Sugar is a broad term for a lot of different molecules that make foods and drinks sweet. Today, sugar is in just about every food and drink we consume. How your body processes different types of sugar varies. Plus, during pregnancy, there are changes to the way your body reacts to and processes glucose. This article explains walks you from understanding sugar and its effects on you and your baby to monitoring your sugar intake and keeping your consumption within recommended levels.
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What is Sugar?
Sugar is a broad term for a lot of different molecules that make foods and drinks sweet. There are two types of sugars, monosaccharides, and disaccharides.
Monosaccharides are simple sugars and 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 make glucose during photosynthesis. Most of the carbohydrates we eat our bodies convert 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 molecule of galactose with a molecule of glucose.
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 molecule of glucose with a molecule of fructose.
Types of Sugar
Table sugar, the white stuff we think of when we think of sugar, refers to sucrose. This is a disaccharide composed of glucose and fructose. By law, in the United States, sucrose is the only substance that can be called “sugar” on food labels. In this article, we are talking about sugar in terms of all of the different mono- and disaccharides in both natural and processed foods. Next week we will talk about artificial sweeteners.
Today we have a lot of different types of sugar available. Most of these are some combination of glucose and fructose. In addition to cane sugar, there is sugar from other sources, like beets, dates, and coconuts. 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 enzymes are added to convert part of the glucose into fructose. The result is a sweetener with 55% fructose and 45% glucose. In reality, it is not a lot different from table sugar, which is 50% glucose and 50% fructose. High fructose corn syrup is common because it is cheaper than sugar.
How Your Body Processes Sugar
When you eat sugars, your body breaks them down into glucose and fructose. These monosaccharides are processed differently.
Your body uses glucose for energy. When you consume glucose, it is absorbed in your gastrointestinal tract and enters your bloodstream. This makes your pancreas produce a hormone called insulin, which helps muscles, fat, and other cells absorb glucose for fuel. Any time you eat, your body has an insulin response to regulate the amount of sugar in your blood. Excess glucose is then either stored as glycogen in your muscles or as lipid in fat tissue.
Fructose is processed differently. It has to be processed by your liver and converts into either glucose that your body can use for fuel or fat that your body has to store. Overconsumption of sugars can lead to non-alcoholic fatty liver disease. This disease is estimated to affect 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, which can have the same effects.
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 less glucose is absorbed, more of it reaches your baby. I am sure you can imagine that a growing baby needs a lot of energy. This process makes sense because your baby is using 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 the insulin and higher levels of glucose are in your blood, your pancreas reacts by producing more insulin. Overall this still keeps your blood sugar levels in check. The problem comes in 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 being absorbed and used as energy and instead goes to your baby.
Gestational Diabetes is a type of diabetes that just occurs during your pregnancy and goes away after the birth of your baby. Thankfully it is not permanent, but it does put you at a higher risk of developing Type II diabetes later in life.
Risks of Gestational Diabetes
There is a lot of evidence on the risks of gestation diabetes. Some of the risks to your baby include:
- Macrosomia is a baby who weighs more than 4,500 g (9 lb, 15 oz). This can increase injury to their shoulder during birth, known as shoulder dystocia, or other birth injuries.
- As your baby’s body is trying to deal with the high levels of glucose, their pancreas responds by producing more insulin. This can result in them having lower blood glucose levels at birth, which can be associated with breathing problems.
- A higher risk of admission to the NICU (neonatal intensive care unit)
- Babies born with excess insulin are at a higher risk for obesity and type 2 diabetes
- Higher risk of stillbirth
The risks to you of gestational diabetes include:
- Preterm labor
- Gestational diabetes puts you at a higher risk of cesarean birth
- Raises your risk of hypertension and preeclampsia
- You are also more likely to get gestational diabetes in a subsequent pregnancy and develop type 2 diabetes later in life.
Rates of Gestational Diabetes
Rates of gestational diabetes have been slowly increasing in the United States, and it affects close to 6% of pregnancies. The rates vary among ethnicities like among Asian women; it is 11.1%. Rates also vary by weight; in obese women, it is 13.6%, in underweight women it is 2.9%. While this may not affect you, the testing will because it has become standard procedure to test all pregnant women, even if you do not have any risk factors.
The Limitations of Research on Diet and Nutrition
Studies on the long term effects of consuming any food are complicated because there are so many variables. If you increase your consumption of one food, you are likely to 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 the majority of studies rely on questionnaires that require participants to self-report on the foods they consume. The problem is that the reporting is typically not very accurate.
On top of the challenges to having an evidence-based approach to what the right diet is, there is not a one size fits all. Everyone is different. We have different dietary needs based on our genetic makeup, where we live, our levels of activity, our health, the list goes on.
While I cannot give the perfect diet to follow, I can confidently tell you that the ideal diet is primarily healthy whole foods. What does this mean? You want to focus on food that grows out of the ground, or on a bush, or a tree. Meats ideally are coming from pasture-raised animals. 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 not healthy.
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 about the hazards of sugar while promoting fat as the dietary culprit in coronary heart disease. The biggest problem was that the sugar industry did not disclose its role in funding and directing this research. This scandal is one example of how dollars are swaying 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 back in the 1970s, the average American consumed about 37 grams per day. Now that number is up to 55 grams per day. Children consume even more sugar, with an average of 73 grams per day.
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 be consuming. In a perfect world, we are eating 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
In the United States, there is no daily value for total sugars. There is a daily value for added sugars. The FDA recommendation is 50 grams or about 12.5 teaspoons per day based on a 2,000 calorie daily diet. This means you should be limiting calories from added sugars to less than 10 percent of total calories per day. For example, if you consume a 2,000 calorie daily diet, that would be 200 calories or 50 grams of added sugars per day. The idea is that consuming too much sugar can make it challenging to meet nutrient needs while staying within calorie limits. This is the idea behind empty calories.
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
In 2016 the FDA revised its guidelines for sugar on the nutrition facts label on foods and drinks. Total Sugars include both naturally occurring and any added sugars. Added sugars include sugars that 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 found in milk, fruits, and vegetables.
The newer labeling makes it a little easier to get a quick idea of how much sugar a product contains. According to 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
There are a lot of healthy whole foods that naturally contain sugar, along with other essential nutrients like fiber, protein, vitamins, and calcium. If you eat an orange, you will be consuming around 10-13 grams of sugar. You will also be getting a lot of fiber from the fruit. The fiber prevents some of the sugar (up to 30%) from being absorbed. Fiber also creates a slower rise in your blood sugar.
Alternatively, you could drink an 8-ounce glass of orange juice. That has the sugar content of about two oranges, without most of the fiber. You also likely consume it faster than you would if you were eating an orange, which means the sugar hits your bloodstream more quickly. Another benefit you are missing out on without fiber in whole fruit is you don’t feel as full after drinking a glass of orange juice as you would if you ate the fruit.
Tips for Reducing Your Sugar Consumption
The good news is there are many small things you can do to make a significant change in your sugar consumption.
Read Labels and Track Your Sugar
The first step in knowing how much sugar you are consuming is to read labels and keep track of what you eat. Tracking your diet can be cumbersome, but you do not have to do this forever. Even doing this for a week will put you on track to know how much sugar you are eating and give you a baseline. Over time you learn what foods to avoid, and you don’t need to keep reading labels constantly. You can keep track of your sugar with an app on your phone, with a food journal, or in a note-taking app.
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, and you insert a test strip into the monitor and put a drop of blood onto the test strip. You may have the option to test your blood glucose in place of a glucose challenge screening test. It is a lot 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 different food affects your blood glucose levels. This is going to help you modify your diet to eat healthier foods because you see the immediate effects.
Look for Hidden Sources of Sugar
Just about every processed food includes some amount of 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 are keeping track of how much sugar you consume in a day. Processed foods are a significant source of hidden sugar. Often foods labeled as fat-free contain additional sugar. Bread, yogurt, protein bars, and cereal often have a high amount of sugar. You also want to pay attention to the serving size. The serving size of cereal may be smaller than the amount you pour into a bowl. Be realistic about what is an actual serving size for you.
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 instead.
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 will be different 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.
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 for gestational diabetes. Your care provider may have more specific recommendations for sugar consumption based on your health and risk factors.
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