Any discussion of health and wellness must include some mention of nutrition. Unfortunately, depending on who you are talking to, anecdotes will likely prevail as opposed to facts or research. Although we know a person’s diet is very important to well-being and health maintenance, there is a dearth of specifics on how our nutrients affect disease prevention or resolution. We know a balanced diet is important, but what is that? What exactly does a “balanced diet” look like?

Cultural influences play a tremendous part in food styles, with geography obviously important. Those living in an arid, desert climate certainly aren’t going to be pescatarians. The diet of the average Westerner has changed radically over the last century. But our anatomy and physiology were determined by evolutionary factors. A major influence was the introduction of agriculture and animal husbandry ten thousand years ago. On an evolutionary time scale, this is too rapid a development. The modern diet came on the scene relatively quickly in evolutionary terms, in the “blink of an eye”.

Many would argue the so-called diseases of civilization, heart disease, diabetes, stroke, and others, have emerged largely due to dietary changes. One of the most fundamental changes has been in the consumption of sugar. The average American eats about 77 grams of sugar per day, which is about three times what the recommendation is. This equals about 230 calories per day, potentially adding up to as much as 23 pounds of body fat per year. Excess consumption of simple carbohydrates and sugars are believed to be a serious contributor to our obesity epidemic. They also place you at risk for type 2 diabetes, heart disease and fatty liver disease.

What are carbohydrates? They are simply sugar molecules linked together in long chains. When eaten, these links are broken apart, releasing the sugars into the blood stream. The most important sugar molecule is glucose, which is the type of sugar used by the body, but many others can be found in nature. All of them result in the formation of glucose when consumed.

Foods that are disassembled easily release their component sugars suddenly, flooding the bloodstream. These foodstuffs are said to have a high glycemic index (GI), while proteins and many vegetables, having a lower GI, take longer to break down. This results in the slower release of sugar molecules into the blood. High GI foods lead to a spike in blood levels, while low-glycemic foods helps maintain good glucose control through the slow and steady release of glucose.

The manner in which foods are handled and processed in Western society has fundamentally altered critical nutritional components and characteristics of the human diet. Multiple radical changes have taken place, from the amount and type of fiber to the macronutrients, that being the proteins, fats and especially the carbohydrates. The latter is one of greater significance to Americans, since the carbohydrate load for most of us far surpasses that of prehistoric man.

What of those living in the early nineteenth century? I guarantee they weren’t worrying about where to get their next packet of Sweet’N Low. Sugar comes in many forms…..and sweeteners today in even more. A plethora of options exist today, from the natural to the partially natural, to the completely artificial (as though manufactured from a chemistry set). These are generally classified by what they are derived from.

Numerous natural options are available, although just because they are “natural” does not mean they are healthy. Fruit sugar, generally referred to as fructose, was espoused as a healthier sweetener for diabetics since it has a lower glycemic index. Subsequently, high-fructose products have been linked to long-term metabolic complications like insulin resistance, belly fat accumulation and high triglyceride levels.

Coconut sugar has become popular and with good reason since it provides some nutritional value. For example, it is high in vitamin C and improves antioxidant levels. Additionally, coconut sugar contains electrolytes like potassium, magnesium and sodium, all of which are essential to heart, nerve and kidney function. Honey, used for centuries, has many of these same benefits. Agave nectar is another healthier option. Although it provides fewer nutrients than raw honey, it is significantly more flavorful so you need less. Also, it has a slightly lower glycemic index than table sugar.

Why do artificial sweeteners exist? Simply put, people want to eat or drink things that are sweet without the calories of sugar. Most are hoping over time consuming fewer calories will translate to less weight gain, more loss of excess weight, and a lower risk of weight-related problems such as diabetes and high blood pressure.

As to the nutritive value of sugar, other than being immediately available for energy, it has none. Sugar is inflammatory, obviously high in calories, and can be found in surprising places. Foods that you wouldn’t think to be sugary often hide it in some way. The larger food corporations employ a devious tactic of adding these sweeteners to their products to make them more desirable. High fructose corn syrup, corn syrup solids, and many other sweeteners are being put into our prepared edible products, without the obvious inclusion of “sugar”. What is the uninformed consumer to do?

The artificial sweeteners are far more potent, ie sweeter, than table sugar and high-fructose corn syrup. A miniscule amount produces a sweet taste equal to that of sugar, without the calories. If you have diabetes, artificial sweeteners and stevia are preferable to real sugar since they won’t immediately raise your blood sugar. The question of potential harm caused by these substances has been raised since the invention of saccharin. Back in the day, studies performed on rats did reveal an association with cancer, but the quantities required to have these effects were unreasonable. Further studies led to the removal of any such warning. But a new study has raised the possibility that the artificial sweeteners used in diet beverages may increase the risk of dementia and stroke.

Varied concerns have been raised related to the consumption of the manufactured sweeteners. Animal studies suggest that they may be addictive but a review of human trials could find no obvious consequences to the health of regular consumers. Some research suggests these substances can prevent us from associating sweetness with calories. As a result, we may crave more sweets and choose sweet food over nutritious food. Additionally, the overstimulation of sugar receptors from use of these hyper-sweeteners may limit our tolerance for more complex tastes. In summary, the use of the artificial sweeteners provided no clear health benefits but potential danger cannot be excluded.

A recommended strategy is to get educated about your options. Read food labels for hidden ingredients or those containing sugar in some other form. Start by decreasing the amount of sweetener in your coffee, tea or cereal. Try adding fruit instead of some type of sugar. Dilute your juices by mixing with water, so that some sweetness is still provided. Drink less processed, sweetened beverages since a large percentage of the sugar in the Western diet is consumed in this form.

Our sense of taste provides critical information about the nature and quality of food. Of all the basic taste qualities, sweetness is the most universally liked, thus it is easy to understand the appeal of diet soft drinks and other artificially sweetened beverages. Cutting out all sweeteners isn’t realistic, but a healthy goal is to reduce the amount of sugar in your diet.

Our deep-seated desire for sweet has been so strong over the centuries it has influenced the course of human history. But the modern era has introduced foods which may underlie many of the chronic diseases of Western civilization. Until we know more, it seems reasonable to suggest the healthiest approach is one of moderation and limitation. Reducing your intake of sweets, regardless of their form, is best, with several healthier options on the market. Get informed, and make careful, intelligent decisions. In the big picture, your health depends on it.

Editor’s note: Dr. Conway McLean is a physician practicing foot and ankle medicine in the Upper Peninsula, with a move of his Marquette office to the downtown area. McLean has lectured internationally on wound care and surgery, being double board certified in surgery, and also in wound care. He has a sub-specialty in foot-ankle orthotics. Dr. McLean welcomes questions or comments atdrcmclean@outlook.com.