A new study links 45 health problems to “free sugar.” Here’s what that means, and how to avoid it

“Sugar is bad for you” is an old health axiom, but the depths to which sugar can harm one’s body has perhaps not yet been fully tabulated. Indeed, according to a new study by the prestigious medical journal BMJ, sugar consumption is linked to 45 different ailments. Yes, you read that right: forty-five different health problems all exacerbated by or correlated with eating that sweet white powder.

From obesity and type 2 diabetes to seven types of cancer and 18 endocrine/metabolic outcomes, sugar has already been found to have addictive qualities, so much so that it is common for people to binge on it.

But not all sugars are created alike, and the bad stuff is something that’s known as “free sugar.” According to Dr. James DiNicolantonio, the Associate Editor of British Medical Journal’s (BMJ) Open Heart and a cardiovascular research scientist and doctor of pharmacy at Saint Luke’s Mid America Heart Institute in Kansas City, this refers to any sugar that does not come from a whole food (or a food that has been processed and refined as little as possible). This is contrast to sugars from foods that have been in our diet for a long time, and which occur naturally typically — say, in fruits like apples or vegetables like carrots.

As such, the white crystalline sugar you put in coffee or the high fructose corn syrup in your soda and fast food has free or added sugars. A delicious and untampered orange or banana, which humans have long been accustomed to eat, does not have them.

“If you think about it, added sugar really isn’t a single substance. No one is eating just tablespoons of sugar. They are most likely eating that added sugar in highly processed or ultra-processed foods.”

This distinction, however seemingly slight, makes a world of difference when it comes to your health. As the BMJ study revealed after reviewing 73 meta-analyses of 8,601 unique scientific articles about added sugar, they found significant links with 45 different adverse health outcomes. These include asthma, cancer, depression, type 2 diabetes, gout, heart attacks, hypertension, obesity, strokes and tooth decay.

As DiNicolantonio explained to Salon, added sugars are linked to a wide range of health issues because they appear in three-fourths of packaged foods, including soft drinks and fruit juices, and comprise anywhere from one-fourth to two-fifths of the total caloric intake of children and roughly one-seventh of the total caloric intake of adults. This “overconsumption drives type 2 diabetes, fatty liver, obesity, kidney disease and cardiovascular disease,” DiNicolantonio told Salon.

Most people who consume over 30 to 40 grams of added sugar consistently will “increase their risk for numerous health issues,” DiNicolantonio concluded. “For those who are more active (i.e. athletes) they can get away with eating more sugar, but ideally most of their sugar intake should come from whole food.”

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So why is sugar so versatile in its ability to damage the body? Part of it is because sugars are not typically consumed alone, in the form of cubes or powder; that means studies into sugar consumption can’t completely isolate the substance from the other things they are often mixed with. In other words, we are not really talking about just one substance. Hence, any study about the impact of added sugars on human health is effectively discussing all of the common unhealthy foods that usually join those added sugars.

The overconsumption of added sugars “drives type 2 diabetes, fatty liver, obesity, kidney disease and cardiovascular disease.”

“If you think about it, added sugar really isn’t a single substance,” Dr. Alexandra DiFeliceantonio from Fralin Biomedical Research Institute at Virginia Tech Carillon told Salon by email. DiFeliceantonio was not involved in the study. “No one is eating just tablespoons of sugar. They are most likely eating that added sugar in highly processed or ultra-processed foods. Those foods may contain other additives, high-levels of fat, or other substances that are linked to poor health outcomes. So, it’s not that this one substance, sugar, is causing all these problems, but that this substance is present in a whole host of foods that are contributing to these health issues.”

DiFeliceantonio clarified that sugar could be causing some health problems on its own, but noted that it is “more likely a combination of factors.”

Dr. Nicole Avena, an assistant professor of neuroscience at Mount Sinai Medical School and a visiting professor of health psychology at Princeton University who studies human health but was also not involved in the study, offered advice on how people who are health-conscious can protect themselves from added sugars.

“I think it’s really a good idea to do a food diary,” Avena suggested. “Do one or two days where you eat like you typically would and write down every single thing you eat — down to what condiments you’re using — and you can really get a clear picture then of how much sugar you’re actually consuming. And a lot of people are shocked when they do this because they think they’re eating a relatively healthy diet. But when you start to break it down and look at the salad dressings, look at the condiments, even things like nuts that people think of as a healthy snack, but it often has added sugar in there.”

DiNicolantonio also urged consumers to consider healthy substitutes for their favorite sweets.

“The best way to beat a sugar craving is to find healthy alternatives that provide a little natural sugar — like berries, an apple, or even a little raw honey or maple syrup,” DiNicolantonio opined.

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