The Skinny On Sweeteners

I am frequently asked about the sweeteners that can be used with a low carbohydrate diet. There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.

First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat. Most sugars are labeled with the ending “ose".

With an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream. Glucose (a carbohydrate in its most simple form) stimulates insulin to rise. A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day. Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.

Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides.

Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate. Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.

Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels. Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content. Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods. This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).

Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.

Aspartame
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™). Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days.

Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994, vol. 44: 1787). Most people enjoy without problem, however.

Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar. It also contains no carbohydrates. To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste. The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar. Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.). It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).

This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market. It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas. I have found in my private medical practice that this sweetener significantly limits weight loss.

Sucralose
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking. It is available as a bulk sweetener and actually measures equivalently to table sugar. Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127). 1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.

Saccharine
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners. It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.

Cyclamate
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.

Stevia
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves. It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter. Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release. Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.

Sugar Alcohols
Sugar alcohols are also called polyols. These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH). These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate. However, they are incompletely absorbed by the human intestine. This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates. In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals.

Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950). Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637).

So, in summary, which sweeteners will not cause weight gain or cholesterol changes? From the research that is presently available, aspartame, Stevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight. I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Three MOST Difficult Activities in the World

The top three MOST difficult things to do in the world:

1. Counting the hair on your head
2. Washing your eyes with soap
3. Breathing while your tongue is sticking out



Please, put your tongue back in your mouth . . .

Trey Gowdey Eplains Why IRS Shouldn't Have Your Medical Records

Clicking Will Change Your Life . . .

Hepatitis A Linked to Frozen Berry Mix

Hepatitis A has been linked to a contaminated batch of berries sold at Costco's in five different states. See the news video below . .  .

If you have eaten these berries and have symptoms of stomach pain, fatigue, nausea, diarrhea, or yellowing discoloration of the skin or white parts of the eye, see your doctor.

US News | Weird News | More ABC News Videos

New ICD-10 Code Requirements

Senator Rand Paul, an opthamologist, explains how much our government just wants to take care of us.

Analysis of the Obvious

When familiar things happen, mankind doesn't get bothered much about them.  It requires a very unusual mind to undertake the analysis of the obvious . . .

One of those is the planetary trio that will occur this evening in the night sky.  Look to the west just after the setting of the sun and you will see Jupiter, Mercury and Venus just above the horizon.  A planetary trio like this will not reoccur until 2021.

May 25th, 2013
Oklahoma Skyline - Mike O'Neal

We see the stars  in the evening sky all the time.  So why is the obvious  . . . interesting?  The first chapter of Genesis, 14th verse, states "And God said, Let there be lights in the firmament of the heaven to divide the day from the night; and let them be for signs, and for seasons, and for days, and years."

Both Mercury and Venus will appear as a "morning star" or "evening star" throughout the year, however, Jupiter will only appear with Mercury and Venus as an evening star once every 12 years.   Because of their orbits, they will always appear on the same side of the horizon as the sun when they are seen.

The Native American legends and the correlating 260-day Sacred Round (also called the tzolkin) Mayan and Aztec calendars state that Venus (the brightest of the stars), or the "Dawn Star," follows the life and death of a white and bearded god named Quetzalcoatl who visited them in the first century AD (which sounds a lot like the resurrected Christ).

Their calendar closely followed Venus or the "Dawn Star" in marking important religious or spiritual events throughout history.  It may well be that long ago these principles were understood by them. Jesus Christ referred to himself as the "bright and morning star" in Revelations 22:16.

Venus Cycle as observed on Earth
(JohnPratt.com) 

To understand why Venus (the brighter star) and Mercury are called "Morning" and "Evening" stars, see the Venus Cycle pictured to the right. Points 1, 2, and 3 correlate with "man's conception" according to the Mayan Priests and their Sacred Round calendar. Numbers 4 & 5 correlate with Christ's adult life and mortal ministry on the Earth.

According to the Venus and Hebrew calendars, the three wise men appeared on May 27th, 1 B.C., correlating with the three stars coming together at their closest positions this evening.

All three planets can be seen within a simple binocular view with Mercury being the most difficult to see without the aid of binoculars.

Either way, pull out your binoculars this evening at dusk and show your family something they won't see for another 12 years. That's what I'll be doing . . .

Memorial Day . . .

Be safe out there this weekend. . .

The Essence of Experience in Leadership

The great illusion of leadership is to think that man can be lead out of the desert by someone who has never been there. . .

Electronic Health Record challenges . . .

One of the challenges of using an electronic health record (EHR) is that of communication and order generation with ancillary services.  Medicare has mandated conversion to the use of electronic prescribing and commercial insurance has followed suit. The challenge is that as we are all becoming more paperless, ancillary services are no longer accepting prescriptions that don't have an "actual signature".  Medicare as also mandated that every order be "physically signed" which is becoming impossible with use of EHR.

This hasn't posed a problem with Medicare or with the commercial insurances, but it has begun to drive a wedge between the patient and his or her physician. We send a prescription electronically and the ancillary service kicks it back because it isn't "actually signed on paper."  Patient's feel our office is not doing its job correctly because the ancillary services told him that he "orders were signed correctly."  We are doing our job and having to duplicate services.  Everyone gets irritated all the way around the process.
Because we as a society are used to getting "our burger our our way" within a two-and-a-half minute window, my staff frequently gets an ear-full. Screaming and cursing at the doctor's office staff is not the way to get things done or aid your cause.
The burden that is created by the mandate for EHR use causes a significant change in the office flow.  It takes a good 6-12 months for a physician's to improve efficiency when the whole office flow changes.  My office is not alone in this problem.  We just recently changed our electronic health care record and significant process changes were made which has caused us delay and efficiency drops while we accommodate the new flows and attempt to write orders that were signed with electronic signatures with "actual wet signatures."
I have been using electronic health records for over 11 years.  The process isn't getting any easier, unfortunately. If you are a patient, or an ancillary service, please be patient with your doctor's office.  We are becoming as regulated as the airlines . . . who knows  . . . you may soon need to pass through a TSA scanner before you can enter my office.  Wouldn't that be exciting?!

Meet Brutus

Meet my friend Brutus . . . !

It's coming . . . mark my words. 15,000 IRS agents looking at your healthcare information as it flows through CMS. 

Change

The challenge in life is to adjust to changing times while still holding true to unchanging principles . . .

Journaling Thoughts . . .

A man would do well  to carry a pencil in his pocket, and write down the thoughts of the moment. Those that come unsought for are commonly the most valuable, and should be secured, because they seldom return.
Francis Bacon

(Anyone who's name ends in bacon ought to be listened to!)

Another reason: those who don't keep journals, will be defined by those who do. Think about it.

The Middle-Aged Mormon Man gives a great synopsis here.

Mother's Day

Life does not come with an instruction manual . . .

It comes instead with a mother.

Characteristics of Great Leaders . . .

1. JUST DO IT.

• A leader's most powerful ally is his or her own example.  
• Leaders don't just talk about doing something; they do it.

Influence

Money motivates neither the best people nor the best in people.  It can move the body and influence the mind, but it cannot touch the heart or move the spirit; that is reserved for belief, principle, and morality.

The Microbiome of the Gut: Medicine's Final Frontier?

I have been fascinated by a new school of technology that has revealed itself to us in the last few years presented by Suzanne Devkota, PhD, at the recent ASBP Conference. There are 100 trillion bacterial cells in our bodies (more than the number of cells that make up our body). Recently bacterial 16s ribosomal genes have been identified that give us a very fast, specific and quantitative identification of the bacteria in the stomach and gut.  It gives us a new gene map of the gastrointestinal system. This identification process not only allows us to look at the current bacteria in the gut, but lets us look at bacteria present in the guts of our ancestors.  It also gives us insight into how we metabolize food and how these bacteria can be helpful in the treatment of disease.

There are thousands of bacteria in our bodies that live symbiotically with us of which we were never aware. Landmark papers have been released about these bacteria and their effects begining in 2001.  Most of these papers have focused on how these bacteria affect obesity. There are three very interesting benefits I found important.

1. The spectrum of bacteria in our gut affects how we metabolize and break down different foods in our diet. It also influences our health. 

2. Mothers transfer the microbiomes early on through the method of birth.  There are very specific bacteria that confer specific beneficial or harmful immunity to a person's body.

3. These bacteria have the ability to perform Lateral Gene Transfer. Bacteria have the ability to share genes "laterally," to their neighbor, that confer antibiotic resistance, immunity or action. 

What is also important is that these microbes can process dietary fibers more effectively leading to increased formation of glucose and free fatty acids and triglycerides.  This can be the reasons that some people gain weight from the same fiber intake that others don't. These bacteria can also increases Lipoprotien Lipase, the enzyme in the body that stimulates increased fat storage. 

Another fascinating piece of information relating to this field of study reveals that certain bacteria found in patient's with type II diabetes causes a "gut leakiness  that arises predisposing many to various forms of bowel inflammation. 

The types of fat we eat actually have an effect on the bacteria colonies and upon the degree of "leakiness" in the GI system.  This may be why so many patient feel like they have "gluten" intolerance or gastrointestinal inflammation.

Omega 3 fatty acids have been found to help protect the bacteria and the "leakiness" in the GI system.  

We still have much to learn in this area and much to gain as we apply what we are learning. 

Stay tuned . . .

The Real ....

More Bacon Please . . .

Imperfect People