Understanding Sugar and Health: A Balanced Perspective

When I grabbed my kids’ birthday cake this week, a familiar feeling of guilt crept in. I mean, is this thing packed with sugar?

The health and wellness world is swamped with voices promoting zero or no sugar diets. Sometimes it’s suggested as a quick detox, and other times as a long-term solution. Sugar has really taken a beating lately from influencers and even US Health Secretary Robert F. Kennedy Jr., who labeled it “poison” last spring.

When Kennedy mentions “sugar,” he’s actually referring to added sugars—those refined brown or cane sugars and syrups that go into candy, packaged granola, and sodas.

Many studies have linked added sugars to diabetes, inflammation, obesity, and even cancer. However, some people, including Kennedy, seem to push the anti-sugar narrative a bit too far. Recent US dietary guidelines suggest that children under ten should avoid all added sugars. Previously, the guidelines focused on those age two and younger. For adults, the advice is to limit added sugars to 10 milligrams per meal (which is about the amount you’d find in a small container of Greek yogurt).

According to Kennedy’s view, holidays like Halloween or birthdays would look completely different. Yet, a complete ban isn’t really backed by scientific evidence. Sugar is everywhere, making it hard to conduct an experiment on what happens if you consume no sugar at all. What’s more useful is the understanding that less sugar tends to be better than more.

It’s important to clarify that not all sugars are bad—and they aren’t all the same. The focus should really be on which types of sugars you’re eating and in what quantities. Let’s break it down.

Generally, sugar can be divided into two types: the natural sugars found in fruits and carbs, and the “added” sugars that are artificially mixed into foods for flavor. The added sugars in your frappuccino or pastries? Not great, especially in large amounts. But naturally occurring sugars in fruits and whole grains? They can absolutely fit into a healthy diet, one that even Kennedy might endorse.

There’s a physiological reason for making this distinction: Sugars in fruit come with other nutrients, especially fiber, which slow digestion and help your body manage sugar more effectively. Research shows that eating whole oranges results in a lesser blood sugar spike compared to drinking orange juice. Another study explored the risk of Type 2 diabetes linked to fruit consumption, finding no increase; in fact, the risk actually decreased—unless you were drinking fruit juice, which correlated with a higher risk.

Natural sugars? They’re generally fine. But added sugars? Those undergo processing that removes beneficial nutrients, resulting in pure sugar. These kinds of sugars raise more health concerns due to the dramatic fluctuations in blood sugar they can cause. A significant 2023 meta-analysis revealed links between sugary drinks and increased risks of Type 2 diabetes, hypertension, and heart disease. And just how much sugar you consume matters, too; the more you eat, the greater the potential risks. Dietitians often express concerns about sweetened beverages like juices and sodas, which can be sneaky sources of extra sugar.

It’s a good idea to monitor your added sugar intake. However, trying to eliminate sugars entirely goes against a key idea emerging in nutrition science: metabolic flexibility.

This concept relies on the idea that your health improves the more adaptable your body is to different energy sources, whether fats or sugars. While obesity or diabetes may limit this flexibility, outright eliminating certain foods can also have negative effects. A 2022 meta-analysis noted that consistently low sugar intake might not be beneficial after all.

Forget “no” sugar and focus on “low” sugar

This fixation on sugar is just one aspect of what’s perplexing about Kennedy and his Make America Healthy Again movement: They’ve identified a real issue worth considering, yet the message often becomes oversimplified, obscuring important nuances. The “zero sugar” mentality overshoots the mark.

If you scrutinize the dietary guidelines (which most Americans probably won’t do), you’d find clarity; they even explain what “added sugars” entail. But Kennedy frequently speaks about removing sugar completely from one’s diet. He recently stated that Americans should have a clear understanding of the sugar content in their foods, implying that the ideal sugar intake is zero.

This kind of messaging might frustrate people, leading them to ask questions like, “How can I find fruits with no sugar?” (Which, as you can guess, isn’t possible.) We definitely don’t want to dissuade people from eating healthy foods—like apples, oranges, and berries—just because they contain some sugar.

Summarizing all of this, you start to grasp a more accurate perspective on sugar and health: Don’t stress about the sugars in fruits or whole grains; those come with nutrients that aid in sugar processing. Still, try to limit sugary drinks, candy, and refined carbs.

Also, be cautious about food-related stress. Over-focusing on nutritional content and “clean” eating can lead to disordered eating, a condition known as orthorexia. And we definitely don’t want to pass on those anxieties to kids. As Dr. Amer Al-Nimr, a pediatric gastroenterologist at Dartmouth, wisely points out, “We don’t want people receiving the message that food is bad or a source of concern.”

It’s virtually impossible to have no sugar—and who would want that, anyway? Do your best to manage sugar intake, but remember that enjoying the occasional treat is perfectly fine, and fruit is certainly not an issue. It’s perfectly okay to let yourself—and your child—indulge in a cupcake at a birthday party. It might not be the “healthiest” choice, but it’s still sweet.