How much sugar is OK? Paper adds to debate

— How many spoonfuls of sugar can you have in a day? The World Health Organization advises no more than about 6 teaspoons of added sugar — less than a can of soda. The same recommendation was made for children in a study published in the journal Circulation in August.

The US government put a limit on sugar for the first time in its 2015 dietary guidelines, recommending that added sugar should make up no more than 10% of your daily calories. For a 2,000-calorie-a-day diet, that would be 12 teaspoons.

Now, a review paper published in the journal Annals of Internal Medicine on Monday suggests that such guidelines might be wrong, saying they are based on low-quality evidence.

Current guidelines on dietary sugar fail to adhere to standards made by the American nongovernmental organization Institute of Medicine in 2011, said Bradley Johnston, a scientist at Toronto’s Hospital for Sick Children and an assistant professor in the department of clinical epidemiology and biostatistics at McMaster University in Canada. He was the senior corresponding author of the new paper.

“Although our findings question the specific sugar recommendations from guidelines produced by leading authorities, the findings should not be used to justify high or increased consumption of sugary foods and beverages,” Johnston said.

Rather, “results from our review should be used to promote improvement in the development of trustworthy guidelines on sugar intake,” he said. For instance, that there has been similar confusion over recommendations for how much water you should drink each day. “Some suggest eight glasses. However, we don’t really know. Perhaps it is 12 or six or four.”

Yet some experts argue that the new paper’s findings themselves should be questioned, especially because the review was funded by the North American branch of the International Life Sciences Institute, a nonprofit organization with ties to Coca-Cola, Hershey’s and other food companies.

“In essence, this study suggests that placing limits on ‘junk food’ is based on ‘junk science,’ a conclusion favorable to the junk food industry,” said Dr. Dean Schillinger, a professor of medicine at the University of California, San Francisco, who wrote an editorial that accompanied the new paper and outlined his concerns.

“Studies are more likely to conclude there is no relationship between sugar consumption and health outcomes when scientists receive financial support from food and beverage companies,” he said.

‘Guideline recommendations have to do a better job’

For the paper, Johnston and his colleagues reviewed nine separate guidelines on sugar made by health authorities from around the world between 1995 and 2016.

The researchers used two separate methods frequently employed in studies to rate the guidelines for trustworthiness and to assess their quality of evidence.

Using one of the methods, the researchers found that, for otherwise healthy members of the public, the overall quality of evidence to support recommendations made in the guidelines was low to very low.

“In other words, there is a lot of uncertainty around the recommended thresholds, especially for outcomes that are important to the public, (such as) obesity (and) type 2 diabetes,” Johnston said.

According to the other method, the quality of the development of the guidelines was moderate, the researchers found. “That is, guideline recommendations have to do a better job of assessing the quality of evidence underpinning their recommendations and be more transparent on what the quality of the evidence actually is,” Johnston said.

In the United States, dietary guidelines made by the federal government are released every five years, so consumers may have to wait until 2020 for new guidance.

A war against diabetes

Although all of the reviewed guidelines in the paper recommended a decrease in sugar consumption, “the rationale and evidence used to make each recommendation were inconsistent,” the researchers wrote.

But since the researchers reviewed guidelines published over a 20-year period, Schillinger said, they were likely to find inconsistencies. “It is widely known that science evolves over time,” Schillinger said.

“In addition, their claims regarding the low quality of guidelines are based on the application of inappropriate metrics,” he said. One of the methods the researchers used in the paper “is the wrong tool for the job and virtually guaranteed that they would falsely conclude that guidelines are of low quality,” Schillinger said.

Schillinger also pointed to the new paper’s funding as a major limitation, which has been seen before in the history of sugar research.

The Sugar Association, previously called the Sugar Research Foundation, funded studies on sugar health risks in the 1960s and ’70s, according to a historical analysis published online in the journal JAMA Internal Medicine in September.

Those previous studies promoted the consumption of fat as a primary risk factor for heart disease and avoided placing blame on sugar, according to the analysis.

A separate paper published in the American Journal of Preventive Medicine in October shed light on how Coca-Cola and PepsiCo have sponsored national health and medical organizations.

“Added sugars not only provide unnecessary and ’empty’ non-nutritious calories but also appear to affect unique and specific unhealthy metabolic pathways that contribute to obesity and diabetes and heart disease, irrespective of calories,” Schillinger said.

“We are in a public health war against diabetes, and we need to create smart strategies to win this war and prevent needless suffering and death. This is serious business,” he said.

“To illustrate the seriousness of the war on diabetes, in the first 10 years of the Iraq (and) Afghanistan war, about 1,500 US soldiers lost a limb in battle,” Schillinger said, citing a 2015 report (PDF) released by the Congressional Research Service.

In comparison, over the same time period, about 730,000 adults with diabetes lost limbs, Schillinger said. About 73,000 lower-limb amputations were performed in adults with diagnosed diabetes in 2010 alone, according to a 2014 National Diabetes Statistics Report (PDF).

“It is time we fought a home-front war against diabetes,” he said.

Schillinger added that he stands by current governmental guidelines recommending that added sugar should not exceed between 5% and 10% of your daily calories.

“This translates into about 80 to 160 calories derived from added sugars for a youth,” Schillinger said. He said that one can of soda contains about 150 calories worth of sugar.

The average percent of total daily calories from added sugars consumed among men and women between 2005 and 2010 was 13%, according to the Centers for Disease Control and Prevention.

“Were the public to believe and follow such guidelines, this would mean that profits for junk food companies would fall by half,” Schillinger said. “So there is both a lot of money and a lot of lives on the line.”

More benefits to a high-fat Mediterranean diet, new study says

— Are you avoiding fats in your daily diet? It may be time to stop — that is, if your daily diet is Mediterranean.

A new paper confirms that a Mediterranean diet rich in “healthy” fats — such as those found in olive oil, eggs, nuts and fatty fish — might lower your risk of heart disease, breast cancer and type 2 diabetes.

Heart disease is the leading cause of death among adults in the United States, followed by cancer, according to the Centers for Disease Control and Prevention.

More research is needed to determine exactly why certain foods in a high-fat Mediterranean diet are associated with a lower risk of cancer and other ailments, said Dr. Hanna Bloomfield, core investigator at the Department of Veterans Affairs Center for Chronic Disease Outcomes Research and lead author of the paper.

“It is not known but may be because of an anti-inflammatory effect,” she added. Nonetheless, the paper offers even more support for the long list of benefits that the diet offers.

For the paper, which was published in the Annals of Internal Medicine on Monday, researchers reviewed 332 previous studies and analyzed about 56 of those studies, taking a close look at the health benefits of a Mediterranean diet that included a lot of fat.

“Healthy fats are mono-unsaturated fats as found in olive oil, canola oil and avocados,” Bloomfield said. Unhealthy fats include saturated and trans fats, such as those found in potato chips.

The researchers described a Mediterranean diet as a diet that placed no restriction on fat intake and included two or more of seven components:

High mono-unsaturated-to-saturated fat ratio, which can be the result of using olive oil as a main cooking ingredient High fruit and vegetable intake High consumption of dark green leafy vegetables High grain and cereal intake Moderate red wine consumption Moderate consumption of dairy products Low consumption of red meat and meat products with an increased consumption of fish

The analysis showed that even though such a diet may not affect overall mortality, it may be effective at reducing incidences of certain diseases.

“I was not surprised because the literature on which this study was based has been out there for a while,” Bloomfield said.

Dr. Dariush Mozaffarian, dean of the Tufts Friedman School of Nutrition Science & Policy who was not involved in the new paper, said that he’s also not surprised by these results.

“There’s not much new here,” he added. After all, in recent years, numerous studies have touted the benefits of a Mediterranean diet, finding that it boosts bone and heart health.

A new study, published in the American Medical Association’s journal of Internal Medicine this month, suggests that replacing saturated and trans fat with unsaturated fats can help you live longer.

Separate research published in the journal Lancet last month found that a high-fat Mediterranean diet may be more effective than a low-fat diet at helping you lose weight.

“Probably because people who are on fat-restricted diets tend to get more of their calories from sugar, such as soda, and unrefined grains,” Bloomfield said.

She advises that Americans incorporate more avocado, nuts and olive oil in their daily diets in order to consume more “healthy” fat.

Black and blue: Double despair for African-American police

— Even before five fellow Dallas officers were shot and killed last week, Morris Pope was already in sorrow.

Like much of the country, the senior corporal had seen the police shooting deaths of black men in Falcon Heights, Minnesota, and Baton Rouge, Louisiana, on video.

“It hurt me when I saw what happened in Minnesota. I told my wife, I can’t do this job anymore. I was that hurt about what I’ve seen,” Pope said.

The shootings by and against police caused double despair for the 12% of local police officers across the United States who identify as black and wear blue uniforms. Now, in the aftermath of a tragic first week of July, CNN asked several of them to reflect on what it’s like to be part of two communities in pain.

“When you’re a black officer, you have a very unique perspective,” Pope said.

Many officers were hesitant to open up about the recent tragedies for fear of losing their jobs or jeopardizing their safety. But Pope and others argued it’s more important now than ever to encourage dialogue.

“I hope people look at the Dallas shooting and realize that, wow, we have a problem,” said Anwar Sanders, 27, a black police officer in New Mexico. “And we have to think long term to fix that problem, or history will keep repeating itself.”

Spotting the fear

Indeed, issues around race, gun violence and policing in the United States are not new.

The Rev. Martin Luther King Jr. mentioned police brutality in his “I Have a Dream” speech. Later, the videotaped police beating of taxi driver Rodney King in Los Angeles in 1991 led to riots. More recent videos showed the police killings of Walter Scott in North Charleston, South Carolina; Tamir Rice in Cleveland; Eric Garner in New York; and then last week Alton Sterling in Louisiana and Philando Castile in Minnesota.

“It’s the same thing that’s happening over and over again, and it’s just different names, different places and different people,” said Reginald Cotton, 33, a black Illinois police detective.

After watching videos of the violence last week, Cotton’s first thought was, “There’s so much anger out there.”

He said, “People are scared of police and the police are scared of people.”

To fix the problem, Cotton begs for police departments and the communities they patrol to band together. People need to know what police see on the street, he said, and police need to know what residents are feeling.

“We need to eat at the same table and break bread and talk and get things out,” said Cotton, who’s also the founder of the Charity Contributors of Chicago, which raises money for nonprofit groups to help minority communities. “We have to educate our officers on how to develop trust within the community and how to become a part of the community.”

Black officers in Dallas also said the relationship between minority communities and police departments is struggling.

“Unless we get to have a serious dialogue and be honest about a relationship that sometimes doesn’t even exist at all, we will always be at this point where everyone loses,” said Pope, an officer of 29 years who serves as parliamentarian of the Black Police Association of Greater Dallas.

Recognizing racism

Sanders, the police officer in New Mexico, said if white officers policing a black community don’t make an effort to engage and nurture that relationship, they might make judgments based on fear, misunderstanding and stereotypes.

For example, if an officer views residents of a mostly black community as more violent or dangerous, then that officer might be more inclined to use force when interacting with them, leading to headline-making shootings.

“Some people don’t even know they think that way,” Sanders said.

“I see it all the time,” he added. “I was at the gym and a white woman saw me walk in. She got off her machine and moved her bag so that it was away from me. … She didn’t realize I’m a cop. She just saw me as a threat.”

In an emotional video posted live to Facebook, Ohio police Officer Nakia Jones said officers who experience such fear should quit. The video has garnered more than 7.5 million views.

“If you’re afraid to go talk to an African-American female or male or a Mexican male or female because they’re not white like you, take the uniform off,” Jones, an officer of 20 years, says in the video. “You have no business being a police officer.”

The true meaning of blue

Building a relationship with the community is what being a police officer is about, Cotton said.

When he first became a police officer, Cotton said he thought the job was all about catching the typical “bad guys,” maybe drug dealers or car thieves. Over time, he realized the most important aspect of the job is being part of the community.

“I remember getting a random call about a woman who couldn’t light her pilot light. I was 24 at the time,” Cotton said.

“I walked into the home, and it was this 80-year-old lady who said that she didn’t have any family members in the area and if she bent down to light the pilot light, she might not get back up,” he said. “That really struck a chord in my heart, and I thought, wow, this is what it’s about. For a year straight, I asked her, ‘Are you alright? Everything OK?’ “

But police see the negatives in a community, too. “I just saw two dead babies in a triple homicide last week,” he said. “These things change people.”

Still, if more officers focus on the positives, it might strengthen ties between people and police, Cotton said.

“The reason why I became a police officer was to make a difference in people’s lives. I knew what it was like to have a parent on drugs. I knew what it was like to watch people be picked on and bullied on,” Jones, the Ohio officer, says in the Facebook Live video.

“I wanted to make a difference. … I am my brothers’ and my sisters’ keeper. That’s why I’m going to keep this uniform on.”

Similarly, Sanders values his ties to the community he polices. As he spoke to CNN on the phone, a young man approached the officer and said, “My brother wants to be a cop. … What should he do?”

“Just go online and apply, buddy,” Sanders said.

Starting the dialogue

Meanwhile, Cotton plans to organize a panel discussion for his community about the recent shootings and protests. He wants to include police officers, city officials and residents.

“It’s about keeping the conversation open,” he said, “and actually talking with each other and not to each other.”

Thomas Glover, a Dallas police lieutenant and president of the Black Police Association of Greater Dallas, said dialogue needs to be followed by action.

“In order to make progress, we have to put some concrete things in place,” said Glover, who has served 35 years with the department. He called for federal laws that would make police misconduct illegal.

“A lot of people say we already have those, but we don’t see a lot of people prosecuted under them,” Glover said. “We ought to have some type of permanent outside review for police officers and police action set up all across this country. … But No. 1, we ought to have a dialogue.”

CNN’s Scott Glover contributed to this report.

To improve your memory, get moving … or take a nap

— Scientists have unlocked new secrets for boosting memory retention: One involves breaking a sweat, and the other involves taking a snooze.

Exercising about four hours after you learn something can improve how well you remember it, according to a small study published in the journal Current Biology this month.

Of course, working out on the regular has long been associated with enhanced memory and thinking skills. The new findings, however, offer a specific time window for taking an acute advantage of this association, said Guillén Fernández, a co-author of the study and professor of cognitive neuroscience at the Donders Institute for Brain, Cognition and Behaviour in the Netherlands.

“In addition, it might lead to additional studies optimizing the delay and intensity of post-learning exercise to achieve best study success, which might be relevant for education,” Fernández said. In other words, the study supports the idea that after-school sports can help students retain what was learned in the classroom.

For the study, 72 men and women completed a task in which they watched 90 photos appear one-by-one on a screen for about 40 minutes. The participants were instructed to remember exactly where on the screen the pictures appeared.

Next, the participants were separated into three groups. One group exercised immediately after completing the task. The second group exercised four hours after completing the task, and the third didn’t exercise at all. The groups that exercised took part in a 35-minute interval training session on an exercise bike.

Two days later, all of the participants completed a test measuring how well they remembered the picture locations. They did so while hooked up to an MRI scanner.

What did the researchers find? It turned out that exercising immediately after learning the picture locations had no effect on memory retention, but waiting four hours resulted in a 10% increase in memory retention, on average.

That’s not all. The MRI scans revealed that, during the recall test, those who exercised after waiting a few hours had increased activity in their brains’ hippocampus, a region associated with learning and memory.

“We have no conclusive answer why the immediate exercise didn’t enhance memory,” Fernández said, but he added that a follow-up study is underway to examine the influence that exercise has on memory in greater detail.

If you’d rather nap than work out, you’re in luck. Separate studies have shown that sleeping soon after learning something can also help you remember it.

“Sleep helps transform short-term memories into long-term memories by helping make stronger connections between these new experiences and our old memories, that allows the new experiences to be integrated with our general knowledge and understanding of the world,” said Sara Mednick, a professor of psychology at the University of California, Riverside.

Mednick led research, published in the Proceedings of the National Academy of Sciences this month, that describes the role the body’s autonomic nervous system plays during sleep in memory consolidation, a process that many previously thought was just the work of the central nervous system.

For the research, 81 men and women were asked to complete word problems in the morning. They also were “primed” with unrelated words in a separate exercise. Shortly after completing the task, 60 of the participants took a 90-minute nap while the rest watched a video. The researchers tracked the heart rate activity of the napping participants while they experienced rapid eye movement sleep to gauge the involvement of the autonomic nervous system. The autonomic nervous system regulates heartbeat.

Later in the day, all of the participants were asked to complete word problems for a second time. These problems were either identical to the previous task or completely new, or the answers had been primed.

The researchers noticed that the participants who had a nap were more likely than those who didn’t nap to use the primed words to answer the problems, which suggests that they were thinking more “flexibly” to use the primed words in new ways. In fact, the researchers could account for up to 73% of the performance increase from the morning task to the second task by considering the REM and heart rate activity that was recorded during napping.

Thus, the autonomic nervous system may be an unexplored contributor to how sleep can boost memory.

“Other studies have shown that delaying sleep after learning is not good for retention,” Mednick said. “The current study suggests that both the mind and body are working together to improve memory.”

When it comes to exercise, however, the finding that delaying a workout after learning can improve retention is most intriguing, said Sandra Chapman, founder and chief director of the Center for Brain Health at the University of Texas at Dallas.

“The study highlights that elevating metabolic rate at a later stage, when information is moving from short-term memory to long-term memory, has more impact than immediately after information has been encoded,” said Chapman, who was not involved in the study. “The design was elegant, suggesting that the benefit of exercise was still measurable in the hippocampi two days later.”

For now, the researchers concluded that delayed exercise may improve memory retention because working out can lead to the release of neurotransmitters in the brain called dopamine and noradrenaline.

Previous studies have shown that these neurotransmitters, through a series of biochemical-related events, can help the brain more easily consolidate memories.

“Research shows that exercise increases the size of the brain’s memory center, known as the hippocampus,” Chapman said. “Aerobic exercise in particular appears to increase levels of brain-derived neurotrophic factor, a protein that supports memory and is also linked to neurogenesis, the birth of new brain cells.”

This isn’t the first time that such neurotransmitters (and certain activities) have been linked to enhancing memory. Separate research has found that having more sex may help promote better memory retention, and yes, dopamine is released when you’re “getting busy.”

And coffee drinkers, this one’s for you: Caffeine has been linked to enhanced memory, as well as the release of dopamine.

Research has also shown that exercise can reduce insulin resistance and inflammation, as well as stimulate the release of neurotransmitters that support the health of brain cells.

A study published this month in the journal Cell Metabolism found that blood levels of a protein associated with memory, called cathepsin B, increase after running. This finding ties running in particular to memory function.

Dr. Thomas Wisniewski, professor of neurology at the NYU Langone Medical Center, also noted that exercise is good for both heart health and brain health, especially in older adults.

“Whatever is good for your heart is good for your brain. The general basis for that is that the brain is 1% to 2% of our body weight, but it takes 20% of cardiac output,” said Wisniewski, who was not involved in the new study. “It’s the most oxygen-hungry part of the body. So, if your cardiovascular system is fit, your brain is more fit.”