Tag /

Sugar

Sugar-sweetened beverages (SSBs) featured article

Sugar-sweetened beverages (SSB) include commonly consumed products such as soda, sports drinks, and energy drinks; coffee, tea, and water with added sugars; and some fruit juices, although not all nutrition experts agree on fruit juice’s inclusion as an SSB. While the consumption of SSBs has declined in recent decades, they remain a leading contributor to sugar intake among people living in the United States.

While the over-consumption of sugar from any source is harmful for health, SSBs present a physiologically unique risk to health due to a converging set of factors. Because they contain no supporting food matrix to slow absorption, SSBs are rapidly absorbed by the gut and cause blood sugar spikes. Sugars from fruits and vegetables are packaged with a matrix of fiber and micronutrients that reduce the rate of digestion. This slow digestion and absorption reduces blood sugar spikes and supports better glycemic control. Additionally, many SSBs [exceed the recommended maximum...

Episodes

Posted on November 6th 2021 (over 3 years)

Dr. Rhonda Patrick answers audience questions on various health, nutrition, and science topics in this Q&A session.

Posted on December 2nd 2020 (over 4 years)

Choosing how much broccoli or broccoli sprouts to eat is really up to individual tolerance. Isothiocyanates are inherently bitter, and the human body naturally resists the intake of bitter foods. Aiming for 2 to 4 ounces of sprouts per day is a reasonable a...

Posted on June 6th 2020 (almost 5 years)

Dr. Rhonda Patrick answers audience questions on various health, nutrition, and science topics in this Q&A session.

Topic Pages

  • Sugar-sweetened beverages (SSBs)

    Sugar-sweetened beverages such as soda, juice, and sports drinks provide large doses of rapidly absorbable sugar, posing a unique risk to health.

News & Publications

  • Artificial sweeteners like sucralose are marketed as healthier alternatives to sugar, but they may send mixed signals to the brain. A recent study found that sucralose increased hunger and altered activity in the part of the brain that regulates appetite, with effects differing by body weight.

    Researchers asked 75 young adults—some with a healthy weight and some with overweight or obesity—to drink a beverage sweetened with either sucralose (often marketed as Splenda), sucrose (table sugar), or plain water on three separate occasions. Afterward, the researchers measured the participants' blood glucose levels, collected their self-reported hunger ratings, and conducted brain scans to examine activity and connectivity in key regions involved in appetite control.

    Compared to sugar, sucralose increased blood flow to the hypothalamus and promoted stronger feelings of hunger. Sucralose also heightened hypothalamic activity more than water but didn’t influence hunger. Only sugar elevated blood glucose levels, an increase linked to reduced activity in the hunger-regulating regions of the brain.

    Interestingly, the brain’s response to sucralose differed based on body weight: In people with a healthy weight, sucralose enhanced connections between the hypothalamus and areas involved in attention and decision-making. In those with overweight, sucralose diminished connections to brain regions that process bodily sensations. And those with obesity exhibited little to no change in these neural connections. Compared to water, both sweeteners elicited distinct patterns of brain activity depending on weight status.

    These findings suggest that sucralose interferes with the brain’s normal appetite-regulating signals by mimicking sweetness without delivering the expected rise in blood sugar. This mismatch appears to increase hunger and alter brain connectivity in ways that vary depending on body weight. Artificial sweeteners also affect the gut microbiome. Learn more in this clip featuring Dr. Eran Elinav.

  • It’s no surprise that sugar-sweetened drinks can contribute to weight gain, dental problems, and metabolic impairments. But emerging evidence suggests they can also harm your heart. A recent study found that consuming more than eight sugar-sweetened drinks weekly increases the risk of various cardiovascular diseases by as much as 31%.

    Researchers investigated links between sugar intake and cardiovascular disease among nearly 70,000 people. They asked participants about their sugar intake from various sugar-sweetened foods and drinks. Then, using national disease registers, they ascertained the incidence of various cardiovascular diseases, including ischemic and hemorrhagic stroke, myocardial infarction (heart attack), heart failure, aortic stenosis (narrowing of the aorta), atrial fibrillation (abnormal heart rhythm), and abdominal aortic aneurysm (ballooning of the major blood vessel in the abdomen).

    They found that the risk of developing cardiovascular disease varied according to disease type and sugar source. However, drinking more than eight sugar-sweetened beverages weekly carried the greatest risk, increasing a person’s chances of ischemic stroke by 19%, heart failure by 18%, atrial fibrillation by 11%, and abdominal aortic aneurysms by 31%.

    The investigators posited that sugar in beverages is readily metabolized, increasing its potential for harm. Learn more about the health effects of sugar-sweetened beverages in our overview article.

  • Foods with a high glycemic index, such as sugar-sweetened soft drinks, desserts, and white bread products, contain sugars that are rapidly absorbed into the bloodstream, causing hyperglycemia (high blood glucose). Regular consumption of high glycemic foods may lead to insulin resistance, type 2 diabetes, and obesity. Low-calorie sweeteners (i.e., artificial sweeteners) such as allulose have a low glycemic index and can be used in place of sugar to reduce the intake of calories and high-glycemic carbohydrates; however, the effects of allulose in addition to sugar require further investigation. Findings published in a new report show that allulose significantly reduces glucose and insulin levels following sugar consumption.

    Allulose is a rare sugar that can be found in small amounts in some fruits and grains and is sold as a low-calorie sweetener. Allulose is an epimer of fructose, meaning its chemical structure is very similar to fructose, giving it a nearly identical taste and texture; however, allulose provides only 0.4 calories per gram, compared to 4 calories per gram of fructose. A meta-analysis of previous research found that small doses of allulose improved glucose and insulin regulation; however, additional randomized controlled trials are needed, especially in Western populations and in people without type 2 diabetes.

    The researchers recruited 30 participants (average age, 33 years) without type 2 diabetes and asked them to follow an individualized diet plan that provided 50 to 65 percent of calories from carbohydrates for up to eight weeks. Participants completed five study visits with one to two weeks between visits. At each visit, the researchers gave participants a beverage containing 50 grams of fructose (the amount in about 16 ounces of sugar-sweetened soda) with escalating doses of allulose (0, 2.5, 5, 7.5, or 10 grams). They measured glucose and insulin levels in the blood 0, 30, 60, 90, and 120 minutes after beverage consumption.

    Allulose consumption reduced plasma glucose levels among participants in a dose-dependent manner, meaning as the dose of allulose increased from 0 to 10 grams, glucose levels at each time point decreased. The relationship between allulose and lower glucose levels was statistically significant at the 30-minute time point when either 7.5 or 10 grams of allulose was added to the fructose beverage. Compared to consuming a fructose beverage with no added allulose, the 10-gram dose of allulose also significantly decreased insulin levels 30 minutes after beverage consumption.

    These findings demonstrate that allulose decreased glucose and insulin levels when added to a high-sugar beverage in healthy young people without diabetes. The authors suggested that future studies explore more of the mechanisms underlying these results.

  • Hyperglycemia, which occurs when glucose levels in the blood rise to dangerous levels, is a hallmark of diseases such as metabolic syndrome and type 2 diabetes. The effects of hyperglycemia are well documented and include cellular damage, inflammation, and pro-cancer effects; however, few studies have elucidated the cellular mechanisms of hyperglycemia. Findings of a new report suggest mitochondrial damage explains the connection between hyperglycemia and disease.

    Glucose is consumed in the diet from simple sugars and starches. Glucose transport proteins, which move glucose from the bloodstream into cells, are expressed in the heart, skeletal muscle, adipose tissue, and brain among others. TXNIP is a protein that binds to glucose transporters, preventing the movement of glucose into cells. Mice who do not produce the TXNIP protein, called knockouts, experience uncontrolled glucose transport into cells. Glucose metabolism produces damaging compounds called reactive oxygen species, which attack the delicate lipid membranes in mitochondria, the cell structures that produce energy.

    Brown adipose tissue is particularly vulnerable to the effects of hyperglycemia. This fatty tissue produces heat in response to cold temperatures, while white adipose tissue is mainly for energy storage. Brown adipose tissue appears brown because it has a higher density of mitochondria, which may make these cells more susceptible to damage from hyperglycemia, especially in cold temperatures.

    The investigators compared normal mice with those that did not express the TXNIP protein in their brown adipose tissue. After exposing both groups of animals to cold temperatures (40°F, 4°C) for four hours, the researchers measured their body temperatures using a thermal camera and performed an in vitro study to examine the cellular integrity of mitochondria and their ability to produce energy from multiple common fuel sources.

    These experiments revealed that TXNIP knockout mice had lower body temperatures after cold exposure than normal mice, suggesting that their brown adipose tissue was less effective at producing heat under stress conditions. Their mitochondria also showed signs of membrane damage and reduced concentration of polyunsaturated fats, which indicated that they were significantly more stressed due to reactive oxygen species produced during cold exposure compared to mitochondria in normal mice. TXNIP knockout mice had lower expression of genes related to energy metabolism and heat production.

    Interestingly, the researchers found that severely restricting the TXNIP-deficient animals’ glucose intake by feeding them a ketogenic diet for five weeks mitigated the stress-induced deficit in mitochondrial function and reversed the detrimental changes to the polyunsaturated fat content of their mitochondrial membranes.

    These findings indicate that excess sugar intake creates mitochondrial dysfunction, which contributes to poor health. A ketogenic diet reversed the effects of hyperglycemia on mitochondrial function.

  • Metabolic diseases, such as type 2 diabetes, cardiovascular disease, and non-alcoholic fatty liver disease (NAFLD), represent a major public health burden. Dietary factors such as excess sugar intake are associated with greater metabolic disease risk; however, it is unclear how different types of sugars (e.g., glucose, fructose, or sucrose) differentially impact metabolic health. In this report, researchers investigated the effects of sugar-sweetened beverages on fatty acid synthesis, blood triglycerides, and hepatic insulin resistance in healthy males.

    Following the consumption of glucose, the pancreas secretes insulin into the bloodstream so that insulin-sensitive organs such as the liver, skeletal muscle, and adipose tissue can transport glucose into their cells. Excess sugars are converted to fats in the liver via a process called de novo lipogenesis and then stored in adipose tissue; however, as fat levels in adipose tissue rise (i.e., overweight and obesity), fat accumulates in the liver leading to the development of NAFLD. Fructose, the main sweetener found in sugar-sweetened beverages, does not require insulin to be absorbed and is preferentially taken up by the liver, accelerating NAFLD development independent of weight gain.

    The authors recruited 94 healthy lean males (average age, 23 years) and assigned them to consume beverages sweetened with moderate amounts of either glucose, fructose, or sucrose (a sugar that contains both glucose and fructose) in addition to their normal diet for seven weeks. The beverages contained an amount of sugar found in about two cans of non-diet soda. The researchers assigned a fourth group of participants to consume their normal diet with no added sugar-sweetened beverages. They assessed fatty acid and triglyceride synthesis by the liver and whole-body fat metabolism.

    Daily consumption of beverages sweetened with fructose and sucrose, but not glucose, led to a twofold increase in the production of free fatty acids in the liver. Fructose intake did not increase triglyceride production in the liver or whole-body fat metabolism. Participants from all four groups consumed about the same amount of calories, and while body weight tended to increase for all groups, this relationship was only statistically significant for the group consuming glucose-sweetened beverages. Glucose and insulin tolerance did not change with sugar-sweetened beverage consumption.

    The investigators concluded that consumption of beverages sweetened with fructose and sucrose increased free fatty acid production in the liver. While they did not observe changes in other metabolic markers such as insulin tolerance, they hypothesized that the alterations in fat production by the liver pave the way for metabolic disease development.

  • Hypogonadism, a disorder in which dysfunction of the ovaries or testes results in the diminished production of sex hormones, is a growing concern, demonstrated by a marked increase in prescriptions for testosterone replacement. Previous research has reported lower serum testosterone in males with type 2 diabetes and metabolic disease. To expand on this observational research, investigators aimed to determine the effects of a glucose challenge on testosterone levels.

    Testosterone levels change in response to food intake, which activates the secretion of messenger molecules from the hypothalamus that affect the reproductive organs. While some studies have reported a decrease in serum testosterone in response to glucose intake, others have found an increase in serum testosterone in response to a dose of insulin. The mechanisms underlying the relationship between glucose intake and testosterone levels have yet to be illuminated.

    The authors conducted their investigational study with a group of 74 healthy males (19 to 74 years old) of varying weight status who had not been diagnosed with type 2 diabetes. The researchers administered an oral glucose tolerance test in which participants consumed 75 grams of glucose, which is roughly the amount of sugar in two cans of sugar-sweetened soda, and had their blood drawn before consuming the glucose (baseline) and at 30, 60, 90, and 120 minutes afterward. The researchers also collected blood for the measurement of testosterone and other hormones, including luteinizing hormone, which stimulates testosterone production.

    At baseline, 57 percent of the participants had normal glucose tolerance, 30 percent had impaired glucose tolerance, and 13 percent met the criteria for a diagnosis of type 2 diabetes. Glucose intake resulted in lower serum testosterone at all time points following glucose consumption, with an average maximum decrease of 25 percent from baseline levels. The authors reported no changes in plasma concentrations of luteinizing hormone or cortisol and a significant decrease in plasma levels of the hormone leptin. Finally, they reported no differences in testosterone response between men of varying glucose tolerance or weight status.

    The investigators concluded that a challenge of 75 grams of glucose significantly decreased serum testosterone levels, although the mechanisms that drove the decrease are still unclear, given that no changes in luteinizing hormone were found.

  • Sugar-sweetened beverages are the largest source of added sugar in the American diet. The over consumption of sugar-sweetened beverages is linked to insulin resistance and to multiple diseases including obesity, type 2 diabetes, cardiovascular disease, and gout. One group of investigators aimed to determine the relationship between sugar-sweetened beverage consumption and serum testosterone.

    Testosterone is essential for masculine development during puberty and reproductive capacity in adult males. Epidemiological evidence has revealed higher serum testosterone levels in males without diabetes compared to males with diabetes and in active males compared to sedentary males. Previous clinical research has reported a relationship between sugar-sweetened beverage consumption and decreased sperm motility and fertility; however, its relationship with testosterone has not yet been demonstrated.

    The authors reviewed data from the 2011-2012 National Health and Nutrition Examination Survey, a large-scale survey research project that tracks the health and nutrition of adults and children in the United States over time. Research staff for this project administer an interview to participants to collect dietary and demographic information and medical, dental, and laboratory tests to collect physiologic measures.

    The investigators of this report specifically chose a sample of younger males (between ages 20 and 39 years) because this is the period when fertility is highest. They categorized participants (545 males total) into four levels of sugar-sweetened beverage consumption with participants in the lowest level consuming 137 calories of sugar-sweetened beverages or less per day and the highest consuming 442 calories or more per day.

    Ninety percent of participants had a normal testosterone level, defined as greater than 231 nanograms per deciliter. Participants in the highest level of sugar-sweetened beverage consumption were more than twice as likely to have low serum testosterone. After taking into account other factors, including age, race/ethnicity, poverty/income, tobacco and alcohol consumption, and physical activity the authors also found that participants with overweight and obesity were nearly four times more likely to have low serum testosterone compared to lean males, independent of sugar-sweetened beverage consumption.

    This report demonstrates that sugar-sweetened beverage consumption and higher body mass index were both associated with lower testosterone levels in males. These associations were independent of each other and not due to other demographic and lifestyle factors.

  • Obesity and metabolic disease are associated with reduced fertility and alterations in several markers of reproductive health, including plasma concentrations of sex hormone-binding globulin. Low levels of sex hormone-binding globulin are common in those with obesity and are predictive of cardiovascular disease and type 2 diabetes risk, although it is unclear how glucose and insulin regulation affect sex hormone-binding globulin levels. A group of investigators recently performed a series of experiments with the aim of identifying mechanisms of sugar metabolism and sex hormone-binding globulin production.

    Sex hormone-binding globulin, which is produced by liver, transports sex hormones in the blood and regulates their uptake by sensitive tissues. Hepatocyte nuclear factor-4α, also produced by the liver, stimulates sex hormone-binding globulin production and increases serum testosterone by decreasing its half-life. De novo lipogenesis, the process by which the liver converts excess sugar into fatty acids, suppresses hepatocyte nuclear factor-4α activation and sex hormone-binding globulin production.

    In the first experiment, the researchers used transgenic mice whose genomes had been altered to express the human sex hormone-binding globulin gene. They fed these mice a diet high in either sucrose, glucose, or fructose (three types of simple sugars) for one week and measured blood levels of sex hormone-binding globulin. In a second experiment, the researchers exposed human liver cells to varying amounts of insulin and to high concentrations of either glucose or fructose and measured gene expression. Finally, they exposed the same type of liver cells to varying concentrations of glucose and fructose and to the fatty acid palmitate and measured gene expression.

    After five days a high fructose diet reduced sex hormone-binding globulin levels in the mice by fructose 80 percent. Sex hormone-binding globulin levels decreased by 40 percent on a high glucose diet and 50 percent on a high sucrose diet. Insulin exposure did not affect sex hormone-binding globulin production in mice. In liver cells, glucose and fructose exposure over five days reduced sex hormone-binding globulin accumulation by 50 percent. This change corresponded to a three- to fourfold reduction in the expression of hepatocyte nuclear factor-4α. Additionally, glucose or fructose exposure over five days resulted in a two- to threefold increase in palmitate production (due to de novo lipogenesis), which corresponded to reductions in sex hormone-binding globulin. Finally, exposure to varying amounts of palmitate over five days reduced hepatocyte nuclear factor-4α expression and sex hormone-binding globulin production.

    The authors of this comprehensive study concluded that excess sugar intake resulted in increased de novo lipogenesis, which led to a suppression of hepatic HNF-4α activity, which in turn attenuated sex hormone-binding globulin expression. This work provides a detailed explanation of why sex hormone-binding globulin is a sensitive biomarker of metabolic syndrome and why simple sugars, especially fructose, decrease fertility.

  • Current dietary guidelines for people living in the United States recommend limiting calories from sugar intake to less than 10 percent of total daily calories. Despite these recommendations, evidence indicates that some people living in the United States consume as much as 23 percent of their daily calories in the form of added sugars. Findings from a recent study suggest that high dietary sugar intake increases a person’s risk for cancer.

    Cancer is the second leading cause of death in the United States. Unlike normal cells, cancer cells preferentially rely on glycolysis (the breakdown of sugar) to produce energy. This altered metabolism, widely recognized as a hallmark of cancer, promotes cell proliferation and cancer metastasis.

    The authors of the study drew on data from more than 101,000 participants enrolled in NutriNet-Santé, an ongoing observational cohort study based in France. Participants completed online 24-hour dietary records detailing their usual consumption of more than 3,500 food and beverage items. The authors of the study performed statistical analyses to identify associations between sugar intake and cancer risk, taking into account known risk factors, such as socioeconomic status, body size, lifestyle, medical history, and nutritional factors.

    They found that higher dietary sugar intake increased the overall risk of developing cancer 17 percent. The risk of breast cancer increased 50 percent with high sugar intake. These findings suggest that reducing dietary sugar intake decreases a person’s risk of developing cancer and highlight the importance of policies and interventions to reduce intake.

    The effects of sugar extend to longevity, as well. In fact, consumption of sugar-sweetened beverages is associated with dramatically accelerated telomere shortening – equivalent to as much as five years of a person’s life. Watch this clip in which Dr. Elissa Epel discusses the harmful effects of what she calls a “toxic lifestyle,” one that includes the consumption of sugary drinks.

  • Sugar provides necessary energy in the human diet, but excess sugar consumption is associated with weight gain and metabolic disorders. The average person living in the United States consumes approximately 100 pounds of sugar per year. Findings from a recent study suggest that our preference for sugar has its origins in the brain.

    The authors of the study gave mice water that was sweetened with either sugar or acesulfame, an artificial sweetener commonly used in diet drinks and foods. At first, the mice chose to drink both solutions, but after two days, the mice chose the sugar-sweetened water only.

    The researchers analyzed the brain activity of the mice when they drank the two solutions and found that a particular region of the brain responds to sugar – an area called the caudal nucleus of the solitary tract, which is located in the brain stem. They discovered that signals originating in the gut travel along the vagus nerve to this region of the brain to create a gut-brain-axis specific to glucose and similar molecules. Intake of these molecules stimulates even greater consumption, setting up an environment conducive to overconsumption.

    Identification of this neural pathway provides insights into human consumption of sugar and might inform the development of new strategies to reduce intake.