Q&A: (Sweeteners Part 1) What’s the Bitter Truth About Natural and Added Sugars?
Understanding the full spectrum of sweeteners—from natural sugars in fruit and milk to added and alternative sugars in processed foods—is key to informed eating. Each type affects health differently, influencing blood sugar, satiety, and energy intake.
Take-Home Messages 🔑
|
Introduction 📚 |
Understanding the types of sugars and sweeteners is key to making informed dietary choices that support long-term health. |
|
Carbohydrates/Natural Sugars in Whole Foods 🍎 |
Carbohydrates, a macronutrient that serves as the body’s primary energy source, are found in fruits, vegetables, bread, grains and dairy. 🍎🥦🍞🥛 They provide essential nutrients such as vitamins, minerals and fibre. The Acceptable Macronutrient Distribution Range (AMDR) for carbohydrates is 45–65% of total daily energy intake, ensuring a balanced and healthy diet. |
|
Added Sugars in Processed Foods 🍭 |
Added sugars in processed foods are often hidden and contribute excess energy without nutritional benefit, increasing chronic disease risk. |
|
Alternative Sweeteners 🍯 |
Alternative sweeteners like honey and maple syrup provide trace nutrients but are still metabolically similar to added sugars. |
|
Whole-Food Benefits 🌿 |
Natural sugars in whole foods are absorbed more gradually, promoting satiety and stable blood glucose, while their fibre and nutrients enhance metabolic health. |
|
Carbohydrate Exchanges 🥗 |
Carbohydrate exchanges help manage portion sizes and support balanced blood glucose control in meal planning |
|
Guidelines on Free Sugar Intake 🚫 |
Health authorities recommend limiting free sugar intake to <10% of energy, with <5% offering additional benefits, especially for children |
|
Daily
Teaspoon Guidelines 🍽️ |
Free
sugar intake should not exceed 9 teaspoons (36 g) per day for men, 6
teaspoons (24 g) for women, and 3–6 teaspoons (12–24 g) for children |
|
Hidden Sugars in Everyday Foods 👀 |
Common foods like sauces, drinks, and snacks often contain significant added sugars; small amounts can quickly add up |
|
Food
Label Literacy 🏷️ |
Learning
to interpret nutrition labels and ingredient lists helps consumers identify
and reduce added sugar intake. Look out for added sugars that may appear
under alternative names such as sucrose, glucose, fructose, maltose,
dextrose, high-fructose corn syrup, molasses/treacle, agave nectar, cane
sugar, evaporated cane juice, and fruit juice concentrate.
Ingredients are listed in descending order by weight—so the closer a sugar
source appears to the top of the list, the more of it is present in the
product. 🍬 |
Introduction 📚🍇
A comprehensive understanding of the full spectrum of sugars and sweeteners in the diet is essential for making informed, health-conscious nutritional choices. From naturally occurring sugars such as fructose in fruit and lactose in milk, to so-called “alternative” sweeteners such as honey and coconut sugar, and extending to refined sugars and high-intensity artificial sweeteners commonly found in processed foods—each type has distinct physiological and metabolic effects.
In this first of two instalments, we will explore:
• Naturally occurring carbohydrates or simple sugars in fruits, vegetables, and milk.
• Added sugars concealed in processed foods and beverages and their contribution to excess energy intake with minimal satiety.
• Alternative sweeteners such as honey, coconut sugar, and date syrup—their flavour appeal and trace nutrients, alongside the metabolic reality that they still count as added sugars.
• Practical strategies for identifying and reducing added sugars in the diet without sacrificing flavour or enjoyment.
Understanding the many names under which sweeteners appear on food labels is crucial for navigating today's food environment—yet doing so can be confusing, as labelling terminology is often inconsistent or misleading.
The second instalment will delve into the world of low- and no-energy sweeteners—both artificial and naturally derived, including sucralose and stevia—to assess whether they truly provide a guilt-free sweet fix.
Carbohydrates and Natural Sugars: The Basics 🥦🍎🥛
Carbohydrates are a fundamental component of our diets. In dietary terms, simple carbohydrates or natural sugars are organic molecules that consist of carbon, hydrogen and oxygen atoms (CHO). They are naturally present in foods i.e. fruits, milk and vegetables or added during food processing. Each gram of carbohydrate and protein provides 17 kilojoules (4 calories). Naturally occurring sugars, such as fructose in fruits and lactose in milk, are accompanied by fibre and/or vitamins and minerals, making them nutritionally beneficial because they arrive bundled in a whole-food package that changes how our bodies handle them.
Table: Whole-Food Features That Turn Natural Sugars into a Health Bonus
|
Whole-food
feature |
Why it
matters |
|
Dietary fibre
(present in fruit and many vegetables) |
Slows
gastric emptying, attenuates postprandial glycaemic response, promotes the
growth of beneficial gut microbiota and enhances satiety to reduce the risk
of insulin resistance and overconsumption. |
|
Water
content |
Lowers
the energy density of foods, promoting satiety with fewer kilojoules, thereby
assisting in energy balance and weight management. |
|
Vitamins and
minerals |
Serve as
essential cofactors in metabolic processes. Their presence enhances the nutritional
value of natural sugars by contributing to overall metabolic health. |
|
Phytonutrients |
Colourful
plant compounds (flavonoids, carotenoids, polyphenols) exert antioxidant and
anti-inflammatory effects, offering protective benefits for cardiovascular
and metabolic health. |
|
Protein and
fat (in dairy products) |
The
presence of casein, whey proteins and milk fat alongside lactose slows
carbohydrate digestion and prolongs satiety, moderating the glycaemic
response. |
|
Natural intact
food matrix |
Consumption
of whole foods (e.g., unprocessed fruit or whole milk) requires more
mastication and digestion, thereby enhancing gut hormone responses (e.g.,
GLP-1, PYY) and improving satiety signalling compared to refined sugars. |
Natural sugars exist in forms such as monosaccharides (a single sugar molecule i.e. glucose, fructose, galactose) or disaccharides (two monosaccharides bonded together i.e. sucrose, lactose, maltose). They are broken down in the digestive tract into monosaccharides (mainly glucose), then absorbed into the bloodstream. Blood sugar refers to the concentration of glucose circulating in the bloodstream, which serves as a readily available source of energy for the body’s cells. Its levels are tightly regulated by hormones—primarily insulin and glucagon—to maintain metabolic balance. Glycogen is the stored form of glucose in the liver and muscles, used to maintain blood sugar levels or fuel physical activity when needed.
Guidelines for Carbohydrate Intake 📊🍞
The recommended dietary allowance (RDA i.e. the daily intake level to meet the requirements of nearly all healthy individuals) for carbohydrates, based on the minimum amount of glucose required by the brain daily, is 130 g for adults. This requirement can be easily achieved through a balanced diet that includes fruits, vegetables and grains.
The acceptable macronutrient distribution range (AMDR) for carbohydrates is 45–65% of total energy intake (1). Research indicates that an optimal carbohydrate intake for minimal mortality risk lies between 50–55% of total energy (2). However, both low- and high-carbohydrate diets have been linked to increased mortality risk, particularly when low-carb diets prioritise animal-based proteins and fats rather than plant-based alternatives, which are associated with lower mortality (2, 3).
Although the sugar in fruit juices is natural, it is not considered healthy to consume more than half of your daily fruit servings as juice. It is strongly recommended to consume whole fruits instead.
Table: Carbohydrate Exchanges for Meal Planning🥕
|
Food
Group |
CHO per
Exchange* (g) |
Example
Serving per Exchange |
|
Fruits |
15 g |
1
small apple or ½ banana |
|
Milk |
12–15
g |
1 cup
milk or ½ cup yogurt |
|
Non-starchy
Vegetables |
5 g |
1 cup
raw or ½ cup cooked vegetables |
|
Starchy
Vegetables |
15 g |
½ cup
corn or ½ cup mashed potatoes |
|
Grains
and Starches |
15 g |
1
slice bread or ½ cup cooked rice |
|
Sugars |
4 g/1
teaspoon# |
1
tablespoon honey or sugar |
Footnote: *An exchange standardises food portions with equal amounts of carbohydrates, proteins, or fats, allowing flexible meal planning by substituting foods within the same category while maintaining consistent macronutrient intake. #The actual weight of sugar in a teaspoon can vary depending on factors such as how the sugar is packed or its granule size.
Guidelines for Added Sugar Intake 🚫🍭
Dietitians distinguish between natural and added sugars to encourage healthier choices. Added sugar refers to any sugar or sweetener that is added to foods or beverages during processing, preparation or at the table rather than occurring naturally within the original whole food. They contribute to excess energy intake without providing additional nutrients and are also called empty kilojoules/calories/energy. Added sugars must be limited for health reasons.
According to guidelines from the World Health Organisation (4) and the American Heart Association (AHA, https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars)(5), added sugars should make up no more than 5–10% of daily energy intake. The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN, 2017) recommends that children and adolescents (2–18 years) consume less than 5% of energy from free sugars, while infants and toddlers under 2 years should consume "less" — ideally avoiding free sugar altogether during this critical developmental period (6).
For most individuals, this translates to approximately 9 teaspoons (36 g) per day for men, 6 teaspoons (24 g) for women, and 3–6 teaspoons (12–24 g) for children. A standard serving size of sugar is often measured as 1 teaspoon (4 g). Practical examples include a serving of soft drink containing ~10 teaspoons (40 g) of sugar. Given the limitations in methodological rigor and evidence quality highlighted by a systematic review (7), current sugar intake guidelines should be improved in the future. However, current intake are far above the recommendations (8). For context, the average American consumes approximately three times the recommended daily intake of added sugar , while South Africans are also reported to exceed these guidelines (9).
This is particularly important, as excessive consumption of added sugars has been strongly associated with a range of adverse health outcomes. These include an increased risk of chronic conditions such as obesity, type 2 diabetes, cardiovascular disease and non-alcoholic fatty liver disease (10). Restricting free sugars reduces body fat mass and lowers low density lipoprotein cholesterol (LDL-C) with minimal impact on energy expenditure, metabolism or the gut microbiome (11). A systematic review and meta-analysis of 40 studies (1,212,107 participants) found that higher dietary sugar intake was associated with a 21% increased risk of depression, with women being more affected than men, while no significant association was observed with anxiety risk (12). Furthermore, added sugars have been implicated in cognitive decline and may even contribute to the development of certain cancers (10, 13).
Drawing on a natural experiment from post–World War II UK, researchers demonstrated that early-life sugar restriction—particularly after six months of age—conferred long-term protective health benefits, including a lower risk of developing type 2 diabetes and hypertension, as well as delayed disease onset later in life (14). Children in the "Food, Fun and Family" intervention reduced screen time and sugar intake, which led to a decrease in sleep bruxism (involuntary teeth grinding)(15). Efforts to reduce added sugar consumption can play a vital role in improving overall health and reducing the risk of chronic diseases.
Added and Sugar Alternatives: Hidden Kilojoules in Everyday Foods 🧃🍬
Added industrial sugars are energy containing sweeteners that have been refined or manufactured through industrial processes—such as table sugar (refined sucrose from cane or beet), high-fructose corn syrup (HFCS), glucose–fructose syrups, invert sugar, dextrose, maltose and similar syrups.
Type
|
Typical sources
|
Chemistry & metabolism
|
Health concerns
|
Table sugar (sucrose)
|
Cane & beet sugar; home baking; confectionery
(16)
|
Disaccharide (glucose + fructose). Rapidly
digested to its two monosaccharides.
|
Excess energy with no micronutrients (“empty
kilojoules”).
|
High-fructose corn syrup (HFCS)
|
Soft drinks, sauces, baked goods (16)
|
42 % or 55 % fructose; liquid form makes it cheap
and easy to blend. Fructose overload in the liver depletes adenosine
triphosphate (ATP) → adenosine
monophosphate (AMP) → uric acid (17).
|
Regular high intakes are linked to weight gain,
elevated triglyceride levels, and steatosis hepatis when it is associated
with a positive energy balance (8) as well as hyperuricaemia,
hypertension, metabolic disorders and gout (18).
|
Glucose–fructose / invert syrups, dextrose,
maltose syrups
|
Sports drinks, energy bars, baby food (16)
|
Exist as monosaccharides or disaccharides.
Fast absorption spikes blood glucose and insulin.
|
Contribute to passive over-consumption because
liquids and highly processed foods bypass normal satiety cues.
|
Traditional (Energy Containing/Caloric) Sugar Alternatives: A Halo with Strings Attached 🍯🌴🍁
Although marketed as “more natural,” most whole-food-based sweeteners supply almost the same kilojoules as sucrose. Their advantages lie mainly in flavour complexity and trace nutrients, not in dramatic metabolic benefits.
Table: Traditional Sugar Alternatives
Sweetener
|
How it’s made
|
Potential benefits
|
Caveats
|
Maple syrup
|
Sap from sugar-maple trees is boiled to
concentrate sugars into an amber syrup (16).
|
Small trials show lower glucose area under the
curve, systolic blood pressure and android fat mass in individuals with mild
metabolic alterations, compared to sucrose syrup (19). May nurture a healthier gut microbiota (19).
|
≈ 67 % sucrose—still energy-dense. Quality and
polyphenol content vary by grade.
|
Coconut (palm) sugar
|
Sap of coconut-palm flower buds is evaporated to
a light-brown granule (20).
|
Slightly lower glycaemic index (GI ≈ 50–54) and
contains potassium, zinc (20).
|
Kilojoule-for-kilojoule = table sugar (~ 16 kJ /
4 kcal g⁻¹).
|
Honey (raw & processed)
|
Nectar enzymatically transformed by bees, then
extracted from comb.
|
Antibacterial and antioxidant properties; raw
honey retains more bioactives (21).
|
High energy; processed honey loses heat-labile
compounds. Never feed to infants < 1 yr (botulism risk) (22).
|
Molasses/treacle, turbinado, demerara, muscovado,
jaggery
|
By-products of cane refining or minimally
crystallised cane juice (16).
|
Provide iron, calcium, B-vitamins in small
amounts.
|
Extra nutrients are trivial at typical serving
sizes; kilojoules equal to sucrose.
|
Maple syrup
|
Sap from sugar-maple trees is boiled to
concentrate sugars into an amber syrup.
|
Small trials show lower glucose area under the
curve, systolic blood pressure and android fat mass in individuals with mild
metabolic alterations, compared to sucrose syrup (19). May nurture a healthier gut microbiota (19).
|
≈ 67 % sucrose—still energy-dense. Quality and polyphenol
content vary by grade.
|
Coconut (palm) sugar
|
Sap of coconut-palm flower buds is evaporated to
a light-brown granule (20).
|
Slightly lower glycaemic index (GI ≈ 50–54) and
contains potassium, zinc (20).
|
Kilojoule-for-kilojoule = table sugar (~ 16 kJ /
4 kcal g⁻¹).
|
Honey (raw and processed)
|
Nectar enzymatically transformed by bees, then extracted
from comb.
|
Antibacterial & antioxidant properties; raw
honey retains more bioactives (21).
|
High energy; processed honey loses heat-labile
compounds. Never feed to infants < 1 yr (botulism risk) (22).
|
Molasses/treacle, turbinado, demerara, muscovado,
jaggery
|
By-products of cane refining or minimally crystallised
cane juice.
|
Provide iron, calcium, B-vitamins in small
amounts.
|
Extra nutrients are trivial at typical serving
sizes; kilojoules equal sucrose.
|
Allulose (D-psicose) is a rare, low-energy sugar (~0.84 kJ/g) with about 70% the sweetness of sucrose. Allulose is found in trace amounts in foods like figs, raisins and wheat. However, natural food sources are too limited for large-scale use, so most allulose on the market is made by enzymatically converting fructose (usually from corn or beet) into allulose. Allulose is mostly excreted unmetabolised, and shown to reduce postprandial blood glucose levels in healthy adults (23), though further human studies are needed to confirm its long-term metabolic effects, gut microbiota impact, and safety at typical intake levels (24).
Table: Niche Sugar Alternatives (16)
Alternative
|
Why it merits a mention
|
Key nutritional / metabolic points
|
Agave nectar/syrup
|
Heavily promoted “low-GI” sweetener
|
70–90 % fructose; low GI yet high fructose load
may raise triglycerides and uric acid if over-used.
|
Allulose
|
Rare
sugar with functional sweetening and glycaemic benefits
|
~0.84
kJ/g; mostly excreted unmetabolised; reduces post-meal blood glucose; GRAS in
U.S., pending EU (24).
|
Date sugar / date syrup
|
Whole-food baking swap
|
Ground/puréed dates retain fibre, minerals and
polyphenols, but energy density ≈ table sugar.
|
Brown-rice syrup
|
Common in vegan & “organic” snacks
|
Mostly maltose → very high GI; can carry
inorganic-arsenic residues from rice.
|
Sorghum / barley-malt syrup
|
Traditional African, Asian and craft-brew
sweeteners
|
Predominantly glucose and maltose; trace minerals
but kilojoules match other syrups.
|
Yacón syrup
|
Trending “prebiotic” sweetener
|
~ 40 % fructooligosaccharides: fewer absorbable
kilojoules; > 20 g day⁻¹ may cause bloating.
|
Understanding Added Sugar: A Practical Guide🔍🥤
The table below highlights how small servings of common sweet treats, widely recognised as significant sources of sugar, and condiments, often overlooked as contributors, can quickly add up to a substantial sugar intake. By visualising sugar content in terms of teaspoons (4 g), this guide raises awareness about hidden sugars in everyday foods, empowering individuals to make more informed dietary choices.
Table: Sweet Treats and Their Sugar Equivalent per Serving (4 g)
|
Sweet
Treat |
Amount
Equivalent to 1 Teaspoon of Sugar (4 g) |
|
Chocolate
Bar |
~1
small square (5–6 g) of milk chocolate |
|
Hard
Candy |
~1
piece (e.g. a small lollipop) |
|
Bubble
Gum (Sugar-coated) |
~1–2
pieces (depending on the brand) |
|
Soft
drink, sugar sweetened beverage, soda, fizzy drink, Cola, pop, aerated drink,
sparkling beverage |
~30–40
ml (~⅛ cup or 2–3 sips) |
|
Ice
Cream |
~1
tablespoon |
|
Fruit-flavoured
Yogurt |
~1
tablespoon |
|
Honey
or Syrup |
~1
teaspoon |
|
Jam or
Jelly |
~1
teaspoon |
|
Cookies/Biscuits |
~⅓ to
½ of a medium cookie (depending on size) |
|
Cereal
Bars |
~⅓ of
a small cereal bar |
|
Cake
or Muffin |
~1
small bite (approximately 10–12 g) |
|
Chutney |
~1
teaspoon |
|
Ketchup |
~1
teaspoon |
In the table below I provide practical guidance with specific examples and tips for decoding food labels, empowering consumers to make informed choices about added sugars in their diet. Added sugars, distinct from natural sugars found in fruits and dairy, are often hidden in ingredient lists under various names. Understanding how to interpret food labels can help limit excessive sugar intake and promote healthier dietary habits.
Table: Tips for Understanding Added Sugar on Food Labels 🍪
|
Tip |
Details |
Example/Key
Points |
|
Check
the Nutrition Facts Panel |
Look
for "Total Sugars" (includes natural and added sugars) and
"Added Sugars" (listed separately in grams and as a percentage of
daily value*). |
The
daily value for added sugar is 50 grams, based on an 8,400 kJ (2,000-calorie)
diet. Example: A product with 20 g of added sugar contributes 40% of the
daily value. |
|
Decode
the Ingredients List |
Identify
sugars by their various names; added sugars often appear under unfamiliar
terms. |
Common
names for added sugars: - Sugars:
Sucrose, glucose, fructose, dextrose, maltose, galactose. - Syrups:
Agave nectar/syrup, corn syrup, high-fructose corn syrup (HFCS), malt syrup,
rice syrup, brown-rice syrup, maple syrup, date syrup, sorghum/ barley-malt
syrup, Yacón syrup. - Natural
Sweeteners: Honey, molasses, raw sugar or turbinado sugar, agave nectar,
cane juice, coconut sugar, date sugar, b, concentrated fruit juice sweetener. - Other
Names: Evaporated cane juice, fruit juice concentrate, barley malt, carob
syrup, maltodextrin. Tip: The closer these
ingredients are to the top of the list, the higher their quantity in the
product. |
|
Pay
Attention to Serving Sizes |
Compare
the sugar content per serving to how much you actually consume. |
Example:
A label lists 10 g of sugar per serving, but you eat 3 servings, consuming 30
g sugar. |
|
Visualise
Sugar Content |
Convert
sugar grams into teaspoons to better understand amounts. |
1
teaspoon = 4 g of sugar. Example: 20 g = 5 teaspoons. |
|
Compare
Similar Products |
Check
the sugar content of comparable products to choose lower-sugar options. |
Example:
Compare breakfast cereals or sauces to find the one with the least added
sugar. |
|
Context
Matters |
Limit
foods high in added sugars and prioritise foods with natural sugars and
additional nutrients. |
- Limit:
Sodas/soft drinks/carbonated beverages/colas, candy and pastries, sugar
coated cereals - Prioritise:
Fruits and dairy, which contain natural sugars along with vitamins, minerals,
and fibre. |
Footnote: The Daily Value (DV) on a food label is a reference number that indicates the recommended amount of a nutrient you should consume each day, based on a standard diet of 8,400 kilojoules (2,000 calories).
Several health claims related to sugar appear on food packaging, but are easily misunderstood or misleading without proper context. For example, a product labelled “no added sugar” means no sugars or sweeteners were added during processing, yet it may still contain naturally occurring sugars from ingredients such as fruit purée, milk or fruit juice concentrate. Similarly, “reduced sugar” indicates at least 25% less sugar than the standard version of the product, but the original may have been high in sugar to begin with. “Sugar-free” products contain less than 0.5 grams of sugar per serving, though they often include sugar alcohols or artificial sweeteners and may not be low in kilojoules. “Unsweetened” means no sugars or sweeteners have been added, but the item may still contain natural sugars. The terms “light” or “lite” can refer to reductions in fat, kilojoules, or sugar, but must be clarified on the label. Claims such as “naturally sweetened” and “no refined sugar” are not legally defined and can be misleading—such products often contain energy containing/caloric sweeteners such as honey, coconut sugar, or fruit juice concentrates that still contribute to total sugar intake and affect blood glucose. Finally, “low sugar” is not formally regulated in many countries, allowing manufacturers to use the term loosely. Interpreting food and drink labels can be challenging, especially in South Africa, where many products—despite containing high levels of sugar or artificial sweeteners—lack clear warning labels (25), leaving consumers without the necessary information to make informed choices. For these reasons, it is essential to look beyond front-of-pack claims and examine the nutrition label and ingredients list to make informed choices.
Conclusion 📝🍯
Understanding the distinction between natural and added sugars empowers individuals to make healthier dietary choices. While natural sugars found in whole foods come with beneficial nutrients like fibre, vitamins, and minerals, added sugars contribute excess energy without added nutritional value and are linked to an increased risk of chronic diseases. By becoming more aware of the sources of added sugars, reading food labels carefully, and prioritising whole foods, we can better manage our sugar intake and promote long-term health and well-being. Small, informed changes can have a lasting impact on our overall health.
Reflections to Raise Awareness of Sugar Intake🧘 💡
- Examine the labels of processed foods like sauces, dressings, cereals, and condiments, as well as beverages like sodas, juices, and energy drinks, which often contain surprising amounts of added sugar. Are you making informed choices by selecting lower-sugar alternatives and limiting these hidden sources in your diet?
- Be aware of the sugar content in your drinks by visualising it: 4 grams of sugar equals a teaspoon. For example, a single soda may contain 10 teaspoons of sugar. Could you replace sugary beverages with healthier options like water, unsweetened tea, or coffee?
- Even small portions of sweet treats can significantly impact your sugar intake. Are you aware of how much sugar you're consuming per serving and its cumulative effect over the day? Consider limiting portion sizes and avoiding multiple servings in one sitting to stay within recommended guidelines.
- Focus on gradually reducing overall sweetness in your diet to retrain your palate. Discover and savour the inherent sweetness in whole foods like fresh fruit and vegetables (corn and carrots) and milk, allowing you to appreciate the subtle, natural flavours they offer. Enhance the taste of drinks naturally with spices such as cinnamon or vanilla, adding depth without extra sweetness. Are you intentionally reducing sweetness in your daily choices, rather than replacing sugar with artificial alternatives or other sweeteners?
- Just because something contains a “natural” sweetener doesn’t make it a healthy choice. Focus on whole, minimally processed foods where possible.
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References📚
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In developing this work, the author utilised ChatGPT-4 to assist with language editing.
