 Recommendations to limit sugar consumption vary around the globe, with guidelines ranging from limit sweet desserts to one every other day, to keep sugar consumption to four less occasions per day. In the US, the American Heart Association is leading the charge of proposing dramatic reductions in the consumption of soft drinks and other sweetened products. They recommend sticking to under about 5% of calories a day from added sugars, which may not even allow a single can of soda. Why the American Heart Association? Because the overconsumption of added sugars has long been associated with an increased risk of cardiovascular disease, meaning heart disease and strokes. We used to think that added sugars was just a marker for an unhealthy diet. At fast food restaurants, people are probably more likely to order a cheeseburger with their super-sized soda than a salad. But the new thinking is that, no, the added sugars in processed foods and drinks may be an independent risk factor in and of itself, worse than just empty calories, but actively disease-promoting calories based on data like this. This is how much sugar the American public is eating. Only about 1% meet the American Heart Association recommendation to push added sugar consumption to 5% or 6% of your daily caloric intake. Most people are up around 15%. And that's where cardiovascular disease risk starts to take off, with a doubling of risk at 25% of calories and a quadrupling of risk for those getting a third of their daily caloric intake from added sugar. We went from eating 7 pounds of sugar every year to 100 years ago to 50 pounds to now over 100 pounds of sugar. We're hardwired to like sweet foods because we evolved the surrounding surrounded by fruit, not fruit loops. But this adaptation is terribly misused and abused today. Hijacked by the food industry for our pleasure and their profits. Why are we consuming so much sugar despite knowing how much it can harm us? Well, yes, it may have an addictive quality. Yes, there's that hard wiring, but the processed food industry isn't helping. 75% of packaged food products in the United States contain added sweeteners, mostly coming from sugar-sweetened beverages like soda, thought responsible for more than 100,000 deaths worldwide and millions of years of healthy life lost. No problem, why not just switch to diet by choosing diet soda? Can't we get the sweet taste we crave without the downsides? Unfortunately, routine consumption of diet soft drinks is associated with increases in the same risks that many seek to avoid by using artificial sweeteners. Here what studies have found for the increased risk of cardiovascular disease associated with regular soda. And here's the cardiovascular risks associated with diet soda. In other words, the belief that switching to diet soda will reduce long-term health risks is not well supported by scientific evidence and instead may contribute to the very health risks people were seeking to avoid in the first place. But why? I mean, it makes sense why drinking all that sugar might increase stroke risk with the extra inflammation and triglycerides, but why, in this pair of Harvard studies, did a can of diet soda appear to increase stroke risk the same amount? Yes, maybe the caramel coloring in brown sodas like colas may play a role, but another possibility is that artificial sweeteners may increase the desire for sugar sweeteners to ever energy-dense beverages and foods. See, the problem with artificial sweeteners is that there's a disconnect that ultimately develops between the amount of sweetness the brain tastes and how much blood sugar ends up coming up to the brain. The brain feels cheated and figures you have to eat more and more and more sweeteners in order to get any calories out of it. As a consequence, at the end of the day, your brain says, OK, at some point I need some blood sugar here, and then you eat an entire cake. Because no one can hold out in the end. If you give people sprite, sprite zero, or unsweetened, carbonated lemon-lime water and you don't tell them what is what and what the study's about, then later on you offer them a choice. They can have M&Ms, spring water, or sugar-free gum. Guess who picks the M&Ms? Those that drank the artificially sweetened soda were nearly three times more likely to take the candy than either those that consumed the sugar sweetened, drinks, or the unsweetened drinks. So it wasn't a matter of sweet versus non-sweetened. It wasn't a matter of calories versus no-calories. There's something about non-caloric sweeteners that tricks the brain. Then they did another study in which everyone was given Oreos, and they asked people how satisfied the cookies made them feel. And again, those that drank the sprite zero, the artificially sweetened sprite, reported feeling less satisfied than either the normal sprite or the sparkling water. These results are consistent with recent brain imaging studies demonstrating that regular consumption of artificial sweeteners can alter the neuro pathways responsible for the pleasure response to food. The only way to really prevent this problem to break the addiction is to go completely cold turkey and go off all sweeteners, artificial as well as table sugar and high-fructose corn syrup. Eventually, the brain resets itself and you don't crave it as much. We've always assumed the consumption of both sugar and artificial sweeteners may be changing our palates or taste preferences over time, increasing our desire for sweet foods. Unfortunately, the data on this are lacking. Until now, 20 folks agreed to cut out all added sugars and artificial sweeteners for two weeks, and afterwards 95% found that sweet foods and drinks tasted sweeter, or to who's sweet? And said, moving forward, they would use less or even no sugar at all. And most stopped craving sugar within the first week, six days. This suggests a two-week sugar challenge, or even a one-week challenge, make help to reset taste preferences and make consuming less or no sugar easier. And so maybe we should be recommending it to our patients. Eating fewer processed foods and choosing more real, whole, plant-based foods and make it easy to consume less sugar.