Ask the Doctors by Eve Glazier, M.D. and Elizabeth Ko, M.D

An Apple or an Oreo for Lunch? Take a Guess ...

Dear Doctor: I read that sugar might be worse for your heart than fat. Should I give up sweets?

Dear Reader: If you're one of the millions of Americans with a sweet tooth, there's some good news. According to current guidelines from the American Heart Association, eating a modest amount of added sugar each day -- six teaspoons for women, nine teaspoons for men -- is safe for your heart.

But before you pop open the cookie jar (or that pint of Ben and Jerry's), let's review some hard facts. Research shows that eating too much sugar can significantly increase your risk of heart disease. Individuals who received between 17 and 21 percent of their total daily calories from added sugar had a 38 percent greater chance of dying from heart disease compared to people who limited added sugar to 8 percent of their total daily calories.

That study, published in the Journal of the American Medical Association in 2014, had even more sobering news. People who got more than 21 percent of their daily calories from added sugar doubled their risk of heart disease. Considering that the average American now eats up to 20 teaspoons of sugar per day, we've got a problem.

Although saturated fat has received the lion's share of blame for heart disease in the United States for many years, sugar is now taking center stage. Studies show that sugar leads to potentially harmful changes in levels of blood cholesterol and triglycerides, both markers of heart disease. Diets high in added sugar have been tied to other abnormalities associated with heart disease, such as high blood glucose levels, decreased glucose tolerance, insulin resistance and fatty liver disease.

While the occasional sugar splurge is probably not a problem, keeping daily consumption to a minimum is vital to heart health. Which brings us back to that recommended maximum of six (or nine, if you're a man) added teaspoons of sugar per day.

It may sound like a lot, but consider this -- the average 12-ounce can of soda has about 10 teaspoons of sugar. And with the stealthy addition of sugar to products like breads, canned vegetables, pasta and barbecue sauces, staying within guidelines takes vigilance.

Still, it's worth it. A recent study showed that when a group of obese children reduced added sugar from their diets, it took just nine days for their triglyceride levels -- a marker of heart disease -- to drop by one-third.

So, an apple or an Oreo for your afternoon snack? Not really a difficult choice.

(Eve Glazier, M.D., MBA, is an internist and assistant professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and primary care physician at UCLA Health.)