In many ways, sugar is like a drug. It impacts mood, digestion, sleep and can profoundly affect cognition. Sugar triggers the brain's reward system in a similar way to drugs, though it's far more complex than "Oreos are like cocaine." Withdrawals are also not unheard of, and sugar consumption can be compulsive; however, it's probably not addictive in the same way that heroin or alcohol can be. "Sucrose use disorder" is not an actual diagnosis like substance use disorder.
Regardless, society seems to have a problem with sugar. Aside from its negative environmental and social impacts, excessive sugar consumption is linked to a wide range of poor health outcomes, including metabolic diseases like obesity and diabetes, cardiovascular damage and dental decay. But it seems impossible to avoid sugar, even if you try, due to the fact unscrupulous companies unnecessarily inject it into food products, including bread, salad dressing, soup, pasta sauces, cereal, tonic water, jerky and much more.
Avoiding sugar is hard, but we crave it for a good reason. Sugar is rich in calories, but it was much more rare before industrial society turned it into the roughly $70 billion business it is today. In order to survive in a nutrition-scarce world millions of years ago, humans evolved to seek out sugars wherever we could find it. In plants, sugars come in the form of fructose, sucrose and maltose, while lactose is a sugar found in milk. The body breaks all of these chemicals down into glucose, which is used for energy and storing fat.
But humans have crafted ingenious ways of making sure we always have a ready supply of sugar on hand, perhaps too much of a good thing. And we like to have our cake and eat it too, so have also invented chemical alternatives to sugar that do not exist in nature or hacking natural sugars to be even more potent.
There's actually a long history of developing sugar alternatives. In Ancient Rome, it was customary to boil grape syrup into a concentrated form called "sapa" or "defrutum" that was frequently used to enhance the flavor of wine. However, it was brewed in kettles or pots lined with lead, which produced lead acetate, also known as "salt of Saturn" or "lead sugar." Though sweet, lead acetate is highly toxic.
Scientists have recreated these antiquarian concoctions using old recipes, finding that anywhere between 240 to 1,000 milligrams of lead were present in these poisonous drinks. Just a single teaspoon (five milliliters) would have been enough to cause chronic lead poisoning. Some anthropologists believe such tainted wine contributed to the fall of Rome more so than lead-laced plumbing.
Unfortunately, even today these sweet shortcuts come with a price, which is becoming increasingly clear thanks to advances in scientific research. The most recent bombshell concerns erythritol, a mildly sweet sugar alcohol widely used in everything from chocolate and gum to dietary supplements and soft drinks. (It also seems to kill bugs.) Although first discovered in the 19th century, this tiny molecule (consisting of a mere four carbon atoms) entered widespread use in 1990 thanks to breakthroughs in Japanese fermentation technology that allowed it to be produced at scale.
It quickly became one of the most popular sweeteners globally due to the fact that erythritol has literally zero calories. This is because the body excretes it too quickly to metabolize it, too tough even for the bacteria in our guts to break it down. Despite this, it is still associated with weight gain and the development of type 2 diabetes.
Erythritol is derived from plants like corn, so it's often marketed as "natural" and isn't technically an artificial sweetener. Our bodies even naturally produce it in small amounts. But Cleveland Clinic researchers published a study last month in the journal Nature Medicine that found that erythritol consumption was linked to a dramatic increase in heart attacks and strokes. Given the fact that some people consume up to 30 grams of erythritol per day — far more than is found in fruits or vegetables — this could be a serious risk of death.
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So far, this link is just an association, but the underlying mechanism points to erythritol increasing the risk of blood clots, which is especially concerning for people who have diabetes, obesity or a history of cardiovascular disease — the same groups of people who may be inclined to avoid sugar and reach for an alternative in the first place.
Future studies are needed to really tease out this relationship, but in the meantime, many organizations, including the Food and Drug Administration (FDA) and the European Food Safety Authority consider erythritol to be safe for humans to consume. Dose, of course, plays a major role as well, but these agencies put no limit on daily consumption of erythritol. The level of exposure and the associated risk is dependent on how much erythritol one ingests. But another major concern is that many people often can't tell how much of this stuff they're eating.
"The FDA does not require disclosure of erythritol content in food products, making its levels in foods as an additive hard to track," the Cleveland Clinic researchers wrote. "The present results highlight the need to establish reporting requirements, safety profiles and margins of daily intake amounts given that broad consumption continues to increase. Public policy decisions need to be evidence-based and better informed."
As Salon has reported, the FDA may soon change its definition on what constitutes "healthy" food, which would conceivably address the common practice of adding sugars to low-fat food products and labeling them as nutritionally beneficial. But some corporations such as KIND, a New York City-based snack food company, have pushed back against these proposed changes, claiming it would encourage companies to use artificial sweeteners. The FDA has no plans to regulate these alternatives.
In a way we can think of alternative sweeteners as more adjacent to drugs than sugar, if not outright. These are foreign chemicals that profoundly alter our biochemistry, as demonstrated in a study published last August in the journal Cell Press. In a randomized-controlled trial with 120 adults with four sweeteners – including stevia, aspartame, saccharin or sucralose – researchers at the Weizmann Institute of Science found these additives significantly altered the human microbiome, the resident microbes in our guts deeply associated with our health.
The implications of this research still aren't clear, but it's yet another indication that alternatives to sugar aren't consequence-free. That also doesn't mean these products are "dangerous" or radioactive, but given how widespread and severe the trend of companies loading food products with artificial sweeteners is, consumers could use better information and better science to inform their dietary choices.