Chapter 8: Sugar, Sweeteners, and Alcohol

Chapter grade for scientific accuracy: F (46.67%)

Back in my Chapter 1 post, I said I wasn’t going to pay heed to any of the anecdotes littered throughout It Starts With Food (ISWF). I lied (sue me). The personal story at the beginning of this chapter caught my eye. I think you’ll see why in a moment. 

Whole30

“I was diagnosed with Lyme disease in October of 2009…I hurt everywhere…I was in so much pain! My doctor told me it could take six months of antibiotics or more to start feeling better. I thought to myself, ‘I do not have six months to wait!’ I found the Whole30 and thought, ‘Let me try it—what do I have to lose?’ Well, I had a lot to lose—like every one of my Lyme disease symptoms, and a few pounds as well! I started feeling better after day three, and I just kept feeling better—to the point at which I feel healthier now than I did before I had Lyme, as long as I stay on my dietary course!”

—Anita H., Albany, New York

Let’s assume that Anita had been correctly diagnosed with Lyme disease and that she did not seek out treatment for it. Judging by her story, these seem like reasonable assumptions. The first oddity is that her doctor told her she needed six months of antibiotics. The NIH and Infectious Disease Society of America’s Lyme Treatment Guidelines don’t suggest any course of treatment over 30 days [1-5]. Maybe she got a bad doc or maybe she’s remembering it wrong (or something else). At any rate, here is what happens when you don’t treat Lyme disease [1,2,5]:

  • “Untreated patients may be at especially high risk for development of Lyme arthritis” [6]
  • Symptoms may come and go.
  • Untreated, Lyme disease can spread to the brain, heart, and joints.
  • Stage 3 Lyme disease can cause long-term joint inflammation and heart rhythm problems.
  • Brain and nervous system problems are also possible, and may include:
    • Decreased concentration
    • Memory disorders
    • Nerve damage
    • Numbness
    • Pain
    • Paralysis of the face muscles
    • Sleep disorders
    • Vision problems

Sounds fun doesn’t it?

It comes off as a bit irresponsible to include this anecdote in the book with its implication that the Whole30 has super curative powers against diseases like Lyme. No evidence exists to indicate any dietary measures can cure you of this infectious illness. Lyme disease is no joke and to indirectly suggest that your diet plan can cure it is careless. But I guess that’s why the Hartwig's felt it was necessary to include this disclaimer at the beginning of the book:

"The information included in this book is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in this book does not create a physician-patient relationship." 

Onto the meat of the chapter. ISWF begins by laying out their Good Food Standards. Foods that they say violate the following rules are out:

  1. Doesn’t promote a healthy psychological response
  2. Doesn’t promote a healthy hormonal response
  3. Doesn’t support a healthy gut
  4. Doesn’t support immune function or minimize inflammation

First on the chopping block, we have sugar.

Whole30

“Sugar does not make you healthier…In a most unscientific experiment, we Googled “sugar is healthy” to see if we could find any support for this hypothesis. The first link that appeared was titled “Experts agree—sugar is a health destroyer.” True story [40].”

Unfortunately, the article cited was a link to Natural News. Natural News is run by the “health ranger” Mike Adams and is one of the most popular online repositories for quackery and pseudoscience. The folks at Science-Based Medicine summed up Mike Adams quite nicely with this quote [7].

“[Adams] is a one-stop shop…of virtually every quackery known to humankind, all slathered with a heaping, helping of unrelenting hostility to science-based medicine and science in general. True, Mike Adams is not as big as, say, Joe Mercola…but what Adams lacks in fame he makes up for in sheer crazy.”

I know their ‘experiment’ was supposed to be tongue in cheek but really? A Natural News article?

Whole30

“Because the sweetness of sugar is addictive, eating an excess amount is easy [41].”

To support their claim that “sugar is addictive” they cited a Huffington Post article written by Dr. David Katz, MD. The title of this article is “Sugar Isn’t Evil – A Rebuttal”. That may sound like an article going against the ‘sugar addiction’ claim, but Dr. Katz goes to some length to build his case that sugar meets the criteria for an addictive substance. 

It should be noted that The American Psychological Association does not classify sugar as an addictive substance [17]. The current body of literature does not support the idea that sugar is addictive in humans [37,38,39]. Claiming that sugar is addictive minimizes the struggle of those who deal with real addictions. If you think you suffer from addiction you should seek out help from a professional, not go on a 30-day diet. 

Whole30

“Artificial sweeteners may be even more problematic [than sugar] because they are designed to deliver a sweetness hit that is far beyond what you could ever find in nature [42]. 

Aspartame (Equal) and Stevia (Truvia) are 200-300 times sweeter than table sugar. 
Sucralose (Splenda) is 600 times sweeter than table sugar.
Saccharin (Sweet’N Low) is up to 700 times sweeter than table sugar.”

The erroneous idea that artificial sweeteners taste hundreds of times sweeter than sugar stems from a misunderstanding of how sweetness is measured, i.e. the potency vs the intensity. Dr. Walters, Ph.D. gives a good overview of the testing procedures.

“Sucrose is the standard to which all other sweeteners are compared. Humans can recognize sweetness in about 1% or 2% sucrose solution. Coffee is typically sweetened to about the level of 5% sucrose [and] soft drinks about 10%. 15% sucrose is really sweet and starts to feel a little syrupy. Taste panelists are often trained to quantitate sweetness on a 0-15 sweetness scale…using [a range of] 2-15% sucrose solutions as references. Other sweeteners are then tasted at a series of dilutions to determine the concentration that is as sweet as a given sucrose concentration.  For example, if a 1% solution of sweetener X is as sweet as a 10% sucrose solution, then sweetener X is said to be 10 times as potent as sucrose” [8,10].

In essence, when someone says that “Sucralose (Splenda) is 600 times sweeter than table sugar” they are saying that Splenda is 600 times more potent than table sugar because you can use a lower dose to obtain the same perception of sweetness. It is not an indication that Splenda delivers a higher-intensity stimulus than sugar; merely that it triggers the taste receptors for sweetness on your tongue at a lower threshold.

Now you might be thinking “If you just consumed higher and higher doses of these artificial sweeteners, wouldn’t you eventually hit a dosage where the artificial sweeteners deliver a higher stimulus than sugar?”

Let’s examine that question in the context of the next quote.

Whole30

“These artificial sweeteners provide taste and reward sensations the likes of which we (biologically) have never before experienced, burning our taste buds (and pleasure centers) out on stimuli that are simply otherworldly.”

The taste buds in your mouth have a “sweetness ceiling”, meaning that after a certain concentration we see the sweetness rating level off. In artificial sweeteners, the metallic and bitter compounds begin to override the sweet taste at higher doses [11]. When artificial sweeteners are tested against natural sweeteners (sucrose, maple syrup, and agave nectar) it is actually the natural sweeteners that rank higher [9]. Aspartame (Equal), Sucralose (Splenda), Acesulfame K (Sunett/Sweet One), and Rebaudioside A (Rebiana) all have a lower maximal sweetness than table sugar [9]. Maple Syrup and Agave Nectar have the highest sweetness ratings.

[9]

The findings from this paper put it best [9]:

“Non-Nutritive Sweeteners (NNS) are not supernormal stimuli. Although NNS have low psychophysical detection thresholds compared with sugars, it is not valid to use thresholds or the dose over threshold to estimate the perceived intensity of these sweeteners…present data do not support the claim that NNS produce deleterious health effects by overstimulating sweet taste receptors to produce hyper-intense sweet sensations.”

Now that we’ve cleared that up, let’s look at some more claims.

Whole30

“Research suggests that the taste organ (your tongue and taste buds) is a peripheral target for leptin. Leptin resistance…may lead to an “enhanced behavioral preference for sweet substances.” When you’re leptin resistant, the taste of sweetness is dulled, which makes you eat more to satisfy your craving [12].”

The article cited was a study performed on diabetic obese and nondiabetic thin mice. The researchers found that in nondiabetic mice, increased leptin tended to “selectively suppress [the] taste nerve responses to sweet stimuli” [12]. That suppression was not seen in diabetic obese mice, leading the researchers to hypothesize that “leptin influences food intake…at [the] peripheral level acting as a sweet-sensing modulator” [12]. It’s important to note that all currently available research in this area has only been performed on mice; this effect has yet to be demonstrated in humans. Of the animal research available the results are mixed, with some studies showing an effect of leptin levels and others showing none [13]. One paper opined that “understanding the functional logic of taste bud circuitry, including the role of leptin, remains incomplete” [14].

Whole30

“Artificial sweeteners like Splenda may also kill off your beneficial flora, even when consumed in “normal” amounts.”

To support this claim, a study about the effects of Splenda on certain gut bacteria in rats was cited. This study showed decreased amounts of beneficial gut bacteria after 24 weeks of Splenda ingestion. However, this study has never been replicated and no trials have been conducted in humans. There also seems to be some questions about the validity of the methods used.

You can read the original paper here:

Splenda alters gut microflora and increases intestinal p-glycoprotein and cytochrome p-450 in male rats. 

The critiques here:

Expert panel report on a study of Splenda in male rats. 

An overview of the safety of sucralose. 

And the authors reply here:

Sucralose revisited: rebuttal of two papers about Splenda safety. 

Whole30

“Sugar also messes with the healthy environment of our guts, specifically altering the delicate balance of “good” and “bad” bacteria. Unfriendly gut bacteria love refined sugars, which means your added sugar intake serves only to promote the existence of the bad guys—and can reduce the population of good guys.”

If this is true, ALL sugar, not just ‘added’ sugar, disrupt your gut bacteria. If we assume that the above statement is accurate (I do not believe it is that black and white) sugar from fruit and sweet potatoes should also harm your gut bacteria. And don’t forget the sugar they are referring to (sucrose) is made up of fructose and glucose. So does that mean that any food that has glucose or fructose in it can be assumed to upset your microbiome? No citation was provided for this statement, but their logic doesn’t really pan out. 

Whole30

“Numerous reports have associated the use of various artificial sweeteners with various conditions, like cancer, inflammatory bowel disease, migraines, kidney disorders, autoimmune conditions, carpal tunnel syndrome, and neurotoxicity. There have not been enough long-term studies on humans to definitively confirm or deny these associations, but for us, the potential risks represent additional downsides in an already very long list—more than enough justification to avoid artificial sweeteners altogether.”

That is a pretty bold statement to make considering the Hartwig’s provide exactly 0 citations. As grandmother always said, “Citation or GTFO”. What if I told you that there was a substance commonly found in many foods that caused 4,147 deaths per year [15], has been found in biopsies of pre-cancerous tumors, and is an industrial solvent and coolant [16]. Sounds pretty scary, right? The substance I’m referring to is water, which contributes to 4,147 drownings annually. Context is key and when no context is provided in order to spin a narrative you’re just fear mongering. 

Whole30

“Splenda has more in common with pesticides than table sugar.”

Who cares? Are you eating a pesticide? No, you’re not. It does not matter if Splenda has “more in common” with pesticides than sucrose (there are literally hundreds of pesticides with vastly different chemical structures so I’m not sure which one they are referring to). The only thing that matters is how Splenda affects your body. This statement is just more unnecessary promotion of chemophobia. 

Whole30

“Alcohol is addictive [17].”

I’d say alcohol “can be” addictive. But honestly, I’m just glad to find something the authors and I can agree on [17]. 

Whole30

“…when combined with sugar (Jack and Coke, anyone?), alcohol increases insulin secretion, which pulls too much blood sugar out of the bloodstream, causing temporary hypoglycemia [18,26].”

This is pretty much true. An alcohol+carb drink will stimulate insulin to a greater extent than a carb drink alone, but alcohol by itself has very little effect on insulin secretion [18,19]. And as they note the effect is temporary and is dependent upon when your last meal was. 

Let’s run through the next series of claims made about alcohol.

Whole30

“Alcohol directly promotes intestinal permeability and overgrowth of gut bacteria… [20]”

“Both acute and chronic alcohol use impair cellular immunity… [22]”

“Alcohol is also pro-oxidative… [25]”

 - Intestinal Permeability

The intestinal permeability data reviewed in the cited article were from studies looking at rats who had been chronically fed alcohol and human alcoholics [20]. The article did not discuss what, if any, intestinal permeability would be seen in those who drink moderately.

 - Overgrowth Of Gut Bacteria 

The studies that found an overgrowth of gram-negative bacteria were, again, all conducted in alcoholics making it hard to extrapolate these results to a more casual drinker. As noted by the authors of the article, the following questions still remained [20]:

  • Does alcohol affect bacterial growth in a dose-dependent manner? 
  • Is bacterial growth associated with increased amount of endotoxin production? 
  • What types of bacteria are affected by alcohol?

The researchers noted that in rats administered an oat supplement (oats, ironically, being banned while on the Whole30) saw decreased severity of gut leakiness as well as liver injury while simultaneously being fed large amounts of alcohol [20,21]. It is a rat study so who knows if this would help human alcoholics, but it seemed an interesting aside.

 - Acute and Chronic Alcohol Use Impair Cellular Immunity

It is well established that chronic alcohol consumption is good for no one [22]. However, the effects of acute alcohol consumption are a bit more nuanced than “acute alcohol consumption impairs cellular immunity”. In fact, the paper cited had many positive things to say about moderate alcohol intake:

  • Associated with decreased mortality and cardiovascular morbidity
  • Alcohol-induced elevation in HDL (the ‘good’ cholesterol) may help protect against atherosclerosis
  • Can reduce inflammation, a key component of CHD

The researchers also stated that any hit your immune system takes will most likely be short term and that the “clinical implication of such a transient [short] immunodepression after acute, moderate alcohol use need further studies” [22].

 - Alcohol is Also Pro-Oxidative

So are components of tea and the nitrates (when converted to nitric oxide) found in plants like celery and green leafy vegetables [24]. Having too few pro-oxidative substances in your diet isn’t necessarily a good thing [23]. A balance between oxidants and antioxidants is important as both play critical roles in the body. Oxidants, for example, help to limit the growth of tumor cells [24]. The amount and frequency of alcohol consumption will be a determining factor in the anti/pro-oxidant balance and low, infrequent alcohol doses are highly unlikely to cause any meaningful harm. Many cohort studies have shown potential health benefits from moderate alcohol intake [33,34,35,36].

Whole30

“…If you were Mr. Red Wine Producer, you might read (or fund) some studies on the heart- healthy effects of certain antioxidants, like resveratrol, realize your wine contains tiny amounts of this healthy compound, and start marketing your wine as “heart-healthy” [27].”

“A fluid ounce of red wine averages 160 micrograms of resveratrol… [28]”

“To get the same dose of resveratrol used in the mice studies, a person would have to drink more than 60 liters (that’s 80 bottles) of red wine every day [29].”

I can’t figure out where they got this number from >>> “A fluid ounce of red wine averages 160 micrograms of resveratrol.”

The paper they cite was actually a study of resveratrol content in edible peanuts, but the abstract mentions the average resveratrol content in red wine ranges from 0.6-8.0 mcg/mL. But that would make the range per ounce 17.74-236.59 mcg/oz. which averages out to 127.17 mcg/oz., not 160. I know it’s a trivial point, but it speaks to the attention to detail. 

It is true that the potential benefits of resveratrol consumption through wine have been over-hyped (although there may be future applications for a resveratrol supplement) [31,32] but cohort studies have consistently shown a modest benefit of low to moderate alcohol consumption [33,34,35,36]. 

The Scienciness Scale

Of the claims made in this chapter, here is how they stack up on the Scienciness Scale.

Scienciness Categories

True (4 Points) – true statements
Mostly True (3 Points) – where the bulk of the claim is factually accurate
Misleading (2 Points) – where statements are presented out of context
Mostly False (1 Point) – where the bulk of the claim is factually inaccurate
False (0 Points) – false statements

Results

15 Statements Evaluated
28 Out of 60 Possible Points Earned
46.67% Overall Factual Accuracy

Chapter 8 Scienciness Scale

Statement Categorization

True

“Alcohol is addictive [17].”

“To get the same dose of resveratrol used in the mice studies, a person would have to drink more than 60 liters (that’s 80 bottles) of red wine every day [29].”

Mostly True

“…when combined with sugar (Jack and Coke, anyone?), alcohol increases insulin secretion, which pulls too much blood sugar out of the bloodstream, causing temporary hypoglycemia [18,26].”

“A fluid ounce of red wine averages 160 micrograms of resveratrol… [28]”

Misleading

"Research suggests that the taste organ (your tongue and taste buds) is a peripheral target for leptin. Leptin resistance…may lead to an “enhanced behavioral preference for sweet substances.” When you’re leptin resistant, the taste of sweetness is dulled, which makes you eat more to satisfy your craving.

“Artificial sweeteners like Splenda may also kill off your beneficial flora, even when consumed in “normal” amounts.”

“Splenda has more in common with pesticides than table sugar.”

“Alcohol directly promotes intestinal permeability and overgrowth of gut bacteria… [20]”

“Both acute and chronic alcohol use impair cellular immunity… [22]”

“Alcohol is also pro-oxidative… [25]”

Mostly False

"Sugar also messes with the healthy environment of our guts, specifically altering the delicate balance of “good” and “bad” bacteria. Unfriendly gut bacteria love refined sugars, which means your added sugar intake serves only to promote the existence of the bad guys—and can reduce the population of good guys.”

“Numerous reports have associated the use of various artificial sweeteners with various conditions, like cancer, inflammatory bowel disease, migraines, kidney disorders, autoimmune conditions, carpal tunnel syndrome, and neurotoxicity. There have not been enough long-term studies on humans to definitively confirm or deny these associations, but for us, the potential risks represent additional downsides in an already very long list—more than enough justification to avoid artificial sweeteners altogether.”

False

"Because the sweetness of sugar is addictive, eating an excess amount is easy.”

“Artificial sweeteners may be even more problematic [than sugar] because they are designed to deliver a sweetness hit that is far beyond what you could ever find in nature. 
Aspartame (Equal) and Stevia (Truvia) are 200 to 300 times sweeter than table sugar. 
Sucralose (Splenda) is 600 times sweeter than table sugar.
Saccharin (Sweet’N Low) is up to 700 times sweeter than table sugar.”

“These artificial sweeteners provide taste and reward sensations the likes of which we (biologically) have never before experienced, burning our taste buds (and pleasure centers) out on stimuli that are simply otherworldly.”

Sources

  1. http://www.idsociety.org/uploadedfiles/idsa/guidelines-patient_care/pdf_library/lyme%20disease.pdf
  2. http://www.nlm.nih.gov/medlineplus/ency/article/001319.htm
  3. http://pusware.com/testpus/disease_Lyme.html
  4. http://pusware.com/testpus/bug_Borrelia.html
  5. http://www.cdc.gov/lyme/signs_symptoms/index.html
  6. http://www.ncbi.nlm.nih.gov/pubmed/11133377
  7. http://www.sciencebasedmedicine.org/mike-adams-on-dr-mehmet-ozs-colon-polyps-spontaneous-disease/
  8. http://www.sweetenerbook.com/assets/blogs/measure.html
  9. http://www.ncbi.nlm.nih.gov/pubmed/24942868
  10. http://pubs.acs.org/doi/abs/10.1021/bk-1991-0450.ch020
  11. http://www.ncbi.nlm.nih.gov/pubmed/7712215
  12. http://www.ncbi.nlm.nih.gov/pubmed/10995460
  13. http://www.ncbi.nlm.nih.gov/pubmed/25740302
  14. http://www.ncbi.nlm.nih.gov/pubmed/25740303
  15. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6234a9.htm
  16. http://www.dhmo.org/facts.html
  17. http://www.ncbi.nlm.nih.gov/pubmed/23737408
  18. http://www.ncbi.nlm.nih.gov/pubmed/68385
  19. http://www.ncbi.nlm.nih.gov/pubmed/9506730
  20. http://www.ncbi.nlm.nih.gov/pubmed/18504085
  21. http://www.ncbi.nlm.nih.gov/pubmed/11602653
  22. http://www.ncbi.nlm.nih.gov/pubmed/10659718
  23. http://www.ncbi.nlm.nih.gov/pubmed/22419320
  24. http://www.ncbi.nlm.nih.gov/pubmed/20558130
  25. http://www.ncbi.nlm.nih.gov/pubmed/21315761
  26. http://www.ncbi.nlm.nih.gov/pubmed/17916634
  27. http://articles.latimes.com/2012/jan/12/news/la-dipak-das-resveratrol-diederik-stapel-20120112
  28. http://www.ncbi.nlm.nih.gov/pubmed/10775379
  29. http://www.mayoclinic.org/diseases-conditions/heart-disease/in-depth/red-wine/art-20048281
  30. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0019881
  31. http://www.ncbi.nlm.nih.gov/pubmed/24629966
  32. http://www.ncbi.nlm.nih.gov/pubmed/21698226
  33. http://www.ncbi.nlm.nih.gov/pubmed/21343207
  34. http://www.ncbi.nlm.nih.gov/pubmed/24315622
  35. http://www.ncbi.nlm.nih.gov/pubmed/25567363
  36. http://www.ncbi.nlm.nih.gov/pubmed/25598021
  37. http://www.ncbi.nlm.nih.gov/pubmed/17617461
  38. http://www.ncbi.nlm.nih.gov/pubmed/20056521
  39. http://www.ncbi.nlm.nih.gov/pubmed/25205078
  40. http://www.naturalnews.com/032327_sugar_health.html
  41. http://www.huffingtonpost.com/david-katz-md/sugar-health-evil-toxic_b_850032.html
  42. http://permanent.access.gpo.gov/lps1609/www.fda.gov/fdac/features/2006/406_sweeteners.html
  43. http://www.ncbi.nlm.nih.gov/pubmed/18800291