​William McCarthy, adjunct professor at the UCLA Fielding School of Public Health, and Susan Babey, co-director of the Center's Chronic Disease Program, coordinated a recent national roundtable of leading experts on sugar in foods and will present findings from that meeting at today's Center Health Policy Seminar. In this brief interview, McCarthy discusses what might come out of the meeting, some of the surprising findings, and how we can cut back our excess sugar intake.

Q: What was the purpose of bringing so many experts together in one room to discuss added sugar in foods?

​The impetus for this expert roundtable came from Kaiser Permanente's Health Policy Institute in collaboration with the American Heart Association. The American Heart Association has made decreasing Americans' excess added sugar intake a core part of their 2020 Impact Goals because of the increasingly strong research linking excess sugar intake to negative cardiometabolic outcomes. Kaiser Permanente's clinicians are increasingly aware of the need to get their patients to limit their daily intake of added sugars and would benefit from guidance about the latest consensus science concerning effective clinical approaches to reducing daily added sugar consumption.

Because Kaiser Permanente recognizes that there is more to reducing population level excess sugar intake than clinician interventions, they were open to the expert roundtable addressing the full range of public health and clinical approaches to intervention, as well as some focus on putative mechanisms by which excess added sugar is thought to harm cardiometabolic functioning.

Kaiser Permanente contracted with the UCLA Center for Health Policy Research to identify leading researchers who could speak to the full range of research on added sugars and to convene the roundtable on a day when most of the identified researchers could make it for a face-to-face meeting.

The end product was expected to be a state-of-the-art view of what is known about the linkages between added sugar intake and cardiometabolic outcomes, and about the range of strategies that have been tested for their effectiveness in reducing patients' excess added sugar intake.

Q: Were there any surprises coming out of the meeting? What did you hear that you had not heard before?

​A common assumption among psychologists treating obese patients is that many of them are "addicted" to consuming excess added sugar, implying a level of physiological compulsiveness that could only be remedied by limiting the patient's exposure to sugary foods.

Our UCLA colleague Emeran Mayer, MD, PhD, author of the Brain-Gut Connection, challenged this notion of physiological compulsion by noting that one of the surprising benefits of gastric bypass surgery is a marked reduction in appetite for sugary foods. How does constricting the stomach and shortening the usable small intestine ― actions that are limited to the gut ― have such a profound effect on how the appetite and reward systems in the brain respond to sugar intake? If "addiction" is so easily remedied at the level of the gut, we may need to rethink compulsive consumption of added sugar as an addiction.

Q: USDA data show Americans consumed 12 teaspoons of refined cane/beet sugar a day in 2015 ― that's 91 cups a year. How can consumers break up with sugar, or at least, cut back?

​Although experts differ on the recommended daily limit, added sugar consumption is a normal part of eating. The American Heart Association recommends limiting added sugars to no more than 5 percent of daily calories; the American Dietary Guidelines for Americans recommends a limit of 10 percent daily. On a 2000 kcal/day diet, that translates to a daily limit of 13 teaspoons of total added sugars.

But added sugars include high fructose corn syrup and other caloric sweeteners in addition to refined cane/beet sugar. According to the USDA, Americans consumed 22 teaspoons of total added sugars in 2015, which is 9 teaspoons more than recommended. Because added sugar is ubiquitous in processed foods ― over 70 percent of processed foods have added sugar ― the short answer to the question of what practical steps to take to reduce added sugar consumption is to limit the daily consumption of processed foods.

But the alternative to processed foods ― namely minimally processed, fresh fruits, vegetables, and whole grains which almost all Americans know they should be eating more of ― don't taste as good as most processed foods. Ten thousand years ago our hominid forebears had no problem consuming 14 daily servings of fruits and vegetables (and avoiding consumption of processed foods) whereas we moderns fall shy of even just five combined fruit and vegetable servings per day. We will not solve the excess added sugar challenge if we don't solve the problem of how to get Americans to eat more minimally processed fruits, vegetables, and whole grain foods.

Epidemiological data show that seniors, the highly educated and chronic exercisers are more successful at eating recommended amounts of minimally processed fruits and vegetables than the young, those with less than high school education and non-exercisers. Some combination of experience, knowledgeable and persistent experimentation with different food choices, and adherence to daily aerobic physical activity seem to contribute to the solution.