Today, the average American consumes almost 152 pounds of sugar each year, a staggering amount of refined simple carbohydrates equivalent to 6 cups of white sugar every week. This may be the single biggest dietary contributor to the rise in chronic disease. But, the noncaloric sweeteners recommended in health-conscious communities may be trading one health detriment for another; so this week, let’s talk about sugars and sweeteners, the good, the bad, and the ugly.
How Sugar Is Linked to Health Problems
Let’s start with sugar. Table sugar (cane sugar or beet sugar) is predominantly sucrose, a disaccharide made of one glucose and one fructose molecule. Sucrose is digested and absorbed quickly and the glucose it contains has a rapid impact on blood sugar levels and insulin secretion. Consumption of glucose is associated with increased production of oxygen radicals and markers of inflammation, even in healthy people. However, it is exaggerated in people who are obese or have type 2 diabetes, high cholesterol, or metabolic syndrome. And, high sugar consumption can lead to nutrient deficiencies. This is discussed in detail in:
And, high fructose consumption (the other half of the sucrose molecule) has been linked to obesity, insulin resistance, hypertension, fatty liver disease, type 2 diabetes, cardiovascular disease, metabolic syndrome and increased cancer risk. In fact, the biological effects of too much fructose is likely the driving force behind the association between high sugar intake and chronic diseases.
This is particularly important not just because of the rise of high-fructose corn syrup but also because many sweet treats marketed to diabetics use fructose-based sweeteners like agave syrup. Just because they don’t cause a rise in blood sugars, doesn’t mean they’re harmless. In fact, the evidence points to fructose-based sweeteners being even worse. This is discussed in detail in:
- Is Fructose a Key Player in the Rise of Chronic Health Problems?
- Fructose and Vitamin D Deficiency: The Perfect Storm?
- Why is High Fructose Corn Syrup Bad For Us?
- Is It Paleo? Fructose and Fructose-Based Sweeteners (I’m looking at you, Agave!)
It’s important to note that there is good evidence that consuming fructose from whole fruits is not the same as fructose-based sweeteners. In fact, one recent study compared the metabolic effects of consuming 100 grams of fructose from high-fructose corn syrup versus from fresh fruit. While both showed some problematic effects, it was much worse in the HFCS group. And studies show that eating 300 grams of fruit daily (about 4 servings, and up to about 45 grams of fructose) causes the biggest decrease in all-cause mortality (a general marker of health and longevity), so eating fruit is good! This is discussed in detail in:
So, one piece of good news is that we don’t need to count fresh fruit towards sugar intake. And, here’s more good news: the cusp for the negative effects of high-sugar intake really is around 10% of total calories from added sugars. So, we don’t have to give up all sweet foods to be healthy, but rather choose our sugars wisely and moderate our intake. The most important sugars to limit are refined ones (which don’t offer any redeeming nutritional qualities), which you can get lists of here:
Unfortunately, the sweet taste of sugar is highly addictive, so it can be really tough to reduce our intake or give it up if. Listen to:
- The Whole View Podcast, Episode 323: Cheat or Treat, Let’s Talk Sweets!
- The Whole View Podcast, Episode 300: How Do You Handle Sugar and Salt Cravings?
But Sweeteners Are Not a Good Solution
So, it’s human nature to look for the alternative, some sweet deliciousness not linked to health problems that we don’t need to feel guilty about! Sweet substances that are not sugars are called sweeteners — they are artificial or natural substances that taste sweet but don’t contain caloric sugar molecules like glucose and fructose. And, while I’m sure you won’t be surprised to learn that the artificial sweetener aspartame causes even more health problems than sugar, you might not know that other nonnutritive sweeteners like sorbitol, mannitol, xylitol, and erythritol cause gut dysbiosis and increased intestinal permeability. This is discussed in detail in:
- Is It Paleo? Splenda, Erythritol, Stevia and other low-calorie sweeteners
- The Whole View Podcast, Episode 309: Aspartame Is Evil
And, here’s where I’m about to be the bearer of bad news. Even the two “natural” sweeteners predominantly used in products marketed to health-conscious communities — yes, I’m talking about stevia and monk fruit — are problematic. There are now high-quality studies proving that stevia is an endocrine disruptor and is also problematic for the gut microbiome. (Yes, this applies to the stevia plant and whole leaf stevia, too.) And monk fruit extract isn’t even approved as a food additive due to toxicity concerns (it’s only approved for use in supplements). These are discussed in:
In fact, I get asked All. The. Time about whatever sugar substitute is trending. If whole leaf stevia is off the table (pardon the pun), how about allulose or kabocha extract? Allulose is the molecular mirror image of fructose. While it hasn’t been extensively studied, it’s brought into the body by the same receptor (GLUT5) so we know that it can biologically behave similar to fructose and we’d therefore expect similar problems. Kabocha extract is a pentose (5-carbon) sugar called xylose, which, similar to its derivative xylitol, is known to cause gastrointestinal discomfort and laxative effects when consumed even in moderate quantitates. Neither have been studied in terms of long-term effects, impact on the gut microbiome, or endocrine effects.
Please don’t shoot the messenger! Instead, let’s focus on the best way to enjoy a sweet treat! And, that’s real, natural sugars, in moderation. The best choices are unrefined sugars that offer some nutritional value, like unrefined organic cane sugar, molasses, maple syrup, and honey.
Natural Sugars That Are Actually Healthy
In fact, blackstrap molasses is so nutrient dense that it contains 1.5 times more calcium per calorie than cheese and 5 times more iron per calorie than steak! Plus, it’s rich in copper, selenium, manganese, magnesium, potassium and vitamins B2, B3 and B6. Just one tablespoon contains 20% of the DV of calcium, iron, copper, and manganese, for only 42 calories. Truly, blackstrap molasses is the sugar you can love! I discuss it more in:
And, there are also compelling reasons to choose honey! Honey has known antioxidant and antimicrobial properties and may promote tissue health. Even though it’s a natural sugar, there’s evidence that honey can help regulate blood sugar levels in diabetics (yes, honey is anti-diabetic!) and improve the efficacy of metformin! It’s also been shown to be therapeutic in both chronic constipation and chronic diarrhea because it acts as a selective prebiotic for Lactobacillus and Bifidobacterium, while also inhibiting the growth of undesirable microorganisms that can act as pathogens. There’s even some evidence showing that eating honey can reduce cardiovascular disease risk factors and cancer risk! Plus, honey contains calcium, potassium, magnesium, phosphorus, selenium, copper, iron, manganese, chromium, zinc, and vitamins B1, B2, B3, B5, B6, B9, C and K! In fact, when we examine all of the health problems associated with high-sugar intake, honey seems to reduce their risk, indicating that maybe we shouldn’t count honey towards our sugar intake either! I discuss this in:
All this to say that there really isn’t a way to cheat sweet (well, honey might be close), but we also don’t need to if we’re conscientious about how often and how much sweet treats we’re indulging in. Natural sugars in moderation absolutely can fit into a healthy diet!