Health experts have been nudging Americans to kick the sugar habit for years, and now it’s official: The Food and Drug Administration is recommending a daily cap on sugar for the first time.
The goal is for Americans to limit added sugar to no more than 10 percent of daily calories, according to the proposed guidelines. For someone older than 3, that means eating no more than 12.5 teaspoons, or 50 grams, of it a day.
That’s about the same amount of sugar found in a can of Coke, but for most people, giving up sugary soft drinks will not be enough to meet the recommendations. Caloric sweeteners like sugar, honey and high-fructose corn syrup are found in obvious places like sodas, cookies and candy — but they are also lurking in foods with health appeal, like low-fat yogurt, granola and wholegrain breads, as well as in ketchup, pasta sauce, canned fruit and prepared soups, salad dressings and marinades.
“There is a lot of hidden sugar in our food supply, and it’s not just in sweets,” said Dr. Frank Hu, a member of the Dietary Guidelines Advisory Committee and a professor of nutrition and epidemiology at Harvard.
Currently, nutrition labels on food packaging reveal only the total amount of sugar in a product. The F.D.A. has said it wants to change the labels to help consumers distinguish between the amount of naturally occurring sugar and the amount of added sugar.
“When you see a yogurt with pictures of blueberries and strawberries on the label — right now there could be a teeny tiny amount of real fruit in there and an awful lot of added sugar, or lots of fruit and dairy and little added sugar, and the consumer cannot distinguish between the two,” said Susan Mayne, the director of the Center for Food Safety and Applied Nutrition at the F.D.A.
Critics from the food industry have balked at the sugar cap and the new label requirements, saying the new labels will only confuse shoppers. A study published in The Journal of the Academy of Nutrition and Dietetics in June found that people overestimated the amount of sugar in products that listed “added sugars,” and were less likely to buy them.
“Metabolically speaking, our bodies don’t differentiate between added and natural sugars,” said Kris Sollid, a dietitian who is one of the study’s authors and director of nutrients communications for the International Food Information Council, which receives funding from food and beverage companies including Coca-Cola and PepsiCo.
If people are watching their weight, he said, “it’s more important to look at total calories.”
Dietitians agree that knowing total calories is important, but note that added sugars represent empty calories, devoid of nutrients. While milk and fruit contain natural sugars, they are nutrient-dense foods that provide calcium, protein, vitamins or dietary fiber.
The World Health Organization endorses a 10 percent cap on sugars, excluding those in fresh fruits, vegetables and milk, and urges people to aim even lower, limiting sugars to 5 percent of caloric intake to derive greater health benefits.
The American Heart Association also recommends stricter sugar limits, saying women should consume only about 100 calories a day in added sugars — about six teaspoons — and men no more than 150 calories, or nine teaspoons. The F.D.A. is recommending that children 1 to 3 should not consume more than 25 grams of added sugar a day.
Nearly half of the added sugar consumed in the United States comes from sweetened drinks, much of it in soft drinks, but also in sweetened tea and coffee, fruit drinks and sports drinks, according to analyses from the National Health and Nutrition Examination Surveys.
The 10 percent cap was derived from modeling different kinds of healthy diet patterns — American, Mediterranean and vegetarian — and determining how many discretionary calories are left over for sugar after an individual ge the nutrients he or she needs, said Dr. Susan Krebs-Smith,, the chief of the risk factors assessment branch at the National Cancer Institute.
“When all that’s taken into consideration, there’s a very small allowance for discretionary calories, or what some people call ‘empty calories,’” Dr. Krebs-Smith said.
She compared the new sugar recommendations to living on a budget. “If we were advising the public on how to spend their money,” she said, “we wouldn’t have trouble telling them to focus on spending on essentials like food, shelter and clothing.”
Sugar makes up about 13.5 percent of Americans’ caloric intake, so public health experts think the goal of 10 percent is attainable. But that’s an average figure: Younger people, blacks and the poor tend to consume higher amounts of sugar and would need to make deeper cuts to reach the goal.
Children and teenagers over all get 16 percent of their calories from sugar, a figure that drops to 14 percent of calories for adults aged 20 to 39, with further drops as people age, according to data from the Centers for Disease Control and Prevention.
While dietary guidelines have been encouraging people to cut back on sugar for decades, the focus has largely been on preventing weight gain. But new research suggests a high-sugar diet may have metabolic effects, separate from weight gain, that promote chronic disease by causing inflammation, insulin resistance and hypertension.
Most recently, sugar in the diet has also been implicated in cardiovascular disease deaths: A large study led by Dr. Hu reported last year that adults who had the highest intake of sugar — consuming 25 percent of daily calories as sugar — were nearly three times more likely to die of heart disease over a 14-year period, compared with those whose sugar intake was less than 10 percent of calories.
Several recent randomized clinical trials have shown that getting children to cut back on sugar-sweetened beverages alone can slow weight gain and fat accumulation. Many experts are convinced that the brain doesn’t register liquid calories the same way it registers calories in food. “Even after consuming 200 or 300 calories from soda,” Dr. Hu said, “you don’t feel satisfied, or full.”
But even enthusiastic supporters of the new rules worry that a cap on sugar could boomerang. Sugar is often used to make reduced-fat dairy and high-fiber grains more palatable, so what would happen if people eliminated sugar from their diet?
In the 1970s, doctors and nutrition experts began advocating low-fat diets for heart health, leading to a proliferation of low-fat and fat-free products that were high in sugar. When low-carb diets became a fad, food makers responded with low-carb pastas and low-carb brownies that were loaded with fat and calories.
“We call this the unanticipated consequences,” said Alice H. Lichtenstein, a professor of nutrition science at Tufts University who serves on the dietary guidelines committee. “Every time we focus on just one component of the diet, we get in these crazy situations.”
