Sweet tooth

You can’t have missed the headlines last week about children’s dental health. A survey by government agency, Public Health England, found that on average 12% of 3 year olds have suffered dental decay. Rates were particularly high in Leicester, at 34%.

The BBC stated that “Researchers also said that some children had a particular type of decay known as early childhood caries. This affects the upper front teeth and spreads quickly to other teeth. It is linked to the consumption of sugary drinks in baby bottles or sipping cups.”

It’s interesting that they didn’t mention the increased use of puree pouches. Dentists have previously raised concerns about infants sucking the puree directly from the pouch. This also puts their front teeth in contact with more of the puree than spoon-feeding and so could also be a contributing factor to tooth decay, if consumed in this way regularly.


Unfortunately pouches like the ones in the photo do not include recommendations on the packaging stating that they should not be sucked directly from the pouch but served in a bowl.*

Sweet treats

The best way to limit tooth decay is to limit sweets and sugary foods. It’s as simple as that, and everyone knows it. But it can be hard in a culture where sweet treats have become an every day occurrence, to swim against the tide.  Overwhelmingly the foods that are promoted to children – be it Cheerios, Frosties, Penguin bars, Haribos, or Ribena – are high in sugar. Parents get blamed if their children are overweight or have tooth decay. The buck stops with us. But our efforts to get our children to eat healthily are undermined by food industry promotions.

If you give your child sweets or chocolate, smoothies or cake the ideal time is after their main meal, when their teeth are protected by the other foods consumed. It’s also recommended to drink water after eating something sweet to remove at least some of the sugars in the mouth. Drinking through a straw can reduce sugar coming into contact with teeth. Delaying brushing teeth until at least an hour after eating sweet food is also recommended to as tooth enamel is softened in the hour directly after consuming sugars.

Sugar in fruit

Of course, sugar doesn’t just come from sweets, chocolate, cakes biscuits and soft drinks.

Sugar in a whole unprocessed piece of fruit is inside the fruit cells – “inside” means intrinsic. Because they are held inside the cells they come into less contact with the teeth compared to extrinsic sugars. Fruit is therefore fine as a snack between meals as long as it’s not consumed excessively.

Yes you’ve guessed it – “extrinsic” means outside the cells. If you process fruit – whether it’s making a smoothie, pureeing, juicing or drying it, this changes the fruit structure so that sugar is released – becomes extrinsic and therefore comes into more contact with teeth. This means regularly consuming fruit in these forms in between meals leads to greater risk of tooth decay.

The term non milk extrinsic sugars refers to these sugars, and whilst sugar in milk is extrinsic, it doesn’t cause dental decay – which is why they’re called “non milk”.


Generally, the advice is to avoid giving sugary food and drinks including smoothies, purees, dried fruit, fruit juice and sugar sweetened milkshakes, between meals.

So that includes these dried fruit snacks (below) and similar types of dried fruit bars and strips. They contain concentrated sugars that stick to teeth. Basically if it looks and tastes like a sweet, even if it is made of 100% fruit, then treat it like a sweet.

Research from the British Dental Association has found that the acidity ph for smoothies was below 5.5, at which teeth are more likely to become eroded.


The best drinks to protect children’s teeth and health are water and milk. Fruit juice can be drunk at mealtimes, watered down so it’s half water half juice. But is not needed as an every day drink. If you are already giving juice, squash, sugary drinks or fizzy drinks to your children try and reduce gradually over time, with squash and juice you can gradually water it down so that it’s more water eventually and then switch over to water. Making changes to children’s diets that are gradual tends to works well.

Even sugar free drinks can be damaging to teeth if consumed between meals as they can be acidic. Also they are usually sweetened with artificial sweeteners, which are not recommended for young children. (Under EU regulations any weaning food or drink is not permitted to contain artificial sweeteners).

Never give a soft drink in a sippy cup or bottle as again, the sugars come into contact with teeth more. Advice is to give young children drinks from a free flowing cup.

Brushing teeth

Start brushing teeth morning and evening as soon as teeth appear. Reading a story at the same time, singing a song or getting them to brush their dolly’s or teddy’s teeth can help. Or brushing your own at the same time. If they’re old enough to appreciate stickers you could try using them as a reward. Your little one will get used to the routine. Also dentists recommend helping your child brush their teeth until they are 7 as they’re not able to get to all the nooks and crannies.

Ideas for healthy snacks

So having outlined what isn’t recommended, it’s only fair to give some examples that are recommended. Here are a few ideas of snacks, am sure there are lots of other ideas out there too… if you have any to share please post a comment as am always looking for ideas.

Here a few ideas off the top of my head:

Fruit of any kind (undried, not juice)
Vegetable sticks with or without dips like cream cheese
Cherry tomatoes cut in half
Home made plain popcorn (more for older children – as can be a choking hazard for younger children)
Bread roll
Bread sticks
Crackers with cheese
Unsweetened pancakes (I’ve adapted this recipe so it has no added sugar and relies just on the vanilla extract for sweetness)**
Rice cakes (spread with nut butter or cream cheese)
Handful of nuts (again for older children – they can be chopped into smaller pieces for younger children but not given to babies)
Crumpets with butter
Oatcakes (with cream cheese or butter)

Guidance on snacks for 1-4 year olds and 5-11 year olds has also been produced by Dr Helen Crawley when she worked at the Caroline Walker Trust.

Of course there are going to be times when your children have sweet things between meals, it’s really just about setting healthy eating habits for life so making everyday snacks healthy and breaking the rules every so often.

*They do suggest serving from a spoon or bowl. but ideally they should specifically warn against sucking directly from the pouch.

** If you’re making pancakes, use all the mixture and if you have left over pancakes, freeze them for snacks.


Sugar: how much is too much?

Today saw the UK’s Scientific Advisory Council on Nutrition publish their recommendations for sugar intake for the UK population, based on the most up-to-date evidence.

The recommendations are draft and are out for consultation. The aim is to set targets to reduce sugar consumption as a means to halt the alarming rise in obesity, and type two diabetes. SACN have recommended that a maximum of 5% of our calories come from added or “free” sugars. This includes added sugar and sugars from fruit juices and honey.

The World Health Organization recently recommended a maximum of 10% of energy from added and free sugars while advising governments to aim to reduce intakes to 5% so the SACN recommendations are in line with this.

Campaigners responses

Action on sugar, the campaign organisation has welcomed the recommendations. As one of the main sources of free sugars are soft drinks, Sustain has launched a campaign to call on the government to introduce a tax on sugary drinks duty – with revenue going into a children’s future fund – you can sign this campaign here.

Dental health

Independent experts, Professors Aubrey Sheiham and Philip James have today published a paper in the Journal of Public Health and Nutrition which recommends intakes should reduce to no more than 3% to address dental health issues.

The key is going to be how the Government responds to the recommendation. They have so far taken a very easy line with food industry. Setting up the Responsibility Deal which effectively allowed food industry to set their own targets on sugar reduction. This has resulted in them reducing sugar on some products but not on others, making the whole thing a bit of a sham.

The SACN recommendations are all based on a review of the latest evidence. The concern is that after the consultation, the recommended intakes get watered down, to what is considered an achievable level based on current intakes, as well as, of course food industry lobbying. As someone said to me earlier today, it’s going to be an interesting few months (not least as we are heading for an election within the year).

So, what is 5% of your energy intake?

So what does this all mean for you and me, and our kids and our parents and grandparents? Cutting added sugar and fructose is very in at the moment but what if you still like a sweet treat or you’re giving your children sweet treats – how much too much?

Well I thought it would be interesting to do a few calculations to work out how much 5% of our calorie intake is .. and here are my workings out below. So you can see clearly how many grams or teaspoons as a maximum you and yours should be consuming in a day based on these recommendations. And it’s worth emphasising that this is a maximum, not a target, ideally intakes should be below this level.

SACN draft recommendations

Right, so the next step is to look at some examples of sugary foods/drinks and how much sugar these contain…

(Accessed on 26 June 2014)

This list is obviously far from exhaustive, but I just wanted to have a look out of interest. I might add to it if I get some time in the next few days.

If you want to work out how many teaspoons of sugar a product contains, look at the sugar content (in grams) and divide by 5 as there are 5 grams in a teaspoon of sugar. If you are looking at foods that contain milk, remember that milk has it’s own sugars which are not included in this calculation.

Summer raspberry smoothie for breakfast

In the rush of the morning I didn’t get a chance to take a photo of this – will have to add later. Like most, getting ready and out the house is a chaotic dash and children add to the distractions.

I can’t leave the house without breakfast. This habit was instilled in me by my mum, who while others in the 80’s were serving up sugary breakfast cereals, always made us a healthy, cooked breakfast of some sort.

These days, I find it easiest to have a smoothie, juice or yogurt and fruit with granola for breakfast.

To get the right balance of ingredients use …
about 100g of raspberries (or other berries)
1 banana
about 100ml of apple juice
1 tablespoon organic Greek yogurt
1 tablespoon of pumpkin seeds (for fibre and omega 3’s)

Being pregnant at the moment, I also mix in a teaspoon of an omega 3 oil supplement. Between weeks 14-18 the foetal brain is going through a crucial stage in development, though I take the supplement throughout pregnancy. Omega 3 oils (in the form of DHA rather than EPA) are so important for brain cell development.

Whizz it all up in the blender and serve – with a straw to protect your teeth from the fruit sugars. It’s also a good idea to have some water afterwards – to get rid of any remaining sugars in your mouth. Also don’t brush your teeth for up to an hour after having anything sugary as tooth enamel is softened and brushing will erode it.

This smoothie is high in vitamin C, vitamin B6 and provides potassium, folate and other vitamins and minerals. It contains a third of your (if you are a woman between 18-64!) recommended fibre intake for the day, and provides 2 of your recommended at least 5 a day.

I took mine in the car. Invest in a flask – if you leave for work/school run early in the morning before your appetite has woken up, it will stop you from reaching for that muffin or croissant when you are out and about.

If you want flask inspiration, my lovely friend, Kate has designed these vintage inspired flasks which she sells in her Brighton Shop, Bluebelle and Co.

Home-made vs ready-made?
Making your own is so much better than buying bottles or cartons of smoothies. Aside from being cheaper, its fresh so will will have maximum vitamins and minerals, bioflavinoids and other important health-giving micronutrients – and these get depleted in processing. If you look at ingredients in shop bought smoothies sometimes only about 12% of the juice is made up of berries – the rest being from cheaper fruits. If you make it yourself you know what’s in it.

Ups and downs of fruit sugars
The pumpkin seeds may make it a little crunchy (blend thoroughly). They provide fibre, which slows down release of the fruit sugars. Sugars from fruit are released more slowly than processed soft drinks with added sugar and so do not result in spikes in blood glucose levels, which lead to insulin release which in turn makes the body store sugar as fat. So a smoothie like this will have a low glycaemic index* which indicates that its sugars are released into your blood at a slow rate.

Now I am not going to lie to you – this smoothie contains 34g of sugar in the form of extrinsic sugars which means outside of the fruit cell. There are recommendations on how much extrinsic sugar you should have in your diet. As a rule – if you have a smoothie like this for breakfast you definitely shouldn’t have any more fruit juice. And in terms of extrinsic or added sugars – keep it to a maximum of 15g for the rest of the day.

The World Health Organisation recommends that extrinsic sugars (not intrinsic sugars from milk and in whole fruit) should make up no more than 10% of energy intake. This equates to about 50g of sugar for women. While industry Guideline Daily Amounts (GDA’s) which is what some retailers and food companies use on packaging – and is a standard devised by industry, recommends a maximum intake of about 90g for women. Bear in mind this is a standard set by industry (a 500ml bottle of coke would contain more than your maximum 50g sugar recommended under WHO guidance). So probably best to follow the WHO 50g maximum level for a healthier diet, as it’s set by the independent health organisation!

Dispatches this week
Whilst writing have been reminded of this week’s Dispatches exposé of how industry are misusing 5 a day claims. Have just watched it whilst writing this. I think the programme points are fairly common sense. It’s best not to rely on 5 a day claims on ready made foods. When you are working out if you have had at least 5 a day, focus on the meals and snacks that have included fresh fruit and vegetables that you bought yourself. As outlined in the programme too, the Government should be stricter on how these claims are used by industry.

Also worth remembering that the government set the level as at least 5 a day because they thought this would be achievable by the UK population. The benefits of eating fruit and vegetables have been shown in studies where people eat 8 portions or more so that’s what you should be aiming for!

My daughter often has some of the home made juice or smoothies I make. The trick with children sometimes is not to offer it to them – it makes them want to try it. Generally children should have fruit juice diluted 1:1 at mealtimes – this helps the body to absorb iron. Don’t give any drinks other than milk or water between meals to protect their teeth.

Also if you’re thinking this won’t fill you up – I didn’t need to eat anything until lunchtime.

*You can check the Glycaemic index of a food on this University of Sydney website. The website includes GI’s for shop bought smoothies and they are between 30-44 which are low compared to the measurement for the release of glucose which has a GI of 100. I would estimate that this home made smoothie would be towards the lower end of the GI because of its fibre content.