Ask a Dietitian: What’s the Deal with Sugar? 

Chew on this … the top six calorie sources, in order of calorie contribution, are as follows: grain-based desserts (cookies, snack cakes, etc.), yeast breads, chicken-based dishes, sweet drinks, pizza and alcoholic beverages. Notice a trend? Most of these items are primarily composed of… wait for it… SUGAR. It’s everywhere and present in so many unsuspecting consumables. According to the AHA, Americans ingest about 20 teaspoons of sugar each day, with teens and men consuming the most. But take heart: If you give me just five minutes, I can help clear up any confusion and misconception about this sweet little devil that is sugar.

I’m a geek, so as always, let’s begin with a quick chemistry review. Simple sugars, also known as monosaccharaides, are glucose, fructose and galactose. When two monosaccharides get together, they make disaccharides (di= two); these are maltose, sucrose and lactose. To better illustrate this, consider the following: When we eat table sugar (sucrose), our bodies break it down to fructose and glucose. In basic metabolism, anytime we eat and digest a food containing carbohydrates, our bodies break that food back down into monosaccharaides—the most prevalent being glucose. The glucose that is needed by the body is then carried into the cells, with the help of insulin. Any extra glucose floating around in there (sayyy after you go a little too crazy at the pizza buffet) will be stored in the liver or muscles as glycogen, or converted to fat for storage in adipose cells. When our bodies are lacking glucose (during periods of intense exercise or starvation), that glycogen is then re-released back into the bloodstream to be used as energy. Onward.

Foods are made up up macronutrients: carbohydrates, fat and protein. Sugar belongs to the carbohydrate family and contributes 4 calories per gram. Carbohydrates made up of naturally occurring sugars, like fresh fruit, starchy vegetables, whole grains and quality dairy sources are both nutritious and splendid components of a healthy diet when consumed in moderation. These are generally non-offenders if thoughtfully selected to avoid any wacky preservatives or additives. For the sake of this blog post, I will be tackling the dangers of added sugars—these are just like they sound, sugars that are added back into foods through manufacturing. This is done for any number of reasons, one being to enhance flavor. These sneaky added sugars are getting us into a lot of trouble. So how much is too much?

Dietitians, physicians and other medical professionals have really honed in and adjusted our recommendations on sugar over the past 5-10 years. Why, you ask? Well, it seems that sugar may be the culprit to more health issues than once thought, particularly in the form of high fructose corn syrup (HFCS). One study published by the American Society of Clinical Nutrition noted the consumption of HFCS increased > 1000% between 1970 and 1990, mirroring a massive increase in the amount of obesity. We also know that prolonged excessive intake of sugar, specifically added sugars, can increase one’s chance of developing insulin resistance.

Insulin resistance occurs when our blood cells become less sensitive to the presence of glucose in the bloodstream, causing cells to utilize glucose less efficiently. It’s kind of like an awful pair of high heels—horrifically uncomfortable at first, but the more you wear them, you kind of get used to the pain, so it becomes your new norm. Thing is, these stupid heels are so bad for your feet. Insulin resistance is kind of the same, and we can thank our highly processed western diet for the increased incidences of this. You see, insulin resistance is a slippery slope and the stepping-stone to the development of serious chronic diseases like heart disease, obesity, metabolic syndrome and type 2 diabetes. It’s no wonder our recommendations have shifted, with an emphasis on limiting the sweet stuff.

Current FDA recommendations state that no more than 10% of one’s daily calorie needs come from added sugars. The WHO goes above and beyond by recommending we keep our added sugar intake to less than 5% per day. So, if you are shooting for around 1,800 calories a day, we’re talking no more than 180 calories (45 grams or just over 11 teaspoons) from added sugar, using the 10% rule. Can I blow your mind? What if I told you some jarred marinara sauces had 12 grams of sugar per serving, or some yogurts (particularly the fat-free ones) have 25+ grams of added sugar. Woof. I’ll take chocolate, thanks.

Sugar is sneaky. And food manufacturers aren’t necessarily helping when it comes to transparency. Besides adding sweetness to foods, sugar also works as a preservative, texture modifier, fermentation substrate, flavoring and bulking agent. Even more, sugar has about a million different alibis. It is kind of the Jekyll and Hyde of food, if you will. Sugar has many different makeups and names. You’ve got your “plain” sugar (white, refined, high fructose corn syrup), big-word sugars (dextrose, fructose, disaccharides) and natural sugars (honey, molasses, coconut sugar). But let it be known, at the end of the day, no matter if it’s brown, white, crystal, organic or refined … they are all sugar. Yes, natural sugars do offer some benefits (we’ll discuss soon), but our bodies ultimately metabolize them the same, storing excess as fat. Too much of a good thing is still, not good.

How do these cute little white sugar cubes get in my sugar bowl? Sugar is obtained from extracting sugar beets or sugar cane. Sugar beets are usually grown in cooler more temperate climates like Russia, Ukraine or the northern United States while sugar cane comes from warmer regions like Mexico, Brazil or the southern U.S. Sounds fancy and worldly, so it must be healthy, right? Well, it was until we started messing with it. When those sugar crystals reach refineries, we strip it of many natural properties in an effort to improve taste, usage and shelf life. Naturally occurring sugars, like honey, pure maple syrup or molasses, are kept in their true form. While these sources of sugar still affect our bodies the same as refined sugar, they are beneficial as they contain some trace elements found in the environment and antioxidants. Natural sugars are usually more aromatic, concentrated and tasteful, leading us to consume smaller quantities overall. My favorite kind of naturally-occuring sugar is honey—sweet, simple, not overpowering. Some studies are even suggesting that consuming local honey is a bee-utiful way to improve allergy symptoms. Just another reason to shop local, y’all!

So if we’re aiming to consume no more than 5-10% of our calories from added sugars, where can we start? Here’s my list of top recommendations:

  • Avoid sugary beverages, including juice. Have you ever made fresh-squeezed orange juice? Think about how many oranges you have to juice to get 6-8 ounces of juice, at least 6-8 oranges. How often do you sit down to eat 6-8 oranges? My guess is probably never because … yuck and hello heartburn. Too much of a good thing isn’t good. Instead, try eating an orange and satisfy that itch for a juice with a fruit infused water.
  • Avoid as many pre-packaged and processed foods as possible. Chances are they’re no good and laden with excessive amounts of sugar, salt and other preservatives.
  • Plan your groceries ahead and cook at home as much as possible.
  • When using or cooking with sugar, try to use natural forms like honey, pure maple syrup or molasses. Not only are these sweeter and more flavorful than your refined sugars (making it easier to not overeat) but you will get bonus points for trace minerals + antioxidants.
  • Read labels when you can. “Added sugars,” in grams and as percent Daily Value (%DV), will be included on the label, so it’s really right there at your fingertips. Just remember, the label will reflect a 2,000-calorie diet, so you may need to adjust the %DV based off your personal calorie needs.
  • Surround yourself with a positive support group, as this will make it easier to be healthy when eating out or cooking in. Please, do not ditch your friends who drink big gulps on the reg, they’re probably really awesome people. Just try to set a positive example and keep your eyes on the prize.

This journey towards health, happiness and fitness is just that, a journey. Give yourself grace and forgive yourself if you slip up. We’re not all at the same point when it comes to wellness and that’s okay. Heck, I’m no angel. My diet is a mess some days—especially when it comes to sugar. What counts is that you’re trying and taking baby steps towards a healthier lifestyle. Weekday Weekend’s philosophy is a fabulous example of just this and why I’m so proud to have collaborated on this project—try your best, adjust as needed and always save room for some fun on the weekends.

A quick note from Lindsey:

Nice work, Sarah!  I thought I might touch a little more on food addiction; It’s a topic that I’ve started covering in one of my classes, so I’ve recently been reading more about it. In college, you and I were taught that certain foods can be addictive and we simply accepted that at face value. However, in my recent research, I’ve learned that there’s a bit of contention as to whether food addiction exists or not.

What does seem to be the case is hyper-palatable or calorie-dense foods, similar to addictive drugs, stimulate dopamine release in our brains. (1.) Dopamine is involved in our brain’s reward and pleasure centers and we are wired to seek out those things that stimulate it. (1.) It probably comes as no surprise that high sugar foods are one of those hyper-palatable foods that spark this response and make us feel all warm and fuzzy after we eat it. This leads us to want to reach for high sugar foods again and again. Many believe this response happens because our genes are adapted to an environment where food was scarce (2.) (think 12,000 plus years ago), so gorging on these foods when they were around, increased our survival. Unfortunately, what that means in modern times is that we are physiologically geared to crave that piece of cake at work for what’s-his-name’s birthday. Whether or not these behaviors qualify as true addiction or addictive-like behavior, we know sugar has a tricky way of finding its way into our bodies. Something that may be helpful is to, first, simply be aware of the potential for high sugar foods to create addictive-like behaviors. Second, I would suggest having a plan for when situations arise that are likely to have tempting foods. This might be keeping a bag of nuts in your purse, bringing a healthy dish to a potluck, or keeping fruit at your desk. Planning ahead may be a big step on our way to kicking our cave-like cake cravings.

Q: Since we are only supposed to allow 5-10% of our daily diet to be composed of added sugars, can we skip sugar/carbohydrates for a few days and then go crazy?

A: The answer is no, but nice try 🙂 What we’re shooting for here is moderation, which will lead to permanent lifestyle changes. There are no “rollover” minutes when it comes to a healthy, balanced diet. Not only will this lead to burnout and imbalance, worst of all, this will only foster unhealthy relationships with food. Again, we are talking specifically about added sugars. So if you’re trying to keep it under 10% a day, start small; swap your flavored yogurt (usually 10-13 grams added sugar) to plain Greek yogurt sweetened with 1/2 tsp. of honey and fresh fruit (this will net you about 3 grams of added sugar coming ONLY from the honey—we don’t count the sugar in fresh fruit as “added”). Educate yourself but try not to obsess too much about numbers and grams, as this can become exhausting and disheartening. If you want to cut back, I usually advise my patients to retrospectively look back on their diet for three days. Assess about how much added sugar you consumed, then start by making 1-2 small changes. This will eventually lead to big, wonderful changes over time!

Q: I’ve noticed that some people really seem to have a ‘sweet tooth’ while others don’t. For example, my husband couldn’t care less about eating sugary treats while I feel like if I didn’t try to moderate my sugar intake I’d be baking cookies every night. Is there any way to change those cravings? Or is there any science you know of behind why some people may struggle with this more than others?

A: The struggle is real! I, too, have a HUGE sweet tooth. In my experience, it seems you’ve either got your sweet, salty or savory folks; when I’m blue, I reach for chocolate while my co-worker grabs the potato chips. I have a few thoughts on this: It seems there could be a genetic component towards these sweet cravings; one study published in the journal of Cell Metabolism seemed to illustrate a correlation between a particular hormone secreted by the liver with decreased cravings for sweets, so there’s that. You might also want to thank your mother for that sweet tooth. Studies show when a mother eats sweets, those flavors are carried to both amniotic fluid and breast milk. As kids get older, if their mothers diet was high in sweets or simple sugars, they go on to show a preference for these foods. It’s also worth nothing that your olfactory sense is one of your most primitive senses. This begs the question, when times get tough, will I crave grandma’s homemade brownies or something similar, because that takes me back to a happy place?

All this to say, there are many different theories, but no doubt, change is possible. If you want to make a change, I’m a believer in small, simple adjustments to your everyday routine as opposed to cutting something out cold turkey. Start reading labels and go back to the basics. Some examples are choosing fresh fruit over canned, adding one less spoonful of sugar in your coffee or selecting fresh breads. My absolute favorite bread is Ezekiel sprouted grain loaf (found in the freezer aisle) which has 0 g of sugar. Bread as it should be! Other more “processed” breads will often contain a few grams of sugar, usually coming from high fructose corn syrup.

If you’d like to read more expert advice from Sarah and Lindsey, check out all the articles in our series, Ask a Dietitian. You can also find them dishing out great advice and tips in our upcoming cookbook, Weekday Weekend. Let us know if you have any questions or have other topics you’d like to learn about from them.

Credits // Author: Sarah O’Callaghan with contributions from Lindsey Kelsay. Photo: Emma Chapman, edited with ACS desktop actions. 1.) Corsica, J. a, & Pelchat, M. L. (2010). Food addiction: true or false? Current Opinion in Gastroenterology, 26(2), 165–9. http://doi.org/10.1097/MOG.0b013e328336528d 2.) Lieberman, D. E. (2013). The Story of the Human Body: Evolution, Health, and Disease. New York: Vintage Books.
  • I always get confused with milk…and maybe this is a whole other topic but it seems like there is a lot of sugar in “typical” milk. Are there other types or brands that you recommend (almond,etc) thank you!! And I have really been enjoying this new series!
    Andrea

    • Thanks Andrea! Milk and milk alternatives are confusing. Cow’s milk has 12g of sugar coming only from lactose, which is a naturally occurring sugar. So we don’t need to factor that into our 5-10%/day, as we would with, say, chocolate milk. Coconut, soy or almond milk are some lower sugar alternatives, though they lack some of the protein and micronutrients present in cow’s milk. However, milk alternatives have MANY benefits as well, I could go on for days. Thanks for the future post idea 😉

  • Most nights, I have a glass of wine or a beer with my dinner. I realize that alcohol is sugar, but does an option exist where I can choose a beer or wine with less sugar than others? Or is all beer and all wine pretty equal in sugar content, no matter how it’s processed?

    • Great question! Alcohol is okay when consumed in moderation & unfortunately, beer and wine don’t contain a label listing added sugars. I’m not a brewmaster but here’s what I do know; when it comes to beer, most of the sugar is “eaten up” in the fermentation process by yeast. However – some beers contain “non fermented” or added sugars, such as meads and ciders. Alcohol contains 7 calories per gram, therefore, the higher your ABV (alcohol by volume), the higher the calorie content and so on. Dry wines are lower in sugar when compared to champagnes and, of course, wine coolers. If you’re a liquor drinker, a shot of clear liquor (gin or vodka) with sparkling water and a slice of lemon or lime is about as “low sugar” as you can get. I hope that helps!

  • I love this new component of positive education on real day to day things on ABM! I have been an avid reader for years, and love being able to focus on DIY not just in my home, but my diet, my skin regimen, food, etc! So good you guys! Yay!

  • A ketogenic way of eating is the best decision I ever made for my health! It helped me kick my sugar & carb addiction extremely fast.

  • As a direct result of being overweight and trying to change that, I have been pretty food-obsessed my whole life. Studied and followed Whole30, paleo, and recently started a diet focused on balancing my macro-nutrient intake. This is probably the most helpful, useful, and succinct explanation on sugar intake I’ve ever read. Thanks so much!

  • Love this new nutrition series you guys have added to the blog. I’m glad you touched on this sugar topic too! I’ve been doing so much research on sugars after fighting with being overweight for years and after staring at many labels in the grocery stores for what felt like months, I now know what brands (in Canada) have less sugar! It’s crazy how much some condiments, sauces, etc have in them!

  • Great and educational article, guys. Has anyone seen Katie Couric’s documentary Fed Up? It’s a great explanation on how so many processed and packaged foods ended up with such unhealthy amounts of added sugar and how it’s affected obesity rates in the developed world. If you’re interested in this topic it’s definitely worth checking out 🙂

  • I would LOVE if you guys your own version of eat this not that. Ive made a lot of changes over the years and I recently have cut out meat. My breakfasts have gone from boiled eggs to oatmeal. And although I can see a difference in my energy level and weight, I have so much room for improvement. I eat healthy all day and then after an hour commute and a 10 hour day, Im tired and dont want to make anything. I already find it hard to meal prep for the weeks lunches and cant fathom doing dinner as well. But right now im relying on frozen pizza and i know how awful it is. Suggestions welcomed

    • Well that’s a super fun idea! Meal planning can be overwhelming and, at times, redundant (spaghetti again?). Seriously, I can’t wait for you to get your hands on Weekday Weekend. It is brimming with healthy meal ideas that are refreshing, tasty and nutritious. Just you wait 😉

    • Meal planning is super daunting and very overwhelming at first, but I promise it gets better! I’ve done it for years. I prep every breakfast and lunch each Sunday and list out the meals we have for dinners. It sucks and is a lot of work at first, but it’s like developing any new habit or skill – you get better, smarter, and faster at it with practice. My husband is a musician and I’m constantly encouraging him. When you learn guitar you don’t automatically pick it up and crank out sick solos; you have to build your calluses and learn your scales. You can do it!!

  • Great article!
    I think this one helps a lot of people to understand and open their eyes for added sugars.
    I have a fructose intolerance and therefore I started to avoid nearly all sugars.
    If you have information for an good diet for this case I would love to read your article.
    Thank you

  • I used to feel crazy around sugar / sweet things. Then I realized that cravings are like itches. When you eat whatever you are craving…the craving goes away. Just like when you scratch an itch…the itch goes away. And if you are incorporating sweet things on a regular basis you end up eating just enough of the sweet thing to make the craving go away instead of ending up in your kitchen alone eating 5+ chocolate chip cookies.

    For me, trying to put limits on my sugar intake only ever helped more feel more neurotic about feeding my body, which I’m not a fan of. Eating feels so much more peaceful when you listen to hunger and fullness cues, honor your cravings, and understand why you feel compelled to emotionally eat from time to time.

    Just wanted to comment with my two cents 🙂

  • Loved this! So informative and easy to read.

    I am curious–if all sugar is broken down the same way, then why is “added” sugar automatically worse than natural sugar? For example, if you’re having lots of watermelon, which is very high in sugar, and consume 12g of sugar, v.s. a yogurt with 9g of sugar, isn’t the lower-sugar choice always better (strictly speaking in terms of sugar, not the other nutritional components of the food)? Is it theoretically possible for someone to still experience the negative effects of too much sugar from all-natural sources? I definitely understand that as a rule, processed foods have tons of added sugar and so it’s easier to eat natural/whole foods that have way less, but I’m just curious why the added sugar is inherently worse if everything else is equal.

    Obviously, I don’t think anyone is actually out there gorging on tons of fruit and going into a sugar high haha–I’m just curious 🙂

    • Hey Eliza, good question! I think the simplest way I can answer this is just by offering the simple reminder that sugar – in excess – doesn’t really offer any health benefits. Whether it’s fruit or ice cream, too much is never a good thing. If we were able to isolate the sugars (added vs. natural), technically they would be the same. Unfortunately we can’t do that, so the fiber and vitamins in your fruit trump the colorings, preservatives and trans fats present in say, a donut. When you eat an apple, it will also contain fiber, which slows digestion and technically decreases the uptake of sugar into our bloodstream, which is a win! It’s complex and you make a very valid point, but hopefully this helps clear up any confusion 🙂