Sugar

• The emphasis on reducing fat intake in the middle of the 20^th century led to an unintended increase in the carbohydrate intake particularly the more dangerous refined carbohydrates. When manufacturers reduced the fat content of the food because of the growing concern about high-fat diets, they often added sugar to make it taste better.⁵ 

• Over the past decades, differences in the quality of carbohydrates have become better understood (See Glycemic Index). The medical community has realized the dangers of a high carbohydrate diet especially the added sugar. Regardless of its form sugar (e.g. fructose, sucrose or high fructose corn syrup, etc) appears to be a potentially serious contributor to cardiovascular risk.

• The explosive growth of the soft drink industry has further brought this topic to the forefront of scientific scrutiny. Soft drinks and other sugar-sweetened beverages (SSB) are the primary sources of added sugars in American children, adolescents, and adults.^{6, 7}About half of that sugar is in soft drinks, and the rest comes from baked goods, table sugar, jellies, candy, desserts, and ready-to-eat cereals. ⁶

• Added sugars (caloric sweeteners used as ingredients in processed or prepared foods) are an increasing and potentially modifiable component in the US diet.⁵ Positive energy balance with as few as 100-200 calorie surplus daily can yield an excess of 10-20 pounds over one year’s time.^{8, 9}

• “Supersized” portions in the U.S. have maximized energy content of numerous foods and beverages. In the current  obeseogenic era, excessive intake of nutrient-poor discretionary calories, such as  added sugars and soft drinks must be avoided.¹

• Soft drinks contribute to weight gain because of their high added-sugar content and low satiety. Liquid energy such as soft drinks, does not suppress appetite leading to no reduction in energy consumption at the next meal resulting in increased energy intake.¹ To make matters worse, “typical” servings of soft drinks have increased over the years and now a standard 12 oz serving of Coke or Pepsi contain 140 calories. Americans consume an average 17oz (200 calories) per day of soft drinks.⁶

• Fructose from table sugar  or high fructose corn syrup may also increase blood pressure and promote the accumulation of visceral adiposity, dyslipidemia, and ectopic fat deposition (from increased hepatic de novo lipogenesis).¹ This does not apply to fructose when it is consumed as whole fruits (not made into juice), which is densely packed with nutrients and soluble fiber and often have a low glycemic load.

• Consumption of added sugars among US adolescents is positively associated with obesity and multiple measures known to increase cardiovascular disease risk.¹²  This is because children who consume more calories due to larger portion of soft drinks do not eat less at other times.¹¹

• Apart from obesity, high consumption of added sugar (consuming >25% of the calories) was associated with significant increase in triglycerides (7mg/dl), LDL (5mg/dl), and a decrease in HDL (11mg/dl) compared to those who had low consumption (<5% of the calories). ⁵Also the risk of low HDL was increased up to 300% among  high consumers of added sugar.⁵

• There is every reason to reduce the intake of added sugar, which may directly or indirectly affect health adversely.

• The 1999-2006 National Health and Nutrition Examination Survey found that 16% of the daily calories come from added sugar. The average American adult now consumes 3.2 ounces of added sugars a day ─ equivalent to 21 teaspoons, or 359 calories.⁵

• The American Heart Association recommends that women consume no more than 100 calories of added sugars a day─ about one ounce, or six teaspoons of sugar─ and that men limit their intake to 150 calories a day, or about nine teaspoons.¹ Limit the intake of soft drinks to 36 ounces per week ( 5oz/d).¹

Sources

1. Johnson RK, Appel LJ, Brands M, et al. Dietary Sugars Intake and Cardiovascular Health. A Scientific Statement From the American Heart Association. Circulation. Aug 24 2009.

2. Hellerstein M K. Carbohydrate-induced hypertriglyceridemia: modifying factors and implications for cardiovascular risk. Current opinion in lipidology. Feb 2002;13(1):33-40.

3. Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. May 2003;77(5):1146-1155.

4. Ma Y, Li Y, Chiriboga DE, et al. Association between carbohydrate intake and serum lipids. J Am Coll Nutr. Apr 2006;25(2):155-163.

5. Welsh JA, Sharma A, Abramson JL, Vaccarino V, Gillespie C, Vos MB. Caloric sweetener consumption and dyslipidemia among US adults. JAMA. Apr 21 2010;303(15):1490-1497.

6. Wang Y.C, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988-2004. Pediatrics. Jun 2008;121(6):e1604-1614.

7. Briefel R R, Johnson CL. Secular trends in dietary intake in the United States. Annu Rev Nutr. 2004;24:401-431.

8. French S A, Story M, Jeffery RW. Environmental influences on eating and physical activity. Annu Rev Public Health. 2001;22:309-335.

9. Nielsen SJ, Siega-Riz AM, Popkin BM. Trends in energy intake in U.S. between 1977 and 1996: similar shifts seen across age groups. Obesity research. May 2002;10(5):370-378.

10. Lichtenstein AH, Appel LJ, Brands M, et al. Diet and lifestyle recommendations revision 2006: a scientific statement from the American Heart Association Nutrition Committee. Circulation. Jul 4 2006;114(1):82-96.

11. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. Dec 2007;120 Suppl 4:S164-192.

12. Welsh JA, Sharma A, Cunningham SA, Vos MB. Consumption of added sugars and indicators of cardiovascular disease risk among US adolescents. Circulation. Jan 25 2011;123(3):249-257.