What your patients might not know about how a soda habit affects their heart health

While sugar has a bad rap for its role in metabolic syndrome, obesity and diabetes risk, its rap sheet also includes cardiovascular disease.But it is sugary beverages such as soda-pop, energy drinks, sweetened fruit juices, flavoured water and drinkable yogurt that are among the worst offenders. According to the Heart & Stroke Foundation (HSF), people should consume no more than 10% total calories per day from added sugars, and ideally less than 5%. For an average 2,000 calorie-a-day diet, 10% is about 48 grams (or 12 teaspoons) of added sugars, their website says. A single can of pop contains about 85% of daily added sugar—that’s a whopping 10 teaspoons of sugar. Sugary drinks and excess sugar consumption is associated with hypertension, heart disease, diabetes, obesity and other conditions including dental caries.Several studies have shown strong associations between dental caries and heart disease. A 2017 study from the University of Waterloo projected that sugary drink consumption would result in over 63,000 deaths and cost the healthcare system more than $50-billion over the next 25 years.On food labels, Health Canada uses “recommended daily values” (DV), and introduced front-of-the-package “high sugar” warning labels. For example, a can of Red Bull, which sports such a label, comes in at 50g— half the DV amount. The company also offers sugar-free products. Ice-cream tends to be high too, with a 188 ml serving of Chapman’s Chocolate & Brownies flavour clocking in at 33 g of DV—though Chapman’s also offers no-sugar added options. A Tim Horton’s blueberry donut contains 31 g of sugar, which is about the same as a 355 ml can of Canada Dry ginger ale which contains 32 g of liquid sweetness. A grande caffe mocha at Starbucks has 35 g of sugar.It can be tough to keep sugar intake down, especially with the popularity of sugary beverages. An HSF study, the Health and Economic Impact of a Tax on Sugary Drinks in Canada, stated that “in 2015, Canadians purchased an average of 341 ml of SSBs (sugar-sweetened beverages) per day, and an average of 444 ml of sugary drinks per day when accounting for 100% juice.” It added that those drinking the most were young Canadians and that “the average Canadian youth consumed an estimated 578 ml of sugary drinks per day, whereas children up to age eight consumed 326 ml per day.”But what is it that make so much sugar so bad for cardiovascular health? An overview paper from 2016 sheds some light. It addressed risks from both dietary saturated fats and different types of sugars on CHD – and said that excess sugars can be more of a problem.A diet high in sugar can increase total cholesterol (TC), triglyceride as and LDL-cholesterol, as well as the TC/HDL ratio. Consuming a diet high in sugar can impair glucose tolerance, insulin resistance, elevate uric acid levels and alter platelet function, it said.In addition, consuming fructose or sucrose can increase myocardial oxygen demand, cardiac sympathetic nerve activity and platelet adhesiveness. Excess sugar also contributes to pathways leading to vascular inflammation. All bad news.The good news is all of these abnormalities can be reversed when switching to a diet low in sugar, it said. The risks vary between different type of sugars. “Monosaccharide, fructose and the disaccharide, sucrose (both fructose and glucose), seem to be of greater concern than the glucose alone,” the paper said. But while different sugars can affect specific aspects of CVD risk more than others, none are innocent. Excess sugars also contribute to diabetes. “A diet high in added sugars promotes insulin resistance and diabetes, and patients with diabetes have more coronary atherosclerosis than patients without diabetes,” the paper said.The researchers concluded that “to reduce the burden of CHD, guidelines should focus particularly on reducing intake of concentrated sugars, specifically the fructose-containing sugars like sucrose and high-fructose corn syrup in the form of ultra-processed foods and beverages.”The Canadian Diabetes Association emphasizes that added sugars are the problem, not the naturally occurring sugar you consume when eating something such as an apple. “Most naturally occurring sugars are found in foods that contain fibre and/or protein which help lower the overall blood sugar response. Added sugars increase blood sugar more rapidly than naturally occurring ones,” according to the CDA website.It goes on to say all types of added sugars are problematic, “whether white, brown or cane sugars, corn syrup, honey, molasses or maple syrup, are absorbed the same way in the body and have the same impact on blood sugar.”Canada’s HSF has been on the sugary drink case for years and is stilling pushing for a sugar tax—taxes or levies on sugary beverages that increase the cost of the beverages with the idea that higher costs will reduce purchases, consumption and CVD risk. Success was met when Newfoundland and Labrador implemented a tax that added about 7 cents per beverage. But the program lasted only two years due to its unpopularity.However, the HSF reported that there was a 12% decline in sales of sugary drinks during the time the tax was in place. The numbers might’ve been higher, but the tax excluded some added-sugar beverages such as chocolate milk and flavoured coffees which all saw an increase in consumption.The move was in response to the World Health Organization which urged countries to reduce sugary drink consumption through sugary drink levies. As of August 2023, about 117 countries and territories had introduced levies on sugary drinksIt’s tough to keep sugar intake down. Sugar isn’t just in beverages and desserts. It is often added to foods such as breakfast cereals, bottled spaghetti sauce, curry and stir fry cooking sauces, chocolate milk and more. Extra sugar is even often added to items that are already naturally sweet such as apple sauce, fruit yogurt and fruit juice. Over the course of a day, what you consume adds up. So, it’s worth reading labels. For your heart’s sake.Extra source: Diabetes Canada offers a list of sweeteners made from different types of sugars, some raise blood sugar, some don’t.

What your patients might not know about how a soda habit affects their heart health

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