The Bitter Truth About Sugar

By C. Nathan Okechukwu, M.D., Chairman, Department of Medicine


In 2012, amid cries of “fascism” and “nanny state,” then mayor of  New York City, Michael Bloomberg, pushed for and got the health board to approve a ban on giant servings of sugary beverages in the city’s food service establishments. While that ban was later overruled, we have seen an increase in public awareness of the harmful effects of excessive sugar intake on health, particularly in its capacity to promote obesity.

We have also seen peer-reviewed research aimed at shedding light on the harmful health effects of sugar over-consumption in the American public. Thus far these concerns have, as in the New York City ban, largely been focused on obesity as the primary health concern. Therefore, the link between excessive sugar consumption to increased cardiovascular risk has usually been seen as secondary to the obesity caused by overly exuberant sugar intake.

file2951265750491However, in the April 2014 publication of the Journal of the American Medical Association (JAMA), Yang Quanhe and colleagues showed in their analysis, that the risk of cardiovascular disease (CVD) mortality becomes elevated once added sugar intake exceeds 15% of daily calories1. In a daily diet of 2000 calories, this would be the equivalent of drinking two 12-ounce cans of Pepsi. This risk was independent of other lifestyle factors (e.g., smoking and alcohol consumption, lipid problems, hypertension and obesity) and continued to rise greatly, reaching a staggering 400% risk of death from CVD when sugar intake reached and/or exceeded a third of daily calories.

Unlike sodium and trans-fats, the U.S. government does not provide any dietary limitation to the public regarding daily consumption of added sugar. However, the Institute of Medicine recommends that added sugar should make up no more than 25% of daily calories. Additionally, the American Heart Association recommends that daily sugar intake should be no more than 5.0% and 7.5% of a daily diet of 2000 calories for women and men, respectively.

Finally, the World Health Organization (WHO) in its new draft guideline3 recommends that free sugars should make up less than 10% of total energy intake per day.

For the American consumer, sugar-sweetened beverages, such as soda, energy drinks and some fruit juices, are the principal source of added sugar. These beverages account for just over 37% of all sugar consumed nationally.2   

ckhs-stock-images-177Although the public outcry directed towards the New York initiative might be understandable, based on the data from Yang and colleagues one can begin to see why there could be the need for public health officials to create guidelines and help shape policy that educates physicians and their patients, helping them to make good choices about daily sugar consumption.

In summary, the study by Yang et al raises the strong likelihood that, beyond its role in promoting obesity, added sugar is an independent risk factor for CVD mortality.

Talk with your healthcare provider today if you have questions about your individual dietary needs.


  1. Yang Quanhe et al. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults, JAMA Intern Med. 2014;174(4):516-524.
  2. Schmidt LA. New Unsweetened Truths About Sugar 1Philip R. Lee Institute for Health Policy Studies, Clinical and Translational Sciences Institute, and Department of Anthropology, History and Social Medicine, School of Medicine, University of California at San Francisco .  JAMA Intern Med. 2014;174(4):525-526. doi:10.1001/jamainternmed.2013.12991

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