For a healthy diet to be sustainable, it must be one that can be enjoyed. Calories consumed should match metabolic needs and activity, and also provide essential nutrients, but it’s not going to provide nutrition if it’s not eaten. Therefore, it’s important to work with patients and find nutritious foods that they will realistically choose on a regular basis. Sweeteners are not essential, but they do increase palatability which can help deliver essential nutrients. For instance, a patient may eat more vegetables if you “allow” maple syrup to be added to steamed carrots, top sweet potatoes with mini marshmallows, or add sugar or honey to oatmeal. A sweetener can cut the tartness of yogurt and adding honey or sugar to herbal tea may make it more palatable to soothe a sore throat. Adding a sweetener to a high fiber bran or barbecue sauce to pinto beans helps deliver the fiber and important vitamins and minerals in these foods. All of these foods (carrots, oats, yogurt, sweet potatoes, bran, beans) will enhance diet quality, only if they are eaten.
Sweetness is Known by Several Names
Glucose and fructose are simple sugars called monosaccharides that are found naturally in many foods. Long chains of glucose make up starches. Glucose and fructose are both chemically made of 6 atoms of carbon, 12 of hydrogen, and 6 of oxygen (C6H12O6). But, their structures are different and they are metabolized differently when consumed alone, but HFCS-55 (high fructose corn syrup) is the most widely used type, and is 55 percent fructose, 45 percent glucose. This composition allows HFCS to be compared to sucrose and honey (which are both 50/50 fructose and glucose). While media headlines about sweeteners can sometimes confuse consumers, it’s important to know that HFCS is a safe and useful caloric sweetener. The science community has widely accepted that HFCS is metabolized in the same way as other caloric sweeteners (such as sugar) and there is no causal link between HFCS and obesity or other metabolic disease.
How Function Plays into Sweetness
While many sweeteners can contribute sweetness and calories, the type of sweetener used in a recipe may be based on attributes and benefits beyond sweetness. Liquid sweeteners such as HFCS and corn syrup blend well with other ingredients, making them preferable for manufacturing of some packaged foods and beverages. Some recipes also call for a liquid sweetener to improve the smooth texture and reduce the risk of crystallization. HFCS allows product textures that aren’t possible with granular sweeteners. Other recipes call for crystalline sugar or sweeteners to provide different textures, improve the moist texture, or to ensure appropriate volume of a baked produced. A different benefit is that HFCS acts as a preservative, eliminating the need for other additives. The science of sugars allows manufacturers and home cooks to choose different sweeteners to create a variety of product attributes, even within a single product. For instance, they may create a product that has one moist layer, with another crisp layer, by using different sweeteners.
A Calorie is a Calorie
When discussing the use of products made with HFCS with your patients, it’s important to understand that HFCS contributes the same calories (as carbohydrate – 4 calories per gram) as table sugar. The Dietary Guidelines for Americans advise that added sugars should be limited in the diet to 10 percent of total calories. Calorie needs vary from person to person, depending on age, gender, activity and health.
Advising patients to be mindful of their overall sugar intake, not the type, will result in the best outcomes. It’s also important to consider the patient’s overall eating pattern, not just sugar intake. Encourage patients to read the Nutrition Facts panel on food and beverage packages, noting the serving size, calories, and both total sugar and added sugar.
Cutting Sugar Intake through Portion Size
Portions are also important. As the portion increases, the calories, sugar, and other nutrients do as well. See the chart below for some common examples of foods and beverages with sugar, and how small or larger portions vary.
|Food/Beverage||Small Portion||Large Portion|
|Orange Juice||18 g sugar in 8 ounces||36 g sugar in 16 ounces|
|Regular Soda||24 g sugar in 8 ounces||48 g sugar in 16 ounces|
|Sweetened Whole Grain Wheat Cereal||11 g sugar in one cup||17 g sugar in 1 1/2 cups|
|Light French Salad Dressing||7 g sugar in 2 TB||14 g sugar in 1/4 cup|
|Caesar Salad Dressing||1 g sugar in 2TB||2 g sugar in 1/4 cup|
|Chocolate sandwich cookie||14 g sugar in 3 cookies||28 g sugar in 6 cookies|
As you can see viewing the chart, the larger the portion, the more sugar added to the diet. Rather than advising patients to completely avoid cookies, or soda, or certain types of sugar in general, it may be more effective to find out what they are eating and drinking and then helping them understand which foods and beverages contribute added sugars to the diet, and how they can monitor their portions of these foods. Helping patients create meal plans that they can enjoy, allows them some control over their choices, but can result in a more sustainable and complete nutrient profile.
As Mary Poppins was known to say, “A spoonful of sugar helps the medicine go down.” And food is medicine. Shift your focus from singling out certain sweeteners and instead focus on finding ways for your patients to enjoy a diet that includes a wider variety of fruits and vegetables, grains, beans, and other plant-based foods.
Rosanne Rust MS, RDN, LDN is a registered, licensed dietitian-nutritionist with over 25 years experience. As a Nutrition Communications Consultant she delivers clear messages helping you understand the science of nutrition so you can enjoy eating for better health. Rosanne is the co-author of several books, including DASH Diet For Dummies® and the The Glycemic Index Cookbook For Dummies®. A wife, and mother of 3 boys, she practices what she preaches, enjoying regular exercise, good food and festive entertaining. Follow her on Twitter @RustNutrition.