The Peter Attia Drive - #361 - AMA #74： Sugar and sugar substitutes： weight control, metabolic effects, and health trade-offs

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

00:00:15.880 I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access

00:00:20.320 the AMA episodes in full, along with a ton of other membership benefits we've created,

00:00:24.960 or you can learn more now by going to peteratiyahmd.com forward slash subscribe. So without

00:00:31.300 further delay, here's today's sneak peek of the ask me anything episode.

00:00:38.880 Welcome to ask me anything AMA episode 74. In today's AMA, we're taking a closer look at one

00:00:46.200 of the most common and misunderstood questions we receive, how to evaluate sugar and its substitutes

00:00:53.580 in the context of health. To help answer these questions, we'll walk through a three-part

00:00:58.800 framework that reflects the most popular scenarios where sugar substitutes come into play. One,

00:01:05.760 beverages, things like regular soda versus diet soda. Two, protein supplements, powders and bars,

00:01:13.080 which often rely on sweeteners to make them even remotely palatable. And three, sweet treats,

00:01:19.360 everything from candy to low-calorie desserts, where the goal is simply to satisfy a sweet craving

00:01:26.500 while minimizing the consumption of sugar and calories. We'll discuss why humans are hardwired

00:01:33.540 to crave sweetness and how that evolutionary advantage now collides with today's food environment.

00:01:39.080 Whether or not sugar is uniquely fattening, the evidence on isocaloric comparisons and sugar's rapid

00:01:45.660 effects on hunger hormones. Fructose versus glucose, drinks versus solids, and natural

00:01:52.160 quote-unquote versus refined sugars. Why the timing of your sugar intake matters.

00:01:59.140 What the big three sweeteners, saccharin, aspartame, and sucralose, do and don't deliver for weight loss,

00:02:04.800 glycemic control, and the microbiome. What makes allulose a standout sweetener and why

00:02:10.840 it is challenging to use in all products. Sugar alcohols, erythritol, xylitol, and sorbitol,

00:02:19.200 their calorie savings, common GI pitfalls, and xylitol's unique dental benefits,

00:02:24.060 and the long-term safety of common sweeteners. Do they raise cancer or heart disease risk?

00:02:30.060 If you're a subscriber and you want to watch the full video of this podcast, you can find it on the

00:02:34.980 show notes page. If you're not a subscriber, you can watch the sneak peek of the video on our YouTube

00:02:41.120 page. So without further delay, I hope you enjoy AMA number 74.

00:02:51.500 Peter, welcome to another AMA. How are you doing?

00:02:54.180 Good. Thank you for having me.

00:02:55.940 Ah, yes. Thank you for showing up. Anything interesting going on today? Anything recent going on?

00:03:03.180 Well, I was playing what I thought was the game of my life this morning in chess. And then I made a

00:03:10.340 very tactical blunder and found myself on the receiving end of checkmate inside of two moves

00:03:16.780 at the hands of my seven-year-old, which is becoming a constant theme these days. He's probably beating

00:03:23.860 me six out of 10 games, which is simultaneously enjoyable to watch and infuriating to experience.

00:03:31.420 I was going to say for people who have listened a while, read the book, the assumption would be

00:03:38.420 you might not take losing to a seven-year-old in a mental game, overtly positive. So what's the

00:03:46.220 reaction like when you have a seven-year-old, not only he have his friends lecturing you on

00:03:52.020 diet sodas, which fits to this conversation today, and then they're beating you in chess.

00:03:57.900 I hope that kid is listening. So I am actually not a competitive person. I think people are always

00:04:05.900 surprised to hear that because they assume I am. I'm really not. I'm internally competitive. I'm not

00:04:10.580 at all externally competitive, but chess is different. Chess is the only thing I do because

00:04:17.240 you have to play against another person where I get insanely upset when I lose. And so I'm trying

00:04:24.640 to teach the boys sportsmanship. So every time I lose, I put my hand across the table and I say,

00:04:30.020 good game. And we shake hands. And I have mostly done a good job of that. But a week ago when

00:04:37.360 Ari beat me, I took my king. Well, he was going to beat me. So I was resigning. So I wanted to just

00:04:45.080 tip my king over, which is to say I resign. Or maybe he had checkmated me and I put my king down.

00:04:50.320 But anyway, I was so pissed. I smacked my king across the room. And my wife happened to be sitting

00:04:56.940 there and see this. And she is like, amazing modeling there, Peter. Like, what a great job

00:05:04.560 of a 52-year-old modeling for his two boys how to be a sore loser. Good for you. Good for you.

00:05:12.480 So now you have, you're pissed that you lost, the shame of the realization that your wife is

00:05:19.140 right. Plus you're pissed at her for calling you out. I mean, it was not a fun couple of hours after

00:05:26.120 that. I just love the concept of you and your wife dual parenting, except when you play chess.

00:05:33.900 And at that point, your wife now has four children that she's looking after to make sure

00:05:38.740 they don't do anything rash. My guess is people who are listening right now who don't play chess

00:05:43.300 are like, what are you idiots talking about? I hope that somebody listening also plays chess

00:05:48.220 and can go, yeah, I get it, man. I get it. Sometimes. Look, I've seen videos of Magnus Carlsen

00:05:54.260 taking a sledgehammer to a computer screen when he lost to a bot. So I get it.

00:06:00.140 So there's something to look forward to for you. You still have areas you can move up the ladder

00:06:04.920 in reaction. And it's even better because most people haven't met your seven-year-old,

00:06:10.580 but for anyone who has the joy that he would get when you did that is going to be great because

00:06:15.960 I feel like he loves a little trash talk himself. He does. His nickname is little bag smoker.

00:06:22.300 And he just walks around going, I'm going to smoke your bags. Like I am going to smoke your bags.

00:06:28.520 Oh, I just love it. It's all right. Well, that tangent out the way, what we're talking about

00:06:36.680 today is something we hinted at earlier, which you got lectured on at elementary school the other day,

00:06:42.760 which was diet soda. So today's topic is one that I think is interesting, not only because we get so

00:06:48.640 many questions on it, but I think the reason we get so many questions on it is it's a topic people

00:06:53.460 think about and are faced with decisions day to day. And that's everything around sugar and sugar

00:06:58.980 substitutes. So we'll start looking at sugar, why we're wired to crave it, how it affects appetite,

00:07:05.840 how it affects weight, how it affects metabolic health, natural sugar versus refined sugar,

00:07:11.520 timing of sugar and how much that matters compared to how much you consume. And then we'll look at

00:07:16.360 sugar substitutes, everything from aspartame to sucralose, stevia, monk fruit, allulose,

00:07:22.700 what their effects on weight, insulin, microbiome are, what we know about sugar alcohols like

00:07:29.500 xylitol, erythritol, what we know about the risk of cancer, cardiovascular disease, long-term safety,

00:07:35.820 and then hopefully be able to wrap it up with what your philosophy foundation is for how you

00:07:41.200 apply this knowledge for yourself and patients. So all that said, a lot of good stuff to get to.

00:07:47.860 Anything else you want to add before we get rolling?

00:07:51.460 Two things. One is, this is a topic we covered two years ago, maybe three years ago. And in working

00:07:59.900 with the research team who did an awesome job in the preparation of this, what we saw was there had

00:08:06.260 been so much additional literature on various topics, especially on the non-nutritive sweetener side.

00:08:12.920 So not so much on sugar per se, which we'll start by talking about, but on the sugar substitute side,

00:08:18.160 that I think this is a very important podcast, even if you think you were fully up to speed on

00:08:23.040 our point of view on this based on where we were two years ago. So again, science makes progress.

00:08:28.100 And I think a lot of progress has been made. That's kind of the first comment I would make.

00:08:32.140 Second comment I would make is, despite the fact that we're going to go down a bunch of rabbit holes,

00:08:36.780 I want to make sure everybody listening is anchoring to a framework. This is where we're going to land

00:08:41.680 this plane. Okay. Where I want to be able to land this plane is in a practical recommendation

00:08:46.520 around the following scenarios, which is if I'm currently eating a ton of sugar, is that okay?

00:08:55.000 If not, am I better off switching to sugar substitutes, but at the same quantities of

00:09:02.560 the food that I was eating before? The example I would give here is if I'm sitting here drinking

00:09:07.620 six Mountain Dews a day, would I be better off doing everything the same, but moving to six

00:09:14.760 diet Mountain Dews a day? So I want to be able to land that plane and talk about those trade-offs.

00:09:20.260 The second thing I want to be able to get at is really explore the nuance around what are the,

00:09:27.220 what I think of as the three cases for artificial sweeteners. So let's just put the sugar question

00:09:33.640 aside. And I really think it boils down to three cases. One of them is beverages. So I gave that

00:09:39.300 example a second ago, diet Mountain Dew versus Mountain Dew, diet Coke versus Coke, et cetera.

00:09:43.620 I want to make sure we understand that. The second is in protein products. So this is either protein

00:09:49.920 powders or protein bars. Why this matters comes down to something I don't think I fully understood

00:09:58.580 until I got heavily involved with a company that makes protein bars, David, the David bar.

00:10:04.740 What you don't realize until you get into the world of protein is protein is a brutal macronutrient

00:10:11.620 to work with. The reason I will always maintain that if your goal is to get X number of grams of protein,

00:10:18.820 do your best to get it in real food is that is hands down the best way to do it. If you're trying

00:10:24.400 to hit 150 grams of protein per day, I would like you and I would encourage you to get every gram of

00:10:30.360 that through actual food. The problem is most people can't myself included. Okay. So we are typically

00:10:37.520 relying on at least one form of processed food in the form of protein. Well, largely processed foods in

00:10:45.660 the form of protein fall into two categories and hydrous salty protein, meaning protein sources where the

00:10:53.060 water has been stripped out and a preservative or two has been added. And that's usually in the form

00:10:58.960 of jerky or a stick or something like that. Or you're on a totally different path where you're

00:11:04.040 going with a sweetened protein product, namely in the form of a powder to make a shake or a bar.

00:11:09.600 Why? Why does that latter one have to be sweetened? This is the thing that, again, I didn't fully

00:11:15.300 understand until I kind of got into the chemistry of this stuff. Basically, the short and long answer is

00:11:20.860 protein is impossible to work with and it tastes horrible. That's what it comes down to. I think

00:11:26.180 most people would be surprised at how difficult it is to work with protein compared to carbohydrates

00:11:32.240 and fat and how abhorrent it tastes. So if you can't get all your protein in real food, which we want you

00:11:39.520 to, and you're stuck supporting your protein needs with something that is processed and you don't want to

00:11:46.880 go down the dry salty route, you're going to have to ingest something sweet. And the reason is if you

00:11:52.620 don't, you won't be able to consume it unless you have no taste buds. And even then you probably won't

00:11:57.560 be able to tolerate the texture of it. So this becomes the second very important use case around

00:12:03.720 artificial sweeteners is are you better off with an artificial sweetener or a real sugar in a protein

00:12:09.840 product. The third use case comes down to treats. Do you like sweet treats? I love sweet treats.

00:12:19.120 I love me some licorice. I mean, I just love anything sweet. I'm not particularly unique in

00:12:25.140 that regard, but I do. And so that becomes the third meta case that I want to make sure people

00:12:30.960 are thinking through, which is if I want something sweet and it's not fruit, am I better off eating

00:12:37.480 something sweet that is sweetened with sucrose or high fructose corn syrup or pick your favorite

00:12:42.880 thing or something that is sweetened with one of these artificial sweeteners? Okay. I say all of

00:12:47.980 that Nick to just make sure that the listener understands where we're going. Thank you for

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The Peter Attia Drive - August 18, 2025

#361 - AMA #74： Sugar and sugar substitutes： weight control, metabolic effects, and health trade-offs

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