Healthy sweetness? Between myth and reality

Süssungsmittel sind Lebensmittelzusatzstoffe. Sie sind als kalorienfreie oder kalorienreduzierte Alternativen für Zucker in vielen verarbeiteten Lebensmitteln wie Erfrischungsgetränken, Süsswaren und Milchprodukten enthalten. 

Welche Süssungsmittel sind derzeit in Europa zugelassen?
In der EU sind gemäss Verordnung (EG) Nr. 1333/2008 derzeit 19 Süssungsmittel zugelassen,
die Spezifikationen und Reinheitskriterien sind in der Verordnung (EU) Nr. 231/2012 geregelt. Von den zugelassenen Süssungsmitteln werden 11 häufig auch als Süssstoffe bezeichnet, und zwar Acesulfam K (E 950), Aspartam (E 951), Cyclohexansulfamidsäure und ihre
Na- und Ca-Salze (Cyclamat) (E 952), Saccharin und seine Na-, K- und Ca-Salze (E 954),
Sucralose (E 955), Thaumatin (E 957), Neohesperidin DC (E 959), Steviolglycoside (E 960),
Neotam (E 961), Aspartam-Acesulfamsalz (E 962) und Advantam (E 969).
Acht der derzeit zugelassenen Süssungsmittel sind Zuckeraustauschstoffe: Sorbit (E 420),
Mannit (E 421), Isomalt (E 953), Polyglycitolsirup (E 964), Maltit (E 965), Lactit (E 966), Xylit
(E 967) und Erythrit (E 968). Chemisch betrachtet handelt es sich bei diesen Stoffen um Zuckeralkohole (Polyole).

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Systematisches Review

The effect of physical exercise on nutrition has gained substantial interest in the last decade. Meaningful results have been produced concerning the effect of physical exercise on different appetite hormones and food choice/preference. While it is well known that taste and nutrition are related, the relation between taste and physical activity has not yet been fully explored. This systematic review aims to provide a detailed view of the literature on physical exercise and its effect on taste perceptions. Five tastes were included in this review: sweet, salty, bitter, sour, and umami. Sweet taste intensity, sensitivity, and preference were increased by acute physical exercise, but sweet preference was reduced by chronic physical activity. Perceived intensity and sensitivity decreased overall for salty taste, but an increased preference was noted during/following exercise. Sour taste intensity ratings were decreased following exercise and preference was enhanced. Umami taste intensity and sensitivity increased following exercise and preference was decreased. No significant results were obtained for bitter taste. While evidence regarding the effect of exercise on taste has arisen from this review, the pre-testing nutrition, testing conditions, type of test, and exercise modality must be standardized in order to produce meaningful and reproducible results in the future.

DOI: 10.3390/nu12092741

Study: strong evidence

Narratives Review

The liking of sweet taste seems to be very powerful in many individuals. Some researchers argue that the preference of sweet taste is innate to all of us, and important, because it enables us to detect plants with available glucose [27]. Thus, sweet taste preferences seem to be logical from an evolutionary perspective because it offers a primary energy source.

While the above-mentioned studies rely on behavioral data, a recent study used imaging data to examine the psychological sweet effect. This approach promises an understanding of the underlying mechanisms of the reported effects. While recording their brain activity with electroencephalography (EEG), Wang et al. exposed their participants to sweet taste or control conditions and subsequently asked them to perform a lexical decision task, including romantic and control items. They found an enhanced N400 component for romantic words in the sweet taste condition, suggesting that sweet taste facilitates the semantic processing of romantic cognitions [19,20], thereby supporting the above mentioned behavioral research.
As mentioned above, sweet taste is linked metaphorically to romantic feelings in many languages. However, in some languages or cultures, this link is not present. In Israeli culture, sweetness is used as a metaphor for inauthenticity. Gilead et al. conducted a study that included 62 Israeli participants who had to eat sweet or spicy snacks, and then were asked to perform a social judgement task [14]. They found results according to the specific cultural-linguistic characteristics of the participants, suggesting that culture and language provide at least important contributions to the conceptual metaphor of sweetness and love.
Taken together, these results suggest that sweet taste may represent a conceptual metaphor and, thereby, has an impact on our romantic feelings and behavior (in contrast to bitter or sour taste).

DOI: 10.3390/app112411967

Study: weak evidence

Narratives Review

Dopaminergic reward circuits.

Reward and reinforcement learning are linked to dopaminergic circuits that facilitate goal-directed behaviours and promote the ‘wanting’ of food rewards134,135. These circuits are conceptualized to mediate subconscious aspects of food reward and selection4. Eliminating dopaminergic signalling in mice does not prevent sugar consumption, and mice can still discriminate sugar from water136. This deficiency did reduce the total number of consumption bouts[G], but the rate of licking and bout size were greater136, suggesting that dopamine is not required to detect sucrose palatability[G]. By contrast, pharmacological inhibition of dopamine D1 receptors in the striatum during training sessions but not during testing sessions prevented flavour preference conditioning137. Thus, dopamine signalling underlies the learned associations between food value and environmental cues rather than intrinsic sugar preferences.

Two independent dopaminergic circuits arise in the midbrain: the mesolimbic[G] system projecting from the ventral tegmental area (VTA) to the ventral striatum, and the nigrostriatal[G] system projecting from the substantia nigra pars compacta (SNPc) to the dorsal striatum (Fig. 3). Outputs from these two basal ganglia regions project to motor feeding circuits to control behaviour. Oral and intra-intestinal infusion of sucrose shows increased activation of neurons and dopamine release in both pathways77,138–141. However, in sham-fed rats, in which the oral cavity is exclusively stimulated, sucrose only induces dopamine release in the ventral striatum139. Thus, while the mesolimbic system receives signals from oral and post-ingestive sites, the nigrostriatal system only receives input from the intestine and post-absorptive sensors.

DOI: 10.1038/s41583-022-00613-5

Study: weak evidence

Scoping Review

Human preference for sweet foods is universal, with hedonic responses changing over a person’s lifetime [1]. Sweet molecules in nature are sugars found primarily in plants (i.e., fructose, sucrose, and glucose), in addition to lactose found in many species’ milk, all of which provide a source of energy and sweetness. It has been hypothesized that sweetness preference may exist to identify energy-rich foods (i.e., containing readily available glucose) [2], which provides necessary metabolic fuel for the brain.

Age and Sweetness Preference
In nine studies, the effect of age on sweetness preference was assessed (Table S3-1 of Supplementary File S3). In four of the experimental studies, the sweetness preferences of children or adolescents were compared to those of young adults [33,34,35,36]. Children and adolescents tended to have a significantly greater sweetness preference compared to young adults. One study showed that children had a significantly greater sweetness preference than adolescents [35]. In another study, elderly individuals had a significantly greater preference for sucrose-sweetened iced tea than young adults; however, there was a significant age-by-gender effect when individuals consumed iced tea sweetened with aspartame. For example, elderly males preferred sweeter iced tea than did elderly females and young males, but not compared with young females [37]. In the remaining four studies, children had a significantly greater sweetness preference than their mothers, independent of the sweetening agent (sucrose, sucralose, or aspartame) [38,39,40,41]. Importantly, Bobowski and Mennella [41] observed significant differences in sweetness preference between children and their mothers only when using a five-point facial hedonic scale, but not when using a three-point facial hedonic scale. Thus, overall, there appears to be a U- or J-shaped curve characterizing sweetness preference, such that sweetness preference is high in childhood, decreases with advancing age, but then increases in elderly, perhaps more so in elderly males than females.

3.4.9. Ethnicity and Lifestyle and Sweetness Preference

3.4.12. Other Factors and Sweetness Preference

DOI: 10.3390/nu12030718

Study: weak evidence

querschnittliche Beobachtungsstudie (Cross-Sectional Study)

The 2020–2025 Dietary Guidelines for Americans recommend that less than 10% of total calories come from added sugars. Yet, added sugars account for more than 13% of the average American’s calorie intake [1]. While adding sweeteners like sugar or honey to a food or beverage is an obvious added sugar, most people consume added sugars from processed and packaged food and beverage products like sugar-sweetened beverages, sweets and desserts, sweetened coffee and tea, and candy.

Background/Objectives: The Dietary Guidelines for Americans recommend consuming less than 10% of total calories from added sugars. Low-calorie sweeteners, sugar alcohols, and natural low-calorie sweeteners are used to reduce added sugar intake, but there are concerns about their long-term health impacts, especially for children. This paper describes the food and beverage television advertising landscape as it pertains to sweeteners. Methods: This cross-sectional study uses television ratings data licensed from The Nielsen Company for the United States in 2022. Nutrition facts panels and ingredient lists were collected for food and beverage product advertisements seen on television and assessed for the presence of added sugars, low-calorie sweeteners, sugar alcohols, and natural low-calorie sweeteners (forms of stevia and monk fruit), as well as whether products were high in added sugars based on federal Interagency Working Group guidelines for advertising to children. Results: Of the sweeteners examined, added sugars were most commonly found in food and beverage product advertisements seen on television (60–68% of advertisements seen across age groups), followed by low-calorie sweeteners (6–10%), sugar alcohols (2–4%), and natural low-calorie sweeteners (2%). About one-third (32–33%) of advertisements seen by 2–5- and 6–11-year-olds were high in added sugars, similar to the percentage seen by 12–17- and 18+-year-olds (34–35%). Advertisements seen for cereal (86–95%) and sweets (92–93%) were most likely to have added sugars, while those for sweets (89–90%) were most likely to be high in added sugars. Conclusions: Sweeteners are common in food and beverage product advertisements seen on television, including alternatives to added sugars for which there are concerns about long-term impacts on health. Continued monitoring and additional research on other advertising media platforms used by food and beverage companies (e.g., digital media) is needed.

DOI: 10.3390/nu16233981

Study: moderate evidence

Narratives Review

Sweetness is the taste that is strongly identified with affection and reward. Indulgence in sweets has been described as a ‘universal human weakness.’ Carious lesions were sparse in ancient times but increased dramatically in the industrialised world. Epidemiological studies in many parts of the world support the hypotheses that increase in dental caries was associated with dietary changes.

DOI: 10.3889/oamjms.2018.336

Study: weak evidence

Cross-sectional study (Querschnittsstudie)

Although artificial sweeteners were introduced into the food industry in the 1800s, their widespread use surged in the 1990s, coinciding with the rise in obesity and increasing concerns over excessive sugar consumption [2,3]. Initially marketed as a healthier alternative, particularly for individuals with diabetes or those managing their weight, artificial sweeteners gained popularity due to their low-calorie nature. As scientific research increasingly linked high sugar intake to chronic diseases, artificial sweeteners became a common ingredient in various food products. Today, commonly used artificial sweeteners include acesulfame-K, aspartame, cyclamate, saccharin, sucralose, and neotame, often used alone or in combination.

Regulatory agencies consider most artificial sweeteners safe with no harmful effects, as they are either not metabolized by the human body or broken down into naturally occurring components [4]. However, emerging evidence suggests potential adverse metabolic effects, including an increased risk of weight gain, insulin resistance, and cardiovascular disease [5,6]. Some studies indicate that artificial sweeteners may trigger cravings for sugar by stimulating appetite due to reduced caloric value, potentially leading to higher overall food consumption, weight gain, and glucose intolerance [7,8]. Furthermore, artificial sweeteners have been associated with an increased risk of type 2 diabetes, premature mortality, and gastrointestinal tract alterations [3,9,10,11], as well as a risk of cardiovascular disease, hypertension, and stroke.

DOI: 10.3390/nu17050814

Study: moderate evidence

prospektive Kohortenstudie

The harmful effects of added sugars on various health outcomes including cardiometabolic disorders have been extensively studied, meta-analysed1 2 and are currently recognised as major risk factors by public health authorities. In particular, the World Health Organization recommends that less than 5% daily energy intake should come from free sugar.3 Artificial sweeteners emerged as an alternative to added sugar that enabled the sweet taste to be reproduced without using sugar and therefore reduced calorie content from free sugar, which was highly appreciated by consumers.

One of these studies was performed in the NutriNet-Santé cohort28 and found that sugary drinks and artificially sweetened beverages were associated with increased CVD risk. Systematic reviews and meta-analyses35 36 have suggested direct associations between artificially sweetened beverages and CVD risk. The WHO 2022 report on the health effects of artificial sweeteners notably observed associations between consumption of beverages with artificial sweeteners (used as a proxy) and some intermediate markers of CVD,8 including a modest increase in the unfavourable total cholesterol to HDL cholesterol ratio (meta-analysis of four randomised control trials), and an increased risk of hypertension (meta-analysis of four prospective studies). The international health authority also identified an increase in CVD mortality, and in the incidence of cardiovascular events and strokes associated with greater intake of soft drinks containing artificial sweeteners (meta-analysis of four randomised control trials). However, prospective studies remain limited and the level of evidence for these associations is still considered low by WHO.8 Additionally, because artificially sweetened beverages only represent part of the total artificial sweetener intake, it is crucial to consider all dietary sources in causal studies.

Artificial sweeteners emerged as an alternative to added sugar that enabled the sweet taste to be reproduced without using sugar and therefore reduced calorie content from free sugar, which was highly appreciated by consumers.4 Artificial sweeteners currently represent a $7200m (£5900m; €7000m) market globally, with a 5% annual growth projected to attain $9700m by 2028.5 An extensive number of brands worldwide contain these food additives, especially ultra-processed foods such as artificially sweetened beverages, some snacks, and low calorie ready-to-go meals or dairy products; overall more than 23'000 products worldwide contain artificial sweeteners.6 Artificial sweeteners are also directly used by consumers as table top sweeteners instead of sugar. Acceptable daily intakes for each artificial sweetener have been set by the European Food Safety Authority (EFSA), the United States Food and Drug Administration, or the Joint Expert Committee on Food Additives. Nonetheless, they remain a topic of controversy and are currently undergoing a re-evaluation by several health authorities, including the EFSA7 and WHO.

DOI: 10.1136/bmj-2022-071204

Study: moderate evidence

Narratives Review

High sugar intake is associated with weight gain, obesity, and hypertriglyceridemia, which can lead to Cardiovascular disease(CVD), diabetes, and other metabolic diseases.

Increased sugar intake leads to well-established adverse health outcomes such as weight gain, dental caries, diabetes, and cardiometabolic disorders. Thus, the World Health Organization (WHO) has suggested keeping total sugar intake to less than 10% of the total daily calorie intake.

As a result, people are opting for low-calorie and sugar-free products; any food marketed as “ Sugar-free” or “ Diet food” contains artificial sweeteners.

They are used in a variety of food and drinks and are heavily marketed as better alternatives to table sugar by the food industry. They produce more pronounced sweetness and have zero to a few calories per gram. The aggressive marketing of these sugar substitutes by their makers has resulted in their overuse. Additionally, the increased prevalence of conditions such as obesity, metabolic syndrome, and diabetes, in addition to increased consumer knowledge, has resulted in a continuous radical shift in favor of using artificial sweeteners.

DOI: 10.1186/s43162-023-00232-1

Study: weak evidence

prospektive Kohortenstudie

In this large cohort study, artificial sweeteners (especially aspartame and acesulfame-K), which are used in many food and beverage brands worldwide, were associated with increased cancer risk. These findings provide important and novel insights for the ongoing re-evaluation of food additive sweeteners by the European Food Safety Authority and other health agencies globally.

DOI: 10.1371/journal.pmed.1003950

Study: moderate evidence

Für einen durchschnittlichen Erwachsenen (bei einer Kalorienzufuhr von 2.000 kcal) entsprechen 10 Energieprozent nicht mehr als 50 Gramm Zucker pro Tag (ca. 10 Teelöffel bzw. 14 Stück Würfelzucker).

Bei Kindern ist die maximal empfohlene Aufnahme an freiem Zucker – je nach Alter und Geschlecht – geringer. Bei Jugendlichen und sportlich Aktiven kann es auch mehr sein. Für ein- bis dreijährige Kinder entsprechen 10 Energieprozent ungefähr 30 Gramm Zucker pro Tag (ca. 6 Teelöffel) (berechnet auf Basis der D-A-CH-Referenzwerte für die Nährstoffzufuhr).

Um das Risiko einer ungesunden Gewichtszunahme und Karies zu verringern, empfiehlt die Weltgesundheitsorganisation (WHO) die Aufnahme an freiem Zucker in sämtlichen Lebensphasen auf unter 10 Energieprozent zu reduzieren. Unter „freie Zucker“ werden hier alle Zuckerarten verstanden, die Speisen und Getränken beigefügt werden. Aber auch jener Zucker, der natürlich in Honig, Sirup, Fruchtsaftkonzentraten und Fruchtsäften vorkommt.

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Narratives Review

In recent years strong concerns have been raised about excessive sugar intake and its effect on health. During the last fifty years, the consumption of sugar has tripled around the world.

Sugar intake is a major public health problem that has gained popularity in recent years among people of all ages. Dietary sugar in excess raises the risk of metabolic conditions including obesity and diabetes as well as cardiovascular disorders (Alkhaldi et al., 2021). In many countries, different epidemiological studies and trials have associated a high consumption of sugar-sweetened beverages (one of the main dietary sugar sources) with weight gain, poor dental health, cancer, metabolic syndrome, heart disease and type 2 diabetes mellitus.

Sugar has become an inseparable part of many food cultures. Besides being an imperative element in the production of various sweets, sugar has many beneficial properties in foods such as preservatives, bulking agents, texturizers, moisturizers, dispersants, stabilizers, fermentation substrates, flavor carriers, and browning and decorative agents (Manickvasagan et al., 2017). The term “sugars” refers to mono- and di-saccharides in terms of chemical categorization. Glucose, fructose, and galactose are the three main monosaccharides – hexoses (six-carbon sugars) that makeup naturally occurring di-, oligo-, and polysaccharides (Fidler Mis et al., 2017), while “Sugar” is referred to as sucrose also known as table sugar, which is made up from fructose and glucose units.

The WHO recommends reducing the intake of added sugar to <10% of the total energy (Organization, 2003). The U.S. Department of Agriculture's (USDA) food guide recommends consuming added sugar within the range of 6–10% of total energy.

Artificial sweeteners are synthetically produced substitutes for sugar, whose sweetening power of sucrose is significantly higher per unit of weight (up to 4000 times sweeter, depending on the type) (Dhartiben and Aparnathi, 2017). They have very few or no calories and are not carbohydrates (Saraiva et al., 2020). Acesulfame K, advantame, aspartame, cyclamate, neotame, saccharin, and sucralose, are to be distinguished from sugar substitutes such as sorbitol, maltitol or xylitol, which have a much lower sweetening power and are modified sugars (sugar alcohols) (Carocho et al., 2017). In practice, artificial sweeteners are usually mixed with sugar substitutes to make the sweetness of the products more pleasant and in particular to mask the often slightly bitter aftertaste of some artificial sweeteners.

Artificial sweeteners are controversial, and the health authorities of different countries have different opinions. Some are banned in the United States due to suspected cancer risks, however, are permitted in the European Union.

Artificial sweeteners are controversial, and the health authorities of different countries have different opinions. Some are banned in the United States due to suspected cancer risks, however, are permitted in the European Union (Landrigan and Straif, 2021). Several studies have shown that artificial sweeteners raise insulin levels because the body responds to sugar when the signal “sweet” is received. If the “sweet” signal comes from an artificial sweetener rather than sugar, the blood sugar level drops as a result of the insulin secreted by the body as a precaution, resulting in hunger attacks.

The public's growing interest in health and wellbeing has raised demand for low-calorie goods (Manickvasagan et al., 2017). That’s why many inventions have focused on the replacement of refined sugar (table sugar) with sugars from natural sources that can be used in solid, semi-solid and liquid food applications. Sugars from natural sources (unrefined sugar) include a variety of bioactive compounds, minerals, fibers, antioxidants, and..

DOI: 10.1016/j.heliyon.2022.e10711

Study: weak evidence

randomisierte kontrollierte Studie (RCT) mit zusätzlicher translationaler Forschung in Tiermodellen.

Non-nutritive sweeteners (NNS) are commonly integrated into human diet and presumed to be inert; however, animal studies suggest that they may impact the microbiome and downstream glycemic responses. We causally assessed NNS impacts in humans and their microbiomes in a randomized-controlled trial encompassing 120 healthy adults, administered saccharin, sucralose, aspartame, and stevia sachets for 2 weeks in doses lower than the acceptable daily intake, compared with controls receiving sachet-contained vehicle glucose or no supplement. As groups, each administered NNS distinctly altered stool and oral microbiome and plasma metabolome, whereas saccharin and sucralose significantly impaired glycemic responses. Importantly, gnotobiotic mice conventionalized with microbiomes from multiple top and bottom responders of each of the four NNS-supplemented groups featured glycemic responses largely reflecting those noted in respective human donors, which were preempted by distinct microbial signals, as exemplified by sucralose. Collectively, human NNS consumption may induce person-specific, microbiome-dependent glycemic alterations, necessitating future assessment of clinical implications.

DOI: 10.1016/j.cell.2022.07.016

Study: strong evidence

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Narratives Review

Carbohydrates (=saccharides) are groups of chemical compounds that include sugars, starch, and cellulose [1]. Saccharides are divided into four chemical subgroups according to the degree of polymerization by indication of the length of the carbohydrate chain: monosaccharides (with only 1 sugar unit), disaccharides (with 2 sugar units), oligosaccharides (containing 3–9 sugar units), and polysaccharides (with ≥10 sugar units).

1.3. Carbohydrate ADME Processes
The fate of carbohydrates in an organism can be described by the absorption, distribution, metabolism, and excretion (ADME) process. In mammals, dietary di-, oligo- and polysaccharides are digested in the mouth, stomach, and intestine and are broken down into monosaccharides by special (salivary amylase, stomach acid, and specific carbohydrases—glycoside hydrolases, respectively) enzymes, and finally, the small intestine absorbs them into the bloodstream. Cellulose dietary fibres are indigestible carbohydrates fermented in the large intestine using the presence of bacteria [53]. Monosaccharides are transported through the hepatic portal vein to the liver. Fructose and galactose are phosphorylated to glucose by fructo- and galactokinase. Glucose is metabolized in all body cells by glycolysis [54]. This metabolic pathway converts 1 glucose molecule into 2 pyruvic acid molecules—the substrate for the citric acid cycle (CAC). Glycolysis also releases 2 high-energy adenosine triphosphate (ATP) molecules and 2 molecules of reduced nicotinamide adenine dinucleotide. The complete breakdown of one glucose molecule by aerobic respiration (glycolysis + CAC) forms approximately 30–33 molecules of ATP [55]. Glucose serves as a substrate of cellular respiration or is stored as glycogen in glycogenesis.

Table 1. Classification of dietary carbohydrates.

DOI: 10.3390/nu14142940

Study: weak evidence

Süssungsmittel oder Zuckeraustauschstoffe sind Lebensmittelzusatzstoffe, die Lebensmitteln und Getränken wie Erfrischungsgetränken, Desserts, Molkereiprodukten, Süssigkeiten, Kaugummi, kalorienarmen Produkten sowie Produkten für eine gewichtskontrollierende Ernährung einen süssen Geschmack verleihen.

Einige Süssungsmittel, wie etwa Aspartam oder Sucralose, sind um ein Vielfaches süsser als Zucker.

Süssungsmittel können auf unterschiedliche Weise hergestellt werden, beispielsweise durch Extraktion aus Pflanzen (z. B. Steviolglykoside oder Thaumatin) oder aus anderen Materialien pflanzlichen Ursprungs (z. B. Neohesperidin DC, das aus Zitrusfrüchten gewonnen wird).

Darüber hinaus können sie synthetisch (z. B. Saccharin) oder durch den Einsatz von Mikroorganismen im Produktionsprozess hergestellt werden (z. B. Erythrit).

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Systematisches Review

Of the 7769 possible relevant studies (including 3547 duplicates) identified in the initial search, finally, 13 clinical trials were included in the systematic review. All studies except three had a parallel design. Of 13 studies, 8 trials did not have placebo/control groups. The included studies examined the impact of oral consumption of honey on glycemic status (n = 12), anthropometric indices (n = 6), lipid profiles (n = 10), and blood pressure (n = 3). Based on the Jadad scale, 5 studies had acceptable methodological quality, and the remaining (n = 8) had low methodological quality.

The current systematic review showed that oral consumption of honey might have no significant effects on the modulation of metabolic profiles in nondiabetic subjects. In addition, a high intake of honey might increase glucose levels and worsen other metabolic parameters in patients with T2DM. Due to substantial heterogeneity in study design and limited clinical trials, results, however, should be interpreted with great caution.

DOI: 10.1155/2021/6666832

Study: strong evidence

Narratives Review

Honey, traditionally, is used for its anti-aging properties, enhancing the immune system, killing bacteria, treatment of bronchial phlegm, and relieving a sore throat, cough, and cold [2]. Moreover, according to literature, honey represents various pharmacological properties such as anti-inflammatory [3], antioxidant [4], anti-cancer activities against breast and cervical cancer [5], prostate cancer [6], and osteosarcoma [7]. The therapeutic effect of honey on human health can be either oral administration or topical application.

The food industry is one of the critical and fast developing industries worldwide, owing to the tremendous growth of the human population and increased interest of consumers toward the consumption of high-quality products. Moreover, it has been proven that low-quality food products and junk foods may have an adverse impact on consumers’ health [10]. Food adulteration will multiple this risk since the nature of food has been altered. “Food adulteration” is described as the act of intentionally decreasing the quality of food either by adding or swapping low-quality materials or eliminating various important integrant. When the cheaper and low-grade elements are added to an original product threaten the consumer’s health, it is considered and declared “adulterated.” Honey, as one of the most common foods worldwide, also has been subjected to adulteration.

Although honey is recognized as high-quality food, it is more vulnerable to adulteration, mislabeling, and unethical mixing with cheaper and low-grade honey, sugars, and other substances. Moreover, due to its limited availability, proved therapeutic and healing properties, and the increased population concerns regarding their health, there is a rising demand for the natural food product. This increased economic value would make honey a vulnerable adulteration target [12]. Moreover, while honey is a well-known high nutritional value food, it can also be toxic naturally by transferring plant toxins such as pyrrolizidine alkaloids, or because of adulterants that are added into the pure honey by mankind to gain economic profits [13]. Food adulteration has been a major concern for consumers, as it does not only decrease the quality of food products but also results in several adverse health effects. Authentic testing of food and the toxicology of adulterants is required for a value assessment to assure consumer protection against fraudulent activities. According to the regulation set by Alimentarius.

Reference [15] mentioned that sugars could be used in two different ways as adulterants; direct adulteration and indirect adulteration. During direct adulteration, a certain ratio of syrups is added to harvested honey to increase its sweet taste, while in indirect adulteration the bees were overfed with sugar syrups to increase the honey yield in hives. According to Se et al. [13], the most frequent sugar syrups for honey adulteration are high fructose corn syrup (HFCS), corn sugar syrup (COSS), inverted sugar syrup (ISS), and cane sugar syrup (CASS); there is a high preference towards HFCS (from simple isomerization of COSS) according to Se et al.

Honey can be adulterated directly (addition of adulterants) [28], indirectly (bee-feeding) [26,29], or by blending it with other cheap honey [30,31], which will be discussed further below. The quality of honey is closely related to its impurities and adulterants.
The adverse health impact of honey adulteration on consumers may lead to increased blood sugar, followed by the release of the insulin hormone and type II diabetes, abdominal weight gain and obesity, a rise in the blood lipid levels, and high blood pressure [32]. Furthermore, adulterants can affect internal organs, potentially causing a fatty liver [13], acute and chronic kidney injury [33] and elevate visceral fat pads and total body fat, which can lead to death.

DOI: 10.3390/foods9111538

Study: weak evidence

Narratives Review

Honey is defined as “the natural sweet substance produced by Apis mellifera bees from the nectar of plants or from secretions of living parts of plants or excretions of plant-sucking insects on the living parts of plants, which the bees collect, transform by combining with specific substances of their own, deposit, dehydrate, store and leave in honeycombs to ripen and mature”.

The welfare of honey bees (Apis mellifera) has received significant attention due to their crucial roles in agroecosystems, such as pollination, serving as bioindicators, producing hive products, and their use in Api tourism and apitherapy [1,2,3,4,5,6,7,8]. Food production is heavily reliant on bees, as more than 80% of plants are pollinated by honeybees, and some plants cannot reproduce without their pollination. Additionally, the well-being of bees is directly linked to improved honey production, highlighting the importance of maintaining their health [1,2,3,4,5,6,7,8].
Bee welfare is an important topic for both the ecosystem and the economy, as bees are essential for pollinating many cultivated and wild plants. Bee welfare refers to maintaining optimal conditions for their health and survival requiring sustainable beekeeping management practices.

DOI: 10.3390/molecules25020374

Study: weak evidence

Laborstudie: Vergleich von verschiedenen Extraktionsmethoden für Zuckersirup aus Datteln

e. Date
syrup is used in food preparations like sweets, snacks, confectionery,
bakery products and health foods. Mature date fruits are also processed
into products such as date bars, date syrup, etc. Dates are known to
be rich in carbohydrates (80%) but quite low in protein (2-3%). Date
fruits (Tamr) contained moisture ranged from 10 to 22%, total sugars
62 to 75%, protein 2.2 to 2.7%, fiber 5 to 8%, fat 0.4 to 0.7%, ash 3.5 to
4.2%, total acidity 0.06 to 0.20%, ascorbic acid 30.0 to 50.0 mg %,on dry
weight basis. Date fruit as a nutritive product contains sugar substances
about (70.6-76.3%), proteins (1.9-3%), fat (0.2-2.8%), minerals (1.3%)
and vitamins [4]. The flesh of a fully ripe date (Tamr), consist of twothird sugars and one-quarter water, the rest being mainly cellulose,
pectin, ash, and vitamins. The date is considered as a nutritious fruit as
research has indicated the clear contribution of dates to human health
when consumed with other food constituents. Dates contain sufficient
quantities of minerals and vitamins that help to prevent deficiency
[5]. Dates also have an emerging role of importance as a substitute for refined sugar. In food technology, date syrup as the main and general
by-product of date is used for foodstuffs such as jams, marmalades,
concentrated beverages, chocolates, ice cream, confectioneries, honey,
etc [6-8]. As the Kabkab (Iranian Kabkab Dates) date has a high amount
of wastes, it can be used for the date syrup production with economical
advantageous [9]. Date syrup (dibs) is probably the most common
derived date product. It is produced as an incidental by-product when
bagged humid dates are heaped for several months, some syrups
extracted by the force of their own weight. In addition, it is produced
in the home and village by extraction and boiling down of juice, and on
a semi and full industrial scale. As the Reziz date has a high amount of
wastes, it can be used for the date syrup production with economical
advantageous. In date’s syrup industry the fruit are mixed with water
and heated for around 1 h at 70°C, when the main components, sugars,
are extracted. This method destroys some nutritive components and
darkens the product’s color.

DOI: 10.4172/2157-7110.1000402

Study: weak evidence

Datteln: 0,54 kg CO2eq/kg.

Dattelsirup: 1,40 kg CO2eq/kg

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Die Untersuchung des Zuckergehaltes von elf Kokosblütenzuckern ergab einen durchschnittlichen Saccharosegehalt von 90 %. Weitere Zuckerarten wie Glukose oder Fruktose stellte das LGL in nicht nennenswerten Mengen fest. In der Zuckerzusammensetzung unterscheidet sich Kokosblütenzucker damit nicht wesentlich von Haushaltszucker.

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Narratives Review

GI is affected by the composition of sugar in a food. For example, sucrose which is made up of glucose and fructose, has a lower GI than glucose because half of the sucrose molecule is made up of fructose, a type of sugar that elicits low blood sugar response45. In addition, while the GI of sucrose is 68, the GI of glucose is 10045. This variation in GI as a result of composition of sugar could also affect the GL.

DOI: 10.4314/ahs.v16i2.15

Study: weak evidence

Narratives Review

Coconut sap categorized as a low glycemic index (GI 35) food.

DOI: 10.3390/ijerph20043671

Study: weak evidence

experimentelle Ernährungsstudie (Interventionsstudie), die den GI von Lebensmitteln empirisch bestimmt.

Table 1 – Glycemic index (GI) of carbohydrate (CHO) foods in the Philippines.

DOI: 10.1016/j.jff.2010.10.002

Study: weak evidence

experimentelle Ernährungsstudie (Interventionsstudie), die den GI von Lebensmitteln empirisch bestimmt.

This research's objective was to compare the glycemic response of 30 healthy volunteers in 4-hour fasting after the intake of coconut sugar, sucrose and brown sugar, ranging in age from 19 to 50 years, being 73% female and 27% male, who were randomly divided into three distinct groups with the intake of 50g of the respective sugars. Capillary blood glucose was measured in times: 0; 15; 30; 45 and 60 minutes. The data was evaluated using the analysis of variance, and the Scott-Knott test was chosen to verify the differences in results. We conclude that the three kinds of sugars presented statistically the same behaviors (p <0.05) regarding the increase of glycemia in times 15, 30 and 60 minutes in relation to time zero, there was a significant difference (p <0.05) in the time of 45 minutes, where a longer time for the coconut sugar decrease occurred. However, it is concluded that coconut sugar behaves similarly to the other sugars, and should be re-evaluated as a product that has a low glycemic index.

DOI: 10.56238/uniknowindevolp-014

Study: weak evidence

experimentelle Primärstudie (Labor- und Backversuch)

Agave syrup is the sweet substance obtained by the hydrolysis of fructans present in the Agave spp. heads. In Mexico, where Agave spp. is endemic, there are about 205 species; however, agave syrup is obtained mostly from Agave tequilana Weber var. blue.

DOI: 10.3390/foods9070895

Study: weak evidence

Narratives Review

In some areas, AS is popular for its low glycemic index (10–27), which is much lower than honey and sucrose [2,16,68], and partially for its carbohydrate pool that contains up to 90% fructose [69]. As AS has a high fructose concentration, it can be used as a sweeter which is better than other many commercially available syrups mostly made up of glucose or sucrose [16]. As a result, not as much AS is required to reach a comparable level of sweetness. This promotes it as a calorie-reduced sweetener. However, such an approach is not without criticism.

AS can be controversial if we wish to know if it is a healthier option to sweeteners and table sugar. Syrup proponents argue that it is a better sweetener for diabetics than honey or table sugar thanks to its low glycemic index, and because it creates a smaller blood sugar spike [34,71]. There are, however, additional aspects to bear in mind. According to Jones (2012) [72], the types and content of sugars, macronutrients and ingredients that differ in food products lead to vastly varied glycemic index values. Furthermore, the glycemic index does not correctly reflect food processing and/or cooking methods, individuals’ diet or quantities consumed [1,72]. Nor should the glycemic index be employed as the only criterion to establish a given food or diet’s health effects [1], but ought to be combined with different nutritional factors. Consumers can be misled and end up believing that a low glycemic index allows them to consume more than with conventional sweeteners.

Recent research reports that fructose overconsumption is connected to the liver accumulating fat. This is associated with cardiovascular disease, insulin resistance [73], among other harmful problems [74]. Stanhope et al. (2011) [75] report that those who eat 25% of their daily calories in the form of high-fructose corn syrup (55% fructose, 45% glucose) can present higher triglyceride and cholesterol levels than those who eat pure fructose. However, this is more than what most people eat on a daily basis. It is also noteworthy that fructose is not ingested alone in a typical diet but is often combined with glucose.

The way that AS is advertised and how much is consumed may be the most important concerns. There is very little knowledge about the long-term effects of ingesting fructose-high foods or beverages on human health [77]. Given these uncertainties, consumers ought to endeavor to consume energy-dense foods in moderation, including AS. Regardless of the source of sugar, one calorie is one calorie for body fatness alterations [78] The sugars in ASs apparently have the same effect on human weight loss as other sugars do [78]. This means that AS is no more natural than either fruit juice concentrate or high-fructose maize syrup. While enterprises are entitled to sell AS as a sweetener, they ought not to claim that this alternative is more natural or healthier than other widely used sweeteners or sucrose. Making strong claims that favor AS intake should be avoided simply because additional research into fructose and its effects on human nutrition and metabolism is necessary.

DOI: 10.3390/ijerph19127022

Study: weak evidence

Narratives Review

High-fructose syrups are used as sugar substitutes due to their physical and functional properties. High fructose corn syrup (HFCS) is used in bakery products, dairy products, breakfast cereals and beverages, but it has been reported that there might be a direct relationship between high fructose intake and adverse health effects such as obesity and the metabolic syndrome. Thus, fructose has recently received much attention, most of which was negative. Although studies have indicated that there might be a correlation between high fructose-rich diet and several adverse effects, however, the results of these studies cannot be certainly generalised to the effects of HFCS; because they have investigated pure fructose at very high concentrations in measurement of metabolic upsets. This review critically considered the advantages and possible disadvantages of HFCS application and consumption in food industry, as a current challenging issue between nutritionists and food technologists.

DOI: 10.1080/09637486.2020.1862068

Study: weak evidence

Systematisches Review mit Meta-Analyse

Fructose is a natural monosaccharide (glycemic index, GI: 19-23), used as a sweetener in the food industry, whilst high fructose corn syrup (HFCS) is a liquid substitute for sucrose with 42 or 55% (dry) fructose, and is obtained from the hydrolysis of corn starch to glucose using glucoamylase and α-amylase, followed by glucose isomerization to fructose, which results in the production of a mixture of glucose and fructose (9, 10). HFCS can provide flavor, color, texture, stability, and freshness in some food products, such as beverages, processed foods, baking products, ice cream and confectioneries.

Up to 20% of fructose may be stored as hepatic glycogen, and a large part is converted to LDL/VLDL.

It has been demonstrated in a rat study that the addition of sugars, in general, and HFCS directly or indirectly contribute to obesity, as well as various types of metabolic disorders and diseases (12). Studies have shown that excess consumption of sugar can lead to weight gain, confers a greater risk of developing metabolic heart disease, and an increased risk of early mortality (2, 13–15). HFCS is a nutritional sweetener that is thought to be harmful for human health, partly attributed to preliminary research that shows consumption of large quantities of fructose (i.e. the main constituent of HFCS) can lead to deleterious metabolic consequences in the body (16–18). Sucrose is also comprised of glucose and fructose, which is absorbed in the digestive tract (19). Therefore, there is minimal difference between HFCS and sucrose, due to the ability of the human digestive system to absorb sucrose and fructose. Previous trials have shown that the use of HFCS in comparison with sucrose yields no significant difference in health-related indicators, such as glycemic index, calorie intake, lipid metabolism and inflammation (20–23). However, there is evidence to suggest that fructose consumption in comparison with sucrose has a significantly greater effect on indicators of health (24, 25). Thus, given the current equivocality in the field, the aim of the present study is to determine the impact of HFCS vs. sucrose on anthropometric and metabolic parameters.

DOI: 10.3389/fnut.2022.1013310

Study: strong evidence

Narratives Review

Over the past decade fructose from either sucrose or high-fructose corn syrup has received growing attention as it has been associated with a widening group of health-related problems. Several meta-analyses have shown a relationship between the consumption of sugar-sweetened soft drinks and obesity (9–11). The relation of these beverages to obesity can be attributed to the increased caloric intake and to the fact that beverages do not suppress the intake of other foods to an appropriate degree—thus beverage calories serve as “add-on” calories enhancing the risk of obesity (12) (Fig. 1). Meta-analyses have also suggested that the consumption of sugar-sweetened beverages is related to the risk of diabetes, the metabolic syndrome, and cardiovascular disease (13).

Several short-term clinical trials have provided insights into the metabolic consequences of ingesting sugar-sweetened beverages. In one study there was an increase in body weight, blood pressure, and inflammatory markers (14,15), and in a second study there was an increase in triglycerides levels (particularly at night), a stimulation of de novo lipogenesis, and an increase in visceral fat (16,17). In the third study, which compared milk, diet cola, a sugar-sweetened cola, and water, the sugar-sweetened beverage increased liver fat, visceral fat, and triglycerides over the 6 months of beverage intake (18). The latter study suggests that consuming two 16-ounce sugar-containing beverages per day for 6 months can mimic many of the features of the metabolic syndrome and nonalcoholic fatty liver disease.

DOI: 10.2337/dc12-1631

Study: weak evidence

Narratives Review

HFCS has become a favorite substitute for sucrose in carbonated beverages, baked goods, canned fruits, jams and jellies, and dairy products (10). The major user of HFCS in the world is the United States; however, HFCS is now manufactured and used in many countries throughout the world (7). In the United States, HFCS is the major source of caloric sweeteners in soft drinks and many other sweetened beverages and is also included in numerous other foods; therefore, HFCS constitutes a major source of dietary fructose. Few data are available on foods containing HFCS in countries other than the United States.

HFCS made by enzymatic isomerization of glucose to fructose was introduced as HFCS-42 (42% fructose) and HFCS-55 (55% fructose) in 1967 and 1977, respectively, and opened a new frontier for the sweetener and soft drink industries. Using a glucose isomerase, the starch in corn can be efficiently converted to glucose and then to various amounts of fructose. The hydrolysis of sucrose produces a 50:50 molar mixture of fructose and glucose. The development of these inexpensive, sweet corn-based syrups made it profitable to replace sucrose (sugar) and simple sugars with HFCS in our diet, and they now represent 40% of all added caloric sweeteners (8). Fructose is sweeter than sucrose.

There are important similarities between the trend in HFCS availability and the trends in the prevalence of obesity in the United States (Figure 1). Using age-standardized, nationally representative measures of obesity at 5 time points from 1960 to 1999 (35) and data on the availability of HFCS collected annually over this same period, we graphed both patterns. The data on obesity are from the National Center for Health Statistics for the following periods: 1960–1962 (National Health Examination Survey I), 1971–1975 [National Health and Nutrition Examination Survey (NHANES)], 1976–1980 (NHANES II), 1988–1994 (NHANES III), and 1999 (NHANES 1999–2000) (35). The HFCS data are those from Table 1. The prevalence of overweight (BMI of 25–29.9) and the prevalence of obesity (BMI > 30) were fit with fourth-order polynomial curves so that the limited number of data points could be fitted into a curve to capture the US trends. We also included estimates of free-fructose intake and total fructose intake. Total fructose is the sum of free fructose and fructose that is part of the disaccharide sucrose. Free fructose is the monosaccharide in HFCS and is also obtained in small amounts from other sources. Free-fructose intake closely follows the intake of HFCS. Total fructose intake increased nearly 30% between 1970 and 2000.

DOI: 10.1093/ajcn/79.4.537

Study: weak evidence

Narratives Review

Non-nutritional sweeteners (NNSs) were introduced into the market as food ingredients in the 19th century [4]. Since then, NNSs have become extremely popular as sugar substitutes for weight control and prevention of obesity, especially during the past three decades, when the worldwide incidence of childhood and adulthood obesity has increased dramatically.

Apart from the common use of sweeteners for weight loss, diabetes management, and the prevention of dental caries [6,7], they are also added in pharmaceutical and other healthcare products, such as toothpaste and food supplements.

DOI: 10.3390/nu16183162

Study: weak evidence

Kontrollierte randomisierte Studie RCT

Regular aerobic exercises increase the sweet taste sensitivity, especially for higher concentrations of sucrose and decrease sweet taste preference in people with diabetes . These alterations in sweet taste perception, are likely to contribute to a better glycemic control in people with diabetes.

DOI: 10.1186/s12902-022-00936-5

Study: strong evidence

Narratives Review

Maple syrup is a delicacy prepared by boiling the sap taken from different Acer species, mainly sugar maple (Acer saccharum Marsh.) trees. Agriculture and Agri-Food Canada [2] reports Canada as the world’s largest producer of maple products and it is responsible for nearly 71% of the maple syrup production in the world.

DOI: 10.3390/ijerph192013684

Study: weak evidence

Currently, more than 72% of the world’s maple syrup production is made in Quebec (Canada). 

According to a study by the AGECO Group, a can of maple syrup in 2021 emits approximately 600 g of GHGs, the equivalent of traveling 1.7 km by car.

In fact, today 50% of the syrup is produced with an oil-fired evaporator, which generates significant CO₂ emissions during its combustion to create heat.

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Narratives Review

In contrast, carbohydrates are the main dietary component of maple syrup and it must be recognized that the potential health benefits as noted above, may be partially offset by the link between carbohydrate consumption and diseases such as diabetes and obesity.

DOI: 10.1016/j.heliyon.2023.e19216

Study: weak evidence

Narratives Review mit Kommentar-Charakter

Oral health impact: They are all harmful to teeth due to the high levels of fermentable
carbohydrates.

Honey is composed of fermentable carbohydrate which is cariogenic.

DOI: 10.1016/j.cub.2020.05.059 External Link

Study: weak evidence

Systematisches Review

Polyols can induce dose-dependent symptoms of flatulence, abdominal discomfort, and laxative effects when consumed by both healthy volunteers and patients with IBS.

DOI: 10.3945/an.117.015560

Study: strong evidence

Book

In both adults and children, WHO recommends reducing the intake of free sugars to less than 10% of total energy intake2 (strong recommendation)

Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates.

The recommendation to further limit free sugars intake to less than 5% of total energy intake, which is also supported by other recent analyses (15, 16), is based on the recognition that the negative health effects of dental caries are cumulative, tracking from childhood to adulthood (21, 22). Because dental caries is the result of lifelong exposure to a dietary risk factor (i.e. free sugars), even a small reduction in the risk of dental caries in childhood is of significance in later life; therefore, to minimize lifelong risk of dental caries, the free sugars intake should be as low as possible.

No evidence for harm associated with reducing the intake of free sugars to less than 5% of total energy intake was identified.

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Narratives Review

Sweet sensation activates areas of the brain involved in food memory and reward, but various sweet compounds differ in their specific effects. [...] The consumption of sucrose results in significantly greater global brain activation than both saccharin and sucralose.

Specifically, sucrose elicits greater dopamine release than saccharin in the nucleus accumbens core and greater activation than sucralose in the anterior insula, frontal operculum, striatum and anterior cingulate.

Currently, it is debated whether the attenuated response of the brain to LCS is beneficial or detrimental to energy intake and weight management.

DOI: 10.3390/nu11112717

Study: weak evidence

experimentelle Primärstudie (klinische Laborstudie mit fMRT)

Sucralose leads to the smallest and most transient decrease in BOLD in the hypothalamus [...] indicates that sucralose might not have a similar satiating effect on the brain as the natural sugars.

In the VTA, sucralose ingestion led to the same effect as the ingestion of plain water [...] being a prolonged [BOLD signal] increase.

Sucralose might not activate the reward pathways in the brain in the same way as natural sugars, potentially affecting satiety and craving responses.

DOI: 10.1016/j.nut.2018.09.004

Study: weak evidence

Narratives Review

Although artificial sweeteners maintain the same palatability as natural sugars, the metabolic routes are different. Therefore, artificial sweeteners affect body weight and glucose homeostasis differently compared to natural sugars via underlying physiological processes comprising the gut microbiota, reward-system, adipogenesis, insulin secretory capacity, intestinal glucose absorption, and insulin resistance. The gut microbiota, in particular, may play a major role in the physiological effects of artificial sweeteners on body weight regulation and glucose homeostasis.

As artificial sweeteners and natural sugars bind differently to the sweet taste receptors, the gustatory branch is activated differently as well [...] artificial sweeteners may generate weaker signals that are sent to areas involved in reward and satisfaction, as consistently demonstrated by using functional Magnetic Resonance Imaging (fMRI) in several randomized cross-over trials.

Therefore, it has been suggested that artificial sweeteners do not activate the food reward pathways in the same way as natural sugars.

DOI: 10.3389/fnut.2020.598340

Study: weak evidence

Experimentelle Laborstudie

DOI: 10.1007/s00217-002-0505-2

Study: weak evidence

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