# 4.4 Sugar's Bad Rap

Sugar can be found in several foods and drinks, but it has always had a bad rap. It is important to understand the difference between natural and added sugars. Natural sugar includes those that are found naturally in foods, such as fruits and vegetables. Added sugars are those that are not found naturally in foods. Some of the main sources of added sugar include soda, energy drinks, sports drinks, fruit juices, candy, desserts, prepackaged foods, and sweetened yogurt.
It is important to understand the dangers of excess added sugar. Sugar is extremely addictive, so, once a person eats a small amount, he or she will begin to crave more. Excess sugar intake can negatively affect your immune system, and it also causes an increase in belly fat. An excess amount of fat around the waist can be very dangerous. Abdominal obesity raises the risk of both type 2 diabetes and heart disease. One study showed that those who consumed “twenty-five percent or more of their daily calories as sugar were more than twice as likely to die from heart disease as those whose diets included less than ten percent added sugar."
Sugar can also negatively affect a person’s metabolism. In a condition known as metabolic syndrome, a person is at higher risk for high blood sugar, high blood pressure, and high cholesterol levels. Studies have also shown that a high intake of added sugar can make the symptoms associated with ADHD worse.
Artificial sweeteners have been another topic open for debate. Artificial sweeteners are used as sugar substitutes because they have fewer calories. Artificial sweeteners can be commonly found in soda, “sugar-free” candy and gum, dairy products, jams, and other processed foods. Because artificial sweeteners are so much sweeter than regular sugar, they only need to be used in small amounts. Many people consume or use artificial sweeteners whey they are dieting because of the low calorie count. Diabetics also commonly use artificial sweeteners. Because artificial sweeteners do not contain a high amount of carbohydrates, they do not raise blood sugar levels like sugar does. Although artificial sweeteners contain fewer calories and carbohydrates, they should still be consumed in moderation. The Food and Drug Administration (FDA) has created an acceptable daily intake (ADI) for each artificial sweetener. One type of artificial sweetener, saccharin, was linked to bladder cancer in rats, so the sweetener had to have a warning label. One of the most common types of artificial sweeteners is aspartame, also commonly called NutraSweet. Some studies have shown an increased risk of certain types of cancer for those who consume excessive amounts of aspartame. Some people are born with a birth defect that causes a buildup of the amino acid phenylalanine in the body that causes a disease called phenylketonuria (PKU). People with this defect should always avoid aspartame. Like sugar, it is important to limit the intake of artificial sweeteners.
There are several controversies surrounding added sugar. Perhaps the most troublesome is the fact that there is a theory that supports that highly concentrated forms of sugar such as high fructose corn syrup and table sugar may be addictive. It becomes addictive because as the primary fuel of the brain sugar could increase serotonin levels. The mechanisms for this are still currently debated. Nevertheless, there are more established molecular mechanisms for diseases that are the result of excess sugar. For instance, obesity has been linked to excess sugar consumption. And even further, scientist have uncovered that aside from the essential primary role sugar serves as ATP provider, sugar can also significantly alter the composition of protein and fat molecules when it adheres to them. This in turn may alter the way cells recognize each other.
Now questions arise when we consider the ethics of large food corporations and their abused use of sugar. Products that contribute to this are candies, sodas, desserts, and sugar sweetened drinks (such as Iced Tea). According to American Heart Association the highest amount of added sugar a male can consume a day is around 37.5 grams this amounts to about 9 teaspoons, and the highest amount of added sugar a female can consume a day is around 25 grams which amounts to about 6 teaspoons. Now if we should be eating so little added sugar, then products such as Coca-Cola/Pepsi that average to about 71 grams of sugar per bottle should not be allowed on the market. These severely sugared drinks are an extreme form of sugar consumption. If one bottle of soda contains so much added sugar, then an individual has clearly surpassed their daily intake. Also, due to the excess, he or she should probably not continue consuming added sugars for the rest of the day. However, this is seldom the case. More often than not we see individuals drinking a soda that is accompanying their already sugary meal. The result of the voluntary abuse is all kinds of diseases from Type 2 diabetes to obesity. These diseases’ put a toll on individual’s body, and it is a well-established notion that obesity increases a person’s likelihood of cancer, so sugar indirectly contributes to cancer. Moreover, overconsumption of added sugars results in an unhealthy diet. This occurs because sometimes individuals whom consume large amounts of added sugar have trouble meeting their other nutritional needs, since they receive most of their calories from sugar.

## 4.4.1 Diabetes

Diabetes is a disease process that occurs due to the carbohydrates metabolism and insufficient hormone insulin in the body. There are the Diabetes Type 1 and Diabetes Type 2, also there is the Gestational Diabetes (GDM).
Type 1 Diabetes: it occurs to children, teenagers or young adults. So in this case they are insulin-dependent because the body doesn’t produce more or there is a little insulin in their body. Pancreas beta cells no longer produce insulin once the body immune system has attacked and destroyed them.
People with this form of diabetes need to do some things:
* Injections of insulin every day in order to control the levels of glucose in their blood.
* Need to choose the correct food.
* Physical Activity
* Controlling blood pressure and cholesterol
Type 2 diabetes: The Pancreas produce insulin, but when the Diabetes Type 2 occurs the body stops producing insulin partially or completely. It refers to the insulin resistance. And there are associated things to it:
* Diet and physical inactivity
* Increasing age
* Obesity: The obesity happens because the insulin resistance lead to elevated blood glucose levels
* . Stress.
GDM is a form of diabetes consisting of high blood glucose levels during pregnancy. Gestational diabetes is caused by the hormones of pregnancy. Women with gestational diabetes may have obese children due to their gestational age once they receive more insulin than necessary.
Syndrome metabolic is associated with many risk factors among them we can have: cardiovascular diseases, abdominal obesity and type 2 diabetes (caused by the insulin resistance). There are many risks of metabolic syndrome: dyslipidemia (hypertriglyceridemia, elevated levels of apolipoprotein B, particles of LDL-cholesterol and small, dense low HDL-cholesterol), hypertension and hyperglycemia.
Symptoms are:
* Thirst
* Frequent urination
* Fatigue
* Hunger
* Weight loss and weakness
* Visual changes
* Slow healing of cuts and bruises
* Itching of the skin, or feminine itching in women
* Pain or numbness in the toes and occasionally the fingers
* No symptoms at all
Without proper management they can lead to very high blood sugar levels which can result in long term damage to various organs and tissues. Some complications are:
* Eyes: Glaucoma and retinopathy
* Foot and skin complication
* Nephropathy, once high levels of blood sugar makes the kidneys to filter blood much more than necessary, therefore kidneys work level is increased
* Neuropathy: There are many reasons for having neuropathy, one of them is: excess blood glucose can injure the walls of tiny blood vessels that nourish your nerves, especially in the legs
Treatment: Type 1 Diabetes: People need to be aware of all information on treatment including the different types of insulin available (1). Thus, it is very important to know the type of insulin to be taken.
Management: With the recent technological advances in today’s society, there are now a plethora of options for diabetics to effectively manage their diabetes. One recent advancement that has allowed diabetics to have tighter control of their blood sugar levels is the constant glucose monitor. A constant glucose monitor consists of a small catheter inserted underneath the skin that checks the glucose levels in the tissue fluid. A transmitter is attached to the sensor which is able to send the blood sugar levels through radio waves to a receiver, that then displays the blood sugar levels onto its’ screen. The transmitter is equivalent to about the size of a quarter which can be placed can be placed on the abdomen or gluteal area. The intention of these devices are to give a patient an overall idea of their blood sugar trends including where they have been and where they are headed. This allows for diabetics to be able to take care of a blood sugar high or low before their it reaches dangerous levels. The receiver that displays the blood sugars is also able to transmit a sound that alerts a patient when their blood sugar has become high or low. This is beneficial because diabetics do not always feel their levels dropping or rising, therefore they are alerted when their blood sugar reaches an alarming level so they are able to take care of it.
One advancement that has also greatly impacted the lives of many diabetics are insulin pumps. Insulin pumps are devices that deliver insulin into the skin via a catheter 24 hours a day. There is a steady rate of insulin that is released throughout the day, along with doses to compensate for the carbohydrates a person eats. Through these methods, the insulin pump is able to act like a functioning pancreas, which contributes to greater blood sugar control. The pump prevents diabetics from taking multiple injections of insulin a day. Instead the insulin is released from the pump which then runs through a series of a tubes before being inserted into the body through the catheter. This prevents the pain of multiple shots of insulin a day and the build of scar tissue that is often associated with repeated injections. The insulin pump is often used in conjunction with the constant glucose monitor, allowing for the ultimate control of blood sugars for diabetics. The constant glucose monitor and the insulin pump are typically used on type 1 diabetics, but recently type 2 diabetics have also begun to take advantage of the all the benefits these products offer. These technologies have made it possible for diabetics to live close to normal lives. They have provided diabetics with a better way to regulate blood sugars and have paved the way for future technology to improve the lives of diabetics.
Type 2 Diabetes: there are many treatments for it:
* Diet control: People need to eat right food combination because in the nutrition area there are some goals: controlled sugar blood, meals plan, loss or maintain weight. Also it is necessary to have their food in the correct time
* Gymnastics or body activity: it is important for having controlled diabetes, it decreases insulin resistance and increases insulin sensitivity, lowers triglycerides, the blood fat that contributes to clogged arteries, helps regulate blood pressure and others.
* Test blood glucose
* Oral medication
* Insulin injections: their blood glucose levels remain too high and insulin treatment is recommended by their doctor.
Web Resources about Diabetes
* American Diabetes Association - Planing Meals
This website not only shows you how counting carbohydrates if that it helps you to know what is a glycemic index, what effects has the glycemic index of a food and how it impacts on your sugar spikes. Also there are examples of foods with its glycemic index.
* American Diabetes Association- My food Advisor
This website goes to help you track the foods that you are eating and give you ideas for recipes and tips for eating out.
* USDA Carbohydrate counting and Exchnage list:
* ADA-carbohydrate counting:
* Full exchange list (2008) from mayo clinic:
These website goes to help you to begin counting carbohydrates through the exchange lists. This exchange system help your health care team decide if changes in medication and or your meal plan should be made with the aim of keep your blood sugar level within your target range. Moreover, it's allow you can to substitute servings or types of foods from one list for other on the same list. In this way you can have an individual meal plan.

## 4.4.2 Dental Caries

Caries are the result of the destruction of the tooth structure; it happens because of bacterial effect, acid, plaque and tartar.
Caries is the result of poor hygiene in the mouth. Also people eat foods containing carbohydrates such as breads, cereals, milk, soda, cakes, or candy that are left on the teeth. Carbohydrates increase risk of tooth decay.
The bacteria that live in the mouth digest these foods mentioned above, turning them into acids. The acid form tooth plaques and later these plaques can be turned into caries. Its more common in back molars, just above the gum line on all teeth.
When people don’t have treatment against the caries it can cause more problems such as: pain, infection and tooth loss.
Treatment
The treatment can depend on how your caries are, but the dentists usually use the following:
* Fluoride
* Teeth restoration what can make the teeth functioning much better.
* Crowns or “ caps” are used in some cases, however crowns are not very a good treatment once it causes teeth weakness
* Root canals treatment
Prevention:
* People need to do three things for having a healthy mouth: brushing the teeth at least twice a day using fluoride toothpaste, flossing and mouthwash.
* If you don’t brush the teeth, you can wash your mouth before eating and drink water.
* Be careful with quality of some foods (snack, fermented carbohydrates and drinks) in your diet.

## 4.4.3 Hyperactivity

According to the “Instituto Paulista de Déficit de Atenção – IPDA” this is a syndrome with characteristics of oblivion, being easily distracted, impulsiveness, inability to concentrate, aggressiveness, and similar behaviors.
According to “Paulo Gonçalves – Especialista em Hiperatividade” he believes that it is related to genetics, the same characteristic of genetics and environmental.
Family history can intensify hyperactivity symptoms (when family doesn’t have structured family, clean rules, and determined time for do many things and others), also habits you learn in the life.
There are many causes:
* Consumption of artificial yellow food and aspartame
* Sugar consumption such as food, such as : chocolate, sweets and drinks for example: soft drink
* Alcohol used in pregnancy once it can cause brain damage and drugs
* Lead poisoning can cause symptoms same of hyperactivity
* Deficiency of vitamin (calcium, magnesium, Vitamin B6, omega-6 and omega-3)
* Sexual abuse
* Sleep deprivation
* Family history
* Anxiety and depression
Treatment:
* Cognitive Behavioral Therapy - psychotherapy.
* Audiology because many people or children who have this syndrome are not able to read very well because they can have dyslexia and dysorthographia.
* Some medication: psychostimulants, medication atomoxetine (Strattera), methylphenidate (Ritalin, Concerta, Daytrana), dextroamphetamine-amphetamine (Adderall), dextroamphetamine (Dexedrine, Dextrostat) and others.
* Supplementation of vitamin, minerals and nutrients
* Eliminating sugar specifically, it does suggest to the parents to avoid giving food additives to their children once it might be better to avoid it as these foods contain aspartame.
* Homeopathy: Doctors have worked in herbal remedies and natural substances that in large doses would actually cause some of the symptoms of hyperactivity
Prevention:
* During pregnancy: Don't drink alcohol, smoke cigarettes or use drugs
* Protect your child from exposure to pollutants and toxins
* Put together a daily routine for your child with clear expectations that include such things as bedtime, morning time, mealtime, simple chores and television.
* Work with teachers and caregivers to identify problems in advance.

## 4.4.4 Obesity

Obesity has increased since 1970 and thus the chronic diseases, diabetes, hypertension and others have risen in children and adults. As these diseases have appeared in many Nations, they have become an epidemic, a crisis of public health
Obesity can be classified thrum two methods:
1º Body mass index (BMI) is your weight in kilograms divided by your height in meters squared. This is a standard method however its classification can vary for children, adults and old people.
2º People with very fat waists (94 cm or more in men and 80 cm or more in women) are more likely to develop obesity-related health problems. so, these measures are very important for determining health outcomes related to obesity and to metabolic syndrome.
Below there are some factors that contribute for having obesity problems: Genetics: Some syndromes can cause obesity because there is mutation or chromosomal abnormalities, such as Prader–Willi and Bardet–Biedl syndromes.
Gender: More prevalent in women. Also more common in Australian women http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/E233F8695823F16CCA2574DD00818E64/$File/obesity-2.pdf Once men have a very fast metabolism than the women. However, in accordance to the CDC study in 2009 and 2010 the obesity prevalence did not differ between men and womenhttp://www.cdc.gov/nchs/data/databriefs/db82.pdf, but others believe that women tend to be more overweight than men.
Physical activity: People live a sedentary life style.
Psychological factors: Individuals who suffer from psychological disorders (e.g. depression, anxiety, and eating disorders) may have more difficulty controlling their consumption of food and maintaining a healthy weight. Once the search for food can give them comfort, distressed also they can transfer to the food their feelings such as: sadness, anxiety, stress, lonely, and frustration.
Malnutrition: Malnutrition is found in the food profile of the families nowadays once they consume industry food which is rich in fat, carbohydrates, sugar and sodium. On the other side they do not use to have vegetables, salad, fruits and cereals.
Pregnancy: During the pregnancy women need more macronutrients and micronutrients; however they eat much more than necessary what make them to get fatter. After having their babies they face more difficulty in coming back to their previous weight.
These factories have their consequences in the health such as cardiovascular disease, type 2 diabetes, heart problems, hypertension, dyslipidemia (for example triglycerides and high cholesterol), Coronary disease, some cancers (for example: breast, colon, endometrial (related to the uterine lining) prostate and kidney, breathing problems (for example: asthma, sleep apnea)
“Excess weight reduces the quality of life, raises medical expenditures, places stress on the health care system and results in productivity losses due to disability, illness and premature mortality.”
In order to avoid this situation the treatment should be in accordance with the diseases; changing the food habit and having regular physical activity for adults and children.

## 4.4.5 Hypoglycemia

Hypoglycemia occurs when blood glucose levels get too low. Symptoms of hypoglycemia usually occur when blood sugar levels are below 70 mg/dL. Symptoms of Hypoglycemia include but are not limited to: dizziness, hunger, shaking, weakness, increased pulse, and sweating. If you experience hypoglycemia and do not try to increase your blood glucose, you could be susceptible to decreased concentration, coordination, passing out, and coma.
Hypoglycemia can commonly be seen in diabetics and can be caused by multiple factors. In diabetics, specifically, too much insulin intake can lower glucose levels to a point where hypoglycemia occurs. As well as insulin, diabetic medicines like Amaryl or Glucotrol can dangerously lower blood glucose to a dangerous point if not taken properly or with food consumption. Low blood glucose can also be seen in diabetics if alcohol is ingested with aspirin, Probalan, Zyloprim, or Coumadin.
Hypoglycemia can be avoided by remembering to ingest food with simple sugars after taking insulin or any diabetic medication. Common foods that can raise blood glucose levels quickly include orange juice, hard candies, sodas, honey, or glucose tablets.
A common symptom of hypoglycemia is passing out. If someone passes out due to hypoglycemia, a glucagon injection can be served to increase their glucose levels quickly. If food or juices are administered while passed out, there is a high possibility of choking in the patient.
Hypoglycemia is a possibility in those not diagnosed with diabetes. There are two types of hypoglycemia that can affect those unaffected by diabetes: reactive hypoglycemia and fasting hypoglycemia. Reactive hypoglycemia happens four hours after meals are ingested and is also known as postprandial hypoglycemia. Fasting hypoglycemia is also known as postabsorptive hypoglycemia and is attributed to some kind of underlying disease. Symptoms of both types are the same as hypoglycemia seen in diabetics.
Reactive hypoglycemia is seen when blood glucose levels are below 70 mg/dL and can be relieved by eating. The cause of reactive hypoglycemia is still unsure but is thought to be attributed to more sensitive release of epinephrine or insufficient release of glucagon in the body.
Fasting hypoglycemia is seen when blood glucose levels are below 50 mg/dL and is after sleeping, physical activity, or in between meals. Fasting hypoglycemia can be attributed to hormonal deficiencies, tumors, ingestion of alcohol, hyperinsulinism, illness, medication, or tumors. When someone has fasting hypoglycemia tests and treatment can usually correct the underlying problems.
It is possible for someone to be unaware of hypoglycemia; this typically happens when the brain does not communicate with the body and no symptoms or signs of hypoglycemia are shown. This case is when hypoglycemia can become life-threatening.

## 4.4.6 Heart Disease

Sugar has always had a bad reputation when it comes to weight gain and cavities. However new studies show that sugar may be a leading cause in the increased risk of dying with heart disease. A study was done on the risks of added sugar and the results clearly exemplified the hazards of added sugar.
They showed that “participants who took in 25% or more of their daily calories as sugar were more than twice as likely to die from heart disease when compared to those who only took in 10%”(Eating too much sugar increases the risk of heart disease, 1). From here, scientists concluded that, “the risk of dying from heart disease rose in tandem with the percentage of sugar in the diet” (Eating too much sugar increases the risk of heart disease, 1). This held true regardless of a person’s sex, age, weight, body-mass index, and physical activity level. In this study, researchers also considered whether it was possible that sugar wasn’t the factor that was increasing these risks, but just the lack of fruits and veggies in a person’s diet. However, when researchers measured the participants Healthy Eating Index that showed how well there diets matched up with federal dietary guidelines, it became clear that “Regardless of their healthy eating index scores, people who ate more sugar still had higher cardiovascular mortality” (Eating too much sugar increases the risk of heart disease, 1).
Taking in 25% of a person’s daily calories through sugar may seem extreme and unlikely, however about 1 in every 10 Americans do it. The biggest sources of added sugar in people’s diets include sugar-sweetened beverages such as energy drinks, sodas, and sport drinks. Because of these types of lifestyle choices that American’s make daily, they are increasing their risk of heart disease. Exactly how this sugar is increasing the risk of heart disease hasn’t yet become clear. However, research has shown that eating and drinking an excess amount of sugar can raise blood pressure. It is also known to stimulate the liver to dump more excess fats into the bloodstream, both of which are known by scientists to increase a person’s risk (Sugar: Killing us Sweetly. Staggering Health Consequences of Sugar on Health of Americans, 2).
Researchers believe that there may be other factors that cause sugar to increase the risk of heart disease besides these two reasons also and believe these will become clearer after further research studies are done. Specific guidelines for fats and sodium are offered, however there is no known “limit” for sugar. There is however pretty outdated advice dating back to 2002, recommended by the American Heart Association, saying that women should consume less than 100 calories from daily sugar. This is now known to be unreasonable, however experts do believe that the least amount of added sugar you can consume on a daily basis the better (Sugar and Cardiovascular Disease, 1). For most people, this may include kicking a soda habit or replacing their sweets addictions with more fruits and veggies.

## 4.4.7 Alternative Sweeteners

Alternative sweeteners are a type of sugar substitute that can be used for many different reasons. Many people use alternative sweeteners to help aid in weight loss. They can also be used to help control blood glucose, weight gain, and dental caries (Whitney). The reason alternative sweeteners are used for weight loss is because they contribute zero calories (Artificial). This, in turn, means that alternative sweeteners provide almost no energy to the body (Whitney). There are both benefits and drawbacks to alternative sweeteners, and in moderation, they are typically okay. However, in larger doses, alternative sweeteners can be harmful.
Some of the common alternative sweeteners are Acesulfame potassium, Aspartame, Saccharin, and Sucralose. Acesulfame potassium is found in the brands Sunnett and Sweet One. Aspartame is found in Equal and NutraSweet. Saccharin is found in SugarTwin and Sweet’N Low. Sucralose is found in Splenda (Artificial Sweeteners). Some of these sweeteners come from naturally occurring substances, but overall, they are synthetic sugar substitutes (Artificial). Besides being found in small sugar packets; alternative sweeteners are commonly found in processed foods. They are so popular, because they are typically sweeter than just sugar. For example, another type of alternative sweetener, Advantame, has a relative sweetness to pure sucrose of 20,000 to 1 (Whitney).
A few of the benefits of alternative sweeteners is that they don’t promote dental caries, they can help with weight control, and people with diabetes can use them as an alternative to sugar. Artificial sweeteners don’t raise blood sugar levels, and therefore are generally okay for diabetics to use (Artificial). For those looking to lose weight, artificial sweeteners are very attractive. Alternative sweeteners are called “non-nutritive” sweeteners, because they provide no energy to the body (Whitney). With this in mind, it is more appealing to use artificial sweeteners instead of the table sugar, which is a high calorie food. Reduced calories, along with exercise and good diet, can result in weight loss.
Although there are benefits to alternative sweeteners, there are also some drawbacks. The most glaring concern of alternative sweeteners is their contribution to causing cancer. Studies have not confirmed that alternative sweeteners can cause cancer, but there was a scare with saccharin in the 1970s that linked it to bladder cancer (Artificial). This label has since been dropped, but it is important for alternative sweeteners to not exceed the recommended intake, regardless. The Food and Drug Administration has set guidelines for the intake of alternative sweeteners, and these are known as the acceptable daily intakes (Whitney). As with many other foods, alternative sweeteners should be used in moderation, and they need to be a part of a balanced diet.
'Dangers of Artificial Sweeteners' Although there are benefits to alternative sweeteners, there are also some drawbacks. As with many other foods, alternative sweeteners should be used in moderation, and they need to be a part of a balanced diet. Because artificial sweeteners can be up to 7000 times sweeter than table sugar they have the tendency to make your taste buds less receptive to natural sources of sweetness, for example the sweetness in fruits or in milk. This can cause a person to want foods that are sweeter and sweater causing them to eat more foods that are unhealthy like candy and sodas instead of fruit.
Artificial sweeteners can also interfere with the breakdown of food in a person’s stomach. When a person eats something sweet the brain signals the stomach that something containing high calories was just eaten and is on its way.The stomach then prepares for the large amount of calories, but when only a small amount of calories arrive its too late the stomach is ready to break down a large amount of calories.This causes the stomach to break down food inefficiently, which can cause problems. Also when something sweet enters the mouth the brain also signals the pancreas to release insulin.Even though it would not be needed, causing confusion in the body.This confusion can cause a person to over eat.The stomach wants to match with what was tasted in the mouth.If the mouth tastes a lot of calories but only a few are delivered to the stomach it can cause a persons body loose control of how much they eat. Causing a person to want to eat more to mach the taste of sweetness that was in their mouth.
Although diet sodas contain artificial sweeteners that have no calories, studies have shown that people who drink diet sodas with artificial sweeteners regularly are more likely to get type 2 diabetes than people who don’t drink soda at all. Studies also show that people who drink diet soda tend to be more over weight than people who drink regular soda. A well-known artificial sweetener is sucralose. Sucralose is made by chlorinating sucrose. This process is done by chemically substituting three chlorine atoms for three hydroxyl groups. The problem with this is that chlorine is a well-known carcinogen. There are no real long term studies on the affect of sucralose or other artificial sweeteners as a result know one really knows how safe or how dangerous they will be in the long run. This just proves there are no short cuts. Instead of drinking as much diet soda as you want thinking it is perfectly safe. It is safer just to drink regular soda in moderation.

### 4.4.7.1 Sugar Alcohol

Sugar alcohol is another popular alternative to sugar. Also known as Polyols, sugar alcohols occur naturally in food and come from plants such as fruits and berries. Common types of sugar alcohols are mannitol, sorbitol, xylitol, lactitol, isomalt, maltitol and hydrogenated starch hydrolysates (HSH). Sugar alcohol is found mostly in foods labeled "sugar free" or "no added sugar" such as gum, hard candies, cookies, soft drinks and throat lozenges, toothpaste and even mouthwash. Despite the name, there is no ethanol in sugar alcohols and does not affect the liver.
There are few benefits to consuming sugar alcohols verses regular sugar. This sugar alternative does not cause tooth decay and contains a low glycemic index. Sugar alcohol requires little to no insulin to metabolized. As such, blood sugar does not spike due to the slow conversion process of sugar alcohol to glucose. Sugar alcohols also contain fewer calories than sugar or other sugar substitutes, such as sucrose, making it a very appealing alternative.
However, sugar alcohols are not easily absorbed by the body and must be broken down in the large intestine by gut bacteria. Sugar alcohols may have a laxative type of effect when ingested in large quantities. Excessive amounts eaten in short periods of time can cause symptoms like gas, bloating and diarrhea. Weight gain has been seen when these products are overeaten.
Sugar alcohol differs from other artificial sweeteners such as saccharin and aspartame. First, sugar alcohol contains an average 2.6 (1.5-3) calories per gram where other artificial sweeteners contain zero. Another difference is sugar alcohols contain carbohydrates where other artificial sweeteners do not. To calculate the number of carbohydrates sugar alcohol contains in a product, refer to the nutrition label. Take the total number of sugar alcohol grams and divide it by 2, then subtract that number from the total number of carbohydrates.

# References

Artificial Sweeteners. (n.d.). Retrieved November 25, 2015, from http://www.hsph.harvard.edu/nutritionsource/healthy-drinks/artificial-sweeteners/
Artificial sweeteners and other sugar substitutes. (2015, August 20). Retrieved November 25, 2015, from http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936
Counting Sugar Alcohols. Diabetes Education Online. https://dtc.ucsf.edu/living-with-diabetes/diet-and-nutrition/understanding-carbohydrates/counting-carbohydrates/learning-to-read-labels/counting-sugar-alcohols/. Accessed August 5, 2017.
Edwards D. The Two Most Dangerous Artificial Sweeteners. Global Healing Center 2015. Available at: http://www.globalhealingcenter.com/natural-health/two-of-the-most-dangerous-artificial-sweeteners/. Accessed 2015.
Main E. Trying To Lose Weight? Stay Away From Artificial Sweeteners No-cal is no good way to get your sugar fix. rodalesorganiclife.com 2015. Available at: http://www.rodalesorganiclife.com/food/trying-lose-weight-stay-away-artificial-sweeteners. Accessed 2015.
Sugar Alcohol. Yale New Haven Hospital. https://www.ynhh.org/services/nutrition/sugar-alcohol.aspx. Accessed August 5, 2017.
What Are Sugar Alcohols? Joslin Diabetes Center. http://www.joslin.org/info/what_are_sugar_alcohols.html. Accessed August 5, 2017.
Whitney E., Rolfes S. (2015). Alternative Sweeteners. Understanding Nutrition. Retrieved from http://ng.cengage.com/static/nb/ui/index.html?nbId=196342&nbNodeId=58604887&deploymentId=4842767387588213997397576#!&parentId=58604888

## References

* ↑ http://www.popsugar.com/fitness/Why-Added-Sugar-Bad-35787797
* ↑ http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/artificial-sweeteners/art-20046936
* ↑ http://www.physicaltherapyjournal.com/content/63/6/960.full.pdf
* ↑ http://diabetes.niddk.nih.gov/dm/pubs/type1and2/what.aspx
* ↑ https://www.idf.org/about-diabetes/risk-factors
* ↑ https://www.idf.org/types-diabetes
* ↑ http://diabetes.niddk.nih.gov/dm/pubs/type1and2/what.aspx
* ↑ http://web.archive.org/web/20120617133840/http://www.fm.usp.br/gdc/docs/revistadc_166_10-sindrome-metabol.pdf
* ↑ http://circ.ahajournals.org/content/109/3/433.full
* ↑ http://lomalindahealth.org/medical-center/our-services/diabetes-treatment-center/resources/diabetes-in-a-nutshell/diabetes-causes.page
* ↑ http://lomalindahealth.org/medical-center/our-services/diabetes-treatment-center/resources/diabetes-in-a-nutshell/medications.page
* ↑ https://www.niddk.nih.gov/health-information/diabetes/overview/managing-diabetes/continuous-glucose-monitoring
* ↑ https://www.medtronicdiabetes.com/treatments/continuous-glucose-monitoring
* ↑ https://www.medtronicdiabetes.com/treatments/insulin-pump-therapy
* ↑ http://www.diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/how-do-insulin-pumps-work.html?referrer=https%3A%2F%2Fwww.google.com%2F
* ↑ http://lomalindahealth.org/medical-center/our-services/diabetes-treatment-center/resources/diabetes-in-a-nutshell/medications.page
* ↑ http://lomalindahealth.org/medical-center/our-services/diabetes-treatment-center/resources/diabetes-in-a-nutshell/medications.page
* ↑ http://www.diabetes.co.uk/treatment.html
* ↑ http://www.diabetes.co.uk/treatment.html
* ↑ http://www.diabetes.org.uk/Guide-to-diabetes/Introduction-to-diabetes/Treating_diabetes/
* ↑ http://www.diabetes.org/food-and-fitness/food/planning-meals/
* ↑ http://www.trackerdiabetes.org
* ↑ http://finic.nal.usda.gov/diet-and disease/diabetes/carbohydrate -counting-and exchange-list
* ↑ http://www.diabetes.org/food-and-fitness/food/carbohydratecounting
* ↑ http://www.mayoclinic.com/health /diabetes-diet.DA 00077
* ↑ http://www.webmd.com/oral-health/guide/dental-health-cavities
* ↑ http://health.nytimes.com/health/guides/disease/dental-cavities/overview.html
* ↑ http://www.webmd.com/oral-health/guide/dental-health-cavities
* ↑ http://health.nytimes.com/health/guides/disease/dental-cavities/overview.html
* ↑ http://www.colgate.com/app/CP/US/EN/OC/Information/Articles/Oral-and-Dental-Health-Basics/Checkups-and-Dental-Procedures/Fillings/article/What-is-a-Filling.cvsp
* ↑ http://www.nhs.uk/Conditions/Dental-decay/Pages/Prevention.aspx
* ↑ http://www.webmd.com/oral-health/tc/tooth-decay-prevention
* ↑ http://www.dda-deficitdeatencao.com.br/oquee/index.html
* ↑ http://www.nlm.nih.gov/medlineplus/ency/article/003256.htm
* ↑ http://en.wikipedia.org/wiki/Hyperactivity#cite_note-4
* ↑ http://www.tdah.org.br/index.php?option=com_k2&view=item&layout=item&id=11&Itemid=116&lang=br
* ↑ http://www.nativeremedies.com/ailment/hyperactivity-natural-supplements-info.html#anchor-3
* ↑ http://www.tdah.org.br/br/sobre-tdah/tratamento.html
* ↑ http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=treatments-and-drugs
* ↑ http://www.nativeremedies.com/ailment/hyperactivity-natural-supplements-info.html#anchor-3
* ↑ http://www.webmd.com/parenting/features/busting-sugar-hyperactivity-myth
* ↑ http://www.nativeremedies.com/ailment/hyperactivity-natural-supplements-info.html#anchor-3
* ↑ http://www.mayoclinic.com/health/adhd/DS00275/DSECTION=prevention
* ↑ http://nutricao.diabetes.org.br/alimentacao-saudavel/1638-nutricao
* ↑ http://epirev.oxfordjournals.org/content/29/1/6.full.pdf
* ↑ http://www.nhs.uk/Conditions/Obesity/Pages/Introduction.aspx
* ↑ http://www.webmd.com/diet/what-is-obesity
* ↑ http://www.hsph.harvard.edu/obesity-prevention-source/obesity-causes/genes-and-obesity/
* ↑ http://www.scielo.br/scielo.php?pid=S0004-27302003000600001&script=sci_arttext
* ↑ http://www.jlgh.org/Past-Issues/Volume-4---Issue-4/Behavioral-and-Psychological-Factors-in-Obesity.aspx
* ↑ http://www.scielosp.org/pdf/csp/v24s2/18.pdf
* ↑ http://www.nber.org/papers/w13289.pdf?new_window=1
* ↑ http://win.niddk.nih.gov/publications/PDFs/stat904z.pdf