A new study is taking the fizz out of sodas and the sweetness away from sugar-laden treats. The study, published in JAMA Internal Medicine, details the observable association between high sugar consumption and the risk of death from cardiovascular disease. An invited commentary on the study by Laura A. Schmidt states that sugar is more dangerous than the previous “empty calorie” designation suggests and has larger implications than just increasing the risk of obesity. “Too much sugar does not just make us fat; it can also make us sick,” Schmidt says.
For years, a link has existed between added sugars and the risk factors of cardiovascular disease, but the researchers behind a study published Monday wanted to see if this held true for death as a result of heart diseases, as well. To do this, eating habits and an assessment of health was analyzed. This data came from three rounds of the National Health and Nutrition Examination Survey. The survey is a multistage polling of people in the U.S., and it was periodically conducted prior to 1994, becoming continuous in 1999. Included in the data are self-reported 24-hour dietary recalls and the results of physical examinations. To establish a food’s sugar estimate, nutritional information from databases was used.
Using this system, the researchers discovered that the mean percentage of added sugar consumption between 2005 and 2010 was 14.9 percent. This is lower than data from 1988-1994 (when the mean was 15.7 percent) and nearly 2 percentage points below the mean from 1999 to 2004 (16.8 percent). Even though the mean dropped, 71.4 percent of adults still consumed more than 10 percent of their calories through added sugars, and added sugars comprise at least quarter of the caloric intake for 9.9 percent of adults.
But how much sugar is too sweet? The study notes that there is little consensus on this point. The Institute of Medicine says to limit daily intake to no more than 25 percent, the World Health Organization says to have no more than 10 percent of calories from added sugars, and the American Heart Association offers yet another number. The organization says for women, the maximum per-day amount of calories from added sugar is 100; for men, it is slightly higher, at 150 calories per day.
When participants were then matched up with mortality rates — specifically, mortality rates due to cardiovascular disease — added sugar played a large role, regardless of a person’s background or lifestyle. Analyzed against WHO and American Heart Association guidelines, when 10 to 25 percent of a person’s calories came from added sugars, the risk of mortality from cardiovascular diseases was 30 percent higher than those who fell under the daily recommended sugar intake levels. When people consume more than 25 percent of their calories from added sugar, the risk almost triples.
The main sources of sugar in a person’s diet are sugar-sweetened beverages (37.1 percent), followed by grain-based desserts (13.7 percent). Fruit drinks (8.9 percent) are the next main source, while dairy desserts (6.1 percent) and candy (5.8 percent) round out the list. The study specifically singled out sugar-sweetened beverages. When a person consumes seven or more servings per week, researchers saw an association with an increased risk of cardiovascular disease mortality. Even after adjusting for blood pressure and cholesterol, the association remained high. Biological factors may have had a role, but the link was seen across various demographics like age, level of physical activity, sex, race, and educational attainment.
A 360 milliliter can of soda is cited as containing 35 grams of sugar, on average. This amounts to 140 calories, or 7 percent of a person’s intake if he or she consumes 2,000 calories per day. That’s beyond the limit set by the American Heart Association and approaching the upper bounds of the point set by WHO.
By shining a spotlight on soda, the study drew the attention of the American Beverages Association, which reacted to the study in a statement. “This study shows that adult consumption of added sugars has actually declined, as recently reported by the CDC,” the organization said. “A significant part of that reduction is from decreased added sugars from beverages due, in part, to our member companies’ ongoing innovation in providing more low- and no-calorie options. Furthermore, this is an observational study which cannot — and does not — show that cardiovascular disease is caused by drinking sugar-sweetened beverages.”
Also eliciting a response from the American Beverage Association was a suggestion in the commentary by Schmidt that a tax be introduced in the U.S. on sugar-sweetened beverages. “Sugar-sweetened beverages are by far the single largest source of added sugar in the American diet, accounting for 37.1% of all that is consumed nationally,” Schmidt wrote. “Their prospective analysis further documents that even relatively modest but regular consumption of SSBs — drinking one 12-ounce soda a day — increases the risk of CVD mortality by almost one-third, independent of total calories and other cofactors. Their study thus underscores the appropriateness of evidence-based sugar regulations, specifically, SSB taxation.”
The ABA’s statement said this would not have a significant impact on consumption in the U.S. Furthermore, the organization said it is unfair to single out a specific ingredient, because that oversimplifies heart disease. Finally, the ABA used the example of Arkansas and West Virginia to state the desired results will not materialize through a tax. An excise tax on soft drink exists in both states, yet each are among the 10 states with the highest rates of obesity in the country.
It is a battle that is far from over. In Schmidt’s commentary, she discussed how the study is part of a recent trend in how sugar is evaluated: ”We are in the midst of a paradigm shift in research on the health effects of sugar, one fueled by extremely high rates of added sugar overconsumption in the American public.” The old model looked to unhealthy behaviors, while the new has its sights set on chronic diseases, dementia, and other adverse affects.