DRAFT Australian Dietary Guidelines - Eat For Health

The sugars contained in the cellular structure of foods, such as the intrinsic sugars of fresh fruit
and vegetables, have been found to have little cariogenic potential, whereas foods high in extrinsic
sugars are most damaging to teeth [594].
Bone strength: Evidence suggests an association between consumption of soft drinks and
increased risk of reduced bone strength (Grade C, Section 15.3 in Evidence Report [14]) [476-
479]. Cola drinks (sugar-sweetened and diet varieties), but not other carbonated drinks, are
associated with significantly lower bone mineral density in women, but not in men [479]. In young
men, significant adverse changes in indices of bone remodelling and bone resorption markers
occurred when cola drinks were added to a low-calcium diet compared with adding milk [476]. A
systematic review reported an inverse relationship between soft drink consumption and milk
intake [458].
It appears that soft drink consumption is associated with some problems related to bone health,
but, with the exception of some limited evidence related to cola drinks, it remains unclear
whether soft drinks exert a direct effect or reflect their inverse relationship with milk
consumption.
ADHD: There is no evidence that added sugars are involved in the aetiology of attention
deficit/hyperactivity disorder (ADHD) [595].
3.3.3 How limiting intake of foods and drinks containing
added sugars may improve health outcomes
Dental caries: Important factors for development of caries include the bacterium Streptococcus
mutans, dietary sugars and a susceptible tooth surface. Fermentable carbohydrates (both sugars
and starches) are a substrate for bacteria such as S. mutans and S. sobrinus, which increase the acidproducing
potential of dental plaque [596]. Dietary sugars other than sucrose - for example,
glucose and lactose - can also induce caries, although these sugars are less cariogenic than sucrose
because, in addition to being converted to acid metabolites, sucrose is uniquely used for
extracellular polysaccharide synthesis.
Oral hygiene, dental care, fluoridated water supplies, the type of food and salivary function are
also important. The more frequently foods containing added sugars are consumed, the greater the
risk of caries since frequent consumption does not allow remineralisation of the teeth [597]. The
duration of exposure depends on how long sugary foods stay in the mouth and the number of
eating occasions. On the basis of the scientific evidence, advice on sugar intake for the prevention
of dental caries should include frequency of intake as well as the amount. The acidity of sweetened
drinks is also relevant to dental erosion, a major factor in dental decay [483]. This applies equally
to sugar-sweetened or diet soft drinks, since their acidity is comparable.
DRAFT Australian Dietary Guidelines- December 2011 90