Key Takeaways:

• When we talk about sugar, we’re referring to simple carbohydrates, which are either monosaccharides or disaccharides.

• Simple carbohydrates can be categorized into two types: 1) naturally occurring sugar and 2) added sugar.

• In most cases, the excessive consumption of added sugar is more concerning than the consumption of naturally occurring sugar.

• While different simple sugars have varying metabolic fates and, thus, potential impact on health (e.g., fructose consumption has been associated with liver issues), limiting your consumption of certain sugars over others isn’t practical.

• A more realistic approach is to prioritize consuming naturally occurring sugars over added ones and limiting your added sugars to no more than 10% of your daily calorie intake.

All simple sugars are bad.

They cause dramatic spikes and dips in your blood glucose levels, often leaving you lethargic, irritable, and hungry. Plus, not to mention accelerate skin aging and increase your risk of developing type 2 diabetes and cardiovascular diseases.

Or, at least, that’s what we’ve always been told.

But it’s time to question this no-nuance line of thought. Because there are many different types of sugar, and not all are as unhealthy as we think. Let’s start from the beginning. 

An introduction to sugar

Sugar is a type of carbohydrate.

When you consume carbohydrates, your body digests and breaks them down into its preferred energy source: glucose. Carbohydrates come in two primary forms, which mainly differ in the number of sugar or saccharide molecules they contain:

• Simple carbohydrates (or simple sugars): Includes monosaccharides (consisting of one sugar molecule) and disaccharides (consisting of two sugar molecules).

• Complex carbohydrates (or starches): Made up of three or more sugar molecules.

Thanks to their molecular structures, simple carbs are readily broken down and absorbed into the bloodstream, causing a sharp rise in blood glucose levels. Complex carbohydrates, on the other hand, are broken down slowly, allowing a “gentler” rise in blood glucose levels.

Given that, simple sugars seem like they deserve the bad rep they get. Only there's more to the story.

Naturally occurring sugar versus added sugar

We can further divide simple sugars into two broad categories:

• Naturally occurring sugars: Intrinsic to the foods they are found in, such as fruits and dairy products.

• Added sugars: As the name implies, these are sugars added to packaged foods and beverages during processing. Where you'd find added sugars include sugar-sweetened drinks (e.g., the perennial favorite bubble tea), desserts, sweet snacks, and breakfast cereal. 

The truth is most of the health concerns surrounding a high sugar intake are due to the excessive consumption of added sugar instead of naturally occurring sugars.

According to an extensive 2023 review of 73 meta-analyses published in BMJ, it’s the high consumption of added sugar that's associated with significantly higher risks of 45 adverse health outcomes, including type 2 diabetes, obesity, high blood pressure, heart attack, stroke, depression, and early death.

But … why? What makes naturally occurring sugars more "healthful" or less concerning than added sugars? 

Answer: overall nutrient profile.

Once again, naturally occurring sugars are found naturally in foods like fruits and milk.

Generally, this means they come in more modest amounts alongside many other good-for-you-nutrients, such as gut-health-promoting fiber and satiating protein.

Added sugars, on the other hand, are typically found in highly-processed foods — think soda, fruit drinks, cookies, and cakes — that offer little nutritional value beyond heaps of sugar and calories.

Of course, please don’t take the above to mean, “You’re free to pound naturally occurring sugars”.

Naturally occurring sugar is still sugar and will negatively impact your blood glucose levels and health when taken excessively. All we're saying is that you're less likely to overeat naturally occurring sugar than added sugars; in most cases, you’ll still need to moderate your intake regardless.

Different types of sugar and their health impact

You may be wondering, "OK, I need to watch out for added sugars, but which, exactly? Do the different types of sugar have varying effects on my health?"

To answer your second question, the answer is a cautious, theoretical yes — because simple sugars have different metabolic fates (i.e., where they’re broken down, then absorbed in the body differs). 

Let's take a closer look at the four different types of sugar.

Glucose

Your body’s preferred source of energy.

When you consume glucose, your body absorbs it directly across the lining of your small intestine into the bloodstream. The resulting rise in blood glucose levels stimulates insulin release, helping glucose enter your body's cells for energy.

Glucose occurs naturally in foods such as honey, fruits, and grains. It can also be found in sugar-sweetened, processed foods like candy, soft drinks, and bread.

Fructose (“fruit sugar”)

Like glucose, fructose is a monosaccharide directly absorbed into your bloodstream from the small intestine.

Interestingly, it doesn't appear to increase blood sugar or insulin levels immediately — but that doesn't mean it's good for you.

Your liver must convert fructose into glucose before using it as an energy source.

Thus, there’s some evidence that excessive fructose intake may increase your risk of metabolic syndrome and non-alcoholic fatty liver disease.

Fructose occurs naturally in fruits, fruit juices, some vegetables, and honey. Foods high in added fructose include sauces and fast foods.

Sucrose (“table sugar”)

A disaccharide consisting of glucose and fructose.

Sucrose is primarily broken down by the enzyme sucrase in the small intestine; your body then absorbs and uses the resulting glucose and sucrose, as described above.

You can find sucrose in sugarcane, dates, and honey. Foods high in added sucrose include canned fruits, ketchup, and spaghetti sauce. 

Lactose (“dairy sugar”)

A disaccharide consisting of galactose and glucose.

Lactose is commonly called "milk sugar" because it is found naturally in mammals' milk, including cows, goats, and humans.

Typically, when you consume lactose (from milk and dairy products), an enzyme in the small intestine called lactase breaks it down into its constituent monosaccharides: galactose and glucose.

That is … if you’re not lactose intolerant.

The body doesn't make enough lactase to break down lactose in individuals with lactose intolerance. Instead, the undigested lactose sits in the gut and gets broken down by bacteria, causing many uncomfortable gastrointestinal symptoms, such as gas, bloating, and diarrhea.

Lactose intolerance often runs in families (i.e., hereditary, and is most common in people of African, Asian, Hispanic, and American Indian descent). In some cases, however, lactose intolerance may develop because of celiac and Crohn’s disease.

Watch your added sugar intake

From the looks of it, sucrose and fructose may seem arguably "unhealthier" than glucose and lactose, thanks to all that talk about liver health.

So, does this mean you should only eat glucose and lactose?

Try, and you’ll quickly realize it’s close to impossible; the reality is that simple carbohydrates (regardless of whether they’re naturally occurring or added) are composed of the different types of sugar — glucose, fructose, sucrose, and lactose — in varying ratios.

This means you'll have to look at your sugar intake more holistically. If nothing else, perhaps the two most actionable takeaways you could glean from this article would be:

1. Prioritize naturally occurring sugars since they come with the nice bonus of nutritional benefits and dietary fiber.

2. Limit your added sugar intake; Healthhub recommends limiting your intake to no more than 10% of your daily energy intake. For most adults, that is about 50 grams of sugar based on a 2,000-calorie diet.

That said, it's important to note that your lifestyle and any existing health conditions could alter the daily amount of sugar's impact on your health. For example, if you're extremely physically active, you may benefit from slightly more added sugar than someone with a sedentary lifestyle.

So, on that note, why not check out NOVI Magnum for expert, personalized sugar intake recommendations?

With NOVI Magnum, you get:

• Real-time blood sugar data. You will get glucose levels reading in real-time to see the immediate impact of what you eat so you and your care team will understand your body better.

• Personalized insights by your doctor and coach. Your doctor and your dietitian will create a holistic treatment plan covering medication, nutrition and fitness that best suits your unique health goals.

• Build accountability and habits. Whether you want to eat better or exercise more, your coach will create an evidence-based, step-by-step program based on your preferences. Through continuous messaging support and reviews by your coach and doctor, you will be forming healthier habits before you know it!