Sugar

About sugar

Sugars are carbohydrates. Like all carbohydrates, they provide a source of energy in our diet.

Sugar is a term that includes all sweet carbohydrates, although the term is most often used to describe sucrose or table sugar, a ‘double sugar’. The body breaks down carbohydrates into simple sugars such as glucose, that can be readily used in the body.

There are several different sugars. Sugars occur naturally in some foods, such as fruit and dairy products, and are also added to a wide variety of foods. Sugar can take many different forms, including white, raw or brown sugar, honey or corn syrup.

Too much sugar in your diet can make your diet high in kilojoules or 'energy dense' and can contribute to health problems like obesity, diabetes and tooth decay.

Refined (or processed) sugar provides a quick, simple source of energy, but it doesn’t contain other nutrients such as vitamins and minerals.

Sugars are popular in the processed food industry because they add taste, colour, bulk and thickness to food products. They also prevent mould forming and act as a preservative.

Sugar in moderation

A ‘moderate’ intake of refined sugar can be an acceptable part of a healthy diet. Experts define a moderate intake as about 10% of your total energy intake per day. However, people who consume a lot of sugary food and drinks at the expense of more nutritious food choices, may be taking in a lot of ‘empty calories’.

Adding a little sugar to nutritious grain foods, such as wholegrain bread and cereals, may encourage people to eat more of these foods by making them more tasty.

Sugar and obesity

The overall quality of evidence linking changes in body weight in relation to both increasing and decreasing sugar intake in adults and children is moderate. However, there is general agreement that energy (kilojoules) above the body’s needs will be stored as fat.

Sugar is a form of carbohydrate and it provides the same amount of energy or kilojoules (kJ) per gram as other forms of carbohydrates found in breads, rice, pasta and fruits.

One gram of carbohydrate provides 16kJ of energy. One gram of fat provides 37kJ. Therefore, fats in food contribute double the energy than the equivalent amounts provided by sugar.

Although sugar provides less energy than fat, it can contribute to the ‘energy density’ (number of kilojoules) of foods and drinks. It’s easy to overindulge in foods, especially drinks, with high sugar content.

Having too much sugar adds to the amount of kilojoules in food and in your overall diet. Eating too much of any food, especially those high in sugar, without doing enough exercise, will cause you to become overweight.

How much sugar is recommended?

The Australian dietary guidelines do not have specific recommendations regarding how much sugar to consume per day. They do recommend ’limiting intake of foods and drinks containing added sugars such as confectionary, sugar-sweetened soft drinks and cordials, fruit drinks, vitamin waters, energy and sports drinks’.

In 2015, the World Health Organisation (WHO) developed evidence-based recommendations on the intake of sugars to reduce the risk of disease risk in adults and children, with a particular focus on the prevention and control of unhealthy weight gain and dental caries (decay):

• WHO recommends a reduced intake of free sugars throughout the life course (strong recommendation).
• In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake (strong recommendation).
• WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation).

Soft drinks are high in sugar

Sweetened drinks are heavily advertised, cheap and commonly available. They include soft drinks, cordial, energy drinks, sports drinks, fruit drinks and flavoured mineral waters.

The standard serving size for soft drink has increased. Previously, soft drink was available in 375ml cans. Soft drinks are now commonly sold in 600ml bottles, which provide up to 16 teaspoons of sugar.

For an average 14-year-old girl, a 600ml bottle of soft drink alone will provide more than 12% of her daily energy needs. This means she would exceed the recommended energy intake from refined sugar with just one drink.

Studies of children in Australia have found that consumption of sugar-sweetened beverages was associated with obesity risk. Participants who consumed more than one serving (more than 250g) were 26% more likely to be overweight or obese.

Rethink Sugary Drink is a partnership between health and community organisations with the aim of reducing consumption of sugary drinks. They provide some useful resources on the amount of sugar in drinks, and how you can reduce your consumption.

Fats in sweet foods

Sugars are often found together with fats in foods like chocolate, biscuits and cakes. A high fat intake is quite likely to contribute to being overweight or obese because fat is very ‘energy dense’.

It is a healthy choice to limit both the fat and the sugar content in the foods you eat. Lots of commercially produced sweet foods contain high levels of saturated fat, which will increase your blood cholesterol levels and your risk of heart disease.

Carbohydrates and glucose

Your body breaks down carbohydrates and converts them into a simple sugar called glucose. This ready form of energy is carried through the blood and delivered to every cell.

The supply of glucose needs to be constant and dependable, so your body has developed a number of systems to ensure this supply. For instance, the pancreas secretes a hormone called insulin that regulates the amount of glucose in the blood.

Insulin allows glucose to enter body cells. It also helps with the storage of excess glucose in the liver, which supplements blood glucose levels if they start to fall.

A person with diabetes has either insufficient or inefficient insulin, which means their blood glucose levels tend to be too high. There are 2 types of diabetes:

• type 1 diabetes
• type 2 diabetes

Type 2 diabetes is associated with overweight and obesity and can be controlled, or even reversed, through dietary modification.

A small amount of sugar is safe for people with diabetes

There is no evidence that a diet high in sugar directly causes either type 1 or type 2 diabetes. However, being overweight or obese is a risk factor for type 2 diabetes and perhaps someone who is overweight might also eat a lot of sugar.

Early evidence shows that some people with type 2 diabetes who are overweight and recently diagnosed can reverse type 2 diabetes if they are able to achieve significant weight loss.

In the past, people with diabetes were told to avoid eating all foods containing refined sugar. This was because it was believed the sugar would have a bad effect on their blood glucose levels. However, more recent research on the glycaemic index (see below) has shown that sugar affects blood glucose levels less than some other more starchy foods, like refined bread and breakfast cereal.

People with diabetes can have a small amount of sugar in their diet. If you are adding sugar, it is best to add it to healthier foods such as wholegrain breads and cereals. For example, adding 2 teaspoons of regular jam spread on wholegrain bread, or a sprinkle of sugar on your porridge is okay.

People with diabetes should limit or avoid foods in which the main ingredient is sugar, such as sweets and cakes. It is also important to maintain a healthy weight to manage diabetes.

Glycaemic index

A food’s glycaemic index (GI) refers to how quickly the carbohydrate is broken down and absorbed into the bloodstream. ‘High GI’ foods enter the bloodstream more quickly than ‘low GI’ foods, causing a greater increase in the level of blood glucose (this is known as the body’s ‘glycaemic response’). The lower the GI, the slower the rise in blood glucose levels will be when the food is consumed. The effect may differ from person to person.

Recent studies have suggested a link between foods with a high GI and a number of conditions including:

• abdominal obesity
• type 2 diabetes
• high cholesterol
• hypertension (high blood pressure)
• heart disease.

There is no direct relationship between a food’s glycaemic index and the degree of processing, level of fibre or even sugar in the food. Some vegetables may even be high in GI. There are books and websites available giving details of the GI of a wide range of foods.

A healthy diet can include moderate amounts of sugar together with a range of low GI carbohydrate choices.

People with diabetes need low GI foods

The glycaemic index is a useful tool for people with diabetes to help regulate their glucose levels. People with type 2 diabetes need the glucose in their diet to be absorbed slowly. They need to eat foods with a low GI. At least one low GI food is recommended at each meal.

The quality and quantity of carbohydrate foods eaten will also affect blood glucose levels. Talk to your dietitian about the recommended quantities of carbohydrate-based foods you need.

People respond differently to different foods, regardless of the food’s glycaemic index. If you have diabetes, you will need to monitor your blood glucose levels regularly.

Sugar and attention deficit hyperactivity disorder

There is no evidence to suggest a direct link between attention deficit hyperactivity disorder (ADHD) and the consumption of sugar.

Tooth decay and sugar

Sugar and tooth decay are closely linked. Dental plaque is a clingy film made up of food particles, bacteria and mucous. The bacteria in plaque depend on sugars to produce acids, which break down the enamel and start tooth decay. Dental caries are a major preventable public health problem all over the world.

All carbohydrates contribute to this process, not just sugar, but large amounts of sugar in sweets and soft drinks are most likely to contribute to decay. Other nutritious foods (like dried fruits) also allow the bacteria in plaque to produce acids. Sticky sugars that cling to the teeth are worse than sugars that are easily swallowed, such as fresh fruit.

Ways to reduce the risk of tooth decay include:

• Cut down on sticky, sugary foods like lollies.
• Drink water instead of cordials, soft drinks and juices. If you do drink sugary drinks, don’t drink them before going to bed or over a long duration.
• Allow at least 2 hours between meals.
• Brush and floss regularly and after meals.
• Drink fluoridated water or use fluoride treatments.
• Visit the dentist regularly.

Where to get help

• Your GP (doctor)
• Dietitians Australia - find a dietitian near you Tel. 1800 812 942
• Dentist
• Nutrition Australia
• Rethink Sugary Drink
• Diabetes Victoria Tel. 1300 437 386
• World Health Organization