#8 Added Sugars: What Are They and How to Identify Them

A bit of detail about added sugars
Dr. Plantel gets into added sugar detail
Rashmi Schramm, MD

Rashmi Schramm, MD

Dr. Schramm is a board certified family physician and integrative health coach with 20 years of practice experience.

Added sugars are exactly what they imply, sugars added to foods that otherwise would not contain the amount added.

Added sugars are prevalent in a wide variety of foods but especially so in ultra-processed foods such as soda, candy, desserts, ready to eat cereal, and fruit juices. They can also hide in foods that are perceived as healthier such as yogurt, breakfast bars, and pre-packaged oatmeal.

Types of added sugars in our food include ingredients ending in “ose” such as glucose, sucrose (a disaccharide of glucose and fructose), fructose (including high fructose corn syrup), cane sugar or syrup, agave nectar, maple syrup, honey, coconut sugar, fruit juice concentrates or nectars. Consumers may have confusion surrounding added sugars because front of product package claims may include words like “natural” which can make one think this automatically translates into “healthy.”

The American Heart Association recommends

no more than 36 grams or 9 teaspoons for men and 25 grams or 6 teaspoons for women of added sugar daily.

The reality is that in the United States, we consume excessive amounts of added sugar which can increase risk of the development of obesity, type 2 diabetes mellitus, cardiovascular disease, metabolic syndrome and non-alcoholic fatty liver disease. A recently published population based cohort study by Mullee et al (2019, JAMA Internal Medicine) examined an association between total, sugar-sweetened and artificially sweetened soft drink consumption and subsequent all-cause and cause-specific mortality.

The authors of the study found that there was a higher all-cause mortality among those who consumed greater than 2 or more 250 ml servings per day versus less than one 250 ml serving per month of total soft drinks (both artificially & sugar sweetened), (HR 1.17, 95% CI 1.11-1.22, p<0.01).

They also saw associations between artificially sweetened soft drinks and death from circulatory disease and between sugar-sweetened soft drinks and death from digestive diseases. These results were independent of body weight and BMI (i.e association also observed in those with normal weight and. BMI as well).


I want to a talk about a few specific added sugars in further details as there can be confusion surrounding their use.

High fructose corn syrup

is produced from corn syrup (made of glucose) which is processed to increase the fructose content through an enzymatic reaction. Glucose is converted by glucose isomerase (the enzyme) into fructose.

Contrary to the name, high fructose corn syrup is a mix of both glucose and fructose. It is two times sweeter than glucose.

The most common form contains 42% or 55% fructose. High fructose corn syrup has replaced table sugar (aka sucrose which is glucose and fructose bound together, not separate like in high fructose corn syrup) in the food industry. Factors that contributed to this change include production quotas of domestic sugar, tariffs on foreign sugar, US corn subsidies, and raising the price of sucrose. High fructose corn syrup can hide in a variety of foods that you wouldn’t think contained it in the first place (ketchup, jams, jellies, bread, yogurt). High fructose corn syrup should be viewed as any other added sugar and limited in our day to day eating.

I do not want to demonize fructose because it is the natural sugar found in many fruits and some vegetables. These fruits and veggies also contain minerals, vitamins, fiber, and phytochemical which are generally not found in foods that contain high fructose corn syrup.

Coconut sugar

is often touted as a“healthy alternative” to white sugar but in reality, coconut sugar is just another form of added sugar.

Coconut sugar is made from coconut palm sap and resembles brown, granulated sugar.

It is made up of sucrose (70-79%), glucose and fructose (3-9% each).

Coconut sugar undergoes little processing so it does retain a small amount of the vitamins and minerals. These retained nutrients are one of the claims as to why it’s “healthier”. For instance, coconut sugar is reported to be “400 times higher in potassium” than table sugar, but you would need to eat large amounts of coconut sugar to gain the benefits of these vitamins and minerals.

I hope this short guide to added sugars helps you make informed decisions for your day to day eating!


Asghar MT, Yusof YA, Mokhtar MN, Ya’acob ME, Mohd Ghazali H, Chang LS, Manaf YN. Coconut (Cocos nucifera L.) sap as a potential source of sugar: Antioxidant and nutritional properties. Food Sci Nutr. 2019 Sep 30;8(4):1777-1787. doi: 10.1002/fsn3.1191. PMID: 32328243; PMCID: PMC7174220.

Mullee A, Romaguera D, Pearson-Stuttard J, et al. Association Between Soft Drink Consumption and Mortality in 10 European Countries. JAMA Intern Med. 2019;179(11):1479–1490. doi:10.1001/jamainternmed.2019.2478

Mai BH, Yan LJ. The negative and detrimental effects of high fructose on the liver, with special reference to metabolic disorders. Diabetes Metab Syndr Obes. 2019;12:821-826. Published 2019 May 27. doi:10.2147/DMSO.S198968



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4 Responses

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