For a medical take on cane sugar cola versus high fructose corn syrup (HFCS) cola, we reached out to Tammy Tavdy, D.O., an endocrinologist with the Scarsdale Medical Group in Harrison. (It is part of White Plains Hospital, which in turn is part of the Montefiore Health System.) She is board-certified in internal medicine as well as in endocrinology, diabetes and metabolism.
Tavdy received her medical degree from the New York Institute of Technology College of Osteopathic Medicine, completing her residency in internal medicine at the Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, where she was selected chief resident. As chief resident, she was a member of the Montefiore Internal Medicine Residency Recruitment Committee and a preceptor for the Transition to Clerkship courses for the medical students. She remained at the institution to complete her fellowship in endocrinology, diabetes and metabolism.
Prior to joining Scarsdale Medical Group, Tavdy was a co-author for the official question bank of the United States Medical Licensing Examination (USMLE-Rx) program, which also produces the “First Aid” book series. She has contributed to several peer-reviewed publications, including the American Association of Clinical Endocrinology, The Journal of Clinical Endocrinology & Metabolism and the Journal of the Endocrine Society.
Dr. Tavdy, thank you for your time. Why are we hearing so much about replacing high fructose corn syrup with cane sugar in sodas now?
“The increased prevalence of metabolic disease worldwide has heightened concerns about the adverse effects of excessive sugar consumption. Moreover, there has been much controversy concerning the differences between sucrose and high fructose corn syrup with respect to their impacts on metabolic health.
“Sucrose and high fructose corn syrup (HFCS) are both considered to be sweeteners, but they differ in their origins and compositions. Sucrose (common forms including brown and white sugars) derives from the sugar cane plant. HFCS derives from corn starch, which via enzymatic processing breaks down into glucose and is then blended into the syrup. It is this “processing” component that sparks a great deal of controversy with respect to HFCS containing products.”
Is there a health benefit to using sugar as a “natural” ingredient? Isn’t sugar just sugar?
“Physiologically, we process sucrose and HFCS very differently. Intake of HFCS does not lead to a ‘glucose spike.’ Therefore, insulin secretion is not stimulated, and the result is that fructose gets stored into adipose tissue (fat storage). Sucrose, on the other hand, does lead to a ‘glucose spike,’ thereby triggering an insulin response. As a result, the byproducts of the sucrose (glucose and fructose) are used as energy sources by various tissues in the body. The caveat here is that if there is an excess intake in the sucrose, the body will store this into the adipose tissue, also leading to fat storage.”
How much sugar should we be consuming daily?
“The American Heart Association (AHA) recommends that the total intake of free or added sugars from all sources should be kept below 25 grams per day (about 6 teaspoons) for optimal cardiometabolic health. A 12 ounce can of Coca-Cola contains HFCS as its primary sweetener – approximately 39 grams of added sugar. As you see, one can of soda very easily exceeds the daily recommended intake.”
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What about those people who say that they never drink soda or eat dessert but like to drink red wine: Isn’t there a lot of sugar in wine and spirits, which, as you know, have been classified as carcinogens?
“When it comes to wine and spirits, their sugar content is very different when compared to sodas. For those who love dry red and white wines, the residual sugar levels are quite little (between 0 and 3 grams per bottle). The residual sugar refers to the ‘wine sweetness’ and is the byproduct of the natural grape sugars after alcoholic fermentation is completed. As expected, the more residual sugar remaining in a wine, the sweeter the wine is. A sweeter wine can contain more than 33 grams of residual sugar.
“Pure spirits such as vodka, whiskey and tequila do not contain any sugar as distillation removes all remaining carbohydrates. The high sugar content of flavored spirits is due to the added flavorings and syrups. As you see, for the sake of comparison, a glass of dry red or white wine does contain far less sugar than a can of soda.”
Is it equally dangerous to eliminate sugar altogether from our diets?
“There is a great amount of evidence supporting the complete elimination of sugar from the diet. Many publications comment on the overwhelmingly positive effects of eliminating sugar from the diet, as there is significant reduction in body weight, waist circumference, visceral adiposity, liver fat, serum triglycerides and improvements in insulin sensitivity even when total caloric intake is held constant.”
What about sugar substitutes: Are these and the diet sodas that contain them healthy alternatives?
“The American Cancer Society does not condemn artificial sweeteners and does not explicitly state a direct link between sugar substitutes and cancer risk. Aspartame has been classified as a ‘possible carcinogen,’ so use of a natural sweetener such as stevia in lieu of aspartame would have its benefits.
“For patients with diabetes, the American Diabetes Association recognizes nonnutritive sweeteners as acceptable alternatives as they do not affect glycemic control.”
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Fruit would seem to be a natural source of sweetness. What should be the daily requirement?
“Daily fruit recommendations for adults are at least two servings per day. It is always best to choose whole fruits over fruit juices as whole fruits help to retain fiber. Low sugar fruits include berries, grapefruit and avocados. High sugar fruits include mango, grapes, pineapple, bananas. It is best to pair high sugar fruits with fiber to help slow digestion. Smoothies are also a great option, but whole fruit is generally better as you do lose some fiber from the fruit during the blending, which can lead to a higher glucose spike.”
For those of us who like our sweets, what are some healthy alternative beverages that offer the crisp sweetness of a cola?
“A favorite alternative to that ‘crisp’ Coke sweetness is zero-calorie, sugar-free, low-sodium sparkling water (La Croix, Waterloo, etc.). This is a tip that I frequently share with my patients. If you prefer zero carbonation, ready-to-drink flavored still waters (Hint) are tasty and contain no juice and are also sugar-free.”
And for those of us who can’t quit colas altogether, is one a week a good rule of thumb?
“I believe in living in moderation. I tell my patients that to live sustainably, you must think wisely and intentionally about the foods you are eating and ask yourself: ‘Is this making a positive contribution to my overall nutrition?’ That being said, I do believe that constant restriction will backfire in the long run. The American Heart Association supports no more than one serving (approximately 200 to 455 milliliters, or one 12 fluid ounce can) of soda containing HFCS or other added sweeteners per week, which is a reasonable recommendation.”
