“Sugar is poison”. Can one molecule really cause all the issues it is claimed to? We break down an analysis that shows that limiting sugar intake too much actually increases the risk of heart disease.

Sugar comes in many forms, with many different types of sugar molecules. We cover these in our book Diet Like a Doctor, but the classical table sugar is called “sucrose”. Sucrose the result of combining two smaller sugar molecules called “glucose” and “fructose”.

Most studies preaching the danger of sugar base the argument using sucrose-sweetened beverages. We know, however, that HOW your consume sugar matters. Drinking sucrose solution doesn’t necessarily have to have the the same consequences as eating sucrose in a cake. There are surprisingly few studies looking at the effects of FOODS high in sucrose; sweets, chocolates, jam, cakes, pastries.

Comparing High, Medium and Low Sugar Consumers

In this study, sucrose consumption (measured as percentage of energy from sucrose, E%) of 26 190 Swedish individuals was estimated using a 7-day food diary, interviews and questionnaires. Three groups were created: high (>15 E%), medium (7.5-10E%), and low consumers (<5E%). Risk of life-threatening heart disease in these groups was then evaluated (follow-up time: 17 years).

Individuals with higher sucrose consumption had lower educational levels, smoked more, drank less and ate less wholegrains, meat and fish. HOWEVER, individuals with moderate sucrose consumption ate the most fruits and vegetables, drank the most milk, but also exercised the least.

High Consumers Had a 37% Increased Risk

After adjusting for group differences (including total energy intake), the study found that high sucrose consumers have 37% increased risk of life-threatening heart disease compared to low consumers. This is what we already know and keep hearing. There was no single food explaining this risk. Rather the authors suggest increases in blood fats, blood pressure, or inflammation caused by sugar intake to be possible mechanisms. Remember that is a relative risk, and not an absolute risk (see article on relative vs absolute risk). The next part is what is interesting.

Low Consumers Also Had an Increased Risk

However, there was a NON-LINEAR relationship between the amount sucrose consumed and the risk of death. This means that less sucrose isn’t better. The group with low sucrose consumption had a HIGHER risk of death compared to group with medium sucrose consumption. In fact, there was no benefit of eating less than 8.2E% sugar. This could be because neurotically limiting sugar intake may mean limiting healthy sources of sugar including fruits and certain vegetables, or be associated with other behavior that increases risk of heart disease.

it is important to note that the results from one study like this aren’t generalizable, but give us an interesting piece to the puzzle. The population was aged 44 to 73 years, and data was collected between 1991 and 1996. The study also couldn’t differentiate between added sugar and naturally occurring sugar when measuring sucrose.

Summary

All in all, sugar in itself shouldn’t be feared as much as it is today. Even though we do need to reduce sugar intake, this should mainly mean limiting ADDED sugars. Sugar is no poison, and this study shows that the dose makes the poison. The World Health Organization and Nordic Nutrition Recommendations both state that <10E% can come from added sugars. If you want to protect your teeth, there is limited evidence that you can strive for <5E%, but by no means do you need to eliminate sugars from your diet. Moderation and focusing on the bigger picture is what will get you losing fat most effectively.

References (DOI):

  1. 1017/S0007114516003561
  2. World Health Organization (2015) Guideline: Sugar Intake for Adults and Children.
  3. Nordic Council of Ministers (2014) Nordic Nutrition Recommendations 2012, 5th ed.

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