Research
Macro partitioning
Sugars are not inherently harmful; their effect on cardiometabolic health depends on energy balance and food source. Sugar-sweetened beverages cause harm due to excess energy, while sugars in high-quality foods (fruit, yogurt, whole grain cereals) provide benefit when substituted for refined starches.
Do not fear sugars in whole foods. Fruit, yogurt, and whole grain cereals containing sugars are beneficial when they replace refined starches. Avoid sugar-sweetened beverages which provide excess energy without nutrients.
GoodQualifiesHIGH confidence
The evidence for sugars as a marker of carbohydrate quality appears to be highly dependent on energy control (comparator) and food source (matrix), with sugar-sweetened beverages providing excess energy showing evidence of harm, and with high-quality carbohydrate food sources containing sugars such as fruit, 100% fruit juice, yogurt, and breakfast cereals showing evidence of benefit in energy-matched substitutions for refined starches.
Why this rating
Based on systematic reviews and meta-analyses of RCTs and cohort studies.
Source
Low-carbohydrate diets and cardiometabolic health: the importance of carbohydrate quality over quantity
John L. Sievenpiper · Nutrition Reviews · 2019
DOI 10.1093/nutrit/nuz082
narrative_reviewCited 136×
Read the paper DOI resolved against Crossref · corpus check 2026-06-10
More from this paper
- High-quality carbohydrate diets (emphasizing whole grains, pulses, fruit, low glycemic index/load, and high viscous fiber) decrease intermediate cardiometabolic risk factors and are associated with reduced incidence of diabetes, cardiovascular disease, and mortality, whereas low-carbohydrate diets show no long-term superiority for weight loss or sustained glycemic control.Strong
- The carbohydrate-insulin model, which posits that high carbohydrate intake causes hyperinsulinemia leading to fat storage and weight gain, is experimentally falsified because low-carbohydrate diets fail to produce the expected fat loss or sustained increase in energy expenditure.Strong
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