Eat Better, Live Longer Series: Sugar II - Fake Sugar & the Boiling Frog

I used to run from sugar ……… Now I chase after it.

We know there is too much sugar in our stuff…. So we try to pay attention……. becoming that nerdy person in the aisle reading labels.

With real sugar, we at least know who the bad guy is and what he is capable of …. We know he feeds inflammation, cancer, obesity, T2d, and is the root cause of the majority of non-communicable diseases (NCD) that kill over 43 million people a year globally.

However, we don’t really know the fake sugar guys & what they are really capable of or what they are doing to us. There are so many… It's hard to keep up. This BLOG tries to help with that.

In this blog, I talk about all the sweeteners on the market, what they are used for, and what the literature says about them……… It’s a much wider cast of the net than my first ax grinding in May 2024, when I was desperately trying to understand my wife’s cancer. It’s a bit long – but I hope it serves you well.

First, an observation about AI. I used AI to dredge the internet for research for each non-sugar sweetener (NSS). I asked it to categorize, compare, sort – all kinds of things to build out data that’s useful.

The observation: In almost every chat search, the system concluded that human data was insufficient to clearly say whether a sweetener was bad, good, or neutral, despite its age on the commercial stage.

………. in almost every case – it stops short of warning you about x,y,z.

………. And in almost every case, it typically defaulted to – The product is generally recognized as safe as long as you use it in the recommended proportions

……….And in almost every case, citing an animal trial, it would always caveat the findings with – “this outcome has not been proven in human beings” (or something like this).

This scares the shit out of me because there are a few paradigms in my self-preservation tool kit that have served me pretty well over the years.

• If someone seems like they are hiding something, they probably are. It’s hard to put a value on transparency.
• You can’t get something for nothing – which is often a promise of NSSs – “it's sweet, no calories, does not spike your blood sugar, passes right through the body” -Win, Win, Win…….. - yeah right – there’s a price somewhere.
• I believe in the manufacturing paradigm of good, fast, and cheap. This paradigm teaches us about trade-offs - we can only have 2 of the 3 on any given Sunday. Ie – if you want something fast and cheap, it will not be very good. (Let's not forget why the beverage industry adopted HFCS over cane sugar in the 70s – it was cheap [which means there is a price somewhere- and now almost 50 years later - we are discovering that price is our health.]
• I still remember and believe the quote from the Food Inc. documentary of the 90s –– “stay to the outside of the supermarket, don’t go down the aisles” “the outside is where the whole foods are (Veg, fruit, meats, dairy) and the aisles are where the manufactured foods are”. What good advice.

Ok – here we go ….

There are a total of 42 sweeteners in today’s food supply – ranging from cane sugar to maltodextrin. They are used in both the USA and the EU.

14/44 are Natural Caloric Sweeteners, 9/44 are alcohol sugars, 6/44 are Artificial / High intensity sweeteners, 10/44 are Natural, High intensity sweeteners, and 3/44 are industrial Carbohydrates/ bulking agents.

Next, a little about age. How long a sweetener has been on the commercial stage gives us insight into the depth and breadth of trials and studies that have occurred – even if they are buried. Old sweeteners are well studied; new sweeteners are not

There are 5 Categories of Sweeteners in commercial use

1. Artificial / High Intensity: Aspartame, Sucralose, Acesulfame-K, Saccharin, Neotame, Advantame.

How Industry uses them.

• Aspartame- Diet sodas, sugar-free flavored water, sports drinks, sugar-free foods – yogurt, pudding, and ice cream, gums, mints, and candies. “Lite” products, table top sweeteners, chewable vitamins, liquid medicines.
• Sucralose – Same products as above + used in maximum allowable quantities in Fruit spreads, Jam, and jellies, and canned fruits.
• Acesulfame-K – Same as products above + Ace-K is heat stable, so it is very popular in baked goods. Additionally, -K blends very well with other artificial sweeteners, and manufacturers use it to create better sweetness profiles and mask aftertastes.
• Saccharin – Still widely used in the food and beverage industry but highly favored in the pharmaceutical sector due to its heat and chemical stability. Chewable, liquids, gummies, syrups.
• Neotame (or E961). This A/HI sweetener is 7000 times sweeter than sugar. Which means very small amounts are needed to achieve “sweet.” It is heat-stable and an exceptional masking agent (for bitterness & aftertastes). Used in products above but extremely popular in candies and frozen desserts, dairy products, and drink mixes.
• Advantame (or E969) is 20,000 times sweeter than sugar. Compared to other A/HI sweeteners, Advantame is relatively new to the industry, and therefore, little is known about its long-term use. Advantame is functional not only in sweetness replacement but also as a flavor enhancer (especially for dairy, fruit, citrus, and mint flavors) and in chewing gum to extend “chew time.”

Body of Literature Takeaways.

In the short term, industry-supported research often showed a decrease in BMI when free sugars were replaced with NSSs.

However, longer-term multiyear studies link higher artificial sweetener intake to

• Increased Cardiovascular disease.
• Stokes
• Hypertension
• Gut Dysbiosis
• Type 2 Diabetes
• Inflammation
• Cancer
• Mortality in general

Meta-analysis of three studies on pregnant women showed a linkage to increased risk of pre-term births, and one study found associations between NSSs use with an increased risk of Asthma, allergies, and lower cognitive function of offspring.

An 8-year American Academy of Neurology study of over 12 thousand subjects found that the daily use of artificial sweeteners contributed to a 62% faster cognitive decline in memory and critical thinking, and a 173% faster decline in verbal fluency (coming up with words). Artificial sweeteners cited were Aspartame, Ace-K, Erythritol, saccharin, sorbitol, tagatose, and Xylitol.) The study was commissioned to challenge the notion that sugar-free equals risk-free.

The most significant reports and studies are:

• WHO Guideline – Use of non-sugar sweeteners (2023). Cites long-term studies. A policy grade guide recommending NSSs is, at a minimum, not a viable alternative for weight control.
• Nature Medicine 2023 – Artificial sweetener Erythritol and cardiovascular event risk.
• NutriNet- Sonte 2022 – Artificial Sweeteners and Cardiovascular Risk. A large French study found higher CVD and stroke risk with NSS, especially aspartame, Ace-K, and sucralose.
• Nature 2014 – Artificial Sweeteners induce glucose intolerance by altering the human gut microbiome.

2. Sugar Alcohols: Erythritol, xylitol, sorbitol, maltitol, isomalt, lactitol, HSH, Glycerol.

How Industry uses them.

• Sugar alcohols dominate the “sugar-free industry.” Used in Gums, candies, mints, keto snacks, sugar-free treats, ice cream, and also used as sweeteners in the medical industry – gummies, chewable medicines.
• Erythritol is by far the most dominant SA. Dominates the Keto and low-carb snack industry.
• Xylitol & Sorbitol dominate the gum and candies industry.
• Isomalt dominates hard candies.
• Maltitol dominates the protein bar and replacement meal bar industry.
• HSH stands for Hydrogenated Starch Hydrolysate. It is a bulk sweetener used in many products.

Body of Literature Takeaways.

• Sugar alcohol causes smaller rises in blood sugar and insulin compared to regular sugar.
• Polyols cause gastrointestinal distress (gas, bloating, diarrhea) when consumed in excess.
• There are also emerging studies that suggest that Erythritol and other polyols may be associated with increased risk of cardiovascular events and the formation of blood clots.

3. Industrial Carbohydrates / Bulking Agents: Maltodextrin, dextrin, polydextrose.

How Industry uses them.

• Maltodextrin is a starch-derived carbohydrate additive made by enzymatically or acid hydrolyzing plant starch (potato, corn, wheat, rice) to produce short glucose chains. High Glycemic index because the maltose chains quickly break into glucose molecules. Used for a rapid energy source in clinical/medical settings or industrially in food production. (thickener, bulking agent, carrier of flavors).
• Used in soups, sauces, dressings, instant things, and snack bars. Very low cost.
• Dextrins are low molecular weight carbs derived from starch. Used in ultra-processed foods – batters, coatings, glazes, powder mixes, sauces, and processed meals.
• Polydextrose is a synthetic (food industry-produced) glucose polymer. Functions as a low-calorie bulking agent and are utilized in fiber-fortified foods, low-sugar and low-fat products, baked goods, confections, beverages, and frozen desserts. It is commonly used in the food industry for products such as gums, candies, mints, keto snacks, sugar-free treats, and ice cream. Additionally, it serves as a sweetener in the medical industry for items like gummies and chewable medications.

Body of Literature Takeaways.

• Studies cite maltodextrin and other dextrins impair the intestinal mucus barrier, promote inflammation, and alter the gut biome.
• Anecdotal reports: digestive distress, reactive hypoglycemia, increased appetite and cravings, autoimmune issues.

4. Low Calorie / Rare Sugars: Allulose, tagatose, trehalose, inulin.

How Industry uses them.

• Allulose - Bakery products, confectionery, dairy, and some beverages. Allulose has similar properties to sugar, which makes it a popular choice for manufacturers seeking low-calorie options. It is also attractive because, in many cases, it does not have to be added to the “added sugar” line of a label.
• Tagatose is also used in food products, but is used more in active health formulations like low sugar syrups, chewable, cosmetics, mouthwash etc.
• Trehalose is used widely by the food and beverage industry because it is predominantly a stabilizer (of proteins and fats) and bulking agent that also provides a mild, clean sweetness (45% of sugar). Trehalose is also popular in the manufacturing of biological products. It stabilizes proteins, antibodies, and vaccines used to protect products from heat, dehydration, and freeze-thaw cycles.

Body of Literature Takeaways.

• There are several studies on rare sugars that show positive outcomes in weight gain, blood sugar control, T2D markers, etc. However, human trials are cited as few and short.
• Although promising in their outcomes, evidence is limited on their long-term use.
• Predominant cautions of rare sugars are related to gastrointestinal side effects above 30 g. (bloating, diarrhea, etc.)
• GRAS in the United States, however, some other regulatory agencies, like the German Federal Institute of Risk Assessment, opined that more data is needed surrounding the long-term use and its effect on the human microbiome.

5. Natural Caloric Sweeteners: Sucrose, HFCS, Dextrose, Fructose, Maltose, Brown Sugar, Molasses, Honey, Maple Syrup, Coconut sugar, Agave syrup, Invert Sugar, Rice Syrup, Sorghum syrup.

How Industry uses them.

• Natural syrups are widely used in the food and beverage industry.
• Honey – premium baked goods, sauces, marinades, glazes, beverages, gummies
• Agave – Beverages, cocktails, dairy and plant-based yogurts and deserts, vegan bars
• Coconut – better for you snacks, baked goods, cookies, chocolates, paleo, vegan, sauces, seasonings.
• Invert sugar (glucose and fructose) – candy confections, marshmallow, ice cream, granola.
• Rice syrup – Granola bars, cereal clusters, baby food, infant formula, gluten-free bakery items
• HFCS – sodas, baked goods, breakfast cereals and bars, condiments and sauces, dairy and dessert, candy and confections.

Body of Literature Takeaways.

• A study in Cellular & Molecular Gastroenterology & Hepatology found that sugar’s impact on the body goes beyond gut dysbiosis and includes toxicity to gut stem cells that are responsible for maintaining gut integrity.
• HFCS- The health literature against HFCS is vast and linked to: obesity, diabetes, insulin resistance, NAFLD (non-alcoholic fatty liver disease), metabolic syndrome, cardiovascular disease, gout, and inflammation.
• Notwithstanding the body of evidence against HFCS, when it comes to natural sweeteners, quantity matters. Excess caloric sweeteners contribute to weight gain, higher triglycerides, higher risk of metabolic issues, and inflammation.
• Some natural sweeteners are better choices than others – Agave syrup vs honey, for example – Agave boasts a low GI # but is very high in fructose (often 70-90%). Honey, on the other hand, is low fructose and possesses other positive attributes.
• The WHO daily recommended allowance of sugar is 25 g for women, 36g for men. A teaspoon of sugar is 4 grams. According to the CDC (in 2017), the Average American was consuming 68 grams of sugar per day.
• Fun facts - 1 x can of Pepsi contains 41g of sugar. 1 x Carmel Macchiato from Starbucks contains 33 grams of sugar. A squirt of ketchup on your fries = 4 grams of sugar.

5. Natural / High Intensity: Stevia, Mont fruit, thaumatin, brazzein, miraculin

How Industry uses them

• Stevia (steviol glycosides) is a standalone tabletop sweetener (Truvia) but is also present in countless beverages, snacks, and health-marketed products. Stevia appears to be a good short-term tool to reduce added sugar, but the long-term metabolic effects at the population level are outstanding.
• Monk Fruit is a popular standalone sweetener, but it is also present in a variety of products. Safety information to date suggests that mogroside extracts are low toxicity and generally regarded as safe, but the toxicology database at the population level is limited. Consumers should watch for more human safety & metabolic data as products scale.
• Thaumatin (sweet protein) is used by manufacturers as a flavor modifier/enhancer, and it is often combined with other sweeteners. Used in Ice cream, beverages, and confections.
• Brazzein (sweet protein) is found in an African fruit. It is incredibly young on the commercial stage, and research is mostly clinical/early commercialization trials.
• Miraculin – a taste-modifying protein from miracle berry. Used recreationally or in medical trials to help with taste dysfunction (eg, cancer patients). It is not a packaged food sweetener in mainstream products.

Body of Literature Takeaways.

• Multiple trials and studies over the last half-decade on stevia support positive outcomes in glycemic control.
• The FDA and other regulatory bodies approve stevia as safe with no evidence of carcinogenic or reproductive toxicity.
• However, there are some deep-buried animal studies in the literature that found impacts on fertility rates in rats and mice fed stevia through their water source. One study cited contraceptive properties in a rat population study where the rats experienced reduced pregnancy rates, and the effect persisted for 50-60 days after withdrawal of the stevia. Further studies found disrupted estrous cycles, reduced pregnancy rates, smaller litters [especially male pups], and longer gestation periods.
• Monk Fruit is generally recognized as safe (GRAS), but EFSA (the EU) concluded the toxicity database is insufficient to fully assure safety for all uses. The EFSA specifically called out the need for a longer-term study on the testis effect in rodents. {There are studies out there citing some effect in the testis of male rats exposed to monkfruit. (‘The impact on the testicular effect cannot be dismissed, and further study is needed.)

So, what do I make of all this? … Well, let me wrap up with a quick short story that will provide some perspective.

Recently, I had a routine blood work follow-up with the VA for a few elevated Liver enzymes. In this appointment, I spent an hour with a liver doctor in his office. (I’m fine by the way). This dude taught me a lot about fatty liver disease in the US.

Did you know that, as long as the medical community can remember, Alcohol has been the #1 cause of fatty liver disease in the US?

Did you also know that a couple of years ago, Alcohol was overtaken by “diet and other things we drink” as the #1 cause. [please imagine & visualize, the whaling of sirens, flashing lights & arrows pointing to this fact…. Important – help yourself info that’s not even talked about]

This fact kind of puts a bow on the world NSSs.

They are not safe, and the scary part is that it takes decades to fully uncover and bring to light what they do to us.

HFCS is 47 years old, Aspartame is 50, and it was not until this decade that we really started sounding the alarm on obesity, T2D, CVD, inflammation, fatty liver, and cancer.

I wonder what they will be saying about Advantame (11 years old) in twenty years?

       To close out this bubbly blog post ………. Yes - there is a real cost to using NSSs and that cost manifests itself slowly. You’ve heard of the boiling frog parable.  

We can absolutely blame corporate giants for putting this shit in our food and drinks……….…. but that ship has sailed.

So what can we do now  ?? ……… I don’t have all the answers – but I can prime the pump with a couple of practical ideas.

• 1) Be the nerd in the aisle reading labels.
• 2) Full stop / hard boycott of any product that says “Sugar free”, “Zero Calorie” & please, stop using those pink, yellow, and blue packets of sweeteners on the table – they will kill you eventually.
• 3) Cut the sugar – especially liquid sugar (soda, fruit juice & sweetened coffee drinks – they are the worst offenders)
• 4) Decide who is on your team and who is not. Of the 42 players out there, who will you allow in your life and who will you not? (me? - I give a little grace to monk fruit, pure cane sugar, and occasionally stevia when I need the bigger product [ie, electrolyte powder for running].

Is there more to our health story than NSSs and Sugar ?? ……….

Of course, there is – The Pharmaceutical business for one. What can we do about that?

I don’t know – treat food like its medicine OR take medicine like it's food I reckon….. and maybe send Secretary Kennedy a letter of encouragement and thanks for the battle he is waging on our behalf.

Is there more to our health story?

Sure ….………..- Big Agriculture’s chemical assault on planet earth and its impacts on the human gut biome. – Yeah , there is some of that - what can we do ?

I don’t know……… …. support agriculture that you think is righteous.

But is there even more? ……………. I think so……...

There is another rock I have flipped over before, and I think is worth flipping over again ……..

The Western diet & our culture’s way of eating at an everyday level.

But we will kick that can down the road and use it to wrap up this series in January or February.

It will feature Robert and Tina - Average, middle-class Americans trying not to die prematurely.

Until next time

Farmer Kevin