Sugar and Sweeteners: Everything You Need to Know

Sugar and Sweeteners: Everything You Need to Know

Dr. Sarah  0:16  

That is a very good question. The answer is, it depends. It’s actually, I can’t actually give you a quick yes or no, so let’s actually talk about the health impact of over abundance of sugar in our diets, and then talk about non nutritive sweeteners as a substitute and where those fall in so and also, let’s talk about this not from a weight perspective. I feel like the the studies looking at how swapping out soda for diet soda or water for diet soda in terms of weight loss is kind of a different it’s a different way to look at the value of those foods, and I think one that I don’t care at all about, like I just I don’t care. I don’t care what it does for weight. I care about what it does for health. So let’s look at things that are related to health, like cardiovascular disease risk or cancer risk or all cause mortality risk, which is a general indicator of health and longevity that’s used in scientific studies to determine whether or not something is good or bad for us overall. So I’m just gonna, I’m not even, I’m just gonna ignore the studies that are measuring the benefit for weight loss goals, because I just feel like that’s like it might be relevant to you, dear viewer, but I don’t feel like it’s relevant to nutrivore as a dietary concept, the concept of getting all of the nutrients our bodies need from the foods we eat and to support health through long term beneficial eating patterns, right? So we’re going to just take this from a health perspective and not from a weight perspective. And I think it’s the little bit simpler if we take it from a health perspective. So from a health perspective, getting more than 10% of our calories from added sugars. So that is the simple sugars, like table sugar, cane sugar, right? Maple syrup, honey, corn syrup, right? Like invert sugar, all of those types of things added to foods that can be added to food in the processing. So it might be in the packaged food you’re buying. If you are buying a packaged food, added sugars have to be on the nutrition facts label, so you can just look and see how many grams of added sugars there are per serving. But it can also be the sugar that you add at home, the maple syrup you pour in your pancakes, or the spoon of sugar you add to your coffee, or the spoon of honey that you add to your tea. So added sugar refers to the sugars that you add to food, and when more than 10% of our calories come from added sugar that increases risk of cardiovascular disease, how much more than 10% will determine how much more it increases risk of cardiovascular disease. But what’s important is we can get up to 10% of our calories from added sugars without that having any kind of negative health impact, and when we consider total sugars, so we’re considering both added sugars as well as the sugars inherent to foods like fruit and milk, then we can get up to 25% of Our calories, maybe even up to 30, like, definitely 25 but maybe, maybe even maybe it’s a little bit higher than that, but up to 25% or calories from total sugars without it causing any signal to cardiovascular disease incidence or mortality, or all cause mortality, So we don’t see any health harm from up to 25% of our diets from total sugars, and up to 10% of our diets from added sugars. So if you were going to swap out your regular soda for diet soda, it your your regular sugar, your spoonful of regular sugar, for your little packet of of a non nutritive sweetener, it depends, like whether or not that’s beneficial depends on, were you starting above or below that 10% threshold. If you were starting below that 10% threshold, and you’re just doing a swap, so about the same amount equivalent of non nutritive sweeteners. Both of those things are health neutral, if we’re talking higher. So here’s the thing, is also above the equivalent, and studies the thresholds a little bit murky. So some studies show about the equivalent of one diet soda per day. Others show. So one and a half or two diet sodas a day, but about that amount of sugar substitutes, right? Things like aspartame, so somewhere around that is the threshold above which there is a signal from non nutritive sweeteners. In the studies, this has not been as rigorously studied as sugar. There’s not as much data, but we do have some big cohort studies now that show that high consumption of non nutritive sweeteners also increases cardiovascular disease risk and cancer risk and risk of all cause mortality compared to not consuming non nutritive sweeteners, but the amount that something like aspartame increases the risk of cardiovascular disease or cancer is less than the amount that sugar does if we’re above that threshold. So what this means is that if you were, say, consuming 20% of your calories from added sugar, swapping out half of those for sweeteners is or all of it for sweeteners, you might be still above that threshold where, like the sweetener is still increasing your risk, but it’s not as high as your risk was if all of that was sugar. So you are still lowering your overall risk of long term health problems by swapping out all of that excess added sugar for a non nutritive sweetener. But if you’re at that 10% calories from sugar, added sugar level or below, there’s no benefit. If you were not consuming any added sugar, and you’re like, oh, now I’m, I’m now a Diet Coke drinker, but I was drinking water before. That’s now dialing up your risk so it completely like the answer to this question is, it completely depends on what our starting point is, right, how much are we consuming now and then? How much are we swapping it out for? And how much is our like, our total consumption after that swap. So as long as we’re kind of below 10% calories from added sugars, was quite a lot of sugar, by the way. So if you consume a 2000 calorie per day diet, 10% of those calories would be 200 calories. That’s 50 grams of sugar, which is about a quarter cup of, like table sugar per day would be 10% of your calories of a 2000 calorie per day diet. There’s lots of sneaky places. So depending on the foods that you eat, you might not have quite that much room. And depending on, you know, if you’re a person who drinks sweet tea or soda or adds sugar to your coffee, like it can add up above a quarter cup pretty quickly. But also, if you’re somebody who eats a mainly whole foods diet, that’s a lot of room for dessert or, you know, a treat, you know, like that’s a lot of sugar that has no health harm. So depending on what your starting point is, it might be hard to get down to a quarter cup of sugar per day, but it might feel like absolutely liberating, because you can eat up to a quarter cup of sugar per day, so depending on your starting point, that was either good news

Producer Potts  8:07  

or bad news. Okay, can I just clarify here, just to make sure I’m following you correctly, because I’m sure the audience has this question too. So are you saying that if I am drinking regular Coke and that stays under that 50 grams of sugar a day, it’s about benefit. Okay, so if I’m drinking one can of Coke a day, there’s no benefit to swapping that out for diet. However, if I’m having two cans a day, it would be good to have one diet and one regular and I would still be health neutral. But if I’m having like, three or four more a day, the regular Coke plus the two Diet Cokes, are probably getting me up to that risk level, and I need to dial that down. Anyways. Does that make sense? Am I stacking that correctly?

Dr. Sarah  8:59  

I feel like it’s time to pull out the whiteboard.

Producer Potts  9:01  

Oh, no, okay, okay, let’s do it.

Dr. Sarah  9:05  

So let’s draw risk of badness, risk of something bad happening on the Y axis. And we all have kind of like a baseline risk, right? That is related to our genetics and epigenetics, our access to medical care, social determinants of health, our diet and lifestyle, our other health related behaviors, like whether or not we smoke or drink. So we’re gonna say that. We’re gonna call that like. That’s our zero line, right? So, okay, our zero line is like, my risk of health, badness related to all of my things. Now we’re just going to modify sugar, and we’re just gonna, we’re gonna, basically, we’re gonna call it 50 gram implement and like 10% of calories, like one Coke, um. Uh, sort of like increments of what we’re doing here. So okay, a one coke person versus a two coke person. So if I have one can of Coke a day, my risk is going to stay here. It’s going to stay on the zero line. So this is, this is where it is. It’s nothing. If I swap that out for Diet Coke. It’s still here. It didn’t change at all. Okay, so it doesn’t matter. So if I really want the regular Coke, that’s what I want to do with my added sugars for the day. I should have the coke.

Producer Potts  10:39  

 If I really want something else with my added sugars and I want, I then I can regular

 ice cream, versus, like, a sugar free ice cream or something.

Dr. Sarah  10:43  

Let’s say, let’s say I want to have chocolate chip cookies, like regular, like my grandma’s special recipe. Oh, I’m gonna have my diet coke so I can have the chocolate chip cookies so I can stay below 10% of sugar. But that’s also like, not enough added or not enough non nutritive sweeteners to cause anything. So here, here’s what happens.

Producer Potts  11:02  

Oh, wait, so are you saying, Hold on now, I want to make sure. So let’s say so I could have my regular Coke, yes, and then I could have something that’s a similar amount of a non nutritive sweetener, and I will still say level, yes. Wow. That’s amazing. Okay, that’s cool. 

Dr. Sarah  11:23  

Okay,  they both have a threshold above which our risk of health badness increases. So as long as we’re below that threshold for added sugars and for non nutritional sweeteners, we’re good. Okay, so then let’s say we’re talking about two Cokes, right? 20% of calories from added sugars. We’re up here now. Our risks are increased. We got here. So now, if I, uh, if I swap out one of these, like, this is two, this is two cans, right? This is the toucan, Toucan Sam, that, wow, that’s that’s not, not the word can, okay, so that’s, that’s our 20% of calories. So if I swap out one of those cokes for Diet Coke, I’m back down to here. I’m back down to health neutral, because now I am below the threshold for both of those things.

Producer Potts  12:18  

Oh, okay, okay, gotcha again.

Dr. Sarah  12:22  

This is not that is not making room for grammar. Chocolate chip cookies. Okay, right? No, I got what you’re saying? Like, Coke is my favorite thing, by the way. We’re not sponsored by coke. It’s just like the default

Producer Potts  12:32  

so or Pepsi, whatever your whatever your thing is, okay,

Dr. Sarah  12:36  

So now let’s say we’re at three cans. Okay, okay. Three. Wow. I cannot write. I cannot write on the side. This is really challenging. Okay, so now we’re at three cans. We’re at 30% calories from added sugar. So let’s say I swap out one of those cans for diet soda. So I’m gonna kind of come back to this level, right? So that’s kind of where I would end up, because, uh, the diet soda is below the threshold of causing issues, but now the sugar is still above the threshold. Okay, so we’ll come back down to, like, about equal to our two cans. Let’s say I swap out two of those cans. I’m not going to come back down here yet. I’m going to come here. My risk will be somewhere in the middle, because now I’m on one can of regular Coke and two cans of diet. I’m below the threshold for the sugar. We’re at the threshold, but I’m above the threshold for the non nutritive sweeteners to start increasing risk. Gotcha, your health issues. And this is like, also, this is not once in a while, like one day where you have five Cokes, or have five Diet Cokes, like that doesn’t matter. This is every single day over years, increasing risk by a percentage, right? So, yeah, again and above your baseline. So then, let’s say we were having four cans a day four. I did it for the first time. Okay, so now, right? If we swap out one of those cans, we’re going to end up here at our risk, right? Kind of similar to the three cans, right? If we swap out two of those cans, now we’re going to end up here, because now we’re still that much higher, above the threshold for sugar and above the threshold for non nutritive sweeteners. Gotcha, we swap out three of those cans. We might end up here somewhere. So all of this is a matter of like, understanding that risk is not a light switch. It’s not on or off. It’s not that I swap out this thing and then I have no. Risk because also we this wasn’t zero. We didn’t start at zero. We started at whatever right individual risk is. So like, zero somewhere down here, zero doesn’t exist. Like, we don’t have zero risk for things if we’re right, right. So, all of this is about understanding relative risk. So the other thing is this, let’s say it’s a 10% increased risk of cardiovascular disease that’s on top of your baseline risk of cardiovascular disease, your baseline risk, if you’re young, if you’re fit, if you don’t have the APOE four gene, right? Like, if your diet’s really good, you live in a good neighborhood, you’re living in a good socioeconomic status, right? If you do, you might have a really low risk. So a 10% increase in risk is not an objectively huge increase in risk, or you might have a really high risk already, and 10% is a meaningful difference. So all of this is about understanding it’s better to understand the risk of health badness as a volume knob, rather than a light switch. Every little choice that you make that is a health promoting choice turns the volume down, but there’s no off, right? There’s no we don’t get to this is not a volume knob that turns everything off. It’s like a dimmer switch where there is like, uh, where the lowest setting the light is still on, right? Yeah, um, and things that we do that are not health promoting choices like smoking or, you know, drinking alcohol, or being sedentary, or, you know, eating mainly fast food, right? All of those things are going to increase the volume. But also, there’s lots of things that are changing, changing the volume on our risk that, again, we don’t have control over, and sometimes the swap right like so again, for me saying, like, I would want to save my added sugar for my grandma’s chocolate chip cookies, so if I also want a sweet beverage, I might choose the Diet Coke over the Coke, right? But also, once in a while, I might have both the regular Coke and the cookies, right, right? Because that’s not, that’s not an everyday thing for me, daily have it wasn’t everyday thing for me. It would be better to do that swap, right? So it’s about understanding that all of the little choices kind of stack to reduce our volume when we’re doing this health promoting choices, and we might choose some things that give us quality of life, that either don’t lower the volume or maybe increase the volume, and we’re balancing it with other things that lower the volume, and that might be an acceptable trade in our brains. So understanding that it’s not, it’s not ever black and white. It depends on your starting point, your health concerns, what you would be trading it for. It’s really important to like, I would not say that regular Coke is bad. I would not say that Diet Coke is bad. How much of it are you drinking, right? And what does the rest of your diet look like? What are your health related behaviors look like? What do your other risk factors look like? And is this a worthwhile trade for you and so for a lot of people, right? They would rather add vegetables to reduce their risk than lower their soda consumption, right to reduce risk.

Producer Potts  18:27  

I think it’s so freeing to know that we can do that. Because I think with diet culture messaging, it is like, if you drink any soda, diet or regular, you’re an unhealthy person, like you’re causing risk in your body, like, if you have any amount of everything, and I think it’s so helpful for you to demonstrate this is like, it’s so individual. And also you can make different choices on different days, and that’s okay. It’s about overall, what your patterns look like. And then we can even make even slight adjustments by using things like honey and molasses, which have nutrition to them, um, where regular table sugar or a non nutritive sweetener does so then there’s even that if we want to tweak that more. So I think this look at sweeteners and sugars is so helpful. So thank you. I mean that really just like, yeah, it’s not black and white.