February 2010 Issue

Sweet Defeat
By Lindsey Getz   
Today’s Dietitian
Vol. 12 No. 2 P. 30

Go ahead, have a heart-to-heart with clients about the AHA’s recent recommendations and how they can cut their intake of added sugars.

A recent American Heart Association (AHA) scientific statement containing specific guidelines on limiting sugar intake has sparked conversation about just how much sugar people should consume and how to make cutting back less bothersome.

The truth is that most Americans consume much more sugar than they realize. And according to the AHA’s statement, published in Circulation, high sugar intake can be dangerous and has been linked to numerous health concerns, including obesity, high blood pressure, and other risk factors for heart disease and stroke.

Using the new AHA guidelines, nutrition professionals can educate clients and patients on how to recognize sources of added sugar in their diet, why consuming a surplus of sugar can be deleterious to health, and how best to curtail their sweet habits.

Beware Hidden Sources
According to the statement, a prudent upper-limit intake for added sugars is one half of a person’s discretionary calorie allowance. Consumers can use MyPyramid.gov to find out exactly what their calorie intake should be. The link titled “Get a Personalized Plan” allows users to enter their age, sex, height, weight, and activity level to find out how many calories they need to maintain their current weight. It will also provide how many discretionary calories they can afford each day. According to the statement, for most American women and men, those figures are no more than 100 kcal and 150 kcal of added sugars per day, respectively. Those numbers equate to approximately 6 teaspoons for women and 9 teaspoons for men—likely much less than Americans are currently consuming each day.

Added sugars are sugars and syrups included in foods during processing or preparation, as well as sugars and syrups that consumers add themselves, says lead author Rachel K. Johnson, PhD, MPH, RD, associate provost and a professor of nutrition at the University of Vermont in Burlington. These sugars are different from naturally occurring sugars. According to the AHA statement, a healthy and well-balanced diet contains naturally occurring sugars because monosaccharides (eg, fructose) and disaccharides (eg, sucrose, lactose) are present in fruits, vegetables, dairy products, and many grains. Naturally occurring sugars supply healthy nutrients while still fulfilling people’s cravings for sweets.

Johnson says the best way to determine whether a food contains added sugar is to read the ingredient list. Although added sugars may appear in a variety of ways, in terms of calorie content, all added sugars are essentially the same. She says the names for added sugars used on food labels include those listed in the sidebar accompanying this article. Give your clients this list so they can better check food labels and comprehend the sugar content.

Food label education is an important duty for dietitians. Elisa Zied, MS, RD, CDN, a spokesperson for the American Dietetic Association and the author of Nutrition at Your Fingertips, says food labels can confuse or even overwhelm consumers, and educated clients will feel more confident when shopping.

“As of now, sugar grams listed on the Nutrition Facts panel on food labels don’t distinguish naturally occurring sugars from added sugar,” she says, “so it’s important to scour the ingredients list for hidden sources of sugar.”

The main sources of added sugars in the Western diet include soft drinks and other sugar-sweetened beverages such as fruit juices and sports drinks. In fact, according to the AHA statement, between 1970 and 2000, the per-person daily consumption of caloric soft drinks increased 70% from 7.8 to 13.2 oz. Other common sources of added sugar include desserts, syrups, jellies, candies, presweetened ready-to-eat cereals, sweetened dairy products, and sweetened grain products, says Johnson.

While consumers may know that such foods are sugar sweetened without reading labels, there are other items that may not be so obvious. “Consumers may be surprised at some of the foods that contain added sugars,” says Johnson. “Examples include ketchup, barbeque sauce, baked beans, and even some salad dressings.”

Zied agrees that many consumers don’t realize sugar lurks in a variety of unsuspecting foods, even foods that may seem healthy, such as pretzels, crackers, and whole wheat bread. She cites other examples such as canned beans and fruits, pancake and waffle mixes, and some vegetable juices.

“That’s why it’s so important to read the fine print on labels,” Zied says. “Look for foods made without added sugar by reading the label. There are many types of whole wheat crackers, for example, that do not contain added sugar. Oil-based salad dressings such as olive oil or balsamic vinegar are a better bet than creamy salad dressings. And instead of using canned tomato sauce, which has added sugar, buy those that do not contain the added sugar, or better yet use fresh tomatoes to make your own sauce by adding olive oil, garlic, and onion powder.”

The Problem With Sugar Overload
It seems logical that eating too much sugar isn’t healthy. But because many clients may not realize how much added sugar they’re actually consuming, addressing the reasons why they should cut back once you’ve helped them recognize the amount they take in is important.

“High intakes of added sugar have been linked to overweight and obesity, a lower intake of essential nutrients, increased triglyceride levels, hypertension, and inflammation,” says Johnson. “All of these are risk factors for cardiovascular disease, which is what the AHA scientific statement focuses on specifically.”

The statement indicates that an emerging, though inconclusive, body of evidence suggests an increased intake of added sugar may raise blood pressure. The studies examined include animal studies in which rats were given high doses of fructose, acute ingestion studies in which humans consumed high doses of different sugars, and epidemiological studies in which human consumption of one or more soft drinks per day increased the odds of developing high blood pressure.

In addition, Zied says too much added sugar in the diet can also “take up space,” leaving little room for healthy foods. “People only have so many calories to consume each day, and if a lot of those calories come from added sugars or high-sugar/nutrient-poor foods, that means you have fewer opportunities for nutritious options like fruits, vegetables, whole grains, low-fat dairy foods, and lean sources of protein,” she says.

“Sugar provides calories and carbohydrates but no other key nutrients,” she continues. “Too much sugar in the diet also appears to be associated with inflammation in the body. Inflammation contributes to chronic diseases like heart disease and type 2 diabetes.”

Help Clients Succeed
Once clients realize just how much sugar they’re consuming and how pervasive it is in common foods, cutting back can seem daunting. They may consume well over the amount recommended by the AHA. Encourage clients to start out small, and note that beverages are often a great starting point for change.

“Ask your clients to pay special attention to what they drink,” Johnson suggests. “Soft drinks and other sugar-sweetened beverages are the No. 1 source of added sugar in Americans’ diets. Beverages are especially problematic because research shows that liquid calories are not as satiating as calories consumed as solid food. As a result, people don’t compensate for liquid calories in the same way they do calories from solid food. In addition, intakes of energy-containing beverages are associated with greater calorie intake and may contribute to overweight and obesity.”

Robin Edelman, MS, RD, CDE, diabetes program administrator for the Vermont Department of Health, says dietitians should encourage clients to quench their thirst with healthier alternatives, with either plain or carbonated water being the best choice. (A squirt of lemon can add flavor.) For people who love fruit juices, which are often packed with sugar, Edelman suggests adding a splash of their favorite fruit juice to a glass of sparkling water. It will provide the flavor they enjoy and significantly reduce the sugar content.

Candy is another sweet treat that many may find difficult to relinquish. Zied recommends clients substitute mixed nuts, dried fruit (made without added sugar), and low-sugar cereals for candy. These foods are much healthier yet are still tasty and satisfying. Munching on trail mix that includes several small pieces of chocolate is a great way to get that sweet fix without eating an entire candy bar.

Zied also suggests clients prepare healthy alternatives to their favorite desserts. Muffins, cookies, cakes, and cupcakes are often loaded with added sugars. Clients can use low-calorie sugar substitutes to replace part of the sugar and reduce the calories in these recipes. However, RDs should emphasize to clients that even with the reduced sugar content, these foods should not be consumed regularly and are still considered treats.

But enjoying a treat now and again isn’t a bad thing. Clients who allow themselves an occasional indulgence rather than trying to abstain often find success making healthy changes. Those who attempt to deny themselves all sweets may not have as much success, says Edelman, especially if they previously consumed a lot of sugar. Encouraging clients to exercise is also important. Tell them to get moving to burn those extra calories when they allow themselves a treat, suggests Edelman. They can balance the extra calories by taking a brisk walk or engaging in a little exercise.

Johnson agrees, saying those who struggle with reducing sweets need to compensate by increasing their daily workout regimen. “I tell people that if they can’t live with their added sugars limit, then they need to up their energy needs by moving more,” she says.

Of course, just because you’re informing clients that they are “allowed” a certain amount of added sugar each day doesn’t mean they should stock up on candy and other sweets. Many of these foods may have more than the AHA’s recommended daily limit in one serving or less. Johnson encourages her clients to use their added sugar allotment to enhance the flavor and palatability of already nutrient-rich foods such as sweetened yogurt, flavored milk, and high-fiber whole grain breakfast cereals. “I’d much rather see someone use their added sugar allotment this way than in a nutrient-void soft drink or candy bar,” she says.

Time for Change
In today’s world, it seems people are eating more and moving less—and that’s a true concern. According to the AHA, Americans’ total calorie intake has increased by an average of 150 to 300 kcal/day over the last 30 years. Approximately 50% of that increase comes from liquid calories, mostly sugar-sweetened beverages such as soda. Yet, despite these rising numbers, there has been no evidence of an increase in physical activity. The AHA believes these facts make it likely (but yet unproven) that Americans’ expanding waistlines are linked to an increased intake of added sugars.

The statement concludes: “To achieve and maintain healthy weights and decrease cardiovascular risk, while at the same time meeting essential nutrient needs, the AHA encourages people to consume an overall healthy diet that is consistent with the AHA’s 2006 diet and lifestyle recommendations. Most American women should eat or drink no more than 100 calories per day from added sugars, and most American men should eat or drink no more than 150 calories per day from added sugars.”

While your clients may hear these new recommendations and think reducing sugar intake is an impossible task, you can play a vital role in helping them achieve success by teaching them how to read food labels and keeping them motivated with attainable goals. By taking small steps, clients can begin to cut back on the sweet stuff and get on track to a healthier lifestyle.

— Lindsey Getz is a freelance writer based in Royersford, Pa.


A Sugar by Any Other Name Would Taste as Sweet
• Brown sugar
• Corn sweetener
• Corn syrup
• Dextrose
• Fructose
• Fruit juice concentrates
• Glucose
• High-fructose corn syrup
• Honey
• Invert sugar
• Lactose
• Malt syrup
• Maltose
• Molasses
• Raw sugar
• Sucrose
• Syrup