High-Sugar Diet

We know that too much sugar in your diet can lead to type 2 diabetes and obesity, but what about your heart?

A study published today in JAMA Internal Medicine demonstrates a link between sugar added in meal preparation or processed foods and the risk of death from a heart problem. Even one 140-calorie soda (or any other sugar-sweetened beverage) a day resulted in an increased risk of death.

The study, which analyzed government data on diet and mortality outcomes over a period of several years, also found that many of us consume more added sugar than some health organizations recommend.

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Where the Excess Sugar Comes From

Quanhe Yang of the U.S. Centers for Disease Control and Prevention and colleagues studied self-reported data on three groups of people, during five- to six-year periods between 1988 and 2010. The groups represented a cross-section of Americans in terms of race, age, and education levels. Each sample contained between 8,786 and 11,733 people.

Groups excluded from the study included people already suffering from diabetes, heart disease, or cancer.

The authors used nutrition information from established government models to determine levels of added sugar. Mostly, the sugar came from sugar-sweetened beverages, grain-based desserts, dairy products, candy, and breakfast cereal.

Compared with people in the study who received only 8 percent of their total daily calories from added sugar, those who consumed 17 to 21 percent increased their risk of death by heart disease by 38 percent. The statistic doubled for those who exceeded 21 percent of their daily calories in sugar.

Yang's work showed that Americans who consume the most added sugar included those who are young, black, non-smokers, and people who have a low level of physical activity.

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Death by Added Sugar

Rachel Johnson, a spokesperson for the American Heart Association, also sits on President Obama's Council on Fitness, Sports & Nutrition. She told Healthline that sugar leads to problems such as high blood pressure, hypertension, inflammation, and high levels of triglycerides and bad cholesterol. “This paper is saying, OK, all these factors are really adding up to the ultimate end point, which is death.”

The average portion of daily calories made up of added sugar fluctuated throughout the study periods. It went from 15.7 percent during the 1988–1994 group to 16.8 percent for the study group ending in 2004. For the period from 2005 to 2010, it dropped to 14.9 percent.

These levels exceed guidelines set by the global World Health Organization, which advises limiting added sugar to 10 percent of total calories. The U.S.-based Institute of Medicine has the limit set at a much higher 25 percent.

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Laura Schmidt, a professor at the Institute for Health Policy Studies at the University of California, San Francisco, calls for much stricter guidelines. In an editorial also published today in JAMA Internal Medicine, she calls for added government intervention and specifically targets sugar-sweetened beverages.

“Yang et al underscore the need for federal guidelines that help consumers set safe limits on their intake as well evidence-based regulatory strategies that discourage excess sugar consumption at the population level," she writes. 

A New 'War on Sugar'?

Americans love sugar, but a war on sugar has already begun, with Mexico going so far as to tax sugary foods beginning this year. Communities in the U.S. have seen successes with obesity campaigns, Johnson said, but more work needs to be done.

Perhaps the most visible example of the anti-sugar battle has been former New York mayor Michael Bloomberg's initiative to limit sales of super-sized soft drinks in restaurants. New York Courts prevented him from implementing the law, declaring it unconstitutional. Many have accused Bloomberg of trying to institute a “nanny” state.

“First they laugh, then they ignore you, then they fight you, and then you win,” Johnson said of public policy work.

The American Heart Association recommends that women consume no more than 100 calories per day from added sugar. For men, it's 150 calories. This falls below even the WHO guidelines, for most people.

But how do we change our habits concerning sugar? It helps to acknowledge that it's an addictive substance, Johnson said. “In terms of behavior change, we can't help the people who say, 'I'm not even thinking about changing, none of this evidence convinces me.'”

But at the policy level, groups such as the American Heart Association and Pew Charitable Trust are advancing awareness about the hazards of sugar. The goal is to make the healthy choice the easy choice.

For example, beginning this year, schools nationwide will be required to offer healthy food alternatives in vending machines, Johnson said.

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Practicing Self-Control with Sugar

Registered dietitian Lise Gloede told Healthline that many people she sees in her practice have no idea how dangerous too much added sugar can be. “Many people reward and soothe themselves with highly sugared foods, and unfortunately it can end up killing them," she said.

Here are four tips for cutting back on added sugar, based on suggestions by Gloede and Johnson:

  1. Substitute fruit for ice cream, candies, or pastries for dessert. Natural sugar is not dangerous like added sugar.
  2. Limit adding sugar only to slightly sweeten healthy meals.
  3. Keep in mind that it's not just soda that causes trouble. A sweetened, flavored coffee is no better. The same goes for energy drinks.
  4. They call them “treats” for a reason. Sugary confections aren't meant for frequent snacking.