by Marion Nestle
Mar 2 2012

How much sugar(s) do you eat?

Earlier this week I received a 3-page, single-spaced letter—plus 4 pages of charts and figures–from Andrew Briscoe III, the President and CEO of the Sugar Association.

I opened it with some trepidation because the last letter I got from the Sugar Association threatened to sue me (to read it, click here and scroll down to the Controversies section).

Whew.  This one merely expresses general concerns about:

the misinformation reported on added sugars consumption and the overstatement of added sugars contribution to increased caloric intakes.  Americans do not consume 25 percent of their calories from added sugars. We write to provide you with accurate data….

I don’t think I ever said that the average American consumes 25% of calories from sugars (although some surely do) but I have complained that the Institute of Medicine’s “safe” level of intake of sugars is 25% of calories.  This is higher than public health recommendations to restrict sugars to 10% of calories or less.  It is meant as an upper limit, but is often interpreted as a license to eat this much.

One quarter of daily calories from sugars is too high for something that provides no additional nutritional value.

The letter concludes:

The Sugar Association is committed to ensuring that all advice consumers receive regarding sugar intake is based on the best available scientific evidence and related data.  The American consumer will be better served by dietary advice that is science-based, practical and accurate, no matter the issue.

Can’t argue with that.  But as with all matters concerning nutrition, the issue is which science you choose to cite and how you interpret it.

Mr. Briscoe uses the term sugars, plural, because sucrose, HFCS, syrups, honey, and other such things are all sugars.

How much do Americans actually consume?  Mr. Briscoe was kind enough to provide USDA tables that address this question.  These describe the availability of sugars in the food supply, not necessarily what people are actually eating.

My interpretation of the tables is that they say:

  • Sugars comprise 17% of total calorie availability.
  • Adjusted for waste, the availability of sugars is about 27.5 teaspoons per day per capita (meaning everyone:  men, women, and tiny babies).
  • Translating this into calories: 27.5 teaspoons x 4 grams per teaspoon x 4 calories per gram = 440 calories per day per capita.
  • On a 2000 calorie diet, that’s 22% of total energy intake, although it will be lower for people who take in more calories.

The CDC has just released a summary of intake of added sugars among children and adolescents, in calories per day.

At 4 calories a gram, 400 calories is 100 grams or 3.5 ounces.  Can these calories contribute to weight gain or other health problems?

You bet.

As Mark Bittman put it in his New York Times column this week,

Let me state the obvious: there is no nutritional need for foods with added sugar.

All of this is part of the bigger question: How do we regulate the consumption of dangerous foods? As a nation, we’ve accepted the need to limit the marketing and availability of tobacco and alcohol. The first is dangerous in any quantity, and the second becomes dangerous when overconsumed.

And added sweeteners, experts increasingly argue, have more in common with these substances than with fruit.

No wonder the Sugar Association uses its own interpretation of the science to suggest that current levels of intake are benign and that no level of intake poses a risk.  Mr. Briscoe’s letter says:

No authoritative scientific body that has conducted a major systematic review of the scientific literature has a found a public health need to set an Upper Level (UL) for total or added sugars intake.  Every comprehensive review of the scientific literature concludes that, with the exception of dental caries, no causal link can be established between the intake of sugars and lifestyle diseases, including obesity.

I’m glad he mentioned dental caries.  Karen Sokal, a physician in California, has been tracking the onset of tooth decay among children in Latin America who are now consuming sodas and candy on a daily basis.  She writes:

Mark Bittman’s excellent editorial, “Regulating our Sugar Habit,” (Feb 27) concludes that eating too much sugar has become “the biggest public health challenge facing the developed world.”  Indeed, it poses a big health challenge for the entire world, especially developing countries.

In my 30 years of global health work, I have seen an explosion in the marketing and consumption of non-nutritious foods and beverages followed by a dramatic rise in childhood tooth decay and obesity. Quarterly business reports praise the food and beverage industry’s increased profits based on increased sales in “emerging markets.” The NY Times article on Kellogg’s purchase of Pringles (Feb 12) stated, “The snack business is growing faster and has greater appeal internationally,” which analysts noted “appears somewhat out of sync with the trends toward better-for-you snacking.”

Governmental regulations to ensure the production and marketing of healthful food and beverages must be applied worldwide and protect the health of the world’s most vulnerable populations.

Indeed, they must.  The Sugar Association has much to answer for in its opposition to public health recommendations to eat less sugar.

  • There is some part of me that can’t believe what I’m about to write.

    Are we sure that we are not just berating a food group in the same way that we vilified fats in the 1960s and 70s?

    Trade associations will always act in the best interests of those that pay for them to exist. If you move what they say a little, or perhaps a lot, closer to the middle, they may have something worth listening to.

    Having reviewed some papers sent to me by an Oxford professor on obesity and its causes, as well as reviewing other research materials, it could be that we are missing the point a little.

    There are biological and evolutionary reasons why we like sugars and starches more than we should, and the food environment has become expert at fulfilling the desire. And yes, perhaps those that create the populist food environment have stepped over the bounds of acceptable public health practices in supplying sugars and protecting special interests.

    But until we fully define the underlying reasons that create the public demand for sugars and refined carbs, and the reasons that sustain an inability to give up these preferences, the trade associations will always have a point of refuge behind the gaps in the science. And there are gaps in the science.

  • If I’m understanding this correctly, Mr. Briscoe is bristling that you may have implied that 25% of calorie intake came from sugars, and his data shows this number might be closer to 22%.

    Whether you said this or not, why don’t we give him the benefit of the doubt and look his organization’s data instead? (That way you won’t run the risk of another lawsuit threat)

    I don’t see the Sugar Association scoring any points in this discussion.

  • Peggy Holloway

    I have consumed no sugar for 12 years. Being aware of “added sugar” is a good start, but remember that all effective carbohydrates are , essentially sugar, and must also be restricted. I have also done that for 12 years. Despite a serious family history of insulin-resistance-related issues, at 59 I am incredibly healthy with normal blood sugar and blood pressure, high HDL, and low-triglycerides. I have the energy of someone half my age and cycle thousands of miles a year.
    If someone says “but you need carbohydrates” my response is “poppycock – and I am living proof you don’t!”

  • Margeretrc

    I rarely consume sugar or starch in any form, so others are getting my share. As Peggy Holloway states, once in the body, starch is sugar, too. However, sugars in the form of sucrose and HFCS, supply not only glucose, but fructose, a particularly insidious kind of sugar, by all reports and the science on that is getting stronger and stronger, and we should only be getting that in moderate amounts of whole fruit. Sadly, we don’t. Even foods deemed “healthy” by the experts–100% fruit juice, for example–are sources of an unhealthy amount of fructose (and glucose.) And it is pretty much omnipresent in processed foods as part of the added sugar. So I have no problem believing either the CDC data nor that it certainly contributes to weight gain and health problems. But people have to get the energy they need from somewhere and as long as fat continues to be vilified, people will eat more than they should of the only other source of efficient energy there is in the food supply. Thank goodness Harvard Health has recently come out with the recommendation that we need to stop glorifying low fat diets and start talking about the problems with a diet high in carbohydrates that results from a diet low in fat! Definitely a step in the right direction.

  • Sara

    Thanks for this post. I’ve been following the sugar debate with much interest lately. I see myself as a sugar addict. I tend to eat sweets as a reward, to perk myself up when I’m tired, to celebrate birthdays and other occasions, to relax at the end of the day, to socialize with family and friends… Sugar is just such a part of our current American culture. In addition, I have found myself eating more sugar-enhanced foods like granola bars (supposedly healthy, right?) and flavored yogurts.

    About a month ago, I decided to go cold turkey on added sugars. It was tough at first, but now I find I don’t miss it so much. I am forced to eat less processed food, and I have rediscovered the natural sweetness of things like fruit. I don’t know that I will never eat sugar again, but if and when I do go back to eating it, I hope it will be in more moderation.

  • The Sugar Association exists for one purpose: to sell sugar. They will attack anyone who is perceived as harming their livelihood. We evolved on a low-sugar diet. Clearly something is out of whack with our modern diet and sedentary lifestyle, and consuming too much sugar is a probable culprit among a few others (processed food, sitting on our butts…).

  • Cathy Richards

    The IOM is crazy to say that added sugars can be up to 25% of calories. Yeah maybe if you’re a triathlete. Even so, that’s a lot of calories coming from something that contributes no benefit to the body other than fuel.

    Even the WHO recommendation re: max 10% of calories from added sugar is pretty high, and they actually unsweetened fruit juice in their ‘added sugar’ list.

    The nutrient deficiency implications, and metabolic syndrome consequences from reduced duration of satiety and subsequent overeating are significant.

    The dental implications are HUGE — not just because of the sugar content, but because most added sugars come in the form of recappable bottled drinks that people sip over time rather than consuming in a few minutes, increasing the duration of dental exposure to the sugars and reducing the pH rebalancing and remineralizing effect of saliva (which requires at least 1 full hour to have any effect). Further, most of the bottled drinks contain acids (added or ‘natural’) which make the dental enamel more susceptible to demineralization and plaque related decay.

  • I agree that from a public health perspective sugar is an issue and will need to be addressed. I’m guessing a tobacco like approach, tax for the products with added sugar and warning labels on items that have added sugar.

    I find it a little ironic that there is this talk about sugar and yet we have States passing laws to allow the sale of raw milk.

  • Michael

    I agree with the thrust of your argument here, Marion, and certainly think that getting a quarter of one’s energy from sugar is crazy. However, I think your back-of-the-envelope calculation suggesting that Americans get 22% of total energy intake from sugars is unreasonable. You start off from saying “Sugars comprise 17% of total calorie availability.” This suggests that, with the limitations of food disappearance data, sugars in fact comprise about 17% of energy intake! To convert this into Calories of sugar and then cram the *same* amount of energy into a 2000 Calorie diet — which as you yourself have patiently explained:

    … is in no way representative of what typical Americans actually eat, is really a tortured exercise that can’t clarify the debate. Either use the 17% number (which, to be clear, I agree is still to high!), or go after better data; eg, the National Cancer Institute’s “Usual Dietary Intake” analysis:

    … suggests average intake of 22.5 teaspoons/d’ at 16.3 Cal/tsp, that’s 366.75 Calories; I can’t find their (2001-04) estimate for total energy intake, but CDC says that in 1999, average “Males consume 2,475 calories daily and females consume 1,833 calories”

    … so that’s 2154 Calories. Crunching the numbers, surprisingly, that comes out remarkably close to the food disappearnce data:17% of energy.

    Again, still too much — but not 22%.

  • Anthro

    I’ve done just fine on a well-balanced diet that includes carbs and fats (and even a bit of sugar here and there), but is certainly low fat. The Margarets/Peggys go on and on with their fat crusade while blatantly ignoring every word of the author of this blog. It’s the CALORIES–from whatever source. And of course they should come from whole foods, not refined sugars.

    If you eat the right amount of calories for your needs, it matters little what the source of those calories is in terms of weight gain. If you want to be slim AND healthy, you should eat from all food groups, emphasizing veggies and fruits.

    We are all still waiting for Margaret to disclose her qualifications for arguing against Marion’s public health recommendations. Cherry-picking studies doesn’t count, Margaret.

  • Nads

    I always love how sugar is referred to as a food group. Even if it was just empty calories, up to 400 cals or even more a day of a nutrient deficient “food” is such a waste. I used to be an obese food addict and my diet was atrocious. I used to eat twice as much as I should have and at least half was sugary foods. Considering all the other processed junk there is in the average western diet, it’s a wonder we meet the rdi of anything. But worse still, now we know it’s not that sugar is just empty calories. It’s the cause of heart disease and some liver disease, and possibly dementia, depression and even contributing to cancer levels. Not sure how much longer it can be ignored.

  • mister worms

    Is tooth decay any less of a problem than obesity? It’s completely preventable yet it’s reach is so widespread that we take the caries disease process as inevitable.

    Tooth decay has been a destructive force in my life and even though I don’t use added sugars now and restrict fermentable carbohydrates to be free of the disease, its after effects are expensive, a big source of stress and an ongoing financial burden.

    I’d urge parents to take tooth decay very seriously and know that it’s possible to take control of the disease.

  • Pingback: Not Food Products, but Food; Not Water Products, but Water | The Holistic Dentist()

  • NYVegan

    It appears that Mr. Tennenbaum, who represents the Sugar Association, is accustomed to sending out threats of legal action to anyone who critiques sugar. See: (search for “sugar”), and you’ll see a snippet of a letter sent to another author, and it sounds (almost?) identical to the one he sent you.

    Interestingly, Mr. Tennenbaum lists many clients on his website, but the Sugar Association is not listed there. If he still represents them, I can understand how he’d be embarrassed to publicize that fact.

  • Peggy Holloway

    I eat no sugar. And very little that metabolizes as glucose or contains other “natural” sugars. I am on a ketogenic diet and it is truly phenomenal. I just logged my 3000 cycling mile for the summer and 2 weeks completed a century ride in heat, wind, and hills. My partner, a retired physician who is sold on HFLC, also completed the 100 mile bike ride and we both still had plenty of energy by the end of the day and neither had eaten or drunk anything all day except water. He is 71 and I am 60.