Types of Sugar: The Ultimate Guide to Added Sugar

Frequent, excessive consumption of added sugar presents a profound health risk to consumers.

Deciphering nutrition labels, managing sugar intake, and avoiding added sugars is challenging for the average consumer when ingredients are clearly displayed; it can be nearly impossible when added sugar content is not disclosed, ingredients are disguised, and package labels contain misleading claims.

This GreenChoice report shows the presence of added sugars in commonly consumed food and beverages to increase the understanding of where and how added sugars are typically consumed.

Outside of the common culprits like sugar-sweetened beverages and sweets, our findings highlight the pervasiveness of added sugars in several health food categories and even within foods marketed as free of added sugars.

GreenChoice(™) believes that consumers have the right to know what they are consuming and have easy access to the information needed to make well-informed food choices.

What’s Inside:

What Is Sugar?

Added Sugar

Health Risks

Federal Definitions and Regulations

Analytic Methods

Sugar Content in Common Foods

Added Sugars in Health Food Categories

Misleading Claims

Conclusion and Takeaways

References

What is Sugar? 

Within the food industry, the term “sugar” is used to identify sweet-tasting, easily digestible carbohydrates. Mainly classified as monosaccharides and disaccharides, these sugars can be identified by their suffix ‘-ose’: fructose, glucose, galactose, sucrose (table sugar), maltose, and lactose. As the building blocks of carbohydrates, monosaccharides and disaccharides naturally occur in single ingredient foods containing carbohydrates such as fruits and vegetables, legumes, grains, dairy, nuts and seeds, and organ meats.

Though glucose is the body’s preferred source of energy and is vital for survival, added, and isolated forms of glucose and sugar (outside of carbohydrate containing foods) are not essential. The human body produces its own glucose during digestion through the breakdown of carbohydrates, which is absorbed into the bloodstream and, with the help of the pancreatic hormone insulin, is delivered to the body’s cells and used as energy. 

What are Added Sugars?

The term “added sugar” refers to sugar that is not naturally occurring or inherent within a product. Added sugars are isolated and concentrated forms of sugar that are added to food and beverage products during processing to enhance flavor, texture, color, fermentation, and/or preservation. Unlike the sugar found within single ingredient, carbohydrate-containing foods, the majority of added sugar ingredients are considered “empty calories,” in that they contribute sugar and extra calories with little to no other nutritional value.  

Added sugars are typically found within ingredient lists under wholesome, natural-sounding names or obscure “pseudonyms.” 

Figure 1. Types of Sugar: Added Sugars and Sugar Pseudonyms

Research on added sugars in the food supply is limited. Inconsistent naming practices within product ingredient lists and their absence on nutrition fact labels makes added sugars difficult to identify, track, and measure. Lab tests do not distinguish between naturally occurring and added sugars, and measurement and disclosure within products is wholly dependent on food manufacturers. 

Recommendations for added sugar intake vary by authority: The 2015-2020 Dietary Guidelines for Americans (1) and the World Health Organization (WHO) suggest limiting added sugars to no more than 10 percent of daily calories, or 12.5 teaspoons a day (50 grams) on a 2,000-calorie diet; WHO further recommends less than half of this amount (6 teaspoons a day, or 25 grams) for optimal dental health (2).

The American Heart Association (AHA) guidelines for cardiovascular health (3) take another approach, limiting added sugar consumption to 9 teaspoons a day for men (36 grams), 6 teaspoons for women and children ages 2 and up (25 grams),  and no added sugar for children under 2 years (4).

The pervasiveness of added sugar in the food supply contributes to the consumption of excessive calories with little nutritional value, and is associated with numerous health risks for the average American. The most recent estimates indicate that American adults consume 19 teaspoons of added sugars on a daily basis (5),  more than 1.5 times the most generous daily limits, and up to 3 times more than the most conservative guidelines recommend. American toddlers aged 19-23 months consume more than 7 teaspoons daily (6).

Health Risks of Added Sugar

Experts agree, diets rich in added sugar are linked to the development or worsening of many chronic diseases (7).  Added sugar consumption has been linked to the following health problems:

1. Liver Damage: High amounts of added sugar, specifically in the form of fructose, may overwork the liver and have similar effects as alcohol, leading to excess fat synthesis and full fledged non-alcoholic fatty liver disease (NAFLD) (7).
2. Hypertension and Cardiovascular Disease: Unique from other carbohydrate sources, added sugar may increase blood pressure, triglycerides, inflammation, and oxidative stress in the body, increasing the risk for heart and vascular diseases (3).
3. Weight Gain: Added sugar intake may interfere with hormonal systems that control fat storage and satiety and lead to overeating and metabolic dysfunction (3).
4. Diabetes: Added sugars are associated with an increased risk of developing Type 2 Diabetes through interference with the pancreatic hormone insulin (8).
5. Dental Disease: Worldwide, tooth decay is the most common noncommunicable disease. Added sugars in food are a major driver through oral bacteria that metabolize sugars into acids that demineralize tooth enamel (9).

Federal Definitions & Regulations for Sugar

Historically,  U.S. food and beverage manufacturers were not required to disclose on the Nutrition Facts label how much added sugar a product contains. As long as “no sugar or sugar containing ingredient is added during processing,” (10) manufacturers were allowed to include label claims of “No Added Sugars” and “Without Added Sugars.” The earlier definitions of “sugar or sugar containing ingredient’ did not include sugar-containing ingredients with names that did not clearly state “sugar.” This limited definition created a sizeable loophole in product labeling and marketing related to added sugar, allowing manufacturers to make questionable and misleading  claims about the amount of added sugars within their sweetened products.

In 2016, the FDA published final rules for an updated Nutrition Facts label for packaged foods.  Although these rules had been  intended to take effect in 2018, they were delayed until 2021. The new rules will require manufacturers to disclose the total amount of added sugar within a product and include an updated definition of the term “added sugar” which includes sugar that are “either added during the processing of foods or are packaged as such, and includes sugars (free, mono- and disaccharides), sugars from syrups and honey, and sugars from concentrated fruit or vegetable juices that are in excess of what would be expected from the same volume of 100 percent fruit or vegetable juice of the same type.” Sugars from vinegars present in a final product post-processing are also included in this updated definition (11). 

Food industry lobbyists ultimately persuaded the FDA to delay its original timeline for compliance with the new labeling laws, citing concerns over consumer perception of added sugars. The current plans for roll-out of the new regulations vary by manufacturer size and type.  Manufacturers netting $10 million or more in annual sales must switch to the new label by January 1, 2020, while those with under $10 million in annual food sales have until January 1, 2021 to comply (12); compliance for manufacturers of single-ingredient sugars such as honey and maple syrup and certain cranberry products have an even longer extension until July 1, 2021 to make the changes (13)

While certain brands have already begun to include the updated nutrition facts labels on their packaging, food and beverage manufacturers are not currently required to disclose added sugar on the Nutrition Facts label, and their timeline for required adherence to updated definitions of added sugars vary.

Analytic Methods

For this report GreenChoice analyzed our database of close to 70,000 products to identify the presence of added sugars within common food and beverages. To ensure an unbiased analysis, the sample for this report included only food and beverage products containing complete product information, leading to a total sample of 55,072 products.  

Products represented grocery items available at, but not limited to, Harris Teeter, Wegmans, Walmart, Whole Foods, Stop and Shop, Target, and Hannaford.  

The 55,072 products analyzed spanned a variety of food and beverage categories including Beverages; Bread and Bakery; Dairy and Eggs; Produce; Prepared Foods; Sweets, Snacks, and Dips; Seafood; Pantry, Frozen Foods, and Meat (Figure 2). The distribution of product categories in the sample follow the distribution within the GreenChoice database and are reflective of dry grocery foods (Pantry and Sweets/Snacks) as the largest contributors to supermarket sales (14).

Figure 2: Breakdown of product sample, by category

To identify products containing added sugar, GreenChoice compiled a list of 54 known names and pseudonyms for added sugars (Figure 1). General terms “sugar” and “syrup” were included to capture any additional, alternate names of added sugars that may have been omitted. Product data and added sugar terms were imported from mySQL into Python and assigned multiple product attributes including: Product Name, Product Category, Product Type, Ingredient List, Product Description, and Total Sugar value in grams. Rules for inclusion and exclusion were assigned and applied to avoid products which were 100% juice or jam products or contained 100% juice equivalents and exclude single ingredient sugar products (i.e. bottle of corn syrup or package of granulated sugar). The presence of multiple types of added sugar within one product was also assessed and defined.

Our analysis revealed that close to 60% of products in our sample contain a source of added sugar (Figure 3). These results are within 10% of previous estimates, which have reported that up to 68% of common barcoded food and beverage products in the U.S. contain added sugars (15). It was notable that 3 out of 4 of sugar-containing products were found to contain added sugars within their ingredient lists.

Figure 3: Presence of Sugar Within the Sample

Sugar Content in Common Foods

Figure 4 shows that the Beverages categories led with the highest total sugar content, at an average of 3.4 teaspoons (over 14 grams) of sugar per serving, driven by sugar-sweetened beverages like non-diet sodas, flavored juice drinks, sports drinks, sweetened teas, coffee drinks, energy drinks, and electrolyte replacement drinks. 

Closely following the Beverage category, the products in Bread and Bakery category averaged in at 2.6 teaspoons (close to 11 grams) of sugar per serving, likely driven by the pastries and baked goods within the category.

Figure 4:  Comparison of average sugar content across categories

Added Sugar in Health Food Categories

Our GreenChoice analysis found added sugar to be pervasive within many “healthy” food product categories. Notable findings include the following:

Organic Foods with Added Sugar

• Over a third of organics – 35.5% – contain a source of added sugar 
• Top 3 most frequently used names for added sugars: Sugar, juice concentrate, and cane syrup 
• Top 3 product types with the most sugar per serving: Soft drinks, Sports/energy/nutritional drinks, and Juice drinks

Whole Grain, Multigrain, & Ancient Grain Products with Added Sugar

• Close to 71% of products marketed as whole grain, multi-grain, or ancient grain contain added sugar
• Top 3 most frequently used names for added sugars: Sugar, Honey, Molasses
• Top 3 product types with the most sugar per serving:  Nutrition and granola bars, Cereals and granola, and Miscellaneous snacks

Non-Dairy Beverages with Added Sugar

• Over 45% of non-dairy milks contain added sugar. 
• Top 3 most frequently used names for added sugars: Cane sugar, honey, cane juice
• Average sugar per serving:: Hempmilk, Nutmilks, and Soymilk

Nutrition Bars with Added Sugar

• Close to 80% of nutrition bars contain added sugars
• Top 3 most frequently used names for added sugars: Cane Sugar/Sugar, Brown Rice Syrup, Honey
• Top 3 product types with the most sugar per serving: Energy bars, fruit bars, protein bars

Misleading Sugar Claims

The FDA’s Code of Federal Regulations for nutrient content claims states that, “The terms ‘no added sugar,’ ‘without added sugar,’ or ‘no sugar added’ may be used only if no amount of sugars, as defined in 101.9(c)(6)(ii), or any other ingredient that contains sugars that functionally substitute for added sugars is added during processing or packaging,” (16).

GreenChoice analyzed the label and product information of the product sample for the regulated terms “No Added Sugar,” “No Sugar Added” or “Without Added Sugar” to compare against ingredient lists and nutrition labels.

Close to 6% of products that were marketed as free of added sugar were found to contain added sugar ingredients. These product marketing claims do not meet the standards of the most up-to-date federal labeling regulations. Sugar pseudonyms among products with misleading claims include:

Misleading marketing claims related to sugar extend to products with  outside of added sugars; products containing 0.5 grams or less of sugar per serving have long been legally allowed to market as “sugar free,” “free of sugar,” “no sugar,” “zero sugar,” “without sugar,” or “sugarless” on product labels (16).

Consumers should be aware that until the FDA’s updated nutrition labeling laws are fully implemented, extra care should be taken to review ingredients lists along with product information and labels to identify sugar-containing products.  

Conclusion & Takeaways

GreenChoice’s analysis of 55,072 common food and beverage products shows that nearly 60% of products contain added sugars.

The report found that hidden sources of added sugars are surprisingly pervasive across common categories of foods, especially those products marketed as health-promoting like organics, whole grains, nutrition bars, non-dairy beverages, and healthier-for-you frozen meals. Top sugar pseudonyms in these products included cane syrup, cane juice, juice concentrate, brown rice syrup, dextrose, and honey.

The report demonstrates some of the consequences of the delayed compliance with the FDA’s updated nutrition labeling laws. It is clear that some manufacturers of products containing added sugars are still using limited definitions of added sugar to use regulated marketing claims like ‘no added sugar,’ ‘without added sugar,’ or ‘no sugar added.’

These findings add unique insight to the mounting evidence that added sugars are too often discreetly disguised in ingredient lists using a wide array of uncommon or unrecognizable names, misleading consumers and undermining healthy choices.

The ubiquity of added sugar in the food supply is likely feeding chronic disease epidemics in the U.S. It’s estimated that American adults currently consume 1.5 to 3 times the amount of added sugar (5) as recommended by the American Heart Association and the World Health Organization, driving the risk of cardiovascular and liver disease, diabetes and obesity, and dental caries. 

Through revealing the state of hidden added sugars in our food, GreenChoice seeks to mobilize the power of informed consumerism in promoting healthy choices, combating chronic disease, and positively influencing the food supply. 

References

“Changes to the Nutrition Facts Label.” U.S. Food and Drug Administration. U.S. Food and Drug Administration, June 18, 2019.

Department of Health and Human Services, Food and Drug Administration, and Center for Food Safety and Applied Nutrition. A Food Labeling Guide: Guidance for Industry. College Park, MD: 2013.

Dietary Guidelines Advisory Committee. “Scientific Report of the 2015 Dietary Guidelines Advisory Committee: Advisory Report to the Secretary of Health and Human Services and the Secretary of Agriculture.” (2015): U.S. Department of Agriculture, Agricultural Research Service, Washington, DC.

Dinicolantonio, James J., James H. O’keefe, and Sean C. Lucan. “Added Fructose: A Principal Driver of Type 2 Diabetes Mellitus and Its Consequences.” Mayo Clinic Proceedings 90, no. 3 (March 2015): 372–81.

FMI Information Service. “Supermarket Sales by Department – Percent of Total Supermarket Sales.” Key Industry Facts (June 2019).

 “Food Labeling.” Code of Federal Regulations, title 21CFR101.60 (2018).

Johnson, Rachel K., Lawrence J. Appel, Michael Brands, Barbara V. Howard, Michael Lefevre, Robert H. Lustig, Frank Sacks, Lyn M. Steffen, and Judith Wylie-Rosett. “Dietary sugars intake and cardiovascular health: a scientific statement from the American Heart Association.” Circulation 120, no. 11 (2009): 1011-1020.

Lustig, Robert H., Laura A. Schmidt, and Claire D. Brindis. “Public health: The toxic truth about sugar.” Nature 482, no. 7383 (2012): 27.

Food and Drug Administration. FDA Extends Nutrition Facts Label Compliance Dates. 2018. 

Food and Drug Administration. Guidance for Industry: Nutrition and Supplement Facts Labels Questions and Answers Related to the Compliance Date, Added Sugars, and Declaration of Quantitative Amounts of Vitamins and Minerals. FDA-2016-D-4414. College Park, MD: Office of Nutrition and Food Labeling, College Park, MD: 2018.

Food and Drug Administration. Statement on New Guidance for the Declaration of Added 

Sugars on Food Labels for Single-Ingredient Sugars and Syrups and Certain Cranberry Products. Susan T. Mayne.. Center for Food Safety and Applied Nutrition, 2019.

Popkin, Barry M., and Corinna Hawkes. “Sweetening of the global diet, particularly beverages: patterns, trends, and policy responses.” The Lancet Diabetes & Endocrinology 4, no. 2 (2016): 174-186.

The World Health Organization. “Sugars intake for adults and children: Guideline.” 2015.

The World Health Organization. “Technical information note: Sugars and dental caries.” 

WHO/NMH/NHD/17.12. 2017.

Vos, Miriam B., Jill L. Kaar, Jean A. Welsh, Linda V. Van Horn, Daniel I. Feig, Cheryl AM Anderson, Mahesh J. Patel et al. “Added sugars and cardiovascular disease risk in children: a scientific statement from the American Heart Association.” Circulation 135, no. 19 (2017): e1017-e1034.

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