CentraState - Healthy Directions

The Skinny on Sugar Substitutes A merican consumers are confronted in supermarkets and restaurants by an enormous variety of sugar substitutes. The overconsumption of sugar and the addition of sugar derivatives has been directly linked to the explosion of diabetes incidence in the United States. How does a consumer, particularly one who is concerned about their sugar consumption, such as a person with diabetes, navigate through these choices? "They need to understand the differences and risks of these products," says Spencer Kroll, MD, a board-certified internal medicine physician and lipidologist and on staff at CentraState. "Sugar substitutes can broadly be divided into artificial sweeteners and natural sweeteners. Although the intention of putting these sweeteners in foods is to lower caloric content and have less effect on blood sugar, many of these substitutes have direct dangerous side effects. Sugar substitutes, in the form of other saccharides, such as fructose, could cause more weight gain than eating straight sugar." There is some evidence to suggest plant-derived sugar substitutes, most notably high fructose corn syrup, could be a contributor in the rise of diabetes incidence. These substitutes include all of the processed corn derivatives such as maltose, dextrose, and other plant-based substitutes such as agave syrup. Artificial sweeteners have a long history of controversy due to their potential increased risk of cancer causation. The FDA has released maximum intake levels of these artificial sweeteners such as saccharin and aspartame, whose daily intake are often surpassed by the average consumer. "A recent concern comes from several credible studies that suggest that artificial sweeteners increase appetite, thereby causing overconsumption of food and ultimately also increasing blood sugar levels," Dr. Kroll says. "So far they seem to be safe alternatives that balance the risks and the benefits of calorie and sugar reduction for patients with diabetes. These sugar substitutes have not been on the market for very long and studies are ongoing as to their safety." Let's take a look at some of the popular substitutes and their pros and cons: Agave Marketed as: Agave nectar 1.5x sweeter than sugar Source: agave plant Calories per serving: 21 Pros: For a sweetener that's not too sweet and is derived from a natural source, agave is a good solution that is similar to honey and dissolves well. It has a neutral taste compared to honey and sugar, and is vegan. Cons: Agave is high in fructose, so it's not an ideal choice for people with pre-diabetes or diabetes. It is also relatively high in calories compared to other sugar alternatives. Dr. Kroll's comment: This is a sugar substitute similar to corn syrup. It will similarly raise a patient's blood sugar. People with diabetes should stay away from this and not be lulled into a false sense of security because this is still ultimately broken down to sugar. Spencer Kroll, MD, board-certified internal medicine physician Winter 2016 Healthy Directions 14

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