Nutritional Medicine Updates

How Much Sugar And The Best Alternatives

lumps of sugar

How much sugar per day is acceptable, and what are the best alternatives? If you have a ‘sweet tooth’ and can only drink tea or coffee by piling in the sugar cubes, you can now blame your over-sensitive taste buds. Researchers from the University of York have discovered that sugar masks the bitterness of tea and coffee by causing caffeine molecules to clump together. This makes them less easily detected by your taste buds, especially if you’ve inherited efficient bitter receptors.

But knowing why you like added sugar is little consolation now the W.H.O recommends that we should eat no more than 5% of total dietary energy in the form of free sugars. They also advise that you should keep your consumption of sugar-sweetened beverages to a minimum.

What Are Free Sugars?

Free sugars are sugars added to food – whether by manufacturers during production, the chef during cooking, or you at the table. Free sugars also include the sugars present in syrups and fruit juices – even those that are unsweetened – as well as sugars that are naturally present in honey. Free sugars do not include lactose sugar, which is naturally present in milk, or the sugars present in whole fruits.

So, if you peel and eat an orange, this does not contribute to your free sugar intake. but if you squeezed that orange and drank the juice instead, the sugars in the juice would count.

This may seem confusing, but the reasoning behind this distinction is that the sugars present in whole fruit are confined within plant cells, and the fibre present slows their absorption into the circulation.

Also, an average orange only weighs around 120g, while orange juice tends to be quaffed down in 250ml volumes and may contain the juice of six or more large oranges. As a result, the glycemic load of an orange (120g) is 4, compared with a GL of 12 for a glass (250ml) of unsweetened orange juice. Eating a whole orange therefore has less impact on your blood glucose levels and your overall health.

Some sugar is important in your diet to maintain blood glucose levels, especially after prolonged exercise, and the benefits of eating at least 5-a-day fruit and vegetables, and drinking milk (an excellent source of calcium) are more than outweighed by the sugar they contain. Don’t overdo dried fruits such as dates, however, as these are a highly concentrated source of sugar that it’s all too easy to eat by the handful. If you like sweet flavours, opt for dried prunes whose sweetness comes from natural sorbitol andm as a bonus, prunes may protect against bowel cancer.

Too much sugar is harmful

Sugars contribute to tooth decay and, when consumed in excess, can lead to weight gain. In sensible amounts, sugar is not associated with adverse health problems. When eaten in excess, however, high intakes of sugar are associated with increased risks of developing obesity, type 2 diabetes, heart attack, stroke, fatty liver disease, dementia and even some cancers.

Excess sugar provides so-called ‘empty’ calories as they do not provide any other nutritional benefits such as vitamins, minerals or fibre, just pure energy of which most of us already get more than enough.

Sugar and diabetes

When you eat table sugar, sucrose, it is digested down to release two different sugars, glucose and fructose. The glucose is absorbed straight into the blood stream to cause a rapid spike in blood sugar levels. This, in turn, triggers the release of insulin hormone which acts as the key allowing glucose to enter muscle and fat cells. Glucose levels subsequently fall and may dip too low, so you feel hungry again a couple of hours after eating a high sugar meal or snack. This can set up a vicious cycle that fuels excess snacking and weight gain, which can lead eventually to type 2 diabetes. Just switching one sugar-sweetened drink per day to an unsweetened drink can significantly reduce your risk of type 2 diabetes, for example.

The fructose part of table sugar is metabolised in your liver, with some converted into glucose, and some converted into triglyceride fat. Excess fructose can contribute to fatty liver changes and, if you eat a lot of fructose (eg in the form of high fructose corn syrup) this may increase the risk of developing fatty liver disease. This effect is similar to that of alcohol and researchers have also found that fructose sugar may affect the brain in a similar way to alcohol, contributing to the addictive quality of sweet foods, and further encouraging over-eating and weight gain.

However, early suggestions that fructose may have played a role in the epidemic of obesity (many of which were based around animal studies fed very little else) have now been disproven. More recent research shows that even high fructose corn syrup has indistinguishable metabolic and health effects in humans. As an alternative to a spoonful of sugar, you could do a lot worse than use a spoonful of fructose which has a lower glycemic index of just 19 compared to 100 for pure glucose and 63 for table sugar (sucrose).

How much sugar per day?

sugar_cubesSticking to no more than 5% total energy as free sugars isn’t an easy calculation unless you know exactly how many calories you eat and drink on a daily basis. If you need 2000 kcals per day to maintain a healthy weight, then the 5% maximum amount of free sugar you are allowed per day is 100 kcals. As one gram of sugar provides 4 kcals, this is equivalent to no more than 25 grams of sugar.

One teaspoonful of sugar weighs 4g, so we are talking about 6 teaspoonfuls of free sugar per day for an average person following a 2000 kcal per day diet to maintain a healthy weight. Those who need more calories to maintain a healthy weight can eat slightly more sugar. The following table from Public Health England suggests that the average adult can have up to 30g free sugars (7 sugar cubes) maximum per day.

f you are reducing your intake of sugar, the guidelines advise that you replace excess free sugars with starches (present in wholegrains), sugars contained within the cellular structure of foods (ie fruit and veg) plus milk and milk products so that, overall, you obtain 50% of your energy intake from carbohydrates.

If you are overweight, however, don’t replace the sugar you’ve cut back on with other foods (except vegetables, salads stuff and fruit) – you need to cut back on total energy intake to lose weight. This is important, as the recommendations are healthy eating guidelines aimed at people with a healthy weight for their height. When you need to lose weight, all bets are off. For many people, the most effective way to lose weight is to cut back on free sugars and carbohydrates while eating more protein in the form of a low GI, paleo-style diet.

Sugar on food labels

food_labelA lot of sugar is hidden within manufactured foods, sometimes disguised on healthy-sounding labels such as ‘natural fruit sugar’, or ‘sweetened with fruit juice’. These still count as free sugars.

A can of cola may contain 30g free sugar (7½ teaspoonfuls), a serving of cornflakes can provide 17g free sugar (4½ teaspoonfuls) while a serving of savoury tomato soup can hide as much as 12g free sugar ( 3 teaspoonfuls).

Even flavoured waters can include several teaspoons of sugar per bottle.

A typical 150ml glass of red wine provides less than half a teaspoon of sugar, but sweeter wines provide more. A 100ml glass of sweet Sauternes could set you back 13g of sugar (over 3 teaspoons sugar) with the alcohol providing additional excess energy.

You may need to do some separate sleuthing to find out exactly how much sugar is included in your favourite tipple as bottles only usually declare total energy per serving plus units of alcohol.

So, best advice if you want to cut back on sugar is to check labels where possible, select those with the lowest sugar and energy values, cut back on serving sizes (or at least don’t super-size) and aim to re-train that sweet tooth so you need less sugar (or artificial sweeteners) overall.

Another key recommendation from the new guidelines is to eat more fibre, as this helps to slow the absorption of dietary sugars to reduce their glycemic load.

The full SACN report is available one line, plus a supporting document that is more easily digested, called Why 5%?

Healthier sugar alternatives

In the real world, not everyone finds it easy to follow national eating guidelines – especially when  recommendations are constantly changing. When you need added sweetness, and are struggling to reduce your sugar intake to no more than 25g or 6 teaspoons per day, how can you avoid following a bland, bitter diet?

Whole fruits such as berries provide a welcome touch of sweetness.

You can use an artificial sweetener such as sucralose, but if you are sensitive to its laxative effects, or if you prefer a more natural alternative, some sugar substitutes have less impact on your blood glucose levels than others. These sweeteners may be a healthier option than table sugar (sucrose) but you still need to keep their use to a minimum as you wean yourself away from sweetness.

Stevia as a sugar alternative

Stevia is derived from the leaves of a South America plant, which contains substances (stevioside, rebaudioside A) that are at least 30 times sweeter than sugar.

I’ve picked and chewed a fresh stevia leaf in the Brazilian Amazon and it remains my go-to sweetener of choice. The best brands contain pure powdered stevia leaves, which you use in tiny amounts, or provide bulk in the form of fructo-oligsaccharides –  prebiotic fibre which also offer some natural sweetness and, in addition, are beneficial for bowel bacteria balance.

Other brands have opted to mimic the granular nature of sucrose sugar and mix stevia extracts with sugar alcohols such as erithritol. These may only contain 1% stevia leaf extracts.

Stur Liquid Water Enhancer which is sweetened with stevia are designed to be squirted into water to make a tasty drink that’s far healthier than fizzy soda.

Coconut palm sugar as a sugar alternative

Coconut palm sugar is the crystallised sap collected from the flowers of coconut palms. It has a similar nutritional profile to that of brown sugar and mainly consists of sucrose plus small amounts of free glucose and fructose. Coconut palm sugar provides small amounts of B vitamins (even vitamin B12), iron and magnesium, and is a better choice than white sugar as long as you don’t have too much. Palmira jaggery has a lower glycemic index than table sugar (40 compared to 63 for refined table sugar).

Palmyra jaggery as a sugar alternative

Palmyra, or palm jaggery, is an unrefined sugar made from the sap tapped from palm trees. Coconut jaggery and data jaggery is also available. These are dark and rich, with a caramel flavour that is a great alternative for white sugar in baking. Palm jaggery has a relatively low GI of around 40 and contains less fructose than most other sugars. Jaggery also provides some vitamins, including vitamin B6 and vitamin B12, as well as being a useful source of calcium, iron and potassium. It remains high in calories, however, so as with most sugar substitutes, use jaggery in small amounts.

Date syrup as a sugar alternative

Date sugar is literally made by grinding up dried, sugar-rich dates, such as Medjool dates, although it doesn’t count as one of your 5-a-day! Date syrup is made by adding date sugar to water to obtain a syrup consistency. Every 100g of date sugar provides 84g of sucrose sugar, with the remaining weight consisting of other non-sugar carbohydrates, pectin fibre, protein and water. Date sugar also provides some vitamin B1, vitamin B2, vitamin B3, vitamin C and iron. Again, it’s a better choice than processed white sugar, but use sparingly.

Maple syrup as a sugar alternative

Maple syrup is made from boiled tree sap and, because it contains water to dilute the natural sugars, has less sweetness, a lower glycemic index of around 54, as well as fewer calories. Maple syrup contains useful amounts of nutrients such as vitamin B2, manganese and zinc. It also contains some antioxidant tree polyphenols similar to those that give tea and red wine some health benefits. Although maple syrup is not that different to white sugar, it is a better option to drizzle sparingly on your porridge or pancakes to provide a dash of sweetness (fresh berries would be even better of course).

Sweet Freedom as a sugar alternative

Sweet Freedom is made from sugars extracted from apples, grapes and carob, and has 25% fewer calories and a lower glycemic index (GI 35) than sugar. It’s available in paler coloured Original (to replace white sugar and other sweeteners with a neutral taste) and Dark, which is richer in taste to replace brown sugar, honey, golden and maple syrup). A chocolate flavoured version is also available.

Agave syrup as a sugar alternative

Agave syrup is made from the juice of the blue agave cactus. Its sweetness is due to a high fructose content, which has less impact on blood sugar levels than glucose (GI 27) but still needs to be kept to a minimum as described above. Agave syrup is also available in Light and Dark versions.

Yacon syrup as a sugar alternative

Yacon syrup is from an Andean  tuber that is a staple food in South America. The tuber is pulped and the juice is extracted and evaporated down. Yacon syrup has a very low glycemic index as there are hardly any glucose present – the sweetness comes from inulin, a prebiotic fibre (fructo-oligosaccharide) that tastes sweet and has the additional advantage of promoting a healthy balance of bowel bacteria. but is not digested in the small intestine and instead acts as a prebiotic fibre helping to feed beneficial bacteria. Yacon does contain some fructose but used sparingly is a healthier alternative to golden syrup.Yacon syrup has a caramel flavour similar to molasses.

Monk fruit as an alternative to sugar

Monk fruit has been used as a sweetener in China for centuries, and is also known as lo han guo the ‘longevity fruit’. Monk fruit sweetener is made from the juice, which contains natural sweeteners (mogrosides) that are at least 200 times sweeter than sugar, and are metabolised in a different way. As a result, monk fruit sweetener has no impact on blood glucose levels (zero glycemic index) and provides no calories.

Honey as a sugar substitute

Honey is the most traditional sugar substitute. It offers a concentrated source of simple sugars (GI between 30 and 50, depending on fluidity) and is up to one and a half times sweeter than table sugar, so less is needed. Some types of honey provide medicinal benefits derived from the plants on which the honeybees have foraged. Of these, the best known as Manuka honey.

Honey does have a relatively high fructose content (around 52%), but raw honey has a lower glycemic index (GI 30 to 40) than processed honey (GI 60-70) so raw honey is the best version to opt for. Don’t give any type of honey to infants under the age of 1 year as their immature digestive system may not be able to protect them against certain bacterial spores that are sometimes present.

Sugar alcohols as sugar alternatives

Some sweeteners, such as xylitol, erythritol, lactitol, sorbitol and maltitol, are derived from sugars and are known as sugar alcohols. Despite their sweet taste, they are not processed in the body like sugars. Erythritol, sorbitol, lactitol and xylitol do not raise blood glucose levels but maltitol raises blood glucose levels to the same extent as sucrose.

Xylitol is the sugar alcohol of choice if you wish to use these on their own. It was originally derived from the bark of the birch tree and has 40% fewer calories than sugar, a low GI of 7, and has the advantage of actively protecting against tooth decay.

Erythritol is often blended with stevia to produce a low-glycemic sweetener which can be used in a similar way to granulated sugar.

Sugar alcohols are widely found in ‘low calorie’ foods, but their use is limited by their laxative effect. This is not always a bad thing, of course, but some people are more sensitive to this effect than others. Eating more than 10g to 20g sugar alcohols per day can cause flatulence, bloating and diarrhoea so use them with caution.

Which sweetener do you prefer?

Image credits: humusak/pixabay; ris_a_mui/pixabay;



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Dr Sarah Brewer
QUORA EXPERT - TOP WRITER 2018 Dr Sarah Brewer MSc (Nutr Med), MA (Cantab), MB, BChir, RNutr, MBANT, CNHC Cert IoD qualified from Cambridge University with degrees in Natural Sciences, Medicine and Surgery. After working in general practice, she gained a master's degree in nutritional medicine from the University of Surrey. Sarah is a registered Medical Doctor, a registered Nutritionist and a registered Nutritional Therapist. She is an award winning author of over 70 popular self-help books and a columnist for Prima magazine.

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