A
mericans eat a lot of sugar. They eat a lot of everything. Doctors know this better than anyone. We see the consequences of overeating every day in our practices. Almost 70 percent of American adults are overweight. Half of all overweight Americans are obese. Something is clearly out of hand. We need new strategies to address America’s—and the world’s—epidemic of obesity.

The health problems associated with obesity almost defy enumeration. Obese individuals die at an earlier age; they are at higher risk of hyper tension, stroke, coronary artery disease, venous thromboembolism, some cancers, sleep apnea, liver disease, pancreatic disease, even some psychiatric disorders. They are at higher risk of diabetes, which directly raises the risk of deadly heart disease.

Now there is even more alarming news. Studies have shown an association between obesity and Alzheimer’s disease. With our nation’s aging demographic, this is cause for particular concern. It could spell a perfect storm of cardiovascular disease, diabetes, and dementia—with no one to blame but us and our poor lifestyle choices.

As one of America’s leading health-care institutions, Cleveland Clinic has a particular responsibility to set a good example in health and wellness. In 2006, we launched a series of programs to promote healthy lifestyles among the 40,000 caregivers across all our facilities. We offered free smoking cessation classes, fitness club memberships, yoga and relaxation programs to all members of our employee health plan. We also took a good look at the foods we served in our hospital, cafeterias, and vending machines. We banned all trans fats from our kitchens. Sugary soft drinks and snacks were removed from vending machines and dining areas and replaced with sugar-free or lower-sugar alternatives.

Like Cleveland Clinic, Anne Alexander and the team at
Prevention
are committed to promoting healthier lifestyles.
The Sugar Smart Diet
is an approach that merits serious consideration. It targets sugar as a major driver of unwanted weight gain. It points out the strong association of excess belly fat with heart disease and diabetes. It offers personal testimony from individuals who have changed their diets and improved their prospects for better health. Best of all, it offers its recommendations as part of a lifestyle that includes better all-around nutrition and exercise.

My thanks to Anne Alexander for raising awareness of sugar in the American diet and for her positive approach to better health. I hope that everyone who reads this book will take its message to heart.

—
Delos M. Cosgrove, MD, chief executive officer and president of Cleveland Clinic, Cleveland, OH

ACKNOWLEDGMENTS

P
ersonally and professionally, I am indebted to CEO Maria Rodale for her inspiring leadership, encouragement to pursue this project, and regular edict to trust my gut. I am so grateful to work at a very special company where the corporate mission is to inspire and enable people to improve their lives and the world around them.

I am also profoundly grateful for the kismet that brought Julia VanTine into this project in the nick of time. Her relentless research and laugh-out-loud funny, extremely talented writing turned this idea into a real book. A thousand thank-yous, Julia!

I’m lucky enough to be surrounded by a team of highly talented people every day, and many of them played an important role in the creation and execution of this book. Editorial Director Anne Egan jumpstarted this project, and Editorial Director Jennifer Levesque, Executive Editor Trisha Calvo, and Editorial Assistant Jessica Fromm pulled things together. The book looks as great as it does thanks to Jeffrey Batzli, Chris Gangi, Amy King, and Joanna Williams. Hope Clarke, Sara Cox, and Chris Krogermeier kept everyone organized and on track. Thanks to the entire
Prevention
and
prevention.com
staff, especially Polly Chevalier, Siobhan O’Connor, Lauren Paul, Amy Rushlow, Amy Beal, and Melissa Roberson.

Many thank-yous to Stephanie Clarke, RD, and Willow Jarosh, RD, owners of C&J Nutrition in New York City, for their nutrition guidance. The meals and recipes they created truly made getting sugar smart a satisfying, flavorful pleasure.

Thanks to
Prevention
’s former fitness director, Michele Stanten, who developed the Sugar Smart Workout and coordinated our test panel. Kelly Hartshorne, RN, offered invaluable assistance. And much gratitude goes to our test panelists Lisa Dickinson, Robyn Endress, Nora Haefele, Chrissie Hartner, Patricia Huxta, Gayle Hendricks, Colleen Krcelich, Jessica Lievendag, Scott
Lievendag, Renee Marchisotto, Jeanne McDonald, Lisa Miller, Robin Molnar, Kathy Rocchetti, Carol Stiegler, Myra Stoudt, David Sun, and Stephanie Zwetolitz. Thank you for putting this plan to the test and for sharing your journey. Your feedback made this plan better, and your stories and experiences are an inspiration to everyone aiming to eat healthfully.

You can’t get sugar smart without addressing your emotional connection to sugar. These three emotional eating experts provided a number of the highly effective craving-controlling strategies you’ll find in this book. Thank you to:

Susan Albers, PsyD, a psychologist at the Cleveland Clinic Family Health Center and author of
Eat Q: Unlock the Weight-Loss Power of Emotional Intelligence
Karen R. Koenig, LCSW, MEd, author of
The Food and Feelings Workbook: A Full Course Meal on Emotional Health
Jennifer L. Taitz, PsyD, author of
End Emotional Eating: Using Dialectical Behavior Therapy Skills to Cope with Difficult Emotions and Develop a Healthy Relationship to Food

I’d also like to thank our Sugar Smart mentors Arthur Agatston, MD; Tasneem Bhatia, MD; David Katz, MD, MPH; Ashley Koff, RD; Pam Peeke, MD, MPH, FACP; and Andrew Weil, MD, for their contributions to this book, as well as for the expertise they’ve shared with
Prevention
and the support they have given us over the years as members of our advisory board, columnists, story sources, and guides to all things health.

And finally to my children: Thank you for your forbearance all those times Mommy was on the computer and for helping me scope out sugar bombs in the grocery store!

INTRODUCTION
Welcome to the Sweet Life!

W
hen I was a kid, sugar was a treat. It was dessert on weekends—a piece of pie or a bowl of ice cream. The miracle of Easter morning was a Russell Stover chocolate bunny and a few Peeps waiting just for me. Once a year, for the Super Bowl, my parents would open a bottle of Coke, and my brothers and I savored one glass each of that rare flavor rush. Sugar was simple: white and sweet and pure. It had its place—in a little bowl on the breakfast table.

Little did I know it, but over the next 40 years, sugar would leave its innocent perch and creep into almost every refined food on the grocery store shelf. Like most everyone else, I didn’t notice this sugary invasion until I suddenly stumbled upon it with the fresh eyes of an outsider.

That’s because about 15 years ago, when I was an editor-in-chief at Rodale, my family and I had the chance to move first to London and, later, Eastern Europe. As the mother of three small children, healthy eating was a priority for me—and a no-brainer in Warsaw. Fresh food markets were everywhere, and processed foods were hard to find! We ate according to the seasons and lived on real, whole food—grilled meats, fruits and locally grown veggies, thick yogurt, and dense loaves of bread flecked with chunks of whole wheat and rye kernels, so chewy and filling that one slice satisfied both belly and soul. We savored
młoda kapusta
(young cabbage) with fresh dill, heads of broccoli as big as watermelon, with such flavor my kids never resisted, and
chłodnik,
a chilled yogurt soup colored a delightful pink by fresh beets and filled with chopped fresh veggies. In the spring, fruit sellers would appear on street corners all over Warsaw. Every few weeks, a new fruit was featured as it came into season—mountains of strawberries, raspberries, blackberries, or cherries. Some nights,
I would pick up a kilo (more than 2 pounds) of fresh cherries on my way home from work, and my kids and I would polish off the whole bowl and call it dinner!

That didn’t mean we didn’t love our sweets, though. There’s nothing like a Sunday stroll through one of Warsaw’s beautiful parks with
lody
(ice cream) served in golf ball–size scoops and balanced on top of a waffle cone. We treasured our Sunday
lody
the same way I treasured having a little bowl of ice cream on the weekends as a child.

P
rompted by my desire to raise my children in America, we decided to move back to the States. On my first trip to the supermarket, I filled my cart with healthy choices, including whole grain cereal, whole wheat bread, and low-fat yogurt. Nothing new there—these were staples of our Eastern European diet.

What
was
new: my appetite. I was ravenous. All the time.

In the first weeks after our arrival, we lived in a temporary apartment about 45 minutes from my kids’ new school. Each morning, we shared a healthy breakfast of whole wheat toast, fruit, and bran cereal or yogurt, then piled into the car. But by the time we arrived at their school, I was
starving
. I could barely focus on kissing my kids good-bye for the day. I had a must-eat-something-
now
kind of hunger that was off the charts. I was eating my Warsaw-style breakfast every morning—what was going on?

One day, after experiencing this relentless out-of-control hunger, I drove straight back to our apartment and read the nutrition labels on my “healthy” cereal, bread, and yogurt.
Every single item
listed sugar or high-fructose corn syrup as the second or third ingredient. I went through all of my cabinets, stocked with what I thought were healthy foods, and, damn it, sugar was
everywhere: in our soups, our pasta sauce, our packaged noodle dinners, our cans of chili, our cooking sauces, our rice dinners, even in our whole wheat crackers that we liked to munch on during the car ride home after school.

I was shocked. Having been out of the States for a decade, returning once a year for family visits, I was, in some sense, a newbie to the American diet, looking at these supposedly healthy foods with fresh, wide-open eyes. And I was ticked off.
What the hell was all of this sugar doing in my food? What was it doing to my family’s health? And how could I possibly stop this secret invasion of sugar into my family’s food supply and rumbling stomachs?

That lightbulb moment—followed by many others—led to this book.
The Sugar Smart Diet
is the revolutionary result of asking one simple question: How can we free ourselves from sugar overload and reclaim its simple, sweet pleasure?

The answer lies in achieving what I call sugar freedom—breaking the powerful hold that invasive sugar has on both your body and your mind. Get ready to lose weight and belly fat, reenergize your body, and reinvigorate your mind. The sweet life awaits you!

WHAT’S THE SWEET LIFE?

When you live the sweet life, you assert your sugar freedom—enjoying the pleasure of sugar, but not letting it run your show. You call the shots. Not your cravings. Not the doughnuts in the break room. Not the food industry.
You
.

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