WHILE excess fat and salt are well-known dietary villains, especially when it comes to heart health, mounting evidence suggests that a sugar-laden diet may raise your risk of dying of heart disease - even if you aren’t overweight, says the June 2014 issue of the Harvard Medical School Harvard Heart Letter.

“Currently, our dietary guidelines include recommendations for fat and salt but not for sugar,” says Dr. Teresa Fung, adjunct professor of nutrition at the Harvard School of Public Health.

She supports the American Heart Association’s recommendation that women consume less than 100 calories of added sugar per day (the equivalent of 25 grams or 6 teaspoons) and men consume less than 150 per day (about 37.5 grams or 9 teaspoons).

The federal Dietary Guidelines Advisory Committee is considering issuing a new limit for sugar in its 2015 recommendations, says Dr. Fung.

“Added sugar” means not just the sugar you spoon into beverages and onto food but also the sugar that’s added to many processed foods, as well as sugars found naturally in foods, like fructose in fruit and lactose in milk.

Sugar-sweetened beverages such as sodas, energy drinks and sports drinks are by far the biggest sources of added sugar in the average American’s diet - they account for more than one-third of the added sugar we consume as a nation.

Other important sources include cookies, cakes, pastries and similar treats; fruit drinks, ice cream, frozen yogurt and the like; candy; and ready-to-eat cereal.

Although added sugars make up at least 10 percent of the calories the average American eats in a day, about one person in 10 gets a whopping one-quarter or more of calories, according to a study published in JAMA Internal Medicine - Over the course of the 15-year study, participants who took in 25 percent or more of their daily calories as sugar were more than twice as likely to die from heart disease than those whose diets included less than 10 percent added sugar.

Over all, the odds of dying from heart disease rose in tandem with the percentage of sugar in the diet - regardless of a person’s age, sex, physical activity level, or body mass index (a measure of weight that accounts for height), adds the health letter.

While the exact mechanism of how excess sugar might harm the heart is unclear, earlier research has shown certain factors to contribute to heart disease risk:

• Drinking sugar-sweetened beverages can raise blood pressure

• A high-sugar diet may stimulate the liver to dump more fats into the bloodstream - sugar is a carbohydrate which can increase triglyceride levels in the blood, and triglycerides are fat, which can end up in the arteries

• High sugar intake has been linked to lowered HDL (good) cholesterol levels

• Excess sugar contributes to weight gain

• Too much extra sugar could cut your lifetime short by increasing your risk for type 2 diabetes

• Sugar delivers “empty calories” - calories unaccompanied by fiber, vitamins, minerals and other nutrients

• Too much added sugar often crowds out healthier foods from a person’s diet

“Regardless of their Healthy Eating Index scores, people who ate more sugar still had higher cardiovascular mortality,” says Dr. Fung.

This proves that the excess added sugar is the real culprit in raising an individual’s cardiovascular risk.

The following sugar labeling terms may help you determine how sweet a food item is:

• Sugar-free - Means less than 0.5 grams of sugar per serving

• Reduced sugar or less sugar -  At least 25 percent less sugar per serving compared with a standard serving of the traditional variety of the food

• No added sugar or without added sugar - No sugars or sugar-containing ingredients added during processing

• Low sugar - Not defined or allowed on food labels

A few self-help strategies are offered to aid in cutting sugar from your diet:

• Focus on natural foods, including fresh fruit, to satisfy your sweet tooth

• Look for lower-sugar versions of processed food

• Try to curb a soda habit - Mix a little fruit juice with seltzer water as a replacement

• Make your own iced tea and add a small amount of sweetener to it, instead of buying the sugary version

• Cook your own meals to make sure you don’t get any sweet surprises in your food

• Get plain yogurt and add a little bit of fruit to it for sweetness, instead of buying the pre-sweetened variety

• When buying packaged foods, compare the labels of different brands and purchase the one with the least amount of sugar

• Be on the lookout for sugar that goes by other names - like high-fructose corn syrup, molasses, honey, fruit juice concentrate and cane sugar. “When it comes to added sugar, whether it’s natural or not natural, nutritionally, it does not make a difference,” Dr. Fung says.

• Finally, be mindful of products where you wouldn’t necessarily expect to find sugar - like ketchup, barbecue sauce and tomato sauce, all of which can be loaded with it, concludes Dr. Fung.

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