Is Sugar the Only Thing to Limit in the American Diet?

Why We Should Take a Look at Our Diet as a Whole

Girl adding sugar to yogurt
Vera Lair/Stocksy United

These days, the harms of excessive sugar in our diets are getting a lot of attention. Those harms are real, and the attention warranted up to a point. What is not warranted are the claims that the harms of excess sugar are newly discovered, or have been concealed from the public. The very first Dietary Guidelines for Americans, all the way back in 1980, had seven key take-away points. Number five was to limit intake of sugar.

The tendency to invoke one scapegoat or silver bullet when it's the whole dietary pattern that matters is a classic example of missing the forest for the trees. Sugar is excessive in our diets; but it certainly is not the one thing wrong with prevailing eating patterns, nor do the harms of excess sugar exonerate refined starches, fatty and processed meats, excess sodium, or saturated fats.

Thoughtful commentary on sugar in the context of the whole diet is provided below. From my perspective, it lands right in the sweet spot, with a focus on wholesome foods, mostly plants, in sensible combinations as the best way to get nutrition right.

Andy Bellatti, MS, RD
Co-founder and Strategic Director of Dietitians for Professional Integrity

There are many reasons to limit our intake of added sugars (i.e. table sugar, agave, honey, maple syrup, etc.) and free sugars (i.e. fruit juice). An increasing body of research is connecting the dots between high intakes of these sugars and increased risks of—and worsening of—hypertension, cardiovascular disease, and type 2 diabetes.

Added and free sugars provide calories, but no nutrition. This is why you can drink a few hundred calories of soda—or eat a few hundred calories of candy—and still be hungry. Eating an orange is a much better choice than drinking orange juice because the juice is a concentrated source of sugar, while the whole fruit also provides fiber and more nutrients that offer various health benefits.

So, yes, it is definitely important to keep an eye on sugar intake. Several health organizations have set daily recommended limits. The American Heart Association recommends no more than 36 grams (9 teaspoons) for adult men and 24 grams (6 teaspoons) for adult women. The World Health Organization recommends capping added sugar intake at 10 percent of total calories, and states that five percent is even better. For someone eating 1,600 calories a day, 10 percent of total calories equals 40 grams (10 teaspoons) and five percent of total calories equals 20 grams (5 teaspoons).

The average American is getting roughly 88 grams of added sugar a day, so a general call to reduce intake is smart.

With all of that said, it is never wise to blame one food or nutrient for all of our public health ills. As important as limiting added sugar is, it is equally important to limit one's intake of red meat, processed meats, sodium, and refined grains (i.e. baked goods made with white flour).

One of the negative unintended consequences of focusing strictly on sugar is that, by default, unhealthy foods that don't contain added sugar (i.e. bacon, sausages, margarine) can be misconstrued as "healthy." Nutrition is about a food's total package.

Nacho cheese Doritos have 0 grams of sugar, but that does not make them a health food.

And, as important as limiting added sugar is, it is equally important to make sure that we eat 25 to 30 grams of fiber a day (the average American eats 14 grams). Fiber is exclusively found in whole, plant-based foods. Concerns about added sugar, as valid and science-based as they are, should not be mistaken as a green light to load up on steak, sausage, and ham.

Christopher Gardner, PhD
Professor of Medicine, Stanford University

If there is only one wrong thing about the American diet, then this might suggest everything else is right, or at least OK, which isn’t correct.

We cannot vindicate trans fats, sodium, saturated fat, processed meat, artificial dyes, and so on.

Were the question modified to ask if sugar is the most negative of the American diet, we could easily poke holes in that statement by finding individuals who do not overdo sugar intake, but still have an unhealthy diet.

I can certainly imagine that the simplicity of vilifying sugar and trying to avoid it could be helpful to some individuals. With the exception of natural sugars of fruits and vegetables, all of the foods that Americans eat with added sugars are hyper-palatable and ultra-processed foods, and most of those would fall into the categories of candy, junk foods, and fast foods. Those foods are also low in fiber, low in vegetables, and not plant-based whole foods.

My concern is that by focusing on what to vilify and avoid, rather than what to celebrate and include, many clever Americans will find a way to avoid sugars but choose another not-so-healthy replacement  (with the food industry’s help), and still manage to avoid fiber, vegetables, and a plant-based whole food diet.

Let’s focus on what Americans should eat more of—from a nutrient perspective, we should focus on fiber, from a food group perspective we should focus on vegetables, from a diet-pattern perspective, we should focus on a more plant-based whole food diet.

Joel Kahn, MD, FACC
Clinical Professor of Medicine (Cardiology), Wayne State University School of Medicine

Sugar is not the one and only thing wrong with the American diet, particularly amongst children. The habit of eating healthy meals has been all but lost. In a recent publication of the American Heart Association, the number of children who adhere to a healthy diet was recorded as under 1 percent! Yes, you read that right. Among adults it is a slightly higher but still miserable 1.5 percent.

The definition used as the healthy dietary pattern was not complete avoidance of all the 57 versions of sugar. Rather, the recommendations were far more balanced. The goals recorded in the AHA paper were to "consume ≥4.5 cups/day of fruits and vegetables, ≥2 servings/wk of fish, and ≥3 servings/day of whole grains and no more than 36 oz/wk of sugar-sweetened beverages and 1500 mg/d of sodium."

The public anxiety about the health consequences of dietary sugar are highlighted in two articles in the New York Times. In one, the author reports on the dozens of names for added and hidden sugars in food. In fact, there are 57 that we are advised to check for and avoid on labels. It would seem like a full time occupation, perhaps aided by a sugar-synonym smart phone app, to screen all product labels for these 57 versions. The article is without scientific references and represents the angst the public has- that if eating 150-170 pounds of sugar a year is an outrageous and dangerous statistic, then eating any sugar must also be harmful. Author Gary Taubes is in part responsible for that paranoia which is without scientific support.

There is no doubt that the American public and its children eat too much added sugar in processed foods and drinks and would benefit from a drastic reduction in that amount. However, to stand a chance in reversing the epidemic of obesity, type 2 diabetes, non-alcoholic fatty liver disease, and other chronic lifestyle maladies, diet cannot be approached with the focus that a single nutrient is the devil, as the devil is the Western dietary pattern stuffed with added oils, salt, sugars, and chemical additives wrapped in plastic lined containers.