Some added sugar sources are worse than others for disease risk, study suggests

By Madeline Holcombe, CNN

(CNN) — What kind of sugary treat you are having might change its impact on your health, according to a new study.

Sugary drinks were associated with a greater risk of developing cardiovascular health disease than sweets like baked goods, said lead study author Suzanne Janzi, a doctoral student in nutritional epidemiology at Lund University in Sweden, via email.

The study, published Monday in the journal Frontiers in Public Health, surveyed nearly 70,000 Swedish men and women about their diet and lifestyle between 1997 and 2009. Their incidences of cardiovascular disease –– including strokes, heart attacks and heart failures–– were collected from the national health registers through 2019, according to the study.

Researchers looked at sugar consumption in three categories: sugary beverages, sweets like pastries, and toppings like honey or sugar added to tea or coffee, according to the study.

Consuming sweet drinks (all sodas and fruit drinks that were not pure fruit juices) was associated with a higher risk of heart disease than those individuals who had more baked treats, but surprisingly those participants who consumed the least amount of sugar did not end up with the lowest risk of heart disease, Janzi said.

Is no sugar really worse?

It is important to note that the study was observational, meaning that while researchers found associations, they can’t say for sure that the ways people ate sugar caused the different rates of heart disease, Janzi said.

They did adjust for other factors that might also influence the association, including age, sex, alcohol, smoking, exercise level and body mass index, or BMI, she added. But there may be others that they have not accounted for in their analysis.

The results are also limited by the population studied, which is primarily of European descent, said Dr. Robert Eckel, professor emeritus of medicine at the University of Colorado Anschutz medical campus and former president of the American Heart Association.

Outside factors might be behind the association between low added sugar intake and increased cardiovascular risk, since there are no biological mechanisms to explain it, Janzi said.

“One theory is that people with very low sugar intake might be replacing sugar with other unhealthy foods or nutrients,” she added.

It could also be that those who limit their sugar consumption to extremely low levels are doing so for an existing health condition, or that they have very restrictive diets overall that do not provide all the important nutrients they need, Janzi said.

She also points to a Swedish social tradition called “fika,” where people gather for coffee and pastries.

“This practice is so ingrained in Swedish society that many workplaces have scheduled ‘fika breaks’ daily,” Janzi said. “It’s possible that the consumption of treats during these social interactions is strongly linked to social relationships, which have previously been linked to cardiovascular health.”

The connection between low sugar and higher cardiovascular risk does need to be studied further, however, she said.

Why it’s worse to drink your sugar

There are some biological theories behind why sugary drinks are more associated with heart disease than pastries, Janzi said.

“Liquid sugars are absorbed more rapidly in the digestive system since they do not require the same breakdown processes as solid foods,” she said. “Solid sugars are often part of foods that contain other nutrients like fiber, proteins, and fats.”

Those nutrients slow digestion, meaning there is a more gradual release of sugar into the bloodstream, Janzi said.

While fats, fiber and proteins in solid food leave you feeling fuller longer, liquid sugars often don’t fill you up –– which can lead to appetite dysregulation and the consumption of too many calories, she added.

“Different sources of added sugars also vary in their consumption patterns, which could further explain why they associate differently with cardiovascular disease risk,” Janzi added.

Less sugar via less soda

The study suggests that you don’t need to cut out all sugar to prevent cardiovascular disease, Janzi said.

“We all enjoy a dessert,” Eckel added. “Should we not have birthday cake and ice cream when your kids are having a birthday party?”

But most Americans are probably consuming too much added sugar, and sweetened drinks are a good place to make reductions, he said.

The American Heart Association recommends no more than 6 teaspoons of added sugar a day for women and 9 for men.

A sustainable reduction might mean taking steps to reduce your sugar instead of going cold turkey.

“Cut back by one serving per day until you’re down to one drink per day,” registered dietitian and CNN contributor Lisa Drayer said in a previous story. “Then aim for one every other day until you can phase out soft drinks entirely.

“Alternate with seltzer/sparkling water can help you cut back,” she added. “Eventually you can replace soft drinks with seltzer or sparkling water if you are craving carbonation.”

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