savoury and sweet biscuits, baked products, canned or packaged fruit products, sweets and chocolates. The WHO advises reducing the intake of free sugars found in foods and beverages (including added sugars, but excluding sugars naturally present in fresh fruits, vegetables and milk) to less than 10% of total energy (kilojoule) intake for the day (i.e. 50 g of sugar, which is approximately 12 teaspoons per day), with a conditional recommendation to further reduce intake to 5% of total energy (approximately 6 teaspoons per day) for additional health benefits. The South African Food-Based Dietary Guidelines also advise to ‘use sugar and foods and drinks high in sugar sparingly’. To put this into perspective, a 500 ml bottle of a carbonated drink will provide your maximum sugar allowance for an entire day!

The sugar tax – is it a good idea?

The proposed tax on SSBs will mean roughly a 20% tax will be added on to sugary drinks, which is intended to decrease the purchase and consumption of SSBs. Encouragingly, in Mexico, a sugar tax has reduced sugary drink sales by 12% in the first year. The sugar tax is likely to affect shelf prices, but will also motivate manufacturers to reduce the amount of sugar added to their products.

ADSA welcomes the proposed tax on SSBs, but acknowledges that the sugar tax is only part of the solution to address the growing obesity problem. Just as taxing tobacco does not reduce or stop smoking by all people, taxing SSBs will not reduce or stop all purchasing and consumption of SSBs and reduce obesity on its own. Obesity is a complex condition, and sugar is not the only cause. There is a need for multiple interventions across a variety of different sectors to address unhealthy diets and lifestyles and have an impact on the obesity epidemic. ADSA recommends that revenue generated from the tax should go towards health promoting interventions, such as subsidies to reduce the costs of fruits and vegetables, education around healthy choices and creating an enabling environment to make those healthier choices easier.

In addition to reducing the consumption of SSBs to prevent obesity and promote long-term health, ADSA continues to recommend a healthy diet which includes whole grains, fruit, vegetables, nuts, legumes, healthy oils, proteins such as lean meats and seafood, and a reduced intake of processed meats and salt, accompanied by regular physical activity.

ADSA’s detailed Position Statement on the Proposed Taxation of Sugar-Sweetened Beverages, with references, can be accessed here: http://www.adsa.org.za/Portals/14/Documents/2016/Nov/ADSA%20Position%20Statement%20on%20Sugar%20Tax_Final_28%20Nov%202016.pdf

 

What your dietitian wants you to know about diabetes

Chat 1 Comment November 15, 2016 nutritionadsa

There were 2.28 million cases of diabetes in South Africa in 2015 according to the International Diabetes Foundation and around 1.21 million people with undiagnosed diabetes. Considering these numbers it remains vitally important to continue educating South Africans about diabetes and to address the myths that are often associated with this lifestyle disease.

Nasreen Jaffer, Registered Dietitian and ADSA (Association for Dietetics in South Africa) spokesperson has a special interest in diabetes. She debunks some of the myths surrounding diabetes and nutrition:

People with diabetes have to follow a special diet or have to eat special diabetic foods.

People with diabetes do not have to follow a ‘special’ diet. People with diabetes need to make the same healthy eating choices as everyone else. Healthy eating choices include vegetables and fruit; whole grains; fish, lean meats and poultry; dairy products; seeds, nuts, legumes and plant oils. Everyone needs to limit fatty red meats, processed meats, salt and foods high in salt, and foods and beverages with added sugar.

There are foods that should be avoided completely.

The answer, is ‘no’. Moderation is key, the minute you’ve banned a certain food entirely, you’re likely to start craving it intensely. Your health and weight are more affected by what you do daily than what you eat once or twice a week, so if you’re in the mood for a piece of cake once in a while, buy a small one and share. If you deprive yourself of something you’re craving, it’s just a matter of time until your binge on it and sabotage your motivation. However, crisps, chocolates, and sweets are high in saturated and trans fat, while sugar-sweetened beverages like soft drinks, iced tea and energy drinks contain a large amount of sugar, so these have to be limited.

 If I am diabetic, my diet is going to be more expensive.

It is not necessary to buy expensive foods marketed to diabetics. Healthy eating can be economical, and is often cheaper than buying unhealthy treats. Buying seasonal fresh fruit and vegetables is cheaper than buying fruit juices and sugar-sweetened beverages. If you replace sweets, chocolates, crisps, puddings and cakes with fruits, yoghurt and salads as your snacks and desserts, you’ll find you will save money. Legumes, such as lentils and beans, are cheaper alternatives to red meat, while providing numerous health benefits.

Eating too much sugar causes diabetes.

Too much sugar does not necessarily cause diabetes, but because foods and drinks with added sugar are often energy-dense (high in kilojoules), consuming too much of these on a regular basis can lead to weight gain. This can put us at risk for type 2 diabetes. Sugar-sweetened beverages seem to have the strongest link to type 2 diabetes. ‘Sugar’ doesn’t only refer to the sugar added to tea and coffee, but also includes sugar and sweetened products added when cooking and at the table. Look out for hidden sugars in pre-prepared and processed foods, like some breakfast cereals, sweetened drinks, dairy products, sauces and sweet treats. People with diabetes should limit or avoid adding sugar as it can have a negative effect on blood sugar levels.

 People with diabetes cannot eat carbohydrates.

No, this is not true. While all foods that contain carbohydrates will affect your blood sugar levels, people with diabetes can still eat carbohydrate foods. There are healthy types of carbohydrates that you do want to include in your eating plan, and the type or quality of carbohydrate foods is important. Therefore, for optimal blood glucose control it is important to control the quantity, and distribute carbohydrate foods equally throughout the day. For example, choose wholegrain or high-fibre carbohydrate foods as they don’t increase blood sugar as quickly as refined grains, and make sure that each meal is balanced, containing not only carbohydrate foods, but also protein or dairy, non-starchy vegetables or healthy fats.

People with diabetes should restrict their fruit intake.

Because fruit contains natural sugars, too much fruit can contribute to an increase in blood glucose levels. However, eating fruit also adds fibre, and essential vitamins and minerals to the diet, so while people with diabetes should not eat excessive amounts of fruit, fruit should not be completely eliminated. Portion control is important, and people with diabetes should choose whole fruit rather than fruit juice. It is recommended that you consult your dietitian to calculate the amount of fruit that you should include in your daily diet.

If one of my parents has diabetes, there is nothing I can do about it – I will develop diabetes eventually.

If you have a genetic predisposition to type 2 diabetes, you have all the reason you need to embrace a healthy lifestyle. While genetics may contribute 30 to 40% to the development of any condition, including diabetes, environmental and lifestyle factors may have a 60 to 70% impact. If you maintain a healthy body weight, stick to a healthy eating plan, avoid tobacco use and keep physically active regularly, you have a very good chance of not developing diabetes.

If I have diabetes, I can’t exercise.

On the contrary, diabetes is a compelling reason to exercise regularly. The reason for this is that physical activity plays a very important role in lowering blood glucose levels. Exercise also predisposes your body cells to being more sensitive to insulin, and of course, it helps to achieve and maintain a healthy body weight. Aim for at least 150 minutes of moderate intensity activity a week, such as brisk walking, while doing some resistance or strength exercises at least twice a week. If you use insulin it is important to check your blood glucose levels before and after physical activity. If you get results below 6 mmol/l it is recommended that you lower your insulin dose or eat a healthy snack to prevent a hypoglycemic attack during or after exercise.

Early diagnosis of diabetes is vitally important. This year the theme of World Diabetes Day is “Eyes on Diabetes”, focusing on the screening for type 2 diabetes to ensure early diagnosis and treatment, which can in turn reduce the risk of serious complications. The sooner that elevated blood glucose levels can be treated and returned to normal, the better. If you are diagnosed with either pre-diabetes or diabetes, you need to start moving towards a healthier lifestyle that focuses on regular physical activity, good nutrition and weight-loss if you are overweight or obese.

Everyone over the age of 45 years should be screened for diabetes every 2 to 3 years, or earlier if you are overweight and have other risk factors for diabetes (such as a family history, high blood pressure or previous diabetes during pregnancy). If you haven’t yet been screened, visit a healthcare professional to find out if you are at risk.

Should you experience any of the following symptoms contact your doctor as soon as possible – sudden weight loss, hunger, blurred vision, tiredness, excessive thirst and frequent urination.

To find a registered dietitian in your area who can assist you with a diabetic-friendly lifestyle plan, visit www.adsa.org.za.

 

Carte Blanche – Sugar Addiction

Leave a comment May 31, 2015 nutritionadsa

Tonight at 7pm Carte Blanche is airing an insert on ‘Sugar Addiction’ which includes an interview with ADSA President, Claire Julsing-Strydom. They asked some interesting questions and we would like to share those with you:

Is sugar addiction real?

The answer is that yes sugar can lead to addictive like eating behaviour. Food addiction is real, especially in individuals who have a predisposition towards addiction and addictive like eating behaviour. Studies refer to the hedonic pathway of food record, what we know is that excessive sugar intake alters dopamine and opioid neurotransmission thereby increasing food intake.  But it is important to note that BOTH sugar and high fat foods mobilise the latter establishing hard wired cravings in these areas.  Current literature indicates that addictive like eating behaviour can be attributed to refined carbohydrates (sugar and white flour) as well as fats.  The Yale Food addiction scale suggests that highly processed foods that combine sugar and fat are more likely to lead to addictive like eating behaviours.

How much sugar is too much?

The intake of added sugar appears to be increasing steadily across the South African population. Children typically consume approximately 40-60 g/day, possibly rising to as much as 100g/day in adolescents. This represents roughly 5-10% of dietary energy, but could be as much as 20% in many individuals. The South African Food Based Dietary guidelines recommend that sugar and foods and drinks high in sugar be used sparingly.  The World Health Organisation have in their most recent guidelines recommended reducing total energy from sugar to below 5% from the previous 10%.  This equates to about 25g pf sugar per day which is approximately the same as 5 teaspoons of sugar. Keep in mind then that a single can of cold drink will exceed 25g of sugar.

In a balanced diet what kind of sugars should we be eating?

Naturally occurring sugars in whole foods such as lactose in yoghurt or fructose in fruits which occur in a fibre matrix have a very different metabolic process then refined carbohydrates and sugar.  It is important to avoid the excess intake of sugar – there is allowance for moderate intake in accordance with dietary guidelines. However research does intake that intakes of added sugars in on the rise and people need to start adjusting their intakes.

Why does ADSA have sponsors that have products that contain sugar?

Woolworths and Pick n Pay are sponsors of ADSA they stock chocolate and colds drinks, but just because they stock these particular food items and are sponsors of ADSA, does not mean that we as ADSA endorse or promote these particular products.  Our sponsorship policy states that we don’t endorse products and in accordance with the South African Food Based Dietary Guidelines and evidence based information we make recommendations to our patients based on their individual nutritional requirements.

A food product that contains sugar can be included in a balanced meal plan as discussed earlier in line with local and international guidelines. Excess sugar intake however should be avoided as it is associated with adverse health risks. What is important to note is that when we have sponsorship discussions with industry it is made very clear that our sponsorship policy does not allow for endorsements in any way. ADSA is an NGO and all the dietitians that work for ADSA do so on a voluntary basis and do not get paid for the work that they do to serve the dietetics profession and the public by informing them on nutrition related matters. Various companies sponsor ADSA and all the funds that we collect through sponsorship are pooled. These funds are used in order to support the dietetics profession and ultimately the improvement of nutritional status for all South Africans. To read more on our sponsorship policy please visit our website: www.adsa.org.za

Response to Grass Consumer Group Questions

10 Comments February 25, 2015 nutritionadsa

Grass Consumer Group asked us some very important questions on Twitter last week. Some of our answers won’t quite fit into 140 characters, so we’ve put together a Q&A in response to their questions:

Question1: ‘You state that you share science-based research with your members – what about public awareness? Any sugar studies? How do you promote the nutritional well being of the community?

We are involved in numerous activities to raise public awareness around nutrition issues including National Nutrition Week, a Department of Health initiative to inform the public on practical ways to incorporate the South African Food Based Dietary Guidelines. This includes messages around sugar.

We also support the South African Food Based Dietary guidelines that clearly state the following about sugar: “Use foods and drinks containing sugar sparingly, and not between meals” and agree with the following abstract from SAJCN on the reviewed dietary guidelines 2010: “This should remain unchanged. An excessive intake of sugar should be seen as a public health challenge that requires many approaches to be managed, including new policies and appropriate dietary advice.” (http://www.sajcn.co.za/index.php/SAJCN/article/view/752)

The South African Food Based Dietary guidelines and this technical paper were shared with dietitians and nutritionists at the 25th Congress of the Nutrition Society of South Africa and the 13th Congress of the Association for Dietetics in South Africa.

A document “Guidelines for Healthy Eating Information for Nutrition Educators” was created to be used by nutrition educators in the public sector.

We have partnered with PEN Global Resource for Nutrition Practice, a dynamic knowledge translation subscription service to bring our members the most up-to-date, evidence-based nutrition resources.

ADSA Spokespeople are always available to engage with the media on nutrition topics and communicate nutrition messages to the public via ADSA website http://www.adsa.org.za, ADSA blog https://nutritionconfidence.wordpress.com/, ADSA Twitter account https://twitter.com/ADSA_RD and ADSA Facebook page https://www.facebook.com/ADSAorgza.

We share nutrition information around many topics, including but not limited to strategies to reduce salt intake (we are involved in the Salt Watch campaign), sugar, obesity, portion control, food labeling, nutrition during pregnancy, breastfeeding, nutrition for active kids, nutrition for cancer patients and nutrition for optimal diabetes management.

We have in the past (and will continue in the future) been involved with campaigns during Salt Awareness Week, Breastfeeding Week, Diabetes Month and many more.

Question 2: How do you approach your sponsors? Who approaches whom? What is a gold sponsor?

Some of our sponsors have approached us directly and others we approach. We (ADSA) and some of our members work with industry and think that is a powerful way to make change happen. We believe that it is important for us and dietitians to be involved with the food industry – imagine the food supply if we didn’t.

At the same time we don’t believe in endorsing brands to the communities within which we work, hence the decision to remove logos from our public-facing channels as this can influence public perception. Our sponsors are also not allowed to use the ADSA logo on their websites or with their products. We don’t hide our sponsors (https://nutritionconfidence.wordpress.com/2015/02/19/a-word-from-claire-julsing-strydom-adsas-president-on-sponsorships/) but don’t allow for endorsements of any kind and therefore have made these changes to our sponsorship policy. More info about our sponsors or their products are only available to our members through the Log In function on our website. It hasn’t always been like this, but we learn and evolve and make changes.

Our members are trained health professionals that are able to look at a variety of food products (that are used by the public) with the necessary knowledge to ascertain how and when various nutrients and food products would be beneficial for a client based on their individualised nutritional requirements.

We are currently working with corporates outside the food industry, to get them on board as sponsors, because we are unable to function as a not-for-profit organisation without financial support. The income from our membership fees only covers 66% of the budget we need to continue educating and supporting our dietitians, as well as promoting the nutritional well being of the community. Sponsorship funds are pooled and use for the administrative costs. All nutrition related matters or purchasing of functionalities like PEN will come from membership fees, which have increased dramatically in the last year to accommodate these changes.

We have various tiers of sponsorship, which are based on the level of financial contribution a company makes and offers different benefits to the sponsor. These benefits are all related to industry affairs and member communication, not public interaction or communication. Our sponsors have never influenced decisions made by ADSA and donate funds to the association to promote the dietetics profession in South Africa and ultimately improve nutrition education to the public through dietitians and we are grateful to our sponsors for their assistance.

Question 3: Please respond to why you promote sports cereal bars for kids and suggest sweetened low fat flavoured milk drinks for kids as per this article on your website: http://www.adsa.org.za/Portals/14/Documents/Nutrition%20Info/NutritionTipsForActiveChildrenByKarlienSmit.pdf

The @GrassAction tweet with regards to the article was taken out of context. We advocate evidence-based, individualised advice.  When choosing foods, context, portion and frequency are key considerations. This article specifically referred to active kids that take part in sports and is backed by relevant evidence.

As medical professionals we are bound by ethical codes and at all times ensure that our content is backed-up by evidence. The links are included in the article. Please have a read-through and let us know if there are specific questions you have about the evidence or flaws within that evidence.

We stand by this article, within the context of “An ideal training diet for active children”.

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We find that many South African’s blindly follow nutrition advice and fad diets without asking questions, digging deeper and really looking at the research. Without consumer groups like Grass Action some questions would never make it into the public space. Thank you for asking the tough questions.