Diabetes mellitus, or diabetes, is a disease affecting the regulation of blood glucose (sugar) levels.
An organ called the pancreas creates the hormone insulin, which helps keep blood sugar levels in a healthy range.
With diabetes, the pancreas either doesn’t make enough insulin, or the body doesn’t respond to it well. Without proper insulin function, blood sugar levels rise and can lead to health problems if left untreated.
Diabetes is becoming more prevalent worldwide. As of 2015, 30.3 million people in the United States, or about 9.4 percent of the population, had diabetes. Unfortunately, more than 1 in 4 people with diabetes don’t know they have it. Having undiagnosed diabetes increases the risk of complications from lack of prompt treatment.
Many people also have prediabetes, a condition where blood sugars are slightly elevated but not high enough to be considered diabetes. Having prediabetes is a major risk factor for eventually developing type 2 diabetes. The U.S. Centers for Disease Control (CDC) estimates that up to 30% of people with prediabetes will develop type 2 diabetes within five years of their prediabetes diagnosis.
Chronic high blood sugars increase the risk of diabetes complications, so keeping blood sugar levels controlled is the main priority for managing diabetes. One of the ways to help promote good blood sugar control is through healthy lifestyle habits. Along with other aspects of diabetes self-management, a healthy diet can help improve blood sugars and reduce the risk of diabetes-related complications.
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Hidden sugars and diabetes
Carbohydrates are a macronutrient and protein and fat; together, these nutrients provide fuel for the body to use as energy to survive. Carbs have the most significant impact on blood sugar levels since they break down into sugar when digested. Carbohydrates are found in foods like grains, fruits, vegetables, and milk products.
There are three types of carbohydrates: starch, fiber, and sugars. Starch is found in plant-based foods such as potatoes, beans, and bread. Fiber is also found in plant-based foods, but it doesn’t raise blood sugar levels because it isn’t digested, unlike starch. Sugars are found in foods like fruit but can also be refined and added to foods to enhance their flavor.
Sugars are important to focus on when considering a diet to promote healthy blood sugar levels. There are two types of sugar: natural and added. Natural sugars are naturally found in foods such as fruit, milk, plain yogurt, and vegetables. While it’s essential to be mindful of total sugar intake, added sugars are associated with adverse health outcomes. Added sugar consumption has been associated with an increased risk of heart disease, fatty liver disease, diabetes, heart disease, and even certain cancers.
In people without diabetes, eating foods rich in sugar causes the body to produce a large amount of insulin to counteract the rise in blood sugar. Over time, this repeated response can lead to insulin resistance, which is when the body doesn’t use insulin as effectively as it should. Insulin resistance is a leading cause of type 2 diabetes.
Added sugars are prevalent in many processed foods, which many people rely on due to convenience. It’s estimated that up to 74% of processed foods contain added sugar. Added sugar has many names, which can make it difficult to spot. The new nutrition facts label now has a line for added sugars, making it easier to spot. Some labels still don’t contain a line for added sugars, so checking the nutrition facts ingredient label is important to determine if added sugars are present. Some of the names for added sugar include:
- Agave nectar
- Barbados sugar
- Barley malt
- Beet sugar
- Blackstrap molasses
- Brown rice syrup
- Brown sugar
- Buttered syrup
- Cane juice crystals
- Cane sugar
- Caramel
- Carob syrup
- Castor sugar
- Confectioner’s sugar
- Corn syrup
- Corn syrup solids
- Crystalline fructose
- Date sugar
- Demerara sugar
- Dextran
- Dextrose
- Diastatic malt
- Distance
- Ethyl maltol
- Evaporated cane juice
- Florida crystals
- Fructose
- Fruit juice
- Fruit juice concentrate
- Galactose
- Glucose
- Glucose solids
- Golden sugar
- Golden syrup
- Grape sugar
- High-fructose corn syrup
- Honey
- Icing sugar
- Invert sugar
- Lactose
- Malt syrup
- Maltose
- Maple syrup
- Molasses
- Muscovado sugar
- Organic raw sugar
- Panocha
- Raw sugar
- Refiner’s syrup
- Rice syrup
- Sorghum syrup
- Sucrose
- Sugar
- Treacle
- Turbinado sugar
- Yellow sugar
The American Heart Association recommends that women don’t consume more than 6 teaspoons (24 grams) of added sugar per day, and men keep their added sugar intake below 9 teaspoons (36 grams) per day. Unfortunately, the average American adult consumes around 77 grams of added sugar per day. Tip: Find the “added sugars” or “sugars” line under the “Total Carbohydrates” on a food label.
Identifying common foods and beverages with added sugar can help people with and without diabetes make healthier choices. Some common processed foods that contain added sugar include:
1) Bottled Sauces
Bottled sauces: Sauces are among the more surprising sources of added sugar because they don’t always taste sweet. Many tomato-based sauces are common culprits, such as pasta sauce.
In addition to being high in added sugar, many sauces are high in sodium. Eating a diet high in sodium is one of the lifestyle factors associated with increased blood pressure, which is a risk factor for heart disease. People with diabetes are two to four times more likely to die from heart disease than those without diabetes.
Some sauces high in added sugar (per USDA nutrient database or standard/common brands’ available nutrition data) include:
- Ketchup: one tablespoon of tomato ketchup contains 4 grams of sugar. For a visual, one sugar cube contains 4 grams of sugar, so with each tablespoon of ketchup added, it’s like adding a sugar cube to the meal! People usually enjoy much more than one tablespoon of ketchup with their burgers, fries, etc., so this can really add up.
- Sweet and sour sauce: Two tablespoons of standard sweet and sour sauce contains 7 grams of sugar, which isn’t surprising since “sweet” is in the name. Sweet and sour dishes such as Chinese meals can really pack a punch sugar-wise when this sauce is used.
- Honey mustard: Unlike regular mustard, which doesn’t contain added sugar, honey mustard contains almost 5 grams of sugar per two-tablespoon serving size.
- Salsas: Many types of salsas are available so that the sugar content can vary greatly depending on its ingredients. Fruit-based salsas such as pineapple mango salsa can be higher in sugar; two tablespoons of a peach salsa can contain 2 grams of sugar. While this might not seem like a lot, people usually use more than two tablespoons of salsa at a time. A healthier alternative would be to make your own salsa with fresh fruit to avoid the refined sugars used in most jarred fruit-flavored salsas.
- Worcestershire sauce: One teaspoon of a common store’s brand of Worcestershire sauce contains 1 gram of sugar from high-fructose corn syrup
- Barbeque sauce: Barbeque sauces are incredibly high in sugar, with a whopping 6 grams of sugar per tablespoon.
- Teriyaki sauce: Similar to sweet and sour sauce, Teriyaki sauce is high in sugar, with around 2.5 grams of sugar in each tablespoon.
- Sweet relish: One tablespoon of sweet relish contains almost 4.5 grams of sugar.
- Pasta sauce: A half-cup portion of a popular pasta sauce contains 4 grams of sugar per half-cup serving.
2) Frozen dinners
Processed foods such as frozen meals (“TV dinners”) often have sugars added to increase palatability and enhance flavor. After all, refined sugar is an inexpensive and easy way to make something taste good!
While not all frozen dinners are high in sugar, they are all high in sodium. Most frozen meals contain over a quarter of the daily requirement for sodium in a single serving, so they aren’t a great choice for most people regardless of whether they have diabetes.
Meals with tomato-based sauces can be especially high in added sugar, so comparing labels and choosing a frozen meal with the lowest added sugar and lowest sodium content is recommended.
3) Bread
Sugar is often added to bread to help the leavening process, making bread rise and giving it its texture. However, some bread contains more added sugar than others, so it’s best to compare nutrition facts labels to choose a bread with the lowest amount of added sugar. For instance, one slice of potato bread can contain around 4 grams of sugar, while a slice of sprouted Ezekiel bread doesn’t contain any sugar.
4) Yogurt
Yogurt is usually flavored, making it a high-sugar food. One serving of a standard vanilla yogurt contains almost 30 grams of sugar, mostly from added sugars.
Plain, unsweetened yogurt is the best choice for people with diabetes as it doesn’t contain added sugar. It does contain natural sugar from milk but isn’t sweetened and is rich in protein, so it is a healthy choice. Fruit can be added to plain yogurt to give it flavor or be used to make smoothies. Greek yogurt is also preferred because it’s lower in natural milk sugar (lactose) and higher in protein from the straining process.
Some flavored yogurts are lower in added sugar from artificial sweeteners, which don’t raise blood sugars. It’s essential to check the ingredients to determine if a flavored yogurt uses real sugar or artificial sugar to determine how it might fit into a healthy diet for diabetes.
5) Instant oatmeal
Plain oatmeal is a good cereal choice for people with diabetes because it’s high in fiber and free of added sugar. However, flavored instant oatmeal is a high-sugar food. A packet of Maple Brown Sugar flavored instant oats contains 12 grams of added sugar, almost half of the daily recommended amount!
6) Sports energy drinks
While sports drinks can be useful for athletes competing in endurance sports, they are much too high in sugar for the average person to consume regularly. While there are some reduced- and sugar-free sports drinks available, a standard 30-ounce bottle contains almost 100% of the daily recommended amount of added sugar, with 48 grams of added sugar total.
7) Non-dairy milk
Non-dairy milk alternatives can contain added sugar, especially when they’re flavored. One cup of vanilla soy milk contains 8 grams of added sugar, and a cup of plain soy milk from the same brand still contains 5 grams of added sugar. To avoid this added sugar, opt for unsweetened varieties instead.
8) Smoothies
Pre-made smoothies can be very high in sugar from the use of fruit, fruit juices, and even added sugars. A small strawberry banana smoothie from Mcdonald’s contains 39 grams of sugar, including added sugar in the form of cane sugar and fructose. A healthier alternative is to make a homemade smoothie with fresh or frozen fruit and plain yogurt while avoiding the use of fruit juices and fruit juice concentrates.
9) Granola
Often touted as a health food because of some of its healthy ingredients, granola is usually packed with added sugar. ⅔ cup of basic granola contains 9 grams of added sugar.
Instead of granola, making oatmeal with plain oats and adding cinnamon, almonds, and a small handful of raisins can give a similar taste without the sugar.
10) Flavored coffee
Flavored coffee drinks such as lattes, mochas, etc., usually contain a fair amount of sugar; this can quickly add up towards the daily allotment for added sugar. For instance, a 16-ounce vanilla latte from Starbucks contains 35 grams of sugar.
To help reduce the added sugar content by 50%, consider asking for drinks to be made with half the amount of sweetener. For instance, if a 16-ounce latte usually has four pumps of liquid vanilla flavor, ask for it to contain only two pumps for the same size.
11) Premade soup
Premade soups can have hidden sugar that is difficult to spot because it’s masked with sodium and other more savory flavors. Tomato soup is especially notorious for being high in sugar; the classic Campbell’s Tomato Soup contains 8 grams of added sugar per serving.
12) Breakfast cereals
Breakfast cereals are another food notorious for being high in added sugar. While some cereals are clearly high in sugar, such as chocolate-flavored varieties, many kinds of cereal marketed as healthy can be just as high in sugar. Most cold cereals contain at least a small amount of added sugar, so it’s best to read the nutrition labels and compare to find the best choice.
Sugar content is listed per serving, so if more than one serving is eaten, that amount needs to be multiplied by however servings were consumed.
13) Salad dressing
Similar to sauces, salad dressings can be loaded with added sugar. Vinaigrettes and fruit-flavored dressings are especially high in sugar. 2 tablespoons of a sun-dried tomato vinaigrette contain 14 grams of sugar, and one tablespoon of Italian dressing contains almost 2 grams of sugar. Fat-free dressings tend to be higher in sugar to make up for the lack of flavor as well.
A healthier alternative to salad dressings is to drizzle a mixture of olive oil and balsamic vinegar over salad greens. The vitamin K in dark leafy greens is better absorbed with the fat from the olive oil, so fat-free dressings won’t allow for that absorption as well as this healthier dressing option.
Conclusion
High sugar foods and beverages directly impact blood sugar levels, which is why they play a large role when planning out a healthy diet for people with diabetes. Many foods contain added sugar, which can lead to blood sugar spikes and other health problems if regularly consumed in large amounts.
Foods that don’t taste overly sweet can still contain large amounts of added sugars, such as condiments, sauces, and salad dressings. Other foods marketed as “healthy” like yogurts, granolas, and some cereals are also culprits for containing large amounts of added sugar. Reading food labels is the best way to identify how much sugar is in a product, as well as the source from which it comes.
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