Sugars and Health
What are carbohydrates?
Carbohydrates include starches, sugars, and fibre, which are found mostly in the Grain Products, Milk and Alternative, and Vegetables and Fruit food groups of Eating Well with Canada’s Food Guide.
Carbohydrates are also found in other foods such as jam, honey and
soft drinks. The body breaks down starches and sugars into the sugar
glucose. Glucose acts like gas in a car – it provides the
body with the energy it needs to ‘run’. Most health
authorities recommend that 45-65% of our total calories should
come from carbohydrates from a variety of sources.
What is 'sugar' and what are 'sugars'?
refers to sucrose, a carbohydrate found naturally in most fruits
and vegetables. Sucrose is the major product of photosynthesis,
a natural process that turns sunlight into energy. Sucrose is the
most abundant sugar found in nature, and occurs in the greatest
quantities in sugar cane and sugar beets, which are used to produce
sugar commercially. While the term ‘sugar’ refers to
sucrose, the term ‘sugars’ can also be used to describe
sucrose, as well as other types of sugars found in nature such as
glucose, fructose and lactose.
To learn more about Different Sugars for Different Tastes,
What's the difference between simple and complex carbohydrates?
The term ‘complex carbohydrates’ is commonly used to
describe starches or fibre and ‘simple carbohydrates’
is often used to describe sugars. However, these terms are not useful
for comparing the health effects of different carbohydrates. It
was once thought that simple carbohydrates (sugars) raised blood
sugar levels quickly and complex carbohydrates caused a more desirable
slower rise. However, research on the glycemic
index (GI) reveals that the opposite can be true. For example,
table sugar (sucrose) raises blood sugar slower than some starchy
foods like mashed potatoes, white bread or corn flakes. In fact,
a recent report by the World Health Organization and Food and Agriculture
Organization of the United Nations advises against using the term
“complex carbohydrates”. It’s best to describe
carbohydrates according to their common chemical name; e.g., starch,
sucrose, glucose, etc.
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How much sugar do Canadians eat?
The amount of sugar we use per person has not changed for several
decades. However, we use sugar differently now; Canadians cook less
with it at home but shop more for products that contain sugar. It is estimated that Canadians consume approximately 13% of their energy (calories) as added sugars, equivalent to about 53 g of added sugars per person per day. This is considered a moderate amount and well
within current dietary guidelines. “Added sugars” include
all sugar, corn syrups, honey, and maple syrup added to foods. It
does not include sugars that naturally occur in fruits, vegetables
and dairy products.
When people are looking for an estimate of sugar intake, they may
mistakenly quote statistics called "per capita disappearance"
or "sugar available for consumption" (reported as kilograms
of sugar per person per year). This "disappearance" data
is a measure of the amount of sugar produced in Canada plus imports
minus exports, divided by the population of Canada. This number
does not tell us how much sugar Canadians are actually eating. Rather,
it substantially overestimates actual intake because it includes
sugar that is wasted or used up in the process of making foods (e.g.,
bread, wine) or for non-food uses.
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Sugars and Health
Does sugar make kids hyperactive?
No. Although many believe that sugar can lead to hyperactivity and
other behavioural problems in children, several comprehensive scientific
reviews have concluded that no evidence exists to link sugar intake
to hyperactivity in normal children or those with Attention Deficit
Hyperactivity Disorder. Researchers have suggested that occasional
bouts of excess energy among healthy children may be linked to the
excitement associated with special activities like parties, holiday
celebrations and recess, not the sweets or other foods served at
Is sugar addictive?
Sugar is not addictive. Addiction refers to compulsive behaviours
characterized by a continued craving for a substance, as can be
the case with alcohol and drugs. Sugar does not produce the effects
of tolerance and withdrawal, characteristic of addictive substances.
Our preference for sweet tastes is with us from birth, but this
preference should not be confused with addiction.
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Does sugar cause cavities?
Sugars and starches in foods including bread, fruit, vegetables,
milk and breakfast cereals can promote tooth decay (dental caries).
It is not the total amount of sugars and starches ingested that
contributes to the formation of dental caries, but the frequency
of carbohydrate consumption, how long the food is in the mouth,
and if it sticks to the teeth. The longer teeth are in contact with
carbohydrates in these foods, the greater the risk of tooth decay.
However, if proper oral hygiene is maintained and fluoride used,
caries are not likely to form.
What is the best way to prevent cavities?
Although a combination of proper oral hygiene (regular brushing
and flossing of teeth) and fluoride use are the primary tools for
preventing tooth decay, dietary changes may help. With respect to
diet, it is not the total amount of sugars and starches eaten that
contributes to the formation of cavities, but the frequency of carbohydrate
consumption, other types of foods consumed, how long the food is
in the mouth, and if it sticks to the teeth.
Sugars and starches can be consumed without harmful effects when
they are ingested as part of main meals rather than eaten continuously
throughout the day. Thus, spacing meals at least two hours apart
and eating high-protein foods in combination with carbohydrates
may protect against dental caries. Also, the chewing action in combination
with raw and cooked foods in the mouth can increase salivary production,
which minimizes the effect of carbohydrates on teeth.
Carbohydrate-containing foods that are sticky and that adhere to
teeth are potentially more cavity-causing because they are difficult
to brush away and may remain in the mouth for longer periods of
time. Examples of foods that can stick between the teeth include
caramels, dried fruit, bread, potato chips and crackers. Therefore,
controlling the frequency of consumption of carbohydrate foods that
adhere to teeth can help to prevent the formation of cavities.
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Does sugar contribute to the development of diabetes?
No, sugar intake is not linked to the development of diabetes. It
was previously believed that sucrose (table sugar) and other sugars
contributed to the development of diabetes and that people with
diabetes should avoid sugars. This belief was based on the assumption
that sugars were more rapidly digested and absorbed than other carbohydrates
and would therefore cause high blood glucose levels. In fact, sucrose
and fructose actually produce a lower blood glucose response than
equal amounts of many starches like bread and potatoes. Furthermore,
recent Canadian, American and International recommendations have
concluded that sugars do not contribute to the development of diabetes
and can be included as part of healthy meal plans for people with
type 1 and type 2 diabetes. It is for this reason the Canadian Diabetes
Association does not recommend the avoidance of sugars.
Can people with diabetes have sugar?
Yes, people with diabetes can consume sugar. The Canadian Diabetes
Association (CDA) does not recommend the avoidance of sugars but
rather suggests that "naturally occurring and added sugars
should be included as part of the daily carbohydrate allowance and
as part of a healthy eating plan" for people with diabetes.
The CDA advocates that in addition to naturally occurring sugars
in fruits, vegetables and dairy products, sugars added to foods
can contribute up to 10% of daily energy requirements without harmful
effects on blood sugar or lipid control in people with diabetes.
Does eating sweet foods cause a sugar high followed by
People often mistakenly think that eating sugar-containing foods
causes a dramatic rise in blood sugar followed by an extreme low,
causing fatigue and food cravings. In fact, in healthy people, blood
sugar levels are kept within a narrow range, and fatigue and food
cravings are rarely due to low blood sugar (or hypoglycemia). The
body is able to defend blood sugar levels by secreting hormones
that regulate the storage or release of blood glucose. Studies in
humans have shown that sugar actually causes a smaller increase
in blood sugar than eating certain starchy foods such as mashed
potatoes and white bread.
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How many calories and what nutrients are in sugar?
Sugar is a source of carbohydrate and energy. It provides 4 calories
per gram or 16 calories in a level teaspoon (4 g). This compares
to 36 calories for the same amount (4 g) of fat or oil (e.g., butter,
margarine, canola oil). On its own, sugar has no other nutrients.
However, it occurs naturally in vitamin- and mineral- rich fruits,
vegetables and other carbohydrate-containing foods. It is also added
to many nutrient-rich foods to improve their flavour, texture and
Is brown sugar better for you than white?
Brown sugar is not more nutritious than white. In fact, there are
no significant nutritional differences between these types of sugars.
Brown sugar is composed of white sugar crystals that have been flavoured
and coloured by small quantities of dark sugar syrups (molasses).
Brown sugar is produced in two different ways – it is crystallized
directly from the dark syrups obtained during the refining process;
or dark sugar syrups are added to refined white sugar.
Is it better for you to eat honey instead of sugar?
Honey, brown sugar, white sugar and maple syrup all have similar
nutritional values. They all provide carbohydrate and energy, but
insignificant amounts of vitamins and minerals. Sugar and other
carbohydrate sweeteners play an important role in making other foods
taste better, and, through their many uses in food preservation,
cooking, etc., increase the variety of foods available.
Does sugar contribute empty calories?
The view that sugar contributes nothing but empty calories fails
to recognize the role of sugar in the context of the total diet.
It is important to keep in mind that most sugar is consumed as part
of the four food groups outlined in Canada’s
Food Guide. Sugar is seldom eaten as a pure
substance but as an ingredient in what is often a food high in vitamins
and minerals such as a bran muffin. In fact, sugar improves the
flavour and appeal of many nutritious foods. For example, small
amounts of sugar improve acceptance of tart fruits like rhubarb
or grapefruit and many ready-to-eat and hot cereals.
There is no evidence that sugar, at current levels of intake, displaces
other nutrients in the diet. In fact, when sugar intakes are very
low, nutrient inadequacies can occur. It is only at unusually high
levels that sugars may have a negative impact on nutritional status.
It is estimated that Canadians get about 13% of their daily energy
intake from sugars added to foods. This is considered a moderate
amount, and studies have shown that intakes at this level are consistent
with healthy eating. Sugar can be a part of a healthy balanced diet.
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How does the body use carbohydrate?
Carbohydrate is the unique fuel source for the brain and central
nervous system. To use carbohydrate for energy, it must be converted
to the sugar glucose, the body’s preferred fuel. When a carbohydrate-containing
food is eaten, the body cannot tell whether the sugar in the food
came from a fruit or vegetable or whether it was spooned from a
bowl. Sugar, regardless of its source, is broken down in the same
carbohydrate (sugar and starches) in foods become glucose –
and glucose is the only form of carbohydrate that is used directly
by the muscles for energy. Each gram of carbohydrate provides 4
calories of energy. Glucose can be used to provide immediate energy
to the body’s cells or be stored in small quantities for future
use. Excess glucose is stored as glycogen in the liver as well as
in muscle cells. Glycogen can be converted back to glucose when
the body needs energy and blood glucose levels are low. If glycogen
reserves are full, excess glucose may be stored as fat, a secondary
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Should athletes eat a lot of carbohydrate including sugar?
People who are very active (e.g., athletes) have particularly high
carbohydrate (sugars and starches) requirements. Athletes should
consume at least 60% of their calories from carbohydrate-containing
foods. During low intensity exercise, the body gets most of its
energy from body fat. As the intensity of exercise increases, so
does the percentage of energy coming from carbohydrate. Carbohydrate
is stored in muscles in the form of glycogen, and the more glycogen
people have stored in their muscles, the longer they can exercise
before feeling tired. This can be accomplished by eating carbohydrates
before, during and after high intensity exercise.
A recreational athlete who regularly eats a carbohydrate-rich diet will probably have enough carbohydrate stored to fuel activity. Eating Well with Canada’s Food Guide is designed to meet the nutrient and energy needs for the majority of Canadians. Active Canadians may require higher intakes of energy and certain nutrients, such as carbohydrate, than recommended by the Guide. The DRI report recommends that all Canadians consume 45 to 65% of their total calories from carbohydrate. This range ensures sufficient intakes of essential nutrients and is based on evidence that suggests a role for carbohydrates in the prevention of chronic disease.
What is carbohydrate loading?
Traditionally, “carbohydrate loading” was used by athletes
as a dietary training strategy over the 3 days prior to an event,
which was designed to maximize muscle glycogen stores. Glucose,
the body’s preferred fuel, is stored as glycogen in muscles
and in the liver. When muscles are exercised, they use both fats
and carbohydrates as fuel. As the intensity of the workout increases,
muscles depend more and more on carbohydrates, from glycogen and
glucose in the blood. For most people, glycogen stores are enough
to keep them going during exercise. But if an activity lasts longer
than an hour, glycogen stores may get used up, tiring muscles.
This classic method used by endurance and/or elite athletes exhausted
glycogen stores through intense exercise coupled with a low-carbohydrate
diet. When glycogen stores were depleted, a high carbohydrate diet
would then be consumed (>90% of total Calories). Athletes often
experienced low blood sugar, irritability, and chronic fatigue by
adhering to this regime. Today, evidence suggests that similar results,
without the negative side effects, can be achieved by gradually
decreasing the amount of exercise during the six days prior to competition
while progressively increasing total carbohydrate intake up to 70%
of total calories in the last 72 hours before the event.
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How does weight gain occur?
Weight gain occurs when more calories are eaten from all foods than
are used for normal bodily functions (e.g., heart beating, breathing)
and physical activity. All food sources of protein, carbohydrate
(sugars and starches), fat, and alcohol contribute calories. All
of these nutrients can be converted into body fat if eaten in greater
amounts than needed by the body. Many factors contribute to people
eating more calories than they use, including social and cultural
factors, and genetics. There is no single factor that causes weight
Is sugar fattening?
Sugar, like other carbohydrates, contributes calories, but does
not uniquely contribute to excess calories or weight gain. Sugar,
like other carbohydrates, contains 16 calories per teaspoon, whereas
fat contains 36 calories per teaspoon. Eating patterns high in fat
are more likely to lead to excess calorie intake than those high
in carbohydrate (sugars and starches). Because no single factor
causes weight gain, decreasing or avoiding specific foods or nutrients
in isolation will not prevent weight gain, or lead to weight loss.
Rather than eliminate specific foods, it’s better to match
the amount of energy consumed from food with the amount of energy
expended, which can be increased by physical activity.
Does the sweet taste of sugar encourage people to over-eat?
No. Although our appetite for sweet taste is with us from birth,
sugar and other carbohydrate sweeteners do not encourage people
to overindulge. In fact, our preference for sweet flavours is actually
reduced as we experience fullness after eating.
Are people who eat more sugar more likely to be overweight?
No. In fact, studies consistently show that the opposite is true.
People who eat more sugars are less likely to be overweight or obese
than those who eat less sugars. This observation is most likely
due to the fact that people who eat less sugars generally eat more
fat, known as the “sugar-fat see-saw”.
Should I be on a low-carbohydrate diet to lose weight?
No one has found a quick and easy way to ‘melt’ away
those pounds! Many popular diets state that carbohydrate-rich foods
will promote weight gain because they cause too much insulin to
be released, which will increase body fat. They claim that weight
loss can occur by replacing carbohydrates with protein and fat,
without eating fewer calories. The truth is that body fatness depends
on the amount of calories eaten and the amount of energy expended
through daily activities. In fact, diets that recommend less carbohydrate
and more protein are usually set up so the dieter’s total
calorie intake is reduced. The dieter is actually eating less, but
not healthier! Also, much of the initial weight loss comes from
water loss when glycogen in muscle is used to keep the dieter’s
glucose levels normal. Unfortunately, as soon as the diet stops,
that part of the weight is quickly regained. Scientific studies
have shown that eating more carbohydrate-rich foods generally leads
to a healthier diet and to a lower body weight.
What is the best way to lose weight?
To lose weight, fewer calories must be consumed than used by the
body, so a modest decrease in caloric intake and increase in physical
activity is advisable. Carbohydrates (starches and sugars) should
make up the majority of calories, just as recommended for healthy
eating. The rest of the calories will come from fat and protein.
Weight loss should be slow and steady (0.5-1 kg or 1-2 lbs per week),
To learn more about Balancing Food and Activity for Healthy Weights,
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