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brown & white sugar crystals

Originally published 11 Nov 2018. Last updated 12 Sept 2020.

When we wind the clocks back 20 years, fat was the main villain, not sugar. Fat was blamed for everything from heart attacks to weight gain.

Because of this, the 1990s became the low-fat decade. Many food manufacturers jumped on board this low-fat train and reformulated their recipes to ensure their products’ fat content were greatly reduced. These items sold like low-fat hotcakes.

Do you remember a dessert line launched by Nabisco® called Snackwell’s®? If you haven’t, don’t worry about it. These were marketed as the low-fat desserts that still tasted good… only they didn’t… which is why you never hear about them anymore.


Listen to Dr. Neal address this topic on Episode 85 and Episode 715 of the podcast Optimal Health Daily.


The Pendulum Swings to Sugar

But at some point, we realized that limiting fat in our diets didn’t lead to a decreased risk of disease. In fact, we saw rates of heart disease and type 2 diabetes increase! Uh oh. Something was wrong with this equation. Maybe limiting fat wasn’t the answer.

What we have learned is that when people began limiting the amounts of fat in their diets, they increased their intakes of carbohydrate-rich foods to make up for this (suddenly pasta and rice were your friends!). So, as long as it was low-fat, you were good to go! The trouble is when folks increased their consumption of carbohydrates, they chose the ones that we don’t want to consume all that often:

  • White breads
  • White rice
  • White pastas
  • Sugary cereals

These foods get converted to sugar in the body very quickly, which is not what we want. When your blood sugar rises too quickly, the body has to try and compensate for this which can lead to an increased risk for a number of diseases like heart disease and type 2 diabetes.

Now the pendulum has swung the other way. Fat is good–sugar is not. When we consume foods that are high in fat, like avocado, nuts, and seeds for example, it doesn’t really affect our blood sugar levels. Plus, these foods help us feel full longer. Foods that are high in sugar make us feel hungry soon after. Ever notice how a bowl of plain, white rice never seems to satisfy our appetites?

Do We Need to Completely Avoid Sugar in our Diets?

Simply put, no.

It is impossible to remove all sugar from the diet. This is because pretty much everything we eat is composed of sugar in one form or another.

Fruit, for example, contains fructose – a type of sugar. Vegetables, even green leafy vegetables, contain some sugar. Vegetables need sugar to survive and grow!

Alcohol, whether it’s wine, beer, or hard liquor contains sugar. The body even converts parts of the fats and oils we consume to sugar!

Whenever you consume carbohydrate-rich foods, even whole grains, you are basically eating sugar.

Now don’t get me wrong. These foods have vitamins, minerals, and some fiber along with them so they’re perfectly fine to eat. I’m just making the point that it would be impossible to avoid all sugar in our diet.

The trick is to reduce the amount of ADDED sugars we consume.

You can't avoid all sugar. The trick is to limit how much added sugar we get in our diets. Click To Tweet

Why Should We Watch How Many Added Sugars We Consume Each Day?

Researchers have found that regularly consuming lots of added sugar over years and years can increase a person’s risk for developing many of the chronic diseases that are very common, especially in the U.S.

Consuming added sugars increases the risk for:

  • heart disease
  • stroke
  • type 2 diabetes
  • even some forms of cancer

This doesn’t mean we need to avoid all added sugars all the time. While the body doesn’t prefer it, it is equipped to handle small doses of this stuff.

Where Do Added Sugars Come From?

Added sugars are most often found in the foods we likely already know we should be consuming less often:

  • sodas
  • sweet breakfast cereals
  • baked goods like cookies, cakes, donuts, you know most desserts…

You get the idea.

Can You Offset High Sugar Intake?

The goal really is to try and slow down how quickly that added sugar gets absorbed into the bloodstream. To do this, consider consuming some fiber or protein with your meals and snacks.

Using a smoothie with added sugar as an example, if the recipe calls for some plain yogurt or leafy greens like kale, that can help slow down the body’s absorption of that sugar you added.

Yogurt is not a great source of fiber, but a good source of protein. On the contrary, kale is not a good source of protein, but a good source of fiber. If the recipe calls for one or the other (or both), it may help.

Let’s use another example: having a piece of toast for breakfast. If it’s a whole grain variety, that means it likely contains some dietary fiber which will help slow down the body converting this to sugar. Then if you top it with 1 tablespoon of nut butter, you would add protein and even more fiber.

Is it Possible to Get Too Much Added Sugar in the Diet?

The American Heart Association recently released their guidelines for how much added sugar men and women should limit themselves to consuming each day.

For guys, no more than 9 teaspoons of added sugar each day or about 36 grams. For ladies, no more than 6 teaspoons of added sugar per day or about 25 grams.

I agree with these guidelines, but there's a problem… it gets tricky to follow these guidelines, because if you were to look for added sugars on food labels, it’s not always obvious.

How Do We Know How Much Added Sugar is in our Foods?

Not all food manufacturers list the amount of added sugars in their products separately. Luckily, this will change once the U.S. implements its new food label policy. In the meantime, we have to do a little detective work.

So for now, the answer is: we don’t know for sure. But before we simply give up and lose all hope, there is a little trick we can use. It’s not perfect, but it will help:

The Nutrition Facts Label

Take a moment to examine the Nutrition Facts panel on the product you’re thinking about buying. Along with the calories, total grams of fat, grams of carbohydrates, etc. you’re going to see sugar listed there as well. The problem is that when you see sugar listed there you don’t know whether these are natural sugars or added sugars.

For example, if you look at the amount of sugar on a box of Raisin Bran® cereal, it will look like a lot initially. Well, where does much of that sugar come from? The raisins! Raisins are dried grapes. Grapes are a fruit so they’re going to be naturally high in sugar. This is where just looking at the Nutrition Facts label can be misleading. It doesn’t always tell you whether these sugars are found naturally or whether they’ve been added! But you know better now.

The Ingredients List

Instead, you’re going to scroll down to the ingredients list. Why the ingredients list? Each ingredient is listed by weight. This means that the first ingredient listed is the one the product is made of most. The second ingredient is what the product is made of second most, and so on. When looking at the ingredients list, if you see the word, “sugar,” any of its cousins like honey, molasses, cane sugar, sweeteners, high fructose corn syrup, or anything ending in –ose like:

  • lactose
  • maltose
  • fructose
  • dextrose

…then it’s basically sugar. There are so many sneaky ways to list sugar on the ingredients list and it’s a challenge to keep track of them all, but if you find these listed near the top of the ingredients list, this food has a lot of added sugar and you most likely want to limit how much you consume.

Again, there’s no need to try and avoid sugar in your diet completely. In fact, it’s nearly impossible to do. But if you can limit your intake of added sugars, you’re likely going to reduce your risk for a number of chronic diseases.

Listen to Dr. Neal address this topic on Episode 85 and Episode 715 of the podcast Optimal Health Daily.


Are Sugar Substitutes and Artificial Sweeteners Safe?

sugar_substitute

Listen to Dr. Neal address artificial sweeteners on Episode 70 of the podcast Optimal Health Daily.

When I was a health educator for a weight loss program, we would always tell our patients if they wanted to satisfy their sweet craving, diet soda and other foods with so-called alternative sweeteners were a good option. This was especially true for those with diabetes. Why would we recommend the consumption of artificial sweeteners? It was because these foods typically had no (or very few) calories and no real sugar. This means that they could consume as many sodas and sugar-free hard candies as they would like, still satisfy their sweet craving, but without worrying about getting off track with their weight loss or blood sugar goals. But was this really the best advice?

Artificial Sweeteners and Sugar Options

There are so many artificial sweeteners available at your local market now, it’s hard to keep track. While some of them have been sold commercially for decades, others are rookies and newer to the game. What we’re learning is, not all of these sugar substitutes are created “equal.” Get it? Because Equal® is one type of sugar substitute? Ok, I’ll stop.

For some of the newer substitutes on the market, there’s not much scientific data on their health effects so I may not be able to speak to all of them. But I will mention the following:

  • Equal (aka aspartame, NutraSweet or AminoSweet)
  • Sweet ‘N’ Low (saccharin)
  • Splenda (sucralose)
  • Stevia
  • Sugar alcohols (like sorbitol and mannitol)
  • Yacon syrup

Stevia

First up on this artificial sweeteners list is Stevia®. Stevia is sometimes, but not often, called “Rebiana.” This sweetener comes in different forms like Truvia, PureVia, and SweetLeaf. Each is a little different in their chemical compositions. Stevia itself comes from the leaves of the yerba dulce plant. For now, it is generally recognized as safe. This means that, at this time, there’s not enough scientific evidence to show that Stevia consumption may harm us. But I should mention that there are some studies that have shown Stevia may lead to genetic mutations, but these studies were performed in a lab and not with actual living humans.

Sugar Alcohols

Next, sugar alcohols. These actually are made up of real sugar, but less of it. You usually find sugar alcohols in sugar-free gums and candies. They are called sugar alcohols because they do in fact contain some real sugar, but they also consist of a little bit of alcohol as well. From a taste standpoint, these aren’t as sweet as real sugar but the advantage is that they are absorbed into the bloodstream much more slowly. For those struggling to manage their blood sugar, this is a good thing. Sugar alcohols are generally recognized as safe, but I always warn folks to watch how much of these they consume. When you start approaching 50 grams of sugar alcohols per day, they may have a laxative effect.

Aspartame

What about Equal or NutraSweet? Both of these artificial sweeteners are made of aspartame. You’ll find Equal or NutraSweet in diet sodas. The Harvard School of Public Health found an association between diet soda consumption and cancer in men. Meaning, as men consumed more diet soda with Equal or NutraSweet, their risk of cancer also went up. They believe this is due to the fact that our bodies convert aspartame to formaldehyde. Formaldehyde may sound familiar—this is what coroners use to preserve human bodies after they have passed on.

Turns out, formaldehyde is also a known carcinogen (or cancer-causing agent). So, at this time, it’s probably best to limit your consumption of Equal and NutraSweet.

In my experience, many people confuse Equal and NutraSweet with Sweet ‘N’ Low®, so I feel like I should mention this one as well. Sweet ‘N’ Low is also known as saccharin… and this is one we probably also want to avoid.

Sweet'N Low

Moving on to Sweet'N Low (saccharin)… this one we likely also want to avoid. People like to use this substitute because it is 350 times sweeter than sugar, so a little goes a long way. Different scientific sources have found that there’s an increased risk for cancer with consumption.

Splenda (sucralose), relatively new to the market, should be consumed with caution. Splenda is made by reacting sucrose (a type of sugar) with chlorine.

There are some concerns that sucralose alter our microbiome (or the health and variety of the good bacteria in our gut). Once the microbiome is involved, the effects could range from regulation of body weight, to incidence of inflammatory bowel disease, and the absorption and metabolism of foods and nutrients by the body.

It’s advised that folks shouldn’t get more than 5 milligrams of Splenda per kilogram of body weight. So, a 150 lb. (68 kg) person shouldn’t consume more than 340 mg of Splenda per day. Consider: each individual packet of Splenda is about 4,000 mg.

Yacon Syrup

Finally, yacon syrup. A rookie when it comes to the sugar substitute game, this product became a household name after Dr. Oz promoted this as a potential weight loss tool. After his TV producers conducted a study of over 700 women, results found that yacon syrup may have helped with their weight loss. But, the study had huge design flaws. So it’s hard to know whether the syrup helped the women lose the weight or whether it was due to something else entirely. At this time, I would say save your money until we have more research to know whether it’s truly safe to consume in the longer term and whether it actually helps with weight loss.

And going back to my story at the beginning, given this information: telling my patients to substitute diet soda for regular soda in any quantities they wished, may have been a bit shortsighted. Now, I should mention something about the natural sugars found in foods. Natural sugars found in foods, likely don’t pose the same health risks. But consuming minimally-processed foods are the key. Think about fruit, for example. Fruits can be high in sugar, but they also contain fiber which has 2 effects on the body:

  1. it slows down the body’s absorption of those sugars, and
  2. the fiber acts as a prebiotic in that it can help our gut grow more helpful bacteria and help promote a healthy microbiome.

Bottom line is: the only sugar substitutes that would be considered safe to use on a regular basis at this point are sugar alcohols (sorbitol and mannitol) and possibly Stevia. While the others don’t need to be avoided completely, it would be wise to limit your consumption.

Listen to Dr. Neal address this topic on Episode 70 of the podcast Optimal Health Daily.

mm

Neal Malik

Dr. Neal Malik ("Dr. Neal") is currently a professor at California State University, San Bernardino. Before this, he served as Department Chair at Bastyr University California. Dr. Neal has also published peer-reviewed scientific research and presented at national conferences. Send in your health related question and Dr. Neal will answer it on the Optimal Health Daily show!
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