Is sugar bad for you? Exploring the health debate

Sugar often gets blamed for everything from weight gain to heart disease. But is it really the villain it’s made out to be? The answer isn’t simple.

Sugar appears in many forms, and those distinctions matter for health, says Tara M. Schmidt, M.Ed., RDN, LD, a lead registered dietitian and instructor of nutrition at Mayo Clinic in Minnesota.

Before deciding whether sugar is “bad,” it helps to understand where it comes from, how it’s used and what else comes with it.

Comparing natural to refined sugar

When most people talk about sugar, they’re probably thinking of added sugars rather than the naturally occurring sugars in whole foods, Schmidt says.

Sugars that occur naturally in foods don’t exist in a vacuum. They come with other nutrients. “Foods with natural sugars — things like fruit and milk — are also providing us with other really excellent nutrition,” Schmidt says. For example, milk supplies protein, calcium and vitamin D, while fruit offers fiber and essential vitamins.

Added sugars, on the other hand, start from natural sources — such as sugar beets, sugar cane or corn — but are then refined or processed into many different forms.

These processed forms, including table sugar and corn syrup, are added to foods during manufacturing. This distinguishes them from the sugars that naturally occur in fruit, milk and other whole foods.

“It’s important not to vilify sugar as a whole, but to look at what the food is giving us,” Schmidt says. “A brownie and an apple may both contain sugar, but what comes with that sugar is very different. An apple provides fiber and vitamin C, while a brownie is more likely to also contain saturated fat and sodium.”

Breaking down the health risks of sugar

Reducing added sugar is often something people think of when they want to lose weight — and for good reason. Research has consistently shown that high intake of added sugar is linked to obesity and higher body mass index (BMI), particularly when consumed in sugar-sweetened beverages.

But added sugar can have a wide range of other health consequences. Studies have linked higher sugar intake to an increased risk of stroke, depression, cancer, high blood pressure and high triglycerides, which are fats in the blood that can increase the risk of heart disease.

Added sugar — particularly from ultraprocessed foods — also can drive inflammation, Schmidt says. Chronic inflammation linked to sugar intake may contribute to metabolic syndrome, fatty liver disease (MASLD) and other inflammatory conditions. Some studies also suggest that diets high in added sugar may contribute to insulin resistance and type 2 diabetes.

High intake of added sugars, especially forms of fructose found in sodas, fruit drinks and sweetened beverages, can raise uric acid levels in the blood. This increases the risk of gout, a form of painful arthritis caused by uric acid crystal buildup in the joints. Studies have found that people who consume sugary beverages daily are significantly more likely to develop gout compared with those who rarely consume them.

Are sugar alcohols bad for you or a safer sweetener?

Sugar alcohols aren’t actually sugar, though the name can be misleading. Sugar alcohols are often used in processed foods that are labeled sugar-free or low-calorie. Schmidt recommends consuming them sparingly.

“Sugar alcohols are a way that we can sweeten foods with lower calories,” Schmidt says. These carbohydrates — including xylitol, erythritol, sorbitol and mannitol — are commonly found in sugar-free or low-calorie products. One reason they’re popular is because they don’t cause spikes in blood sugar or add calories, which some people find useful for managing their weight or blood glucose levels.

However, moderation matters. Sugar alcohols are metabolized differently than table sugar. “If they’re consumed in excess, they can cause digestive issues like gas, bloating or diarrhea,” Schmidt says.

Artificial sweeteners offer another way to satisfy sweet cravings without calories. “They’re manufactured compounds designed to taste like sugar,” she says. “They’re hypersweet — even in very small amounts.”

The downside, Schmidt notes, is that they are ultraprocessed ingredients. “Deciding whether to use them is a personal choice rather than an all-or-nothing decision,” she says. Some people use them to reduce calories or manage blood sugar, while others prefer to avoid highly processed additives. The FDA has approved several artificial sweeteners for general use, though research continues into their long-term health effects.

Smart strategies for reducing sugar

If you enjoy sweets, when and how you eat them can make a real difference. “One strategy I often suggest is enjoying your sweet treat with a meal,” Schmidt says. That’s because consuming sugar alongside protein and fiber slows the rise in blood glucose. “Your blood sugar increase is more gradual,” she explains.

This approach also can help prevent overeating. “You’re less likely to have four cookies if you eat one with a meal instead of during an afternoon energy crash,” Schmidt says. This strategy also aligns with dental advice. Experts agree that minimizing frequent sugar exposure throughout the day is better for both oral health and blood glucose control than snacking on sweets repeatedly.

When reducing added sugar, focus on the biggest sources first. “For people one year and older, the top source of added sugar is sugar-sweetened beverages, including sodas, fruit drinks, sports drinks and energy drinks,” Schmidt says. Desserts and sweet snacks are the second-largest source.

Cutting back on these sources can make the biggest impact on reducing added sugar. Sugary drinks — because they deliver sugar in liquid form — can contribute a large share of daily added sugars without promoting fullness. That may lead to increased overall calorie intake. Research shows that even small reductions in the amount of sugar-sweetened beverages you drink can improve weight, and blood glucose levels and triglyceride levels over time.

While reducing added sugar is wise advice for most people, you don’t need to eliminate all sugar to improve your health. Schmidt recommends experimenting with ways to cut added sugar consumption. Try using less sweetened creamer in your coffee, choose plain yogurt with fruit for breakfast or a snack, or reduce dessert portions. “There are a lot of small changes that, over the course of a day or a month, can really add up,” she says.