This Issue

Sugar-sweetened beverages

Water: It’s the real thing

Skipping sugar-sweetened beverages

Q & A

A closer look

Often people do not realize they are consuming so much sugar because the sweetener goes by many different names. One hint — words ending in “ose,” such as sucrose, glucose and fructose are all sugars.

Because this is a juice drink people assume it is healthy. It does contain some juice, but most of the sugars are added, not natural. Learn to read between the lines. While the first ingredient is water, the next five are sugars, but the word “sugar” is listed only once.

One serving (one cup) of this fruit drink contains 120 calories and 31 grams or almost 8 teaspoons of sugar, exceeding the American Heart Association’s recommended daily limit of added sugars. One teaspoon of sugar has about 4 grams of sugar and 16 calories.

A closer look

Spot the added sugars

Stop. Rethink your drink.

Water — all dressed up

How much is too much?


Spot the added sugars



• Brown sugar

• Cane sugar

• Corn sweetener

• Corn syrup

• Evaporated cane juice

• Fruit juice concentrates

• High-fructose corn syrup

• Honey

• Maple syrup

• Molasses

• Raw sugar

• Syrup

How much is too much?


honeyThe body requires glucose to provide energy to do its job. We can get that sugar naturally from fruits, vegetables, milk and whole grains, which are full of nutrients. Added sugars, on the other hand, are sugars and syrups added to foods during preparation or at the table. These added sugars bring with them sweetness and calories, but lack nutrition. The American Heart Association recommends a daily limit of added sugars according to the information below.


Women’s daily limit
6 teaspoons = 100 Calories = 25 grams

Men’s daily limit
9 teaspoons = 150 Calories = 37.5 grams

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Water — all dressed up

Infused water is plain tap water flavored with fruits, vegetables or herbs, and is a healthy alternative for those who find the beverage bland.

Citrus Cucumber Water

1 large lemon, sliced
1 large orange, sliced
1 large cucumber, sliced
1 half gallon of water

Place all sliced fruits and vegetables in a pitcher and add water. Refrigerate and allow the water to “infuse” for at least two hours. Pour over ice and enjoy.

Source: Boston Medical Center Nutrition and Fitness for Life Program

Sugar-sweetened beverages
Taste so good, but are oh sooo bad


According to the American Heart Association, regular soft drinks — at 33 percent — are the major source of added sugars in the American diet. Fruit drinks account for an additional 10 percent. Consumption of sugar-sweetened beverages is highest among male teens. (Photo courtesy of Boston Public Health Commission)

Vanessa Martin does not mince words. That’s understandable — it comes with the territory. Martin is a union president at Boston Medical Center and the mother of a 2-year-old boy.

Always in a rush, she readily admits that she rarely paid attention to what she was drinking. Convenience outweighed health — and her decisions at vending machines were starting to have deadly consequences. “Instead of drinking water, I drank a lot of soda,” she said.

And they began to add up — three 20-ounce sugared sodas a day and a few more at lunch and dinner. What she didn’t know is that five of her drinks amounted to 1,250 calories — the total amount of calories some people consume in a day. What’s worse is that it was more than 12 times the maximum amount of added sugars the American Heart Association recommends for women each day.

Ultimately she paid the price.

At her physical last July, she learned that her blood pressure was elevated, her total cholesterol exceeded the normal limit and her body mass index was moving in the wrong direction. But the reading that got the most attention was her glucose level.

“Diabetes runs in my family,” she explained. The fact that she was now borderline diabetic was a jolt. “That scared me,” she said. “It was like being told I had cancer.”

According to Martin, the only behavior she had changed in the past year was her excessive intake of sugar-sweetened beverages (SSBs). She ate the same amount and type of food and did not increase or decrease her physical activity. “I did not know that sodas contained that much sugar,” she admitted. “It doesn’t register in your head that it [sugared soda] contributes to weight.”

It’s everywhere — in sodas, sports drinks, energy and juice drinks and ready-to-drink teas and coffees. It has sneaked into salad dressings, yogurts, peanut butter, cereals, jams and even cough syrup.

The “it” is high fructose corn syrup (HFCS). Developed by two scientists in the late 1950s, HFCS is the result of a process that changes corn syrup — a liquid sweetener used in toppings and baking — from one type of sugar (glucose) to another type of sugar (fructose). HFCS is much sweeter than table sugar, is cheaper to produce and has a longer shelf life. It can also be mixed with just about anything.

But it’s the SSBs that cause more concern. On an average day, 63 percent of adults and 80 percent of youths drink SSBs. While years ago colas and pops were the rage, now several other SSBs have entered the market, many of which tout themselves as healthy.


Vivien Morris (center), a dietitian at Boston Medical Center, offers infused, or naturally-flavored water, to Alan Aikens at BMC’s farmers’ market. On her left is Beza Alayew, an intern from Boston University’s School of Public Health. (Yawu Miller photo)

Click image to enlarge

Vitamin waters claim to be packed full of vitamins, but the label indicates that the second and third ingredients are sugar. Fruit drinks imply one is drinking fruit juice, and you may be — in forms of juice concentrate, which is sugar. “Sports” drinks were specifically designed to replenish electrolytes lost in sweat after fierce competition. They hydrated “athletes” while giving a quick boost to energy. But now people use them to quench their thirst after just mild activity or no activity at all. The problem is that a major ingredient is sugar.


Evidently, some students believe the hype that sports drinks are a healthier substitute. Researchers from the University of Texas Health Science Center found that students in grades 8 and 11 in Texas who ate fruits and vegetables and engaged in physical activity drank sports drinks rather than sodas for good health. More than one fourth of the students queried said that they consumed three or more of these “healthy” SSBs a day.

As production of HFCS — and the SSBs — burgeoned something else began to burgeon at about the same time. According to the Centers for Disease Control and Prevention (CDC), between 1960 and 1962, roughly 31 percent of U.S. adults aged 20 to 74 were overweight, 13 percent were obese and less than 1 percent was extremely obese.

In the late 1970s when HFCS was entering the market, obesity increased 11 percent, but extreme obesity rose almost 56 percent. The numbers have soared from there. By 2007 and 2008, obesity rates had more than doubled and extreme obesity rates increased almost six fold. Boston is not exempt. In 2008, 54 percent of Boston adults were overweight or obese.

Health experts point a guilty finger at SSBs for the rise in obesity and the medical conditions that surface in its wake. Several studies have shown a correlation between a high intake of SSBs and diabetes, high blood pressure, tooth decay, cardiovascular disease and metabolic syndrome, a triad of symptoms which may include high blood pressure, low “good” cholesterol, increased waist size, high triglycerides (fat in the blood) and insulin resistance. SSBs have even been found to increase the incidence of gout, a type of arthritis that causes inflammation and pain in the big toe.

And it does not take much to wreak havoc. Scientists from Harvard School of Public Health found that drinking two sugary drinks a day increases the risk of type 2 diabetes by 26 percent and metabolic syndrome by 20 percent. Even one drink a day increases the risk of diabetes by 15 percent.

It’s not that sugar in itself is bad for you. Quite the contrary. The body needs sugar for energy. Without it, the body shuts down. But it is possible to get the required amount of sugar by eating a well-balanced diet. Natural sugar is abundant in fruit, vegetables, milk and whole grains. It’s the added sugar of any kind — HFCS, table sugar and honey, for example — that causes the problem.

There is no nutritional value in added sugars.

The American Heart Association recommends an upper limit of 6 teaspoons or 100 calories of added sugar each day for women and 9 teaspoons or 150 calories a day for men. But the most recent national survey conducted by the CDC found that 22 teaspoons of added sugar was more the norm. A 20-ounce bottle of soda alone contains almost 17 teaspoons of sugar.

Increased consumption of SSBs has taken a toll on African Americans. Studies have shown that blacks consume more SSBs — and at a younger age — than other groups. And pay the penalty. Healthy Boston 2010, a report published by the Boston Public Health Commission, noted that almost one-third of blacks and Latinos in Boston are obese compared to 17 percent of white residents. Blacks and Latinos have rates of diabetes that are three and two times higher, respectively, than whites.


Dr. Walter Willett, chair of the Department of Nutrition at Harvard’s School of Public Health



Source: Harvard University School of Public Health

Undoubtedly, other factors contribute to the rise in obesity. People eat more of the wrong foods and exercise less. But it’s the perception of beverages that makes the difference. Consumers know that eating too much food can lead to weight gain, but tend to ignore the consequences of what they drink. It’s as though what one imbibes does not count, especially given the fact that SSBs are not as filling or satisfying as solid foods. But when the consumption of SSBs escalates without a reduction in food and an increase in physical activity, the results will eventually show themselves — literally.

Martin learned her lesson. Her numbers were enough to scare her straight. When her research online confirmed the negative impact SSBs have on health, she went cold turkey — just like she did when she stopped smoking cigarettes several years ago.

“I won’t have soda in my house,” she said. She still admits to having a taste for sweet tea, but she mixes half a glass of the tea with half a glass of water. She’s even safeguarding her son from sugar’s impact. “I mix his apple juice with 50 percent water too,” she said.

Martin likened sugared beverages to drugs. “It’s like crack cocaine,” she said. “They [beverage manufacturers] sell a 2-liter bottle for next to nothing, then jack up the price, and people still buy it. All they’re doing is making you an addict.”

It didn’t take long before Harris started changing her habit. Her new attitude worked. At her next physical, her total cholesterol had plummeted and her BMI and glucose readings were on track.

“If I didn’t take control of myself now, I knew that eventually I would not have a choice,” she said. “I didn’t want to be dependent on anyone or anything.”