Sugar and teeth: How much is too much?
How much sugar is too much?
Everyone knows sugar isn’t great for dental and general health, but how much is too much? In this article, we’re going to arm you with the information you need to take the first steps towards improving the health of your child.
In recent years, there has been a shift towards a ‘new normal’ where certain foods that used to be a rare treat are now eaten weekly and sometimes daily. Sneaky labelling makes it difficult to identify the sugars hidden in our foods and ‘health’ foods that are high in sugar are common. Our busy lives often lead to an increase of pre-packaged and convenience foods that make it difficult for us to track exactly what we’re consumed.
We are living in troubling times where 1 in 3 Australian kids will have a decayed tooth by the age of 6 years.
Sugar intake is a huge part of this.
Limiting added sugar intake can be very tricky but we hope to provide you with some information that will help both motivate you to reduce sugar your child’s sugar intake, and hopefully lower their risk of dental decay and general health problems both in the short-term and in later life.
Our hope is that with a better awareness of what your kids are eating, you can make one tiny change, one small improvement, and then another, and another that will transform your child’s health and future-proof their smile.
What are Added Sugars?
Added sugars are any sugars that aren’t found in whole foods (fruits, vegetables, plain yoghurt, cheese).
Sugars from fruit juice, dried fruits, honey, fruit juice concentrates, syrups and other natural sweeteners are considered added sugars.
Added sugars are often in unexpected foods such as soups, yoghurts, sauces, breakfast cereals and muesli bars.
You may be on alert for ‘sugar’ in labels, but are your eyes peeled for maltodextrin? Or molasses? Or barley malt extract?
Take this Nutri-Grain breakfast cereal label as an example:
(6.5 teaspoons of added sugar per 100g and a 4-star health rating but that’s another story)
Added sugars you may find in food labels
Added sugars can be hard to spot, so here is a list of some examples found in foods and drinks:
- Rice malt syrup, date syrup, agave syrup, corn syrup, golden syrup, honey, fruit sugar syrup
- Fruit juice concentrate
- Dextrose, maltose, sucrose, glucose, fructose
- Malt extract, malt, malt glucose
- Sorbitol, mannitol, glycerol, xylitol, polydextrose, isomalt, maltitol, maltitol syrup or lactitol
- Raw Sugar, brown sugar, invert sugar, molasses
Where are the Added Sugars?
According to paediatric dentists added sugar is in about 80% of packaged food and drinks, so you will need to become very well practised at reading nutritional labels to get a good idea of how much added sugar you are consuming.
Sugar-sweetened drinks such as fruit juices, soft-drinks, cordials and flavoured milks are the major sources of added sugar in children’s diets.
In fact, added sugars are in so many foods and drinks that it’s probably easier to talk about what they’re NOT in: whole fresh fruits, whole grains, vegetables, cheese, plain yoghurt, water & milk.
Once you’ve armed yourself with the skills to work out how much sugar is in the foods and drinks you consume, you can then start slowly swapping foods out of your child’s diet that are high in sugar for those that are slightly lower in sugar.
So What are the Limits?
We, as pediatric dentists, endorse the World Health Organisation recommendation of an upper limit of 6 teaspoons (25g) of added sugar per day or 5% of the total daily energy intake. Kids who don’t consume a lot of calories in a day would likely need less than this.
Children under 2 years old should not be consuming any added sugar at all. This is REALLY important as 0-2 years of age is when taste preferences are established.
To put this in perspective, the Australian average intake PER DAY of added sugar is about 60g (14 teaspoons). Teenage males are the highest consumers, with some eating 160g (38 teaspoons) a day or 58kg per year. Yikes.
How Many Teaspoons Are In That Food?
For most foods or drinks*, go to the nutritional label and find the ‘sugars’. Divide the grams of sugar by 4 to find the equivalent number of teaspoons.
| NUTRITIONAL INFORMATION | ||
| Servings per package: 3 SERVING SIZE: 150g | ||
| QUANTITY PER SERVING | QUANTITY PER 100g | |
| Energy | 608kj | 405kj |
| Protein | 4.2g | 2.8g |
| Fat, total | 7.4g | 4.9g |
| – Saturated | 4.5g | 3.0g |
| Carbohydrate | 18.6g | 12.4g |
| -Sugars | 10.5g | 7.2g |
| Sodium | 90mg | 60mg |
There are 10.5g of sugar per serve of this food product which equals 10.5 ÷ 4 = 2.6 teaspoons of sugar
Be aware that serving sizes are often underestimated and your child might be eating 2 or 3 servings by consuming a whole packet, pouch or bottle.
One cup of juice (250mL) contains 5.75 teaspoons of sugar (even when freshly squeezed).
One packet of sultanas contains 7.5 teaspoons of added sugar.
One Rafferty’s Vanilla Custard pouch contains 3 teaspoons of added sugar.
One pouch of Vaalia Kids strawberry yoghurt has about 2 teaspoons of added sugar.
It all adds up, especially with very young kids.
Low sugar means less than 5g sugar per 100g
*The exception will be foods like yoghurt that have 4g per 100g of sugars that are lactose and not considered added sugars, so you can ignore that first 4g of sugar. So for yoghurt, the added sugars will be anything over and above 4g (one teaspoon).
Tips on Reducing Sugar
We love the Ellyn Satter philosophy that parents are responsible for what, when and where of feeding; children are responsible for how much and whether of eating. (A quick note to parents of children with problem eating, additional needs and sensory aversions – we hear you that this often doesn’t work in your families so please continue doing whatever you need to do to keep your kids eating).
When trying to limit sugars, we think the easiest way is to not have it readily available and to offer an alternative that you are happy for your child to eat. It’s tough for everyone when a child asks repeatedly for food they know is in the cupboard that you’d prefer they don’t have.
This may mean not having that food or drink in the house, or at least stashed in a secret cupboard!
Language to combat pestering could be along the lines of ‘xyz is a sometimes food, so I’m happy for you to have it at parties/Nan’s house/Easter/Christmas/Hanukkah/Eid, but that’s not an everyday food we have in the house. So if you’re hungry you can have cucumber sticks.’
Covert and Overt Restriction
Not having particular foods available is called covert restriction. It is a restriction that the child cannot see and is unaware of. This means not having high sugar treats in the house, or not walking home past the corner store.
Overt restriction is when a food is available but the child isn’t allowed to have it. This refers to having treats in the house that the child is aware of but not allowed to eat, or drinking a sweet drink in front of them but not letting them have a taste.
Overt restriction of foods isn’t recommended as it can interrupt self-regulation, introduce conflict, increase liking for a particular food, and potentially leading to weight dysregulation.
This is all well and good, but what about at parties and other scenarios where sweet food is freely available? There needs to be some balance with the amount of sweet food and drink being consumed without making a huge deal about it.
Perhaps a good compromise is allowing kids to eat whatever you’re comfortable with, but emphasise balance by limiting the portion sizes or the number of servings of the high sugar food.
This is especially required for children of dentists who’ve never seen a lolly in their lives and are often found under the party table with a bowl full making themselves sick.
Key Takeaways:
- Zero teaspoons of added sugar for 0-2 year olds.
- Maximum of 6 teaspoons per day added sugar for 3-12 year olds.
- 4 grams of sugar = 1 teaspoon.
- Low sugar means less than 5g sugar per 100g food
- Sweetened drinks are the biggest source of added sugars for children
- Find the highest sugar food your child eats most days of the week and swap it for a lower sugar alternative. And repeat!
One tiny change, followed by one more tiny change, and then another and another can transform your child’s health.