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Sweet tea may contain up to 40 grams of sugar per glass. 

States just above and around the Mason-Dixon Line don’t shy away from serving customers plain iced tea with sugar packets when sweet tea is requested. In South Carolina, that's considered borderline criminal activity.

Real sweet tea is often sweetened while warm and then chilled. It’s also made with around 40 grams of sugar per glass — well above the daily recommended limit, said Dr. Reid Castellone, a Summerville family physician.

“We are in the South and (sweet tea) is a strong part of heritage,” said the doctor, who works at Palmetto Primary Care Physicians.

Sweet tea, purportedly born just north of Charleston in Summerville, is a consistent source of health conversations between local physicians and patients. The issue doctors have found is that while many patients see the harms of drinks like sodas, there is often an oversight when it comes to the iconic beverage.

With dozens of restaurants throughout South Carolina making their own brews of sweet tea as well, many people don’t often even have the opportunity to know exactly how much sugar they are even consuming, which is the one of the key health concerns with the drink.

“You don’t realize how much sugar is going in it,” said Dr. Kenneth Perry, assistant medical director for Trident Health. “If you’re making it at home, you could possibly moderate a little better.”

South Carolina has the 10th highest obesity rate in the United States. With diabetes, the state ranks 7th with nearly 80 percent of diabetic adults also having high blood pressure, according to the S.C. Department of Health and Environmental Control.

Dr. Louis Haenel, an endocrinologist at Roper St. Francis, explained that heavy consumption of sweet tea can feed a lot of these health concerns, especially among adults who aren’t active and have a genetic predisposition for obesity and diabetes.

When patients come in, one of the first things he tries to establish with them is creating a food diary. Far too often, he said, when they express concerns about not seeing any health improvements, a lot of their problems can be traced to overlooking unhealthy beverages like sweet tea.

“It was incredibly eye-opening how many calories a patient drinks,” he said.

The bulk of those calories from sweet tea are empty calories, he said, or calories without any nutritious benefit. To paint a better understanding of what’s happening with that sugar consumption, in a single carbohydrate like sugar, there are four calories per gram, according to the U.S. Department of Agriculture.

Multiplied by the 40 grams of sugar typically found in sweet tea, that’s 160 calories for one glass of sweet tea. Four glasses in a day could be more than 600 calories for a somewhat moderate estimate for the average amount of sugar in a single glass. Most adults are recommended to consume around total 2,000 calories a day.

Those empty calories build fat, lead to weight gain and pressure the body to make more insulin, which could eventually cause the body to not use the insulin properly or not make enough. This condition is referred to as Type 2 diabetes.

“We’re creating a very hazardous metabolic environment,” Haenel said.

Additional health concerns include hypertension, heart disease and issues with cholesterol. Even with just the black tea component of the beverage, Castellone explained that it has been found that heavy consumption correlates to the development of kidney stones, since it’s rich in oxalate that contributes to the stones.

For weening off the drink, Perry explained that some people might even experience similar stress-like withdrawal symptoms that an addict would feel. A 2016 study in the European Journal of Nutrition found that these withdrawal symptoms would likely come from neurological responses to sweet things and not so much the sugar itself. 

Since South Carolina has such a deep connection with sweet tea, many local physicians often encourage moderation with close monitoring of consumption. Sweet tea isn’t the dagger, Haenel said

“It becomes the bad part of a bad decision-making algorithm,” he said.

While heavy consumption in impactful, it is only worsened when combined with a unhealthy lifestyle.

“It’s not about eliminating it,” Perry said. “The more control you have over it, the better you’ll be in the long run.”

For most states, Haenel explained that everyone has a comfort food item that may cause harm if consumed heavily. Sweet tea just happens to be one of the items for South Carolina. He said that since most people aren’t aware of the harm associated with it, it ends up being a problem.

When ordering sweet tea at a restaurant, some physicians advise asking for half unsweetened iced tea and half sweet tea to moderate the sugar. If someone is making the tea at home, then it is suggested to gradually reduce the amount of sugar used. It is also suggested to balance out the tea consumption with heavier amounts of water.

“The majority of things in life are fine in moderation,” Castellone said.