Yesterday I received an email notification that new content from the American Heart Association's journal Circulation was available. Now available online in the journal is the AHA's new (and first ever) Scientific Statement on Dietary Sugar Intake. In their statement, the scientific panel notes that the average American ingests 22 teaspoons of added sugar a day. At 16 calories per teaspoon, that's 352 added calories per day. Over a week, that translates to an additional 2464 calories, or 0.70 pounds of fat worth of calories.
Added sugar is defined as sugars that are added during the preparation or processing of a food product and do not include naturally occurring sugars, like those found in fruits, vegetables, and grains.What I found fascinating is the fact that there is an apparent sex difference and age-related trend in intake.
These data show that adolescent boys consume on average 35 teaspoons, or 560 calories, of added sugar per day. Consider that one teaspoon weighs four grams -- the average adolescent boy consumes 140 grams of sugar per day. That's this much:
Figure 2: 140 grams, or 5 ounces, in convenient beef form.
For those of you that are interested, these data come from the National Health And Nutrition Examination Survey (NHANES). This CDC-sponsored program has generated a huge data set of dietary information that investigators are still continuing to work with.
As the AHA's scientific panel members note, the majority of added sugars in the American diet come from beverages:
Figure 3: Combining sodas and fruit drinks, Americans get 43% of their added daily sugar in drinks
Considering current dietary intakes and the adverse health effects of excessive sugar consumption (which we can talk about in future posts), The American Heart Association's Scientific Panel has recommended that most men ingest no more than 150 calories of added sugar, and most women no more than 100 calories, each day. To put that in perspective, that looks like this:
Figure 4: One bottle of Pepsi contains 250 calories, all from sugar. That means the recommended limit on added sugar consumption for a woman is equivalent to 40% of a 20oz bottle of Pepsi, or 8oz. For men, the recommended limit is 60% of the bottle, or 12oz. And, that's only if you have no other dietary sources of added sugar that day
For those of you that are interested, these data come from the National Health And Nutrition Examination Survey (NHANES). This CDC-sponsored program has generated a huge data set of dietary information that investigators are still continuing to work with.
As the AHA's scientific panel members note, the majority of added sugars in the American diet come from beverages:
Considering current dietary intakes and the adverse health effects of excessive sugar consumption (which we can talk about in future posts), The American Heart Association's Scientific Panel has recommended that most men ingest no more than 150 calories of added sugar, and most women no more than 100 calories, each day. To put that in perspective, that looks like this:
Figure 4: One bottle of Pepsi contains 250 calories, all from sugar. That means the recommended limit on added sugar consumption for a woman is equivalent to 40% of a 20oz bottle of Pepsi, or 8oz. For men, the recommended limit is 60% of the bottle, or 12oz. And, that's only if you have no other dietary sources of added sugar that day
Medicine & Health
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Someone reading this may therefore assume diet drinks with Aspartame, Splenda, etc. may be okay because it's 0 calories and added "sugar". Can anyone comment authoritatively on this? The way I see it, it's still just empty calories and not very good for you when consumed regularly on a weekly or (heaven forbid) daily basis.
Posted by: Callinectes | August 25, 2009 12:42 PM
One might argue that diet drinks still activate the "Hedonistic food pathways" in the brain (centers in the ventral tegmental area and nucleus accumbens) that lead us to associate reward with food intake, causing us to take in more energy-dense food. There is some work associating diet drinks with metabolic syndrome and diabetes. See Nettleton, et al, Diet Soda Intake and Risk of Incident Metabolic Syndrome and Type 2 Diabetes in the Multi-Ethnic Study of Atherosclerosis (MESA), in Diabetes Care from April 2009. Diabetes Care is a journal of the American Diabetes Association. That said, I don't know of any multi-variate studies comparing risk between sugar drinks, diet drinks, and non-sweet drinks and I think the data here are less clear.
But, let's be clear that Aspartame and Splenda are zero calorie sweeteners, meaning they would technically not contribute to the AHA's recommended daily intake.
Posted by: Isis the Scientist | August 25, 2009 12:50 PM
It's about time! While sodas are important sources of sugar, generally in the form of high-fructose corn syrup, sports drinks must also be considered.
My personal villain is... apple juice. It is basically sugar water and empty calories. Yet somehow this has become a common childhood drink.
Posted by: Pascale | August 25, 2009 12:53 PM
That would go for all fruit drinks not only apple juice. Juice drinks isolate and concentrate the fructose. But how would that apply then to coconut juice? This is my biggest question right now.
Even though I know how bad sugar is for the body you will need to pry my jack and cola from my cold dead fingers, so to speak...
Posted by: theroachman | August 25, 2009 1:13 PM
Damn my ventral tegmental area!
Pascale, I assume you drink the 100% juice? I water down my kids' juice to about half water half juice, and I've continued the habit for myself. So, still getting some (natural) sugar but not as much.
Another thing I hate about all the sugary foods is that now my oldest is in elementary school, they have "labels for education" and "box tops" that help schools earn money when you buy the participating brands. I really want to support the school, but I refuse to buy junk in order to do so. There are a few healthy options (whole-grain Cheerios, Juicy Juice 100%) but they're few and far between.
I can't help but think Leo Goetz had it right, they really do fuck you at the drive-through (or grocery store)!
Posted by: Callinectes | August 25, 2009 1:17 PM
@Pascale- would 100% juice apple-juice even count under the AHA recommendations? Afterall, it has no *added* sugar.
I went on a no-added-sugar diet for one week. It was incredibly hard. Harder than just *not* eating, in a way. I never could have done it without fruit, either. I love sweet things.
However, strawberries activate my hedonistic circuits better than Pepsi. Unless it's filtched Pepsi. Filtched Pepsi is the sweetest...
Is 'added' sugar villified just because it represents the proverbial 'empty calories'? Is there really a meaningful difference between sugar from strawberries and sugar from Pepsi? I really, really, really wanna believe my strawberries are healthy (aside from the vitamin C, which isn't really all that hard to get and so a relatively poor justification for extra sugar).
The thing that strikes me about the pie chart is how inverted it is from my own added sugar intake. I get a lot of added sugar, but mostly it's not in complete stereotypical junk food- I love chocolate milk and fruit flavored yogurt; I tend to think even the baked goods I so love, like muffins, have more 'food value' than soda.
Posted by: becca | August 25, 2009 1:38 PM
I'm with you on the "wholesome" calories vs. sugary drink calories, but I fear that sugar is still sugar, and calories are calories. Put the strawberries in some plain nonfat yogurt!
If there is a diet gingerale out there, I'd love to know. My one vice is Jack and gingerale.
Posted by: Callinectes | August 25, 2009 1:44 PM
I'm still amazed that people eat that much pie...
my pie intake must be shockingly below average.
In looking at the popular media covering this, they seem to be having a lot of trouble defining the type of sugar AHA seems to be targeting (added/processed/sweetening, etc). Which makes me fear that their readerships are really not gonna get the implications of this news :/
Posted by: Gabe | August 25, 2009 1:45 PM
I hear ya, Gabe. This may require another post later tonight.
Posted by: Isis the Scientist | August 25, 2009 1:46 PM
I have done some looking into the "diet soda makes you fat and diabetic" hypothesis, but I have not seen any studies that did a decent job of controlling for the likelihood that fat and diabetic people are more likely to be diet soda drinkers in the first place, because they are looking to lose weight and control their blood sugar.
It's been a couple years since I've looked, however.
Posted by: Comrade PhysioProf | August 25, 2009 1:49 PM
@becca: The sugar in your strawberries may not be significantly different from the sugar in a Pepsi, but the amount of strawberries you can comfortably eat is quite different from the amount of Pepsi most people can comfortably drink, therefore resulting in a lower sugar intake over all. Observe, an entire cup of raw strawberry halves has only 7g of sugar (and 3g of dietary fiber, definitely a positive):
http://www.nutritiondata.com/facts/fruits-and-fruit-juices/2064/2
Posted by: Kim | August 25, 2009 1:53 PM
Figure 3, the pie chart, is either mislabeled or a bad representation of the data (my money's on the latter). It's pretty clear that the 'sugars' and 'fruit drinks' categories, the blue and red, do not add up to 43%; more like 30% visually. And combining the sugars-and-candy and fruit-drinks sections to make a statement about calorie intake from drinks seems either very confused or dishonest--and that's without noting that the soft-drink category isn't mentioned in the caption at all.
Posted by: Priam | August 25, 2009 2:15 PM
Since I work in a regulatory role (health products and food) I'll point out that if you are using little packets, they generally use a carbohydrate to bulk the "zero calorie" sweetener up, and that this does add calories. A packet of "zero-calorie" Splenda actually has 4 Calories of carbohydrates.
From Splenda's Canadian website:
Posted by: Epinephrine | August 25, 2009 2:29 PM
I completely cut out the soft drinks in my life. Only once in a great while will I have a soda, lemonade or iced tea of some sort.
Now I just need to cut down the carbs.
Posted by: Tony P | August 25, 2009 2:43 PM
"In SPLENDA® Packets, sucralose is combined with maltodextrin and dextrose. These ingredients contribute a total of 1 gram of carbohydrate or 4 calories per packet."
This means that besides having aspartame it has Glutamate, two majos excitotoxins that increase apetite. Great I dont eat that junk. As well as sugar.
Posted by: Me | August 25, 2009 2:51 PM
@ Me:
No, Splenda doesn't contain either glutamate or aspartame.
Dextrose and maltodextrin are both carbohydrates, not amino acids.
Sucralose is the sweetener in Splenda, and is a polychlorinated carbohydrate, ot an amino acid. It is not the same compound as aspartame.
Glutamate is an amino acid, and aspartame is made up of aspartic acid and phenylalanine, both amino acids.
Posted by: Epinephrine | August 25, 2009 3:09 PM
Priam, #12 - The soft drinks color is brown, not blue. You need to be looking at the brown and the red, not the red and the blue. Pie chart looks OK to me.
I am addicted to bottled Frappucino mochas. I am trying to lose weight and save some money (the damned things cost waaay too much up here in AK), so have been building my own imitation Fraps, using chocolate syrup, sugar, coffee, a dash of vanilla, and 1% milk. The regular bottled Fraps are 180 calories per; mine are about 110 calories. When I buy a real Frap now and then, it now tastes waaay too sweet.
Posted by: OmegaMom | August 25, 2009 3:22 PM
This is so handy. My students often ask about high fructose corn syrup, citing the tv ads that say it's naturally from corn and OK for you in moderation. I try to point out that it's hard to consume hfcs in moderation when it's added to so many things we eat, even things we don't think of as "sweet".
Posted by: entropic ankh | August 25, 2009 3:36 PM
Cut out the sugar in pop and soda and usually you get ones with dangerous artificial sweeteners. Except ZEVIA. Zevia is the first all natural, 0 calorie stevia sweetened soda in the world! No ASPARTAME & no Splenda. It tastes very good and its at Whole Foods. Six delicious flavors including Cola, Twist, Root Beer, Ginger Ale and Black Cherry.
- Margaret
PS If anyone wants to try ZEVIA to review it on their website please feel free to email me at margaret at zevia dot com.
Posted by: Margaret | August 25, 2009 3:40 PM
@Kim- clearly, you underestimate my comfortable-strawberry-eating-capacity. A cup? I usually get them in the pound containers (about 3 cups, maybe?) and I can eat them before I even get home from the grocery store. I am a terribly gluttonous strawberry monster.
On another note- I find nutrtiondata.com to be really useful, but also really bizarre sometimes. Strawberries are *not* a 4.3/5 on fullness! And how did blueberries end up as a "mildly inflammatory" food???
@Callinectes- what I really need is probiotic/digestive health/with fiber/nonfat/nonsweetened organic yogurt to put my strawberries in. Ideally vanilla flavored but I could probably add the extract. In large containers.
Posted by: becca | August 25, 2009 4:06 PM
margaret@zevia.com wrote:
Citation needed. The sweeteners currently in use have been studied extensively. In fact, I can easily dig up articles reviewing their safety.
Ok, shill for the "new sweetener", to what degree have steviol glycosides been studied? If Sucralose is safe (show me research to suggest otherwise), why would anyone switch to your "natural" sweetener?
The use of the word natural is meant to be reassuring, but that's a fallacy - natural =/= healthy. Most of the nasty toxins you've heard of are natural. Switching from safe sweeteners to practically untested sweeteners isn't a smart idea.
Anyone have access to this paper?
Urinary Tract Tumors, Biology and Risk for Artificial Sweeteners Use with Particular Emphasis on some South American Countries
I'm curious. I doubt the paper can be even remotely conclusive, but epidemiology is the tool to use when looking for small or rare effects in large groups over time, not 4-week clinical trials.
Posted by: Epinephrine | August 25, 2009 4:38 PM
@becca- My 15 mo-old can tell you all about the inflammatory effects of blueberries. He loves them dearly, but we all regret it the next day...
On a general note, maybe soda companies will understand that they should go back to "normal" size containers. One serving would probably be just fine, but the bottles nowadays are 2.5 servings (probably because what you are paying for is the container).
Posted by: Patchi | August 25, 2009 4:38 PM
Zero-cal soda makes you eat more?
http://scienceblogs.com/drugmonkey/2009/08/noncaloric_sweeteners_might_no.php
Ping, as they say...
Posted by: BikeMonkey | August 25, 2009 5:06 PM
Darling Goddess,
Re: your comment #2 about hedonistic food pathways,
I don't know the total story either on the order of causality. But I've converted to Izze anyway:
http://www.izze.com/#products
Posted by: Gingerale | August 25, 2009 5:54 PM
Just for the record, I've had two diet Pepsis today. They were superb.
Posted by: Isis the Scientist | August 25, 2009 7:08 PM
Just for the record, how much sugar is in a can of soda-pop? How big is that "bottle"? A bottle is too variable a measurement for soft drinks.
Unfortunately, a lot of people think that liquids don't count.
Bottom line: learn to drink water. We seldom have apple juice, sometimes orange juice or grapefruit juice, which can be watered down. For sparkle and bite, add soda water--zero food energy.
I was confused about milk providing sugar (other than a bit of lactose) until I thought of frappuchinos (600 Calories?), milk shakes (800 Calories and up?), and ice cream (the sky's the limit).
Patchi, what else is he eating? That doesn't sound like it's causing an inflamation, more like gas if you all regret it. Certain fruits should not be consumed at the same meal as beer--cherries come to mind. Perhaps blueberries are similar.
Posted by: Monado, FCD | August 25, 2009 7:53 PM
Margaret
Zevia is vile crappola and as a worker for Zevia you know that its true
Sorry MsSpammer I will drink the real stuff with my whiskey. In moderation of course.
Or better yet if you need those bubble drink straight up mineral water and if you need sugar add stevia.
Posted by: theroachman | August 25, 2009 8:37 PM
Epinephrine
Stevia is the a leaf of the plant stevia rebaudiana a native herb from Paraguay. It is dried to retain the chlorophyll or rendered with alcohol to separate the plant sugars. Stevia is by far the least processed sugar there is. It is also FDA approved as a food. It was classified as a food supplement for many years. Thus the FDA involvement.
Posted by: theroachman | August 25, 2009 8:46 PM
@theroachman
I know what stevia is, and it's not actually a sugar - sugars are a very specific group of compounds, though some steviols have sugars bonded to them. Steviol is most related to what are called "essential oils" or terpenes. Steviol glycosides are formed when sugar groups (the glycoside part of the name) bond to steviol.
My point was that the "natural" nature of a compound is completely unrelated to its toxicity. Tetrodotoxin and botulinum are both perfectly natural. There are likewise safe compounds that are entirely artificial.
The reason I wrote "citation needed" to the Zemia salesperson is that she's ripping into other sweeteners as part of her job, but providing no evidence - just scare tactics. The competing sweeteners work well, and are well tolerated - why replace them? There is no real reason to, so her approach is use the fallacious association of "natural" with "safe," and to lie through her teeth about the safety of her competition. And I hate liars.
The reason I asked about the paper is that my workplace doesn't have access to this article, and I'm not about to shell out 50+ dollars to find out what's in it. It's interesting to me because the abstract hints that there may be health issues with the use of some artificial sweeteners, and stevia has been used principally in South America for the past 30 years or so. It would be ironic if Margaret's Zemia were in fact using a more dangerous "natural" sweetener, and the fact is that you won't uncover slightly elevated urinary tract tumour rates with the short clinical trials used to assess pharmocological/toxicological effects.
Posted by: Epinephrine | August 25, 2009 10:04 PM
Not to mention, I've seen stevia as a sweetener in soft drinks before. e.g., Virgil's Diet Root Beer. (Not as good as the regular.) And I'd never heard of Zevia. So even the claims to exclusivity are bogus. And spam always makes me make a mental note to avoid something, so... all around marketing failure.
I do like stevia, though. I buy it in powdered form (with either no filler or inulin as filler -- lactose is counterproductive, and silica is gross), and grow the plant on my window sill.
Posted by: caia | August 25, 2009 11:41 PM
This might be slightly off-topic, but when will the AHA release a full-fledged article on the necessity of physical activity? Any article linking LDL's, excess sugar, etc. are all fine and dandy especially when there's a fairly comprehensive link to weight gain and heart problems. But the bottom line is that too many calories in and not enough calories out are the major problem for America's obesity (and complications) epidemic. Just a little bit of food for thought.
Posted by: Ender | August 26, 2009 1:13 AM
Epinephrine,
I downloaded the paper. A bit mysterious that its a year old but not indexed by pubmed. If you email me at udflutes @ yahoo dotcom, I will send you/anyone else the pdf.
Posted by: flutesUD | August 26, 2009 1:24 AM
The key to healthy drinking is alphabetical. Stay close to the end of the alphabet - water, wine, whiskey, wassail.
Posted by: Donna B. | August 26, 2009 6:09 AM
Your sex effect graph Should account for bodyweight differences. That would shrink the apparent effect. Any mean metabolic differences by bodyweight to account for as well?
Posted by: DrugMonkey | August 26, 2009 9:39 AM
Several years ago I came up with my rule for fluids:
Never drink anything with calories that does not intoxicate you.
Occasionally I succumb to the call of a chocolate shake. I am big on unsweetened ice tea (24/7, all year round). Otherwise I stick with diet stuff as a mixer (Diet Coke + Bourbon = Happy Campers).
I picked on apple juice specifically, although all juice-based drinks are a poor substitute for eating the fruit. Orange, grapefruit, cranberry, grape, etc, all contain vitamins, antioxidants, etc, thus, some nutritional value. Apple juice has that with which it is supplemented, and it often contains added sugars. I think it became popular because it is basically sugar water and it doesn't stain. It also "seems" healthier that letting your kid have a soda, although my kids have been allowed the diet stuff since they were old enough to ask for it.
There are studies that suggest that high fructose sweeteners may carry additional risks beyond other sugars (see Ketohexokinase-Dependent Metabolism of Fructose Induces Proinflammatory Mediators in Proximal Tubular Cells. J Am Soc Nephrol 20: 545–553, 2009. doi: 10.1681/ASN.2008060576). I find this interesting for a couple of reasons:
(1) The obesity epidemic really geared up in the 1970s, even though lifestyles were becoming sedentary throughout the post-WWII era; this is when our ag policy began favoring the production of corn on an amazing scale and high fructose corn syrup became an ingredient in, well, everything.
(2) I was quoted in the newspaper as stating that high fructose sweeteners might contribute to the increased risk of kidney stones we see in children; within 48 hours I had a 4 inch package of materials from the corn bureau (this is Nebraska, after all) telling me that high-fructose corn syrup was safer than maternal breast milk. This led me to believe that I had touched a raw nerve and that there was more to this story than I initially expected.
If you get a chance to see the documentary "King Corn" do so. It is a great flick that the ADA screened at their meeting 2 years back, and it illustrates the corn story well.
Posted by: Pascale | August 26, 2009 10:33 AM
While the recommendations are good, I suspect that they may result in the opposite of better nutrition -- many overweight folks will simply give up, saying that the guidelines are just too constrictive-- and throw out the whole set of guidelines, rather than just try to get closer to them. Yes, it is an "excuse", but the overeaters mind is not always logical. There is a tendency for "pass-fail" -- if I can't succeed completely, I give up completely. I would MUCH rather that they emphasize a direction of limiting sugars rather than state specific limits that imply a "pass-fail". Emphasize an ideal and direction, not an arbitrary target.
Posted by: Susan | August 26, 2009 11:10 AM
Stevia, blecch. I'm a supertaster and to me stevia is the bitterest, nastiest, crap ever. There is no perceptible concentration of stevia where the bitterness (and by bitterness I mean a pervasive gustatory stench) doesn't completely overwhelm the sweetness. And I'm not the only one; apparently from ten to twenty percent of the population perceives it the same way to a significant degree. Eww.
I'm a diabetic and a low-carber and I refuse to touch anything that contains aspartame, sucralose, acesulfame-K, maltitol, mannitol, sorbitol, saccharin, cyclamates, stevia, fructose, honey, malt syrup, or agave syrup. I'll do a little xylitol, and I've tasted yacon and luo han guo, and tagatose is very promising but outrageously costly, but for me the ONLY sweetener worth mentioning is erythritol. If someone came out with an erythritol soft drink not made with any of those other sweeteners, I'd buy it.
But stevia alone? ewwwwwwwwww.
Posted by: speedwell | August 26, 2009 1:16 PM
I found a very nice (and very precise) paper on energy balance due to overfeeding (by 50% of energy requirements) with glucose, sucrose, fructose or fat. They were essentially indistinguishable. Glycogen stores increased but a little more slowly with fat.
http://www.ajcn.org/cgi/content/full/72/2/369
They conclude “We conclude that there is no evidence for differential effects of excess glucose, fructose, or sucrose in relation to fat balance when these carbohydrates were fed under controlled conditions and that their net effect is similar to an excess of dietary fat.”
There is a similar paper that looks at deliberate overfeeding and underfeeding.
http://www.ajcn.org/cgi/content/abstract/64/3/259
It takes a couple of days for metabolism to stabilize after radically changing the amount of carbohydrate and fat consumed. I think the radical changes are not good, and that one should be moderate in how they change their diet over time. It is when your reserves of carbohydrate get too low that you are more apt to binge.
I think the AHA emphasis on "added sugar" isn't based on science at all. The first paper I link to shows that the source of the carbohydrate doesn't matter in the long term, and presumably you are going to maintain your diet for longer than a few days. It is total calories that matter. Maybe the AHA thinks that it is easier to avoid calories as added sugars, but that is subjective and idiosyncratic, not a scientific finding.
Posted by: daedalus2u | August 26, 2009 8:27 PM
Posted by: Epinephrine | August 25, 2009 10:04 PM
Sorry for the miscommunication between posts. But Zevia has been tested safe. The company I work for test these things before we let them out for our customers. The stuff is crappola but it flies off the shelf like crazy. If it turns out they were lying and we missed something, happens sometimes, we will kick the punks off our shelves.
Posted by: theroachman | August 26, 2009 9:42 PM
Re: fruit juice/apple juice
Water it down. I started with half fruit juice, half water, and then gradually increased the water: my current formula is 1 part juice to 3 parts water. It provides enough flavor that I willingly drink the stuff, but has far less sugar.
I can't drink full-strength fruit juice any more -- it's far too sweet.
Posted by: Chrissl | August 27, 2009 12:26 PM
I think that, with all of this diet stuff going on in the blogosphere, it may be time for me to write about my own relationship to food.
I'll be back somewhere around here later with a pingathat.
Posted by: Toaster | August 27, 2009 3:37 PM
Drat. I love me some Mountain Dew.
Posted by: Enkidu | August 28, 2009 8:28 AM