"Which one is better, sugar or artificial sweeteners?” It’s a question I am asked all the time by patients trying to make sense of confusing labels in the grocery store and the mixed messages in the media.

Sugar is Sugar is Sugar…. the Metabolic Impact of Added Sugars

Regardless of the type of added sugar you consume, the body breaks them all down the same way.  The consumption of added sugars has been linked to an increased risk for obesity, as well as an increasing risk factor for cardiovascular disease, elevated cholesterol, high blood pressure, type 2 diabetes, non-alcoholic fatty liver disease, cognitive decline and even cancer.

It would seem to make sense that you can turn to artificial or other high-intensity sweeteners for a safer alternative.  But are they really all they claim to be?

A recent study conducted at George Washington University in Washington, DC found a possible link between high intake of sucralose – an artificial sweetener - and increased fat formation, particularly for people with obesity and/or high blood sugar. Mounting evidence continues to link other high intensity sweeteners with metabolic dysfunction. How can this happen since artificial sweeteners yield little to no calories? One theory suggests that the delivery of such an overly sweet taste causes overexpression of receptors found on the tongue. Because the body is expecting sugar, it may set in motion the process of carbohydrate digestion along with a rise in blood insulin levels prompted by certain high-intensity sweeteners.  Over time this could lead to excess glucose being released into the bloodstream, promoting inflammation, fat formation and metabolic syndrome. It’s also likely that regularly consuming highly sweetened food and beverages leads to difficulty appreciating naturally sweet things like fruits, vegetables and some dairy foods. And, a higher intake of added sugars tends displace more nutrient dense foods.

Don’t be Fooled! Sugar Alternatives are Still Sugar

A current trend among food manufacturers involves replacing sucrose (a.k.a. table sugar), with more naturally-derived or sounding alternatives such as raw sugar, honey, maple syrup and agave just to name a few.  This attempt to outsmart consumers who have grown increasingly wary of added sugars seems to be working. I’ve encountered a growing number of patients who report they have switched from using white sugar to another form such as raw sugar or honey, thinking they are saving on calories or even consuming a “health food.”  Imagine their surprise when I tell them that all sugars, no matter how they start out, are broken down to simple sugars.

RELATED POST: THE MANY NAMES OF SUGAR 

Navigating a Sweet World

The American Heart Association (AHA) recommends women consume no more than 6 teaspoons or 24 grams of added sugars daily while men should stay below 9 teaspoons or 36 grams. Compare that to our actual current intake of around 20 teaspoons or a whopping 80 grams per day and it’s clear we have a long way to go. Considering how freely sugar is added to foods, sticking to the AHA guidelines is no easy feat.  Even “healthy” foods and foods that aren’t thought of as sweet can contain an entire day’s worth of added sugar. For example, instant oatmeal has around 13 grams of added sugars, many yogurts contain 10 grams or more and salad dressing could add another 5-10 grams. That’s the adult allotment for the day in one meal. Even the FDA voted to more clearly identify added sugars on food labels when the new labeling laws go into effect in 2020. For now, the best bet for optimal health is to use all types of added sweeteners sparingly. Here are some tips to help you meal plan and grocery shop with minimal sweetener exposure:

1. Read labels, particularly for healthy sounding packaged foods and foods typically not thought of as sweet. We all know that a cupcake or package of cookies has added sweetener, but you’d be surprised how much sugar manufacturers sneak into bread, condiments, sauces and other “regular” foods.
2. Gradually wean off foods and beverages with added sweetness by using and consuming less over time. Compare labels and choose products with the lowest quantities. Do this slowly and your taste buds will adjust to the reduced amount without the shock of going cold turkey.
3. Be cautious when you see a product labeled ‘diet’, ‘lite’, ‘sugar-free’ or ‘zero-calories’ as they are often made with artificial or other high-intensity sweeteners. Read the ingredient list carefully and make the right decision for you.
4. Enjoy the natural sweetness of fruits, vegetables and dairy foods. They all contain naturally occurring sugars but it can be difficult to fully appreciate their flavors if we regularly consume things with added sweeteners.

5. Make foods from scratch whenever possible as a way to control the quality of ingredients and presence of any sweeteners. Have a list of reliable store-bought items for times when you can’t or prefer not to make your own.

Confusing messages about healthy eating are as numerous as the various sweeteners so liberally added to our food supply. I hope this post arms you with enough information so that you can make the best possible choices for your body and health goals.