Yes, Swedish Food Federation. Sugar can lead to fatty liver disease – here’s an update.

Last Friday we published a clip on the blog from the Swedish television show SVT Plus, in which Ann Fernholm talked about sugar. Shortly after, the Swedish Food Federation’s dietitian, Elisabeth Rytter, had something to say in response. Below is Ann’s answer to Elisabeth Rytter.

Pseudoscience. Not evidence-based. The Swedish Food Federation’s dietitian Elisabeth Rytter has made it clear what she thinks of my statements, and has ”corrected” the information about sugar discussed on SVT Plus. According to Rytter, I have spread lies about sugar, and she questions if I’ve actually read the background to the Swedish Food Administration’s dietary advice on sugar. Quote: ”It does not say that sugar increases the risk of fatty liver disease.”

She also thinks I have incorrect knowledge concerning fructose: ”Fernholm also says that fructose is the culprit, which is a non-evidence-based statement. The focus on fructose and why it’s bad for you is another example of pseudoscience, that has been spread much too widely”.

For those who don’t know: the Swedish Food Federation, that Rytter represents, is a conglomeration of food industry groups such as The Swedish Ice Cream Company, The Swedish Chocolate, Confectionery and Cookie Association, Sweden’s Bakers & Patisseries, and Sweden’s Breweries.

News Flash: sugar is directly related to increased amounts of fat in the liver

Elisabeth Rytter, if you are reading this, I will admit that you are at least partially correct. It was (actually) a long time ago that I read the background to the Swedish Food Administration’s dietary advice. Then again, the latest update they made was in 2012. That’s five years ago, which is a long time when it comes to research and, if you haven’t noticed, many exciting studies have been published in the meantime! Honestly, I hardly know where to start.

But let’s begin with a study conducted by researchers at Sahlgrenska (a university hospital in Sweden). The experiment was conducted as follows: 71 men with abdominal obesity were allowed to drink a liter of lemonade (a total of 75 grams of fructose), every day for 12 weeks. Result: blood-soluble fats were disrupted, and the fat in the liver increased by 10 percent. The researchers reported that ”data shows a negative effect as a result of moderate fructose consumption over 12 weeks on several cardiovascular risk factors, especially fat content in the liver…”

The study had no control group, which is a major weakness. BUT, other controlled studies show that fructose increases the fat production in the liver more than, for example, glucose.

Less fat in the liver of children who received (almost) sugar-free food

This summer we received some great news: the amount of fat present in the liver can decrease radically among children who avoid sugar. 41 children struggling with obesity were included in the study. Initially, the children had, on average, about 7.2 percent fat content in their livers. For nine days, they were only allowed to eat food that the researchers gave them. I know that you, Rytter, disapprove of the WHO’s health goal, which encourages an intake of 5% of calories from sugar or less. These children received 4 percent of all calories from sugar, even better.

So what happened? In nine days, the amount of fat in their liver was almost halved.

You have to agree, that’s pretty amazing! Fatty-liver disease was something that, up until recently, mostly affected alcoholics. Now, one out of ten young people in the United States and Europe qualify as having the condition. Fatty-liver disease increases the risk of liver cancer – a cancer that is unfortunately growing in today’s society. It is also a major cause of type 2 diabetes. If the children in the study can reduce or remove the fat from their livers, they can drastically reduce their risk of dying prematurely.

There is another study that I intended to share. It’s about the fact that children with fatty-liver disease have been shown to have an especially high level of special enzymes in the liver, that specifically break down fructose. But I wouldn’t want to kick someone who’s already down. Maybe we should just forget what you wrote about pseudoscience. I won’t tell the researchers at Sahlgrenska, or those in San Francisco. Although their studies could have been better controlled, you might want to think twice before you call them pseudoscience.

Ann Fernholm runs the blog and has written the best-selling book My Sweet Heart. She writes here at Food Pharmacy once a week.


Santa Maria’s response: we will reduce the amount of sugar.

On Friday, I emailed Santa Maria about their food, asking why some of their products are mostly based on sugar and water. I was inspired to write by the number of people who, like me, are tired of always having to read the ingredients of everything they buy. Below you’ll find Santa Maria’s response, and after that, my answer to them.

Hello Ann, thanks for your email. We absolutely welcome a continued debate about the content of our food. Santa Maria, of course, wants to make products that both taste good and do good. Therefore, we are intensely working on removing sugar, salt and unnecessary additives from our products. We’ve made a fair bit of progress. Since 2015 we’ve removed 395 tons of sugar and 223 tons of salt from our products. But we’re not done. By 2020, we hope to have reduced our total sugar content by 50%, and salt by 25%, compared to 2014. At the same time, I will say that these ingredients play an important role in many of our products. Not only in terms of taste, but in other qualities as well. For example: There are many different ways to make a spice-rub. Ours originated from an American recipe, in which raw sugar (which is by the way, many times more expensive than refined white sugar) is used for flavor and caramelization. If you want a different type of rub you can of course choose another brand, or make one yourself from scratch.

Last but not least, what would you say about coming to Mölndal, so we can explain more about how we work and also hear your thoughts and ideas about what we can do differently?

Have a nice weekend,
Eva Berglie

My response:

Hi and thanks! You’ve made some exciting progress in removing sugar from your food, though it’s not clear if the 395 tons are per year, or total since 2015. At the least, that’s around 40 grams per Swede.

My thought is that food sold in stores should be safe to eat, even in the long run. We consumers should not have to be ”additive-detectives” reading every ingredient list in the store while shopping, but be confident that, for example, a guacamole is based on avocado and not water, starch, thickeners and chlorophyll. We all have incredible biochemical machinery within us, developed through millions of years of evolution. That machinery needs to be filled with vitamins, antioxidants and minerals to work. In addition, our intestinal bacteria need the fibers you find in real foods (for example avocado). Neither sugar or rendered starch adds any vitamins to the body. When you base your food on processed additives the nutrition levels are too low.

I would love to come to your headquarters sometime when I’m close to Gothenburg. It would be interesting to see how the company works, and my hope is that you are open to hearing our perspective, for example about the research that indicates that high sugar consumption can lead to excess fat in the liver. Problems with fatty livers are increasing worldwide, including among children. Figures from the United States and Europe show that one out of ten children are now affected, which is frightening. Fat in your liver leads to type 2 diabetes and liver cancer. Type 2 diabetes can then cause cardiovascular disease, and is also linked to various cancers.

Personally, I think that you who work in the food industry have great opportunities to improve public health. If the food you produce is good for the human body – for example, if you stop basing your sauces on sugar – fewer children and adults will develop obesity and type 2 diabetes. Maybe start with clearly marking the amount of added sugar on the packaging.

Ann Fernholm

Ann Fernholm runs the blog and has written the best-selling book My Sweet Heart. She writes here at Food Pharmacy once a week.


Santa Maria – how to sell (mostly) sugar and salt for 359 sek/kg.

 Recently, I had reasons to look a little closer at the food company Santa Maria’s assortment – they who supply all of Sweden with their ”Friday-tacos”. It led to a thorough examination of their ingredient lists and ended with the email below, which was signed today and sent to Santa Maria.


Hi Santa Maria! Since some time back, I’ve followed your business and I’m writing to express my admiration for your sense regarding business. It actually started when I was about to  buy a rub in the store and fell for this one:

Just the word chipotle makes me feel good, but as usual (an acquired work injury), I could not help examining the ingredients:

Sugar. And the nutrition declaration:

34 grams of sugar. Ok? In my opinion, a rub should primarily consist of spices. At first, I was pretty doubtful, I’ll admit that. But then I glanced at the kilo price:

359 sek/kg. It’s quite brilliant. You make a spice-mix where one third is sugar, which has a world-market price of around three SEK, mix it with salt (that I guess is even cheaper), a little lemon peel and other spices and then it becomes a product where sugar and salt are sold for more than a HUNDRED times what it’s worth.

A profit machine

I hope you don’t perceive me as intrusive, but already in the store, I had to visit the site, to check your annual report. Darn, you’re making money – year after year! 217 million in profit and a profit margin of 13.16 percent last year. Economy is not my strong side – but I assume you all are pretty pleased with that? You beat Nordic Sugar’s profit margin of 8.87 percent by far. Arla and Dafgårds are moving in slow-motion with their 4.8 and 6.03 percent.

Your profitability caused some curiosity. How do you get such a viable company in the tough world of food industry?

Chemistry instead of raw ingredients

In your case, it must have been about hiring chemists instead of cooks. Take your guacamole for example. In store, Tóp and you are about the same kilo price, but they have 95 percent avocado in their guacamole while you have succeded to reduce the amounts to 1.5 percent. It’s just to congratulate: of course, it’s better business to sell a hodgepodge colored with chlorophyll (e141), mostly made from water and that gets its consistency with starch and thickeners, than to sell a real guacamole (that also must be cooled). People are so difficult when it comes to additives – but chlorophyll is all natural.

4 percent cheese instead of 62 percent

I bet you also feel satisfied with the composition of the Cheddar Cheese dip. Again, you’re able to have the same price as your competitors, but without spending money on expensive raw ingredients. Your main ingredients: skim milk, water, sunflower oil, modified starch (tapioca), cheddar cheese (4%), salt…

Texas Longhorn’s main ingredients: Water, Cheese (Cheddar cheese (48%), Cheese (14%), Water, Butter, Milk Protein…

A thumb up to the longhorn, who has 15 times more cheese in it’s dip.

Sauces based on water and sugar

The price per kilo on some of your sauces is also impressive. The Pad Thai sauce (124 sek/liter in store), Sweet Chili (52 sek/liter) and American BBQ (96 sek/liter) as some kind of development of ketchup (25 sek/liter). Your sauces costs more than ketchup, but instead of expensive tomato puree, you base the sauces on water and sugar, or sugar and water. At least there is some variation!

Dextrose – the main ingredient of the ”taco-spice”

Then you’ve been very wise when it comes to the presentation of the ingredients in your best-selling ”taco-spice” (355 sek/kg):

At first I wondered why you had put chilipeppers, cumin and garlic into the group ”spices”. But of course, it’s so that dextrose won’t be first on the list. If you had presented the spices separately (as you still do in parentheses), all spices had fallen after dextrose. Then the list would be:

Dextrose, onions (19%), chilli peppers (11%), cumin (10%), garlic (6%), salt, oregano (4%), yeast extract, potato starch, potato fiber, antifungal agent (e551), seasoning extracts (peppers).

Clearly, the spice mix sells better if you’re able to conceal that it’s based primarily on sugar. One tip: oregano is also a spice, which you can put in the parenthesis (before dextrose).

I’m sorry this all became so lengthy. Before I finish, I just want to say that I miss a part of your Tex Mex assortment: the minced meat itself. Can that also be made out of water, sugar and modified starch?


Ann Fernholm

Ps. I eventually bought another rub that gave me more spices for the buck.

Ann Fernholm runs the blog and has written the best-selling book My Sweet Heart. She writes here at Food Pharmacy once a week.