The Peter Attia Drive - #141 - AMA #18： Deep dive： sugar and sugar substitutes

00:00:00.000 Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.

00:00:16.500 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can

00:00:20.460 access the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:25.440 or you can learn more now by going to peteratiyahmd.com forward slash subscribe.

00:00:31.120 So without further delay, here's today's sneak peek of the ask me anything episode.

00:00:39.200 Welcome to ask me anything episode number 18. Once again, joined by my head of research,

00:00:45.380 Bob Kaplan. In today's episode, we talk exclusively about sugar and sugar substitutes. There've been

00:00:52.700 a lot of questions posed about so many aspects of this. So questions that are follow-ups to the,

00:00:58.620 what is it about sugar that's so bad? Is sucrose worse than high fructose corn syrup? Those types

00:01:03.000 of questions. What about naturally occurring sugars? So we sort of tackle a bunch of those questions.

00:01:09.040 And then the other half of the episode gets into all the substitutes for sugar, which are largely

00:01:13.600 broken down into three categories, the non-nutritive versions. Those are things like

00:01:18.100 aspartame and stevia, which again, you could further subdivide as naturally occurring versus

00:01:22.480 synthetic, the alcohol sugars, and then actual sugars that are not sugar, such as allulose. And

00:01:28.840 that's a question that has come up specifically. So I think that anyone who's interested in allulose,

00:01:33.520 which I've talked about in the past, will find this episode very interesting. So without further

00:01:37.940 delay, I hope you enjoy AMA number 18. Hey, Peter, how you doing? Doing awesome, man.

00:01:50.060 Unfortunately, I didn't get a name to put up. I was going to put on Cleon Daskalakis as my username

00:01:55.320 for this one, for this AMA, keeping with the thread of 80s goalies. That one stumps me, man.

00:02:01.080 The backup goaltender for the Boston Bruins, I want to say mid-80s, 84, 86. He might've played

00:02:08.020 double-digit games. I think he's from Boston, went to Boston University, I remember, and backed

00:02:13.040 up either both these people, Pete Peters and Doug Keens. Of course. Yeah. Prior to the Bill

00:02:17.540 Ranford and Andy Moog days, the sloppy seconds from the Edmonton Oilers. Well, we've got a pretty

00:02:24.000 good one here for today, Bob. We're going to talk about sugar and probably do so in a way that

00:02:29.940 I'm guessing most people aren't prepared for the depth we're going to go into on both sugar and

00:02:37.120 artificial sweeteners. Because we have just been getting so many questions on this topic

00:02:41.380 that I think we decided collectively, don't scatter this information too broadly and do it in sort of

00:02:48.060 a half-baked way. Like let's put together kind of the all singing, all dancing place for it to exist,

00:02:53.520 both in audio form and also with show notes. And the team's been working pretty hard on assembling

00:02:58.160 this. So where do you want to start this discussion around artificial sweeteners, sugars? What do you

00:03:03.880 think is the best way into this? Probably talk about sugar in general. I think a lot of the

00:03:08.300 questions were, one was on allulose in particular, but really, and some of them were on safety. Are

00:03:14.380 these non-nutritive sweeteners safe? Are all sweeteners basically the same? Are they more or less,

00:03:18.860 are they all created equal? So it's probably makes sense to back up and talk about sugar and what

00:03:23.760 that term actually means. Yeah. And we actually had a Sunday email that kind of covered this topic

00:03:29.500 because as we were putting our thoughts together for this AMA, we realized that we should also at

00:03:35.900 least put some of those together in the Sunday email. So yeah, let's take this step back and talk

00:03:41.480 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

00:03:46.280 spot for me. I hate inaccurate nomenclature. It really, really grinds my gears. So unfortunately,

00:03:56.040 the word sugar just upsets me. It gives me a little bit of chest pain, tons of consternation.

00:04:03.900 I don't like it. I don't like talking about it, but I'm going to explain why that's the case.

00:04:08.880 The reason I'm frustrated by this terminology is it means a lot of different things. And all of

00:04:16.080 those things can be true. Glucose is a sugar. Galactose is a sugar. Fructose is a sugar.

00:04:25.360 Sucrose is a sugar. As you mentioned, allulose is a sugar. Now to lump all of those things in one

00:04:33.300 category is unhelpful. So what I instead want to do is get folks to sort of think about these things

00:04:42.940 through the lens of molecules and less through their names. In other words, it's sort of like

00:04:49.800 if you were trying to evaluate a hockey team, it wouldn't be very helpful if you only thought of

00:04:55.580 them as, Hey, that's Bob, that's Peter, that's Richard, that's Nick. It would be more helpful

00:05:02.460 if you could think that's a goalie. He's pretty good. He sort of does this. He does that. That's

00:05:07.180 a defenseman. He plays this way. He shoots this way. In other words, think of them through their

00:05:11.680 basic attributes and not through the most generic nomenclature of their existence. Okay. So let's

00:05:17.900 start with the two monomers that we care most about glucose and fructose. So what do I mean by

00:05:27.540 monomers? So monomers means these things form the simplest building blocks of carbohydrates.

00:05:37.340 Now, both glucose and fructose actually have the same chemical formula, which is kind of

00:05:44.300 interesting, isn't it? In other words, they have the same number of carbons, the same number of

00:05:49.780 hydrogens, and the same number of oxygens. So if you looked at them in their chemical formula, they

00:05:55.280 would both be C6, six carbons, H12, 12 hydrogens, O6, six oxygens. They're obviously not the same,

00:06:03.480 or we'd give them the same name. Glucose is arranged in a six carbon ring, whereas fructose

00:06:11.000 is arranged in a five carbon ring. And one of those carbons hangs outside the balance.

00:06:16.480 So it sticks outside the ring. And it turns out that makes all the difference in the world. That

00:06:21.420 to me is one of just the coolest things about biology and biochemistry specifically is even

00:06:26.520 the minorest tweak can have a profound difference. Now, I'm not going to go into this in huge detail

00:06:32.100 today. But Bob, how many podcasts do we have where we've touched on the difference between glucose

00:06:38.180 and fructose? Rob Lustig, I think, talked about it. Rick Johnson is another one where we talked about

00:06:43.620 glucose versus fructose. Yeah. Those would be the two best, right? I think Rob Lustig and Rick Johnson

00:06:48.960 do an exceptional job explaining why all things equal if you just took humans or mice or dogs or camels

00:06:58.780 and force fed them glucose or fructose to their heart's content. Even though they're the same

00:07:04.600 chemical formula and very similar chemical structure, they would have dramatically different

00:07:09.660 metabolic effects. Now we rarely consume fructose by itself. We often consume glucose by itself in the

00:07:19.180 sense that when starches are broken down, they often end up in the form of glucose. So if you're eating

00:07:25.920 a bowl of rice or consuming pasta, that will often break down from more complex starches into simple

00:07:35.260 monomers of glucose. But usually when you're consuming things that are sweet, i.e. things that

00:07:42.200 contain fructose, they come with a dose of glucose as well. So if you're eating an apple or consuming

00:07:48.860 honey, eating a mango, you're getting some balance of glucose and fructose in that fruit. And as a

00:07:56.680 general rule, the sweeter it is, the more fructose it has. Okay. Is glucose a sugar? Yes. Is fructose a

00:08:03.760 sugar? Yes. Are they the same? Not even close. When people use the word sugar, I think the first thing

00:08:12.260 that jumps to mind is probably something that is technically referred to as sucrose. Sucrose is what

00:08:20.740 happens when you take one molecule of glucose and one molecule of fructose and put them together

00:08:28.620 covalently. So that means they are bonded together and you now have what's called a disaccharide. And as

00:08:35.000 the name suggests, that's what happens when you take two monosaccharides and merge them and you get

00:08:41.240 this disaccharide. The easiest example of where sucrose exists is refined sugar. So when you look

00:08:48.760 at white granulated sweet sugar, that is exactly what sucrose is. And the easiest places that we get

00:08:55.420 that are basically refining it out of things like canes and beets and things like that. And I remember

00:09:02.600 as a kid, actually, when we would go back and visit my grandparents, guys out working in the field

00:09:07.880 were picking canes. And I remember sucking on those canes like there was no tomorrow. And I just couldn't

00:09:12.900 believe how good they tasted. And the reason they tasted so damn good was I was just mainlining sucrose

00:09:18.860 out of these very fibrous canes. I still remember this. Like it was like chewing on a stick. You can

00:09:25.560 extract the sucrose out of that just as you can with beets. And that's how we make sucrose. I don't know

00:09:32.000 the numbers, Bob. You might. Do you have a sense of what the relative distribution of U.S. consumption

00:09:38.480 of sucrose versus high fructose corn syrup is? Not off the top of my head. Directionally, is it more

00:09:44.800 high fructose corn syrup? Yeah, I think it's like it's ebbed and flowed because I think if you go do

00:09:50.320 the whole history, but back in the Nixon era, I think Lustig talked about this quite a bit. We had sugar

00:09:55.260 and then we introduced high fructose corn syrup and fructose. The name fructose comes from fruit. So it's a fruit

00:10:00.960 sugar. So we all thought that fructose is almost like a health food. And I think actually for

00:10:06.160 diabetics as well, I remember this, that things like honey, people would say, oh, it's okay for

00:10:10.660 diabetics because we'll probably get into this, that fructose doesn't stimulate insulin secretion the way

00:10:15.460 that glucose does. High fructose corn syrup, it's a four-letter acronym, but it's like a four-letter

00:10:20.540 word now. But for a time, we almost thought of it as a health food. Consumption skyrocketed. And now I

00:10:27.160 think it's relevant probably to this conversation as well, that there's been a turn towards

00:10:30.940 almost back to quote unquote natural sugars, which gets into the argument too. You'll hear it often

00:10:36.380 that people will say, well, probably this is a question we'll get to. You're better off having

00:10:40.840 the Coke versus the diet Coke because the diet Coke is full of chemicals and the Coke contains

00:10:45.220 sugar. And that's something that we can naturally handle. We've got our blood sugar. So again,

00:10:51.340 you talk about terminology and how that gets confused, but I think there was a really big spike in high

00:10:56.760 fructose corn syrup. And now I think that there's been like a, it's almost supply and demand market

00:11:02.020 driven perhaps that people, if they had the choice between high fructose corn syrup and sugar, I think

00:11:07.280 they now think that sugar is quote unquote healthier, less deleterious than high fructose corn syrup.

00:11:13.200 Yeah. And I'm glad you brought up the, going back to the early seventies, because it is kind of an

00:11:17.760 interesting story, which goes back to basically it was either an embargo or some tariffs or something

00:11:25.540 like that on sugar. And there was this new technology, I think being developed in Japan

00:11:31.480 that could effectively make something almost like sucrose, but in a solution. So instead of taking

00:11:38.540 one-to-one glucose fructose and fusing these things in this disaccharide, you could say, Hey, look,

00:11:44.680 why not just take a solution of glucose, a solution of fructose? It was not 50, 50, it was 45, 55 in

00:11:53.040 favor of fructose. So that made it a little sweeter. And basically you could produce this in unlimited

00:11:57.980 quantities, problem solved. And you make a very good point, which was there was a belief. And frankly,

00:12:04.240 there probably still is a belief that fructose is better for someone with diabetes because you don't

00:12:10.040 have to chase it with insulin. Of course, notwithstanding the fact that fructose does so much for insulin

00:12:15.980 resistance. We're not going to get into that as much detail now, because we'll get into it a bit more

00:12:20.400 later. And of course it's been covered exquisitely and beautifully by both Rob and Rick. And I think

00:12:26.940 you're absolutely right that probably into the early two thousands, high fructose corn syrup was the

00:12:34.520 dominant sweetener added to foods. And there's been a little bit of a revolt. And of course the

00:12:41.800 irony of it, it's been back to things that are more natural, quote unquote, it's like, Oh, don't

00:12:46.340 give me your high fructose corn syrup. I'm going to eat my dried mangoes and my dates. And even sucrose

00:12:54.040 is probably better. So let's move on to that point. There's another distinction that most people have

00:12:58.780 probably noticed when they look at food labels, which is sugars and added sugars, a properly

00:13:05.140 adherent food label will list both. It will say carbohydrates, fiber, grams, sugar, grams, and

00:13:13.420 beneath that added sugar, grams. So what do all of those numbers mean? Thank you for listening to

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The Peter Attia Drive - December 14, 2020

#141 - AMA #18： Deep dive： sugar and sugar substitutes

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