Sugar: Its many disguises

Uma Naidoo, MD


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.

US Department of Agriculture and
US Department of Health and Human Services (2015-2020)
Limit consumption of added sugars to <10% of calories per day
World Health Organization (March 2015) Restrict added sugar consumption to <10% of daily calories
American Heart Association (2009) Limit added sugars to 5% of daily calories (for women, 100 calories/day; for men, 150 calories/day)

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:

Related Information: Reducing Sugar and Salt


  1. Sami Motaghedi

    Fruits, honey, root veggies, and bread are healthy to eat. I eat carbs daily or I’ll need to drink coffee/energy drinks to survive the day.

  2. Maria Jasmine Freeman

    Very well said; thanks. Add to that one point; simple refined sugars are great food for pathogenic flora in our guts, meanwhile the healthy flora would be food-deprived by the escorting low-fiber intake. In this manner, pathogenic flora proliferate immensely, resulting in Dysbiosis, reverberating at multiple fronts, not the least of, the occurrence of a leaky gut presumably culpable of obesity, and allergic, immune, and hormonal disorders, and more. From here, in this framework, perhaps honey, by virtue of its content of prebiotics( oligosaccharides), amino acids, enzymes, etc .., can be voted for as healthy despite its sugar content.
    Back to nature; vegetables, grains, nuts, ( and fish), probiotic foods, and the least processed foods are best.
    Hana Fayyad M.D.

  3. Charles Garascia

    On the other hand: Any Starch we eat is turned into Sugar by the Hydrochloric Acid in our stomachs. This is a catalytic reaction that can’t be changed. So a bread roll at a meal really represents a lot of sugar. All bread, pancakes, rolls, tortillas, chips, etc. all mostly become Sugar after eating. Maybe eating foods that slowly release their starches may make sense?

  4. Coryl LaRue Jones, PhD

    1954, a 220 lbs teen, hospitalized for observation because they said I gained weight because I cheated on my diet–in 7 days I gained 3 pounds because they fed me jello and canned fruit. 1968, a 165 lbs PhD at conference at a medical school, they said I could request my special diet (no carbs) because the co-sponsor was their nutrition department. When the attendees received roast beef, I got canned fruit and cottage cheese. When confronted, the nutritionist said I had their protein, no carb plate. 2012, hospitalized with MERSA in a Hopkins hospital, coming out of a coma: toast, fruit juice, fruit in a bowl, no protein. Negotiations rose to the chief nutritionist, but a concession, I could get two units of protein instead of one, and I could leave the fruit juice, fructose, starch, sugars, etc., on the tray. I didn’t have to eat it. We have not come a long way.

  5. joe overstreet

    I have reviewed my eating habits and really believe my intake of sugar helped me with my heart disease which caused 4 bypasses. three heaping teaspoons in four or five coffees really adds up. my mental facilities improved greatly and I feel new. twenty five pounds of them poison didn’t last long. since I gave up sugar there’s an unopened bag in their pantry. amazing.

  6. Laura

    Your post omits the Dietary Reference Intakes, which are the basis for nutrient recommendations in the United States and Canada. There are no upper limits for added sugars in the DRIs; however, it is recommended that intakes not exceed 25% of energy as this may result in lower micro-nutrient levels in certain populations. Also all plants produce sugars – glucose, fructose and sucrose – through photosynthesis. The sugars in the ketchup includes sugars from tomatoes; the sugars in the vegetable juice are from the various vegetables and fruit that are in this product. These are naturally occurring sugars, similar to those found in the corresponding vegetables or fruits.

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