If you have a sweet tooth, you may want to think more carefully about which types of added sugars you have in your diet, because a new study suggests that not all of them carry the same risks for your heart. 

The new study examined data on almost 70,000 adults in Sweden who completed dietary questionnaires in 1997 and 2009 indicating how many calories they got from three sources of added sugars: sodas and sugary drinks, toppings like honey or jam, and sweet treats like pastries, candy, or ice cream. Researchers also looked at Swedish health registry data to see how many people developed cardiovascular diseases.

At the start of the study, participants were almost 60 years old on average and had a mean body mass index (BMI) of 25.3 (putting them in the overweight category, but by less than one point). On average, they got 9.1 percent of their calories from added sugars. 

After more than two decades of follow-up, nearly 26,000 people were diagnosed with cardiovascular disease. 

“One reason that drinking sugar sweetened beverages increases the risk of these diseases is that the increased blood sugar and insulin levels lead to internal inflammation, which is the cornerstone to many diseases,” says Samantha Heller, RD, a clinical dietician in New York City, who wasn’t involved in the new study. 

“It may also be that these beverages and foods displace healthier options that would otherwise reduce inflammation and provide antioxidants, fiber, and other healthful compounds,” Heller says. 

Why Having Occasional Treats May Be Better Than Total Abstinence

Interestingly, when it comes to sweets like pastries, chocolate, and candy, the study found people who indulged occasionally had a lower risk of heart disease than people who never ate sweets at all. 

“This might reflect underlying dietary behaviors. Individuals consuming very little sugar might have very restrictive diets or might be limiting sugar due to preexisting health conditions,” lead study author Suzanne Janzi, a PhD candidate at Lund University in Sweden, said in a statement. 

Beyond this, otherwise healthy people who are trying to overcome a sweet tooth may be more successful with eating desserts in moderation than with giving up sugar altogether, says Maya Adam MD, PhD, a clinical associate professor at the Stanford School of Medicine in California, who wasn’t involved in the new study. 

“When we eliminate things we love from our diet, that’s often a hard change to maintain in the long run. The same goes for crash diets,” Dr. Adam says. “We end up ping-ponging between periods of total abstinence and periods of overindulgence. That’s not healthy.”

Healthy Swaps for Soda and Other Sweet Drinks

The study wasn’t a controlled experiment designed to prove whether or how different types of sugar consumption might directly cause specific forms of cardiovascular disease. 

Even so, there are plenty of ways to satisfy cravings for sweets without overindulging in sodas and other sugary drinks, says Brooke Aggarwal, EdD, an assistant professor at Columbia University Irving Medical Center in New York City, who studies behavioral and psychological factors that can influence whether people adopt a heart-healthy lifestyle. 

“Cut back on sugary drinks and go for water sweetened with a slice of fruit instead, or tea, coffee, or milk,” advises Dr. Aggarwal, who wasn’t involved in the new study. “Homemade smoothies are also a great way to get a sweet taste and additional nutrients in the form of a drink without unnecessary added sugar.”

If smoothies aren’t your thing, you can also try sparkling water with some fresh fruit slices or a sprig of fresh mint to mimic some of the fruity flavor of some sodas, Heller suggests. “If that’s too big of a leap, start by mixing fresh fruit juice with sparkling water,” Heller says. 

The most important thing is to find healthier substitutions that you actually enjoy and don’t find too cumbersome to stick with over time, Heller adds. 

“At the end of the day, dietary change is only healthy if we can sustain it over time,” Heller says. “That’s why moderation is key!”