Sweeteners, Part 1: The Whys and The Wherefore


The Pitfalls of Consuming Sugar: 

Potential health effects of sugar overconsumption include 

1) elevated blood sugar, insulin resistance and hyperinsulinemia (Basciano, Federico, & Adeli, 2005), 

2) nonalcoholic fatty liver disease (NAFLD) (with high fructose intake being recognised as a contributor) (Ter Horst & Serlie, 2017), 

3) increased cardiovascular disease risk (Di Nicolantonio, Lucan, & O’Keefe, 2017) (with people consuming 25% or more of their calories from sugar were three times as likely to die from heart disease as those who consumed the least added sugar (Yang et al., 2014), 

4) increased inflammation around the whole body (Aeberli et al., 2011), 5) gut issues including irritable bowel syndrome and inflammatory bowel disease (Dixon, Kabi, Nickerson, & McDonald, 2015) (which may be due in part to adverse changes in gut bacteria (Brown, DeCoffe, Molcan, & Gibson, 2012)), 

6) possibly increased Alzheimer’s disease risk (Moreira, 2013) (with special attention drawn to sugary beverages (Pase et al., 2017)) and a 

7) controversial link to ADHD where a major study found improvements in ADHD symptoms by excluding many foods, including reducing the intake of sugar and processed foods (Pelsser et al., 2011).

The Pitfalls of Consuming Sugar: 

Potential health effects of sugar overconsumption include 

1) elevated blood sugar, insulin resistance and hyperinsulinemia (Basciano, Federico, & Adeli, 2005), 

2) nonalcoholic fatty liver disease (NAFLD) (with high fructose intake being recognised as a contributor) (Ter Horst & Serlie, 2017), 

3) increased cardiovascular disease risk (Di Nicolantonio, Lucan, & O’Keefe, 2017) (with people consuming 25% or more of their calories from sugar were three times as likely to die from heart disease as those who consumed the least added sugar (Yang et al., 2014), 

4) increased inflammation around the whole body (Aeberli et al., 2011), 5) gut issues including irritable bowel syndrome and inflammatory bowel disease (Dixon, Kabi, Nickerson, & McDonald, 2015) (which may be due in part to adverse changes in gut bacteria (Brown, DeCoffe, Molcan, & Gibson, 2012)), 

6) possibly increased Alzheimer’s disease risk (Moreira, 2013) (with special attention drawn to sugary beverages (Pase et al., 2017)) and a 

7) controversial link to ADHD where a major study found improvements in ADHD symptoms by excluding many foods, including reducing the intake of sugar and processed foods (Pelsser et al., 2011).


A Brief History of Sugar

The Persians, followed by the Greeks, encountered the famous "reeds that produce honey without bees" in India between the 6th and 4th centuries BC. They adopted and then spread sugarcane agriculture. Merchants began to trade in sugar from India, which was considered a luxury and an expensive spice. 

In the 18th century AD, sugarcane plantations began in the Caribbean, South American, Indian Ocean and Pacific island nations and the need for labourers became a major driver of large human migrations, both the voluntary in indentured servants and the involuntary migrations, in the form of slave labour (https://en.wikipedia.org/wiki/Sugarcane). By the mid to late 1800’s the Trans Atlantic trade routes were the basis of modern day banking and financed the British Empire (Crafty Knowledge, 2019). 

Changes in food supply (industrial revolution of the nineteen century) allowed for mass production of flour and sugar with the manufacturing in the last decades of processed and ultra-processed inexpensive and highly caloric foods that are abundant in sugars, salts and fats. The television set and later the computer lead us toward a sedentary lifestyle. Although humans have culturally and technologically evolved our genome has changed very little in the last 10,000 years.

Early in our evolution the ingestion of food or drugs emerged as positive reinforcement and evolved common neural circuits for reward. In other words we were rewarded by our brain for eating sugars and it may have been a useful signal to distinguish ripe fruit from unripe fruit (it is thought that this is also why colour vision developed) (Dunn, 2014), bitter plants can be poisonous or aren’t fit for nutrition, but are most appropriate to be taken in small amounts i.e. in medicinal quantities (many medicinal herbs are bitter and bitters is a class of herbal medicines used to stimulate digestive juice and enzyme secretion).

Nutrition transition theory describe global trends toward a “Western diet” containing refined foods high in fat and sugar and low in fiber.  This was accompanied by a shift in global disease from famine and malnutrition to chronic and degenerative disease associated with urban-industrial lifestyles, which also affects a wide range of animals, namely pets, which have been gaining weight, alongside us and our children (Wiss, Avena, & Rada, 2018).


The Fat Demon and Sugar For Flavour

Ancel Keys was an American physiologist who studied the influence of diet on health. In particular, he hypothesised that dietary saturated fat causes cardiovascular heart disease and should be avoided (Mozaffarian, Rosenberg, & Uauy, 2018). However, numerous modern studies have disproved this hypothesis and it is now accepted that saturated fats have NO effect on heart disease (Calder, 2010) (Marventano et al., 2015). Moreover, the vegetable oils, once recommended as replacements have now been shown to have harmful effects formerly attributed to saturated fats (Schwingshackl & Hoffmann, 2014). 

In the 1960’s, the sugar industry funded a research group called the Sugar Research Foundation with the remit to "refute" concerns about sugar's possible role in heart disease. The report downplayed the risks of sugar and highlighted the hazards of fat and was published in the New England Journal of Medicine in 1967, with no disclosure of the sugar industry funding (Kearns, Schmidt, & Stanton, 2017). This was very astute, because review papers, especially if you get them published in a very prominent journal, tend to shape the overall scientific discussion. In 1954, the president of the SRF gave a speech describing a great business opportunity saying that if Americans could be persuaded to eat a lower fat diet “for the sake of their health” they would need to replace that fat with something else. America's per capita sugar consumption could go up by a third (Kearns et al., 2017).

In 2015, the New York Times obtained emails revealing Coca Cola’s relationship to sponsored researchers who were conducting studies aimed at minimising the implication of the effects of sugary drinks on obesity (Connor, 2015). Even more recently the Associated Press obtained emails showing how a confectioners trade association to show that children who eat sweets have healthier body weights than those who do not (Nestle, 2016)!

Over the past 15 years the amount of money US politicians have received from sugar lobbyists has steadily increased reaching a peak of $8 million USD in 2016 (Open Secrets: Center for Responsive Politics, n.d.)

Changes in Dietary Guidelines

The 2015-2020 Dietary Guidelines for Americans recommend that added sugars be limited to less than 10% of total calories. For a person consuming 2000 calories per day, (Office of disease prevention and health promotion, 2015). This is 50 grams or about 12 teaspoons of sugar per day!

The American Heart Association‘s recommendations are somewhat stricter with proposed limits of 25 grams (6 teaspoons) of added sugar per day for women and 38 grams (9 teaspoons) per day for men (American heart association, 2018).

In 2015 The World Health Organization (WHO) recommended that added sugars be limited to less than 10% of total calorie intake and ideally less than 5% of total calories (or about 6 teaspoons daily) for maximal health benefits (World Health Organization, 2015). 

These limits are for added sugars and all the processed foods and beverages to which they’re added and don’t include naturally occurring sugars in fruit or fruit juice. The recommended intake still seems too high given the potential health risks — especially as the guidelines don’t include any limits on naturally occurring sugars at all. 

The new dietary Guidelines published by the Swedish Government recommend no more than 75g per day; that’s just one slice of Vogels! Controlling carbs is one thing but trying to resist a sugary treat is very difficult.

If you take out the fat there’s no flavour or creaminess so typically sugar is added so some of the worst offenders are non-fat and low-fat products that are marketed as healthy alternatives. 

Added Sugar 

It’s all very well not adding sugar to your own food but 74% of processed foods sold in US supermarkets between 2005 and 2009 contained added sugars (Ng, Slining, & Popkin, 2012).

The Heart Foundation of New Zealand has been working with Australasian food companies to set targets and reduce sugar in breakfast cereals, cereal and nut/seed bars, tomato sauce, baked beans and canned spaghetti and aims to address targets for yoghurts, dairy desserts and cooking sauces (e.g. pasta sauces) (Heart Foundation New Zealand, 2017). 

Non-fat and low-fat foods high in sugar include:- 

flavoured yogurt contains up to 28 grams (7 teaspoons) of sugar per cup

fat-free salad dressing contains up to 10 grams (2.5 teaspoons) of sugar per 2 tablespoons 

(from Diet Doctor https://www.dietdoctor.com/low-carb/sugar). 

This habitual exposure to sugars hidden in our food desensitises us to sweet flavour and tends to make us more averse to bitter flavours or even unadulterated savoury flavour. These bitter flavour principles are commonly found in our vegetables especially members of the Brassica family (cauliflower, broccoli etc.) (Ganora, 2009) this helps to maintain our “sweet tooth’.

Be warned, there are many different names for sugar (Diet Doctor, n.d.).

From https://www.healthnavigator.org.nz/healthy-living/eating-drinking/s/sugar-how-to-cut-down/


Sugar Addiction!: It’s Real!

Experts disagree about whether “sugar addiction” is a legitimate term but anyone who struggles with it can confirm that it is indeed real. Studies on sugar and addiction confirm that sugar can be involved with addiction behavior, hormones and brain centres involved in addiction and evidence is accumulating on the overlap of neural circuitry (brain connections) and commonalities between drug abuse and food addictions in humans (Wiss et al., 2018). 

Dopamine is a chemical that helps control the pleasure and reward centres in your brain. Animal and human research has shown that in many individuals sugar activates dopamine receptors similarly to cocaine and other addictive drugs (Avena, Rada, & Hoebel, 2008) (Lennerz & Lennerz, 2018).


Sugar Craving and a ‘Sweet Tooth’

Carb or sweet cravings are part of the curse of being on a constantly high carb diet. Ones blood sugars and insulin levels see-saw continuously throughout the day meaning that morning and afternoon tea and even supper are necessary steps for assuaging hunger and even the shakes and other symptoms associated with hypo’s of diabetics including tiredness, lethargy, irritation, or hangover within 1-2 hours of previously eating.  

The mechanism is thought to be that an abnormally rapid rise in blood sugar after eating. This normally leads to insulin secretion which in turn initiates rapid glucose uptake by tissues. The consequent fall in blood glucose is indicated as the reason for the "sugar crash". People who experience this feel as though they have to eat often to counteract the symptoms.

Reactive hypoglycemia, postprandial hypoglycemia, or sugar crash is a term describing recurrent episodes of symptomatic hypoglycemia occurring within four hours after a high carbohydrate meal in people with and without diabetes. It is regarded as a prelude to diabetes (Quercia et al., 2017)

Why Do We Snack?

Researchers found that snacking is also driven not by a biological cue such as hunger, changes in insulin or glucose concentrations but is driven by availability, distracted eating (e.g. in front of the TV) and the highly palatable nature of these foods (Hess, Jonnalagadda, & Slavin, 2016) and even sugar addiction. Regulation of food intake may be driven by an individual’s sensitivity to reward (Hess et al., 2016). 

Snacking is strongly positively associated with home availability of unhealthy foods and strongly based on nutritional characteristics e.g. energy-dense, nutrient poor sugary food i.e. lollies, chips, biscuits, sugary drinks.

Snacking between meals currently contributes an estimated one third of children’s daily energy intakes in the United States and a quarter in some European nations. Children who snack frequently consume greater energy, have poorer quality diets and exhibit other risk factors for excessive weight gain. Current literature suggests that in order to promote healthy eating habits, parents must strike a balance between setting reasonable limits, providing healthful foods and structured eating occasions and supporting children’s unique food preferences and regulation of appetite (Blaine, Kachurak, Davison, Klabunde, & Fisher, 2017).

Access to relatively inexpensive and convenient “snack” foods have changed normal eating behavior including less time spent preparing meals at home (Wiss et al., 2018). When we are hungry we tend to make more healthy choices of what to eat than when we aren’t hungry (Hess et al., 2016). Recent research suggests that highly processed foods are addictive and the hedonic (hedonistic) mechanisms (pleasure-seeking pathways) may play a critical role in the cause and development of obesity. It has also been suggested that the focus on calorie counting is misguided and that future strategies should emphasise dietary (Wiss et al., 2018).


The Place and Case For Sweeteners

Having said all that it is after all nice to enjoy some sweet treats. There are plenty of sugar replacements on the market from nature and the lab. Some have no impact on blood sugar - others have some effect. We’ll take a look at how these alternatives are metabolised and perceived by the body and even how they affect hunger, satiety and inclination for weight gain. There are a number of reasons to control their use or in some products avoid them all together. We have a dizzying range of choices in the natural and artificial sweetener market and one should understand the pros and pitfalls of each.

The first question to ask is why these products might be useful to a person? 

The most pressing medical reasons are as part of a balanced multipronged approach to managing diabetes. If a person is seeking to control or moderate their carbohydrate intake in line with a low carb diet, for ALL it’s health benefits, then they are aiming for around 50-100g per day. A ketogenic diet requires a very low carbohydrate (20-50g per day) intake. 

If you’re not in these groups then perhaps it’s worth asking the question, do I need my food to taste sweet?

References

Aeberli, I., Gerber, P. A., Hochuli, M., Kohler, S., Haile, S. R., Gouni-Berthold, I., … Berneis, K. (2011). Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: A randomized controlled trial. American Journal of Clinical Nutrition, 94(2), 479–485. https://doi.org/10.3945/ajcn.111.013540

American heart association. (2018). Too Much Sugar Isn ’ t So Sweet for Your Health. Retrieved from https://www.heart.org/en/healthy-living/healthy-eating/eat-smart/sugar/added-sugars

Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and Biobehavioral Reviews, 32(1), 20–39. https://doi.org/10.1016/j.neubiorev.2007.04.019

Basciano, H., Federico, L., & Adeli, K. (2005). Fructose, insulin resistance, and metabolic dyslipidemia. Nutrition and Metabolism, 2, 1–14. https://doi.org/10.1186/1743-7075-2-5

Blaine, R. E., Kachurak, A., Davison, K. K., Klabunde, R., & Fisher, J. O. (2017). Food parenting and child snacking: A systematic review. International Journal of Behavioral Nutrition and Physical Activity, 14(1). https://doi.org/10.1186/s12966-017-0593-9

Brown, K., DeCoffe, D., Molcan, E., & Gibson, D. L. (2012). Diet-induced dysbiosis of the intestinal microbiota and the effects on immunity and disease. Nutrients, 4(8), 1095–1119. https://doi.org/10.3390/nu4081095

Calder, P. C. (2010). The American Heart Association advisory on n-6 fatty acids: Evidence based or biased evidence? British Journal of Nutrition, 104(11), 1575–1576. https://doi.org/10.1017/S0007114510004253

Connor, A. (2015). Coca-Cola Funds Scientists Who Shift Blame for Obesity Away From Bad Diets - The New York Times. New York Times, 1–7. Retrieved from http://well.blogs.nytimes.com/2015/08/09/coca-cola-funds-scientists-who-shift-blame-for-obesity-away-from-bad-diets/?_r=0

Crafty Knowledge. (2019). A Brief History of Sugar From Slavery to Sweetener. England. Retrieved from https://www.youtube.com/watch?v=mn4F4yWSU3w

Di Nicolantonio, J. J., Lucan, S. C., & O’Keefe, J. H. (2017). The Evidence for Saturated Fat and for Sugar Related to Coronary Heart Disease. Physiology & Behavior, 58(5), 464–472. https://doi.org/10.1016/j.physbeh.2017.03.040

Diet Doctor. (n.d.). Ingredients to Avoid Ingredients to Avoid Trans fats and processed vegetable oils. Retrieved from https://www.dietdoctor.com/wp-content/uploads/2017/09/Ingredients-to-Avoid.pdf

Dixon, L. J., Kabi, A., Nickerson, K. P., & McDonald, C. (2015). Combinatorial Effects of Diet and Genetics on Inflammatory Bowel Disease Pathogenesis, 21(4), 912–922. https://doi.org/10.1097/MIB.0000000000000289. Combinatorial

Dunn, R. (2014). The Wild Life of Our Bodies: Predators, Parasites, and Partners That Shape Who We Are. New York, NY: Harper Perenial.

Ganora, L. (2009). Herbal constituents: Foundations of phytochemistry. Louisville, CO: Herbalchemy.

Heart Foundation New Zealand. (2017). Reducing sugar to help Kiwi heart health. Retrieved from https://www.heartfoundation.org.nz/about-us/news/blogs/reducing-sugar-in-kiwi-food

Hess, J. M., Jonnalagadda, S. S., & Slavin, J. L. (2016). What Is a Snack, Why Do We Snack, and How Can We Choose Better Snacks? A Review of the Definitions of Snacking, Motivations to Snack, Contributions to Dietary Intake, and Recommendations for Improvement. Advances in Nutrition, 7(3), 466–475. https://doi.org/10.3945/an.115.009571

Kearns, C. E., Schmidt, L. A., & Stanton, A. G. (2017). Sugar Industry and Coronary Heart Disease Research: A Historical Analysis of Internal Industry Documents. Physiology & Behavior, 176(11), 139–148. https://doi.org/10.1016/j.physbeh.2017.03.040

Lennerz, B., & Lennerz, J. K. (2018). Food addiction, high-glycemic-index carbohydrates, and obesity. Clinical Chemistry, 64(1), 64–71. https://doi.org/10.1373/clinchem.2017.273532

Marventano, S., Kolacz, P., Castellano, S., Galvano, F., Buscemi, S., Mistretta, A., & Grosso, G. (2015). A review of recent evidence in human studies of n-3 and n-6 PUFA intake on cardiovascular disease, cancer, and depressive disorders: Does the ratio really matter? International Journal of Food Sciences and Nutrition, 66(6), 611–622. https://doi.org/10.3109/09637486.2015.1077790

Moreira, P. I. (2013). High-sugar diets, type 2 diabetes and Alzheimer’s disease. Current Opinion in Clinical Nutrition and Metabolic Care, 16(4), 440–445. https://doi.org/10.1097/MCO.0b013e328361c7d1

Mozaffarian, D., Rosenberg, I., & Uauy, R. (2018). History of modern nutrition science—implications for current research, dietary guidelines, and food policy. BMJ, k2392. https://doi.org/10.1136/bmj.k2392

Nestle, M. (2016). Food industry funding of nutrition research: The relevance of history for current debates. JAMA Internal Medicine, 176(11), 1685–1686. https://doi.org/10.1001/jamainternmed.2016.5400

Ng, S. W., Slining, M. M., & Popkin, B. M. (2012). Use of caloric and non-caloric sweeteners in US consumer packaged foods, 2005–9. Journal of the Academy of Nutrition and Dietetics., 112(11), 1828–1834. https://doi.org/10.1016/j.jand.2012.07.009

Office of disease prevention and health promotion. (2015). Cut Down on Added Sugars.

Open Secrets: Center for Responsive Politics. (n.d.). Sugar Cane & Sugar Beets Summary. Retrieved from https://www.opensecrets.org/industries/indus.php?ind=A1200

Pase, M. P., Himali, J. J., Jacques, P. F., DeCarli, C., Satizabal, C. L., Aparicio, H., … Seshadri, S. (2017). Sugary beverage intake and preclinical Alzheimer’s disease in the community. Alzheimer’s and Dementia, 13(9), 955–964. https://doi.org/10.1016/j.jalz.2017.01.024

Pelsser, L. M., Frankena, K., Toorman, J., Savelkoul, H. F., Dubois, A. E., Pereira, R. R., … Buitelaar, J. K. (2011). Effects of a restricted elimination diet on the behaviour of children with attention-deficit hyperactivity disorder (INCA study): A randomised controlled trial. The Lancet, 377(9764), 494–503. https://doi.org/10.1016/S0140-6736(10)62227-1

Quercia, S., Turroni, S., Fiori, J., Soverini, M., Rampelli, S., Biagi, E., … Candela, M. (2017). Gut microbiome response to short-term dietary interventions in reactive hypoglycemia subjects. Diabetes/Metabolism Research and Reviews, 33(8), 1–9. https://doi.org/10.1002/dmrr.2927

Schwingshackl, L., & Hoffmann, G. (2014). Dietary fatty acids in the secondary prevention of coronary heart disease: A systematic review, meta-analysis and meta-regression. BMJ Open, 4(4). https://doi.org/10.1136/bmjopen-2013-004487

Ter Horst, K. W., & Serlie, M. J. (2017). Fructose consumption, lipogenesis, and non-alcoholic fatty liver disease. Nutrients, 9(9), 1–20. https://doi.org/10.3390/nu9090981

Wiss, D. A., Avena, N., & Rada, P. (2018). Sugar addiction: From evolution to revolution. Frontiers in Psychiatry, 9(NOV). https://doi.org/10.3389/fpsyt.2018.00545

World Health Organization (WHO). (2015). WHO calls on countries to reduce sugars intake among adults and children. Retrieved from https://www.who.int/mediacentre/news/releases/2015/sugar-guideline/en/

Yang, Q., Zhang, Z., Gregg, E. W., Flanders, W. D., Merritt, R., & Hu, F. B. (2014). Added sugar intake and cardiovascular diseases mortality among us adults. JAMA Internal Medicine, 174(4), 516–524. https://doi.org/10.1001/jamainternmed.2013.13563

 

 

Eschscholzia californica