Expert Opinion: Unmasking Added Sugar & Healthy Sugar Alternatives

Recently, there has been a lot of controversy & conversation on “health drinks” & snacks with Added Sugar. So, what really are the facts and how can you make better choices? Let's know the Bitter-sweet truth.

Do we really need sugar for energy?

While sugar is not necessary for survival, glucose, which is derived from sugar and carbohydrates, is vital for providing energy to cells, especially those in the brain and muscles. Cereal grains are rich in carbohydrates and provide energy when consumed. However, the body can also produce glucose from other sources like protein and fats, through gluconeogenesis.

 Therefore, while sugar can provide a quick source of energy, it is not essential as long as the body has access to other macronutrients like carbohydrates, fats, and proteins. We often incorporate sugar into a variety of foods to enhance our enjoyment and provide a sense of reward, as it triggers feelings of happiness in our brains.

Why excess sugar is bad?

• Consuming large amounts of refined sugars can cause rapid spikes and drops in blood sugar levels, leading to fluctuations in energy levels, mood swings, and increased hunger. 
• High sugar intake has been linked to weight gain, an increased risk of chronic diseases such as insulin resistance (body has difficulty using insulin to process sugar, causing high blood sugar levels), type 2 diabetes, heart disease, and certain types of cancer.
• Chronically high sugar intake can contribute to low-grade inflammation in the body which can damage blood vessel walls and make them more prone to accumulating cholesterol deposits, leading to a condition called atherosclerosis.
• Pre-diabetics continuously taking sugar increases the load on your pancreas (the organ that secretes insulin needed to keep blood sugar in control). The more sugar you take, the more likely you will go from pre-diabetes to diabetes earlier on in life.

Is Blood sugar spike bad even in a Healthy individual?

• Frequent blood sugar spikes throughout the day in a normal healthy person can gradually lead to insulin resistance, weight gain, increased risk of type 2 diabetes, inflammation (increasing bad gut bacteria which in turn leads to many health issues), energy fluctuations, cardiovascular issues, and long-term complications like nerve damage and kidney disease.
• Foods high in added sugars often lack essential nutrients, such as vitamins, minerals, and fiber. Consuming these foods regularly can displace more nutrient-dense foods in the diet, leading to nutrient deficiencies and overall poor diet quality and also can be addictive.

Unmasking Added Sugars: How to Spot Them

Identifying added sugars on food labels can be challenging, as they may be listed under various names such as sucrose, glucose, liquid glucose, high fructose corn syrup, maltose, dextrose, brown sugar, caramel, maltodextrin, sugar alcohols like xylitol, maltitol, erythritol, sorbitol and many others. To make informed choices, it's crucial to scrutinize ingredient lists and opt for products which are safer and have minimal added sugars. Read on to know more. 

How much sugar is too much?

As per ICMR guidelines latest update, recommended daily allowance (RDA) of added Sugar for Indians is 20-25 grams a day, which is less than 5 tsp of sugar.

The World Health Organization (WHO) recommends that a healthy adult should limit their intake of added sugars to no more than 10% of their daily calorie intake. Reducing this to 5% is even more beneficial for optimal health. However, Indian doctors argue against this guideline, citing the unique genetic predispositions of the Indian population. They emphasize that Indians are more susceptible to developing diabetes at a younger age and lower BMI due to genetic factors. Therefore, it's advised to minimize sugar intake as much as possible to mitigate the heightened risk of diabetes associated with Indian genetics. While the pancreas may initially compensate for lifestyle choices, the long-term risks of developing diabetes remain significant.

Which kind of Sugar is better? 

Free sugar, Bound sugar & Non-nutritive sugars have different impacts on blood sugar levels and hence our health

• Free sugars are those added to foods and beverages by the manufacturer, cook, or consumer, as well as sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates. They can also include sugars released from fruit and vegetable juices during processing. Refined flours lack fiber and nutrients, turning quickly into glucose. So, eating foods made from refined flour like maida is as good as eating sugar.
• Bound sugars, on the other hand, are naturally occurring sugars found within the cellular structure of whole fruits, vegetables, and grains. These sugars are bound to fiber and other components of the plant cell walls. Bound sugars are metabolized more slowly in the body because they are released gradually during digestion due to the presence of fiber preventing blood sugar spike levels and provides a more sustained release of energy. Even lactose in milk is found within the cellular structure of the milk, along with proteins and fats. This structure slows down the digestion and absorption of lactose in the body.
• Non-nutritive Sugar, Non-nutritive sugar alternatives, also known as sugar substitutes, are substances used to sweeten foods and beverages without adding significant calories or carbohydrates and as the name goes with no nutritional value. These sweeteners are often much sweeter than sugar, so only small amounts are needed to achieve the desired level of sweetness. Some common Non-nutritive artificial sugar alternatives include aspartame, sucralose, saccharin, Ace-K, neotame and stevia is a natural sweetener all these are commonly used in low-calorie or sugar-free products. Sugar alcohols, occurring naturally in fruits and veggies or produced synthetically, are non-nutritive sweeteners. Sugar alcohols, like erythritol, xylitol, sorbitol, mannitol, and isomalt, are used as sugar substitutes. They also offer sweetness without the calorie or carbohydrate content of sugar, commonly found in sugar-free products like gum and candies. Although these reduce calorie intake, have little impact on blood glucose levels, and seem promising alternatives to reduce chronic illness, recent research has raised a concern about the long-term impact of these substitutes, it is an evolving subject and needs more research. If you have any pre-existing health conditions or are consuming a lot of sugar alcohol, talk to your doctor. Moderation is key to avoiding any potential health risks associated with excessive consumption.

World Health Organisation (WHO) suggests that non-sugar sweeteners not be used as a means of achieving weight control or reducing the risk of noncommunicable diseases.

What are the Healthy Sugar Alternatives?

Let us see if honey, Jaggery, coconut sugar, brown sugar, monk fruit and stevia are better. 

• Fructose in Honey is a type of sugar found naturally in fruits, honey, and some vegetables. While fructose itself is not inherently "better" or "worse" than other types of sugar, it is metabolized differently. It's mainly processed in the liver, and has lower glycemic index (GI) compared to glucose, meaning a more gradual increase in blood sugar levels.
• Consuming large amounts of fructose, especially in the form of concentrated sources like high fructose Corn Syrup, can still lead to spikes in blood sugar and insulin levels over time and excessive fructose intake from processed foods can lead to health issues like fatty liver disease and insulin resistance. Despite having a lower glycemic index than glucose, consuming too much fructose can still cause blood sugar spikes.

• Brown sugar is typically made by adding molasses back into refined white sugar, contains trace amounts of minerals such as calcium, potassium, iron, and magnesium due to the presence of molasses. While these minerals do provide some nutritional benefits, the amounts present in brown sugar are not significant enough to have a substantial impact on health.
• Jaggery is a natural sweetener made from sugarcane or date palm sap, and contains vitamins and minerals, making it a healthier alternative to refined sugar. However, it's still high in calories and should be consumed in moderation.
•  Monk fruit sweetener is derived from the monk fruit (Siraitia grosvenorii), a small green gourd native to southern China. Sweetener is considered healthy because it's low in calories, has a low glycemic index, and is derived from a natural source with potential antioxidant benefits. However, moderation is key, and it's important to choose pure monk fruit extract without added sugars or artificial ingredients
• Coconut sugar is made from the sap of the flower buds of the coconut palm tree. It has lower GI than white sugar, retains some nutrients and antioxidants from the sap but should still be consumed in moderation due to its calorie content.
• Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant. Stevia is much sweeter than table sugar, with estimates ranging from 200 to 300 times sweeter so you need a much smaller amount of stevia to achieve the same level of sweetness. Since stevia has minimal calories, it can be an attractive option for people looking to manage weight or blood sugar levels.

 ‘Added Sugar’, Labels, and how much is too much?

Many packaged foods like biscuits, breakfast cereals, juice, soup mix, ketchup, jam, pea nut butter etc have added sugar, given in per 100 g.  One should be aware of how much sugar is present in every serving to keep track of daily limit depending on health goals. Many of the products with so called ‘Healthy’ or ‘High fiber’ labels are also loaded with sugar.

Here's how to interpret the added sugar content on a food label

• Low in Added Sugars: If a serving of food has 5% RDA or less of added sugars, it's considered low.
• High in Added Sugars: A serving of food with 20% RDA or more of added sugars is considered high.

Additional Tips:

• Pay attention to serving sizes: The % RDA percentage is based on a specific serving size listed on the label. Be sure to factor that in when evaluating the sugar content 
• Consider your total daily intake: Even if a single serving is low in added sugars, be mindful of how many servings you are consuming not just from one food, but many such foods throughout the day. Say morning breakfast cereal, toast, biscuits with chai, chewing gum or mouth freshener, ice cream, soft drinks, tomato ketchup or sauce, and of course chocolates and all those sweet treats. 
• Don't just rely on RDA: While %RDA is a helpful tool; some people may need to limit added sugar more than others.

By understanding the RDA and your own dietary needs, you can make informed choices about the amount of added sugar you consume.