Happy holidays! December is upon us, and with it come the familiar, tempting smells of cinnamon, hot chocolate, and fresh cookies. Holiday lunches and office parties are full of tasty foods, abundant sweets, and celebratory cocktails. Physicians’ offices brim with festive tokens of appreciation: boxed chocolates, gift baskets, and holiday baking. The air, both figuratively and literally, seems sweeter in December.

But as physicians, we know that sugar in our society has become more than an occasional indulgence. A 2023 study in the British Medical Journal found significant harmful associations between excess dietary sugar consumption and 18 endocrine/metabolic outcomes, 10 cardiovascular outcomes, 7 cancer outcomes, and 10 other negative outcomes spanning neuropsychiatric, dental, hepatic, osteal, and allergic conditions.[1] Each 250 mL/day increment of sugar-sweetened beverage consumption was associated with a 17% higher risk of coronary heart disease and a 4% higher risk of all-cause mortality.[1]

Sugar-sweetened beverages are the largest source of added sugars worldwide,[1] and childhood obesity has been independently associated with their consumption.[2] These drinks have become so prevalent in our daily lives that avoiding them is nearly impossible—especially during the holidays.

Sugars also come in many different forms and with many different names, which can make it confusing to know what we are consuming and which options are more or less healthy.

Added sugars are those that are added during manufacturing or processing or at the table to change a food’s composition and make it more appealing.[3] Common examples include table sugar, brown sugar, corn syrup, high-fructose corn syrup, glucose, dextrose, agave syrup, maltose, and fruit juice concentrates. High amounts of added sugars are typical in products like sports drinks, soda, candy, sweetened cereals, condiments (e.g., ketchup, salad dressing, BBQ sauce), ice cream, and baked goods. Added sugars are usually absorbed rapidly and provide calories without nutrients. Honey and maple syrup can also be added sugars, although they may also have health benefits through antioxidants, vitamins, minerals, and antimicrobial properties.[4]

Natural sugars are those in whole, unprocessed foods like whole fruits, vegetables, and dairy. These naturally occurring sugars, like fructose, glucose, and lactose, are delivered along with fibre, water, vitamins, and minerals, which slow absorption, promote satiety, and dampen blood-glucose spikes.[5]

Free sugars are what the World Health Organization (WHO) defines as all of the added sugars plus whatever natural sugars are present in honey, syrups, and fruit juices.[3] In its most recent guideline (2015), the WHO recommends that children and adults keep free sugar consumption to less than 10% of their total energy intake, ideally under 5%.[6]

One useful tool for reducing excess sugar is understanding how to read food labels. In Canada, the nutrition facts table on packaged foods lists “sugars” (total sugars), along with a daily percentage value: 5% or less is “a little” and 15% or more is considered “a lot,” based on 100 g of sugar per day, or 20% of a 2000-calorie diet.[7] Notably, Canada does not require labels to distinguish between naturally occurring and added sugars. For example, a cup of plain yogurt contains lactose (a natural sugar) but no added sugars, so consumers must check the ingredient list to determine the type of sugar present. Natural sources of sugar, such as those from fruits, vegetables, and dairy, are a recommended part of a balanced diet.

If you’re interested in cutting down on sugar, consider these strategies:[3,8,9]

• Reduce gradually, even by half a teaspoon each week, to retrain your taste buds.
• 4 g of sugar = 1 teaspoon.
• Assume that sugars in foods with little or no dairy or fruit are all free sugars.
• Replace sugar-sweetened beverages with water or unsweetened tea.
• When baking, halve the sugar in recipes or substitute with unsweetened applesauce or bananas.
• Use natural alternatives like fruit, cinnamon, or coconut to sweeten foods.
• Low-calorie sweeteners can serve as a short-term bridge to reduce sugar intake.
• For those who drink alcohol, distilled spirits (e.g., vodka, gin, rum) are usually sugar-free, and “dry” wines contain less than 1 to 2 g of sugar per 5 oz serving.[10] Cocktails with juice, cola mixers, eggnog, and creamy liqueurs have 5 to 10 times that amount of sugar. Most regular beers (e.g., lager, ale, pilsner) and “light” beers have very little sugar (0 to 2 g per serving), while darker beers have comparatively more sugar.[11] In general, try drinking water between alcoholic drinks to stay hydrated and reduce overall sugar intake.

Sugar is an inseparable part of celebration, but it doesn’t need to overshadow our health. As physicians, we can help families keep festive traditions joyful while offering practical, evidence-based guidance. Rather than villainizing all forms of sugar, educating patients on achieving balance can be more sustainable and empowering. Small, mindful changes around added sugar can protect well-being and model healthy habits for children, ensuring that holiday treats remain merry, not scary.
—Caitlin Dunne, MD, FRCSC

Acknowledgments

I would like to thank Ms Dani Renouf, RD, at St. Paul’s Hospital for her assistance in reviewing and editing and Ms Brooke Ballantyne Scott, medical librarian, Fraser Health, for her assistance with a literature search.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

1.    Huang Y, Chen Z, Chen B, et al. Dietary sugar consumption and health: Umbrella review. BMJ 2023;381:e071609. https://doi.org/10.1136/bmj-2022-071609.

2.    Ludwig DS, Peterson KE, Gortmaker SL. Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. Lancet 2001;357(9255):505-508. https://doi.org/10.1016/s0140-6736(00)04041-1.

3.    Beck L. Need a reason to cut back on sugar? Here are 45. Globe and Mail. Updated 25 April 2023. Accessed 3 November 2025. www.theglobeandmail.com/life/health-and-fitness/article-reduce-sugar-intake-studies/.

4.    Lubeck B. Maple syrup vs. honey: Which sweetener is better for nutrition, healing, and blood sugar? Verywell Health. 29 September 2025. Accessed 3 November 2025. www.verywellhealth.com/maple-syrup-vs-honey-11820103.

5.    American Heart Association. Sugar 101. Last reviewed 23 September 2024. Accessed 3 November 2025. www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/sugar-101.

6.    World Health Organization. Guideline: Sugars intake for adults and children. 4 March 2015. Accessed 3 November 2025. www.who.int/publications/i/item/9789241549028.

7.    Government of Canada. Nutrition labelling: Nutrition facts table. Accessed 3 November 2025. www.canada.ca/en/health-canada/services/food-nutrition/nutrition-labelling/nutrition-facts-tables.html.

8.    Prager C, Cassetty S. How to start cutting back on sugar in just 7 days, according to a dietitian. Prevention. Updated 5 January 2022. Accessed 3 November 2025. www.prevention.com/food-nutrition/healthy-eating/a35109234/how-to-cut-back-on-sugar/.

9.    American Heart Association. Tips for cutting down on sugar. Last reviewed 31 July 2024. Accessed 3 November 2025. www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/tips-for-cutting-down-on-sugar.

10.    Williams L. Cutting back on sugar? Here’s what wine drinkers need to know. Wine Spectator. 21 September 2023. Accessed 3 November 2025. www.winespectator.com/articles/what-healthy-wine-drinkers-need-to-know-about-sugar.

11.    Lang A. How much sugar is in beer? Healthline. 4 March 2020. Accessed 3 November 2025. www.healthline.com/nutrition/how-much-sugar-in-beer.