Chapter 2- Sugar -and the evils there of

Sugars are types of soluble carbohydrate that provide energy in our diet.

Compared to other types of carbohydrate they are quickly absorbed into our body and are less filling.

They can be used to enhance the flavour of food and drink which makes them an attractive option for both consumers and the food and drink industry.

Sugars are either intrinsic or extrinsic.

Intrinsic sugars occur naturally within the cellular structure of food as in fruit and veg. Generally intrinsic sugars are not thought to have an adverse effect on general or dental health as the sugar is ’locked in’.

Extrinsic sugars can be ‘natural’ as in honey or lactose [milk sugar] or added to food by either the manufacturer, the cook, or the consumer [you and me].

Leaving aside milk sugar all the other types of extrinsic sugars are known as FREE SUGARS [WHO 2015] and are detrimental to our health and to our teeth!

Food labelling has got much better in recent years but it is still quite difficult to tell how much sugar is in the contents of the packet. Or how much carbohydrate is actually sugar.

As a little guide here are a few clues;-

The nearer the front of the list of ingredients something is, the higher the content.

Some manufacturers use a traffic light system for sugar content. Green is good!

The WHO recommends that free sugars make up no more than 10% of your diet but the new guidelines recommend that if this was reduced to 5% it would have further benefits.

For an adult woman of normal BMI this is 25grms or 6 teaspoons.

For an adult man of normal BMI this is 8 teaspoons.

A lot less for children as they have lower energy requirements.

A standard can of cola contains 8-9 teaspoons!

Consuming too much sugar leads to;-

Overweightness and obesity.

Increased risk of high blood pressure, type 2 diabetes, cardiovascular disease and some cancers.

Dental plaque which causes tooth decay and gum disease.

‘5 a DAY’

Fruit contains intrinsic sugars so they are locked in. As long as you make that 3 veg and 2 fruit and no more than 1 piece of citrus fruit per day so you don’t dissolve your teeth away with acid the health benefits from the roughage, vitamins and minerals outweigh the small amount of acid damage.

Different fruit and veg contain different vitamins and minerals- mix up the colours.


Juicing fruit releases the sugar content of the fruit and turns it into free sugar. Frequent exposure to the sugars and acids when fruit is juiced leads to tooth decay and dental erosion.

Smoothies are the same, if you drink them drink the pulp as well, you need the fibre as well as the vitamins and minerals.

Don’t drink either in between meals.


Contains super concentrated sugar as all the water content has been removed. It is also very sticky so it stays on your teeth for longer. Don’t use as a between meals snack.

The worst snack you can give a small child is a carton of juice and a little box of raisins!


Milk is an important source of calcium and phosphate both of which contribute to the maintenance of healthy teeth. Milk also contains caesin a protein which forms a film on teeth protecting them from loss of calcium and phosphate when exposed to acids.

Milk does contain milk sugar [lactose] but this is considered to be the least cariogenic [cavity forming] of the sugars.

However do not put your baby to bed with a bottle of milk as this prolonged exposure leads to early childhood decay [used to be called bottle caries and rots all of the baby’s front teeth].

Be careful of milk alternatives- some of them contain a lot of sugar, read the label very carefully.


A healthy, balanced diet and physical activity is recommended for healthy weight, in particular, a diet high in vegetables, a moderate amount of fruit, complex [unrefined] carbohydrates, protein and low in fat, saturated fat, salt and sugar.

Figures available in NHS digital state that in 2014 62% adults in England were overweight or obese an increase of 9% over 20yrs. 2/3 men and 6/10 women. 1 in 5 kids aged 10-11 were overweight or obese.

28% of children between the ages of 2 and 15 years are now classified as being overweight or obese!


Many foods and drinks contain sugars which is not always obvious to the purchaser. These will be listed on the labels as:-

‘glucose’, ‘glucose syrup’, ‘fructose’, ‘concentrated fruit juice’, ‘sucrose’, ‘dextrose’, ‘honey’, ‘inverted sugar’, ‘maltose’, ‘hydrolysed starches’, ‘molasses treacle’, ‘corn syrup’, etc.

Honey is refined sugar it’s just been refined by bees and not Mister’s Tate and Lyle!

These are all sugars and cause tooth decay. The use of the following expressions on food/drink packages does not mean that they are safe for teeth:

No added sugar’, ‘no artificial sweetener’, ‘sugar free’, ‘low sugar’, ‘lite’, etc.

Beware the expressions used on packaging ‘tooth kind’ makes it sound as if the more you drink it, the more good you are doing to your teeth it doesn’t mean this at all, it just means ‘not as bad as all the rest’!

Keep sugar to meal times only. The combination of sugary food and/or drinks, with bacteria in the mouth [plaque] leads to the production of acid which causes tooth decay.

Each time food and/or drinks are consumed that contain sugar, the plaque bacteria on your teeth produce acids. It is a by-product of them metabolising the sugar.

Tooth decay is ‘site specific’. That is you get decay where you have plaque.

These acids can attack the teeth for up to 2 hours before they are neutralised by saliva. Sweets and sweet food and drinks are best eaten at the end of meals, and not in between but better still not eaten at all, only as a treat and not on a regular basis.

Don’t snack on sugary food and drink.

Safer snacks for in-between meals are:- toast, sandwiches, pitta bread, bread sticks, cream crackers, rice cakes, crisp bread, oat cakes, nuts [not for under 5s].

Safer fillings/toppings for the above are:- meat, cheese, egg, tinned fish, marmite [not for babies under 6 months], humus.

Raw fruit (Apples, oranges, bananas, pears, kiwi fruit, melon peach etc)

Raw vegetables (Sticks of carrot, celery, cucumber, radish etc)

Plain natural yoghurt or fromage frais with chopped or pureed fruit. Most readily prepared yogurts or fromage frais contain sugars.

Dried fruit [raisons, sultanas etc] is high in sugar and there for not a safe snack. Muesli bars sold as a healthy alternative are high in honey, dried fruit and glucose syrup. As such they are harmful to teeth if eaten as a snack in-between meals.

Milk, water, tea and coffee without sugar are the only safe drinks for teeth in-between meals.

When you shop use the Change4Life food app to help you.

In a nutshell.

Plaque + Sugar = acid = cavities.

Cut down the amount of sugar.

Cut out the frequency of sugar.

3 meals and 2 snacks per day.

If you do eat or drink sugar do so at the end of a meal.

Only eat sugarless snacks in-between meals.

Get the bacteria off your teeth and don’t feed them with sugar!

Xylitol and other sweeteners and sugar substitutes.

Sugar is damaging to teeth and makes you fat but some people like things that taste sweet. There are various sugar substitutes.

No calorie sweeteners [non-nutritive].

These are safe for teeth as they cannot be converted to acid by the bacteria in plaque. They come in tablet form so you can add them to your coffee or tea and they are often added to sugar free squash, diet fizzy drinks etc. Personally I dislike the taste of them, I find they leave a nasty aftertaste, in my opinion it’s better to wean yourself off the craving for sugar but each to his/her own. They have been used in the slimming industry for years. One big problem with them is they are acidic and so contribute to dental erosion [see chapter3]. Some also irritate your bladder and make you want to pee more.

Names you might be familiar with are Aspartame and Saccharine.

These low calorie sweeteners should not be given to young children.

If a product contains some sort of sugar and an artificial sweetener, the sweetener will not protect you from the damaging effect of the rest of the sugar.

Calorific sweeteners [nutritive].

These are sugar alcohols, Xylitol is probably the best known one, it’s a natural sweetener, derived from the fibrous parts of plants. It cannot be metabolised to acid by the bacteria in plaque. You can buy it in bags like sugar to put in your cooking. It will make you fat but it won’t rot your teeth [though it does have 40% less calories than sugar and a lower glycaemic index]. Another one you might be familiar with is sorbitol.

There have been lots of other claims re Xylitol;- inhibits bacterial growth, demineralisation of enamel and formation of plaque but none of them have been proved in clinical trials, as in ‘on people’ as opposed to in a lab though there is lots of ongoing research especially in Scandinavian countries.

All in all it’s not a bad idea if you do a lot of baking to buy a bag of xylitol and see how you like it.

Further watching.

I suggest you watch a few things on YouTube.

To watch with your kids;-That Sugar Song by the Rolling Oats. The Science of Sugar.

For older kids and adults;- The Truth about Sugar a BBC production.


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