Reminder to Patients: Reduced Sugar Intake Improves Health and Prolongs Life

Abstract

Most clinicians are aware of the risks of consuming excess dietary sugar and the detrimental effects it has on a person’s health. But how should clinicians handle this issue with patients? What are the messages that should be shared about the benefits of consuming less sugar and most importantly, practical strategies to make that happen? In this column, we will review some important facts about sugar consumption and how to help patients optimize their health through an integrative approach to less consumption of added sugars.

Facts

A recent review by Gillespie and colleagues looked at “the role of free sugars in human health, specifically obesity, diabetes, cardiovascular diseases, cognition, and mood.”¹ Their findings affirmed a “negative effect of excessive added sugar consumption on human health and wellbeing.”¹ However, they added that “Specific class and source of carbohydrate appears to greatly influence the impact of these macronutrients on health.”¹ To demonstrate the rising intake of sugar in this country, the authors stated that high-fructose corn syrup consumption increased from <1% of caloric sweeteners in the 1970s to 42% by the year 2000. They stated that “added sugars and sweeteners reached a peak of over 153 pounds per person per year in the US in 1999. These changes in diet coincided with a dramatic rise in obesity, diabetes, and cardiovascular disease.”¹ They added that despite a recent decline of intake of added sugars and sweeteners, global sugar consumption is still high and above the recommended 5% or 10% of daily energy intake.

A CDC (Centers for Disease Control and Prevention) article reported that in 2017–2018, the average daily intake of added sugars was 17 teaspoons for children and young adults of age 2–19 years, and in the same time period the average intake of added sugars was 17 teaspoons for adults aged 20 and older.²

Most major health organizations agree that for the best health outcomes, people should consume approximately 5% of free sugars or less in their total caloric intake in order to improve health or maintain optimal health. The AHA (American Heart Association) recommends “limiting added sugars to no >6% of calories each day. For most American women, that’s no more than 100 calories per day, or about six teaspoons of sugar. For men, it’s 150 calories per day, or about nine teaspoons.³ The NHS (National Health Service) recommends that “sugars added to food or drinks, and sugars found naturally in honey, syrups, and unsweetened fruit and vegetable juices, smoothies and purées—should not make up >5% of the energy (calories) you get from food and drink each day.”⁴

Added Sugar

Scapin and colleagues state that the term added sugars is complex and defined differently by various parties.⁵ After their review of this issue they suggested a definition as follows: “Added sugars are sugars and syrups added to foods and beverages during food processing, preparation, or meals. They include compounds such as white sugar, high-fructose corn syrup, honey, and fruit juice and fruit juice concentrates, among others, and excludes sugars naturally present in foods, such as lactose in milk and sucrose and/or fructose in fruit. A sugar naturally occurring in a specific food, including fructose and sucrose, extracted and isolated from its source food and added to another food will be classified as an added sugar in the new food.”⁵

A recent report from the Dietary Guidelines stated that foods with added sugars that account for the greatest levels of intake include sugar sweetened beverages 24%; desserts and sweet snacks 19%; coffee and tea 11%; candy and sugars 11%; sandwiches 7%; cereals and bars 7%; higher fat milk and yogurt 4%; and other sources 19%. Advising patients about the intake of these particular foods and beverages is important.⁶

Integrative Strategies for Clinicians to Help Patients Reduce Sugar Intake

When one tells a person, “Don’t look to your left,” what is the first thing that happens? The person more often than not looks to their left. This is because their brain doesn’t have enough time to process or integrate what has been said to them and takes it as a warning, so they do the opposite behavior from what they are being told. Similarly, if a clinician tells a patient, “Stop eating sugar” it is likely that the patient will crave more sugar and have an even more complicated process with their consumption. So, the messages need to be clear and simplified when it comes to making healthy food and beverage choices. For example, a clinician may ask a patient (rather than beginning by giving advice), “How do they feel about the amount of sugar they eat?” Depending on the response, the clinician can continue to ask questions and if consumption is high, ask the patient what they think they can change in their diet to reduce added sugars.

Most importantly, clinicians should refer patients to a nutritionist or dietician and/or health coach for extended conversations and education if that person is significantly overweight or obese or has a very high intake of sugar. Or, a person should be referred to a diabetes education center if the person is pre-diabetic or has diabetes—this seems obvious, and yet these diabetic services are greatly underutilized. There are, however, many things that clinicians can share with patients in an integrative approach.

Suggestions for reducing added sugars

The Dietary Guidelines for Americans 2020–2025 offers many basic ways of reducing the intake of added sugars including reducing meal and sugar portions, eating sugary foods less often, and choosing food and beverage options that are low in added sugars. The document stated, “When added sugars in foods and beverages exceed 10% of calories, a healthy dietary pattern within calorie limits is very difficult to achieve.”⁶

A Harvard article looking at the adverse effects of sugar consumption on cardiovascular disease stated that “Consuming too much added sugar can raise blood pressure and increase chronic inflammation, both of which are pathological pathways to heart disease. Excess consumption of sugar, especially in sugary beverages, also contributes to weight gain by tricking your body into turning off its appetite-control system because liquid calories are not as satisfying as calories from solid foods. This is why it is easier for people to add more calories to their regular diet when consuming sugary beverages.”⁷

When talking with patients, clinicians, however, should avoid solely focusing on what is bad about sugar with their patients and rather focus on helping them make healthy dietary choices. Eating whole foods rich in nutrients optimizes the effects of a dietary pattern on one’s health. There are many testimonies of people with eczema, for example, who stated that once they stopped eating added sugar their eczema cleared up. Of course, this will not be true for every person, but many people have seen significant physical, emotional, and health benefits from simply reducing sugar intake.

While many people follow a variety of dietary patterns that can be healthy, most people are getting on board with the fact that the consumption of a dietary pattern that is rich in whole foods and plant-based has been shown to improve many health indices including glucose levels.

Here are some specific suggestions for helping people make better dietary choices that reduce sugar intake:

Eat whole foods. Rather than focusing on avoiding sugar, guiding a person toward a whole foods diet helps eliminate some of the complication because the person simply focuses on eating whole foods such as vegetables, fruit, and healthy sources of protein. Eating a wide variety of these food sources can help ensure the right intake of important nutrients, vitamins, and minerals.

Choose whole foods wisely. It is important for patients to learn to read labels for sugar content on food and beverage packaging. Remember that even whole foods contain sugar, and these sugars need to be considered and chosen in a moderate amount. For example, some fruits are higher in sugar than others such as mangoes, grapes, and cherries. However, fruits are also high in fiber and nutrients and certainly should be included in a well-balanced diet.

Remember that unhealthy foods are replacing healthy foods. To address the reduction of sugar and sugar cravings, The Institute for Integrative Nutrition recommends: “Eat more complete meals at mealtime, which cuts down on snacking; always carry a non-sugary snack with you such as nuts and seeds, carrot sticks, nori sheets, dried chickpeas, and others; try sugar-free desserts—fruit is an obvious choice; however, the Internet is full of incredible recipes that are delicious and sugar-free; ‘Crowd it out’ means focusing on choosing more healthy foods rather than avoiding unhealthy foods. This way one’s taste buds change toward eating more healthy foods naturally.”⁸

Additional food choice selections

The Harvard Nutrition site has important recommendations regarding sugar reduction which include:

“Choose plain yogurt with no added sugar and stir in fresh or frozen fruit or unsweetened applesauce and a dash of cinnamon.

Choose cereals with 5% of the Daily Value or less of added sugars and add sliced ripe bananas or berries.

Choose water, seltzer, herbal tea, coffee, and other beverages with no added sugar. Add a slice of orange, lemon, lime, or cucumber for a subtle flavor boost.

When a sweet craving hits, try one of these first: 1/4 cup of unsweetened dried fruit; 1 cup of ripe fresh fruit; or a 1-ounce square of 75% dark chocolate.”⁹

The key is to keep it simple. Clinicians can offer a focus group in their office on reducing sugar intake or have an educated staff member hold the group or offer presentations on the topic in the community.

It is important to remember that other complementary therapies in an integrative approach to glucose management have demonstrated that people who regularly practice various mind-body techniques such as yoga and/or meditation may lower their blood sugar over time; acupuncture has been shown to lower glucose levels; exercise is certainly a mainstay for managing glucose levels; and various supplements, and herbs have also shown beneficial effects in glucose management. Of course, when a person starts any of these complementary therapies, they need to be carefully monitored if they are taking medications to control their blood sugar.

Conclusion

Remember that the above tips are not shared all at once with a patient but rather presented as achievable choices for patients that can be suggested a few at a time during visits and then repeated at following visits. A discussion about consumption of added sugars should be a conversation, not a strictly teaching session. Printing a handout for people can be helpful. Clinicians who share their personal tips for cutting back on sugar truly help their patients by example. In fact, research has shown that clinicians who share personal healthy lifestyle behaviors with patients directly influence their patients’ choices.

Gillespie and colleagues concluded that “very little scientific evidence exists that indicates a benefit of added dietary sugars; however, an overwhelming and growing body of evidence highlights the negative effects of excessive or prolonged sugar intake.”¹ The CDC article authors stated, “To live healthier, longer lives, most Americans need to move more and eat better, including consuming fewer added sugars.”²▪

References

1. Gillespie

, Kemps

, White

, et al. The impact of free sugar on human health—A narrative review. Nutrients, 2023; 15:889.

2. Centers for Disease Control and Prevention. Get the Facts: Added Sugars. Online document at www.cdc.gov/nutrition/data-statistics/added-sugars.html Accessed May 13, 2024.

3. American Heart Association. Added Sugars. Online document at www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars Accessed May 13, 2024.

4. National Health Service. Sugar: The Facts. Online document at www.nhs.uk/live-well/eat-well/food-types/how-does-sugar-in-our-diet-affect-ourhealth/#:∼:text=Adults%20should%20have%20no%20more,day%20(5%20sugar%20cubes Accessed May 13, 2024.

5. Scapin

, Fernandes

, Proenca

. Added sugars: Definitions, classifications, metabolism and health implications. Rev Nutri, 2017; 30:663-677.

6. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th edition. December 2020. Online document at www.dietaryguidelines.gov/sites/default/files/202103/Dietary_Guidelines_for_Americans-20202025.pdf#page=56 Accessed May 13, 2024.

7. Harvard Health Publishing. Harvard Medical School. The Sweet Danger of Sugar. Heart Health. Online document at www.health.harvard.edu/heart-health/the-sweet-danger-of-sugar Accessed May 13, 2024.

8. Institute for Integrative Nutrition. Four Simple Ways to Cut the Sugar and Reduce Cravings for Good. Online document at www.integrativenutrition.com/blog/2016/10/4-simple-ways-to-cut-the-sugar-and-reduce-cravings-for-good Accessed May 13, 2024.

9. Harvard TH Chan School of Public Health. Added Sugar. Online document at www.hsph.harvard.edu/nutritionsource/carbohydrates/added-sugar-in-the-diet/ Accessed May 13, 2024.