Sugar.  Everyone loves to hate it. But is it REALLY all that bad?

With the exception of fat, no other single nutrient has been more maligned and misrepresented than carbohydrate.

Sugar, as it’s commonly known, has been singularly scapegoated as the culprit behind our expanding waistlines, chronic diseases, and child hyperactivity disorders – among others.

The mass media, ever thirsty for a sensationalized headline, has muddled fact and fiction, referring to sugar as a metabolic poison. Popular diet book authors and purveyors of potions and pills have profited by feeding a confused public small portions of the truth that are meant to serve their sales agendas.

But the question that nobody seems to be asking is, can something that tastes so good REALLY be so bad for health?

Why does everyone believe sugar is bad?

Sugar has been demonised by alarmist book titles like “Sweet Poison” and “I Quit Sugar,” social media, anti-sugar websites, popular magazines, and the personal trainer at your local gym. When lies and half-truths get repeated often enough, they become true in everyone’s minds (much like old wive’s tales).

But to understand what sugar has done to earn its unsavory reputation, you have to first understand what food processing has done to carbohydrate.

Food science technology allows manufacturers to isolate, extract, and manipulate starches and simple sugars, which can then be added to foods to enhance:

  • Flavor
  • Texture
  • Color
  • Sweetness
  • Shelf life

The knee-jerk public reaction is that ALL added sugar is bad news. However, this view does not take into consideration that sugary foods consumed in moderation as part of a healthy, nutrient-rich diet are unlikely to pose any significant harm.

What exactly does “in moderation” mean anyway? 

The word moderation can mean different things to different people so it’s important to draw some lines in the sand and set limits for a frame of reference.

The World Health Organisation recommends adults and children reduce their added sugar intake to less than 10% of their daily calorie intake, but suggests that a further reduction to 5% (about 25 grams or 6 teaspoons) per day would confer additional health benefits.

Sounds easy enough, but how does our sugar intake ACTUALLY measure up?

Added sugar: recommended vs. actual intakes

Unfortunately, added sugar intake in the United States and Australia far exceeds these recommendations. In the US, added sugar accounts for almost 270 calories, or 13% of daily energy intake. The highest sugar intakes were found in children, adolescents, and young adults and ranged between 15 and 17% of daily energy intake.

is sugar bad?

Sugar Intake: Recommended versus actual intake. Source: https://health.gov/dietaryguidelines/2015/guidelines/chapter-2/a-closer-look-at-current-intakes-and-recommended-shifts/

According to recent health survey data released from the Australian Bureau of Statistics, Australians are consuming 60 grams of added sugar per day (14 level teaspoons of white sugar). Children, adolescents, and young adults were most likely to exceed the WHO recommendations, with males aged 14-18 years found to be consuming 22 teaspoons of added sugar per day (and the top 10% of male teenagers consuming as high as 38 teaspoons of free sugars per day).

In both countries, beverage intake was responsible for the highest intakes (including soft drinks, sports and energy drinks, fruit and vegetable juices). Leading food sources included muffins, cakes, and confectionary.

Is sugar making us fat?

Is sugar bad for you? If in a Big Gulp, then yes!While all the alarmists would have you believe that a single granule of the sweet stuff on your tongue will make your ass wider than an axe handle, the evidence clearly shows that the devil is in the dose – and we’re chowing it down by the truckload.

Foods high in refined sugar are also high in calories and low in nutrient density so it’s easy to eat a lot of them. They are less satisfying which can leave you feeling hungrier sooner and more likely to reach for the next doughnut and can of Coke.

Further reading: Check out these articles on satiety and nutrient/energy density.

Before we start pointing fingers, remember that the current obesity epidemic is due to not only the overconsumption of refined, high sugar, high fat, high calorie junk foods, but also the epidemic levels of physical inactivity (i.e., long hours chained to a desk, playing video games, using messaging apps, etc). According to the World Health Organisation, 1 in 4 adults is not physically active and 80% of the world’s adolescent population is insufficiently physically active.

Translation: we’re easily putting down the calories, but we’re not doing enough to burn them off. Sugar is at the scene of the obesity crime, but it clearly isn’t a “lone shooter.”

Sugar 101: back to basics

So what is sugar anyway?

Time to get back to basics. There are six nutrients, three of which provide calories. They are: protein, fat, and carbohydrate.

You might be thinking, “hey, wait! Where’s sugar?”

Simply put, sugar IS carbohydrate, but in its most basic form.


The simplest of carbohydrates are called “monosaccharides.” They are:

  • Glucose
  • Fructose
  • Galactose


Carbohydrates that contain two monosaccharides are called “disaccharides.”  Common examples are:

  • Sucrose (table sugar) – formed from glucose and fructose
  • Lactose (milk sugar) – formed from glucose and galactose

Both monosaccharides and disaccharides are commonly referred to as sugars. In general, the smaller the molecule, the sweeter the taste.


Long-chain complex carbohydrates (known as polysaccharides) are comparatively less refined and therefore less sweet on your tongue. Examples of polysaccharides include:

  • Starch – this is the carbohydrate stored in plants. Humans have an enzyme called amylase that allows us to break down starch into glucose.
  • Glycogen – this is the storage form of carbohydrate in humans and animals.
  • Cellulose – this is the strong, thick fiber that gives vegetables and fruits their rigid shape and structure. Humans cannot digest it since our enzymes are unable to break the chemical bonds that hold it together.

What are the different types of sugars?

Natural sugars

Natural sugars are “naturally” present in foods. Fructose, for example, is the naturally occurring sugar that gives fruit its sweetness.

As a fruit ripens, longer chain carbohydrates called starches break down into simpler, sweeter sugar molecules. Honey also derives its sweetness from fructose.

Refined sugars

Refined sugars are made via the processing and refining of starches.  In the case of sucrose, the processing of starches in sugar cane or sugar beets produces the sweet tasting white crystals most people recognize as table sugar.

Added sugars

“Added sugars” can be either natural or refined such as those added to foods. Commonly added sugars include table sugar, high fructose corn syrup (controversial and frequently maligned), as well as supposedly healthier sweeteners like agave nectar and honey.

Whoa!  Supposedly healthier? What does that mean? Are honey and agave nectar REALLY healthier than sucrose or high fructose corn syrup?

Is honey healthy?

While it is true that honey, especially raw honey, contains trace amounts of vitamins, minerals, phytonutrients and even amino acids to varying degrees depending on the type, the contribution of these nutrients to a healthful diet if consumed regularly has not been well established.

A current review of the scientific literature shows that the health benefits attributed to honey are often associated with ingesting large amounts (50-80 grams). Thus, the supposed benefits of honey could be due to the additive effect of these trace elements.  If this is true, then honey’s benefits come at a relatively high caloric cost (i.e., high energy, low nutrient density).

A recent report by the Food Safety News found that about two-thirds of commercially produced honey has been filtered to the point that it no longer contains any traces of pollen and can’t be identified as true honey.

Is agave nectar healthier than sugar?

Agave nectar has been shown in mice to moderate weight gain, glucose, and insulin levels compared to sucrose.

In a human study of adults aged 20 to 45, consumption of 50 grams of agave nectar elicited a lower blood glucose response compared to the equivalent amount of sucrose. However, a greater level of nausea was reported in the agave nectar group.

Agave nectar is very high in fructose, almost 85%, which would explain its beneficial effects on blood glucose response, but in the high doses found in many junk foods, it can contribute to obesity and poor health.

Despite some early positive press, agave nectar has lost its shine as a media darling. It’s now been trashed and tossed onto same heap as other refined sweeteners like high fructose corn syrup.

Once you get past all the marketing hype, most sweeteners, including honey, are surprisingly more alike than they are different. You need only look at their chemical composition to understand why.

Chemical composition of different types of sugar

Chemically speaking, table sugar, the dissacharide derived from sugar cane, is composed of the monosaccharides glucose and fructose where glucose and fructose occur in equal amounts.

High fructose corn syrup (HFCS), also a glucose and fructose solution, is made from corn. It is produced as HFCS-42, HFCS-55 or HFCS-90, which contain 42 percent, 55 percent or 90 percent of fructose, respectively.

Likewise, agave nectar is a mixture of glucose and fructose obtained by refining the agave plant.

Even honey is little more than a solution of glucose and fructose, with the exact ratio of glucose to fructose varying from product to product, though often occurring at or near a 1:1 ratio. Pollen is filtered to make it more aesthetically pleasing. Unfortunately, the sweet-tasting end products offer comparatively little nutritional value.

Natural sugar guilty by association

In our zeal to slay the sugar monster, we have thrown out the natural sugar baby with the added sugar bathwater.

Some self-styled nutrition experts have slammed fruit by naively reasoning that because it contains fruit sugar, and fruit sugar contains fructose, it must therefore be bad for you.

What critics consistently neglect to acknowledge is that an orange (which contains fructose the way nature intended) also provides valuable fiber, vitamin C, potassium, folic acid and a whole slew of other important micronutrients and phytonutrients.

Because of these other food constituents (fiber in particular), the food leaves the stomach slower and leads to a slower rise in blood sugar (as opposed to a can of Coke).

For more information, check out this article on fruit sugar and health on this site.

Right, so refined sugar may not be good for me, but is it BAD for me?

Based on the current science the best answer to this question is kinda, sorta, maybe, but this ambiguity must be put into context.

Commercially-produced sweeteners are derived from whole foods. At their core, they possess some combination of the naturally occurring sugars, fructose and glucose.

The difference is, when eaten in the original unprocessed whole foods, these sugars and the starches they come from are diluted, distributed, and evenly balanced out by a combination of other healthy nutrients (i.e., fiber, phytonutrients, protein, fat, vitamins, minerals).

The refining process distorts this balance and comes at a high nutritional cost – very high in calories and low in nutrient density Still, the fact that refined sugar isn’t a chock full of wholesome nutrition does not necessarily make it bad for us.

Fructose intake and fatty liver?

Unlike glucose, fructose is metabolized in the liver. There are conflicting opinions, but research on fructose suggests that consuming very LARGE AMOUNTS of this monosaccharide may have a negative impact on your health and contribute to conditions like fatty liver in some people. Nearly anything in moderation can potentially be harmful in excess – and sugar is no different (excessive water intake can kill you too).

It is important to note that many of the fructose studies were conducted in rats or on small groups of obese individuals. Therefore, these results may not readily apply to healthy weight or mildly overweight people.

Much of the research to date included the ingestion of pure fructose solutions at very high levels, which are not representative of the amounts consumed in the average diet.

The real take home message here is that findings from available fructose studies do not provide any compelling evidence against moderate consumption against a backdrop of an otherwise diverse and healthy diet.

Moreover, it is important to acknowledge that the facts have been misrepresented by the mainstream media and self-styled nutrition “experts,” usually for a sensationalized story line or as marketing fodder.

So sugar is not a bad, rotten, evil poison after all?

Sugar is sugar is sugar – empty calories that aren’t necessary. For those who are eating a diverse and nutrient dense diet, occasionally drizzling your favorite whole wheat pancakes in a little syrup is probably okay and does not pose any clear or well-established risk to your health.

However, routinely drenching pancakes made from refined white flour in agave nectar and washing it down with a 2-liter bottle of Coke is clearly not going to do your health any favors.

Bottom line: sugar redeemed

The issue with sugar may not be one of “good versus bad” but rather one of “some versus too much.” It has been my experience that people who cut down the added sugar from their diet don’t miss it (this nutritionist included). So, while accustomed to the sweetness of added sugars, when given the chance, tastes buds happily and naturally recalibrate.

This strategy, by default, results in a more nutrient-dense diet which leaves the stomach slower, leaving you feeling fuller for longer, and therefore less likely to overeat. People who lose weight and keep it off through a diet low in refined sugar do so mainly as a result of continued calorie control – and less so because “sugar is a poison.”

Additional Reading

Schneider, Andrew. “Tests Show Most Store Honey Isn’t Honey.” Food Safety Network. November 1, 2011. http://www.foodsafetynews.com/2011/11/tests-show-most-store-honey-isnt-honey/(link)

Hooshmand Shirin, Holloway Brittany, Nemoseck Tricia, Cole Sarah, Petrisko Yumi, Hong Mee Young, and Kern Mark. Effects of Agave Nectar Versus Sucrose on Weight Gain, Adiposity, Blood Glucose, Insulin, and Lipid Responses in Mice. Journal of Medicinal Food. September 2014, 17(9): 1017-1021. doi:10.1089/jmf.2013.0162. (link)

Cravinho,A, Hammon, M, Rieger, K, Kern, M. Acute Ingestive Effects of Agave Nectar Versus Sucrose in Healthy Young Adults. The FASEB Journal. 29(1) Supplement 596.17. (link)

Willems, JL & Low, NH. Major Carbohydrate, Polyol, and Oligosaccharide Profiles of Agave Syrup. Application of this Data to Authenticity Analysis. J. Agric. Food Chem., 2012, 60(35): 8745–8754. DOI: 10.1021/jf3027342.  https://www.ncbi.nlm.nih.gov/pubmed/22909406 (link)

Bogdanov, S., Jurendic, T., Sieber, R., Gallmann, P. Honey for Nutrition and Health: A Review.  J Am. Coll Nutr 2008, 27:677-689.  http://www.jacn.org/content/27/6/677.long (link)

Rizkalla, S. Health implication of fructose consumption:  A recent review of data.  Nutrition and Metabolism 2010, 7:82. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2991323/pdf/1743-7075-7-82.pdf (link)

Stanhope, K., Havel, P. Fructose Consumption:  Recent results and their potential implication.  Ann NY Acad Sci. 2010; 1190: 15-24.  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3075927/pdf/nihms279303.pdf (link)

Dolan, L., Potter, S., Burdock, G.  Evidence-Based Review on the Effect of Normal Dietary Consumption of Fructose on Blood Lipids and Body Weight of Overweight and Obese Individuals. Crit Rev Food Sci Nutr 2010; 50 (10): 889-918. https://www.ncbi.nlm.nih.gov/pubmed/21108071 (link)


Shaun graduated from the University of Delaware in 1994 with a Bachelor of Science in Nutritional Sciences and minors in Biology and Chemistry and then again in 1997 with a Master of Physical Therapy. A licensed Physical Therapist and Certified Personal Trainer/Group Exercise Instructor with over two decades of experience in the health and fitness industry, she has held positions as a fitness/aerobic instructor, personal trainer, massage therapist, wellness/nutrition counselor, course instructor/adjunct faculty, and an outpatient physical therapist specializing in sports medicine. To learn more about Shaun’s experience and her professional interests you can visit her Facebook page and LinkedIn profile.


  1. James Pearo

    I enjoyed this article. Very thorough and informative.

  2. Shana, RD

    Appreciate the no-nonsense information. I am also curious, since he’s not listed in the references, if you read any data/presentations from Dr. Robert Lustig? If not, I think you would find it very interesting and might even have to write a follow-up comment. Thanks!

    • Dr Bill Sukala

      Hi Shana,
      Thank you for your post. I am familiar with Lustig and I chose not to provide a platform for his alarmist views which selectively cherry pick data to support his views. Rather than rewrite it here, I would suggest you read Alan Aragon’s point by point argument (click here: http://www.alanaragonblog.com/2010/01/29/the-bitter-truth-about-fructose-alarmism/). While Lustig has clearly made some waves with his views, I believe that many are lulled into a false sense of submission because he is a medical doctor.

      It is also interesting that the general public (brainwashed by the media) and other self-styled nutritionists (not dietitians) claim that doctors know nothing about nutrition. Yet the minute a doctor writes a book on nutrition or comes out with some theory of their own, everyone goes out and spouts off their ideas as if they were the gospel. I do think it is good to challenge paradigms, though there should also be more rigorous scrutiny to ensure that some obscure theory does not become regurgitated dogma by the masses.

      Kind regards,

  3. Shaun Bevins

    Just wanted to add my 10 cents in response to Shana’s comment. I think one point many of “us” would like to stress is there is a difference between saying something is innately bad and saying that too much of something combined with other variables has the potential to contribute to bad outcomes.

    No one here is arguing that sugar is a super food, but to call it poison (unequivocally), IMO, misses the mark. Pointing the finger at one food or even one behavior is naive and potentially dangerous in the sense that it can prevent us from addressing the real problem(s).

    When it comes to obesity there are likely a number of contributing factors, factors that include: stress, poor sleeping habits, a sedentary lifestyle, too many processed foods (meat, fats, and carbs), too many calories, and maybe even genetics and other environmental factors that haven’t been identified.

    Unfortunately, common sense and moderate views don’t sell books.

    Most nutritionists I know would agree that people are eating way too much refined sugar…but that doesn’t make sugar innately bad. Splitting hairs? Not when you consider that this kind of alarmist view is used to vilify foods like fruits.

    The other thing that happens is marketing gurus are all too happy to exploit these alarmist views…think agave nectar…or honey…or even rice syrup. All these sugars have chemical structures that are similar to high fructose corn syrup. There are some minor differences, but not enough to make them substantially different, yet people get duped into thinking brownies made with agave nectar are “healthier” than those made with white sugar.

    Historically, when it comes to diet, these extreme/alarmist views get attention, but the wrong kind. One need only to look at the no-fat craze of not so long ago to see how demonizing a nutrient outside the context of a complete diet only makes things worse. I personally try to get people to cut back on sugar…not because I think it is poison, but because most of us are eating too much, period.

    Last point…there is nothing wrong with trying to understand the impact of sugar/fructose on the body. Nutrition is a science, and science changes and grows. But anyone who understands the science, understands you can’t simply look at one, two, or even three studies to get a true understanding of the impact of a single nutrient. It is really a gradual building of information that over time allows us to draw conclusions with some level of confidence. I can appreciate Dr. Lustig’s view even if I don’t agree with the extreme nature of those views. At the end of the day, we’d both like to see people eat less sugar.

    Most nutritionists are happy to follow the science where it leads, but only when there is compelling evidence to support the science.

  4. Daniel

    This was a delightful article. I’m glad to have here a summary of the dozen hours of research I did for a paper on the American diet I recently wrote.

    I am a pre-med student. I am sad to admit that it’s nearly impossible for the average American to attain reliable information about their health. We live in a corrupt and declining country with fascist tendencies where war and exploitation are prioritized over people’s lives and well being.

  5. Cynthia Neal

    May need to rethink this one with the recent revelation of sugar industry’s research payoff to conceal the truth that sugar is bad for us!!! And to think they let good old salt take the wrap all these years!

    • Dr Bill Sukala

      I believe the sugar article is fair and balanced and still stands despite that other article (sad). A little sugar is one thing but a lot is an issue.

  6. C

    Some of us gave up reading food labels altogether. We went back to cooking from scratch, sourcing our ingredients from the most reputable and smallest producers we could find (amish, etc.), and growing our own. Many countries do not have truth in food labeling. Daniels comment is right on.


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