Tuesday, January 6, 2015

Added Sugar

Did you make a New Year’s resolution to eat well or lose weight? Have you decided to cut down on the added sugar in your life? Reducing the amount of added sugars you consume is one way to enhance the quality of the food you eat, eliminate some unwanted calories and work toward improving your overall health. Making the decision to cut down on added sugars is simpler than actually doing it. Let’s be honest; sugar tastes good.  

Brown Sugar
By Moe Rubenzahl (Moe Rubenzahl) GFDL (http://www.gnu.org/copyleft/fdl.html) via Wikimedia Commons


How much added sugar do Americans consume?


According to the Center for Disease Control, adults and children in the United States are consuming more than the recommended amount of added sugar. About 13% of the calories adults 20 and older eat come from added sugars, according to the National Health and Nutrition Examination Survey (NHANES) data collected from 2005-2010. 


NHANES data from 2005-2008 revealed that children age 2 through 19 get about 16% of their calories each day from added sugars 

The current Dietary Guidelines for Americans states that no more than 5% to 15% of total calories each day come from a combination of added sugars and solid (saturated) fats (CDC data briefs). The American Heart Association specifically recommends that women consume no more than 100 calories per day from added sugars (6 teaspoons) and men consume no more than 150 calories per day from added sugars (9 teaspoons) (AHA page). If that seems like a lot of sugar, consider that a typical 12-oz regular (not diet) cola contains 150 calories and about 10 teaspoons of sugar (Harvard School of Public Health-Added Sugar).

Resources

 

What is added sugar and why is it used?


Added sugars are sugars that are introduced to foods and drinks during preparation or processing. Added sugars are not an inherent part of a food or beverage. Examples include adding a packet of sugar to a cup of coffee, sugar coated breakfast cereals, products like energy bars sweetened with nectar, honey, or syrups of any kind. Added sugars contribute calories (4 kilocalories per gram) and that is why added sugars are considered nutritive sweeteners. The term “nutritive sweetener” is deceptive because regardless of the source of its origin, added sugars contribute empty calories. Sugars are added to enhance flavor, texture, color, reduce acidity, preserve fruits, and provide energy for fermentation. Sugar is also added as a bulking agent.


Do added sugars affect health?


You can’t get something for nothing
Added sugars increase the calorie content of the foods and drinks you consume. They come with a cost of 4 kcals/gram. If you regularly consume more calories than you need you increase the likelihood you will gain weight. A can of regular soda contains about 150 calories. If you drink 1 can of regular soda every day of the year and do not make room for that in your eating plan it can lead to as much as 10-15 lbs. of weight gained over the course of the year. 

Sugary drinks provide calories and may immediately satisfy hunger or craving. Sugar added foods and drinks provide empty calories that are quickly digested and absorbed. The sugar gets into your bloodstream quickly and is delivered to your cells and tissues. Dietary components like complex carbohydrates, protein, and unsaturated fats help you digest and absorb food more slowly than added sugars. They allow you to feel full longer and provide your body with the fuel you need at a steadier pace.


You get unwanted fat and displace other nutrients
Foods that contain a lot of added sugar are more likely to be higher in saturated fat. Not only do you get additional calories from sugar, you also get additional calories from fat. Calories you may not need or want and that you may not realize are in the product. When people consume foods and drinks that are high in sugar, it is often at the expense of other more nutritious food items that provide vitamins, minerals, protein, fiber, phytochemicals, and some unsaturated fat.


Triglycerides
Triglycerides are a type of fat found circulating in the blood and in fat cells. A diet that contains a lot of added sugars is associated with higher blood triglycerides. High blood triglycerides are associated with an increased risk of heart disease. When you consume more sugars than you need, some will get stored as glycogen in the liver and muscle while the rest will get converted into fat and be incorporated into triglycerides.


Oral health / tooth decay
Microorganisms love to feed on sugar. When you eat more added sugar, microorganisms have more fuel. More fuel means they grow and prosper at the expense of your teeth (tooth decay). Oral hygiene is important to promote dental health.


Resources
Bray, G. A., & Popkin, B. M. (2014). Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care, 37(4), 950-956. doi: 10.2337/dc13-2085


The many faces of added sugars


Ingredients on food labels are always listed by weight from highest to lowest. If sugar is listed in the first three ingredients, you know two things: 1) it is an added sugar and 2) there probably is a lot of it in the food or beverage. Currently, you have to read the ingredient list to find if the sugars in your food and drinks are added or not. In order to figure that out, you have to know what to look for. This list includes the most common types of added sugar you might encounter:

White sugar
Brown sugar
Raw sugar
Corn syrup
Corn syrup solids
Dextrin
High fructose corn syrup
Malt syrup
Maple syrup
Pancake syrup
Fructose sweetener
Liquid fructose
Fructose
Honey
Molasses
Anhydrous dextrose
Crystal dextrose
Dextrose
Nectar (all kinds, like agave)
Fruit juice concentrate
Invert sugar
Malt sugar
Glucose
Maltose
Sucrose
Syrup (all kinds, like brown rice)
Cane sugar
Cane crystals
Evaporated cane juice



Resources


Nutrition Facts Panel

As of January 2015, deciphering the added sugar content in food products
Figure 1. Nutrition Facts Panel
Used Now (1/2015)
remains an exhausting and often confusing task. Naturally occurring and added sugars are included together under a single category of “sugars” on the Nutrition Facts panel (figure 1). The food represented in the Nutrition Facts panel (figure 1) contains 37 grams of carbohydrate, 4 grams of dietary fiber, and 1 gram of “sugars.” In order to figure out if the sugars are added sugars or sugars that are inherently part of the food (like lactose – milk sugar – that is a natural part of milk) you would have to read
the “ingredients” list and hunt for the sugars. To do that, you have to be able to recognize names of added sugars.


In August of 2014, the Food and Drug Administration proposed changes to the food label.
Figure 2. PROPOSED Changes
to Nutrition Facts Panel
The goal is to make food labels easier to read and to update the labels to reflect the most current knowledge about diet and health. One of the changes, if the label is put into practice, will be to display “added sugars” as its own category. This would make reading and using the Nutrition Facts panel much easier. Figure 2 shows a version of the proposed revised label (it is still a draft and is not in use) from the FDA’s website. You can see in figure 2 that there are no added sugars in this product and so the 1 gram of sugars come from naturally occurring sugars that are an inherent part of the food.




Resources


Are some nutritive sweeteners (added sugars) healthier than others?


When it comes to reducing the risk of cardiovascular disease and body weight, it is the amount of sugar you eat rather than the source of the sugar that seems to matter most. A healthy human body metabolizes nutritive sweeteners of all kinds the same way (American Heart Association, Mayo Clinic - Added Sugar, Harvard School of Public Health - Added Sugar, Mayo Clinic - Artificial Sweeteners). If your diet regularly contains excess added nutritive sweeteners beyond your caloric needs, you increase the likelihood that you will gain weight and, possibly, increase your risk of heart disease. A 2014 literature review and systematic (meta) analysis found that drinking sugar-sweetened beverages was associated with increased blood pressure (Malik, Akram, Shetty, Malik, & Yanchou Njike, 2014).

Honey has been used in different cultures and traditions to treat many conditions but the efficacy of it remains unclear. The Mayo Clinic reviewed research about honey and health. They ranked the evidence using an A, B, C, D, F grading system (Mayo Clinic - Honey). In general, honey received Cs for all areas reviewed which the Mayo Clinic defines as “unclear evidence for this use.” At this time, there are no medical recommendations to support the use of honey to treat any medical conditions

Different sugars contain different plant chemicals (phytochemicals). For example, in 2011, over 26 phytochemicals were identified in maple syrup (Li & Seeram, 2011). The potential role and impact of these phytochemicals on the human body is currently in the early phases of research and understanding (Gonzalez-Sarrias, Li, & Seeram, 2012). Maple syrup is not a recommended treatment for any condition.

In 2014, a mouse study was published that tested whether or not agave nectar elicited different responses in mice compared to mice fed similar amounts of sucrose (table sugar) in terms of weight gain, blood glucose control and whether or not they developed high cholesterol. The research revealed that mice that ate agave nectar instead of sucrose gained less weight and had better glucose control than their sucrose-fed counterparts (Hooshmand et al., 2014). This was a small mouse study, so more research is needed to find out if similar effects are found in other species of mice, other rodent models, and (most importantly) in humans. Agave nectar is not recommended to prevent obesity, insulin resistance, or improve blood glucose control.

At this time, no research supports the use of any type of sweetener over any other. The recommendation from the American Heart Association, the United States Department of Agriculture and the Department of Health and Human Services is to limit added sugars.


Final Thoughts

Reducing the amount of added sugars you consume is a healthy lifestyle choice. Research continues to indicate too much added sugar in the diet contributes to weight gain, elevated blood pressure, and an increased risk of heart disease. Reducing added sugar in your diet in small ways can have a positive effect on your overall health.

In the future, I look forward to learning more about how gut microorganisms impact the nutrient metabolism, nutrient utilization, and other functions of their human hosts. This is a new area of research. A paper was published at the end of November 2014 in PLoS One that reported results of a study that looked at how microorganisms obtained from obese and lean people differed and how they could assess that difference based on how the cultured microorganisms metabolized different nutrients, including carbohydrates (sugars) (Aguirre, Jonkers, Troost, Roeselers, & Venema, 2014).


Literature Cited


Aguirre, M., Jonkers, D. M., Troost, F. J., Roeselers, G., & Venema, K. (2014). In vitro characterization of the impact of different substrates on metabolite production, energy extraction and composition of gut microbiota from lean and obese subjects. PLoS One, 9(11), e113864. doi: 10.1371/journal.pone.0113864

Bray, G. A., & Popkin, B. M. (2014). Dietary sugar and body weight: have we reached a crisis in the epidemic of obesity and diabetes?: health be damned! Pour on the sugar. Diabetes Care, 37(4), 950-956. doi: 10.2337/dc13-2085

Gonzalez-Sarrias, A., Li, L., & Seeram, N. P. (2012). Effects of maple (Acer) plant part extracts on proliferation, apoptosis and cell cycle arrest of human tumorigenic and non-tumorigenic colon cells. Phytother Res, 26(7), 995-1002. doi: 10.1002/ptr.3677

Hooshmand, S., Holloway, B., Nemoseck, T., Cole, S., Petrisko, Y., Hong, M. Y., & Kern, M. (2014). Effects of agave nectar versus sucrose on weight gain, adiposity, blood glucose, insulin, and lipid responses in mice. J Med Food, 17(9), 1017-1021. doi: 10.1089/jmf.2013.0162

Li, L., & Seeram, N. P. (2011). Further investigation into maple syrup yields 3 new lignans, a new phenylpropanoid, and 26 other phytochemicals. J Agric Food Chem, 59(14), 7708-7716. doi: 10.1021/jf2011613


Malik, A. H., Akram, Y., Shetty, S., Malik, S. S., & Yanchou Njike, V. (2014). Impact of sugar-sweetened beverages on blood pressure. Am J Cardiol, 113(9), 1574-1580. doi: 10.1016/j.amjcard.2014.01.437