The other White Death (you call it sugar)

Let’s have a talk about sugar.  (And you can blame John for the title.)

Previous research has shown that increased consumption of added sugars in foods and beverages can lead to hypertension, type II diabetes and obesity.

“Added sugars” are those that are placed in foods and beverages to help increase their consumption by making them sweeter. Examples would be sweetened teas, canned fruits packed in sugar syrup, ice cream, candy, desserts, sodas containing sugars and many other similar products.

In light of the fact that added sugars can contribute to the above diseases, various organizations like the World Health Organization, American Heart Association (AHA) and others have proposed that we limit our exposure to added sugar.

How much “added sugar” people eat today

The recommended amount varies per organization, from getting fewer than 25% of our total calories from added sugar, down to getting only about 5% or our total calories from added sugars. Five percent would be about 100 calories/day from added sugars.  That’s about the number of calories you’d find in 6 teaspoons of sugar.  Not very much considering that the average can of soda contains on the order of about 160-210 calories of added sugar per 12 ounce can.

Sugar, via Shutterstock

Sugar, via Shutterstock

This study took a look at added sugar and cardiovascular risk.  The researchers used data drawn from the National Health and Nutrition Examination Surveys (NHANES) for the periods 1988-1994, 1999-2004 and 2005-2010.  The NHANES data is drawn from a large number of US citizens who are aged 18 and older.  The intake of added sugar per person per day is around 16% of total calories.  Higher than what the AHA recommends.  About 10% of adults consumed as much as 25% of their daily calories from sugar.  Much of the added sugar intake came from sugar-added beverages and juices.

The health risks of eating too much “added-sugar”

The investigators looked at the NHANES data from all three time periods.  They focused on the amount of sugar consumed and the risk of dying from cardiovascular disease.

The data shows that the risk of dying from a heart attack increases substantially as added sugar consumption increases above 15%.

For someone who normally eats a 2000 calorie diet, a single 20-ounce bottle of sweetened soda would take them to the 15% level of added sugar.  That is, after drinking that bottle of soda, they should consume nothing else containing added sugar for that day.  Their data shows that the risk of death increases as the amount of added sugar increases.  The risk of cardiovascular death can be up to four-times higher in someone who eats or drinks about 700 calories or more of added sugar/day (about 30% added sugar).  Even increasing added sugar intake slightly over 15% can cause a substantial increase in risk of death.

Similar risks are seen in other countries, as well.  Previous studies have shown that those people who drink more sugary beverages are at higher risk of death from a variety of causes.  In Mexico, per capita consumption of sweetened beverages is high.  In Japan, it’s low.  In Mexico about 318 people/million die due to this increase in sugar consumption.  In Japan, the rate is about 10 per million.   It’s estimated that, worldwide, about 200,000 people die per year due to increased intake of sweetened beverages.

The upshot is that it is necessary to monitor how much added sugar that we consume to avoid increasing our risk of cardiovascular death.  One good thing is that the US Food and Drug Administration is proposing changes to the nutrition labels on foods and beverages.  The new labels will clearly show if there is added sugar and, if added sugars are present,  how much is contained in the product.  That should help us keep an eye on excessive sugar consumption.  And we need to because of its contribution to diabetes, obesity, hypertension and cardiovascular risk.


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Mark Thoma, MD, is a physician who did his residency in internal medicine. Mark has a long history of social activism, and was an early technogeek, and science junkie, after evolving through his nerd phase. Favorite quote: “The most exciting phrase to hear in science... is not 'Eureka!' (I found it!) but 'That's funny.'” - Isaac Asimov

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