Spoonful of Sugar Makes the Nutrients Go Down?

There has been lots of hoopla lately about the sugar in breakfast cereals.

Kellogg recently announced that it would put an upper limit on sugar for cereals and all the foods it markets to children. General Mills announced some time ago that at least half the grain in all its cereals would be whole grain.

Breakfast cereal is also an object of heavy scrutiny by all manner of health experts and consumer watchdogs, and that's a good thing. Kids eat lots of breakfast cereal. They also drink lots of soda, but more about that later.

Anything kids eat a lot of should be healthful and nutritious, so let's take a closer look at just what sugar is doing in breakfast cereals in the first place.

Cereal 101

Most breakfast cereals are fortified with numerous essential vitamins and minerals. Not every single one you need, mind you, but a lot.

Have you ever tasted raw vitamins and minerals? They tend to taste bitter. Just suck on an iron pill and you'll get the picture.

To complicate matters, fortified cereal usually has amounts of nutrients not usually found in nature (Mother Nature doesn't usually put precisely "a third of 10 essential vitamins and minerals" into a single serving of a food). So how can you get around the bitter, often metallic taste of added nutrients? Cut it with a little salt and/or sugar.

Sugar was added to cereal, and kids (and adults) ate it up. A little more sugar got added, and they ate up more, and by now some cereals are a full 50 percent added sugar. It was getting so that kids are having some grain with their sugar … and enough already.

A saving grace of cereal, however, is that it's a "vehicle food." Cereal could be eaten alone, but it is most often eaten with milk and perhaps some fruit. Indeed, it can be a great way to get milk and fresh fruit into kids (and adults, too).

The question is how much is enough, and where should the boundary be drawn?

A single serving of most cereals (about an ounce, or 30 grams, on average) has about 110 calories. Add a cup of 1 percent milk and you have another 100 calories. Add one-half cup of fresh fruit and tack on another 60 calories, for a total of 270 calories and a nice, balanced meal in the morning that won't add to your waistline -- or that of your kids.

Should Cereal Have Less Sugar?

Some would argue that because cereal is a staple and is often eaten daily, it should have less sugar, so let's look at the cereal calories more closely.

A very sweet cereal has a whopping 15 grams of sugar per serving (basically, it's half sugar) -- you're talking about just under four teaspoons of sugar. That's pretty significant for a cereal, but it pales compared to the sugar content of a single 12-ounce can of cola that has about 10 teaspoons of sugar and absolutely nothing redeeming about it nutritionally; you don't eat cola with fruit, and there's no calcium source involved, and no whole grain.

Is it perhaps more important that kids are getting much more sugar daily from soda, punch and fruit-flavored drinks than they would from a week's worth of a moderately sweetened breakfast cereal?

Teenage boys get nearly 19 ounces of soda and fruit drinks daily, and most kids are getting at least 12 ounces of such drinks daily. Teenagers often drink twice that or more.

Think about those 1-liter bottles of soda that end up being a single serving of about 28 teaspoons of sugar -- about half cup. Have a look at the list below for a comparison:

Sweetest cereal -- 15 grams of sugar (about 4 teaspoons)

Moderately sweet cereal -- 9 grams of sugar (about 2 teaspoons)

Kids' oat cereal -- 1 gram of sugar (about one-quarter teaspoon)

8-ounce cola -- 28 grams of sugar (about 7 teaspoons)

16-ounce cola -- 56 grams of sugar (about 14 teaspoons)

8-ounce orange drink -- 27 grams of sugar (about 7 teaspoons)

What About Childhood Obesity?

Does the sugar in cereals contribute to obesity? The studies don't bear this out.

Studies on both adults and children showed that frequent cereal eaters -- meaning adults and children who ate cereal at least eight times in 14 days -- tended to have a lower body mass index (a measure of weight for height) than people who ate cereal from zero to three times in 14 days.

Of course, cereal eating may also just be a marker of a healthier eating behavior and more structured lifestyle, i.e. eating breakfast daily, regular meal times, etc.

But if so, breakfast eating is still a great habit for everyone to have. Studies show that people who eat breakfast daily have an easier time controlling weight, and kids who eat breakfast do better in school.

Of course, even kids' cereals don't have to have tons of sugar, and plenty of kid-friendly cereals have little or no added sugar. But if the child then adds several spoonfuls from the sugar bowl, is he or she any better off? Some would say yes, because at least there would be an option for control by the consumer (or the consumer's parent).

My issue with sugar in cereal is perhaps more consumer-savvy. Simply put, I'd rather pay for whole grain than sugar, and I advise my patients on a budget to do the same. The more sugar in the cereal, the less grain. Sugar is much cheaper than whole grain, so a whole grain cereal with less added sugar gives you more bang for the buck.

A little sugar in a cereal is fine. Whole grain cereal is a nutrient-rich food, and if eating it gets kids eating a breakfast that also includes fruit and milk, it can be a reasonable way to allot a few extra calories. The idea is to make the sugar supplementary to the grain, not vice-versa.

Here are some good tips for getting the cereal down without so much added sugar:

Combine a sweet cereal with a plain one that's whole grain. A 50/50 mix cuts the sugar almost in half.

Look for less than 10 grams of added sugar on the label. It'll still be plenty sweet, and aim for a whole grain cereal.

Get the sweetness factor up by adding fresh or dried fruit. You'll never get it sweeter than dried fruit, and it'll add some badly needed fiber to kids' diets, along with some minerals and antioxidants of its own. Think past raisins, too. Cranberries are colorful, kids like them and they're antioxidant warehouses.

If you add sugar to a plain cereal, think about the "rule of 1." That is, one spoonful is OK; more may be pushing it.

Add any sugar AFTER you add the milk, so it stays on top of the cereal, where you can taste it in every spoonful, and doesn't wash down to the bottom of the bowl. This way you'll make that one spoonful work for you.

Keith-Thomas Ayoob is an associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.