Reduce Sugar Salt 12 r

8/13/2019 Reduce Sugar Salt 12 r

1/45

A Harvard Medical School Special Health Repor

Price: 29

In this report:

Sodas and juice

Salt and sodium

What the labels mean

Self-defense: Sugar-reducing strategies

Recipes

SPECIAL SECTION

Blood pressure matters

Reducing Sugar and Salt:Strategies for minimizing risks to your health

This Harvard Health Publication was prepared exclusively for blanco prieto - Purchased at http://www.health.harvard.edu/


2/45

Copyright NoticeThis report is copyrighted by Harvard University and is protected byU.S. and international copyright. All rights reserved.

Heres what you CANdo

-

-

-

-

to others. For more information

Copyright Clearance Center (CCC)

Permissions Requests

Licensing, Bulk, and Corporate Sales

Harvard Health Publications

Heres what you CANT do(without prior permission)

-

-

-

explain what is legal and what is not.

Harvard Health Publications | Harvard Medical School | 10 Shattuck Street, Second Floor | Boston, MA 02115This Harvard Health Publication was prepared exclusively for blanco prieto - Purchased at http://www.health.harvard.edu/


3/45

REDUCING SUGAR AND SALT

SPECIAL HEALTH REPORT

e ca tor eresa ung, c , .

Adjunct Professor of Nutrition,arvard School of Public Health

tor. . errett

opy tor

o n et ertonrt rectoreves en ns

rea ve rec or u rouse

ustratorscott e g ton, ason aram e

u s e y arvar e ca c oont ony . omaro , . ., tor n ewar o urn, u s ng rector

n association with

Belvoir Media Group, LLC, 800 Connecticut Avenue, Nor-

walk, CT 06854-1631. Robert Englander, Chairman andCEO; Timothy H. Cole, Executive Vice President, Editorial

Director; Philip L. Penny, Chief Operating Officer; Greg

King, Executive Vice President, Marketing Director; Ron Goldberg,

hief Financial Officer; Tom Canfield, Vice President, Circulation.

opyright 2012 by Harvard University. Written permission is

required to reproduce, in any manner, in whole or in part, the

material contained herein. Submit reprint requests in writing to:

Harvard Health Publications

10 Shattuck St., 2nd Floor, Boston, MA 02115

617-432-1485 Fax: 617-432-4719

e teFor the latest information and most up-to-date publication

list, visit us online at www.health.harvard.edu

us omer erv ceFor all subscription questions or problems (rates, subscrib-

ing, address changes, billing problems) call 877-649-9457,

end an email to [email protected],

r write to Harvard Health Publications, P.O. Box 9308,

Big Sandy, TX 75755-9308.

r er ng pec a ea t eportsHarvard Medical School publishes Special Health Reports

n a wide range of topics. To order copies of this or other

reports, please see the instructions at the back of this

report, or go to our website: www.health.harvard.edu.

For bulk rates, corporate sales and licensing:

Belvoir Media Group

Attn: Harvard Health Publications

P.O. Box 5656Norwalk, CT 06856-5656

mail: [email protected]

ISBN 978-1-61401-015-9

The goal of materials provided by Harvard Health Publications

is to interpret medical information for the general reader. This

report is not intended as a substitute for personal medical

dvice, which should be obtained directly from a physician.

Contents

A brief history of sugar and salt . . . . . . . . . . . . . . . . . . . . . .2

The lowdown on sugar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Rise and fall . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Insulin resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Glycemic index: The type of carbohydrate matters . . . . . . . . . . . . .8

Factors that affect a foods glycemic index . . . . . . . . . . . . . . . . . .8

Glycemic load: Measuring the full effect . . . . . . . . . . . . . . . . . . . . 8

Beyond the glycemic load . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

o as an u ce

e uc ng sugar 12

Salt and sodium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Sodium in excess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Sodium reduction helps . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

A salt step-down in the works . . . . . . . . . . . . . . . . . . . . . . . . . .17

SPECIAL SECTION: Blood pressure matters . . . . . . . . . . . 18Understanding the numbers . . . . . . . . . . . . . . . . . . . . . . . . . . .19

A call to action . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Sugar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

Salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21

Self-defense: Sugar-reducing strategies . . . . . . . . . . . . . . 23

Do some detective work . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .23

Say no to liquid calories . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .25

What about artificial sweeteners? . . . . . . . . . . . . . . . . . . . . . . .25

Other strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .26

Self-defense: Conquering your salt habit. . . . . . . . . . . . . . 28

10 tips for reducing salt in your diet . . . . . . . . . . . . . . . . . . . . .29

Recipes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32

Breakfast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

Lunch and Dinner Entres . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

Snacks and Side . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Desserts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .38

Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41



4/45

Harvard Health Publications | Harvard Medical School | 10 Shattuck Street, Second Floor | Boston, MA 02115

Dear Rea er,

Salt and sugar are two of the most humdrum items in kitchen cupboards. But they have been

centers o controversy in aca emic e ates an arguments over pu ic ea t po icies as ex-

perts dispute the hazards of taking in too much of these nutrients and the benefits of cutting

ac . In just t e ast ew years, t e evi ence o ow muc arm t ese tasty flavor en ancers

can o as ecome un enia e.

Its not t e spoon u o sugar at rea ast or t e as o sa t at t e inner ta e t at are t e ig

worries. Instea , its t e sugars a e to sweetene everages, juices, esserts, an cerea s, an

t e sa t i en in prepare oo s. We nee zero a e sugar ecause we get a t e sugar wenee rom w ats natura y in oo , an ecause t e o y can ma e oo sugar rom a most

any carbohydrate-containing food. Yet added sugars now provide almost 20% of the average

Americans ai y ca ories. We nee on y a scant amount o so ium ess t an one gram a ay

(about 1/30th of an ounce)to survive. But because it is in so many of the processed foods we

ave come to re y on, we ta e in an average o a out 3.5 grams o so ium a ay.

W y are t e excesses o sugar an sa t an issue? A e sugars provi e so-ca e empty ca o-

ries, energy wit no ot er nutritiona va ue. ere is mounting evi ence t at t ey are e ping

ue t e astronomica rise in o esity an ia etes in t e Unite States an aroun t e wor .

oo much salt can lead to high blood pressure and related health problems like stroke, heartisease, an i ney ai ure.

We cant blame salt and sugar for tasting good. ey are, aer all, key stimulators of our taste

u s, an or soun evo utionary reasons. Sugar s sweetness represents ca oric energy, t e ue

o i e. An every ce in t e o y nee s t e so ium in sa t. But t e consequences o over oing

t em are visi e a aroun us.

is report aims to e p you ma e your own ecisions y exp aining t e serious ea t ris s

associated with taking in too much sugar and salt and offering ways to reduce their use with-

out sacrificing taste.

Sincerely,

eresa Fung, Sc.D.,RD

A junct Pro essor o Nutrition, Harvar Sc oo o Pu ic Hea t



5/45

2 Reducing Sugar and Salt www.hea l th .ha rva rd .edu

A brief history of sugar and salt

Sugar an sa t are inexpensive ingre ients t at are

u iquitous in t e oo supp y. at asnt a ways

een t e case.

Sugar starte out as a ar -to-come- y ingre ient.

roughout most of human history, it was available

on y w en ruit ripene or ees a een usy. But

once the technology of extracting sugar from plants

evo ve first rom sugar cane an t en rom eets

sugar not on y ecame a un ant ut a so e pe

irect t e course o istory, ea ing in t e New Wor

o co onies, p antations, an t e scourge o s avery.

Salt was once so diffi cult to get that it was used

as currency. In some ear y economies it was wort its

weight in gold. e word salary comes from the Latin

sa arium, w ic means sa t money. It is t oug t to

re er to part o t e pay given to Roman so iers to uy

sa t. Cities were ui t aroun sa t eposits; wars ave

een oug t over it.

o ay, sugar an sa t are pro uce in vast quan-

ities. Accor ing to estimates y t e U.S. Department

of Agriculture and the U.S. Geological Survey, in 2011

e wor pro uce near y 200 mi ion tons o sugar

and 320 million tons of salt.

As a resu t, two commo ities t at were once ar

to come y are now a most impossi e to avoi . In

recent years, researc ers commente in t e jour-

na ature in 2012, sugar as een a e to virtu-

ally every processed food, limiting consumer choice.

Nature ma e sugar ar to get; man ma e it easy.

Why is this a problem? As described more fully in

t e o owing c apters, too muc o a goo t ing can

e azar ous to ea t . e average American ta es in

more t an 350 ca ories a ay rom a e sugars, oen

in so a, energy rin s, an ot er sweetene ever-

ages. ose empty calories are contributing to the obe-

sity pro em in t e Unite States. A out one-t ir o

American children and more than two-thirds of adults

are overweig t or o ese. Excess weig t is strong y

in e to t e eve opment o ia etes, eart isease,

some cancers, osteoart ritis, an more. Too muc sa t

is a ey contri utor to ig oo pressure yperten-

sion). By age 65, more t an a o Americans ave

ig oo pressure; aer age 75, t ree-quarters ave

it. People with high blood pressure are more prone to

aving a stro e or eart attac or eve oping eart

failure or kidney failure.

It on y ma es sense t at cutting ac on a e

sugars can e p cut ca ories. An a compe ing stu y

pu is e in e New Eng an Journa o Me icine

estimate t at i Americans as a w o e cut ac sa t

intake by teaspoon a day (about 1,200 milligrams

o so ium; see Table 1, le), at sma c ange wou

prevent up to 99,000 heart attacks, 66,000 strokes, and

92,000 premature eat s eac year.

Becoming aware o ow muc sugar an so ium

you consume, an fin ing ways to a just t em ea t -

u y, are goo strategies or your ea t . In t e o owing

pages we s ow you ow to o t at.

Table 1 ompar ng sa an so um

By weight, table salt (sodium chloride) is about 40% sodium.This table can help you convert between teaspoons of salt andmilligrams of sodium.

SALT(TEASPOONS)

SALT(MILLIGRAMS)

SODIUM(MILLIGRAMS)

1,450 600

2,900 1,200

4,250 1,800

1 5,800 2,300



6/45

3www.hea l th .ha rva rd .edu Reducing Sugar and Salt

The lowdown on sugar

Asugars, rom refine w ite sugar to oney an

agave nectar, are a type o car o y rate. Car o-

y rates are c emica compoun s t at contain on y

ree e ementscar on, y rogen, an oxygenin a

dizzying array of combinations. Sugars and other car-

o y rates are t e main nutrient in rea , pasta, cere-

als, beans, vegetables, and dairy foods.

Once upon a time, t e on y sugars we consume

were t ose natura y in t e oo s we ate. To ay, muc

o t e sugar in our oo supp y as een put t ere

y umans. e USDA egan to use t e term a e

sugars in 2000 to help consumers identify foods that

ave a e ca ories wit no a e nutrition. A e

sugarswhite sugar, brown sugar, maple syrup, honey,

mo asses, ig - ructose corn syrup, an morenow

represent 16% o t e tota ca ories we consume. In

ot er wor s, a out one-sixt o our ca ories ave no

nutritiona va ue. A e sugar as een in e to an

overa ec ine in t e qua ity o t e U.S. iet, as we

as to weig t gain an increases in o esity an eart

disease. e latest Dietary Guidelines for Americans

oo aim at sugars a e to oo s uring processing

in food plants, in the kitchens of restaurants, and even

at our rea ast ta es.

C emists initia y ivi e car o y rates into two

groups: simp e an comp ex. Simp e car o y rates

inc u e sugars i e g ucose sometimes ca e ex-

rose), fructose (fruit sugar), lactose (milk sugar),

an sucrose ta e sugar). Comp ex car o y rates

were made up of interlocking chains of sugar mole-

cu es, i e t ose oun in starc an fi er. Simp e ver-

sus comp ex is a per ect ivision or c emists, ut it

oesnt at a exp ain ow car o y rates affect ea t .

Our o ies re y on just one type o sugarg u-

cose. But we never nee to eat g ucose, or any sugar

or t at matter, since t e o y can turn many in s

of food into glucose. ink of glucose as the univer-

sa currency o t e o ys car o y rate economy, an

he organs of the digestive system as a 24/7 currency

exc ange, turning simp e an comp ex car o y rates

into g ucose. I nee e , our o ies can even turn pro-

tein an at into oo sugar.

W en you eat a ow o w ite rice, a s ice o

whole-grain bread, or an orange, the body breaks

own igesti e car o y rates into sugar mo ecu es.

Glucose is rapidly passed into the bloodstream and

e ivere to ce s rom t e rain to t e toes. Leover

g ucose can e in e into ong c ains ca e g ycogen

an store in t e iver or ater use, or converte into

at an store in at ce s. e spee wit w ic a car-

bohydrate-containing food becomes blood sugar can

influence weig t an ong-term ea t .

Rise and fallPicture a ro er coaster trac p enty o ups an

owns, some ig an steep, ot ers ow an gent e.

ats essentially what your blood sugar and insulin

eve s oo i e over t e course o a ay. Mea s an

snacks cause highs that drop to lows later on. Learning

to eat in a way t at ma es your oo sugar eve s oo

more like a kiddie coaster than a wild, breathtaking

ri e can ma e a ifference to your ea t .

Because every ce in t e o y epen s on

instant access to just t e rig t amount o oo sugar,

Go i oc s- i e mec anisms are in p ace to ma e sure

that blood sugar doesnt rise too high or fall too low.

Sometimes, t oug , t ey can e overw e me .

A rise in blood sugar stimulates the pancreas to

re ease insu in into t e oo stream. is ormone te s

ce s to a sor g ucose; wit out insu in, t ey cant ta e

it in. e ig er t e oo sugar eve , t e more insu-

in re ease . As ce s sponge up g ucose, t e amount o

g ucose in t e oo stream egins to ri ownwar ,

o owe y t e amount o insu in (see Figure 1, page

4). As blood sugar approaches the lowest safe level, the

pancreas egins re easing anot er ormone, ca e g u-

cagon. It tells the liver to start breaking down glycogen



7/45


an re ease t e resu ting g ucose into t e oo stream.

is provides a steady supply of blood sugar for the

rain an ot er ce s. at re ease o store g ucose is

why you can go for hours, or even days, without eating

an your ce s sti ave a stea y supp y o ue .

Heres w ere t e type o car o y rate comes into

play. A meal or snack containing foods that the body

imme iate y converts into g ucose i e w ite rea

or white rice) causes a rapid, high spike in blood

sugar. ats o owe y an equa y ig spi e in insu-

in (see Figure 1, below). But a ig jo t o insu in can

quic y rive oo sugar own to or e ow t e sa e

zone. I t ere isnt any more igesti e car o y rate

in t e stomac or intestines, t e gut an rain sen

out signa s t at get you oo ing or somet ing more to

eatwhile at the same time the liver is breaking down

g ycogen an pumping g ucose into t e oo stream.

Easily digested carbohydrates are abundant in

t e American iet (see Carbs matter, le). ey are

t oug t to contri ute to weig t gain ecause t ey trig-

ger unger signa s re ative y soon aer eating. In a i-

tion, t e g ut o insu in t at o ows a ig spi e in oo

sugar prompts the body to convert glucose into fat.

A mea or snac o s ow y igeste car o y rates

(like whole grains or beans) smooths out the blood

sugarinsu in ro er coaster. e igestive system ta es

ow oo sugar an insu in rise an a in t e oo stream epen s on t e type o car o y rate t at is eing igeste .

Source: Eat, Drink, and Be Healthy(Free Press, 2005)

Figure 1 Blood sugar roller coaster

1 2 3 4 5

Time (hour)

Easily Digested Carbohydrate

Change

in

blood

sugar,insulin

Blood Glucose

Insulin

Slowly Digested Carbohydrate

Change

in

blood

sugar,insulin

0 1 2 3 4 5

Time (hour)

Blood Glucose

Insulin

Carbs matter

Car o y rates contri ute a out a o a ca oriesto a typica American iet. A worrisome a o t esecarbohydrate calories come from eight sources, noneo w ic even remote y qua i es as a ea t oo . Aare c oc - u o rapi y igeste car o y rates.

1. So t rin s, so as, an ruit- avore rin s

2. Cake, sweet rolls, doughnuts, and pastries

3. Pizza

4. Potato c ips, corn c ips, an popcorn

5. Rice

6. Brea , ro s, uns, Eng is mu ns, an age s

7. eer

8. Frozen potatoes an Frenc ries



8/45


onger to rea own t ese car o y rates into sugar

molecules (see Figure 1, page 4). at means blood

sugar rises more s ow y an its a ower pea , as oes

insulin. is is good for health (see Insulin resis-

tance, below). It a so means it ta es onger to get un-

gry aga n.

mong peop e wit ia etes, ig eve s o oo

sugar an insu in contri ute to many o t e comp i-

cations o t is isease, suc as nerve amage, oss

o vision, i ney isease, sexua ys unction, an

wounds that wont heal. Routine high blood sugar and

insu in can a so pose pro ems or seeming y ea t y

individuals. ey can tip people toward developing

ia etes. Researc suggests t ey may a so contri ute

o ot er c ronic con itions, inc u ing reast cancer,

co on cancer, an po ycystic ovary syn rome. W i e

smoot ing out your oo sugar an insu in eve s

may help you prevent these conditions, the proven

enefits are preventing eart isease an ia etes an

controlling weight.

Insulin resistanceIn a ea t y o y, iver an at ce s imme iate y

respond to insulins open up for sugar signal and

egin to pu in g ucose rom t e oo stream. In a

growing number of people, the response to this essen-

ia signa ecomes mute . is resistance to insu in

causes two key problems. It keeps blood sugar at high

eve s or onger perio s. Over time, t is can amage

nerves, blood vessels, and other tissues. It also makes

t e pancreas pro uce more an more insu in aer

every meal or snack in an effort to help cells to absorb

oo sugar. As an overwor e pancreas wears out,

insu in pro uction s ows. is causes oo sugar to

s yroc et aer eating an to remain ig or onger

perio s. ese are signs o type 2 ia etes once ca e

a u t-onset ia etes an non-insu in- epen ent ia-

etes). In 1980, a out six mi ion Americans a ia-

betes. Today, it affects more than 25 million, one-third

o w om ont now t ey ave it.

Insulin resistance isnt just a blood sugar problem.

It as a so een in e wit a variety o ot er pro -

ems, inc u ing ig oo pressure, ig oo ev-

e s o trig yceri es a type o at), ow oo eve s o

ig - ensity ipoprotein HDL, goo c o estero ),

heart disease, and possibly some cancers.

Hig oo sugar an insu in eve s a so contri -

ute to the buildup of fat around the waist. is belly

at tec nica y ca e a omina at or viscera at)

appears to pose more o a ea t pro em t an at t at

accumu ates aroun t e ips an t ig s. It as een

in e to ig oo pressure, ig c o estero , ig

oo sugar, an eart isease (see Do you have met-

abolic syndrome? page 6). Be y at offers a snaps ot

that can tell you how healthy you are. Simply measur-

ing t e waist can e use u ecause many peop e gain

abdominal fat as they go through midlife, even those

Is high-fructose corn syrup a special problem?

For centuries, Americans satis e t eir craving or sugarwith sucrose (table sugar) from sugar cane and sugar beets,

oney, map e sugar, an mo asses. Beginning in t e 1970s,more an more o w at sweetens our oo s an everageshas come from corn, most of it in the form of high-fructosecorn syrup. Found in everything from sugared sodas to baby

oo , ig - ructose corn syrup now ma es up more t ana o t e a e sugar we now consume.

C emica y, ig - ructose corn syrup is very simi ar tosucrose. Every molecule of sucrose contains one molecule ofg ucose an one o ructose. Hig - ructose corn syrup is pureg ucose mixe wit pure ructose in a most equa propor-tions (about 55% fructose and 45% glucose). So its likelyt at ta e sugar an corn sweeteners ave simi ar e ects on

oo sugar, insu in, an meta o ism.

Yet some peop e ave vi i e ig - ructose corn syrup asone of the key culprits behind the obesity epidemic. Itsan easy argument to make, since its adoption by the foodin ustry para e s t e trajectory o o esity rates. An w i eits true that the body processes fructose in a different wayhan it processes glucose, both refined sugar and high-

ructose corn syrup contain a out t e same amounts oructose.

So ar, t ere isn t any so i evi ence t at ig - ructose cornsyrup is worse than any other added sugar. Whats impor-ant is eeping your inta e o alla e sugars in c ec . T e

American Heart Association recommen s eeping your in-ake of added sugars under 100 calories a day (24 grams, or

6 teaspoons or women an un er 150 ca ories 36 grams,or 9 teaspoons or men.



9/45


w o are not gaining weig t. A waist ine t at expan s

more than two or three inches over the years should

trigger a warning t at you nee to reeva uate your

diet and physical activity levels. To see how your waist

measurement stac s up, see Figure 2, below.

Four main actors contri ute to insu in resistance.

One o t em cant e contro e , ut t e ot er t ree can. Genes. Insu in resistance is more common

among Native Americans, Pacific Is an ers, an ot er

peop e o Asian eritage t an it is among t ose o

European descent. Although you cant change your

genes, you can eat a genetic pre isposition to insu in

resistance by staying lean, being physically active, and

eating a ea t u iet. Weight. e urt er you stray rom a ea t y

weig t, t e ar er it is or your o y to an e g u-

cose. One way to etermine i your weig t is in t e

healthy range is to determine your body mass index

BMI). is is a measure o weig t or eig t. You can

find your BMI in Table 2, page 7, or calculate it online

at www.health.harvard.edu/BMI. Exercise. During exercise, musc es extract g u-

cose rom t e oo more effi cient y, an wit ess

Do you have metabolic syndrome?Meta o ic syn rome, a c uster o con itions t at occurtoget er, increases t e ris o eart isease, stro e, an

ia etes. One o its ey eatures is a arge waist. I you

have one, youre more likely to have the other character-istics.

You ave meta o ic syn rome i you ave t ree or more

o t ese ve traits:

1. Waist circum erence more t an 35 inc es in

women or 40 inches in men

2. Fasting oo trig yceri e eve o 150 mi igrams/

deciliter (mg/dL) or higher

3. HDL goo c o estero o ess t an 40 mg/ L in

men or less than 50 mg/dL in women

4. Systoic oo pressure t e top num er o a rea -

ing) of 130 mm Hg or higher, or diastolic pressure

t e ower num er o 85 mm Hg or ig er5. Fasting blood sugar level of 100 mg/dL or higher.

(Note: You are considered to have a trait if you receive

treatment or it, even i your num ers are norma wit

this treatment.)

Source: National Heart, Lung, and Blood Institute

Figure 2 Check your belly

Waist circumference

Minimum waist-to-hip ratio associatedwith increased health risks:

For men:0.91.00For women:0.85

ips are usuallyeasured at theidest circumference,round the buttocks

Waist circumference associatedwith increased health risks:

For men:More than 40 inches 102 cmFor women: More than 35 inches (88 cm)

Waist-to-hip ratio



10/45


e p nee e rom insu in, t an musc es o at rest.

e effect lasts for several hours aerward. Being a

couc potato oesnt o muc to c ear g ucose rom

he bloodstream. People who arent very active have

ig er at-to-musc e ratios t an active peop e, even i

eir BMIs are in t e ea t y range.

Dietary fat.A t oug t e mix o ats in t e iet

plays a small role in insulin resistance, it can make a

i erence. A ig inta e o trans at rom margarines

and prepared foods) and a low intake of polyunsatu-

rate at rom vegeta e oi s an atty is ) contri ute

to insu in resistance.

Table 2 n ng your

The body mass index (BMI) is an index of weight by height. The definitions of normal, overweight, and obese were established after researchersexamined the BMIs of millions of people and correlated them with rates of illness and death. These studies identified the normal BMI range asthat associated with the lowest rates of illness and death.

HEIGHT BODY WEIGHT IN POUNDS

10 91115 119138 143162 167186 191+

11 94119 124143 148168 173193 198+

50 97123 128148 153174179199

204+

51 100127 132153 158180 185206 211+

52 104131 136158 164186 191213 218+

53 107135 141163 169191 197220 225+

54 110140 145169 174197 204227 232+

55 114144 150174 180204 210234 240+

56 118148 155179 186210 216241 247+

57 121153 159185 191217 223249 255+

58 125158 164190 197223 230256 262+

59 128162 169196 203230 236263 270+

510 132167 174202 209236 243271 278+

511 136172 179208 215243 250279 286+

60 140177 184213 221250 258287 294+

61 144182 189219 227257 265295 302+

62 148186 194225 233264 272303 311+

63 152192 200232 240272 279311 319+

64 156197 205238 246279 287320 328+

BMI 19

24 25

29 30

34 35

39 40+

NORMAL OVERWEIGHT CLASS I OBESITY CLASS II OBESITY CLASS III OBESITY

You can ca cu ate your own BMI wit t e o owing ormu a:

1. ake your weight in pounds and multiply it by 703.

.Measure your eig t in inc es an mu tip y it y itse .

3.Divide the number from step two into the number from step one. The answer is your BMI. If your BMI is less than 20 you areun erweig t; etween 20 to 24.9, you are at a norma , ea t y weig t; etween 25 to 30, you are overweig t; an a ove 30,you are o ese.



11/45


Glycemic index:The type of carbohydrate mattersC assi ying car o y rates as simp e versus comp ex

does little to tell us which carbohydrate-containing

oo s re ease t eir sugars in a flas an w ic yie

em more i e t ose time -re ease co capsu es you

see on te evision commercia s.

o fin a etter way, Cana ian nutrition researc er

Davi Jen ins an is co eagues i somet ing revo-

utionary in t e ear y 1980st ey measure ow i -

erent types of carbohydrate-containing foods affected

oo sugar compare wit pure g ucose. ey ca e

his comparison the glycemic index.

Measuring g ycemic in ex is a painsta ing process

at requires a vo unteer to consume an amount o a

est oo w o e oats, pear, ac eans, ice cream,

an so ont at contains 50 grams o car o y rate.

His or her blood sugar is then measured at regular

interva s over t e next two ours. On anot er ay,

he same volunteer does the same thing, but this time

consumes 50 grams o g ucose. en t e va ues or t e

oo an g ucose are compare , y ivi ing t e rise in

oo sugar spar e y t e test oo y t e rise ue to

g ucose.

e higher the glycemic index, the faster and

more strong y t e oo affects oo sugar. e ower

he glycemic index, the lower and slower the rise in

oo sugar.

Since the concept was created, researchers have

measure t e g ycemic in ex o severa t ousan

oo s. As you can see in Table 3, page 9, t e g ycemic

in ex c ear y s ows t at not a comp ex car o y rates

are goo , an not a simp e ones are a . Cornfla es,

chemically a complex carbohydrate, have a high gly-

cemic in exin t e 80smeaning t ey quic y an

strongly boost blood sugar. Fructose, the simplest of

sugars, as a very ow g ycemic in ex23meaning

it as itt e effect on oo sugar. Its use u to t in o

oo s in t ree categories: Low glycemic index (55 or less):Most ruits an veg-

eta es, eans, minima y processe grains, pasta,

ow- at airy oo s, an nuts. Moderate glycemic index (56 to 69):Sweet potatoes,

corn, w ite rice, pasta, some rea ast cerea s

such as Cream of Wheat and Mini Wheats.

High glycemic index (70 or higher): W ite rea ,

white rice, potatoes, rice cakes, most crackers,

age s, ca es, oug nuts, croissants, wa es, most

packaged breakfast cereals.

C oosing oo s ow on t e g ycemic in ex can

e p you avoi ig oo sugar ig s an ows.

Factors that affect a foodsglycemic indexGlycemic index isnt a set, unvarying value like molecu-

ar weig t. Processing an coo ing met o s, as we as

what you eat with the food, all affect how rapidly your

o y rea s own its car o y rates an ow quic y

your oo stream a sor s t e i erate g ucose. Grinding grain dramatically increases how fast

digestive enzymes can attack the starch and break it

apart.Wheat flour has more surface area to attack than

w eat erries. Most w eat our as a so een strippe

of its branthe protective, hard-to-digest, fibrous

outer coat t at s ows t e action o igestive enzymes.

Stee -cut oats, w ic are s ice oat grains, ave a ower

g ycemic in ex t an regu ar oatmea , w ic is ma e o

smas e oat grains.The more indigestible fiber a food contains, the

lower its glycemic index.T ats ecause i er carries

along partly digested food and protects it from diges-

tion. T is sprea s out t e a sorption o g ucose into

the bloodstream.Fats slow the digestive process.Eating at wit a

car o y rate-ric oo can temper t e rise in oo sugar.Lemon juice, vinegar, and other acidic ingredients

a so e ay t e rise in oo sugar a ter you eat a car o-

hydrate-rich food.

Glycemic load:

Measuring the full effecte g ycemic in ex o a oo te s on y part o t e

story. How muc o t e oo is consume a so affects

blood sugar and insulin levels. ats why research-

ers at t e Harvar Sc oo o Pu ic Hea t eve ope

the concept they call glycemic load. It is calculated by

mu tip ying a oo s g ycemic in ex y t e num er o

grams of carbohydrate consumed and dividing by 100.



12/45


Table 3 Glycemic index and glycemic load values for commonly eaten foods

The glycemic index and glycemic load offer information about how a food affects blood sugar and insulin. The lower the glycemic index or glycemicload, the less the food affects blood sugar and insulin levels. Scientists have calculated glycemic index and glycemic load for more than 2,500 foods. Asample is provided in the table below. The University of Sydney in Australia maintains a free searchable database of glycemic index and glycemic loadvalues at www.glycemicindex.com. The healthiest choices are those with a glycemic index below 55 and a glycemic load below 10.

FOOD SERVING SIZEGLYCEMICINDEX (%)

CARBOHYDRATE(in grams)

GLYCEMICLOAD*

WHITE RICE 5 ounces 89 48 43

CRANBERRY JUICE 1 cup 68 35 24

SPAGHETTI, COOKED 1 cup 49 48 24

CORNFLAKES 1 cup 93 25 23

SNICKERS BAR 1 bar (2 ounces) 68 34 23

JELLY BEANS 1 ounce 80 28 22

POTATOES (WHITE), BOILED 1 cup 78 26 20

GRAPE-NUTS CEREAL cup 75 22 16

COCA-COLA 12 ounces 63 26 16CHEERIOS 1 cup 74 20 15

SHREDDED WHEAT CEREAL 2 biscuits 67 20 13

OATMEAL (ROLLED OATS) 1 cup 58 22 13

BANANA (RIPE) 1 medium 51 25 13

RAISIN BRAN CEREAL 1 cup 61 19 12

ORANGE JUICE 1 cup 46 26 12

CORN TORTILLA 2 medium 46 22 11

WHITE BREAD 1 slice 75 14 10

STRAWBERRY JAM 1 tablespoon 51 20 10

WHOLE-WHEAT BREAD 1 slice 74 13 10

PIZZA HUT SUPER SUPREME PIZZA 2 slices 36 24 9

ENGLISH MUFFIN 1 muffin 77 11 8

ALL-BRAN CEREAL cup 42 21 8

BLACK BEANS 1 cup 43 23 7

APPLE (GOLDEN DELICIOUS) 1 medium 39 16 6

ENGLISH MUFFIN, WHOLE GRAIN 1 muffin 43 11

PUMPERNICKEL (DARK RYE BREAD) 1 slice 41 12MILK, SKIM 1 cup 37 13

RED LENTILS 1 cup 21 18

TABLE SUGAR (SUCROSE) 1 teaspoon 65 2.6

FRUCTOSE 1 teaspoon 15 0.6

*Glycemic load is calculated by multiplying grams of carbohydrate by glycemic index and dividing by 100.Source: Atkinson FS, Foster-Powell K, Brand-Miller JC. International tables of glycemic index and glycemic load values: 2008, Diabetes Care(2008), Vol. 31, No.

, pp. .



13/45


a e spag etti, or examp e. It as a g ycemic

index of 46. An average serving delivers 31 grams of

car o y rate: 46 times 31 ivi e y 100 equa s 14.

s with the glycemic index, putting foods into

ree categories can e p etermine goo c oices an

ort on s zes: Low glycemic load (10 or lower):Lenti s an eans

i ney, gar anzo, ac , etc.); i er-ric ruits an

vegeta es; nuts an see s; w o e grains i e ar-

ey, w eat erries, an t e i e. Medium glycemic load (11 to 19):Steel-cut oatmeal;

w o e-w eat pasta an some rea s; ruit juices

without extra sugar; brown rice; sweet potatoes. High glycemic load (20 or higher):So a, energy rin s,

an ot er sugar-sweetene everages; can y;

w ite rice; Frenc ries an a e potatoes; sug-

ary rea ast cerea s.

Because glycemic load includes information on

ow muc car o y rate is consume , it is etter

han glycemic index alone at capturing whats going

on in your oo stream aer you eat a car o y rate-

containing oo .

Some oo s ave a ig g ycemic in ex ut very

itt e car o y rate per serving. Ta e waterme on as

an example. It has a high glycemic index (80), which

mig t ma e you stay away rom it. Yet as its name

implies, watermelon is mostly water; a cup of water-

me on cu es contains just six grams o car o y rates.

So t e g ycemic oa is sma , un er 5.

Sugary so a as a mo erate g ycemic in ex

ecause it contains a air amount o ructose, w ic

as re ative y itt e effect on oo sugar. But it a so

e ivers p enty o car o y rates, so it as a ig g y-

cemic load.

Fo owing a iet wit a ow g ycemic oa wi e p

you to make healthier food choices. And because the

oo s are typica y ig er in fi er an nutrients, you

wi ee satisfie onger, w ic can e p contro weig t.

Beyond glycemic loade g ycemic in ex an g ycemic oa are gui es to

choosing carbohydrate-containing foods, not strict

ru es. Its a so important to eva uate t e ot er nutri-

ents in a oo . Some car o y rate-ric oo s e iver

ar more t an just sugar. Fruits an vegeta es offer

Figure 3Sugar intake through sweetened drinks

n the United States, average consumption of sugar from sweetened beverages peaks in the teen years.Source: CDC/NCHS, National Health and Nutrition Examination Survey, 20052008.

Caloriesperday

Age (years)

0

50

100

150

200

250

300 FemaleMale

60 and over40592039121961125All

178

71

141

273

252

159

112

171

138

70 70

103

86

42



14/45


fi er, vitamins, minera s, an p enty o active p yto-

chemicals. e same is true for intact or slightly pro-

cesse grains.

e biggest value of the glycemic load may be

or eci ing among various options. W en pic ing

a snac or p anning a mea , c oosing oo s wit ow

g ycemic oa s is etter or your insu in-ma ing ce s

an your overa ea t t an c oosing t ose wit ig

g ycemic oa s.

Sodas and juiceSprinkling 10 to 12 teaspoons of sugar on a bowl of

cerea wou ma e it muc too sweet to eat. Yet accor -

ing to t e Harvar Sc oo o Pu ic Hea t s Nutrition

Source, t ats ow muc sugar is in a 12-ounce can o

many popu ar so rin s. See www.hsph.harvard.

edu/nutritionsource/healthy-drinks/how-sweet-is-it

or a ist o t e amount o sugar in popu ar everages.)

Given ow muc so a, ruit everages, an ot er so

drinks Americans consume, almost half of the added

sugar in t e U.S. iet comes rom so rin s an ruit

juices. Among youths, sugar intake from sugar-sweet-

ene everages represents near y 15% o t eir ai y

inta e o ca ories (see Figure 3, page 10).

A num er o stu ies ave in e sugar-sweetene

rin s to weig t gain an an increase ris o type 2

diabetes. e most recent, a trio of reports published

n e New Eng an Journa o Me icine, in regu-

lar consumption of sugar-sweetened beverages to the

eve opment o o esity in c i ren, a o escents, an

adults. Other studies have found that men and women

w o regu ar y ran sugar-sweetene everages were

at increase ris o stro e an eart isease, even

aer ot er un ea t u i esty e or ietary actors were

accounte or.

Sugar-sweetened beverages generally deliver pure

ca ories wit out any o t e ea t u nutrients you

What about fruit juice?

Fruit juice is i erent rom so as an ot er sugar-sweetene everages, rig t? It epen s on ow muc youdrink. As an accompaniment to your breakfast, or as theoccasiona t irst quenc er, 100 juicenot juice- avoresugar watercan e part o a ea t y iet. Rea juice

gives you some vitamins, minerals, and maybe a bit ofer.

Keep in mind that 100% fruit juice can deliver a lot ofca ories. Twe ve ounces o orange juice e ivers a out 150ca ories, t e same as a simi ar amount o sugar-sweetenesoda. If juice is part of your morning routine, use a smallg ass t at o s 6 ounces.

e main pro em wit rin ing juice to quenc t irst ist at many peop e on t eat ess to a just or t e extra ca -ories in it. Thats a surefire recipe for gradual weight gain.Its also easy to confuse 100% juice with juice drinks,w ic are itt e more t an juice- avore sugar water.

I you use juice to quenc your t irst, i ute it wit regu aror spar ing water. Start wit two parts juice to one partwater and gradually work your way to one part juice tot ree or our parts water. Or s ip t e juice a toget er ana a squeeze o emon or ime to p ain or spar ing water.Vegetable juices are usually lower in calories than fruit

juices, ut c ec t e a e to e surean on t orget toma e note o t e so ium content.

An eep in min t at not a juices are equa . Grape ruitjuice, or examp e, c anges t e way some peop e a sorand metabolize certain drugs. It can make it hard for the

o y to a sor some rugs, ea ing to ower oo eve s.is appens wit t e a ergy me ication exo ena ine A -

legra); digoxin, which is used to treat heart failure; losartanCozaar , use to contro oo pressure; an t e antican-

cer rug vin astine. Grape ruit juice canboost oo eve sof other drugs, sometimes to dangerous heights. Drugsin t is category inc u e ca cium-c anne oc ers suc ase o ipine P en i , ni e ipine Procar ia , an niso ipine

(Sular), which are used to control high blood pressure; car-amazepine Car atro , Tegreto , use to contro epi epsy;

some wi e y use c o estero - owering me ications sucas lovastatin (Mevacor), atorvastatin (Lipitor), and simvas-atin Zocor ; cyc osporine, an immunosuppressant ta en

main y y peop e w o ave a an organ transp ant; anbuspirone (BuSpar), used to fight alcohol abuse, depres-sion, panic isor er, an a variety o ot er pro ems.

Something in grapefruit juice also appears to create condi-ions t at e p orm i ney stones. In t e Nurses Hea t

Stu y an t e Heat Pro essiona s Fo ow-up Stu y, every8 ounces of grapefruit juice consumed a day increased

e c ances o eve oping i ney stones y 44 . W i emore researc is nee e to con rm t is n ing, it s a gooreason to limit your intake of grapefruit juice.



15/45


mig t get rom rea ruit juices or, etter yet, ruit

vitamins, minerals, other phytochemicals, and in

some cases even some fi er. ats a pro em or sev-

eral reasons: Weight gain.Many peop e treat iqui ca ories

rom sugar-sweetene everages as some ow i erent

rom oo ca ories, an ont ma e up or t e ca o-

ries in so a or juice y eating ess. Drin ing one can

o so a a ay oesnt seem i e a ig ea , an pro -

a y isnt i you cut ac on ca ories e sew ere an eat

lenty of fruits and vegetables. But if you dont adjust

your iet, t e extra 120 to 150 ca ories a ay rom a

sugar-sweetened beverage could easily translate into

ig er num ers on t e sca e an extra at aroun t e

e y. Exhausting insulin.T e rapi y igeste sugars in

so a an ruit juices quic y oost oo sugar an

insu in eve s. W en t is appens severa times a

dayin addition to the blood sugar boosts that occur

aer eatingit can cause pro ems. Among women

participating in the Nurses Health Study, those who

ran one so a a ay near y ou e t eir ris o ia-

etes. Among peop e w o are insu in resistant, ta ing

in ots o easi y igeste car o y rates raises t e oo

eve o trig yceri es, a in o at-carrying partic e t at

increases t e ris o eart isease.

Reducing sugarNow that you know more about added sugars and how

t ey can affect ea t , its time to earn w ere t ey are

an ow you can cut ac . Strategies or oing t is are

escri e in Self-defense: Sugar-reducing strategies,

beginning on page 23.



16/45


Salt and sodium

To a c emist, sa t is w at you get w en positive an

negative ions enter eac ot ers or it. To t e rest o

us, sa t is so ium c ori e, t e w ite crysta s e over

w en seawater evaporates.

e human body needs sodium for many essen-

ia tas s. Nerves nee it to transmit impu ses. Musc e

fibers, including those in the heart and blood vessels,

nee it to contract an re ax. So ium e ps t e o y

maintain a proper flui a ance. But it oesnt ta e

muc so ium to accomp is t ese jo s. e Yano-

mamo peop e o t e Amazon rain orest get y on just

200 milligrams (mg) of sodium a day (the amount in

1/10t teaspoon o sa t). By comparison, t e average

merican gets 17 times more than that3,400 mg a

ay a out 1 teaspoons o sa t; see Figure 4, below).

e current Dietary Gui e ines or Americans

p aces t e ea t y upper imit or so ium at 2,300 mg a

day, or about 1 teaspoon of salt. at drops to no more

t an 1,500 mg a ay or A rican Americans, in ivi ua s

with high blood pressure (hypertension), diabetes, or

i ney isease, an anyone over age 51. e American

Heart Association says that everyone should try to keep

so ium inta e un er 1,500 mg a ay.

Too muc sa t as een in e to ea t pro ems

or centuries. A out 5,000 years ago, Emperor Huang

Di Neijin o C ina wrote: I too muc sa t is use or

food, the pulse hardens. In the modern era, Dr. Lewis

Da rom t e Broo aven Nationa La oratory egan

proposing in the 1950s that diets high in sodium con-

tri ute to ig oo pressure. His ypot esis was

c a enge y ot er researc ers, an t e so ium con-

troversy as rage ever since.

e ong-running e ate over w et er cutting

ac on sa t in t e iet as meaning u effects on

ea t as een most y ai to rest. A arge o y o

research accumulated over the past two decades shows

c ear enefits rom consuming ess sa tnot just or

lowering blood pressure but also for reducing the risk

o stro e an eart pro ems (see Self-defense: Con-

quering your salt habit, page 28).

Sodium in excesse uman o y as sop isticate mec anisms

for making sure enough sodium is always available.

C a t at up to two acts: every ce in t e o y nee s

so ium, an so ium was scarce t roug out most o

uman evo ution. Now t at so ium is a un ant, t ose

mec anisms may e wor ing against us.

Most Americans get ar more so ium t an t ey

nee . Its ar not to. Prepare oo s are oa e wit

table salt. An 8-ounce serving of macaroni and cheese

or an or er o ast oo ries can serve up as muc as

1,000 mg of sodium (see Table 4, page 14).

Figure 4 The rise of sodium consumption

0

Women

ages 2074

Men

ages 2074

Sodium(

mg/day)

500

1,000

1,500

2,000

2,500

3,000

3,500

4,000

4,500

1971197420032006

he American diet has become saltier since the seventies.

ccor ing to ietary surveys, average ietary so ium inta e rose

consi era y rom t e ear y 1970s to t e ear y 2000s.Source: Institute of Medicine.



17/45


In ea t y in ivi ua s, t e i neys respon to

excess sodium by flushing it out in the urine. When

is process oesnt wor proper y an extra so ium

is retained, the kidneys hang on to water. Some of

at water ma es its way into t e oo stream. As

e amount o flui flowing t roug oo vesse s

increases, t e pressure insi e t em increases, orcing

e eart to wor ar er. In a ition, excess so ium

ma es oo vesse s ess flexi e, unting t eir a i ity

to re ax an contract wit ease. It may a so overstimu-

late the growth of heart tissue.

A out one-quarter o peop e wit norma oo

pressure and nearly 50% of people who have high

oo pressure are sa t sensitive, meaning consuming

too muc so ium e evates t eir oo pressure an

puts t em at ris or comp ications. Dozens o stu ies

ave s own t at oo pressure rises wit ig er ev-

e s o so ium in t e ietan t at cur ing sa t inta e

Table 4 Hidden salt in commercially prepared food

DAILY LIMIT (2,300 MG)

Kung Pao chicken with rice 2 cups 2,610 113

Ham sandwich with mustard 9 ounces 2,340 102

Lasagna 2 cups 2,060 90

Sauerkraut, canned 1 cup 1,560 68

Tuna salad sub sandwich 6 inches 1,293 56

Baked beans, canned 1 cup 1,106 48

Chicken noodle soup, canned 1 cup 1,106 48

Macaroni and cheese, canned 1 cup 1,061 46

Pasta sauce 1 cup 1,030 45

Corned beef brisket 3 ounces 964 42

Burger King Whopper 1 900 39Chicken pot pie 1 small 857 37

Dill pickle 1 (3 ounces) 833 36

Chicken bouillon 4-gram cube 743 32

Ham 2 slices 739 32

Vegetable juice cocktail 1 cup 653 28

KFC Biscuit 1 560 24

Cottage cheese cup 457 20

American cheese 1 slice 442 18

McDonald's French fries Super size 390 17

Waffle, frozen 1 383 17

Raisin Bran cereal 1 cup 361 16

Green beans, canned 1 cup 354 15

Cheese pizza 1 slice 336 15

Sources: U.S. Department of Agriculture, Agricultural Research Service. 2012. USDA National Nutrient Database for Standard Reference, Release 25. Nutrient Dataaboratory Home Page, www.ars.usda.gov/ba/bhnrc/ndland the Center for Science in the Public Interest (see www.cspinet.org/salt.



18/45


owers oo pressure. e an mar DASH-So ium

rial is perhaps the best example of these (see e

DASH diet, below).

Writing in the Journal of Human Hypertension,

researc ers at t e Imperia Co ege o Science, Tec -

no ogy, an Me icine in Lon on escri e ot er

harmful effects attributed to high salt consumption

eyon raising oo pressure. Hig so ium inta e

increases the mass of the le ventricle (the hearts

main pumping c am er), w ic ma es t e eart wor

The DASH dietDASH stan s or Dietary Approac es to Stop Hypertension, a

iet eve ope y nutritionists to ower oo pressure. Putto t e test in two arge c inica tria st e rst escri e in

The New England Journal of Medicinein 1997t e DASHiet passe wit ying co ors. For many peop e w o o ow

it, t e iet is enoug to eep oo pressure in t e normarange wit out me icine.

Key eatures o t e DASH iet inc u e p enty o ruits,

vegetables, and whole grains; several servings daily ofow- at airy pro ucts; some s , pou try, rie eans, nuts,

an see s; an minima re meat, sweets, an sugar- a eneverages. T is mix o oo s provi es amp e ca cium,potassium, magnesium, vitamins, and fiber while limiting

saturate at, c o estero , an so ium. Compare wit t etypica American iet, t e DASH eating p an as a re ative y

ig er ca cium content an ess sa t, tota at, saturate at,an c o estero . It a so as 173 more magnesium, 150

more potassium, 240 more er, an 30 more protein.he blood pressurereducing ability of the DASH diet cant

e attri ute to any sing e nutrient.

In t e origina DASH stu y, 459 vo unteers were ran om yassigned to one of three diets. One was based on what most

Americans eat, wit 37 o ca ories rom at. T e seconwas a simi ar regimen wit ruits an vegeta es a e .

e t ir was a com ination iett e DASH ietcon-

taining 27 o ca ories rom at, p us p enty o ruits anvegeta es, w o e grains, ow- at or non at airy pro ucts,

an sma amounts o meat, s , pou try, an nuts.

A ter o owing t e DASH p an or eig t wee s, participantswit ig oo pressure experience average re uctions

o 11.4 mi imeters o mercury mm Hg in systo ic pressuret e top num er o a oo pressure rea ing an 5.5 mm

Hg in iasto ic pressure t e ottom num er . T ese resu tsare compara e to t e e ects o some oo pressure

rugs. Participants wit or er ine ig oo pressure a soexperience improvements, suggesting t at t e DASH ietmay eep some peop e rom eve oping ig oo pres-

sure in the first place. The second diet, which was higherin ats ut a so ric in ruits an vegeta es, a so owere

blood pressure, although not as much as the DASH plan.A re uctions occurre wit out peop e c anging t eir sa t

intake, alcohol consumption, or weightfactors known toin uence oo pressure.

urt er ana ysis o t e tria s resu ts oun t at t e DASHdiet reduced blood pressure in virtually all groups tested re-gardless of such factors as age, sex, race, and hypertensionstatus. Its e ects were most pronounce , t oug , in A ricanAmericans and people with high blood pressure. In fact, theresults were so promising that federal dietary guidelinesnow recommen t at a Americansnot just t ose wit

ig oo pressure o ow t e DASH iet.

A o ow-up stu y, t e DASH-So ium tria , compare a typi-cal American diet (the control diet) with the DASH diet at

i erent so ium eve s 3,300, 2,400, or 1,500 mg per ay .eop e wit ig oo pressure w o ate t e DASH iet athe lowest sodium level had an average systolic pressure

rea ing 11.5 mm Hg ower t an participants eating t econtro iet at t e ig est so ium.

Sti more support or DASH came rom t e Harvar - aseurses Hea t Stu y. Among near y 90,000 ema e nurses

whose diets, other habits, and health were followed for 24years, t ose w ose eating patterns most c ose y resem e

e DASH iet a ewer eart attac s an stro es anwere less likely to have died of heart disease compared withwomen reporting average American iets.

Com ining a structure weig t- oss program wit t e DASHiet can rop your oo pressure even more t an DASH

a one, accor ing to a stu y o 144 overweig t or o ese peo-p e wit ig oo pressure w o weren t ta ing any oopressure owering rugs. A out a t ir o t em o owe

e DASH iet a ong wit a weig t-management program.Another third did DASH alone, and the other third followed

eir regu ar iet. T e weig t-management program re ieon a strategy nown as appetite awareness training,which teaches people to identify their natural hunger andu ness cues to e p t em earn w en an ow muc to eat.

e program a so inc u e supervise exercise sessions t at

eatured biking, walking, or jogging for 45 minutes (includ-ing a warm-up an coo - own t ree times a wee .

After four months, average blood pressure readings for theDASH-p us-weig t-management group roppe y 16.1/9.9mm Hg, compare wit 11.2/7.5 mm Hg or t e DASH-on ygroup and 3.4/3.8 mm Hg for the control group. The bloodpressure re uctions seen in t e weig t-management groupwere simi ar to w at octors wou expect rom a ig oseof a blood pressure drug.



19/45


ar er. Too muc so ium t ic ens an stiffens t e

arteries that nourish the heart and kidneys. It is linked

o increase ris o stro e, eart isease, an eart

ailure. High sodium intake may also increase the loss

o ca cium an one in o er women an men.

One way to eva uate t e evi ence on a particu ar

opic, i e t e effect o so ium on ea t , is to com ine

e resu ts o many stu ies an ana yze t em toget er.

is is called a meta-analysis. One meta-analysis of

stu ies con ucte etween 1966 an 2008, pu is e

in the British Medical Journal, found that high salt

inta e was associate wit significant y increase

risk of stroke and total cardiovascular disease. e

researc ers oun t at most popu ations aroun t e

wor ave ai y sa t inta es ig er t an 6,000 mg

or 2,500 mg so ium), wit parts o Eastern Europe

an Asia averaging a ove 12,000 mg o sa t 5,000 mg

so ium) a ay. ey estimate t at re ucing ai y sa t

intake could yield modest reductions in blood pres-

sure t at wou ower stro e rates y 24% an eart

disease by 18%.

Sodium reduction helpsIn t e 1980s, t e Tria s o Hypertension Prevention

teste various e aviora an ietary strategies or

e ping peop e avoi an fig t ig oo pressure.

e first group, which included men and women

ages 30 to 54 wit s ig t y e evate oo pressures,

were asked to try non-pharmaceutical interventions,

inc u ing so ium re uction, weig t oss, stress man-

agement, an nutritiona supp ements. ey were

taug t ow to ower so ium inta e y earning to

i enti y so ium in t eir iet an se ecting an prepar-

ing lower-sodium foods and seasonings. (People in the

contro group were as e to o ow t eir usua eating

habits and given general guidelines for a healthy life-

sty e.) e participants were o owe or 18 mont s

etween 1987 an 1990.

Vo unteers in t e secon tria group were in t e

same age range an a so a s ig t y e evate oo

pressures, ut were somew at overweig t. Some were

as e to ose weig t, some to re uce so ium, some

both, and some neither. ey were followed for three

years etween 1990 an 1995.

Fieen years later, researchers from Harvard-

affi iate Brig am an Womens Hospita examine

ow t e participants ea t a are since t e tria s

en e . Among t ose w o a o owe a ower-so ium

regimen, t e ris o aving a a car iovascu ar

eventsuch as a heart attack or strokewas 25%

ower t an among t ose w o a n t c ange t eir

sodium intake. Sodium reduction, previously shown to

ower oo pressure, may a so re uce ong-term ris o

car iovascu ar events, t e researc ers conc u e .

Cutting ac on sa t appears to save ives, too. In

a tria con ucte in Taiwan invo ving near y 2,000

e er y men, owering ietary so ium an increasing

potassium e to a 41% rop in eat s rom car io-

vascular disease.

A more recent stu y pu is e in e New Eng-

land Journal of Medicineprojected that in the United

QIf I exercise daily and sweat, which means

I lose salt, can I have more than the daily

recommended limit of sodium?

AAlthough technically the answer is Yes, it really

depends on how much you exercise and sweat,

and how much sodium is currently in your diet. You

lmost certainly get most of it from salt (sodium chloride).

You need to have enough sodium in your diet each day to

keep up with the sodium you lose in urine and sweat. It is

recommended that most adults ages 50 or younger have

no more than 2,300 milligrams (mg) per day of sodium. For

people 51 or older, for African Americans of any age, and

for people with diabetes, high blood pressure, or kidney

disease, the recommended level is 1,500 mg per day.

But the average U.S. adult takes in about 3,400 mg of

odium per daymuch more than recommended. Their

bodies remove some of the excess sodium each day by

passing it out in the urine.

If you are a manual laborer working a shift of eight to

12 hours, you can lose a lot of sodium5,000 to 6,000

mg per day. If that describes you, you can safely have more

than the recommended amount of sodium in your diet. Onthe other hand, if you work out at the gym for 30 minutes

day and are otherwise sedentary, there is a reasonable

hance that you still may be taking in too much salt. While

the exercise is good for you in many ways, it isnt a reason

to increase the salt in your diet.

Anthony L. Komaroff, M.D.Editor in Chief

Harvard Health Letter



20/45


States, cutting ac on ietary sa t y 3,000 mg a ay

about teaspoon, or 1,200 mg of sodium) would

re uce t e num er o new cases o coronary artery

disease by 60,000 to 120,000, strokes by 32,000 to

66,000, eart attac s y 54,000 to 99,000, an eat s

y 44,000 to 92,000. So ium re uction wou e goo

or a segments o t e popu ation, wit women en-

efiting particu ar y rom stro e re uction, t e e er y

rom re uce inci ence o coronary artery is-

ease, an younger a u ts rom ower eat rates. e

researchers estimated that such a population-wide

effort wou save 10 i ion to 24 i ion annua y

and add years to life.

A salt step-down in the works? e accumu ating evi ence against excess sa t as

spurred several organizations into action. e World

Hea t Organization recommen e imiting con-

sumption o sa t to no more t an 5,000 mg a ay

(about 2,000 mg of sodium). e federal Dietary

Gui e ines or Americans recommen e a imit o

5,800 mg of salt (2,300 mg of sodium). In a long-

awaite stu y an report commissione y Congress,

t e Institute o Me icine recommen e in 2010 t at

t e FDA require re uctions in t e amount o sa t in

commercia y prepare oo in t e Unite States. e

proposa suggests a step- own approac t at wou

gra ua y ower t e amount o sa t in prepare oo s

from 2010 to 2020. Such a move could make a big dif-

erence, since most o t e sa t in t e American iet is

put there by someone elsea food company or cook.

For more etai on t ese an ot er efforts, see A call

to action, page 20

But t eres no nee to wait or government or pu -

ic ea t agencies to act. ere are many t ings you

can do right now to de-salt your diet; see Self-defense:

Conquering your salt habit, beginning on page 28.



21/45

Reducing Sugar and Salt www.hea l th .ha rva rd .edu8

SPECIAL SECTION

Blood pressure matters

Blood pressure has gotten a bad reputation, taking the rap

for its harmful variant, high blood pressure. Pressure

is absolutely essential for circulation. Without it, blood

couldnt move from the heart to the brain, toes, and everywhere

in between, then get back to the heart again. Pressure in thebloodstream comes from two sources: contractions of the heart

and resistance from blood vessels.

norma contraction o t e

eft ventricle, the hearts main

umping c am er, pus es out

about 70 milliliters of blood (2

ounces). is pu se creates a wave

o pressure t at passes t roug

t e aorta an a t e arteries in t e

body. Relaxed and flexible arter-

ies offer a ea t y amount o resis-

tance to each pulse of blood.

B oo pressure c anges con-

stant y. It respon s instant y to

w at you are oing, t in ing, an

feeling. It also follows a daily cycle,

itting a ow point just e ore you

wake and peaking during midday.

Hig oo pressure octors

ca it ypertension) is not a isease.

Instea , it is a sign t at somet ing

is wrong in t e eart, oo vesse s,

i neys, or e sew ere. Sometimes

it stems rom an overpro uction o

hormones by the thyroid or adrenal

g an s. It can e cause y t e use

of prescription or over-the-counter

me ications suc as aspirin, i upro-

en, pseu oep e rine, some anti e-

Figure 5How high blood pressure affects the body

High blood pressure has far-reaching

effects. It not only harms arteries,

ma ing t em sti er an narrower,

but can also damage the heart,

rain, eyes, an i neys. T ese are

known as the target organs ofypertension. Hig oo pressure is

a key contributor to heart attack and

stroke, heart failure, kidney failure,

and many other chronic conditions.



22/45

www.hea l th .ha rva rd .edu Reducing Sugar and Salt

Blood pressure matters | SPECIAL SECTION

ressants, steroi s, an ot ers. Most

o t e time, t oug , ig oo

ressure resu ts w en arteries ave

become rigid or constricted. Less-

flexi e arteries offer more resis-

ance to the flow of blood, which

s ows up as ig er oo pressure.

Untreate ig oo pres-

sure can ea to eart isease an

stro e. It can amage t e i neys,

estroy vision, an cause pro ems

in t e rain t at ea to memory

oss and dementia (see Figure 5,

page 18). It oes t is wit out caus-

ing any symptoms, which is why

ypertension is sometimes re erre

o as a si ent i er.

Hig sa t consumption is one

reason oo pressure rises. Ot er

ey contributors include smok-

ing, excess weig t, ac o p ysica

activity, a poor iet, rin ing too

muc a co o , an some me icines

and diseases.

Understandingthe numbersW en oo pressure is measure ,

t e resu t is two num ers, oen

given like this: 122/87. e num-

ers origina y represente mi -

limeters of mercury, because the

origina oo pressure evices

used a column filled with mercury

an mar e in mi imeters.

e top num er gives t e sys-

to ic pressure. is is t e amount

o pressure generate y a eart-

beat (the hearts pumping phase

is nown as systo e). e ottom

num er gives t e iasto ic pres-

sure. It represents t e pressure in

the bloodstream when the heart

re axes etween eats t is resting

phase is known as diastole).

A ea t y oo pressure is

120/80 or ower.

B oo pressure ten s to c im

wit age, a sign o s ow ut stea y

amage to oo vesse s. At one

time, t e ru e o t um or a ea t y

systolic blood pressure was 100 plus

your age. For an octogenarian, t at

would be 180 to 190. We now know

t at s muc too ig .

To ay, ypertension is efine

as aving a systo ic rea ing o at east

140 or a iasto ic rea ing o at east

90, or both (see Table 5, below).

Table 5 ass y ng an rea ng yper ens on

CATEGORY*

SYSTOLIC BLOOD

PRESSURE (TOP NUMBER)

DIASTOLIC BLOOD PRESSURE

(BOTTOM NUMBER) WHAT YOU SHOULD DO

Normal Less than 120 ess than 80Stick with a healthy lifestyle, including following adiet rich in fruits and vegetables and low in salt, usingalcohol moderately, and maintaining a healthy weight.

Prehypertension 120139 80 89

Change health habits. If youre heavy, lose weight.Reduce salt in your diet. Eat more fruits and vegetables,and get more exercise. Drink alcohol only in moderation.You do not need medication at this stage if you donthave other health conditions. If you have diabetes orkidney disease, begin drug therapy if your blood pressureis at or above 130/80.**

Stage 1hypertension

140159 9099

Change your health habits and take a blood pressure

drug. Many people start with one medication, but mayneed to go to a second or third to find a treatment thatworks. If you have other health conditions, you may needa different drug or an additional one.

Stage 2hypertension

160 or higher 100 or higherChange your health habits. Its likely that youll need totake at least two blood pressure medications.

*When systolic and diastolic pressures fall into different categories, physicians rate overall blood pressure by the higher category. For example, 150/85 mm Hg is

classified as stage 1 hypertension, not prehypertension. **Because both hypertension and diabetes target the same major organs, drug therapy is generally initiated at

an earlier stage in people with diabetes. The goal is to maintain blood pressures below the 130/80 threshold. For people with diabetes or chronic kidney disease, stage 1

hypertension is defined as systolic pressure of 130159 or diastolic pressure of 8089.



23/45


A call to action

Some groups are a vocating stronger measures to

egin re ucing sa t an sugar in t e American

iet. Heres a oo at some o t eir efforts.

Sugar e Harvard School of Public Health has been helping

ea t e c arge to improve t e U.S. iet. In Apri 2012,

e Department o Nutritions acu ty e a wi e y

u icize press con erence c a enging everage

manu acturers to create a new c ass o rin s wit

70% less sugar. Weve suggested that manufacturers

rovi e an option in etween ig -sugar an sugar-

ree drinks to help people step down if they cant

go co tur ey rom u sugar to no sugar, sai

Dr. Wa ter Wi ett, c airman o t e Department o

Nutrition at Harvar Sc oo o Pu ic Hea t . Fu -

sugar everages, e sai , are in a c ass wit to acco.

eres only harm, no benefit.

e Institute o Me icine IOM)a ig y

regarded, independent nonprofit organization that

rovi es evi ence- ase in ormation an a vice to t e

government and public on matters of healthrecently

recommen e to t e FDA t at it require manu acturers

o start a new ront-o -t e- ox a e ing system t at

etai s t e amount o a e sugar in eac serving o

a pro uct. Meanw i e, t e USDA as provi e an

online interactive food tracker that lists the amount of

a e sugar in more t an 8,000 oo s an a ows you

o compare them side by side to help you make choices.

e we site, avai a e at www.choosemyplate.gova so

rovi es too s or e ping you c oose nutritiona goa s

an to eep trac o t e oo s you eat an ow t ey

stac up towar meeting t ose targets.

e University researc ers ave

oun t at t e east ea t u

ereals are most heavily mar-

ete to c i ren. Some o

the worst nutrition offend-

ers are cerea s i e Corn Pops, Reeses Puffs, an Froot

Loopscerea s t at are ig er in sugar an ower in

fiber than cereals marketed to adults. ey are the

ocus o mi ions o o ars in te evision a vertising

and Internet marketing each year. A new rating system

eve ope y t e Ru Center or Foo Po icy an

Obesity at Yale takes into account a cereals nutritional

va ue an ow eavi y it is mar ete to c i ren. e

searc a e ata ase is avai a e at www.cerealfacts.org

In June 2012, t e Wa t Disney Company

announce p ans to a vertise on y ea t ier oo s to

ids on its media outlets beginning in 2014, making

it t e first major me ia company to set a stan ar

or food and drink ads during shows aimed at kids.

o get an a s ot, a cerea wi ave to ave ess t an

10 grams o sugar per serving. Accor ing to t e Ru

Center, oo an rin a s aime at i s ec ine y

5% in 2011, ut on average, c i ren sti are expose

o a out 13 a s a ay t at promote pro ucts wit

itt e or no nutritiona va ue. An Disney s cut-off

evel for cereal advertisements10 gramsis still 2

easpoons o sugar, or a t e recommen e ai y

imit of 5 teaspoons of added sugar.

recent ea t po icy report in e New Eng an

Journa o Me icine cite t e in etween sugar-

sweetene everages an t e ris s o o esity, ia etes,

an eart isease, an propose using taxes to re uce

consumption. Not only would a tax discourage

consumption, t e aut ors argue , ut t e revenues

could be used for health care programs. Currently,

33 states ave sa es taxes on so rin s, ut t e

average rate o 5.2% is not steep enoug to iscourage

consumption, an t e revenues are not earmar e

or ea t care. e aut ors propose a o 1-cent-

er-ounce tax on any everage t at as a e ca oric

sweetener. Ot er options wou e a tax per gram o

added sugar or setting a threshold of 1 gram of sugar

er ounce. e a vantage o t e t res o approac ,

hey noted, would be that it would encourage

Source: Thinkstock



24/45


manu acturers to go ac to t e rawing oar an

reformulate their products.

e revenues generate rom a tax on sugar-

sweetened beverages would be considerable, the study

suggeste . A nationwi e tax o 1 cent per ounce wou

raise 14.9 i ion in t e first year a one. e un s, t e

aut ors propose , cou go towar c i oo nutri-

ion an o esity prevention programs.

Researc y Dr. Ro ert H. Lustig an co eagues

at t e Department o Pe iatrics an t e Center or

Obesity Assessment, Study, and Treatment at the

University o Ca i ornia, San Francisco, suggests t at

he worldwide increase in sugar consumption is the

root cause o a wi e range o c ronic iseases reac -

ing epi emic eve s. Sugar as ecome so ingraine in

e American iet t at e ucation an awareness cam-

aigns wi not so ve t e pro -

em, the authors said, calling for

u ic inter vention. A co o ,

hey wrote in the journal Nature,

as een regu ate or t e pu -

ic goo ase on our criteria:

unavoi a i ity pervasiveness

roug out society), toxicity,

otentia or a use, an a nega-

ive impact on society. Sugar

meets the same criteria, they wrote. It similarly war-

rants some orm o societa intervention. Using t e

control of tobacco and alcohol as a model, they pro-

ose imiting avai a i ity. An t ey ca e or t e

FDA to consi er removing ructose rom t e ist o

ro ucts it genera y regar s as sa e.

In Septem er 2012, New Yor Citys Boar o

Health voted to limit to 16 ounces the size of sugary

rin s so in oo service esta is ments in or er to

combat the growing obesity epidemic that is taking

e ives o 6,000 New Yor ers every year, as t e

oar s announcement sai . e imit app ies to any

everage t at is more t an 25 ca ories per 8 ounces

an oes not app y to everages t at are 100% ruit

or vegetable juice. Obesity is an illness that is slowly,

ain u y estroying ea t an ta ing ives, sai New

Yorks Deputy Mayor for Health and Human Services

Lin a I. Gi s. Over time, our environment as een

increasingly working against uspeople move less

an eat more, portion sizes ave grown, an sugary

beveragesfull of empty calorieshave grown

exponentia y.

SaltOn t e so ium si e, a recent stu y o 21 states s owe

t at U.S. a u ts are a rea y re ucing t e amount o

so ium t ey consume. More t an 70% o a u ts w o

a ig oo pressure a een a vise to re uce

sodium in their diets, and four out of five of those

a a rea y egun to o so on t eir own. Ot er ata

showed that the majority of adults in the United States

un erstan t e connection etween so ium inta e

an ea t , an 68% o peop e over age 50 are t in ing

a out re ucing sa t in t eir iet or ave a rea y

starte . e Harvar Sc oo o

Public Health has estimated that

cutting t e average in ivi ua s

consumption of salt by half

wou prevent at east 150,000

eat s a year in t e Unite States

a one.

out 10% o t e so ium in

our iet is rom t e natura con-

ent in oo s, 10% is rom t e

shaker, and 80% comes from processed and restaurant

oo s. Current y, t ere is no imit on t e amount o

salt food manufacturers can put into their products.

Li e sugar, sa t enjoys a regu atory status nown as

GRAS, or genera y regar e as sa e, w ic a ows

oo manu acturers to a un imite amounts to any

oo . For years now, some pu ic ea t a vocates

have been trying to get that status revoked.

In 2008, t e American Me ica Association

(AMA) called for the FDA to revoke salts GRAS status

to a ow stricter regu ation o t e amount o so ium

in oo s. Step en Havas, t e AMAs vice presi ent

or science, qua ity, an pu ic ea t , sai t at t e

eat s attri uta e to excess so ium inta e represent

a uge to t e equiva ent o a jum o jet wit 400

a u ts a oar cras ing every ay o t e year, year aer

year. e AMA called on the FDA and food manu-

acturers to set as t eir goa a 50% re uction in t e

amount of sodium in fast food, restaurant foods, and

Source: Thinkstock



25/45


rocesse oo s over t e next 10 years. Dr. Havas sai

meeting this goal would save 150,000 lives a year.

W i e t e IOM as agree t at t e current eve

of sodium in manufactured foods is too high to be

sa e, it as not recommen e t at sa t e ta en off

e GRAS ist. However, a committee appointe y

e IOM recommen e in 2010 t at t e FDA regu ate

e amount o sa t in commercia y prepare oo s y

wor ing wit oo companies to step own t e amount

o sa t use . e committees report ac now e ge t at

he strategy of labeling and education has not worked

o re uce so ium inta e. Rat er, t e IOM as ca e

or the FDA to work with restaurants and food manu-

acturers to enact a gra ua re uction in sa t content

at wou ma e c anges impercepti e to consum-

ers. e pre erence or sa ty taste can e c ange , t e

IOM report state . W at is nee e is a coor inate

effort to reduce sodium in foods across the board by

manu acturers an restaurantst at is, create a eve

laying field for the food industry. All segments of the

oo in ustry wou e carrying out t e same re uc-

ions an none wou e at a isa vantage.

Some cerea an snac ma ers ave egun to

ower sodium levels in their products, but overall the

eve s remain ig . It remains to e seen i ot er seg-

ments of the food industry will follow suit without

new regu ations orcing t em to o so.

cost ana ysis con ucte at Stan or University

an pu is e in Anna s o Interna Me icine c aime

at a nationwi e tax on so ium cou save over a mi -

ion life-years and billions of dollars. Although no

country as imp emente a tax to ecrease so ium

consumption, the researchers wrote, economic

incentives affect consumer e avior, an taxes ave

been successful in reducing tobacco and alcohol con-

sumption. e stu y cite a co a orative effort in

Great Britain etween government an in ustry t at

roug t a out a 9.5% ecrease in typica so ium

inta e. e researc ers estimate t at an equiva ent

decrease in the United States, whether brought about

y taxes, regu ations, or vo untary comp iance, wou

revent 513,885 strokes and 480,358 heart attacks over

e i etimes o peop e ages 40 to 85 a ive to ay an

wou save 32.1 i ion in irect me ica costs.

Sodium cutbacksEncouragingly, many food companies have already begun cutting back on sodium content in their products, some by25 w ic is not a ot, ut sti a goo start. T e Nationa Sa t Re uction Initiative is a coa ition o 85 organizations anoca an state eat aut orities t at ave p e ge to e p oo provi ers vo untari y re uce t e amount o so ium in 62packaged food categories and 25 restaurant food categories. The effort started in New York City in 2010 with the HealthyHeartCut t e Sa t campaign. Here are t e companies t at ave signe on so ar to re uce so ium content y 20 overt e next ve years t e ist is i e y to c ange as more esta is ments join; o ow t e up ate ist on t e initiatives we siteat www.nyc.gov/health/salt):

u on a n

Bertucci s Ita ian Restaurant

Black Bear European Style

De i Boars Head Provisions

Butter a

Camp e Soup Company

De aize America

Dietz & Watson

FreshDirect

Furmano s

Goya Foo s

Hain Celestial

Heinz

Hostess Bran s

Ken s Foo s

Kra t Foo s

LiDestri Foo s/FrancescoRina i

Mars Food US

cCain Foo s

remio

ed Gold

Sny ers-Lance

Starbucks Coffee Company

Su way

arget Corporation

ni ever

no C icago Gri

ite Rose



26/45


Self-defense: Sugar-reducing strategies

Te uman o y oes not nee any a e sugar. It

gets a it nee s rom w ats natura y in oo . Cut-

ing ac on t e amount o sugar you consume wi

e p you manage your weig t an eep eart isease

and diabetes at bay. e American Heart Associa-

ion recommen s eeping ca ories rom a e sugars

under 100 calories a day (24 grams, or 6 teaspoons)

or women an un er 150 ca ories 36 grams, or 9 tea-

spoons) or men.

I you eci e its time to start re ucing t e amount

o a e sugar in your an your ami ys iet, t ere

is no reason to wait for new government guidelines

or or t e oo an everage in ustry to vo untari y

start lowering the amount of sugar used to attract our

aste u s. e easiest an quic est way is to i enti y

e oo s an rin s t at contri ute t e most a e

sugar to your iet an imit or rep ace t em a toget er.

Rea ing a e s is a goo p ace to start.

Do some detective workSpotting a e sugar on oo a e s can require some

sleuthing. Manufacturers are required to provide the

ota amount o sugar in a serving ut o not ave to

spe out ow muc o t is sugar as een a e an

ow muc is natura y in t e oo (see Figure 6, right).

e sugars must e inc u e on t e ingre ients ist,

which is presented in descending order by weight. e

ric is ecip ering w ic ingre ients are a e sug-

ars. ey come in a variety of guises. Aside from the

o vious onessugar, oney, mo assesa e sugar

can appear as agave nectar, cane crysta s, corn sweet-

ener, crysta ine ructose, extrose, evaporate cane

juice, ructose, ig - ructose corn syrup, invert sugar,

actose, ma tose, ma t syrup, an more.

wise approac is to avoi pro ucts t at ave any

of these added sugars at or near the top of the list of

ingre ientsor ones t at ave severa ifferent types

of sugar scattered throughout the list. If a product is

chock-full of sugar, you would expect to see sugar

iste first, or may e secon . But oo ma ers can

fudge the list by adding sweeteners that arent techni-

ca y ca e sugart at term is app ie on y to ta e

sugar, or sucrose ut t at a to t e sugar content

a t e same. e tric is t at eac sweetener is iste

separate y. e contri ution o eac a e sugar may

be small enough that it shows up fourth, fih, or even

urt er own t e ist. But a t em up an you can

get a surprising dose of added sugar.

Lets ta e as an examp e a popu ar oat- ase cerea

wit a mon s w ose pac age oasts t at it is great

tasting, eart ea t y an w o e grain guarantee .

Heres t e ist o ingre ients:

Whole-grain oats, whole-grain wheat, brown sugar,almond pieces, sugar, crisp oats,* corn syrup, barleymalt extract, potassium citrate, toasted oats,* salt,malt syrup, wheat bits,* honey, and cinnamon.

contain sugar, high-fructose corn syrup, honey, and/or brownsugar molasses

Near y a o t e a e sugar consume y Americans ages two

years and older comes from sugar-sweetened beverages.

Source: Dietary Guidelines for Americans, 2010

Figure 6 Sources of added sugars

Yeast breads2.1%

Sugarsand honey

Ready-to-eatcereals

Tea

All otherfood categories

15.4%

Soda, energy drinks,sports drinks

35.7%

Grain-baseddesserts12.9%Fruit drinks

10.5%

Dairydesserts6.5%

Candy

6.1%

3.8%

3.5%

3.5%



27/45


Com ine rown sugar, sugar, corn syrup, ar ey ma t

extract, high-fructose corn syrup, honey, brown sugar

mo

Reduce Sugar Salt 12 r

Documents

Transcript of Reduce Sugar Salt 12 r