The Peter Attia Drive - #141 - AMA #18: Deep dive: sugar and sugar substitutes

Episode Date: December 14, 2020

In this “Ask Me Anything” (AMA) episode, Peter and Bob talk all about sugar and sugar substitutes and provide a way to think about sugar consumption. The conversation begins by defining the various forms of sugar, delineating between added sugar and naturally occurring sugar, and describing the important variables that determine the potential for metabolic damage from consumption. They then take a dive deep into three main categories of sugar substitutes—non-nutritive sweeteners, alcohol sugars, and leaving allulose, in a class by itself—including the safety profile of each, impact on blood sugar and insulin, side-effects, taste preferences, and more.  If you’re not a subscriber and listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or on our website at the AMA #18 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.  We discuss: Delineating the various forms of “sugar” (2:00); Added sugar vs. naturally occurring sugar (12:30); Important variables related to sugar consumption: Density, volume, and velocity (17:00); Alternatives to sugar: Non-nutritive sweeteners (22:30); Alternatives to sugar: Alcohol sugars (34:15); Alternatives to sugar: Allulose (39:00); Contextualizing risk when it comes to sugar substitutes (45:00); Why some people report feeling better when eliminating non-nutritive sweeteners from their diet (46:30); The impact of sweetness—Cephalic insulin response and the metabolic drive to eat more (49:45); and More. Learn more: https://peterattiamd.com/ Show notes page for this episode: https://peterattiamd.com/ama18/  Subscribe to receive exclusive subscriber-only content: https://peterattiamd.com/subscribe/ Sign up to receive Peter's email newsletter: https://peterattiamd.com/newsletter/ Connect with Peter on Facebook | Twitter | Instagram.

Hey everyone, welcome to a sneak peek, ask me anything, or AMA episode of the Drive Podcast. I'm your host, Peter Atia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to PeterittiaMD.com forward slash subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode. Welcome to Ask Me Anything Episode number 18. Once again, joined by my header research, Bob Kaplan. In today's episode, we talk exclusively about sugar and sugar substitutes. There have been a lot of questions posed about so many aspects of this. So questions that are follow-ups to the

what is it about sugar that's so bad is sucrose worse than hyphructose corn syrup, those types of questions. What about naturally occurring sugars? So we sort of tack all a bunch of those questions. And then the other half of the episode gets into all the substitutes for sugar, which are largely broken down into three categories, the non-nutritive versions. Those are things like aspartame and stevia, which again, you could further subdivide as naturally occurring versus synthetic, the alcohol sugars and then actual sugars that are not sugar, such as allulose.

And that's a question that has come up specifically. So I think that anyone who's interested in allulose, which I've talked about in the past, will find this episode very interesting. So without further delay, I hope you enjoy AMA number 18. Oh! Oh! Hey Peter, how you doing? Doing awesome man. Unfortunately I didn't get a name to put up. I was going to put on Cleon Daskalakis as my user name for this one for this AMA,

keeping with the thread of 80s goalies. That one stumps me man. Back up goal tender for the Boston Bruins. I want to say mid 80s, 84, 86. He might have played double digit games. I think he's from Boston, went to Boston University, I remember. And backed up either both these people, Pete Peters and Doug Keens. Of course. Yeah. Prior to the bill, Randford and Andy Mogh days, the sloppy seconds from the Edmonton Oilers.

Well, we've got a pretty good one here for today, Bob. We're gonna talk about sugar and probably do so in a way that I'm guessing most people aren't prepared for the depth we're gonna go into on both sugar and artificial sweeteners. Cause we have just been getting so many questions on this topic that I think we decided collectively don't scatter this

information too broadly and do it in sort of a half-baked way. Like let's put together kind of the all-singing, all-dancing place for it to exist both in audio form and also with show notes and the team's been working pretty hard on assembling this. So where do you want to start this discussion around artificial sweeteners, sugars? What do you think is the best way into this? Probably talk about sugar in general. I think a lot of the questions were one was on alliellos in particular,

but really, and some of them are on safety. Are these non-nutritive sweeteners safe? Are all sweeteners basically the same? Are they more or less? Are they all created equals? That's probably makes sense to back up and talk about sugar and what that term actually means. Yeah, and we actually had a Sunday email that kind of covered this topic

because as we were putting our thoughts together for this AMA, we realized that we should also at least put some of those together in the Sunday email. So yeah, let's take this step back and talk about sugar. And this is a, as you know, Bob, you've known me for, I don't know, 10 years. This is a sore spot for me. I hate inaccurate nomenclature.

It really, really grinds my gears. So unfortunately, the word sugar just upsets me. It gives me a little bit of chest pain, tons of consternation. I don't like it. I don't like talking about it. But I'm going to explain why that's the case. The reason I'm frustrated by this terminology is it means a lot of different things. And all of those things can be true. Glucose is a sugar. Galactose is a sugar. Fructose is a sugar. Sootcrose is a sugar. As you mentioned, allulose is a sugar. Now, to lump all of those things

in one category is unhelpful. So what I instead want to do is get folks to sort of think about these things through the lens of molecules and less through their names. In other words, it's sort of like if you were trying to evaluate a hockey team, it wouldn't be very helpful if you only thought of them as, hey, that's Bob, that's Peter, that's Richard, that's Nick. It would be more helpful if you could think, that's a goalie, he's pretty good, he sort of does this, he does that, that's a defense It would be more helpful if you could think that's a goalie. He's pretty good. He sort of does this. He does that. That's a defenseman. He plays this way. He shoots this way. In other words, think of them through their basic attributes and not through the most generic

nomenclature of their existence. Okay, so let's start with the two monomers that we care most about. the two monomers that we care most about. Glucose and fructose. So what do I mean by monomers? So monomers means these things form the simplest building blocks of carbohydrates. Now both glucose and fructose actually have the same chemical formula, which is kind of interesting, isn't it? In other words, they have the same chemical formula, which is kind of interesting, isn't it? In

other words, they have the same number of carbons, the same number of hydrogens, and the same number of oxygens. So if you looked at them in their chemical formula, they would both be C6, 6 carbons, H12, 12 hydrogens, O6, 6 oxygens. They're obviously not the same, or we'd give them the same name. glucose is arranged in a 6-carbon ring, whereas fructose is arranged in a 5-carbon ring, and one of those carbons hangs outside the balance, so it sticks outside the ring. And it turns out that makes all the difference in the world. That, to me, is one of just the coolest things about biology and biochemistry specifically,

is even the minorest tweak can have a profound difference. Now, I'm gonna go into this in huge detail today, but Bob, how many podcasts do we have where we've touched on the difference between glucose and fructose? Rob Lustig, I think, talked about it. Rick Johnson is another one where we talked about glucose versus fructose. Yeah, those would be the two best, right? I think Rob Lust it, Rick Johnson is another one where we talked about glucose versus fructose.

Yeah, those would be the two best, right? I think Rob Lustig and Rick Johnson do an exceptional job explaining why all things equal if you just took humans or mice or dogs or canals and force fed them glucose or fructose to their hearts content. Even though they're the same chemical formula and very similar chemical structure, they would have dramatically different metabolic effects. Now we rarely consume fructose by itself. We often consume glucose by itself, in the sense that when starches are broken down, they often end up in the form of glucose. So if you're eating a bowl of rice or consuming pasta, that will often break down from more

complex starches into simple monomers of glucose. But usually when you're consuming things that are sweet, i.e. things that contain fructose, they come with a dose of glucose as well. So if you're eating an apple or consuming honey, eating a mango, you're getting some balance of glucose and fructose in that fruit. And as a general rule, the sweeter it is, the more fructose it has. Okay. Is glucose a sugar?

Yes. Is fructose a sugar? Yes. Are they the same? Not even close. When people use the word sugar, I think the first thing that jumps to mind is probably something that is technically referred to as sucrose. is what happens when you take one molecule of glucose and one molecule of fructose and put them together covalently. So that means they are bonded together and you now have what's called a die saccharide and the name suggests, that's what happens

when you take two mono saccharides and merge them and you get this die saccharide. The easiest example of where sucrose exists is refined sugar. So when you look at white granulated sweet sugar, that is exactly what sucrose is. And the easiest places that we get that are basically refining it out of things

like canes and beets and things like that. And I remember as a kid actually, when we would go back and visit my grandparents, guys out working in the field were picking canes. And I remember sucking on those canes like there was no tomorrow and I just couldn't believe how good they tasted. And the reason they tasted sodium good

was I was just mainlining sucrose out of these very fibrous canes. I still remember this, like it was like chewing on a stick. You can extract the sucrose out of that just as you can with beats. That's how we make sucrose. I don't know the numbers, Bob. You might. Do you have a sense of what the relative distribution of US consumption of sucrose versus high fructose corn syrup is? Not off the top of my head. Directionally, is it more high fructose corn syrup? Yeah, I think it's like it's ebbed and flowed because I think if you go do the whole history but back in the Nixon era, I think Lusstik talked about this quite a bit.

We had sugar and then we introduced high fructose corn syrup and fructose, the name fructose comes from fruit. So it's a fruit sugar. We all thought that fructose is almost like a health food. And I think actually for diabetics as well, I remember this, that things like honey people'd say, oh, it's okay for diabetics because we'll probably get into this, that fructose doesn't stimulate insulin secretion the way that glucose does. High fructose corn syrup, it's a four-liter acronym, but it's like a four-liter word now. But for a time, we almost thought it as a health

food. Consumption skyrocketed. And now, I think it's relevant probably to this conversation as well that there's been a turn towards almost back to, quote unquote, natural sugars, which gets into the argument too. You'll hear it often that people will say, well, probably this is a question we'll get to.

You're better off having the Coke versus the Diet Coke because the Diet Coke is full of chemicals and the Coke contains sugar. And that's something that we can naturally handle. We've got our blood sugar. So again, you talk about terminology and how that gets confused. But I think there was a really big spike in high fructose corn syrup. And now I think that there's been like a, it's almost supply and demand market driven, perhaps, that people, if they had the choice between high-frocious corn syrup and sugar, I think they now think that sugar is, quote unquote, healthier, less deleterious than high-frocious corn syrup.

Yeah, and I'm glad you brought up the going back to the early 70s, because it is kind of an interesting story, which goes back to basically, it was either an embargo or some tariffs or something like that on sugar. There was this new technology, I think, being developed in Japan that could effectively make something almost like sucrose, but in a solution. Instead of taking one to one glucose fructose and fusing these things in this disaccharide, you could say, hey, look, why not just take a solution of glucose, a solution of fructose? It was not 50-50, it was 45-55 in favor of fructose, so that made it a little sweeter. And basically, you could produce this in unlimited quantities, problem-solved, and you make a very good point, which was there was a belief, and frankly,

there probably still is a belief that fructose is better for someone with diabetes because you don't have to chase it with insulin, of course, not withstanding the fact that fructose does so much for insulin resistance. We're not going to get into that as much detail now because we'll get into it a bit more later, and of course, it's been covered exquisitely and beautifully by a bit more later. And of course, it's been covered exquisitely and beautifully by both Rob and Rick. And I think you're absolutely right that probably into the early 2000s, high fructose corn syrup was the dominant sweetener added to foods. And there's been a little bit of a revolt. And of course, the irony of it, it's been back to things that are more natural, quote unquote. It's like, Oh, don't give me your high fructose corn syrup. I'm going to eat my

dried mangoes and my dates. And even sucrose is probably better. So let's move on to that point. There's another distinction that most people have probably noticed when they look at food labels, which is sugars and added sugars. A properly adherent food label will list both. It will say carbohydrates, fiber, grams, sugar, grams, and beneath that added sugar, grams. So what do all of those numbers mean? Thank you for listening to today's Sneak Peak AMA episode of the Drive. If you're interested in hearing the complete version of this AMA, you'll want to become a member.

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