Candy holds a complex position in the realm of health, sparking debates about its potential benefits and drawbacks. While excessive sugar consumption is a well-documented threat to cardiovascular health, candy's role in cultural traditions and its potential impact on mental and spiritual well-being cannot be ignored.
The Allure of Candy
For thousands of years, candy has been a part of cultural traditions and celebrations. Many people continue to enjoy it as an occasional treat. Nearly all Americans (97%) report eating candy at least once per year. In moderation, candy can offer a small indulgence that lifts spirits, similar to music, art, and other fine foods.
The Dark Side of Sugar
Sugar occurs naturally in all foods that contain carbohydrates, such as fruits, vegetables, grains, and dairy. Consuming whole foods that contain natural sugar is generally considered acceptable. Because your body digests these foods slowly, the sugar in them offers a steady supply of energy to your cells. However, the American diet often includes excessive amounts of added sugar from sources like soft drinks, fruit drinks, flavored yogurts, cereals, cookies, cakes, candy, and processed foods.
According to the National Cancer Institute, adult men consume an average of 24 teaspoons of added sugar per day. Dr. Frank Hu, a professor of nutrition at Harvard T.H., notes that while the effects of excess sugar on obesity and diabetes are well-documented, its impact on heart health may surprise many. A study published in JAMA Internal Medicine found an association between high-sugar diets and a greater risk of dying from heart disease.
How Sugar Impacts Heart Health
The exact mechanisms by which sugar affects heart health remain unclear, but several indirect connections have been identified. High amounts of sugar can overload the liver, which metabolizes sugar like alcohol and converts dietary carbohydrates to fat, according to Dr. Hu.
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Excess sugar consumption can also raise blood pressure and increase chronic inflammation, both of which are pathological pathways to heart disease. Furthermore, sugary beverages contribute to weight gain by interfering with the body's appetite-control system, as liquid calories are less satisfying than calories from solid foods.
Dr. Hu emphasizes that the effects of added sugar intake, including higher blood pressure, inflammation, weight gain, diabetes, and fatty liver disease, are all linked to an increased risk of heart attack and stroke.
Recommended Sugar Intake
The American Heart Association recommends that women consume no more than 100 calories (about 6 teaspoons or 24 grams) and men no more than 150 calories (about 9 teaspoons or 36 grams) of added sugar per day. Reading food labels and tracking added sugar intake are essential for monitoring sugar consumption.
Dr. Hu warns against overzealous attempts to cut back on added sugar, as this can backfire. Reducing added sugar intake over time can benefit overall health, including maintaining a moderate weight and healthy blood sugar levels.
The "No Sugar" Challenge
Some people participate in "no sugar" challenges to reduce their intake. These challenges typically involve cutting out all sources of added sugar for a set period, such as 30 days, while focusing on consuming nutrient-dense whole foods. Natural sugars found in vegetables, fruits, and dairy products are generally permitted.
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While any dietary pattern that reduces or eliminates added sugar is likely to reduce obesity and improve health, consistency is key. The benefits of a 30-day challenge may be lost if a person returns to a high-sugar diet afterward.
Benefits of Reducing Added Sugar
Reducing added sugar intake can lead to several health benefits, including:
- Improved Blood Sugar Management: Reducing added sugar can lower blood sugar and insulin levels, potentially reducing the risk of type 2 diabetes, retinopathy, dementia, chronic kidney disease, NAFLD, polycystic ovary syndrome, and cardiovascular disease.
- Weight Management: Foods and beverages high in added sugar are often high in calories and low in nutrients, contributing to weight gain and obesity. Cutting out added sugar can aid in weight loss, especially when combined with a nutrient-dense diet.
- Improved Oral Health: Added sugar intake from sweetened beverages increases the risk of cavities and tooth decay.
- Improved Liver Health: High-sugar diets, particularly those high in fructose, can increase the risk of developing NAFLD.
- Improved Heart Health: Sugar-sweetened beverages are linked to heart disease risk factors, including high blood pressure, increased triglycerides, and high cholesterol.
- Other Potential Benefits: Reducing sugar intake may also help reduce anxiety and depressive symptoms and improve skin health.
Foods to Avoid and Embrace
During a "no sugar" challenge, it is recommended to restrict foods and beverages high in added sugars, such as:
- Sweeteners (table sugar, honey, maple syrup, corn syrup, agave, coconut sugar)
- Sweetened beverages (soda, sweetened smoothies and juices, sweetened coffee drinks, sports drinks)
- Condiments with added sugar (ketchup, BBQ sauce, honey mustard, coffee creamer)
- Sweetened dairy products (flavored yogurt, ice cream, chocolate milk)
- Sugary baked goods (cookies, cakes, donuts, bread with added sugar)
- Sugary breakfast foods (sugar-sweetened cereals, bars, granola, flavored oatmeal)
- Candy (chocolate, gummy candies, caramels)
- Sugary alcoholic beverages (mixed drinks, sweetened liquor, sweetened canned alcoholic drinks)
It is also advisable to minimize refined grains and replace them with whole-grain products without added sugars.
Instead, focus on consuming whole, nutrient-dense foods, including:
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- Vegetables (broccoli, cauliflower, spinach, carrots, asparagus, zucchini, sweet potatoes)
- Fruits (apples, oranges, berries, grapes, cherries, grapefruit)
- Proteins (chicken, fish, beef, tofu, eggs)
- Healthy fat sources (egg yolks, avocados, nuts, seeds, olive oil, unsweetened yogurt)
- Complex carb sources (beans, quinoa, sweet potatoes, butternut squash, brown rice)
- Unsweetened beverages (water, sparkling water, unsweetened coffee, tea)
Potential Downsides of Restrictive Diets
Reducing added sugar intake generally has no adverse physical health effects when done responsibly. However, restrictive dietary patterns may lead to an unhealthy preoccupation with healthy food or harmful food rules. Individuals with disordered eating tendencies may be more susceptible to these effects.
Consulting a registered dietitian can help ensure balanced meals and provide education, support, and guidance.
Candy's Role in the Diet: A Broader Perspective
While candy often receives a negative reputation, research suggests that current levels of candy consumption are not associated with risk of weight gain and cardiovascular disease in children and adults. Behavioral nutrition experts emphasize the importance of understanding factors that influence candy consumption to provide guidance for moderation.
Moderation vs. Restriction
Evidence suggests that moderation through portion control may be more effective than elimination or restriction of highly palatable foods like candy in relation to weight management and improved dietary health. A definition of moderation for candy intake is an amount equivalent to an average of up to 50-100 kcal/d for adults, fitting within a range of energy needs when nutrient-dense foods are chosen first.
Restricting access to palatable foods can have potentially negative consequences, including heightened desire for restricted foods and a tendency for subsequent overeating when restrictions are removed.
Candy Consumption Patterns
Nationwide food consumption data reveals that 26% of Americans aged ≥2 y consume candy on a given day, with youth aged 2-18 y reporting 31% consumption. On a day of candy consumption, consumers reported eating, on average, ∼40 g of candy (176 kcal). Per capita candy intake of all Americans was 10 g/d, representing 2.2% of total calories, or 45.2 kcal.
Recent Research on Candy and Health
Several epidemiologic studies have investigated the potential effects of candy consumption on health risk factors in children and adults, including body weight and markers of disease risk.
One study in >15,000 US adults found that total candy intake was not associated with increased weight or BMI, cardiovascular risk factors, or risk of metabolic syndrome. A similar study in >11,000 children and adolescents found that candy consumers were less likely to be overweight or obese than those who did not consume candy on the day of the recall, and no associations existed between candy consumption and cardiovascular risk factors.
However, conflicting results indicate that eating patterns including candy were associated with increased likelihood of weight gain in adults and children in cross-sectional studies. In these studies, candy was often categorized with other "sweets," limiting the conclusions specific to candy.
Potential Benefits of Specific Types of Candy
Consuming modest amounts of some types of candy, such as cocoa, dark chocolate, and chewing gum, has been associated with positive effects on weight and cardiovascular health.
Observational and intervention studies have indicated that modest amounts of cocoa and chocolate are associated with a range of positive effects on cardiovascular health. Clinical trials have confirmed short-term cardiovascular effects from consumption of products rich in cocoa flavanols. Meta-analyses of intervention studies found consistent short- and long-term improvements in insulin resistance, lipid profiles, vascular dilation, and multiple risk factors associated with chocolate and cocoa consumption.
Cocoa flavanols may also improve cognitive function and mood by improving blood flow to the brain.
Chewing sugar-free gum stimulates saliva, which helps to neutralize plaque acids, increase clearance of sugars, acids, and food debris, and re-mineralize tooth enamel. Systematic reviews of clinical and observational studies confirmed the effects of sugar-free gum on cavity reduction.
Environmental Factors and Candy Consumption
External factors, including a food's visibility, proximity, serving container, and package size, influence estimated and actual amounts of food consumed. These environmental factors can affect consumption norms, making it difficult to monitor food intake and recognize satiety.
Larger package and portion sizes have been shown to increase total energy intake, while reductions in portion or package size led to sustained decreases in energy intake. The size of the unit of food or package tends to set a consumption norm for consumers.
The Impact of Restriction
Restricting access to palatable foods, particularly in children, can be counterproductive. Restriction tends to focus children's attention on the restricted foods, increases their desire to obtain the food, and results in higher intake of the restricted food when it becomes available to eat. Longitudinal studies have revealed that restrictive feeding practices may diminish children's ability to self-regulate food intake, with subsequent increased risk of overeating and weight gain.
"Healthy Candy": A Misnomer?
The term "healthy candy" is often used to describe trendy sweets that promise to satisfy sweet cravings without the extra calories, sugar, or artificial ingredients found in traditional candy. These alternatives may contain natural sweeteners, low- or zero-calorie sugar substitutes, and added fiber.
However, experts caution that "healthy candy" is a misnomer. While these candies may be a better alternative for certain individuals, they do not qualify as health foods.
Ingredients in "Healthy Candy"
"Healthy candy" typically features:
- Low- or zero-sugar
- Low-calorie
- Naturally sweetened
- "Keto-friendly" ingredients
Instead of refined sugar, these candies may contain:
- Artificial sweeteners (aspartame, acesulfame potassium, sucralose, neotame, advantame, saccharin)
- Sugar alcohols (xylitol, erythritol, sorbitol, maltitol, mannitol, isomalt, lactitol)
- Plant- or fruit-based sweeteners (stevia, monk fruit extract, agave, fruit puree, coconut sugar, date sugar)
- High-fiber ingredients (chicory root, soluble tapioca fiber, soluble corn fiber)
Potential Benefits and Risks
Low-calorie and low- or zero-sugar candies can be a better alternative for individuals trying to limit or reduce their sugar intake, such as diabetics, people with an addictive tendency towards sugar, or those following the ketogenic diet. They may also be a better choice for people concerned about tooth decay.
However, it is important to note that:
- Artificial sweeteners and sugar alcohols may be linked to long-term health risks, such as cancer and heart disease.
- Consuming large amounts of sugar alcohols can cause gastrointestinal issues.
- The high fiber content in some candies can cause gassiness or digestive discomfort.
Moderation is Key
Even "healthier" candies should be enjoyed as an occasional treat and not as a snack or meal replacement.
Weight Loss and "Healthy Candy"
Candies made with non-sugar sweeteners may be helpful as part of a plan to cut back on sugar. However, they have not been shown to aid with long-term weight loss. The World Health Organization recommends against using "non-sugar sweeteners" to manage weight, noting that they don't help with weight control.
Healthier Alternatives
If you're looking to satisfy your sweet tooth in a healthier way, consider these alternatives:
- Fresh fruit (strawberries, raspberries, grapes, peaches)
- Dried fruit (mangoes, raisins, figs, apricots)
- Dark chocolate
If you choose to enjoy regular candy, consume it in moderation and ideally with a meal.