According to the 1964 Walt Disney musical Mary Poppins, just a spoonful of sugar helps the medicine down. Yet, it is unlikely that you will hear anyone singing praises about sugar in 2018. The American public has become increasingly fixated on the sugar content of foods. Some prominent voices in health care and the media have even called sugar “toxic” and “the root of all evil.”


Currently, 51 percent of American adults report that they are trying to limit or avoid sugars when choosing foods and beverages. There’s little doubt that Americans consume too much sugar. But there is no concrete data to tell us exactly how much is too much.

One of my responsibilities as a Registered Dietitian-Nutritionist (RDN) is to sift through all of the nutrition misinformation and media hype. Here is some solid, evidence-based information about how too much sugar can be potentially harmful to our bodies.

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Are all sugars the same?

I frequently hear statements such as, “I cannot eat fruit…it has too much sugar.” Or “My doctor said to avoid all breads, because bread turns to sugar.” And “I will only use raw sugar, it is healthier because it is natural.” Evidently, consumers are confused regarding sugars.

To clarify this complex scientific information, let’s start with the basics. Sugars, both intrinsic (present in whole foods) and extrinsic (those added to foods) constitute a type of carbohydrate. In a nutshell, carbohydrates are the body’s preferred source of energy. They also serve as the sole source of fuel for the brain.

All carbohydrates are composed of building blocks known as monosaccharides. There are three types of monosaccharides – glucose (the primary source of energy for cells), fructose (found in foods like fruit and honey), and galactose (primarily found in dairy products). These monosaccharides are arranged in chain-like structures of various lengths and combinations to form “simple carbohydrates” and “complex carbohydrates.”

Simple carbohydrates consist of one to two sugar molecules that link together to form a compound. Complex carbohydrates are longer chains of sugar molecules that form a coil-like structure.

Regardless of their length or complexity, our body must break carbohydrates down after eating to be absorbed. Therefore, the popular claim that “all carbohydrates turn into sugar” is inaccurate and oversimplified. It is true that oatmeal, blueberries, whole wheat bread, candy, and quinoa are all eventually absorbed in the intestines as monosaccharides and/or disaccharides. However, these compounds are not synonymous with “sugar.” Ultimately, carbohydrates are essential for life, and the body can only use them in relatively simple forms.

Types of Sugar

The human body does not differentiate between naturally occurring sugars and those that are added to foods. The metabolism of all carbohydrates follows the same pathway, yielding the core monosaccharides as the end result. However, this does not necessarily make a cupcake and an apple nutritionally the same.

I often advise clients interested in managing their sugar consumption to “choose your sugars based on the company they keep.” In other words, what nutrients does a food offer your body, beyond just the energy obtained from the carbohydrate molecules? In addition to monosaccharides and disaccharides, does a food also contain fiber, vitamins, minerals, or antioxidants?

It is worth noting that foods high in added sugars tend to be higher in calories and lower in essential nutrients, whereas the opposite tends to be true of foods with naturally occurring sugars. When comparing the cupcake and apple, the cupcake will likely provide a lot of calories, saturated fat, cholesterol, sodium, and trans-fat. But it also offers minimal fiber, vitamins, or minerals. The apple, on the other hand, is low in calories and rich in fiber, vitamin C, antioxidants, flavonoids, and polyphenols. Apples also only have trace amounts of sodium, and no fat or cholesterol.

Natural vs. Added Sugars

In May 2016, the FDA announced revisions to the Nutrition Facts label reflecting changes in nutrition science. They are also designed to help consumers to make more informed food choices. Among these changes, food manufacturers must list the amount of added sugar in all pre-packaged products by the year 2020. Added sugars refer to any sugars and/or syrups that are added to foods and beverages during processing, preparation, and/or before consumption. These added sugars can take the form of many ingredientsand are not always readily identifiable.

Here are some examples of added sugars:

  • Organic cane sugar
  • Corn syrup
  • High-fructose corn syrup
  • Caramel
  • Brown rice syrup
  • Maple syrup
  • Honey
  • Molasses
  • Turbinado sugar
  • Cane juice
  • Cane syrup
  • Raw sugar
  • Malt syrup
  • Brown sugar
  • Fruit juice
  • Fruit juice concentrate
  • Fruit purees
  • Fruit nectars
  • Evaporated cane juice
  • Any ingredient with a suffix of –ose

There is no health advantage to consuming any type of added sugar. Added sugars provide little nutritional value beyond the calories they contain. Sucrose, or white table sugar, is probably the most recognizable form of added sugar. It is made from sugar cane or sugar beets. Brown sugar, confectioner’s (powdered) sugar, turbinado sugar, raw sugar, and unrefined sugar are created from sugar cane juice. They are also considered to be forms of sucrose.

Honey, agave nectar, maple syrup, and molasses, sometimes referred to as “natural sweeteners,” come from other plant sources. These “natural sweeteners” are often perceived as more healthful alternatives to sucrose. But the evidence does not support that perception. The Food and Drug Administration (FDA) still considers “natural sweeteners” to be sources of added sugar, and they are very similar to white sugar in terms of caloric density, nutritive value, and effects upon blood glucose.

Some “natural sweeteners” do have very small amounts of trace minerals, but also supply a very concentrated source of calories. In addition, whether a sweetener comes from bees, maple trees, or sugar cane, it will cause the blood sugar to rise rapidly.

Eating foods rich in added sugars can set the stage for numerous health problems. High-sugar foods often displace more nutritious foods. This can result in low dietary quality and inadequate intake of important vitamins, minerals, and other nutrients.

Over-eating tends to predict excessive energy intake and weight gain. Added sugars are no more likely to contribute to weight gain than any other source of excess calories. But added sugars are exceptionally easy to overconsume. This is because they empty from the stomach very quickly and do not induce prolonged feelings of fullness.

Recurrent eating of added sugars, including “natural sweeteners,” can increase triglyceride and blood sugar levels. This heightens the risk of developing cardiovascular disease and type 2 diabetes. Other chronic diseases and adverse metabolic effects can also occur in response to diets high in added sugars. This includes non-alcoholic steatohepatitis (NASH, also known as fatty liver), insulin resistance, excessive fat deposition, chronic inflammation, obesity, and Alzheimer’s disease. Also, all forms of sugar act as a food source for the bacteria in the mouth to multiply and grow. Thus these foods can promote tooth decay and cavities.

What should my daily sugar intake be?

The average American adult consumes 14.6 to16 percent of their daily calories from added sugars. This is approximately 119 grams of sugar (or about 30 teaspoons) each day, which contributes a whopping 476 calories to a single day’s food intake. Children ages 2 to18 consume approximately 23 teaspoons of added sugar per day, or 18 percent of total energy needs. These amounts equate to eating about 130 pounds worth of added sugars per person each year.

Sugar-sweetened beverages (regular soda, fruit juices, fruit punch, sports drinks, specialty coffees and teas) are the greatest source of added sugars in the diet and have no nutritional benefits. Sugar-sweetened beverages are associated with higher energy intake, greater body weight, metabolic abnormalities, hepatic insulin resistance, increased inflammation, oxidative stress, and poor nutrition. The body is also less sensitive to calorie intake when delivered in a liquid form. Our appetite does not tend to adjust so as to compensate for the calories found in beverages.

The most updated recommendation from the World Health Organization (WHO) and Dietary Guidelines for Americans advise limiting added sugar intake to less than 10 percent of daily calories. For a person eating a 1600 calorie diet, this equates to less than 40 grams of added sugar (or 10 teaspoons) daily.

Reducing intake of all added sugars, including sucrose, high-fructose corn syrup, and “natural sweeteners” is a well-founded dietary strategy to help control body weight and prevent chronic disease. To achieve these als, monitor the amount of added sugar used when cooking and/or eating. Also, choose fewer and smaller portions of foods and beverages that contain a significant amount of added sugars.

Check out our next blog to learn more about sweeteners!

About UPMC Harrisburg

UPMC Harrisburg is a nationally recognized leader in providing high-quality, patient-centered health care services in south central PA. and surrounding rural communities. UPMC Harrisburg includes seven acute care hospitals and over 160 outpatient clinics and ancillary facilities serving Dauphin, Cumberland, Perry, York, Lancaster, Lebanon, Juniata, Franklin, Adams, and parts of Snyder counties. These locations care for more than 1.2 million area residents yearly, providing life-saving emergency care, essential primary care, and leading-edge diagnostic services. Its cardiovascular program is nationally recognized for its innovation and quality. It also leads the region with its cancer, neurology, transplant, obstetrics-gynecology, maternity care, and orthopaedic programs.

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