Sugar is a sweet crystalline substance obtained from various plants, especially from sugarcane and sugar beet. It essentially contains sucrose and is used as a sweetener in food and drinks. Having said that, we consume sugar in many other forms through the food we eat. Lactose (a sugar present in milk) is a disaccharide containing glucose and galactose units. Fructose, a sugar of the hexose class, is found especially in honey and fruits. Maltose is a sugar produced by the breakdown of starch, e.g., by enzymes found in malt. Plants and most algae mainly make glucose, a simple sugar, during photosynthesis from water and carbon dioxide, using energy from sunlight, where it is used to make cellulose in cell walls, which is the most abundant carbohydrate.
One may come across ice-cream brands claiming to have ‘No Added Sugar’ and yet taste sweet. That is because they have lactose present in them. That does not make them ‘Sugar-Free’, though. Similarly, a manufacturer of fruit juice claiming to have ‘no added sugar’ can claim so as no sucrose has been added in the juice. However, the juice will contain fructose and is therefore not ‘sugar-free.
Before buying any product with the label ‘No Sugar or Sugar-Free’, what you really need to do is read the food label carefully and with a little more patience, because of the fact that food labels are confusing and not easy to understand for a lay person. The ambiguity is higher if the consumer wants to know how much sugar is actually added. Let’s understand the available products in the market with a special context to diabetes.

‘No added sugar’
During the processing of a food product, if no sugar or sugar-containing products are added, then a product can be labelled as ‘No Added Sugar’. But it can’t be presumed to be free from sugar; it simply means that the manufacturer didn’t add any sugar during the process of manufacturing. A product with ‘No Added Sugar’ label may contain traces of natural sugars, sweeteners or sugar alcohols. Foods carrying this claim are generally confectionaries, chocolate bars, spreads, fruit juices, and preserved foods.

‘Unsweetened’
This means the product contains no added sugars, no artificial sweeteners, and no sugar alcohols. However, it doesn’t mean the food contains no sugar at all, as it may have naturally occurring sugars. For instance, even single-ingredient products like juices will have fructose or fruit sugar. Yet they will be labelled as ‘No Added Sugar’ or ‘Unsweetened’ even though the natural sugar fructose present in the fruit may contribute as much as 20g of sugar in a 200ml glass of juice (Source: V Rao).

‘Sugar-Free’
For obvious reasons, the food products with this label are most popular among consumers and especially diabetics. In order for a product to be labelled as sugar-free, it shouldn’t contain more than 0.5g of naturally occurring or added sugars per serving. The point to ponder here is whether artificial sweeteners or sugar alcohols should be excluded from this 0.5g. Before buying products with a sugar-free label, always have a look at the above mentioned parameter. Scan the ingredients to check if other sources of sugar are on the list. If there are other ingredients like artificial sweeteners or fructose, know that they will contribute to your total calorie intake. Common foods that carry this claim are chewing gums, syrups, candies, and juices.
In order to meet the regulations laid down by authorities like FDA in the US and FSSAI in India, food manufacturers add sweetening agents like sugar alcohols (also called polyols) to the product. Sugar alcohols have a chemical structure that partially resembles both sugar and alcohol, hence the name. However, they do not contain any alcohol. By adding these substances, they can make the product sweet and at the same time reap the benefits of adding labels like ‘no added sugar’ or ‘sugar-free’. These substances are either natural or artificial, have the same or higher sweetness quotient, and are lower in calories. These products are as palatable as any regular sugary processed food. They also work as a bulking agent in the product, but provide you with almost no nutrition. Erythritol, Isomalt, Maltitol, Mannitol, Sorbitol, Xylitol are the most commonly used sugar alcohol additives. Occasional consumption of artificial sweeteners and sugar alcohols is comparatively okay, but excessive consumption of these products should be avoided.
If you are a diabetic or you are on a keto diet, you need to watch out for polyols, as these substances are essentially carbohydrates and will set your sugars up. You may consume these under the impression that they are helping to keep your sugars in control or supporting your keto diet, but sugar alcohols like Isomalt, Maltitol, Mannitol, etc, can contribute to anywhere between 1.5kcal to 3 kcal/gm. (V. Rao)
Excessive consumption of products with sugar alcohol could have a laxative effect and you may experience gas, bloating and diarrhea. (V. Rao)
Most of these sweeteners are way higher on the sweetness index as compared to natural sugar. Overconsumption of these can impair the sweet receptors in the body due to over-stimulation. Consequently, you will not find sweet foods sweet enough and will have to add extra sugar. It will also hamper your tastes for naturally sweet foods like fruits and certain vegetables. (V. Rao)
There’s also a psychological angle to this. If you think you have controlled your calorie intake through the day because you had more of ‘Sugar-free’ foods, you may be tempted to reward yourself by having extra servings of other sweet foods. This could be especially detrimental to diabetics. Teens tend to binge on colas because they believe that choosing the diet version makes it less harmful, and they end up consuming much more than they usually would. (V. Rao)

Sugar substitutes available in market
Saccharin (Sweet-n-low), Aspartame (NutraSweet, Equal), Acesulfame potassium (Sunett), Sucralose (Splenda), Stevia (Pure Via, Truvia) are some of the artificial sweeteners, also called sugar substitutes, low-calorie sweeteners or non-nutritive sweeteners, available in the market. They offer the sweetness of sugar without the calories. Artificial sweeteners are many times sweeter than sugar, so it takes a smaller amount to sweeten foods. This is why foods made with artificial sweeteners may have fewer calories than those made with sugar. Sugar substitutes don’t affect your blood sugar level. In fact, most artificial sweeteners are considered ‘free foods’ containing less than 20 calories and 5 grams or less of carbohydrates. However, other ingredients in foods containing artificial sweeteners can still affect your blood sugar level. Some studies have found that the benefits of substituting sugar-sweetened food and beverages with those that have been sweetened artificially may not be as clear as once thought. This may be especially true when artificial sweeteners are consumed in large amounts. One reason may be a “rebound” effect, in which some people end up consuming more of an unhealthy type of food because of the misperception that it’s healthy because it’s sugar-free. Also, be cautious with sugar alcohols including Mannitol, Sorbitol and Xylitol. Sugar alcohols can increase your blood sugar level. And for some people, sugar alcohols may cause diarrhea (source: Journals).

Regulations by Food Authorities
The Food Safety and Standards Authority of India (FSSAI) has spelt out the meaning of these terms in the Food Safety and Standards (Advertising and Claims) Regulations, 2018, which govern advertising and claims made by food business operators, to prevent consumers from being misled. A “claim” is any representation which is printed, oral, audio or visual, and states, suggests, or implies that a specific kind of food/ food product has particular qualities relating to its origin, nutritional properties, nature, processing, composition or otherwise.
As per Schedule I of the FSSAI Regulations, a ‘Sugar-Free’ product is one which contains not more than 0.5 g of sugar per 100 g for solids or 100 ml for liquids. Thus, the product may not be with zero-sugar at all, as is presumed by a majority of people.
As Per Schedule II of the FSSAI Regulations, the FSSAI has permitted certain synonyms, which may be used by Food Business Operators for claims defined in the Regulations, as long as there is no change in the intent and meaning of the claim. For the word ‘Free’, the words ‘Zero, No, Without, Negligible Source’ can be used. This, therefore, means that products claiming to be ‘Sugar-Free’ can actually claim to state ‘No Sugar’ or ‘Zero Sugar’ or ‘Without Sugar’ although they may well contain up to 0.5 g of sugar per 100 g for solids or 100 ml for liquids. This would not only be grossly misleading, but could create a health hazard. On the other hand, a product claiming to have ‘Low Sugar’ contains not more than 5 g of sugars per 100 g for solids or 2.5 g of sugars per 100 ml for liquids. When a brand makes a claim that its product has ‘No added sugar’ in it, it is claiming that no sugar or sugar-containing products have been added during processing/ manufacturing the food item. However, that should not lead one to conclude that the food product is sugar-free.
The FSSAI has mandated that where claims regarding the non-addition of sugars are being made, where sugars are naturally present in the food, in advertisements and packaging, the following indication should also appear on the packaging: ‘CONTAINS NATURALLY OCCURING SUGARS’. It is advisable to look beyond the claims on the labels on the front of the packaging, and always look at the label on the back. The nutrition facts provided there will enable you to make an informed decision based on your needs and your preferences. Consuming excess sugar may lead to a raft of health issues, ranging from a rise in blood sugar levels, sudden drop and inflammation in the body, to chronic illnesses like heart problems and diabetes, trouble in concentration, mood swings, etc. It is no wonder then that many individuals who want to avoid consuming sugar in its sucrose form, opt for alternatives such as artificial sweeteners. Amongst the most popular kinds of alternatives used are Stevia (extracted from the Stevia plant in South America, which is virtually calorie-free), Xylitol (a sugar-alcohol, lower in calories than sugar), Yacon syrup (derived from plants in South America), Aspartame (artificial non-saccharide sweetener 200 times sweeter than sucrose), Sucralose (an artificial sweetener made from sugar), Saccharin (an artificial sweetener with effectively no food energy, about 300–400 times as sweet as sucrose but has a bitter or metallic aftertaste, especially at high concentrations), Neotame (a non-caloric artificial sweetener, 8000 times sweeter than sucrose), and Acesulfame potassium (calorie-free sugar substitute). Some commonly known brands are Equal (Aspartame), Splenda (Sucralose), E950 (Acesulfame potassium). One should consume them (if at all) with care, as certain artificial sweeteners have recently be known to be harmful for the health, as they can raise one’s blood sugar levels more than sugar.

The writer is Advisor, Food and Consumer Affairs, Government of Madhya Pradesh, AIGGPA, Bhopal. The opinions expressed in this article are based on scientific research and have nothing to do with the organisation he works for. Aamir Manan Deva

Aamir Manan Deva