Hidden Sugars

One of my patients sent me a photo of balsamic vinegar the other day.  She was so excited to share because she knows I do love a little balsamic!  Her text read:  ‘Hey Dr K!  This Balsamic glaze is AMAZING!  You’ll love it!’

The bottle looked super-cool and trendy with a gold-embossed label adorned with images of grape vines.  There was certainly visual appeal and a definite healthy Mediterranean style to the packaging.  ‘Only natural ingredients’ was printed in bold along the bottom of the bottle.

So, the next time I went to the supermarket, I looked for the ‘AMAZING’ balsamic glaze to see whether it would fit my low-carb, no-sugar, real-food Mediterranean lifestyle strategy.

The ingredients list:

• Balsamic Vinegar [67%] (Grape Concentrate, Wine Vinegar, Preservative: Sulphur dioxide)
• Sugar
• Glucose (Preservative: Sulphur dioxide)
• Starch
• Caramel
• Colourants
• Preservatives: (Potassium sorbate, Sodium benzoate)

On the nutrient breakdown section of the food label: There are 49g sugar in 100ml of the product.  So, in essence, it’s highly-preserved vinegar-flavoured syrup.  Who knows whether the preservatives and colourants are ‘natural ingredients’ or not.

With dismay, I returned the bottle to the shelf.  Another example of enticing and potentially misleading food packaging.  I get angry every time I go shopping because I see people being fooled into buying food products that are making them sick and shortening their lives.

In this article, I’m going to focus on hidden sugars because this is the most common and most detrimental of all concealed ingredients and it’s really important for you to recognize hidden sugars so you can avoid them whenever possible.

Why Do Food Manufacturers Hide Sugar?

The food industry does not care about your health and well-being.  The food industry is interested in one variable only:  Profit.

So, food manufacturers will use any strategy possible to increase sales of their products while keeping costs to a minimum.  Hiding sugar is one of the most important strategies for several reasons:

1. Taste and Market Appeal: Sugar enhances flavour, making products more palatable and desirable to consumers.  Sweetness is universally appealing.  We are genetically programmed to enjoy anything sweet and will therefore eat more of it.   Sweetness can mask the taste of less desirable ingredients like preservatives and other chemical additives that prolong shelf life or make the product more stable.
2. Preservation: Sugar acts as a preservative in processed foods, extending shelf life.  The longer the product can remain on the shelf, the more likely someone will end up buying it and the more money the food manufacturer will make.
3. Cost-Effectiveness: Sugar is often cheaper than natural ingredients like whole fruits or honey, allowing manufacturers to produce cheaper, sweet-tasting products.
4. Deceptive Labelling: Hiding sugar under different names allows manufacturers to market products as “healthy” or “low sugar,” appealing to health-conscious consumers while still including sweeteners.

Dangers and Hazards of Hidden Sugars

Is it really such a bad thing if we eat hidden sugars?

YES!  Hidden sugars are potentially toxic and cause some awful and serious negative health consequences:

1. Blood Sugar Spikes and Crashes

Large fluctuations in your blood sugar level leads to fatigue, irritability, and increased sugar cravings. High sugar intake causes an energy ‘high’ followed by a sharp crash, with resultant fatigue and low productivity.  And over time, these sugar spikes contribute to insulin resistance, prediabetes, and type 2 diabetes.

2. Excess Calorie Consumption and Appetite Dysregulation 

Hidden sugars add significant “empty calories” with little nutritional value.  You gain nothing useful from eating added sugar.  Instead, these useless calories contribute to overeating and weight gain.  Sugar disrupts hunger and satiety hormones (ghrelin and leptin), leading to overeating, excessive hunger, cravings and an inability to experience appropriate satiety.

3. Increased Fat Storage

Excess sugar, especially fructose, is converted into fat in the liver.  Eating large amounts of sugar is linked to weight gain, belly fat, and fatty liver disease.

4. Chronic Inflammation and Increased Risk of Disease

Regular sugar consumption increases the risk of obesity, diabetes, and certain cancers. High sugar intake fuels inflammation, which contributes to conditions like heart disease, dementia and autoimmune diseases.

5. Elevated Risk of Cardiovascular Disease

Heart disease is associated with higher triglycerides, lower HDL (“good cholesterol”), and increased blood pressure, all of which can be caused by excess sugars in your diet.  And, unfortunately, exercise doesn’t really mitigate these metabolic effects.  Tou cannot outrun a bad diet.

6. Dental Health Problems

Sugars feed harmful bacteria in your mouth, causing cavities, tooth decay, and gum disease.  Poor dental health is associated with systemic inflammation and long-term chronic disease.

7. Gut Health Issues

Sugars (especially artificial sugar alternatives and sweeteners) disrupt the balance of gut bacteria…we call this ‘dysbiosis’.  This leads to digestive issues, inflammation, and poor nutrient absorption.

8. Mental Health Effects

Sugar consumption is linked to mood swings, brain fog, and difficulty concentrating.  Added sugars in the diet are associated with increased risk of depression and anxiety due to imbalanced neurotransmitters and nerve system inflammation. Sugar activates your brain’s reward pathways, creating dependency and cravings similar to addictive substances.  This encourages overconsumption of sugary and ultra-processed foods which are nutrient-poor and not good for brain health.

9. Hormonal Imbalances

High sugar intake contributes to stress hormone (cortisol) elevation, affecting overall hormonal balance.  Significant consumption of added sugar can disrupt metabolism and menstrual cycles over time.  PCOS and sub-fertility are closely associated with high-sugar diets.

It should be quite clear to you that hidden sugars are BAD, from a health perspective and from an ethical standpoint.  And food marketers know you will likely be on the lookout for ‘SUGAR’ on a food label, so they will try to conceal or disguise the sugar content to fool you into believing products contain less sugar than they actually do.

So, how do you recognise HIDDEN SUGARS or SUGARS IN DISGUISE so that you can outsmart stealthy food packaging?  

Well, you must understand that sugar comes in different formulations.  It’s not only the crystalline white stuff that many people add to their oatmeal in the morning.    So, you have to become familiar with the other names for sugar that might appear on a food label.

Some general tips:

• Look for ingredients ending in “-ose” (e.g., glucose, fructose, dextrose).
• Be cautious of terms like “natural sweeteners,” “fruit juice concentrates,” or “syrups.”
• Read ingredient lists carefully; sugar can appear under dozens of names.

Here’s a list of some common sugars, sugar alternatives and sweeteners along with a few notes on their metabolic effects:

Common Sugars

• Sucrose (Cane / Table Sugar): Rapidly spikes blood sugar and insulin; contributes to energy crashes and cravings.
• Fructose (Found in High-Fructose Corn Syrup): Metabolized by the liver; linked to fatty liver disease, insulin resistance, and increased appetite.
• Glucose / Dextrose: Directly raises blood sugar and insulin levels; primary energy source for the body.

Natural Sugar Alternatives

• Honey: A mix of glucose and fructose; slightly lower glycaemic impact but still raises blood sugar.
• Coconut Sugar: Lower glycaemic index; still contains sucrose and affects blood sugar.
• Molasses: Provides trace nutrients but similar metabolic effects to sugar.
• Syrups:  Often used by food producers because they sound ‘natural’ and can be disguised.  They generally contain some minerals but raise blood sugar in a similar way to sucrose.
  • Agave nectar/syrup
  • Maple syrup
  • Rice syrup
  • Corn syrup
  • Golden syrup
  • Malt syrup
  • Brown rice syrup
• Concentrates:  Produced by concentrating naturally occurring sweet liquids to create intensely sweet food additives:
  • Fruit juice concentrates
  • Cane juice concentrate / evaporated cane juice

• Other sugars / starches with a significant glycaemic impact:  All of these ingredients (whether they sound organic / healthy / wholesome / natural or not) have a significant and detrimental effect on metabolism and should be avoided:
  • Raw sugar
  • Organic cane sugar
  • Turbinado sugar
  • Beet sugar
  • Barley malt
  • Caramel
  • Diastatic malt
  • Ethyl maltol
  • Maltodextrin

• Artificial Sweeteners

4. • Aspartame: No effect on blood sugar; may disturb gut bacteria and appetite regulation.
   • Sucralose: Minimal impact on blood sugar; potential metabolic changes with excessive use.
   • Saccharin: Zero-calorie; no impact on blood sugar;  may disrupt gut health over time.

• Sugar Alcohols

• • Erythritol: Minimal effect on blood sugar; can cause digestive upset in large quantities.
  • Xylitol: Low glycaemic impact; may improve dental health but can upset digestion and have a laxative effect.
  • Sorbitol and Maltitol: Low impact on blood sugar; often lead to bloating or diarrhea.

• Natural Zero-Calorie Sweeteners
  • Stevia: No impact on blood sugar; may reduce cravings for sugary foods.  This is generally your best option as a sugar alternative.
  • Monk Fruit: Zero glycaemic impact; often mixed with other sweeteners in commercial products.

Remember that your health is determined by the choices you make.  Your food choices have an important impact on how you feel, your metabolism and your longevity.  Be on the lookout for hidden sugars whenever you go shopping.  Read food labels and become familiar with the strategies food manufacturers use to try and trick you.  You are smarter than they are.