You can find sugar just about anywhere.
It has become an extremely common ingredient in modern food, yet the dangers of sugar continue to be consistently underestimated.
In fact, many people still actively choose food that is high in sugar over food that contains fat. In many cases, people don't think about the effects of sugar on the body.
With obesity continuing to be such a significant problem in the United States, it is more important than ever to take the time to look at just what sugar is doing to our bodies and whether we should change our eating patterns.
For that matter, we need to look at how much sugar we are consuming.
Trends in the Modern Diet
Over time, the amount of processed foods in our diet has been steadily increasing. Many of us rely on processed foods as the core aspects of our diet and some processed foods are even viewed as healthy.
Ironically, modern issues with sugar arose, in part, because we were trying to be healthier.
As obesity started to become a major problem in the United States, the government focused on a dietary approach that involved dramatically lowering fat intake. This focus contributed to an emphasis on carbs as energy sources and on processed low-fat food. In the process, we’ve dramatically increased the amount of sugar we consume.
In particular, we now consume an excessive amount of fructose. That fructose largely comes from the use of sugar in so many foods in addition to the prevalent use of high fructose corn syrup as a sugar alternative (1).
Overall, Americans consume a large amount of sugar. Much of that comes from the food we choose to eat. After all, people often turn to sugar-sweetened drinks as well as candy, chocolate and processed foods. All of that sugar adds up and the effects of sugar on the body really can be quite significant.
At the same time, sugar is also present in places that people don’t expect. Being aware of those locations is one of the first steps in cutting down the sugar you take in. For example, many low-fat products tend to be high in sugar, as manufacturers add in sugar to make sure the product still tastes decent.
Likewise, products like bread, soup, salad dressing, yogurt and frozen dinners all too often have added sugar. In many cases, you can’t even taste that sugar.
So, even if you don’t intentionally eat a lot of sugar, your sugar intake may still be pretty high if you consume a lot of processed foods. For example, here’s an ingredients list from Sunbeam Enriched White Bread.
In this case, high fructose corn syrup is present, which I’ll go into later on, but it’s basically the same as sugar for the purposes of this discussion.
Not only does the bread have sugar, but it is also fairly high on the ingredients list. In fact, it’s the third item, after the wheat flour and water. That’s pretty concerning. There is no reason why sugar should be an added ingredient in bread, yet American bread often does contain either sugar or high fructose corn syrup.
In a similar way, there are many foods that have hidden sugar. For example, the site BuiltLean lists 7 types of food with hidden sugars and how you can avoid them.
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The Chemistry of Sugar
The term sugar is actually a general one, referring to a range of different carbohydrates. The form of sugar that we specifically think about is sucrose, which consists of glucose and fructose. In the body, sugar is broken down into those two components, which are considered simple sugars.
In general, glucose is one of the key energy sources for the body. We get this from our diet and if we don’t get enough of it, our bodies create it. As such, glucose is necessary for our survival.
In contrast, fructose isn’t an essential compound.
The liver converts fructose into glucose, which it can then use. However, the rate of conversion is limited. Because of this, consuming a little bit of fructose is fine. But, if you consume too much, the liver won’t be able to convert it all and some will instead get converted into triglycerides, a type of fatty acid (2,3). In turn, that can contribute to a fatty liver, which is associated with many health issues, including non-alcoholic fatty liver disease (4,5).
Sugar and High Fructose Corn Syrup
Any discussion of sugar in the American diet has to consider high fructose corn syrup (HFCS). This compound is a sweetener that is commonly used as a substitute for sugar. One of the key differences is that high fructose corn syrup has more fructose than sugar and by extension, less glucose. It also tends to be cheaper to produce and easier to use in many cases.
In the United States, high fructose corn syrup is a common ingredient in many different food products and tends to be used in many places where you would typically find sugar. There is considerable debate surrounding high fructose corn syrup and its implications for health.
In general though, the fact that it has more fructose is a concerning factor. After all, this is the part of normal sugar that the body already has to convert. As a result, it’s likely that high fructose corn syrup will contribute to more triglycerides and more fat development than sucrose will.
Sugar in Fruit
Fruit are a bit of an anomaly when it comes to discussing sugar. After all, they are high in fructose, which can make them seem like a bad choice for health.
For that reason, there is a lot of debate about whether we should be eating fruit or not. After all, the effects of sugar on the body are roughly the same for natural sources of sugar.
In general, I would argue that fruit is still healthy, especially because of all the phytonutrients that they contain. Additionally, fruit tends to take time and energy to consume and you’re getting benefits from the fiber in the fruit at the same time.
Nevertheless, it is still important to watch your intake.
For example, having a few pieces of fruit per day is pretty healthy, but it’s easy to overconsume if you’re eating fruit salad or dried fruit, or if you drink fruit juice.
Impacts of Sugar on Health
For a long time, fat has been promoted as the villain when it comes to health and many people still think that way. But, there is growing evidence that sugar may be much more dangerous for health than fat. In fact, we’ve consistently underestimated the dangers of sugar.
For example, one of the main reasons for avoiding fat is that it is thought to increase the risk of heart disease (although the evidence isn’t as strong as you might think). Yet, research indicates that sugars can also increase some of the risk factors for heart disease (6,7,8,9).
At the same time, excess sugar consumption has been linked to the development of type 2 diabetes (10).
That effect is connected to the way that sugar can contribute to insulin resistance (11,12,13). That insulin resistance can then play a role in the development of diabetes (14,15) and metabolic syndrome (16).
Sugar-sweetened drinks have also been associated with some cognitive impacts, including the potential to decrease memory and cognitive function in some populations (20,21,22), although more research is needed to show how significant this issue is.
The Connection Between Sugar and Gut Health
In general, our diet can have extensive impacts on our body. Some of those impacts might be obvious and immediately apparent, but others take time to even recognize.
In the case of sugar, one important area is gut health and this plays a key role in the effects of sugar on the body.
This is actually a pretty new field, but there is growing recognition that the bacteria in our gut (our microbiota) play a huge role in our overall health. For example, these microbes have the potential to increase or decrease the level of inflammation as well as the overall risk of some diseases (26).
The modern movement towards more sugar and more processed food has coincided with an increase in inflammatory diseases. Research suggests that disruptions to the microbiota may be a key reason for this pattern (27).
Dr. David Williams also talks about the various ways that good gut bacteria can support overall health.
Sugar and Obesity
Not surprisingly, there is a strong association between sugar and weight gain. After all, sugar is a key source of calories and it’s extremely easy to consume too much of it.
One reason for this may be the way that sugar contributes to a higher insulin response. Research has also indicated a linear relationship between BMI and insulin response. This means that people with a higher BMI are more sensitive to the impacts on insulin. This results in a dangerous cycle between BMI, insulin response and high-calorie drinks (30).
Indeed, fructose also contributes to insulin resistance, the creation of fat and the elevation of triglycerides in the blood (31). This can then contribute to leptin resistance (32,33), which in turn plays a role in weight gain.
Research also suggests that simply replacing sugar-sweetened drinks with water or milk can significantly decrease the amount of fatness in children (34).
Other Arguments Against Sugar
One of the key problems with sugar is that it represents empty calories. This means that sugars provide little to no nutrition for the calories that they provide.
Now, empty calories aren’t unhealthy on their own and they don't directly contribute to the effects of sugar on the body. After all, most of us have at least one favorite treat that doesn’t offer any real nutritional benefits.
However, empty calories can still be a major issue.
Because empty calories don’t have nutrients, they don’t tend to make people feel full or satisfied and this is certainly the case with sugar (35). That lack of satiety makes it very easy to consume too many calories. That pattern is especially true in foods that have added sugar because that sugar often does little to the taste of the food but can significantly increase the amount of calories that a person is consuming.
It’s easy to see how unhealthy this can be over time. After all, consuming excess calories is a key factor in weight gain, which can lead to many other health issues.
Sugar is also bad for oral health, contributing to the development of cavities and other oral health issues. This is especially significant for people who consume sugar in between meals, such as having candy or soda as a snack (36).
Sugar is Addictive
Many of us find sugar intake very difficult to control, especially as we tend to end up craving sugary food. As it turns out, there may be a good reason for that pattern.
Research is starting to show the presence of neural circuitry that reinforces our consumption of sugar. In many ways, the pattern is similar to what happens with addiction. The pathways in the brain can contribute to compulsive sugar seeking behavior, which frequently leads to an over-consumption of sugar (37,38).
At the same time, the consumption of sugar releases dopamine, which is something that also happens during the use of drugs. In some dietary conditions, the effect of sugar can be similar to that of drug abuse (39).
Anecdotal evidence also suggests that people do become addicted to sugar and to the sugar in foods.
For example, many people find it extremely difficult to cut down their sugar intake or to cut out some parts of their diet, like sugary sodas. Likewise, people can even experience withdrawal symptoms when trying to give up sugar (40,41). The addictive nature of sugar may even be why so many people struggle to maintain diets and find losing weight almost impossible.
The addictive nature of sugar is a major issue and it makes sugar consumption that much more concerning.
After all, that addictive nature makes it far too easy to consume too much sugar. Likewise, it can make it extremely difficult for people to decrease their sugar intake to healthy levels.
Sugar is Often in Beverage Form
In many cases, we take in sugar through sugar-sweetened drinks. This includes soda, fruit juices, fruit drinks, energy drinks, sports drinks and many other examples. In fact, even many milk-based beverages have added sugar.
This is an issue because of how the human body processes calories.
Specifically, liquid calories tend to be processed differently than other types of calories.
In practice, this means that it’s incredibly easy to drink an excessive amount of calories without even realizing it. If you eat a lot of calories, typically you will get some feedback from your body, but the same often isn’t true for liquid calories.
Additionally, consuming fructose in drink form has even less of an impact on satiety than consuming glucose (42). That’s incredibly important because many sugar-sweetened drinks in the United States (including soda) do use high fructose corn syrup rather than sugar.
The Implications of Sugar
So, what does this all mean?
Clearly sugar is detrimental to health. After all, it contributes to a range of health conditions, can be addictive, easily contributes to weight gain and doesn’t offer much in the way of nutrition.
Nevertheless, it’s important to note that there is still a lot of controversy surrounding the impacts of sugar. One reason for this is that there has been a lot of variation in the research, making it difficult to compare studies to one another or to compare the studies to human consumption patterns.
Furthermore, there has been relatively little research that has looked at the impacts of decreasing sugar levels. Researchers have not even been able to agree on how much sugar we should be consuming (43). As such, much more research is needed.
But, if you’re interested in the effects of sugar, you can take a look at the video The Bitter Truth by Dr. Lustig, which is an amazing look into the implications of sugar.
The video is now more than five years old and there has been a lot of new research since then, but it is still a great introduction to the topic and covers far more than I can in the course of one post.
The overall controversy is mostly connected to the chemical impacts of sugar and fructose specifically. But, regardless of those, we do know that sugar causes a lot of harm simply from the calories alone and from our eating patterns. As such, decreasing sugar intake is likely to improve health for many people, regardless of the specific chemical effects that sugar has on the body.
After all, most of us really do need to decrease just how much sugar we take in. That’s particularly true if you eat a lot of processed foods or if you are fond of sugar-sweetened drinks. Cutting down your sugar intake is a good way to decrease the effects of sugar on your body and really is an important goal.
Some people take this to an extreme – cutting sugar out of every possible part of their life and their diet. Doing this effectively can be challenging, especially because there is hidden sugar in so many foods. People that cut out sugar altogether find that they have to make most things themselves.
In general, cutting sugar entirely out of your diet can often be time consuming and expensive. However, there are people who successfully do so as well as blogs that can teach you recipes that are appealing without sugar.
Typically, the best approach is to change your sugar intake slowly.
It’s tempting to try and cut out all of your sugar at once, but that can be ineffective. Reducing your sugar intake slowly can help you combat any withdrawal symptoms and also gives you time to adjust to a new lifestyle and a new diet.
But, cutting out sugar altogether isn’t going to be the answer for everyone.
Instead, many people choose to cut down sugar instead. This might involve taking a step back and looking at where sugar is in your diet and figuring out places where that sugar really isn’t necessary. Following a low carb diet can help a lot with this process and decreasing your reliance on processed foods is also important.
Likewise, other people focus on cutting down on added and refined sugars, rather than sugar itself. So, under this approach, you would still consume fruit and might use ingredients like honey (e.g. 44).
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