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Heart Health, Explained

Diet: Sugary Foods and the Risk of Cardiovascular Disease

Epidemiological studies have suggested that eating too much added sugar increases the risk for cardiovascular disease, but few studies have examined mortality risk. Now a new study has found that eating sugary foods increases the risk of dying from heart disease. This new study, published online in JAMA Internal Medicine and publicized in The New York Times February 6, 2014, says that most adults get 10 percent or more of their calories from added sugar. Importantly, this study says that this is a risk factor that can be modified.

Sugary Foods Q&A

Q: Why does consuming too much sugar increase heart disease risk? What biological mechanisms are at work? What is “added sugar” and what are the major sources in Americans’ diet?

A: Individuals who consume too much sugar, especially sugar-sweetened beverages, have a tendency to gain more weight. As a result, this leads to a higher risk of obesity and related health concerns including diabetes, high blood pressure and elevated cholesterol levels. These risk factors lead to an increased chance of developing heart and vascular disease.

Increased intake of sugar leads to increased levels of “bad” cholesterol, or LDL, and triglycerides as well as a decrease in the “good” cholesterol levels, or HDL, made by the liver. Elevated triglycerides and LDL are known risk factors for heart and vascular disease. If the liver continues to process all of the excess sugar, this ultimately leads to high levels of sugar being converted to fat. This in turn can lead to insulin resistance, which is a fundamental problem in obesity, and the development of diabetes.

“Added sugar” is any sugar or syrup that has been added to a food or food product. Much of the sugar in processed or packaged foods is considered added sugar. These are considered “empty calories,” meaning your body cannot utilize them for energy and, as a result, turns them into fat. Major sources include soft drinks, cereals, candy, cookies, pies, dairy desserts and milk products. For example, one 360ml can of regular soda contains 35 grams (8.75 teaspoons or 140 calories) of sugar. The American Heart Association recommends 100 calories/day (6 teaspoons) of added sugar for women and 150 calories/day (9 teaspoons) of added sugar for men.

Q: Many of the foods and beverages available in grocery stores contain added sugar. How can these foods be avoided, and how can an individual best reduce consumption of added sugar to reduce the risk of cardiovascular disease and the risk of dying from heart disease?

A: Added sugar was not a significant component of our diet until the advent of modern food-processing methods. Sugar has no nutritional value other than to provide calories. Learning how to read nutrition labels is essential. Be on the lookout for these key words: “high fructose corn syrup, corn syrup, molasses, malt syrup, corn sweetener, honey, lactose, maltose, dextrose, glucose, fruit juice concentrate, sucrose, sugar.” Always avoid “low fat” options and anything advertised as “light.” Manufacturers will have taken the fat out of the item but add sugar to improve the flavor. A general rule to follow: “If it contains more than 3 grams of sugar per 100 grams, don’t eat it!” Another good rule to follow is to “never drink your sugar.” Choose either still or sparkling water as your beverage, or drink unsweetened tea instead of a soft drink. Remember that the foods lowest in sugar content tend to be displayed around the outer aisles of the supermarket. Learn to “shop the perimeter.”

Q: We understand the investigators who conducted this new study analyzed data from a nationally representative sample of more than 31,000 adults, gathered from a larger 20-year study of health and mortality. How did the investigators compute sugar consumption and the associated risk of dying from heart disease, and what specifically did they find?

A: To estimate the intake of added sugar, the authors of the study used both the U.S. Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey (NHANES) and the U.S. Department of Agriculture’s MyPyramid Equivalents Database (MPED). Some foods were estimated to the closest USDA food codes to estimate added sugar content from the study participants’ dietary recalls. Using complex statistical analysis, the study authors found that regular consumption of sugar-sweetened beverages (more than 7 servings per week) was associated with increased risk of cardiovascular disease mortality. This increased risk was independent of any other risk factors for dying from heart disease, including high blood pressure and cholesterol levels. This association between sugar intake and risk of dying of heart disease was seen regardless of age groups, sex, race (except non-Hispanic blacks – for reasons yet to further investigated), educational level, body mass index (BMI), and physical activity levels.

Reference: Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults, JAMA Internal Medicine, online Feb. 3, 2014

HEALTH NEWS IN PERSPECTIVE

Answers to your questions on timely topics in cardiac care to help make sense of research reports in the media. The series includes questions on your heart and the effect of medications, exercise, diet, and hormones.

Team Specialist

Jayme Rock-Willoughby, DO — Non-invasive Cardiologist OhioHealth Healthcare System, Columbus, Ohio

Q&A Editor

Teresa Caulin-Glaser, MD, FACC, FAACVPR System Vice President, Heart & Vascular Services OhioHealth Healthcare System, Columbus, Ohio

Heart Health Explained is a collaboration of Women’s Health Research at Yale and the OhioHealth Healthcare System, a nationally recognized not-for-profit organization with providers across 46 counties, offering a holistic approach to prevention, treatment and rehabilitation of heart disease. OhioHealth is staffed by physicians, psychologists, nutritionists and nurses who answer the questions of the moment on heart and vascular health.

The information provided here may help you make more informed choices. However, it is not a substitute for an individualized medical opinion or diagnosis, and everyone should always consult with their personal physicians to make decisions about their condition or treatment.