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Is Sugar Killing Us? Maybe

By Laurie Triplette
Natural Sweeteners Versus Artificial Sweeteners
During 2014 The Old Bride intends to explore trends in food science and preferences, and to share my findings with our readers. We’ll check out the wheat belly/no-gluten diet, the Paleo diet, food allergies and sensitivities, and other hot topics. In the works for months, my first food-and-health topic focuses on sugars and sugar substitutes. Who knew the sugar issue would publicly explode this week. Thanks go to Dr. Kathy Knight, Janie W. Cole, and Emmy Parkes of the UM Department of Nutrition and Food Sciences for their input.
Some Heartbreaking Truths About Sweeteners
Is sugar killing us? Maybe.
A flurry of news media reports this week proclaim that added sugars in our foods might hold a fatal attraction that can cause heart stress and related coronary problems. The media coverage came in the wake of research conclusions published online Monday, Feb. 3, in the Journal of the American Medical Association / JAMA, formerly the Archives of Internal Medicine.
The report details extensive studies of data collected nationally between 1988 and 2010 from the National Health and Nutrition Examination Survey (NHANES). The NHANES data, updated annually by the U.S. Centers for Disease Control and Prevention (CDC), were examined by researchers at Emory University School of Medicine with the CDC and Harvard School of Public Health. Their first findings were published in 2013 in the Journal of the American Heart Association.
According to Quanhe Yang, lead-study co-author of the latest report and epidemiologist at the CDC, this is the first nationwide study to link Americans’ consumption of added sugar with their risk of dying from heart disease. The study takes into account the individuals’ weight, age, health, diet and exercise habits. Previous research studies already had linked sugar consumption to diabetes, weight gain, and obesity.
Yang states that about 37% of our daily added sugars occur in the form of sweetened beverages, with the rest coming from sugars added to processed foods, including grain-based desserts, fruit drinks, dairy desserts, and candy. Naturally occurring sugar is not considered added sugar. Naturally occurring sugar comes from fresh fruits and natural fruit juice, milk and dairy products, or from vegetables.
The CDC report published in 2013 revealed that just one molecule of glucose metabolite glucose-6 phosphate (G6P) can lead to a improper heart function. G6P build-up is inevitable from consumption of too much sugar and starch (which converts to sugar).
An over-buildup of G6P leads to high blood pressure, high triglycerides (high cholesterol), and overall heart-muscle stress.
The latest report contains data indicating that people who consumed the most added sugar daily — around 20% or more of their daily caloric intake  — were twice as likely to die from heart disease as those who consume less than 10% in added sugars.  According to the JAMA article, those with caloric intake of 19% in sugars had about a 38% higher risk of dying from coronary disease.
The Emory-CDC researchers found that the average American consumes about 15% of our daily calorie intake as added sugars. This means that in a daily 2,000-calorie diet, one 140-calorie soft drink equals 7% of added-sugars consumption. Each person’s body is different, so even one soft drink daily could dramatically impact heart health in some individuals. But seven or more servings of sugar-sweetened beverages each week definitely link increased risk of dying from coronary heart disease.
“We’ve all heard many conflicting statements about sugar and how bad it is for us,” said Kathy B. Knight, PhD, RD, Associate Professor and Interim Chair of the Department of Nutrition and Hospitality Management at Ole Miss. The Old Bride interviewed Dr. Knight in her campus office on January 23.
“Too much sugar is bad for us. But there’s still a lot of misinformation in the public about sugar. We’ve heard that there is a standard daily limit to the amount of sugar an individual should consume and remain healthy. This is not true. There is no standardized specific guideline for daily amounts of sugar that can be consumed safely,” she noted.
“Every person’s body is different. The nutritional requirements and limitations are different in every person’s body,” Knight said.
She cited some of the conflicting data: The Institute of Medicine recommends that sugar consumption be less than 25% of total calories. The World Health Organization recommends less than 10%, and the American Heart Association recommends fewer than 150 calories per day for men (about 9 teaspoons) and fewer than 100 calories per day for women (abut 6 teaspoons). U.S. dietary guidelines suggest that a healthy diet is one that is low in added sugars, limited to a combined daily caloric intake of no more than about 15% in added sugars AND fats.
In addition to conflicting guidelines regarding daily sugar and added-sugar consumption, Knight pointed out other myths regarding sugar. “For example, the public has been told that sugar causes hyperactivity in children. Not true. Food sensitivities and allergies are caused by proteins in the foods.“
What is true, added Janie W. Cole, RD, LD, of the University of Mississippi Nutrition Clinic, is that sugar is addictive.
“Sugar has been called a poison, a toxin … sugar gets a bad wrap when it’s really not bad at all in moderation.”
Medical experts all seem to agree on this one point: Sugar is addictive because it affects the brain much in the same way as morphine and other opioids. When isolating the effects of fat and sugar on our brains, the sugar impact was distinctly separate from the impact of fat, and the brain’s reaction/response to sugar was highly sensitive. (REFERENCE: Nicole Avena, PhD, a neuroscientist with the New York Obesity Research Center at Columbia University, and author of Why Diets Fail (Because You’re Addicted to Sugar)
Cole noted, “Sugar is harder to resist than any other food. We need it to function, which is why our bodies can synthesize it in our liver from fat, complex carbohydrates and protein. All sugars are carbohydrates composed of carbon, hydrogen and oxygen, and our body converts all carbohydrates into sugar.”
Simple sugars are monosaccharides, which include glucose (also known as dextrose), fructose, and galactose. Granulated sugars such as table sugar are a disaccharide known as sucrose, which hydrolyzes into fructose and glucose. Other disaccharides include maltose and lactose. Chemical substitutes known as artificial sweeteners are not technically a sugar.
Over-consumption of fructose — including high-fructose corn syrup — accelerates cellular damage and aging, according to Robert H. Lustig, MD, MSL, author of Fat Chance: Beating the Odds Against Sugar, Processed Food, Obesity and Disease and also of The Fat Chance Cookbook.. The cells die off faster than normal. Excess fructose in our system converts into liver fat. Lustig says a fatty liver and high percentage of rapid-death cells increases a body’s risks for cancer, cognitive decline, and other degenerative diseases.
“People always ask whether some natural sugars are better than others,” said Knight. “Sugar is sugar. None of the natural sugars are better or worse than the others. Some are just very expensive to grow or to refine.
When asked about the merits of high fructose corn syrup versus cane sugar, Knight pointed out that both metabolize the same way in our bodies. “But corn syrup is easier to use for food processing manufacturing, requiring less labor on the back end than granulated sugar. On the other hand, granulated sugar is better for baking because it aerates the batter and acts as a tenderizer.”
What about artificial sweeteners such as aspartame and saccharine?
Knight said that the original studies claiming that saccharin causes cancer have been proven to be overblown. Some of the chemical sugar substitutes and some of the other natural sweeteners such as agave or stevia have been known to trigger individual sensitivity or allergic reactions. For example, Aspartame has been proven to cause intolerance in some individuals because of the two amino acids it contains.
So why all the fuss about packaged and processed foods when discussing added sugar? It turns out that 80% of all packaged foods contain added sugar — even savory crackers and pepperoni. It’s added because sugar has antibacterial properties and also has flavor-stabilizing properties. Plus, it makes the foods taste more appealing to consumers.
All consumers should learn to read food labels on packaged foods. People who need to restrict their sugar intake need to identify the many forms in which it might be added to packaged foods. There are more than 50 names for different sugars that are added to our packaged foods. Those sugars include high fructose corn syrup, agave, molasses, caramel, dextrose, glucose solids, d-mannose, aspartame, sucrose, honey, and stevia.
Cole and Knight encourage consumers to limit their added-sugar intake. In order to control the added sugars, make your food from scratch, using fresh or flash-frozen ingredients.
Cole dismissed some recent claims that artificial sweeteners are as bad for diabetics as natural sugars.
“I definitely would recommend that a diabetic choose an artificial sweetener over a natural sugar if one must consume sweets once in a while. The point is moderation, meaning perhaps a diet soft drink once in a while. But not two or three times a day. Everything needs to be consumed in moderation. And that’s where it gets complicated because sugar, like salt, is addictive,” she said.
“It triggers something in our brains and we start to crave more of it. That’s why we often recommend doing without added sugars of any type, and start relying on a balanced diet containing only the natural sugars contained in fruits. We have found that when people go sugar free, they stop craving it, and can taste even the smallest amounts more distinctly,” Cole said.
Knight concurs. “The truth is that we don’t know that much about how much sugar is too much. So we should use moderation until we find out for sure. As we say, everything in moderation.”
Laurie Triplette is a writer, historian, and accredited appraiser of fine arts, dedicated to preserving Southern culture and foodways. Author of the award-winning community family cookbook GIMME SOME SUGAR, DARLIN’, and editor of ZEBRA TALES (Tailgating Recipes from the Ladies of the NFLRA), Triplette is a member of the Association of Food Journalists (AFJ),Southern Foodways Alliance (SFA)  and the Southern Food and Beverage Museum (SOFAB). Check out the GIMME SOME SUGAR, DARLIN’ web site: www.tripleheartpress.com and follow Laurie’s food adventures on Facebook and Twitter (@LaurieTriplette).
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We consume natural sweeteners, added sugars, and artificial sweeteners in our foods. Natural sweeteners occur in foods such as fruits and vegetables, plants such as agave cactus, stevia plants, and maple trees, and in honey. “Added sugars” are sugars that have been refined in some way and added to our foods. Artificial sweeteners are not sugars at all, but are chemical compounds that taste sweet. The natural sweeteners can be in the form of crystals or syrups; some of the syrups are purely the result of refining sugar crystals, such as high fructose corn syrup; but most of the syrups are harvested as a natural liquid product such as honey, agave nectar, and maple syrup.
All refined sugars are equal in nutrition. This includes white granulated sugar, brown sugar, and the raw sugars such as turbinado. They are 99 percent sucrose, which is a simple carbohydrate. Brown sugars merely contain higher molasses content.
Some of the other natural sugars and sugar substitutes taste sweeter than refined sugar. Honey ranges 25 to 50 % sweeter. Stevia Reb A is highly purified from the stevia plant and is several hundred times sweeter than cane sugar. Agave nectar is 1-1/2 times sweeter than equivalent amounts of white cane sugar. Most artificial sweeteners are 100 times more intense than regular cane sugar. They are considered “non-nutritive sweeteners” because all but aspartame pass through our bodies without being digested. Aspartame is absorbed. There are no known side effects from this absorption.
Terms Referring to Sugars
Sugars: Naturally occurring carbohydrates that contain calories and raise blood glucose levels (the level of sugar in the blood stream). Examples: cane sugar, brown sugar, confectioner’s sugar, fructose, honey, and molasses.
Reduced-calorie sweetener: Sugar alcohols, which contain about half the calories of sugars, and considered a separate type of carbohydrate. Sugar alcohols can raise blood sugar levels, bit not as much as other carbohydrates. Examples: isomalt, maltitol, mannitol, sorbitol, xylitol (often used in sugar-free gum and candy).
Low-calorie sweeteners: Artificial sweeteners created in a lab as chemicals; considered “free foods” because they contain zero calories and do not raise blood sugar levels.
Terms Referring To Sugar Content In Foods
No sugar: Product contains no sugar. It MAY contain sugar alcohols or artificial sweeteners.
No added sugar: No extra sugar was added during processing, but original source may have contained sugar such as the fructose in fruit juice, and sugar alcohols or artificial sweeteners may have been added.
Sugar free: Product contains no sugars, but may contain sugar alcohols or artificial sweeteners.
Dietetic: Murky term, not defined by the Food and Drug Administration (FDA), and so can mean whatever the manufacturer decides; often to indicate that the product has reduced calories.
All natural: Another murky term, not defined by the Food and Drug Administration (FDA), and so can mean whatever the manufacturer decides; often to indicate that the product contains no artificial ingredients, but it may contain natural sweeteners such as sugars or sugar alcohol.
Types of Natural Sweeteners
Beet sugar
Similar to cane sugar, but made by extracting the sugar juice from beets and refining it to crystallize it. Beet sugar production requires more fossil fuels than cane sugar production.
Cane sugar
Readily available; farm production well established. Regular table sugar is sucrose, a crystal composed of fructose and glucose that are bonded together; it must be broken down in the body in order for the glucose and fructose to be absorbed in the body.
Cane syrup (Steen’s and other brands)
The syrup derived from pressing or otherwise extracting the juice from sugar cane and boiling it to condense it, but not to the point of crystallization.
Corn syrup (Karo light and dark, and other brands) 
Corn syrup is chemically produced from corn starch mixed with natural enzymes that break the cornstarch down into glucose. It is heated to convert it into syrup. Light corn syrup has been heated less than dark corn syrup. The sugars in corn syrup are harder to process in our bodies than table sugar.
High fructose corn syrup (Generally a commercial-grade product used in food manufacturing)
Very sweet. The syrup is obtained by adding natural enzymes to corn syrup to convert some of the glucose into fructose; the two sugars are combined but not bound together, so they do not go through the digestive system, but directly into the bloodstream. The fructose goes directly into the liver, while the glucose triggers insulin spiking.
Coconut palm sugar
A good substitute for brown cane sugar, but farm sourcing has stirred controversy regarding environmental issues and impact on other desirable produce (coconuts)
Agave Nectar
The syrup created by extracting the sap from agave cacti, filtering it, and heating it to create light (less heat, more filtration) or dark syrup. Equivalent to corn syrup or honey. Fructose content varies by brand and type.
Brown rice malt syrup
Also known as rice syrup or rice malt, created by culturing cooked rice with enzymes; has a higher glycemic index than table sugar, and only slightly less than glucose.
Fruit juice concentrates
What remains after removing much of the water contained in the natural fruit juice. Be sure to check for additives; it is different from not-from-concentrate fruit juice.
A well known natural sweetener produced by honey bees, with a distinctive flavor and health benefits to consumers
Maple syrup
The syrup created by extracting xylem sap from various types of maple trees and processing it by heating to remove water; graded by degree of concentration of the sap. Consists mostly of sucrose, with some glucose and fructose.
Thick, dark brown syrup created from raw sugar during the refining process; strong flavor.
A type of molasses made by extracting the green juice from the sorghum plant, which resembles sugar cane, and cooking the juice into syrup; very high in potassium and antioxidants, but strong flavor.
Stevia Rebandioside A (Stevia, Truvía)
Extract from the leaves of the stevia plant; readily available in the U.S.
Types of Artificial Sweeteners
Acesulfame potassium / acesulfame K (Sunett, Sweet One)
May be used in both hot and cold foods, including baking.
Aspartame  (Nutrasweet, Equal)
Loses its sweetness at high temperatures, and is not good for baking. People with phenolketonuria should avoid it.
Neotame (n/a)
Saccharin  (Sweet & Low, Sweet Twin, Sugar Twin)
Can be used both hot and cold.
Sucralose  (Splenda)
May be used in both hot and cold foods, including baking. Often included in processed foods.


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