We are presently living in a sugar-coated environment. Nowadays, sugar is easily accessible, cheap, and present in up to three out of every four products that we can buy in supermarkets. As a result, the individual consumption of sugar worldwide has increased fifty-fold over the past 200 years. Just as sugar intake has increased, so has the concern about how it might impact our health. While the connection between overall diet and disease has been explored widely, there are still unanswered questions regarding sugar consumption specifically.
What is sugar?
We tend to interchangeably use the terms carbohydrates and sugar, but this is a common misconception. While all sugars are carbohydrates, not all carbohydrates are sugars. Sugar represents the simplest form of carbohydrates, consisting only of one or two molecules. They are soluble in water and are present (naturally or added) in foods and drinks granting them their sweet taste. However, sugars can also be used as part of other processes, such as preservation (like in jams) or fermentation (like in wine). Sugars are naturally present in fruits, vegetables, or milk; and are usually added to pastries, sweets, or sodas, among others.
Which sugars should we be worried about?
Dietary sugars are usually classified into total sugars, free sugars, and added sugars. Added sugars are those simple carbohydrates that are not naturally present in foods and beverages. These sugars have been, as the name indicates, added to foods during processing, manufacturing, cooking, or consumption. The definition of free sugars includes all added sugars plus sugars naturally present in honeys and syrups, as well as in fruit and vegetable juices and juice concentrates. Lastly, total sugars is a term used to refer to all sugars contained in the diet, whether they are added, free, or present in whole fruits and vegetables, or in dairy products.
Sugars consumed in either added or free form are generally considered more harmful for our health. Added sugars are not naturally present in foods and beverages so they only add to the caloric intake without any additional value. While the free sugars from, for instance, natural juices might still provide vitamins and minerals, these have less fibre and nutritional benefits than consuming the fruit whole.
Moreover, sugars that are consumed in liquid form present two additional issues. First, they do not make us feel as full, so we end up consuming more than we really need, adding to our overall caloric intake. Second, as they do not require digestion, they are more easily absorbed causing more acute effects in the body.
How much sugar should we eat?
Answering this question is more difficult than one might think. Even the scientists behind national nutritional recommendations (such as the Nordic Nutrition Recommendations, the Dietary Guidelines for Americans, and Public Health England, to name a few) and international organisations (such as the World Health Organisation) have not managed to reach consensus. To this day, there is still a disagreement as to which type of sugar to focus on (added or free), where to set up the threshold for safe consumption, or which health outcomes to use as a basis for recommendations.
As a result, the European Food and Safety Authority set out to investigate sugar consumption in relation to pregnancy-related conditions, dental caries, and chronic metabolic disease, which include pathologies of the heart and the blood vessels (cardiovascular disease), diabetes, and obesity, among others. The European Food and Safety Authority concluded that while there is in fact an association between sugar consumption and the development of chronic metabolic diseases, there is not enough scientific evidence to establish a safe consumption threshold, particularly when related to cardiovascular disease. Nonetheless, their overall recommendation is to reduce our consumption of added and free sugars to a minimum within the limits of a nutritionally adequate diet.
Learn more!
I will be defending my PhD project “Sugar-Coated: the role of sugar intake and cardiovascular disease development in the context of nutritional recommendations” the next 21st of April 2022 at 13:30. This is a public defence seminar, so all are welcome! Join us at Agardhsalen, Clinical Research Centre (Jan Waldenströms gata 35), Malmö or on Zoom (Meeting ID: 628 4387 4127). You can also access the book and published papers here.