Edulcorants: entre mythe et réalité [Sweeteners: between myth and reality]

As the prevalence of obesity and diabetes are continually increasing, the use of "false sugars" otherwise known as sweeteners, and their associated health issues are being more and more discussed. A higher sugared power, less calories as well as a moderated or non-existent effect on blood sugar would lead to believe that sweeteners are helpful. However, we CANNOT say that they are THE solution as they can contain calories, may have some undesired effects, and moreover they ease the conscience without actually allowing a weight loss with their sole use. They are to be used with judgment, wittingly and especially when comparing sweetened products. The sweetener myth is often far from reality. It is therefore important to give our patients the means to analyze their dietary intake with regard to their sweeteners ingestion.

Fructose and metabolic diseases: new findings, new questions.

There has been much concern regarding the role of dietary fructose in the development of metabolic diseases. This concern arises from the continuous increase in fructose (and total added caloric sweeteners consumption) in recent decades, and from the increased use of high-fructose corn syrup (HFCS) as a sweetener. A large body of evidence shows that a high-fructose diet leads to the development of obesity, diabetes, and dyslipidemia in rodents. In humans, fructose has long been known to increase plasma triglyceride concentrations. In addition, when ingested in large amounts as part of a hypercaloric diet, it can cause hepatic insulin resistance, increased total and visceral fat mass, and accumulation of ectopic fat in the liver and skeletal muscle. These early effects may be instrumental in causing, in the long run, the development of the metabolic syndrome. There is however only limited evidence that fructose per se, when consumed in moderate amounts, has deleterious effects. Several effects of a high-fructose diet in humans can be observed with high-fat or high-glucose diets as well, suggesting that an excess caloric intake may be the main factor involved in the development of the metabolic syndrome. The major source of fructose in our diet is with sweetened beverages (and with other products in which caloric sweeteners have been added). The progressive replacement of sucrose by HFCS is however unlikely to be directly involved in the epidemy of metabolic disease, because HFCS appears to have basically the same metabolic effects as sucrose. Consumption of sweetened beverages is however clearly associated with excess calorie intake, and an increased risk of diabetes and cardiovascular diseases through an increase in body weight. This has led to the recommendation to limit the daily intake of sugar calories.