Hidden Calories: Added Sugar is Now the Default Option

Added sweeteners are hidden in most foods and drinks, adding unneeded and unhealthy calories to our diets.

It was an early day in med school. As usual, I was underslept and struggling to fight off fatigue. Like most of my classmates, I relied on psychoactive stimulants to keep me going. In my case, this meant I drank lots of coffee.

That morning, bleary eyed and half-awake, I shuffled up to the counter of the coffee shop and ordered an iced coffee. A few minutes later, I was handed a gigantic plastic cup filled with what appeared to be a milkshake. I asked whether there had been a mistake but was quickly informed that this concoction was in fact, my “iced coffee.”

When I tasted this opaque concoction, I realized that in addition to resembling a milkshake from the outside, my “iced coffee” likely contained as just as much sugar. How did I get my order so wrong? I asked the barista what I should have said if I just wanted coffee with ice, to which she replied, “unsweetened, black iced coffee.”

My confusion that morning reflects a major problem in America. Foods and beverages filled with added sugar are now the default option.

How significant has this issue become? A recent study from the University of North Carolina reviewed over a million packaged foods and beverages in the US, demonstrating that that 68% contained added sweeteners. Sweet is simply standard when it comes to food and drink. It’s no wonder the barista didn’t understand my confusion.

At a population health level, it’s worth considering the impact of this shift in our food and drink. We know added sugars are closely linked to weight gain and diabetes, as well as cardiovascular disease. The vast majority of Americans are now overweight or obese, and both diabetes and cardiovascular disease are epidemic in the United States. The negative influence of sweetened foods on our healthcare system and our individual health just cannot be overlooked.

From a behavioral economics perspective, there’s another aspect of the added sweetener issue to consider. In general, people are likely to stick with the default option. For example, when people have to check a box to opt-in in order to become organ donors, they tend not to. Conversely, if they have to check a box to opt out of donation, they’re more likely to remain donors. Applying this research to sweetened foods and beverages, we start to better understand why people are likely to go along with the status quo. There are times when doing what is best is what is easiest, but this is simply not the case when it comes to our foods and beverages.

We’ve started pushing back, even if it’s just in a small way, by requiring nutrition facts to show added sugars. But why wouldn’t we also want to know the same about foods we buy in a restaurant? As much as we worry about knowing what foods and beverages are GMO and pesticide-free, there’s far data telling us we should worry about the direct health consequences of added sugar, which is found in everything from salad dressing to yogurt.

The bottom line is that added sweeteners are bad for you, and they are being put into most of our foods and our drinks. It’s kind of like a large-scale poisoning, but because it’s a slow and hidden process, and because it’s enjoyable in the short run, we’re not too concerned about it. The real issue here is not just about eating sugar. If you eat a slice of cake, you probably know it’s not the best thing for you, but you can still consciously choose to enjoy it on occasion. But when it comes to hidden, added sweeteners, we’re oblivious to what we’re consuming. How can we hope to live healthy lives when we don’t even know what we’re putting into our bodies?

There are, however, several easy ways to mitigate the risk of added sweeteners. First, check the nutrition facts on your foods and beverages. Look specifically at the added sugars to get a feel for how much extra sweetener you’re consuming. Next, feel empowered to ask your waiter or barista whether your food or drink contains added sugar, and when possible, to read the labels of ingredients they are using in your food and drink. If you don’t feel comfortable with this, you can make a lot of progress by just avoiding foods that are heavy on added condiments and sauces, since those are major sources of added sugar. Finally, it’s worth familiarizing yourself with the many names that added sugar hides behind. Whether it’s evaporated cane juice, molasses, agave nectar or otherwise, none of it is doing you any favors, and improved sugar literacy gives you a major leg up on keeping it out of your food and drink.

Dr. Austin Perlmutter, co-author of BRAIN WASH, is a board-certified internal medicine physician.

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