Nutrition part 4 - Sugar: What you need to know before you finish that selection box

It's December. Everywhere you turn there are tins of chocolates, festive treats in the office, mince pies at every gathering, and that constant stream of sweet goodies that seems impossible to escape. Then your colleague comes into the office and tells you that you shouldn't be eating that satsuma as its full of sugar as well.

So let's talk about sugar—what it is, how it affects your body, and most importantly how to make good choices.

Chocolates

Understanding different types of sugar

I like to think about sugar as falling into two categories and understanding the difference is crucial for making better food choices.

Natural sugars are found in whole foods like fruit, vegetables, milk, and legumes. When you eat a satsuma yes, you're consuming sugar (fructose), but you're also getting fibre, vitamins, minerals, and beneficial plant compounds. The fibre in whole fruit slows down how quickly that sugar enters your bloodstream, and you're getting genuine nutrition alongside it.

Added sugars are sugars or syrups added to foods during processing or preparation. This includes the obvious culprits like chocolate, biscuits, cakes, and fizzy drinks, but also hides in less obvious places like pasta sauce, "healthy" breakfast cereals, flavoured yoghurts, and even savoury foods. These sugars provide what nutritionists call "empty calories"—energy without any accompanying nutrients.

The World Health Organization uses the term "free sugars," which includes all added sugars plus the naturally occurring sugars in honey, syrups, fruit juices, and fruit juice concentrates. This distinction matters because the sugar in a whole orange behaves very differently in your body than the sugar in a glass of orange juice.

Why sugar intake matters for your health

When you consume sugar, especially in large amounts or without accompanying fibre and protein, several things happen.

Your blood glucose rises rapidly, which triggers your pancreas to release insulin. Insulin's job is to help move that glucose from your bloodstream into your cells for energy. This system works brilliantly when you eat balanced meals with whole foods. The problem arises when we consistently consume large amounts of sugar, particularly refined sugars.

Over time, when your cells are repeatedly exposed to high levels of insulin, they can become less responsive to insulin's signals. This is called insulin resistance. Your body then has to produce even more insulin to do the same job, creating a cycle that can lead to elevated blood glucose levels, increased fat storage (particularly around the middle), and eventually conditions like type 2 diabetes.

For women, this becomes particularly significant during perimenopause and menopause. Research tells us that declining oestrogen and progesterone during these life stages contributes to elevated blood sugar, decreased muscle mass, and increased insulin resistance. The metabolic protection that reproductive hormones provided begins to decline, making blood sugar management even more critical.

Insulin resistance isn't just about blood sugar and weight. It's associated with increased risk of cardiovascular disease, high blood pressure, abnormal cholesterol levels, polycystic ovary syndrome (PCOS), and increased inflammation throughout the body. For women with PCOS, insulin resistance is a major contributor, affecting between 5-18% of women of reproductive age and causing disruptions in ovulation, menstrual cycles, and fertility.

Sugar

Current recommendations: How much is too much?

The World Health Organization recommends that free sugars should be less than 10% of your total daily energy intake, with a conditional recommendation to reduce this further to below 5% for additional health benefits. For most women, this translates to roughly 25 grams (about 6 teaspoons) per day.

The American Heart Association offers similar guidance, recommending women limit added sugars to no more than 100 calories per day—approximately 25 grams or 6 teaspoons.

To put this in perspective, a single 330ml can of fizzy drink contains approximately 35 grams of sugar. A flavoured latte from your local coffee shop might contain 25-30 grams. A serving of flavoured yoghurt could have 15-20 grams. You can see how quickly these numbers add up, often before you've even had a proper meal.

The reality of sugar in our diets

Here's the uncomfortable truth: most of us consume far more sugar than these recommendations. On average, people in the UK consume around 60 grams of added sugar daily—more than double the recommended amount.

The biggest sources aren't always where you'd expect. Yes, chocolate biscuits, and cakes contribute significantly. But so do sugary drinks (including fruit juice), breakfast cereals, yoghurts, and processed foods where sugar is added for flavour, texture, or preservation.

Sugar hides under many different names on ingredient lists: glucose, fructose, sucrose, maltose, dextrose, agave syrup, golden syrup, maple syrup, honey, molasses, date syrup, and many more. Even products marketed as "healthy" or "natural" can be surprisingly high in added sugars.

How sugar affects body composition and weight

If you're working toward changing your body composition, understanding sugar's role becomes even more important. When you consume more sugar than your body can immediately use for energy, several things happen.

First, the excess glucose gets stored in your muscles and liver as glycogen. Once those stores are full, the remainder gets converted to fat and stored, particularly around your middle. This visceral fat (the deep belly fat that surrounds your organs) is particularly problematic because it's metabolically active and produces hormones and inflammatory substances that can contribute to insulin resistance and other health problems.

High sugar intake can disrupt the hormones that regulate hunger and fullness. Research shows that excess sugar consumption can lead to leptin resistance—leptin is the hormone that tells your brain you're full. When your cells stop responding properly to leptin, you can feel hungry even when your body has adequate energy stores. This makes it much harder to maintain a healthy weight or change your body composition.

Sugar's impact on blood glucose levels also affects your energy throughout the day. When you eat something high in sugar without accompanying protein, fat, or fibre, your blood glucose spikes rapidly, followed by a crash. This roller coaster creates those afternoon energy slumps, increased cravings for more sugar, difficulty concentrating, and that "tired but wired" feeling

Sugar and body composition

Beyond weight: Sugar's impact on overall health

The effects of sugar extend beyond body composition. High sugar intake has been linked to increased stress and anxiety levels. Sugar can cause rapid blood glucose fluctuations that lead to mood swings and irritability. Studies have shown that diets high in sugar may disrupt your body's stress response system, leaving you feeling more anxious.

Sleep quality suffers too. Consuming high amounts of sugar, particularly in the evening, can interfere with your sleep patterns. When your blood sugar drops during the night (hypoglycaemia), it can actually wake you up similar to the effect of alcohol on blood sugar and sleep quality.

Your cardiovascular health is affected as well. High sugar intake is associated with increased triglycerides (a type of fat in your blood), reduced HDL (good cholesterol), and increased risk of heart disease. Chronic inflammation, which sugar promotes, is now recognized as a significant risk factor for numerous health conditions.

Making better choices: practical strategies

The goal isn't to become obsessed with every gram of sugar or to eliminate all sweetness from your life. It's about making informed choices most of the time that support your health, energy, and fitness goals.

Start by focusing on whole foods. Build your eating habits around minimally processed foods: vegetables, fruits, wholegrain's, lean proteins, nuts, seeds, and legumes. These foods contain natural sugars but come packaged with fibre, vitamins, minerals, and other nutrients that slow sugar absorption and provide genuine nutrition.

Read food labels carefully. Look at both total sugars and added sugars. A plain yoghurt might show 12 grams of sugar per serving, but that's the naturally occurring lactose in milk. A flavoured yoghurt might show 20 grams—meaning 8 grams have been added. Learn to recognize sugar's many names in ingredient lists.

Be strategic with fruit. Whole fruit is genuinely nutritious and the fibre content makes a significant difference in how your body processes the natural sugars.

However, fruit juice—even 100% fruit juice—behaves more like added sugar in your body because the fibre has been removed. If you enjoy juice, have a very small glass with a meal rather than on its own, or better yet, eat the whole fruit instead.

Watch the "health halo" foods. Products marketed as healthy, natural, or organic can still be high in sugar. Granola, protein bars, smoothies, and "natural" breakfast cereals often contain as much sugar as conventional sweets. Don't let clever marketing fool you.

Make simple swaps. These don't have to be dramatic or difficult. Swap flavoured lattes for plain ones. Choose plain yoghurt and add your own fruit rather than buying flavoured versions. Replace fizzy drinks with water or sparkling water with a squeeze of fresh lemon or lime. Swap fruit juice for the whole fruit. These small changes, repeated consistently, make a real difference.

Pay attention to timing. If you're going to have something sweet, having it as part of a balanced meal rather than on its own helps moderate the blood sugar response. The protein, fat, and fibre from the rest of your meal slow down sugar absorption.

Don't fall into the artificial sweetener trap. While they might seem like an easy solution, the World Health Organization advises caution with sugar substitutes. Evidence on their long-term effectiveness for weight control is unclear, and they may still trigger cravings for sweet foods and don't address the underlying habit of expecting everything to taste sweet.

The role of exercise in blood sugar management

Here's where your commitment to staying active really pays dividends. Exercise is one of the most powerful tools for improving blood sugar management. When you exercise, your muscles can take up glucose without needing insulin—it's like a bypass route that helps clear glucose from your bloodstream.

Regular physical activity, particularly strength training and high-intensity interval training, improves your cells' sensitivity to insulin. This means your body doesn't have to produce as much insulin to manage blood glucose levels. The benefits persist even after your workout is finished.

Research shows that even a 15-minute walk can help lower blood glucose levels, particularly if done after meals. For women with insulin resistance or those at risk of developing it, combining strength training with attention to nutrition creates a powerful intervention that can literally change your metabolic health.

This is part of why the combination of regular exercise and sensible nutrition is so effective. You're not just burning calories—you're fundamentally changing how your body processes and manages glucose, making you more metabolically healthy overall.

A balanced perspective

The message here isn't that sugar is evil and must be eliminated entirely. Completely avoiding all added sugars is neither realistic nor necessary for most people. A Mince pie at Christmas, your favourite biscuit with tea occasionally, things can absolutely be part of a healthy life.

The issue is that for many of us, sugar has moved from an occasional treat to a daily staple in large quantities, often without us fully realizing it – especially at Christmas. When sugar is hidden in so many processed foods and when portion sizes have increased so dramatically, it's easy to consume far more than our bodies are designed to handle. Build your eating habits around whole foods that nourish your body. Save genuinely sweet foods for occasions when you can truly enjoy them rather than consuming them mindlessly throughout the day.

Moving forward

So if you are reaching for that box of chocolates over Christmas, have a couple with a cup of tea and genuinely enjoy them. Just take a few chocolates, put the box away then sit down and savour them—rather than eating half the box whilst standing at the buffet table.

Remember, the goal is progress, not perfection. There will be days when you have more sugar than intended, and that's perfectly fine. What matters is your overall pattern of choices over weeks and months, not individual days.

References

American Heart Association (2024) 'Added sugars', American Heart Association. Available at: https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars

Centers for Disease Control and Prevention (2024) 'About insulin resistance and type 2 diabetes', CDC. Available at: https://www.cdc.gov/diabetes/about/insulin-resistance-type-2-diabetes.html

Knüppel, A., Shipley, M.J., Llewellyn, C.H. & Brunner, E.J. (2017) 'Sugar intake from sweet food and beverages, common mental disorder and depression: prospective findings from the Whitehall II study', Scientific Reports, 7(1), article 6287. https://doi.org/10.1038/s41598-017-05649-7

Malik, V.S., Pan, A., Willett, W.C. & Hu, F.B. (2013) 'Sugar-sweetened beverages and weight gain in children and adults: a systematic review and meta-analysis', American Journal of Clinical Nutrition, 98(4), pp. 1084-1102. https://doi.org/10.3945/ajcn.113.058362

Shapiro, A., Mu, W., Roncal, C., Cheng, K.Y., Johnson, R.J. & Scarpace, P.J. (2008) 'Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding', American Journal of Physiology-Regulatory, Integrative and Comparative Physiology, 295(5), pp. R1370-R1375. https://doi.org/10.1152/ajpregu.00322.2007

St-Onge, M.P., Roberts, A., Shechter, A. & Choudhury, A.R. (2016) 'Fiber and saturated fat are associated with sleep arousals and slow wave sleep', Journal of Clinical Sleep Medicine, 12(1), pp. 19-24. https://doi.org/10.5664/jcsm.5384

Stanhope, K.L., Schwarz, J.M., Keim, N.L., Griffen, S.C., Bremer, A.A., Graham, J.L., Hatcher, B., Cox, C.L., Dyachenko, A., Zhang, W., McGahan, J.P., Seibert, A., Krauss, R.M., Chiu, S., Schaefer, E.J., Ai, M., Otokozawa, S., Nakajima, K., Nakano, T., Beysen, C., Hellerstein, M.K., Berglund, L. & Havel, P.J. (2009) 'Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans', Journal of Clinical Investigation, 119(5), pp. 1322-1334. https://doi.org/10.1172/JCI37385

Tryon, M.S., DeCant, R. & Laugero, K.D. (2015) 'Having your cake and eating it too: a habit of comfort food may link chronic social stress exposure and acute stress-induced cortisol hyporesponsiveness', Physiology & Behavior, 114, pp. 32-37. https://doi.org/10.1016/j.physbeh.2014.12.042

World Health Organization (2015) 'WHO calls on countries to reduce sugars intake among adults and children', WHO News Release, 4 March. Available at: https://www.who.int/news/item/04-03-2015-who-calls-on-countries-to-reduce-sugars-intake-among-adults-and-children

World Health Organization (2015) Guideline: Sugars intake for adults and children. Geneva: World Health Organization. Available at: https://www.who.int/publications-detail-redirect/9789241549028