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01 - Introduction
Definition of sugar and its types
Sugar is a type of carbohydrate that is naturally present in many foods, including fruits, vegetables, and dairy products. It is also added to many processed foods and beverages to enhance their flavor, texture, and shelf life.
There are several types of sugar, including:
Glucose: a simple sugar that is the primary source of energy for the body's cells and is produced through the breakdown of carbohydrates.
Fructose: a simple sugar that is naturally present in fruits and some vegetables, and is often added to processed foods as high-fructose corn syrup.
Sucrose: a type of sugar that is commonly known as table sugar and is made up of glucose and fructose molecules. It is commonly used as a sweetener in food and drinks.
Lactose: a type of sugar that is naturally present in milk and dairy products.
Maltose: a type of sugar that is formed by the breakdown of starches and is often used in the production of beer and other alcoholic beverages.
Galactose: a type of sugar that is found in small amounts in milk and dairy products.
Importance of sugar in our diet
Sugar plays an important role in our diet as it is a source of energy for our body. Carbohydrates, including sugars, are broken down into glucose which is then used by our cells as a primary source of energy. This energy is essential for our body to function properly and carry out daily activities.
Additionally, sugars can provide a quick source of energy, especially during physical activity. This is because glucose can be quickly absorbed into the bloodstream and transported to the cells that need it.
Moreover, sugar can also enhance the taste and flavor of many foods and beverages, making them more enjoyable to eat. This can encourage people to consume a more varied and nutrient-dense diet, as they are more likely to enjoy healthy foods if they taste good.
It is important to consume sugar in moderation, as excessive intake can lead to various health problems such as obesity, type 2 diabetes, and heart disease. It is recommended to limit added sugars in the diet and focus on consuming natural sources of sugars found in fruits, vegetables, and dairy products.
Recommended daily intake of sugar
The recommended daily intake of sugar varies depending on age, sex, and activity level. The World Health Organization (WHO) recommends that adults and children should limit their intake of added sugars to less than 10% of their total daily energy intake. Ideally, it is recommended to reduce this to less than 5% for additional health benefits.
For adults, this translates to no more than 50 grams (or 12 teaspoons) of added sugar per day, based on a daily energy intake of 2000 calories. However, it is important to note that this recommendation does not include the natural sugars found in fruits, vegetables, and dairy products.
For children, the recommended intake of added sugars varies based on age and energy needs. The American Heart Association (AHA) recommends that children aged 2-18 years should consume less than 25 grams (or 6 teaspoons) of added sugar per day.
It is important to note that many processed foods and beverages contain added sugars, including soft drinks, candy, baked goods, and sweetened dairy products. Therefore, it is essential to read food labels and be mindful of the sugar content in the foods and beverages we consume to stay within the recommended daily limits.
Overview of the risks of consuming too much sugar
Consuming too much sugar can have various negative effects on our health. Here are some of the main risks associated with excessive sugar intake:
Obesity: High sugar intake is linked to an increased risk of obesity. Sugary foods and drinks are often high in calories but low in nutrients, which can lead to weight gain and obesity over time.
Type 2 diabetes: Consuming too much sugar can lead to insulin resistance, a condition in which the body is unable to use insulin effectively. This can result in high blood sugar levels and increase the risk of developing type 2 diabetes.
Cardiovascular disease: A high sugar diet can increase the risk of heart disease and stroke. Excessive sugar consumption can raise blood pressure and triglyceride levels, leading to inflammation and damage to blood vessels.
Tooth decay: Sugary foods and drinks can cause tooth decay, especially if consumed frequently or over a prolonged period of time. Bacteria in the mouth feed on sugar and produce acid, which can erode tooth enamel and lead to cavities.
Non-alcoholic fatty liver disease (NAFLD): High sugar intake can contribute to the development of NAFLD, a condition in which excess fat accumulates in the liver. This can lead to inflammation and liver damage over time.
Increased risk of cancer: Some studies have suggested that a high sugar diet may increase the risk of certain types of cancer, including breast, colon, and pancreatic cancer.
Overall, consuming too much sugar can have a negative impact on our health and increase the risk of various health problems. It is important to consume sugar in moderation and focus on natural sources of sugars found in fruits, vegetables, and dairy products.
References
World Health Organization. Guideline: Sugars intake for adults and children. Available at: https://www.who.int/publications/i/item/9789241549028
American Heart Association. Sugars and added sugars. Available at: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugars-and-added-sugars
Malik VS, Hu FB. Sugar-sweetened beverages and cardiometabolic health: an update of the evidence. Nutrients. 2019;11(8):1840.
Bray GA. Soft drink consumption and obesity: it is all about fructose. Curr Opin Lipidol. 2010;21(1):51-7.
Yang Q, Zhang Z, Gregg EW, et al. Added sugar intake and cardiovascular diseases mortality among US adults. JAMA Intern Med. 2014;174(4):516-24.
Schwingshackl L, Hoffmann G. Adherence to Mediterranean diet and risk of cancer: a systematic review and meta-analysis of observational studies. Int J Cancer. 2014;135(8):1884-97.
Drouin-Chartier JP, Brassard D, Tessier-Grenier M, et al. Systematic review of the association between dairy product consumption and risk of cardiovascular-related clinical outcomes. Adv Nutr. 2016;7(6):1026-40.
Centers for Disease Control and Prevention. Tooth decay (cavities). Available at: https://www.cdc.gov/oralhealth/conditions/index.html
Mayo Clinic. Nonalcoholic fatty liver disease. Available at: https://www.mayoclinic.org/diseases-conditions/nonalcoholic-fatty-liver-disease/symptoms-causes/syc-20354567
02 - Increased Risk of Obesity
How sugar contributes to weight gain
Consuming sugar can contribute to weight gain in several ways:
High in calories: Sugar is a source of empty calories, meaning that it provides energy (calories) but no nutritional value. High-sugar foods and drinks tend to be high in calories but low in nutrients, which can contribute to weight gain if consumed in excess.
Increases appetite: Consuming sugar can increase appetite and lead to overeating. Sugar triggers the release of dopamine in the brain, which can create a sense of pleasure and reward. However, this can also lead to cravings for more sugar and a desire to continue consuming high-calorie foods.
Affects metabolism: Consuming too much sugar can disrupt metabolism, which can contribute to weight gain. A high-sugar diet can lead to insulin resistance, a condition in which the body is unable to use insulin effectively. This can result in high blood sugar levels and an increased risk of developing type 2 diabetes.
Increases fat storage: Consuming sugar can increase the storage of fat in the body, particularly in the abdominal region. Excess sugar is converted into triglycerides, which are stored in fat cells for later use. However, if these cells become full, the excess fat is stored in other parts of the body and can lead to weight gain.
Affects hormone levels: Consuming sugar can affect hormone levels in the body, including insulin and leptin, which can contribute to weight gain. Insulin regulates blood sugar levels and can promote the storage of fat. Leptin is a hormone that regulates appetite and metabolism, and high sugar intake can reduce its effectiveness, leading to overeating and weight gain.
Consuming too much sugar can contribute to weight gain through several mechanisms. It is important to consume sugar in moderation and focus on natural sources of sugars found in fruits, vegetables, and dairy products. Additionally, consuming a balanced diet and engaging in regular physical activity can help maintain a healthy weight and reduce the risk of weight-related health problems.
The link between sugar and body fat
There is a clear link between sugar consumption and body fat. When we consume sugar, our bodies break it down into glucose, which is then used for energy. However, if we consume more sugar than our bodies need, the excess glucose is converted into fat and stored in fat cells.
There are several ways in which sugar consumption can lead to the accumulation of body fat:
High in calories: Sugar is a source of empty calories, meaning that it provides energy (calories) but no nutritional value. Foods and drinks that are high in sugar tend to be high in calories, which can contribute to weight gain if consumed in excess. Excess calories are stored in the body as fat.
Increases appetite: Consuming sugar can increase appetite and lead to overeating. Sugar triggers the release of dopamine in the brain, which can create a sense of pleasure and reward. However, this can also lead to cravings for more sugar and a desire to continue consuming high-calorie foods. This can result in consuming more calories than the body needs, leading to fat accumulation.
Affects metabolism: Consuming too much sugar can disrupt metabolism, which can contribute to weight gain. A high-sugar diet can lead to insulin resistance, a condition in which the body is unable to use insulin effectively. This can result in high blood sugar levels and an increased risk of developing type 2 diabetes. Insulin also promotes fat storage, so when the body is resistant to insulin, more glucose is stored as fat.
Affects hormone levels: Consuming sugar can affect hormone levels in the body, including insulin and leptin, which can contribute to weight gain. Insulin regulates blood sugar levels and can promote the storage of fat. Leptin is a hormone that regulates appetite and metabolism, and high sugar intake can reduce its effectiveness, leading to overeating and weight gain.
Consuming too much sugar can lead to the accumulation of body fat through several mechanisms. It is important to consume sugar in moderation and focus on natural sources of sugars found in fruits, vegetables, and dairy products. Additionally, consuming a balanced diet and engaging in regular physical activity can help maintain a healthy weight and reduce the risk of weight-related health problems.
The role of high sugar intake in the obesity epidemic
High sugar intake has been identified as one of the contributing factors to the obesity epidemic. The following are some of the ways in which high sugar intake can contribute to obesity:
High in calories: Sugary foods and drinks are often high in calories but low in nutrients, which can contribute to weight gain if consumed in excess. Consuming more calories than the body needs can lead to weight gain and eventually obesity.
Increases appetite: Consuming sugar can increase appetite and lead to overeating. Sugar triggers the release of dopamine in the brain, which can create a sense of pleasure and reward. However, this can also lead to cravings for more sugar and a desire to continue consuming high-calorie foods. This can result in consuming more calories than the body needs, leading to weight gain and eventually obesity.
Disrupts metabolism: Consuming too much sugar can disrupt metabolism, which can contribute to weight gain and obesity. A high-sugar diet can lead to insulin resistance, a condition in which the body is unable to use insulin effectively. This can result in high blood sugar levels and an increased risk of developing type 2 diabetes. Insulin also promotes fat storage, so when the body is resistant to insulin, more glucose is stored as fat.
Contributes to fat storage: Consuming sugar can increase the storage of fat in the body, particularly in the abdominal region. Excess sugar is converted into triglycerides, which are stored in fat cells for later use. However, if these cells become full, the excess fat is stored in other parts of the body and can lead to weight gain and eventually obesity.
Contributes to the development of metabolic syndrome: Metabolic syndrome is a cluster of conditions that increase the risk of developing heart disease, stroke, and type 2 diabetes. High sugar intake has been linked to the development of metabolic syndrome, which can lead to obesity.
High sugar intake can contribute to the obesity epidemic through several mechanisms. It is important to consume sugar in moderation and focus on natural sources of sugars found in fruits, vegetables, and dairy products. Additionally, consuming a balanced diet and engaging in regular physical activity can help maintain a healthy weight and reduce the risk of weight-related health problems.
Examples of high-sugar foods and beverages that contribute to obesity
There are many high-sugar foods and beverages that can contribute to obesity if consumed in excess. Here are some examples:
Soft drinks: Soft drinks, including regular soda, energy drinks, and sports drinks, are some of the most significant sources of added sugar in the diet. A single 12-ounce can of regular soda can contain up to 10 teaspoons of sugar.
Candy: Candy, including chocolate bars, gummy candies, and hard candies, is also high in sugar and calories. A small bag of candy can contain several teaspoons of sugar.
Baked goods: Baked goods, including cakes, cookies, and pastries, are often high in sugar and calories. They also tend to be high in fat, which can contribute to weight gain if consumed in excess.
Fruit juice: Fruit juice, including 100% fruit juice, can be high in sugar and calories. Even though it comes from natural sources, fruit juice lacks the fiber found in whole fruits, which can help regulate blood sugar levels and promote feelings of fullness.
Sweetened breakfast cereals: Many breakfast cereals are high in added sugar, even those that are marketed as "healthy." A single serving of some cereals can contain up to 12 teaspoons of sugar.
Sauces and condiments: Many sauces and condiments, including ketchup, barbecue sauce, and salad dressings, are high in added sugar. Consuming these in excess can contribute to weight gain.
Ice cream and frozen desserts: Ice cream and other frozen desserts are high in sugar and calories. They also tend to be high in fat, which can contribute to weight gain if consumed in excess.
Consuming too many high-sugar foods and beverages can contribute to obesity if consumed in excess. It is important to consume these foods in moderation and focus on natural sources of sugars found in fruits, vegetables, and dairy products.
References
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., & Hu, F. B. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 121(11), 1356-1364.
Hu, F. B. (2013). Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity reviews, 14(8), 606-619.
Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H., ... & Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(11), 1011-1020.
Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. The American journal of clinical nutrition, 98(1), 234-242.
Welsh, J. A., Sharma, A. J., Grellinger, L., & Vos, M. B. (2011). Consumption of added sugars is decreasing in the United States. The American journal of clinical nutrition, 94(3), 726-734.
Lustig, R. H. (2010). Fructose: metabolic, hedonic, and societal parallels with ethanol. Journal of the American Dietetic Association, 110(9), 1307-1321.
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., Willett, W. C., & Hu, F. B. (2010). Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes care, 33(11), 2477-2483.
Sievenpiper, J. L., de Souza, R. J., Mirrahimi, A., Yu, M. E., Carleton, A. J., Beyene, J., ... & Jenkins, D. J. (2012). Effect of fructose on body weight in controlled feeding trials: a systematic review and meta-analysis. Annals of internal medicine, 156(4), 291-304.
World Health Organization. (2015). Guideline: sugars intake for adults and children. World Health Organization.
Vos, M. B., Kaar, J. L., Welsh, J. A., Van Horn, L. V., Feig, D. I., Anderson, C. A., ... & Johnson, R. K. (2017). Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation, 135(19), e1017-e1034.
03 - Type 2 Diabetes
How excess sugar consumption affects blood sugar levels
When we consume foods or drinks that contain sugar, our bodies break down the carbohydrates into glucose (sugar), which is then absorbed into the bloodstream. The pancreas then releases insulin, a hormone that helps regulate blood sugar levels by allowing cells to use the glucose for energy or storing it in the liver and muscles for later use.
However, consuming excessive amounts of sugar can overwhelm the body's ability to produce enough insulin to regulate blood sugar levels properly. This can lead to a condition called hyperglycemia, where there is too much glucose in the bloodstream. Over time, this can increase the risk of developing type 2 diabetes, a chronic condition where the body becomes resistant to insulin, and blood sugar levels remain elevated.
Furthermore, consuming foods with high glycemic index values, which are foods that cause a rapid spike in blood sugar levels, can lead to a cycle of overeating and cravings for more sugar. This can lead to weight gain and obesity, which can increase the risk of developing various health problems, including heart disease, stroke, and certain types of cancer.
Excess sugar consumption can cause spikes in blood sugar levels, which can lead to a range of health problems, including type 2 diabetes, weight gain, and obesity.
The link between sugar intake and insulin resistance
Insulin resistance is a condition where the body's cells become less responsive to the effects of insulin, leading to higher levels of insulin in the blood. This can occur when the body is exposed to high levels of insulin over an extended period, such as with excessive sugar consumption.
When we eat sugar, it causes a rapid increase in blood glucose levels, which triggers the release of insulin. Over time, consuming too much sugar can cause the body to produce too much insulin, which can lead to insulin resistance.
Excessive sugar consumption can also lead to inflammation in the body, which can contribute to insulin resistance. When there is inflammation, the body's cells become less responsive to insulin, making it harder for glucose to enter the cells and causing higher levels of glucose in the bloodstream.
Insulin resistance can increase the risk of developing type 2 diabetes, as well as other health problems, such as heart disease, high blood pressure, and certain cancers.
Excessive sugar consumption can lead to insulin resistance, which can increase the risk of developing various health problems, including type 2 diabetes and heart disease. By reducing sugar intake and maintaining a healthy diet and lifestyle, it is possible to reduce the risk of developing insulin resistance and related health problems.
The relationship between sugar and the development of type 2 diabetes
There is a clear relationship between sugar intake and the development of type 2 diabetes. Type 2 diabetes is a chronic condition where the body becomes resistant to insulin, leading to high levels of glucose in the blood. Excessive sugar consumption over time can contribute to the development of type 2 diabetes in several ways.
Firstly, consuming large amounts of sugar can cause the body to produce too much insulin, which can lead to insulin resistance. Over time, insulin resistance can cause the pancreas to produce less insulin, which can lead to high blood glucose levels and the development of type 2 diabetes.
Secondly, consuming sugar-sweetened beverages, such as soda or fruit juice, can lead to weight gain and obesity, which are major risk factors for developing type 2 diabetes. Excessive sugar intake can also cause inflammation in the body, which can contribute to insulin resistance and the development of type 2 diabetes.
Additionally, consuming high amounts of sugar can cause damage to the beta cells in the pancreas, which are responsible for producing insulin. This can lead to a reduction in insulin production and the development of type 2 diabetes.
Excessive sugar consumption can contribute to the development of type 2 diabetes by causing insulin resistance, weight gain and obesity, inflammation, and damage to the beta cells in the pancreas. By reducing sugar intake and maintaining a healthy diet and lifestyle, it is possible to reduce the risk of developing type 2 diabetes.
Strategies for preventing or managing type 2 diabetes through dietary changes
Dietary changes can play an important role in preventing or managing type 2 diabetes. Here are some strategies for preventing or managing type 2 diabetes through dietary changes:
Reduce sugar intake: As excessive sugar consumption can contribute to the development of type 2 diabetes, reducing sugar intake is an important step in prevention and management. This can be achieved by cutting back on sugary drinks, desserts, and snacks, and choosing foods with lower sugar content.
Choose complex carbohydrates: Complex carbohydrates, such as whole grains, vegetables, and fruits, are broken down more slowly by the body and can help regulate blood sugar levels. Choose whole grain bread, pasta, and rice instead of their refined counterparts, and choose fruits and vegetables instead of sugary snacks.
Increase fiber intake: Fiber can help regulate blood sugar levels by slowing down the absorption of glucose in the bloodstream. Foods high in fiber include whole grains, vegetables, fruits, legumes, and nuts.
Incorporate lean protein: Lean protein can help stabilize blood sugar levels and prevent overeating. Choose lean meats, such as chicken or turkey, fish, and plant-based protein sources, such as tofu or legumes.
Watch portion sizes: Eating too much can contribute to weight gain and increase the risk of developing type 2 diabetes. Pay attention to portion sizes and aim to eat smaller, more frequent meals throughout the day.
Limit saturated and trans fats: Saturated and trans fats can contribute to inflammation and insulin resistance, increasing the risk of developing type 2 diabetes. Choose lean meats and low-fat dairy products, and avoid processed foods and fried foods.
Stay hydrated: Drinking plenty of water can help regulate blood sugar levels and prevent dehydration, which can lead to high blood sugar levels.
By making these dietary changes, it is possible to prevent or manage type 2 diabetes and improve overall health. However, it is important to consult with a healthcare professional or registered dietitian before making any significant changes to your diet.
References
American Diabetes Association. (2021). Diabetes Diet, Eating, & Physical Activity. https://www.diabetes.org/nutrition/healthy-food-choices-made-easy
Centers for Disease Control and Prevention. (2021). Eating for a Healthy Life. https://www.cdc.gov/diabetes/managing/eat-well.html
Harvard Health Publishing. (2021). Healthy eating for type 2 diabetes. https://www.health.harvard.edu/diseases-and-conditions/healthy-eating-for-type-2-diabetes
Mayo Clinic. (2021). Diabetes diet: Create your healthy-eating plan. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-diet/art-20044295
National Institute of Diabetes and Digestive and Kidney Diseases. (2021). Eating, Diet, & Nutrition for Diabetes. https://www.niddk.nih.gov/health-information/diabetes/overview/eating-diet-nutrition
04 - Tooth Decay
Sugar is a common ingredient in many foods and drinks, and while it can be enjoyable in moderation, consuming too much sugar can have negative effects on our health. One of the ways that excess sugar consumption can harm our health is through the development of tooth decay.
To understand how sugar contributes to tooth decay, it is helpful to first understand the basics of tooth anatomy. Our teeth are made up of several layers, with the hard outer layer called enamel. Underneath the enamel is a layer of dentin, and at the center of the tooth is the pulp, which contains nerves and blood vessels.
When we eat foods and drinks that are high in sugar, the bacteria in our mouths feed on the sugar and produce acid as a byproduct. This acid can then dissolve the enamel of our teeth, which can lead to the development of cavities. Over time, these cavities can become larger and deeper, eventually reaching the dentin and potentially causing pain or sensitivity. If left untreated, cavities can continue to progress and may even reach the pulp of the tooth, which can lead to infection and other complications.
In addition to directly causing cavities, excess sugar consumption can also contribute to poor oral health in other ways. For example, sugary foods and drinks are often acidic and can lower the pH level of our saliva, which can create an environment that is more conducive to the growth of harmful bacteria. This can increase the risk of gum disease, which is a condition that can cause inflammation, bleeding, and even tooth loss if left untreated.
To prevent tooth decay and other oral health problems associated with excess sugar consumption, it is important to limit our intake of sugary foods and drinks. This can be challenging, as many processed foods and drinks contain high levels of added sugars that can be difficult to avoid. However, there are several strategies that can help to reduce sugar intake and promote better oral health.
One strategy for reducing sugar intake is to choose whole foods over processed snacks and meals. Fresh fruits and vegetables are low in added sugars and are also nutrient-dense, providing our bodies with essential vitamins and minerals. Choosing whole grains over processed carbohydrates, such as white bread or sugary cereal, can also help to reduce sugar intake.
Another strategy for reducing sugar intake is to limit the consumption of sugary drinks, such as soda, juice, and sports drinks. These beverages are often high in added sugars and can contribute significantly to daily sugar intake. Drinking water or unsweetened tea instead can help to reduce sugar intake and promote better hydration.
It is also important to be mindful of the timing of sugary foods and drinks. Consuming sugary foods and drinks before bedtime can be particularly harmful, as the sugar can linger in the mouth overnight and provide an ongoing food source for bacteria. This can contribute to the development of cavities and other oral health problems.
Finally, good oral hygiene practices are essential for maintaining healthy teeth and gums. Brushing twice a day with fluoride toothpaste and flossing daily can help to remove food particles and bacteria from the mouth and reduce the risk of tooth decay and gum disease. Regular dental checkups and cleanings can also help to identify and treat any early signs of oral health problems.
Excess sugar consumption can contribute to the development of tooth decay and other oral health problems. By limiting our intake of sugary foods and drinks, choosing whole foods over processed snacks, and practicing good oral hygiene, we can reduce our risk of oral health problems and promote better overall health.
References
American Dental Association. "Sugar and Your Teeth." Accessed May 1, 2023. https://www.mouthhealthy.org/en/nutrition/sugar-and-your-teeth.
Centers for Disease Control and Prevention. "Oral Health." Accessed May 1, 2023. https://www.cdc.gov/oralhealth/index.html.
Kassebaum, N. J., Bernabé, E., Dahiya, M., Bhandari, B., Murray, C. J. L., & Marcenes, W. (2015). Global burden of untreated caries: a systematic review and metaregression. Journal of dental research, 94(5), 650–658. https://doi.org/10.1177/0022034515573272
Malik, V. S., & Hu, F. B. (2015). Sugar-sweetened beverages and cardiometabolic health: an update of the evidence. Nutrition, metabolism, and cardiovascular diseases : NMCD, 25(3), 173–183. https://doi.org/10.1016/j.numecd.2014.11.011
Moynihan, P. J., & Petersen, P. E. (2004). Diet, nutrition and the prevention of dental diseases. Public health nutrition, 7(1A), 201–226. https://doi.org/10.1079/PHN2003589
Vartanian, L. R., Schwartz, M. B., & Brownell, K. D. (2007). Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. American journal of public health, 97(4), 667–675. https://doi.org/10.2105/ajph.2005.083782
05 - Increased Risk of Heart Disease
Heart disease is a major cause of death globally, and several factors contribute to its development. One of these factors is high sugar consumption. Sugar, particularly added sugars, has been linked to an increased risk of heart disease. In this article, we will explore how sugar consumption affects cholesterol levels, the link between high sugar intake and heart disease risk, the impact of added sugars on cardiovascular health, and strategies for reducing sugar intake to improve heart health.
How Sugar Consumption Affects Cholesterol Levels
Cholesterol is a type of fat found in the blood, and there are two types of cholesterol: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). LDL cholesterol is often referred to as "bad" cholesterol because it can build up in the walls of arteries, leading to the formation of plaques that can narrow and harden the arteries. HDL cholesterol, on the other hand, is often referred to as "good" cholesterol because it helps remove LDL cholesterol from the arteries.
Consuming too much sugar can contribute to an increase in LDL cholesterol levels, which can increase the risk of heart disease. This is because high sugar intake can lead to an increase in triglycerides, which are a type of fat found in the blood. High triglyceride levels can contribute to the formation of LDL cholesterol and the development of plaque in the arteries.
The Link Between High Sugar Intake and Heart Disease Risk
Several studies have found a link between high sugar intake and an increased risk of heart disease. One study published in JAMA Internal Medicine found that individuals who consumed more than 25% of their daily calories from added sugars had a higher risk of dying from cardiovascular disease than those who consumed less than 10% of their calories from added sugars.
Another study published in the journal Circulation found that consuming sugar-sweetened beverages was associated with an increased risk of coronary heart disease. The study found that individuals who consumed the most sugar-sweetened beverages had a 20% higher risk of coronary heart disease compared to those who consumed the least.
The Impact of Added Sugars on Cardiovascular Health
Added sugars, which are sugars that are added to foods and beverages during processing, can have a negative impact on cardiovascular health. In addition to contributing to an increase in LDL cholesterol levels, high sugar intake can also contribute to inflammation in the body, which is a risk factor for heart disease.
Added sugars are found in a wide range of foods and beverages, including soda, candy, baked goods, and processed foods. Consuming these foods and beverages regularly can lead to an increase in sugar intake and an increased risk of heart disease.
Strategies for Reducing Sugar Intake to Improve Heart Health
Reducing sugar intake can be a challenge, as sugar is found in many foods and beverages. However, there are several strategies that individuals can use to reduce their sugar intake and improve their heart health.
Read food labels: Food labels can be a helpful tool in identifying foods and beverages that contain added sugars. Look for ingredients such as sugar, corn syrup, high fructose corn syrup, and dextrose.
Choose whole foods: Whole foods, such as fruits, vegetables, whole grains, and lean proteins, are typically low in added sugars and can help provide the nutrients needed for good heart health.
Limit sugar-sweetened beverages: Sugar-sweetened beverages, such as soda, sports drinks, and sweetened tea and coffee, are a major source of added sugars in the diet. Choose water, unsweetened tea or coffee, or low-fat milk instead.
Cut back on processed foods: Processed foods, such as snack foods, baked goods, and frozen meals, often contain added sugars. Choosing whole foods and cooking meals at home can help reduce sugar.
References
Malik, V. S., Schulze, M. B., & Hu, F. B. (2018). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American journal of clinical nutrition, 98(4), 1084-1102.
Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R., & Hu, F. B. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine, 174(4), 516-524.
Stanhope, K. L. (2016). Sugar consumption, metabolic disease and obesity: the state of the controversy. Critical reviews in clinical laboratory sciences, 53(1), 52-67.
Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H., ... & Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(11), 1011-1020.
Vos, M. B., Kaar, J. L., Welsh, J. A., Van Horn, L. V., Feig, D. I., Anderson, C. A., ... & Johnson, R. K. (2017). Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association. Circulation, 135(19), e1017-e1034.
06 - Non-Alcoholic Fatty Liver Disease
Non-alcoholic fatty liver disease (NAFLD) is a condition characterized by the accumulation of fat in the liver cells of people who consume little to no alcohol. The main cause of NAFLD is excess calorie consumption, particularly from added sugars and refined carbohydrates. The excessive consumption of added sugars is linked to the development of insulin resistance, which impairs the liver's ability to metabolize and store glucose. As a result, glucose is converted to fat and stored in the liver, leading to the development of fatty liver disease.
One of the primary ways that excess sugar consumption contributes to the development of NAFLD is by increasing the amount of fat in the bloodstream. When you consume too much sugar, your liver converts the excess glucose into fat, which is then released into the bloodstream. High levels of fat in the blood can lead to the accumulation of fat in the liver, causing inflammation and damage.
In addition to causing liver damage and inflammation, high sugar intake can also lead to the development of other metabolic disorders such as obesity, diabetes, and high blood pressure, which increase the risk of NAFLD. These conditions are often interrelated, with insulin resistance and inflammation playing key roles in the development of each.
Reducing sugar intake is crucial for improving liver function and preventing or reversing the development of NAFLD. This can be achieved by cutting back on added sugars and refined carbohydrates, such as sugary drinks, candy, cakes, and white bread. Instead, focus on eating whole foods that are high in fiber, such as fruits, vegetables, and whole grains. These foods take longer to digest, helping to stabilize blood sugar levels and reduce the risk of developing insulin resistance.
In addition to dietary changes, regular physical activity is also important for maintaining a healthy weight and reducing the risk of developing NAFLD. Exercise has been shown to improve insulin sensitivity, reduce inflammation, and promote healthy liver function. Aim for at least 30 minutes of moderate-intensity physical activity, such as brisk walking, cycling, or swimming, on most days of the week.
Other lifestyle changes that may help improve liver health and reduce the risk of NAFLD include getting enough sleep, managing stress, and avoiding alcohol and tobacco. Getting enough sleep is important for regulating hormones that control hunger and satiety, while managing stress can help reduce cortisol levels, which can contribute to inflammation and insulin resistance. Avoiding alcohol and tobacco is also important, as these substances can cause liver damage and inflammation.
Excess sugar consumption is a significant risk factor for the development of non-alcoholic fatty liver disease. Reducing sugar intake by cutting back on added sugars and refined carbohydrates, increasing physical activity, and adopting other healthy lifestyle habits can help improve liver function and reduce the risk of developing NAFLD. If you are concerned about your risk of developing NAFLD or other metabolic disorders, talk to your healthcare provider for personalized advice and support.
Sources:
Lazo, M., Solga, S. F., Horska, A., Bonekamp, S., Diehl, A. M., & Brancati, F. L. (2010). Effect of a 12-month intensive lifestyle intervention on hepatic steatosis in adults with type 2 diabetes. Diabetes care, 33(10), 2156-2163.
Abdelmalek, M. F., Suzuki, A., Guy, C., Unalp-Arida, A., Colvin, R., Johnson, R. J., & Diehl, A. M. (2010). Increased fructose consumption is associated with fibrosis severity in patients with nonalcoholic fatty liver disease. Hepatology, 51(6), 1961-1971.
07 - Increased Risk of Cancer
Sugar consumption has been linked to an increased risk of cancer. While sugar itself doesn't cause cancer, it can contribute to the development of the disease through various mechanisms. In this article, we will discuss the link between sugar intake and cancer risk, how excess sugar consumption contributes to cancer development, the impact of high sugar intake on overall cancer risk, and strategies for reducing sugar intake to lower cancer risk.
The Link between Sugar Intake and Cancer Risk
There is growing evidence that consuming high amounts of sugar can increase the risk of certain types of cancer. In fact, a study published in the Journal of Clinical Oncology found that high sugar intake was associated with an increased risk of breast cancer and lung cancer.
Other studies have also found a link between high sugar intake and an increased risk of colorectal cancer, pancreatic cancer, and endometrial cancer. While the exact mechanism behind this link is not fully understood, there are several ways in which sugar can contribute to cancer development.
How Excess Sugar Consumption Contributes to Cancer Development
One of the ways in which sugar consumption can contribute to cancer development is through the promotion of inflammation. High sugar intake has been shown to increase the production of inflammatory molecules in the body, which can lead to chronic inflammation. Chronic inflammation is a known risk factor for cancer, as it can damage DNA and promote the growth of cancer cells.
In addition to promoting inflammation, excess sugar consumption can also contribute to cancer development by increasing insulin resistance. When we consume too much sugar, our body produces more insulin to help regulate blood sugar levels. Over time, this can lead to insulin resistance, a condition in which the body becomes less responsive to insulin. Insulin resistance has been linked to an increased risk of several types of cancer, including colorectal cancer, pancreatic cancer, and endometrial cancer.
Another way in which sugar consumption can contribute to cancer development is through the promotion of obesity. Consuming high amounts of sugar can lead to weight gain and obesity, both of which are known risk factors for cancer. In fact, a study published in the New England Journal of Medicine found that obesity was responsible for 14% of all cancer deaths in men and 20% of all cancer deaths in women.
The Impact of High Sugar Intake on Overall Cancer Risk
While the link between sugar consumption and cancer risk is not fully understood, it is clear that consuming high amounts of sugar can have a negative impact on overall cancer risk. In addition to the types of cancer mentioned above, high sugar intake has also been linked to an increased risk of liver cancer, esophageal cancer, and stomach cancer.
In addition to increasing cancer risk, consuming high amounts of sugar can also make it more difficult to manage cancer treatment. Cancer cells rely on glucose (a type of sugar) for their energy needs, and consuming high amounts of sugar can increase the amount of glucose in the blood. This can make it more difficult for cancer patients to manage their blood sugar levels, which can make it harder to tolerate cancer treatment.
Strategies for Reducing Sugar Intake to Lower Cancer Risk
Reducing sugar intake is an important step in lowering cancer risk. Here are some strategies for reducing sugar intake:
Read food labels: Sugar can be hidden in many processed foods, so it's important to read food labels carefully. Look for added sugars on the ingredient list, as well as total sugar content.
Choose whole foods: Whole foods like fruits, vegetables, and whole grains are naturally low in sugar and high in fiber, which can help regulate blood sugar levels and promote a healthy weight.
Limit sugary drinks: Sugary drinks like soda, sports drinks, and fruit juices are some of the biggest sources of added sugar in the American diet
References
Bray, G. A., Popkin, B. M., & Nielsen, S. J. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. The American Journal of Clinical Nutrition, 79(4), 537-543. https://doi.org/10.1093/ajcn/79.4.537
Chiu, S., Sievenpiper, J. L., de Souza, R. J., Cozma, A. I., Mirrahimi, A., Carleton, A. J., ... & Jenkins, D. J. (2014). Effect of fructose on markers of non-alcoholic fatty liver disease (NAFLD): a systematic review and meta-analysis of controlled feeding trials. European Journal of Clinical Nutrition, 68(4), 416-423. https://doi.org/10.1038/ejcn.2014.8
DiNicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2018). The evidence for saturated fat and for sugar related to coronary heart disease. Progress in Cardiovascular Diseases, 61(1), 61-66. https://doi.org/10.1016/j.pcad.2018.05.002
Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H., ... & Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(11), 1011-1020. https://doi.org/10.1161/CIRCULATIONAHA.109.192627
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., & Hu, F. B. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 121(11), 1356-1364. https://doi.org/10.1161/CIRCULATIONAHA.109.876185
Stanhope, K. L., Bremer, A. A., Medici, V., Nakajima, K., Ito, Y., Nakano, T., ... & Havel, P. J. (2011). Consumption of fructose and high fructose corn syrup increase postprandial triglycerides, LDL-cholesterol, and apolipoprotein-B in young men and women. The Journal of Clinical Endocrinology & Metabolism, 96(10), E1596-E1605. https://doi.org/10.1210/jc.2011-1251
Threapleton, D. E., Greenwood, D. C., Evans, C. E., Cleghorn, C. L., Nykjaer, C., Woodhead, C., ... & Burley, V. J. (2013). Dietary fibre intake and risk of cardiovascular disease: systematic review and meta-analysis. BMJ, 347, f6879. https://doi.org/10.1136/bmj.f6879
World Health Organization. (2015). Guideline: sugars intake for adults and children. https://apps.who.int/iris/bitstream/handle/10665/149782/9789241549028_eng.pdf?sequence=1
08 - Poor Nutrient Absorption
Sugar has a significant impact on our digestive system, which can lead to poor nutrient absorption. The consumption of high amounts of sugar can affect the gut microbiome and lead to inflammation, which can contribute to nutrient deficiencies. In this section, we will discuss how high sugar intake affects nutrient absorption, the impact of excess sugar on gut health, the link between sugar consumption and nutrient deficiencies, and strategies for reducing sugar intake to improve nutrient absorption.
How high sugar intake affects nutrient absorption
High sugar intake can negatively affect nutrient absorption in a number of ways. First, consuming too much sugar can damage the intestinal lining and impair nutrient absorption. When we consume high amounts of sugar, it can lead to inflammation in the gut, which can cause the intestinal lining to become inflamed and damaged. This can affect the ability of the intestinal lining to absorb nutrients properly.
Additionally, high sugar intake can alter the gut microbiome, which can also affect nutrient absorption. The gut microbiome plays a crucial role in the absorption and processing of nutrients. When the gut microbiome is imbalanced due to high sugar intake, it can negatively impact the absorption of nutrients.
Finally, high sugar intake can lead to an overgrowth of harmful bacteria in the gut, which can further impair nutrient absorption. Harmful bacteria can compete with beneficial bacteria for nutrients, which can lead to nutrient deficiencies.
The impact of excess sugar on gut health
The gut plays a crucial role in our overall health, and high sugar intake can negatively impact gut health in a number of ways. First, consuming too much sugar can alter the gut microbiome, which can lead to a number of health issues, including inflammation, insulin resistance, and obesity. Additionally, high sugar intake can lead to gut dysbiosis, which occurs when there is an imbalance in the gut microbiome.
Gut dysbiosis can lead to a number of health issues, including nutrient deficiencies, inflammation, and autoimmune diseases. Finally, high sugar intake can also cause gut inflammation, which can further impair nutrient absorption and contribute to a variety of health issues.
The link between sugar consumption and nutrient deficiencies
High sugar intake has been linked to a number of nutrient deficiencies, including deficiencies in vitamins B and C, calcium, and magnesium. When we consume high amounts of sugar, it can lead to an increase in insulin secretion, which can impair the absorption of certain nutrients.
Additionally, sugar can bind to certain minerals, making them less available for absorption. This can lead to deficiencies in minerals such as calcium and magnesium, which are important for bone health.
Finally, high sugar intake can also lead to nutrient deficiencies indirectly, by impairing gut health and nutrient absorption. When the gut is inflamed or imbalanced due to high sugar intake, it can lead to nutrient deficiencies over time.
Strategies for reducing sugar intake to improve nutrient absorption
Reducing sugar intake is an important step in improving nutrient absorption and gut health. Some strategies for reducing sugar intake include:
Reading food labels: It's important to read food labels to identify hidden sources of sugar. Sugar can be found in a variety of processed foods, including sauces, condiments, and even some types of bread.
Choosing whole foods: Choosing whole foods, such as fruits, vegetables, and whole grains, can help reduce sugar intake and improve nutrient absorption.
Limiting sugary beverages: Sugary beverages, such as soda and juice, are a major source of added sugar in the diet. Limiting or eliminating these beverages can help reduce sugar intake and improve gut health.
Cooking at home: Cooking at home allows you to control the amount of sugar in your meals and avoid hidden sources of sugar.
Incorporating probiotics: Probiotics can help improve gut health and nutrient absorption by promoting the growth of beneficial bacteria in the gut.
References
O'Neil, C. E., & Nicklas, T. A. (2013). A review of the relationship between C-reactive protein and nutrition in pediatric obesity. Journal of clinical densitometry, 16(4), 431-440. https://doi.org/10.1016/j.jocd.2013.04.007
Malik, V. S., Schulze, M. B., & Hu, F. B. (2006). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American journal of clinical nutrition, 84(2), 274-288. https://doi.org/10.1093/ajcn/84.1.274
Lustig, R. H. (2010). Fructose: metabolic, hedonic, and societal parallels with ethanol. Journal of the American Dietetic Association, 110(9), 1307-1321. https://doi.org/10.1016/j.jada.2010.06.008
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., & Hu, F. B. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 121(11), 1356-1364. https://doi.org/10.1161/CIRCULATIONAHA.109.876185
Stanhope, K. L. (2012). Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annual review of medicine, 63, 329-343. https://doi.org/10.1146/annurev-med-042010-113026
Hu, F. B. (2013). Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity Reviews, 14(8), 606-619. https://doi.org/10.1111/obr.12040
Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H., … & Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(11), 1011-1020. https://doi.org/10.1161/CIRCULATIONAHA.109.192627
Basu, S., Yoffe, P., Hills, N., & Lustig, R. H. (2013). The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PloS one, 8(2), e57873. https://doi.org/10.1371/journal.pone.0057873
Song, M., Fung, T. T., Hu, F. B., Willett, W. C., Longo, V. D., & Chan, A. T. (2014). Association of animal and plant protein intake with all-cause and cause-specific mortality. JAMA internal medicine, 174(5), 763-772. https://doi.org/10.1001/jamainternmed.2014.18
Bocarsly, M. E., Powell, E. S., Avena, N. M., & Hoebel, B. G. (2010). High-fr
09 - Addiction and Dependence
Sugar has been found to have addictive properties, with some experts referring to it as "the new nicotine" due to the difficulties people face in trying to reduce their sugar intake. When sugar is consumed, it triggers the release of dopamine in the brain, which is a neurotransmitter that is associated with pleasure and reward. Over time, frequent sugar consumption can lead to a tolerance for sugar, which means that more sugar is needed to achieve the same pleasurable effect. This can eventually lead to a dependence on sugar, where people experience withdrawal symptoms if they try to reduce their intake.
The link between high sugar intake and cravings is well-established. A study published in the American Journal of Clinical Nutrition found that consuming high-sugar foods and beverages can lead to a cycle of craving and consumption that can be difficult to break. This can lead to overeating and weight gain, as well as other negative health outcomes.
Sugar addiction can have a significant impact on overall health. In addition to contributing to weight gain and obesity, sugar addiction has been linked to a range of health problems, including type 2 diabetes, heart disease, and liver disease. Additionally, sugar addiction can make it difficult to maintain a healthy diet and lifestyle, which can further exacerbate health problems.
Reducing sugar intake can be challenging for those who are addicted to sugar. However, there are strategies that can be effective in overcoming sugar addiction and reducing dependence on sugar. These include gradually reducing sugar intake over time, substituting sugary foods and drinks with healthier options, and finding other ways to cope with stress and emotional issues that may be driving sugar addiction.
It is important to note that while sugar addiction is a real and serious issue, it is not the only factor contributing to high sugar consumption. Many people consume high amounts of sugar due to the prevalence of sugary foods and drinks in the food environment, as well as social and cultural factors that encourage high-sugar diets. Therefore, reducing sugar intake will require a multifaceted approach that includes both individual strategies for reducing sugar consumption and broader efforts to promote healthy food environments and reduce the availability of high-sugar foods and beverages.
Sugar addiction and dependence can have a significant impact on overall health, and reducing sugar intake is an important step in improving health outcomes. Strategies for reducing sugar intake include gradual reduction of sugar intake, substituting sugary foods and drinks with healthier options, and finding other ways to cope with stress and emotional issues.
References
Hu, F. B. (2013). Resolved: there is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obesity reviews, 14(8), 606-619.
Malik, V. S., Popkin, B. M., Bray, G. A., Després, J. P., & Willett, W. C. (2010). Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation, 121(11), 1356-1364.
Lustig, R. H., Schmidt, L. A., & Brindis, C. D. (2012). Public health: The toxic truth about sugar. Nature, 482(7383), 27-29.
Basu, S., Yoffe, P., Hills, N., & Lustig, R. H. (2013). The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. PLoS One, 8(2), e57873.
Jang, C., Hui, S., Lu, W., Cowan, A. J., Morshead, K. B., He, T. T., ... & Rabinowitz, J. D. (2018). The small intestine converts dietary fructose into glucose and organic acids. Cell metabolism, 27(2), 351-361.
Bray, G. A., Nielsen, S. J., & Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. American Journal of Clinical Nutrition, 79(4), 537-543.
Stanhope, K. L. (2016). Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical Reviews in Clinical Laboratory Sciences, 53(1), 52-67.
U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015). 2015-2020 Dietary Guidelines for Americans. 8th Edition.
Stanhope, K. L., Schwarz, J. M., Keim, N. L., Griffen, S. C., Bremer, A. A., Graham, J. L., ... & Havel, P. J. (2009). Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans. Journal of clinical investigation, 119(5), 1322-1334.
Malik, V. S., Willett, W. C., & Hu, F. B. (2013). Sugar-sweetened beverages and BMI in children and adolescents: reanalyses of a meta-analysis. American journal of clinical nutrition, 98(2), 349-355.
10 - Conclusion
In conclusion, consuming too much sugar can lead to a variety of negative health outcomes, including weight gain, increased risk of heart disease, type 2 diabetes, fatty liver disease, cancer, poor nutrient absorption, addiction and dependence, and poor oral health. These risks are compounded by the prevalence of added sugars in many processed and packaged foods, as well as in sweetened beverages.
To reduce the risks associated with high sugar consumption, it is recommended to limit added sugar intake to no more than 10% of daily caloric intake, which translates to about 50 grams or 12 teaspoons of sugar per day for the average adult. This can be achieved by reducing intake of sugary drinks, desserts, and processed foods, and instead choosing whole foods like fruits, vegetables, whole grains, and lean proteins. Additionally, it is important to read food labels carefully and be mindful of hidden sources of added sugars.
Moderation and balance are key in maintaining good health, and reducing sugar intake is an important aspect of this. By making conscious choices to limit sugar intake, individuals can reduce their risk of negative health outcomes and promote overall well-being.
References
Johnson, R. K., Appel, L. J., Brands, M., Howard, B. V., Lefevre, M., Lustig, R. H., ... & Wylie-Rosett, J. (2009). Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association. Circulation, 120(11), 1011-1020.
Malik, V. S., Schulze, M. B., & Hu, F. B. (2006). Intake of sugar-sweetened beverages and weight gain: a systematic review. The American journal of clinical nutrition, 84(2), 274-288.
Stanhope, K. L. (2012). Role of fructose-containing sugars in the epidemics of obesity and metabolic syndrome. Annual review of medicine, 63, 329-343.
Vos, M. B., & Lavine, J. E. (2013). Dietary fructose in nonalcoholic fatty liver disease. Hepatology, 57(6), 2525-2531.
World Health Organization. (2015). Guideline: sugars intake for adults and children. Geneva: World Health Organization.
Lustig, R. H. (2010). Fructose: it's “alcohol without the buzz”. Advances in Nutrition, 1(1), 136-142.
Sharma, A., Amarnath, S., Thulasimani, M., & Ramaswamy, S. (2016). Artificial sweeteners as a sugar substitute: Are they really safe?. Indian Journal of Pharmacology, 48(3), 237.
The Mayo Clinic. (2021). Added sugar: Don't get sabotaged by sweeteners. Retrieved from https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/added-sugar/art-20045328.
University of California, San Francisco. (n.d.). The Toxic Truth About Sugar. Retrieved from https://www.ucsf.edu/news/2017/03/406446/toxic-truth-about-sugar.
