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ACSM'S Health & Fitness Journal:
doi: 10.1249/FIT.0b013e3181cff270
DEPARTMENTS: You Asked For It: Question Authority

You Asked For It: Question Authority

Nieman, David C. Dr.P.H., FACSM

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David C. Nieman, Dr.P.H., FACSM, is professor and director of the Human Performance Laboratory, Appalachian State University, in Boone, North Carolina, an active researcher, and author of several textbooks on health and fitness. Email your questions to niemandc@appstate.edu.

Q: Should I eliminate sugar from my diet? I drink a sports drink bottle after each workout. I have read that sugar causes obesity, diabetes, heart disease, mental depression, misbehavior in children, cancer, and immune suppression.

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A: More nonsense has been written about sugar than any other diet component. No, you should not eliminate sugar from your diet. Sugar is not a poison and causes none of the diseases or health problems you listed. The issue is not elimination of sugar but moderation.

Yes, most Americans consume far too much sugar. But the only major health concerns with sugar are tooth decay and increased risk of weight gain (5,9). Both sugars and starches can promote tooth decay. The more often foods containing sugars and starches are eaten, and the longer these foods are in the mouth before the teeth are brushed, the greater the risk for tooth decay.

High sugar intake does increase the likelihood of weight gain but only because high-sugar foods make it easy to overeat, not because sugar causes hormonal imbalances favoring fat storage (a myth supported by several popular weight loss plans). People who drink regular soft drinks tend to consume more calories than they need and do not compensate by reducing food intake (9). The net result is weight gain (5,6). When people reduce intake of sugar-sweetened beverages, they tend to lose weight (4).

Despite widespread concerns, intake of sugar does not directly cause heart disease, cancer, diabetes, or abnormal behavior (5,9). Some parents are convinced that sugar affects the behavior of their children, but there is no good scientific support that sugar causes hyperactivity, impairment in mental function, or abnormal behavior (3).

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Sugars occur naturally in many foods, including milk, fruits, some vegetables, cereals, and grains. These foods also supply many other important nutrients. On the other hand, so-called added sugars - syrups and sugars added during processing or at the table - supply calories but few nutrients. So it is a good idea to moderate intake of added sugars or "empty calories" to improve your chances of maintaining a healthy body weight and consuming all the vitamins, minerals, and other nutrients needed for good health. Food labels contain information on total sugars per serving but do not distinguish between natural sugars and added sugars. Thus, it is difficult to determine the amount of added sugars in foods and beverages.

Foods rich in added sugars include soft drinks and desserts. Carbonated drinks are the single biggest source of added sugars in the American diet (about 8 to 10 teaspoons per can), supplying 38% of all added sugar ingested (Figure 1) (5,7). Carbonated soft drink consumption has been soaring and now accounts for more than one fourth of Americans' beverage consumption.

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Figure 1
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Sugar is hidden in many other foods (7). One cup of yogurt, for example, has seven teaspoons of sugar, one cup of canned corn has three, and one tablespoon of ketchup has one. Desserts often have more sugar than expected: a glazed donut has six teaspoons of sugar, one chocolate eclair or a piece of angel food cake each has seven, two ounces of chocolate candy has eight, a piece of iced chocolate cake or berry pie each has 10, and four ounces of hard candy has 20.

To locate hidden sugars, check the list of ingredients on the food label: sugars are listed by many different names, including brown sugar, corn sweetener, corn syrup, fructose, fruit juice concentrate, glucose or dextrose, high-fructose corn syrup, honey, lactose, maltose, molasses, raw sugar, table sugar or sucrose, and syrup. If one of these appears near the top of the list, the food is probably high in added sugars.

The average American male and female ingest far too much sugar, about 25 and 18 teaspoons of added sugar on average each day, respectively (Figure 2) (5). Added sugars represent about 350 calories in the average American's diet. The U.S. Department of Agriculture recommends about half this level, but guidelines vary according to calories ingested (about 8 teaspoons of added sugar per day if eating a 2,000-calorie diet, and up to 18 teaspoons if calories are 3,000 per day) (8). Sugar substitutes such as sorbitol, saccharin (e.g., Sweet 'N Low), aspartame (e.g., Equal), sucralose (e.g., Splenda), acesulfame-k (e.g., Sunett), and stevia-derived sweeteners (e.g., PureVia) are ingredients in many foods and have been shown to be safe by many different research teams and professional organizations (2). Most of the sugar substitutes do not provide significant calories and can be useful if one is trying to lose weight. Foods containing sugar substitutes, however, may not always be lower in calories than similar products that contain sugars. Thus, the food label should be carefully reviewed.

Figure 2
Figure 2
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For very physically active people, sugars in sport beverages can be an additional source of energy. For most fitness enthusiasts, however, sports drinks are not needed and negate the benefit of burning calories during the exercise bout. The American College of Sports Medicine recommends that sugar-based sports beverages are useful for maintaining blood sugar levels and performance when high-intensity exercise persists for one hour or longer (1). Most sports drinks contain about 240 calories of sugar for each liter (or 15 teaspoons). This amount of sugar is useful for the long-endurance athlete, not the 30-minute per day jogger.

In brief, because maintaining a nutritious diet and a healthy body weight is very important, sugars should be used in moderation by most people and sparingly by people with low calorie needs. Unless your workout is intense and longer than one hour, I recommend that you drink water instead of a sugar-sweetened beverage. This practice will help ensure that you gain maximal benefits from your exercise routine.

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References

1. American College of Sports Medicine, Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS. American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc. 2007;39:377-90.

2. American Dietetic Association. Position of the American Dietetic Association: use of nutritive and nonnutritive sweeteners. J Am Diet Assoc. 2004;104(2):255-75.

3. Benton D. Sucrose and behavioral problems. Crit Rev Food Sci Nutr. 2008;48(5):385-401.

4. Chen L, Appel LJ, Loria C, et al. Reduction in consumption of sugar-sweetened beverages is associated with weight loss: the PREMIER trial. Am J Clin Nutr. 2009;89(5):1299-306.

5. Johnson RK, Appel LJ, Brands M, et al. American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity, and Metabolism and the Council on Epidemiology and Prevention. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120(11):1011-20.

6. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review. Am J Clin Nutr. 2006;84(2):274-88.

7. Nutrient Data Laboratory, Beltsville Human Nutrition Research Center, Agricultural Research Service, U.S. Department of Agriculture [Internet]. USDA database for the added sugars content of selected foods. February 2006; [cited 2009 Sept 26]. Available from: http://www.nal.usda.gov/fnic/foodcomp/Data/add_sug/pdf.

8. U.S. Department of Health and Human Services and U.S. Department of Agriculture. Dietary Guidelines for Americans. 6th ed. Washington (DC): U.S. Government Printing Office; 2005.

9. Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. Am J Public Health. 2007;97:667-75.

© 2010 American College of Sports Medicine

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