NUTRITION SERIES: Natural vs. Added Sugars: The Throwdown!

A spoonful of sugar helps the medicine go down! 

I wanted to address one of the hottest topics of the age: What is the difference between natural and added sugars? How "bad" are added sugars?

I have received this question approximately one billion times, and thought it was time to answer. 

Let's start from the basics: What counts as an added sugar? 

You'd be surprised - sugars that people call natural sugars are indeed also "added' sugars.

Just because it is called "added," doesn't mean it doesn't exist "naturally." Honey, for example, comes from bees. It's still a sugar that is ADDED to food to make it sweeter. Hence, "added" sugar. 

Added sugar is just sugar. Period. 

Natural sugar is the sugar already inherently contained in the food - like the sugar already contained in milk or fruit. However, there's no difference between "added" vs. "natural" in terms of where the sugar comes from (CDC, 2022).

Added sugar is literally any sugar that can be added, such as:

Cane juice and cane syrup, corn sweetener and high fructose corn syrup, fruit juice concentrate and nectar, honey, malt, maple syrup, molasses, brown sugar, dextrose, fructose, fruit nectars, glucose, lactose, maltose, raw sugar, and sucrose (CDC, 2022; Mayo Clinic, 2021; AHA, 2022).

If any of these sound familiar, it's because they are. Fructose is and lactose are the sugars naturally found in fruit and milk, respectively. They can also be added sugars. 

All sugars are carbohydrates that break down into energy that is the main fuel source for our brains and bodies. There is no "good" or "bad" sugar. There is no difference between a natural or an added sugar. 

Okay, I think I've driven this point home. So let's move on.
What's the point of making a big fuss over added sugars if they're all the same, then? 

There is a significant amount of demonization of them. As you probably know, this is infuriating to me. It creates a fear of foods that people enjoy, and the result of that is never people eating a more balanced diet - it generally leads to a lifetime of constantly thinking about food and what you're eating, and it can lead to restrict-binge cycles of eating, which is dangerous and not fun for anybody (Harrison, 2019). 

The only real point to be made about the reason for all of the talk about added sugar is that sometimes having a significant amount of it can limit the other nutrients available to you in your diet in a given day. You may become more full off of added sugar which leaves less room for protein, or fat, or fruits/vegetables, per se. 

One article discusses how, by separating natural and added sugar, the FDA is creating a "false dichotomy" because the benefits of fruit stem from its fiber, not its natural sugar (Gearing, 2017). It is NOT about the type of sugar. There is not science supportive of the endorsement of natural sugars vs. added sugars, as they have similar metabolic effects (Gearing, 2017).

So added sugar merely doesn't contain important nutrients in it outside of being a carbohydrate (which we also need) and contributing to our overall daily intake needs. Neither does natural sugar. However, natural sugar is already in a fruit that already contains fiber, but the fiber is separate from the type of sugar in the fruit. That's not to say that there aren't foods with added sugars that also contain fiber and other nutrients as well. 

Now the point I'm trying to drive home is: We do our best to include enough of all food groups - never cut anything out of your diet, just do your best to have enough of everything. 

It's also okay when we don't always. Sometimes we have more, sometimes we have less… of everything. It's all part of intuitive eating, which will be a whole other post. Eating is also social, and it is important to participate in social events and be part of the party for mental health reasons. Food isn't so black and white. 

Telling yourself to "cut out" or even "limit" added sugars is language that can cause you to feel restricted and lead to less desirable behaviors, so it's important to focus on including enough of everything every day vs. cutting anything out on any day. Not just allowing yourself to have it at certain times, that's also a restrictive mindset. Just paying attention to having balanced meals with every food group. 

And remember, you are allowed to do anything. There is no moral compass as to how you eat. Food does not involve morality. There's no hurting puppies when you have more vegetables on a given day any more than when you have more added sugars. 

Now if you are hurting puppies, that's another story. I ask that on behalf of puppies, you please stop.

Let's circle back. 

I made a post a while back about toddler nutrition, where I discussed how it is actually encouraged to include added sugars in their diet along with other nutrient dense foods to help them try new foods that can then encourage a larger variety in their diets as well, and added sugars were considered vital in this process for their growth and development, and integral to bringing pleasure to eating and drinking (Murray, 2017). This whole "balanced eating" phenomenon applies to every age group. 

Added sugars are not "dangerous" in and of themselves. It's making sure you get enough of all nutrients. Have I said that yet? I can't remember. 

One last significant point I want to make is where the social and behavioral determinants of health come in regarding added sugars. A study done on children ages 12 -15 looked at dental caries for those consuming more vs. less added sugars (Hong et al., 2018). 

It was found that lower socioeconomic status is associated with a higher consumption frequency of added sugar, as WELL as fewer dental check ups, and less frequent brushing of teeth (Hong et al., 2018).

Those consuming more added sugars were presenting with more dental caries, but the study did not separate the fact that lower socioeconomic status poses a risk to access to and time for dentist appointments that can help prevent these dental caries (Hong et al., 2018). Let's not forget to mention that lack of brushing teeth is a huge piece of the puzzle as well.

So, higher consumption of added sugars is associated with more dental caries… but so is not going to the dentist, and not brushing teeth as often (Hong et al., 2018). Social justice fits into every category of the healthcare system. Those who consumed more drinks and foods with added sugars were from lower socioeconomic status, brushed their teeth less often, and attended a dentist only "when in trouble or never," and also drank water less frequently (Hong et al., 2018). I don't know about you, but brushing my teeth has a lot to do with the fact that I've had access to dentist appointments, which is not included in many insurance plans.

Drinking water more frequently also helped lower the association between eating and drinking more added sugars and dental caries, in regions that had more fluoridated water (Hong et al., 2018). What else contains fluoride that prevents dental caries? Toothpaste. What do those of lower socioeconomic status do less? Brush teeth, and go to the dentist (Hong et al., 2018).

There are many factors associated with less access due to socioeconomic status, including the ability to afford more foods with added sugars that are cheaper and more convenient and less foods that are nutrient dense (Alkerwi, 2015; Pechey, 2016). Less access due to distance, time, health care access, in addition to money needs to be taken into consideration as well. 

Our health outcomes are largely determined by our societal upbringing. It is unfair, and makes it inappropriate to point fingers at those who may have more difficulties than others in eating a balanced diet, and feeding their children balanced diets. 

So now we know, there is no difference between added and natural sugars, it's all about balance, and socioeconomic status is a significant contributing factor towards the ability to address dental concerns, healthcare concerns, and have the means through time/money/distance of purchasing foods that allow for balanced eating. 

Thank you for coming to my TED blog post.

References

American Heart Association. (2021). Sugar 101. https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-101#:~:text=Naturally%20occurring%20sugars%20are%20found,adding%20sugar%20to%20your%20cereal

Alkerwi, A., Vernier, C., Sauvageot, N., Crichton, G. E., & Elias, M. F. (2015). Demographic and socioeconomic disparity in nutrition: application of a novel Correlated Component Regression approach. BMJ open, 5(5), e006814. https://doi.org/10.1136/bmjopen-2014-006814

Centers for Disease Control and Prevention. (2022). Know Your Limit for Added Sugars. https://www.cdc.gov/healthyweight/healthy_eating/sugar.html#:~:text=Added%20sugars%20are%20sugars%20and,milk%20are%20not%20added%20sugars

Gearing, M.E. (2017). Natural and Added Sugars: Two Sides of the Same Coin. Harvard University. 

Harrison, C. (2019). Anti-Diet: Reclaim Your Time, Money, Well-Being, and Happiness Through Intuitive Eating. Little, Brown Spark.

Hong, J., Whelton, H., Douglas, G., Kang, J. (2018, August 20). Consumption Frequency of Added Sugars and UK Children's Dental Caries. Community Dentistry and Oral Epidemiology. 46(5), 457-464.  https://doi.org/10.1111/cdoe.1241

Mayo Clinic. (2021). Nutrition and Healthy Eating. https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/added-sugar/art-20045328

Murray, R.D. (2017, September 14). Savoring Sweet: Sugars in Infant and Toddler Feeding. Annuals of Nutrition and Metabolism. 70(suppl 3), 38-46. 10.1159/000479246

Pechey, R., Monsivais, P. (2016, July). Socioeconomic inequalities in the healthiness of food choices: Exploring the contributions of food expenditures. Preventive Medicine. 88, 203-209. 0.1016/j.ypmed.2016.04.012