Meaning of a negative value for non-fiber, non-sugar carbohydrate based on a nutrition label

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One of the questions for my lab is to find the non-fiber, non-sugar carbohydrate per serving of an onion. Now the total carbohydrate for this onion is 11 g, the total sugars for the onion is 9 g, and the total fiber is 3 g.

11-9-3 = -1 g of non-fiber, non-sugar carbs for this onion and this is not making any sense to me.

The individual values in the OP's onion label are not out of line with the U.S. Department of Agriculture's reference data. There are two of the latter, one for "Onions, raw" and one for "Onions, sweet, raw". Their figures would lead to expecting carbohydrates of 13.8g or 11.2g, respectively, for a 148g sample.

The negative difference can be explained by simple rounding error. If the measured carbs, fiber, and sugar values were actually 11.49, 2.51, and 8.51 g then the label values would be rounded to those shown on the label, yet the difference of the measured values would be a positive value: 0.47 g.

The values on the nutrition label from the question (11 g total carbs, 9 g sugars, 3 g fiber) could be actually explained by rounding:

• Total carbohydrates: 11.45 (rounded to 11)
• Sugars: 8.55 g (rounded to 9 g)
• Fiber: 2.55 g (rounded to 3 g)

… which would mean there are additional 0.35 grams of non-sugar, non-fiber carbohydrates…

… BUT…

… using such a label with only rounded values (and students not knowing the exact values), does not make it possible for students to calculate the amount of non-sugar, non-fiber carbohydrates.

So, another explanation is that there is an error in either total carbohydrates (11 g - too low) or in sugars (9 g - too high; more likely 6 g), according to NutritionData for 150 grams of raw onion:

• Total carbohydrates: 14 g
• Sugars: 6.4 g
• Fiber: 2.6 g

In either case, it seems they have used a nutrition label that is inappropriate to ask a question about the amount of non-sugar, non-fiber carbohydrates in raw onion.

How Do You Tell the Difference Between Good and Bad Carbohydrates?

Everyone needs to eat carbohydrates, but that doesn't mean you should fuel up with cookies, candy, and potato chips. Learn about the best foods to reach for — and the ones to skip.

Carbohydrates are an essential part of a healthy diet, but it’s important to know they're not all created equal. How do you tell the difference between “good carbs” and “bad carbs”? The answer is both simple — and complex.

Here’s everything you need to know about making smart carbohydrate choices.

Introduction

According to the World Health Organization, in 2014 roughly 39% of adults worldwide were overweight and 13% were obese [1]. These problems are not only prevalent in high-income countries many low- and middle-income countries are now also experiencing problems with obesity. For example, according to the 2012 Health and Nutrition National Survey (HNNS) conducted in Ecuador, considered by the World Bank a middle-income country, 30% of school-aged children, 26% of teenagers and 63% of adults are either overweight or obese as result of a diet high in calories and low physical activity [2]. In addition, the prevalence of chronic diseases associated with overweight and obesity such as diabetes, hypertension, and cardiovascular disease are considered high in the country and estimated to be related to about 1 in 4 deaths [2].

The 2012 HNNS found that the Ecuadorean diet includes excessive amounts of rice, palm oil and dairy, and low amounts of fruits, vegetables and legumes, which results in an intake of refined carbohydrates and saturated fats above international recommendations. Additionally, the HNNS identified high intake of sugary beverages by the population. For example, 82% of teenagers reported consuming carbonated soft drinks (CSD) regularly. Because of these findings, the report recommended a comprehensive front-of-package labelling system to help consumers better interpret the content of fat, sugar and salt in processed foods. Shortly after, in November of 2013, the Ecuadorean Ministry of Public Health issued the technical regulation for the labelling of packed processed food products, which aims to address the prevalence of chronic diseases associated with overweight and obesity via the promotion of healthy eating [3].

The Ecuadorean labelling of packed food products regulation established the inclusion of a traffic-light (TL) like graphical system in the package of processed foods for sale in the country for both domestic and imported food products. The system is intended to provide consumers with easy to interpret nutritional information related to a food product’s contents of sugar, fat and salt beyond the information already included in the nutrition facts labels regulated by the Codex Alimentarius. Medium and large food companies were required to comply with the regulation before August 29 th , 2014, and small companies before November 29 th , 2014 [3].

Because the policy is relatively new, the literature evaluating its impact on the purchasing habits of Ecuadorean consumers is very limited. No previous study has evaluated the impact of the policy using actual households’ food purchases data. Therefore, the objective of this paper is to evaluate the impact of the TL nutritional information system in the buying habits of Ecuadorean consumers. More specifically, we focus on the impact of TL on the buying habits of CSD given their high level of consumption in the country and the Latin American region [2, 4]. Moreover, the main health concern with the consumption of CSD is their sugar content. The focus on only one nutrient, as we will discuss later, simplifies the analyses and interpretation of results given data limitations.

This paper also contributes to the international nutritional policy literature by expanding the limited body of studies that empirically evaluates the effectiveness of nutritional labelling aimed at changing the buying and consumption habits of the population toward healthier food products [5, 6]. To the best of our knowledge, this is the first study to evaluate a supplemental nutritional labelling policy implemented at the national level. This is important since other countries, such as Chile, have adopted similar supplemental nutritional labelling policies [7]. Another important contribution of this study is the estimation of CSD products’ price and expenditure elasticities which can be useful for the evaluation of fiscal policies.

Traffic-light nutritional labelling in Ecuador

There are two main types of nutritional labels for package products: 1) nutrient declaration/facts labels, and 2) supplementary nutrition information labels. The nutrient declaration label is the standard label that can be found in any processed food product that shows the serving per container and the nutritional content per-serving and the percentage daily value based on a 2,000 calorie diet. It is intended to provide consumers with a profile of the nutrient composition of the food product and its inclusion is mandatory in many countries including Ecuador [3, 8]. Supplementary nutrition information labels, as their name suggests, are intended to help consumers better interpret the nutrient declaration label to improve their understanding of the nutritional content of food products. There are two types of supplementary nutrition labels: nutrient specific and summary systems [9]. Nutrient specific supplementary nutrition labels indicate information on a few key ingredients whereas summary systems provide an overall nutrient score (e.g., a number or stars)[9]. The TL label is a nutrient specific supplementary nutrition label. In contrast to the TL label adopted in other regions which contains information on 5 nutrients [9], the TL label in Ecuador only denotes the content of 3 ingredients: sugar, fat and salt [3] (Fig 1).

Source: Own with images from www.pacakingnews.co.uk and Freire et al. [18].

The Ecuadorian labelling regulation considers four levels of concentration for each of the three nutrients: low, medium, high and it does not contain (Table 1). For each nutrient, a green light and the word Low are used if the concentration is considered low. Similarly, a yellow light and the word Medium and a red light and the word High are used for medium and high concentrations of the nutrients, respectively. If the food product does not contain a nutrient, no traffic light is used but a “it does not contain” message is added before the name of the nutrient that is not present.

According to the technical regulation [3], the presence of the TL label is in addition to the nutrient declaration label, it can be placed in the front or back of the product’s package and its size must be commensurate to the size of the chosen panel (between 15 and 32%). Given the rounded shape of CSD containers, the TL label is placed on the “side” of the bottle whereas the “front” contains the product’s name.

Literature review

There is an abundant body of literature evaluating the acceptability by consumers and efficacy of supplementary nutrition labels at helping consumers identify healthier food alternatives in controlled and experimental environments, but very limited literature empirically evaluating its effect on actual consumer behavior.

Overall, the literature suggests that TL labelling is more effective than other types of supplementary nutrition information labels in helping consumers identify healthier products. It has been found that consumers are more likely to identify healthier products when the TL labelling is used compared to GDA labelling [10, 11]. Additionally, consumers are able to better interpret the nutritional information when TL is used relative to GDA labelling and also when no supplementary nutrition information is provided [12]. Some authors also argue that TL labelling not only helps consumers better identify the healthiness of the product but also reduces the complexity of the decision making because of its simplicity [13]. While consumers may understand the TL, evidence of its effectiveness on intended or hypothetical purchasing decision is mixed [14, 15].

With respect to the literature evaluating the effect of the TL labelling on actual consumer buying behaviour, Sacks et al. evaluated retailer sales of ready meals and sandwiches in the United Kigdom after the introduction of a voluntary TL labelling on the package of the retailer’s own brands [6]. While supplementary nutrition information labelling is not required in the United Kingdom, the Public Ministry of Health recommends its use. During the period of the study, products with and without TL labels were available to consumers. To evaluate the effectivenes of TL labelling at promoting the purchases of healthier alternatives, the study assessed the association between the change in sales after the introduction of the label and the healthiness of the products according to the color of the TL labels. The results showed no significant association between these two variables. Another study conducted in Australia evaluated online sales of 53 food products with and without the TL label displayed on the product website. The study results also suggested no association between the change in sales of the products after the introduction of the labels and their healthiness [16]. A limitation of both studies is that they were conducted over very short periods of time[6, 16]. Another retail study conducted in the United States, found that in-store TL labelling when combined with financial incentives modestly reduced the consumption of sugar sweetened beverages after 5 months of the introduction of the TL [17].

Finally, we only identified three studies related to the use of the TL labelling in Ecuador [18, 19, 20]. These studies found that whereas consumers indicate they know about and understand the TL label, they also acknowledge its presence does not influence their purchasing decisions [19, 20]. None of these studies evaluated the effect of the TL labelling on actual purchasing behavior.

Conceptual framework

According to neoclassical consumer theory, consumers maximize utility from the consumption of goods and services subject to a budget constraint. The utility function represents consumer preferences which are based on knowledge and information they have available (i.e., consumer´ information set). The introduction of a policy such as the TL labelling makes available new information that consumers can use in their decision-making process as part of their information set. As a result, the demand curve of soft drinks after the introduction of the TL may not be same as the one before the introduction of the TL labelling [21]. Therefore, information in general, and TL labels particularly, can both shift and rotate the demand curve (see also Teisl, Bockastael, and Levy’s 2001 for an alternative theoretical formulation [22]), as they change consumer´s willingness to pay (WTP) for a product. A shift in the demand curve correspond to the case when the effect on WTP for a product due to information is the same for all consumers. On the other hand, rotation in the demand curve corresponds to the case where the effect in WTP values differs across consumers [23, 24]

For illustration purposes, consider the market demands for high-sugar CSD, for low-sugar CSD (Fig 2) and shift effects only. TL labelling aims to reduce the consumption of sugar from soft drinks by inducing a downward shift in the demand for high sugar CSD (from HS0 to HS1) and an upward shift in the demand for low sugar CSD (from LS0 to LS1).

The shifts cause changes in the equilibrium quantities and prices in both markets. The downward shift from HS0 to HS1 in the high-sugar soft drinks market causes a reduction in the equilibrium quantity demanded from Q0 to Q1 and a decrease in the equilibrium price from P0 to P1. Similarly, the upward shift from LS0 to LS1 causes an increase in the equilibrium quantities and prices for low sugar beverages. If, as it should be expected, high- and low-sugar CSD are substitutes, the increase in the price of low-sugar CSD shifts upward the demand curve for high-sugar CSD and the decrease in the price of high-sugar CSD shifts downward the demand curve for low-sugar CSD thus, both curves would tend to move the curves towards their original positions. The final effect of the policy is thus dependent upon the magnitude of the demand shifts as well as supply and demand relations.

For simplicity, the aforementioned theoretical model only considers the markets for two aggregate CSD products (high sugar and low sugar) but it highlights the expected market effects of TL labelling as well as the importance of considering market interdependencies into the analyses. The empirical model used in this study takes into account several CSD products as well as other food products and uses micro-level data to evaluate the final impact of the TL policy on the demand for CSD products. Our empirical approach also allows us to evaluate the effect of the TL on the slope of the demand curves. The information in the label would be expected to make high sugar CSD more sensitive to changes in the own price (i.e., steeper) and low sugar CSD less sensitive to changes in the own price (i.e., flatter).

Sugary Drinks

Sugary drinks (also categorized as sugar-sweetened beverages or “soft” drinks) refer to any beverage with added sugar or other sweeteners (high fructose corn syrup, sucrose, fruit juice concentrates, and more). This includes soda, pop, cola, tonic, fruit punch, lemonade (and other “ades”), sweetened powdered drinks, as well as sports and energy drinks.

As a category, these beverages are the single largest source of calories and added sugar in the U.S. diet. [1, 2] In other parts of the world, particularly developing countries, sugary drink consumption is rising dramatically due to widespread urbanization and beverage marketing. [3]

How sweet is it?

Aside from soda, energy drinks have as much sugar as soft drinks, enough caffeine to raise your blood pressure, and additives whose long-term health effects are unknown. For these reasons, it’s best to skip energy drinks. The guide includes sports beverages as well. Although designed to give athletes carbohydrates, electrolytes, and fluid during high-intensity workouts that last one hour or more, for everyone else they’re just another source of calories and sugar.

Drinks naturally high in sugar like 100% fruit juices are also featured. While juice often contains healthful nutrients like vitamins, minerals, and phytochemicals, it should also be limited as it contains just as much sugar (though from naturally occurring fruit sugars) and calories as soft drinks.

Sugary drinks and health

When it comes to ranking beverages best for our health, sugary drinks fall at the bottom of the list because they provide so many calories and virtually no other nutrients. People who drink sugary beverages do not feel as full as if they had eaten the same calories from solid food, and research indicates they also don’t compensate for the high caloric content of these beverages by eating less food. [4] The average can of sugar-sweetened soda or fruit punch provides about 150 calories, almost all of them from added sugar. If you were to drink just one of these sugary drinks every day, and not cut back on calories elsewhere, you could gain up to 5 pounds in a year. Beyond weight gain, routinely drinking these sugar-loaded beverages can increase the risk of type 2 diabetes, heart disease, and other chronic diseases. Furthermore, higher consumption of sugary beverages has been linked with an increased risk of premature death. [36]

The more ounces of sugary beverages a person has each day, the more calories he or she takes in later in the day. This is the opposite of what happens with solid food, as people tend to compensate for a large meal by taking in fewer calories at a later meal. This compensatory effect doesn’t seem to be present after consuming soft drinks, for several possible reasons:

• Fluids don’t provide the same feeling of fullness or satisfaction as solid foods, as the body doesn’t “register” liquid calories as it does calories from solid food. This may prompt a person to keep eating even after intake of a high-calorie drink.
• It is possible that sweet-tasting soft drinks—regardless of whether they are sweetened with sugar or a calorie-free sugar substitute—might stimulate the appetite for other sweet, high-carbohydrate foods.
• Even though soda may contain more sugar than a cookie, because people think of soda as a drink and a cookie as a dessert they are more likely to limit food than beverages.

Dozens of studies have explored possible links between soft drinks and weight, and they consistently show that increased consumption of soft drinks is associated with increased energy (caloric) intake.

• One meta-analysis of 88 studies showed that the effect appeared to be stronger in women. [5]
• Studies in children and adults have found that reducing sugary drink consumption can lead to better weight control among those who are initially overweight. [6,7]
• An 18-month trial involving 641 primarily normal-weight children randomly assigned to receive either a sugar-free, artificially sweetened beverage (sugar-free group) or a similar sugar-containing beverage (sugar group) found that replacement of sugar-containing beverages with noncaloric beverages reduced weight gain and fat accumulation in the normal-weight children. [8]
• Other studies have found a significant link between sugary drink consumption and weight gain in children. [9] One study found that for each additional 12-ounce soda children consumed each day, the odds of becoming obese increased by 60% during 1½ years of follow-up. [10]
• A 20-year study on 120,000 men and women found that people who increased their sugary drink consumption by one 12-ounce serving per day gained more weight over time—on average, an extra pound every 4 years—than people who did not change their intake. [11]
• A groundbreaking study of 33,097 individuals showed that among people with a genetic predisposition for obesity, those who drank sugary drinks were more likely to be obese than those who did not. [12] This study is important because it suggests that genetic risk for obesity does not need to become a reality if healthy habits, like avoiding sugary drinks, are followed. On the other hand, genetic obesity risk seems to be amplified by consuming sugary drinks. Read an interview with the study’s lead researcher.

Alternatively, drinking water in place of sugary drinks or fruit juices is associated with lower long-term weight gain. [13]

People who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes than people who rarely have such drinks. [14] Risks are even greater in young adults and Asians.

Strong evidence indicates that sugar-sweetened soft drinks contribute to the development of diabetes.

• The Nurses’ Health Study explored this connection by following the health of more than 90,000 women for eight years. The nurses who said they had one or more servings a day of a sugar-sweetened soft drink or fruit punch were twice as likely to have developed type 2 diabetes during the study than those who rarely had these beverages. [15]
• A similar increase in risk of diabetes with increasing soft drink and fruit drink consumption was seen recently in the Black Women’s Health Study, an ongoing long-term study of nearly 60,000 African-American women from all parts of the United States. [16] Interestingly, the increased risk with soft drinks was tightly linked to increased weight.
• In the Framingham Heart Study, men and women who had one or more soft drinks a day were 25 percent more likely to have developed trouble managing blood sugar and nearly 50 percent more likely to have developed metabolic syndrome. [17]
• A 2019 study looking at 22–26 years’ worth of data from more than 192,000 men and women participating in three long-term studies (the Nurses’ Health Study, the Nurses’ Health Study II, and the Health Professionals’ Follow-up Study) found that increasing total sugary beverage intake—including both sugar sweetened beverages and 100% fruit juice—by more than 4 ounces per day over a four-year period was associated with a 16% higher risk of type 2 diabetes in the following four years. [37]
• Increasing consumption of artificially sweetened beverages by more than 4 ounces per day over four years was linked with 18% higher diabetes risk, but the authors note these findings should be interpreted with caution due to the possibility of reverse causation (individuals already at high risk for diabetes may switch from sugary beverages to diet drinks) and surveillance bias (high-risk individuals are more likely to be screened for diabetes and thus diagnosed more rapidly).
• The study also found that drinking more artificially sweetened beverages in place of sugary beverages did not appear to lessen diabetes risk. However, replacing one daily serving of a sugary beverage with water, coffee, or tea was linked with a 2–10% lower risk of diabetes.
• A study that followed 40,000 men for two decades found that those who averaged one can of a sugary beverage per day had a 20% higher risk of having a heart attack or dying from a heart attack than men who rarely consumed sugary drinks. [18]
• A related study in women found a similar sugary beverage–heart disease link. The Nurses’ Health Study, which tracked the health of nearly 90,000 women over two decades, found that women who drank more than two servings of sugary beverage each day had a 40 percent higher risk of heart attacks or death from heart disease than women who rarely drank sugary beverages. [19]
• People who drink a lot of sugary drinks often tend to weigh more—and eat less healthfully—than people who don’t drink sugary drinks, and the volunteers in the Nurses’ Health Study were no exception. But researchers accounted for differences in diet quality, energy intake, and weight among the study volunteers. They found that having an otherwise healthy diet, or being at a healthy weight, only slightly diminished the risk associated with drinking sugary beverages.
• This suggests that weighing too much, or simply eating too many calories, may only partly explain the relationship between sugary drinks and heart disease. Some risk may also be attributed to the metabolic effects of fructose from the sugar or HFCS used to sweeten these beverages.
• The adverse effects of the high glycemic load from these beverages on blood glucose, cholesterol fractions, and inflammatory factors probably also contribute to the higher risk of heart disease. Read more about blood sugar and glycemic load.

A 22-year-long study of 80,000 women found that those who consumed a can a day of sugary drink had a 75% higher risk of gout than women who rarely had such drinks. [20] Researchers found a similarly-elevated risk in men. [21]

Soda may pose a unique challenge to healthy bones:

• Soda contains high levels of phosphate.
• Consuming more phosphate than calcium can have a deleterious effect on bone health. [22]
• Getting enough calciumis extremely important during childhood and adolescence, when bones are being built.
• Soft drinks are generally devoid of calcium and other healthful nutrients, yet they are actively marketed to young age groups.
• Milk is a good source of calcium and protein, and also provides vitamin D, vitamin B6, vitamin B12, and other micronutrients.
• There is an inverse pattern between soft drink consumption and milk consumption – when one goes up, the other goes down. [5]

According to a large, long-term study of 37,716 men and 80,647 women in the U.S., the more sugary beverages people drink, the greater their risk of premature death — particularly from cardiovascular disease, and to a lesser extent from cancer. [36]

• After adjusting for major diet and lifestyle factors, the researchers found that the more sugary beverages a person drank, the more their risk of early death from any cause increased. Compared with drinking sugary beverages less than once per month, drinking one to four per month was linked with a 1% increased risk two to six per week with a 6% increase one to two per day with a 14% increase and two or more per day with a 21% increase. The increased early death risk linked with sugary drink consumption was more apparent among women than among men.
• There was a particularly strong link between drinking sugary beverages and increased risk of early death from cardiovascular disease. Compared with infrequent drinkers, those who drank two or more servings per day had a 31% higher risk of early death from cardiovascular disease. Each additional serving per day of sugary drink was linked with a 10% increased higher risk of cardiovascular disease-related death.
• Among both men and women, there was a modest link between consumption and early death risk from cancer.
• The study also found that drinking one artificially sweetened beverage per day instead of a sugary one lowered the risk of premature death. However, drinking four or more artificially sweetened beverages per day was associated with increased risk of mortality in women, so researchers cautioned against excessive consumption of artificially-sweetened beverages.

Sugary drink supersizing and the obesity epidemic

There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. [23] Unfortunately, sugary beverages are a regular drink of choice for millions around the world, and a major contributor to the obesity epidemic.

Compounding the problem is that sugary drink portion sizes have risen dramatically over the past 40 years, leading to increased consumption among children and adults:

• Before the 1950s, standard soft-drink bottles were 6.5 ounces. In the 1950s, soft-drink makers introduced larger sizes, including the 12-ounce can, which became widely available in 1960. [24] By the early 1990s, 20-ounce plastic bottles became the norm. [25] Today, contour-shaped plastic bottles are available in even larger sizes, such as 1-liter.
• In the 1970s, sugary drinks made up about 4% of U.S. daily calorie intake by 2001, that had risen to about 9%. [26]
• Children and youth in the US averaged 224 calories per day from sugary beverages in 1999 to 2004—nearly 11% of their daily calorie intake. [27] From 1989 to 2008, calories from sugary beverages increased by 60% in children ages 6 to 11, from 130 to 209 calories per day, and the percentage of children consuming them rose from 79% to 91%. [28] In 2005, sugary drinks (soda, energy, sports drinks) were the top calorie source in teens’ diets (226 calories per day), beating out pizza (213 calories per day). [2]
• Although consumption of sugary drinks in the U.S. has decreased in the past decade, [29] half of the population consumes sugary drinks on a given day 1 in 4 people get at least 200 calories from such drinks and 5% get at least 567 calories—equivalent to four cans of soda. [30] These intake levels exceed dietary recommendations for consuming no more than 10% of total daily calories from added sugar [31]
• Globally, and in developing countries in particular, sugary drink consumption is rising dramatically due to widespread urbanization and beverage marketing. [3]

The role of sugary drink marketing

Beverage companies spend billions of dollars marketing sugary drinks, yet generally rebuffs suggestions that its products and marketing tactics play any role in the obesity epidemic. [32]

• In 2013, Coca-Cola launched an “anti-obesity” advertisement recognizing that sweetened soda and many other foods and drinks have contributed to the obesity epidemic. The company advertised its wide array of calorie-free beverages and encouraged individuals to take responsibility for their own drink choices and weight. Responses to the advertisement were mixed, with many experts calling it misleading and inaccurate in stating the health dangers of soda.

Adding to the confusion, studies funded by the beverage industry are four to eight times more likely to show a finding favorable to industry than independently-funded studies. [33]

It’s also important to note that a significant portion of sugary drink marketing is typically aimed directly at children and adolescents. [34]

• A 2019 analysis by the UConn Rudd Center for Food Policy and Obesity found that kids ages 2-11 saw twice as many ads for sugary drinks than for other beverages, and they also saw four times as many ads for certain drinks than adults did. [35] Researchers also analyzed nearly 70 “children’s drinks” (those marketed to parents and/or directly to children), and found that sweetened drinks contributed 62% of children’s drink sales in 2018, including \$1.2 billion in fruit drinks (90% of children’s sweetened drink sales) and \$146 million in flavored, sweetened water sales.

Cutting back on sugary drinks

When it comes to our health, it’s clear that sugary drinks should be avoided. There is a range of healthier beverages that can be consumed in their place, with water being the top option.

Of course, if you’re a frequent soda drinker, this is easier said than done. If it’s the carbonation you like, give sparkling water a try. If the taste is too bland, try a naturally flavored sparkling water. If that’s still too much of a jump, add a splash of juice, sliced citrus, or even some fresh herbs. You can do this with home-brewed tea as well, like this sparkling iced tea with lemon, cucumber, and mint.

Action beyond the individual level

Reducing our preference for sweet beverages will require concerted action on several levels—from creative food scientists and marketers in the beverage industry, as well as from individual consumers and families, schools and worksites, and state and federal government. We must work together toward this worthy and urgent cause: alleviating the cost and the burden of chronic diseases associated with the obesity and diabetes epidemics in the U.S. and around the world. Fortunately, sugary drinks are a growing topic in policy discussions both nationally and internationally. Learn more about how different stakeholders can take action against sugary drinks.

Related

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21. Choi HK, Curhan G. Soft drinks, fructose consumption, and the risk of gout in men: prospective cohort study. BMJ. 2008 Feb 7336(7639):309-12.
22. Malik VS, Schulze MB, Hu FB. Intake of sugar-sweetened beverages and weight gain: a systematic review–. The American journal of clinical nutrition. 2006 Aug 184(2):274-88.
23. Hu FB. Resolved: there is sufficient scientific evidence that decreasing sugar‐sweetened beverage consumption will reduce the prevalence of obesity and obesity‐related diseases. Obesity reviews. 2013 Aug14(8):606-19.
24. The Coca-Cola Company. History of Bottling. Accessed June 2013: https://www.coca-colacompany.com/our-company/history-of-bottling
25. Jacobson M. Liquid Candy: How Soft Drinks are Harming Americans’ Health. Washington, DC: Center for Science in the Public Interest 2005.
26. Nielsen SJ, Popkin BM. Changes in beverage intake between 1977 and 2001. American journal of preventive medicine. 2004 Oct 127(3):205-10.
27. Wang YC, Bleich SN, Gortmaker SL. Increasing caloric contribution from sugar-sweetened beverages and 100% fruit juices among US children and adolescents, 1988–2004. Pediatrics. 2008 Jun 1121(6):e1604-14.
28. Lasater G, Piernas C, Popkin BM. Beverage patterns and trends among school-aged children in the US, 1989-2008. Nutrition journal. 2011 Dec10(1):103.
29. Welsh JA, Sharma AJ, Grellinger L, Vos MB. Consumption of added sugars is decreasing in the United States–. The American journal of clinical nutrition. 2011 Jul 1394(3):726-34.
30. Ogden CL, Kit BK, Carroll MD, Park S. Consumption of sugar drinks in the United States, 2005-2008. Hyattsville, MD: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Health Statistics 2011 Aug.
31. U.S. Department of Health and Human Services and U.S. Department of Agriculture. 2015 – 2020 Dietary Guidelines for Americans. 8th Edition. December 2015. Available at http://health.gov/dietaryguidelines/2015/guidelines/.
32. Coca-Cola: Don’t blame us for the obesity epidemic! The New York Daily News June 8, 2012.
33. Lesser LI, Ebbeling CB, Goozner M, Wypij D, Ludwig DS. Relationship between funding source and conclusion among nutrition-related scientific articles. PLoS Medicine. 2007 Jan 94(1):e5.
34. US Federal Trade Commission. Marketing Food to Children and Adolescents: A Review of Industry Expenditures, Activities, and Self-Regulation. Washington, DC: US Federal Trade Commission 2008.
35. Harris J, Romo-Palafox M, Choi Y, Kibwana A. Children’s DrinkFACTS 2019: Sales, Nutrition, and Marketing of Children’s Drinks. UConn Rudd Center for Food Policy and Obesity 2019.
36. Malik V, Li Y, Pan A, De Koning L, Schernhammer E, Willett W, Hu F. Long-Term Consumption of Sugar-Sweetened and Artificially Sweetened Beverages and Risk of Mortality in US Adults. Circulation. 2019 Mar 18.
37. Drouin-Chartier JP, Zheng Y, Li Y, Malik V, Pan A, Bhupathiraju SN, Manson JE, Tobias DK, Willett WC, and Hu FB. Changes in Consumption of Sugary Beverages and Artificially Sweetened Beverages and Subsequent Risk of Type 2 Diabetes: Results from Three Large Prospective U.S. Cohorts of Women and Men. Diabetes Care. online 2019 Oct 3.

The contents of this website are for educational purposes and are not intended to offer personal medical advice. You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The Nutrition Source does not recommend or endorse any products.

Low-carb sweeteners, the best and the worst

This guide is based on scientific evidence, following our policy for evidence-based guides. Click for more info.

Which sweeteners can you use on a low-carb diet? Check out the visual guide below. The sweeteners to the left are very low in carbs and have generally been shown to have little impact on blood sugar and insulin levels. 1 The sweeteners to the right, in the red zone, should be avoided.

Numbers

The numbers above are based on the effect each sweetener has on blood sugar and insulin response, for an equal amount of sweetness compared to white sugar (100% pure sugar). Keep in mind that many sweetener packets contain a small amount of dextrose, which is pure sugar.

For example, a packet of Splenda provides about the same sweetness as two teaspoons (8 grams) of sugar. Each packet contains about 0.9 grams of carbohydrate from dextrose. That’s 0.9 / 8 = 0.11 times the effect of sugar, for an equal amount of sweetness. Pure 100% sugar has a number of 100, so Splenda gets a number of 100 x 0.11 = 11.

If you’re aiming to stay low carb, steer clear of the sweeteners to the right in the picture above. We suggest mainly using stevia, erythritol, monk fruit, or xylitol.

Potential negative effects of all sweeteners

Note that while the sweeteners to the left above have minimal direct effects on blood sugar and insulin levels, they may still have other potential negative effects.

The question marks by the sweeteners labeled “zero” indicate that although they appear to have no effects on blood glucose and insulin, their impact on obesity, diabetes, gut health, and long-term risk for metabolic disease is not yet known. More research on the long-term impacts of these sweeteners is needed. 2

Additionally, the effects of artificial sweeteners on pregnant women, the developing fetus, and young children are unknown and could be potentially risky for long-term metabolic health. 3 Again, more research is certainly needed.

Furthermore, all sweeteners can potentially maintain cravings for sweet foods. 4 Also, when added to foods – such as muffins or yogurt – they may lead to greater feelings of reward.

All sweet tastes, whether real sugar or sugar substitutes, act upon the same sweet taste receptors of the tongue and may trigger similar reward pathways in the brain, which some researchers suggest can maintain sugar addictions and cravings. 5

So by adding sweeteners to your foods, you may be increasing the risk that you’ll end up eating more than you need. This can slow down weight loss, or even cause weight gain. However, this doesn’t seem to happen in everyone. 6

If you’re able to, you may be better off just avoiding all sweeteners. Note that on a low-carb diet, cravings for sugary foods tend to decrease over time, making it easier and easier to stay away from them. 7

However, we realize that using sugar-free sweeteners in moderation can help some people remain low carb. Like drinking a glass of wine with dinner, they may find that having a low-carb brownie after dinner is completely satisfying.

If you do want to include sweeteners occasionally, keep reading to learn how to make the best low-carb choices.

Using sugar as a sweetener

Note that many sweeteners – white or brown sugar, maple syrup, coconut sugar and dates – have a number of exactly 100. This is because these sweeteners are made up of sugar. Sugar is also known as sucrose, which is 50% glucose and 50% fructose.

To get the same amount of sweetness as white sugar, these sweeteners will have a similar effect on blood sugar, weight and insulin resistance. 8

Sugar is potentially harmful for your health — no surprise — so none of these are good options, especially if you’re on a low-carb diet. Avoid.

Even worse than sugar: fructose

Some sweeteners may be even more problematic than sugar in the long run.

Regular sugar contains 50% glucose and 50% fructose.

However, certain sweeteners contain more fructose than glucose. These sweeteners are slower to raise blood glucose, resulting in a deceptively low glycemic index (GI), a measure of how quickly a carbohydrate-containing food results in a blood sugar increase after eating it. Yet they may still have potentially harmful effects.

Consuming excessive fructose can increase the likelihood of developing fatty liver and insulin resistance, increasing the risk of weight gain and future health problems. 9

Sweeteners with higher amounts of fructose – high fructose corn syrup (soda), fruit juice concentrate, honey, and agave syrup – might have slightly worse long-term effects than pure sugar. 10 Thus we give them a number of 100+. Which sweetener has the highest fructose content of all? Agave syrup (also called agave nectar). 11

Agave syrup and other high-fructose “healthy” alternative sweeteners are often marketed as being “low glyemic index” because they don’t raise blood sugar as much as white sugar does. But they may possibly be an even worse choice than white sugar when it comes to your weight and health due to fructose’s adverse effects. 12

So in addition to steering clear of sugar, it’s important to avoid these high-fructose sweeteners on a low-carb diet.

Our top 4 recommendations

If consuming sweets from time to time helps you sustain your low-carb journey, here are our top 4 options:

Option #1: Stevia

Stevia comes from the Stevia rebaudiana plant, which is native to South America, where it has been used for several hundred years. Steviol glycosides extracted from the plant are responsible for its sweet taste.

• Stevia doesn’t contain carbs or calories and does not raise blood sugar levels. 13
• It appears to be safe with a low potential for toxicity. 14
• Because stevia is very sweet, a little goes a long way.
• Stevia doesn’t really taste like sugar. It has a licorice-like flavor and an undeniable aftertaste when used in moderate to large mounts. Therefore, we recommend using it sparingly.
• It is challenging to cook with to get similar results as sugar and often can’t simply be swapped into existing recipes.
• There’s not enough long-term data on stevia to be certain of its true impact on the health of frequent users. 15

Sweetness: 200-350 times sweeter than table sugar.

Best choices: Liquid stevia or 100% pure powdered or granulated stevia. Note that some packets of granulated stevia such as Stevia in the Raw contain the sugar dextrose. The brand Truvia contains added erythritol (see below) but no dextrose.

Option #2: Erythritol

Erythritol is a sugar alcohol, a compound that resembles sugar but is only partially digested and absorbed by the body.

• Erythritol doesn’t raise blood sugar or insulin levels. 16
• It provides nearly zero calories and is virtually carb-free. After being absorbed, it passes into the urine without being used by the body. 17
• In its granulated or powdered form it is easy to use to replace real sugar in recipes.
• Erythritol might be helpful in preventing dental plaque and cavities, compared to other sweeteners. 18
• Erythritol has a noticeable cooling sensation on the tongue, particularly when used in large amounts.
• Although it causes fewer digestive issues than most sugar alcohols, some people have reported bloating, gas and loose stools after consuming erythritol.
• While absorbing erythritol into the blood and excreting it into the urine appears to be safe, there may be some potential for unknown health risks (none are known at this time).

Sweetness: 70% as sweet as table sugar.

Best choices: Granulated or powdered erythritol or erythritol and stevia blends.

Option #3: Monk fruit

Monk fruit is a relatively new sugar substitute. Also called luo han guo, monk fruit was generally dried and used in herbal teas, soups and broths in Asian medicine. It was cultivated by monks in Northern Thailand and Southern China, hence its more popular name.

Although the fruit in whole form contains fructose and sucrose, monk fruit’s intense sweetness comes from non-caloric compounds called mogrosides. In 1995, Proctor & Gamble patented a method of solvent extraction of the mogrosides from monk fruit.

The US FDA has ruled that monk fruit is generally regarded as safe. It has not yet been accepted for sale by the European Union.

• It is calorie-free and does not raise blood sugar or insulin levels. 19
• It has a better taste profile than stevia. In fact, it is often mixed with stevia to reduce cost and blunt stevia’s aftertaste. It is also mixed with erythritol to reduce expense and improve use in cooking.
• It doesn’t cause digestive upset.
• It’s very sweet, so a little goes a long way.
• It is fairly expensive.
• It’s often mixed with other “fillers” like inulin, prebiotic fibres and other undeclared ingredients.
• Be careful of labels that say “propriety blend,” as the product may contain very little monk fruit extract.
• It is very new, and there aren’t any studies on its long-term effects.

Sweetness: 150-200 times sweeter than table sugar.

Best choices: Granulated blends with erythritol or stevia, pure liquid drops, or liquid drops with stevia. Also used in replacement products like monkfruit-sweetened artificial maple syrup and chocolate syrup.

Option #4: Xylitol

Like erythritol, xylitol is a sugar alcohol found in fruits and vegetables in small amounts. It is produced commercially from corn cobs or birch trees. Xylitol is one of the most frequently used sweeteners in sugar-free chewing gum and mouthwash.

Unlike the other three sweeteners discussed above, xylitol is only low carb, not zero carb. So it may not be the best choice on a keto diet (below 20 grams of net carbs per day) unless used in very small amounts.

• Xylitol has a low glycemic index of 13, and only 50% is absorbed in the digestive tract. 20 When used in small amounts, this results in a very minor impact on blood sugar and insulin levels. 21
• Although it tastes like sugar and has a level of sweetness identical to sugar, xylitol provides 2.5 calories per gram, whereas sugar provides 4 calories per gram.
• Like erythritol, it’s been shown to help prevent cavities, compared to most other sweeteners. 22
• Because 50% of xylitol is not absorbed but instead fermented by bacteria in your colon, it may cause digestive issues (such as gas, loose stools, bloating) when consumed in moderate to large amounts. 23
• Although xylitol is safe for humans, it is toxic and potentially lethal for pets, like cats and dogs. If you use xylitol, make sure to keep it away from your animals.

Sweetness: Equivalent in sweetness to table sugar.

Best choices: Pure granulated xylitol made from corn cob or birch wood extraction.

Although we prefer to use erythritol in most of our dessert recipes, xylitol is included in some of our ice cream recipes because it freezes better.

Other low-carb sweeteners

For a more extensive list of sweeteners, see our keto sweeteners guide.

The “zero-calorie” sweeteners that are almost 100% carbs

Packets of Equal, Sweet’n Low and Splenda are labeled “zero calories,” but this isn’t the case.

FDA rules allow products with less than 1 gram of carbs and 4 calories per serving to be labeled “zero calories.” So manufacturers cleverly add about 0.9 grams of glucose/dextrose, as a bulking agent, to a small dose of artificial (synthetic) sweetener.

Voilà — a sweetener packet full of carbs that can be labeled “zero calories” without risking a lawsuit.

The packets actually contain almost 4 calories each, and almost a gram of carbs. While 0.9 grams of carbs may not seem like much, on a low-carb diet it can matter — especially if you use several packets a day. Ten packets equals 9 grams of carbs.

So at least be aware of this. We don’t recommend these sweeteners because of the deceptive marketing. There are also lingering potential health concerns regarding some of these synthetic sweeteners, including aspartame and sucralose. 24

Why maltitol is not a good option

Maltitol is the most common type of sugar alcohol used in “sugar-free” candy, desserts, and low-carb products because it’s considerably less expensive than erythritol, xylitol, and other sugar alcohols.

Maltitol is not a good choice for people on low-carb diets. About 50% of this sweetener is absorbed in the small intestine, which can raise blood sugar and insulin levels, especially in those with diabetes or prediabetes. 25 It also provides about three-quarters as many calories as sugar, which is more than most low-carb sweeteners. 26

In addition, the roughly 50% that’s not absorbed is fermented in the colon. Studies have shown that maltitol may cause significant digestive distress (gas, bloating, diarrhea, etc.), especially when consumed in large amounts. 27

Diet soft drinks – yes or no?

Can you drink diet soft drinks on a low-carb diet? Ideally, you may want to avoid them.

There’s some research suggesting that diet beverages may make it harder to lose weight, despite containing no calories. 28

What’s more, a 2016 study found that most studies showing a favorable or neutral relationship between sugar-sweetened beverages and weight were funded by industry and full of conflict of interest, research bias and unreproduced findings. 29

However, if you feel you must drink diet sodas, at least they will allow you to stay low carb. Regular soda, sweetened with sugar or HFCS, will very quickly result in a high carb intake, negating the positive effects of a low-carb diet.

A final word on low-carb sweeteners

While some sweeteners may be better than others, the best strategy for achieving optimal health and weight loss may be learning to enjoy real foods in their unsweetened state. Over time, you may discover a whole new appreciation for the subtle sweetness of natural, unprocessed foods.

However, some people may not lose their taste for sweets. If you are one of them, occasionally using sweeteners may make it easier for you to stick with low carb.

Determining whether including low-carb sweeteners makes sense for you is key to achieving long-term success.

Do you find it almost impossible to consider giving up sweet foods? You can do it. Here’s something that may interest you: our course on sugar addiction and how to take back control.

How to choose healthy crackers.

When buying crackers, there are a few things you need to consider to ensure you're buying the best.

• Make sure "whole grain" is the first ingredient: "You want to make sure that they are 100% whole grain crackers. The first ingredient should be 100% whole grain flour," says registered dietitian Amanda A. Kostro Miller, RD, LDN, who serves on the advisory board for Smart Healthy Living.
• Look for crackers with at least 3 grams of fiber. "Another thing to strive for in a healthy cracker is fiber. Look on the nutrition label of your crackers. Strive to search for crackers that have the most fiber compared to other brands. Some of the crackers in the grocery store may only have 3 grams per serving," Kostro Miller says.
• Beware of high sodium levels. "When possible, try to choose crackers that have less sodium, because controlling your sodium intake is important for everyone," Kostro Miller says.
• There should be little or no added sugar. Most Americans are already consuming a high-sugar diet. You want to make sure that savory crackers aren't taking on to your daily limit of added sugar. "A little added honey is alright, but it's usually best to avoid high fructose corn syrup or crackers with more than one type of sugar. If you're looking for a healthy cracker choice, keep the added sugar in check: no more than 1-2 grams of sugar per serving is best," says dietitian Caitlin Self, MS, CNS, LDN.

A Primer on Fat – Part 2

Hopefully after my last post you chose to indulge in a guilt-free steak. I know I did. The beauty of the whole thing is that it kind of makes sense that steak shouldn’t directly cause heart disease. Animals have been eating each other (and therefore humans eating animals) for a long time. Yes, even before the creation of Oreos and Hot Pockets there was good ol’ steak. Now that I’ve covered the nuances of saturated and trans fats, it’s time to move on to monounsaturated fats (MUFAs) and polyunsaturated fats (PUFAs). These fats are much less “good vs. bad” and more about balance and ratios. Let’s dig deeper and see exactly what that means.

Magnificent MUFAs

MUFAs are one of those rare foods you get the green light on from most online sources. Aside from the potential to take on a serious caloric load, MUFAs are associated with many significant benefits to your health. Some benefits of MUFAs are:

• Weight loss, especially when compared to diets loaded with trans fat
• Assists with hormonal balance in your body
• Keeps your hair, skin, nails, etc. smooth
• Raises good (HDL) cholesterol and lowers bad (LDL) cholesterol

Sounds like a pretty good food for you to be eating. One of the major sources of MUFAs that has gained popularity over the years is olive oil. Interestingly, many skin care products also feature olive oil as a power ingredient. It’s just one of those foods that seems to be beneficial to many bodily systems. MUFAs are the fat that experts recommend eating the most of, and in general I wouldn’t worry about exactly how much of it you’re eating. I’m not a fan of counting calories, and as long as you’re eating healthy foods and working out your health should take care of itself. Some other sources of MUFAs are nuts and avocados, so go crazy with some guac and take comfort in knowing you’re doing your heart a favor.

Wellness made easy… and delicious!

Portioned PUFAs

Unlike MUFAs, which are surprisingly straightforward, PUFAs are a little more of a mind game. PUFAs are generally accepted as healthy, but you must take in a balanced ratio of the different types of PUFA to maintain Wellness. Maybe you’ve heard of the highly coveted Omega-3 fats. Of course, I don’t doubt that you knew that Omega-3 fats are indeed fats. What you may not have known is that the Omega-3 part refers to the chemical structure of the fat. There are also Omega-6 fats and Omega-9 fats. As far as you and I are concerned, the physical makeup of the fat is inconsequential. What we’re interested in is the effect that those chemicals will have on our health.

Omega-6 (O6) fats and Omega-3 (O3) fats are your body’s yin and yang. O6 has some inflammatory properties, while O3 has some anti-inflammatory properties. Your first instinct might just be to remove O6 from your diet. After all, I’ve never had any inflammation that I enjoyed. But there’s a catch: some of the body’s essential fatty acids are of the O6 composition. What is an essential fatty acid? It’s one that your body can’t manufacture from other things you eat. So basically, your only way to get them is to eat them. To balance out the inflammatory effects, you must eat O3 fats.

One thing I can promise you is that you will never have a hard time eating enough O6 fats. They are literally everywhere. The most commonly used cooking oils (corn, soybean, and peanut) all have much higher amounts of O6 than O3. The challenge with our modern diet is getting enough O3 to balance the O6 overload. To make things even more complicated, there are several types of O3 fats… I warned you PUFAs were tougher!

This is the O6:O3 balance in your typical American diet. Not good, to say the least.

To understand O3 fats, think of them as a tiered structure. The better tier consists of two oils, known as DHA and EPA, which are sourced primarily from fish. The lower tier consists of something known as ALA and is derived from plant sources like walnuts and flax. If you eat the lower tier of O3, your body will have to internally convert it to the higher tier. The efficiency rate is horrible at less than 5% yield. My advice would be to focus on eating animal sources of O3 when trying to supplement your diet.

• Eat a balanced amount of O6 to O3 fats (really by focusing on consuming O3)
• Eat animal sources of O3 fats (fish is your best bet, except tilapia)

So what benefits will you enjoy by keeping your O6:O3 ratio in check? Check out your exceptional rewards:

• Decreased risk of stroke
• Can help reduce the pain associated with arthritis
• Enhanced cognitive abilities
• Reduced risk of dementia

And if you somehow manage to overload on O3? That can cause problems just like overloading on O6 can. While excess O6 causes inflammation, excess O3 causes anti-inflammatory effects which can inhibit the healing process. Balance, as always, is everything!

That wraps up your introduction to fats. They can be a little tricky, but don’t get mired down in the details. Avoid trans fats, exhibit moderation with saturated fats and MUFAs, and maintain a balanced intake of O6 to O3 PUFAs to keep your Wellness optimal. It can be that simple. Figuring out the exact numbers can be difficult, so a ballpark approach is your best bet. Enjoy fats and all of the benefits they have to offer your body and taste buds, they are a great way to enrich your diet when used appropriately.

Everything shown has healthy, natural fats. And they’re all tasty to boot!

Differences Between the Weston A. Price Foundation Diet and the Paleo Diet

We are posting this information to clear up the considerable confusion about the Weston A. Price Foundation dietary principles and the “paleo diet.” We feel it necessary to do this because we often hear the two diets mentioned together—“the Weston Price Paleo Diet”—and we feel it very important to note that the principles of these two diets are not the same.

Rest assured, we are not doing this to “attack” anyone personally we are posting this information because we have a duty to provide accurate information about nutrition.

We are aware that many people experience short-term benefits from the paleo diet, especially people coming off the Standard American Diet (SAD) or vegan/vegetarian diets. However, in the long term, the paleo diet can lead to cravings and serious deficiencies.

We also appreciate the fact that many people who have adopted paleo diets are supporting farmers and ranchers who produce pasture-raised animal foods and many paleo dieters are members of the Farm-to-Consumer Legal Defense Fund.

We also realize that there are many versions of the paleo diet, some of which incorporate some of the WAPF dietary principles. Nevertheless, the principles proposed by the two main spokesmen for the paleo diet—Loren Cordain and Robb Wolf—have virtually NO points in common with the WAPF principles.

For reviews of these two books, see

The Paleo Diet by Loren Cordain: www.westonaprice.org/thumbs-down-reviews/paleo-diet

The Paleo Diet Solution by Robb Wolf: www.westonaprice.org/thumbs-down-reviews/the-paleo-solution-by-robb-wolf

A Google search for “Paleo Diet” brings up first the Loren Cordain and Robb Wolf websites, along with the Wikipedia entry for the paleo diet The following analysis compares the WAPF diet with the paleodiet principles expressed in these websites and the books by Cordain and Wolf

NOTE: As of May 2015, the diet recommended by Cordain at thepaleodiet.com is as follows:

 EAT DON’T EAT Grass-produced Meats Cereal Grains Fish/Seafood Legumes Fresh Fruits and veggies Dairy Eggs Refined Sugar Nuts and seeds Processed Foods Healthful oils (Olive, walnut, flaxseed, macadamia, avocado, coconut) Salt Refined vegetable oils Potatoes

As of May, 2015, Robb Wolf recommends the following diet at RobbWolf.com

 OK TO EAT AVOID Fruits Dairy Vegetables Grain Lean Meats Processed Food & Sugars Seafood Legumes Nuts and seeds Starches Healthy fats* Alcohol

* Defined as HEALTHY FATS FROM NUTS, SEEDS, AVOCADOS, OLIVE OIL, FISH OIL AND GRASS-FED MEAT

Conclusion and Implications

Most importantly, fava bean�sed diets did not cause hemolytic anemia and did not alter glucose handling in dogs after 7 days of feeding, thus fava beans appear safe as a dog food ingredient. In contrast, the high-protein grain-free commercial diet adversely altered blood chemistry compared with the normal protein, grain-containing commercial diet we tested. Moreover, the normal protein, grain-based diet appeared to cause excess sympathetic tone, a trend that if it were to continue with long-term feeding, might lead to adverse changes in cardiac health that are distinct from DCM. On the other hand, fermentation with C. utilis looks promising to reduce antinutritional factors and potentially improve health through improvements in nutrient digestibility and increased RBC levels in dogs. Studies using longer feeding periods are needed to determine whether these short-term changes are sustained to produce clinically significant changes in dogs.

5 CONCLUSION

The replacement of sucrose with alternative sweeteners is not a straightforward process. These alternative sweeteners often display accompanying off-flavors, or lack the temporal sensory profile of sucrose, with sweetness often either fading too fast or lingering too long. However, many studies suggest that the negative qualities of these sweeteners could be improved through mixtures (Glória, 2003 , O'Brien-Nabors, 2011 , Prakash et al., 2014 , Schiffman et al., 1985 , Spillane, 2006 , von Rymon Lipinski, 1985 ), which can negate some flavor deficiencies (Ayya & Lawless, 1992 ). Furthermore, the desire for “healthy” and “natural” sweeteners does not imply that these substitutes are biologically inert. Successful sugar reduction strategies in the future will rely on data concerning the sensory performance of sweeteners alongside knowledge of how these sweeteners impact whole body metabolism. From the sensory and metabolic effects we have summarized above, polyols, rare sugars, and rebaudiosides may be promising candidates in the future. These sweeteners have fewer side-tastes and seem to exert a minimal negative effects on gut health (Figure 2). Furthermore, consumers seem to value a natural label in sucrose replacement, despite few being familiar with available options.