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Sugar
Bonnie LiebmanThe Sweetening of the American Diet
Not obesity. Not heart disease. Not poor diets or just about anything else. As far as the Food and Drug Administration and most nutritionists are concerned, sugar causes no health problems whatsoever. "Other than the contribution to dental caries," says the FDA, "sugar is safe."
That prevailing wisdom has helped fuel the sugar-coating of the American diet. We're eating more sugar than ever before--20 percent more than in 1986. That means more and more junk foods that either squeeze healthier foods out of the diet or add empty calories few of us can afford. And it's not just our teeth--but our waistlines, hearts, and bones--that may suffer.
The insatiable American sweet tooth has done it again. In 1996, the latest year for which figures are available, our intake of refined sugars rose ... for the tenth year in a row (see "Up, Up, and Away"). Enough sugar was produced to provide every man, woman, and child in the U.S. with 152 pounds of refined sweeteners--table sugar, high-fructose corn syrup, dextrose, etc.
That's an overestimate because all the sweeteners produced don't necessarily reach our mouths. But you can still use those figures to compare one year to another. And in 1996, we averaged 25 more pounds of sugar per person than we did in 1986.
Nothing--not artificial sweeteners (they're on the rise, too) or growing alarm over surging obesity rates or an increasingly nutrition-savvy public--seems capable of turning the tide.
Using diet surveys--which underestimate what people eat--the average American swallows 20 teaspoons of added sugars a day.(1) That's 16 percent of a day's calories. Among teenagers, it's 20 percent. ("Added sugars" don't include the naturally occurring sugars in milk and fruit.)
What's behind sugar's success? The soft drink industry--which trumpets its plans to swallow up all other beverages, including milk and water--deserves much of the blame (see "Liquid Candy," p. 8). So do restaurant serving sizes--for soft drinks, ice cream, candy, pastries, and other sweets--that can only be described as obese (see "How Sweet It Is," pp. 6 & 7).
Then there's the mistaken mindset (thanks to Madison Avenue) that a fat-free food--no matter how high in sugar or calories--adds no fat to your thighs or waist. And let's not forget the persistent PR efforts of the sugar industry, led by its Sugar Association.
It works hard to "educate" the public about "sugar's role in a healthful diet." It also influences the people who influence what you eat. For example, "as a public service," the Association publishes a column in the Journal of the American Dietetic Association. The ADA's "position statement" on sugars was co-authored by an advisor to the Canadian sugar industry. Maybe that's why it fails to see the problems caused by America's sweet tooth.
Calories, Calories
"Sugar can become a friend of the dieter by adding a low-calorie (only 15 calories per teaspoon), appealing taste to healthful carbohydrates," says the Sugar Association.
A teaspoon? Try ten teaspoons in a 2-oz. 3Musketeers bar or 12 teaspoons in a Cinnabon.
Most sugar-laden foods are high in calories (the Cinnabon has 670). And it's calorie-dense foods--whether they're loaded with sugar, fat, or both--that may be fattening the American waistline.
"Reducing calorie density will help people prevent weight gain and may help take weight off," says Susan Roberts of the Jean Mayer U.S. Department of Agriculture Human Nutrition Research Center on Aging at Tufts University in Boston.
A calorie-dense food has more calories per ounce than a food with low calorie density. For example, a McDonald's Garden Salad (without dressing) and a Quarter Pounder both weigh about six ounces (170 grams). The salad has 35 calories (0.2 calories per gram), while the Quarter Pounder has 420 calories (2.5 calories per gram). The burger is 13 times more calorie-dense.
"The majority of studies suggests that people spontaneously eat fewer calories if they're eating a calorically less-dense diet," says Roberts.
Each gram of sugar has four calories. So does the pure starch in potatoes, rice, and pasta. But those starchy foods also contain water, so they actually supply about one calorie per gram. (Drier foods like bread and breakfast cereals supply more calories per gram; hot cereals supply fewer.)
"Sugars are similar to starch, but they're usually consumed in a more-concentrated form," Roberts explains. "And fat-sugar combinations, like cookies, are the worst of all because they're really calorie-dense and they're very palatable."
So far, long-term studies show that diets that are less calorie-dense (they're usually low in fat and sugar) can help people lose about two to seven pounds--and keep it off--without even trying.(2) That's nowhere near the kind of weight loss that diet books promise. But promises are cheap ... especially when they're made with no evidence. In the real world, weight loss that lasts doesn't come easy.
"The body defends itself better at weight loss than weight gain," says Roberts. When people cut calories, their metabolic rate and body temperature drop to avoid using calories. "The body tries to be as efficient as possible so it doesn't lose weight."
The next wave of research, she says, is on how to prevent weight gain in the first place. And that's where diets with low calorie density--and that means few fatty or sugary foods--may come in. "A diet that doesn't produce an enormous weight loss may still be good for preventing weight gain," says Roberts.
A Sweet-Fat Tooth
"Sugar is no more fattening than any other food," says the Sugar Association's Web site (www.sugar.org).
Ounce for ounce, sugar has the same number of calories as other carbohydrates and protein, and less than half the calories of fat. But sugar isn't just any old food.
"There's a subset of obese and overweight women whose weight is associated with--and possibly due to--an appetite for fat-sugar mixtures," says Adam Drewnowski of the University of Michigan School of Public Health. "They crave foods like chocolate, ice cream, cake, and cookies."
The women who love sugar-fat mixtures are more likely to be binge-eaters or yo-yo dieters, he adds. In one study, obese people whose weight had fluctuated by an average of 25 pounds during the previous year had stronger preferences for fatty, sugary cake icings than obese people whose weight changed by an average of 14 pounds.(3)
The preference for fat-sugar mixtures in some women, says Drewnowski, is linked to endorphins--opiates made by the body. When he gave binge-eaters a drug that blocks the action of opiates, they ate less of the fatty sweetened cream (but not the other foods) that he offered them.(4)
"When these people say they're addicted to chocolate, ice cream, and other sweets, they're not far off." (He hasn't tested their response to fat-free or sugar-free cakes and ice cream.)
The sugar-fat appetite is less common among overweight men, says Drewnowski. "Men tend to prefer meats like steak, hot dogs, and sausage."
That's not to say that fatty sweets are solely to blame for a nation that's growing out of its clothes and its stadium seats. "We don't know how important the women who crave fat-sugar mixtures are to the entire population," says Drewnowski.
The sugar industry argues that sugar plays no role in obesity because, in some studies, sugar-eaters are actually thinner than others.(5) But those studies are flawed because the weight differences are due to age, not sugar.(6)
"The young eat more sugar and they're thinner," says Drewnowski. "Older people eat less sugar, they have a sedentary lifestyle, and they're more overweight."
Heart Disease
"The body treats all carbohydrates the same," claims the Sugar Association. In fact, sugar may boost blood triglyceride and insulin levels more than other carbohydrates, at least in some people. And higher triglycerides raise the risk of heart disease.
"There's no question that carbohydrates are not all equal," says Stanford University's Gerald Reaven. When he fed people who already had high triglycerides a high-carbohydrate, low-fat diet, their triglycerides and insulin climbed. But they rose higher when he upped the sugar than when he raised carbs from starchy foods like bread or potatoes.(7)
In the 1980s, researchers at the U.S. Department of Agriculture got similar results in people--usually middle-aged men or post- (but not pre-) menopausal women--they called "carbohydrate-sensitive."(8-10)
"Today those people would be classified as insulin-resistant," says Judith Hallfrisch of the USDA's Human Nutrition Research Center in Beltsville, Maryland. "When we fed them a diet that was 20 percent sugar, triglycerides went up hundreds of points in some people." At the time, 20 percent was high, she adds. Now it's what many Americans eat.
If you're insulin-resistant, the insulin your body produces isn't effective at getting sugar from your blood into your cells, where it can be burned or stored as fuel. "Insulin resistance is dangerous," says Reaven, "because either you get diabetes or you get Syndrome X, which raises your risk of heart disease."
Syndrome X is a cluster of risk factors that includes high insulin, high triglycerides, low HDL ("good") cholesterol, and high blood pressure. In fact, the easiest way to find out if you're insulin-resistant is to have your triglycerides and HDL checked.
How many Americans are insulin-resistant? "The vast majority of people with diabetes or impaired glucose tolerance, up to half of those with high blood pressure, and about a quarter of the healthy population," estimates Reaven.
Being overweight makes insulin resistance worse, but some obese people never get it, he adds. That's because genes account for half of the risk. How heavy and sedentary you are each accounts for a quarter.
"There are more and more insulin-resistant people every day because the population is getting fatter and older," says Hallfrisch.
Some researchers urge insulin-resistant people to avoid high-carbohydrate, low-fat diets to keep their triglycerides from rising and their HDL from falling.
But a recent study suggests that some high-carb, low-fat diets may raise triglycerides more than others. In a small pilot study, Christopher Gardner and colleagues at Stanford University compared a low-fat "convenience-food diet" to a low-fat vegetarian "plant-food diet." They tested 14 people with high cholesterol levels, rather than high triglycerides.(11)
"Both diets had the same amount of calories, fat, saturated fat, cholesterol, protein, and carbohydrates," says Gardner. "But the convenience-food diet had things like SnackWell's cookies, fat-free cream cheese, Baked Tostitos, and low-fat bologna. The plant-food diet was packed with grains, salads, vegetables, and other whole foods," so it had more fiber.
Both diets contained about the same amount of sugar, he adds, but in the plant-food diet it came from fruit and in the other it came largely from fruit juices, sweetened yogurt, and low-fat cookies.
The difference in triglycerides was "stunning," says Gardner. "They went up 30 percent on the convenience-food diet and down 25 percent on the plant-food diet."
A larger study is under way. If the results are similar, says Gardner, "you can't just talk about nutrients like fat and carbohydrates anymore. You have to talk about foods."
And that would make it harder for people to argue that sugary fat-free cakes, cookies, and ice cream can be the staples of a healthy low-fat diet.
Running on Empty
Your mother didn't need a report from major health authorities to figure it out. She knew that too much candy and too many soft drinks, cookies, and other sweets could mean too few fruits, vegetables, vitamins, and minerals in your diet.
"Foods that tend to be high in added sugar tend to not be high in other nutrients," says Alice Lichtenstein of the USDA Human Nutrition Research Center on Aging at Tufts University.
And those sugary junk foods squeeze more-nutritious foods out of the diet. Take soft drinks.
Your risk of osteoporosis later in life depends in part on how much bone mass you build early in life. And girls build 92 percent of their bone mass by age 18. That's why children and teenagers need more calcium than people aged 25 to 50. So what are they drinking? Coke.
The average teenager now gulps twice as much soda as milk. (In the late 70s, milk topped soda almost two to one.) No wonder the average teenage girl gets 40 percent less calcium than she needs.
"Teens in particular should be drinking milk instead of soft drinks," says Velimir Matkovic, a calcium expert at the Ohio State University Medical Center in Columbus.
And it's not just milk that sugar replaces. "If people get a big chunk of their calories from added sugar, they're not getting good things like fruits, vegetables, whole grains, fiber, vitamins, and minerals," says Walter Willett, chair of the nutrition department at the Harvard School of Public Health. Those "good things" aren't incidental. They may cut the risk of cancer, diabetes, and heart disease.
Not surprisingly, the few adults--less than one percent of the population--who get all the recommended servings of fruits, vegetables, and other food groups also seem to eat the least sugar (and fat).(12)
"When a high proportion of your calories comes from sugar, it makes it more difficult to meet nutrient needs," says Lichtenstein.
That may not be a problem for athletes or for teenage boys who devour 3,000 calories a day and stay trim. But most Americans simply aren't active enough to use up the calories they consume.
"If we were all lumberjacks and had to split wood and carry it into the house to keep warm, we could afford those extra calories," says Lichtenstein. "But we don't even get up to change the channel on the TV anymore."
[GRAPHS OMITTED]
(1) USDA, Pyramid Servings Data, 1997.
(2) Nutrition Reviews 56: S29, 1998.
(3) Am. J. Clin. Nutr. 54: 635, 1991.
(4) Am. I. Clin. Nutr. 61: 1206, 1995.
(5) Internat. J. Obesity 18: 820, 1994.
(6) Obesity Research 5: 511, 1997.
(7) J. Clin. Endocrin. Metab. 59: 636, 1984.
(8) Am. J. Clin. Nutr. 66: 1072, 1997.
(9) Am. J. Clin. Nutr. 58 (Suppl.): 800S, 1993.
(10) Am. J. Clin. Nutr. 62 (Suppl.): 2505, 1995.
(11) Can. J. Cardiol. 13 (Suppl. B): 236B, 1997.
(12) Am. J. Clin. Nutr. 65 (Suppl.): 1264S, 1997.
RELATED ARTICLE: THE BOTTOM LINE
* Added sugar consumption has risen 20 percent since 1986. Added sugars now account for 16 percent of the calories consumed by the average American ... and 20 percent of teenagers' calories.
* Added sugars--found largely in junk foods like soft drinks, cakes, and cookies--squeeze healthier foods out of the diet. That's especially a problem for sedentary people, who cannot afford to squander calories.
* Sugar contributes to obesity because most heavily sweetened foods are high in calories.
* In people who are insulin-resistant, sugar raises the risk of heart disease by boosting blood triglycerides more than other carbohydrates do.
RELATED ARTICLE: How Sweet It Is
How much added sugar should people eat?
"Try to limit your added sugars to six teaspoons a day if you eat about 1,600 calories, 12 teaspoons at 2,200 calories, or 18 teaspoons at 2,800 calories," says the U.S. Department of Agriculture. That works out to between six percent and ten percent of calories from sugar.
But Americans are eating far more than that. About 16 percent of the average person's calories come from added sugars. And some people get considerably more than average.
Where does it all come from? Soft drinks and sweet baked goods like cookies, cakes, and pastries contribute the biggest chunks, according to estimates from the late 1980s. And since then, soda consumption has jumped by about 20 percent.
Use this chart to check out your own sweet tooth. (If you want to see whether you meet the USDA's advice, divide the number of grams of sugar by four to get teaspoons.) You may be surprised to find that even though fat-free cakes, cookies, and ice cream often taste sweeter than their fatty counterparts, they contain about as much sugar.
And don't forget to check the calories and fat in your favorite sweets. You wouldn't want to inadvertently switch from a high-sugar candy bar to a high-fat one.
Within each category, foods are ranked from least to most sugar, then least to most total fat.
Total
Sugar Fat
Calories (grams) (grams
Candy
KitKat (1 package--1.5 oz.) 220 21 11
Reese's Peanut Butter 250 21 14
Cups (2--1.6 oz.)
Milky Way Lite (1--1.6 oz.) 170 24 5
Twizzlers Strawberry Twists 230 26 1
(10 twists--2.5 oz.)
Butterfinger (1--2.1 oz.) 270 29 11
Snickers(1--2.1 oz.) 280 29 14
M&Ms (1 package--1.7 oz.) 240 31 10
Milky Way (1--2.1 oz.) 270 35 10
Junior Mints (1 box--1.6 oz.) 180 37 3
3Musketeers (1--2.1 oz.) 260 40 8
Skittles (1 package--2 oz.) 240 45 3
Cereals
Cheerios (1 cup) 110 1 2
Kellogg's Frosted 180 10 1
Mini-Wheats (5 biscuits)
Honey Nut Cheerios (1 cup) 120 11 2
Kellogg's Frosted Flakes (3/4 cup) 120 13 0
Frosted Cheerios (1 cup) 120 13 1
Cookies (number closest to 1 ounce)
Nabisco Old Fashioned Ginger Snaps (4) 120 9 3
Pepperidge Farm Nantucket 140 9 7
Chocolate Chunk (1)
SnackWell's Creme Sandwich (2) 110 10 3
Nabisco Reduced Fat Chips Ahoy! (3) 140 10 5
Nabisco Chips Ahoy! (3) 160 10 8
SnackWell's Chocolate Sandwich (2) 110 11 3
Pepperidge Farm Milano (3) 180 11 10
Keebler Soft Batch Chocolate Chip (2) 160 12 7
Nabisco Oreo (3) 160 13 7
SnackWell's Fat Free Devil's Food (2) 100 14 0
SnackWell's Mint Creme (2) 110 14 4
Nabisco Reduced Fat Oreo (3) 130 14 4
Boston Market Chocolate Chip (1) 340 29 17
Teas, "Fruit" Drinks, etc. (1 cup)
Gatorade, any flavor 50 14 0
Arizona Original Iced Tea with 90 24 0
Lemon Flavor
Ocean Spray Cranberry Juice Cocktail 140 25 0
Tropicana Twister Orange Raspberry 120 26 0
Snapple Pink Lemonade 120 27 0
Fruitopia Strawberry Passion Awareness 110 29 0
Ocean Spray Cranapple 160 29 0
Dairy Products (1 cup, unless
otherwise noted)
Dannon Coffee, Lemon, or Vanilla 210 16 3
Lowfat Yogurt
Haagen-Dazs Low Fat Chocolate 340 30(*) 5
or Vanilla Ice Cream
Breyers Natural Vanilla Ice Cream 300 30(*) 18
Baskin-Robbins Chocolate Ice Cream 300 32(*) 18
Breyers Fat Free Vanilla Ice Cream 220 42(*) 0
Haagen-Dazs Chocolate or 540 42(*) 36
Vanilla Ice Cream
Haagen-Dazs Low Fat Coffee 340 44(*) 5
Fudge Ice Cream
McDonald's Hot Fudge Sundae (6.5 oz.) 340 47(*) 12
Haagen-Dazs Chocolate Chocolate 600 48(*) 40
Chip Ice Cream
Dairy Queen Vanilla Cone, 410 49(*) 12
large (9 oz.)
Ben & Jerry's Low Fat Blond Brownie 380 64(*) 5
Sundae Ice Cream
Ben & Jerry's Devil's Food 320 66(*) 4
Chocolate Sorbet
Wendy's Frosty, large (20 oz.) 540 70(*) 14
McDonald's Vanilla Shake, 480 71(*) 13
large (20 oz.)
McDonald's McFlurry (9 oz.)(1) 610 75(*) 22
Dairy Queen Heath Breeze, 710 103(*) 18
medium (14 oz.)
Dairy Queen Chocolate Shake, 770 113(*) 20
medium (19 oz.)
Dairy Queen Chocolate Malt, 880 131(*) 22
medium (20 oz.)
Pastries, Cakes, etc.
Hostess Twinkles (1--1.5 oz.) 150 14 5
Hostess Lights Low Fat 130 16 2
Twinkles (1--1.5 oz.)
Entenmann's light Golden or 130 17 0
Marble Loaf (1/8--1.5 oz.)
Entenmann's light Cinnamon 160 17 3
Buns (1--2 oz.)
Hostess Cup Cakes (1--2 oz.) 180 17 6
Entenmann's Light Chocolate 120 18 0
Loaf (1/8--2 oz.)
Entenmann's All Butter 210 18 9
Loaf(1/6--2 oz.)
Hostess Lights Low Fat Cup 140 19 2
Cakes (1--1.5 oz.)
Entenmann's Crumb Topped 260 19 13
Donuts (1--2 oz.)
Entenmann's Cinnamon Swirl 300 19 13
Buns (1--3 oz.)
Little Debbie Apple Streusel 230 23 7
Coffee Cakes (2--2 oz.)
McDonald's Cheese Danish (1--3.5 oz.) 410 26 22
Sara Lee French Cheesecake 410 27 25
(1/5--4.5 oz.)
Hostess Iced Honey Bun (1--3.5 oz.) 420 27 25
Little Debbie Fudge 310 28 15
Brownies (1--2.5 oz.)
Au Bon Pain Lowfat Triple 260 30 4
Berry Muffin (1--4 oz.)
Sara Lee German Chocolate Layer 280 30 15
Cake (118--3 oz.)
Boston Market Brownie (1--3.5 oz.) 450 32 27
Entenmann's Light Fudge Iced Chocolate 190 33 0
Cake (1/6--3 oz.)
Entenmann's Chocolate 310 36 14
Fudge Cake (1/6--3 oz.)
Au Bon Pain Blueberry 430 36 18
Muffin (1--4.5 oz.)
Au Bon Pain Pecan Roll (1--6.5 oz.) 800 42 45
Mrs. Fields Double Fudge 420 47 25
Brownie (1--3 oz.)
Cinnabon (1--7.5 oz.) 670 49 34
Cheesecake Factory Original 710 49 49
Cheesecake (1sl.--7 oz.)
Cheesecake Factory Lite 580 52 29
Cheesecake (1sl.--7.5 oz.)
Soft Drinks (12-oz. can)
Canada Dry Ginger Ale 120 33 0
Sprite 140 38 0
Coca-Cola Classic, Dr Pepper, Pepsi(1) 150 40 0
A&W Root Beer, Mountain Dew(1) 170 47 0
Sunkist Orange Soda 190 52 0
(*) Includes milk sugar. (1) average.
Sources: Manufacturers and Nutrition Action Healthletter restaurant studies.
Chart compiled by Ingrid VanTuinen.
Use of this information for commercial purposes is prohibited without written permission from CSPI.
COPYRIGHT 1998 Center for Science in the Public Interest
COPYRIGHT 2008 Gale, Cengage Learning