Not All Sugars Are Created Equal

Lactose is the sugar found in milk and essentially nowhere else in the world. (There are a few reports of traces being found in various plants, but it's not clear whether those can be confirmed.) There are about 12 grams of lactose in a cup, eight ounces, of milk. That's one reason why nutritionists favor milk over sodas. An equivalently-sized glass of Coke has 27 grams of sugar.

But what kind of sugar is sugar? In the United States the word "sugar" on an ingredients list means sucrose, the sugar that is found in sugar cane or sugar beets. Any other sweetener must be individually named.

What's in these sweeteners? The new January-February 2010 issue of the Nutrition Action Healthletter (so new that the website hasn't been updated to mention it yet: what's wrong with people who can't get their websites up to date?) has an interesting sidebar to its cover article on "Sugar Overload." It tells you what's in sugars. It may not be what you expect.

Lactose is a disaccharide, meaning it is made up of two simple sugars, glucose and galactose. Sugar is an example of a carbohydrate and all carbohydrates eventually break down in the body to form glucose, which is the body's energy source. Glucose is already there. Galactose breaks down in about 45 minutes. Complex carbohydrates, like the starches, are usually just long chains of glucose molecules. That's why all carbohydrates provide 4 calories of energy per gram.

Sucrose is also a disaccharide, made up of fructose and glucose. It's a chemical combination of the two, just as lactose is a chemical combination of galactose and glucose. Fructose metabolism is somewhat more complex than galactose metabolism, one reason that it is controversial as a sweetener. The big difference between sucrose and high fructose corn syrup (HFCS), though, is that sucrose is a chemical combination of glucose and fructose and HFCS is a physical combination of the two. There are several commercial mixtures of glucose and fructose that are sold as HFCS but the version that is 58% glucose and 42% fructose has the same sweetness as sucrose, which is why it's used as a substitute.

So what is the effect of HFCS? That same page I linked to above says there isn't one.

Studies that have compared high fructose corn syrup (an ingredient in nearly all soft drinks sold in the US) to sucrose (common table sugar) find that most measured physiological effects are equivalent. For instance, Melanson et al. (2006), studied the effects of HFCS and sucrose sweetened drinks on blood glucose, insulin, leptin, and ghrelin levels. They found no significant differences in any of these parameters.[48] This is not surprising since sucrose is a disaccharide which digests to 50% fructose and 50% glucose; while the high fructose corn syrup most commonly used on soft drinks is 55% fructose and 45% glucose. The difference between the two lies in the fact that HFCS contains little sucrose, the fructose and glucose being independent moieties.

48. Melanson, K.; et al. (2006). "Eating Rate and Satiation.". Obesity Society (NAASO) 2006 Annual Meeting, October 20-24,Hynes Convention Center, Boston, Massachusetts. doi:10.1111/1467-9280.02452 (inactive 2008-06-25).

Let the furious comments begin.

What about other sugars? Let's circle back to that Nutrition Action Healthletter article.

Agave syrup or nectar: 84% fructose, 8% glucose, 8% sucrose.
Apple juice concentrate: 60% fructose, 27% glucose, 13% sucrose.
Brown sugar: 97% sucrose, 1% fructose, 1% glucose.
Evaporated cane juice: 100% sucrose.
Dextrose: 100% glucose.
Grape juice concentrate: 52% fructose, 48% glucose.
High-fructose corn syrup: 58% glucose, 42% fructose or 55% fructose, 45% glucose.
Honey: 50% fructose, 44% glucose, 1% sucrose.
Maple syrup: 95% sucrose, 4% sucrose, 1% fructose.
Molasses: 53% sucrose, 23% fructose, 21% glucose.
Orange juice concentrate: 46% sucrose, 28% fructose, 26% glucose.
Raw sugar, Table sugar, Confectioner's sugar, Baker's sugar, Powdered sugar: 100% sucrose.

(If the percentages don't equal 100% the remainder are other carbohydrates.)

That's right. Agave nectar, the darling of coconut milk nondairy alternatives, is much higher in fructose than HFCS. So is apple juice content rate. And honey is basically the equivalent of HFCS.

If you want to scorn HFCS you're free to do so. Just be aware that the alternatives may have far more fructose that they aren't telling you about. It's not the food: it's how much you have of it and what percentage that plays in your overall diet. Please don't get fooled by phony claims of "organic" or "natural." First understand the chemistry and composition of food. Then make wise decisions.

Sorbet: Dairy-Free But Watch the Sugar

Though the northeast is suffering through a June that features far more rainy days than scorchers, the calendar and the astronomers proclaim that we've arrived in summer. And since editors are slaves to calendars, garnering material weeks or months early to appear on the proscribed date, frozen dessert articles are appearing like clockwork. If anybody under the age of 50 understands what that metaphor means.

Therefore we have Erin Lindholm on amNewYork, who provided a terrific reminder that most frozen desserts are sugar-filled candy confections. They taste great, they satisfy the craving for coolness in the heat, but they need to be occasional treats. You can't load up on the cool stuff and then eat your way through the rest of the day without taking these extras into account.

Sorbets are especially subject to this blindness. Because they're fruit-based and often dairy-free, even fat-free, most people will think of them as a light and less calorific alternative to ice cream. That might be true. Even so, you might be surprised at the sugar wallop they're packing.

While it’s true that sorbet’s a lower-calorie, lower-fat (often fat-free) alternative to ice cream, and it’s made of fruit and often dairy-free, that’s not a green light to eat the whole pint in one sitting.

“It should still be considered a treat or dessert unless it’s homemade, and you know what’s really going into it,” noted nutritionist Liz Stein.

The first step, said Stein, is to check the sugar. For all their appeal, “sorbets are still loaded with sugar.”

In the four market brands taste-tested for this article — Ciao Bella, Haagen Dazs, Sharon’s and Whole Fruit — sugar per serving ranged from 19g to a whopping 38g, which is a huge variable when we’re talking about a scoop of frozen delight.

Second, said Stein, is figure out where the sugar’s coming from. The fruit accounts for some of it, but "you want to choose a sorbet that has natural sugar, as opposed to high-fructose corn syrup." Case-in-point: In four samples, we found everything from cane sugar to plain old "sugar" to corn syrup.

I'm not as much a foe of high-fructose corn syrup as Stein. Sugar is mostly sugar, with four calories per gram no matter what the source. Cane sugar is the same thing as "plain old sugar." Corn syrup is the simple sugar glucose. Sugar is glucose plus fructose in equal parts, but converts to glucose inside the body. High fructose corn syrup (HFCS) is also glucose plus fructose, with a variety of blends from 42% fructose to 90% fructose depending on the needs of the final product. As a commercial syrup it also contains water, usually one-quarter of the total. This means that HFCS only has three calories per gram. It's made commercially starting from a corn syrup base.

I know that many people get hysterical over the tremendous amount of use of HFCS in consumer products, because it is much cheaper than sugar. (Remember that it's one-quarter really cheap water.) The science is not clear that HFCS promotes obesity or has any truly bad effects on the general population. My feeling is that any sugar consumed in large quantities is going to have an effect on obesity. It wasn't the switch to HFCS that made Americans obese, it was the change in habits, the lessening of physical activity, and the growth in portion size that made supersizing the new normal.

Back to the point. Go ahead, have a small sorbet as a summer treat. No reason at all to cut out treats entirely. Just remember that fruit or not, you're eating a cupful of sugar, with some cups having even more sugar than others. Moderation in all things, except moderation.

When Are "Facts" not Facts?

I don't usually comment on other blogs. Search on "lactose" and you get almost nothing back for the time and effort you expend. Every once in a while, though, I stumble over a load of such concentrated ignorance that I need to contain it before it spreads further.

The home page of dietblog appears at first glance to be a source of reasonable health information. Closer inspection reveals the hidden truth. Each entry is from anyone who registers and is only as good as the knowledge and opinions of the blogger. That means readers are likely to fall immediately into an abyss of food nonsense.

What caught my eye was a post It's Easy to Eat Right and That's a Fact! by a blogger named ej.

Everything I have said here, and everything else that I'll say on this site is fact, so don't have a go at me because none of this is my opinion - it's fact.

Did somebody wave a red flag?

Here's one of ej's "facts:"

Humans have been consuming fat since the year dot. Therefore our bodies know the fat and it can use the fat accordingly. We find it hard to eat too much fat because our bodies have an 'off switch' for fat - it detects when we have consumed enough fat and we feel full. ... Full fat milk is fine to have in moderation, as lactose is detected by the enzymes in the liver, so the body can deal with it.

What in world could ej possibly have meant by those sentences?

First, our bodies don't have an "off switch" for fat. Fat can, well, make you fat, just as sugar can. All sources of proteins, fats, and carbohydrates are broken down by the body into their components. If they can be used by the body or burned as fuel they will be. If not, they will be stored. As fat.

Lactose is, of course, not fat. It is a sugar. It is not "detected by the enzymes in the liver" whatever that means. Lactose gets digested by the enzymes in the small intestine, specifically the lactase enzyme. Those of us with lactose intolerance make little to no lactase, so we can't digest lactose. It doesn't matter in the tiniest whether that lactose is wrapped in whole milk or skim milk. The body doesn't notice, and the liver never sees it at any time, in any way.

Everybody about ej's approach to sugar is beyond odd. Take these statements:

They say there is a lot of sugar in fruit so it's bad for you. NO. Fruit has natural sugar, yes, but it also has fiber and nutrients in it that counteract the sugar when we eat it, so the sugar is still there, but our body can use it positively.

Here's one thing most of you probably don't know. Our bodies can't detect fructose...

What is the sugar in fruit? Right. It's fructose. Until the past few thousand years, the vast majority of the sugar that an adult human would encounter would be fructose. Natural honey is a physical rather than chemical combination of fructose and glucose. A few vegetables, notably sugar cane and sugar beets, are predominantly sucrose, itself a complex sugar made out of fructose and glucose, but those had limited range compared to fructose-heavy fruits.

BTW, it's fructose, not lactose, that is metabolized by the liver. The Wikipedia page on fructose has a jumble of contradictory and inconsistent statements on fructose digestion, but check Figure 6 Metabolic conversion of fructose to glycogen in the liver. Maybe this is what ej has read about once and misinterpreted. Saying our bodies "can't detect fructose" is sheer nonsense no matter how one interprets it.

No one diet is right, and by that I mean no one type of diet is right. You can lose weight on every type of diet. Empty sugars, which are sugars without good supporting nutrition, the nutrients found mainly in, um, fruit, do contribute to obesity. Too much fat also contributes. Too much food period is a cause of obesity. Cutting calories will help you lose weight when accompanied by an increase in exercise. Eating healthy, sensible foods is a must.

So is understanding a few basics about food, digestion, and nutrition. Everything poor ej doesn't know.

I'm Back - And Not a Moment Too Soon

C'mon, world. I was only gone for a week. How could everything have gone to hell so quickly?

You know my usual rants about reporters not getting it right. Here's a world-class example from Jen Braaten of the Grand Forks Herald:

With age comes the susceptibility to anemia, or inadequate iron. Anderson also notes that the lactose enzyme gets smaller within the body, making it more difficult to digest milk or milk products.

The lactose enzyme gets smaller? Is it like The Incredible Shrinking Man? Why not just say straightforwardly - and correctly - that our bodies tend to make less of the enzyme as we grow older?

Blogs. Well, what can you say about blogs? On November 1, Jimmy Moore posted a screed against high fructose corn syrup (HFCS) in his Atkins Diet blog, Livin' La Vida Lo-Carb. Numbers are not his strong point, though.

This is a scary thought for me personally because I used to consume the equivalent of 16-20 cans of Coca-Cola on a daily basis before I started livin' la vida low-carb. That's about 45g sugar, all in the form of high fructose corn syrup, per can. So I was guzzling down--BRACE YOURSELF--upwards of 900 grams of fructose just in my soda consumption before the Atkins diet. And we won't even talk about the HFCS that was in all those snack cakes I used to eat, too! EEEEEEK!

Sigh. High fructose is not at all the same thing as all fructose. HFCS comes in several varieties, but the type normally used in soft drinks is about 55% fructose and 45% glucose. That cuts the number of fructose grams down to just under 500. Still a lot, but 400 g - nearly a pound - less than he stated.

In addition, his screed against fructose has the basic problem that all sugar has about 4 calories per gram. So Moore was consuming a whopping 3600 grams/day of calories just from colas. That's in addition to those snack cakes. And presumably everything else he ate all day long.

So why blame the fructose? He doesn't list even a single thing wrong with his body that he himself attributes to fructose.

Although lack of understanding of all processes with sugar is a severe problem in this country, I wouldn't bother with this blog if Moore didn't also mislead with a more directly relevant comment:

Many people also have fructose intolerance, similar to lactose intolerance with milk-based products...

Not too terribly similar, though. It can't be. Lactose intolerance results from the lack of an enzyme to split the complex sugar lactose into simpler sugars. Fructose is itself a simple sugar, however. No enzyme needs to be manufactured by the body. The two conditions are similar only in that undigested lactose or fructose may cause gastrointestinal symptoms. Most doctors put hereditary fructose intolerance in the category of "rare" diseases, with no more than 1 in 20,000 affected. Lactose intolerance affects more than 15,000 in 20,000 worldwide.

Avoid screeds. They're bad for your health.

One more example before my blood pressure gets too high.

Reporters aren't responsible for headlines, so when I saw that the headline "Soy milk may be as effective as skim in promoting weight loss" over a story by Mike Danahey at the CourierNewsOnline.com wasn't backed up well, if at all, by the actual article I could have shifted the blame upward. But then...

The study is in the Journal of the American Dietetic Association's October 2007 issue. Volume 107, Issue 10, Pages 1811-1814 (October 2007) "Preliminary Study: Soy Milk as Effective as Skim Milk in Promoting Weight Loss," by Judith M. Lukaszuk, Paul Luebbers, and Beth A. Gordon.

The 56-day study followed 14 overweight women, ages 18 to 45, from the DeKalb area. They randomly were assigned to include about three cups a day of either soy or skim milk in their calorically restricted diets.

Those on soy milk also were given a soy protein supplement so that the protein intake levels would be similar. The diet was made up of 45 percent carbohydrates, 30 percent protein and 25 percent fat.

"They then maintained the lifestyles they had when they started the study," said Lukaszuk. That included a woman who enjoys getting a latte every morning, but substituting soy milk and skipping the whipped cream.

All the women lost weight, decreased body fat percentage and went down in waist size, and the greatest losses were seen in those with high dairy intake, the study found.

However, the journal abstract said that:

There were no significant differences in weight, fat percent, abdominal circumference, and fat-free mass between groups.

One group did lost a pound more than the other, but that was not a statistically significant amount, so the greatest losses were due to dairy statement is misleading and shouldn't have been included in the article.

I have to note that the study put all the women on diets that served them 500 calories/day less than they usually ate. It's the calorie restriction that helped account for the loss in weight. However, the study, limited as it was, attempted to determine whether it was the protein in milk rather than some other property that accompanies weight loss. This very preliminary evidence indicates that any equivalent protein intake will work. Vegans and others on soymilk diets, take note.