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The Link Between Added Sugars and Heart Disease

Sweetness in Practice Contributor - Feb 2, 2016
Julie Feb full

As healthcare professionals, we often discuss the role of reducing foods rich in saturated fat and sodium to support heart health. However, we may be overlooking the role that added sugars might play in increasing one’s risk of heart disease. Indeed, according to the United States Department of Agriculture’s (USDA’s) Nutrition Evidence Library there is “moderate” evidence from numerous studies over the past ten to fifteen years that have identified an association between diets rich in added sugars or sugar-sweetened beverages and the onset of hypertension, stroke, higher triglycerides and coronary heart disease (CHD).1

While many Americans claim to understand that reducing added sugars is a necessity, national food consumption data suggests otherwise. The data shows that as a nation, we enjoy around 18 teaspoons of sugar daily, which amounts to about 13 percent of total calories.1 The recently released Scientific Report of the 2015 Dietary Guidelines Advisory Committee (DGAC) names beverages (not including milk or 100% juice) and snacks/sweets as the two categories that are by far the largest food sources of added sugars (47% and 31%, respectively). One of the biggest culprits is sugar-sweetened beverages (i.e., soft drinks, fruit drinks and sport and energy drinks), providing some 39 percent of added sugars in the diet.1

The Not-So-Sweet News about Added Sugar and Heart Health

When it comes to the research on this subject, several studies highlight the association between sugars in the diet and the increase in heart disease risk factors. One recent study published in JAMA: Internal Medicine reported that those who consumed about 17 to 21 percent of calories as added sugar had a 38 percent higher risk of death from cardiovascular disease (CVD), compared to those who consumed approximately 8 percent of their calories from added sugar. Further, those individuals who consumed 21 percent or more of their calories in the form of added sugar doubled the relative risk of death from a cardiovascular-related event. This study also found that the majority of adults (71 percent) consumed more than 10 percent of their daily calories from added sugar.3

According to the authors of the same JAMA paper, “the biological mechanisms underlying the association between added sugar intake in the diet and CVD risk are not completely understood".3 Although evidence is limited, some data suggest increased intake of added sugars may have a role in the development of hypertension, while another study shows increases in triglycerides and lower HDL-cholesterol levels due to consumption of sugar-sweetened beverages.4,5 Another study reported that consumption of sugar-sweetened beverages markedly increased high-sensitivity C-reactive protein, a marker of inflammation.6 While the exact mechanisms may still be unknown, this research shows that it’s prudent advice to recommend limiting added sugars to improve overall health.

According to their 2015 report, the DGAC recommends limiting added sugars to no more than 10 percent of one’s total daily caloric intake.2 The AHA recommends limiting added sugar intake to half of one’s discretionary calories.7 For most women this means no more than 100 calories per day (about 6 teaspoons), and for most men this means no more than 150 calories per day (about 9 teaspoons).2,7 To put this in perspective, just one 12-ounce can of regular cola contains 140 - 150 calories, which contributes nine to ten teaspoons of sugar.

The Sweet News about Sugar Substitutes

According to a 2012 joint position statement released by the American Heart Association and the American Diabetes Association, there are some data to suggest that sugar substitutes can be used to replace added sugars in a structured diet. When sugar substitutes are incorporated into the diet in place of regular sugar, without a compensatory increase in calories from other sources, a modest reduction in calorie intake and weight loss may result.8

While sugar substitutes may offer a practical option for our patients with a sweet tooth, confusion may still exist in regard to best uses for them. To help clients understand how to use, it’s important that they understand the sugar equivalents of Truvía® Natural Sweetener, the zero-calorie, stevia-based natural sweetener. One packet of Truvía® Natural Sweetener has the same sweetness as two teaspoons of sugar without the calories. For cooking and baking, use Truvía® Cane Sugar Blend and Truvía® Brown Sugar Blend, which both bake and brown just like sugar and brown sugar, but with 75% fewer calories than sugar. It’s important to remind patients that, like most foods, even a natural sugar alternative needs to be used in moderation because occasionally, some patients may feel that using a sugar substitute gives them license to eat and drink more, thereby negating many of the benefits these products can provide.

We can’t expect our patients to change their eating habits overnight, but simply raising awareness of the link between added sugars and increased risk of cardiovascular disease is a good start. Work with your clients to identify what they can change in their diets for heart month—and hopefully it’s a heart-healthy habit they can live with for life.

To learn more about how Truvía® sweetener can play a useful role in a healthy balanced diet, click here. »


  1. US Department of Agriculture. Nutrition Evidence Library.gov. What is the relationship between added sugars and risk of cardiovascular disease? (2015 DGAC). Accessed on 19 Jan 2016. Retrieved from http://www.nel.gov/evidence.cfm?evidence_summary_i...

  2. US Department of Health and Human Services: United States Department of Agriculture. Scientific Report of the 2015 Dietary Guidelines Advisory Committee. Part D. Chapter 6: Cross-Cutting Topics of Public Health Importance – Continued. Available at: http://health.gov/dietaryguidelines/2015-scientifi... , Accessed December 22, 2015.

  3. Yang Q, Zhang Z, Gregg EW, Flanders W, Merritt R, Hu FB. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014;174(4):516-524. doi:10.1001/jamainternmed.2013.13563

  4. Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation. 2010;121(11):1356-1364.

  5. de Koning L, Malik VS, Kellogg MD, Rimm EB, Willett WC, Hu FB. Sweetened beverage consumption, incident coronary heart disease, and biomarkers of risk in men. Circulation. 2012;125(14):1735-1741.

  6. Aeberli I, Gerber PA, Hochuli M, et al. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr. 2011;94(2):479-485.

  7. Johnson RK, Appel LJ, Brands M, et al. Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation. 2009;120:1011-20.

  8. Gardner C, Wylie-Rosett J, Gidding SS, et al. On behalf the American Heart Association Nutrition Committee of the Council on Nutrition, Physical Activity and Metabolism, Council on Arteriosclerosis, Thrombosis and Vascular Biology, Council on Cardiovascular Disease in the Young, and the American Diabetes Association. Nonnutritive sweeteners: current use and health perspectives: a scientific statement from the American Heart Association and the American Diabetes Association. Circulation. 2012;126:509–519.