Curbing Americatswee by BONNIE LIEBMAN

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HEALTHÜTLETTER CENTER FOR SCIENCE IN THE PUBLIC INTEREST

I \h Curbing AmericaTSwee BY BONNIE LIEBMAN

America is on a sugar binge.

Between 1970 and 2005, our intaKe of added sugars—cane and beet sugar, high-fructose corn syrup, dextrose, and other sweeteners—jumped 20 percent. We now consume 22 to 30 teaspoons a day. That's 350 to 475 empty calories that most people can't afford.

A growing body of research suggests that added sugars or su gar-sweetened beverages boost the risk of disease. "We know that sugars contribute to obesity, which in turn increases the risk of cardiovascular disease and type 2 diabetes," says Linda Van Horn, who chairs the American Heart Association's Nutrition Committee.

A new report from the heart association urges Americans to slash their sugar intake. The new targets: only 100 calories a day of added sugars for women and 150 calories a day for men. That's not much.

Continued on p. 3.

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Who can afford the roughly 400 calories' worth of added sugars What led the American Heart As- that the typical American consumes each day? vegetables, fruit, lean protein, sociation to issue its new scientific low-fat dairy, whole grains, statement on "Dietary Sugars In- "No adults, except those who are extremely physically active— and other foods you need to take and Cardiovascular Health"? we're talking about the Michael Phelpses of the world," says Linda stay healthy. (It's like discre- The association cited the Van Horn, a professor of preventive medicine at the Northwestern tionary income that people can spend on luxuries once "worldwide pandemic of obe- University Feinberg School of Medicine In Chicago. "The rest of us sity and cardiovascular disease" they've paid their bills.) in explaining its "heightened have no business consuming that many calories from sugars." "There's no question that concerns about the adverse ef- sugars are a major culprit in There's new evidence that added sugars—or sugar-sweetened fects of excessive consumption obesity, because they're a of sugars."' beverages—may raise the risk of obesity, heart disease, diabetes, source of empty calories that "Added sugars have become and gout. most Americans don't need," such a predominant feature of says Van Horn. "They have no the .American diet that we can't Here are 10 reasons to cut back on added sugars. nutritional benefit whatso- help but recognize their major ever." contribution to excess calories," The fact is that most people explains Van Horn. The average American What's wrong with sugars? For starters, simply can't afford a 500-calorie scone swallows 350 to 475 calories' worth of they're not good for your teeth, especially or a 600-calorie venti White Chocolate added sugars each day (depending on the if they come in sticky foods. Here are 10 Mocha when they stop at Starbucks. type of data used to estimate intakes). other reasons to cut back. "Added sugars either crowd out healthy Exactly what are added sugars? They foods, or they make you fat if you eat include high-fructose corn syrup, ordinary You can't afford the empty them in addition to healthy foods," table sugar, honey, agave syrup, and all 1 calories. The American Heart explains Frank Sacks, a professor of car- other sweeteners with calories. {In this ar- Association based its advice on what diovascular disease prevention at the Har- ticle, the word "sugars" refers to them all.) scientists call "discretionary calories" vard School of Public Health in Boston. To hear some critics talk, high-fructose —that is, how much room you have for So the heart association turned to the corn syrup is the real villain. Table sugar empty calories once you've eaten all the discretionary calorie allowances calcu- gets a free pass. (See "I-ear of ^-^^ - , ^ lated by the U.S. Department Fructose," p. 5.) of Agriculture. (To find yours, In fact, high-fructose corn Sugars 101 ¡ go to mypyramid.gov.) syrup is roughly half fructose CH,OH CH,OH j A typical woman, who and half glucose, as is table I should shoot for 1,800 calories sugar (sucrose) once it breaks a day, for example, would need down in the body. And about 1,600 calories a day from although the fructose half vegetables, fruits, lean protein, dairy foods, and whole grains may cause some problems, the CH,OH glucose half causes others. So if OH to get the nutrients she needs. there's a villain, it's all sugars. That leaves about 200 "Added sugars are added H OH OH H calories to spend (like discre- sugars," says Rachel Johnson, Glucose Fructose tionary income) on whatever a professor of nutrition at the Sucrose she wants. "We said, okay, half University of Vermont who of that discretionary calorie chaired the heart association Sucrose (table sugar) is broken down—in the body and (to some allowance can come from solid panel that issued the new sug- extent) in foods—to half fructose and half glucose. At that point fats and half can come from ars advice. it is essentially identical to high-fructose corn syrup. added sugars," explains John-

)ANUARY/FEBRUARY 201 O 3 COVER STORY Where's the Added Sugar? son. That's about 100 calories each. wine or beer. A typical man should shoot for 2,200 "It's been shocking to some people Coke. Pepsi. Sprite. Regular sodas add the calories a day. He gets about 150 calories wben I've said tbat we've been fairly most sugar to a typical American's diet. to spend on each. conservative, because if you're con- But don't forget about coffee drinks, teas, "Solid fats" include not just butter or suming alcohol regularly, you sbould sports drinks, and fruit drinks that have a margarine, but tbe extra fat you get if you be having even less added sugar," notes heaith halo. choube dairy food^ (milk, cbeese, yogurt, Johnson. ice cream) that aren't fat-free, poultry If you want more sugar, you can with skin, and cakes, cookies, pies, and always burn more calories. otber sweets that aren't fat-free. So un- "What I tell people who can't live less you eat mostly fat-free foods, your with the added-sugars recommenda- lOO-calorie solid-fat allowance is going to tion is that they need to move more," disappear quickly. says Johnson. "Tben you can have And guess what happens to your added more sugar." sugars allowance if you want a glass of Sugar- 2 sweetened Sugar by Any Other Name beverages promote obesity. We're eating Here's the scoop on some popular sugars. Sucrose 20 percent more added (table sugar) breaks down into 50% fructose, 50% sugars now than we glucose in the body. did in 1970. What's Agave syrup or nectar (84% fructose. 8% glucose. largely responsible for Source: Circulation ¿009. 8% sucrose). From the Mexican Agave cactus. the leap in sugars intake? Apple juice concentrate (60% fructose. 27% glucose. "Soft drinks, soft more food than betöre. I h;it plus tin.' 13% sucrose). Made by cooKing down apple juice. drinks, soft drinks," says calories in the soft drinks led them to Brown sugar (9F% sucrose. 1% fructose, 1% glucose). Granu- Johnson. In 1965, Ameri- gain weight. lated white sugar mixed with a small amount of molasses. cans got an average of 12 And in a recent trial that lasted V/¿ Corn syrup (8% to 96% glucose. 0% fructose. 0% sucrose). A percent of their calories years, people who cut back on liquid calo- liquid made from cornstarch. from beverages. In 2001, ries lost more weight than those who cut beverages accounted for the same number of solid calories."* Evaporated cane juice (100% sucrose). Crystals made by evaporating liquid that has been pressed from sugarcane. 21 percent.' "i keep telling people, 'If you're trying "Soft drinks are the to cut back on added sugars, look at what Fructose (100% fructose). Found naturafiy in fruits and numher-one source of you're drinking,'" says Johnson. vegetables. We get most of our fructose from high-fructose corn syrup. added sugars in Ameri- What's more, in a study of 51,000 wom- cans' diets," says Johnson. en, those who went from drinking regular Glucose or Dextrose (100% glucose). Small amounts are .-\nd sugary liquids may soda no more than once a week to at least found naturally in fruit and vegetables, but most is made from make us fatter because once a day gained the most weight over cornstarch. It's also found in honey and most other sugars. they don't curh our ap- four years.^ Grape juice concentrate (52% fructose. 48% glucose). petite for more food.^ It's not just soda pop. Made by cooking down grape juice. "Wben you give people "If you look at consumption data, soft High-fructose corn syrup (HFCS) (typically 55% fructose. liquid calories before a drinks are leveling off, but other sugar- 45% glucose or 58% glucose. 42% fructose). Corn syrup with meal, they don't compen- sweetened beverages—sports drinks, some of its glucose converted into fructose. sate by eating less at the energy drinks, sweetened teas—are taking meal or later, in tbe same Honey (50% fructose. 44% glucose. 1% sucrose). Made by off," Johnson notes. honeybees from plant nectar. way they do for calories "Just walk down the supermarket aisles. from solid food," notes An entire one is filled with soft drinks Maple syrup 1^95% sucrose. 4% glucose. 1% fructose). Boiled Johnson. and another is filled with other sugar- down tree sap from the sugar maple tree. In a classic study at sweetened beverages that have a health Molasses (53% sucrose, 23% fructose. 21% glucose). By- Purdue University, re- halo." product of sugarcane refining. Blackstrap moiasses is a searchers gave 15 young good source of iron and calcium. adults 450 calories of Sugar-sweetened drinks may Orange juice concentrate (46% sucrose. 28% Setose. sugars each day as either 3• raise the risk of heart disease. 26% glucose). Made by cooking down orange juice. a liquid (a soft drink) or a "Sugars have for many years been solid (jelly beans).' After considered neutral in tbeir impact on Raw sugar (100% sucrose). Partially refined sugar with some cardiovascular disease," says Northwest- moiasses left. one month on tbe jelly beans, the volunteers ern University's Linda Van Horn. "But in Table sugar, Confectioner's sugar, Baker's sugar, compensated hy eating an obese environment like ours, we can't Powdered sugar (100% sucrose). Most is refined from less of other foods, so turn a blind eye to added sugars that sugarcane or beets. they gained no weight. contribute to excess calorie intake." Note: II percentages don't add up to 100, other sugars account for tfie But on the soft drinks, Clearly, excess weight isn't good for difference. Sources: USDA Nutrient Dalabase and company information. they actually ate slightly the heart. A big belly is one part of the

4 NUTRITION ACTION HEALTHLETTER • (ANUAHY/FEBRUARY 2010 COVER STORY metabolic syndrome, which raises the risk a diet that got 17 percent Fear of Fructose L)f heart disease (and diabetes). But sugar- of its calories from either "Made with no high-fructose sweetened beverages may promote heart glucose or fructose.^ corn syrup," brags the label disease whether or not they make you (That's a high dose, of Thomas' Original English :.iain weight. since Americans average Muffins and dozens of other When Harvard researchers tracked 16 percent of their calo- more than 88,000 women for 24 years, ries from added sugars, foods. What's wrong with they found that—regardless of weight— roughly half of it from high-fructose corn syrup those who drank at least two sugar-sweet- fructose and half of it (HFOS)? L'ned beverages a day had a 20 percent from glucose.) Here's what the popular higher risk of heart disease than those After six weeks, trig- Web site run by Dr. Joseph who drank less than one sugar-sweetened lycéride levels through- Mercóla (mercola.com) beverage a month.^ out the day were 32 claims: "Part of what makes "Our data suggest that soft drinks percent higher when HFOS such an unhealthy product is that it is metabolized to increase the risk above and beyond their the men (but not the fat in your body far more rapidly than any other sugar, and, women) ate the high- impact on weight," notes study coauthor because most fructose is consumed in liquid form (soda), its loAnn Manson, a professor of medicine at fructose diet. negative metabolic effects are significantly magnified, Harvard Medical School. Peter Havel and col- And when scientists tracked 4,000 men leagues at the University "Among them: diabetes, obesity, metabolic syndrome, an .ind women in the Framingham Heart of California, Davis, increase in triglycérides and LDL (bad) cholesterol levels, liver Study for four years, those who drank got similar results when disease." at least one soft drink a day had a 44 they studied 32 over- There's some truth to some of those claims, but Mercóla percent higher risk of being diagnosed weight or obese men makes a common mistake; he seems to confuse high- with the metabolic syndrome than those and women over 40. fructose corn syrup with fructose, as though high-fructose who drank less than one soft drink a day, Participants got a hefty corn syrup were mostly fructose. It's not. regardless of how much they weighed.' 25 percent of their "High-fructose corn syrup is typically 55 percent fructose, Why else would sugar-sweetened drinks calories from beverages sweetened with either explains Kimber Stanhope, who conducts research on sugars raise the risk of heart attacks? One pos- at the University of California, Davis. "But sucrose, or table sibility; the fructose in added sugars (like fructose or glucose for high-fructose corn syrup and table sugar) 10 weeks.'" sugar, is 50 percent fructose." raises levels of fats called triglycérides. Once again, blood Glucose makes up the rest of both HFCS and sucrose. So Higher-than-normal triglycérides are an- levels of triglycérides it's not surprising that researchers find few differences—in other sign of the metabolic syndrome, after a meal were higher biood sugar, insuiin, ghrelin (which stimulates appetite), or on fructose than on leptin (which curbs appetite)—when they pit high-fructose Fructose raises triglycérides. glucose. "It's a strong corn syrup against table sugar,' 4• Cholesterol isn't the only thing and consistent effect," "We still have no comparative data showing that HFOS or in blood that's linked to heart attacks. says researcher Kimber sucrose is better or worse than the other," says Stanhope. People with higher-than-normal triglycér- Stanhope, who works What's the harm in minimizing high-fructose corn syrup? with Havel. ides (at least 150) are also at risk, espe- Nothing. "But people become so conscious of avoiding cially if their triglycérides soar after a Triglycérides rose high-fructose corn syrup that they forget about avoiding other meal.^ And fructose raises triglycérides more in men, but they sweeteners," says University of Vermont researcher Rachel after meals. also rose in women, Johnson, For example, researchers at the Univer- notes Stanhope, "pos- sity of Minnesota fed 24 men and women sibly because the women "I ate a granóla bar the other day that listed brown rice syrup in our study were older on the ingredient list. Doesn't that sound healthy? It's just a and heavier" than those sweetener. Added sugars all add empty calories," in the earlier study. Why would people on Mm. /. Gin. Nutr. 87:1194, 2008, a high-fructose diet have higher triglycérides than people on a high-glucose diet? tose? "It starts converting some of the fruc- When you consume a large dose of glu- tose into fat," Stanhope explains. "Much cose, the liver doesn't pull much of it in of this fat gets sent into the bloodstream, if you don't need the calories. In contrast, resulting in higher levels of triglycérides." fructose ends up in the liver whether you That would explain why large doses of need the calories or not. fructose boost triglycéride levels in the "The liver will take up nearly the entire bloodstream and possibly in the liver. amount of fructose," says Stanhope. Would smaller doses do the same? "Very little of the fructose stays in the "We're testing lower doses right now," bloodstream." says Stanhope. "We're studying over 200 younger people, so it will take a while." Soda drinkers have a higher risk of What does the liver do with all that fruc- heart disease and diabetes. NUTRITION ACTION HEALTHLETTER • j A N U A R V / F E B R U AR V 2010 5 Added Sugars Tout de Sweet Candy, Chocolate, etc. (teospoons) Werther's Original Hard Candies (3 pieces, 0.6 oz.) 21/2 A typical woman should get no more Lindt Excellence 70% Cocoa Dark Chocolate (4 squares, 1.4 oz.) 3 than 100 calories {about 6V2 tea- Dove Dark Chocolate Promises (5 pieces, 1.4 oz.) S spoons) a day from added sugars, Hershey's Milk Chocolate Bar (1.6 oz.) 5Vi* says the American Heart Asso- York Peppermint Patties (l patty, 1.4 oz.) 6V2 ciation. A typical man should get Jelly Belly Jelly Beans (35 pieces, 1.4 oz.) no more than 150 calories (about M&M's Milk Chocolate (56 pieces, 1.7 oz.) 9V2 teaspoons)—roughly what's in a 12 oz. can of Coke. Maple syrup ('4 cup, 2.9 oz.) U Sweets (1 item, unless otherwise noted) Here's how much added sugars you'd get in a sampling of Pepperidge Farm Milano, original (3 cookies, 1.2 oz.) 3 popular foods. (The numbers don't include the naturally oc- Entenmann's Crumb Coffee Cake ('/w cake. 2 oz.) Vh curring sugars in fruit or milk.) To convert teaspoons to grams Mrs. Fields semi-sweet Chocolate Chip Cookie (1.2 oz.) V/2 of sugar, multiply by 4. To convert teaspoons to calories from Nabisco Oreo (3 cookies. 1.2 oz.) Vh sugar, multiply by 16. ... ._ Pepperidge Farm Double Chocolate Milano (3 cookies, 1.4 oz.) A ^ ^ ' ' Added Sugars Food (teaspoons) Entenmann's Rich Frosted Donut (2.1 oz.) AV2 Jell-O Strawberry (I snack cup, 3.5 oz.) 4V2 Dairy Sara Lee All Butter Pound Cake (1 slice, 2.7oz.) Ice cream, vanilla (Yi cup) 3 Entenmann's Glazed Buttermilk Donut (2.1 oz.) Chocolate milk, reduced fat 2% (8 n. oz.) 3'/2 Krispy Kreme Chocolate Iced Kreme Filled Doughnut (3.1 oz.) 6 Yogurt, low-fat vanilla (6 oz.) 3'/a Entenmann's Chocolate Fudge Cake ('A coke, 2.3 oz.) 7 Yogurt, low-fat fruit (6 oz.) 41/2 Krispy Kreme Glazed Chocolate Doughnut (2.8 oz.) 7 Silk Chocolate Soymilk (S11. oz.) 5 Starbucks Chocolate Chunk Cookie fi oz.) 8 TCBY Old Fashioned Vanilla Frozen Yogurt (regularcup, 8.7oz.) 6* Starbucks Marble Loaf (1 slice, 3.8 oz.) 8 Baîkin-Robbins Vanilla Ice Cream Cone (doubte scoop, 8.4 oz.) 11 Vi* Panera Chocolate Chipper Cookie (3.3 oz.) 8V2 Chocolate shake, fast food (16 tt. oz.) 13 Panera Chocolate Fudge Brownie (3.5 oz.) 8V2 Dairy Queen Heath Blizzard (medium, 14.5 oz.) 26* Starbucks Classic Coffee Cake (4 oz.) 8'/2 Baskin-Robbins Oreo Outrageous Sundae (12.6 oz.) 27* Hostess Twinkies (2 cakes, 3 oz.) Coldstone Creamery Founders Favorite (Cotta Have It, 14.6 oz.) 30^2* Starbucks Pumpkin Scone (4.2 oz.) n Beverages Entenmann's Super Cinnamon Buns (6oz.) ^V/2 Propel Lemon (24 fl. oz.) IVi Hostess Sno Balls (2 cakes, 3.5 oz.) MVi Starbucks Caffè Mocha (gronde, 16 fl. oz.) 3* Panera Pecan Roll (S.Soz.) 12 Starbucks Caramel Macchiato (grarjde, 16 fl. oz.) 4* Panera Pumpkin Muffin (6oz.) 12 Starbucks Vanilla Latte (grande, 16 fl. oz.) 4* Cinnabon Classic Cinnamon Roll (7.8 oz.) 14 Hawaiian Punch Fruit Juicy Red (8 fl. oz.) 4Vi* Denny's Hershey's Chocolate Cake (J slice, 5 oz.) 14 41/2* SunnyD Tangy Original (8 fl. oz.) Dunkin' Donuts Coffee Cake Muffin (5.8 oz.) 14V2 Starbucks Cinnamon Dolce Latte (grande, 16 ft. oz.) 5* Uno Chicago Grill Chocolate Chocolate Malt Layer Cake 0 slice, 9.5 oz.) 25 Starbucks Tazo Shaken Iced Tea, any flavor (grande, 16 fl. oz.) 5 Cereals & Cereal Bars Gatorade Lemon-Lime (20 tl. oz.) 8'/2 Kashi TLC Trail Mix Chewy Granóla Bar (1 bar, 1.2 oz.) Vh Glacéau Vitamin Water Revive (20 fl. oz.) 8y2 General Mills Cinnamon Toast Crunch (% cup, 1.1 oz.) 2V2 Starbucks Tazo Passion Shaken Iced Tea Lemonade (gronde, 16 fl. oz.) 8'/2 General Mills Honey Nut Cheerios (V* cup, 1 oz.) 2Vi Coca-Cola (12 fl. oz. con) 10 Kellogg's Bite Size Frosted Mini-Wheats (24 biscuits, 2.1 oz.) 3 Snapple Lemon Tea (16 fl. oz.) lOVi Kashi GoLean Crunch! Original (1 cup, 1.9 oz.) Vh Nestea Iced Tea Sweetened Lemon (16.9 ft. oz.) 12 Kellogg's Cracklin' Oat Bran (% cup, 1.8 oz.) 4 Schweppes Tonic Water (20 fl. oz.) 14 Kashi GoLean Cookies 'N Cream Chewy Bar f) bar, 2.8 oz.) 9 SoBe Green Tea (20 tl. oz.) 15'/2 Miscellaneous Sprite (20 fl. oz.) 16 Bush's Homestyle Baked Beans (Yi cup, 4.5 oz.) 3 Arizona Southern Style Sweet Tea (23 fí. oz.) 16V4 Cracker |ack (l^ cup, í oz.) 4 Coca-Cola (20 fl. oz.) 16V2 Häagen-Dazs Chocolate Sorbet (l^cup, 3.7oz.) 5 Minute Maid Lemonade (20 fl. oz.) 17 Pepsi (20 fl. oz.) 17V2 ' CSPI estimate. Note: Added sugars are rounded to the nearest half teaspoon. Sources: Company information and U.S. Department of Agriculture Nutrient Sunkist Orange Soda (20 fl. oz.) 21 Database. Chart compiled by Amy Ramsay. J 6 NUTRITION ACTION HEALTHIETTER • |ANUAR Y .'F EBR UAH Y 2010 COVER STORY

r joints (especially those of the big toe), Sugar-sweetened beverages where it can cause excruciating pain. 5• may promote diabetes. When "Obesity is the major risk factor for gout researchers tracked roughly 91,000 because it's so common and it substantial- women for eight years, those who drank ly increases the risk," says Gary Curhan, at least one sugar-sweetened soft drink a an associate professor of medicine at the day had an 83 percent higher risk of Harvard Medical School. type 2 diabetes than those who drank But fructose is also a culprit. "We know less than one a month.^ that fructose increases uric acid, and that When the scientists took weight out of uric acid causes gout," says Curhan. the equation, soda drinkers had a 40 per- In a study of roughly 46,000 men, cent higher risk. those who got at least 12 percent of their "Weight gain appears to account for A Starbucks grande Cinnamon calories from fructose were nearly twice as half of the increased risk," says Manson. Dolce Latte has 5 teaspoons likely to be diagnosed with gout over the What could explain the other half? of added sugars. next 12 years as those who got less than "Sugar-sweetened soft drinks might V ^ -. ^ 7 percent of their calories from fructose." also increase the risk of type 2 diabetes drop in insulin sensitivity. Reduced sensi- "After we adjusted for weight and all because they're high in rapidly absorbable tivity to insulin is linked to a higher risk the other risk factors for gout that we carbohydrates," she suggests. of heart disease and diabetes. But it's too know about, people with higher intakes of High-fructose corn syrup is roughly early to know if Stanhope's results will fructose had a substantially higher risk of half fructose, which goes largely to the hold up in future studies. gout," Curhan explains. liver, so it doesn't raise blood sugar. But If fructose makes insulin less efficient, At least that's true in men, who are far the glucose half of high-fructose corn no one knows how. "It may be due to an more likely to get the disease. "We're just syrup heads straight to the bloodstream. increase in the amount of triglycéride starting to look at women," says Curhan. "Consumption of sugar-sweetened soft stored in the liver," speculates Stanhope, drinks causes a fast and dramatic increase "which could then lead to a chain of Fructose may promote over- in blood sugar levels," says Manson. "In events that causes insulin receptors to 8 eating. Leptin is a hormone made our studies, people who eat foods that perform less effectively." by fat cells. It's supposed to make you raise blood sugar levels have a higher risk stop eating. of diabetes." Fructose may raise the risk of "Leptin tells your brain that you've got 7.gout. Gout hurts. If your blood has enough calories on board," says Robert Fructose may boost visceral too much uric acid, the excess ends up in Lustig, a professor of clinical pediatrics at 6 fat. In the University the University of California, of California, Davis, study, ^— -^'— -r^^ San Francisco, who served on the 32 men and women the heart association sugar gained about the same weight panel. "When you don't (roughly three pounds) get that signal, you're still after 10 weeks whether they When researchers gave people either regular or diet soft hungry." drank beverages sweetened drinks for several weeks, the participants gained weight When researchers fed rats a with fructose or glucose."^ only on the regular sodas.'-^ But all non-caloric sweeteners huge dose of fructose (60 per- But there were differences. are not created equal. Here's our take on their safety: cent of their diet) for six The fructose eaters (espe- months, the animals became cially the men) gained more • Acesulfame-potassium. Tests conducted in the 1970s resistant to leptin—that is, deep abdominal—or viscer- were of mediocre quality. One suggested an increased can- leptin injections failed to al—fat than the glucose eaters. cer risk in female rats. curb their appetite.'^ That's critical because visceral • Aspartame (NutraSweet, Equal). Judging by two recent (Obese people can also be fat is linked to a higher risk of rat studies, it may slightly increase cancer risk. At the very leptin-resistant. "They have heart disease and diabetes. least, new studies should be conducted. lots of leptin, but it doesn't work," explains Lustig.) In contrast, the glucose • Saccharin (Sweet'N Low), in animal studies, it has eaters gained more subcuta- Over time, a high-fructose caused cancer of the urinary bladder, uterus, ovaries, skin, diet blocks the leptin signal neous fat, which is just below blood vessels, and other organs, the skin and is less likely to in the brain, notes Lustig. "So raise the risk of diabetes and • Stevia. Coke and Pepsi have started to use it to sweeten leptin can't extinguish hunger heart disease. some beverages. It appears to be safe, though there should and can't extinguish reward." Since this study was the be more independent testing. The result: you keep eating. first to see fructose's effect on • Sucraiose (Splenda). it appears to be safe, though there In fact, when the rats were visceral fat. Stanhope notes, hasn't been much independent testing. (Sucraiose isn't as allowed to eat as much palat- "it would be good to see the natural as ads have implied. It's made by chlorinating sugar able food as they wanted, result confirmed in other molecules,) they gained nearly twice as studies." much weight as rats that got Another new finding: 'Am. /. Cl'm. Nutr. 76: 721, 2002. no fructose. the fructose drinkers had a ^Am. ¡. Clin. Nutr. SI: 963. 1990. But so far, it's not clear what happens when people

NUTRiriON ACTION HEALTHLETTER • | A N Ü ARY/FEBRUARY 2010 7 COVER STORY eat fructose in less-excessive amounts. To stick to the heart association's new In two preliminary studies, 17 recommendations, you'll need to use obese men and women and 12 your added sugars calorie allowance normal-weight women had higher wisely. (To find out how much added leptin levels over a 24-hour period when sugar is in popular foods, see "Tout de they consumed 30 percent of their calo- Sweet," p. 6.) ries from glucose-sweetened beverages "Be discriminating," suggests the with meals than when they consumed University of Vermont's Rachel Johnson. the same amount of fructose-sweetened "People enjoy sweet taste, and if you're beverages with meals.'*''' Few other stud- discriminating, it has a role in a healthy ies have been done. diet. We're not all going to eat non-fat Does that mean we should be eating plain yogurt." foods sweetened with glucose, which is Panera's Chocolate Chipper cookie But "they're called discretionary calo- what's in ordinary corn syrup? packs 440 calories (130 of them ries for a reason," she adds. "Use them "Why do we need corn syrup anyway?" from sugar), but few nutrients. to enhance the palatability of already- asks Lustig. "We're better off getting carbs nutritious foods. from foods that are packaged naturally "I'd rather see someone consume added with their own fiber. If we got carbs from "And certainly not if you're trying to opti- sugars in a flavored yogurt or a whole- whole grains, vegetables, fruit, and beans, mize your diet to lower blood pressure." grain breakfast cereal or by putting maple we wouldn't overeat." His advice: "I never drink liquid calo- syrup on oatmeal than consume them in Fruit contains fructose (as well as ries, and I keep sweets and snacks out of a doughnut or soft drink." #' sucrose and glucose). Do we need to limit the house. It's okay to indulge once in apples and oranges? "I'm not concerned a while, but if I get hungry at night and ' Circulation 120:1011, 2009. about fructose from fruit," says Lustig. there are no sweets around, 1 eat nuts or ^ Physioi- Behav. 59:179,1996. "How many oranges can you eat in one an apple." ^ Int. ¡. Obesity 24: 794, 2000. sitting?" •* Am. I. Clin. Nutr. 89: 1299, 2009. 1 (l '^^^^ sugary foods are ^lAMA 292: 927, 2004. Minimizing added sugars keeps I \^m junk. Coca-Cola, Pepsi, ^ Atn. ¡. Clin. Nutr. 89; 1037, 2009. 9• a lid on blood pressure. 'There's Cinnabon, Krispy Kreme, Dunkin' ' Circulation 71 ó; 480, 2007. ^ ¡AMA 298: 309,2007. a possibility that sugar raises blood Donuts, Snapple, Entenmann's, Hostess, Sara Lee, Little Debbie. ' Am. /. On. Nuir. 72: 1128, 2000. pressure," says Frank Sacks of the Harvard l°y. air. tnvest- ITS): 1322, 2009. School of Public Health. "But it's far from Just about any sweets made by those ^^ BMI 336: 309,2008. definitive." and similar companies are high in sugars Am. ]. Physiol. Regul. tntegr. Comp. Physiol. However, what is clear is that there's and low in nutrients. Many are also 295: 1 370, 2008. little place for sugar in a diet that's de- packed with virtually worthless white '^y. Gin. Endocrinol. Metab. 89: 2963, 2004. signed to lower blood pressure (see Nutri- flour. And many are now supersized. Do ^•"y. Clin. Endocrinol. Metob. 94: 1562, 2009. tion Action, Oct. 2009, cover story). you need a Cinnabon that's the size of a ^^ ¡AMA 294: 2455, 2005. The OmniHeart Study tested three diets boxed lunch? on people with hypertension (blood pressure at least 140 over 90) or pre-hypertension (blood pressure at least 120 over 80).'^ Each diet was rich in fruits, vegetables, low-fat dairy foods, beans, nuts, Shoot for 100 calories (6y2 teaspoons, or 25 grams) a day of added and other foods that supply potassium, sugars if you're a woman and 150 calories (9'/2 teaspoons, or 38 grams) magnesium, and other key nutrients. a day if you're a man. Even less may be better for your heart {see "What "The higher-carh OmniHeart diet did a Should I Eat?" Nutrition Action, Oct. 2009). great job of lowering blood pressure," says Sacks. It had just five teaspoons (80 calo- Don't drink sugar-sweetened beverages. Limit fruit juices to no more ries) of added sugars a day. In people with than 1 cup a day. hypertension, it trimmed systolic blood pressure (the top number) by an impres- Limit all added sugars, including high-fructose corn syrup, cane or beet sive 13 points. sugar, evaporated cane juice, brown rice syrup, agave syrup, and honey. But, adds Sacks, "the other two Omni- Don't worry about the naturally occurring sugar in fruit, milk, and plain Heart diets—which were higher in either yogurt. protein or unsaturated fat—did better." Those diets, which contained only two To estimate your calorie needs and get a more precise added-sugars or three teaspoons (30 to 50 calories) of limit, go to mypyramid.gov and click on "Get a personalized plan" in the added sugars a day, cut systolic blood "I Want To..." box. pressure by 16 points in people with hypertension. If a food contains little or no milk or fruit (which have natural sugars), the "There's not much room for added sug- "Sugars" number on the package's Nutrition Facts panel will tell you how ars in most people's diets." concludes Sacks. much added sugars are in each serving.

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