What is worse for you than sugar? Unpacking the true culprits

November 17, 2025 •

5 min read

According to a study published in JAMA Internal Medicine, individuals getting 25% or more of their daily calories from added sugars are twice as likely to die from heart disease, yet many factors are often overlooked. Beyond mere sweetness, the answer to what is worse for you than sugar involves a complex web of diet and lifestyle elements that pose equal or greater threats.

Quick Summary

This article explores why factors like ultra-processed foods, artificial sweeteners, trans fats, and lifestyle habits like chronic stress and poor sleep often pose a greater risk to long-term health than sugar alone.

Key Points

Ultra-Processed Foods (UPFs) are Worse: Engineered for overconsumption, UPFs combine sugar, unhealthy fats, salt, and additives, creating a synergistic harm greater than sugar alone.
Lifestyle Factors Are Major Culprits: Chronic stress, lack of sleep, and a sedentary lifestyle independently contribute to severe metabolic and cardiovascular risks, often exceeding the damage from sugar.
Trans Fats are Extremely Dangerous: The FDA has banned artificial trans fats because they are the 'worst' fats, uniquely increasing bad cholesterol and decreasing good cholesterol.
Artificial Sweeteners are Not a 'Healthy' Alternative: The long-term effects are controversial and linked to gut microbiome disruption and potential metabolic issues, perpetuating a craving for sweetness.
It's About the Whole Picture: Focusing solely on sugar overlooks the combined and often more potent harm from a poor diet high in processed foods and an unhealthy lifestyle characterized by stress and inactivity.

The Rise of the Ultra-Processed Food Threat

While sugar has long been demonized, it is often just one component of a larger, more sinister problem: ultra-processed foods (UPFs). UPFs are industrial formulations of ingredients, often containing little to no whole foods, and include additives, colorings, and flavorings. These foods are engineered to be hyper-palatable, inexpensive, and have a long shelf life, driving overconsumption. While sugar is metabolically harmful, the combination of ingredients and processing in UPFs creates a 'cocktail of harm' that is profoundly detrimental to health.

The Cocktail of Harm

Diets high in UPFs are consistently linked to an increased risk of obesity, type 2 diabetes, heart disease, and some cancers. They displace nutrient-dense whole foods and are typically high in calories, unhealthy saturated and trans fats, and salt, but low in dietary fiber, vitamins, and minerals. Some research even suggests the processing itself, regardless of the nutritional content, can negatively impact health. This is because the food matrix is broken down, affecting nutrient absorption and satiating potential. When we eat ultra-processed foods, we consume not just sugar, but a cascade of problematic substances and conditions that collectively overwhelm the body.

The Artificial Sweetener Controversy

In an attempt to avoid sugar, many have turned to artificial sweeteners. However, the choice is not as simple as swapping one for the other. Research on the long-term effects of artificial sweeteners is still emerging and often contradictory, but a growing body of evidence suggests they are far from benign.

Potential Health Concerns

Gut Microbiome Disruption: Some studies indicate that artificial sweeteners like sucralose and saccharin can significantly alter the composition of gut microbiota, which is crucial for metabolism, immunity, and overall health. These changes have been linked to impaired glucose tolerance and metabolic dysfunction.
Cardiovascular and Metabolic Risks: Some observational studies have linked regular consumption of artificially sweetened beverages to a higher risk of type 2 diabetes and cardiovascular disease. Certain sugar alcohols and artificial sweeteners have also been associated with specific health risks, such as erythritol and increased risk of heart attack and stroke.
Reinforced Sweet Cravings: Instead of retraining taste buds, these zero-calorie sweeteners may perpetuate a preference for intensely sweet foods, making it harder to appreciate the natural sweetness of fruits and vegetables.

The Silent Assault of Lifestyle Factors

Beyond dietary choices, several lifestyle factors often overlooked in the sugar debate exert a far more damaging effect on metabolic health and overall well-being.

Lack of Sleep's Metabolic Toll

Chronic sleep deprivation is a major driver of insulin resistance and weight gain. It disrupts the hormones that regulate hunger (ghrelin) and fullness (leptin), making us feel hungrier and less satisfied, particularly with cravings for high-sugar and high-fat foods. Even a single night of poor sleep can increase insulin resistance, raising blood sugar levels. Over time, this chronic disruption significantly elevates the risk of type 2 diabetes, obesity, and other health issues.

The Hidden Dangers of Chronic Stress

Chronic psychological and physiological stress releases a flood of hormones, most notably cortisol. Cortisol increases glucose in the bloodstream and can induce insulin resistance, mimicking the effects of a high-sugar diet. A prolonged stress response not only keeps blood sugar chronically high but also impairs the body's ability to cope with fluctuations. Stress is also linked to poorer mental health and a cycle of emotional eating, where sugary foods are used as a coping mechanism, further exacerbating metabolic issues.

The Sedentary Lifestyle Factor

Physical inactivity is a cornerstone of poor metabolic health and is often intertwined with excessive sugar consumption. A sedentary lifestyle directly impairs insulin sensitivity, a core driver of metabolic disease. Studies show that combining reduced physical activity with a high-sugar diet can have a compounded negative effect on blood vessel function and insulin response, sometimes affecting men and women differently. Independent of diet, high sedentary behavior is an independent risk factor for chronic diseases.

Comparison: Is it Really a Fair Fight?

To understand why some factors are worse than sugar, a comparison is helpful. While sugar's harm is potent, especially in high doses, the comprehensive damage from other culprits is arguably more pervasive and insidious.


Health Factor	Primary Mechanism of Harm	Impact on Insulin Sensitivity	Effect on Satiety/Cravings	Overall Health Risk
Added Sugar	Rapid blood sugar spikes; excess converted to fat.	Decreased with high chronic intake.	Increases cravings; poor satiety.	High, linked to diabetes, heart disease, obesity.
Ultra-Processed Foods	Combines sugar, unhealthy fats, and salt; lacks nutrients.	Decreased due to combined metabolic stress.	Hyper-palatable, promotes overeating.	Very High, synergistic effects leading to numerous chronic diseases.
Trans Fats	Increases LDL ('bad') cholesterol, decreases HDL ('good').	Indirectly through systemic inflammation and weight gain.	Minimal direct effect.	Very High, specifically for cardiovascular disease.
Chronic Stress	Hormonal cascade (cortisol) raises blood sugar.	Decreased significantly; can cause insulin resistance.	Emotional eating and sugar cravings.	Very High, impacts physical and mental health, and metabolic function.
Lack of Sleep	Disrupts hormones (leptin/ghrelin); increases insulin resistance.	Decreased dramatically, even after one night.	Drives intense cravings for high-calorie, sugary foods.	Very High, linked to obesity, diabetes, and neurological issues.
Artificial Sweeteners	Potential gut microbiome disruption; metabolic confusion.	Inconsistent but possible negative effect on glucose tolerance.	May perpetuate sweet cravings and appetite confusion.	Medium-High, with potential long-term effects still under study.

Conclusion: A Holistic View Beyond Sugar

The single-minded focus on sugar often overlooks the bigger picture of modern diet and lifestyle. While managing sugar intake is crucial, it's not the whole story. Ultra-processed foods deliver a potent combination of harmful ingredients, trans fats are arguably the most dangerous dietary fat, and foundational lifestyle issues like chronic stress, poor sleep, and a sedentary life create a metabolic environment ripe for disease. True health improvement requires a holistic approach that moves beyond demonizing a single ingredient and instead addresses the entire diet, behavioral, and environmental landscape. Prioritizing whole, minimally processed foods and adopting supportive habits—like quality sleep, stress management, and regular movement—offers a far more powerful pathway to lasting health.

For more information on the guidelines for non-sugar sweeteners, you can refer to the World Health Organization (WHO) website for details on their recommendations.

Frequently Asked Questions

Yes, many ultra-processed foods are considered worse because they combine sugar with other harmful ingredients like unhealthy fats, excessive salt, and additives. They also lack fiber and nutrients, contributing to a cascade of health issues beyond what sugar alone can cause.

Lack of sleep directly impacts hormone regulation and insulin sensitivity. It increases hunger hormones (ghrelin) and decreases fullness hormones (leptin), while also raising blood sugar levels. This metabolic disruption can lead to weight gain, diabetes, and other health problems.

Trans fat is generally considered more harmful to cardiovascular health. It uniquely raises 'bad' LDL cholesterol and lowers 'good' HDL cholesterol, significantly increasing the risk of heart disease. The FDA has banned its main source in processed foods because of these risks.

The switch is not a simple solution. While artificial sweeteners have fewer calories, they have been linked to potential gut microbiome disruption and metabolic risks. The WHO recommends against using non-sugar sweeteners for weight control, advocating instead for a reduction in overall sweetness.

Chronic stress, by releasing cortisol, can cause blood sugar levels to rise and lead to insulin resistance, mimicking and sometimes amplifying the effects of a high-sugar diet. It creates a vicious cycle that impacts both physical and mental health.

For most purposes, experts agree that HFCS and table sugar (sucrose) are equally unhealthy. They are chemically very similar, both containing roughly equal parts glucose and fructose. Focusing on reducing overall consumption of both is more beneficial than debating which is worse.

The most effective action is to reduce your consumption of ultra-processed foods and prioritize a diet rich in whole, minimally processed foods like fruits, vegetables, and lean proteins. Combining this with sufficient sleep, stress management, and regular exercise offers the most comprehensive health benefits.