Be Healthy - Sugar-sweetened Beverages

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VOL. 6 • NO. 1

© September 2011

SUGAR-SWEETENED BEVERAGES Taste so good, but are oh sooo bad Vanessa Martin does not mince words. That’s understandable — it comes with the territory. Martin is a union president at Boston Medical Center and the mother of a 2-year-old boy.

Always in a rush, she readily admits that she rarely paid attention to what she was drinking. Convenience outweighed health — and her decisions at vending machines were starting to have deadly consequences. “Instead of drinking water, I drank a lot of soda,” she said.

And they began to add up — three 20-ounce sugared sodas a day and a few more at lunch and dinner. What she didn’t know is that five of her drinks amounted to 1,250 calories — the total amount of calories some people consume in a day. What’s worse is that it was more than 12 times the maximum amount of added sugars the American Heart Association recommends for women each day.

Ultimately she paid the price.

At her physical last July, she learned that her blood pressure was elevated, her total cholesterol exceeded the normal limit and her body mass index was moving in the wrong direction. But the reading that got the most attention was her glucose level.

“Diabetes runs in my family,” she explained. The fact that she was now borderline diabetic was a jolt. “That scared me,” she said. “It was like being told I had cancer.”

According to Martin, the only behavior she had changed in the past year was her excessive intake of sugar-sweetened beverages (SSBs). She ate the same amount and type of food and did not increase or decrease her physical activity. “I did not know that sodas contained that much sugar,” she admitted. “It doesn’t register in your head that it [sugared soda] contributes to weight.”

It’s everywhere — in sodas, sports drinks, energy and juice drinks and ready-to-drink teas and coffees. It has sneaked into salad dressings, yogurts, peanut butter, cereals, jams and even cough syrup.

The “it” is high fructose corn syrup (HFCS). Developed by two scientists in the late 1950s, HFCS is the result of a process that changes corn syrup — a liquid sweetener used in toppings and baking — from one type of sugar (glucose) to another type of sugar (fructose). HFCS is much sweeter than table sugar, is cheaper to produce and has a longer shelf life. It can also be mixed

According to the American Heart Association, regular soft drinks — at 33 percent — are the major source of added sugars in the American diet. Fruit drinks account for an additional 10 percent. Consumption of sugar-sweetened beverages is highest among male teens. (Photo courtesy of Boston Public Health Commission)

with just about anything.

But it’s the SSBs that cause more concern. On an average day, 63 percent of adults and 80 percent of youths drink SSBs. While years ago colas and pops were the rage, now several other SSBs have entered the market, many of which tout themselves as healthy.

Vitamin waters claim to be packed full of vitamins, but the label indicates that the second and third ingredients are sugar. Fruit drinks imply one is drinking fruit juice, and you may be — in forms of juice concentrate, which is sugar. “Sports” drinks were specifically designed to replenish electrolytes lost in sweat after fierce competition. They hydrated “athletes” while giving a quick boost to energy. But now people use them to quench their thirst

after just mild activity or no activity at all. The problem is that a major ingredient is sugar.

Evidently, some students believe the hype that sports drinks are a healthier substitute. Researchers from the University of Texas Health Science Center found that students in grades 8 and 11 in Texas who ate fruits and vegetables and engaged in physical activity drank sports drinks rather than sodas for good health. More than one fourth of the students queried said that they consumed three or more of these “healthy” SSBs a day.

As production of HFCS — and the SSBs — burgeoned something else began to burgeon at about the same time. According to the Centers for Disease Control and Prevention Martin, continued to page 4

Water: It’s the real thing

Carollynn Porter (right) and her 11-year-old daughter, Lynn-Tyia, have switched from sugary to more healthy beverages to help control their weight and improve their health. (Ernesto Arroyo photo)

Vivien Morris has one word for all those addicted to sugar-sweetened beverages (SSBs) — water.

As director of Community Initiatives Nutrition and Fitness for Life Program at Boston Medical Center, she said she understands people’s taste for sweet things. It starts very young. “Newborns like breast milk because it’s sweet,” she explained. “But we learn other tastes and enjoy them as well. Everything does not have to be sweet.”

It’s hard to convince kids of that sometimes. They are being programmed at a young age. Marketers target their message to youth, and they listen. Morris is convinced that the uptick in childhood obesity is linked to the uptick in consumption and availability of SSBs. But she is more concerned about what will happen to these kids down the road. The jury is still out on what life holds for people who get type 2 diabetes at a young age.

Typically, diabetes is a disease of older people.

When the complications of the disease — blindness, amputation, kidney failure — surface years later, the victims are in the twilight of their years. “What will happen 20 years from now with kids who have been diagnosed with diabetes? They will still be in the prime of their lives,” she questioned.

Morris recognizes that minority communities are often targeted by marketers of SSBs. “They’re

cheap,” she explained. “Especially if you get an off-brand. Corner stores sell them in brightly colored containers that attract children.”

Carollynn Porter, 33, readily admits that she was partly to blame for all the sodas and other SSBs her 11-year-old daughter, Lynn-Tyia, was drinking. “I drank sodas, sweet teas, lemonade, fruit drinks — anything I could find,” she confessed.

She could drink six to seven cans a day. A 2-liter bottle of soda was kid stuff. “To me I was addicted to cola,” she said. But she wasn’t the only one drinking all that sugar. Like mother like daughter, Lynn-Tyia was keeping pace. Lynn-Tyia’s reason for drinking so much SSBs was pretty straightforward. “I just like it,” she said.

But as both their weights started to increase, Porter said she realized that she had a problem. “I really didn’t see it at first,” Porter admitted, especially since Lynn-Tyia used to be a skinny kid. “I was blind-sided.”

She said she realized in order to help her daughter she had to make changes in her life first. “It’s on me,” she confessed. And change she did. Out went the SSBs. “We drink flavored sparkling water now or just plain water,” she said. Sugary sodas have been replaced with diet sodas.

Lynn-Tyia, a fifth grader at Boston Renaissance Morris, continued to page 4

SKIPPING SUGAR-SWEETENED BEVERAGES This summer, a national health study ranked Massachusetts fourth among states with the lowest rates of obesity.

Zooming in more closely, though, the picture looks less rosy. More than half of Boston adults — and nearly 44 percent of Boston public school students — are overweight or obese, according to the Boston Public Health Commission.

Black and Latino residents are almost twice as likely to struggle with obesity as white residents, and sugary drinks are part of the problem. Skipping them could help whittle down waistlines while improving health.

What is sugar?

Sugar is a sweetener derived from plants that the body converts easily to fuel. The sweet, white crystals of table sugar made from cane or beets are one easily recognized form of it.

“Often, people don’t realize they’re consuming sugar because it goes by many other names,” said Dr. Jan Cook, medical director of Blue Cross Blue Shield of Massachu-

setts. “Checking ingredients listed on food labels helps.

High fructose corn syrup, honey, concentrated fruit juice and cane juice, are forms of sugar often used as added sweeteners. Also look for ingredients that end in ‘ose,’ such as sucrose (table sugar), fructose (fruit sugar), dextrose (another name for glucose, the sugar that circulates in blood to deliver energy to cells), maltose (malt sugar) and lactose (milk sugar).”

What is a sugar-sweetened beverage?

The Boston Public Health Commission defines it as a drink that has any kind of caloric sweetener added to it.

Most sugar-sweetened drinks have little or no nutritional value. Some examples are sodas and other carbonated soft drinks; energy or sports drinks; fruit drinks and fruit punches; sweetened coffee and tea drinks and sweetened milk and milk alternatives like chocolate milk or vanilla soy milk.

Sweet drinks rarely make you feel full, so you probably won’t eat less than usual to compensate for the extra calories you’ve sipped. This can quickly add up. According to the Harvard School of Public Health, a can of soda averages 150 calories. Unless you eat less or exercise more to balance those calories, a single soda a day can pack 15 extra pounds onto your body per year. What’s more, studies show higher consumption of sugar-sweetened drinks raises risks for developing diabetes, heart disease, gout, tooth decay and other ailments.

Bigger gulps containing 20 ounces of soft drinks have closer to 250 calories and 16 teaspoons of sugar, notes the Boston Public Health Commission. That far exceeds the American Heart Association’s healthy eating guidelines, which recommend no more than 6 to 9 teaspoons per day of added sugars in foods and beverages.

You might find water a boring alternative, but spicing it up by adding crushed mint or lime, lemon or orange slices for flavor may change your mind. Other healthy choices are: • Unsweetened seltzer, available flavored or plain.

• Unsweetened coffee or tea, brewed hot or cold in caffeinated or caffeine-free versions. A wide variety of flavorful green teas and herbal teas exists. Adding cinnamon or a dash of vanilla extract may help satisfy a sweet-tooth.

• Unsweetened fat-free or low fat milk, which delivers added nutritional benefits of calcium, vitamin D and protein at 86 or 102 calories per cup, respectively.

Watch out for blended products labeled “100 percent fruit juice” that are sweetened with grape or pear juice or a concentrated fruit juice. These have little nutritional value. Fruit punch and juice drinks or cocktails may have added sugars like corn syrup that make them a poor choice, too. Reserve sports drinks intended for fueling athletes for tough workouts lasting 60 minutes or longer.

Which healthy drinks could I choose instead?

Reach for water first. Turning on the tap saves you money right away and may improve your health in the long run.

How can parents encourage children to drink healthy beverages?

TRY THESE TIPS FOR HEALTHY CHOICES: • Stock up. Keep cool water, flavored seltzers and unsweetened fat free or low fat milk in the fridge. (Note: the American Pediatrics Association recommends whole milk products for most children younger than 2. At that age, fat is important for energy and healthy growth.)

• Shop wisely. Cross soda, sweetened milk, energy drinks and sports drinks off the family grocery list (see “Strike a bargain,” below). Encourage children to read food labels with you and make smart choices. When buying juice, for example, check ingredients on food labels for added sweeteners. Pure apple, orange or vegetable juice is a healthy choice in small amounts (4 to 6 ounces or less per day, say nutrition experts at Harvard School of Public Health. Better still, eat the fruits and vegetables, which have fiber and other nutrients).

• Try spritzers. Let children mix plain or flavored seltzers with a splash of juice. Add a squeeze of lemon or lime, if you like.

• Fill ‘er up. Reach for refillable water bottles rather than juice boxes or sodas. Straws and popular characters can make these especially appealing to younger children.

• Be a good model. Put a pitcher of ice water on the table at meals. If you drink it yourself, children are more likely to follow suit.

• Check school beverage options. Encourage schools to make sure water fountains work and allow students to carry refillable water bottles.

• Strike a bargain. Put money saved by not buying sugary drinks into a jar. Agree on a fun way to spend the sweet savings.

SUGAR-FREE DIET DRINKS Sugar-free diet drinks promise all the sweetness at few — or zero — calories. Sounds like a win-win, right? Not quite. Artificially sweetened drinks may condition taste buds to crave sweet foods, warn experts at Harvard School of Public Health. That cycle is hard to break. Just as with any high-calorie food, skip these drinks or make them an occasional treat.

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Questions & Answers 1. If the body requires sugar for energy, why are added sugars found in beverages considered harmful to a person’s health?

Carbohydrates provide the body with the fuel it needs for physical activity and for proper organ function. Carbohydrates are sometimes Kathy Cunningham, M.Ed, R.D., L.D.N. grouped into two main Sr. Program Manager and Dietitian groups. Complex carboBoston Public Health Commission hydrates, such as fruits, vegetables and whole grains, are the best sources of carbohydrates and contain vitamins, minerals and fiber. Simple carbohydrates, on the other hand, such as corn or table sugar, are known as refined — or less healthy — sugars. After digestion all carbohydrates are broken down to glucose (also known as blood sugar) that the body uses for energy and fuel. The human body can produce all the glucose it needs from complex carbohydrates. Refined sugars add no nutritional value to the body.

2. Is honey a healthier alternative to table sugar?

Not really. Honey and table sugar are actually very similar.

They both contain glucose and fructose, two types of sugars.

However, they differ in structure and the number of calories. One teaspoon of table sugar contains 16 calories while a teaspoon of natural sweetener honey has 22 calories. All sweeteners in the diet should be limited.

3. Why is the consumption of sugar-sweetened beverages (SSBs) higher in African Americans?

The personal and environmental factors that influence SSB consumption is complex. Heavier advertising and marketing of SSBs to black Americans is strongly seen as one environmental influence. Several reports suggest that the marketing of SSBs by the beverage industry is disproportionally higher in black communities than in white communities, which may encourage and account for higher levels of SSB consumption among African Americans.

A CLOSER

LOOK Often people do not realize they are consuming so much sugar because the sweetener goes by many different names.

One hint — words ending in “ose,” such as sucrose, glucose and fructose are all sugars.

Because this is a juice drink people assume it is healthy. It does contain some juice, but most of the sugars are added, not natural. Learn to read between the lines. While the first ingredient is water, the next five are sugars, but the word “sugar” is listed only once.

One serving (one cup) of this fruit drink contains 120 calories and 31 grams or almost 8 teaspoons of sugar, exceeding the American Heart Association’s recommended daily limit of added sugars. One teaspoon of sugar has about 4 grams of sugar and 16 calories.

SPOT

White Cranberry and Peach Juice Drink 23% Juice

Nutrition Facts Serving Size 1 cup (240 ml) Servings Per Container 1 Amount Per Serving Calories 120

Calories from Fat 0 % Daily Value

Total Fat 0g

0%

Sodium 35mg

1%

Potassium 30mg

1%

Total Carbohydrate 31g

10%

Sugars 31g Protein 0g Vitamin C

100%

Ingredients: Filtered Water, White Cranberry Juice from Concentrate, High Fructose Corn Syrup, Peach Juice from Concentrate, White Grape Juice from Concentrate, Sugar, Natural Flavors, Ascorbic Acid (Vitamin C), Citric Acid, Canthaxanthin (color)

THE ADDED SUGARS

• Brown sugar • Cane sugar • Corn sweetener • Corn syrup • Evaporated cane juice • Fruit juice concentrates

• High-fructose corn syrup • Honey • Maple syrup • Molasses • Raw sugar • Syrup

For a more complete list, visit http://www.health.gov/DietaryGuidelines/dga2005/document/html/chapter7.htm.

4. Are SSBs more harmful to the health of children than to adults?

Over the past 30 years, children and adolescents in the U.S — especially black and Mexican American youth — have sharply increased their consumption of SSBs. Such consumption has been linked to less healthy diets and negative health outcomes, such as overweight and obesity and type 2 diabetes. This form of diabetes was at one time called adult onset diabetes; however, now children are being diagnosed at earlier ages. Drinking SSBs displaces intake of healthier beverages, such as low-fat milk and water which also leads to decreased bone density, dental decay, headaches, anxiety and lack of sleep that effect healthy growth and development of young children.

5. Is juice a healthy substitute for SSBs? People should not drink more than one small serving of 100 percent fruit juice per day, which is 4 ounces for children and 6 ounces for adolescents and adults. Fruit juice has a high concentration of sugar and calories and lacks some of the nutrients and other benefits of whole fruit. It is best to offer children fresh fruit or canned fruit without sugar added. When children do drink juice it should be 100 percent juice and not sugar-sweetened juice drinks.

6. Is there a link between SSBs and high blood pressure?

Research has shown that people who drink a lot of SSBs have less healthy diets. They are consuming empty calories without the nutritional benefits of real food. People are consuming more unhealthy sodium and less healthy potassium, magnesium and calcium, which combined contribute to higher blood pressure levels.

7. If the label on a drink indicates that it does not contain high fructose corn syrup, does that mean it contains no sugar and is healthier to drink?

Limiting foods and beverages with high fructose corn syrup (HFCS) is a good idea; however, it is important to limit all added sugars. HFCS in beverage products typically contains more fructose than other added sugars. Research is finding that fructose is metabolized differently from other sugars. It is broken down in the liver and changes to triglycerides (fat) and is sent to the bloodstream causing a rise in blood triglycerides and an increase in the risk for diabetes and heart disease. While some products may not contain HFCS, it is important to read the ingredient labels and identify other sugars or artificial sugars that should be limited. Ingredients are listed on the label in order of descending abundance, so if any sugar or artificial sweetener appears near the beginning of the list you know there is a lot present and should be consumed rarely if at all.

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician.

We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

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Martin, continued from page 1 (CDC), between 1960 and 1962, roughly 31 percent of U.S. adults aged 20 to 74 were overweight, 13 percent were obese and less than 1 percent was extremely obese.

In the late 1970s when HFCS was entering the market, obesity increased 11 percent, but extreme obesity rose almost 56 percent.

The numbers have soared from there. By 2007 and 2008, obesity rates had more than doubled and extreme obesity rates increased almost six fold. Boston is not exempt. In 2008, 54 percent of Boston adults were overweight or obese.

Health experts point a guilty finger at SSBs for the rise in obesity and the medical conditions that surface in its wake. Several studies have shown a correlation between a high intake of SSBs and diabetes, high blood pressure, tooth decay, cardiovascular disease and metabolic syndrome, a triad of symptoms which may include high blood pressure, low “good” cholesterol, increased waist size, high triglycerides (fat in the blood) and insulin resistance. SSBs have even been found to increase the incidence of gout, a

contains almost 17 teaspoons of sugar.

Increased consumption of SSBs has taken a toll on African Americans. Studies have shown that blacks consume more SSBs — and at a younger age — than other groups. And pay the penalty. Healthy Boston 2010, a report published by the Boston Public Health Commission, noted that almost one-third of blacks and Latinos in Boston are obese compared to 17 percent of white residents. Blacks and Latinos have rates of diabetes that are three and two times higher, respectively, than whites.

Undoubtedly, other factors contribute to the rise in obesity. People eat more of the wrong foods and exercise less. But it’s the perception of beverages that makes the difference. Consumers know that eating too much food can lead to weight gain, but tend to ignore the consequences of what they drink. It’s as though what one imbibes does not count, especially given the fact that SSBs are not as filling or satisfying as solid foods. But when the consumption of SSBs escalates without a reduction in food and an increase in physical activity, the results will eventually show themselves — literally.

The City of Boston has banned sugary beverages from city-owned property and citymanaged food and beverage programs. Only healthier drinks, such as low-calorie beverages, 100 percent juices, water and seltzers will be allowed.

Vivien Morris (center), a dietitian at Boston Medical Center, offers infused, or naturally-flavored water, to Alan Aikens at BMC’s farmers’ market. On her left is Beza Alayew, an intern from Boston University’s School of Public Health. (Yawu Miller photo)

type of arthritis that causes inflammation and pain in the big toe.

And it does not take much to wreak havoc. Scientists from Harvard School of Public Health found that drinking two sugary drinks a day increases the risk of type 2 diabetes by 26 percent and metabolic syndrome by 20 percent. Even one drink a day increases the risk of diabetes by 15 percent.

It’s not that sugar in itself is bad for you.

Quite the contrary. The body needs sugar for energy. Without it, the body shuts down. But it is possible to get the required amount of sugar by eating a well-balanced diet. Natural sugar is abundant in fruit, vegetables, milk and whole grains. It’s the added sugar of any kind — HFCS, table sugar and honey, for example — that causes the problem.

There is no nutritional value in added sugars.

The American Heart Association recommends an upper limit of 6 teaspoons or 100 calories of added sugar each day for women and 9 teaspoons or 150 calories a day for men. But the most recent national survey conducted by the CDC found that 22 teaspoons of added sugar was more the norm. A 20-ounce bottle of soda alone

HOW

Martin learned her lesson. Her numbers were enough to scare her straight. When her research online confirmed the negative impact SSBs have on health, she went cold turkey — just like she did when she stopped smoking cigarettes several years ago.

“I won’t have soda in my house,” she said. She still admits to having a taste for sweet tea, but she mixes half a glass of the tea with half a glass of water. She’s even safeguarding her son from sugar’s impact. “I mix his apple juice with 50 percent water too,” she said.

Martin likened sugared beverages to drugs. “It’s like crack cocaine,” she said.

“They [beverage manufacturers] sell a 2-liter bottle for next to nothing, then jack up the price, and people still buy it. All they’re doing is making you an addict.”

It didn’t take long before Harris started changing her habit. Her new attitude worked.

At her next physical, her total cholesterol had plummeted and her BMI and glucose readings were on track.

“If I didn’t take control of myself now, I knew that eventually I would not have a choice,” she said. “I didn’t want to be dependent on anyone or anything.”

MUCH IS TOO MUCH?

The body requires glucose to provide energy to do its job. We can get that sugar naturally from fruits, vegetables, milk and whole grains, which are full of nutrients. Added sugars, on the other hand, are sugars and syrups added to foods during preparation or at the table. These added sugars bring with them sweetness and calories, but lack nutrition. The American Heart Association recommends a daily limit of added sugars according to the information below.

WOMEN’S DAILY LIMIT 6 teaspoons = 100 Calories = 25 grams

MEN’S DAILY LIMIT 9 teaspoons = 150 Calories = 37.5 grams

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WATER — ALL DRESSED UP Infused water is plain tap water flavored with fruits, vegetables or herbs, and is a healthy alternative for those who find the beverage bland.

CITRUS CUCUMBER WATER 1 large lemon, sliced 1 large orange, sliced 1 large cucumber, sliced 1 half gallon of water Place all sliced fruits and vegetables in a pitcher and add water. Refrigerate and allow the water to “infuse” for at least two hours. Pour over ice and enjoy.

Source: Boston Medical Center Nutrition and Fitness for Life Program

Morris, continued from page 1

Charter School, likes math and writing and plays a little tennis on the side. For her switching from SSBs was not a problem. The diet sodas she now drinks taste the same to her.

And she’s fond of almond milk.

But she admitted she did notice one change. As she grew heavier, she ran more slowly. As she switched to a healthier eating plan and less sugary beverages she made another discovery. “I can run a little faster now,” she said.

Excessive consumption of SSBs is easy to resolve — at least conceptually. There’s a drink that has stood the test of time. By all accounts, water is nature’s best beverage. More than that, just as the body requires energy, it also requires water to survive.

For some the gigantic leap from sugared sodas to water is too hard. Then baby steps will do. Diet sodas are not an optimal solution but are a good first step. If it’s the bubbly that tickles your fancy, flavored sparkling water or seltzer is a good substitute. If water is too bland for your taste, add some fruits, such as pineapple, watermelon or berries.

Public health officials have not stood idly by. SSBs were banned from vending machines in the Boston Public Schools in 2004. Apparently, it paid off. A recent study showed that two years following the

ban, Boston public high school students on average consumed a significantly lower amount of SBBs. Mayor Thomas M. Menino of Boston has gone one step further. As of October 2011, SSBs are banned from all city properties and functions, including vending machines and food and beverage services programs. A local hospital followed suit.

The Boston Public Health Commission is orchestrating the Sugar-Sweetened Beverage Initiative to increase public awareness of the connection between SSB consumption and obesity, while the Boston Medical Center (BMC) is promoting a similar program called the Sugar-Sweetened Beverage Task Force.

Morris is actively involved in the BMC task force. Don’t get her started on the benefits of eliminating SSBs. She has heard all the complaints before on why people don’t drink water. “It has no taste” is one. “I just don’t like it” is another. Some admit they never got in the habit. To those, Morris suggests, “try it.”

If people like more than the daily recommended serving of juice she recommends diluting half a glass of juice, with half a glass of water. “You don’t have to stop there,” she said.

“Once you adjust to that, you can dilute again.”

And she said she realizes that bottled water can be more expensive than cheap sodas.

But she is steadfast in her belief what should be the number one beverage in America.

Yup, water.

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.