Reduce Your Intake of Refined Sugar

There are two main types of simple sugars, which are carbohydrates. Monosaccharides have one sugar, and disaccharides have two monosaccharides that are bonded together. (This is in contrast to polysaccharides, which have three or more sugars and are called complex carbohydrates.) Monosaccharides work faster than disaccharides; they are easily digested and give the body a quick energy boost. Before being useful to the body, dissccharides must be converted into their two monosaccharide components. Glucose, fructose, and galactose are common monosaccarides; sucrose, lactose, and maltose are common dissccharides. Sugars are found naturally in milk products (lactose) and fruits (fructose). Most of the sugar in the American diet is from adding sugar products to foods. When people discuss reducing the intake of sugar, they are normally not advising a reduction in the intake of milk or fruit. Rather, they are suggesting a reduction in the added sugar.

It is very clear that refined sugar, or sugar that has been processed from raw sugar to remove impurities and colors, is an integral part of our daily lives. And, it is not only found in the sugar bowl that may sit on the kitchen table. Refined sugar, which is also known as table sugar or pure sucrose, is ubiquitous. Just about any processed food that we eat contains sugar, and sugar is found in sodas, sweetened drinks, desserts, and baked goods.

There are actually a few different types of refined sugar. The most common type of refined sugar is granulated sugar. This is the sugar people add to coffee and tea, and it is used for cooking and baking. A second type of refined sugar is called sanding sugar. It has a coarser texture than granulated sugar. When used in baking, it retains a grainy feel. A third type of refined sugar, super-refined sugar, is used in sugary beverages and pie meringues. Finally, powered sugar, which is also known as confectioner’s sugar, is smoother than the other types of refined sugar and is used in icings and dessert toppings. ¹

In addition, not all sugars are equally sweet. Fructose is one of the sweetest sugars. It is followed, respectively, by sucrose, glucose, galactose, maltose, and lactose. ²

According to the Sugar Association, a teaspoon of sugar, which is pure sucrose, has 15 calories. During processing, it is not chemically altered or bleached. The addition of molasses adds flavor and color to brown sugar. Darker versions of brown sugar contain more molasses than lighter versions. Moreover, the Sugar Association maintains that “sugar is a healthy part of a diet.” Carbohydrates, such as sugar, “are the preferred sources of the body’s fuel for brain power, muscle energy and every natural process that goes on in every functioning cell.” ³

Obviously, not everyone extolls the healthfulness of sugar. Many have associated it with a host of different medical problems such as obesity, type 2 diabetes, cardiovascular concerns, and other serious illnesses.

In a study published in 2013 in PLoS ONE, researchers from Palo Alto, Berkeley, and San Francisco wanted to learn if the intake of sugar plays a role in the prevalence of type 2 diabetes in different populations. Data from 175 countries were included in the calculations. The researchers found an association between 150 kcal/person/day increase in sugar availability (about the amount of sugar in one can of soda/day) and an increase in diabetes prevalence by 1.1 percent. This association occurred between 2000 and 2010. So, during this time, the more sugar in the food supply of each country, the higher the incidence of type 2 diabetes in the population. Countries with declining amounts of sugar, such as Bangladesh, South Korea, Albania, and Nigeria, witnessed reductions in the rates of type 2 diabetes. The researchers concluded that their findings “lend credence to the notion that further investigations into sugar availability and/or consumption are warranted to further elucidate the pathogenesis of diabetes at an individual level and the drivers of diabetes at a population level.” ⁴

In a study published in 2011 in Clinical and Translational Science, researchers from Nashville, Tennessee, and Davis, California, investigated the association between the consumption of the dietary sugar known as fructose and the incidences of insulin resistance and metabolic syndrome. (Insulin resistance is a medical problem in which the cells fail to respond normally to the actions of the hormone insulin, and metabolic syndrome is a cluster of conditions such as excess body fat around the waist, high blood sugar levels, high blood pressure, and abnormal cholesterol levels, which increase the risk for cardiovascular problems and diabetes.) The researchers noted that there have been numerous studies that have demonstrated that diets that are high in fructose induce insulin resistance in rodents. But, they wanted to come closer to a human model. So, they studied high fructose diets in rhesus monkeys, which, as primates, are more metabolically akin to humans. The cohort consisted of 29 adult male rhesus monkeys between the ages of 12 and 20 years. For 12 months, they were fed a diet with 30 percent of the total energy from fructose. By the end of the study all of the monkeys had developed symptoms of metabolic syndrome. Four of the monkeys had type 2 diabetes. Unlike many studies, this trial had no control group. As a result, researchers could not determine how many cases of metabolic syndrome were actually caused by fructose. Nevertheless, the researchers concluded that they “successfully demonstrated that, like in humans, consumption of a high-fructose diet in rhesus monkeys produces many of the components of the metabolic syndrome.” ⁵

In a study published in 2014 in PLoS ONE, researchers from Australia and Thailand wanted to learn if consumption of sugar-sweetened beverages in a large group of Thai university students contributed to weight gain. Why is this a problem? “Thailand is now a major producer of sugar which Thais have consumed in increasing quantities over the last few decades.” And, the consumption of sugar-sweetened beverages “has played a substantial part in this increase in Thailand.”

The researchers conducted their analyses from 59,283 respondents, with a median age of 30 years, who returned two separate questionnaires administered in 2005 and 2009. The researchers learned that most of the respondents consumed sugar-sweetened beverages 3 times or less per month; only a small minority drank them every day. Males were more likely than females to be frequent drinkers of these beverages. The researchers found that the higher frequency of sugar-sweetened beverage consumption in 2005 was associated with weight gain in 2009. Sugar-sweetened beverage consumption in 2005 “was the strongest predictor of future weight gain among the physical activity and energy-dense diet variables available in our survey.” Still, the researchers were pleased to report that the overall consumption of these drinks declined during the study period. In fact, the proportion of people drinking three or more sugar-sweetened drinks per week dropped from 23 percent in 2005 to 16 percent in 2009. The researchers concluded that their findings support their hypothesis that drinking sugar-sweetened beverages “in even moderate amounts leads in the mid-to-longer term to increases in weight; that increasing intake increases this effect; and perhaps most importantly, that diminishing it reduces weight gain.” ⁶

In an article published in 2013 in BMJ, researchers from New Zealand conducted a systematic review and meta-analysis of randomized controlled trials and cohort studies on the association between the intake of dietary sugars and body weight in adults and children. Their data consisted of 30 trials and 38 cohort studies. The researchers found that, in adults, a reduced intake of dietary sugars was associated with a decrease in body weight, and an increase in sugar intake “was associated with comparable weight increase.” And the researchers added that they “were able to show a consistent effect when comparing groups with the highest intakes of sugars with those with the lowest intakes.” While the findings were somewhat uniform for adults, the “evidence was less consistent in children.” ⁷

In a study published in 2014 in JAMA Internal Medicine, researchers from Boston and Atlanta noted that researchers have found an association between intake of added sugar and cardiovascular risk factors. They wanted to learn if sugar was associated with death from cardiovascular disease. The cohort consisted of self-reported data from three groups of people representing a cross-section of America; there were about 40,000 people in the cohort. Excluded from the study were people who were already diagnosed with diabetes, heart disease, or cancer. The researchers found that compared to people who obtained only 8 percent of their total daily calories from sugar, those who obtained 17 to 21 percent of their daily calories from sugar increased their risk of death from cardiovascular disease by 38 percent. “The positive association between added sugar intake and CVD [cardiovascular disease] mortality remained significant after adjusting for the conventional CVD risk factors, such as blood pressure and total serum cholesterol.” And, it is not that difficult to add significant amounts of sugar to the diet. The researchers mentioned that “one 60-ml can of regular soda contains about 35 g of sugar (140 calories).” The researchers concluded that most adults in the United States “consume more added sugar than is recommended for a healthy diet.” ⁹

In a prospective study published in 2009 in the American Journal of Clinical Nutrition, researchers from several Boston locations examined the association between the consumption of sugar-sweetened beverages and the risk of coronary heart disease in women. The cohort consisted of 88,520 women for the Nurses’ Health Study; they ranged in age from 34 to 59 years. During 24 years of follow-up, there were 3,105 incident cases of coronary heart disease. After the researchers adjusted for nondietary risk factors for coronary heart disease, they found “a significant positive association” between the consumption of sugar-sweetened beverages and coronary heart disease. According to the researchers, their findings “provide further rationale for limiting the consumption of SSBs.” ¹⁰

Still, reducing added sugar in the diet is a daunting task. The literature on this topic offers a few suggestions. In a 2012 article in Health Affairs, researchers from New York City and San Francisco advised levying a penny-per-ounce tax on sugar-sweetened beverages. According to these researchers, data compiled by the beverage industry determined that in 2009 Americans consumed 13.8 billion gallons of sugar-sweetened beverages. To lower this level of consumption, a number of states have proposed initiating a penny-per-ounce tax. So, a 12-ounce can of regular soda would cost an extra 12 cents. It has been estimated that such a tax would reduce the consumption of these drinks by 15 percent in adults between the ages of 25 and 64 years. “The tax would have a greater impact on consumption and weight among younger adults and men, who consume more sugar-sweetened beverages at baseline, than among older adults and women.” The researchers compared the health benefits of a tax on sugar-sweetened beverages to the tax on tobacco products, which has markedly reduced their use. “In addition to generating substantial revenue, which can be used to fund health services or other infrastructure, the proposed penny-per-ounce excise tax on sugar-sweetened beverages is predicted to greatly reduce the adverse health and cost burdens of obesity, diabetes, and cardiovascular disease among US adults.” ¹²

And, it may not be as difficult as some believe to reduce or eliminate the consumption of sugar-filled beverages. In a randomized trial published in 2013 in PLoS ONE, researchers from Australia and the Netherlands tested the response of children to substituting sugar-free beverages for sugar-sweetened beverages. The cohort consisted of 203 children between the ages of 7 and 11 years. For about 1 1/2 years, during their morning snack time in school, Dutch children were given either a noncaloric, artificially sweetened drink or a sugar-sweetened drink. One hundred and forty-six or 72 percent of the children completed the study. The researchers found no statistically significant difference in satiety between the two groups of children; both groups of children were similarly pleased with their drinks. The researchers concluded that “the sugar content of the drinks did not have a measurable effect on satiety.” ¹³

In a startling article published in 2013 in Current Opinion in Clinical Nutrition and Metabolic Care, researchers from France reviewed research studies that investigated the comparison of the addiction to drugs to the addiction to foods with high amounts of added sugar. The researchers acknowledged that such an analogy may at first seem “absurd.” However, like drugs, foods that have high amounts of sugar may alter brain activity. “People now often report seeking and consuming sweet foods for their drug-like psychoactive and mood-altering effects.” The researchers concluded that “there is now strong evidence” that foods that contain large amounts of added sugar “can induce reward and craving that are at least comparable to addictive drugs.” ¹⁵

1. LIVESTRONG, www.livestrong.com.

2. Elmhurst College, www.elmhurst.edu.

3. The Sugar Association, www.sugar.org.

4. Sanjay Basu, Paula Yoffe, Nancy Hills, and Robert H. Lustig, “The Relationship of Sugar to Population-Level Diabetes Prevalence: An Econometric Analysis of Repeated Cross-Sectional Data,” PLoS ONE 8, no. 2 (2013): e57873.

5. Andrew A. Bremer, Kimber L. Stanhope, James L. Graham et al., “Fructose-Fed Rhesus Monkeys: A Nonhuman Primate Model of Insulin Resistance, Metabolic Syndrome, and Type 2 Diabetes,” Clinical and Translational Science 4, no. 4 (2011): 243-52.

6. Lynette Lim, Cathy Banwell, Chris Bain et al., “Sugar Sweetened Beverages and Weight Gain over Four Years in a Thai National Cohort—A Prospective Analysis,” PLoS ONE 9, no. 5 (2014): e95309.

7. Lisa Te Morenga, Simonette Mallard, and Jim Mann, “Dietary Sugars and Body Weight: Systematic Review and Meta-Analyses of Randomised Controlled Trials and Cohort Studies,” BMJ 346 (2013): e7492.

8. Eduardo Bernabé, Miira M. Vehkalahti, Aubrey Sheiham et al., “Sugar-Sweetened Beverages and Dental Caries in Adults: A Four-Year Prospective Study,” Journal of Dentistry 42 (2014): 952-58.

9. Quanhe Yang, Zefeng Zhang, Edward W. Gregg et al., “Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults,” JAMA Internal Medicine 174, no. 4 (2014): 516-24.

10. Teresa T. Fung, Vasanti Malik, Kathryn M. Rexrode et al., “Sweetened Beverage Consumption and Risk of Coronary Heart Disease in Women,” American Journal of Clinical Nutrition 89, no. 4 (2009): 1037-42.

11. American Heart Association, www.heart.org.

12. Y. Claire Wang, Pamela Coxson, Yu-Ming Shen et al., “A Penny-Per-Ounce Tax on Sugar-Sweetened Beverages Would Cut Health and Cost Burdens of Diabetes,” Health Affairs 31, no. 1 (2012): 199-207.

13. Janne C. de Ruyter, Martijn B. Katan, Lothar D. J. Kuijper et al., “The Effect of Sugar-Free Versus Sugar-Sweetened Beverages on Satiety, Liking and Wanting: An 18 Month Randomized Double-Blind Trial in Children,” PLoS ONE 8, no. 10 (2013): e78039.

14. Julie A. Mennella, Susana Finkbeiner, Sarah V. Lipchock et al., “Preferences for Salty and Sweet Tastes are Elevated and Related to Each Other During Childhood,” PLoS ONE 9, no. 3 (2014): e92201.

15. Serge H. Almed, Karine Guillem, and Youna Vandaele, “Sugar Addiction: Pushing the Drug-Sugar Analogy to the Limit,” Current Opinion in Clinical Nutrition and Metabolic Care 16, no. 4 (2013): 434-39.