In chapter 3, as they introduce the important organic macromolecules, they also discuss several aspects of how they can influence our diet and health. There are discussions of the negative affects of anabolic steroids, concerns about trans fats and the possible evolutionary basis of lactose intolerance. One topic I’d like to have you investigate a little further is the concerns (and misconceptions!) about sugar in our diets. Some diet advice out there suggests we avoid sugars all together, but you now know from the lecture that carbohydrates are an important part of our diets as they provide us with energy. Many foods that naturally contain carbohydrates also contain other important dietary components, like fiber, vitamins and minerals. The problem seems to be with ADDED sugars in our diet. I acached the article to read.
Consider the following questions as a starting-off point for your discussion post:
- Was anything in this article surprising or new to you?
- Do you think others are well-educated on this issue? Uninformed? Misinformed?
- Do you feel like you have a better understanding of the issues surrounding sugars in your diet now or are you still confused?
Do a search online to find another article about sugar in your diet. Share the link in your post. Assess the information provided in the article you found. Does it seem accurate based on what you learned in class and read in the article I shared or is it based on incomplete or inaccurate information? Explain.
Post should summarize your thoughts on what we are discussing. Sometimes (as above) I might give you questions to use as a starting point but you don’t have to comment on all my questions and you are free to bring up other thoughts!
Magnesium & stroke, p. 8 Getting a good night’s sleep, p. 9 Three easy salads, p. 12
B Y B O N N I E L I E B M A N
You’ve heard of a beer belly. Now there’s new
evidence that the fructose in added sugars may
send more of your extra calories to that bulge
where your waist used to be.
For years, researchers have found a higher risk of
type 2 diabetes, heart disease, high blood pres-
sure, high triglycerides, gout, and weight gain
in people who consume more sugar-sweetened
beverages. Now a flurry of new studies suggests
that our out-of-control sweet tooth is connected
to our out-of-control belly fat.
And it’s that kind of fat that may cripple the
body’s ability to use insulin, setting the stage for
diabetes and heart disease.
C o n t i n u e d o n p . 3 .
How Much is
Too Much Sugar?
A P R I L 2 0 1 2 $ 2 . 5 0
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N U T R I T I O N A C T I O N H E A L T H L E T T E R ■ A P R I L 2 0 1 2 3
in solid foods? “There’s not as much evi-
dence for them,” says Malik. “We haven’t
looked at that carefully yet.”
“We focused on sugar-sweetened bever-
ages because they’re the largest contribu-
tor of added sugar intake,” she adds, “and
because of the lack of compensation for
liquid calories.”
Studies find that people may “compen-
sate” for the calories they get
from solid foods by eating
less later in the day. But that
doesn’t seem to happen when
people drink liquid calories.4
“In one study, people given
jelly beans consumed less at
subsequent meals than those
who were given the same
calories as liquid sugary bev-
erages,” says Malik.
More evidence that sugary
beverages can plaster on the
pounds: In three studies,
scientists randomly assigned
people to consume either sug-
ary beverages (made with sugar or high-
fructose corn syrup) versus diet beverages
(usually made with aspartame) for three
to 10 weeks.5-7 Sure enough, only those
who consumed sugar or high-fructose
corn syrup gained weight.
But now researchers are hot on the trail
of a new lead: Is the fructose that makes
up roughly half of most added sugars
more likely to migrate to
your belly than elsewhere?
A Beeline to the Belly
Clearly, too many calories
from anything—sugary bever-
ages, beer, burgers, fries,
pizza, ice cream, or dozens of
other foods—explains why
many American waists have
been replaced by a spare tire.
And studies haven’t found
that you’d gain more pounds
from, say, 100 calories of
added sugars than from 100
calories of other foods. But
calories from fructose (which
is found only in added sugars
and fruit) may be more likely
than other calories to aim for
OBESITY
Do sugary foods and drinks de-
serve more blame for America’s
obesity epidemic than other
foods?
“There is strong evidence
linking sugar-sweetened bever-
ages to weight,” says Vasanti
Malik, a research fellow at the
Harvard School of Public Health.
For example, when she and
her colleagues tracked more
than 50,000 women for four
years, they found that weight
gain was greatest (about 10
pounds) among women who went from
drinking no more than one sugar-sweet-
ened drink a week to at least one a day.1
“But most industry-funded studies have
reported no association,” she notes. “This
back-and-forth with industry has been
muddying the waters.”
For example, a 2009 meta-analysis by
scientists with industry ties found no link
between soft drinks and weight
in children.2
“But there were some errors in
the way they scaled the data,”
Malik explains.
What’s more, some studies
in the industry-funded analysis
only compared soda drinkers to
non-soda drinkers who consumed
the same number of calories.
“It doesn’t make sense to
adjust for total calories because
extra calories may explain how
sugar-sweetened beverages lead
to obesity,” says Malik.
“When we re-analyzed the
data correctly, there was an as-
sociation between weight and
sugar-sweetened beverages.”3
What about the added sugars
Sucrose (table sugar) is broken down—in the body and
(to some extent) in foods—to half fructose and half
glucose. At that point it is almost identical to most high-
fructose corn syrup. Fruit contains a mixture of fructose,
sucrose, and glucose.
> > > > >
CH2
O
H
H H
H
OH
HH OH
Glucose Fructose
Sucrose
OH
HOOH HH
H
O
O
O
CH2OH
CH2OH
Sugars 101
C O V E R S T O R Y
Soft drinks, sports drinks, fruit drinks, energy drinks, coffee drinks, cupcakes, cookies, muffins, doughnuts, granola bars,
chocolate, ice cream, sweetened yogurt, cereal, candy. The list
of sweet temptations is endless.
The average American now consumes 22 to 28 teaspoons of
added sugars a day—mostly high-fructose corn syrup and or-
dinary table sugar (sucrose). That’s 350 to 440 empty calories
that few of us can afford.
How much added sugar is too much? Cutting back to 100
calories (6½ teaspoons) a day for women and 150 calories
(9½ teaspoons) a day for men might mean slimmer waist –
lines and a lower risk of disease.
How Much is Too Much?
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4 N U T R I T I O N A C T I O N H E A L T H L E T T E R ■ A P R I L 2 0 1 2
C O V E R S T O R Y
your waist.
To find out if fructose is destined to
end up around your midsection, research-
ers compare fructose to glucose (which
is found in added sugars but is also the
building block of starches).
The first solid evidence came in 2009.
Researchers gave 32 overweight or obese
middle-aged men and women 25 percent
of their calories from beverages sweetened
with either fructose or glucose for 10
weeks.8
Both groups gained the same weight
(about three pounds). But their new fat
didn’t all go to the same place.
“We saw an increase in visceral fat in
people fed fructose,” says study author
Kimber Stanhope of the University of
California, Davis.
Visceral (deep belly) fat is more
closely linked to a higher risk of heart
disease and diabetes than subcuta-
neous (just below the skin) fat. (See
“Where’s the Fat?”)
“The high-fructose corn syrup indus-
try’s scientific consultants criticized
our study,” says Stanhope. “They said,
‘This is meaningless. No one consumes
foods sweetened with pure fructose so
no one consumes that much fructose.’”
Now two new studies have reported
similar results with less fructose:
■■ Danish scientists assigned 47 over-
weight men and women to drink a liter
(not quite three 12 oz. cans) a day of
one of four drinks: regular cola (sweet-
ened with sucrose),
reduced-fat milk,
diet cola (sweetened
with aspartame), or
water.9 (Sucrose is
half glucose and half
fructose.)
After six months,
visceral fat went up
only in those drink-
ing regular cola. “The
increase in visceral fat
was quite impressive,”
says Stanhope.
And a liter isn’t
much. Roughly half
the population doesn’t
drink sugary beverages,
but among the drink-
ers, 50 percent swallow
at least half a liter a
day and 5 percent gulp
down at least 1¹∕³ liters.
10
■■ Swiss researchers
assigned 29 healthy,
normal-weight men to
drink beverages with
one of the following:
10 teaspoons of fruc-
tose, 20 teaspoons of
fructose, 10 teaspoons of
glucose, 20 teaspoons of
glucose, or 20 teaspoons
of sucrose each day.11
“Those aren’t large
amounts,” notes
Stanhope. A 12 oz. can
of soda has about 10
teaspoons of sugars
(roughly half fructose
and half glucose). The
10-teaspoon dose was
only about 7 percent of
the men’s calories.
After just three weeks, waist-to-hip
ratio rose slightly only in the men who
got fructose (alone or in sucrose), but not
glucose. (Measuring waist-to-hip ratio
isn’t as accurate as measuring visceral fat,
but when your waist expands, it’s often
because visceral fat expands.)
“With three studies now, these data
suggest that added sugars cause an in-
crease in visceral fat,” says Stanhope.
And links between visceral fat and sug-
ary foods or drinks are now showing up
elsewhere. When University of Minnesota
researchers studied nearly 800 men and
women, those who drank the most sugar-
sweetened beverages had more visceral fat
and larger waists.12
“We observed greater overall abdominal
fat with increasing sugar-sweetened bever-
age consumption, and the increase in vis-
ceral fat was driving it,” says Andrew Ode-
gaard, a research associate at the University
of Minnesota School of Public Health.
And among roughly 560 teenagers,
those who consumed the most fructose
(from beverages and food) had the most
visceral fat, as well as the most insulin
resistance, higher blood pressure, and
higher blood sugar levels.13
“We took into account a lot of vari-
ables that could make this relationship
spurious—fiber, calorie intake, fat and
lean mass, socioeconomic status, physical
activity,” says author Norman Pollock,
an assistant professor of pediatrics at the
Georgia Health Sciences University in Au-
Sugar by Any Other Name
With a few exceptions (like agave and corn syrup), most sweeteners
and the naturally occurring sugars in fruit break down into roughly
half fructose and half glucose in the body.* The natural sugar in
milk (lactose) breaks down into half glucose and half galactose.
0 25 50 75 100
100%
100%
51.5%48.5%
49.5%49.5%
47.5%49.5%
50%50%
50%50%
50%50%
44.5%50.5%
49%51%
48%52%
45%55%
33.5%66.5%
12%88%
100%
* Sucrose is shown as its component sugars (fructose and glucose).
Note: If percentages don’t add up to 100, other sugars account for the difference.
Sources: USDA Nutrient Database and company information.
Fructose Glucose
WHERE’S THE FAT?
Muscle Fat
Liver Fat
Subcutaneous
Fat
Visceral Fat
Glucose or Dextrose
Corn syrup
Maple syrup
Brown sugar
Molasses
Evaporated cane
juice (Sucrose)
Raw sugar (Sucrose)
Table sugar (Sucrose)
Honey
Orange juice concentrate
Grape juice concentrate
High-fructose corn
syrup (HFCS)
Apple juice concentrate
Agave
Fructose
The fructose in most added sugars appears to
boost liver, muscle, and visceral fat. Excess
fat anywhere in the body increases the risk of
insulin resistance and diabetes. But a fatty liver
and visceral fat may increase your risk the most.
N U T R I T I O N A C T I O N H E A L T H L E T T E R ■ A P R I L 2 0 1 2 5
C O V E R S T O R Y
gusta. “But the relationship with visceral
fat was still there.”
It’s not as though added sugars are the
only cause of a ballooning belly. Most of
our expanding waistlines is due to eating
too many calories, period.
But each notch on that belt could have
serious consequences for your health.
“From what we understand, visceral
fat may be what really drives insulin resis-
tance and cardiometabolic disorders like
type 2 diabetes and heart disease,” says
Odegaard.
DIABETES & HEART DISEASE
The link between diabetes and sugars is
clearest when researchers look at sugary
drinks.
“We summarized the results from
eight studies,” explains Harvard’s Vasanti
Malik. All told, the meta-analysis pooled
data on more than 300,000 people.14 The
results: “For each 12 oz. serving of a sugar-
sweetened beverage you drink per day,
you’re getting about a 15 percent increased
risk for diabetes,” says Malik. “So it really
doesn’t take much to increase your risk.”
“Fewer studies have looked at cardio-
vascular disease,” she observes. “But we
found an increased risk.”
When Malik and colleagues tracked
88,000 nurses for 24 years, those who
consumed at least two sugar-sweetened
beverages a day had a 35 percent higher
risk of heart attack than those who drank
less than one a month.15
Sugar-sweetened-beverage drinkers also
have a higher risk of the metabolic syn-
drome, which can lead to type 2 diabetes or
heart disease.14,16 (You have the metabolic
syndrome if you have at least three of the
following: elevated blood sugar, blood tri-
glycerides, blood pressure,
or waist circumference, or
low HDL cholesterol.)
“In our meta-analysis,
people who drank two
or more sugar-sweetened
beverages a day had
about a 20 percent
increased risk of the
metabolic syndrome
compared to those who
drank none or less than
one per month,” says
Malik.
And it’s not just that
can of Coke. In 2010,
researchers at Emory
University reported that
among a nationally
representative sample of
more than 6,000 adults,
those who got more
sugars from drinks and
foods had lower HDL
(“good”) cholesterol and
higher triglyceride levels
in their blood.17
“Elevated triglycerides,
together with elevated
LDL (“bad”) cholesterol,
contributes to changes
in our blood vessels
that increase the risk of
heart disease,” explains
Emory’s Jean Welsh.
“The job of HDL is to
carry away the triglycer-
ides and the bad choles-
terol so that they don’t
cause damage.”
But none of those
studies can prove cause-
and-effect. “To find out
if fructose is causing
adverse effects, you have
to give people fructose
or glucose drinks for
months,” says Pollock.
That’s just what the
latest studies did.
Look to the Liver
In the Danish study, the people who drank
a liter a day of sucrose-sweetened cola
didn’t just have more visceral fat. Their
liver and muscle fat more than doubled.9
“That’s a substantial increase,” notes
Stanhope. “We had suggested that con-
suming high amounts of fructose-con-
taining sugars could lead to an increase in
liver fat. This is the first well-controlled
study to show it.”
Why does liver fat matter? When the
body stores fat anywhere but in fat cells,
it’s called “ectopic” fat. And ectopic fat,
especially in the liver, means trouble.
“When liver fat levels go up, that may
trigger the sequence of events that leads
to insulin resistance,” says Stanhope.
That’s when insulin loses its ability to
admit blood sugar into cells. It’s often the
first step on the road to diabetes or heart
disease.
> > > > >
Sugar vs. Sugar
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Soda drinkers have a higher risk of
heart disease and diabetes.
“No High Fructose
Corn Syrup,” says
the Kashi GoLean
label.
Is high-fructose
corn syrup worse
than table sugar (su-
crose), even though
both are roughly half
fructose and half
glucose?
“Added sugars—
whether they come
from sucrose, high-fructose corn syrup, or fruit juice con-
centrates—all have equal adverse effects metabolically,”
says Harvard University’s Vasanti Malik. “This obsession
with high-fructose corn syrup is a little misguided.”
In January, researchers at the University of Florida
reported that people who were given 24 ounces of
Dr Pepper sweetened with high-fructose corn syrup had
higher blood sugar levels over the next six hours than
those who got sucrose-sweetened Dr Pepper.1 But other
short-term studies have found no difference.2
“If you’re getting a lot of fructose, it doesn’t matter
where it’s coming from,” says the Georgia Health Scienc-
es University’s Norman Pollock. “Even 100 percent fruit
juice could be bad if you’re consuming large quantities.”
In fact, in some studies, people who drank more fruit
juice had a greater risk of type 2 diabetes or weight gain.3,4
“The sugars in juices are natural, but it’s still a large
amount of sugar,” explains Malik. “We saw an increased
risk of diabetes with juices but not whole fruit, which
suggests that the fiber in fruit—which isn’t in the juice—
might ameliorate the risk of diabetes.”
Her advice: “Drink water, tea, or coffee, keeping the
sweeteners and creamers minimal in the coffees and
teas. If you want a little flavor, try sparkling waters with a
twist of lime or orange. You can cut a little lime or lemon
rind or orange peel and add them yourself.”
1 Metabolism (2011), DOI:10.1016/j.metabol.2011.09.013.
2 Am. J. Clin. Nutr. 87: 1194, 2008.
3 Diabetes Care 31: 1311, 2008.
4 JAMA 292: 927, 2004.
6 N U T R I T I O N A C T I O N H E A L T H L E T T E R ■ A P R I L 2 0 1 2
Sweet Somethings
Here’s how much added sugars you’d
get in a sampling of popular foods.
(The numbers don’t include the naturally oc-
curring sugars in fruit or milk ingredients.)
Most women should get no more than 100 calories
(6½ teaspoons) a day from added sugars. Most men should
get no more than 150 calories (9½ teaspoons). To convert
teaspoons to grams of sugar, multiply by 4. To convert
teaspoons to calories from sugar, multiply by 16.
Sweets (1 cookie, piece of cake, etc., unless noted)
Kashi TLC Oatmeal Dark Chocolate Cookies (1 oz.) 130 2
Pepperidge Farm Nantucket Dark Chocolate Soft Baked
Cookies (1.1 oz.) 140 2.5
Krispy Kreme Original Glazed Doughnut (1.7 oz.) 190 2.5
Nabisco Chips Ahoy! Original (3 cookies, 1.2 oz.) 160 3
Pepperidge Farm Milano Cookies (3 cookies, 1.2 oz.) 180 3
Nabisco Oreo (3 cookies, 1.2 oz.) 160 3.5
Newman’s Own Organics Original Newman-O’s
(3 cookies, 1.3 oz.) 170 3.5
Entenmann’s Ultimate Crumb Cake (¹ ∕¹0 cake, 2 oz.) 250 4
Entenmann’s Rich Frosted Donut (2.1 oz.) 300 4.5
Sara Lee All Butter Pound Cake (¼ cake, 2.7 oz.) 300 5
Pepperidge Farm Golden 3-Layer Cake (¹ ∕8 cake, 2.5 oz.) 230 6.5
Krispy Kreme Glazed Chocolate Cake Doughnut (2.8 oz.) 300 6.5
Au Bon Pain Chocolate Mocha Whoopie Pie (3 oz.) 330 6.5
Marie Callender’s Southern Pecan Pie (¹ ∕8 pie, 4 oz.) 490 6.5
Marie Callender’s Lemon Meringue Pie (¹ ∕9 pie, 4.3 oz.) 320 8.5
Starbucks Marble Pound Cake (3.8 oz.) 350 8.5
Panera Chocolate Chipper cookie (3.3 oz.) 440 8.5
Entenmann’s Cinnamon Danish (4 oz.) 460 8.5
Starbucks Cinnamon Chip Scone (4.2 oz.) 480 8.5
Entenmann’s Jumbo Iced Honey Bun (5 oz.) 660 8.5
Au Bon Pain Red Velvet Cupcake (3.1 oz.) 400 9
Starbucks Reduced-Fat Cinnamon Swirl Coffee Cake (4 oz.) 340 10
Au Bon Pain Hazelnut Mocha Brownie (4 oz.) 450 10.5
Dunkin’ Donuts Chocolate Chip Muffin 610 14
Panera Chocolate Fudge Brownie with icing (4.3 oz.) 470 14.5
Cinnabon Classic Roll 880 15
Cinnabon Caramel Pecanbon 1,080 19
IHOP CINN-A-STACK Pancakes (4) with Old
Fashioned Syrup (¼ cup) 1,110 23.5
The Cheesecake Factory Black-Out Cake 1,330 38
Candy, Chocolate, etc. (1 bar, box, etc., unless noted)
Lindt Excellence 70% Cocoa Smooth Dark (4 squares, 1.4 oz.) 250 3
Planters Sweet ‘N Crunchy Peanuts (1 oz.) 140 3.5
Dove Dark Chocolate Silky Smooth Promises (5 pieces, 1.4 oz.) 210 5
Hershey’s Milk Chocolate Kisses (9 pieces, 1.4 oz.) 200 6
Hershey’s Milk Chocolate bar (1.5 oz.) 210 6
Ghirardelli Chocolate Dark & Mint Squares (3 squares, 1.6 oz.) 210 6.5
M&M’s Milk Chocolate (1.7 oz.) 230 8
Junior Mints, theater size (4 oz.) 480 22.5
Cereals
Quaker Lower Sugar Maple & Brown Sugar Instant
Oatmeal (1 pkt., 1.2 oz.) 120 1
Kellogg’s Original All-Bran (½ cup, 1.1 oz.) 80 1.5
Post Honey Roasted Honey Bunches of Oats (¾ cup, 1 oz.) 120 1.5
General Mills Honey Nut Cheerios (¾ cup, 1 oz.) 110 2.5
Kellogg’s Vanilla Almond Special K (¾ cup, 1 oz.) 110 2.5
Quaker Maple & Brown Sugar Instant Oatmeal (1 pkt., 1.5 oz.) 160 2.5
Kellogg’s Raisin Bran (1 cup, 2.1 oz.) 190 2.5
Bear Naked Maple Pecan Granola (½ cup, 2.2 oz.) 260 2.5
Kellogg’s Frosted Mini-Wheats Bite Size (21 biscuits, 1.9 oz.) 190 3
Kashi GoLean Crunch! (1 cup, 1.9 oz.) 190 3.5
Post Just Bunches! Honey Roasted Honey Bunches
of Oats (²∕³ cup, 2 oz.) 250 3.5
Cereal & Granola Bars (1 bar)
Kashi TLC Honey Almond Flax Chewy Granola Bar (1.2 oz.) 140 1.5
Fiber One Oats & Chocolate Chewy Bar (1.4 oz.) 140 2.5
Nature Valley Vanilla Chewy Yogurt Bar (1.2 oz.) 140 3.5
Quaker Dark Chocolatey Chewy Dipps Granola Bar (1.1 oz.) 140 3.5
Kellogg’s Special K Chocolate Caramel Protein
Meal Bar (1.6 oz.) 170 4
Kashi GoLean Chocolate Malted Crisp Bar (1.9 oz.) 190 4.5
Clif Bar Maple Nut (2.4 oz.) 250 5.5
Beverag
es
Silk Vanilla Soymilk, refrigerated (8 fl. oz.) 100 2
Starbucks Caramel Macchiato (grande, 16 fl. oz.) 240 4*
Starbucks Vanilla Latte (grande, 16 fl. oz.) 250 4*
Silk Chocolate Soymilk, refrigerated (8 fl. oz.) 140 5
Starbucks Tazo Black Shaken Iced Tea (grande, 16 fl. oz.) 80 5.5
Ocean Spray Cranberry Juice Cocktail (8 fl. oz.) 120 5.5*
Schweppes Tonic Water (12 fl. oz.) 130 8
Gatorade Perform Lemon-Lime (20 fl. oz.) 130 9
Starbucks White Chocolate Mocha (grande, 16 fl. oz.) 470 9*
Coca-Cola (12 fl. oz.) 140 10
AriZona Extra Sweet Green Tea (23.5 fl. oz.) 260 17
McDonald’s Sweet Tea (large, 32 fl. oz.) 280 17.5
Starbucks Java Chip Frappuccino (venti, 24 fl. oz.) 560 18.5*
Dairy
Häagen-Dazs Chocolate Ice Cream (3.7 oz.) 260 3*
Dannon All Natural Vanilla Yogurt (6 oz.) 150 4*
Häagen-Dazs Zesty Lemon Sorbet (4 oz.) 120 7
Cold Stone Creamery Sweet Cream Ice Cream (Love it, 8 oz.) 530 8.5*
TCBY Golden Vanilla Yogurt (large, 13.4 fl. oz.) 400 9.5*
Pinkberry Original Frozen Yogurt (large, 13 oz.) 370 14.5*
Cold Stone Creamery Very Vanilla Shake
(Gotta Have It, 24 fl. oz.) 1,550 32.5*
Other
Wholesome Sweeteners Organic Raw Blue Agave (1 Tbs.) 60 4
Honey (1 Tbs.) 60 4.5
Betty Crocker Rich & Creamy Chocolate Frosting (2 Tbs.) 130 4.5
Nutella (2 Tbs.) 200 5*
* Estimate. Note: added sugars are rounded to the nearest half teaspoon.
Source: Company information.
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N U T R I T I O N A C T I O N H E A L T H L E T T E R ■ A P R I L 2 0 1 2 7
The liver may also explain why fruc-
tose leads to higher levels of triglycer-
ides.
“Fructose gets metabolized by the liver
very quickly,” says Welsh. “When there
is more sugar than the liver can process,
it converts the sugar to fat. Some of the
fat goes into the bloodstream, and that’s
why we get elevated triglycerides.”
What’s more, in Stanhope’s study, the
fructose drinkers burned less fat (and
more carbohydrate).18 “The body doesn’t
make fat and burn fat at the same time,”
she explains.
“In our study, fat oxidation got
blocked every time people drank the
fructose drink because that fructose is
getting turned into fat.”
Also troubling: “We saw an increase
in small, dense LDL when people drank
fructose,” says Stanhope. Those are
cholesterol-carrying particles that are
more damaging to arteries than fluffy,
large LDL.
And Stanhope noticed something else.
“LDL increased as much in the high-
fructose corn syrup group as in the pure
fructose group. That was surprising be-
cause the high-fructose corn syrup group
got less fructose.”19
“Do fructose and glucose together
exacerbate the problems?” she asks. “We
can’t say at this point. But it’s possible
that because fructose is activating the
pathways by which sugar gets turned into
fat, more of the glucose is getting turned
into fat, too.”
As if that weren’t enough, fructose may
also lead to gout, a painful inflammation
due to a buildup of uric acid in joints.
“Fructose has been shown to increase
uric acid,” says Malik. “And gout has also
been associated with sugar-sweetened
beverages.”20
The problem isn’t just that fructose
boosts several risk factors for diabetes and
cardiovascular disease.
“It’s that those risk factors—abdominal
obesity, high triglycerides, and insulin re-
sistance—all exacerbate each other,” says
Stanhope. “You get a vicious circle going.”
A case in point: “Some researchers argue
that if you increase visceral fat, it sends
out more inflammatory factors, which
go back to the liver, where they promote
more insulin resistance,” she explains.
Another example: “Fructose-containing
sugars increase fat-making in the liver,
which causes insulin resistance,” says
Stanhope. “But insulin resistance also
increases fat-making in the liver, so all
the processes get revved up.”
“That’s why the metabolic syndrome
is so difficult to treat with one medica-
tion,” she adds. “Everything is feeding on
everything else.”
EMPTY CALORIES
How much is too much added sugar? In
2009, the American Heart Association
suggested a limit: no more than 100 calo-
ries a day for women and no more than
150 calories a day for men.21
The heart association wasn’t just con-
cerned about “the worldwide pandemic of
obesity and cardiovascular disease,” but
also about the healthy foods that added
sugar replaces.
“To follow recommendations to lower
the risk of heart
disease, diabetes,
osteoporosis, hyper-
tension, you name
it, you have to use
most of your calories
for fruits, vegetables,
grains, milk, meat,
fish, poultry, and
oils,” explains Susan
Krebs-Smith of the
National Cancer
Institute. “Very few
calories are left over
for empty calories.”
In her recent anal-
ysis of a nationally
representative survey
of more than 16,000
people, roughly 78
percent of women
and 67 percent of
men ate too much
added sugar.22
“For example, for
someone who eats 2,000 calories a day,
‘too much’ was more than 130 calories’
worth of added sugar,” she says.
Not surprisingly, more than 90 percent
of the people also came up short on
green and orange vegetables, beans, dairy,
and whole grains. “Most calories need to
count for something nutritionally,” adds
Krebs-Smith.
But growing evidence suggests that
added sugars aren’t just empty calories.
They’re harmful calories.
“We saw huge metabolic differences
between people who consumed fructose
instead of glucose, despite the same
weight gain,” says Stanhope.
“Many people believe that excess
calories are the problem, and it doesn’t
matter where they come from. But now
we know that that’s not true.”
1 JAMA 292: 927, 2004.
2 Am. J. Clin. Nutr. 87: 1662, 2008.
3 Am. J. Clin. Nutr. 89: 438, 2009.
4 Int. J. Obes. 24: 794, 2000.
5 Am. J. Clin. Nutr. 51: 963, 1990.
6 Am. J. Clin. Nutr. 76: 721, 2002.
7 Br. J. Nutr. 97: 193, 2002.
8 J. Clin. Invest. 119: 1322, 2009.
9 Am. J. Clin. Nutr. 95: 283, 2012.
10 cdc.gov/nchs/data/databriefs/db71.htm.
11 Am. J. Clin. Nutr. 94: 479, 2011.
12 Obesity 20: 689, 2011.
13 J. Nutr. 142: 251, 2012.
14 Diabetes Care 33: 2477, 2010.
15 Am. J. Clin. Nutr. 89: 1037, 2009.
16 Circulation 116: 480, 2007.
17 JAMA 303: 1490, 2010.
18 Eur. J. Clin. Nutr. 66: 201, 2012.
19 J. Clin. Endocrinol. Metab. 96: E1596, 2011.
20 BMJ 336: 309, 2008.
21 Circulation 120: 1011, 2009.
22 J. Nutr. 140: 1832, 2010.
P
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to
:
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o
rg
e
B
a
c
h
.
■■ Shoot for 100 calories (6½ teaspoons) a day of added
sugars if you’re a woman and 150 calories (9½ tea-
spoons) a day if you’re a man. Even less may be better
for your heart. (See “What Should I Eat?” Oct. 2009, p. 1.)
■■ Don’t drink sugar-sweetened beverages. Limit fruit juices
to no more than 1 cup a day.
■■ Limit all added sugars, including high-fructose corn
syrup, cane or beet sugar, evaporated cane juice, brown
rice syrup, agave syrup, and honey.
■■ Don’t worry about the naturally occurring sugar in fruit,
milk, and plain yogurt.
■■ If a food has little or no milk or fruit (which contain
natural sugars), the “Sugars” number on the package’s
Nutrition Facts panel will tell you how many grams of
added sugars are in each serving. Multiply the grams by
4 to get calo ries from sugar. Divide the grams by 4 to get
teaspoons of sugar.
The Bottom Line
C O V E R S T O R Y
Healthier? A slice of Starbucks Reduced-
Fat Cinnamon Swirl Coffee Cake has
10 teaspoons of added sugars.
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