THE SWEET TRUTH
We all know that sugar is the root of all evil right? Too much of the white stuff has been linked to a range of health issues such as obesity, heart disease, diabetes and mental health, to name a few. Tax on sugary drinks is a hot topic, with the UK poised to add 6-8p on a can of fizzy pop in April next year and Ireland recently announcing to add 27p per litre. But the ‘can the tax’ campaigners in America have recently dumped the 1 cent per ounce levy on fizzy drinks in Chicago. (1) Lobbyists from the drinks industry are piling on the pressure to scrap the tax, and campaigners from the health industry to increase it. It’s uncertain which way it will go in the UK at the next budget. What is clear, is that the debate has highlighted the dangers of high sugar products such as fizzy drinks and confectionary. We all know that we shouldn’t be filling ourselves or our kids up with this stuff.
Because of the backlash against sugar, many manufacturers are seeking alternatives to sweeten food. Products and recipes use artificial sweeteners, natural sugar substitutes, fruit syrups, dried fruits and other agents in an attempt to claim ‘low sugar’. More recently the buzzword is ‘refined sugar’ and we are told that we should avoid this at all costs. So, if a products states on the packet that it has no or low refined sugar, but it still contains 20g sugar per 100g on the ingredients list, is this OK? Confused? Greater clarity is needed beyond the obvious ‘poor choices’ that we all know to avoid. To make an informed choice you need to know the facts and hopefully I can help.
WHAT IS SUGAR?
First you need to understand the basics. This is the science bit, but I’ll keep it short. Sugar is a carbohydrate that is present naturally in fruit and vegetables and in dairy products as lactose. The two main types are simple carbohydrates (monosaccharides and disaccharides), and complex carbohydrates (polysaccharides). Mono means one and saccharides means sugar, so essentially, these are single sugar molecules: glucose, fructose and galactose. Di means two, so these are two of the single sugar molecules joined together, making maltose, sucrose or lactose. Poly means many, so as you would expect these are a string of sugar molecules (starch, glycogen and cellulose). Following so far? The picture below should help. (2)
HOW DOES THE BODY USE IT?
In order to understand this further, you need to know how the body uses it. All foods falling into the carbohydrate category, either natural (e.g. potatoes) or processed (e.g. bread) are broken down in the body to a single sugar. So, bread, pasta, rice, vegetables, chocolate, pastries and biscuits ALL turn into glucose eventually, which is the primary fuel for the brain. The rest is used immediately for energy or stored in muscle cells or the liver for later use. When circulating in the blood, glucose is known as ‘blood sugar’ and insulin is secreted from the pancreas when levels rise, to take glucose into our cells. This prevents blood sugar from getting too high, which is dangerous for health.
The speed which your body absorbs sugar is partly determined by the amount of fibre in food, which slows the process down. That’s why it’s better to eat whole, unprocessed foods. Eating the whole fruit, rather than just the juice is a good example and I am a big fan of blending smoothies rather than juicing, for this reason. The other foods on your plate will also have an impact on blood sugar in your body. If you have a balance of proteins and good fats on your plate, this will further slow the absorption of sugar. So, it is definitely better to include something from each food group with all your meals and snacks.
WHAT ABOUT FRUCTOSE?
Fructose is a sugar found naturally in many fruits, some vegetables and honey. However, it is unlike other sugars because it is not the preferred energy source for muscles or the brain and it’s only processed in the liver. It also has minimal impact on blood sugar levels and does not cause insulin to be released. In the past, this has led to the thinking that we can eat as much fruit as we like, because it doesn’t cause blood sugar spikes, or pose health issues.
Evidence is now emerging which raises concerns about high intakes of dietary fructose, because it can be converted to fat in the liver. Much of this research stems from the prevalence of high fructose corn syrup (HFCS) in the food industry. In America, the per capita consumption of HFCS in 2016 was 41.4 pounds. (3) The consumption in the UK is currently lower, as both sugar and HFCS have been subject to export quotas and production restrictions. Worryingly these limits were lifted by the EU on 1st October this year. (4) This gives food manufacturers free reign to switch to fructose corn syrup, should they choose.
Childhood obesity expert, Dr Robert Lustig explains that as there isn’t a hormone to remove fructose from the blood, it’s stored in the liver as glucose, or turned into a fatty acid molecule called a triglyceride. These fats are returned to the blood and deposited around the body. Once the fat stores are full, they can travel to the heart or liver posing serious health risks. (5)
Recent evidence also links fructose to gut health, revealing that it can cause damage to the intestinal lining and imbalance our gut bacteria. (6) Excessive amounts could therefore contribute to a range of health disorders and can also cause bloating and digestive discomfort. We mustn’t forget that there are a host of fibre, vitamins, minerals and antioxidants in fruit, so it shouldn’t be demonised. However, intake should not be unlimited, more on that later.
REFINED VS UNREFINED
We all know that it’s better to eat whole fruit (in moderation) and vegetables, rather than a chocolate bar. We’ve learned that natural carbohydrate sources will give more sustained energy and stable blood sugar. But what exactly is a refined sugar?
Refined sugar comes from sugar cane or sugar beets, which are processed to extract the sugar. It is typically found as sucrose (commonly known as table sugar), which is the combination of glucose and fructose. During the refining process, all the vitamins, minerals, fibre and antioxidants are stripped away.
Food manufacturers add refined or chemically produced sugar (HFCS) to many foods and drinks to make them more palatable. A lot of these are not things you might typically expect to find sugar in and low-fat foods are often the worst offenders. Get in the habit of checking labels to see what the sugar content is, you might be surprised as you can see! (7)
Unrefined sugar on the other hand, retains all the natural nutrients. These are raw, unrefined sugar products such as honey, maple syrup, brown rice syrup, date syrup and molasses. But, here is where you must be careful, because these unrefined ‘healthy’ sugars can also have refined versions.
The processed golden honey found in supermarkets is completely different from ‘raw’ unpasteurized honey which still contains beneficial enzymes, vitamins, minerals and antioxidants. It also has a GI of about 75, compared to raw honey at around 30. Processed maple syrup that is commonly used on pancakes is often flavoured with maple and loaded with sugar or high fructose corn syrup. Choosing a ‘pure’ maple syrup ensures that it is not as refined and still contains beneficial nutrients. You will pay a premium for these products; however, you need to use a fraction of the amount of the cheaper more processed versions. Supermarkets won’t always stock these, so head to your health food store, or shop online.
WHAT ABOUT DRIED FRUIT?
Lots of recipes are now suggesting that we substitute refined sugar for dried fruits such as raisins, prunes, apricots and dates. Dried fruit has had all the water content removed and with this, the vitamin C content is also dramatically reduced. The fibre and antioxidant content, however are increased. (8,9) But if we look at the fructose content of a range of fruits, it is dried varieties that top the chart. (10)
So, as with everything in life, it is all about balance. If you are going to ditch refined sugar and start eating 20 medjool dates every day, this is probably not the best idea! However, if like me you are going to use dates in recipes to replace sugary snacks and use these sparing, then it’s better than using the refined sugar. Healthy snacks such as energy balls usually use dates (incidentally I use deglet noir as they are not only cheaper but lower in fructose) and I would have one ball a day as a ‘sweet treat’. I find this chart really useful to moderate the amount of high fructose fruit that is consumed. It does shed light on the downside of giving kids boxes of raisins daily, versus say a tangerine.
HOW MUCH DO WE NEED?
The NHS states that we shouldn’t have more than 5% of our calorie intake as sugar, which is 30g of sugar (7.5 teaspoons) a day for anyone aged 11 or over. Children aged 7-10 should not have more than 24g a day (6 teaspoons) and aged 4-6, no more than 19g a day (just under 5 teaspoons). (11) So, you start the kids’ day with a bowl of cheerios and a glass of orange juice, pack them off to school with a carton of fruit juice in their packed lunch and then a kids yogurt later. This, without any ‘sweet’ treats gives them about 12 teaspoons of sugar!
The Government supports the UK Eatwell Guide which shows you their version of a healthy plate and what should come from each food group. (12) On this, they do not include sugary foods at all, but show them separately, saying ‘eat less often and in small amounts’. Their advice is still to eat 5 portions of fruit and vegetables daily, which I believe is now outdated. We should not be eating to prevent disease, rather we should eat to optimise health. From this perspective I much prefer the Alliance for Natural Health ‘Food4Health Plate’ which state that we should eat from 6 groups each day; vegetables (40%), Fruits (10%), Grains (10%), Healthy Fats (10%), Protein (25%) and concentrated nutrients (5%). (13) This could be developed further to include fermented foods, which are beneficial for gut health and are thankfully becoming more readily accessible.
In my opinion we should strive to include 6-8 vegetables a day and minimise fruit to 2-3 portions. Using the fructose guide, it would be smart to try and ensure that you aren’t picking all the high fructose varieties. Dried fruits should be minimised and used sparingly as treats. People with blood sugar and digestive issues could benefit from minimising further, or even removing fruits completely. There should always be room for a treat, so try to pick a day or evening that is your treat time and think about minimising the quantity of the treat, so it’s not a binge! When choosing packaged products, try to pick the lowest percentage of sugar per 100g that you can (under 5% would be a good start) and eat whole foods as much as possible. Remember that if you enjoy a drink on the weekend you should also consider the sugar content. A large glass of dry white, prosecco or red wine is a quarter of a teaspoon, a pint of ale 1 tsp, a pint of lager is 2 tsp, and a pint of sweet cider such is up to 5 tsp! If chocolate is your weakness, treat yourself to a bar of raw chocolate which is made by roasting the cocoa beans to much lower temperatures. This retains nutrients and antioxidants that are usually destroyed. It’s also dairy and refined sugar free.
So, what about the myriad of sugar alternatives on offer? Well here’s an overview and my advice on the ones to buy and avoid:
- Artificial sweeteners such as saccharine, sucralose and aspartame (brand names Nutrasweet, Equal, Splenda) are best avoided altogether. Research indicates that these can disrupt appetite regulation and promote weight gain, as well as negatively impact gut health. (14,15,16)
- Agave nectar was considered a healthy sweetener a few years ago. Recent evidence however shows that whilst it is low in GI, it has an extremely high fructose level (over 70%). From this perspective I would not recommend using this product at all.
- Coconut sugar is from the sap of the coconut tree and has a sweet caramel flavour. It is a low GI option at only 35, low in fructose and contains trace amounts of vitamins and minerals. It also contains inulin, which is a fibre which can help to slow glucose absorption and is beneficial for our gut bacteria. (17) Whilst it isn’t refined, it should be used sparingly as it does contain the same calories as sugar. I have found this works well in small quantities in baking and desserts.
- Xylitol and Erythritol are sugar alcohols or polyols and have low GI and calories. They are naturally derived and can be used in recipes to substitute sugar, in lower quantities. They do not stimulate an insulin response and therefore can be useful for diabetics. People with digestive complaints such as IBS should be cautious as they can cause digestive disturbance. I don’t tend to use these products as I am cautious of their highly processed nature and lack of evidence of safety.
- Maple syrup as discussed should only be used in it’s raw unprocessed form as it contains more nutrients. Its strong taste means you won’t need to use much and I would advise to use it sparingly as it has a GI of 54. I do use maple in some of my recipes and to drizzle it on gluten free pancakes.
- Honey should also be unrefined and raw, or you could splash out on manuka honey which has antimicrobial properties. Not only is raw honey lower GI than processed, it also contains beneficial enzymes and nutrients. Remember though to use in moderation as it is still high in fructose.
- Date syrup is extracted from dates using a soaking and squeezing process. It has a GI of around 50 and is also high in fructose. It is OK to use in moderation, but I prefer to use whole dates in my recipes, which retain the fibre and vitamins and minerals.
- Brown rice syrup is a natural sweetener also called rice malt syrup. Cheaper versions are made from cooked brown rice cultured with enzymes. Better versions use sprouted grains that release the enzymes to break the rice down into maltose and other sugars. Brown rice syrup does not contain any fructose and I think in moderation it is a good sweetener, but it doesn’t work so well in baking.
- Blackstrap molasses is a by-product of sugar, but it is unrefined as it still contains a variety of vitamins and minerals. It has a GI of about 55 and contains high levels of vitamin B6, manganese, magnesium, potassium, iron and selenium. It also contains high levels of antioxidants, compared to other sugar substitutes. (18) I think it’s an underrated sweetener and has more uses than people realise!
- Stevia is a low calorie natural sweetener which comes from the stevia plant in South America. It is much sweeter than sugar, so you only need to use a little. There are some highly processed varieties on the market (such as Truvia) which often add in other chemicals, or come from GMO plants. These products should be totally avoided and really don’t taste good at all. If using stevia, make sure that you only buy full green leaf stevia which is the least processed.
- Chicory root fibre (or inulin) is what gives TROO granola it’s sweetness. It is a soluble fibre, with many health benefits and it has no impact on blood sugar levels. Best of all, inulin is a prebiotic meaning that it feeds the good bacteria in our guts. It isn’t widely available for home use.
For the best choice of all these products, you should head to a health food store, as you won’t find them all in the supermarket. Some on line retailers that stock these are:
THE 28 DAY CHALLENGE
So, it all sounds a bit gloomy, right? Basically, there is sugar everywhere. But honestly, it’s not as hard as you think to cut down. By making a positive change you are not only taking control of your health, but you will most likely shed a few pounds at the same time. As an experiment, I cut refined sugar and alcohol from my diet for 28 days and did not find it nearly as hard as I imagined. Although during this time I did include fruit (2 a day) and used dried fruit (dates) to provide me with healthy ‘treats’ (again 1 small treat per day). I used sugar alternatives sparingly for baking and increased my protein and vegetable intake. I found myself way less hungry, my energy levels improved, my hormones balanced and I lost 1.5 inches from my waistline. I’ve not had any sugar since the end of the detox (2 weeks ago) because I just don’t miss it or want it. I’ve found that the alternatives I’m using are more than enough to satisfy any cravings (which but the way also reduced dramatically). I have had a drink or 3, but am much more moderate about this too. Try the 28-day challenge, it might just step change your diet (and health) for good!
NOTE: THIS HAS BEEN PREPARED INDEPENDENTLY BY NUTRITIONAL THERAPIST JOSIE WAREING AND IS AIMED AT GIVING UNBIASED GUIDANCE ON THE NUTRITIONAL VALUE AND ISSUES WITH SUGAR.
- Lustig, Robert (2013). Fat Chance, the Bitter Truth about Sugar. Harper Collins
- http://anhinternational.org/wp-content/uploads/2016/09/160921-Food4Health-Guidelines-` `poster.pdf