August 29, 2023

Nutritional Biochemistry

Sugar substitutes: deep dive into the pros, cons, available options, and impact on metabolic health

Sugar substitutes offer sweet taste with minimal calories, yet they remain controversial. How well do they solve the problems associated with traditional sugar, and where do they fall short?

Peter Attia

Read Time 33 minutes

We’ve all heard that sugar is bad for us. Long-term, high levels of sugar consumption – in the form of sucrose (i.e., table sugar), high fructose corn syrup, or otherwise – can lead to weight gain and elevated risk for many of the most deadly chronic diseases, including metabolic syndrome and type 2 diabetes, cardiovascular disease, liver disease, Alzheimer’s disease and dementia, and certain types of cancer.

And yet, it’s hard to deny sugar’s appeal (and its ubiquitous presence in Western food environments as a result). Although some may have a stronger sweet tooth than others, all humans are born with a predisposition to enjoy and seek out sweet tastes. This preference is hardwired in the mammalian brain and thus can’t be “unlearned,” and, as Dr. Rick Johnson has previously discussed on the podcast, it likely served as an advantage during human evolution.

So now we have a substance that accelerates disease and mortality, and a substance that is highly-rewarding and holds universal, innate appeal. Two sides of the same sugar-coated coin. But what if we could separate the enjoyable qualities from the health concerns?

Cue the rise of artificial/non-nutritive sweeteners and other sugar substitutes, a class of compounds that provide sweet taste but few or no calories. Theoretically, they offer the best aspects of sugar with none of the downsides, but of course, the story is not that simple. While these compounds remain popular, they are controversial and certainly haven’t made excessive sugar consumption a concern of the past. So how well do these substitutes solve the problems associated with traditional sugar, and where do they fall short? And how do different options compare with each other?

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  1. Good article but down to the basics should I drink Coke zero of regular coke if drinking soft drink at a social event.?

    • Short answer: Both are bad and should be avoided.

      Long answer: If you think in terms of the amount of artificial stuffs that are put into (stabilizers, specially), diet soda tend to be worse than regular soda.
      I personally go to diet because I have pre diabetes, so a high sugar intake (specially in a very short period of time) is a no no to me. If you don´t have diabetes, is not trying to lose weight or restricting sugar intake for whatever reason, I think drinking regular soda is a less worse option.

  2. I can highly recommend glycine as a sweetener. Maybe not the best taste-wise, but comes with a range of additional health benefits.

  3. You didn’t cover Monk Fruit. Based on my research, monk fruit is the best sugar substitute available today.

  4. I’m looking forward to this episode. I’ve been a low carb person for 23 years. I don’t buy anything with sugar in it. I don’t buy anything with sugar substitutes. I think part of the journey of getting off sugar is moving away from needing things to taste sweet.

    HOWEVER… as a cyclist I do consume LMNT sweetened with Stevia. This may be crazy but I have wondered if our brain perceives sweetness, could it trigger the same kind of glycemic/insulin response?

  5. The sugar substitutes discussions (zzz…) rarely dive into the “sweet culture” we’ve created. (“Culture” vs. biology)
    I know it is a tough subject (not charming, huh) as habits are hard to die, sweet flavours and brain/gut connections can be tricky (and tricking), and marketers became masters of storytelling… Which industry, institution or government wants to fund studies to investigate deeply about the chronic sweet taste fulled by added sugars and its substitutes (artificial, natural, and even slow carbs or isolated amino acids like glycine)? We reached to the point that when in the States it is an impossible mission to find a simple dried fruit without a syrup bath. And wherever you are, try to buy a granola without any form of added sweetener or sugar. Good luck.
    No, consumers can’t opt anymore to sweeten – or not – at home their food. Grown up kids, food industry loves to sweeten your food for you, in the exact way THEY need it to be. Industry does that not only because we humans full accept the infantilisation of ourselves, but also because for centuries sugar and now different-intensity sweeteners serve to mask flavours…
    (I need to thank Brian Johnson these days as one of the few that discusses about the root cause of the sugar substitutes talks – that for decades go nowhere.)

  6. Very comprehensive.

    Suggestion: summary of each section in succinct bullet points. It sounds lazy, but would actually be helpful to a layman simply trying to make the right decision on this topic and pass it in to others .

  7. Off topic, but I’d like to give a shout-out to the editors/proof readers of Dr. Attia’s newsletters and show notes. It’s hard to publish this much content and maintain excellent quality. Kudos.

  8. Great article I learnt a lot , I wondered also on thoughts about monk fruit as its appearing in some products I use

  9. I dont buy thing with any sugar or substitute but i do add 100% stevia or 100% monk fruit to my my morning coffee, afternoon matcha tea and night snack of plain sheep yogurt. This article didnt look at those. Ive read they do raise glucose a tiny bit but not like the others.. so i hope im doing ok with those

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