Nutrition Principles and Practice: Added Sugars--Finding Balance

When I was a kid, one of my favorite breakfasts on a cold morning was cinnamon toast. My mom would butter slices of bread, sprinkle them with cinnamon and sugar, and then do a quick broil in the oven. A little slice of heaven. And on mornings like today, when my youngest announced that she was "feeling un-awesome", warm cinnamon toast and a glass of skim milk helped get her day off to a better start.

But the larger food environment we live in today is very different from my childhood. Cinnamon toast was a true treat, as other than some homemade cookies and a very small glass of breakfast OJ, we didn't have a lot of added sugars in our environment. How do I balance my family's eating in our current sugar-prone environment so I can give them these treats without feeling like I am dooming their health?

Cinnamon toast

What is Sugar?

Sugars are simple carbohydrates known as mono- or disaccharides. While a great source of energy and essential for brain function, sugar by itself offers no other nutritional advantages. However, in fruits, the sugar fructose is packaged with the fruit's fiber, vitamins, minerals, and phytochemicals. A glass of milk delivers the sugar lactose along with protein, minerals, and vitamins.

The trouble begins when we move from whole foods like fruits and milk to processed foods. Even minimally processed foods often have added sugars. Unfortunately, the current Nutrition Facts panel only gives a total sugar amount. As a result, a food like chocolate milk is going to have a total sugar amount that includes the naturally-occurring lactose and the added sugars.

What are Added Sugars?

The list of added sugars can be long, but essentially added sugars are any and all sugars added by a cook or manufacturer to a food. I have complied the list below from USDA MyPlate and the American Heart Association.

agave syrup
anhydrous dextrose
brown rice syrup
brown sugar
confectioner's powdered sugar
corn sweetener
corn syrup
corn syrup solids
dextrose
fructose
fruit juice concentrate
high-fructose corn syrup (HFCS)
honey
invert sugar
lactose
malt sugar
maltose
maple syrup
molasses
nectars (e.g., peach nectar, pear nectar)
pancake syrup
raw sugar
sucrose
sugar
white granulated sugar

A recent Canadian Heart and Stroke Association document also argues that Canadians need to watch their consumption of "free sugars". By this they mean fruit juices, sugar that has been freed of its fruit form.

Why limited Added Sugar?

The Yale's Rudd Center for Food Policy and Obesity has put together a great summary of studies regarding added sugar and health. The increased consumption of added sugar has been linked to cardiovascular disease, type 2 diabetes, non-alcoholic fatty liver disease, obesity, and other negative health effects.

How much Added Sugar?

The current Canadian Heart and Stroke Association recommendation is less than 10% of your daily calories from added sugar. For a 2,000 calorie diet, this would be about 200 calories from added sugars or about 12 teaspoons. The American Heart Association general recommendation is 5 teaspoons per day for women (100 calories) and 9 teaspoons for men (150 calories).

Whether you follow the 10% rule or a blanket amount based on gender, both amounts are much lower than current US consumption. The Canadians are at 13% of daily calories (not including fruit juice). The 2005–10 National Health and Nutrition Examination Survey puts Americans at 20 teaspoons per day, with teens having the highest consumption at 34 teaspoons per day.

Calculate your Added Sugar Limit.

Estimate your daily calorie needs. MyPlate has a great table to get you started. For this example, I will use 1800 calories, the general estimate for a woman age 31 to 50.
Calculate 10%. Ten percent of 1800 calories is 180 calories.
Calculate grams of sugar. Sugar, like all carbohydrates is 4 calories per gram. 180 calories divided by 4 calories equals 45 grams. For this example, the daily limit is 45 grams of added sugar.
Convert to teaspoons. Sometimes it is easier to know the upper limit in teaspoons. Sugar is about 4 grams per teaspoon. 45 grams divided by 4 grams equals just over 11 teaspoons.

What about my kids?

For my girls, they need around 1600 calories per day. Ten percent is 160 calories. Their maximum of added sugars should be 40 grams (carbohydrates are 4 calories per gram) or 10 teaspoons of sugar a day.

I raided my pantry to get a better sense of what added sugar is in our lives.

Juice--Last year, I stopped buying juice with any regularity. As I explained to my girls, let's save our sugar for something really fun. But, we had some leftover OJ from a celebration, so each girl had a 6 oz glass this morning. Almost 17 grams. We don't drink soda or sports drinks, but a typical 12 ounce soda has 8 teaspoons of sugar so I probably should have given them a Coke!

Yogurt--One girl is a big fan of Stonyfield's fat free organic lemon. The container has 27 grams of sugar, but that sugar is a combination of the naturally-occurring lactose and the added sugar. Using the power of Google, I found the plain version clocks in at 12 grams of sugar, meaning 15 grams of added sugar.

Pop-Tarts--Yes, we have frosted Strawberry Pop-Tarts and skim milk for some of those dark mornings when we need to be at school at 7:15 am (I often imagine the grass-fed milk screaming in protest in the girls' stomachs). Pop-Tart ingredients # 2, 3, and 4 are various forms of sugar, leading to 16 grams of sugar per pastry (yeah, the wheat contributes some, but who are we kidding?).

Yet, these are the easy foods. Pop-Tarts are never going to be confused with a health food! And it is easy to balance this morning's OJ with a lunch that is largely added sugar-free.

To me, it is the snack crackers with cane sugar or the pretzels with malt that make life more complicated. Not to mention, the chicken stock, pasta sauce, and other pantry staples. While the pretzel and crackers offer a gram or less of sugar on their Nutrition Fact labels, it all adds up.

Beyond doing calculations like that of the Stonyfield yogurt, some websites do offer short lists of added sugars in common foods like this one from the American Heart Association or this empty calorie chart from MyPlate.

What Did I Learn?

ALWAYS read the label. I almost fell over in Whole Foods when I saw sugar listed on the box of chicken stock.
The label is more important than the image. A health halo around juice, yogurt and other processed foods don't mean their labels match their hype.
Cook. A little less sugar in the cookie (or left out of the stock!) is possible when you control the recipe.
Balance your (and your kids) day. Don't count calories, but keep a mental tally of your added sugar intake. Maybe skip the extra syrup on your morning pancakes in favor of a cookie at lunch.
Cinnamon toast is yummy. And since I probably put 1/2 teaspoon of sugar on each slice, at three slices per girl, it is WAY better than some of my other options, even with the sugar in the bread itself.