A familiar mid-afternoon craving strikes. You wander down to the self-serve fro-yo shop and consider the day’s selection: non-fat, low-fat, sugar-free, dairy-free sorbet. Your hand vacillates among the levers—what’s the heart-healthy choice again? It’s no wonder you’re confused. For years, the wisdom was that fat and cholesterol were to be avoided at all costs. But now evidence from a study published this year in JAMA Internal Medicine suggests that a diet high in sugar increases the risk of heart disease even in people who are not overweight. That sweet tooth is starting to look a lot more like an Achilles heel.
But surely the Zumba-loving, farmer’s-market-frequenting, non-smokers among us who enjoy a daily can of regular soda are safe, right? Not so, according to the research, which found that a person’s risk of dying from heart disease increased in direct correlation to the amount of sugar consumed, regardless of age, sex, physical activity, healthiness of the rest of his or her diet, or body mass index.
For many of us, heart disease still conjures images of a rotund middle-aged man going to town on a New York strip. Yet coronary heart disease is the number one cause of death for both men and women in the United States. According to the Heart Foundation, 435,000 American women suffer heart attacks each year; 35,000 are under 55. Under the age of 50, a woman’s heart attack is twice as likely as a man’s to be fatal.
Dr. Francisco Lopez-Jimenez, director of preventive cardiology at Mayo Clinic, isn’t surprised by the study linking sugar to heart disease: “Unfortunately, for decades the focus has been on fat and sodium, and sugar hasn’t gotten a lot of attention,” he says. “But many physicians have suspected the link for years.”
The precise mechanisms of how sugar impacts heart health are still unclear, but research has linked sugar consumption with both increased blood pressure and fatty liver disease (in which the liver dumps harmful fats into the bloodstream, leading to buildups of cholesterol-filled plaque in the arteries).
Many patients have been lulled into believing that if they’re not obese, they have nothing to worry about. Lopez-Jimenez explains that high blood pressure, high insulin, and diabetes—all promoted by excess sugar consumption—are major risk factors for heart disease, even in the absence of a weight problem. “The pancreas responds to sugar consumption by dumping a load of insulin into the bloodstream,” he adds. “Even in non-diabetics, these surges in insulin and glucose negatively impact the arteries over time.”
Sugar lurks in the American diet in often-unexpected amounts—and it’s measured in less-relatable quantities. “People have a hard time thinking in terms of grams,” says Lopez-Jimenez, “but when you translate the sugar content into teaspoons, they can visualize it. You’d think it was crazy if you saw someone putting seven or eight teaspoons of sugar in their coffee, but that’s what people consume when they have a frappuccino or a sports drink.”
The World Health Organization recently revised its dietary guidelines to state that sugar should comprise no more than 5 percent of adults’ daily caloric intake. For the average person, that translates to 25 grams (or six teaspoons) a day—less than the amount in a single can of Coke.
This new focus on sugar doesn’t mean we can throw out the old recommendations to cut back on saturated fat and cholesterol, says Lopez-Jimenez. Instead, it seems the list of risk factors for heart disease is just getting longer.
So if Lopez-Jimenez were at that fro-yo shop, which lever would he advise you to pull? Whichever one you want, with one caveat: “More important than which lever you pull is how many seconds you pull it, and how often,” he says. “Dessert portions should be no bigger than your palm. Then whatever it is you’re getting, you’re getting it in a reasonable amount.”