A well-researched article about sugar in this month’s issue of the JAMA Internal Medicine journal made news across the USA during the first week of February. The gist of the article is that high sugar intake raises the risk of fatal heart attacks much more than we knew before. In the past, it was thought that high sugar intake increased the risk of obesity and type 2 diabetes, but was simply a marker for increased cardiovascular risk due to these associated diseases.
This new study makes it clear that increased sugar intake alone is a serious risk factor for fatal heart disease, independent of any other risk factors. Fatal heart attack risk goes up steadily with rising sugar intake. If daily sugar intake contributes a fourth of total calorie intake, the risk of fatal heart attack is three times higher than average. When daily sugar intake provides over a third of total calories, the risk of fatal heart attack is quadrupled.
In the 1800s, sugar consumption averaged about 100 calories a day. It rose slowly in the the early 1900s, going up to about 235 calories a day by 1970, and over 300 calories a day by the year 2000. Some people consume 1000 or more sugar calories daily, not counting any natural sugar in fruit. Most added sugar is not seen by consumers because it’s hidden in sugary drinks or foods. Even though it’s hidden, such high sugar intake poses very high health risks.
Average sugar consumption started going down a bit in 2005 as people began to realize that high sugar intake is not wise. Still, with intake averaging about fifteen percent of total calories today, it remains too high. The World Health Organization (WHO) recommends keeping added sugar intake to under ten percent of all calories. The American Heart Association advises limiting sugar to not over six teaspoons (100 calories) a day for females, and not over nine teaspoons a day for men. With all that we now know about the toxicity of excess sugar, my view is that 100 calories daily is a sensible limit for both men and women.
The Sugar Paradox
The sugar paradox is that less sugar makes life sweeter in the long run. Today we know that excess sugar intake is responsible for a host of ailments that increase suffering and shorten life. More research is needed to determine exactly how excess sugar causes these problems, but scientists know enough now to say definitely, “Less is best.”
The Sugar Challenge
The trouble is that most of us like the sweet taste of sugar. Knowing this, commercial food producers add sugar to a host of food products to make them as appealing as possible. Unhappily, sugar is also addicting. Brain imaging shows that sugar lights up the same area of the brain as cocaine and other addicting substances, explaining why cutting down on sugar isn’t easy. The problem is how to make our lives sweeter with less sugar. It’s a challenge, but it’s not impossible. We can meet this challenge!
I suggest a three-pronged approach to the sugar challenge. First, we don’t have to totally eliminate sugar from our lives. We must be serious about cutting down our sugar intake, but we can still enjoy it as a condiment. What this means is that we can use it occasionally in small amounts. I’ll suggest specific ways of doing this in a moment.
Second, finding excess sugar, and finding the self-discipline to cut it out is essential. We must find troublesome sugar sources and then follow-up with decisive action to eliminate them. Sweetened soft drinks are a major source of unnecessary sugar intake. Cutting them out is a smart thing to do. Other sources of added sugars are candies, cakes, cookies, and many processed foods. With a well-informed mind and mindset, most of these can be curtailed.
Knowing that we can reward ourselves in other ways makes it easier to do this. A small sugar allowance helps. I enjoy having organic strawberry jam on my toast along with herbal tea at breakfast. It’s low-sugar jam, but it still has a bit of added sugar. A daily allowance of 100 sugar calories lets me enjoy my morning jam and toast without any guilt or threat to health.
Most days, I don’t have any other source of added sugar, but on special occasions I may have a bit of sweet dessert, knowing that it’s within my sugar allowance. (Interestingly, I never want more than a bit. After years of sensible eating, my taste-buds have become so sensitized to sugar that most desserts taste too sweet.)
The way I use my sugar allowance may not be how you would use it, and that’s fine. Use your sugar allowance for any special treat you like. Just don’t go overboard. Enjoy your treat fully, but let it suffice. If you eliminate other sources of hidden added sugar successfully, your sugar allowance will serve you well.
The third prong in meeting the sugar challenge is to enjoy naturally sweet fruits as a substitute for other sweet confections. Most fruit is sweet because of its natural fructose. It doesn’t count as part of your sugar allowance, and in this limited amount, it’s not hazardous to health. We enjoy fresh fruit with many of our meals.
I hope you find this three-pronged approach to cutting down sugar intake helpful. Your self-discipline may surprise you, and the resulting benefits will delight you. In cutting out excess sugar, you’re likely to find life sweeter than you ever thought possible!
Ed Dodge, MD, MPH
This post was published first in Dr. Ed Dodge’s Wellness Newsletter, Feb. 18, 2014 • Volume VI, No. 2.