SINGAPORE: Our children’s teeth are under attack, and the enemy is more insidious than parents think.
Sugar is the main reason that, by the time Singaporean children reach primary school, half of them have cavities – holes in their teeth caused by decay. But foods such as candy bars and lollipops are not the only culprits.
In fact, most people are aware that these sweet treats can cause tooth problems, paediatric dentist Ong Yean Sze has found in recent years.
And yet it is easy, especially for children, to eat too much sugar, as it is hidden in so many other foods, even those commonly perceived to be healthy.
Excessive sugar intake is known to be linked to obesity and other diseases too. When it comes to diabetes, for example, KK Women’s and Children’s Hospital has seen an average of a 60 per cent increase in paediatric patients with type 2 diabetes in less than two decades.
With prevention being key, here are seven things people should know about the sugar in dietary habits today and where it is hiding.
1. SAVOURY FOODS CAN CONTAIN SUGARY SHOCKS
Savoury foods might not be thought of as a source of sugar, but they are. One serving of dark soya sauce, for example, has approximately one teaspoon of sugar.
Other sauces with sugar added as an ingredient include kimchi sauce and pasta sauce, not to mention that bolognese sauce, for instance, already contains tomatoes, which have natural sugars.
Dr Mary Chong, a dietician with the National University of Singapore and the Agency for Science, Technology and Research, also cited sweet and sour pork as a dish with “a lot more sugar than we think”.
2. ‘HEALTHY’ DOESN’T MEAN LESS SUGAR
Even seemingly healthy food can have a higher sugar content than found in junk food. There can be 50 per cent more sugar in low-fat fruit yogurt than in ice cream, shared National University Hospital dietician Denise Teo.
Low-fat yogurt may also have more sugar than the original version, as many companies add sugar to compensate for the lack of taste with reduced fat.
As Nanyang Technological University professor May Oo Lwin noted,
You can have an ingredient that’s lower, but you have an increase in another type of problematic ingredient.
Advertising based on attributes such as “high calcium”, “source of fibre”, “high in Vitamin D” and “wholegrain”, as well as words like “fresh” and “natural”, may give consumers the impression that these are wholesome options.
But those claims do not mean less sugar. Take, for example, bubble tea versus the malted beverage popular among children: The sugar content is the same.
3. FRUITS ARE A SUGAR COCKTAIL
Dried fruit is another popular snack parents give to their children. But a serving of, say, dried cranberries has six teaspoons of sugar, while a serving of gummy bears has five teaspoons, revealed Ms Teo.
Most people are unaware that if fruit is taken excessively, including in the form of juices, fruit-based food and fruit bars, it can cause cavities, said Dr Ong.
That occurs when oral bacteria feed on the acids and sugar in fruits to dissolve tooth enamel, the outer layer of teeth. And the dentist is concerned because “some preschoolers are given fruits throughout the afternoon during their play”.
As for fruit juices, not all are naturally produced. Prof Lwin said: “They could have a lot of additives, which include colouring, sugar and so on. And taken in large quantities, they might not be very healthy.”
4. CHILDREN ARE HAVING THE WRONG DRINKS
When the producers of Channel NewsAsia programme Why It Matters got nine primary school children to track their diet for three days, Dr Chong, who has been researching children’s eating patterns for four years, found the results “shocking”. (Watch the episode here.)
The common drink that goes with their meal is no longer water. It's either a soft drink, a sugary drink or a malted drink, but water seems to have disappeared from their diet, and that's quite scary.
The children were also seen to be drinking chocolate milk rather than the one to two glasses of plain milk a day that dieticians encourage. A glass of plain milk has two teaspoons of sugar, whereas chocolate milk has five.
5. SUGAR REMAINS IN THE MOUTH
One thing that can be done is to ensure that children eat their meals well, with a low frequency of snacking. Dr Ong advises parents to ration their children to one mid-morning snack and one mid-afternoon snack.
“So no frequent snacks, like eating throughout the day … because sugar remains in your mouth for a long time,” she warned.
That is also why her practice Kids Dental World sees children as young as three years old, who mainly have not been weaned off formula milk, drink it all the time and do not brush their teeth before bedtime.
6. HERE’S HOW TO READ NUTRITIONAL LABELS
Another way to reduce sugar consumption and avoid falling victim to marketing tactics is to develop the habit of reading the nutritional labels on food packaging.
Prof Lwin’s research suggests that Singaporeans are not very good at this: About half of her sample were unable to answer questions about how much sugar there was in product preservatives.
The sugar content in foods is listed under carbohydrates, and the amount is always given in grammes. One teaspoon of sugar is around four to five grammes.
WATCH: Where the hidden sugars are (2:37)
7. HOW MUCH IS TOO MUCH?
The World Health Organisation (WHO) has called for a reduced daily intake of not more than six teaspoons of added sugar (sugars put in food or found naturally in honey, syrups and juices), for maximum health benefits in adults and children.
But there is no firm consensus on the healthy limits. The United States and the United Kingdom follow the WHO’s tighter recommendation, while Singapore allows 10 teaspoons, in line with the international guideline that sugar should not exceed a tenth of daily energy intake.
The Health Promotion Board says it focuses on “reducing sugar intake where possible”, instead of a specific limit for the young.
Among the children surveyed by Why It Matters, most struggled to stay within the WHO’s lower limit but kept to the local guideline.
Dr Chong cited one 11-year-old girl, however, who had her morning cup of chocolate milk, a chocolate chip cookie and lemon tea for snacks and an ice malted drink in the evening. How much sugar was that? Twelve teaspoons.
Watch this episode of Why It Matters here (new episodes every Monday).