Health Care Quarterly:

Sugar: Understanding how much is OK

Nevada has seen a 23-percent increase in obesity among middle-aged adults in the last 15 years. Diabetes in the state has increased by a stunning 95 percent, according to United Health Foundation’s America’s Health Ranking’s Senior Report. Nevada’s senior population is expected to increase by 66 percent by 2030, and rates of obesity and chronic disease can be expected to rise proportionately.

In recent years, questions have been raised about the role of carbohydrates and sugar as contributing factors in the obesity epidemic. Low-carbohydrate diets have been touted as the key to weight loss, and some people are even cutting fruit from their diets in an effort to reduce their sugar intake. To add to the confusion, in December the medical journal Annals of Internal Medicine published research indicating we may not need to limit our sugar intake at all. With so much conflicting information, it is no wonder the rates of obesity and related chronic diseases are not declining.

Not all sugar is damaging to our health. Sugar (also called simple carbohydrate) can be categorized into two groups: naturally occurring, and added sugar. All carbohydrates we eat are metabolized into glucose, a simple carbohydrate that fuels every cell in our bodies.

Carbohydrates and naturally occurring sugar are found in foods such as dairy products, fruits, vegetables and whole grains. These foods contain naturally occurring sugar, but are also packed full of vitamins, minerals, fiber, antioxidants and phytochemicals that are protective against disease and necessary for optimal body performance.

Added sugars include table sugar, honey, syrups, fruit juice and fruit juice concentrates that are added to the food and drinks we consume. A high intake of added sugar has been linked to weight gain, obesity and tooth decay. Most of the added sugar in our diet is easy to identify. We drink it in sodas, juices, energy drinks, sports drinks and lattes. We eat cakes, cookies, ice cream, candy and — perhaps more surprisingly — store-bought spaghetti sauce, granola bars and breakfast cereals.

So how much sugar is acceptable? There are no current recommendations for limiting natural sugar found in fruits, vegetables and dairy products. However, the World Health Organization and Dietary Guidelines for Americans recommend adults and children reduce their consumption of added sugar to be less than 10 percent of their total daily calorie intake.

For someone eating 2,000 calories per day, this translates to 200 calories, or about 12 teaspoons of sugar, each day. The American Heart Association recommends an even smaller amount — around nine teaspoons per day for men and six for women. The Food and Drug Administration has recognized the importance of being able to track how much added sugar we are eating each day. Beginning this year, added sugar will begin appearing on the nutrition labels of packaged foods.

While low-carbohydrate diets restricting intake of both natural and added sugar can be effective at trimming pounds quickly, often these diets are difficult to maintain long-term, resulting in regaining lost weight over time. Although weight is certainly an indicator of health and can be a risk factor for disease, it is not the only determinant of health.

Optimal health is not achieved simply by reaching a number on the scale but by fueling your body with the right combination of nutrients, many of which are found in foods containing carbohydrates and natural sugars. Severely restricting all carbohydrate-containing foods may not be the best way to achieve health.

As may be the case with the Annals of Internal Medicine article, sometimes the scientific community adds to the confusion around health and wellness. When you come across an article presenting new research, remember it is adding to the existing body of knowledge, not replacing it. Current health recommendations are built around years of research and evidence, and, while they do change over time, they likely won’t change in response to a single study.

Ultimately, there is not a one-size-fits-all solution to the nation’s health woes, but most can agree that limiting added sugar would help. The best information we have indicates that the way to optimize health is to eat sensibly from all food groups to ensure adequate intake of a wide variety of nutrients. Not all carbohydrates are the same. We should consume more fruits and vegetables, fewer sugar-sweetened beverages and desserts, and get plenty of exercise. The best source of information about your diet and wellness goals is your health care provider or a registered dietitian who can provide current, personalized recommendations that fit into your lifestyle in a way you can maintain.

Carolyn Schut is a registered dietitian with UnitedHealthcare’s Health Plan of Nevada.

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