Experts answered all of your questions about artificial sweeteners, natural sweeteners, and every other type of sugar so you can live a sweet and healthy life
We're inundated with sugar everywhere we turn—both in the news, telling us to cut back on how much we at, and in so many of the foods and drinks we consume daily. And this sugar paradox certainly isn't sweet, as it leaves us uncertain about how to satisfy cravings without candy, if artificial sweeteners are safe, and what the heck you can actually eat. Instead of tossing in the towel on healthy living—or, worse, turning to cookies to relieve your stress—straighten out the facts about all types of sugar so you can treat your body (and your sweet tooth) right.
First, the obvious: Sugar adds empty calories to your diet, and if you're not careful, that can add inches to your waist. Keep that up, and it could lead to obesity, which brings a host of other health problems such as heart disease, says Laura Schmidt, Ph.D., a professor of health policy in the School of Medicine at the University of California, San Francisco.
But many of the issues brought about by excess sugar consumption are believed to be completely unrelated to obesity and more about how the substance is metabolized in your body. "Studies in animals show that fructose intake in particular can alter your ability to control appetite, reduce your ability to burn fat, and induce features of metabolic syndrome, such as raising blood pressure, increasing fat, and causing fatty liver and insulin resistance," says Richard Johnson, M.D., professor of medicine at the University of Colorado in Denver and author of The Fat Switch.
One other not-so-sweet side effect of sugar: wrinkles. "When your body digests sugar molecules such as fructose or glucose, they bind onto proteins and fats and form new molecules called glycation end products, or AGEs,” says David E. Bank, a dermatologist in Mount Kisco, NY and SHAPE advisory board member. As AGEs collect in your cells, they start to destroy skin’s support system, a.k.a., collagen and elastin. “As a result the skin is wrinkly, inflexible and less radiant,” says Bank
It's difficult to isolate the effects of sugar alone on humans since our diets consist of a variety of ingredients and nutrients, so a lot of the research has been done on animals using large, isolated amounts of sugar that do not represent our typical consumption (60 percent of diet rather than 15 percent), says Andrea Giancoli, M.P.H., R.D., a spokesperson for the Academy of Nutrition and Dietetics. Some concern has also been expressed over the fact that those animal studies have used pure fructose rather than a combination of fructose and glucose as we normally consume, adds Johnson, who has personally been performing research on sugar (funded by the National Institutes of Health) for decades.
Each of these molecules is used to create various types of carbohydrates. Fructose is naturally found in many plants, honey, tree and vine fruits, berries, and most root vegetables. It is also what makes sugar sweet. Glucose is in starch and burned to create energy, and galactose is found in milk sugar. Sucrose, or table sugar, is glucose and fructose bound together.
Most carbohydrates are converted to glucose and used for energy or stored as fat. But unlike other sugars, which are metabolized in your blood stream, fructose goes to your liver to be metabolized. When consumed in excess, the liver can no longer process fructose as energy and instead turns it into fat, which ultimately exacerbates metabolic syndrome. Fatty liver can also be caused by alcohol and in serious cases turns into liver disease.
According to the American Heart Association (the only organization to recommend a specific dietary amount), women should consume no more than 6 teaspoons of added sugar each day (the limit for men is 9 teaspoons). This does not include sugar from natural sources such as fruit.
To put this in perspective, a teaspoon of sugar equals 4 grams and 16 calories. A 20-ounce sugar-sweetened beverage (soda, sports drink, or juice) usually contains 15 to 17 teaspoons of the sweet stuff. Currently the average American takes in more than 22 teaspoons—352-plus calories—of added sugar daily. That's 16 teaspoons and 256 calories more than recommended.
Nope, there's nothing wrong with including fresh produce in your diet. "Fruit does contain fructose, but the amount is relatively low (4 to 9 grams per serving), and it also has healthy nutrients, such as vitamins, antioxidants, potassium, and fiber, that help slow sugar absorption and counter some of its effects," Johnson says.
But, like anything else, fruits should be consumed in moderation, which means two to four servings a day—especially if you're diabetic—and in their most natural form. Read: not candied (with added sugar), dried (in which sugar is more concentrated and sometimes sugar is added), or juiced. "Juicing strips fiber out of the fruit and turns it into a more concentrated form of fructose. This makes it very easy to consume a ton of sugar in one small glass and causes your blood sugar to spike more quickly," Schmidt says. That rise in blood sugar triggers the liver to store fat and become insulin resistant, potentially upping your risk for diabetes.
You should also note that certain fruits are higher in sugar than others. Ones that most people think of include bananas (14 grams in one medium, which actually isn't that bad), mangoes (46g), and pomegranates (39g). More sugar means more calories, so if you are watching your total sugar consumption for either weight-loss or diabetic purposes, you should probably limit the number of these high-sugar fruits you eat.
"Unlike lactose in milk and fructose in fruit, added sugars do not occur naturally. They are literally added to foods and beverages during their processing or preparation," says Rachel Johnson, Ph.D., M.P.H., R.D., a nutrition professor at the University of Vermont in Burlington. The sugar added can be any type, including honey, brown sugar, maple syrup, dextrose, fructose, high-fructose corn syrup, granulated sugar, raw sugar, and sucrose, to name a few. For a complete list, visit the USDA MyPlate website.
One theory is that about 20 to 30 years ago, fat became enemy No. 1, so manufacturers began cutting fat out of packaged foods and replacing it with more sugar (often in the form of high-fructose corn syrup) in the hopes that consumers wouldn't notice a change in taste. "The sweetness of sugar pleases our palates," says Kathy McManus, R.D., director of the department of nutrition at Brigham and Women's Hospital in Boston.
As a result, we've grown accustomed to our foods being sweeter than what they're naturally supposed to be. According to the USDA, Americans' annual per-capita consumption of caloric sweeteners increased 39 percent—a whopping 43
pounds—between 1950 and 2000.
Sugar also helps increase the shelf life of certain products.
"Sugar is added to about 80 percent of the products stocked on our supermarket shelves," Schmidt says. Ketchup, bottled sauces, and salad dressings are some of the biggest culprits, and it's also found in things like bread and crackers. One plain bagel, for example, can contain about six grams of sugar.
"Sugar is hidden in all kinds of foods that you wouldn't think of because you consider them savory and not sweet, so learning how to identify those sugars on ingredient labels is important," Schmidt adds. In addition to those you can identify (sugar, honey, syrups), look for words ending in "-ose." And remember, the higher it is on the list, the more sugar that product contains.
No. Both sugars are extracted from sugar cane, "raw sugar is just slightly less refined than regular granulated sugar and retains some of the molasses," Rachel Johnson says. While that means it contains a little iron and calcium, there is no meaningful nutritional value, and both contain roughly the same number of calories.
No. "They are all simple sugars that contribute to excess calories, and your body reacts to them in the same way," McManus says. "Whatever the form, each is very easily digested and absorbed into your blood stream, and when done in excess this can create an insulin resistance and potentially put you at risk for developing diabetes."
Table sugar—a.k.a. sucrose—is composed of 50 percent fructose and 50 percent glucose. HFCS is derived from corn and also contains fructose and glucose; sometimes it has more fructose than sugar does and sometimes it has less, Richard Johnson says. "High-fructose corn syrup is at its worst in soft drinks, when it's composed of close to 55 to 65 percent fructose," he adds. "However, in other products like bread, it actually contains less fructose than table sugar does."
The negative effects of fructose are amplified in HFCS, as it is a higher dose of fructose than most other types. And the introduction of high-fructose corn syrup coincides with the increasing rate of obesity, Richard Johnson adds.
"I think the verdict is still out on all of these substitutes," McManus says. The FDA considers aspartame (marketed under the names Equal, Nutrasweet, and Sugar Twin), sucralose (Splenda), and saccharin (Sweet‘N Low) to be "generally regarded as safe" or GRAS, and has established an acceptable daily intake (ADI) for each. ADI is based on your weight. For example, a 140-pound woman would need to consume about 18 cans of aspartame-sweetened diet soda or 9 packets of saccharin to exceed her ADI. "Moderation is key, and I believe you should seek out foods that are naturally healthier, without added artificial ingredients," McManus adds.
Research also shows that artificial sweeteners may not serve as an ample substitute for sugar when it comes to satisfying cravings. While sugar triggers a reward response in your brain, boosting dopamine levels as energy is metabolized, consuming something artificially sweetened doesn't increase dopamine at all, according to a recent Yale University School of Medicine study.
"These are appealing to consumers because they are more natural than synthetic sweeteners, but they're not completely natural," McManus says.
Just as sucrose is chemically extracted from sugar cane, stevia is extracted from the plant stevia rebaudiana. The Japanese have sweetened things with stevia for decades and South Americans have used stevia leaves for centuries, but the FDA only granted stevia GRAS status in 2008. This sweetener is about 300 times as sweet as sugar.
Monk fruit extract (marketed under the name Nectresse) comes from a gourd that's native to southern China and northern Thailand. Its sweetness comes not from natural sugars but an antioxidant called mogroside, which is 200 to 500 times as sweet as sugar. Although little research has been done on it, monk fruit extract seems to be safe and has been considered GRAS since 2009.
Sugar alcohols are extracted from fruit and vegetables where they naturally occur, and also can be manufactured from other carbs such as fructose and dextrose. These reduced-calorie sweeteners often have names ending in "-ol" such as sorbitol, xylitol, and mannitol, and are commonly found in gum, candy, and low-carb nutrition bars. Considered GRAS by the FDA, they are known to case bloating and other digestive problems for some people, Giancoli says. "Unlike sugar, these alcohols are broken down in the intestines and turned into gas, which often creates gastrointestinal discomfort."
Agave syrup, Giancoli says. Touted as low-glycemic, agave syrup may not have a lot of glucose, but it's up to 90 percent fructose—way higher than even high-fructose corn syrup. So while it is considered natural since it is processed from "honey water" found in the blue agave plant, and it's one and a half times sweeter than sugar so you should theoretically use less of it, you still need to be careful: Too much means too many calories and too much fructose—and all the health risks associated with that.
Stick with nutrient-dense foods that are naturally sweetened such as fresh fruit or plain yogurt with berries, McManus says. And if you can't pass up something with added sugar, make sure it is made with healthy carbs such as oats and whole grains instead of refined carbs like white flour, as the natural fiber in good carbs helps slow the breakdown of sugars. In a pinch, spice some plain oatmeal with cinnamon or nutmeg.
First examine your diet to identify your biggest sources of added sugars, McManus says. Read ingredients lists (look for these words), and try to avoid products with a form of sugar listed as one of the first five ingredients. Check the nutrition facts as well, comparing anything that is sweetened (such as yogurt or oatmeal) to its plain counterpart to distinguish added sugars from naturally occurring ones.
Once you know your sweet spots, start to cut back, focusing on your worst offenders first. If that's sugar-sweetened beverages—the biggest source of added sugars in the American diet, according to the Centers for Disease Control and Prevention—
substitute in diet soda and seltzer water with lime, aiming to eventually drink only seltzer or flat water. "If you want to kick your sugar habit, you need to retrain your palate, and with artificially sweetened products, you'll continue to crave sweetness," Schmidt says. "These sweeteners are like using a nicotine patch to quit smoking—good for transitioning, but not for the long term."
Also try to eat as many whole foods and as few processed packaged ones as possible, keeping foods that might trigger a sugar relapse out of your house.
Yes, according to Richard Johnson. "Sugar is one of the few foods that humans crave. Babies will prefer sugar water over milk," he says. "It appears to be due to the stimulation of dopamine in the brain, which creates a pleasure response." Over time, that response lessens, so you need more sugar for the same effect, and when mice fed sugar water are deprived of their sweet drink, they can exhibit withdrawal symptoms.