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    Have Your Sugar and Eat It, Too

    iStock-538263625Our sweet tooth is more demanding than ever. As a result, food companies add a lot of refined sugar to our foods to make them more palatable. Unless you are eating  food in its natural state, odds are you are consuming some kind of added sugar, and likely more than you think. The average American eats about 150 pounds of added sugar each year. Just flip a food product over and look at the label. Chances are you’ll see some variation of processed sugar, such as high fructose corn syrup. 

    Refined sugars are associated with numerous chronic health ailments including, but certainly not limited to, cardiovascular disease and non-alcoholic fatty liver disease. Cognitive decline is also linked to a high sugar intake. So the excess sugar is not only hurting our waistlines, but also our brains. So what are the alternatives when your sweet tooth gets demanding, but your body and brain know better? 

    Natural sweeteners like raw honey, dates, coconut sugar, and maple syrup have beneficial properties and should be considered in favorite recipes (think dates in a pecan pie or maple syrup on your favorite pancake). While shifting to natural sweeteners is great progress, they still add carbohydrate (and calories) to the diet. 

    For years, people have turned to artificial sweeteners as non-caloric options. However, controversy remains over these chemicals, such as saccharin, acesulfame, neotame, aspartame and sucralose, that have been labeled “safe” but have been associated with negative side effects. In one study looking at patients with Type 2 diabetes, aspartame was found to increase cortisol levels and induce oxidative stress by producing free radicals. There are also some concerns that it may alter gut microbial activity, interfering with the N-methyl D-aspartate (NMDA) receptor. One of aspartame’s breakdown products is phenylalanine, known to inhibit alkaline phosphatase, a gut enzyme found to prevent metabolic syndrome in mice. This mechanism may explain why there may be a lack of weight loss when switching to diet drinks. 

    Sugar substitutes may provide a nice option when we want a sweet treat but don’t want to sabotage our health. Here are some low-to-no calorie sugar substitutes, which have also been associated with various health benefits:

    Allulose – (D-psicose) This sugar is found in foods such as wheat, figs, and raisins. The FDA added it to the list of foods Generally Recognized As Safe (GRAS). It contains approximately 1/10 the calories of table sugar. The arrangement of its chemical formula results in processing that differs from fructose since allulose is eliminated in the urine without being used as fuel. This may be advantageous for anyone concerned about blood sugar levels since consumption doesn’t result in elevated blood sugar or insulin. In addition, research indicates it may provide beneficial effects on blood sugar regulation by reducing lipotoxicity in the liver and by preserving pancreatic B-cell function. Though additional human studies are needed, rat studies found a D-psicose diet was favorable for fat burning via decreased lipogenesis, increased fatty acid oxidation, and elevated 24-hour energy expenditure. Animal studies have not found any side effects or signs of toxicity, however, this sugar substitute is relatively new to the market. 

    Glycine – It is the smallest and simplest amino acid, and also has a sweet taste. It plays many roles in the body and supports many essential processes, such as including blood sugar regulation, by converting glucose into energy. One study of 74 patients with type 2 diabetes found that glycine was likely to have a beneficial effect on immune responses resulting in decreased tissue damage associated with chronic inflammation. This may be due to the impact of supplemental glycine on glutathione (the body’s master antioxidant) levels, which helps prevent disorders associated with oxidative stress. Glycine can be found in a pure powdered form or combined with other natural sweeteners. 

    Isomaltooligosaccharide (IMO) – This alternative sweetener is a mix of short-chain carbohydrates. A good source of prebiotics, it has a digestion-resistant property and is low in calories. IMO is commonly derived from the enzymatic processing of starch  and occurs naturally in honey and some fermented foods such as miso, soy sauce, and sake. It is about 60% as sweet as sugar providing a sweet taste that is not too overpowering, and it blends easily into foods, beverages, and recipes.  One study found that IMO was effective in increasing bowel frequency in constipated individuals while lowering total cholesterol and triglycerides and raising HDL. 

    Monk Fruit  (Luo Han Guo) – also referred to as the “longevity fruit”, the sweetness comes from the antioxidant called mogroside. Mogrosides are not like natural sugars found in other fruits and are metabolized in a different manner. This sweetener has traditionally been used for centuries in China as a remedy for sore throats and cough. It provides plenty of sweetness with just a little bit (about 150-200 times sweeter than table sugar!) without impacting blood sugar levels. Other health benefits associated with monk fruit include:

    Stevia – Stevia has been used as a sweetener and a medicine throughout the world since long ago. It has become more popular as a sugar substitute and does help reduce feelings of hunger while satisfying cravings. Stevia has also been associated with therapeutic benefits that support blood sugar, blood pressure, a healthy inflammatory response, and even modulating the immune system. Furthermore,  a 2018 rat study found found that stevia upregulated nuclear factor erythroid 2-related factor 2 (Nrf2). According to Q. Ma, “Reactive oxidants are counterbalanced by complex antioxidant defense systems regulated by a web of pathways to ensure that the response to oxidants is adequate for the body's needs. Nrf2 controls the basal and induced expression of an array of antioxidant response element-dependent genes to regulate the physiological and pathophysiological outcomes of oxidant exposure.” 

    It is important to note that not all stevia is created equally. Green leaf stevia is minimally processed (leaves are dried and ground into a powder), green in color, and 10-15 times sweeter than sugar. One article referred to green leaf stevia as a “low calorie nutritious component”. Stevia rebaudiana extract is more common and has no calories and no glycemic index. The U.S. Food and Drug Administration has determined that the extract is 200 to 400 times sweeter than table sugar. Buyers beware of the “little packets” or blends that are often sold under the guise of stevia, but contain more chemicals and solvents than the actual components (steviol glycosides) in stevia. 

    Sugar Alcohols – Sugar alcohols come from fruits and berries and can typically be spotted on a label as words ending with –ol. With fewer calories than sugar, sugar alcohols like xylitol and erythritol provide a similar sweetness without raising blood sugar or insulin levels. One benefit of these sugar alcohols is the non-cariogenic protective effects for oral health. This makes sugar alcohols a logical choice when choosing a chewing gum or to satisfy a sweet tooth. Since they are not completely absorbed in the small intestine, over-consuming some types of sugar alcohols can result in gas, bloating, and diarrhea, but are generally well-tolerated. For those with metabolic syndrome or diabetes, sugar alcohols are a smart alternative to natural or artificial sugars.

    While there are many options for natural sweeteners or sugar substitutes, they are all still sweeteners and should be used in moderation. Even though it feels we can have our sugar and eat it too, anything in excess can tip the biological scales out of balance.  


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