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New Recommendations for Intake of Sugars by AHA

Posted: Wednesday, September 02, 2009

New recommendations for maximum dietary intake of "added sugars," released by the American Heart Association, are probably far more healthful than the much-higher current average intake in the U.S.. But without educating the patient, it will have little or no effect.

The statement goes beyond the organization's previously stated position that Americans should cut back on added sugar -- that is, dietary sugar that isn't an intrinsic part of unprocessed food -- to recommend "prudent upper limits" on daily intake. They vary by sex, age, and activity level, but the AHA puts them at 140 kcal for most American men and 100 kcal for most American women.

For the first time, the group has issued guidelines that say most women should consume no more then 6 teaspoons (about 100 calories or 25 grams) of added sugar daily, and most men no more than 9 teaspoons (about 150 calories or 37.5 grams).

But here’s the tricky part: added sugar not only includes the white table sugar you might spoon into a cup of coffee or a bowl of cereal, but also sugar added to food and drinks before you even purchase them. Added sugar is commonly found in soft drinks, candy, cakes, and cookies (though it lurks in many types of food, including some yogurts and even granola.)

Those numbers assume the added sugar accounts for half a person's discretionary calorie allowance -- that is, the difference between estimated calories needed to maintain weight and those "needed to maintain nutrient requirements." As part of this definition, the remaining discretionary calories come from "solid fats." Any consumed alcohol also counts and in the tallying would come out of discretionary calories from either source.

Regular soft drinks and other sweetened beverages are responsible for a third of added sugar intake in the U.S., according to the report. It also provides an overview of main sources of added sugar, its most common forms, and a review of the literature on its recognized and potential contributions to obesity, glucose intolerance, blood-pressure elevation, and dyslipidemia.

The primary pitfalls of added sugars, according to lead author Rachel Johnson, are that they deliver empty calories and they tend to replace other nutrient-rich foods in our diet. "Because most of us lead a fairly sedentary lifestyle, the food we do eat needs to be packed with nutrients," says Johnson, who is a registered dietitian and a professor of nutrition at the University of Vermont, in Burlington.

One of the specific challenges of limiting added sugars is simply recognizing them. Food manufacturers don’t have to list the amount of added sugar on products, says Johnson. Instead, added sugars are lumped in with naturally occurring sources, and usually listed together as "total sugars."

Johnson suggests identifying which sugary foods your family consumes most often, and investigating their specific sugar contents, either by finding the product’s website online, or by consulting the USDA’s food composition database.

Although added sugar is not directly linked to heart disease, it is associated with risk factors such as overweight and obesity, high blood pressure, high levels of triglycerides, and high levels of C-reactive protein, which has been linked to oxidative stress and inflammation, says Linda Van Horn, a registered dietitian and chair of the American Heart Association’s Nutrition Committee.

In contrast, foods with naturally occurring sugars deliver nutrients while still satisfying our craving for sweetness. For example, fruits have essential vitamins and minerals as well as protective agents known as phytonutrients, such as carotenoids and polyphenols; dairy products contain calcium, protein, vitamin D, and more.

In the past, there have been few formal guidelines on how much added sugar is too much. The American Heart Association only went so far as to recommend that people "limit added sugars" or consume them "in moderation." The USDA says that based on an average adult 2000-calorie diet, 10 teaspoons of added sugar, or about 40 grams, is the total that people should not exceed.