Natural sugar vs added sugar for diabetics

By Diana Kelly LeveyMedically Reviewed by Kelly Kennedy, RDN

Reviewed: February 17, 2021

There’s plenty of evidence that a high-sugar diet can come with damaging health risks. For example, too much added sugar has been linked to increased risk of high blood pressure, high cholesterol, reduced “good” cholesterol, inflammation, insulin resistance, obesity, type 2 diabetes, nonalcoholic fatty liver disease, and heart disease. A study published in August 2017 in BMJ Openfound that cutting back on sugar may save you money, as the aforementioned diseases are associated with high medical bills.

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None of this suggests all sugar is bad. But the sugars found in a can of cola are not the same as those in a cup of fresh berries.

Natural vs. Added Sugar: What’s the Difference?

Natural sugars are the ones found in whole, unprocessed foods — such as the fructose in bananas or berries, or lactose in a glass of skim milk, says Vanessa Voltolina, RDN, a clinical dietitian in Westchester, New York.

“Foods with natural sugars tend to be low in calories and sodium, and high in water content and many important vitamins and minerals,” she explains. The fiber in fruits slows down how quickly your body digests it, so you don’t get the same sugar spike you get after eating a doughnut, Voltolina says. And the lactose in milk comes with a healthy serving of protein that provides sustained energy, so you feel full longer than after a sugar-packed soda.

Added sugars, like the ones in doughnuts and soda, are the ones to be more concerned about. Put simply, added sugar is any sugar that gets added to a food — either by you, a chef, or a food manufacturer — before it goes in your mouth, notes the U.S. Department of Agriculture (USDA).

Added sugars include the high fructose corn syrup lurking in some ketchups and breads, as well as the honey or agave you might add to a mug of tea or smoothie. Because they don't necessarily come packaged with other good-for-you nutrients, like protein and fiber, our bodies digest them more quickly, which can cause a rapid increase in blood glucose (sugar). And over time having consistently high blood glucose contributes to health problems such as obesity, type 2 diabetes, and heart disease, according to a study publishedin the journal JAMA Internal Medicine.

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What Too Much Sugar Does to Your Health

The high amounts of refined and added sugars in snack foods, sweets, and sodas have been linked with weight gain and the development of obesity in the United States, as they tend to be calorie dense with none of the nutritive benefits, says Voltolina. These types of sugars can cause rapid increases in blood sugar, which may increase the risk of insulin resistance and eventually type 2 diabetes.

Extra sugar may also increase risk of developing nonalcoholic fatty liver disease, as well as increased triglyceride levels, which may contribute to cardiovascular disease. In a statement published in February 2021 in the journal Circulation, the American Heart Association (AHA) linked high intakes of added sugars with heightened rates of obesity and heart disease.

To avoid these risks, the Dietary Guidelines for Americans 2020–2025 recommends limiting added sugar to less than 10 percent of your daily calories.

The AHA recommends women consume no more than 6 teaspoons (tsp) of added sugar daily (25 grams [g] or about 100 calories), and that men should limit their added sugar intake to 9 tsp or less (36 g or about 150 calories). If you’re adding 2 tsp of sugar to your daily coffee, eating cereal or granola that contains added sugar, and drizzling a store-bought salad dressing on your greens, you may be at or near your daily added-sugar limit by lunchtime even without having any candy or dessert.

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How to Spot Added Sugars in Processed Foods

Don’t be fooled just because you stay away from obviously sweet foods like cake, cookies, doughnuts, and candy. Added sugars hide in a number of foods you may not expect, like processed frozen foods, baby food, dried fruit, cereal, granola, instant oatmeal, salad dressings, ketchup, barbecue sauces, pasta sauces, flavored yogurt, protein bars, and more. They’re also found in organic foods and plenty of foods you’ll find at your local health food store.

The good news is that tallying up “added sugars” on packaged foods just got easier. The Nutrition Facts Label now includes “added sugars” underneath where it says “total sugars."

How Sugar Appears on Ingredients Lists

Sugar goes by a lot of different names — more than 60, if we’re talking about what’s listed on nutrition labels. Here are a few of them.

• Brown sugar
• Corn sweetener
• Corn syrup
• Rice syrup
• Dextrose
• Maltose
• Barley malt
• Fructose sweetener
• Fruit juice concentrates
• Glucose
• High-fructose corn syrup
• Honey
• Invert sugar
• Lactose
• Maltose
• Malt syrup
• Maple syrup
• Molasses
• Pancake syrup
• Raw sugar
• Sucrose
• Trehalose
• Turbinado sugar

To identify an added sugar, look for words that end with “-ose,” as well as phrases that contain “syrup” or “malt.”

Remember: Ingredients on a packaged food are listed in descending order in terms of weight, so when you see these names at the top of the ingredients list, the product contains a lot of sugar.

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Can You Overdo It on Naturally Occurring Sugars?

Some celebrities and others credit weight-loss successes to eliminating all sugars (even the natural ones). But the sugars found in fruit and dairy are part of a healthy diet and shouldn’t be on the “naughty” foods list.

“Like any component of a diet, you can overdo it on sugar, even if it's naturally occurring,” says Voltolina. But most people can stay in the healthy range when it comes to natural sugars if they focus on choosing whole foods over processed ones — try a few slices of fresh fruit on a peanut butter sandwich instead of a jelly or jam, which likely has extra added sugar — and focus on eating a well-balanced diet.

The USDA recommends 2 cups of fruit and at least 2.5 cups of vegetables daily for adults. And adults should get two to three servings of dairy per day — 1 cup of nonfat or low-fat milk, 1 cup of nonfat or low-fat yogurt, or 1.5 ounces of natural cheese all count as one serving. That said, dairy isn’t necessarily a required element for a healthy diet and could be one area where people reduce their intake to further reduce sugar. If you’re someone who drinks soy milk or nut milk, make sure you’re choosing unsweetened versions to keep the added sugars low. At the same time, keep in mind that dairy can be an important source of calcium — a mineral responsible for keeping your skeleton strong — in the American diet, as the National Institutes of Health (NIH) notes. If you’re avoiding dairy, opt for plant-based calcium sources, such as chia seeds, kale, and tofu. You can also get your fix via fortified foods such as orange juice and cereal, according to the NIH.

Eventually, the less sugar you have in your diet, the sweeter foods will taste naturally, says Voltolina. Your taste buds will adjust when you reduce or eliminate added sugars, and you might find that certain sugary foods and beverages will taste too sweet. This will make it easier to cut back on foods with sugar.

Of course, no two bodies are the same. Consider your overall lifestyle and physical activity level when considering dietary choices, Voltolina adds. For more active individuals, more servings of fruit can be a healthful way to add needed calories. Working with a registered dietitian nutritionist can help you adjust your diet, including your sugar intake, as needed. Also, keep in mind any underlying medical conditions. For example, a person with diabetes will need to monitor his or her carb intake more closely, and fruit, while allowed, must be eaten in moderation, as the American Diabetes Association points out.

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What About Artificial Sweeteners and Sugar Substitutes?

Before you rip open a packet of artificial sweetener in lieu of spooning sugar into your coffee or tea, pause. While artificial sweeteners are generally viewed as harmless, says Voltolina, the scientific community is still not in agreement about how safe they are.

Sugar substitutes are categorized as “natural,” like Stevia (approved by the U.S. Food and Drug Administration [FDA]) and monk fruit extract, or “synthetic,” which can include aspartame, saccharin, acesulfame, neotame, and sucralose as FDA-approved artificial sweeteners, previous research notes.

While people often choose artificial sweeteners to lose weight and cut down on calorie intake, earlier research found that artificial sweeteners may enhance sugar cravings and stimulate your appetite. Simply replacing your sugary beverages with diet versions may not give you the positive health outcomes you’re looking to achieve. One observational study found that diet soda consumption was associated with a 36 percent greater risk of metabolic syndrome and 67 percent higher risk of type 2 diabetes.

At the same time, some research on Stevia suggests it may play a role in protecting against some cancers. Separately, Stevia may improve some biochemical parameters like fasting blood sugar in people with chronic kidney disease, suggests a study published in August 2018 in Contemporary Clinical Trials Communications.

A review of 35 observational studies, which was published in January 2019 in the BMJ, found that using sugar substitutes rarely resulted in beneficial health outcomes. Some participants lost weight and others improved fasting blood glucose numbers, but overall, their body mass index (BMI) improvements weren’t significant.

Bottom line: Unless a physician recommends switching to sugar substitutes for health reasons, you’re better off cutting out sugar altogether or reducing it in a recipe. And if you really want a little sugar in your coffee, add as little as possible and enjoy it, suggests Voltolina.

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