Sugar and Health. What to Know About Sugar

Today, our dependence on sugar leads to obvious outcomes, like obesity. But sugar also contributes to deeper health problems.  In the western world, refined sugar finds its way into almost every meal. Whether added to our coffee or tea, included in our breads, cookies, and cakes, or simply consumed directly, in the form of snacks, sweets, and soft-drinks, sugar seems ubiquitous. Of our five flavor profiles, satisfying our sweet taste buds motivates our eating habits above all.

In combination with the hidden volume of sugar found in processed foods, sauces, canned goods, and dairy products, the average American consumes around 150 pounds of pure sugar per year; this, compared with about 17.5 pounds in 1915.  

What is sugar
Sugar is part of our daily nutrition

Obesity represents the most apparent health consequence of excess sugar

The human body does not depend on crystalline sugar for energy, because we break-down enough sugar molecules from complex carbohydrates. Carbohydrates derived from breads and pastas provide the energy our bodies need, satisfying our real demand for sugar. 

homemade spelt bread
Complex carbohydrates, German homemade spelt bread (recipe)

Increased consumption of sugar products means the body first stores sugar in the cells. Once full, the body’s sugar reserves convert to fat, settling on the hips, stomach, bottom, and internally, for example in the liver. This leads to secondary health conditions, such as high blood pressure or diabetes.

Sugar at a Glance

At first glance, we often think of sugar for one variety, household sugar, or sucrose. More broadly, sugar refers to a group of carbohydrates with distinctions made, based molecular structure.

  • Monosaccharides: simple sugars, involving single sugar molecules, such as fructose or glucose;
  • Disaccharides: carbohydrate molecules composed of two monosaccharides, such as lactose or sucrose; 
  • Polysaccharides multiple carbohydrate molecules composed of long chains of monosaccharides, such as starch or cellulose.

All sugars are carbohydrates. Household sugar (sucrose) usually consists of fructose and glucose.  From a biological point of view, our household sugar is usually crystallized sucrose. This basic substance derives from various plants, such as sugar cane, sugar maple, sugar palms, and sugar beets. And, though purified through a refining process, the plant sugars we consume lose valuable minerals and constituent parts. 

sugar and health
Sugar beets

Sucrose appears throughout nature. Long found in sugar beets and the like, sucrose also shows-up in considerable quantities in fruits such as bananas, dates, peaches, and pineapples.

In food we also find dextrose (glucose), fructose, and lactose.  Foods labeled with reference to glucose, fructose or lactose always contain sugar.

Starch is also Sugar

Starch consists of a number of glucose molecules linked together in a long chain. Anyone who chews a piece of bread for a little while longer notices that it tastes sweeter and sweeter over time. This is because a digestive enzyme contained in saliva, amylase splits the starch chain and releases glucose in the mouth. This is also one reason why starch causes blood sugar to rise extremely quickly. 

A Reasonable Basis for Addiction to Sugar

Sugar in itself is indispensable for the body to achieve kinetic function, mental activity, and cellular function. Without sugar we die. The question relates to the forms and sources from which we obtain sugar.

cereals and sugar
Sugar trap: cereals are often high in sugar

Our sugar addiction has evolutionary roots. Sweetness signals energy for our body. Therefore, our motivation for sugar draws from a rational basis.  So, if we want to reduce our sugar consumption, we must dedicate conscious effort.

Healthy Amount of Sugar

As with the basic tenants of Hildegard von Bingen’s principals of balance and ‘discretio,’ sugar serves useful in moderation.  However, as we creep into quantities above 25 grams daily, sugar seeps into the body as a sweet poison, leading to high blood pressure, heart disease, advanced cell aging, obesity, and diabetes.

Many of the healthy foods we know to contain useful vitamins and minerals, such as fruits also contain significant amounts of sugar.

What is Refined Sugar?

Refined sugar refers to the white crystals we heap into our coffee, cereal, or cake mix — otherwise referred to as granulated sugar. This simple form of household sugar typically derives from sugar beet, sugar palm, or sugar cane. 

granulated sugar healthy
Sugar palms

100 years ago, sugar remained a rare commodity.  Only within the last few decades has sugar appeared in great abundance and at low prices. During Hildegard’s time, a Medieval diet would not contemplate sugar, as it was still considered “white gold”.

Rather than “gold,” more commonly, modern dietitians think of sugar as a form of poison. Unfortunately, the contemporary availability and consumption of sugar leads to our most prevalent health concerns, including obesity and the development of acute conditions, such as high blood pressure or type 2 diabetes.

Sugar Appears Everywhere

Sugar hides where you least expect. Food manufacturers bury sugar additives in almost all processed food products. Fostering an unhealthy dependence on sugar from an early age helps direct consumer tastes to ensure we perceive sweet products as superior.

sugar consumption health
Often even healthy considered foods contain lots of sugar, i.e. cornflakes

For example, in the case of packaged cereals, even the healthy varieties often lead us into a sugar trap. For example, some of the old German mueslis appear all natural, but often contain heavy additional sweeteners.

Roughly speaking, three groups can be distinguished: 

  1. Well-known white, refined sugar (sucrose), which is added to many foods. 
  1. Lactose (twofold sugar or disaccharides) and fructose (monosaccharide), which are found in milk and fruit. 
  1. Other carbohydrates, such as starch, which occur naturally in all plant foods. Only meat contains practically no carbohydrates. 

First Step in Avoiding Sugar

Understanding that we satisfy our basic need for sugar from carbohydrates found in nature, we can avoid sugar by refocusing on fiber-rich foods, such as fruits, vegetables, and legumes (chickpeas, chestnuts, whole grain products such as spelt).

chickpeas super food
Chickpeas, fiber rich superfood

Because of the nature and relationship of our taste buds and flavor receptors, we support our effort to control sugar cravings by reaching for counteracting flavors, like bitters.

Is Sugar Unhealthy?

Sugar itself is not the problem. The problem arises from how we incorporate it in our diet. We simply eat too much sugar. Even if our cells were dependent on sugar as an energy source, an intake of 10 g of sugar per day would suffice. Moreover, in contrast to essential amino acids (components of proteins) and essential fatty acids (components of fats), there are no essential carbohydrates.

how much sugar per day
250 ml apple juice contain 25g sugar

The World Health Organization (WHO) advises against consuming more than 25 g sugar (approx. 6 teaspoons) per day. However, our actual sugar intake exceeds those levels. People who do not eat sweets also consume sugar via bread, sausage, dairy products, drinks, and breakfast cereals. 

What Happens to the Body With Too Much Sugar?

Sugar and Insulin

To understand the effects of sugar on the organism, we first address the hormone insulin.

Blood sugar levels in the extreme (too high or too low) damage the body. The brain in particular, which is dependent on glucose as an energy source, suffers from volatile fluctuations in blood sugar levels. 

Insulin serves the important task of lowering blood sugar levels. Insulin releases when blood sugar levels rise. It works by notifying cells to absorb sugar from the blood, thereby regulating the level of sugar found in the blood. The more sugar absorbed into the cells, the lower the blood sugar level.

Glycogen and Glucagon

We store absorbed sugar as glycogen in the liver and muscles. The antagonist of insulin, the hormone, glucagon elevates blood sugar levels by degrading glycogen to glucose. When glycogen stores fill to capacity, excess sugar gets converted and stored as fat. Effectively, glycogen and glucagon work together to preserve the homeostasis, or balance of blood sugar levels.

how much sugar a day
Soft drinks are sugar bombs

Since no limit applies to the amount of fat we store. The body can store kilograms of fat. This means that surplus sugar eventually results in excess fat.

Sugar and Health

Studies confirm that persistently high blood sugar levels often promote more serious health conditions, such as rheumatism, fibromyalgia, osteoporosis, Alzheimer’s disease, or dementia.

Excessive sugar consumption can also trigger or influence unexplained fatigue, lack of drive and energy, depression, anxiety, stomach and intestinal problems such as bloating, flatulence, diarrhea and constipation, hair loss, skin diseases, fungal infections, menstrual problems, nervousness, sleep disorders, and poor concentration.

Sugar and Diabetes

sugar and diabetes

Recent studies suggest that obesity and diabetes depend less on the number of calories we consume, and more on the types of calories we include in our diets.

Consistently, sugar rises (or descends) to the worst diet choice. A team at Stanford University examined the relationship of sugar consumption with the incidence of type 2 diabetes in 175 countries

In a nutshell, the Stanford study revealed that where people consume more calories from sugar than from other foods, the number of diabetics increases eleven times faster, regardless of the amount of exercise, or body mass index (BMI).

Sugar, Insulin and Diabetes

If sugar is supplied again and again and the insulin constantly notifies cells to respond, our cells become stressed. In order to protect themselves, cells react less and less to the insulin, leaving insulin with no choice but to elevate its levels to channel the same amount of sugar into the cells. At some point, cells no longer react to the insulin at all. Enter diabetes mellitus (type II). 

reduce sugar intake
Limiting sugar consumption

Thanks to modern medicine, the diagnosis of diabetes has lost its horror. An appropriate diet can partially improve insulin sensitivity, so that patients must inject less insulin. However, the possible concomitant and secondary health conditions should not be underestimated.

Fructose and Diabetics

Since fructose metabolizes and breaks-down independent of insulin, it hardly affects glucose levels in the blood. For that reason, fructose had been considered a worthwhile sugar substitute for diabetics. 

The energy contained in fructose resembles glucose insofar as being an important source of energy. Like glucose and other sugars, fructose leads to weight gain. But, in contrast to glucose, the bi-products of fructose convert less readily into energy and fat metabolism. Thus, fructose contributes more to filling our fat stores.

Recent studies show fructose increasingly linked to obesity, fatty liver, unhealthy LDL cholesterol levels, increased uric acid levels with consequent gout disease, high blood pressure, as well as reduced cell sensitivity to insulin.

Household Sugar vs. Fructose

Household sugar (sucrose) and fructose contain the same number of calories, both deliver four kilocalories per gram.  Since fructose is cheaper to produce and has a taste-enhancing effect in low-calorie foods, it is often used in the food industry. 

fruits and sugar
Fruits are healthy in general but can contain significants amount of fructose sugar

Fructose may have a more profound, unfavorable effect on the brain. Since it tastes sweeter, it encourages further consumption. In addition, evidence shows that fructose stimulates the formation of storage fats.

Fructose appears more commonly than we immediately perceive. For example, it shows-up in many products billed as ‘light’ and even in apparently unsweetened goods, like barbeque sauces – foods that one would not intuitively consider sugar-heavy.

Tolerability of fructose

Fructose cannot be completely avoided. Among other things, it is found in household sugar and fruit, both permitted in moderate amounts for type 2 diabetics. Fruit ought to remain a regular part of any healthy diet, because of the many health-promoting contents. 

People do not tolerate fructose well, when consumed in high quantities. In general, a dose of 25 g per meal is harmless.  But, the consumption of a soft drink, which often contains as much as 40 g fructose, often leads to abdominal pain.

The 5 Fruits or Veggies Per Day Policy

The recommended “5 a day” rule applies.  Five portions of fruit or vegetables per day, whereby one portion corresponds to either one piece of fruit (e.g. 1 apple) or a handful (e.g. 1 handful of grapes). 

Those who do not tolerate fruit well can also eat vegetables or salads. Only one portion should be consumed each day as juice. This results in about 80 grams of fructose per day. This amount is well tolerated by most people. 

sugar poison
Dried fruits, healthy but high in sugar

However, dried fruits or jams contain a comparatively high amount of fructose. The same applies to many processed foods or sweet drinks, sweetened with fructose or corn syrup containing fructose. Diabetics do best to avoid these high fructose products.

For those who have problems metabolizing fructose, consider fresh and natural foods over processed foods. Natural foods preserve the integrity of dietary fibers, secondary plant substances, vitamins and minerals.

Sugar and Health Experiments on Mice

Compelling evidence of further negative effects from too much sugar derive from studies with mice:

Female mice who received 25 percent of their daily calorie intake in the form of fructose and glucose had twice the mortality risk of female mice in a control group. Mice became more infertile due to the sugared feed and had 25 percent fewer offspring.

Surprisingly, the sugar diet of the mice in the study corresponded closely to the amount that a normal person consumes daily, while eating a normal healthy diet, with the addition of three glasses of sweetened lemonade.

Sugar and Cavities

sugar and caries
Sugar can cause caries

Oral bacteria in the mouth converts sugar to acid, which compromises and breakdown tooth enamel. If too much sugar is eaten too often, the saliva can no longer protect the teeth and holes begin to develop, there are the cavities we try to prevent. 

Sugar and Migraine

Studies have shown that fluctuations in blood sugar levels can trigger migraine headaches. Foods that slowly raise blood sugar levels and preserve consistency over time represent a useful alternative for people who suffer from frequent migraine headaches. Ideally, that means avoiding simple sugars and foods rich in starch.

Sugar and Cancer

Cancer cells love sugar. They depend on it as a primary source of energy. Even if high sugar consumption “feeds” existing cancer cells, cancer cannot be completely “starved” by eliminating sugar from a diet. This is because the blood sugar levels never drop to zero.

Nevertheless, a low sugar, high in fat diet can help. While the cancer cells suffer from a lack of sugar, the rest of the organism obtains its energy from the bi-products of fat degradation, the so-called ketone bodies. This ketogenic diet supports cancer patients, and people with chronic inflammatory conditions. 

Why We Love Sugar

Our early ancestors learned that sweet food was not poisonous and at the same time provided plenty of energy. This knowledge remains rooted deep within us. Plus, sweets simply taste good. Finally, sugar triggers certain reactions in the brain. 

why we love sugar
We love the taste of sugar

Sugar activates the reward system in the brain. Sweet substances trigger a brain response, which ensures well-being. Experiments show that the combination of sugar and fat stimulates the reward system very effectively. 

Since people need rewards for their mental well-being, your body will always tempt you toward sweets – or something comparable that makes you happy.

Sugar Triggers Addictive Behavior

Experiments on rats show that they demonstrated withdrawal symptoms when researchers refused them a previously administered sugar solution. The brain of the animals also underwent changes typical of addiction. Some scientists conclude that sugar is addictive. However, this thesis is controversial because scant evidence supports an actual physiologically addiction like we see with drugs. 

Sugar Affects Our Appearance

Sugar makes us age faster and makes us look old. This is due to the increased production of AGEs (Advanced Glycation Endproducts) resulting from sugar consumption. AGEs represent waste products, mainly produced through the combination of protein and sugar. AGEs saturate among membranes, blood vessels, collagen structures, and other molecules in the body, resulting in an advanced ageing process at the cellular level. 

Consuming too many AGEs, or if too many form spontaneously, our bodies cannot keep up with eliminating them, and they contribute to oxidative stress and inflammation. In short, our cells age faster with increased exposure to AGEs. A reduction in the formation of AGEs supports a basic tenant of Hildegard nutrition that calorie restriction prolongs lifespan.

Behavioral Impacts of Sugar 

Research shows that people who consume excessive sugar have a higher tendency to act aggressively. Sugar consumption among children promotes ADHD, affecting their ability to concentrate for even short periods of time. Ideally, children should avoid consuming sugar, particularly during school hours. 

sugar and children
Children should consume only 12.5g sugar per day

In depressed adults, a sugar-reduced diet helps restore emotional stability. But it is not only on an emotional level that sugar influences behavior; we alter our genetic material (DNA) with sugar, triggering certain inflammation and disease signaling genes.

Quit Sugar Altogether

Perhaps we serve our highest function by abandoning sugar altogether, but the challenge arises in implementation. Occasionally indulging in chocolate satisfies more than just our taste buds. Enforcing a strict ban on all sweets and chocolate underscores the very desire we wish to quell. Better to embrace Hildegard’s views on discretio and moderation, allowing for some reprieve from self-discipline.  And, after eating candy, a glass of water or quick teeth cleaning can prevent the urge to eat the whole bar.

Enforcing Self-Discipline

To help manage our psychological craving for sugar, place your sweets out of sight. If you feel a sudden urge to eat carbohydrate-rich foods, ask where the craving comes from: stress, frustration, boredom, or perhaps fatigue? 

Sufficient exercise and sleep also reduce the desire to eat sweets. It is fundamentally important to avoid hidden sugar bombs such as fruit muesli, cornflakes, fruit juices, fruit yogurts, sausages, ready meals, or fat-reduced products, and to ensure a balanced blood sugar level. Measuring your intake of processed foods helps to manage cravings.

sugar free limonade
Tasty and refreshening without sugar

Avoid beverages containing sugar. Those not yet used to quenching their thirst with water can add a few leaves of peppermint or a dash of lemon juice.  Try exploring bitter flavors in your diet to help balance taste buds.

We have the power to consciously train our sense of taste, so that we gradually perceive smaller and smaller amounts of sugar as sweet. For example, if you gradually reduce your sugar intake over time, the sweetness of fruit yogurt will soon smack as unpleasant. 

Similarly, we can slowly introduce new flavor profiles, like bitter flavors to manage our sugar cravings.

How much sugar should you eat per day?

According to WHO (World Health Organization) recommendations, adults should not consume more than six teaspoons (25g) of sugar per day. For children, the WHO suggests only half as much, i.e. 12.5 grams a day. 

The WHO guidance refers to sugar added to foods and beverages, including sugar naturally found in honey, syrups, fruit juices and fruit juice concentrates. Fresh fruit and vegetables are not included. 

sugar doses
Sugar: find the right doses

A can of lemonade alone contains about ten teaspoons of sugar, and a bar of chocolate contains up to 55 grams. Healthy fruit juices often contain even more sugar than lemonade in direct comparison. A 250 ml glass of apple juice contains up to 25 g of sugar (approximately our entire daily limit).

As an aside, do not reach for large quantities of artificial sweeteners, as these have negative effects on your health.


The New York pediatrician and obesity expert Robert Lustig has investigated the effects of sugar on the metabolic system. We recommend his 90-minute lecture from 2009 entitled Sugar: The Bitter Truth.

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