How Bad Is Sugar? Even the Earliest Exposure Should Be Avoided

With Michael Goran, PhD, and Kimber Stanhope, PhD, RD

One of the most common questions for a new parent to ask is—What should I feed my child? Introducing food is as much about immediate nourishment as long-term health, but there are a few dos and better-nots to guide the way.

During the 19th annual Harvard Nutrition and Obesity Symposium hosted by Harvard, a group of experts added a new note of caution to the list of existing dietary warnings—Watch your sugar.1 While moms and dads have become very aware of the dangers that can arise when kids are exposed to too much sugar, there is new data suggesting the need to cut back much earlier, ideally at the onset of pregnancy.1

Sugar has a negative effect on health, development and learning.Nearly 40% of added sugars come from sweetened drinks and juice, and the rest comes from processed foods.

Beware Exposing Children to Sugar from the Start of Pregnancy

Introducing children—and those just developing in the womb—to added sugars can result in detrimental effects on growth, development, and learning, in addition to increasing the risks of obesity and the related health problems such as diabetes and heart disease; this was the clear message distilled from two days worth of presentations.1

Since babies and children are often exposed to sugar unintentionally, Michael Goran, PhD, professor of pediatrics and director of diabetes and obesity at Children's Hospital Los Angeles at the University of Southern California Keck School of Medicine in Los Angeles, has coined a new term for this: secondhand sugars.

Just as we’re aware of the risks associated with secondhand cigarette smoke, we now face similar health concerns from exposure to added sugars.1-6 It common for women to heed the usual cautions about watching their nutrition during pregnancy: No alcohol. Limit your caffeine. Eat wisely to accommodate the baby, but don't eat so much that you’ll add unwelcomed excess weight. Avoiding sugar should be added to this list.

Dr. Goran is committed to spreading the word that it's critically important that women avoid consuming added sugars or artificial sweeteners while pregnant to avoid introducing these harmful substances to the fetus and through breast milk, Dr. Goran tells EndocrineWeb. Infants and young children who are given sugars are passive consumers of these nutritionally empty nutrients.

"We take a life course perspective,” meaning the work from his lab has focused on evaluating the effect of sugar exposure from the very beginning, he says. His research and that of others have focused on tracking the effects of sugar intake from pregnancy through adulthood,3-7 documenting the impact on health and development.

In distilling down the research, here is what people need to know about the effects that sugar intake may have in early in life—“and yes, it really does matter,” says Dr. Goran and others who have been researching the link between sugar and its impact in children.

Explaining the Vulnerability: 4 Reasons to Avoid Secondhand Sugar in Children 

Infants and children are more vulnerable to the negative effects of added sugars and sweeteners for a number of reasons, Dr. Goran says. Among them:1

  • Children have a greater innate preference for sweets, so they are more likely to want sweeter foods when given a choice.
  • When exposed to added sugars and sweeteners in the womb, this preference may become even stronger after the baby is born.
  • Infants aren't able to digest fructose well because they lack the enzyme needed for its digestion.  That is why new mothers are told to avoid exposing babies to honey during the first year of life, and also the reason that early exposure to high concentrations of fructose may negatively affect the gut microbiome, which in term may increase long-term risks for chronic diseases.
  • As kids grow, they get hungry more quickly and are more likely to eat between meals, which may be appropriate but consider that 90% of snacks have added sugars.

Examining the Data on Sugars and Health in Children

Dr. Gorman and others have looked at the effects of sugar for its impact on weight gain but also on academic performance and learning ability.3-7 Among their many findings:

  • Infants exposed to sugar-sweetened beverages (SSB) including juices at a young age are more likely to develop obesity as young as age 6 years. In one study, 4 following more than 1,100 infants who were evaluated between 2005-2007 and again at age 6 years the researchers found that 9% of those who never consumed sugary drinks (even juice) in infancy were obese by age 6, but the rate nearly doubled to 16% of those who drank SSB after 6 months of age developed obesity.4 And a full 20% of babies who were given juice or other sweetened beverages before 6 months became obese by 6 years old. 
  • Mothers' SSB intake during the second trimester of pregnancy was linked with a greater risk of a higher fat mass in their children by 8 years old. In more than 1,000 mother-child pairs, the average intake of SSBs was about 0.6 serving a day; for each additional serving, their child's fat mass, waist circumference, and risk of overweight increased.5 The researchers concluded that the link was related to the mother's SSB intake, not the child's.
  • Swapping artificially sweetened beverages for juice or SSB’s made with sugar and consumed daily during pregnancy doubled the risk of infants becoming overweight at one year old, based on findings from a study of more than 3,000 mother-child pairs.6 Only 5% of the pregnant women consumed artificially sweetened beverages. In contrast, data from this study did not note an undesirable weight gain by age one.  
  • The impact of consuming artificially sweetened beverages during pregnancy may linger. In a study involving more than 900 mother-child pairs,7 the researchers found that children of mothers who were daily drinkers of artificially sweetened beverages had double the risk of becoming overweight or obese by the of 7 years, compared to women who never drank them.

Experts believe that artificially sweetened beverages may cross the placenta and affect development after the product breaks down. Also, the sweeteners may change the gut microbiome (good bacteria) in the baby or the mom.

It also seems that artificially sweetened beverages affect taste preferences in newborns, heightening their fondness for highly sweetened foods and drinks. The artificially sweetened beverages may also hamper fat burning, which may explain the weight gain commonly seen increasing by age 6 to 8 years.7

Besides concern about weight and obesity, intake of added sugars and sweeteners have been linked with poorer academic performance and learning difficulties in general.

  • One study of more than 4,000 children found that those who drank more than a glass a day of juice or sweet beverage had lower scores in grammar, reading, writing, and numeracy compared to those drinking less or none at all.8
  • Maternal intake of added sugars in foods and beverages during pregnancy appears to have a direct effect on the cognitive development of their children, as measured by poorer problem-solving abilities and less verbal memory when measured at two ages: 3 years and 7 years.9

The good news—Eating fruit helps promote healthy growth and development; therefore, snacking on fruit is the best way to satisfy your own sweet tooth and to meet the desire for sweet in your babies as they grow. 

Another Clinical Perspective Confirms Health Problems Arising from Secondhand Sugar Exposure

"Our children show more cardiovascular disease risk factors, more obesity, and more fatty liver problems at a younger age when compared to children 30 years ago," says Kimber Stanhope, PhD, RD, a research nutritional biologist at the University of California at Davis. She also presented at the symposium and is aware of the research on early sugar exposure.

"The negative effects seen in children who are exposed early to added sugars and sweeteners is not surprising," Dr. Stanhope tells EndocrineWeb. "What we've learned is that the weight gain in children just as in adults has been linked with sweetened beverages often results in a ''double whammy." 

How so? "The weight gain increases other risk factors [such as heart disease, fatty liver]," she explains, and the cascade effect can translate into very poor health consequences at a very young age, and continuing into adulthood.

An Action Plan for Parents: How to Navigate a Sweet Tooth 

What to do on a practical level? The Dietary Guidelines for Americans suggest that everyone limit intake of added sugars, to less than 10% of daily calories.10 However, it’s more prudent to avoid any added sugars while pregnant and to skip juice and any beverages beyond breast milk (or formula) and n babies and toddlers.

"While there really aren't any specific guidelines for sugars during pregnancy; I would say the same [guidelines] as for adults," Dr. Goran. His personal advice would also be to skip the low-calorie sweeteners during pregnancy and while breastfeeding, but he says ''this is just my opinion based on the studies and data that I've seen."

On his Secondhand Sugars page, Dr. Goran says that high fructose corn syrup (HFCS) and artificial sugars are the most damaging sweeteners.2 It's important to differential HFCS from fructose, the sugar that is naturally occurring in fruit; fruit provides a wide array of health benefits unlike high fructose corn syrup, which is most widely available in processed food and drinks, he says.

The reason artificial sweeteners are such a problem is that they can fool the body into triggering hunger, releasing insulin, and causing us to overeat—leading to undesirable weight gain and a cascade of chronic diseases. 

Thinking A Bit More Creatively

All sugars are created equally when it comes to metabolism. The body doesn't distinguish between pure cane sugar, agave, honey, molasses, brown sugar or any other added sweetener, for that matter. If you are adding an ingredient to deliver the sweetness, stop and rethink the value of sidetracking the risks of diabetes, overweight, or heart disease by substituting fruits and vegetables.

  • Beverages: First, it's always better to chew your calories than drink them. So give your children plain milk or water with milk and in between. At most, one 6-ounce serving of orange juice, preferably with the pulp, a day is more than enough juice.
  • Foods: Rather than follow the typical peanut butter and jelly routine, change things up a little by switching out the jelly (jam, preserves, honey) for fruit. Yes, a peanut butter and sliced banana sandwich is a very satisfying combination. So is ricotta cheese on toast with sliced strawberries or peaches. Sliced apples and cheddar cheese make for a great snack. Carrots are naturally sweet too so serve them alone or with a spinach yogurt dip, some hummus, or tzatikis; dipping is fun so go with it!

The theme—look for ways to add whole fruit rather falling back on a version that contains sugar to assure that you and your children have a better shot at a healthy future.

Dr. Goran nor Dr. Stanhope have no relevant disclosures.

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