1

Sugar:

The Sweet & Sour of It

Bonnie Brost RD LD CDE

Essentia Heart & Vascular Center

Bonnie.Brost@EssentiaHealth.org

Thank You

• Disclosures

• “What will matter: Not what you learned but what you

taught” - Barb Fagan

Objectives1. Discuss the recommendations of the American

Heart Association on the limitations of sugar.

2. Discuss the risks of excess sugar intake on lipid

numbers, blood sugar and weight management

3. State at least 2 differences between different types

of sugar and/or sugar substitutes.

4. Discuss the amount of sugar being consumed in the

United States and the amount of sugar that is

currently found in many of our food products today.

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Is Sugar Toxic?

• 60 Minutes - April 1, 2012

You Tube 13 minute video

http://www.youtube.com/watch?v=6n29ZIJ-jQA

Dr Robert Lustig – Endocrinologist

Dr. Kimber Stanhoff – doing 5 year study on sweeteners.

Dr. Louis Cantley – Cancer Researcher

Recommendations

• American Heart AssociationoUpper Limit for “Added Sugars” is set at

•100 calories = 6 tsp for women per day (24 gms)

•150 calories = 9 tsp for men per day (36 gms)

• Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart

Association. Circulation 2009; 120; 1011-1020; originally published online Aug 24, 2009

•NOTE: 1 tsp of sugar = 4 grams of sugar

American Heart Association

Past 30 years, total calorie intake has increased by an average of 150 – 300

calories, and approximately 50% of this increase comes from liquid calories.

At the same time there has been no apparent change in physical activity.

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Use of Nutritive and Nonnutritive Sweeteners

• Position statement from Academy of Nutrition and Dietetics

o J Acad Nutr Diet. 2012; 112: 739-758

Average Sugar Intake

• Usual intake of added sugars for Americans was 22.2 tsp per day (355 calories per day)

• Equals 156 pounds of sugar a year per person! of ADDED Sugar

• Sugar intake is up 19% from 1970 - 2005• Soft drinks and other sugar sweetened beverages are the primary source of added sugars.

• USDA information

• Raise blood sugar- increased risk of diabetes

• Raise triglycerides

• Lower HDL - the good cholesterol!• Welsh, J, et al. Caloric sweetener consumption and dyslipidemia among US

adults. JAMA 2010 April; 303(15): 1490-1497.

• Increase LDL - the lousy cholesterolo Journal of Clinical Endocrinology and Metabolism - August 2011

• Increases calorie intake - obesity

• Increases dental caries9

Effects of Sugar

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Does Sugar Feed Cancer?• Not Directly…

o All cells need sugar to operate….

• Excess simple sugars, call for more insulin release

and it is the insulin that can cause cancer tumors to

grow faster and bigger.

• Humans have an inborn preference for

sweet foods.

• From an evolutionary perspective, in nature,

a sweet taste is a good predictor that an

item is safe to eat. Something sour may

have been toxic.

• Palatable foods such has those high sugar

and high fat, release “reward chemicals” in

our brain producing a powerful

reinforcement.11

We Like It Sweet

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Age in yrs Tsp per day Cups per day

1 - 3 12.2 1/4 cup

4 - 8 21.0 - 1/2 cup

Males 9-13 29.2 2/3 cup

Males 14-18 34.3 3/4 cup

Males > 19 25.4 1/2 cup +

Female 9-13 23.2 1/2 cup

Female 14-18 25.2 1/2 cup +

Female >19 18.3 1/3 cup +

Average Intake of Sugar

2001 - 2004

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• Simple Carbohydrates (sugars) -

o refers to

o monosaccharides:

• glucose, galactose and fructose;

o Disaccharides:

• Sucrose, lactose and maltose

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Definitions

• Naturally occurring (intrinsic) sugars:o sugars that are an integral part of whole fruit, vegetable and milk products

• Added (extrinsic) sugarso sugars and syrups added to foods during processing or preparation and includes

sugars and syrups added at the table.

• Total Sugars:o all sugars in food and beverages.

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Definitions

6

• High Fructose Corn Syrup

o produced from corn syrup

(nearly all glucose), which undergoes

enzymatic processing to increase the

fructose content and is then mixed with

glucose.

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Definitions

• Increases Triglycerides

• Increases Insulin Resistance

• Increases abdominal obesity

• Accelerates Aging Process

• May cause irritable bowel

• Obesity

• Promotes leptin resistance

• Non – Alcoholic Fatty Liver? • Teff et al., Metobolic and endocrine and metabolic effects of consuming fructose and

glucose sweetened beverages with meals in obese men and women: influence of

insulin resistance on plasma triglyceride responses. J. Clin Endocrinol Metab. 2009

May; 95(5): 1562-9

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Fructose Concerns

Let’s Look at Fructose• American Journal of Clinical Nutrition

o http://ajcn.nutrition.org/content/86/4/895.full

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FructoseMetabolized differently from glucose….

Glucose can be absorbed from gut and be used for fuel in cells

Fructose needs to go to the liver to be

metabolized, often converted to triglycerides and released for fuel or storage.

Triglycerides

FructoseNo biological need for fructose….

Lower Glycemic Index than Glucose….

Can increase triglycerides and increases the small particle

LDL. Can lower HDL cholesterol

Can increase the production of uric acid in the body, increasing the risk of gout. High Uric acid can also

increase blood pressure.

“Relation of fructose to health needs further reevaluation”

George A Bray 1From the Pennington Biomedical Research Center,

Louisiana State University System, Baton Rouge, LA http://ajcn.nutrition.org/content/86/4/895.full

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Sugar, Uric Acid and the Etiology of

Diabetes and Obesity

• Diabetes. 2013 Oct;62(10):3307-15. doi:

10.2337/db12-1814.

• Sugar, uric acid, and the etiology of diabetes and

obesity.• Johnson RJ1, Nakagawa T, Sanchez-Lozada LG, Shafiu M, Sundaram S, Le M, Ishimoto T, Sautin YY, Lanaspa MA.

• Recent studies show that fructose-induced uric acd generation

causes mitochondrial oxidative stress that stimulates fat

accumulation independent of excessive caloric intake. These

studies challenge the long-standing dogma that “a calorie is just a calorie.” and suggest that the metabolic effects of food

may matter as much as its energy content. The discovery that

fructose-mediated generation of uric acid may have a causal

role in dabetes and obesity ...

Uric Acid• Searching for the cause of type 2 diabetes has

been a prime area of research since Etienne

Lancereaux described fat diabetes (diabetes gras)

in 1880. Though more studies are needed, the

evidence that fructose-induced hyperuricemia may

have a contributory role is gaining ground. While it

still remains a hypothesis (103), increasing evidence

suggests uric acid may have a fundamental role in

the manifestations of metabolic syndrome (Fig. 3).

Given that hyperuricemia is a remediable risk factor,

we recommend both basic and clinical studies to

address this important possibility.

Fructose MetabolismDiabetes. 2013

Oct;62(10):3307-15. doi:

10.2337/db12-1814.

Sugar, uric acid, and the

etiology of diabetes and

obesity.

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Case Study• Female – Mid 40’s

• Uncontrolled HTN

• 5’1” 180 lbs Abdominal Obesity

• Recently admitted with TIA’s

• HgA1c 6.2%

o Had been drinking 4 Coke’s a day…..

Diabetes

Body Cells

Blood

Food

Liver

Pancreas

Sugar FatsProteinInsulin

Kidney

• High Fructose Corn Syrup (HFCS) - Not the only source of Fructose

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Sweetener %Fructose %GlucoseCalories in

1 tbsp

HFCS 55 55% 45% 53

HFCS 42 42% 58% 53

Corn Syrup 0% 100% 62

Honey 48% 52% 64

Sucrose (Table Sugar)

50% 50% 48

Grape Jc conc 53% 47%

Apple Jc conc 65% 35%

Pear Jc conc 74% 26%

Agave Nectar 74-90% 10-24% 60

Fructose

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• The real problem with HFCS is that it is CHEAP!!!

• and Very Stable in food processing

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High Fructose Corn Syrup

From Mayo Clinic website

The phrase "fructose intolerance" is a general term that

describes two possible conditions:

Hereditary fructose intolerance. People with hereditary fructose intolerance, a rare genetic disorder, lack an enzyme that breaks down fructose. This serious disorder, which is usually diagnosed at a young age, can lead to liver and kidney damage. Usually diagnosed in infancy.

Fructose malabsorption. People with fructose malabsorption have

difficulty digesting fructose. This is a less serious disorder because

it doesn't result in liver or kidney damage. But it can cause

abdominal pain, gas, bloating and diarrhea. Is diagnosed with a

hydrogen breath test. High intake of fructose increases bacteria

growth in the large intestine.

Either condition should be confirmed by a doctor using reliable

testing methods.

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Fructose Intolerance

From Mayo Clinic website

Avoid foods that contain:Fructose

High-fructose corn syrup

Table sugar (sucrose)

Confectioner's sugar or powdered sugar

Fruit and fruit juices - especially apple, pear and grape

Pineapple, berries, bananas and oranges are lower in fructose

Honey

Regular sodas

Flavored water

Sorbitol

Sports drinks

Sweetened milk or sweetened milk beverages

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Fructose Intolerance

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• Barley Malt

• Beet sugar

• Brown Sugar

• Cane-Juice Crystals

• Cane Sugar (Table Sugar)

• Caramel

• Carob Syrup

• Corn Syrup

• Corn Syrup Solids

• Date Sugar

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Names of Sweeteners

• Dextran

• Dextrose (glucose)

• Diastatic Malt

• Ethyl Maltol,

• Fructose

• Fruit Juice

• Fruit Juice Concentrate

• Glucose/Glucose Solids

• Golden Sugar

• Grape Sugar

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Names of Sweeteners

• High Fructose Corn Syrup

• Honey

• Invert Sugar

• Lactose

• Malt Syrup

• Maltodextrin

• Maltose

• Mannitol

• Molasses

• Raw Sugar

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Names of Sweeteners

12

• Refiner’s Syrup

• Sorbitol

• Sorghum Syrup

• Sucrose (Table Sugar)

• Sugar

• Turbinado Sugar

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Names of Sweeteners

Comparisons• Banana Bran Muffins RecipeoMade with Sugar

• 115 Calories, 0 Fat, 160 mg Sodium, 21 gm Carbohydrate, 2.5 gm Fiber, 8 gm Total Sugar of which 4 gram is “added sugar” (= 1 tsp)

•Compare to PERKIN‟S Bran Muffin

o480 Calories, 15 gm Total Fat, 3 g Saturated Fat, 540 mg Sodium, 84 gm Carbohydrate, 6 gm Fiber, 45 gm Total Sugar which is all added (= 11 tsp)

Cranberry Apple Crisp Recipe

• Note differences in Sugar and Carbs• 1/2 cup made with Splenda or Stevia

o 129 calories

o 16 gm Total Carbohydrate

o 9 gm of Total Sugar

o 2 gm of Added Sugar

• 1/2 cup made with real sugar

o 225 calories

o 41 gm Carbohydrate

o 34 gm of Total Sugar

o 28 gm of Added sugar

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Chocolate Zucchini Cake

• Zucchini Chocolate Cake 1/24tho Made with canola oil, 100% dark chocolate cocoa, canola harvest margarine

and uses walnuts instead of frosting!!

• Made with ½ cup Splenda/Stevia and ½ cup sugar• 166 Calories, 3 gm Total Fat, 1 gm Saturated Fat, 80 mg Sodium, 16 gm

Carbohydrate, 1.5 gm Fiber, 3 gm Protein, 6 gm Total Sugar which 5.5 gm is “added sugar” ( less than 1 ½ tsp)

oMade with regular sugar reduced to 1 cup• 179 Calories, 19 gm Carbohydrate, 9 gm Total Sugar which 8.5 gm is

“added sugar” (= just over 2 tsp)

Other Benefits of Chocolate Zucchini Cake…• 100% Cocao Hershey Coco powder

• Canola oil

• Includes vegetable!!!

Sugar Content of Foods

• Brach‟s Candy Corn made with real honey!o 19 pieces

• 140 Calories

oO gm Fat

o 75 mg Sodium

o 36 gm Carbohydrate

• 32 gm Sugar = 8 tsp of sugar!

• Ingredients: Sugar, corn syrup, confectioner’s glaze, salt, honey, dextrose, artificial colors (Titanium Dioxide, Yellow 6, Yellow 5, Red 3, Blue 1), sesame oil.

o 24 oz bag of Candy Corn has 119 teaspoons of Sugar or 40 Tablespoons

or 2.5 cups of SUGAR!!!

Each piece as

almost …..

½ tsp of sugar!!

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Halloween at my House!

Sherbet• Kemps Raspberry Sherbet – Fat Free

• Ingredients• Water, Sugar, Corn Syrup, Raspberry Base (raspberry And Plum Juice

Concentrates, Water, Corn Syrup, Raspberries, Natural And Artificial Flavor, Red 40), Whey, Nonfat Milk, Cream*, Carob Bean Gum, Guar Gum, Mono And Diglycerides, Methyl Cellulose, Pectin, Citric Acid, Red 40, Blue 1. *contributes A

Negligible Amount Of Fat

• ½ cup 110 Calories, Total Fat 0 gm, Sodium 25 mg, Carbohydrate 28 gm, Sugars 21 gm ( over 5 tsp of sugar)

Yoplait Original Yogurt• Manufactured with ”Natural” colors, flavors and

sweeteners. Sugar is the second ingredient after

milk and before blueberries.

• 26 gram of sugar per container.

• “No High Fructose Corn Syrup” on their website

•

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Sugar Content of Food

• Oreo Type Cookies 3 - cookieso 160 Calories

• 2 gm Saturated Fat

• 160 mg Sodium

• 25 gm Carbohydrate

o 14 gm Total Sugar = 3.5 tsp sugar about 1 tsp a cookie

o Ingredients: SUGAR, ENRICHED FLOUR (WHEAT FLOUR, NIACIN, REDUCED IRON, THIAMINE MONONITRATE {VITAMIN B1}, RIBOFLAVIN {VITAMIN B2}, FOLIC ACID), HIGH OLEIC CANOLA OIL AND/OR PALM OIL AND/OR CANOLA OIL, AND/OR SOYBEAN OIL, COCOA (PROCESSED WITH ALKALI), HIGH FRUCTOSE CORN SYRUP, CORNSTARCH, LEAVENING (BAKING SODA AND/OR CALCIUM PHOSPHATE), SALT, SOY LECITHIN (EMULSIFIER), VANILLIN - AN ARTIFICIAL FLAVOR, CHOCOLATE. CONTAINS: WHEAT, SOY.

Mountain Dew• Regular Mountain Dew -12 oz

• Mountain Dew Throwback - 12 ozo only difference instead of high fructose corn syrup, they used “sugar”

o Ingredients: Carbonated water, high fructose corn syrup (sugar), concentrated orange

juice, citric acid, natural flavors, sodium bensoate (preserves freshness), caffeine,

sodium citrate, erythorbic acid (preserves freshness), cum arabic, calcium disodium

EDTA (to protect flavor), brominated vegetables oil, yellow 5

12 oz Regular Throwback

Calories 170 170

Total Fat 0 gm 0 gm

Sodium 65 mg 65 mg

Carbohydrates 46 gm 44 gm

Sugars 46 gm 44 gm

Protein 0 gm 0 gm

Caffeine 54 mg 54 mg

Sugar Content of Foods

• FUZE Green Tea with Honey & Ginsengo 18.5 oz bottle

• 150 Calories

• 0 gm Fat

• 62 mg Sodium

• 40 gm Carbohydrate

o 40 gm Sugar = 10 tsp sugar

o Ingredients: Filtered water, crystalline fructose, honey, natural flavor, ascorbic acid, green tea extract, citric acid, yerba mate leaf extract,

green tea solids, niaciamide, calcium pantothenate, vitamin E acetate, panax ginseng root extract, pyridoxine hydrochloride, cyanocobalamin.

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New Leaf Tea• Strawberry White Tea - 100% Natural

• Sweetened with PURE „Organic‟ CANE SUGAR

• Per bottleo 160 Calories, 0 gm Fat, 38 gm Carbohydrate, 36 gm Total Sugar = (9 tsp)

All natural, ready-to-drink iced teas and

lemonades sweetened with organic

cane sugar.

Available in 14 Great Flavors!

Starbucks

• 20 oz Pumpkin Spice Latte

• 330 Calories, 0 gm Total fat, 0 gm Saturated fat, 280 mg Sodium, 64 gm Carbohydrate, 61 gm Total Sugar (= 15+

tsp) Guessing about 10 tsp are added sugar.

Starbucks Vanilla Frappuccino

• Chilled coffee drink 13.7 oz

• Brewed Starbucks coffee, reduced fat milk, sugar, maltodextrin, pectin, natural flavor

• 290 Calories, 4.5 gm Total Fat, 3 gm Saturated Fat, 150 mg Sodium, 53 gm Total Carbohydrate, 46 gm sugar (over 11 tsp) 9 gm Protein

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• Contains 5% Fruit Juice

• 8 oz serving

• 120 Calories, 0 gm Fat, 190 mg Sodium, 29 gm Carbohydrate, 27 gm Total Sugar, 0 gram Fiber, 0 gm Protein, 100% Vitamin Co = at least 24 gm added sugar = 6 tsp in 8 oz

• Ingredients: Water, High Fructose Corn syrup, and 2% or less of each of the following Juice Concentrates (Orange, Tangerine, Apple, Lime Grapefuit), Citric Acid, Ascorbic Acid , Thyamin Hydrochloride, Natural flavors, modified cornstarch, canola oil, sodium citrate, cellulose gum, xanthum gum, sodium hexametaphosphate, sodium benzoate (to protect flavor), Yellow #5, Yellow #6

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Sunny Delight – Old Version

Sunny Delight - Today• Contains 5% Fruit Juice• 8 oz serving

• 60 Calories, 0 gm Fat, 170 mg Sodium, 16 gm Carbohydrate,

• 14 gm Total Sugar, 0 gram Fiber, 0 gm Protein, 100% Vitamin Co = 3+ tsp added sugar

• Ingredients: Water, Corn syrup, and 2% or less of each of the

following Juice Concentrates (Orange, Tangerine, Apple, Lime Grapefuit), Citric Acid, Malic Acid, Ascorbic Acid , Thyamin Hydrochloride, Natural flavors, modified cornstarch, canola oil, sodium citrate, cellulose gum, sucrolose, sodium hexametaphosphate, potassium sorbate, sodium benzoate (to protect flavor), Yellow #6, Red #40.

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Food vs “Food Like Substances”

• Compare Sunny Delight to a

• Fresh Orange

5151

69 Calories, 0 gm Fat, 1 mg Sodium, 17 gm

Carbohydrate, 12 gm Total Sugar, 3 gram Fiber, 1

gm Protein, 82 mg Vitamin C (110%)

NO Added Sugar!!

120 Calories, 0 gm Fat, 190 mg Sodium, 29 gm

Carbohydrate, 27 gm Total Sugar, 0 gram Fiber,

0 gm Protein, 100% Vitamin C

6 Tsp Added Sugar

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Cereals• General Mills Oatmeal Crisp

• Crunchy Almond - 1 cup serving

• 240 calories, 4 gm Total Fat, 0.5 gm Saturated Fat, 125 mg Sodium, 47 gm Carbohydrate, 5 gm Fiber, 16 gm Total Sugar (= 4 tsp)

•

• Ingredients: Whole grain oats, whole grain wheat, brown sugar, sugar,

almond pieces, corn syrup, salt, oat flour, rice flour , honey, canola oil,

cinnamon, baking soda, natural and artificial flavor, color added, vitamin E

Cereals• Cookie Crisp

• Whole Grain & Calcium Guaranteed

• 1 cup

• 130 Calories, 1.5 gm Total Fat, 0 gm Saturated fat, 200 mg Sodium, 29 gm Carbohydrate, 1.5 gm Fiber 13 gm Total Sugar (= 3.5 tsp)

• Ingredients: Whole grain corn, sugar, corn meal, brown sugar, chocolate flavored chips, salt, rice bran, canola oil, tricalcium phosphate, cocoa processed with alkali, corn syrup, color added, trisodium phosphate, natural and artifical flavor, vitamins and minerals

Flax Plus Multi Grain Flakes

• Great Option for Cereal

• 1 cup serving

• 140 Calories, 2 gm Total Fat, 0 gm Saturated Fat, 150 mg

sodium, 31 gm Total Carbohydrate, 7 gm Fiber, 5 gm Total Sugar = less than 1.5 tsp added sugar, 5 gm

protein.

• Whole wheat flour, what bran, evaporated cane juice, flax, oat bran, barley malt extract, sea salt, tocopherols (natural vitamin E)

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Carrots & Beets?• They are full of sugar, right?

• 1/2 cup cooked carrots has 27 calories and 6.4

grams carbohydrate of which 2.69 grams is sugar

• 1/2 cup cooked beets has 37 Calories, 8.47 grams

carbohydrate of which 6.77 grams is sugar

• From USDA Food Database.

Non- Caloric Sweeteners• Are lower in calories

• Do not contain fructose or glucose

• Do not raise blood sugar

• May raise our “sweet threshold?”

oDr David Kessler - The End of OverEating

oRecent Studies –• American Journal of Clinical Nutrition

• Artificially sweetened sodas do not lead to increased sugar consumption ajcn.112.048405

• „Sugar-free‟ and „diet‟ sodas linked to diabetes ajcn.112.050997

Use of Nutritive and Nonnutritive Sweeteners

• Position statement from Academy of Nutrition and Dietetics

o J Acad Nutr Diet. 2012; 112: 739-758

o Recent study: “Fake sweeteners may mess with the way our bodies metabolize sugar” Sept 17, 2014

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Saccharin• The first “artificial sweetener”

• 300 times sweeter than sugar

• No effect on blood sugar

• Brands: “The pink Packet”o Sweet & Low

o Sugar Twin

o Mainly a tabletop sweetener today

o Cancer?

Aspartame

• Brands: Equal, NutraSweet

• Approved in 1981

• 200 times sweeter than sugar

• Looses it‟s sweetness when heated or stored for long periods of time

• Does not brown during baking

• Used in beverages, frozen desserts, yogurts, beverage powders.

• Cancer?

• PKU concerns? Headaches?

Acesulfame-K

• Brands: Sweet One, Sunnet

• No effect on blood sugar

• Approved in 1988 as a tabletop sweetener than in 2003 approved for general use.

• Usually used in combination with other sweeteners especially sucralose.

• Can withstand high temperatures

• Used in diet beverages, yogurts, baked goods, chewing

gum.

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Sucralose• Brands: Splenda, Natra Taste Gold

• 600 times sweeter than sugar

• No effect on blood sugar

• Heat stable - can be used in cooking and baking

• Beverages,( Diet Rite) baked goods, yogurts

• Made by combining sugar with chlorine

Splenda Brown Sugar Blend

• 1 lb bag = 2 lbs of brown sugar for $4.29

• Use 1/2 cup Splenda brown sugar blend in place of 1 cup of brown sugar.

• Ingredients: Sugar, Molasses, glycerin, sucralose and natural and artificial flavors

• 1/2 tsp = 10 calories, 2 gm of carbohydrateo 1 tsp = 20 calories, 4 gm carbohydrate

• REAL Brown Sugar = 1 tsp = 15 calories, 4 gm carbohydrate

Neotame

• Produced by Nutrasweet

• Similar to Aspartame but used at lower levels

• 7000-13000 times sweeter than sugar

• Is not a problem with PKU

• Approved in 2002

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Sugar Alcohols

• Mannitol, Maltitol, Xylitol, Sorbitol, Isomalt

• Raises blood sugar only slightly

• Half the calories and carbohydrates of regular sugar.

• CAN have a laxative affect - Gas and diarrhea if taking in

too much!!

Erythritol

• Sugar Alcohol

• Sugar alcohol found in fruits

• Does not have laxative effect

• Often used with Stevia

• Brand: Organic Zero is straight Erythritol

Stevia

• Derived from a sweet-tasting leaves of a South American

shrub

• Brands:

• Sweet Leaf - Stevia Leaf Extract

• Truvia - Erythritol, rebiana, natural flavors

• Domino sugar company working to have a stevia product

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Nectrasse• New sweetener by makers of Splenda

• Contains monk fruit extract, sugar, erythritol, and molasses

• ¼ tsp = 0 Calories, 1 gm Carbohydrateo 1 tsp = 4 gm Carbohydrate - Same as sugar?

Low Calorie Beverages?

• Propel

• Crystal Lighto Crystal Light Pure uses Truvia

• True Lemon

• Unsweetened Tea

• Seltzer Water

Recommendations

• American Heart AssociationoUpper Limit for “Added Sugars” is set at

•100 calories = 6 tsp for women per day (24 gms)

•150 calories = 9 tsp for men per day (36 gms)

• Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement From the American Heart

Association. Circulation 2009; 120; 1011-1020; originally published online Aug 24, 2009

•NOTE: 1 tsp of sugar = 4 grams of sugar

24

So Confusing!!!!

• Consume Less!!

• Sugar

• Sweetener!

Diabetes

Body Cells

Blood

Food

Liver

Pancreas

SugarFatsProtein

Insulin

Questions?

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