Sugar
What’s the worst threat to our health from our food supply? Pesticides? Germs like E. coli? All those chemical ingredients you can’t pronounce? Some experts say those are minor threats compared to something we eat a whole lot more of--sugar.
It’s not just in sweet foods and drinks. It’s in peanut butter, tortillas, breads, spaghetti sauce, salad dressing, mayonnaise and lots of other foods you wouldn’t expect. Our sugar intake has gone up to the point where the average American eats and drinks 22 teaspoons of added sugar a day. For boys in their mid-teens it’s 34 teaspoons.
It’s alarming to many health experts. The American Heart Association came out with a scientific statement recommending that women limit themselves to 100 calories a day (about 6 teaspoons) of added sugar, and men to 150 calories (9 teaspoons). Legislators have even considered taxing soda to bring those numbers down. It worked with cigarettes.
What is “added sugar?”
Sugar that’s added to drinks and foods. It comes in many forms (see the list below), from the molasses in your Grandma’s gingerbread to the highly processed high-fructose corn syrup that’s in products from cola to cough syrup.
In contrast are natural, unprocessed sugars within whole grains, fruits, vegetables, and dairy products. These foods are rich in vitamins and minerals your body needs. It takes your body longer to get the sugar out of them than from products with refined forms of sugar, especially drinks. So your blood sugar doesn’t go up and down like it does from added sugar. People who eat a lot of foods with natural sugars are at lower risk of health problems. The opposite is true of people who eat a lot of processed sugar.
What's wrong with sugar?
There's nothing wrong with moderate use of sugar. If we could limit ourselves to small servings of dessert it would be different. But many of us drink and eat added sugar all day long. A 22 teaspoon a day habit has consequences:
- Calories without nutrients If you eat a banana, you get fiber, the mineral potassium and vitamin C along with a sweet taste--all for 90 calories. If you drink a can of soda you get about 136 calories of sugar. That’s it. And many studies have found that the more sugar there is in your diet, the less chance that you’re getting all the nutrients you need. Beverages are the biggest problem. And there’s a lot of concern that kids aren’t getting the calcium they need for growing bones because they’re drinking soda instead of milk.
- Blood sugar surges Added sugar makes your blood sugar level go up fast. Then your body produces insulin to bring it down. You're likely to be hungry again in an hr or two, craving another quick lift from another sugary food or drink. Your blood sugar and insulin production are on a roller coaster.
- Weight gain Over time you’re likely to gain weight from all those extra calories. That’s especially true when the sugar comes in beverage form. Our bodies don’t “register” the calories and eat less to compensate like they do for solid foods. We eat just as much after drinking a sugary drink as we would have if we’d had water.
- Diabetes risk You may develop insulin resistance. That’s when your body can't use the insulin you produce to lower your blood sugar level. It often leads to diabetes.
Doesn’t sugar also make kids hyperactive? Could all the sugar we’re eating be the cause of the rise in ADHD?
We can’t blame that on sugar. ADHD is often inherited, and the brains of kids with ADHD actually function differently. Parents may see kids acting wild at a party where there are lots of sweets and conclude that it’s the sugar. But it’s much more likely that it’s the party atmosphere that’s affecting how kids act. Eating extra sugar makes kids fat, not hyperactive.
I’ve heard that high-fructose corn syrup is especially unhealthy, but it’s in so many products. Should I avoid it?
This is a big controversy right now. Many scientists don’t think there’s any practical difference between types of sugar. They point out that both table sugar and high-fructose corn syrup both contain almost equal mixtures of fructose and glucose. They all make us fatter and thus more prone to disease.
Then there are scientists who’ve done experiments with animals and humans and found differences. They say that:
- The fructose in high-fructose corn syrup, which has a different chemical structure from glucose, can only be broken down in the liver. They say this produces 7 times more advanced glycation end products (AGEs) than when your body breaks down glucose. AGEs are chemicals that damage blood vessels and may increase the odds of diabetes, heart disease, stroke and Alzheimer’s disease.
- When the liver processes fructose, uric acid levels rise within cells and in the blood. They link that with higher blood pressure in people from fructose compared to glucose. They say that happens in experiments even when the amount of salt, alcohol, and calories people eat and drink are equal. They also link uric acid to higher rates of nonalcoholic fatty liver disease.
- In one experiment, where people got either too much glucose or too much fructose, both groups got fatter. But the folks given glucose put on fat under the skin. The fructose group gained fat in their bellies around their organs. Belly fat is known to be more harmful to health.
- Fructose doesn’t stimulate the liver to produce leptin. That’s a hormone that makes you feel full. Thus drinking a cola doesn’t seem to satisfy hunger.
- Fructose makes “bad” LDL cholesterol levels go up.
- Traces of mercury were found in 1/3 of products made with high-fructose corn syrup in a 2009 study. Mercury is often used to make the caustic soda used to make the syrup. The Food and Drug Administration called for immediate changes in processing when this study was published. Mercury is very toxic, especially to kids.
The idea that high-fructose corn syrup is worse than sugar has taken hold. So now many companies are advertising that their products are sweetened with sugar. Consumers think they’re healthier. But even if it’s true, healthier is not the same as healthy. It’s common sense that we need to limit both.
What are the biggest sources of sugar in our diets?
Sweetened drinks like soda, fruit-flavored beverages, and bottled sweetened teas are the biggest single source. Some experts call them liquid candy. Then there are “energy drinks” like Red Bull. One little 8-ounce can has 115 calories and a big dose of caffeine. There’s no protein in it. If you’re looking for energy from caffeine, consider an espresso drink instead. A Starbucks nonfat Grande Latte has 16 grams of protein and 45% of your minimum daily requirement of calcium. It has more calories (160), but it’s a filling 16 ounces, and much more nutritious.
After sugary drinks, sugarcoated cereal and sweet desserts contribute the most sugar to our diets. Some "sugar cereals" contain up to 41% sugar--especially the ones marketed to children. They have 85% more sugar and 65% less fiber than cereals made for the adult market.
All the smaller sources add up, too. Biscuits, baked beans, sauces, salad dressings, even burgers--and the ketchup you put on them--all may have sugar added. That's because sugar (like salt) is a flavor enhancer, so manufacturers add it to all sorts of things to get you to enjoy them and buy them again.
How can I tell if something has a lot of sugar in it?
Read the ingredient list. If sugar is near the top of the list, it's one of the main items in the food, since they're listed from most to least. But manufacturers often disguise how much sugar is in their product by using smaller amounts of several different kinds of sugar. That way none appear too high on the list. And most people don't recognize all the following ingredients as forms of sugar:
- High-fructose corn syrup
- Galactose
- Fruit juice concentrate
- Polydextrose
- Glucose
- Dextrose
- Honey
- Fructose
- Fruit sugar
- Corn syrup
- Lactose
- Milk sugar
- Maltodextrin
- Turbinate sugar
- Sucrose
- Molasses
- Sorghum
- Maltose
- Sugar alcohols (which end in the letters “ol”) including glycol, sorbitol, mannitol, xylitol and many others
For instance, some granola bars contain one healthy ingredient, oats--along with sugar, dextrose, fructose, corn syrup, and sorbitol. The oats don’t make it a health food.
Is there a health difference between fruit drinks and 100% fruit juice?
Fruit drinks are pretty much like soda without the carbonation. They’re made with added sugars and flavoring.
100% fruit juice does contain more nutritious vitamins and minerals. But it’s very high in calories. And it tastes so good that it’s easy to drink a lot. It’s better for kids to eat fruit. The American Academy of Pediatrics recommends no more than 4-6 ounces for kids age 1 to 6, and 8-12 ounces for older kids.
We’re all used to sweet drinks and foods. How can we satisfy that craving and cut back on added sugar?
Your best bet is to replace added sugars with natural ones in fruits. Put fruit on your cereal and into salads. Make smoothies. Leave out fruit for snacks. Cut up ripe fruit for dessert. Your taste buds will adjust, and fruit will taste sweeter over time.
Food author Michael Pollen suggests that you only eat desserts you make at home. The ingredients will be far less processed than store-bought ones. And most of us won’t bake or make ice cream every day.
Another way to reduce sugar consumption is to replace sugar with foods and drinks made using no-calorie substitute sweeteners. Next week we’ll look at these products and the health controversy over them.
References:
1. Block J, et al "Point-of-purchase price and education intervention to reduce consumption of sugary soft drinks" Am J Public Health 2010; 100: 1427-1433.
2. Jalal D, et al "Increased fructose associates with elevated blood pressure" J Am Soc Nephrol 2010; DOI: 10.1681/ASN.2009111111.
3. Chen L, et al "Reducing consumption of sugar-sweetened beverages is associated with reduced blood pressure: A prospective study among United States adults" Circulation 2010; DOI: 10.1161/CIRCULATIONAHA.109.911164.
4. Intake of added sugars and selected nutrients in the United States, National Health and Nutrition Examination Survey (NHANES) 2003-2006. Marriott BP, Olsho L, Hadden L, Connor P. Crit Rev Food Sci Nutr. 2010 Mar;50(3):228-58.
5. Abdelmalek MF, et al "Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease" Hepatology 2010; DOI:10.1002/hep.23535.
6. Welsh JA, et al "Caloric sweetener consumption and dyslipidemia among US adults" JAMA 2010; 303(15): 1490-97.
7. Sturm R, et al "Soda taxes, soft drink consumption, and children's body mass index" Health Aff 2010; DOI: 10.1377/hlthaff.2009.0061.
8. Duffey KJ, et al "Food price and diet and health outcomes" Arch Intern Med 2010; 170(5): 420-26.
9. Katz MH, Bhatia R "Food surcharges and subsidies" Arch Intern Med 2010; 170(5): 405-06.
10. Artificially Sweetened Beverages--Cause for Concern David S. Ludwig, MD, PhD JAMA. 2009;302(22):2477-2478.
11. Usual Intake of Added Sugars* at http://riskfactor.cancer.gov/diet/usualintakes/pop/t35.html
12. Perez-Pozo S, et al "Excessive fructose intake raises blood pressure in humans" AHA BPRC 2009; Abstract P127.
13. Docs Propose Taxing Sweet Drinks to Cut Consumption, Finance Care at http://www.medpagetoday.com/PublicHealthPolicy/HealthPolicy/16015
14. New Targets in the Fat Fight: Soda and Juice at http://www.nytimes.com/2009/09/01/nyregion/01fat.html?ref=health
15. Johnson RK, et al "Dietary sugars intake and cardiovascular health: A scientific statement from the American Heart Association" Circulation 2009; DOI: 10.1161/CIRCULATIONAHA.109.192627.
16. CDC Director Supports Taxing Sugary Drinks at http://www.medpagetoday.com/Washington-Watch/Washington-Watch/15266
17. Parks EJ, et al "Dietary sugars stimulate fatty acid synthesis in adults" J Nutr 2008; 138: 1039-1046.
18. Shoham D, et al "Sugary soda consumption and albuminuria: results from the National Health and Nutrition Examination Survey, 1999-2004" PLoS ONE 2008; DOI: 10.1371/journal.pone.0003431.
19. Stanhope KL, et al "Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans" J Clin Investigation 2009; DOI: 10.1172/JCI137385.
20. Hofmann SM, Tschop MH "Dietary sugars: A fat difference" J Clin Investigation 2009; DOI: 10.1172/JCI139332.
21. Kelly D. Brownell, Ph.D., and Thomas R. Frieden, M.D., M.P.H. Ounces of Prevention — The Public Policy Case for Taxes on Sugared Beverages NEJM 4/8/09
22. Sugar Is Back on Food Labels, This Time as a Selling Point at http://www.nytimes.com/2009/03/21/dining/21sugar.html?ref=health
23. Nutritively Sweetened Beverage Consumption and Obesity The Need for Solid Evidence on a Fluid Issue David B. Allison, PhD; Richard D. Mattes, PhD JAMA. 2009;301(3):318-320.
24. Study Finds High-Fructose Corn Syrup Contains Mercury at http://www.nlm.nih.gov/medlineplus/news/fullstory_74361.html
25. Food Safety for the 21st Century at http://jama.ama-assn.org/cgi/content/full/300/8/957?etoc
Copyright © 2010 McKesson Health Solutions. All Rights Reserved.
Tags:
Page last updated: September 01, 2010