Overview

Sugar is a term that encompasses a wide variety of molecules responsible for making foods and drinks taste sweet. From natural sources like fruits and dairy to processed and added sugars in packaged foods, sugar is present in nearly everything we consume. How your body processes different types of sugar varies depending on the molecular structure and source. During pregnancy, your body undergoes significant changes, including how it reacts to and metabolizes sugar. This episode provides a comprehensive guide to understanding sugar, its impact on your body and baby during pregnancy, and actionable strategies to monitor sugar consumption.

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Why We Crave Sugar

Sugar is a broad term for many molecules that make foods and drinks sweet. Sugar is naturally in some foods. In modern society, manufacturers add sugar to many foods. Evolutionarily, humans prefer sweet foods and are hardwired to seek sugar. Fruits naturally contain sugar, are calorie-dense, and are an efficient energy source. Consuming sugar activates the brain’s reward system, releasing dopamine. This is a neurotransmitter that promotes feelings of pleasure and reinforces behavior. We developed this mechanism as a tool for survival when sweet foods were scarce. In a modern environment, we have abundant sugar, and it is easy to overconsume it. Our environment and access to sugar have evolved much quicker than our brain’s ability to adapt.

Monosaccharides and Disaccharides

There are two types of sugars: monosaccharides and disaccharides.

Monosaccharides are single sugar molecules. These simple sugars include fructose, galactose, and glucose. Fructose is a sugar that naturally occurs in fruits and some root vegetables. Galactose is a component of lactose, which is a sugar in milk. Plants and algae produce glucose during photosynthesis. Your body converts most of the carbohydrates you eat into glucose during digestion.

Disaccharides are compound sugars and are the combination of two monosaccharide molecules. Disaccharides include lactose, maltose, and sucrose. Lactose is the naturally occurring sugar found in milk. Lactose is the combination of a galactose molecule with a glucose molecule. Maltose is from grains. A molecule of maltose is the combination of two molecules of glucose. Sucrose is in sugarcane and beets. It also naturally occurs with fructose and glucose in fruits and some root vegetables. A molecule of sucrose is a glucose molecule with a fructose molecule.

How Your Body Processes Sugar

During digestion, your body breaks sugar down into glucose and fructose. Your body processes each of these monosaccharides differently.

Your body uses glucose for energy. When you consume glucose, it is absorbed in your gastrointestinal tract and enters your bloodstream. Your pancreas produces insulin, a hormone that helps muscles, fat, and other cells absorb glucose for fuel. When you eat, your body has an insulin response to regulate sugar in your blood. Your body stores excess glucose as glycogen in your muscles or as a lipid in fat tissue.

You process fructose differently. It must first be processed by your liver and converted into either glucose that your body can use for fuel or fat it has to store. Overconsumption of sugars can lead to NAFLD (non-alcoholic fatty liver disease). This disease affects 20-30% of the population worldwide. NAFLD is when you have a build-up of fat in your liver that is not caused by overconsumption of alcohol.

How Your Body Processes Sugar During Pregnancy

When you are pregnant, your body naturally becomes more resistant to insulin, which means that more glucose remains in your blood. Since you absorb less glucose, more of it reaches your baby. You can imagine that a growing baby needs a lot of energy. This process makes sense because your baby uses the additional glucose for fuel.

For most expecting moms, this works just like it is supposed to. Even though your body is more resistant to insulin and higher glucose levels are in your blood, your pancreas reacts by producing more insulin. Overall, this still keeps your blood sugar levels in check.

Gestational Diabetes

The problem occurs when your pancreas can’t keep up with the high demand for additional insulin, and more glucose builds up in your blood. This is known as hyperglycemia. Insulin doesn’t cross the placenta, but glucose does. The result is too much glucose that isn’t absorbed and used as energy, which instead goes to your baby.

Gestational Diabetes is a type of diabetes that occurs during your pregnancy and goes away after the birth of your baby. Rates of gestational diabetes continue to increase in the United States, and it affects 8.3% of pregnancies. Gestational diabetes is more common in Hispanic, Asian, Black, Native American, and Alaskan Native women, as well as women who are overweight. Testing for gestational diabetes is standard in the United States between weeks 24-28. If your doctor or midwife diagnoses you with gestational diabetes, you will need to be even more cautious about the amount of sugar you consume.

Thankfully, gestational diabetes is not permanent, but there is a lot of evidence that gestational diabetes does increase your risk for adverse pregnancy outcomes like hypertension, preeclampsia, and cesarean birth. You are also more likely to get gestational diabetes in a subsequent pregnancy and develop type 2 diabetes later in life.  

As your baby’s body manages high glucose levels, its pancreas produces more insulin. This can result in your baby having lower blood glucose levels at birth, which can be associated with breathing problems. Babies born with excess insulin are at a higher risk for obesity and type 2 diabetes. A baby born to a mother with gestational diabetes is also at a higher risk for jaundice, stillbirth, preterm labor, and NICU (neonatal intensive care unit) admission. An associated risk of high glucose is your baby gaining additional weight, and macrosomia is defined as a baby who weighs more than 4,500 g (9 lb, 15 oz). This can increase the risk of injury to their shoulder during birth, known as shoulder dystocia, or other birth injuries.

Understanding the Different Types of Sugar

Table sugar is sucrose, a disaccharide composed of one glucose molecule and one fructose molecule. By law, in the United States, sucrose is the only substance that can be called “sugar” on food labels. Most table sugar is from sugar cane or beets.

In white sugar, the refining process removes impurities and molasses, leaving nearly 100% sucrose. The degree of refinement and the presence of molasses are responsible for the differences between white, brown, and other types of sugar. Molasses adds trace amounts of other sugars and minerals. The sucrose molecule itself is identical across all these sugars. From a health standpoint, these types of sugar have little to no difference. Raw sugar is not technically raw; however, it is less refined and retains more molasses than white sugar.

Sugar can also come from other sources like coconut or dates. Coconut sugar is from the sap of the coconut palm tree and contains sucrose. Coconut sugar also includes other sugars like glucose, fructose, and nutrients, giving it a slightly different flavor and color than pure sucrose. Dates contain natural sugars, including sucrose, glucose, and fructose, but they are not predominantly sucrose. Dates are a whole food, so their sugar content is mixed with fiber, vitamins, and minerals. While sugar from coconut or dates can contain nutrients, they are in trace amounts.

What You Need to Know About GMO Sugar

Sugar from sugar cane is usually labeled “cane sugar.” It is likely derived from beets if not explicitly labeled as cane sugar. In the U.S., over 95% of sugar beets grown are genetically modified. GMO sugar beets are primarily engineered for herbicide resistance, specifically to tolerate glyphosate. Some consumers avoid GMO-derived products due to broader concerns about GMOs or pesticide use. If you prefer to avoid sugar derived from GMO beets, look for products labeled “non-GMO,” “organic,” “cane sugar,” or products that carry certifications like the Non-GMO Project Verified label.

High-Fructose Corn Syrup

Processed foods commonly use high-fructose syrup made from hydrolyzed corn starch that has been processed to make corn syrup. To make it high fructose corn syrup, manufacturers add enzymes to convert part of the glucose into fructose. The result is a sweetener with 55% fructose and 45% glucose. It is not much different from table sugar, which is 50% glucose and 50% fructose. High fructose corn syrup is so prevalent, especially in processed foods, because it is cheaper than sugar. In addition, approximately 92-93% of corn grown in the U.S. is GMO.

The Limitations of Research on Diet and Nutrition

Studies on the long-term effects of consuming food are complicated because of many variables. If you increase your consumption of one food, you will likely decrease your consumption of something else. We do not know whether the change in health or disease is related to eating more of one food or less of another. Another challenge with research on nutrition and diet is that most studies rely on questionnaires that require participants to self-report the foods they consume. The problem is that the reporting is typically not very accurate.

On top of the challenges of having an evidence-based approach to the right diet, there is not a one-size-fits-all. Everyone has different dietary needs based on genetic makeup, where we live, activity levels, health, etc. While I cannot tell you the perfect diet, I can confidently tell you that the ideal diet is primarily healthy whole foods. Whole foods usually don’t come in a box, and they are not processed with a lot of added ingredients. A massive problem with processed foods is that they often contain high amounts of sugar. Even with the limitations on what we can learn from dietary research, we know that consuming a diet high in sugar is unhealthy.

Problems with Studies on the Consumption of Sugar

In 2016, evidence came out showing that the sugar industry sponsored a research program in the 1960s and 1970s that cast doubt on the hazards of sugar while promoting fat as the dietary culprit in coronary heart disease. The scandal is that the sugar industry did not disclose its role in funding and directing this research. As food companies promoted fat-free foods they added sugar to make up for the flavor lost by removing fat. This scandal exemplifies how big business can sway dietary guidelines, especially in the United States.

How Our Consumption of Sugar Has Changed Over Time

Over the years, we have steadily increased the amount of sugar in our diets. Data shows that in the 1970s, the average American consumed about 37 grams of sugar daily. Now, that number is up to 55 grams daily. Children consume even more sugar, averaging 73 grams daily.

How Much Sugar is Too Much?

Data on the health effects of excess sugar consumption have shaped recent recommendations on how much sugar we should consume. In a perfect world, we eat healthy whole foods with no added sugars. In reality, we all consume some sugar. The big question is, how much is too much?

Recommendation from the FDA

The United States has no recommended daily value for total sugars. However, there is a daily value for added sugars. The Dietary Guidelines for Americans state that a limited amount of added sugars can be included as part of an overall healthy eating pattern. The FDA recommends limiting calories from added sugars to less than 10 percent of total calories per day. This is 50 grams or about 12.5 teaspoons per day based on a 2,000-calorie daily diet. Consuming too much sugar can make it challenging to meet nutrient needs while staying within calorie limits.

Recommendation from the World Health Organization

The World Health Organization recommends reducing the intake of free sugars to less than 10% of total energy intake and ideally below 5%. Free sugars include monosaccharides and disaccharides added to foods and beverages, and sugars naturally present in honey, syrups, fruit juices, and fruit juice concentrates.

Decoding Sugars on Food Labels

The FDA has guidelines for listing sugar on the nutrition facts label on foods and drinks. Total Sugars include both naturally occurring and added sugars. Added sugars include sugars that are added during the processing of foods, foods packaged as sweeteners, sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices. They do not include naturally occurring sugars in milk, fruits, and vegetables.

This labeling makes it easier to get a quick idea of how much sugar a product contains. According to Sugar Science, a group developed by a team of health scientists from the University of California, San Francisco (UCSF), there are 61 different names for sugar. That is a long list to memorize if you are reading the ingredients of something to look for sugar. It is much easier to look at the total sugar content on the nutrition label to see total and added sugar.

The Difference of Sugars Found in Whole Foods

Many healthy whole foods naturally contain sugar and other essential nutrients like fiber, protein, vitamins, and calcium. If you eat an orange, you consume around 10-13 grams of sugar. You also get a lot of fiber from the fruit. The fiber prevents your body from absorbing some sugar (up to 30%). Fiber also creates a slower rise in your blood sugar.

Alternatively, you could drink orange juice. An 8-ounce glass of orange juice contains as much sugar as two oranges without much fiber. You drink juice more quickly than you eat whole fruit, which means the sugar hits your bloodstream more quickly. Without the fiber content of whole fruit, you don’t feel as full after drinking a glass of orange juice as you would if you ate an orange. While we consider juice healthy, it can contain high amounts of sugar. It is always healthier to eat whole fruit.

Tips for Reducing Your Sugar Consumption

The good news is you can do many small things to significantly change your sugar consumption.

Read Labels and Track Your Sugar

The first step in knowing how much sugar you consume is to read labels and track what you eat. Tracking your diet can be cumbersome, but you do not have to do this forever. Even tracking your diet for a week will put you on track to know how much sugar you eat and give you a baseline. Over time, you learn what foods to avoid and don’t need to read labels constantly. I encourage you to track your sugar with an app on your phone, a food journal, or a note-taking app to get an idea of how much sugar you consume.

Monitoring Your Blood Sugar

You can measure your blood sugar easily at home. It requires a blood glucose monitor, which you can buy inexpensively. You prick your finger with a device that has a tiny needle, place a drop of blood on a test strip, and insert the test strip into the monitor. You may be able to test your blood glucose instead of a glucose challenge screening test. It is more work than sitting in your doctor’s office for an hour, but there are benefits. Monitoring your blood glucose at home will give you a better idea of how foods affect your blood glucose levels. This will help you modify your diet to eat healthier foods because you see the immediate effects.

Look for Hidden Sources of Sugar

Processed foods are a significant source of hidden sugar. Even my favorite organic whole-grain bread has 5 grams of sugar per slice. That may not seem like a lot, but it adds up if you track how much sugar you consume daily. Often, foods labeled as fat-free contain additional sugar. Manufacturers often add sugars to make up for flavor lost when they remove fat. Bread, yogurt, protein bars, and cereal often have high sugar. You should also pay attention to serving sizes. The serving size of cereal may be smaller than the amount you pour into a bowl. Be realistic about what an actual serving size is for you.

Finding Alternatives

Finding healthier alternatives may be an easier adjustment than cutting out sweets completely. If you have a sweet tooth after dinner, you will always be better off having fruit for dessert than a cupcake. A piece of dark chocolate may satisfy your sweet tooth as much as a big bowl of ice cream. Perhaps you can replace your nightly dessert habit with a cup of tea or another ritual.

Give Yourself Some Space to Enjoy Sweets

Pregnancy can be challenging, and you should enjoy it as much as possible. If paying attention to every single thing you eat stresses you out, stop. You should have the space to enjoy sweets and not feel guilty. You can do this in moderation and still maintain a healthy pregnancy. Moderation differs for everyone, and you know whether you are overdoing it on the sugar. No one eats a perfect diet, and please do not beat yourself up for having dessert. The key is moderation.

Talk to Your Doctor or Midwife

If you have any questions about your diet or your sugar consumption, please bring them up with your doctor or midwife. Especially if you are at a higher risk or have a gestational diabetes diagnosis. Your care provider may have more specific recommendations for sugar consumption based on your health and risk factors.

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