Sweet Heart Health

Sugars are a ubiquitous component of our food supply and are consumed as a naturally occurring component of many foods - including as lactose in milk - and as additions to foods during processing, preparation or at the table. Many dairy foods rely on sugar and other sweeteners to make what is a relatively bland food more appealing. But when does too much sugar make an otherwise nutrient-dense food an increased risk for heart disease?

AHA issues upper limits

In August 2009, the American Heart Association (AHA), Dallas, issued a scientific statement providing specific guidance on limiting the consumption of added sugars. Published in Circulation: Journal of the American Heart Association, AHA provides information about the relationship between excess sugar intake and metabolic abnormalities, adverse health conditions and shortfalls in essential nutrients. This was the first time AHA recommended specific levels and limits on the consumption of added sugars.

And, of course, the sugar and nutritive sweetener industry is not pleased. In fact, no sooner was the AHA statement published than the Sugar Association, Washington, D.C., stated that it was  very disappointed that a premier health organization would issue such a scientific statement without a higher standard of evidence to support its contentions and therefore mislead the average consumer. Very few of the cited references by AHA are directly related to sugars and heart health impacts, according to the Sugar Association. Further, AHA’s statement infers that there is a direct correlation to sugars intake and cardiovascular health, when according to the Sugar Association, it is quite clear that the body of compelling science is lacking.

The Sugar Association contends a misplaced emphasis on sugar-containing foods is an oversimplification of the current cardiovascular problem and will have the same failed outcome as the simplistic low-fat messages of the 1990s. Simply reducing sugars in the diet, as this paper contends, is counterproductive if a reduction in total caloric intake is not achieved. Dietary interventions that focus on the reduction of individual nutrients will continue to obscure the most important message: If one consumes more calories – no matter the source – than one burns, weight gain is inevitable.

Nevertheless, AHA’s statement is out there, and calorie-contributing sweeteners are being attacked by the media. Further, with dairy desserts and milk products, such as ice cream, yogurt and flavored milk, cited as being responsible for 8.6% of total added sugars consumed, dairy foods formulators should explore lower-calorie approaches to sweetening dairy foods. (Check out this month’s Ingredient Technology feature on page 48, which includes commentary from 13 suppliers of sweeteners.)

“Sugar has no nutritional value other than to provide calories,” according to the AHA statement’s lead author Rachel Johnson, associate provost and professor of nutrition at the University of Vermont, Burlington, Vt. “Consuming foods and beverages with excessive amounts of added sugars displaces more nutritious foods and beverages for many people.”

The statement says that most women should consume no more than 100 calories (about 25 grams) of added sugars per day. Most men should consume no more than 150 calories (about 37.5 grams) each day. That’s about six teaspoons of added sugar a day for women and nine for men. In contrast, the statement cites a report from the 2001–04 National Health and Nutrition Examination Survey (NHANES) that showed the average intake of added sugars for all Americans was 22.2 teaspoons per day (355 calories).

Soft drinks and other sugar-sweetened beverages are the number-one source of added sugars in Americans’ diet, according to the statement. “One 12-ounce can of regular soda contains about 130 calories and eight teaspoons of sugar,” Johnson said. “This new statement expands on earlier recommendations and gives consumers more detailed guidance by recommending a specific upper limit on added-sugars intake.”

In addition, the statement recommends that no more than half of a person’s daily discretionary calorie allowance should come from added sugars. Discretionary calories refer to the number of calories “left over” after a person eats the recommended types and amounts of foods to meet nutrient requirements, such as fruit, vegetables, low-fat dairy products, high-fiber whole grains, lean meat, poultry and fish. Added sugars, alcoholic beverages and solid fats - including saturated fat and trans fat - are typically considered discretionary calories that are to be included after individual daily nutrient requirements are met.

She recommends that people use their added sugars “allotment” as a vehicle to enhance the flavor of otherwise nutrient-rich foods. For example, choosing a nutrient-rich dairy product, such as a flavored yogurt or a sugar-sweetened whole-grain breakfast cereal, would be a better choice than a nutrient-void candy. 

Heart-friendly coffee

Separately, coffee drinkers may be less likely to be hospitalized for heart rhythm disturbances, according to a report presented at AHA’s 50th Annual Conference on Cardiovascular Disease Epidemiology and Prevention in early March. Researchers at the Kaiser Permanente Medical Care Program in Oakland, Calif., found that men and women who reported drinking four or more cups of coffee each day had an 18% lower risk of hospitalization for heart rhythm disturbances. Those who reported drinking one to three cups each day had a 7% reduction in risk.

This includes coffee-milk beverages such as latte and cappuccino, made-to-order and ready-to-drink. With the latter, formulators should explore using low-fat milk and alternative sweeteners, to make the coffee-milk drink even more heart friendly.

Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement from the American Heart Association

Study highlights:

  • High intake of added sugars is implicated in numerous poor health conditions, including obesity, high blood pressure and other risk factors for heart disease and stroke.

  • Added sugars and solid fats in food should be eaten sparingly.

  • Most American women should consume no more than 100 calories of added sugars per day; most men, no more than 150 calories.

  • Soft drinks and other sugar-sweetened beverages are the number one source of added sugars in the American diet. 

    Source: Circulation: Journal of the American Heart Association, 2009; 120 (11): 1011-1020