Sugar Facts: The ‘public health pandemic’ of our time

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February is National Children’s Dental Health month; the perfect time to discuss ways to combat the most common chronic infectious disease of childhood – tooth decay. The primary cause of tooth decay is sugar, which causes harmful bacteria to take over in your mouth. Sugar isn’t only bad for your teeth – it’s bad for your health.

Studies have shown that the chronic diseases associated with obesity – diabetes, heart disease, liver problems, stroke and cancer – are driven by sugar. That’s because one of the most common forms of sugar, fructose or fruit sugar, is a chronic, dose-dependent liver toxin. Fructose is primarily processed in the liver. When the liver is pushed “to its max” and can’t process a large dose of fructose, the pancreas puts out the hormone insulin, which tells the muscles and organs to take up the excess sugar in the blood and turn it into fat. High levels of insulin also block brain receptors that sense when you are full. Among other things, this break in the feedback loop can result in gluttony and lack of exercise.

Overabundance of sugar

Sugar is found in almost all packaged foods sold in supermarkets. At least 61 different names for sugar are used on food labels. These include common names like sucrose and high-fructose corn syrup, as well as barley malt, dextrose, maltose, rice syrup, and dehydrated cane juice, among others. Too much sugar in any form is dangerous.

The natural fructose in whole fruit is safe to eat because the fructose is encased in fiber and pectin, so it is released slowly, and the liver has time to neutralize it. Pureeing fruit into smoothies or extracting the juice eliminates the protective effects of the fiber, so drinking a smoothie is equivalent to drinking a soda or other beverage sweetened with high fructose corn syrup or sucrose.

Nations around the world where inhabitants consume processed foods and beverages that are loaded with sugars have experienced a rise in chronic diseases such as obesity, diabetes, heart disease, and others. This global problem is the “great public health pandemic” of our time.

The gatekeeper

The gateway to the digestive system is the oral cavity. Since the dentist is the “gate keeper,” this is a unique platform to empower Soldiers and families to make responsible choices in nutrition and to improve oral health literacy.

The World Health Organization (WHO) has published new guidelines restricting sugar intake based on evidence relating sugar to higher risks of non-transmittable diseases; chiefly identified as obesity and dental caries. The guidelines provide recommendations for policy makers looking to reduce the risk of these two non-transmittable diseases in adults and children. The new guidelines include a science supported recommendation to lower free sugar intake over the course of a lifetime, a strong recommendation to limit free sugar intake to less than 10 percent of total calories consumed, and a conditional recommendation to reduce the free sugar intake to less than 5 percent of total calorie intake.

These guidelines are not intended to apply to those in need of specific therapeutic diets, but are recommended for use by policy makers to develop policies consistent with national nutritional guidelines and cultural customs. The WHO evidence-supported recommendation calls for a reduction in sugar intake that could improve the health of populations.

Oral Hygiene

Your most important weapon against oral disease is a toothbrush. For best results, brush twice-a-day with a fluoride toothpaste. Your toothbrush should have a small, multi-tufted head that can easily fit around your back teeth, soft or ultrasoft nylon bristles with rounded ends that won’t harm the soft tissue, and a long, wide handle that fits your hand comfortably. Electric toothbrushes work well if they are used properly. Use slow movements that cover each tooth. The most effective ones have soft nylon bristles that rotate in a circle, with rotational oscillation, or in-and-out motions.

Floss once a day for at least 2-3 minutes. Rinsing with mouthwash is not a substitute for flossing. Flossing removes plaque, bacteria and food particles that stick on and in between the teeth where a toothbrush can’t reach. There are several different types of floss. Choose the one that most easily fits in between your teeth and is easy for you to hold.

Eat & drink right to prevent tooth decay

Combine treats, juice, soda or sugary drinks with meals.

Limit snacks containing sugars and starches.

Eat foods rich in calcium and vitamin D at least three times a day.

Eat at least eight servings of fruits and vegetables a day, with at least five of them being brightly colored; red, yellow, or orange.

Eat high quality proteins like meats, eggs, and fish at least twice a day.

Eat high fiber, whole grain breads or cereals instead of foods made with white flour.

Avoid dehydration. Drink at least eight glasses of water a day.

Limit sugar-sweetened or acidic beverages such as soda, punch, and juice, to 12oz per day.

Drink sugar-sweetened or acidic drinks quickly to minimize contact time with your teeth.

When drinking sugary or acidic drinks, make sure they are cold and use a straw to keep the drink away from your teeth.

Drink water after sugary or acidic drinks to rinse the acids off your teeth

Preventive measures

The Army’s Performance (P3) Triad is a great start. P3 optimizes health with sleep, activity, and nutrition. The quality and quantity of food you eat plays a role in your physical, mental, and emotional performance in the gym, during the mission, at home, and everywhere in between. Premium fuel gets you premium results.

Performance fueling requires “nutrient rich meals” and builds on nutritional fitness. Eating nutrient-rich foods supports muscle growth, recovery, tissue repair, immune function, and will improve mental and physical performance. In addition, good nutrition can help Soldiers maintain an appropriate weight and help reduce the risk of chronic disease.

To manage a balanced diet, read food labels and compare them with sound nutritional science supported by the WHO. Unlike salt and fats that are added to foods, nutrition labels don’t provide you with a daily reference value for added sugar. However, the American Heart Association (AHA) recommends no more than 9 teaspoons, 38 grams, of added sugar per day for men, and 6 teaspoons, 25 grams, per day for women. The AHA limits for children vary depending on their age and caloric needs, but range between 3-6 teaspoons (12 – 25 grams) per day.

MyPlate, the U.S. Department of Agriculture Food & Nutrition website at, is a reminder to find your healthy eating style and build it throughout your lifetime. Eating healthy is a journey shaped by many factors, including stage of life, situations, preferences, access to food, culture, traditions, and the personal decisions we make over time. MyPlate offers ideas and tips to help you create a healthier eating style that meets your individual needs and improves your health.

The Army Wellness Center, or AWC, provides standardized primary prevention programs and services designed to build and sustain good health and improve the overall healthy lifestyles of Soldiers, family members, retirees, and government civilians. AWC and resources address lifestyle behaviors holistically and over time.

Dental readiness means keeping your mouth healthy. Everything you put in your mouth affects your health. Protect yourself against mouth pain, infection, and loose or missing teeth which can impair your ability to eat high performance, high-fiber foods like fresh fruits and vegetables.

For more information, visit center/nutrition/nutrition-and-oral- health; s/healthyliving/al/Pages/ArmyWellness Centers.aspx; /bill/101st-congress/house-bill/3562 ; and -myplate-mywins

Editor’s Note: Lt. Col. Azure L. Utley, is the commander of the APG Dental Clinic Command and the deputy prosthodontic consultant to the Army Surgeon General. Col. Georgia G. Rogers is the Dental Public Health Consultant to the Army Surgeon General.