- Meet Consumers/Patients
|Nutrition and You: Sugar|
How Sweet It Is—Sometimes Too Sweet!
Sugar makes our food tasty and provides energy in the form of calories. It is the "simple” form of carbohydrate that is found in fruits (as fructose), fruit juices, and table sugar, for example. The average person in the United States consumes about 22 teaspoons of sugar per day — nearly 360 calories from sugar alone and more than 10 teaspoons above the upper daily consumption limit recommended by the Food Guide Pyramid.
The unhealthy links between excessive oral sugar consumption and dental caries and childhood obesity are well known. But did you know that some of the unpleasant gastrointestinal (GI) side effects that we may experience are related to how we digest and absorb excessive amounts of sugar? Our taste buds may welcome the sweetness, but our guts don’t like sugar — at least not in very high quantities all at once!
Where’s the sugar?
Sugars are naturally present in some foods; fructose in fruit and lactose in milk are sugars. Most of the sugars in our diets, however, are added in preparation and processing. These include white and brown sugar, corn syrup, corn syrup solids, malt syrup, maple syrup, fructose sweetener, and liquid fructose. More than one-third of the added sugar in our diets comes from sugar-sweetened beverages (soft drinks, fruit drinks, fruit punch, sports drinks, energy and vitamin water, sweetened ice tea, cordials, and lemonade).
High fructose corn syrup is added intentionally during food processing to increase the palatability of beverages, cereal, baked goods, dairy products, and confections. Ironically, sugar consumption has risen dramatically over the last few decades as health-conscious Americans choose low fat foods and food manufacturers respond by adding inexpensive high fructose corn syrup and other sweeteners to many products.
Food manufacturers also add sugar alcohols, including sorbitol, erythritol, mannitol, and xylitol, to sweeten many dietetic products, such as sugar-free gum, mints, and candies. These sugars are also added to non-food items such as toothpastes, cough syrup, and other liquid medications. Because they are low-digestible carbohydrates, sugar alcohols provide sweetness while decreasing total calories.
Artificial sweeteners or sugar substitutes may also be used instead of sugar. These substances are chemicals or natural compounds that are many times sweeter than table sugar. Consequently we can use much smaller amounts of artificial sweeteners to get the taste we want without added calories or unpleasant GI side effects. Saccharin, used in Sweet N’ Low, is 300 times sweeter than sugar; aspartame, used in NutraSweet and Equal, is 200 times sweeter than sugar; and sucralose, better known as Splenda, is nearly 600 times sweeter than sugar. The National Cancer Institute (www.cancer.gov) reports that artificial sweeteners are safe and moderate use does not increase cancer risk.
What happens in the gut?
Low-digestible carbohydrates such as sugar alcohols are not completely digested or absorbed in the small intestine and are partially fermented in the large intestine, producing gas. In healthy intestines, carbohydrate malabsorption can occur after consumption of small amounts of sugar alcohol, causing abdominal cramps, bloating, gas, and diarrhea. The same symptoms may occur when significant amounts of fructose and large amounts of sucrose are consumed; they may exceed the absorptive capacity of the small intestine.
Intolerance may result from a high osmotic load, rapid intestinal transit, impaired absorption, and/or bacterial overgrowth in the distal small bowel. (High osmotic load refers to unabsorbable water-soluble solutes that remain in the bowel and retain water.) Unpleasant side effects may be worse in individuals who have had gastric surgery or a diagnosis of pancreatic insufficiency, inflammatory bowel disease, celiac sprue, short bowel syndrome, and certain inborn errors of metabolism.
Finding a Balance
How do we satisfy taste and minimize unwanted GI side effects? It’s a balancing act. Remember that sugar primarily adds extra calories to your diet and foods high in added sugar are generally low in nutritional value.
If you do not eat a lot of sugar and do not experience unpleasant side effects, enjoy! If you wish to decrease the amount of sugar in your diet, become an avid food label reader. If the amount of sugar in grams per serving exceeds 50 percent of the total quantity of carbohydrates in grams per serving, the product has too much sugar and should be avoided.
If you crave sweetness, choose natural sources of sugar, such as fruits, vegetables, and dairy products, and benefit from the vitamins, minerals, and fiber that come along with it. Make a smoothie by blending fresh fruit (such as strawberries and banana) with ice cubes. Avoid consuming large amounts of foods with high fructose corn syrup or sugar alcohols.
You can flavor beverages
with fresh berries, peaches, limes, lemons, or oranges. Tomato and vegetable
juices are healthy options to replace fruit juices if you can get away with the
high sodium content. Consume sports drinks sparingly as long as you are not an
endurance athlete or participating in a marathon. Select water as a healthy
alternative to sugar-sweetened beverages unless you have been instructed to
drink oral rehydration solutions. Use moderate amounts of artificial sweeteners.
Finally, if you absolutely must have sugar, take a small taste or sip of your
favorite sweet and savor it for a long while.
column has been compiled and reviewed by Marion Winkler, PhD, RD, CNSC; Carol
Ireton Jones, PhD, RD; Laura Matarese, PhD, RD, LD, FADA, CNSD; and Cheryl
Thompson, PhD, RD, CNSD.
LifelineLetter, May/June 2010