Priya Seetal

Whether it’s white, raw or brown sugar, honey or syrup, nearly all of us add a little sweetness to our cooking and in our teas and coffees to make what we eat and drink taste just the way we want it. 

Sugar is an enjoyable part of a healthy, balanced lifestyle.  Yet right now there is much debate and discussion about how sugar affects our health.  There are many questions about sugar.  Is it safe for me and my family? Does it cause ill health such as diabetes and heart disease?  Is sugar addictive?  The following information answers these questions based on the latest credible scientific evidence.

However before delving into these health issues it is important to understand exactly what sugar is.

There are many types of sugar.  In South Africa, the most common sugar is sucrose or table sugar which comes from sugarcane.  Sucrose is not only found in sugarcane, it is found in many fruits and vegetables such as bananas, carrots and oranges.  Other types of sugars include lactose which is found in milk and glucose and fructose which is found in honey, fruits and vegetables.  Glucose is also the sugar found in our blood.  Sucrose is made up of one unit of glucose and one unit of fructose.  

All these sugars along with starches such as bread, rice, maize meal and potatoes are termed carbohydrate foods.  Carbohydrates give our body glucose which is the most preferred source of energy for our body and the only source of energy for our brain.  The brain alone requires 130g of glucose every day . 1

The glucose found in sucrose is used by our body in the same way that the glucose from any carbohydrate food used.  This is a very subtle and important point when trying to understand the effect of sucrose our health.  Our body does not take glucose from table sugar to cause ill health and use the glucose from another source such as bread and use it for energy.  Once glucose is absorbed from our gut into our blood the body cannot distinguish between the glucose that comes from sucrose and the glucose that comes from other carbohydrate foods such as bread, rice, cereal and potatoes.  As a result it becomes difficult to pinpoint sucrose as harmful to health.  

Sugar and Obesity

In a number of developed economies like US, UK and Australia per capita sugar consumption has been declining whilst obesity has been rising. Clearly, factors other than sugar consumption have a material and overriding impact on obesity trends.

Although there are genetic, behavioural and hormonal influences on body weight, obesity occurs when you take in more calories than you burn through exercise and normal daily activities. The body stores these excess calories as fat.  Sugar, like other carbohydrates and fat and protein, gives us calories.  In terms of weight gain, there is nothing unique about sugar over other sources of calories.  

Multiple studies have investigated the role of sugar in obesity in recent years. It has been argued that sugar is associated with an increased risk of obesity.  Despite this there is still no conclusive evidence of a direct link between sugar consumption and obesity development. 2,3  

Sugar and Diabetes

The belief that eating sugar causes diabetes is the most common misconception about diabetes. Genetics, being overweight and leading an unhealthy lifestyle such as not doing enough physical activity and poor eating habits are risk factors for diabetes. Avoiding sugar will not stop a person from getting diabetes. If you have a family history of diabetes, the best way to avoid developing diabetes is to be physically active, have good eating habits and avoid weight gain.  

There is no evidence that refined sugar has any unique attributes that result in the development of diabetes.  However, like protein, starch, fat and alcohol, sugar is a source of calories in the diet. Excess calories can lead to being overweight which can increase the risk of type 2 diabetes.

What is Diabetes and its different types?

Diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin or when the body cannot make good use of it. Insulin is a hormone made by the pancreas that helps glucose, from the breakdown of food, become available to cells. Not being able to produce insulin or use it effectively leads to raised glucose levels in the blood that can be harmful to the body.
(Source: International Diabetes Federation).

According to the International Diabetes Federation (2014), 2.7 million people in SA have diabetes. Worldwide the figure is 387 million.

Sugar and Your Teeth

Many people associate sugar with dental caries, however, all carbohydrates can contribute to the formation of cavities 4 . Bacteria in the mouth break down carbohydrates which form acids that can leach minerals from tooth enamel. Sticky snacks like raisins and other dried fruits, and starchy foods like breadsticks, cereals and potato chips, linger on teeth and prolong acid production even more than most sweets.

However, sugar and other carbohydrates are not the most important factor in the cause of tooth decay. Several studies have shown that where proper oral hygiene is followed and adequate fluoride exposure exists, caries prevalence has decreased despite increases in sugar consumption 5 . Furthermore, if carbohydrate-containing foods are eaten frequently but oral hygiene is maintained and fluoride used, caries are not likely to form. Therefore, prevention should focus on proper oral hygiene and adequate fluoride use (such as in fluoride toothpaste), rather than fermentable carbohydrates alone 6 .

Is sugar addictive?

Experts from the NeuroFAST Consortium 7 recently produced a Consensus opinion on food addiction stating that “there is no evidence that a specific food, food ingredient or food additive causes a substance based type of addiction.”

Professor Benton from Swansea University in Wales concluded that the current scientific evidence do not support the claim that sugar is addictive 8 .  There are rational reasons for this.  If you are addicted to sugar then eating sugar straight out of the sugar jar would satisfy the craving.  Yet, food cravings are most commonly reported for either savoury/salty foods such as chips or sweet/fatty combinations such as chocolate.  These combinations contribute to the texture and mouth feel.  For example, a person would have cravings for a slice of cake more than they would a sweetened carbonated beverage.  This is despite the fact that the sweetened beverage contains more sugar than the cake. 

Sugar is not hidden in foods

It is sometimes falsely believed that sugar is ‘hidden in foods’.  This is not the case.  All packaged food products in South Africa have labels stating what ingredients have been used to make the food – including sugar.  By South African law, all food products that carry a nutrition information table must also indicate the amount of sugar in the product. 

Sugar has a range of unique properties that make it an important ingredient in modern food production. With the pressure to reduce the sugar body in food, it is important to note that sugar is very difficult to replace in food production. Sugar is one of the simplest structures in nature and, of all the staple products in our diet, has the broadest area of use.  Sugar imparts various properties in the manufacture of foods considered as important sources of nutrients in the South Africa diet. It activates the yeast required to make bread and makes yogurt and high fibre cereals more palatable by adding body and texture.

Sugar has been part of our lives for centuries and can continue to be enjoyed as part of a balanced lifestyle.   


  1. Scientific Opinion on Dietary Reference Values for carbohydrates and dietary fibre, EFSA Journal 2010; 8(3):1462.  DOI: 10.2903/j.efsa.2010.1462
  2. Lisbona Catalán A., Palma Milla, S., Parra Ramirez, P. & Gomez Candela, C. (2013) Obesity and Sugar: Allies or Enemies. Nutr Hosp, 28, 81-87.
  3. Tappy, L. (2016). What Nutritional Physiology tells us about Diet, Sugar and Obesity. Int J Obes, 40, S28-S29
  4. Konig KG, Navia JM. Nutritional role of sugars in oral health. Am J Clin Nutr. 1995;62 (suppl):275S-283S.
  5. Gibson SA, Williams S. Dental caries in pre-school children: associations with social class, toothbrushing habit, and consumption of sugars and sugar-containing foods. Further analysis of data from the National Diet and Nutrition Survey of children aged 1.5Y4.5 years. Caries Res. 1999;33:101-113.
  6. Diagnosis and Management of Dental Caries Throughout Life. National Institutes of Health Consensus Statement.
  7. NeuroFAST consensus opinion on food addiction http://www.neurofast.eu/digitalAssets/1455/1455240_consensus.pdf
  8. Benton (2010) The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical Nutrition 29, 288-303.