In May 2016, the FDA announced changes to the nutrition facts food label that appears on all packaged foods and drinks. Starting in 2018, the new label must clearly state how much sugar the manufacturer added to the product and what percentage of the recommended daily maximum that represents. This is a huge improvement over the current label, which lists only the total amount of sugar in the product, without distinguishing between natural sugar in the food and added sugars. The new label brings the sugar information into better alignment with the updated Dietary Guidelines for Americans and will help to eliminate confusion and conflicting recommendations. Most importantly, the new label will help consumers realize just how much sugar is added to processed foods.

The added sugar problem
In 1977, the average American consumed about 228 calories a day from added sugars. As the 1980s began and inexpensive high-fructose corn syrup entered the food supply, that amount started to creep up—and so did the rates of overweight and obesity. Over three decades, from 1977 to 2010, U.S. adult consumption of added sugars increased by more than 30%. Today, the average adult eats about 300 calories a day in added sugar, working out to about 142 pounds of sugar a year, more than their body weight for many.

Ultraprocessed food such as soft drinks, packaged snacks, and candy now make up more than half of all calories in the U.S. diet. Not surprisingly, because 1 in every 5 calories from these foods is sugar, they contribute about 90% of all added dietary sugar intake.

Today, almost all the added sugars in the American diet come from high-calorie, low nutrient, ultra-processed foods. The foods are carefully engineered to be hyperpalatable. Cutting back on these foods would be the best possible way to cut back on excessive sugar consumption and the health problems this brings.

How added sugar harms
Excess calories from added sugars in the diet contribute to obesity and associated conditions, such as type 2 diabetes, hypertension, dyslipidemias, and cardiovascular disease. Added sugars are also implicated in tooth decay.

Today, 1 in 3 Americans are overweight or obese; by 2050, this number is projected to rise to 1 in 2. Since 1960, we’ve seen a 10-fold increase in type 2 diabetes. In 1980, type 2 diabetes in children was very rare; in 2008, one out of every four teenagers had it. The direct medical costs to treat type 2 diabetes each year are now in excess of $176 billion. Type 2 diabetes is the seventh leading cause of death in the U.S.

Sugar kills slowly in the case of type 2 diabetes, but much faster in the case of cardiovascular disease. A strong link between sugar consumption and death from cardiovascular disease was shown in a 2014 cohort study using National Health and Nutrition Examination Surveys (NHANES) data. The study showed that the risk of death from cardiovascular disease increased exponentially as the usual percentage of calories from added sugar increased. The more added sugars the participants regularly ate, the greater their risk of death from heart disease—no matter what their age, sex, race, weight, smoking status, fitness, and family history of heart disease. Those who consumed 25% or more of their daily calories from added sugar simply had triple the risk of dying of heart disease.

The current epidemics of obesity and type 2 diabetes and the clear link between sugar consumption and death from heart disease show that sugar plays far too large a role in the American diet. Some 65% of adults currently exceed the recommended daily limit for added sugar as outlined in the 2015 Dietary Guidelines for Americans. The current guidelines have finally firmly stated that Americans should consume less than 10% of calories per day from added sugars. (The original 1980 guidelines simple said “Avoid too much sugar.” The 2010 guidelines were more explicit and allowed up to 15% of daily calories from added sugars.) On a diet that includes 2,000 calories a day, getting 25% of those calories from sugar means eating 500 calories from sugar, or 31 teaspoons. Based on the current recommendations, that amount should be cut by two-thirds, to about 160 calories a day, or 10 teaspoons.

Cutting back on sugar
Unfortunately, cutting back on sugar is difficult—and lack of understanding can actually make things worse. Concerns over sugar have led many school systems to replace the sugary sodas in vending machines with supposedly healthier alternatives, such as flavored milk drinks and juice. These drinks may not have bubbles, but they’re no better than soda when it comes to sugar. The “juice” drinks are made largely from juice concentrates, which are basically nothing but fruit-flavored sugar. An 8-ounce serving of chocolate milk has 22 grams of added sugar; 8 ounces of cola has 26 grams; 8 ounces of Snapple apple juice has 24 grams of added sugar. Most containers of these drinks contain far more than 8 ounces; a standard Snapple bottle is 16 ounces while a standard soda can contains 12 ounces. Until these machines are removed entirely from every school, kids will continue to consume supposedly healthy drinks and the added sugars they contain.

Another way to cut back on sugar is to replace it with artificial sweeteners. This too can make things worse. A number of studies have shown that consumption of artificially sweetened sodas can have deleterious metabolic effects and actually can significantly raise the risk of the metabolic syndrome and type 2 diabetes. The only artificial sweetener that doesn’t seem to have health risks is stevia.

It’s up to doctors and other healthcare professionals to help their patients reduce their sugar intake in an intelligent way. Simply discussing the risks of excess sugar isn’t enough, however. Sugar is everywhere in the American diet, even in salad dressings, bread, and soup. Patients need education on just how widespread added sugars are, and they need help in finding ways to cut back. This is a difficult challenge because obvious ideas, such as switching to diet soda, can actually be harmful.

My recommendations:
The best way to help your patients cut back on sugar is with solid dietary advice that will help them crave sugar less. I recommend four basic steps:

1. Eat small meals regularly, making sure to include protein and fat each time. Particularly for patients already showing signs of glucose intolerance, this will help prevent the blood sugar lows that cause cravings for sugary snacks.
2. Eat breakfast and make sure the meal contains both protein and fat. Again, especially for patients with glucose intolerance, this will help keep the blood sugar on an even keel and avoid sugar cravings.
3. Choose whole foods over processed foods. By definition, whole foods don’t contain added sugar. For example, suggest old-fashioned or quick oatmeal with fresh fruit instead of flavored instant oats.
4. Because clients with high sugar consumption may not have a balanced diet, I also recommend taking four supplements every day: A good-quality multivitamin with minerals and phytonutrients, omega-3 fatty acid, vitamin D, and a probiotic.