If you search “sugar toxic” or "sugar addiction" online you’ll find enough headlines to put you into full on panic mode and say, “I’ll never eat a piece of birthday cake again!” But in the heyday of my dieting, my mantra was, “If it’s fat-free, it’s for me!” Back then, fat was enemy number one. Sugar might as well have had a health halo, because all the “good foods” were devoid of fat and filled with sugar. Remember Snackwell’s? It was a line of cookies that was marketed as healthier because they were fat-free. But while they had none of the fat, they had lots of the added sugar. Snackwell’s popularity has dipped now that sugar, not fat, tops the “don’t you dare eat it” list—and with particular fervor too.
Added sugar—that is, any sweeteners (including sugars from honey, agave, and syrups) that are added to a food during processing or packaging—has been called toxic, poison, and addictive by some experts and the media. Perhaps the best-known anti-added sugar public figure is pediatric endocrinologist Dr. Robert Lustig, whose bestselling 2013 book Fat Chance: The Bitter Truth About Sugar calls sugar a toxin. His 90-minute lecture on sugar (a collaboration with the University of San Francisco’s Osher Center for Integrative Medicine), has been viewed nearly 7.6 million times since 2009. In it he calls sucrose (cane sugar) and fructose (a type of sugar that can be found in fruit, honey, maple syrup, agave, table sugar, and sweetened beverages) poison. Elsewhere, he has suggested excessive sugar consumption can be addictive, citing both sugar’s effect on our dopamine levels and our drive to keep those reward neurotransmitters firing. Some of the most popular diets of the moment—Whole 30, the ketogenic diet—eschew any food with added sugar as an ingredient, often in favor of fat. Even homemade salad dressing sweetened with sugar or a little bit of honey and poured over a big bowl of vegetables puts you at risk for breaking these diet rules.
As a registered dietitian nutritionist, I spend lots of time talking to people about their eating habits and how they feel about food. I've found that focusing on details such as exactly how many grams of added sugar you eat can be an unneeded and unhealthy practice for some.
When I raise this point, I’m usually met with “but…health!” and “the food environment!” But these naysayers have never met my sugar-phobic, guilt-ridden clients. Yes, it’s true that processed foods and beverages with added sugar are abundant—if not omnipresent—in our food environment, and too much of those aren't good for our health. And yes, research does show a correlation between excessive added sugar consumption over time and increased risk of death caused by cardiovascular disease, obesity, and Type 2 diabetes, among others. But does that mean that eating any added sugar will take years off your life? There’s no indication of that that I’ve seen.
But what’s even more important to me, as someone who helps people find ways of eating that are good for their psychological as well as physical health, is that there exists a happy medium between the kind of food anxiety where you feel you’re one bite away from certain disease and making the choice to eat foods with added sugar, feeling good about that choice, and overall eating a balanced, nutritious diet that helps keep you healthy.
What bothers me the most about a lot of the rhetoric around sugar is the harsh language people use, like calling sugar “toxic.” The word means “poisonous,” so it makes sense that it incites anxiety and fear when people see it in headlines or hear it in a doctor’s lecture. Often, the impact of using words like "toxin," "toxic," or "poison" is that they scare people away from sugar without really giving information about what makes sugar something that you should limit for health reasons. Keep in mind that any substance, even water, can be dangerous in excessive amounts. While there is still ongoing research, and there is much dialogue and debate out there about the effects of sugar in our diets, the authors of a 2013 paper in Current Opinion in Clinical Nutrition & Metabolic Care on the toxicity of added fructose say that while definitive studies are still missing, clinical trials have not yet shown toxicity. As a 2016 review explains, “the highest level of evidence from systematic review and meta-analysis does not support a direct causal relationship with cardiometabolic disease.”
In addition, calling sugar addictive seems to be a stretch, considering what the research tells us. A 2016 literature review in the European Journal of Nutrition found little evidence to support sugar addiction in either human or animal studies. The review looked at the evidence on highly processed foods with high sugar content and found that addiction-like behaviors (binge eating) occurred only when subjects had previously been restricted from sugar. In fact, the review’s authors make it quite clear: “These behaviours likely arise from intermittent access to sweet tasting or highly palatable foods, not the neurochemical effects of sugar.” The science more likely supports what many dieters know to be true: After cutting out sugar, you want it more; when you finally let yourself indulge, it’s hard to do so mindfully. Another 2016 European Journal of Nutrition review concluded that evidence that sugar is addictive is “limited to the animal neuroscience literature, and it is far from convincing.” Overall, the authors, who examined the literature on food and sugar addiction, evidence suggesting the addictiveness of highly processed foods with added sugar, and animal and human neuroscience literature on drug and sugar addiction, found a lack of evidence supporting sugar as addictive; therefore, they “argue against premature incorporation of sugar addiction into the scientific literature and public policy recommendations.”
I suggest keeping a skeptical eye out for sensational claims or headlines that declare any one food poisonous or entirely off-limits. Even when these claims come from trustworthy researchers or institutions, it’s important to remember that a) studies’ findings aren’t always interpreted properly by the media and b) the more useful takeaway for most consumers is to ask yourself the question, “How is this information helpful to me?” In other words, don’t take researchers’ claims or stories about their claims as doctrine. Instead, think about how that information might help you make more informed choices day to day.
In my work, I’ve found that clients struggling with food anxieties can become agitated at the thought of going out to eat with friends, and may even opt to skip the social endeavor because of the uncertainty of sugar or other ingredients in the food. I tell them not every meal has to be eaten with health in mind. Sometimes, it’s just food with friends. It’s more useful to eat based on your individual likes, dislikes, and health goals, than to follow diet rules based on foods or ingredients you “should” eliminate. If you are looking to eat more healthfully, decide to make changes from a place of love (love of food you like to eat, love of pleasure, love of your own health) and use facts, not fear, to guide your choices.
If you’d like to get over your sugar guilt, here’s where gaining perspective helps. First off, it’s very important to understand that most health experts who are concerned about sugar are talking about “added sugars” (though this clarification doesn’t always make it into the headlines), and what happens when we consume excessive amounts of foods containing them. That means fruits, starchy vegetables, unsweetened dairy products, and other foods that contain naturally occurring sugars aren’t raising eyebrows among experts. (However, you may realize the most popular diets today, Whole30 and keto among them, require following restrictive rules with these types of foods. In my opinion, that’s just another sign to stay far away from these and other ultra restrictive diets. Research consistently shows that the vitamins, fiber, and nutrients in fruits and vegetables are health-promoting. In my experience, any diet that's that restrictive and unsustainable is not a life change worth making.)
The American Heart Association's recommended daily limit for added sugar is six teaspoons for women and nine for men. My take on this? Whether or not a dietary modification would be helpful is highly individual and based on eating patterns. For those who are consuming more added sugar than is recommended, this should serve as a yellow light that causes you to slow down and start a conversation with your doctor or a registered dietitian about your overall health and whether or not you need to make any changes to your diet. There are so many other factors that affect your overall health—like exercise, good sleep, managing stress, getting regular screenings, and not smoking—so these blanket recommendations are helpful from a public health standpoint but not necessarily prescriptive for every single person.
Worrying about every possible gram of white sugary powder that may be lurking inside your food as if it’s arsenic is stressful, and too much food stress is also unhealthy. That goes for beverages too—if water is your primary source of hydration, occasional sweetened beverages may not be a big deal. Of course, it's medically necessary for some people to keep an eye on their added sugar intake, and if that's the case for you then you should make sure you're following your doctor or dietitian's guidance. For those of you for whom that’s not the case, when it comes to choosing foods with added sugar, decide based on taste first. The higher your pleasure, the more likely you will be satisfied and eat with joy, not shame.
If you’re having a hard time finding freedom and flexibility with food, it’s not just you. We live in a society that expects we should all be healthy at all times, while simultaneously surrounding us with a plethora of processed, sugary food options. So, when something does go wrong, the first thing we tend to do is blame the ourselves. How did my will power fail me? Why was I “bad?” Rarely do we acknowledge diet culture—which is built on the idea that hypervigilance is desirable—or our food environment, which makes foods with added sugar readily available.
Remember, wellbeing does not grow from fearing what’s on your fork. It grows from thinking about reasonable changes that still allow you to experience pleasure and birthday cake.
Rebecca Scritchfield is a Washington, D.C.–based dietitian, certified exercise physiologist, and author of the book Body Kindness.
