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Wellness Corner February 2013 - How to think about sweeteners


Wellness Corner February 2013
How to think about sweeteners

by Dr. Gary Pace

We continue to be suspicious about sugar and its relatives, high fructose corn syrup and artificial sweeteners, yet consumption increases. Does the science show real health effects?  Why does this controversy continue without resolution? What is a reasonable approach to take in your family regarding sweeteners?

When Sweetness Enters the Body 

Sucrose, or table sugar, is rapidly broken down in the gut to fructose (in honey and sugar beets) and glucose, and these two molecules are easily absorbed into the blood stream.

The fructose is metabolized by the liver, the glucose by a variety of cells in the body. In laboratory animals, when the fructose arrives at the liver rapidly (as in sodas), most of those calories are converted into fat. 

High fructose corn syrup (HFCS) is a concentrated form of sucrose, so it floods the liver with a high concentration of fructose. While still being debated, there is probably no inherent benefit of an equal amount of sucrose over HFCS.

Artificial sweeteners have been thought of as a way to have the pleasures of sweetness without any of the calories, but it appears to not be so simple. A University of Texas 2005 study showed an increase in insulin response to artificial sweetener given to animals. So, while there were no calories, the body responded by releasing hormones exactly like sugar had been consumed.

Role of Insulin 

Insulin is released from the pancreas when sugar is recognized in the blood stream. Insulin’s role is to transfer the glucose into the cells of the body to be used as energy.  Higher levels lead to weight gain and fat deposition. This in turn can lead to resistance of the cells to the effects of the insulin. Then an upward spiral can occur.  

This quick sketch outlines the progression of normal metabolism to insulin resistance to metabolic syndrome to Type 2 Diabetes—health issues that are rampant in our society.

Circumstantial Evidence? 

Questions about health effects from sugar have been appearing for decades, and there continues to be a great deal of controversy. 

According to the FDA, we now consume more than 90 lbs per person per year. Some research from the 1980s suggested that 40 lbs of sugar per year was a safe baseline. The rise in sugar consumption correlates very nicely with the rise in obesity and rates of diabetes—in 1980, 1 in 7 Americans was obese, 6 million diabetic (with no change in obesity rates in the 20 years previously). In the early 2000s, 1 in 3 were obese with 14 million diabetics. (“Is Sugar Toxic,” NYT Magazine 4/17/11).

In laboratory animals, insulin resistance can be created by overfeeding the animal with fructose. Dr. Pagliassotti, a biochemist in the 1990s, showed that if the animals were fed high levels of fructose—60% of their calories—they developed insulin resistance within a week. At levels closer to what Americans consume—20%-- it was a slow development of the disease.

With population-based evidence of a connection between sugar consumption and the diabetes epidemic, an obvious physiologic mechanism, and demonstration of effects in laboratory animals, why is there still ambiguity? Mother Jones Magazine (November 2012) published some fascinating investigative journalism on the Sugar Industry’s campaign to use tobacco-style tactics to sow a level of doubt about the evidence. Through compelling evidence of internal memos, they report on a concerted public relations campaign waged from the 1980s to the present to hire dissenting scientists who would worked to influence regulatory agencies and prevent guidelines that would limit access to sweeteners.  

Thus, the recent FDA guidelines continue to be very vague about the need to limit sugar consumption, and essentially no regulation from the federal level has been offered, despite the tremendous rise in health problems from obesity and diabetes.


From a health awareness perspective, our current level of consumption of sweeteners is a tremendous problem. Limiting sugar, honey, HFCS, and artificial sweeteners appears to be an important step in controlling obesity and diabetes. Federal recommendations seem to be lagging far behind common sense and the scientific evidence. Prevention of these problems through reasonable eating behaviors is much easier than dealing with the problems after they arise.