Sugar makes the world go round and get round...

Sugar has a huge presence in our diet; it is a source of energy but also a enabler of potential health risks. In fact, there are actually different types of sugar molecules as well as alternatives that mimick sugar's sweet flavor. In this article, we will discuss the many types of sugars and sweeteners in the market, their impact on our health, and what safety regulation concerns do they impose.


Sugar molecules can be classified as two different types: monosaccharides or dissaccharides. Monosaccharides are individual sugar molecules such as fructose, galactose, and glucose.

  • Fructose - Commonly known as fruit sugar, is the sweetest of the sugars. You may have heard of a common ingredient in many processed foods called high-fructose corn syrup, which is manufactured from processed hydrolyzed corn starch. Upon ingestion, fructose does not stimulate insulin secretion from your pancreas. Insulin secretion promotes leptin production, which is the hormone that regulates your sensation of satiety. Thus, fructose overconsumption reduces circulating leptin concentrations. This combined effects of reduced leptin and insulin in your blood could increase the likelihood of weight gain and metabolic consequences such as diabetes. Furthermore, fructose is preferentially metabolized to fat in the liver. Ultimately, consumption of fructose induces insulin resistance, impaired glucose tolerance, and increase the risk of weight gain and metabolic diseases.
  • Galactose - This sugar does not occur by itself but is a part of the disaccharide called lactose. It is also a component of antigens found on the surface of red blood cells that determine blood groups.
  • Glucose - Also known as grape sugar, glucose is the form of sugar that is transported around the bodies of animals in the bloodstream. Most digested carbohydrates are broken down into glucose for the body to use. Blood sugar tests and routine diabetes exams are involved heavily with this sugar molecule. Unlike fructose, the present of glucose after consuming carbohydrates will stimulate insulin release and gradually reach a sense of satiety.


Disaccharides are combinations of two of the monosaccharides. They include lactose, maltose, and sucrose. Once eaten, these disaccharides are split to their respective monosaccharides for further usage.

  • Lactose (Galactose + Glucose) – This is the naturally occurring sugar found in milk. It is broken down when consumed into its constituent parts by the enzyme lactase during digestion. Some adults no longer form the enzyme lactase and thus are unable to digest lactose.
  • Maltose (Glucose + Glucose) – This sugar is formed during the germination of certain grains, the most notable being barley, which is converted into malt.
  • Sucrose (Fructose + Glucose) – Commonly known as table sugar, sucrose is found in the stems of sugar cane and roots of sugar beet. After being eaten, sucrose is split into its constituent parts during digestion by a number of enzymes known as sucrases. Studies have indicated potential links between consumption of sucrose (particularly prevalent in processed foods) and health hazards, including obesity, diabetes, tooth decay.


Sweeteners have the capability of emulating sweetness without the caloric consequences. Three common sweeteners will be discussed in this article: aspartame, splenda, and stevia.

Aspartame – Many diet alternatives to soda utilize aspartame as a sweetener. When eaten, aspartame is metabolized into its original amino acids. Because it is so intensely sweet, relatively little of it is needed to sweeten a food product, and is thus useful for reducing the number of calories in a product. The safety of aspartame has been studied extensively since its discovery with research that includes animal studies, clinical and epidemiological research, and postmarketing surveillance. Multiple peer-reviewed comprehensive review articles and independent reviews by governmental regulatory bodies have found aspartame is safe for consumption at current levels. The results of these studies overwhelmingly demonstrated that aspartame is not associated with adverse health effects, including headaches, seizures, changes in mood, cognition, or behavior, or allergic reactions. Aspartame has been deemed safe for human consumption by over 100 regulatory agencies in their respective countries.

Splenda – Splenda usually contains 95% dextrose and maltodextrin which the body readily metabolizes, combined with a small amount of mostly indigestible sucralose. Sucralose itself is recognized as safe to ingest as a diabetic sugar substitute. As of 2008 the Canadian Diabetes Association suggests that the amount of sucralose that can be consumed on a daily basis over a person's lifetime without any adverse effects is 9 mg/kg. Furthermore, a repeated dose study of sucralose in human subjects concluded that "there is no indication that adverse effects on human health would occur from frequent or long-term exposure to sucralose at the maximum anticipated levels of intake."

Stevia – Stevia has been widely used as a natural sweetener in South America for centuries and in Japan since 1970. A 2011 review found that the use of stevia sweeteners as replacements for sugar might benefit diabetic patients because it is a noncaloric additive. As of 2008, the FDA has classified Stevia as “generally recognized as safe”. Currently, the World Health Organization Joint Experts Committee on Food Additives has approved, based on long-term studies, an acceptable daily intake of Stevia of up to 4 mg/kg.

Ask your physician if you have further questions about the various types of sugars out there and which ones would be good alternatives based on your medical conditions and lifestyle.


Albert Hsia, MS-IV

Dr. David Carfagno, DO, CAQSM


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