About Sugar

 

Sugar is part of our diet and is even essential to our wellbeing. But too much daily sugar has serious consequences for our health.

  Overconsumption of sugar has become a worldwide problem and is becoming a global health crisis. Despite the widespread message about the health consequences of too much sugar, a lot of people still do not take this seriously and underestimate the amount of sugar they really consume. And that is mainly because they are not aware of all the hidden sugars they may consume during regular meal times.    

First of all: some of the consequences of high daily sugar intake are listed here:

 

• Obesity: the high levels of sugar in most processed foods and drinks are a major contributing factor to the obesity epidemic. Excessive sugar consumption will lead to insulin resistance, increased body fat and weight gain, which in turn can increase the risk of developing type 2 diabetes, heart disease (cardiovascular disease), and many other health problems. The relationship between sugar intake and obesity has been extensively studied, and a systematic review published in the Monthly Journal of the Association of Physicians demonstrated a significant association between sugar and sweetened soda consumption and obesity (1)
• Type 2 diabetes: high sugar consumption, resulting from excessive intake of added sugars in food and beverages, can lead to insulin resistance and the development of type 2 diabetes. In this condition, the body becomes resistance to insulin and the body can no longer produce enough insulin to regulate blood sugar levels (glucose metabolism), which results in chronically elevated blood sugar levels that can lead to serious health problems. Naturally occurring sugars in whole fresh fruits, fruit juices and foods however do not have the same impact (2)
• Cardiovascular Disease: high intake of sugar in addition to consumption of processed foods contribute to the occurrence of chronic low-grade inflammation, and development of cardiovascular disease. The inflammatory process itself leading to atherosclerosis, a major risk factor for the development of more severe cardiovascular disease (8)
• Mental Health: the impact of excessive sugar consumption on the perturbation of metabolic, inflammatory and neurobiological processes is thought to potentially increase vulnerability to depression (9)
• Dental Health: the association of sugar consumption – both in sweets and juices – as a cause of the development of dental cavities is well known and is one of the biggest health concerns worldwide, leading to pleading for implementation of sugar-sweetened beverages taxes (10).
• Pregnancy: Excessive sugar consumption during pregnancy is associated with many complications during the pregnancy, with a risk for metabolic disturbances for the mother, but also on the unborn child. It is associated with increased risk of childhood obesity, increased metabolic disturbances and can lead to declined cognitive skills.(12)

 

Sugar is important, but how much is too much?

    Added sugar refers to the amount of sugar that you add to your tea, coffee, breakfast cereals, desserts etc… It does not refer to the naturally occurring sugars in fruit and vegetables or unsweetened dairy: these sugars are “packed” in molecules and fiber that are metabolized differently. Eating a healthy balanced diet with real foods and the right amounts of carbohydrates, fats and proteins at a ratio of 60%, 10% and 30% respectively, provides us with all the sugar we need. This means that no added sugar is needed, and no added sugar would be ideal. The recommended daily consumption of added sugars varies somewhat depending on the source, but should be no more than 5% of total calories. According to the American Heart Association adult women should take no more than 6 teaspoons (= 30 ml or 24 gr) of added sugar per day. Men can take a bit more, around 9 teaspoons (=45 ml or 37,5-38 gr). Children and adolescents can equally take around 9 teaspoons. Daily sugar consumption for pregnant women is not specifically stated. It is important that you check with your physician what an ideal amount of sugar could be in function of your personal medical situation.  

How much sugar do you think you consumed today?

  In reality, most people – even those not using adding sugar to their foods – will consume way more sugar than they think. The main reasons for this are the hidden sugars contained in most store-bought and processed food. A good example are breakfast cereals, but also many of the so called healthy cereal bars. Another main source of added sugar are sugary beverages – including sugar sweetened fruitjuices. Moreover, sugary drinks are almost immediately absorbed in the bloodstream and cause havoc with the body’s glucose metabolism.

So, what are hidden sugars?

Hidden sugars are – as the name says – sugars that are hidden in most of the foods we buy at the grocery store, and that we don’t consider as being sweet per se. Moreover, even foods we regard as being healthy such as “low fat” and “light” products tend to contain considerable amounts of added sugars. That is because sugar is both a cheap taste enhancer, adding flavor, and a preservative (think of traditional homemade jam, where equal amounts of sugar and fruit are boiled together and that keeps for months.) Most low-fat yoghurts, milk products, salad dressings, sauces, ready-made meals, even those that are salty rather than sweet contain high amounts of added sugar. The elimination of naturally present fats (such as milkfat in yoghurt) and replacing them with other additions and added sugar or sweeteners aims to enhance flavor and to reduce calorie content, but will impact digestion and nutritional value of the initial real food. Some foodstuffs will clearly mention the presence of added sugars, and a lot of so-called health foods and products marketed towards healthy lifestyles, will state “no added sugar”. Beware though, because instead of usual sugar, other natural sweeteners are often listed separately by manufacturers (11): this masks the amount of added sugar and is deceiving. Examples are: concentrated fruit juices, like apple or pear juice, are added. Syrups such as date syrup, or powdered dates, have become a real trend in health foods in recent years. Clever ways for avoiding the sugar labels, but with an impact that is almost always as high as that of normally added sugar. In the case of date or coconut flower sweeteners, because these are naturally less sweet, higher amounts may be added in order to obtain the right flavor. Other examples are using terms such as molasses, raw cane sugar, invert sugar, maple or agave syrup, etc. In other health foods, artificial sweeteners might be added which can equally have a negative impact on maintaining a healthy metabolism.

What about sugar in fresh fruit and vegetables?

Fruit and vegetables are an important component of daily diet: several studies show that daily consumption of 5 servings of fresh fruit and vegetables (about 500 to 625 g) are associated with lower mortality (3,4) Some media coverage has been drawing attention to the high sugar content of fruit, especially fruit juices and smoothies, a reason for some people to limit their fruit intake. However, a review study published in Nutrients found that fruit juice provides more benefits than risks and that there is no justification to discourage consumption of fruit juice within a balanced diet (7). Fruits are not only rich in important nutrients, vitamins, and minerals, they are also high in fiber. Sufficient fiber intake has many health benefits, and the impact of modern diets lacking in fiber on gut microflora and association with metabolic diseases has been well studied (5). A healthy diet with adequate fiber consumption also improves cardiovascular and mental health (6) The sugar in whole fruits is differently metabolized than sugar in fruit juices, mainly because of the high fiber content in whole fruits. Smoothies are better than extracted fruit juices for that reason. Fresh fruit should not be avoided because of its natural sugar content.

Conclusion

It is important to learn about the consequences of too much added sugar or sugar substitutes, and to become aware of the amounts really consumed. Here are some helpful tips:

• Consciously use less sugar products, even natural ones such as honey or concentrated fruit juices, not only in tea or coffee, but when cooking and baking.
• Substitute sugar with mashed ripe banana, unsweetened applesauce, or soaked and blended dates. These will add beneficial fibre as well as nutrients.
• Learn to read labels and avoid products with added sugars.
• The higher up an ingredient appears on the list of ingredients, the higher the amount of added sugars, so watch out if sugar (or another name for sugar) is the first or second ingredient.
• Home cooking and choosing fresh products: this might take some effort initially, but taste buds soon get used to less sweetness, and when consciously using less sugar, you will gradually adapt to require less sweetness.
• Instead of having that extra chocolate or biscuit, re-consider, focus on another option. Even better: slowly take three deep breaths and focus on the treat slowly transforming into a beautiful butterfly wishing to get outside to the enticing field of colorful flowers… a simple trick that helps your mind shift focus.
• Be creative and learn to incorporate sweetness by using fresh fruits and berries in meal preparations, even pureed, without any added sugar. Adding some fresh mintleaves, a slice of lemon, some (frozen) raspberries to water or tea can be a visually attractive and subtle way to increase enjoying your beverage.

And don’t forget: eating a healthy diet and applying the above tips leaves room for just a little extra sweetness from time to time, which should then be fully enjoyed, without remorse. References: 

1. Ruanpeng, D et al. “Sugar and artificially sweetened beverages linked to obesity: a systematic review and meta-analysis.” QJM : monthly journal of the Association of Physicians vol. 110,8 (2017): 513-520. doi:10.1093/qjmed/hcx068 
2. Semnani-Azad, Zhila et al. “Association of Major Food Sources of Fructose-Containing Sugars With Incident Metabolic Syndrome: A Systematic Review and Meta-analysis.” JAMA network open vol. 3,7 e209993. 1 Jul. 2020, doi:10.1001/jamanetworkopen.2020.9993 
3. Wang DD, Li Y, Bhupathiraju SN, et al. Fruit and Vegetable Intake and Mortality: Results From 2 Prospective Cohort Studies of US Men and Women and a Meta-Analysis of 26 Cohort Studies. Circulation. 2021;143(17):1642-1654. doi:10.1161/CIRCULATIONAHA.120.048996 
4. Liu W, Hu B, Dehghan M, et al. Fruit, vegetable, and legume intake and the risk of all-cause, cardiovascular, and cancer mortality: A prospective study. Clin Nutr. 2021;40(6):4316-4323. doi:10.1016/j.clnu.2021.01.016 
5. Barber TM, Kabisch S, Pfeiffer AFH, Weickert MO. The Health Benefits of Dietary Fibre. Nutrients. 2020;12(10):3209. Published 2020 Oct 21. doi:10.3390/nu12103209 
6. Fekete M, Szarvas Z, Fazekas-Pongor V, et al. Nutrition Strategies Promoting Healthy Aging: From Improvement of Cardiovascular and Brain Health to Prevention of Age-Associated Diseases. Nutrients. 2022;15(1):47. Published 2022 Dec 22. doi:10.3390/nu15010047 
7. Ruxton CHS, Myers M. Fruit Juices: Are They Helpful or Harmful? An Evidence Review. Nutrients. 2021;13(6):1815. Published 2021 May 27. doi:10.3390/nu13061815 
8. Ma X, Nan F, Liang H, et al. Excessive intake of sugar: An accomplice of inflammation. Front Immunol. 2022;13:988481. Published 2022 Aug 31. doi:10.3389/fimmu.2022.988481 
9. Reis DJ, Ilardi SS, Namekata MS, Wing EK, Fowler CH. The depressogenic potential of added dietary sugars. Med Hypotheses. 2020;134:109421. doi:10.1016/j.mehy.2019.109421 
10. von Philipsborn P, Stratil JM, Burns J, et al. Environmental interventions to reduce the consumption of sugar-sweetened beverages and their effects on health. Cochrane Database Syst Rev. 2019;6(6):CD012292. Published 2019 Jun 12. doi:10.1002/14651858.CD012292.pub2 
11. https://www.hsph.harvard.edu/nutritionsource/carbohydrates/added-sugar-in-the-diet/
12. Casas R, Castro Barquero S, Estruch R. Impact of Sugary Food Consumption on Pregnancy: A Review. Nutrients. 2020;12(11):3574. Published 2020 Nov 22. doi:10.3390/nu12113574