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American Heart Association says the verdict is in - sugar is bad

Friday, September 11, 2009 Posted by Travis Saunders
Image by AdamSelwood.

In the past, I have written several posts about sugar (mainly fructose and high fructose corn syrup, aka HFCS), and how it is a driving force behind the current obesity epidemic.  The evidence is compelling - the intake of added sugars (especially HFCS) has dramatically increased over the past 30 years, an increase which is mirrored by the increased prevalence of obesity.  Further, these added sugars are "empty" calories, which tend to displace other foods that contain more nutrients.  Then there are the many ways that sugar (again, especially HFCS) disrupts both metabolism and the hormones that signal satiety, resulting in increased health risk as well as increased food intake (outlined wonderfully in this powerpoint presentation by Dr Robert Lustig of the University of California at San Fransisco).  That's right - sugar can actually make you more hungry!  The insulin response to sugar and resulting lethargy may result in decreased energy expenditure as well.  In short, sugar does many bad things to the human body, and it should be limited to a very small portion of our daily diet. 

Now is any of this really a shock to anyone?  Probably not.  Even the food industry agrees that both sugar and HFCS should only be consumed in moderation.  Don't believe me?  Check out this commercial for HFCS (email subscribers will need to visit our main page to see the clip):

Ok, so they reverse the statement to say that HFCS is fine in moderation, but the natural implication is that it's not ok to consume in excessive amounts.

But what amount of sugar is moderate, and what amount is excessive?  One can of pop?  A half-litre of chocolate milk?  Without a concrete value attached to it, "moderation" is pretty useless as a public health message.  Thankfully, the American Heart Association has stepped in to fill the gap, with an excellent new review paper that outlines all of the arguments against sugar intake, and then gives concrete recommendations on the amounts that we should be consuming on a daily basis.

The paper, which will be published next week in the journal Circulation, was written by Rachel Johnson and other experts in the fields of nutrition, physical activity, metabolism, and epidemiology.  They make an incredibly strong (and readable) argument that sugar and fructose have toxic effects on the human body, and that people should limit their intake accordingly, just as they would for other toxic substances.  What is that upper limit? As the authors put it:

"A prudent upper limit of intake is half of the discretionary calorie allowance that can be accommodated within the appropriate energy intake level needed for a person to achieve or maintain a healthy weight based on the US Department of Agriculture food intake patterns".

I know that's a bit wordy, so I'll give a concrete example.  Let's say that you're an average male, and thus require 2,200 calories per day to maintain body weight.  It is assumed that it will take roughly 1900 calories to meet your nutrient needs (e.g. vitamins, minerals, etc), which leaves you with 300 "discretionary" calories that do not contribute to your nutrient needs.  This report suggests that no more than half of these discretionary calories should be in the form of sugar.

Thus, men should limit their intake of added sugars to roughly 150 calories/day (9 teaspoons) while women should limit themselves to 80 calories (5 teaspoons).  For reference, a normal can of pop has 8 teaspoons of sugar and 130 calories.  In other words, try to limit your sugar intake to very low levels.

Now the authors go out of their way to say that these limits apply only to "added" sugars, and not to those found naturally in fruits and vegetables.  The word juice is never mentioned in their report, but the sugars in juice are no different from those in pop, and there is no reason to think that they have any different effect on the human body.  So best to limit your juice intake as well - eat your fruits and veggies instead. 

The American Heart Association report is freely available, and it is excellent reading for anyone interested in the health effects of sugar consumption.  It can be found here.

Have a great weekend,


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Johnson, R., Appel, L., Brands, M., Howard, B., Lefevre, M., Lustig, R., Sacks, F., Steffen, L., Wylie-Rosett, J., & , . (2009). Dietary Sugars Intake and Cardiovascular Health. A Scientific Statement From the American Heart Association Circulation DOI: 10.1161/CIRCULATIONAHA.109.192627

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9 Response to "American Heart Association says the verdict is in - sugar is bad"

  1. Matt Said,

    Great post Travis! Switch to honey!

    Posted on September 11, 2009 at 2:05 PM

  2. Anonymous Said,

    It's a very interesting paper and another blow against sugar added foods and drinks. Unfortunately, I don't know how many people are aware of this information, care, or are knowledgeable enough to understand which foods or drinks contain these extra calories or the amount of servings they are actually consuming. I thought this was one of the most interesting parts of the paper...

    "Chronic hyperinsulinemia may
    also contribute to increased caloric intake by preventing
    dopamine clearance from the nucleus accumbens, thus fostering
    pleasure derived from food in situations in which
    energy stores are replete, contributing to excess energy
    intake.78 Obesity results in a decreased density of striatal D2
    receptors,79 which may lead to a compensatory increased
    strata dopamine neurotransmission through mass action.80
    Chronic amygdala activation by stress, which increases cortisol
    secretion, promotes palatable food consumption as a
    form of self-medication.81–83 Several studies in children have
    observed relationships between stress and increased intake of
    sugared beverages, sweets, and snacking.84,85 In a controlled
    study of 9-year-olds, children who were both high on dietary
    restraint and felt more stressed by laboratory challenges
    tended to eat more sugar-containing comfort food.86"

    I have a feeling that the fast food industry has known this for a long time. People have less time, work more, and are becoming increasingly stressed and fast food just happens to be accessible, inexpensive, and feeds into the pleasure centers of our brains.

    Posted on September 11, 2009 at 2:49 PM

  3. Matt Said,

    There was an interesting interview on the "Current" CBC Radio 1 about the combination of fat and sugar that the fast food industry uses to literally cause cravings and addiction, if that is not too strong a term, in the public.

    Posted on September 11, 2009 at 3:31 PM

  4. Anonymous Said,

    "The word juice is never mentioned in their report, but the sugars in juice are no different from those in pop, and there is no reason to think that they have any different effect on the human body."

    But are not the sugars in fruit "no different from those in pop"?

    Posted on September 11, 2009 at 5:52 PM

  5. Travis Saunders, MSc Said,

    Excellent comments all around!


    You make a great point. However, fruit itself often contains fiber, which is filling, and I would think (people with more knowledge in this are can correct me if I'm wrong) also reduces the glycemic load when compared to the same sugars in a fruit juice. You're also likely to consume less sugar since it's much easier to drink 2-3 oranges than it is to eat them (there's really not that much juice in one orange).

    Posted on September 12, 2009 at 10:39 PM

  6. Kevin Said,

    As a recognized sugar expert (I am a pediatric dentist), with a background in Nutrition and Dietetics, I have long been sounding the alarm to my dental colleagues about the importance of promoting "sugar cessation"; or otherwise stated, by virtue of the toxic and addictive nature of sugar, cavity prevention efforts aimed at reducing sweets, also indirectly help prevent chronic systemic disease. The "toxic and addictive nature" thing doesn't sit well with many of my colleagues for various reasons, not the least of which is lack of academic preparedness in diet counseling. Another reason for the dental/medical/healthcare profession's inattention to the dangers of sugar per se, has to do with what , apparently only a select few (like Dr. Robert Lustig) truly grasp RE the actual biochemistry of fructose metabolism by the liver...I have a master's degree in nutritional biochemistry and Lustig's tutorial (SUGAR: THE BITTER TRUTH was a bombshell to me. Another reason for the dental profession's apparent reluctance to get behind sugar cessation like they eventually supported tobacco cessation efforts (e.g., soda/obesity taxes, PSA's RE sugar/soda cessation, etc.) could have something to do with our/their perception that there is lack of scientific evidence for sugar's toxic and addictive nature; and there is always the possibility of politics and (perceived?)pressure from the food and beverage industry (the American Academy of Pediatric Dentistry-AAPD, accepted a one million dollar grant/gift from Coca-Cola in 2005)...hard to pinpoint this one but there have been inferences. Anyway, given the proper training in diet counseling and nuances of techniques in the emerging discipline of Motivational Interviewing(MI), dental professionals, especially dental hygienists, are well-positioned (by virtue of frequent patient encounters, sugar/carbohydrate expertise and trustworthiness) to help mitigate systemic chronic disease epidemics, primarily type 2 diabetes and fatty liver disease. This website/blog of yours is fantastic and I'd like to suggest that you maybe consider adding an "oral-systemic health" forum, where dental and non-dental healthcare professionals...and their patients, can discuss pertinent diet/obesity-related issues.

    Thanks for providing this opportunity.

    Kevin Boyd, MS, DDS

    Posted on October 13, 2009 at 6:02 AM

  7. Travis Saunders Said,

    Wow, thanks for that fantastic comment, Kevin. It's nice to hear the perspective of someone working in a related but different field from our own. Hopefully we will reach a tipping point in the near future when the danger of excess sugar/fructose consumption will become more widely accepted.

    Thanks also for the forum suggestion. I am not sure our HTML skills are up to the challenge, but it is an excellent suggestion nonetheless, and something to aim for in the future.


    Posted on October 13, 2009 at 9:31 AM

  8. Mona Albano Said,

    Could you address the assertion by Linus Pauling that one of the commoner sugars stimulated cholesterol production and that sugar consumption was closely linked to cholesterol levels?

    He had demographic information and said also that dietary studies of prisoners, where they were given more or less sugar, showed a rise and fall in cholesterol levels.

    Posted on November 6, 2009 at 9:13 PM

  9. Travis Saunders Said,

    @ Mona,

    I'm not familiar with those studies, but they sound interesting. I'll keep an eye out for them and hopefully get back to you on that. I do know that both glucose and fructose can be converted into triglycerides by the liver, and that sugar intake is thought to result in decreased HDL (good) cholesterol and increased triglycerides, both of which are very bad things. Here is a paper that has some good info on sugar and risk of various diseases, released by the American Heart Association in 2002.


    Posted on November 7, 2009 at 9:52 AM


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We are PhD students in the School of Kinesiology and Health Studies at Queen's University in Kingston, Ontario. Our research focuses on the relationships between obesity, physical activity, and health risk. This blog is our attempt to consider the many "cures" for obesity that we read about on a daily basis. Enjoy.


The opinions expressed here belong only to Peter and Travis and do not reflect the views of any organization. Any medical discussion on this page is intended to be of a general nature only. This page is not designed to give specific medical advice. If you have a medical problem you should consult your own physician for advice specific to your own situation.

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