Last updated: September 01, 2017

Virtually every child has heard that sugar will rot their teeth, and adults know that idly shoveling spoonfuls of ice cream into their mouths is never a recipe for good health. There’s no doubt that too much sugar can be harmful to your health. But what counts as sugar? Is there a safe level of consumption? Research makes it increasingly clear that all-or-nothing approaches to health rarely work. Here’s what you need to know about sugar.

How does sugar harm your health?

Sugar naturally occurs in many foods, including fruits and vegetables. It’s practically impossible to eliminate sugar from your diet completely. The key to sugar consumption is moderation. Excess sugar consumption is linked to a wide range of health problems, including:

  • Liver damage, including developing fatty liver disease and cirrhosis.
  • Cardiovascular disease, including an increased risk of heart attack and stroke.
  • Diabetes, metabolic syndrome, and insulin resistance.
  • Cancer. Sugar not only elevates the risk of some cancers, but it can also lower the chances of surviving cancer.
  • Dementia, including Alzheimer’s, and age-related cognitive decline.
  • Premature aging, including skin wrinkling.
  • Excess weight gain. Sugar is high in calories, but low in nutrients.
  • Tooth decay and gum disease, both of which are linked to other health problems, including cardiovascular disease.
  • Excess sugar leads to constantly elevated levels of insulin, which can cause inflammation throughout the body.

How much sugar is too much?

There’s an ongoing debate about how much sugar you can safely consume in a day. The American Heart Association recommends no more than 25 grams — 100 calories per day for women, and no more than 36 grams — 150 calories — per day for men.

The U.S. Department of Health and Human Services recommends that no more than 10% of daily calories come from sugar.

Some organizations suggest daily sugar consumption limits are more like 10-25% of daily caloric intake. A 2014 study found that, when sugar consumption exceeds 25% of daily calories, the risk of dying of heart disease doubles.

A 2017 study published in the Annals of Internal Medicine calls into question current guidelines. In this study, researchers argued there is little scientific support for current sugar consumption limits. While the study’s authors claimed that their research does not support a high-sugar diet, some analysts have questioned their findings, according to TIME Magazine. A trade group that advocates for food and beverage companies funded the research, raising concerns about bias.

Barry Sears, Ph.D., creator of the Zone Diet and president of the Inflammation Research Foundation recommends that people eat about 150 grams of carbohydrates per day. The body turns digestible carbohydrates into sugar, before converting them into energy. “All carbohydrates have to be broken down [into] simple sugars to be absorbed… That is enough to provide the brain with its glucose needs, but not cause the over-secretion of insulin. This would translate into 8 servings of non-starchy vegetables per day, 2 servings of fruits, and 0-1 servings of grains or starches,” said Dr. Sears.

No matter which guideline you accept or which study you believe, there’s evidence that eating a lot of sugar is not good for your health. Finding ways to cut out excess sugar can help you maintain a healthy body weight, protect your heart, and maybe even prolong your life. 

Are sugar substitutes a safer bet?

An entire industry of sugar substitutes now touts the benefits of such alternatives. These sugar alternatives include naturally occurring sweeteners, such as honey and stevia, as well as artificial sweeteners such as aspartame. According to Dr. Sears, “All sugar substitutes will fool the body into releasing more insulin that it really needs and this will drive down blood glucose levels to induce hunger. Furthermore, artificial sweeteners appear to damage the microbial composition of the gut that can lead to a leaky gut.”

There’s virtually no evidence that these sweeteners are better than sugar. In some cases, they may even be more dangerous. Alternative sugars fall into three broad categories:

  • Artificial Sweeteners: Artificial sweeteners contain fewer calories than sugar, making them an attractive option for people trying to lose weight. There’s also some evidence that they are better for people with diabetes. But these sweeteners have drawn intense scrutiny. Some studies suggest that sweeteners like saccharin can cause cancer.
  • Natural Sweeteners: Natural sweeteners like honey and stevia are nutritionally similar to sugar. They also have a similar calorie content. Some natural sweeteners boast specific health benefits. For instance, local honey may reduce the risk of seasonal allergies. So while there may be reasons to choose natural sweeteners over sugar, there’s little evidence that they are better for people with diabetes, are less likely to cause weight gain, or don’t count toward total daily sugar consumption.
  • Sugar Alcohols: Sugar alcohols contain chemicals naturally found in fruits. They can be naturally derived from fruits, or artificially manufactured. These sugars contain fewer calories than table sugar, but there’s little evidence that they are safer than traditional sugar.

Why does sugar type matter?

Though sugar substitutes offer few or no benefits over traditional sugar, an emerging body of research suggests that the type of sugar people consume may make a difference, according to ScienceDaily. There are a few dietary sources of sugar:

  • Glucose: Glucose, sometimes called dextrose, is the body’s primary source of energy. The body turns carbohydrates into glucose. Food such as bagels, pasta, and bread are sources of glucose.
  • Fructose: Fructose is naturally occurring sugar from fruit, honey, and high-fructose corn syrup.
  • Sucrose: Sucrose is the white crystallized powder most people normally think of when the think of sugar.   

Fructose, or fruit sugar, may be a better option for diabetics because it does not require insulin to metabolize. This doesn’t mean fructose is universally healthy. A study of rats fed either a glucose or fructose diet found that only the rats fed fructose experienced significant weight gain, according to ScienceDaily. They were also more likely to show signs of liver damage and cardiovascular disease.

High fructose corn syrup, which is prevalent in many processed foods and sodas, is increasingly a subject of concern. A study published in the American Journal of Clinical Nutrition suggests that high fructose corn syrup may play a role in the obesity epidemic. Although research is preliminary, studies also indicate that high fructose corn syrup can cause inflammation, high cholesterol, and high blood triglycerides, which points to a role for high fructose corn syrup in heart disease.

Is fruit an exception to the sugar rule?

So if fructose is bad for you, does that mean fruit is, too? There’s no evidence that consuming fruit causes health problems. Indeed, fruit can help satisfy a craving for sweet, processed snacks. Consider the following:

  • While sugary snacks offer almost no nutritional value, fruit is packed with antioxidants and vitamins.
  • Fruit tends to be rich in fiber. Fiber can slow the digestion of sugar, preventing blood sugar spikes.
  • Although fruit is technically high in sugar, it tends to have less sugar by volume. An ounce of strawberries, for example, contains less sugar than an ounce of cake
  • According to Dr. Sears, “Fruit is intermediate between non-starchy vegetables and grains and starches in glucose content. It is best to eat primarily non-starchy vegetables, limited amounts of fruits, and low amounts of grains and starches in order to maintain an optimal level of glucose in the blood.”

What are the most common hidden sources of sugar?

You probably already know that the tub of ice cream in your freezer and the cake sitting on your counter are chock full of sugar. But not all sugary foods taste sweet or seem like treats. Sodas and sweetened fruit juices are significant sources of sugar. Some other surprisingly sugar-rich foods include:

  • Some condiments, including ketchup, barbecue sauce, and many salad dressings.
  • Boxed cereals, even those marketed as “healthy.”
  • Protein shakes and meal replacement drinks.
  • Many processed foods, including frozen lunches and dinners.
  • Granola bars.
  • Bread and pasta.
  • Some peanut butters.
  • Jams and jellies.
  • Sweetened coffee drinks.
  • Some flavored waters.
  • Electrolyte sports drinks.

What are the other names for sugar?

Sugar is rarely listed simply as “sugar” on a product’s ingredients list, so checking a product’s nutrition facts gives you the most reliable way to assess sugar content. You should also look for these alternative names for sugar:

  • Galactose
  • Florida crystals
  • Dextrose
  • Sucrose
  • Turbinado
  • Barbados sugar
  • Cane sugar
  • Agave nectar
  • Blackstrap molasses
  • Carob syrup
  • Barley malt
  • Dextran
  • Corn sugar
  • High fructose corn syrup
  • Corn syrup solids
  • Lactose
  • Maple syrup
  • Honey
  • Malt syrup
  • Evaporated cane syrup
  • Treacle
  • Rice syrup
  • Yellow sugar
  • Raw sugar
  • Grape sugar
  • Molasses
  • Diastase
  • Demerara sugar

To keep your sugar intake at a healthy level, read the nutrition labels on your packaged foods carefully. If you think you are eating too many sweets and you’re having a hard time changing your ways, talk to your primary care doctor or a specialist, such as a nutritionist or dietician, to help you modify your diet and live a healthier lifestyle.

Feeling inspired? Read about this woman's experience eliminating refined sugar from her diet for 6-months.