Where Sugar Lurks

Mention the word “sugar” to someone who has diabetes, and chances are he’ll tell you that he either avoids it like the plague or at least makes some effort to limit his intake. Years ago, nutrition recommendations for people with diabetes were essentially to avoid sugar as much as possible, based on the thinking that sugar would send blood glucose levels through the roof.


Well, that notion was pretty much disproven, thanks to research that showed that sugar doesn’t act a whole lot differently than many other types of carbohydrate foods (like bread) when it comes to blood glucose control. The consensus became that it’s more the amount of carbohydrate than the type of carbohydrate that has the most impact on blood glucose.

And with that, guidelines were changed, guardedly stating that sugar, in moderation, could be part of a diabetes eating plan provided that it was used in place of other carbohydrate foods. As a dietitian, I spent a lot of time talking to my patients about how to fit sugar or sugary foods into a meal plan and was often met with skepticism and doubt. “Me, eat sugar?” tended to be the response. I also encountered (and still do) people who mistakenly believe that eating something sweet “caused” them to get diabetes.

Diabetes aside, we know that sugar isn’t exactly a paragon of nutrition. Most dietitians I know don’t advise their patients to eat more sugar. In fact, Americans, as a whole, tend to overdo it on the sugar: We tend to consume, on average, 22 teaspoons of sugar every day. That adds up to 350 calories. Much of the sugar that Americans take in comes from sugar-sweetened drinks, by the way.

One teaspoon of sugar contains 4 grams of carbohydrate and 16 calories

Downsides of sugar
Sugar is sweet but its effects on health, well, not so much. Here’s a rundown of what sugar can do in the body.

• Sugar may increase the risk of dying from heart disease, even if you’re not overweight.
• Sugar (in the form of high-fructose corn syrup) can lead to excess abdominal (belly) fat.
• Sugar can raise blood pressure.
• Sugar can lead to weight gain.
• Sugar can speed up the aging process, especially in the skin.
• Sugar can contribute to tooth decay.

How much sugar is safe to eat?
The reality is that we don’t have to avoid sugar altogether. Also, that would pretty much be impossible since sugar occurs naturally in some foods. The American Heart Association suggests that women limit sugar to no more than 100 calories per day (6 teaspoons, or 24 grams) and that men keep it to no more than 150 calories per day (9 teaspoons, or 36 grams). The World Health Organization proposes a tougher sanction on sugar: Keep sugar intake to less than 5% of daily calories (about half of what’s currently recommended).

Where is sugar hiding?
Most people know about the obvious sources of sugar in foods — cake, candy, cookies, soda, ice cream; pretty much anything that’s sweet. But sugar lurks in many other foods, even foods that don’t taste sweet or that we wouldn’t dream would containing anything sweet.

The Nutrition Facts label and the ingredient list on foods provide information about sugar, although currently, the label doesn’t distinguish between sugars that occur naturally in foods (like milk and fruit) and added sugars. Hopefully this will change if proposed revisions to the Nutrition Facts label are passed. In the meantime, if your goal is to limit your sugar intake, scan the ingredient list on packaged foods. Look for the following sources of sugar:

• White sugar
• Granulated sugar
• Brown sugar
• Cane sugar
• Invert sugar
• Turbinado sugar
• Evaporated can juice
• High-fructose corn syrup
• Corn syrup
• Maple syrup
• Honey
• Dextrin
• Molasses

If any of these sugars make up the first few ingredients on the list, or if you see several of these sugars in the listing, chances are, the food or beverage is high in sugar. You can also look at the grams of sugar on the label, remembering that every 4 grams of sugar translates into a teaspoon. Just keep in mind that milk or plain yogurt, for example, will appear to be high in sugar due to the lactose content.

Also, be on the lookout for unexpectedly higher-sugar foods such as the following (this is just a smattering of foods and not meant to be representative):

(Grams of sugar are per serving according to the manufacturer’s serving size)

• Kashi GOLEAN! Crunch cereal: 13 grams
• Fiber One Honey Clusters cereal: 9 grams
• Kellogg’s Raisin Bran cereal: 18 grams
• Kraft Barbecue Sauce, Original: 13 grams
• Cains Sweet Gherkins pickles: 8 grams
• Hidden Valley The Original Ranch Fat Free dressing: 3 grams
• Ken’s Steak House Lite Honey Mustard Dressing: 8 grams
• Campbell’s Classic Tomato Soup on the Go: 20 grams
• Progresso 99% Fat Free Minestrone soup: 4 grams
• Prego Traditional Italian Sauce: 10 grams
• Barilla Meat Sauce: 9 grams
• Chobani Greek Yogurt, Black Cherry: 17 grams
• Dannon Activia Peach Probiotic Yogurt: 17 grams
• Fiber One Honey Whole Wheat bread: 4 grams
• Thomas’ Cinnamon Raisin English Muffins: 8 grams
• Healthy Choice Sweet & Sour Chicken: 19 grams
• Lean Cuisine Spaghetti with Meat Sauce: 9 grams

Do you need to avoid these foods? No. But you may want to keep an eye on how much you eat and how often you eat them. Fat-free ranch dressing isn’t that high in sugar at first glance, but if you use more than the manufacturer’s serving size of 2 tablespoons, the sugar will quickly add up. It’s very hard to avoid sugar altogether, and you don’t have to. Just keep in mind the general goal (no more than 24 grams per day for women and 36 grams per day for men) and use that goal as your reference point when choosing your foods and beverages.

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  • frank

    my heart doctor told me to stop drinking diet drinks because it fools the body into not knowing how to deal with real sugar that you may get in other foods.If you stop using diet drinks how long will it take your body to readjust to procces real sugar.

  • acampbell

    Hi frank,

    Your doctor may be referring to a study that links diet drinks with obesity, Type 2 diabetes, and heart disease. According to the researchers, diet drinks “trick” the body into thinking that you’re really consuming sugar and not artificial sweeteners. As a result, the body starts to release insulin as a way to help handle the load of “sugar” and this insulin release can cause weight gain. This is just one study, however, and we need to learn more about if and how artificial sweeteners affect the body. Your body will continue to “process” real sugar, however. The bottom line is to continue to limit your intake of sugar. While you don’t necessarily have to stop drinking diet beverages altogether, it may be a good idea to limit them, as well.

  • Dave Clark

    Very good and informative article! I will now always be scanning the foods in the store and what I eat on a more regular basis. I have trype II, and have been looking mostly at drinks for the sugar level, but this article gave me much more insight to “finding” sources of sugar!

  • JohnC

    OK agreed: sugar is not a good thing and a teaspoon contains about 4 grams of fast acting carbohydrates.
    A nice slice of whole grain bread contains 10-20 grams of carbohydrates. What do you think raises your blood sugar quicker? It’s not the sugar. My meter told me this a lot of years ago.

    “this insulin release can cause weight gain”
    I agree 100% with Ms. Campbell’s statement. Which is why it is a good idea to limit carb. intake if you have a problem with weight — it takes a lot of insulin for the body to process carbs. and it does end up with you acquiring extra pounds.

    There’s a reason all the low carb. diets take off lbs without watching calories very much…. you don’t need as much insulin. How many more decades is it going to take to make the connection? And it is hard to find a medical person who doesn’t believe that insulin is the chief causing fat-producing hormone in the body. Guess why those using insulin injections to cover their high carb. diets end up gaining so much weight?

    North Americans eat a lot less fat then they used to and most are a lot slimmer – right? Not! I think it is time to take another look at the low fat diet nonsense. It is not like the research isn’t there. All calorie intake is not equal.

  • Terri

    The absolute best way to control your sugar intake is to stay away from processed foods and eat comparably little of fruits that are higher in sugar, very few starchy vegetables and stay away from dried fruits.

  • Joe Keane

    my oldest son is a type 1 diabete, resently he switch over to that pencil type insulin, but I have noticed lately his sugar downs rapidly after he eat’s dinner, about 2 hours his sugar downs to as low as 35 more often now than before maybe 3 to 4 times a month and it is always between 7 & 9 pm after eating a good meal supper that is….my son is 38 years old, and when I question him on this he sort of says mind your own business, in
    so many words. Need advice….thanks

  • bk


    Are these recommendations for total sugar, added and naturally occurring? I hope they just mean to limit added sugars to that amount! I need a little dark chocolate and I prefer it sweetened a little and I need a little ice cream and I am not going to bother with sugar free. If I am going to eat that many calories, I am going to eat a little of the real thing. But I sure intend to continue my 2 or 3 servings of fresh fruit a day. 🙂


  • Lisa

    I do want to ask once again why most of the article in this magazine and most others deal only with type II diabetics and the letters deal with type II issues. Don’t get me wrong, it is a serious issue but those of us who have been dealing with type I for 40 feel like we don’t even exists because the main emphasis is on type II. We need support also.

  • Sara VDW

    Thank you for this interesting and informative article. It is good to know the guidelines of sugar intake for people with diabetes Thank you.

  • acampbell

    Hi Joe,

    It certainly sounds like your son is taking too much insulin for what he’s eating. Understandably, it’s frustrating for you because you’re concerned and you want to help. On the other hand, some people with diabetes do get defensive when it appears that others are telling them what they should do. One approach you might try is to make it about you: Let him know that you’re concerned and worried about him and that you’d like to know how you can best help him. You could also casually mention that you read that low blood sugars after meals are often due to taking too much insulin at mealtime. But, you need to remember that your son is an adult and it’s his diabetes, so ultimately, it’s up to him to manage it. Letting him know that you’re there to support him, though, is a good first step.

  • Diane Fennell

    Hi Lisa,

    Thank you for your comment. We at Diabetes Self-Management aim to take a balanced approach that addresses the needs of people living with all different types of diabetes, including Type 1, Type 2, gestational diabetes, and lesser-known types such as LADA and MODY.

    For examples of our coverage devoted to Type 1 diabetes, please see our weekly blog entries by Scott Coulter, who is living with the condition, or enter “Type 1” into our search function. Here are just a few of the hundreds of pieces we have for people with Type 1 diabetes.

    I hope these resources are helpful. Thank you for your interest in Diabetes Self-Management!

    Diane Fennell
    Web Editor

  • acampbell

    Hi bk,

    Good question! The American Heart Association daily sugar recommendations are for ADDED sugars, so they don’t figure in naturally occurring sugars that are found in say, fruit or milk. As I mentioned, the tricky part with some foods is figuring out how much is naturally occuring and how much is added. Let’s hope food labels will soon address this issue!

  • Mel

    I have a question that nobody I know were able to answer.

    I like yogurt. Not the ones you buy in plastic cups at the grocery store, laden with gobs of sugar but the one I make at home myself, from whole milk.

    My significant other likes yogurt as well but she likes it strained thru filter paper and a colander, in the form called “Greek yogurt”. I make it for her but I end up with a lot of yogurt whey, the juice that gets strained out. I do my straining in the fridge, so I have to collect this whey into a bowl.

    I like drinking the whey, right out of that bowl while the straining process goes on, sometimes. Especially the weather is getting very warm , where I am, I will enjoy this even more.

    I am a type-2 diabetic as you might guess and I don’t know if it is okay to consume this liquid whey. More precisely, I’d like to know, which one of the whey or the strained yogurt in the same volume, say 1 cup of either one, better to consume, as far as the shooting my blood glucose levels.


  • acampbell

    Hi Mel,

    Whey is the liquid that remains after milk has been curdled and strained (typically, to make cheese). Whey protein is used to help build muscle, and possibly may help with weight loss and lowering cholesterol.

    If you are drinking the whey liquid, you should know that 1 cup contains about 60 calorie and 13 grams of carbohydrate. This may be higher or lower than the yogurt, depending on what type and how much yogurt you eat and also on how much whey you drink. Plain whole milk Greek-style yogurt, like what you make, contains about 260 calories and 6 grams of carbohdyrate for a 1 cup serving. Cup for cup, whey contains more carbohydrate, which, in turn would have more of an impact on your blood glucose. But again, you may not be drinking a full cup of whey. Measure out your usual portion and do the same with the yogurt; then, you can compare the calories and carbohydrate grams.

  • Jean Boda

    I just found out that milk and dairy products contain sugar in the form of lactose – 12 grams per 8oz. glass! One company, Hood, apparently has a 3 gram sugar milk, but they add sucralose to make it taste better. There seems to be no such thing as lactose free skim milk.

  • Bean Bagger

    Sugar must be damaging. All I know is I was reading this article and all of sudden I got hungry and ate some junk food.

    Canned ravioli! (True story).

  • acampbell

    Hi Jean,

    Lactose is a sugar that occurs naturally in milk and yogurt. It’s not an “added” sugar that I referred to in my posting. All regular (unflavored) cow’s milk contains about 12–13 grams of carbohydrate per serving (8 ounces), which comes from lactose. Even lactose-free milk, such as Lactaid, has 13 grams of carbohydrate per 8 ounces. Flavored milk, such as chocolate milk, can have twice as much carbohdyrate per serving because the manufacturer has added sugar to the milk. It’s generally not a concern for people to drink milk (assuming that they don’t have a milk allergy or a lactose intolerance) as long as they count the carbohydrate in it.