Sugar, Sweeteners, and Marketing Myths: What Actually Matters

It's pumpkin spice season, which means it's sugar season, so cohosts Erin Stein and Dr. Gillian Goddard are talking about why we love sweet things so much and what's really going on in the body when we eat them. We start with why humans evolved to crave sugar, then break down what "sugar" means: glucose, fructose, lactose, and the "ose" family. Does it really matter which form you eat, for your health? Why do some foods spike blood sugar and send you on a craving roller coaster, while others don't? The answers may surprise you. We also cover high fructose corn syrup and why food companies love it, whether raw sugar, honey, or agave are any better, what artificial sweeteners do in the body, and how alcohol fits in. Uncover the truths behind the endless hype about the sweet stuff. 

References:

A couple of great books about the history of “sugar” as a commodity.

Sugar by Elizabeth Abbott.

The World of Sugar: How the Sweet Stuff Transformed Our Politics, Health and Environment over 2,000 Years by Ulbe Bosma.

The World Corrupted: From Slavery to Obesity by James Walvin.

We take a moment to remind you that while this is a medical discussion, it is not providing a diagnosis or treatment or any medical advice. The only way to get a diagnosis, treatment or medical advice for your particular condition is through a discussion with your doctor.

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Visit www.thesavvypatient.com/podcast for episode transcripts.

Watch full podcast episodes @TheSavvyPatient on Youtube.com.

Get your copy of The Hormone Loop by Dr. Gillian Goddard wherever books are sold.

This episode was produced and edited by Erin Stein. Music: “All We Live For (instrumental)” by Wolfclub licensed through Audiio.com. Intro and outro edited, and video created, by Ian Mayer. The Savvy Patient logo by Amanda Spielman.

TRANSCRIPT

Erin Stein: Hello, everyone. 

Gillian Goddard: Hello.

Erin Stein: Welcome to The Savvy Patient. It is fall. And I just bought a giant pumpkin that is so big I can't even lift it. Thirty-two pounds and yes, I know I need to work out. But it's very dense. That weight is like… could you pick up a thirty-two-pound bowling ball?

Gillian Goddard: Yeah, probably not.

Erin Stein: Probably not. It's harder than you think. Anyway, the point is, it's pumpkin spice season and what is usually in there with that pumpkin spice? Sugar.

Gillian Goddard: Sugar. Lots and lots of sugar.

Erin Stein: Lots of sugar. As I've stated previously, I like sugar.

Gillian Goddard: Most people do.

Erin Stein: Most people do. I mean, but this is the season where many of my former co-workers will remember me buying a bag of those Brach's pumpkins, those Mellowcreme pumpkins, and I would eat the whole bag myself. 

Gillian Goddard: My stomach hurts just thinking about that.

Erin Stein: Not in one day, you know, over the season, but I can't do that anymore. I don't want to eat a whole bag of those pumpkins. I would eat a couple, but my taste buds and desire for sugar have shifted in my older age.

Gillian Goddard: Yeah. There's a reason why we like sugar so much. I think we should talk about that.

Erin Stein: I think we should talk about it. We have taste buds that register sweetness. 

Gillian Goddard: Mm-hmm. We do.

Erin Stein: Why? Why do we have it?

Gillian Goddard: Foods that are sweet are really dense in calories. And when you are an early human hunter gatherer, when you come across those foods you want to eat them because you can store those calories for later. And I think it's important to understand what kinds of sugar hunter-gatherers were coming in contact with, right? It was mostly plants. Like berries, and other types of fruit. Wild grains, wild legumes, they were coming across these things infrequently.

Erin Stein: Mm.

Gillian Goddard: But when they were there, they could consume a lot of them and store up a lot of calories because their sources of calories were not as reliable as the grocery store up the block.

Erin Stein: Yes. And if you stumbled upon some honey…

Gillian Goddard: Mm yeah. Yes. Yes.

Erin Stein: Bonanza!

Gillian Goddard: Although you probably didn't have one of those beekeeper outfits to wear while you got the honey out of the hive either.

Erin Stein: No, you did not. You might have rigged up something, but you were probably just sticking your hand in there.

Gillian Goddard: Probably. Probably. So, we evolved to like sugar because when we came across it, it was important for us to consume it and hang on to it for later, as fat. Because humans didn't know when they were going to come across high calorie foods again. And so, we love that. And our entire biochemistry predicated on this idea of when we have them wanting more.

Erin Stein: Yes, I was just going to say it's like, eat it all right now as much as possible.

Gillian Goddard: Yes, yes, that's exactly right. Eat it all. Eat all of it right now. Eat as much as possible because it's going to be gone. And the problem with our current situation is that it's never gone.

Erin Stein: It's all too readily available.

Gillian Goddard: Readily available. Not only is it the most readily available form of calories, and we'll talk about you know, when I'm talking about sugar, what are we really talking about?

Erin Stein: Yes.

Gillian Goddard: But not only is it the most readily available form of calories, in this era of escalating food prices, it's also cost efficient. You can buy a lot of calories without spending a lot of money if you're only buying sugar or carbohydrates.

Erin Stein: Well, but not all carbohydrates.

Gillian Goddard: So, let's talk about this. There's lots of different types of sugar. When we talk about sugar or carbohydrates, we are talking about foods that get absorbed as glucose into our bloodstream after they've been processed—usually we're not eating straight glucose. There are exceptions to that, but usually we're eating some form of carbohydrate that is a combination of a couple of different types of sugars that we break down in our gut and absorb as glucose. And glucose goes through the wall of our small intestine, although we can absorb it in other ways too. The primary way is to absorb it through the wall of the small intestine into our bloodstream. And it gets used by our brain and muscles for energy, and it gets taken up into our fat cells and converted into fat. And it gets taken up by our liver and stored as glycogen. And so, we have ways of both using glucose right away or storing it for later. And which of those things we do depends a little bit on our personal biochemistry and insulin and how our cells respond to the hormone insulin. But when we talk about foods that get absorbed into our bloodstream as glucose, we are talking about a huge variety of different foods from candy, which is basically straight sugar, to sweet potatoes and strawberries and all different kinds of starches.

Erin Stein: Corn.

Gillian Goddard: Corn. Rice. I mean, most of the world's population subsists on rice. All kinds of grains, all kinds of legumes. Vegetables have some small number of carbohydrates, depending on the type of vegetable, but like green leafy vegetables have a little bit of carbohydrate, very, very little. But fruits, vegetables, and grains, and then good old sugar.

Erin Stein: Actual sugar.

Gillian Goddard: Which is usually from plant sources, right? So, either from sugar cane or from sugar beets. So really, we get sugar from almost everything we eat except things that are purely fat, so like olive oil, or purely protein. So, chicken or fish. Even dairy has a mix of protein, fat, and carbohydrates. And when you think about what dairy comes from and what it's for, which is the sole food source of a baby cow. It makes sense that it would have all three macronutrients.

Erin Stein: Baby cow needs some carbs.

Gillian Goddard: Yeah, so we get carbohydrates from lots and lots of different places. They're a big source of calories and one of the foods that we often crave. So, let's talk about different forms that sugar comes in and what makes them different.

Erin Stein: Yes, because I know there are lots of words that end in "ose" that are different forms of sugar.

Gillian Goddard: Hehehehe.

Erin Stein: Sucrose, fructose, lactose.

Gillian Goddard: Yep. Yep.

Erin Stein: What's the difference?

Gillian Goddard: They're largely the same in that they are molecules of sugar that we break down to be able to absorb. So, fructose is the form of sugar most commonly found in fruit. Lactose is the form of sugar found in milk. And so, we break those sugars down with enzymes in our gut. If you don't have one of those enzymes, or you have a deficiency in the enzyme that breaks down one of those sugars, it can cause you a lot of distress gastrointestinally. That's what lactose intolerance is, a deficiency in the enzyme that takes the lactose molecule and breaks it into its component sugar bits that can get absorbed.

Erin Stein: So weird that my body rejects that one form of sugar.

Gillian Goddard: It is actually quite common. We are born being able to process lactose because we are mammals, which means that in the first years of our life we are reliant on milk. I mean evolutionarily human milk.

Erin Stein: I was just going to say, does human breast milk contain lactose? And that sounds like a gross question, but you know, you don't think about it that way.

Gillian Goddard: Indeed. No, it's true. It does. And so young children almost universally can have this enzyme and can process lactose. But as we age, depending on the diet of our ancestors typically, you see people become more and more lactose intolerant. So, for example, in Asia where cow's milk is not a particularly big part of the diet, they don't drink a lot of milk or eat a lot of cheese. And so, lactose intolerance is much more common among people of Asian descent because they have inherited that; it is there's less of an evolutionary benefit to being able to break down lactose after infancy and early childhood. In cultures where milk is a huge part of the diet, so people of European descent, there is much less lactose intolerance, although obviously it still happens, because it is a part of the diet for a lot longer. But from the point of view of what our body sees, once we've absorbed the sugar into our gut, it's all the same. So, what makes different sugars different is how they get processed in our gut. And much of what makes how we process those sugars different is what naturally comes along with them for the ride.

Erin Stein: Okay.

Gillian Goddard: So, if you eat a gummy candy, really the only thing in that gummy candy other than gelatin is sugar.

Erin Stein: Yes.

Gillian Goddard: There's not a lot of processing that your gut has to do to get that gummy candy ready to get absorbed. To use an even faster example, say you drink a Coke. There's almost nothing that your gut has to do to get that sugar absorbed into your bloodstream. And in fact, these days, Coke is not made with sugar, sucrose. It's made with high fructose corn syrup. And high fructose corn syrup is really easy for our body to absorb from our gut. Almost nothing has to happen for high fructose corn syrup to get absorbed by our small intestine. And it's a liquid. So, it moves through our gastrointestinal tract really, really quickly and we absorb the sugar very, very quickly. Other things that are like that are super sugary candy that is not fatty. So, I'm thinking like in the US, Smarties. Smarties in other countries are different. They have chocolate. But so, these things that are really just pure sugar, like Swedish Fish and Sour Patch Kids and anything gummy, anything chewy, Starburst, all those kinds of things are just pure sugar. They get absorbed super, super easily. Then you start to think about things that change how quickly the body can absorb sugar. And there's three things that change how quickly both the sugar-containing thing moves through your gut and the work your gut has to do to absorb the sugar. There are three things that slow the rate at which sugar moves through your gut, and they are protein, fat and fiber.

Erin Stein: So, what I'm thinking in my head while you're describing this is I've got my Swedish Fish, then I graduate to chocolate, then I graduate to a Snickers bar because it has peanuts.

Gillian Goddard: I don't know that there's enough peanuts in a Snickers bar to really make a difference in how it gets absorbed, but your point is well taken. That's why Snickers really satisfies.

Erin Stein: It does. I was going to say that. But what is really enough to slow it down? Like I assume if you're eating a piece of fruit with some sugar, there's some other nutritional items in a piece of fruit.

Gillian Goddard: So, the biggest thing that slows the uptake of sugar from fruit is the fiber. Yeah.

Erin Stein: Like fiber. Right.

Gillian Goddard: And so, the higher the fiber the fruit, the slower you will absorb the sugar from that fruit. So, berries are the highest in fiber. Blueberries and blackberries are higher even than strawberries, but berries in general are very high in fiber. Tropical fruits tend to hit the bloodstream pretty quickly. They tend to have much higher ratio of sugar to fiber. But the other thing about fruit is they actually come with some nutritional value, which is not true of your Swedish Fish, for example. But the fat in a candy bar, so there is a difference between eating Swedish Fish and eating a Snickers bar. The magnitude of the difference is not the same as the difference between eating a Snickers bar and eating a sweet potato—sweet potatoes are really, really high in fiber. Or beans, which have protein and fiber, or nuts, which have fat. And protein and fiber. Because of the ratio of the sugar to the fiber protein fat, it changes what your body has to do to get the sugar out of that food and how long it takes and how much that sugar will raise the sugar level in your blood.

Erin Stein: So, let's do a 101. Why is it better to absorb it more slowly rather than just get it all at once, take the hit?

Gillian Goddard: Yeah, for two reasons. One is unless you are doing a physical activity that requires a lot of sugar in that exact moment. And I think the best example of this is say you are training for a marathon. People who run distances, not people like me who run, you know, three, four, five miles at a go, but people who are running ten, fifteen, 26.2 miles will need to consume some easily absorbable sugar along the way because they will literally run out of sugar and accessible sugar in their body because their muscles are using the sugar for what it is for, which is energy. 

Erin Stein: Mm-hmm.

Gillian Goddard: Outside of that situation where you're actively utilizing sugar, by using your muscles for an extended period of time. When you eat something where you like spike your blood sugar up very, very quickly, the body's response is to say, we don't need that for quick energy right now. We're going to save it for later. And it starts to save it as quickly as it possibly can. Because it wants to take up all that sugar and store it quickly. And so, it gets saved as fat and it gets saved in our liver. And then our blood sugar often drops as quickly as it grows because the body was like, “sugar! Sugar! we're going to store it all up” and does it very, very fast. And then our blood sugar drops very quickly.

Erin Stein: Think that's exactly the voice that our body uses. It's like “sugar, sugar!”

[laughter]

Gillian Goddard: It certainly feels like that's the voice that it's using. And then the drop in our blood sugar signals to our brain that there's a problem. It's like, “our sugar is dropping. We've gotta do something about it.” And the thing to do about it is to eat more sugar. And so, you end up on this roller coaster ride. If you're listening to this, you can't see me waving my finger up and down. But you end up on this roller coaster ride where your sugar is high, it's low, then you want more and it's high and it's low. Versus if you eat a sweet potato. Perhaps with a side of, I don't know, chicken breast with some protein and a little fat. It takes more time for your body to absorb that sugar from the sweet potato because of the fiber and the fat and the protein. And so, your blood sugar rises and falls more slowly and more gradually. And you never have that outsize, “oh my gosh, we've got to store up all this extra sugar.” And so, you don't get the spike up, but you also don't get the drop down and that means that you don't crave sugar again an hour later.

Erin Stein: When we talk about our hormones and what's happening in perimenopause and the dramatic fluctuations causing the problems...I feel like this is similar. You don't want the dramatic fluctuations.

Gillian Goddard: Our bodies don't like dramatic fluctuations. Our bodies like homeostasis. They like things to stay kind of the same. And the big fluctuations tend to cause a lot of symptoms. And remember, this is a hormonally mediated process, too. This is all because of insulin. Acting in our body. The only part of our body that can take up sugar without insulin is our brain. And sometimes our muscles under certain circumstances. But otherwise, it is all mediated by insulin and insulin is a hormone.

Erin Stein: And what is the insulin doing, mediating?

Gillian Goddard: So, the insulin tells the cells to put glucose transporters in the cell membrane. So that the glucose can bind to that transporter and get brought into the cell where the cell will use it, either store it or use it for energy.

Erin Stein: Shockingly enough, we have suggested that whole foods are better than processed sugar.

Gillian Goddard: Correct.

Erin Stein: Or straight sugar.

Gillian Goddard: Correct.

Erin Stein: We're going to start talking about processed sugar, right? What we normally call sugar, it's something that we didn't always have and then started to make, and then a lot of horrible things happened in different parts of the world. To have plantations of it to turn it into a commodity to be sold. It has a longer history in Asia and India, but then you know those Europeans they got into slavery to start growing a lot of sugar in the Caribbean and Cuba. And that is not great.

Gillian Goddard: Pretty horrific in fact.

Erin Stein: Yeah, it's horrible. And there's a book about that history that I will link in the show notes that is very interesting if you have any interest in why we all have sugar in our kitchens now. It's related to tea; in case you were wondering.

Gillian Goddard: It is. It's related to tea.

Erin Stein: Some horrible things happened and now we have sugar everywhere. Now everyone has access to sugar to add to everything.

Gillian Goddard: It's completely ubiquitous. And it is added to everything.

Erin Stein: Yes. Why do we add it to everything? I know the answer but go ahead and tell me.

Gillian Goddard: 'Cause it makes it taste better.

Erin Stein: Yeah.

Gillian Goddard: It makes us perceive it as being better tasting. So, if you buy something in a jar at the grocery store it almost always has sugar in it. Pasta sauce, salad dressing, condiments, ketchup has a ton of sugar. Soy sauce.

Erin Stein: Ketchup has a lot of sugar. That's why I like it.

Gillian Goddard: Yeah. All these things have not just sugar, but sugar that's been added.

Erin Stein: You know, when you're cooking from scratch, you might add a little pinch of sugar, the same way you might add a little pinch of salt to bring out flavors, but larger amounts are being put into these manufactured foods. And I feel pretty confident saying part of the reason is that it does make us want more.

Gillian Goddard: Correct.

Erin Stein: And then we buy more and they make money.

Gillian Goddard: Yes, so food companies, companies that manufacture processed food, actually have scientists on their staff whose job it is to find the perfect balance of added sugar, fat, and salt to given foods to make them especially. Desirable and palatable so that we will want to eat more.

Erin Stein: Yes.

Gillian Goddard: And in that process, they also remove all of the nutritional value.

Erin Stein: Yeah, isn't that fun?

Gillian Goddard: Think about it, it's one thing to eat a strawberry, or let's even say pineapple, which is pretty high in sugar as fruit goes. But you get things from the pineapple, including fiber and vitamins, that you need to be a healthy human. And my guess is that the salty sweet cookie or candy or chip does not have any of those vitamins and it almost certainly has negligible amounts of fiber.

Erin Stein: Then we get into how that sugar is in everything, the form of sugar that is in everything. And I remember it being a big deal to buy stuff that had fructose added to it instead of glucose or high fructose corn syrup, which we should get into. 

Gillian Goddard: Mm-hmm.

Erin Stein: Does it matter? The form of "ose" that is added does it make a difference.

Gillian Goddard: Not as much as people think. With the exception of high fructose corn syrup and I'm not talking about like making peanut brittle at the holidays where you use corn syrup. I'm talking about high fructose corn syrup that goes into foods like sodas, cookies, candies, that kind of thing. With the exception of high corn syrup, it really doesn't matter whether it's fructose or some other “ose,” as long as you have the enzyme to break it down. It doesn't change how quickly it breaks down. What makes fruit less likely to spike our blood sugar is not that it has fructose in it instead of some other form of sugar, it's that it has fiber. 

Erin Stein: That was marketing.

Gillian Goddard: And people have kind of misunderstood what makes fruit different.

Erin Stein: We did, but I also think we were told a falsehood about cookies made with fructose being better.

Gillian Goddard: Yes, a hundred percent.

Erin Stein: So, let's discuss the high fructose corn syrup. What is that sh-t and what does it do to us that is so bad? 

Gillian Goddard: Yeah.

Erin Stein: We know it's bad. It is bad if you didn't know that.

Gillian Goddard: Yeah. Yeah. Basically, they take corn and convert some of the corn's glucose to fructose. And it does a couple of things for foods that make them more palatable. It's super cheap. It's super sweet. And so, you don't need much of it to get the level of sweetness that you're looking for, but you can also make something very, very, very, very sweet. Like Coke or Mountain Dew, for example. So, you can get a lot of sweetness into a drink with high fructose corn syrup, but it also holds moisture so it can keep foods from getting stale for longer. So, like the chewy cookies that come in a package. It can help with that. Cakes and donuts. I'm thinking of like, you know, like Entenmann's, for example.

Erin Stein: Right.

Gillian Goddard: Something that you're going to buy in a package off a grocery store shelf that is supposed to be soft or chewy. It can help it retain that soft or chewiness for extended periods of time. It gives it a longer shelf life. And then it's also in things that are supposed to be healthy, right? Like cereal bars and in protein bars.

Erin Stein: It’s in a lot of cereal.

Gillian Goddard: It's in a lot of cereals. Cereal is the food that people think is healthy and is about one of the worst things you can put in you. I can't tell you how often I get asked for what is a healthy cereal. And unless you're eating like shredded wheat that doesn't have any frosting on it, they're all pretty terrible.

Erin Stein: Yes. I've actually been on this journey recently because I do, like many people, find it convenient to just eat a bowl of cereal in the morning.

Gillian Goddard: Yes. Yes.

Erin Stein: But many standard cereals have high fructose corn syrup in them.

Gillian Goddard: Yes, they do.

Erin Stein: And I don't like Grape-Nuts. I'm not eating kitty litter in a bowl. I'm sorry.

Gillian Goddard: I actually really like Grape-Nuts, haha.

Erin Stein: So gross. It's like eating gravel. Like, no. It's the form that it comes in.

Gillian Goddard: It's the texture.

Erin Stein: There are these newer, more natural cereals with better ingredients, but they are wildly expensive.

Gillian Goddard: Really expensive. Yeah.

Erin Stein: So expensive and there's so little in the box. You get like maybe three or four bowls out of an entire box.

Gillian Goddard: Yeah. Yeah.

Erin Stein: So, it's not viable for many people.

Gillian Goddard: Right. Yeah.

Erin Stein: Thank God winter is coming, and I can start eating oatmeal again.

Gillian Goddard: Yeah. Although you have to be careful about your oatmeal too, because you gotta make sure that you get the oatmeal that isn't processed to remove all the fiber.

Erin Stein: That's true. And I try to make oats without all the stuff added and add my own. Okay, so back to high fructose corn syrup. I think we've explained why companies are putting it in stuff. It makes it cost effective and salable to all of us chumps.

Gillian Goddard: And then it gets absorbed super quickly into the bloodstream. It's like a straight line pointing toward the sky. And it's pro-inflammatory. All sugar, by the way, is pro-inflammatory. It gets converted into glucose; it gets taken up into our bloodstream, spikes our sugar super high, and then drops it on back down.

Erin Stein: I do want to do a whole episode about inflammation because that is a buzzword that people throw around a lot. But should you eat zero sugar because sugar is pro-inflammatory?

Gillian Goddard: No. You're not going to.

Erin Stein: Okay.

Gillian Goddard: How would you even do that?

Erin Stein: I don't know.

Gillian Goddard: Because when it gets into your blood, it's all the same. It's all glucose. Even a keto diet has twenty grams or so of carbohydrate in it because you literally could not eat anything except for meat and get no carbohydrates. You'd basically have to be a carnivore. And humans didn't evolve to be carnivores. 

Erin Stein: We did not, everyone.

Gillian Goddard: And so that wouldn't be good for you either.

Erin Stein: High fructose corn syrup is like supercharged turbo glucose injection straight into your veins.

Gillian Goddard: Basically, basically.

Erin Stein: Basically, metaphorically speaking, everyone. So, it's the one you want to try and avoid because it is worse than regular sugar being added to things.

Gillian Goddard: And it tends to be in things that aren't all that good for you anyway, right? Like soda.

Erin Stein: And you know, you can drink a soda once in a while. You can have some candy once in a while, but we don't want to be mainlining these things all the time. And is there a difference between the types of sugars that you see in things and that you can buy to add to things? And I'm thinking of like raw sugar versus white sugar. And we've established high fructose corn syrup is the worst, but how much worse and are there things you can look for that would be better?

Gillian Goddard: Yeah, so the term processed is a very broad one and I think that makes it be over applied. What people are talking about when they're talking about processed foods is processed carbohydrates that come in a package that are designed to make you want to eat lots of them. And those are things that you generally want to avoid. But when it comes to adding your own sugar, so you're going to bake a cake or you're going to put sugar in your coffee, for example. All forms of sugar are essentially the same. So, whether you eat white sugar or raw sugar, there's really no difference in how your body processes those two things and absorbs them. Then we start to get into things like sugar substitutes, chemicals that taste sweet that don’t have sugar in them. And I think that this really depends on how much you're talking about when you start to talk about sweeteners. So, like if you pick up a bag of Splenda, it'll be like “a cup for cup like sugar and you can bake with me” and whatever. That kind of creeps me out. That's a lot as opposed to using a small amount in a cup of coffee or something like that. The best sugar substitutes are ones that come from plants and aren't just synthesized in a lab. So, it's monk fruit sweetener or anything made with stevia. Stevia is actually a plant product. As opposed to NutraSweet, which is Equal or Splenda. So green packets are better than yellow and pink packets. But as with anything there are problems with artificial sweeteners and they've actually done studies that show that just cutting diet soda, for example, so soda sweetened typically with aspartame or NutraSweet, just cutting diet soda out of your diet causes you to lose weight. And so, the question would be like if it has no calories, why do people lose weight when they cut out diet soda? And it's because we think, and this is a little difficult to prove, but we think that it is because when you taste the sweetness, and this is true of anything sweet, when you taste it on your tongue, your pancreas is already getting ready for that food to hit your gut. And so, your pancreas is already getting ready to release insulin and so when you eat something with a sweetener you release insulin to absorb those carbohydrates but there aren't any carbohydrates there to absorb and so then it makes people want to eat other carbohydrates.

Erin Stein: That's interesting. Do we have research about these artificial sweeteners that they are bad for you, that they cause cancer? I feel like I've heard that.

Gillian Goddard: The challenge I s that most of those studies are not randomizing people to get one type of sweetener versus another type of sweetener. They're the type of studies where they ask people about their food habits and then look to see whether those different food habits are associated with cancers. And the problem with that, of course, is that people who consume a lot of artificial sweeteners may be not consuming the healthiest diet generally. And so, there's probably confounding effects there. There's not good data making those connections. There's only observational data that is pretty flawed.

Erin Stein: So, the danger in using too much artificial sweetener is that you may still be prompting processes in the body that you are not delivering the glucose to.

Gillian Goddard: And they typically come with, I mean, if you're consuming like artificial sweetener and in a cookie, for example, like say you follow the recipe on the Splenda bag and make cookies out of that, you're still eating all the other carbs that go into the cookie.

Erin Stein: I know, I feel like it's less useful for baking, but what about like honey or agave syrup or things like that? 

Gillian Goddard: All basically just like putting sugar in.

Erin Stein: Right. Everyone thinks there is a difference between the form of these sweeteners that you are putting in.

Gillian Goddard: There is not.

Erin Stein: And artificial sweetener is different, but also not something you should be pounding. 

Gillian Goddard: Right.

Erin Stein: But I think it's very interesting that honey isn't necessarily different. Fructose is not necessarily different. Raw sugar is not necessarily different. I think we've all been falling for a lot of marketing.

Gillian Goddard: I think that's right.

Erin Stein: Which is not to say you should just eat all the sugar that you want. We should still be limiting how much sugar.

Gillian Goddard: Yes, and in fact, especially as you get older, you may not feel very good eating all the sugar. Our body becomes less able to process sugar over time, and so you may not be able to eat all the sugar.

Erin Stein: Why is that?

Gillian Goddard: We become more insulin-resistant, and it takes more insulin to keep our blood sugars normal, and then we end up on this roller coaster of rapidly rising and falling blood sugars. But there are things that we can do to make eating sugar affect how we feel less and to make it raise our blood sugars less, which is not a bad thing. And it's kind of the things that I already alluded to. So, the dietitian in my office always says, “no naked carbs,” meaning you shouldn't be eating a carbohydrate without a protein or a healthy fat or a healthy dose of fiber. And so, it's okay to eat carbohydrates, but you want to be eating a balanced meal, getting all your macronutrients, and I know we talk about it all the time, but also fiber.

Erin Stein: Here's the question. If you've eaten a healthy whole food meal and then you have dessert?

Gillian Goddard: It depends on how long after the meal you're having the dessert. 

Erin Stein: Okay.

Gillian Goddard: If you're at a restaurant and they bring the dessert, you know, ten minutes after your meal, yes, that counts. But there are some desserts that are better than others and the one that always surprises people is ice cream. Ice cream does not have fiber, but it does have fat and protein that makes blood sugars rise and fall more slowly. And if it's real ice cream, it actually has some calcium in it. And so, it is one that people tolerate better. Ice cream is technically a custard. Especially if you have made your ice cream at home. But other custards tend to be better too because they're made with eggs. And so, you're buffering your sugar with a fair amount of protein and fat.

Erin Stein: So, I feel like the lemon meringue of it all is not so bad.

Gillian Goddard: Depends on how much meringue there is.

Erin Stein: That's fair, 'cause I do like the meringue part quite a bit.

Gillian Goddard: Yeah.

Erin Stein: So, wow, I feel like I have freed myself somewhat from worrying too much about the form of the sugar.

Gillian Goddard: You shouldn't be worrying about the form of the sugar. You should be worrying about what you're consuming the sugar with.

Erin Stein: That's a great takeaway.

Gillian Goddard: And what are you getting from the sugar? So, meaning, is the sugar that you're consuming coming along with other things that are good for you? Like the sweet potato is full of vitamins and fiber. Same with most fruit. As opposed to table sugar, which has no other nutritional value.

Erin Stein: What about alcohol?

Gillian Goddard: Mmm, yes. So different forms of alcohol have different amounts of sugar in them. Beer actually has the most sugar, because a lot of the hops and wheat is not converted to alcohol. It's fairly low alcohol. And wine is kind of in the middle. And spirits actually have the least sugar in them because most of the sugar has been converted to alcohol. But people tend to mix spirits with things that are high in sugar like juices.

Erin Stein: Yes. And syrups.

Gillian Goddard: And syrups, exactly, exactly. And so, you have to think about that, but really what determines how much carbohydrate is in alcohol is how much of the sugar is getting converted to alcohol. So, the higher alcohol, the higher proof it is, the less carbs it has.

Erin Stein: Interesting. That's not healthy to encourage.

Gillian Goddard: Well yes. Alcohol then comes along with other issues.

Erin Stein: Yes. I had this idea that alcohol turns into sugar in the body.

Gillian Goddard: So, alcohol is not converted into sugar. It often comes with sugar automatically.

Erin Stein: Mm-hmm.

Gillian Goddard: But alcohol does not get converted into sugar. It gets converted into other chemicals

Erin Stein: That's a good distinction. There's a general idea that drinking alcohol is putting sugar in your body, and I think it depends on what you're drinking and what the alcohol is mixed with, whether you're actually putting sugar in your body.

Gillian Goddard: Yes, absolutely. With again beer being the highest in carbohydrates typically wine and then spirits being the lowest. But again, most people mix their spirits with something that has sugar in it.

Erin Stein: And what is the association between sugar content and calories? Because a lot of products are labeled zero calorie.

Gillian Goddard: So, carbohydrates have calories one gram of carbohydrate has four calories. So, something cannot contain sugar and not have calories.

Erin Stein: Okay. So, the zero calorie stuff probably has those artificial sweeteners in it.

Gillian Goddard: Yes. Yeah.

Erin Stein: And that carries the risk of prompting some desire to have some sugar.

Gillian Goddard: Yep. That's exactly right. That's exactly right.

Erin Stein: Okay, okay. I feel like I learned something today.

Gillian Goddard: I'm so glad. I mean, I think the big thing is that sugar in moderation is not the enemy. It's more in how you consume it and what it's doing for you as an overall part of your diet. That would be my takeaway.

Erin Stein: Good talk. Good talk about sugar. Go enjoy your pumpkin spice!