Added sugar: how much is too much, and what the trials actually show

Added sugar is often blamed directly for heart disease, yet randomized trials in adults found small shifts, 0.11 mmol/L in total cholesterol and about 1.5 mmHg in blood pressure on low certainty evidence, and none measured heart attacks or deaths. The clearer signal in cohort studies comes from sugary drinks, with 25 percent higher type 2 diabetes risk per extra serving, while added sugar counted as a whole showed no link.

How much you need

• WHO strongly recommends adults and children keep free sugars below 10% of energy, and suggests below 5%. — Adults and children Evidence E source
• The US label Daily Value for added sugars is 50 g for adults and children 4 and over, 25 g for ages 1 to 3, with no value set for infants. — US food labeling reference values Evidence E source
• Sweetened beverages supplied 37% of added sugars for US men and 28% for women, and tea and coffee combined about 17% for both. — US adults, WWEIA NHANES Evidence E source
• Only 47% of US adults aged 20 and over met the guideline of under 10% of calories from added sugars, with no significant difference between men and women. — 5017 US adults aged 20 and over Evidence E source
• In the US a 'no added sugar' label requires that no sugars or sugar-containing ingredients that substitute for added sugars were added during processing or packaging. — US food labeling rule Evidence E source
• US rules let naturally sweet foods such as juices, including foods for children under 2, state they are unsweetened or contain no added sweeteners. — US food labeling rule Evidence E source

Who is most likely to fall short

• In cohort evidence reviewed by WHO, observational data link high sugars intake in children with 2.75 times higher odds of a larger caries increment. — Cohort studies in children, reviewed for the WHO guideline Evidence C source
• Among 1317 Mexican American adolescents in NHANES 2009-2018, 61.5% got at least 10% of their energy from added sugars. — 1317 Mexican American adolescents aged 12-19, NHANES 2009-2018 Evidence C source
• In a retrospective cohort, men aged 55 to 75 eating at least 5% of energy as free sugars from solid foods had 34% higher cardiovascular risk, with no clear link in other age and sex groups. — Canadian Community Health Survey 2004-2005 adults, followed to 2017 Evidence C source

What the evidence does and does not show

• A Cochrane review found a minimal effect of lower added sugar intake on total cholesterol (4.3 mg/dL (0.11 mmol/L), 16 trials, 763 people, low certainty) and triglycerides (8.9 mg/dL (0.10 mmol/L), 14 trials, 725 people). — RCTs: 16 trials, 763 participants (TC), 14 trials, 725 participants (TG) Evidence A source
• The same Cochrane review found blood pressure differences of about 1.4 to 1.5 mmHg, and no trial at all that measured heart attacks, strokes or deaths. — 13-14 RCTs, 873 participants Evidence A source
• In randomized trials, replacing cow's milk with soymilk lowered LDL by 7.3 mg/dL (0.19 mmol/L), and added sugar in the soymilk did not meaningfully change the results. — adults in randomized trials of soymilk for cow's milk Evidence A source
• A secondary meta-analysis of RCTs found free sugars intake linearly related to higher fasting glucose, HDL-C and LDL-C, but the data poorly represented typical population intakes. — RCTs on free and added sugars, secondary exploratory analysis Evidence C source
• Carbon isotope ratios from alanine or breath tracked added sugar intake best (R2 0.36 to 0.91), while bulk blood or hair ratios showed only modest associations (R2 0.05 to 0.48). — human studies of carbon isotope ratios Evidence C source

What too much does

• In a dose-response meta-analysis of prospective cohorts, each additional serving of sugary drinks was linked to 25% higher type 2 diabetes risk, while added sugar as a whole showed no association. — prospective cohort studies Evidence C source
• A meta-analysis of cohort and cross-sectional studies linked added sugar with diastolic blood pressure 5.15 mmHg higher, with a wide confidence interval. — cohort and cross-sectional studies Evidence C source
• Observational data link higher added sugar intake with 66% higher odds of Crohn disease and 59% higher odds of ulcerative colitis. — observational studies: 14 on Crohn disease, 18 on ulcerative colitis Evidence C source
• An umbrella review found moderate quality evidence linking the highest versus lowest added sugar intake with ectopic fat accumulation. — meta-analyses of sugar intake and health outcomes Evidence C source

What to do with this

WHO strongly recommends that adults and children keep free sugars below 10 percent of energy. It also suggests going below 5 percent, a conditional advice that rests on evidence of very low quality. The US label Daily Value is 50 g of added sugar for adults and children 4 and over and 25 g for ages 1 to 3, with no value for infants. That number is a reference for the label and no target to eat up to.

Start with drinks. Sweetened beverages supplied 37 percent of added sugar for US men and 28 percent for women, and tea and coffee combined supplied about 17 percent for both. In a national survey of 5,017 US adults, 47 percent stayed under 10 percent of calories. That survey used one 24 hour recall, which probably understates intake.

Read labels closely. A US "no added sugar" claim requires, among other conditions, that no sugars or sugar-containing substitutes were added during processing or packaging. Naturally sweet foods such as juices, including foods for children under 2, may still say "unsweetened", and that word tells you nothing about how much sugar is inside.

Added sugar in a food does not always cancel what the food does. In randomized trials in adults, swapping cow's milk for soymilk lowered LDL cholesterol by 7.3 mg/dL (0.19 mmol/L), and added sugar in the soymilk did not meaningfully change that result.

For children the reason to cut back is teeth. In cohort evidence reviewed by WHO, children with high sugar intake had 2.75 times the odds of more tooth decay (95% CI 1.29 to 5.85). Another study counted 1.28 more decayed, missing or filled tooth surfaces over 2 years for every extra 100 g a day of free sugars.

Where to get it from food

USDA does not report added sugar for individual foods, so this site cannot rank foods by it. The sections above name the foods the studies themselves looked at.

The bottom line

The trials that changed added sugar in adults found small effects. Total cholesterol differed by 4.3 mg/dL (0.11 mmol/L) across 16 trials in 763 people, and systolic pressure by 1.44 mmHg, with no effect on LDL or HDL. Cohorts point at sugary drinks. Each extra serving went with 25 percent higher type 2 diabetes risk (95% CI 17 to 35 percent), while added sugar as a whole showed no association, on low certainty evidence. Other links are weaker. Mostly retrospective studies tie added sugar to 66 percent higher odds of Crohn disease, and a pooled 5.15 mmHg rise in diastolic pressure has an interval running from 0.09 to 10.21. This page holds no trial or cohort evidence on pregnancy or medicines, and children's teeth remain the clearest reason for caution. In one cohort, men aged 55 to 75 eating at least 5 percent of energy as free sugar from solid foods had 34 percent higher cardiovascular risk, with no clear link in other age and sex groups. Sugar intake in the cohorts and surveys here was reported by the people themselves, and objective markers of intake are still being studied.

Sources

1. adsg-daily-r4-01 · Position of an expert body · Agency guideline
   In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake2 (strong recommendation). WHO suggests a further reduction of the intake of free sugars to below 5% of total energy intake (conditional recommendation3).
   WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-02 · independently re-checked
2. adsg-daily-r4-03 · Position of an expert body · Regulatory reference value
   Added Sugars [DRV, Grams (g)] 21 CFR 101.9(c)(9) | 50 Adults and children >= 4 years | N/A Infants through 12 months | 25 Children 1 through 3 years | 50 Pregnant women and lactating women (value from the source's table, not a sentence)
   21 CFR 101.9(c)(9), Daily Reference Values · checked 2026-10-02 · independently re-checked
3. adsg-daily-r4-06 · Position of an expert body · Agency data brief
   On average, males obtained 37 percent and females, 28 percent of added sugars from sweetened beverages; and both males and females obtained about 17 percent of added sugars from tea and coffee, combined.
   USDA FSRG Dietary Data Briefs, What are the main sources of added sugars in adults' diet · checked 2026-10-02 · independently re-checked
4. adsg-daily-r4-07 · Position of an expert body · Agency data brief
   Overall, 47 percent of adults, 20 years and over (N=5017), met the DGA added sugars recommendation by consuming <10 percent of calories from added sugars. There was no significant difference between the percentages of males (49%) and females (45%) meeting the recommendation, at P<0.01.
   USDA FSRG Dietary Data Briefs, What percentage of adults meet the Dietary Guidelines added sugars recommendation · checked 2026-10-02 · independently re-checked
5. adsg-daily-r4-04 · Position of an expert body · Regulatory rule
   (i) No amount of sugars, as defined in § 101.9(c)(6)(ii), or any other ingredient that contains sugars that functionally substitute for added sugars is added during processing or packaging; and
   21 CFR 101.60, Nutrient content claims for the calorie content of foods · checked 2026-10-02 · independently re-checked
6. adsg-daily-r4-05 · Position of an expert body · Regulatory rule
   (3) Paragraph (c)(1) of this section shall not apply to a factual statement that a food, including foods intended specifically for infants and children less than 2 years of age, is unsweetened or contains no added sweeteners in the case of a food that contains apparent substantial inherent sugar content, e.g., juices.
   21 CFR 101.60, Nutrient content claims for the calorie content of foods · checked 2026-10-02 · independently re-checked
7. adsg-daily-r4-02 · Observational data · Agency evidence review
   Rodrigues et al. reported that children with high levels of sugars intake were 2.75 times more likely to have higher caries increment than those with lower levels of sugars intake (OR 2.75; 95% CI: 1.29, 5.85) (50); Rugg-Gunn et al. reported results of regression analysis of DMFS increment by amount of free sugars consumed, which indicated that there was an average increase of 1.28 DMFS (95% CI: 0.10, 2.46) over 2 years with each rise of 100 g/day of free sugars consumed (26)
   WHO, 2015, Guideline: sugars intake for adults and children · checked 2026-10-02 · independently re-checked
8. adsg-daily-r4-17 · Observational data · Cross-sectional study
   Among the 1317 Mexican American adolescents from NHANES 2009–2018, the majority (61.5%) reported high added sugars intake.
   Pediatr Obes, 2026 · checked 2026-10-02 · independently re-checked
9. adsg-daily-r4-11 · Observational data · Cohort study
   Men 55 to 75 years of age had 34% higher CVD hazards with intakes of free sugars from solid sources ≥ 5 TE% vs. below (adjusted HR 1.34, 95% CI 1.05- 1.70). The other three age and sex-specific groups did not demonstrate conclusive associations with CVD.
   BMC Public Health, 2023 · checked 2026-10-02 · independently re-checked
10. adsg-daily-r4-08 · Meta-analysis or systematic review · Cochrane review
    There was minimal effect of low intake of added sugar on total cholesterol levels (MD 0.11, 95% CI 0.01 to 0.21; I² = 0%; 16 studies; 763 participants; low certainty of evidence) and triglycerides (MD 0.10, 95% CI 0.03 to 0.17; I² = 3%; 14 studies; 725 participants) but no evidence of effect on LDL-cholesterol and HDL-cholesterol.
    Cochrane Database Syst Rev, 2022 · checked 2026-10-02 · independently re-checked
11. adsg-daily-r4-09 · Meta-analysis or systematic review · Cochrane review
    No studies reported on cardiovascular events or all-cause mortality. ... There was minimal effect on diastolic blood pressure (MD 1.52, 95% CI 0.67 to 2.37; I² = 0%; 13 studies; 873 participants) and on systolic blood pressure (MD 1.44, 95% 0.08 to 2.80; I² = 27%, 14 studies; 873 participants; low certainty of evidence), but no evidence of effect on fasting plasma glucose.
    Cochrane Database Syst Rev, 2022 · checked 2026-10-02 · independently re-checked
12. adsg-daily-r4-15 · Meta-analysis or systematic review · Meta-analysis
    small important reductions in LDL-C (- 0.19 mmol/L [- 0.29 to - 0.09]) and c-reactive protein (CRP) (- 0.82 mg/L [- 1.26 to - 0.37]); and trivial increases in HDL-C (0.05 mmol/L [0.00 to 0.09]). No other outcomes showed differences. There was no meaningful effect modification by added sugars across outcomes.
    BMC Med, 2024 · checked 2026-10-02 · independently re-checked
13. adsg-daily-r4-16 · Observational data · Meta-analysis
    Across 13 outcomes, Δ%Efs was positively and linearly related to greater fasting glucose, high-density lipoprotein cholesterol (HDL-C), and LDL-C, and non-linearly to body weight. However, the data were limited in their representation of FS intake at typical population levels, and there were insufficient data to investigate the effect of FS from foods on most anthropometric outcomes.
    Nutrients, 2026 · checked 2026-10-02 · independently re-checked
14. adsg-daily-r4-18 · Observational data · Scoping review
    Studies that used CSIA to examine the CIR from the amino acid alanine (CIR-Ala; n = 4) and CIR analyzed from breath (n = 2) provided the most robust evidence for CIR as an objective biomarker of AS and SSBs (R2 range 0.36-0.91). Studies using bulk analysis of hair or blood showed positive, but modest and more variable associations with AS and SSBs (R2 range 0.05-0.48).
    Adv Nutr, 2024 · checked 2026-10-02 · independently re-checked
15. adsg-daily-r4-10 · Observational data · Meta-analysis of cohorts
    Each additional serving of SSB and fruit juice was associated with a higher risk of T2D (risk ratio [RR]: 1.25; 95% CI: 1.17, 1.35 and RR: 1.05; 95% CI: >1.00, 1.11, respectively; moderate certainty). ... No associations were found for added sugar (RR: 0.99; 95% CI: 0.96, 1.01; low certainty) or fructose (RR: 0.98; 95% CI: 0.83, 1.15; very low certainty).
    Adv Nutr, 2025 · checked 2026-10-02 · independently re-checked
16. adsg-daily-r4-13 · Observational data · Meta-analysis of observational studies
    Fructose, sucrose, and added sugar, however, were shown to be associated with elevated DBP with 0.83 mmHg (0.07-1.59), 1.10 mmHg (0.12-2.08), and 5.15 mmHg (0.09-10.21), respectively.
    Crit Rev Food Sci Nutr, 2024 · checked 2026-10-02 · independently re-checked
17. adsg-daily-r4-12 · Observational data · Meta-analysis of observational studies
    Pooled analysis showed that added sugar intake was associated with increased risk of Crohn's disease (OR 1.66; 95% Cl 1.21-2.29; n = 523,730; 14 studies) and ulcerative colitis (OR 1.59; 95% CI 1.25-2.02; n = 787,228; 18 studies).
    United European Gastroenterol J, 2025 · checked 2026-10-02 · independently re-checked
18. adsg-daily-r4-14 · Observational data · Umbrella review
    Moderate quality evidence suggested that the highest versus lowest dietary sugar consumption was associated with increased body weight (sugar sweetened beverages) (class IV evidence) and ectopic fatty accumulation (added sugars) (class IV evidence).
    BMJ, 2023 · checked 2026-10-02 · independently re-checked