America's sweet tooth obsession and its impact on our health

High Fructose Corn Syrup (HFCS) sure gets a bad rap in the media these days, and perhaps for good reasons from a health perspective. Due to its easy availability and low cost, it has found its way into all kinds of foods, even foods one wouldn’t suspect. But it’s not just HFCS that we should be limiting. It is all sugar consumption! While small amounts of sugar may not be harmful to our health, the compounding affect of excessive added sugar consumption daily poses risks to our health. Throughout the course of any day, Americans are consuming almost 100 grams of added sugar per day.(1)

"Added sugar” refers to the sugar that is added during processing. It does not include natural sugars from products such as fruit and dairy products. Even though the FDA does not require that manufacturers identify how much of the sugar content is added versus natural, the vast majority of processed foods and drinks have sugars that have been added. Today, one must become a “label detective” to even recognize the various aliases of sugar. Other names found on labels describing sugar are: organic sugar, raw sugar, honey, brown sugar, molasses, agave syrup, fruit juice concentrates, evaporated cane juice, xylose, maltose, barley malt and maple syrup to name a few. HFCS is 55% fructose and 45% glucose, while table sugar or sucrose is 50% fructose and 50% glucose. So as you can see there is very little difference in the composition, and likewise, very little difference in how the body metabolizes sucrose (or it’s aliases) and HFCS.

Due to the concern over the worldwide health issues related to overconsumption of sugar and its impact on cardiovascular disease (CVD), the American Heart Association (AHA) published a strong statement in its 2009 publication, Circulation, that made recommendations for Americans to slash sugar consumption.(1) The recommendations are based upon age, sex, and physical activity. But for average American men, recommendations are to limit sugar to 38 grams (9 tsp) per day, and for women, 25 grams (6 tsp) per day.

How hard is that? Well, consider these facts: flavored yogurts have 25-35 grams of added sugar. Most 12-ounce sodas, energy and sports drinks have 30-40 grams of added sugar per serving with 20-ounce drinks around 65 grams, and popular breakfast cereals contain 10-20 grams of added sugar per serving. Even bran muffins typically range between 18-24 grams per serving of sugar. See the problem?

Complying with the AHA recommendations will require significant changes in eating and drinking patterns. Begin to ask your patients about their sugar consumption. Think of how many are consuming 1-2 sugary drinks daily, in addition to other dietary exposures to sugars. The problem is prevalent.

In fact, in a 2006 study published by the Journal of the American Dietetic Association researchers analyzed the habits of middle school students in Massachusetts and discovered that sugar-sweetened drinks made up 71% of vending purchases, and were selected three (3) times more often by students than bottled water. This study can be considered representative of most student campuses across the country today.

Discernment of the real facts are challenging regarding the impact of added sugar, and specifically, excess consumption of fructose on overall health. Clearly, more double blind, placebo-controlled studies are warranted; however most of the data to date is unfavorable regarding the impact excess sugar has on systemic health. Proponents of added sugar to processed foods point to animal studies that vilify sugar and remind us that not all data on animal studies translates the same with humans.(2) On the other side, those that hold the opinion that added sugar is virtually a poison to our health(3) remind us that human studies repeatedly have shown a correlation to elevated blood pressure, and triglyceride levels when sugar is consumed in excess(4), which increases the risk for CVD; hence the reason for the American Heart Association’s recommendation to slash sugar. Corresponding with the steady increase in sugar consumption in this country over the past 40 years is a steady increase in the prevalence of obesity and Type II diabetes. Given that these conditions also elevate the risk for heart disease, becoming a label detective and deliberately reducing sugar consumption seems more like a necessity than a choice for most Americans.

It goes without saying that dental professionals regularly see the visible impact excess sugar consumption has in the oral cavity. Much of that impact comes from sugar-sweetened drinks that also contain citric and/or phosphoric acid, which can lead to a favorable demineralization and caries environment.

In data that analyzed the beverage habits of almost 6,000 children, it was reported that carbonated soft drinks comprised 8.5% of total fluid intake for 2 to 10-year-olds, and they showed a significantly higher caries and decay pattern compared to children of the same age consuming high patterns of fruit juice.(5) Unfortunately, many young children who acquire a taste for sugary drinks carry that preference into adulthood.

Educating patients (and parents) about the AHA guidelines for limiting daily sugar consumption is certainly a good place to start for reducing caries and decay risks, and who knows, might even help save a heart in the process!

References 1. Johnson RK, Appel LF, Brands M, Howard BV, Lefevre M, Lustig RH, Sacks F, Steffen LJ, Wylie-Rosett J. Dietary sugars intake and cardiovascular health: A scientific statement from the AHA. Circulation 2009; 120: 1011-1020. 2. White JS. Straight talk about high-fructose corn syrup: what it is and what it ain’t. Am J Clin Nutr 2008: 88 (suppl): 1716S-21S. 3. Lustig RH. The skinny on obesity. Available at http://www.uctv.tv/skinny-on-obesity. Accessed September 10, 2012. 4. Brown IJ, Stamler J, Van Horn L, Robertson, CE, Chan Q, Dyer AR, Huang C, Rodriquez BL, Zhao L, Daviglus ML, Ueshima H, Elliot P. Sugar-sweetened beverages, sugar intake of individuals, and their blood pressure. Hypertension 2011; 57:695-701. 5. Sohn W, Burt BA, Sowers MR. Carbonated soft drinks and dental caries in the primary dentition. J Dent Res 2006; 85:262-267.

Karen Davis speaks internationally, is an accomplished author, and has been recognized as a “Top Clinician in Continuing Education” in Dentistry Today. She can be reached at [email protected].