Dear Laura…Was Emily Oster Right About Sugar Rationing?

Welcome to ‘Dear Laura’ - a monthly column where I fashion myself as an agony aunt and answer the questions that readers submit. If you’d like to send in a question for me to answer next month - then you can submit it here.

I’m happy to answer Qs about anti-diet nutrition, developing a more peaceful relationship to food and weight-inclusive health, annoying diet trends and news stories, body image challenges, and, of course, challenges with feeding your kiddos. Please give as much detail as you’re comfortable with and let me know if you’d like me to include your name or keep it anon.

Please remember that these answers are for educational purposes only and are not a substitute for medical or nutritional advice; please speak to your GP or a qualified nutrition professional if you need further support.

So, let’s start with this week's question:

Hi Laura,

This landed in my inbox from Emily Oster today (see here). I'd be really interested in your take on the study cited. I'm trying so hard to be relaxed about the sugar in my two year old's diet (despite having friends who brag that their kids didn't touch anything with added sugar until age 3 and who complain that nursery is feeding their kids too much sugar). My rule of thumb has essentially been that he can have whatever we're having. He's always been a ‘good’ eater who will eat virtually anything and my number one priority has been to protect his relationship with his body and food long term (and avoid ‘contaminating’ him with the diet culture BS that I was raised with). I suppose now I'm left wondering if my efforts to make sure sugar is not a BFD are actually setting him up for poorer health outcomes in later life? 

I am fully aware that I fall into the ‘worried well’ bracket of parents unnecessarily seeking reassurance, but I consider Emily Oster a pretty reliable source who takes a balanced approach to interpreting research evidence methodically. I'm not actually sure what ‘a lot of added sugar’ or ‘overexposure’ to sugar actually is in practical terms or how to ‘not be overly restrictive whilst cutting back where possible’ as she suggests in her conclusion. Also, the casual mention of UPFs/ob*sity and worse metabolic outcomes at the start is also confusing given that she is usually the queen of emphasising that correlation does not equal causation.

Also, apologies for sending this whilst the world is on fire.

Best Wishes,

Louise

Ah Louise, the world indeed is on fire. And there are lots of things killing us. But sugar is not it. 

There are three parts to your question.

What is up with that study?

What is up with Emily Oster?

And are my kids eating too much sugar??

Let’s do this!

Ok so, what is up with that study?

You might have caught the headlines recently claiming that sugar in the first 1000 days of life is associated with a higher risk of both type 2 diabetes and hypertension (high blood pressure). They were reporting on a study published in Science journal: ‘Exposure to sugar rationing in the first 1000 days of life protected against chronic disease’. Snappy. 

The study, published by a group of academics in the US, leveraged something called a 'natural experiment'. As we hopefully know by now, studying nutrition is wicked hard. It’s virtually impossible to do a randomised control trial where people are completely oblivious to what they eat, because, well, people can see what they eat. Nutritional science largely relies on epidemiology – large studies of patterns and associations in populations – that while interesting, are often ‘contaminated’ by things that are very difficult or impossible to measure. Or, in the case of things like anti-fatness, racism, and ableism, researchers largely ignore or measure in some tokenistic way. 

Natural experiments then can offer an exciting – to nutrition nerds at least – glimpse at what happens when the social conditions materialise in dramatic changes to the diet. Here’s an example that I learned about while I was a nutrition student, some – fuck me – 20 years ago. ‘The Dutch Famine’ study is probably one of the most well known natural experiments in nutritional science. In the winter of 1944-45 the Nazis blocked food entering The Netherlands, specifically in Western areas around Amsterdam. This caused an acute period of starvation, resulting in approximately 20,000 deaths, with already rationed food intake plummeting well below requirements. While pregnant people and infants were typically given more generous food rations, this period of famine meant that there was not enough food to go around, even for these vulnerable groups. Consequently, people who were pregnant suffered from acute malnutrition. Modern day researchers have been able to look back at the children of those pregnant parents who experienced starvation during that winter, and look at the trajectory of their health, compared to children born when food was freely available, shortly after this period of famine when the allied forces liberated the occupied Netherlands. They found that babies who were starved in utero – particularly in the first trimester, which is a critical period of organ development – had a higher risk of poor health in adulthood. Specifically, they were more likely to be affected by cardiovascular disease, type 2 diabetes, and, not that I think being fat is a disease, but these adults were more likely to be fatter. This point I think is important, and one we’ll come back to.