Is Sugar Bad For You?

The thing everyone loves to hate, but is it REALLY that bad for you? 

The sugar in our diets is being blamed by the health industry for everything from obesity to the development of chronic disease. Demonized by books, blogs, and social media gurus, some even call it toxic - a poison to our bodies to be avoided at all costs.

The question no one seems to be asking is how can sugar, which tastes so darn good, be all that bad for our health?

What’s so bad about sugar?

Research such as this, this, and this has associated high sugar intake with increased rates of obesity, heart disease, and cancer. Because of this, many fitness and nutrition professionals began to recommend reducing or even eliminating sugar intake to improve people’s health.

This seems logical, but the thing about scientific research is that it typically opens up more questions to be asked than it does answer them. In this case, we need to question if the increased rates of obesity, heart disease, and cancer came from the sugar or if it came from the increase in calories caused by the sugar intake.

Calories from sugar can be significant. A pumpkin spice latte from Starbucks has about 50g of sugar in it. If you’re drinking that every morning on your way to work, you are taking in about 200 calories from sugar alone. Adding in another latte or a Coke to get you through your afternoon slump could increase your calories by over 400 a day.

Rapid changes in your blood sugar can cause an increase in appetite and excessive eating (this is called polyphasia). When you are taking in these excess calories and still feeling hungry, that’s going to be a recipe for weight gain. 

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The correlation between sugar and obesity.

Sure, a high sugar intake may cause weight gain. The correlation between sugar and obesity was supported in the data, but since correlation does not always mean causation we have to ask if it is specifically the excess sugar causing obesity or the calories from sugar? 

One study followed overweight people who dieted with either 10 percent or 5 percent of their calories coming from sugar (sucrose). For a person on a standard 2000 calorie diet, this would have been 50 grams or 25 grams of sugar, respectively. After 8-weeks, there was no significant difference found between the groups in weight loss or BMI.

Another six month study observed more than 300 people and found that subjects demonstrated no differences in weight loss or body composition on a high-sugar diet compared to a low-sugar diet. The key here was that calories, protein, and fiber were all controlled and kept the same.

Another group of researchers found no difference in weight loss between people that ate 4 percent of their calories from sugar compared to people who ate 43 percent! Conversely, this year-long diet also found no difference in weight gain when comparing a high-sugar diet to a low-sugar diet. 

All of this data suggests that differences in weight, either loss or gain, is not specifically from sugar, but instead from more calories overall because if calories are controlled there is no difference in weight when comparing high and low sugar diets.

How does sugar affect your health?

Weight loss is one thing, but a person’s weight isn’t indicative of their health status so what about other health parameters?

There is one study that shows an association between a high-sugar diet and a greater risk of dying of heart disease. In this study, people who ate 17 percent to 21 percent of their calories from sugar had a 39 percent higher risk of dying from cardiovascular disease compared to those who consumed less than 8 percent of their calories from sugar.

While this study adjusted for caloric consumption, it did not account for protein or fiber intake and did not account for the physical activity of the participants. So to say that the increased risk of mortality from cardiovascular disease is from sugar leaves me with more questions than answers about this correlation.

In several other studies (here, here, here, and here), where sugar was introduced in a moderate amount and calories, protein, carbohydrates, and fiber were all controlled, there was no significant difference in changes in blood pressure, blood lipids, blood glucose, cholesterol, insulin, thyroid hormone, or markers of inflammation.

From my point of view, sugary foods consumed in moderation as part of an otherwise healthy and nutrient-rich diet is unlikely to cause any significant harm.

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How much added sugar per day is okay?

The word moderation will mean different things to different people so it is important to set some generally acceptable boundaries as a frame of reference.

I once caught a friend rummaging through her cabinets. She was trying to better moderate her children’s sugar intake and her husband told her he had heard on a podcast that there was sugar in garlic salt.

She pulled out the garlic salt and was shocked to see sugar in the ingredient list. She began panicking and checking more spices from her cabinet. When she asked me why there would be sugar in garlic salt, I told her:

Sugar could be part of the seasoning formulation - it is delicious stuff! It also could be in there as an anti-caking agent and honestly, she had nothing to worry about. The toxicity of a substance is ALWAYS in the dosage.

In that entire bottle of garlic salt, there was maybe a few grams of sugar in it. And we use garlic salt just a few shakes at a time. So no need to throw out your spices! That’s not where her family’s sugar intake was coming from. A typical serving of the garlic salt maybe had a fraction of a gram of sugar in it and was not going to make, or break, her family’s sugar moderation goals.

The World Health Organization (WHO) recommends that adults and children reduce their added sugar intake to less than 10 percent of their daily caloric intake. For a person on a standard 2000 calorie diet, this is less than 50g per day.

The WHO goes on to recommend that a further reduction of below 5 percent (or less than 25g per day) may provide additional health benefits.

Is fruit sugar bad for you?

An important distinction of the WHO’s recommendation is their specificity of added sugars. Added sugars are defined by either natural or refined sugars that are added to foods. Commonly added sugars include sucrose (table sugar), high fructose corn syrup, honey, and agave nectar.

The purpose of moderating your sugar intake is to prevent an excess consumption of sugar, not to completely eliminate it. An excess consumption of sugar isn’t going to come from whole fruit. Because they are loaded with fiber, water, and have significant chewing resistance, fruit takes longer to eat and digest. The sugars in fruit just can’t be consumed at the same rate as added sugars can be and can’t cause the harm we are talking about.

Additionally, because of the fiber and water content, fruit is very satiating. The sugar in fruit isn’t going to cause the same excessive calorie consumption as a sugary beverage might because the fruit may satisfy your hunger signals the first time around.

Don’t lose sight of your health trying to eat healthy - fruit is an amazing source of fiber, vitamins, and minerals and you don’t need to avoid it to moderate your sugar intake!

Sugar isn’t as toxic as you’ve been told

The question with sugar doesn’t seem to be whether it is good or bad. The question is how much is in moderation and how much is too much. For those eating an otherwise nutrient-dense diet, occasionally putting brown sugar in your morning oatmeal or treating your kids to ice cream isn’t going to hurt.

Too much of anything is bad for your health - and sugar is definitely included here. Just be mindful of your overall added sugar intake and make reasonable swaps and reductions where possible. If you keep your approach balanced and thoughtful, you don’t have to cut anything out of your diet.

+ References

1. Stanhope, K. L. (2015). Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical Reviews in Clinical Laboratory Sciences, 1-16.
2. Yudkin, J., & Watson, R. H. (1969). Sugar and ischaemic heart disease. British Journal of Medicine, 4(5675), 110-111.
3. Sulaiman, S., Shahril, M. R., Wafa, S. W., Shaharudin, S. H., & Hussin, S. N. (2014). Dietary carbohydrate, fiber and sugar and risk of breast cancer according to menopausal status in malaysia. Asian Pacific Journal of Cancer Prevention, 15, 5959-5964.
4. West, J. A., & De Looy, A. E. (2001). Weight loss in overweight subjects following low-sucrose or sucrose-containing diets. International Journal of Obesity & Related Metabolic Disorders, 25(8).
5. Saris, W. H., Astrup, A., Prentice, A. M., Zunft, H. J., Formiguera, X., Verboeket-van de Venne, W. P. H. G., ... & Vasilaras, T. H. (2000). Randomized controlled trial of changes in dietary carbohydrate/fat ratio and simple vs complex carbohydrates on body weight and blood lipids: the CARMEN study. International Journal of Obesity, 24(10), 1310-1318.
6. Raatz, S. K., Torkelson, C. J., Redmon, J. B., Reck, K. P., Kwong, C. A., Swanson, J. E., ... & Bantle, J. P. (2005). Reduced glycemic index and glycemic load diets do not increase the effects of energy restriction on weight loss and insulin sensitivity in obese men and women. The Journal of Nutrition, 135(10), 2387-2391.
7. Surwit, R. S., Feinglos, M. N., McCaskill, C. C., Clay, S. L., Babyak, M. A., Brownlow, B. S., ... & Lin, P. H. (1997). Metabolic and behavioral effects of a high-sucrose diet during weight loss. The American Journal of Clinical Nutrition, 65(4), 908-915.
8. Yang Q;Zhang Z;Gregg EW;Flanders WD;Merritt R;Hu FB; (n.d.). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine. Retrieved October 12, 2021, from https://pubmed.ncbi.nlm.nih.gov/24493081/.
9. World Health Organization. (n.d.). Who guideline : Sugar consumption recommendation. World Health Organization. Retrieved October 12, 2021, from https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children.

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