#141 - AMA #18： Deep dive： sugar and sugar substitutes
Episode Stats
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Summary
In this episode, Dr. Bob Kaplan and I discuss sugar, artificial sweeteners, and sugar substitutes. We discuss the pros and cons of all three, as well as some of the non-nutritive sugar substitutes, such as aspartame, stevia, and other sugars that aren't naturally occurring sugars such as allulose.
Transcript
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Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
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I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can
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So without further delay, here's today's sneak peek of the ask me anything episode.
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Welcome to ask me anything episode number 18. Once again, joined by my head of research,
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Bob Kaplan. In today's episode, we talk exclusively about sugar and sugar substitutes. There've been
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a lot of questions posed about so many aspects of this. So questions that are follow-ups to the,
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what is it about sugar that's so bad? Is sucrose worse than high fructose corn syrup? Those types
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of questions. What about naturally occurring sugars? So we sort of tackle a bunch of those questions.
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And then the other half of the episode gets into all the substitutes for sugar, which are largely
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broken down into three categories, the non-nutritive versions. Those are things like
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aspartame and stevia, which again, you could further subdivide as naturally occurring versus
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synthetic, the alcohol sugars, and then actual sugars that are not sugar, such as allulose. And
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that's a question that has come up specifically. So I think that anyone who's interested in allulose,
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which I've talked about in the past, will find this episode very interesting. So without further
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delay, I hope you enjoy AMA number 18. Hey, Peter, how you doing? Doing awesome, man.
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Unfortunately, I didn't get a name to put up. I was going to put on Cleon Daskalakis as my username
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for this one, for this AMA, keeping with the thread of 80s goalies. That one stumps me, man.
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The backup goaltender for the Boston Bruins, I want to say mid-80s, 84, 86. He might've played
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double-digit games. I think he's from Boston, went to Boston University, I remember, and backed
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up either both these people, Pete Peters and Doug Keens. Of course. Yeah. Prior to the Bill
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Ranford and Andy Moog days, the sloppy seconds from the Edmonton Oilers. Well, we've got a pretty
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good one here for today, Bob. We're going to talk about sugar and probably do so in a way that
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I'm guessing most people aren't prepared for the depth we're going to go into on both sugar and
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artificial sweeteners. Because we have just been getting so many questions on this topic
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that I think we decided collectively, don't scatter this information too broadly and do it in sort of
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a half-baked way. Like let's put together kind of the all singing, all dancing place for it to exist,
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both in audio form and also with show notes. And the team's been working pretty hard on assembling
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this. So where do you want to start this discussion around artificial sweeteners, sugars? What do you
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think is the best way into this? Probably talk about sugar in general. I think a lot of the
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questions were, one was on allulose in particular, but really, and some of them were on safety. Are
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these non-nutritive sweeteners safe? Are all sweeteners basically the same? Are they more or less,
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are they all created equal? So it's probably makes sense to back up and talk about sugar and what
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that term actually means. Yeah. And we actually had a Sunday email that kind of covered this topic
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because as we were putting our thoughts together for this AMA, we realized that we should also at
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least put some of those together in the Sunday email. So yeah, let's take this step back and talk
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about sugar. And this is a, as you know, Bob, you've known me for, I don't know, 10 years. This is a sore
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spot for me. I hate inaccurate nomenclature. It really, really grinds my gears. So unfortunately,
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the word sugar just upsets me. It gives me a little bit of chest pain, tons of consternation.
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I don't like it. I don't like talking about it, but I'm going to explain why that's the case.
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The reason I'm frustrated by this terminology is it means a lot of different things. And all of
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those things can be true. Glucose is a sugar. Galactose is a sugar. Fructose is a sugar.
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Sucrose is a sugar. As you mentioned, allulose is a sugar. Now to lump all of those things in one
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category is unhelpful. So what I instead want to do is get folks to sort of think about these things
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through the lens of molecules and less through their names. In other words, it's sort of like
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if you were trying to evaluate a hockey team, it wouldn't be very helpful if you only thought of
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them as, Hey, that's Bob, that's Peter, that's Richard, that's Nick. It would be more helpful
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if you could think that's a goalie. He's pretty good. He sort of does this. He does that. That's
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a defenseman. He plays this way. He shoots this way. In other words, think of them through their
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basic attributes and not through the most generic nomenclature of their existence. Okay. So let's
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start with the two monomers that we care most about glucose and fructose. So what do I mean by
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monomers? So monomers means these things form the simplest building blocks of carbohydrates.
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Now, both glucose and fructose actually have the same chemical formula, which is kind of
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interesting, isn't it? In other words, they have the same number of carbons, the same number of
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hydrogens, and the same number of oxygens. So if you looked at them in their chemical formula, they
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would both be C6, six carbons, H12, 12 hydrogens, O6, six oxygens. They're obviously not the same,
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or we'd give them the same name. Glucose is arranged in a six carbon ring, whereas fructose
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is arranged in a five carbon ring. And one of those carbons hangs outside the balance.
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So it sticks outside the ring. And it turns out that makes all the difference in the world. That
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to me is one of just the coolest things about biology and biochemistry specifically is even
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the minorest tweak can have a profound difference. Now, I'm not going to go into this in huge detail
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today. But Bob, how many podcasts do we have where we've touched on the difference between glucose
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and fructose? Rob Lustig, I think, talked about it. Rick Johnson is another one where we talked about
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glucose versus fructose. Yeah. Those would be the two best, right? I think Rob Lustig and Rick Johnson
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do an exceptional job explaining why all things equal if you just took humans or mice or dogs or camels
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and force fed them glucose or fructose to their heart's content. Even though they're the same
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chemical formula and very similar chemical structure, they would have dramatically different
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metabolic effects. Now we rarely consume fructose by itself. We often consume glucose by itself in the
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sense that when starches are broken down, they often end up in the form of glucose. So if you're eating
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a bowl of rice or consuming pasta, that will often break down from more complex starches into simple
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monomers of glucose. But usually when you're consuming things that are sweet, i.e. things that
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contain fructose, they come with a dose of glucose as well. So if you're eating an apple or consuming
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honey, eating a mango, you're getting some balance of glucose and fructose in that fruit. And as a
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general rule, the sweeter it is, the more fructose it has. Okay. Is glucose a sugar? Yes. Is fructose a
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sugar? Yes. Are they the same? Not even close. When people use the word sugar, I think the first thing
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that jumps to mind is probably something that is technically referred to as sucrose. Sucrose is what
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happens when you take one molecule of glucose and one molecule of fructose and put them together
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covalently. So that means they are bonded together and you now have what's called a disaccharide. And as
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the name suggests, that's what happens when you take two monosaccharides and merge them and you get
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this disaccharide. The easiest example of where sucrose exists is refined sugar. So when you look
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at white granulated sweet sugar, that is exactly what sucrose is. And the easiest places that we get
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that are basically refining it out of things like canes and beets and things like that. And I remember
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as a kid, actually, when we would go back and visit my grandparents, guys out working in the field
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were picking canes. And I remember sucking on those canes like there was no tomorrow. And I just couldn't
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believe how good they tasted. And the reason they tasted so damn good was I was just mainlining sucrose
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out of these very fibrous canes. I still remember this. Like it was like chewing on a stick. You can
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extract the sucrose out of that just as you can with beets. And that's how we make sucrose. I don't know
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the numbers, Bob. You might. Do you have a sense of what the relative distribution of U.S. consumption
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of sucrose versus high fructose corn syrup is? Not off the top of my head. Directionally, is it more
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high fructose corn syrup? Yeah, I think it's like it's ebbed and flowed because I think if you go do
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the whole history, but back in the Nixon era, I think Lustig talked about this quite a bit. We had sugar
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and then we introduced high fructose corn syrup and fructose. The name fructose comes from fruit. So it's a fruit
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sugar. So we all thought that fructose is almost like a health food. And I think actually for
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diabetics as well, I remember this, that things like honey, people would say, oh, it's okay for
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diabetics because we'll probably get into this, that fructose doesn't stimulate insulin secretion the way
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that glucose does. High fructose corn syrup, it's a four-letter acronym, but it's like a four-letter
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word now. But for a time, we almost thought of it as a health food. Consumption skyrocketed. And now I
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think it's relevant probably to this conversation as well, that there's been a turn towards
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almost back to quote unquote natural sugars, which gets into the argument too. You'll hear it often
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that people will say, well, probably this is a question we'll get to. You're better off having
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the Coke versus the diet Coke because the diet Coke is full of chemicals and the Coke contains
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sugar. And that's something that we can naturally handle. We've got our blood sugar. So again,
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you talk about terminology and how that gets confused, but I think there was a really big spike in high
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fructose corn syrup. And now I think that there's been like a, it's almost supply and demand market
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driven perhaps that people, if they had the choice between high fructose corn syrup and sugar, I think
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they now think that sugar is quote unquote healthier, less deleterious than high fructose corn syrup.
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Yeah. And I'm glad you brought up the, going back to the early seventies, because it is kind of an
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interesting story, which goes back to basically it was either an embargo or some tariffs or something
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like that on sugar. And there was this new technology, I think being developed in Japan
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that could effectively make something almost like sucrose, but in a solution. So instead of taking
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one-to-one glucose fructose and fusing these things in this disaccharide, you could say, Hey, look,
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why not just take a solution of glucose, a solution of fructose? It was not 50, 50, it was 45, 55 in
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favor of fructose. So that made it a little sweeter. And basically you could produce this in unlimited
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quantities, problem solved. And you make a very good point, which was there was a belief. And frankly,
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there probably still is a belief that fructose is better for someone with diabetes because you don't
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have to chase it with insulin. Of course, notwithstanding the fact that fructose does so much for insulin
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resistance. We're not going to get into that as much detail now, because we'll get into it a bit more
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later. And of course it's been covered exquisitely and beautifully by both Rob and Rick. And I think
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you're absolutely right that probably into the early two thousands, high fructose corn syrup was the
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dominant sweetener added to foods. And there's been a little bit of a revolt. And of course the
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irony of it, it's been back to things that are more natural, quote unquote, it's like, Oh, don't
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give me your high fructose corn syrup. I'm going to eat my dried mangoes and my dates. And even sucrose
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is probably better. So let's move on to that point. There's another distinction that most people have
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probably noticed when they look at food labels, which is sugars and added sugars, a properly
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adherent food label will list both. It will say carbohydrates, fiber, grams, sugar, grams, and
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beneath that added sugar, grams. So what do all of those numbers mean? Thank you for listening to
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