Added sugar may be the single unhealthiest ingredient in the modern diet.
On average, Americans eat about 15 teaspoons of added sugar each day, although sources vary on the exact figure (1). Most of this is hidden within processed foods, so people don't even realize they're eating it.
Sugar goes by many different names, so it's very difficult to figure out how much a food actually contains. Photo credit: Shutterstock
Sugar goes by many different names, so it's very difficult to figure out how much a food actually contains. Below are 56 different names for sugar.
But first, let's briefly explain what added sugars are and how the different types can affect your health.
What is Added Sugar?
During processing, sugar is added to food to enhance flavor, texture, shelf life or other properties.
Added sugar is usually a mixture of simple sugars such as glucose, fructose or sucrose. Other types, such as galactose, lactose and maltose, are less common.
Unfortunately, food manufacturers often hide the total amount of sugar by listing it under several different names on ingredients lists.
Bottom Line: Sugar is commonly added to processed foods. Manufactures often use several different kinds of sugar so they can hide the real amount.
Glucose or Fructose—Does it Matter?
In short, yes. Glucose and fructose—even though they're very common and often found together—have very different effects on the body.
Glucose can be metabolized by nearly every cell in the body, while fructose is metabolized almost entirely in the liver (4).
Although eating any extra sugar should be avoided, it is especially important to minimize your intake of added sugars that are high in fructose.
Bottom Line: Added sugar goes by many names, and most types consist of glucose and/or fructose. High-fructose added sugars are more harmful.
56 Different Names for Sugar
Sucrose is the most common type of sugar.
Often called “table sugar," it is a naturally occurring carbohydrate found in many fruits and plants.
Table sugar is usually extracted from sugar cane or sugar beets. It consists of 50 percent glucose and 50 percent fructose, bound together.
Bottom Line: Sucrose is also known as table sugar. It occurs naturally in many fruits and plants, and is added to all sorts of processed foods. It consists of 50 percent glucose and 50 percent fructose.
2. High-Fructose Corn Syrup (HFCS)
High-fructose corn syrup is a widely used sweetener, especially in the US.
It is produced from corn starch via an industrial process, and consists of both fructose and glucose.
There are several different types of HFCS, which contain varying amounts of fructose.
Two notable varieties are:
- HFCS 55: This is the most common type of HFCS. It contains 55 percent fructose and 45 percent glucose, which makes it similar to sucrose in composition.
- HFCS 90: This form contains 90 percent fructose.
High-fructose corn syrup is found in many foods, especially in the US. These include soda, breads, cookies, candy, ice cream, cakes, cereal bars and many others.
Bottom Line: High-fructose corn syrup is produced from corn starch. It consists of varying amounts of fructose and glucose, but the most common type contains 55 percent fructose and 45 percent glucose.
3. Agave Nectar
Agave nectar, also called agave syrup, is a very popular sweetener produced from the agave plant.
It is commonly used as a “healthy" alternative to sugar because it doesn't spike blood sugar levels as much as many other sugar varieties.
However, agave nectar contains about 70–90 percent fructose, and 10–30 percent glucose.
Given the harmful health effects of excess fructose consumption, agave nectar may be even worse for metabolic health than regular sugar.
Bottom Line: Agave nectar or syrup is produced from the agave plant. It contains 70–90 percent fructose and 10–30 percent glucose. It may be even more harmful for health than regular sugar.
4 - 37. Other Sugars with Glucose and Fructose
Most added sugars and sweeteners contain both glucose and fructose.
Here are a few examples:
- Beet sugar
- Blackstrap molasses
- Brown sugar
- Buttered syrup
- Cane juice crystals
- Cane sugar
- Carob syrup
- Castor sugar
- Coconut sugar
- Confectioner's sugar (powdered sugar)
- Date sugar
- Demerara sugar
- Evaporated cane juice
- Florida crystals
- Fruit juice
- Fruit juice concentrate
- Golden sugar
- Golden syrup
- Grape sugar
- Icing sugar
- Invert sugar
- Maple syrup
- Muscovado sugar
- Panela sugar
- Raw sugar
- Refiner's syrup
- Sorghum syrup
- Treacle sugar
- Turbinado sugar
- Yellow sugar
Bottom Line: These sugars all contain varying amounts of both glucose and fructose.
38 - 52. Sugars With Glucose Only
These sweeteners contain glucose, either pure or combined with sugars other than fructose (such as other glucose units or galactose):
- Barley malt
- Brown rice syrup
- Corn syrup
- Corn syrup solids
- Diastatic malt
- Ethyl maltol
- Glucose solids
- Malt syrup
- Rice syrup
Bottom Line: These sugars are comprised of glucose, either on its own or with sugars other than fructose.
53 - 54. Sugars With Fructose Only
These two sweeteners contain only fructose:
- Crystalline fructose
Bottom Line: Pure fructose is simply called fructose or crystalline fructose.
55 - 56. Other Sugars
There are a few added sugars that contain neither glucose nor fructose. They are less sweet and less common, but are sometimes used as sweeteners:
Bottom Line: D-ribose and galactose are not as sweet as glucose and fructose, but are also used as sweeteners.
There's No Need To Avoid Natural Sugars
There's no reason to avoid the sugar that is naturally present in whole foods.
Fruit, vegetables and dairy products naturally contain small amounts of sugar, but they also contain fiber, nutrients and various beneficial compounds.
The negative health effects of high sugar consumption are due to the massive amount of added sugar that is present in the Western diet.
The most effective way to reduce your sugar intake is to eat mostly whole and unprocessed foods.
However, if you decide to buy packaged foods, be on the lookout for the many different names that sugar goes by.
This article was reposted from our media associate Authority Nutrition.
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By Ana Maldonado-Contreras
- Your gut is home to trillions of bacteria that are vital for keeping you healthy.
- Some of these microbes help to regulate the immune system.
- New research, which has not yet been peer-reviewed, shows the presence of certain bacteria in the gut may reveal which people are more vulnerable to a more severe case of COVID-19.
You may not know it, but you have an army of microbes living inside of you that are essential for fighting off threats, including the virus that causes COVID-19.
How Do Resident Bacteria Keep You Healthy?<p>Our immune defense is part of a complex biological response against harmful pathogens, such as viruses or bacteria. However, because our bodies are inhabited by trillions of mostly beneficial bacteria, virus and fungi, activation of our immune response is tightly regulated to distinguish between harmful and helpful microbes.</p><p>Our bacteria are spectacular companions diligently helping prime our immune system defenses to combat infections. A seminal study found that mice treated with antibiotics that eliminate bacteria in the gut exhibited an impaired immune response. These animals had low counts of virus-fighting white blood cells, weak antibody responses and poor production of a protein that is vital for <a href="https://doi.org/10.1073/pnas.1019378108" target="_blank">combating viral infection and modulating the immune response</a>.</p><p><a href="https://doi.org/10.1371/journal.pone.0184976" target="_blank" rel="noopener noreferrer">In another study</a>, mice were fed <em>Lactobacillus</em> bacteria, commonly used as probiotic in fermented food. These microbes reduced the severity of influenza infection. The <em>Lactobacillus</em>-treated mice did not lose weight and had only mild lung damage compared with untreated mice. Similarly, others have found that treatment of mice with <em>Lactobacillus</em> protects against different <a href="https://doi.org/10.1038/srep04638" target="_blank" rel="noopener noreferrer">subtypes of</a> <a href="https://doi.org/10.1038/s41598-017-17487-8" target="_blank" rel="noopener noreferrer">influenza</a> <a href="https://doi.org/10.1371/journal.ppat.1008072" target="_blank" rel="noopener noreferrer">virus</a> and human respiratory syncytial virus – the <a href="https://doi.org/10.1038/s41598-019-39602-7" target="_blank" rel="noopener noreferrer">major cause of viral bronchiolitis and pneumonia in children</a>.</p>
Chronic Disease and Microbes<p>Patients with chronic illnesses including Type 2 diabetes, obesity and cardiovascular disease exhibit a hyperactive immune system that fails to recognize a harmless stimulus and is linked to an altered gut microbiome.</p><p>In these chronic diseases, the gut microbiome lacks bacteria that activate <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">immune cells</a> that block the response against harmless bacteria in our guts. Such alteration of the gut microbiome is also observed in <a href="https://doi.org/10.1073/pnas.1002601107" target="_blank" rel="noopener noreferrer">babies delivered by cesarean section</a>, individuals consuming a poor <a href="https://doi.org/10.1038/nature12820" target="_blank" rel="noopener noreferrer">diet</a> and the <a href="https://doi.org/10.1038/nature11053" target="_blank" rel="noopener noreferrer">elderly</a>.</p><p>In the U.S., 117 million individuals – about half the adult population – <a href="https://health.gov/our-work/food-nutrition/2015-2020-dietary-guidelines/guidelines/" target="_blank" rel="noopener noreferrer">suffer from Type 2 diabetes, obesity, cardiovascular disease or a combination of them</a>. That suggests that half of American adults carry a faulty microbiome army.</p><p>Research in my laboratory focuses on identifying gut bacteria that are critical for creating a balanced immune system, which fights life-threatening bacterial and viral infections, while tolerating the beneficial bacteria in and on us.</p><p>Given that diet affects the diversity of bacteria in the gut, <a href="https://www.umassmed.edu/nutrition/melody-trial-info/" target="_blank" rel="noopener noreferrer">my lab studies show how diet can be used</a> as a therapy for chronic diseases. Using different foods, people can shift their gut microbiome to one that boosts a healthy immune response.</p><p>A fraction of patients infected with SARS-CoV-2, the virus that causes COVID-19 disease, develop severe complications that require hospitalization in intensive care units. What do many of those patients have in common? <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e2.htm" target="_blank" rel="noopener noreferrer">Old age</a> and chronic diet-related diseases like obesity, Type 2 diabetes and cardiovascular disease.</p><p><a href="http://doi.org/10.1016/j.jada.2008.12.019" target="_blank" rel="noopener noreferrer">Black and Latinx people are disproportionately affected by obesity, Type 2 diabetes and cardiovascular disease</a>, all of which are linked to poor nutrition. Thus, it is not a coincidence that <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6933e1.htm" target="_blank" rel="noopener noreferrer">these groups have suffered more deaths from COVID-19</a> compared with whites. This is the case not only in the U.S. but also <a href="https://www.washingtonpost.com/world/europe/blacks-in-britain-are-four-times-as-likely-to-die-of-coronavirus-as-whites-data-show/2020/05/07/2dc76710-9067-11ea-9322-a29e75effc93_story.html" target="_blank" rel="noopener noreferrer">in Britain</a>.</p>
Discovering Microbes That Predict COVID-19 Severity<p>The COVID-19 pandemic has inspired me to shift my research and explore the role of the gut microbiome in the overly aggressive immune response against SARS-CoV-2 infection.</p><p>My colleagues and I have hypothesized that critically ill SARS-CoV-2 patients with conditions like obesity, Type 2 diabetes and cardiovascular disease exhibit an altered gut microbiome that aggravates <a href="https://theconversation.com/exercise-may-help-reduce-risk-of-deadly-covid-19-complication-ards-136922" target="_blank" rel="noopener noreferrer">acute respiratory distress syndrome</a>.</p><p>Acute respiratory distress syndrome, a life-threatening lung injury, in SARS-CoV-2 patients is thought to develop from a <a href="http://doi.org/10.1016/j.cytogfr.2020.05.003" target="_blank" rel="noopener noreferrer">fatal overreaction of the immune response</a> called a <a href="https://theconversation.com/blocking-the-deadly-cytokine-storm-is-a-vital-weapon-for-treating-covid-19-137690" target="_blank" rel="noopener noreferrer">cytokine storm</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">that causes an uncontrolled flood</a> <a href="http://doi.org/10.1016/S2213-2600(20)30216-2" target="_blank" rel="noopener noreferrer">of immune cells into the lungs</a>. In these patients, their own uncontrolled inflammatory immune response, rather than the virus itself, causes the <a href="http://doi.org/10.1007/s00134-020-05991-x" target="_blank" rel="noopener noreferrer">severe lung injury and multiorgan failures</a> that lead to death.</p><p>Several studies <a href="https://doi.org/10.1016/j.trsl.2020.08.004" target="_blank" rel="noopener noreferrer">described in one recent review</a> have identified an altered gut microbiome in patients with COVID-19. However, identification of specific bacteria within the microbiome that could predict COVID-19 severity is lacking.</p><p>To address this question, my colleagues and I recruited COVID-19 hospitalized patients with severe and moderate symptoms. We collected stool and saliva samples to determine whether bacteria within the gut and oral microbiome could predict COVID-19 severity. The identification of microbiome markers that can predict the clinical outcomes of COVID-19 disease is key to help prioritize patients needing urgent treatment.</p><p><a href="https://doi.org/10.1101/2021.01.05.20249061" target="_blank" rel="noopener noreferrer">We demonstrated</a>, in a paper which has not yet been peer reviewed, that the composition of the gut microbiome is the strongest predictor of COVID-19 severity compared to patient's clinical characteristics commonly used to do so. Specifically, we identified that the presence of a bacterium in the stool – called <em>Enterococcus faecalis</em>– was a robust predictor of COVID-19 severity. Not surprisingly, <em>Enterococcus faecalis</em> has been associated with <a href="https://doi.org/10.1053/j.gastro.2011.05.035" target="_blank" rel="noopener noreferrer">chronic</a> <a href="https://doi.org/10.1016/S0002-9440(10)61172-8" target="_blank" rel="noopener noreferrer">inflammation</a>.</p><p><em>Enterococcus faecalis</em> collected from feces can be grown outside of the body in clinical laboratories. Thus, an <em>E. faecalis</em> test might be a cost-effective, rapid and relatively easy way to identify patients who are likely to require more supportive care and therapeutic interventions to improve their chances of survival.</p><p>But it is not yet clear from our research what is the contribution of the altered microbiome in the immune response to SARS-CoV-2 infection. A recent study has shown that <a href="https://doi.org/10.1101/2020.12.11.416180" target="_blank" rel="noopener noreferrer">SARS-CoV-2 infection triggers an imbalance in immune cells</a> called <a href="https://doi.org/10.1111/imr.12170" target="_blank" rel="noopener noreferrer">T regulatory cells that are critical to immune balance</a>.</p><p>Bacteria from the gut microbiome are responsible for the <a href="https://doi.org/10.7554/eLife.30916.001" target="_blank" rel="noopener noreferrer">proper activation</a> <a href="https://doi.org/10.1126/science.1198469" target="_blank" rel="noopener noreferrer">of those T-regulatory</a> <a href="https://doi.org/10.1038/nri.2016.36" target="_blank" rel="noopener noreferrer">cells</a>. Thus, researchers like me need to take repeated patient stool, saliva and blood samples over a longer time frame to learn how the altered microbiome observed in COVID-19 patients can modulate COVID-19 disease severity, perhaps by altering the development of the T-regulatory cells.</p><p>As a Latina scientist investigating interactions between diet, microbiome and immunity, I must stress the importance of better policies to improve access to healthy foods, which lead to a healthier microbiome. It is also important to design culturally sensitive dietary interventions for Black and Latinx communities. While a good-quality diet might not prevent SARS-CoV-2 infection, it can treat the underlying conditions related to its severity.</p><p><em><a href="https://theconversation.com/profiles/ana-maldonado-contreras-1152969" target="_blank">Ana Maldonado-Contreras</a> is an assistant professor of Microbiology and Physiological Systems at the University of Massachusetts Medical School.</em></p><p><em>Disclosure statement: Ana Maldonado-Contreras receives funding from The Helmsley Charitable Trust and her work has been supported by the American Gastroenterological Association. She received The Charles A. King Trust Postdoctoral Research Fellowship. She is also member of the Diversity Committee of the American Gastroenterological Association.</em></p><p><em style="">Reposted with permission from <a href="https://theconversation.com/a-healthy-microbiome-builds-a-strong-immune-system-that-could-help-defeat-covid-19-145668" target="_blank" rel="noopener noreferrer" style="">The Conversation</a>. </em></p>
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