Sugar is naturally present in many foods, including fruits, vegetables and milk. Sugar is also added to countless foods and drinks during manufacturing, cooking and preparation.
These are not nutritionally identical situations.
A whole apple containing naturally occurring sugars also provides fibre, vitamins, minerals, water and beneficial plant compounds. A sugar-sweetened soft drink can deliver a large amount of free or added sugar with relatively little nutritional value.
Health concerns therefore focus particularly on consuming too much free or added sugar, especially from sugary drinks, sweets, desserts and highly processed foods.
High intakes can contribute to excess calorie consumption, unhealthy weight gain and tooth decay and are associated with increased risks of several chronic diseases.
That does not mean sugar is a poison or that it directly causes dozens of unrelated illnesses.
Understanding the difference can help you make healthier choices without unnecessary fear.
What Is Sugar?
Sugar is a type of carbohydrate.
During digestion, carbohydrates are broken down into simpler sugars, including glucose. Glucose is an important source of energy for cells in the body.
Sugars include glucose, fructose and sucrose, among others.
Sucrose—the ordinary table sugar used in many homes—is composed of glucose and fructose.
The health discussion becomes more useful when we distinguish between naturally occurring sugars, added sugars and free sugars.
Naturally Occurring Sugar vs Added Sugar
Naturally occurring sugars are present naturally within foods.
Examples include:
- fructose and glucose in whole fruits
- lactose in milk
- sugars naturally occurring in vegetables.
These foods frequently provide important nutrients alongside their sugars.
Added sugars are sugars and syrups added to foods and beverages during manufacturing, cooking or preparation.
Examples can include:
- table sugar
- brown sugar
- glucose syrup
- corn syrup
- high-fructose corn syrup
- molasses
- honey when used as a sweetener
- other syrups.
The World Health Organization uses the term free sugars. This includes sugars added to foods and drinks as well as sugars naturally present in honey, syrups, fruit juices and fruit-juice concentrates.
Importantly, WHO's free-sugar recommendation does not apply to the sugars naturally present within intact fresh fruits and vegetables or naturally occurring sugars in milk.
Is Sugar Bad for You?
Sugar should not simply be divided into “good” and “bad.”
Small amounts of added sugar can fit into an otherwise nutritious diet.
Problems are more likely to arise when foods and drinks high in free or added sugars make up a substantial part of someone's diet.
These products can contribute large numbers of calories without providing the fibre and broad range of nutrients found in many whole foods.
Sugary drinks are particularly important because substantial amounts of sugar can be consumed quickly without providing the same feeling of fullness as many solid foods.
Let's look at the health concerns for which there is much stronger evidence.
1. Too Much Free Sugar Increases the Risk of Tooth Decay
One of the clearest relationships between sugar and health involves dental caries, or tooth decay.
Bacteria in dental plaque metabolise sugars and produce acids. These acids can gradually damage tooth enamel and contribute to cavities.
Both the amount and frequency of exposure to free sugars matter.
Regularly sipping sugary drinks or frequently eating sugary foods throughout the day repeatedly exposes teeth to conditions that promote decay.
Reducing free sugars, maintaining good oral hygiene and using appropriate fluoride dental products can help protect teeth.
2. Excess Added Sugar Can Contribute to Weight Gain
Foods and drinks containing substantial added sugar can increase total calorie intake.
If someone consistently consumes more energy than their body uses, the excess can contribute to weight gain over time.
Sugar-sweetened drinks deserve particular attention.
Regular consumption of sugary beverages has been associated with weight gain and obesity, and reducing these beverages can be an effective way to reduce unnecessary calorie and sugar intake.
This does not mean that eating one sweet food causes obesity.
Body weight is influenced by the overall balance between energy intake and expenditure as well as genetics, environment, sleep, physical activity, medicines and numerous other factors.
3. High Intake of Sugary Drinks Is Associated With Type 2 Diabetes
Frequently drinking sugar-sweetened beverages is associated with a higher risk of developing type 2 diabetes.
Part of this relationship may occur through weight gain and increased body fat, although other metabolic pathways may also contribute.
However, it is inaccurate to say simply that “sugar causes diabetes.”
Type 1 diabetes, for example, is an autoimmune disease and is not caused by eating sugar.
Type 2 diabetes develops through interactions between genetic susceptibility, insulin resistance, body weight, physical activity, dietary patterns and other factors.
Reducing sugary beverages and maintaining a healthy overall dietary pattern are sensible steps for reducing type 2 diabetes risk.
4. Excessive Added Sugar Is Associated With Cardiovascular Disease
High intake of added sugars—particularly sugar-sweetened beverages—has also been associated with cardiovascular disease.
Diets containing excessive added sugars may contribute to several cardiovascular risk factors, including excess weight and adverse metabolic changes.
Current heart-health guidance therefore recommends minimising added sugars as part of an overall dietary pattern that emphasises fruits, vegetables, whole grains, healthy protein sources and predominantly unsaturated fats.
Reducing sugar should be part of a broader healthy lifestyle rather than viewed as a single cure for heart disease.
5. Sugary Drinks Are Associated With Fatty Liver Disease
Frequent consumption of sugar-sweetened beverages is associated with metabolic dysfunction-associated steatotic liver disease, previously commonly called non-alcoholic fatty liver disease.
Excess calorie intake, overweight, obesity, insulin resistance and metabolic health are important factors in the development of fatty liver disease.
Large amounts of sugar—particularly from sugary beverages—can contribute to an unhealthy dietary pattern and excessive energy intake.
But it would be misleading to claim that every person who eats sugar will develop liver disease.
6. Sugary Drinks Have Been Associated With Gout
Gout is a form of inflammatory arthritis caused by the accumulation of urate crystals in and around joints.
Research has linked frequent consumption of sugar-sweetened beverages, particularly those containing substantial fructose, with increased gout risk.
Gout is nevertheless influenced by multiple factors, including genetics, kidney function, certain medicines, body weight, alcohol intake and other dietary factors.
Someone diagnosed with gout should therefore obtain appropriate medical advice rather than focusing solely on sugar.
7. High-Sugar Foods Can Displace More Nutritious Foods
Another problem with diets containing large amounts of added sugar is what those foods may replace.
If much of someone's calorie intake comes from soft drinks, sweets, cakes, biscuits, pastries and similar foods, there may be less room for nutrient-rich foods such as:
- vegetables
- whole fruits
- legumes
- whole grains
- nuts and seeds
- appropriate protein sources
- nutrient-rich dairy foods or suitable alternatives.
Good nutrition is not simply about avoiding one ingredient. It is about the overall quality and balance of the diet.
How Much Sugar Is Too Much?
The World Health Organization recommends that adults and children reduce their intake of free sugars to less than 10% of total daily energy intake.
WHO states that reducing intake further to below 5% of total energy intake may provide additional health benefits, particularly for dental health.
For a person consuming approximately 2,000 calories per day, 10% of energy is roughly equivalent to 50 grams of free sugars, or about 12 level teaspoons.
The 5% level is approximately 25 grams, or about 6 teaspoons.
These are population-level guidelines rather than personalised prescriptions. Individual energy requirements differ.
Remember that these recommendations concern free sugars, not the sugars naturally contained within intact fruits, vegetables and milk.
Does Fruit Contain Too Much Sugar?
Whole fruit contains natural sugars, but that does not make fruit equivalent to sweets or soft drinks.
Whole fruit provides water, dietary fibre, vitamins, minerals and numerous plant compounds.
The physical structure and fibre of whole fruit also affect how it is eaten and digested.
International healthy-diet guidance encourages consumption of fruits and vegetables.
For most people, reducing whole fruit because they are afraid of its natural sugar is unnecessary.
There may be individual exceptions—for example, someone with a medical condition requiring specific dietary management should follow professional advice.
What About Fruit Juice?
Fruit juice is different from intact whole fruit.
Even 100% fruit juice contains free sugars under the WHO definition because juicing releases sugars from the cellular structure of the fruit and removes much of the fibre found in intact fruit.
It is easy to drink the equivalent of several pieces of fruit quickly as juice.
Whole fruit is therefore generally a better everyday choice.
Is Honey Healthier Than Sugar?
Honey may contain small amounts of other substances, but it is still predominantly sugar.
Under the WHO definition, sugars in honey count as free sugars.
Replacing several teaspoons of table sugar with the same amount of honey does not eliminate your free-sugar intake.
Honey can be enjoyed if you like it, but it should not be treated as an unrestricted healthy substitute for sugar.
Is Brown Sugar Healthier Than White Sugar?
Brown sugar is not substantially healthier than white sugar.
It may contain small quantities of minerals because of its molasses content, but these amounts are not enough to make brown sugar a significant source of nutrients.
Both should be counted as added/free sugars.
The same caution applies to products marketed with names such as:
- raw sugar
- cane sugar
- coconut sugar
- agave syrup
- maple syrup
- date syrup.
Their origins and composition differ, but changing the name of a sweetener does not mean it can be consumed without consideration of quantity.
Does Sugar Feed Cancer?
This is a common and potentially frightening misconception.
All cells in the body—including healthy cells—use glucose for energy.
Cancer cells often use large amounts of glucose, but that does not mean eating sugar selectively feeds cancer in a way that can simply be stopped by eliminating sugar from the diet.
Cancer biology is far more complex.
There is no evidence that eliminating all dietary sugar cures cancer.
However, maintaining a healthy body weight and following an overall healthy dietary pattern can reduce the risk of several cancers. Excessive consumption of calorie-dense sugary foods can contribute indirectly by promoting excess calorie intake and weight gain.
People undergoing cancer treatment should not make severe dietary restrictions without discussing them with their healthcare team.
Does Sugar Cause Hyperactivity in Children?
The idea that sugar automatically makes children hyperactive is widespread.
Controlled research has generally failed to show that sugar itself causes hyperactivity in most children.
Children may consume sugary foods during exciting situations such as birthday parties and celebrations, which can make it easy to attribute their behaviour to sugar rather than the environment.
There are still good reasons to limit excessive added sugar in children's diets—particularly for dental health, nutrition and healthy weight—but claims that sugar universally causes hyperactivity should not be presented as established fact.
Is Sugar Addictive?
People sometimes describe themselves as being “addicted to sugar.”
Highly palatable sweet foods can activate reward pathways in the brain, and people can develop strong preferences and eating habits around them.
However, describing ordinary sugar consumption as equivalent to addiction to substances such as alcohol, nicotine or certain drugs is scientifically controversial.
Food cravings and overeating are complex behaviours influenced by the brain, environment, habits, sleep, stress and availability of highly palatable foods.
It is therefore more useful to focus on sustainable dietary habits than to label everyone who enjoys sweet foods as addicted.
Does Sugar Cause Candida or Yeast Infections?
Candida normally lives on or inside many healthy people without causing illness.
Certain circumstances can increase the risk of candidiasis, including antibiotic use, pregnancy, weakened immunity and poorly controlled diabetes, depending on the type of infection.
There is not good evidence that simply eliminating dietary sugar treats ordinary Candida infections.
People with recurrent or persistent symptoms should seek proper diagnosis rather than relying on restrictive “Candida cleanses” or similar diets.
Do You Need to Eliminate Sugar Completely?
For most healthy people, no.
The goal is not necessarily zero sugar.
The priority is reducing excessive free and added sugars, particularly from foods and drinks that provide large amounts with little nutritional value.
A small amount of sugar used occasionally within an otherwise healthy diet is very different from consuming multiple sugary drinks, sweets and desserts every day.
An overly restrictive approach can also make healthy eating unnecessarily difficult.
Common Sources of Added and Free Sugars
Some sources are obvious, while others are easily overlooked.
Common examples include:
- regular soft drinks
- energy and sports drinks
- sweetened fruit drinks
- sweets and confectionery
- cakes, biscuits and pastries
- sweetened breakfast cereals
- flavoured yoghurts
- sweetened milk drinks
- syrups
- sweetened tea and coffee
- desserts and ice cream
- some sauces and condiments
- honey
- fruit juices and juice concentrates.
The exact ingredients and sugar content vary widely among products.
How to Find Added Sugar on Food Labels
Food-labelling systems vary between countries.
Depending on where you live, a nutrition label may show total sugars, added sugars, or both.
The ingredients list can also provide useful information.
Names for added sweeteners may include sugar, sucrose, glucose, fructose, dextrose, maltose, corn syrup, glucose syrup, molasses, honey, fruit-juice concentrate and other syrups.
Do not become overly concerned about memorising every possible name.
Instead, look at the overall nutritional quality of the product and how frequently you consume it.
Practical Ways to Reduce Added Sugar
You do not need to transform your diet overnight.
Start with the largest sources.
Replace regular sugary drinks with water or unsweetened alternatives more often. If you add several teaspoons of sugar to tea or coffee, gradually reducing the amount can allow your taste preferences to adjust.
Choose whole fruit more often than sweets or sugary desserts.
Compare food labels when choosing breakfast cereals, yoghurts, sauces and drinks because sugar content can vary significantly between similar products.
When cooking at home, experiment with reducing the amount of sugar in recipes where doing so does not affect food safety.
Most importantly, concentrate on your overall dietary pattern rather than trying to achieve perfection.
What About Artificial and Non-Sugar Sweeteners?
Replacing sugar with non-sugar sweeteners can reduce the sugar and calorie content of some foods and beverages.
However, WHO advises against relying on non-sugar sweeteners as a long-term strategy for controlling body weight or reducing the risk of noncommunicable diseases in the general population.
A more sustainable approach is often to gradually reduce the overall sweetness of the diet.
This recommendation does not mean that every approved sweetener is inherently unsafe. Food-safety authorities separately assess individual sweeteners and establish acceptable intake levels.
Children and Added Sugar
Children require nutritious foods to support growth and development.
A diet containing large amounts of sugary drinks, sweets and highly processed snacks can provide unnecessary calories while displacing more nutritious foods.
Frequent free-sugar exposure also contributes to tooth decay.
Parents and caregivers can encourage water as the usual drink, offer whole fruits and other nutrient-rich foods, and avoid using sweets constantly as rewards.
Children do not need to fear sugar, but healthy eating habits established early can be valuable throughout life.
The Bottom Line
Sugar is not responsible for the enormous list of diseases sometimes attributed to it online.
However, there are well-established reasons to limit excessive free and added sugars.
High intake contributes to tooth decay and excess calorie intake and can contribute to unhealthy weight gain. Frequent consumption of sugar-sweetened beverages is also associated with obesity, type 2 diabetes, cardiovascular disease, fatty liver disease and gout.
You do not normally need to eliminate all sugar or avoid nutritious whole fruits because they contain naturally occurring sugars.
Instead, reduce sugary drinks and heavily sweetened foods, choose nutrient-rich whole foods more often, read food labels and aim to keep free sugars within recommended limits.
That is a much more evidence-based approach than trying to “run away” from every form of sugar.
Medical and Nutrition Disclaimer
This article is for general educational and informational purposes only and does not replace personalised advice from a doctor, registered dietitian or other appropriately qualified healthcare professional. People with diabetes, metabolic disorders or other medical conditions requiring dietary management should follow advice appropriate to their individual circumstances.
Sources and Further Reading
World Health Organization — Healthy Diet
https://www.who.int/news-room/fact-sheets/detail/healthy-diet
World Health Organization — Guideline: Sugars Intake for Adults and Children
https://www.who.int/publications/i/item/9789241549028
World Health Organization — Carbohydrate Intake for Adults and Children
https://www.who.int/publications/i/item/9789240073593
World Health Organization — Sugars and Dental Caries
https://www.who.int/publications/i/item/WHO-NMH-NHD-17.12
World Health Organization — Use of Non-Sugar Sweeteners
https://www.who.int/publications/i/item/9789240073616
CDC — Get the Facts: Added Sugars
https://www.cdc.gov/nutrition/php/data-research/added-sugars.html
CDC — Sugar-Sweetened Beverage Consumption
https://www.cdc.gov/nutrition/php/data-research/sugar-sweetened-beverages.html
American Heart Association — Added Sugars
https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars
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