Studies show that when you reduce sugar, you reduce systemic inflammation, thought to be at the root of many diseases. Blood sugar levels, a marker for diabetes and prediabetes, go down. You also reduce your risk of cardiovascular disease. Sugar impacts the endothelium of cells which, in turn, can impair blood vessels. Your gut microbiome—a battlefield where good microbes face off against bad ones—achieves a better balance (sugar helps feed the bad microbes). You may also lose some weight, which also helps lower the risk of many chronic conditions.
Some people get most of their added sugar from sweetened drinks and candy. Many others are also eating a lot of sugar-added processed foods like cookies and other baked goods, which are also high in saturated fat, refined grains, and additives. Undoubtedly, cutting back on that array of unhealthy ingredients factors into the benefits of eating less sugar, especially when you replace all those empty calories with nutrient-rich ones.
If you know that you can be satisfied with just one cookie every now and then, consider the 90/10 rule or the less strict 80/20 rule: 80 or 90 percent of the time, choose nutrient-dense foods. We see in the data that eating sugary foods only 10 to 20 percent of the time doesn’t lead to chronic conditions. This doesn’t mean that 20 percent of your calories should come from sugar, but rather that you choose it only occasionally.
This approach also has the potential to improve your relationship with food. Often, when people restrict certain foods, they start to label every food as good or bad, and when they eat a food they view as bad, they can feel shame and guilt. That’s not what eating should be about. With the 80/20 or 90/10 rule, you have permission to say every once in a while, “I’m going to have that cookie and enjoy it.”
If you’re the kind of person for whom one bite of a cookie will prompt you to eat sugar for the rest of day, or if you experience “food noise,” a preoccupation with food (you constantly think about food and when you’re going to eat next), you might choose to avoid all foods with added sugars and opt for those with only naturally-occurring sugar like fruit.
Some people choose to go cold turkey, while others do well by tapering off sugar in a slower, measured way. Keep in mind that any change to your sugar consumption will take time. In general, the first five weeks are the most challenging, and you may experience setbacks. A survey done at the University of Michigan found that people going off high-sugar, ultra-processed foods reported withdrawal symptoms similar to going off nicotine, like irritability and cravings. But I’ve also seen that the longer you stay away from sugar, the easier it becomes.
Why is giving up sugar so complicated? Sugary foods act on reward pathways in the brain. That’s why eating a cupcake or donut can feel soothing at first. The problem is that once your blood sugar drops, it typically goes below where it was before the sugar fix. So, you feel lousy again and crave more sugar. It’s not a question of willpower: Sugar exerts a profound effect on the brain that can override willpower.
For many people, a sugar reward has been ingrained since childhood. When you fell off your bike, did your parents make it better with a cookie? Was a fight you had with a friend soothed by a trip to a fast-food restaurant? Data shows that how food was presented to you early in life sets up your relationship with it as an adult.
There is also a genetic component, and nutrigenomics is becoming an important part of understanding how each person’s body responds to food. Nutrigenomics is essentially looking at the genetic components of your lifestyle and how your genes and nutrition interact from nutrient metabolism and cardiometabolic health to food preferences. A genetic test done with a simple mouth swab can see if you have a variant associated with a high craving of sugary foods. If you do, a dietitian can show you how to eat in a way that “turns off” that gene.
When you want to cut back on sugar, job one is tamping down your cravings for sweetness. One way to do that is to reduce the intensity of the sweet foods you eat. As an example, a baked apple is naturally sweet but without the intensity that sparks cravings. Unlike donuts, few people will eat three or four baked apples at a sitting.
If you replace added-sugar foods with foods sweetened with artificial sweeteners, you’re not likely to reduce your cravings. An artificial sweetener like sucralose is five to 10 times sweeter than sugar, and when you eat foods sweetened this way, your taste buds will still register high-intensity sweetness. You might be saving some calories, but you’re not retraining your taste buds to be satisfied with a lowerintensity sweetness. Research shows that artificial sweeteners are ineffective as a sugar replacement and that people who use this strategy will eventually just go back to the real thing.
Of course, this all depends on your personal triggers. Some people can have a small amount of artificial sweetener in their morning coffee and be fine. But for others, that’s enough to set off an entire day of out-of-control sugar cravings.
In the same vein, don’t replace table sugar with other highly concentrated sweeteners. I had a patient who told me she was completely sugar-free, but it turned out that she had simply switched to coconut sugar—still sugar. The same goes for agave syrup, maple syrup, and honey: These all have high-intensity sweetness and, as true sugars, don’t help you from a metabolic perspective or to cut cravings. Note: Honey has some benefits, including antimicrobial properties. For people who can have a small amount of sweet without setting off cravings, it’s OK to use in small amounts.
