Sugar: How Much Is Too Much?

This is Part 2 in a 4-part series on Sugar and Other Sweeteners.

(1) Sugar Is Toxic: Heart Disease, Cancer & More
(2) Sugar: How Much Is Too Much?
(3) Artificial Sweeteners Make You Fat
(4) Sugar: Physical Addiction or Emotional Craving?

In Part 1 of this series, I described how sugar is implicated in a wide range of illnesses, from heart disease to cancer, as well as causing obesity. Many scientists researching the relationship between sugar and disease have stopped eating sugar as a result of their findings. But is it necessary for health to stop completely?

And is it necessary to eat for health? Sugar does pose a serious threat. But just because a food is unhealthy doesn’t mean you shouldn’t eat it, or that it’s wrong or bad to eat it. What you eat is not a moral issue, there are other considerations besides health, and it’s your life. There’s a big fallacy in the non-diet world that there are “no bad foods” and that is why you can eat all foods. I say something very different: There are bad foods, but you are still entitled to eat whatever you want – just do it with your eyes open. If you deny that some foods are bad for your health, then you can’t take responsibility for your choices.

The purpose of this article is not to tell you what you “should” eat. It’s to give you information that you can use as input for your own decision.

Epidemiological Evidence

As I mentioned in Part 1, one of the diseases that sugar exacerbates, if not causes, is cancer. Researchers believe that as many as 80% of human cancers are driven by elevated insulin levels.

Until the 1700s, sugar was a luxury and very expensive, so only the wealthy ate it, and even they ate it rarely. During the 1700s, sugar started to become popular. The price of sugar initially dropped due to slavery in the Carribbean, and then dropped more during the industrial revolution as sugar production became increasingly mechanized. By the mid-1800s, per capita consumption had skyrocketed in urban areas. Sugar was considered a necessity and a staple of the Western diet.

Something else started happening in urban areas of Europe in the mid-1800s, especially France and England: Cancer rates started rising. The increase was dramatic enough to prompt a survey of cancer rates worldwide to discover the cause. Data from remote locations came from missionaries. If you want to see why they were so upset, take a look at these very graphic photos from the 1800s (don’t look if you’re squeamish – medicine was still quite primitive back then). The researchers discovered that cancer – plus a cluster of other diseases – was extremely rare in isolated populations eating traditional diets. But when these populations started eating a Western diet, all those previously unknown “diseases of civilization” started to emerge: cancer, cardiovascular disease, obesity, dental cavities, periodontal disease, appendicitis, varicose veins, hemorrhoids, and constipation.

It would be instructive to know exactly how much sugar Europeans were eating in the mid-1800s, since it was apparently just past the threshold of what causes disease. In England, it was about 36 pounds per year. Here’s a graph showing sugar prices and consumption in England from 1600-1850.

At this time, sugar consumption in America lagged a little behind Europe at 25-30 pounds per year, and cancer accounted for about 1% of all deaths (PPT). Today, Americans consume more sugar per capita than Europeans – over 100 pounds per year in 2005 – and about 23% of all deaths are due to cancer. (The number often quoted from the USDA [PDF], 142 pounds of sugar in 2005, is unadjusted for cooking losses, plate waste, and other losses. The graph below is adjusted.)

Stephan Guyenet, who compiled these numbers, writes: “It’s a remarkably straight line, increasing steadily from 6.3 pounds per person per year in 1822 to a maximum of 107.7 lb/person/year in 1999. Wrap your brain around this: in 1822, we ate the amount of added sugar in one 12 ounce can of soda every five days, while today we eat that much sugar every seven hours.”

Just based on this epidemiological data, we should be eating under 30 pounds of sugar per year, and that is not very much sugar. There are 1760 calories in a pound of sugar. If you eat 30 pounds in a year, that means 145 calories of added sugar per day – less than the calories in one can of soda.

The American Heart Association Recommendation

In the 1970s, there was a debate over whether heart disease was caused by sugar in the diet or saturated fat, with John Yudkin leading the argument for sugar and Ancel Keys leading the argument for fat. Ancel Keys won on political grounds, but he was wrong. Since then, many scientists have found fault with Keys’ methods, countless studies have confirmed the relationship between heart disease and sugar, and in 2009 the American Heart Association (AHA) issued its first ever guideline for added sugar intake.

It turns out that 145 calories of added sugar per day is remarkably close to the AHA recommendation, though they arrive at the number differently. The AHA recommends a maximum of 150 calories per day in added sugar for men and 100 calories per day for women – half the discretionary calorie allowance, according to 2005 US Dietary Guidelines.

You may be wondering if it’s really necessary to cut back this much. Kimber Stanhope, one of the researchers interviewed in the 60 Minutes story on sugar toxicity, wondered, too. She studies the effect of fructose on triglycerides and LDL cholesterol, two risk factors for cardiovascular disease. In a study published August 17, 2011 in the Journal of Clinical Endocrinology and Metabolism, she tested the new stringent guideline against the Dietary Guidelines for Americans from 2010, which says sugar can safely be a maximum of 25% of energy requirements (calories).

She had 48 test subjects, took baseline blood work, and then for two weeks fed them beverages sweetened with either glucose, fructose, or high fructose corn syrup (HFCS). In just that short amount of time, she saw increased triglycerides and LDL cholesterol in the 25% energy group fed fructose or HFCS, but not glucose. If the person is eating 2000 calories a day, that’s 500 calories of sugar – about 2.5 cans of soda per day. When Sanjay Gupta of 60 Minutes asked Stanhope if the results surprised her, she said, “I would have to say I was surprised because when I saw our data, I started drinking and eating a whole lot less sugar. I would say our data surprised me.”

Guidelines for Staying Healthy

Figuring out how to follow the AHA recommendation is tricky. Added sugar is in almost every processed and prepared food – not just sweet beverages and desserts. In 1972, when John Yudkin wrote Sweet and Dangerous, the proportion of sugar eaten in the US that came from manufactured foods was “more than 70%”, up from 50% in 1957. I don’t know how he found this number, but it’s probably even higher now. Sugar is in mayonnaise, peanut butter, and bread. Virtually all canned, frozen, packaged, processed, and convenience foods contains sugar. If you eat a lot of these foods, even without sweetened beverages, juice, or sweets, you probably eat significant sugar.

Compounding the calculation difficulty is this: You only need to avoid added sugars – natural sugars are not a problem – but US food labels don’t distinguish between natural sugars and added sugars. So counting your 100 or 150 calories of daily added sugar is virtually impossible, even if you read every label. A more practical approach is to follow some guidelines:

• Drink water, seltzer, or unsweetened herbal tea if you’re thirsty. Avoid soda, juice, and sports drinks. Also remember that alcohol is sugar. Sugar in liquid form is most harmful because it hits the liver quickest.
• Read the label of every packaged food you buy, and avoid brands with added sugar. You can find peanut butter without added sugar if you look.
• Eat less processed and convenience foods – cook at home more. For example, virtually all store-bought mayonnaise and bread contain sugar, but these are easy to make at home, and taste better, too.
• Think of dessert as something you eat once in a while rather than every day. How often? This is probably not the only added sugar you’re eating, so overestimate the sugar calories by assuming that all the carbohydrate calories are from sugar. If you’re a woman and the dessert contains 300 calories from carbohydrates, figure you’re eating three days worth of sugar.
• Don’t use artificial sweeteners. They cause obesity in a different way, as you’ll see in Part 3 of this series.

If you’re reading this and thinking “No way!”, here are some thoughts for you:

• If you’re currently eating sugar once a day or more, you may be physically addicted. Once the physical addiction is broken, it won’t seem so impossible to cut down. I’ll address this in Part 4.
• Don’t let the perfect be the enemy of the good. If you’re eating less sugar than you were, you are still better off.
• It’s not like you can never taste sweetness again. Fruit is delicious!
• It’s your right to continue eating sugar as you have been, but doing so should mean you accept the risks to health and weight, not that you are denying these risks.

Not every food decision is made on the basis of health and what will extend life – or should be. Not every life decision is made on the basis of what will extend life. Quality of life matters, too. If all we cared about was living as long as possible, we’d live in a sterile bubble and never get in a car or do anything. People take risks to make life worth living.

You may decide that eating some amount of sugar is worth the risk. Or you may decide it’s not worth the risk. Either way, these are the facts. The decision is up to you.

Thoughts? Comments? I’d love to hear them.