The purpose of dietary guidelines is to promote a pattern of eating that will allow Canadians to meet their nutrient needs and reduce their risk of developing chronic disease. Currently Canada does not have a quantitative guideline specific to total or added sugars intake as part of a healthy diet.

  • Canadian Dietary Guidelines. Health Canada suggests choosing foods with little to no added sugars, saturated fat, and salt, and choosing water rather than sugars-sweetened drinks.
  • World Health Organization Sugars Guidelines. The World Health Organization recommends reducing free sugars to less than 10% of daily energy intake, based on evidence related to dental caries.

Canadian Dietary Guidelines

The Dietary Reference Intakes (DRIs), developed by the governments of Canada and the United States, reflect the state of scientific knowledge at the time of publishing with respect to nutrient requirements to prevent deficiencies as well as lowering risk of chronic disease (1, 2).

 

 

 

 

 

In the DRI, recommendations for macronutrients such as carbohydrates, protein and fat are given as a range of intakes (based on percentage of energy) known as Acceptable Macronutrient Distribution Ranges (AMDR). The AMDR for carbohydrates, which includes sugars and starches, is 45-65% of energy for adults and children. There is no AMDR specific to total sugars, added sugars, free sugars, or starches.

 

 

In addition, many nutrients have a Tolerable Upper Intake Level (UL) -- the highest average daily nutrient intake level that is likely to pose no risk of adverse health effects. Based on reviewing the available data, no UL was set in the DRIs for total sugars, added sugars, free sugars, or starches.

 Health Canada released a revised Canada's Food Guide in January 2019 to help Canadians eat well and live well (3). The Guide provides recommendations both on what to eat and how to eat. 

  • Indviduals are encouraged to eat a variety of healthy foods each day, including plenty of vegetables and fruits, whole grain foods, and protein foods, and to choose foods with healthy fats. 
  • Canada's Food Guide encourages Canadians to limit "highly processed" foods and beverages, defined as foods and drinks that added excess sodium, sugars, and saturated fat to the diet, and to instead choose foods with little to no added sodium, sugars, and saturated fat. 
  • Water is promoted as the drink of choice and individuals are encouraged to replace sugars-sweetened beverages and fruit juices with water. 
  • The Guide notes that sugar substitutes are "not needed to make healthy eating choices" and can actually "make healthy eating more difficult" because foods and drinks with sugar substitutes may replace healthier foods, and still taste sweet. 
  • There is also a focus on encouraging individuals to be mindful of their eating habits, cook more often, enjoy their food, and eat meals with others more often. 

 

World Health Organization (WHO) Sugars Guidelines

The World Health Organization Guideline on Sugars Intake for Adults and Children presents two strong recommendations and one conditional recommendation on free sugars intake (4). Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook, or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. In practical terms, free sugars represent the combination of added sugars and 100% fruit juices.

  1. WHO recommends a reduced intake of free sugars throughout the life course. 
  • WHO indicates that excess sugars intake results in excess energy intake, which is associated with increased body weight, and that there is no unique effect of sugars compared to other carbohydrates on obesity. 
  1. In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake based on moderate quality evidence from observational studies related to dental caries, not obesity or other chronic diseases. 
  • WHO's evidence review for the 10% target does not account for the large body of research showing that in addition to quantity, the frequency of consuming all fermentable carbohydrates, including sugars and starches, contributes to tooth decay. 

WHO also presents a conditional recommendation to further limit free sugars intake to less than 5% of total calories. These recommendations are based on “very low quality evidence from ecological studies” conducted in the 1950s that evaluated the relationship between free sugars intake of children in Japan in relation to dental caries (5-7).

Researchers systematically reviewed the scientific basis of guideline recommendations on sugars intake around the world, and deemed the quality of evidence to be low for both sugars and body weight, and sugars and dental caries (8).

Summary of WHO Scientific Support for WHO Quantitative Recommendations

WHO Recommendation Strength of Recommendations Strength of Evidence Type of Evidence WHO Reference
"In both adults and children, WHO recommends that intake of free sugars not exceed 10% of total energy" Strong recommendation

Moderate

Dental caries, not obesity

5 observational studies in children; insufficient data for pooling Annex 1, Table 5
"WHO suggests further reduction to below 5% of total energy" Conditional recommendation

Very low

Dental caries, not obesity

3 ecological studies in Japanese children; correlation of dental caries with sugar supply before and in the years following WW II. Meta-analysis not possible due to the variability of outcome measures.  Annex 1, Table 6

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References

  1. The National Academies of Sciences Engineering and Medicine, Institute of Medicine.  https://www.nap.edu/catalog/10490/dietary-reference-intakes-for-energy-carbohydrate-fiber-fat-fatty-acids-cholesterol-protein-and-amino-acids
  2. Health Canada. Dietary Reference Intakes. http://www.hc-sc.gc.ca/fn-an/nutrition/reference/index-eng.php
  3. Health Canada. Canada’s Food Guide. https://food-guide.canada.ca/en/food-guide-snapshot/
  4. World Health Organization. 2015. Guideline: Sugars Intake for Adults and Children
  5. Takahashi K (1959). Statistical study on caries incidence in the first molar in relation with amount of sugar consumption. Jpn J Oral Hyg 9:136.
  6. Okuya Y (1960). The epidemiological study of the relation between caries incidence and sugar consumption on the second molar. Shikwa Gakuho 60:1120-1134.
  7. Koike H (1959). Studies on caries incidence in the first molar in relation with amount of sugar on primary school children in Kyoto. J Okayama Med Soc 72:407.
  8. Erickson J, Sadeghirad B, Lytvyn L, Slavin J, Johnston BC. The Scientific Basis of Guideline Recommendations on Sugar Intake: A Systematic Review. Ann Intern Med. 2017 Feb 21;166(4):257-267.