#16. Sugar substitutes Monday, October 12, 2020 Everybody loves sugar. It makes the unappetizing palatable and the palatable delicious. That's why it's an ingredient in so many foods. Breads and cereals, baked beans and coleslaw, canned soups, peanut butter... The list is long. And often surprising. On many of the most unlikely food labels, sugar makes a cameo. And when it plays a starring role (e.g., yogurts and colas), the sheer amount of it can be staggering. For example, in a two liter of Pepsi, there's over half a pound of it. To illustrate how much that is, you have roughly five liters of blood. And in those five liters, you have less than five grams of sugar (Wasserman, 2008). About as much as a serving of ketchup. But ketchup isn't exceptional. When you look at the ingredient list on most sauces (pasta sauce, barbecue sauce, glazes, dressings, etc.), you'll often find as much sugar in a single serving as you have in all of your circulation combined. Candying our blood with this kind of ingestion has a lot of health consequences. So what do the health conscientious do? Do we give up sweets altogether? Of course not. We rely on sugar substitutes (e.g., sucralose, stevia, saccharine). "Yuck! Those are all chemicals!", I occasionally hear when the subject of sugar substitutes comes up. And, while that's true -- they are chemicals -- so is everything else you eat. Organic chemistry is the study of carbon-containing compounds. That means, technically, an apple is just a ball of chemicals. And corn is just a cob of chemicals. Similarly unthreatening, stevia is a packet of chemicals. "You know what I mean. They're not natural!" Okay, that's true for some of them. But stevia literally grows from plants and even the "artificial" sweeteners aren't all as laboratorial as they might seem. Take aspartame for example. That's aspartic acid and phenylalanine. Two amino acids. You get more of both in an egg. Granted, they aren't chemically bound in the same way, but after more than 50 years of evaluation, that doesn't seem to be particularly important. Either way, let's talk about our sugar-substituting options. The common natural sugar replacements: sugar alcohols, stevia, and monk fruit. (Stevia and monk fruit are the cute, much-more-memorable names for Rebaudioside A and lo han guo respectively.) The common artificial sugar replacements: saccharin (Sweet 'N Low), sucralose (Splenda), acesulfame potassium (Sunett and Sweet One), aspartame (Nutrasweet and Equal), neotame (basically aspartame but a tiny bit less normal), and advantame (another aspartame knockoff). All of these have little effect on blood glucose levels. Some, however, do have a few calories. Sugar alcohols for example. The common ones are maltitol, sorbitol, erythritol, xylitol, isomalt, mannitol, and lactitol. If you're looking at an ingredient list and see an -ol ending, that's a good indicator that the food has sugar alcohol in it. These, being derived from carbohydrates, are considered "nutritive replacements" (meaning they contain some calories). What they don't contain is ethanol, so you can't eat yourself drunk. With the exception of maltitol, which does increase blood sugar and elicit an insulin response, sugar alcohols have a negligible effect on these phenomena. The body doesn't absorb them completely. That's why they're classified as low calorie sugar replacements, and why their ingestion gives many people... we'll call it "acute slippery rectal urgency syndrome" (Wolever et al., 2002). People tend to be more suspicious of artificial sweeteners, but some of them have been around for an awfully long time. Saccharine, for example (the powder inside of the pink packets), was first created in 1879 at Johns Hopkins. Today, more than 140 years later, we have yet to find adverse consequences of ingestion by humans. Despite this, allegations are not new. In 1908, when confronted with such claims, President Theodore Roosevelt said, "Anyone who says saccharine is injurious to health is an idiot." The EPA was more professional in its 2010 statement that the sweetener lacks any evidence of health hazard. That's not to say that sugar substitutes have no effect on anything, and 100% of what is swallowed is peed ("what goes in must come out" is not an expression). People with type 2 diabetes may get a modest insulin response after ingestion of sucralose and aspartame (Mathur et al., 2020). By comparison, stevia doesn't seem to elicit that same response (Anton et al., 2010). Research investigating the metabolic responses to sugar substitutes is still somewhat young and findings should be taken with a grain of... stevia. Okay, enough chitchat. Time for tips: Tip 1) If you are trying out a sugar substitute for the first time, ease into it. Especially if sugar alcohol is involved. Surprise laxative effects rarely enhance one's day. But on a smaller scale, some people in some situations may respond to some forms of counterfeit calories with an increase in appetite and consumption (Mattes et al., 2009). Tip 2) Read labels and ingredient lists. Just because a food product is labeled "Sugar-Free!" does not mean it is healthful. Otherwise, meth, mold, and margarine would be on the menu. Tip 3) It's possible to overdrink water and overeat broccoli, and it's probably easier to over-ingest non-nutritive sweeteners. So, like everything else, exercise moderation in your sugar substitute consumption.