The not-so-sweet truth about sugar

Sugar comes in many varieties, including table sugar, honey, maple syrup, high-fructose corn syrup, molasses, and agave syrup.

This may have you wondering: is all sugar created equal, or is one of these options healthier than another?

The truth is that sugar, whether it occurs naturally in berries, comes out of a maple tree or a beehive, or is poured into your coffee from a packet, is all virtually the same, says Dr. Frank Hu, chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health.

"Sugar molecules are the same biochemically and metabolically," he says. To put it simply: from your body's standpoint, sugar is sugar. And unfortunately, too much of any type is bad for your health.

Differences in digestion

That said, sugars that occur naturally in foods, such as berries or whole grains, are digested differently from sugars that are added to foods, because they are eaten as part of a package that includes things like fiber, protein, and minerals. When you eat sugar along with these other components, your body absorbs and metabolizes it differently than it does a spoonful of sugar you plop into your coffee.

"The digestion and absorption of sugar as part of whole food is much slower and gentler than from added sugars," says Dr. Hu. "You have a slower rise in blood sugar because absorption takes longer." This is because your body has to digest not just the sugar, but also the fiber, protein, and other parts along with it.

On the other hand, when you drink a beverage containing added sugar, you experience a spike in blood sugar, because the sugar enters the bloodstream all at once. When you consume lots of added sugars in drinks and foods, this sharp rise in blood sugar happens again and again and can lead to a condition called insulin resistance, where your body is no longer able to use insulin produced by your body efficiently. Not only is insulin resistance a precursor to diabetes, it can also raise your risk of other chronic diseases, says Dr. Hu.

In addition, the amount of sugar in whole foods is typically much smaller than in foods or drinks with added sugars, says Dr. Hu. The amount of natural sugar in our diet from vegetables or fruits is relatively low compared with sugars that are deliberately added to sweeten other types of food on the market today. "Americans on average get 14% to 15% of their daily calories from added sugars, primarily from sugary beverages," says Dr. Hu.

Nature-made sugars

Some types of sugar, such as maple syrup and honey, may be perceived as healthier because they come more directly from nature, sometimes with less processing. And these options are a little bit different from your standard table sugar because they do contain minerals, such as calcium, potassium, zinc, and manganese, which gives them some added nutritional value.

"But essentially the sugars in them are still the same," says Dr. Hu. And both contain a significant amount of sugar. One tablespoon of honey, for example, contains 16 grams of sugar, and one tablespoon of pure maple syrup has 14 grams of sugar. If you eat them in large amounts, you will still run into the same problems you would with any other type of sugar, including table sugar, which contains 13 grams of sugar per tablespoon. If you consume too much, the drawbacks of the high sugar content outweigh any potential nutritional benefits.

Is high-fructose corn syrup more harmful?

While some types of sugar may be wrongly perceived as healthier, another type, high-fructose corn syrup, has been singled out in recent years as a nutritional bad actor. But is it really worse than other types of sugar? Again, not really, says Dr. Hu.

As much as 55% of the sugar in high fructose corn syrup is a type of sugar called fructose (the rest is mostly glucose). Fructose does have some metabolic drawbacks. While glucose is broken down and used for energy by cells throughout the body, fructose metabolism primarily occurs in the liver. It is there that fructose is quickly converted into fat, in the form of triglycerides, when consumed in large quantities, says Dr. Hu. An accumulation of fat in the liver can lead to a metabolically dangerous condition called nonalcoholic fatty liver disease, he says. Fructose may also contribute to diabetes.

"Another unique problem with fructose is that it stimulates production of uric acid, causing blood levels to rise," he says. Too much uric acid in the body can prompt the formation of uric acid crystals in the joints, causing a painful type of arthritis called gout. If you are at high risk for gout, you should take extra care to avoid sugary beverages that contain fructose, says Dr. Hu.

But while you may think you're safer eating traditional table sugar rather than high-fructose corn syrup, consider that the makeup of high-fructose corn syrup is actually very similar to table sugar. High-fructose corn syrup contains 55% fructose and 42% glucose (along with a very small quantity of other sugar molecules); table sugar is about 50% fructose and 50% glucose. While the amount of fructose in table sugar is less than in high-fructose corn syrup, in truth, the two are not a whole lot different. "Metabolically they are about the same," says Dr. Hu.

Other types of sugar also contain fructose. For example, honey is also about half fructose, and agave nectar is 70% fructose. And while fructose can be harmful if eaten in large amounts, so can glucose.

Ultimately you don't need avoid fructose entirely. After all, fruits, which are an undisputed part of a healthy diet, contain fructose as well. As with any other type of sugar, it's more about limiting the amount you eat than worrying about fructose specifically.

Curing a sweet tooth

Unfortunately, most Americans aren't very good at moderating their sugar intake.

"The typical American diet is too sweet," says Dr. Hu. "I think people need to be very vigilant about the amount of sugar in their diet."

Even if you aren't drinking sugary sodas or pouring mounds of sugar into your tea, you may still be eating too much. Many of the sugars in the American diet are hidden, often in places where you would least expect them.

"There is quite a bit of sugar, for example, in ketchup. It can also lurk in high amounts in 'healthy' foods such as yogurt," says Dr. Hu. "Another thing that people have to be careful of is 100% fruit juices. Those juices contain some vitamins and minerals, but the sugars and calories are almost the same as those sugary sodas. So, it's not a good idea to drink 100% fruit juice on a regular basis."

Keeping an eye on nutrition labels can help you spot these added sugars and cut your intake.

"The new nutrition labels give you not only total sugar, but also added sugar, to help you make more informed decisions," he says.

In addition to looking for the amount of added sugar, scan the ingredient list for other hidden sugars by different names. (See "Many names for sugar.")

Other strategies to cut down on sugar

If you are looking to cut down on the amount of sugar you eat, there are some other strategies that can help, in addition to reading nutrition labels.

Consider temporary alternatives. If you eat a lot of sugary snacks or drinks, making a short-term switch to diet versions containing artificial sweeteners or sugar alcohols can help you curb your sweet tooth, says Dr. Hu.

"For people who drink a lot of soda, it's better to use diet soda while you transition to a healthier beverage, such as water or unsweetened coffee or tea," says Dr. Hu.

However, while artificial sweeteners are a viable temporary alternative to traditional sugar, they should also be used with caution. It's not clear whether they have long-term adverse health consequences, says Dr. Hu.

The same is true for sugar alcohols, which are substances that are made from sugars, but aren't actually sugars or carbohydrates. These aren't as sweet as real sugar and have fewer calories. "These products can be useful as transition products as well," says Dr. Hu. But ultimately the goal should be to transition off sweeteners, both real and artificial, to healthier choices—such as water or fresh fruit — instead of sweets.

Taper off gradually. Slowly reducing the amount of sugar in your diet can change your taste preferences over time.

"Our taste buds can be retrained. If you get conditioned to a very high-intensity sweet taste, some fruits and vegetables, such as carrots, don't taste sweet any more, which is not good," says Dr. Hu.

On the other hand, if you gradually reduce the amount of sugar in your diet, you will get used to the reduced sweetness. "If you then drink something very sweet, you will feel extremely uncomfortable," says Dr. Hu.

Ultimately, when it comes to sugar, the type you eat matters less than the amount you eat, so do your best to cut down.