By Kaye Spector
Health and Medical Reporter, The Plain Dealer
Americans are eating an average of just under a half cup of added sugar a day -- that's 22 teaspoons of the white stuff.
We're not talking about the naturally occurring sugar found in fruits or dairy products but rather the sweeteners and syrups added to foods during processing, preparation or at the dining table. Think soda and sweet tea. Processed foods such as instant oatmeal or breakfast cereal. Condiments including jam or maple syrup.
At a time when we're eating more sugar than ever, the American Heart Association recently said that lowering the amount we consume is essential to achieving and maintaining healthy weight, decreasing cardiovascular disease risk and meeting essential nutrient needs. The association published new guidelines this month.
For example, if you're an average adult woman eating around 1,800 calories a day, the association recommends no more than five teaspoons of added sugar a day. If you're an average adult man eating about 2,200 calories a day, the association advises a limit of nine teaspoons. The recommendations vary based on age and activity level.
"These are good benchmarks," says Brenda Walsh, a registered dietitian at University Hospitals. "Where we're at is way beyond what we should be."
What's wrong with making your life a little sweeter?
First of all, sugar has no nutritional value other than providing calories, and it displaces the more nutritious foods and beverages that we all should be consuming instead, Walsh says.
Second, high intake of added sugars can directly damage your health, says Dr. Leslie Cho, an interventional cardiologist with the Cleveland Clinic. The most significant way -- by creating obesity.
Obesity causes numerous chronic health conditions, including hypertension, diabetes and high cholesterol, which lead to heart attack and stroke, Cho says.
"Sugar is calories. An increase in calories is an increase in weight," she says. "It's really important to maintain a good body weight."
All things being equal, eating 50 more calories a day than you expend -- a mere three teaspoons of sugar -- could result in up to a five-pound weight gain over a year, according to the heart association.
High sugar intake also is associated with increased triglyceride levels, a known risk factor for coronary heart disease.
Higher consumption of high-sugar beverages and foods also is associated with evidence of increased inflammation and oxidative stress, a term for damage to cells, tissues and organs caused by free radicals and other pro-oxidant molecules.
But Americans can't seem to get enough of the sweet stuff.
Americans' intake of added sugars increased from an average of about 16 teaspoons a day in 1977 to about 21 teaspoons by 1994, one study estimates.
That amount has remained high -- and has increased to 22 teaspoons a day among those 20 years and older -- estimates The National Cancer Institute, which looked at data from the 2001 to 2004 National Health and Nutrition Examination Survey.
The biggest culprits are soft drinks and other sugar-sweetened beverages, which are the No. 1 source of added sugars in the American diet, the heart association says. Per-person daily consumption of soft drinks increased 70 percent between 1970 and 2000, from 7.8 ounces to 13.2.
It's probably no coincidence that the usual drink size used to be 8 ounces. Now it's routinely 12 ounces and up -- including beverages like the 64-ounce Double Gulp fountain drink, Walsh says.
Most of Walsh's patients are trying to get their weight or diabetes under control. She says they usually are surprised to hear that a 12-ounce can of soda can contain up to 10 teaspoons of sugar. Many of them drink three sodas every day.
Others drink a gallon of juice every day. While juices contain natural sugars, rather than added sugar, they are high in calories, Walsh says. And "we don't feel full from them."
Better beverage choices are milk -- which provides nutrition -- or water, she says.
Artificial sweeteners do help some of Walsh's patients cut down their sugar intake.
"I'm fine with people using artificial sweeteners if it helps them achieve their goals," she says.
Walsh tells her patients to try fruit when craving a sweet: They get the sugar taste they crave, with the added benefits of nutrition, fiber and satiety.
Consumers may have a tough time avoiding added sugars in processed food. U.S. food labels provide information on total sugars per serving but do not distinguish between sugars that are naturally present in foods and sugars added to enhance taste or texture.
For example, flavored yogurt has about 10 grams of natural sugar and, usually, another 10 to 20 grams of added sugar, depending on the flavor.
Added sugars do, however, show up in the ingredient list. Walsh urges her patients to read them religiously and avoid foods where sugar is listed among the first five or so ingredients. (Manufacturers must list ingredients in order according to greatest weight by volume.)
The best way to avoid added sugar is to cut down on eating processed food, Walsh says. "The more processed a food is, the more sugar they need to add."
Also consider the whole product, not just a package claim such as "low-fat" or "no trans fat" when choosing processed foods. Another undesirable ingredient -- such as sugar -- might be amped up to improve taste.
Yes, that cracker might be made from whole grain, but if the second ingredient is sugar, you might want to pass, says Walsh.
When choosing food, Walsh says, step back and really consider what you're getting: Is it an invented product that is far, far away from its origin in nature? If so, that deep-fried snack made from extruded cornmeal and dusted with cheese-flavored powder might not be the best choice.
"My rule is, 'If Grandma doesn't recognize it, don't eat it,' " Walsh says.
Cho's guidelines for her patients: Be a "mindful eater" of the 200 or so food choices they make every day.
"You have to be responsible for whatever goes into your body," she says.
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