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Dutta A. J, Sinha D, Konwar S, Pegu B. K, Baruah S. Sweeteners and Sugar- Their Impact on Human Metabolic Health and Chronic Diseases. Biotech Res Asia 2024;21(4).
Manuscript received on : 28-08-2024
Manuscript accepted on : 17-10-2024
Published online on:  22-11-2024

Plagiarism Check: Yes

Reviewed by: Dr. Amany Salama

Second Review by: Dr. Rifqi Ahmad Riyanto

Final Approval by: Dr. Hugo Solana

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Sweeteners and Sugar- Their Impact on Human Metabolic Health and Chronic Diseases

Ankur Jyoti Dutta1, Darshita Sinha1, Surajeet Konwar1, Bhaba Kumar Pegu2* and Sarat Baruah2

1Department of Life Science, Dibrugarh University, Dibrugarh, Assam, India.

2Department of Zoology, Madhabdeb University, Assam, India.

Corresponding Author E-mail:- bhabapegu.2010@gmail.com

ABSTRACT: The rising global consumption of sugars and sweeteners has sparked significant concern over their impact on human metabolic health and chronic diseases. This paper reviews the role of various sugars and artificial sweeteners in contributing to health issues such as obesity, diabetes, cardiovascular diseases, and metabolic syndrome. Sugars, including glucose, fructose, and sucrose, are integral to the human diet, providing essential energy but also posing risks when consumed in excess. The research highlights that excessive sugar intake, particularly from processed foods, correlates with a heightened risk of chronic diseases, including diabetes and heart disease. Artificial sweeteners, while offering a low-calorie alternative, also carry potential health risks, such as carcinogenicity and metabolic disturbances. These sweeteners, including saccharin, aspartame, and sucralose, are extensively used in various food products, but their long-term effects remain a topic of debate. The paper underscores the importance of a balanced diet that limits the intake of added sugars and emphasizes the need for further research to fully understand the complex relationship between sugar consumption and chronic diseases. It suggests that natural sweeteners may offer a safer alternative, though more studies are needed to evaluate their effectiveness across different populations, particularly those with metabolic disorders. This review article aims to analyze the effects of sugars and artificial sweeteners on human metabolic health and chronic diseases, such as obesity, diabetes, and cardiovascular conditions. It emphasizes the need for balanced consumption and public health strategies to reduce added sugars and promote safer alternatives.

KEYWORDS: Artificial Sweeteners; Chronic Diseases; Cardiovascular Diseases; Metabolic Health; Sugar Consumption

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Dutta A. J, Sinha D, Konwar S, Pegu B. K, Baruah S. Sweeteners and Sugar- Their Impact on Human Metabolic Health and Chronic Diseases. Biotech Res Asia 2024;21(4).
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Introduction

The taste sense system is a major determinant of quality of life. We choose it mainly based on how much we value the experience of their flavour or how much we dislike it. Humans are one of the few creatures who prefer sweet flavours in a variety of intensities. By the sixteenth week of pregnancy, taste receptors begin to develop in the foetus, and the newborn baby can react favourably to solutions that have been sweetened.1The primary energy source in food is carbohydrate. Their structure and well-balanced taste, which is sweet in sugars make them noteworthy. Carbohydrates have two forms mainly complex molecules and simple carbohydrates which is also known as sugars. The primary dietary sources of sugars include fruit, some vegetables, milk, soft drinks, and confections. A sugar’s structure is referred to as a monosaccharide. The mono-components include glucose, fructose, and galactose. Two monosaccharides combine to make a disaccharide. For instance, glucose and fructose together yield the disaccharide sucrose, also known as table sugar. Maltose is composed of two glucose molecules, while lactose is made up of one glucose molecule and one galactose molecule. All sugars have four calories per gram and are classified as carbs. Consumption of sugar in the diet on a daily basis is crucial. Sugars provide the brain with a quick source of glucose for cognitive muscles and functions.2

In processed foods, added sugar is added for sweetness, flavour enhancement, freezing or melting point modification, and food spoiling prevention. Natural foods are a better source of sugar because they also contain other micronutrients. These days, there are concerns about the potential link between diabetes or metabolic syndrome and high sugar intake, particularly in processed foods.3 All forms of carbohydrates need to be included in a diet. The Food and Agriculture Organisation (FAO) and World Health Organisation (WHO) recommended that simple carbohydrates and sugars account for no more than 10% of total calorie consumption of a worthy diet. Sugars must be included in a balanced diet, with the consumption of sugar- sweetened beverages kept to a minimum. Additionally, it has been suggested that consumption of sweets or sugar-sweetened foods be restricted to no more than three times per day and no more than 6% of total caloric intake in order to get benefits.4

Human diets have included sugar from prehistoric times. China and India are said to have consumed the product first, followed by Europe following the crusades in the eleventh century. Many foods contain both added or extrinsic sugars, which are sugars and syrups added to foods and beverages during processing and preparation, and natural dietary sugars, such as lactose, sucrose and fructose. The United States has seen a sharp rise in sugar consumption during the previous three decades. The primary cause of this growth is the use of high fructose corn syrup (HFCS), which is currently consumed in excess of 62 pounds per person year, mostly in the form of sugar-sweetened beverages (SSB). Soft drinks, fruit drinks, energy and vitamin water drinks are included in SSB.5

Evidence suggests that sugars may have a negative impact on health. An increased risk of dental caries, obesity, cardiovascular disease, diabetes, gout, fatty liver disease, some malignancies, elements of metabolic syndrome, and hyperactivity may be linked to high sugar intake.6

Artificial Sweeteners

Artificial sweeteners are substantially sweeter than table sugar, require lower amounts to achieve to achieve the same level of sweetness, and either do not significantly increase the energy content of meals and beverages or are not metabolised in the human body. These have a low glycemic response and offer the sweetness of sugar without calories.7Certain ideal conditions must be met by artificial sweeteners. They should be inexpensive to produce, give sweetness without an unpleasant aftertaste, have few or no calories, not be mutagenic or carcinogenic when cooked, and not be damaged by heat. A physical or chemical substance that modifies an organism’s genetic material is called mutagenic, whereas a carcinogenic agent can cause cancer.8Saccharin, acesulfame potassium, aspartame, neotame, and sucralose are the five main types of artificial sweeteners.

Table 1: Artificial sweeteners have relative sweetness compared to sucrose, their caloric content, and common applications.

Sl no. Common name Common applications
1. Saccharin It is 200 to 700 times sweeter than sucrose and contains 0 kcal/g. It is commonly used in soft drinks, tabletop sweeteners, jams, chewing gum, and baked goods.7
2. Acesulfame K This sweetener is 200 times sweeter than sucrose with 0 kcal/g. It is used in tabletop sweeteners, candies, chewing gum, and dairy products.7
3. Aspartame Aspartame is 180 to 200 times sweeter than sucrose, providing 4 kcal/g. It is found in soft drinks, yogurt, and pharmaceuticals.7
4. Neotame Significantly sweeter, neotame is 7000 to 13000 times sweeter than sucrose with 0 kcal/g. It is used in baked goods, soft drinks, chewing gum, jams, jellies, puddings, and fruit juices.7
5. Sucralose Sucralose is 600 times sweeter than sucrose, also containing 0 kcal/g. It is used in frozen desserts, fruit juices, chewing gum, and gelatins.7

Since the middle of the 20th century, research has been conducted to determine how consuming sugar affects human health. Nonetheless, there is ongoing discussion over the functions of sugar in neurological, cognitive, and physical health. Consuming too much sugar has been linked to metabolic diseases, diabetes, cancer, heart disease, depression and cognitive decline in addition to obesityand many other9 as shown in Fig 1. The paper aims to give a general idea about role of different sweeteners and sugars on human metabolic health and chronic diseases.

Figure 1: Shows the effect of Sugar, honey, Fruits, and HFCS in different organs.

Click here to view Figure

Effect of Sugar Intake on Human Health

Sweeteners and sugars have some effects on human health and metabolism. The effects of some common types of sugar that we generally consume in our diet are given below-

Glucose

The pancreas secretes insulin in response to glucose consumption. The brain’s increased insulin signals tell us to quit eating because we’ve had enough. After ingesting glucose, our bodies go through several processes, but one in particular that happens in the liver creates very low-density lipoproteins (VLDL), which are linked to cardiovascular disease. Nevertheless, the liver processes glucose in our diet and turns it into VLDL in around 1 out of every 24 calories10.

Sucrose and Fructose

Fructose is generally metabolized by the liver and along with fats large amount of VLDL is produced. The brain is unable to regulate the intake of fructose and sucrose carbohydrates because it is resistant to the protein leptin, which regulates energy intake and assesses the effectiveness of metabolism. This doesn’t imply that consuming these carbohydrates will always be detrimental. When athletes consume these sugars, their livers become more filled with glycogen, which is then used for exercise and other athletic activities.11 This attests to the fact that the consumption of sucrose and fructose is advantageous for people who engage in more physical activity and need quick energy.10

Glucosamine

This glyconutrient aids in preserving the health of the joints. It is a precursor to cartilage and aids in the management of osteoarthritis issues.12 Glucosamine, a key component of glycosaminoglycans found in cartilage, has been studied for its potential therapeutic effects in osteoarthritis treatment.13 Research indicates that glucosamine is preferentially incorporated into the galactosamine moieties of chondroitin sulfates in articular cartilage, facilitating proteoglycan production.14

Galactose

The sugar in milk is made up of glucose and lactose, a disaccharide. This sugar can also be found in a range of fruits, vegetables, and plants. Galactose facilitates calcium absorption, promotes quick healing from wounds, and enhances memory.15

Fucose

Fucose can only be found in significant quantities in the breast milk of humans, marine kelp, brewer’s yeast, and certain types of mushrooms. Monosaccharide L-fucose is present in N and O-linked glycans and glycolipids that are made by mammalian cells. These play key roles in ontogenic events, host-microbe interaction, leukocyte-endothelium adhesion mediated by selection, and blood transfusion. Pathological diseases like as cancer and artherosclerosis are linked to change in their expression.16 Consuming this sugar promotes long-term memory, guards against tumour growth and stops respiratory infections. Furthermore, they function as potent immune system modulators. Rheumatoid arthritis is linked to a lack of this sugar. Low levels of fucose are seen in patients with conditions such as diabetes, hepatic diseases and cystic fibrosis. Fucose plays a crucial role in the body’s extrusion of the herpes virus. When applied, this sugar thickens and hydrate the skin, which also helps to minimise wrinkles.10

Galactosamine

They can be found in some members of red algae Phaeophyceae, shark cartilage and crab shells. It facilitates communication between cells. Giving these sugars aids in controlling inflammation and the immunological system. It also essential for maintaining the health of joints. Cardiovascular disease is linked to its low levels.10

Mannose

An essential part of our immune system is mannose. Recent research suggests that mannose, a hexose sugar, may have unique anti-inflammatory properties compared to other dietary sugars. While excessive intake of glucose and fructose has been linked to increased inflammation and various non-communicable diseases.17 It enters the bloodstream right away after absorption. Aloe vera is the primary source of it, but it can also be found in sea kelp, beans, capsicum, cabbage, tomatoes, and some mushrooms.18

Neuraminic Acid

Colestrum, a special type of sugar, is the first nourishment a mammal receives from its mother after parturition. The sugar is an essential component of the gangliosides found in the brain’s grey matter. It is also present in the follicle-stimulatinghormone , which is necessary for ovulation.19

Xylitol and Erythritol

In light of the growing global usage of added sugars, xylitol and erythritol have gained significant popularity, particularly among individuals with diabetes. Natural sources of both sugars include fruits and veggies like lettuce, strawberries, raspberries, and plums.20Xylitol is a five-carbon alcohol sugar that is a perfect substitute for sucrose for diabetics because it has a lower glycemic index (13 against 65) and calorie content ( 2.4 versus 4.0 kcal/gram).21 On the other hand erythritol is a four-carbon polyol ring is 60-80% sweeter than sucrose.22 These two sweeteners’ different metabolisms play a major role in determining how they affect metabolic diseases. For example, xylitol becomes partially absorbed in the upper gastrointestinal tract, it is then converted to D-xylulose by oxidation in the liver. This final product can now proceed through the pentose phosphate pathway, where the bulk of it will eventually be converted to glucose or a smaller amount of lactate.20 Like artificial sweeteners, erythritol is quickly absorbed but not broken down, therefore it will eventually pass through the urine unaltered.22 These sugar substitutes are considering the substitutes above, xylitol is thought to be safe for diabetics and quickly absorbed and excreted, preventing accumulation in tissues.23

Artificial Sweeteners

Although artificial sweeteners don’t raise blood sugar levels as they are not carbohydrates, they cause some other issues in human health, which are listed in table no 2.The effect of different kinds of free and added sugars on chronic diseases in humans is mentioned in Table no-3

Table 2: An overview of various artificial sweeteners, their known metabolites, and their associated health risks, both acute and chronic.

Sl no. Common name Metabolites and its health risk
1. Saccharin Metabolized into O-sulfamoyl benzoic acid and is associated with acute symptoms like nausea, diarrhea, and vomiting. Chronic exposure can lead to serious conditions such as bladder cancer, low birth weight, and hepatotoxicity.24,25
2. Acesulfame-K Breaks down into acetoacetamide, which may cause headaches in the short term and has been linked to thyroid tumors over prolonged use.26,27
3. Aspartame Composed of methanol, aspartic acid, and phenylalanine. It may cause dizziness, nausea, vomiting, headaches, and thrombocytopenia acutely, with long-term exposure potentially leading to lymphomas.7
4. Neotame Metabolizes into methanol and de-esterified neotame. It can cause headaches and is hepatotoxic at high doses, with chronic exposure potentially resulting in weight loss and lower birth rates.7
5. Sucralose Noted for causing stomach pain, dizziness, and diarrhea, with chronic exposure leading to thymus shrinkage.28

 Table 3: Effect of different kinds of free and added sugars on chronic diseases in humans

Sl no Sugar responsible for the disease Associated chronic diseases References
1 Fruit juice High risk of diabetes mellitus 29
2 Sugar-sweetened beverages Stroke risk increases 30
3 Sucrose Sucrose is not related to diabetes mellitus 31
4 Sugar-sweetened beverages Chronic heart diseases, increase inflammatory markers, increase triglycerides content 32
5 Soft drinks Increase metabolic syndrome prevalence 33
6 Sugar- sweetened beverages Diabetes mellitus 34
7 Soft drinks Ischaemic stroke risk in men and women 35
8 Sugar-sweetened beverages Increase metabolic syndrome risk 36
9 Sugar-sweetened beverages Increase chronic heart disease incidence 37
10 Sugar-sweetened beverages Low high density lipoproteins and increase rate of triglycerides 38
11 Added sugar High stroke risk and decrease aortic stenosis 39
12 Sweet-sugar beverages Increase cerebral infraction 40
13 Fructose Increase rate of low density lipoproteins, increase rate of leptin and triglycerides 41
14 Fructose Increase insulin, increase hepatic insulin resistance, increase body weight 42
15 Glucose and fructose Increase visceral adipose tissue, increase liver fat, increase skeleton muscle fat, increase total cholesterol content 43
16 Fructose and glucose Diabetes mellitus 44
17 Soft drinks or sweetened milk drinks Diabetes mellitus 45
18 Sweet- sugar beverages Cardio vascular diseases 46
19 Sweet-sugar beverages High risk of diabetes mellitus in women 47
20 Sweet-sugar beverages Increase liver fat 48
21 Sweet-sugar beverages Increase metabolic syndrome risk in women, increase obesity prevalence. 49
22 Fructose Increase postprandial de novo lipogenesis, increase rate of fasting glucose, increase fasting insulin, decrease insulin sensitivity index 50
23 Glucose Increase body fat and weight, decrease fasting glucose. 50
24 Added sugars Decrease high density lipoproteins, increase fasting insulin in overweight individuals only, increase insulin resistance in overweight individuals only 51
25 Added sugars Increase cardio vascular disease mortality risk 52
26 Sweet sugar beverages Increase inflammatory biomarkers, increase insulin, decrease adiponectin 53

Conclusion

The impact of sugars and artificial sweeteners on human metabolic health and chronic diseases is a critical area of research, especially given the alarming rise in diet-related health issues globally. This paper highlights the significant risks associated with excessive sugar intake, including obesity, diabetes, and cardiovascular diseases, while also acknowledging the potential adverse effects of artificial sweeteners. The findings underscore the need for a more comprehensive understanding of how these dietary components contribute to chronic diseases, emphasizing the importance of balanced consumption. In today’s world, where processed foods and beverages are increasingly dominant in diets, understanding the long-term effects of sugars and sweeteners is more crucial than ever. Public health strategies must prioritize reducing added sugars and promoting the use of safer alternatives, potentially natural sweeteners with proven health benefits. Future research should focus on elucidating the mechanisms by which sugars and sweeteners influence metabolic processes, exploring their impact across diverse populations, and developing dietary guidelines that reflect these insights.The importance of this topic cannot be overstated, as it directly relates to global health challenges such as the obesity epidemic, the rising prevalence of diabetes, and the burden of cardiovascular diseases. Addressing the role of sugars and sweeteners in these conditions is essential for improving public health outcomes and reducing the incidence of diet-related chronic diseases. By fostering a deeper understanding and encouraging healthier dietary practices, we can make significant strides in promoting overall well-being and preventing the development of serious health conditions.

Acknowledgement

The author would like to thank Magadh University for granting the Ph.D. research work. The Department of Environmental Science, A.N. College, Patna of the Magadh University, is highly appreciated for allowing the GIS laboratory work. The author is also profoundly grateful to the National Remote Sensing Center (NRSC), Indian Space Research Organisation (ISRO), Govt. of India for their guidance during the Satellite data procurement

Funding Sources

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Conflict of Interest

The authors do not have any conflict of interest.

Data Availability Statement

This statement does not apply to this article.

Ethics Statement

This research did not involve human participants, animal subjects, or any material that requires ethical approval.

Informed Consent Statement

This study did not involve human participants, and therefore, informed consent was not required.

Author Contributions

Ankur Jyoti Dutta and Surajeet Konwar: Conceptualization, Methodology, Writing – Original Draft.

Darshita Sinha – Review & Editing.

Bhaba Kr Pegu and Sarat Baruah: Supervision

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