Sugar: Its many disguises

Increasingly, people are aware of the dangers of “too much sugar” in the diet. Consuming excess sugar can lead to a condition called metabolic syndrome, which is characterized by high blood pressure, high blood sugar, unhealthy cholesterol levels, and abdominal fat. Excess sugar also contributes to widespread inflammation and even leads to a higher risk of cardiovascular disease and type 2 diabetes.

Excess sugar intake can be bad for your brain, too. Studies have found that high sugar intake has a negative effect on cognition, and it has also been implicated in hyperactivity and inattention in children and adolescents.

But what does “too much sugar” look like? On the one hand, we have the well-known “problem foods” like sugar-sweetened sodas, candy, and baked treats. On the other hand, we have the naturally occurring sugars in some whole foods (like plain yogurt, milk, or fruit) that are part of a healthy diet.

Between those lurk the less well known hidden sugars that are so common in the average person’s diet.

Sugar’s hiding places

You might be surprised where added and hidden sugars can be found in the foods we eat every day. For example, a tablespoon of one popular brand of tomato ketchup has 4 grams of sugar, and most people add about 3 tablespoons of ketchup to their burgers. That 12 grams of sugar from the ketchup alone is more sugar than you’d find in a serving of two store-bought chocolate chip cookies, which contains only 9 grams of sugar! And a store-bought vegetable juice would seem like a healthy choice at only 60 calories in a single 1-cup (8 ounce) serving — but that single serving size still contains 11 grams of natural sugar, even though the label doesn’t list any added sugar.

A data review completed by the Department of Health and Human Services (HHS) noted that American adults consume 13.4% of their calories from hidden sugars, and in children, this figure is a whopping 17%. The main sources of the hidden sugars in the typical U.S. diet were snacks and sweets (31%), added sugars in beverages (47%), and soda (25%). Of course, few people would be surprised that soda is high in sugar.

What the experts say about hidden sugar

Until now, we clinicians have given dietary advice based on the recently revised MyPlate, which simply reminds us to select foods and beverages with less saturated fat, sodium, and added sugars, without going into much detail. However, a recent article in JAMA has summarized all the current guidelines for sugar intake (I’ve listed them in the table below). These recommendations offer specific advice on sugar consumption and, unlike prior guidelines, they address added and hidden sugars in food — a welcome and important change.

Pay attention to these hidden sources of sugar

Consider these common “sugar traps.”

• Specialty coffees. Take, for example, a new Starbucks coffee drink, the caramelized honey latte. At 340 calories, a “grande” (16-ounce) serving might seem like a relatively harmless once-in-a-while dessert-like treat. In fact, you might even guess that it’s on the healthier side because it contains honey, one of the “less demonized” sugars. Look a little more closely, though, and you’ll see it contains 45 grams of sugar! That’s 180 calories of sugar. This single not-very-nutritious beverage takes you over your daily sugar limit.
• Honey. Let’s look a little more closely at honey as well. One study in the Journal of the American College of Nutrition found that honey contains oligosaccharides (a prebiotic that feeds gut flora) as well as small amounts of proteins, enzymes, amino acids, minerals, trace elements, vitamins, aroma compounds, and polyphenols. So one may argue, therefore, that honey is a healthy ingredient. However, your body breaks down honey — even raw, organic honey — as glucose and fructose. Just like plain old table sugar.
• Fruit juices. Basically, fruit juice is devoid of the healthy fiber you’d get from eating the fruit itself and instead concentrates the sugars. A single 8-ounce (1 cup) serving of Tropicana orange juice contains only 110 calories and 0 grams of fat, but 22 grams of sugar! Those 22 grams of sugar are 88 calories — that is, more than half the calories in your morning glass of juice. And if you’re a woman, that’s nearly your entire sugar-calorie “allowance” for the day using the guidelines from the American Heart Association above. To think of it another way, that’s the equivalent of 5 ½ teaspoons of sugar. You probably wouldn’t add that much sugar to your morning coffee or tea.
• “AKA” sugars. To be an astute label reader, you need to know that sugar can go by many names. For example, sugar can be also known as: agave nectar, barley malt, dextrose, rice syrup, isomalt, or high fructose corn sugar.

Know the sugar content of your food

A healthy diet is rich in fresh fruits and vegetables, healthy proteins (grass-fed meats, fish, poultry, and beans), a variety of whole grains, and healthy oils. Many of these foods include naturally occurring sugars and therefore are part of a healthy diet. But to truly eat well, you need to be on the lookout for hidden and added sugars. We also use guidelines for a healthy diet, for example, such as whole grains with an understanding that certain individuals may have food sensitivities, while others prefer to omit certain foods from their diet for various personal and or scientific reasons.

In future blogs, we will look more closely at sugar in the diet.

To learn more, please watch my video below: