SUGAR is a hot topic in general and even more so when it comes to cancer. In this guide we aim to help you reduce the added sugars in your diet and explain the ‘sugar and cancer’ debate.
By Sadia Badiei, BSc Dietetics and Summary by Aveen Bannon, Registered Dietitian, Dublin Nutrition Centre
Sugar, deliciously sweet but a sneaky little ingredient that’s in a considerable amount of foods! Despite its delicious and innocent taste, excess sugar in the diet is linked to a variety of preventable health conditions. Although it’s easy to label all sugar as “bad”, there are types that, when eaten in moderation, may have nutritional benefits. The key message is not that we need to completely avoid all sugar but that we need to reduce our intake of added sugars.
Types of Sugars
Sugar is a type of carbohydrate found in both food and beverages. Once eaten, sugar is broken down into glucose which is ultimately used for energy. In fact, glucose is the preferred source of fuel for both the brain and our muscles.
Natural vs. Added Sugars
When the World Health Organisation (WHO) recommended that we reduce our sugar intake to less than 10% of our calorie intake, they meant ‘free’ sugars (which are also known as ‘added’ sugars). They specified that they were not including the naturally occurring sugars in fruit (fructose) or dairy (lactose).
These are naturally occurring in foods (i.e. not added). These include the sugars that are naturally occurring in some shape or form in practically all whole fruits, vegetables, dairy and grain products.
These not only add sweetness to foods, but manufacturers add them into products to serve various other functions: preservation, texture and mouth-feel, volume, and rich colour resulting from caramelisation. They can be found in:
+ fizzy drinks
+ sweetened coffee or flavoured tea drinks
+ energy or sport drinks
+ many store bought cereals and soups,
+ desserts such as ice cream or pudding
+ cookies, muffins, cakes etc.
Remember sugar has many disguises! Added or ‘free’ sugars are the sugars that are added to a food either in production or by us. These sugars can include table sugar, glucose, sucrose, honey, syrup, agave nectar and more. Once they have been added to the food they are considered a ‘free sugar’. These are the ones we need to reduce in our diets.
Effects of Excess Added Sugars
+ type 2 diabetes: has been linked to the habitual consumption of sugar-sweetened beverages.
+ weight gain: is connected to excessive intake of sugar. Having excess weight or obesity increases the risk for chronic illnesses such as hypertension, type 2 diabetes, coronary heart disease and various forms of cancers.
+ fatigue: simple sugars can lead to spikes in blood sugar levels, which can come crashing back down making you feel tired and groggy. Complex sugars and carbohydrates break down slower, keeping the blood sugar more stable.
+ cavities: there is a strong association between sugar-sweetened beverages and dental cavities in children, though adults can get cavities just as easily.
+ maple syrup
+ blackstrap molasses
+ agave syrup
+ corn syrup
Ultimately liquid sweeteners are sugars, too. They contain about the same amount of calories as white sugar and are generally metabolised in the same way. Some have trace minerals in very small amounts. While we might love to use these sweeteners for their wonderful flavours and consistencies in particular recipes, they should still be consumed in moderation.
+ acesulfame potassium
These sugar substitutes are zero- or low- calorie alternatives to the sugar options mentioned above. Many companies use them to market their products as “sugar-free”, “diet” or “no calories”. They are found in many diabetic products because they have little or no effect on blood sugar levels. Some can be made from natural leaf extracts, and some are manufactured. Most artificial sweeteners are also remarkably sweeter when compared to table sugar, meaning smaller amounts can be used to create the same sweetness level.
Considerations with artificial sweeteners
a. conflicting evidence
According to the most recent meta-analysis, artificial sweeteners have not been linked to health outcomes such as diabetes, kidney disease, high blood pressure, certain cancers or dental health. However, according to other analyses, they have been associated with increased BMI and other complications. In short, there are biases and limitations to the studies conducted so far and more research is needed.
b. compensating for other sugary foods
As a dietitian I have seen that when people consciously know they are having artificial sweeteners with no calories, they mentally feel they can compensate with something that does have sugar later on. This is similar to exercising and then treating yourself with an indulgent food as a result.
c. potential GI intolerances
Some artificial sweeteners include sugar alcohols, which if consumed in large amounts (say, in a beverage) can have a laxative effect.
d. can it really trick the brain?
Consuming artificial sweeteners lights up similar regions of the brain in terms of satisfaction, as with all other types of sugar. Therefore, artificial sweeteners may not actually help curb sugar cravings from the root because we still tend to crave something sweet. In fact, one study suggests that we use sweet taste to predict the calories in a particular food. And when our bodies receive these non-caloric sweeteners instead, it realises the discrepancy and continues to crave, and can potentially make you eat even more.
Bottom line: I recommend whole food sources above processed foods including added sugars or artificial sweeteners. There is not enough conclusive evidence to lean one way or the other in terms of long-term health effects. Therefore, if you enjoy the flavour and find you do not compensate for sugar elsewhere in your diet, including artificial sweeteners is likely safe included in small amounts.
Spotting Hidden Sugars in Ingredient Lists
When it comes to the ingredient lists of foods, only added sugars are listed. Granulated sugar is easy to spot in the ingredient list. But, food manufacturers can still add sugar in many other ways. Here are some more common types of sugar that can be added:
+ cane sugar
+ invert sugar
+ liquid sweeteners (mentioned above)
Hint: any ingredient that ends in ‘ose’ or has ‘syrup’ in the title is likely a source of added sugar.
Advice for your future
Excessive sugar intake in the form of added sugar, specifically in sugar sweetened beverage can contribute to an increase risk in weight gain, diabetes, cavities and other chronic illnesses.
“A rose by any other name…”
Sugar can be disguised as many things, and it’s valuable to be able to spot a source of sugar in an ingredient list to know what you are buying.
When you can, go for homemade
You have more control over what goes into your recipes and meals when you are in control of the ingredients. This allows you to sweeten dishes using food sources such as fruits in place of refined sugars when possible.
Not all sugar is “bad”
Natural sugars from food sources, like fruit, are delicious and have added benefits of vitamins, minerals, and fibre. Restricting absolutely all sugar from the diet is practically impossible and not recommended.
10 tips to manage sugars
Reduce: For most recipes, you can reduce the amount of sugar by at least 1/4 without noticing a large difference in the taste or texture.
Substitute: Try using dried fruit, apple sauce, dates or mashed banana to replace some of the sugar in recipes such as muffins or cookies.
Spices & extracts: Using spices such as cinnamon or pumpkin pie spice, and pure extracts such as vanilla, almond or lemon can help give flavour without adding sweeteners.
Hydrate: Thirst is often mistaken for a sugar craving.
If you are craving a sweet beverage, try drinking a glass of water first.
Speaking of fluids: Limit fizzy drinks and energy drinks. Try these ideas instead:
+ jazz up your water by adding sliced strawberries or cucumbers
+ dilute 100% fruit juice with water to give your water some flavour and cut down the sweetness of the fruit juice
Do-it-yourself: purchase plain yogurts with no added sugar – you can add your own fresh fruit to the yogurt to give it a touch of sweetness.
Incorporate fruits: If you crave something sweet after meals, opt for fruit instead of sweets, biscuits or cakes:
+ frozen banana halves dipped in yogurt with a sprinkle of almonds
+ baked apple pieces with sprinkle of cinnamon
+ frozen grapes
Sneaky condiments: Condiments can have a surprisingly high amount of sugar added to them. When possible, make your own salad dressings, jams, and spreads so that you can control the sugar.
Read labels: Spotting the sugar in the foods you buy will help you become a more savvy shopper.
Give it time, YOUR taste buds WILL CHANGE: Decreasing your added sugar intake over time will “re-train” your tastebuds to appreciate the natural sweetness of foods.
SUGAR & CANCER
By Aveen Bannon, Registered Dietitian, Dublin Nutrition Centre
Sugar has certainly been a hot topic of debate in nutrition in recent years which has led to increasing concern and confusion about sugar in the diet and it’s relation to cancer.
The sugar debate is not a new concept but in 2015 the World Health Organisation (WHO) updated guidelines recommending that ‘free’ or added sugars should be less than 10% of total calorie intake with a view to reducing this figure to be less than 5% of total calorie intake.
Let’s break it down… Sugars come from carbohydrates. Carbohydrates include starchy foods like potatoes, bread and rice and also refined carbohydrates like sugar and honey. Almost all of the carbohydrates we eat will ultimately be converted into glucose, which is the bodies preferred source of fuel. Glucose is the basic fuel that powers every single one of our cells. If we eat or drink things that are high in sugar e.g. sweets and fizzy drinks, the body converts the sugar into glucose quickly and it gets absorbed straight into our blood ready for our cells to use. With a starchy food like potato the body has to work harder to break it down and convert it into glucose and the glucose will be released into our blood slowly. If there is no carbohydrate in our diet, cells can turn fat and protein into glucose as a last resort, because they need glucose to survive.
This is where the confusion can happen… If all cells need glucose, so do cancer cells. So there was a thought process, if cancer cells need lots of glucose, then cutting sugar out of our diet must help stop cancer growing. Unfortunately, it’s not that simple. As all our healthy cells need glucose, there is no way of telling our bodies to let healthy cells have the glucose they need, but not give it to cancer cells.
What we do really need to focus on is taking less added sugars and choosing the healthier forms of carbohydrates in the right portion size. Too much sugar in our diet can lead to weight gain and obesity is a risk factor for certain cancers. Focus on including lots of whole grains, fruits, vegetables and lean proteins in your diet. By choosing healthier foods to include every day and limiting treats, your overall diet will become healthy and balanced. Avoid sugary drinks and drink water with meals.
This feature on Sugar appears in Issue 2 of Happy Magazine.
A big thank you to both Sadia and Aveen for supplying us this content.