The Peter Attia Drive - August 18, 2025


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

Hosted by
Peter Attia
Mentioned
Mountain Dew David
#360 ‒ How to change your habits： why they form and how to build or break them ｜ Charles Duhigg, M.B.A Lower back pain： causes, treatment, and prevention of lower back injuries and pain ｜ Stuart McGill, Ph.D. (#287 rebroadcast)

Episode Stats


Length

15 minutes

Words per minute

167.04

Word count

2,655

Sentence count

153

Harmful content

Misogyny

2

sentences flagged

Toxicity

4

sentences flagged

Hate speech

4

sentences flagged


Summary

Summaries generated with gmurro/bart-large-finetuned-filtered-spotify-podcast-summ .

In today's AMA, we re taking a closer look at one of the most common and misunderstood questions we receive: How to evaluate sugar and its substitutes in the context of health. To help answer these questions, we ll walk through a three-part framework that reflects the most popular scenarios where sugar substitutes come into play: beverages, things like regular soda versus diet soda, protein supplements, and bars which often rely on sweeteners to make them even remotely palatable, and sweet treats where the goal is simply to satisfy a sweet craving while minimizing the consumption of sugar and calories.

Transcript

Transcript generated with Whisper (turbo).
Misogyny classifications generated with MilaNLProc/bert-base-uncased-ear-misogyny .
Toxicity classifications generated with s-nlp/roberta_toxicity_classifier .
Hate speech classifications generated with facebook/roberta-hate-speech-dynabench-r4-target .
Hosts, guests, and mentioned names generated with spaCy (en_core_web_sm), reconciled against Wikidata.
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 0.91
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 1.00
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. 0.98
00:05:12.480 So now you have, you're pissed that you lost, the shame of the realization that your wife is 0.64
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 0.97
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 1.00
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 0.66
00:06:15.960 I feel like he loves a little trash talk himself. He does. His nickname is little bag smoker. 0.85
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 1.00
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. 1.00
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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