The 411 on Sugar: The Good, The Bad, And Everything In Between
Sugar is a hot topic these days and for good reason. With nutrition research linking excessive consumption of added sugars to heart disease, obesity, and type 2 diabetes people now more than ever are interested in how much sugar they really should be consuming, and what kinds (if any) are better for you than others. [1,2]
With the sugar industry trying its best to deny the nutritional research and recommendations for a decrease in the consumption of added sugars, especially in growing children, people are confused where to turn for unbiased information...welcome to the world of American food policy. 
So why don't we start at the very beginning and work our way down through all the confusing sugar opinions that make this topic so much more complicated than it needs to be.
what is sugar really anyway?
Sugar by definition is just a generic name for a sweet carbohydrate that is used in food, and derived from a few different forms, which are then broken down to provide our body with energy.
When it comes to sugar there are a few different types:
- Sucrose: A disaccharide that is composed of both glucose and fructose. Sucrose is found in some fruits and vegetables, but is most commonly known as white table sugar.
- Glucose: The bodies primary source of energy, which is produced when carbohydrates are metabolized and digested. Starches are comprised of long-chains of glucose molecules.
- Fructose: Also known as "fruit sugar". This sugar is found in fruit, honey, agave, and root vegetables.
- Lactose: The sugar found naturally in milk. It is also a disaccharide and is composed of galactose and glucose.
- Maltose: Another disaccharide that is composed of two glucose molecules and is most commonly found in molasses.
What does sugar do in our bodies?
When we consume any of the above types of sugar in the form of carbohydrates, our body recognizes them as a fuel source and immediately works to utilize the sugar we have just consumed either by using it for energy, or storing it for future use. The difference between the various types of sugar really comes down to how our body processes and metabolizes them, which happens either directly through the blood stream, or through the liver.
Glucose for instance is absorbed directly into the blood stream and then into the cells with the help of the hormone insulin, and is used to supply energy throughout the body. When you hear someone talk about stabilizing their blood sugar, or a diabetic talking about their blood sugar or insulin needs, they are usually referring to how their body is responding to this sugar molecule.
Once the body's energy needs have been fulfilled, excess glucose is then stored in the liver and muscles as glycogen (stored glucose) for future use. However, when a person is consuming an excessive amount of glucose and isn't using up very much of its stored glycogen (aka through a sedentary lifestyle), the body will have to result to storing glucose as fat in the adipose tissue, which is how sugar has been linked to obesity.
Fructose however, is primarily metabolized in the liver, and requires minimal insulin which therefore elicits a low-glycemic response. This basically means that you wouldn't get that same shaky sugar-high as you would if you ate a giant piece of chocolate cake.
When fructose is metabolized, it either is converted to glucose and stored as liver glycogen (to later be used for energy), or stored as fat when it is also consumed in excess (like in the form of HFCS in soda). Are you noticing a trend? Excess sugar when we do not need it for energy, and when our muscles and liver are already filled up with stored glycogen = fat storage.
so if fructose is a sugar found in fruit, what is the big deal about high-fructose corn syrup (HFCS)?
Thanks to clever food marketers, for years HFCS was marketed as a "healthy" and "natural" sugar because it came from plants. What the manufacturers of HFCS failed to include in their marketing was that their health claims were backed by zero science, and that HFCS in fact was just a man made sweetener the combines the fructose and glucose of corn starch to make a highly-refined alternative to cane sugar. Even better, it was a cheap, and not-so environmentally friendly way to sweeten processed foods and beverages, and provided absolutely no nutritional benefits.
What may have initially seemed as a harmless sweetener, soon was found in almost every processed food on the market. This ultimately was found to contribute significantly to the increased consumption of added sugars by Americans through processed foods and sugar-sweetened beverages, which we now know significantly increases the risk for CVD, obesity, and type 2 diabetes. [4,5]
so what about fruit?
Due to the recent demonization of sugar, fruit it starting to take a hit and this is something that I am 100% against. Right now I am going to take a stand for fruit and here is why.
When we are talking about all the negative health effects that come from too much sugar in the diet, we are talking about added sugar (like HFCS) in processed foods, and sugar-sweetened beverages that are being consumed in high-quantities, and we were never meant to be consumed in the first place. Phew, I said it.
Concern over fructose should not extend to the naturally occurring fructose that is found in fruits and vegetables. An otherwise healthy individual who is being told by the media to be afraid of the sugar in one banana is ridiculous.
Yes fruit contain fructose, you want to know what else they contain? Literally thousands of antioxidants and phytonutrients that have been linked to fighting cancer and disease. Vitamins and minerals that help balance our bodies hormones, maintain healthy eye sight, and promote a healthy weight balance.
They also are filled with FIBER, which when consumed with fructose helps slow down the absorption and metabolism of fructose, and helps support a healthy digestion. Fiber my friends comes from fruits, vegetables, and whole grains...all of these foods are carbohydrates...all of these foods contain "sugar"...IT IS OKAY they were meant to be eaten together, in unison as whole foods for this very reason. 
but it's natural sugar so it must be healthy right?
Such a good questions! Is "natural sugar" healthy? The answer really is yes, and no.
For instance, fructose the sugar found in fruit in moderate, whole food amounts can be a healthy way to enjoy some deliciously sweet foods. Who doesn't love a good peach, or a juicy watermelon? When combined with fiber, water, and all the another amazing vitamins and minerals present in fruit, when consumed in moderate amounts the natural sugar found in fruit is absolutely something that can and should be a part of a healthy diet.
However, even the sugar found in fruit (fructose) when consumed in too high of quantities, like in the form of 4 cups of frozen fruit added to a smoothie all at once, isn't something that our bodies were ever meant to handle. Would you normally sit down to eat 4 bananas in one sitting? Probably not.
But even more commonly our bodies are exposed to the natural sugar fructose in the form of high-fructose corn syrup, which like we already discussed is neither healthy nor natural.
Fancy sounding sugars like fair-trade cane sugar, organic cane sugar, raw coconut sugar, etc. all are being marketed to consumers as being "healthier" sugars. This really isn't the case because our bodies will recognize this sugar the same way it recognizes the non-organic stuff. The only difference really is that through a less refining process some of the minerals that come along with some of these sweeteners may remain intake.
But in my opinion, what you really should be thinking about if you are choosing to purchase raw, organic, or fair-trade sweeteners is the positive implications on the environment, and farmers who are working to get you that little sweetener you put in your morning coffee. When you choose the organic, local, or fair-trade option you are choosing to support an industry that doesn't use harmful pesticides, and treats their laborers with respect.
Lastly, honey is an added sugar that stands out from the rest. Even though it is high in fructose and still is considered an added sugar, it also contains incredible medicinal health benefits, and has been used in integrative medicine for a variety of natural remedies. I personally like taking a little raw honey during allergy season, or spraying some propolis on my throat when I fly. For me the minimal added sugar I consume from high quality raw honey is outweighed by the many other wonderful properties found in the food. 
so how much sugar is too much sugar?
The answer to this question is going to vary for everyone by the Academy of Nutrition and Dietetics recommends that no more than 10% of a person's daily diet should come from added sugar. Personally, I like to see that number closer to 5% or ~20g of added sugar in my nutrition clients. This is simply because most added sugars provide zero nutritional value, and can easily be reduced or avoided.
What I recommend is that my clients start looking at food labels and identifying where added sugar is hiding. I then recommend that my clients start to reduce their added sugar intake by making small tweaks like:
- Replacing flavored yogurt with unflavored/unsweetened
- Replacing sweetened almond milk with unsweetened almond milk
- Removing sugar sweetened beverages from the home and replacing them with lemon water or seltzer
- Cutting the sugar in their tea or coffee in half
- Baking desserts at home
These simple tweaks can overtime significantly reduce a person's added sugar consumption and help re-train a person's taste buds to recognize the naturally sweet flavors in whole foods again.
how to spot sugar in your food label
We already talked about all the different types of sugar, and since now you are going to be taking a look at some food labels, why don't we go through some of the many ways that sugar may be hiding in your food without you even knowing it:
- Agave Nectar
- Evaporated Cane Juice
- Malt Syrup
- Brown Sugar
- Maple Syrup
- Cane Crystals
- Fruit Juice
- Fruit Juice Concentrate
- Raw Turbinado
- Cane Sugar
- Raw Cane Sugar
- Corn Sweetener
- High-Fructose Corn Syrup
- Corn Syrup
- Crystalline Fructose
- Dextrose Maltose
- Coconut Sugar
- Fresh Fruit Puree
Now that you know where added sugar may be hiding, if I had to pick options to cook/bake and indulge with I would always choose: Honey, Dates, Sucanat, Maple Syrup, Coconut Sugar, or Fresh Fruit Puree (like mashed banana/apples/berries). All of these options can be found in their raw, organic, and unprocessed form and are ones I prefer if needed.
what should i do if I have a sweet tooth?
Here is the amazing thing, you can still enjoy delicious, decadent sweets and maintain a healthy lifestyle, in fact I encourage you to. The media has made it seem as though we can never have a piece of chocolate again for fear of sugar. This just isn't the case. In fact depriving your body of decadent foods the you choose to enjoy occasionally will only result in you obsessing over your food, and eventually binging on an entire bag of donuts.
Here are some of my absolutely favorite ways to satisfy my sweet tooth without adding too much added sugar into my diet:
so is sugar as bad as everyone is making it out to be?
Probably not. Here is the thing, life and especially nutrition is not black and white. There are so many reasons and research to support why added sugars probably aren't the best things for us, but when it comes down to it I honestly believe that the route of all our nutritional concerns, even our sugar related concerns, comes back to excessive consumption of processed foods, and too little whole foods and plants.
Would I ever recommend that my clients, family, or friends purposefully consume excessive amounts of added sugars -- absolutely not. Would I ever recommend that my clients, family, or friends purposefully consume excessive amounts of kale -- absolutely not. You see where I am going with this? Do I think that high-fructose corn syrup sweetened candy bar is going to kill you, make you obese, or give you type 2 diabetes -- nope.
I am not about black and white thought processes, I do believe really anything is good in excess, and I know that our lives are not meant to be viewed in extremes. Sugar is not evil, it is just simply being consumed in too high of quantities, and manipulated in ways that really were never meant to be manipulated.
So here we find ourselves in a society where demonizing a sugar molecule has become the norm. It used to be fat, now its sugar, it probably will be something else in the next decade. All I know is that educating yourself on how your body responds to sugar, the different types, and how to include it in your diet in a more healthful way in my opinion really is the best thing you can do for the health of your body, and your mind.
 Popkin, B. M., & Hawkes, C. (2016). Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses. The Lancet Diabetes & Endocrinology, 4(2), 174-186.
 Zoellner, J. M., Hedrick, V. E., You, W., Chen, Y., Davy, B. M., Porter, K. J., ... & Estabrooks, P. A. (2016). Effects of a behavioral and health literacy intervention to reduce sugar-sweetened beverages: a randomized-controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 38.
 Nguyen, D. M. (2016). Child Obesity Education: Sugar in Common Snacks.
 Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R., & Hu, F. B. (2014). Added sugar intake and cardiovascular diseases mortality among US adults. JAMA internal medicine, 174(4), 516-524.
 Vartanian, L. R., Schwartz, M. B., & Brownell, K. D. (2007). Effects of soft drink consumption on nutrition and health: a systematic review and meta-analysis. American journal of public health, 97(4), 667-675.
 Bantle, J. P. (2009). Dietary fructose and metabolic syndrome and diabetes. The Journal of nutrition, 139(6), 1263S-1268S.
 Kumar, K. S., Debjit, B., & Chandira, M. R. (2010). Medicinal uses and health benefits of honey: an overview. Journal of Chemical and Pharmaceutical Research, 2(1), 385-395.