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December 2023 Newsletter

A Look at Processed Sugars and Their Substitutes

Hello, this is Dr. Ellen. In this month’s ‘Real Common Sense’ newsletter, I want to write about one of the most problematic and health-detracting ingredients in today’s prepared foods – sugar! I discussed the advantages of a whole food, plant-based vegan diet in previous newsletters. Right now, I want to emphasize the phrase “whole food”. It is well-recognized that generally, the more a food is processed, the less nourishing it becomes. When one specific macronutrient is isolated from a whole food and then used as a single ingredient, it can not only diminish its nutritional value, but even become detrimental to one’s health. This is all-too-well known to be the case with sugars. I’ll take a look at the problem in this newsletter.

By the way, if you haven’t had a chance to see my previous newsletters, you can find them on my website, www.drellencutler.com under ‘Media’. 

The Problems with Free Sugars

There are three main types of natural dietary sugars that are added to foods and beverages during processing to sweeten and increase the flavor. Glucose and fructose are called monosaccharides because each molecule is composed of a single carbon ring. The third is sucrose (‘table sugar’), a disaccharide, made up of one molecule each of glucose and fructose. Interestingly, all three are classified as ‘nutritive sweeteners’.(1) Glucose is the primary molecule used to create the energy necessary for each cell of the body to operate. Glucose enters the cell under the influence of insulin and is then used to make ATP, the ‘energy currency’ of the body.(2) Most of the dietary fructose is converted into glucose, as is the fructose (and glucose) derived from the cleavage of sucrose.

Natural dietary sugars found in plant-based whole foods are indeed nutritive sweeteners. However, when isolated from the plant and added to the manufacture of processed foods, I find it difficult to think of them as ‘nutritive’. They are carbohydrates that have been denuded of the many other co-factors present in the whole food necessary to properly metabolize and utilize their caloric content. Thus, they are referred to as ‘empty calories’.

When you are consuming processed sugars, especially over time, there are a number of symptoms and signs that can become apparent, indicating your body is trying to compensate for the empty calories and is beginning to become unable to compensate successfully. Some of these include increased hunger, craving sweets, weight gain, irritability, ‘brain fog’, being more easily fatigued, and problems with sleep. Other issues include dental cavities and gum disease, acne, abdominal distress (with or without inflammatory bowel disease) and worsening rheumatoid arthritis symptoms.(3) However, the major concerns regarding the use of processed sugars have been the development of metabolic syndrome, which can lead to type 2 diabetes and cardiovascular disease. These can be present initially without having any overt symptoms.

Several negative physiological effects have been described that result from the use of processed sugars. Although a specific mechanism has not yet been identified, it is known that high levels of glucose can damage the lining of our arteries by making it easier for cholesterol to stick to their inner walls, thus causing “hardening” of those arteries (atherosclerosis).(3) This in turn can lead to coronary artery disease and stroke, and even high blood pressure.

A growing field of study has been the role of the gut microbiome in health and disease. In general, a healthy gut microbiota consists of an abundant variety of health-promoting bacteria that outnumber disease-promoting bacteria. The ‘good’ bacteria ferment the undigested parts of consumed foods, producing some absorbable and desirable substances, such as short chain fatty acids (e.g., butyrate). Their growth is enhanced by eating a whole food plant-based diet. Unfortunately, evidence from a number of animal studies has shown that diets high in processed glucose, fructose or sucrose have the opposite effect, thus encouraging gut dysbiosis, promoting various metabolic imbalances and disease.(1)

A major player in developing metabolic diseases related to modern nutrition are Advanced Glycation End-products (AGEs). They can be ingested with high temperature processed foods. However, they are also formed in the body as a result of high dietary sugar intake. AGEs are toxic compounds deriving from reactions of the sugars with proteins. They are involved in the development of age-related diseases, such as neurodegenerative diseases, atherosclerosis, and chronic inflammatory diseases. And in conditions such as diabetes and insulin resistance, the accumulation of AGEs is further accelerated.(4)

Excessive consumption of free/added sugars can also directly cause chronic low-grade inflammation. This occurs by altering the adipose tissue (fat) metabolism and by causing critical changes in the immune system. These alterations can lead to the loss of function of important immune cell populations. Unfortunately, many of these alterations can impact the ability of immune cells to adjust to changes in the environment.(5)

Alternatives to Free Sugar

Over the past few decades, a number of non-sugar sweeteners have been discovered or developed. Sugar alcohols (e.g., xylitol, sorbitol) are often used as alternatives to natural dietary sugars due to their low-caloric content and positive effect on dental health. Even though they are also considered to be nutritive sweeteners, they are poorly absorbed into the bloodstream.(1) Instead, they are fermented in the intestines by the gut microbiota. Depending on the quantity consumed and the sensitivity of the individual, this can lead to abdominal discomfort secondary to gas and bloating. One of the sugar alcohols, erythritol, is an outlier. It is absorbed directly into the bloodstream, causing little to no abdominal distress. However, some studies have shown an association (though not necessarily causation) between plasma erythritol levels and both obesity and cardiometabolic disease.(6)

The other category of non-sugar sweeteners are the non-nutritive sweeteners (e.g., sucralose, saccharin) that, due to their noncaloric value, have gained popularity and are widely used in sugar reduction strategies.(1) The synthetic sweeteners approved by the FDA include saccharin (Sweet and Low®), aspartame (Nutrasweet®, Equal®), sucralose (Splenda®), and acesulfame potassium (Sunett®, Sweet One®). There is some controversy about the safety of these sweeteners. Side effects of artificial sweeteners may include weight gain, poor blood sugar control, and an unhealthy gut.(7) One prospective study suggested that higher intake of artificially sweetened beverages was associated with (though not necessarily causative of) increased risk of stroke, coronary heart disease, and all-cause mortality.(8)

I would like to talk about two other non-caloric sweeteners, monk fruit and stevia. Both in themselves have no calories, carbohydrates, or sugar and are available in several forms. Both may have an unpleasant aftertaste in some individuals. Monk fruit [aka luo han guo] grows in southeast Asia and China on a vine. In animal studies, monk fruit extract was found to have antioxidant properties and may have a positive effect on blood sugar control.(9)  

Both monk fruit and extracts of stevia have been granted “Generally Recognized as Safe” (GRAS) status by the FDA. In some people, stevia can cause bloating, nausea, dizziness, and numbness. Also, stevia is in the same plant family as daisies, sunflowers, and chrysanthemums, and individuals with allergies to these plants or others in the family may need to avoid stevia products. However, studies have suggested that stevia may have several beneficial effects, including improving diabetic markers when replacing free sugars, supporting weight loss, improving the gut microbiota, and helping improve cholesterol levels.(9,10)  

The Bottom Line

Our bodies were designed to eat naturally occurring sugars in their natural form, contained within the whole plant. The presence of the micronutrients and fiber in this natural form allows for the maximal utilization of these sugars as an energy source for every cell in the body. The more processed free sugars you eat, the more problematic they are for your health and wellbeing. There is an enormous body of evidence pointing out the negative effects of excessive or prolonged sugar intake, especially for fructose and high-fructose corn syrup. Simple sugars should ideally be acquired from healthy dietary sources, such as fruits and vegetables, which all provide many nutritional benefits to the body.(11)

As discussed above, there are a number of non-sugar sweeteners that can be used instead of free sugars, but each has its issues. Ideally, when using these, less is more. Currently, monk fruit and stevia (the latter with the above-mentioned caveats) may be better choices, though the aftertaste of each may be a limiting factor for some individuals.

Please be well, be healthy, and remember…

“The [Standard] American diet causes disease. It is composed of 25 percent animal products and 62 percent processed foods and only 5 percent of calories from fruits and vegetables.”

― Joel Fuhrman

Dr. Ellen


  1. “Impact of Dietary Sugars on Gut Microbiota and Metabolic Health” at https://www.mdpi.com/2673-4540/3/4/42
  2. “Physiology, Glucose Metabolism” at https://www.ncbi.nlm.nih.gov/books/NBK560599/#:~:text=Glucose%20metabolism%20involves%20multiple%20processes,encourage%20glucose%20catabolism%20in%20cells.
  3. “12 Potential Signs You’re Eating Too Much Sugar” at https://www.everydayhealth.com/diet-nutrition/potential-signs-youre-eating-too-much-sugar/
  4. “Dietary Sugars and Endogenous Formation of Advanced Glycation Endproducts: Emerging Mechanisms of Disease” at https://www.mdpi.com/2072-6643/9/4/385
  5. “Are Dietary Sugars Potent Adipose Tissue and Immune Cell Modulators?” at https://www.mdpi.com/2673-4540/4/1/5
  6. “Erythritol: An In-Depth Discussion of Its Potential to Be a Beneficial Dietary Component” at https://www.mdpi.com/2072-6643/15/1/204
  7. “What Are Artificial Sweeteners, and Are They Bad for Me? 6 Possible Risks to Consider” at https://www.goodrx.com/well-being/diet-nutrition/artificial-sweeteners
  8. “Artificially Sweetened Beverages and Stroke, Coronary Heart Disease, and All-Cause Mortality in the Women’s Health Initiative” at https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.118.023100?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub%3Dpubmed&
  9. “What are monk fruit and stevia?” at https://www.medicalnewstoday.com/articles/322769#_noHeaderPrefixedContent
  10. “7 Benefits of Stevia and How to Use the Different Types” at https://draxe.com/nutrition/stevia/
  11. “The Impact of Free Sugar on Human Health—A Narrative Review” at https://www.mdpi.com/2072-6643/15/4/889

* These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, mitigate, or prevent any disease.

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