Added Sugar: Not All that Sweet?

The following article is a guest post written by one of EBNC's collaborators, Gina Battaglia, PhD.

In an effort to reduce the obesity epidemic in the United States and other westernized countries, the World Health Organization (WHO) has recently recommended added sugar intake to be less than 5 percent of total calorie intake—half of its previous recommendation.  According to the WHO, added sugar “may result in both reduced intake of foods containing more nutritionally adequate calories and an increase in total caloric intake, leading to an unhealthy diet, weight gain and increased risk of noncommunicable diseases.” (1)

As you probably know, added sugar—such as that in soda, baked goods, and even condiments like ketchup and barbeque sauce—is not really the healthiest thing you can eat.  However, lowering the WHO recommendations for sugar may not directly address the energy balance issue that is the central principle of weight loss and maintenance.  Simply put, you must burn more calories than you eat to lose weight.  Theoretically, you could eat nothing but cookies all day and lose weight if your total calorie intake is less than your energy expenditure (your nutrient intake would be woefully inadequate, but that’s a topic for another day).

Because calorie requirements to maintain or lose weight vary drastically between individuals and depend upon factors such as gender, activity level, and current body size; the amount of sugar “allowable” by these recent guidelines will vary accordingly.  Consider these four hypothetical individuals and their respective calorie requirements:

1) male construction worker trying to maintain weight (3700 kcal)

2) female office worker trying to lose weight (1800 kcal)

3) male nurse trying to lose weight (2400 kcal)

4) stay at home mom trying to maintain weight (2600 kcal)

And the amount of sugar each can eat based on these current guidelines:

1) male construction worker trying to maintain weight (3700 kcal*0.05 = 185 kcal sugar)

2) female office worker trying to lose weight (1800 kcal*0.05 = 90 kcal sugar)

3) male nurse trying to lose weight (2400 kcal*0.05 = 120 kcal sugar)

4) stay at home mom trying to maintain weight (2600 kcal*0.05 = 130 kcal sugar)

 One 12-ounce can of Coca Cola contains 39 grams of sugar, which is equivalent to 10 sugar cubes or 4 Double Stuf Oreo cookies.

One 12-ounce can of Coca Cola contains 39 grams of sugar, which is equivalent to 10 sugar cubes or 4 Double Stuf Oreo cookies.

As illustrated in my hypothetical examples, for most individuals the amount of sugar allowed by WHO standards is less than one can of regular soda per day (a 12-oz can of Coca Cola contains 140 calories of sugar).  Considering that added sugar is also present in unlikely places such as pasta sauce and sweetened yogurt, you may find yourself surpassing the guidelines by lunchtime even if you don’t drink soda.  According to National Health and Nutrition Examination Survey (NHANES) data, sugar consumption in the U.S. makes up ~22.7% of the calories in our diets (2).  This added sugar is heavily blamed by many researchers as the culprit for the epidemic proportions of obesity in the U.S.  Some, such as pediatric endocrinologist Dr. Robert Lustig, from University of California, San Francisco, even compare the toxic and addictive nature of sugar to drugs like cocaine and heroin.  Others are quick to criticize the nearly century-old tradition of selling Girl Scout cookies, suggesting that it is capitalizing on Americans’ love for high-sugar treats.

But high-sugar foods and drinks have been around much longer than this recent rise in obesity rates, which have skyrocketed to include about one-third of the U.S. population.  The portion size increase of these sugary foods may be to blame, as the rise in obesity has increased in parallel with the increase in portion sizes (3).  For example, a commercially sold blueberry muffin contains about 500 calories—nearly 300 more than the average blueberry muffin sold just 20 years ago (4).  And if you’ve ever seen the Big Gulp soda cups at 7-Eleven, you probably know that soft drink portion sizes have gotten a little out of control. 

As the WHO panel of experts indicates, added sugar may make it harder to maintain that calorie deficit, especially if your calorie needs are low.  Many foods high in added sugar are calorie-dense and not satiating, so they can be easy to overdo.  One Oreo Double Stuf cookie has 70 calories, approximately the amount of calories in a medium-sized apple.  If we ignore the nutritional profile of the cookie vs. apple, eating one cookie, in theory, will have the same impact as an apple on your calorie budget.  However, many people will reach for a second (or third or fourth) cookie immediately after eating the first one, whereas they typically don’t reach for a second or third apple.  This tendency to overeat sugar contributes to the obesity epidemic, not sugar in and of itself.

 One Double Stuf Oreo cookie contains the same number of calories as an entire apple (note: these items are not sized to scale).

One Double Stuf Oreo cookie contains the same number of calories as an entire apple (note: these items are not sized to scale).

The concept of eating sugar also introduces the psychological element.  Eating sugar releases the feel-good brain chemicals serotonin and dopamine (5) that increases the likelihood that you’ll eat four (or ten) cookies in one sitting because they taste good, not because you need calories for energy.  Sugar releases the brain chemicals and activates areas of the brain (including the orbitofrontal cortex, caudate nucleus, hippocampus, and insula) where drug cravings are activated, (6) thereby supporting the opinion of experts such as Lustig.  You probably identify with this “addiction” if you are the type of person who can’t stop at just one or two cookies, or you cut yourself several slivers of cake until one-quarter of the entire cake is gone.  These habits can pack on the calories quickly and make it more difficult to maintain a calorie deficit, especially if your calorie needs are similar to the female office worker (1800 kcal) trying to lose weight.  Some individuals find that eliminating sugar completely reduces cravings and makes it easier to maintain a calorie intake suitable for their physical activity level and weight goals. 

However, completely banning sugar from your diet can exert negative psychological effects in other people.  If you’re the person who falls victim to sugar binges three days after complete sugar deprivation, a reasonably-sized portion of added sugar—whether it be a couple of small cookies after dinner or a doughnut at breakfast on Sundays—may help you stick to a healthy eating regimen the majority of the time.  Furthermore, cutting out sugar alone won’t magically result in weight loss if you overcompensate with healthy foods.  A 2012 study found that people who were instructed to eat the amount of fruits and vegetables recommended by the Dietary Guidelines for Americans actually gained weight, presumably because they neglected to compensate for this additional calorie load by reducing intake elsewhere (7). This finding further emphasizes that eating the recommended amount of fruits and vegetables is not a magic bullet to weight loss unless it helps you maintain an overall calorie deficit.

The key to successful weight loss/maintenance is to be aware of your overall calorie needs and to strategize how sugar will fit into your diet.  If you’re the male construction worker, your relatively high energy requirements (3700 kcal) allow you to get away with eating a few extra cookies whereas the female office worker (1800 kcal) will have a tough time fitting these cookies into her diet.  On its own, the WHO guidelines on added sugar intake (reducing sugar intake to < 5% of total calories) will not stop the obesity epidemic.  What these guidelines can do is highlight the role that empty calories (sugar intake) plays in promoting a positive overall energy balance and weight gain.  It is highly unlikely that Americans will reduce their current sugar intake of 22% down to the recommended 5%.  Five percent is a little ambitious, 22% is clearly too high, can we please meet somewhere in the middle?  Let’s try to focus on increasing our healthy behaviors by decreasing sugar consumption.  If we don’t hit the magical 5% and only get to 14% at least we are taking a step in the right direction!

 

Gina Battaglia, PhD

   

References:

  1. Draft Guideline: Sugars intake for adults and children http://www.who.int/nutrition/sugars_public_consultation/en/
  2. Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. Am J Clin Nutr. Apr 2011;93(4):836-843.
  3. Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. American journal of public health. Feb 2002;92(2):246-249.
  4. National Heart, Lung, and Blood Institute: Serving Sizes and Portions http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eat-right/distortion.htm
  5. Fortuna JL. Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes. Journal of psychoactive drugs. Jun 2010;42(2):147-151.
  6. Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical nutrition. Jun 2010;29(3):288-303.
  7. Houchins JA, Burgess JR, Campbell WW, et al. Beverage vs. solid fruits and vegetables: effects on energy intake and body weight. Obesity. Sep 2012;20(9):1844-1850.