Sugar

Sugar is one of the simplest forms of carbohydrate. It is made up of the simple sugars, fructose and glucose. Sugars include the: a) monosaccharides such as glucose, galactose and fructose; b) disaccharides such as sucrose (table sugar), lactose (in milk) and trehalose; c) polyols such as sorbitol and mannitol. Sugar can take many forms - such as white, raw or brown sugar, honey or corn syrup.

Sugar has many properties, both aesthetic and preservative, that make it highly desirable in the processed food industry. It adds taste, colour, bulk and viscosity to food products. It also prevents mould formation and microbiological activity. There are food safety concerns with some formulated low sugar products.

How much sugar are Australians eating?
Sugar is Australia's second largest export crop after wheat - worth 2 billion a year. Sugar cane came to Australia from South Africa with the First Fleet, and today employs 40,000 Australians directly and indirectly. In the past 15 years, Australia's sugar production has doubled, making us the world's seventh largest sugar grower and third largest sugar exporter.

According to the 1995 Nutrition Survey, Australians were obtaining about 45% of their energy intake from carbohydrate of which 20% was derived from sugars and 25% from starch. Half of the sugar intake was in the form of "added sugar " and the other half in the form of "natural sugars" found in fruit, milk, honey. More specifically, about 30% of sugar intake in Australia comes from soft drinks, 23% comes from prepared foods, 11% from confectionery, 8% from bakery items, 8% from alcoholic drinks, 5% from dairy products amd 9% from other sources. The consumption of soft drinks has increased from 87.4 litres per capita in the 1980s to 113 litres in 1999 - an increase of 30% in a decade. In the 1995 National Nutrition Survey 16-24 year olds were consuming on average 400ml of soft drink per day.

Sugar and Health
The Australian dietary guidelines recommend that we consume only moderate amounts of sugar and foods containing added sugars. Overall, current research is finding that sugar is probably more benign than previously believed. In fact, a moderate intake of sugars - about 15 to 20 per cent of total energy - in an otherwise healthy diet is not thought to have any detrimental health effects, apart from tooth decay. In fact, adding sugar or high sugar foods to more nutritious grain foods, such as wholegrain bread and cereals, may encourage people to eat more of these foods by increasing their palatability. Even though sugar per se has not been linked with heart disease, diabetes or adult obesity, there is enough evidence to warrant some caution about consuming too much sugar. High sugar/sucrose intakes have been associated with the following conditions:
1. Dental caries (Moynihan, Br Dent J 2000; 188: 308-12)
2. Increased tendency for blood clots (Marckmann et al., Metabolism 2000; 49: 731-5)
3. Decreased levels of good cholesterol (HDL) (Tillotson et al., Am J Clin Nutr 1997; 65 (1 Suppl): 314-26
4. Increased levels of a blood fat & triglycerides associated with diabetes and heart disease (Daly et al., Am J Clin Nutr 1997; 66: 1072-85)
5. Possibly linked with an increaded risk of colorectal cancer (World Cancer Research Fund 1999)
6. Link between sugar sweetened drinks and childhood obesity
7. The consumption of sugar-rich foods have been associated with greater skin wrinkling in a cross-cultural elderly study (Purba et al., 2001).

It could be that sugar per se is not the problem but rather that the sugar may simply be acting as a marker of the nutrient density or antioxidant quality of the diet and that too much "nutritional space" is being taken up by nutrient poor sweet foods.

Sugar and micronutrients
The micronutrient deficiencies that sucrose and fructose have commonly been associated with are copper and magnesium. Very large doses of fructose and sucrose appear to reduce the absorption, and thus availability, of copper and magnesium. This indicates that there may be an interaction between nutritional status, and fructose and sucrose intake.

Carbohydrates and glucose
The body breaks down carbohydrates into a simple sugar called glucose. This form of ready energy is absorbed from the small intestine into the blood, where it is delivered to each and every cell. The supply of glucose needs to be constant and dependable, so the body has devised a number of fail-safe 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 and helps with the storage of excess glucose in the liver, which supplements blood sugar levels if they start to wane. A person with diabetes has either insufficient or inefficient insulin, which means their blood sugar levels tend to be too high.

Fats add more weight than sugar
Sugar has been called a source of 'empty calories' because it offers taste but has no nutrients. It has long been advised that if you want to lose weight, you should cut out all sweet and sugary foods from your daily diet. However, there is limited evidence to suggest that eating foods high in sugar is associated with excessive food intake or obesity.

Overweight and obesity are caused by regularly consuming more kilojoules (calories) than the body uses. The current thinking is that overeating, in general, causes excess weight gain and obesity, with no one food or food group being solely to blame for the condition. However, sugar may be a problem for people who are largely inactive and need to reduce their energy intake. Therefore, to assist in weight management it is advisable to avoid eating large amounts of sugar or sugary foods. A study published in the Lancer 2001 showed that consumption of sugar-sweetened drinks is related to childhood obesity. Another study showed that there was more than 1 kg body weight gain in subjects after 3 weeks consuming about 4 glasses of soft drink daily compared with volunteers drinking the same amount of diet soft drink. The use of artificial sweetners can help reduce the energy load of sweetened beverages and may assist in weight management. On the other hand a number of studies have concluded that intake of carbohydrate or even sucrose has no relationship with obesity or that the relationship may be negative.

Watch out for fats in sweet foods
Sugars are often associated with a high fat content in foods and can increase the palatability of fat. It is fat which is associated with obesity. Some studies suggest that people who are overweight or obese have a 'fat tooth' rather than a 'sweet tooth'. They tend to eat more fat and less sugar than normal weight people. Fats contain approximately double the amount of kilojoules per gram than sugar, other carbohydrates and protein. Fat (especially saturated fat as opposed to fats from unsaturated fish and olive oil) may be the culprit that causes obesity rather than sugar. This is something to worry about because many commercially produced sweet foods, such as cakes and biscuits, contain high levels of predominantly saturated fat.

Glycaemic index
A food's 'glycaemic index' or GI refers to the time it takes for the carbohydrates to be absorbed into the bloodstream and how much it causes blood glucose to rise (glycaemic response). High glycaemic foods enter the bloodstream more quickly than other foods.

Recent studies have suggested a link between foods with a high glycaemic index and conditions like:
· Abdominal obesity
· Diabetes
· Elevated blood lipids (high cholesterol)
· Hypertension
· Heart disease.

Foods high in sugar don't necessarily generate higher glycaemic responses. Latest research indicates that other, more starchy foods - such as potato, refined bread and breakfast cereals - are much more readily absorbed than sugar and other high sugar foods. This suggests that it is not sugar but a diet with a large proportion of high glycaemic foods, which may contribute to negative health outcomes.

Sugar is safe for people with diabetes
There is no evidence that a diet high in sugar directly causes either Type I or Type II diabetes. Being overweight or obese is a risk factor for diabetes Type II, and perhaps someone who eats too much may also consume high amounts of sugar.

Diabetics in the past were told to avoid eating foods high in refined sugar, based on the idea that sugar would adversely affect blood glucose levels. However, more recent research on the glycaemic index indicates that sugar effects blood sugar levels to less of an extent than other more starchy foods, such as refined bread and breakfast cereal. Sugar is now viewed far less negatively in diabetes control. The GI has become a useful tool for diabetics to use in the regulation of blood sugar levels.

Fructose & health - click here

People with diabetes need low GI foods
People with Type II diabetes benefit from a slow absorption of glucose, which means they need to eat a diet of foods with a low GI. At least one low GI food is recommended at each meal. A little sugar (equivalent of two tablespoons or 50 grams over a day) added to otherwise healthy and lower GI foods, such as spreading honey on wholegrain bread, is generally acceptable and will not adversely affect blood sugar levels.

Foods with a high glycaemic index also have a useful role in managing blood glucose levels, especially when blood glucose falls below normal levels. High glycaemic foods can quickly deliver glucose to the bloodstream to restore blood glucose to normal levels.

Sugar and attention deficit hyperactivity disorder
There's no evidence to suggest a direct link between attention deficit hyperactivity disorder (ADHD) and the consumption of sugar. Some children are sensitive to food additives. Sugar often keeps company with colours and preservatives in foods, such as soft drinks and lollies and may be incorrectly blamed for any reaction occurring after eating these foods.

Tooth decay
The association between sugar and tooth decay has long been established but still sparks discussion. Dental plaque is a clingy film made up of food particles, bacteria and mucous. The bacteria in plaque depend on sugars in order to produce acids, which break down the enamel and start tooth decay. However, carbohydrates in general contribute to this process, not just sugar. For instance, nutritious foods, like dried fruits, also allow the bacteria in plaque to produce acids. Furthermore, tooth decay occurs in populations that do not use sugar or other processed food, showing that sugar is not the only cause of caries (teeth cavities). Sticky sugars that cling to the teeth are worse than sugars that are easily swallowed, such as sweetened drinks. Ways to reduce the risk of tooth decay include:
· Cutting down on sticky sugary foods
· Drinking water after consuming sugary foods and drinks
· Allowing a period of at least two hours between meals
· Brushing and flossing regularly and after meals
· Chewing gum for around 20 minutes after meals
· Drinking fluoridated water or using fluoride treatments
· Visiting the dentist.

Is it OK to eat foods high in naturally occuring sugars e.g dried fruit, jam, honey?
It is sound nutritional advice to limit consumption of foods and beverages that are energy dense and contribute empty calories. For example where you have lots of calories but few nutrients - such as soft drinks, lollies, cordials etc. Healthy foods which are naturally high in sugars are preferable to foods high in added sugar. The former provide other nutrients and phytochemicals apart from the sugar - such foods include fresh fruit, dried fruit, milk, jam, honey.

Nutrient density of the diet and how much sugar is too much
If sugary foods are eaten in large quantities (more than 20% of energy intake) in place of more nutritious foods, then it may be difficult to consume enough of some nutrients which are needed for good health. Cutting back on sugar will not guarantee a healthier diet if fresh fruits and vegetables (natural sources of some sugars) are not eaten in adequate amounts. Health experts recommend that we consume only a moderate amount of sugar and foods containing sugars. An occasional slice of cake, sweet biscuit, chocolate or glass of soft drink will not ruin an otherwise healthy diet.

Can I sprinkle a little sugar on healthy foods or in beverages to improve their flavour e.g porridge, milk, tea?
The body can obtain sufficient sugar for its needs from unrefined/natural carbohydrates such as wholegrain bread, rice, pasta, potatoes, corn and other vegetables, fruit, pulses, nuts, seeds and lactose in milk; these foods are also rich in other nutrients. However, adding some sugar to such nutrient dense healthy foods is acceptable if it helps you eat/drink them. For example, adding some sugar to porridge or weet bix or spreading jam on wholegrain bread can improve the taste and acceptability of the high carbohydrate nutrient dense foods. Adding sugar or milo to milk may encourage a child to drink more milk if they dislike the flavour of plain milk.

If fruit is OK, can I have as much fruit juice as I like?
Fruit juice should not replace fresh fruit because it is devoid of fibre and lower in vitamins and antioxidant phytochemicals. But having some juice is better than not having any fruit at all. Limit juice to 300ml or 2 small glasses per day, especially children, and it should not replace milk in the diets of young children. Try to have a variety of juices across the week, especially juices which contain fruits that you rarely consume in their fresh state e.g cranberries. Prefer juices which are unfiltered, contain the whole fruit and are thus higher in fibre and nutrients. In a study on 168 children aged 2-5 years, 11% were found to be consuming over 360ml juice per day, which was considered to be excessive. Their diets contained a much higher percentage of energy in the form of simple sugars and a lower percentage of fat. The prevalence of overweight and short stature was higher among children who consumed excess fruit juice. 42% of those consuming more than 360ml were short and 53% had a body mass index which was in the overweight or obese range. No association was observed between milk consumption and obesity (Dennison et al. Pediatrics 1997; 99: 15-22).

How much added and 'natural' sugar is recommended daily?
There is insufficient evidence to set an upper safe limit for total sugar intake, but maximum intake is around 25% of energy intake due to its impact on triglycerides and nutrient density of the diet. Moderate intake of sugars of about 15%-20% energy of energy intake has not been found to be a problem, even in diabetes; however, some Australians are having more than this amount. For most Australians consumption of 15%-20% energy as "sugar" (which includes added and 'natural' sugars) is compatible with a healthy diet; this is equivalent to about 80-100g "sugar" per day if consuming 2000kcal. The American Academy of Sciences recommends that "added" sugar foods be minimised and that we consume most sugar in foods in which it is naturally occurring to ensure that our diets remain nutrient dense.

If this recommendation is too difficult, try to have about one third to one half of this intake in the form of "added" sugar (which you add to food or which the food industry adds to food products). This is equivalent to about 1-2 tablespoons or 4-8 teaspoons per day if consuming 2000kcal (e.g 1 can of soft drink has 9 teaspoons sugar). This recommendation also applies to diabetes, although it is preferable for this amount to be distributed throughout the day. The remaining 40-60g of sugar can be consumed as "natural" sugars found in fruit and fruit products (e.g 1 whole orange or 200ml juice has 20g sugar) and in milk and milk products (e.g 1 cup milk has 10g sugar) because these foods are also accompanied by other beneficial nutrients.

Food labels
Sugar is found in obvioulsy sweet foods like soft drinks, fruit juice, cordials, jams, chocolates, ice-creams, cakes, pastries and confectionery. However, sugar can also be found in foods which are not obviously sweet like: savoury biscuits, salad dressings, canned and packet soups, tomato sauce, baked beans, canned vegetables, breakfast cereals and yoghurt. On food labels added sugar may be listed as: sucrose, glucose, lactose, fructose, sorbitol, mannitol, corn syrup, honey, malt, malt extract, maltose, rice extract, molasses, golden syrup, and inverted sugar. If any of these sugar ingredients is listed as one of the first three ingredients, it is likely that the product is high in sugar.
Food labels will provide the total amount of sugars present in the Nutrition Information Panel. The total includes 'added sugar' as well as naturally occurring sugars from fresh, dried, canned and frozen fruit and milk components. A product may not have much 'added sugar' but still be high in 'sugars' if much of the sugars come from fruit or milk components, for example breakfast cereals with dried fruit. In contrast, if a product is high in sugars and it does not contain fruit or milk then most of the sugar is coming from 'added sugar'.

References

US Academy Sciences 2002 Report on Energy, Carbohydrate,
Fat and Protein. A review of the evidence on which recommendations are based.

Review of the literature and evidence on which the Dietary Guidelines for Australians are based 2001 adults & 1999 elderly

Article co-authored by Better Health Channel
(Australian -Victorian Government website)

Last Updated: March 28, 2003