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4newsinhealth.nih.gov/special-issuesbenefits of fruits and other naturallysweet foods.Sugar-sweetened beverages likesoda, energy drinks, and sportsdrinks are the leading source ofadded sugars in the American diet.Juices naturally contain a lot ofsugar. But sometimes, even more isadded to make them taste sweeter.“Juices offer some vitamins andother nutrients, but in general,I think those benefits are greatlyoffset by the harmful effects of toomuch sugar,” Bremer says.Over time, excess sweetenerscan take a toll on your health.“Several studies have founda direct link between excesssugar consumption and obesityand cardiovascular problemsworldwide,” Bremer explains.Cutting BackBecause of these harmful effects,many health organizationsrecommend that Americans cutWise ChoicesCut Added Sugars Choose water, milk, or unsweetened tea or coffee instead ofsodas, sports drinks, energydrinks, and fruit drinks. Reduce sugar in recipes. If a recipesays 1 cup, use 2/3 cup. To enhance flavor, add vanilla,cinnamon, or nutmeg. Eat fresh, canned, frozen, anddried fruits without added sugar.Choose fruits canned in their ownjuice or water rather than syrup. Use fruits to top foods like cerealand pancakes rather than sugars,syrups, or other sweet toppings. Read the ingredients list to pickfood with little or no added sugar. Use the Nutrition Facts label tochoose packaged foods withless sugars.back on added sugars. About 15% ofthe calories in the American adultdiet now come from added sugars.Experts recommend a daily limiton added sugar of no more than10% of calories.But added sugars can be hard toidentify. On a list of ingredients,they may be listed as sucrose(table sugar), corn sweetener,high-fructose corn syrup, fruit-juiceconcentrates, nectars, raw sugar,malt syrup, maple syrup, fructosesweeteners, liquid fructose, honey,molasses, or anhydrous dextrose.Added sugar can also be listedwith any word ending in “-ose,” thechemical suffix for sugars. If anyof these words are among the firstfew ingredients on a food label, thefood is likely high in sugar. To findthe total amount of sugar in a food,look for “Sugars” on the NutritionFacts label under the category“Total Carbohydrate.”To find the total amountof sugar in a food, lookfor “Sugars” on theNutrition Facts labelunder the category“Total Carbohydrate.”Many people try cutting backon calories by switching fromsugar-sweetened to diet foods anddrinks that contain low- or nocalorie sweeteners. These artificialsweeteners—also known as sugarsubstitutes—are many timessweeter than table sugar, so smalleramounts can create the same levelof sweetness.People have debated the safety ofartificial sweeteners for decades.To date, researchers have found noclear evidence that any artificialsweeteners approved for use in theU.S. cause cancer or other serioushealth problems like birth defectsin humans.But can they help with weightloss? The scientific evidence ismixed. Some studies suggest thatdiet drinks can help you drop poundsin the short term. But their longterm effects on weight—and otherhealth aspects—are unclear. Rotherand other NIH-funded researchersare now working to betterunderstand the complex effects thatartificial sweeteners may have onthe human body.Studies of rodents and smallnumbers of people suggest thatartificial sweeteners can affectthe gut microbes that help us digestfood. This in turn can alter thebody’s ability to use glucose, whichmight then lead to weight gain. Butuntil further studies are done inpeople, the long-term impact of thesesweeteners on gut microbes andweight remains uncertain.Beyond the Gut“There’s much controversy aboutthe health effects of artificialsweeteners and the differencesbetween sugars and sweeteners,”says Dr. Ivan de Araujo at the MountSinai Icahn School of Medicine.“Some animal studies indicatethat sweeteners can producephysiological effects. But dependingon what kind of measurement istaken, including in humans, theoutcomes may be conflicting.”The key to good healthis eating a well-balanceddiet with a variety of foodsand getting plenty ofphysical activity.De Araujo and others have beenstudying the effects that sugars andlow-calorie sweeteners might haveon the brain. They are finding thatsugar and sweeteners tap differentlyinto the brain’s reward circuitry,with sugars having a more powerfuland pleasurable effect.“The part of the brain thatmediates the ‘I can’t stop’ kinds of

5newsinhealth.nih.gov/special-issuesbehaviors seems to be especiallysensitive to sugars and largelyinsensitive to artificial sweeteners,”de Araujo says. “Our long-termgoal is really to understand ifsugars or caloric sweeteners drivepersistent intake of food. If exposedto too much sugar, does the braineventually change in ways that leadto excess consumption? That’s whatwe’d like to know.”Some research suggests that theintensely sweet taste of artificial,low-calorie sweeteners can lead toa “sweet tooth,” or a preference forsweet things. This in turn mightlead to overeating. But more studiesare needed to confirm the relativeeffects of caloric versus non-caloricsweeteners.Don’t Sugarcoat It“In the long run, if you want tolose weight, you need to establisha healthy lifestyle that containsunprocessed foods, moderatecalories, and more exercise,”Rother says.When kids grow up eating a lot ofsweet foods, they tend to develop apreference for sweets. But if you givethem a variety of healthy foods likefruits and vegetables early in life,they’ll develop a liking for them, too.“It’s important for parents toexpose children to a variety of tastesearly on but realize that it oftentakes several attempts to get a childto eat such foods,” Bremer says.“Don’t give up too soon.”The key to good health is eatinga well-balanced diet with a variety offoods and getting plenty of physicalactivity. Focus on nutrition-richwhole foods without added sugars.Get tips on healthy eating and weightcontrol at go.usa.gov/xEjmc.Web LinksFor more about sugar andsweeteners, go to: tuffThe Skinny on FatThe Good, the Bad, and the UnknownFat is an essential nutrient forour bodies. It provides energy.It helps our guts absorb certainvitamins from foods. Butwhat types of fat should yoube eating? Are there any youshould avoid?Recommendations aboutdietary fat have shiftedover the last two decades.From the 1970s through the1990s, nutrition researchersemphasized eating a low-fat diet.This was largely becauseof concerns about saturatedfats, explains Dr. Alice H.Lichtenstein, who studies diet andheart health at Tufts University.Saturated fat that’s in thebloodstream raises the levels of LDLcholesterol—the “bad” cholesterol.This in turn raises the risk ofheart disease.But when people started followinglow-fat diets, they didn’t only cutsaturated fats. In many cases, theyreplaced healthy unsaturatedfats with processed carbohydrates,explains Lichtenstein.“Initially, when we recommendedcutting total fat, we did notanticipate people would replace itwith fat-free foods, like cookies,crackers, and ice cream, made withrefined grains and sugar,’” saysLichtenstein. “It is what we refer toas an unanticipated consequence.”As scientists have learned, thosereplacement calories matter. Studieshave shown that replacing saturatedfat with unsaturated fat reducesthe risk of heart disease. However,replacing saturated fat with simplecarbohydrates, such as added sugarand white bread, does not.“There’s still this misconceptionthat eating fat—any kind of fat—isbad, that it will lead to heart attacksor weight gain. That’s not true.People really should be encouragedto eat healthy fats,” says Dr.Frank Sacks, a nutrition expert atHarvard University.Healthy FatsResearch has shown thatunsaturated fats are good for you.These fats come mostly from plantsources. Cooking oils that are liquidat room temperature, such as canola,peanut, safflower, soybean, and oliveoil, contain mostly unsaturated fat.Nuts, seeds, and avocados are alsogood sources. Fatty fish—such assalmon, sardines, and herring—arerich in unsaturated fats, too.Large studies have found thatreplacing saturated fats in your dietwith unsaturated fats can reduceyour risk of heart disease by aboutthe same amount as cholesterollowering drugs.DefinitionsSaturated FatsFats that are solid at room temperature;found in butter, lard, full-fat milk andyogurt, full-fat cheese, and high-fat meat.Unsaturated FatsFats that tend to be liquid at roomtemperature; found in vegetable oils,seafood, and nuts.

6newsinhealth.nih.gov/special-issuesPeople should actively makeunsaturated fats a part of their diet,Sacks says. You don’t need to avoidhealthy fats to lose weight, he adds.In an NIH-funded study Sacksled, called the POUNDS LOST trial,people who ate higher-fat or lowerfat diets had similar rates of weightloss. They were also both successfulat keeping the weight off.“Low-fat diets have the sameeffect on body weight gain orweight loss as higher-fat diets orhigher-protein diets,” he explains.“For weight loss, it’s about gettinga handle on whatever foods in yourdiet are giving you excess calories.”Replacing “Bad” FatsSo are there fats you should avoid?Only a few years ago, doctors stillhad to advise people to avoidso-called trans fats in their diets.These largely manufacturedfats could be found in things likemargarine and many processedWise ChoicesChoosing Fats Eat plant-based foods. Plants cancontain healthy fats, as well asimportant vitamins and minerals. Include plant oils in your diet.Healthy choices include canola,peanut, olive, safflower, soybean,sunflower, corn, and nut oils. Replace foods containingsaturated fats (like butter orlard) with healthier unsaturatedfat options. Limit fatty red meat. Instead, eatmore fish, poultry, or lean meats. Reduce sugars and replaceprocessed grains, such as whitebread and white rice, with wholegrains and brown rice. The bodycan use simple carbohydrates tomake saturated fats.foods. They have been shown toraise the risk of heart disease.Since 2015, the U.S. Food andDrug Administration has takensteps to remove artificial trans fatsfrom the food supply. Most trans fatsnow in food come from the smallamounts found naturally in animalproducts, like meat and butter.Experts already recommend thatpeople limit their intake of animalfats. “So that takes care of thosetrans fats as well,” Lichtenstein says.As for saturated fat, it’scomplicated. Not all of the saturatedfat in the bloodstream comesfrom the saturated fat that we eat,explains Dr. Ronald Krauss, whostudies cholesterol at the UCSFBenioff Children’s Hospital Oakland.Instead, it’s produced when the bodybreaks down simple carbohydratesand sugars. That’s one reason whyreplacing saturated fat in the dietwith simple carbohydrates doesn’treduce the risk of heart disease.Nutrition experts still recommendthat people minimize the amountof saturated fat in the diet. Butresearchers are now looking atwhether the type of food thatsaturated fat is found in matters.For example, the influence of plantbased saturated fats, such as those incoconut and palm oil, is still unclearand being researched further.Recent studies suggest that somefull-fat dairy products, such asyogurt, may actually have benefitsfor the heart, Krauss says.Krauss and his colleagues recentlyran a small study looking at theeffects of replacing some of thesugar allowed in the DASH diet withsaturated dairy fats. The DASH dietwas developed by NIH to help lowerblood pressure.Participants who ate saturateddairy fat instead of sugar had lessof a fat called triglycerides in theirbloodstream. The higher-fat dietwas also as effective at loweringblood pressure as the standardDASH diet.More research is needed tounderstand which foods that containsaturated fats may influence thebody in a good way.Individual NeedsResearchers know that there are bigdifferences in how people’s bodiesreact to different types and amountsof fat. But they still don’t know why.Studies have found that genes aren’tlikely responsible, Sacks explains.Lichtenstein and Krauss are bothstudying how the microbes that livein the gut interact with dietary fats.The makeup of the microbiome—allthe microorganisms that normallylive in the body, mainly in the gut—can differ widely between people.It may turn out that different typesof gut bacteria produce differentcompounds from fats. Thesecompounds could then affect thebody in different ways, Lichtensteinexplains. Or different types offats could promote the growth ofdifferent bacteria in the gut, whichmay then have varying effectson health.“We just don’t know yet, but thereis tremendous interest in tryingto understand the role of the gutmicrobiome in human health,”she says.If there’s one thing that theresearch has shown, it’s that thescience of diets is very complex.Experts have moved away fromfocusing on single nutrients—suchas fat—by themselves. Instead, Sackssays, researchers now talk abouthealthy dietary patterns: ways ofeating that take all aspects of thediet into account. Learn more abouthealthy dietary patterns at health.gov/dietaryguidelines.Web LinksFor more about dietary fat, go y-fat

7newsinhealth.nih.gov/special-issuesThe Salty StuffSalt, Blood Pressure, and Your HealthSalt is essential to our body’s fluids.That’s likely why we evolved to enjoyits taste. On the other hand, anyonewho’s gotten a mouth full of seawaterknows that too much salt tastesterrible. Maybe your body’s trying totell you something. It turns out thattoo much salt can lead to a host ofhealth problems.Dietary salt, or table salt, ismade from two chemical elements:sodium and chloride. That’s why itschemical name is sodium chloride.It’s the sodium part that’s been tiedto health problems. But since most ofthe sodium we ingest is from salt, it’sdifficult to separate the effects of saltand sodium in many studies.Health Effects“The best-known effect of sodium onhealth is the relationship betweensodium and blood pressure,”explains Dr. Holly Nicastro, an NIHnutrition research expert. Dozens ofstudies, in both animals and people,have linked a higher salt intake withhigher blood pressure. Reducing saltintake, on the other hand, lowersblood pressure.Blood pressure is the force ofblood pushing against the walls ofarteries as the heart pumps outblood. When this pressure rises—acondition called high blood pressure,or hypertension—it can damagethe body in many ways over time.High blood pressure has been linkedto heart disease, stroke, kidneyfailure, and other health problems.There are two blood pressurenumbers, and they’re usuallywritten with one above or beforethe other. Systolic, the first, is thepressure when the heart beats,pumping blood through the arteries.Diastolic is the pressure when theheart is at rest between beats. Thenumbers 120/80 mmHg are the onesyou should aim to keep your bloodpressure below.Some research also suggeststhat excessive sodium intakeincreases the risk of stomach cancer.Scientists continue to investigatethis possible connection.Researchers do know that noteveryone is equally sensitive to salt.“From our experiments, we knowthere’s lots of variation in the bloodpressure response to sodium intake,”Nicastro says. Certain groups ofpeople see greater reductions inblood pressure when they lower theirsalt intake: African-Americans,older adults, and people with bloodpressure above normal.“Within those groups, there’sa lot of variation between people,”Nicastro says. But about 1 in 3 adultsnationwide has high blood pressureright now. Another third haveelevated blood pressure, meaningtheir numbers are high enough toput them at risk to develop highblood pressure. In light of this, shesays, “It’s really important for themajority of U.S. adults to reducetheir blood pressure.”How Much Salt?Experts recommend that adults takein less than 2,300 milligrams (mg) ofsodium a day—that’s what’s in about6 grams of salt, or about a teaspoon.People with high blood pressureDefinitionsArteriesThe vessels that carry blood from yourheart throughout your body.StrokeWhen normal blood flow to the brain isstopped, usually by ruptured or blockedblood vessels.

8newsinhealth.nih.gov/special-issuesshould shoot for 1,500 mg. But rightnow, American adults eat an averageof about 3,600 mg of sodium per day.Dr. Kirsten Bibbins-Domingoat the University of California,San Francisco, led an NIH-fundedstudy that used computer modelingto explore the effects of a modestreduction in salt intake in the UnitedStates. The researchers found thatreducing salt intake by 3 grams perday (1,200 mg of sodium) could cutthe number of new cases of heartdisease each year by as many as120,000, stroke by 66,000, and heartattack by nearly 100,000. It couldalso prevent up to 92,000 deathseach year.All segments of the populationwould benefit, with AfricanAmericans having the greatestimprovements overall. Womenwould particularly benefit fromreductions in stroke, older adultsWise ChoicesCut Back on Sodium Look at Nutrition Facts labels andtry to choose prepared foods thathave less than 5% of the Daily Valueof sodium per serving. Use fresh poultry, fish, and leanmeat, rather than canned, smoked,or processed. Choose fresh or frozen vegetablesthat have no added salt. Rinse canned foods to removesome of the sodium. Add less salt—or none—whencooking. Use reduced-sodium bouillon,dressings, and sauces like soy sauce. Use fresh herbs and buy spices andblends without added salt. Cook at home instead of eating out,when possible. But when eatingout, ask that no extra salt be addedto your food.from a decline in heart disease, andyounger adults from fewer deaths.Reducing SaltSome countries have tried to lowersalt intake using various strategies,such as working with industry toreduce the salt content in processedfoods, requiring labels on ready-toeat foods, and educating the public.The UK achieved a 15% reduction insalt consumption between 2003 and2011. During this time, deaths fromstroke fell by 42% and from heartdisease by 40%.But wouldn’t we miss the taste?“Several studies have shown that asyou gradually reduce sodium intake,you lessen your desire for salty food,”Nicastro says. And surveys of peopleacross the UK found that mostpeople didn’t notice any difference inthe taste of their food.“A very modest decrease in theamount of salt, hardly detectablein the taste of food, can havedramatic health benefits for theU.S.,” Bibbins-Domingo stresses.The salt we add to our foodactually accounts for about 10%of our salt consumption. Most ofthe salt we eat comes in processedfoods from stores, restaurants, anddining halls. You may already knowthat fast food, cold cuts, and cannedfoods tend to have a lot of salt.“Many people don’t realize thata lot of our salt is from breads andcereals,” Bibbins-Domingo says.Studies have found that about 15 to20% of the sodium in the averageAmerican’s diet comes from grainproducts, such as breads, cereals,crackers, and chips.“In terms of advice, I think thebest guidance we have is for peopleto pay attention to nutrition factson the labels,” Nicastro says. “Thepercent daily value is a better guidethan the language that’s used on foodlabels like ‘low-salt.’ These labelscan be confusing, because they havevery defined technical meanings.”Try to select foods, she advises, withless than 5% of the daily value of saltp

“The DASH diet is very flexible because you can follow DASH without going to a specialty grocery store. You can follow it with items that are very familiar to most people in this country,” Nicastro says. The DASH eating plan is rich in fruits, vegetables, whole grains, beans