Sugar and sweetener scienceHeidi Wengreen, RD, PhD

Professor of NutritionUtah State University

Learning objectives

• List current recommendations for added sugar consumption. • List health impacts of added sugar consumption.• Demonstrate how much added sugar is in a product of your choice.• Identify the pros and cons of using artificial sweeteners, including

stevia, luo han guo, and advantame.

Definitions

• Sugar: Any mono or disaccharide

• Table sugar: sucrose (glucose + fructose)

• Added sugar: sugars added to foods during processing or preparation

• Natural sugar: sugars found naturally in foods

• Alternative sweetener: substances added to food that sweeten the item while providing less calories than sugar or no calories.

Monosaccharides and disaccharides

Examples of added sugar

• How many added sugars can you list in 1 minute?

How do you tell the difference between added sugars and natural sugars?

Student challenge: Find new nutrition facts panels that include an entry for added sugar.

How much added sugar does the average American consume per day?• Have three people demonstrate this amount with sugar cubes in a

bag.

• https://www.ars.usda.gov/ARSUserFiles/80400530/pdf/DBrief/18_Added_Sugars_Intake_of_Americans_2013-2014.pdf

What is the recommendation regarding added sugars?

• The Dietary Guidelines for Americans 2015-2020 says to limit your calories from added sugar to no more than 10% each day.

What age group has the highest amount of added sugar as a percent of total calories?

What does 10% of calories mean?

• 1 gram of sugar = 4 calories• 1 teaspoon of sugar (or ~ 1 sugar cube) = ~4 grams• 1 teaspoon of sugar = 4 grams * 4 calories per gram = 16 calories• 10% of 2000 calories = 200 calories• 200 calories / 4 calories per gram = 50 grams• 50 grams / 4 grams per teaspoon = 12.5 teaspoons of sugar

What does 10% of calories mean?

• 1 gram of sugar = 4 calories• 1 teaspoon of sugar (or ~ 1 sugar cube) = ~4 grams• 1 teaspoon of sugar = 4 grams * 4 calories per gram = 16 calories• 10% of 2000 calories = 200 calories• 200 calories / 4 calories per gram = 50 grams• 50 grams / 4 grams per teaspoon = 12.5 teaspoons of sugar

* The recommendation is to get no more than 200 calories (50 grams) of added sugar

What is the leading single source of added sugar in the American diet?

What is the leading single source of added sugar in the American diet?• http://www.sugarstacks.com/

Chemical composition of “added sugar”

True or false?

• High fructose corn syrup has more fructose than table sugar, that’s what makes it worse for you than table sugar.

https://www.polleverywhere.com/multiple_choice_polls/mgXbjKApQo7L2ad

Carbohydrate composition of common nutritive sweeteners. Adapted from White AJCN 2008 Straight talk about HFCS.

% Fructose % Glucose % Other

HFCS-42* 42 53 5

HFCS-55* 55 42 3

Corn syrup* 0 100 0

Fructose* 100 0 0

Sucrose 50 50 0

Honey* 49 43 5Other: polymers of glucose or other carbohydrates; *as monosaccharides

There is little evidence that high fructose corn syrup is uniquely contributing to the obesity epidemic, or metabolic disease.

Added sugar adds up

3-D sugar model activity – have students find a hidden source of added sugar and make a 3-D model (using sugar cubes or table sugar in a plastic bag) to demonstrate how much added sugar is in the food. Have students bring their food and 3-D sugar model to class and share.

What are the health impacts of too much added sugar?

Consequences of eating too much added suagar• Obesity• Cardiovascular disease• Diabetes• Non-alcoholic fatty liver disease• Cognitive decline• Some cancers

How is sugar metabolized in the body?

• Video by Dr. Kimber Stanhope from UC Davis on the metabolism of sugar in the body.

https://www.youtube.com/watch?v=utXcI3FqzeM&feature=youtu.be

Glucose travels to the blood to other tissues first, then to the liver if there is enough.

Fructose travels directly to the liver under all conditions. It is then either converted into glucose, stored as glycogen (but storage is limited), or converted to fatty acids.

Fructose consumption has increased over the past several decades, and so has obesity and metabolic syndrome. • Hypertension• Weight gain• Impaired glucose tolerance • Hypertriglyceridemia • Low HDL • Increased uric acid generation• Inflammation and oxidative stress• Impaired liver function fatty liver

Perez-Pozo SE. Excessive fructose intake induces the features of metabolic syndrome in healthy adult men: role of uric acid in the hypertensive response. Int J Obes. 2010;34(3):454-61.

Sugar sweetened beverages may be different than other forms of sugar.

• Our bodies digest, absorb, and metabolize sugar in SSB quicker than sugar in food that contains some fiber or other nutrients.

• It’s easy to over-consume. • Drinking just one 12 ounce can of soda per day was associated with a

33% increased risk of heart disease related mortality. • Drinking 1-2 SSB per day was associated with a 26% higher risk of

developing type II diabetes, as compared to those who rarely drank SSB.

What about alternative sweeteners?

Alternative sweeteners

• Synthetic/natural compounds that taste sweet but provide no or fewer kcalories than simple carbohydrates.

• The FDA has approved the use of 8 “high-intensity sweeteners” as food additives or are *GRAS (generally recognized as safe)

• Saccharin * Stevia• Aspartame * Luo Han Guo fruit extracts• Acesulfame potassium (Ace-K)• Sucralose• Neotame• Advantame – newest addition (2014)!

• People with PKU (phenylalanine ketonuria) must avoid aspartame.

Most diet drinks contain aspartame (FDA says 18-19 12-oz cans/day is safe)* ADI = acceptable daily intake

The first

No of packets to ADI

75

45

23

23

23

9

Sucrose

FDA says NNS are safe, but some epidemiologic studies find consumption associated with weight gain, metabolic syndrome, and type 2 diabetes.

* 3/9 studies found use of NNS associated with T2D after controlling for adiposity.

FDA says NNS are safe, but some (but not all) epidemiologic studies find consumption associated with weight gain, metabolic syndrome, and type 2 diabetes.

WHY?1. Reverse causation – it’s all about lifestyle2. NNS, 0 calories, but aren’t physiologically inert

NNS aren’t physiologically inert

1. NNS may interfere with learned responses that contribute to the control of glucose and energy homeostasis.

2. NNS may interfere with gut microbiota and induce glucose intolerance.

3. NNS interact with sweet-taste receptors expressed through the digestive system (not just in the mouth) and these interactions influence glucose absorption and insulin secretion and insulin resistance.

INFLAMMATION

Also tested, sucralose and aspartame, with similar results.

• There is much to learn about how NNS may contribute to the development of obesity and metabolic disease.

• NNS are chemically diverse and we shouldn’t treat them all the same.

• Ingestion of some NNS has changed the gut microbiotia in some humans and mice in clinical studies.

• The response to NNS may be different for different people.

Different because? Heat stable, ph-stable, not fermentable, 200-400 x as sweet as sucrose

Luo Han Guo fruit extract

Advantame – newest member of the team

• Approved by the FDA in 2014. • Structurally similar to aspartame, but much sweeter – 20,000 x as

sweet as sucrose.• Stable at low pH and high temps.• Saving grace? Tiny amounts are used.

Recommendations?

• The American Diabetes Association and the American Heart Association suggest that NNS can be used in a structured diet to replace sources of added sugar to promote energy balance.

• The Academy of Nutrition and Dietetics says “consumers can safely enjoy a range of NNS when consumed within an eating plan that is guided by current federal nutrition recommendations, as well as individual goals and personal preference”. (JAND, 2012;112(5):739-58).

•My opinion? We need more human studies, but there is enough evidence to be cautious about using NNS.

Caution – sugar centric view?

You are what you eat