Sugar Vs. Sugar Substitutes: Which is Worse?

By Michael F. Roizen, MD

Sugary drinks just can't get out of the spotlight when it comes to nutrition and obesity -- they even became a political issue recently when New York City Mayor Michael Bloomberg declared a citywide ban on the sale of sugar-sweetened drinks over 16 fluid ounces -- with a $200 fine slapped on store owners who don't fall into line. The ban doesn't apply to diet sodas, so does that mean no-calorie fakes are a healthier choice?

Don't be faked out by misleading food labels.

It's like choosing between raising taxes and increasing the national debt. Pick your poison. Okay, neither sugar nor sweeteners like aspartame, sucralose, and Stevia are poison if they're eaten in reasonable quantities, but that's the point. There's nothing reasonable about the amount of sugars and syrups in all kinds of foods, from bagels to frozen veggie mixes. The effect of these added sugars? Imagine eating 22 teaspoons of sugar for breakfast every day. That's average for Americans.

What that does to your health reads like a dirty laundry list. Research shows it lowers HDL (good) cholesterol and raises bad triglycerides. It also gloms onto proteins that create destructive substances called AGEs (short for advanced glycation end products). These set you up for heart disease, stiff joints, wrinkles, Alzheimer's, diabetes, kidney problems, bone fractures, and vision loss. Phew.

Expert Q&A: How can I make healthy changes in my diet and lifestyle?

That's why I'm on a mission to get added sugars out of healthful foods, such as low-fat yogurt and whole-grain cereals. And that's why if you don't like plain black coffee or green tea, I'd say -- reluctantly -- take the sweetener.

Why reluctantly? It's not that sugar substitutes cause cancer or make hair grow in weird places. In fact, sweeteners have been studied far more than most drugs (there've been at least 100 studies on sucralose/Splenda alone). The problem is that they subtly mess with how you react to food.

  • ·Sometimes it's a mind game. For instance, diet sodas can cloud common sense, making you think your no-cal drink "cancels out" the fat calories in burgers and fries.
  • ·Sometimes they make you eat more, not less. Because no-cal sweeteners essentially don't register in your brain's satiety center, instead of satisfying a sweet craving they can send you hunting for something else . . . and then something else. They also train your taste buds to go PING only when they detect intense sweetness.
  • Sometimes there's something going on no one even understands yet. Recent Texas research has linked drinking diet soda to bigger waists -- 70% bigger than in people who didn't touch the stuff. I used to drink a daily diet cola (or six), and am glad I gave 'em all up over a year ago.

There's also evidence that fake sugars and diet sodas don't help you lose weight, and up your risk of metabolic syndrome, which precedes diabetes, heart disease, and more. So it's hard to be enthusiastic about them.

I'd rather you not use sugar substitutes at all, but if you regularly drink soda and a choice needs to be made, diet is the better way to go. Every 12-ounce can of the real thing has about 135 calories and 10 teaspoons of sugar (usually in the form of high fructose corn syrup). Drink a can a day and that's 32 pounds of sugar and 49,000 calories a year -- a 16-pound weight gain. Ditch liquid candy!

If you suspect sugar is in something, trust your instincts. Added sugars/syrups lurk in the darnedest places, including in ketchup, peanut butter, crackers, salad dressings, soups, frozen entrees and fruit cups. Check the ingredients list. Sugar's aliases include high-fructose corn syrup, cane sugar, brown sugar, agave nectar, cane crystals, corn sweetener/syrup, dextrose, evaporated cane juice, fructose, fruit juice concentrates, glucose, invert sugar, lactose, maltose, malt syrup, molasses, honey, and sucrose.

Find more naturally sweet ways to skip sugar substitutes.

If you love dessert, go for Mother Nature's original treat: fruit. Its sugar isn't added, and fruits' vitamins, minerals, and beneficial plant nutrients help protect you from added sugars' aging effects. Nibble an ounce of heart-friendly dark chocolate too, especially with walnuts, oranges, and pears. Yum!

Michael F. Roizen, MD, is the cofounder of and chief wellness officer at the Cleveland Clinic.

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