Are Artificial Sweeteners Killing Your Health? - Dr Peter Attia

how worried should we be about artificial sweeteners you know I don't know uh would be the short answer I I think that this is another one of those things where uh boy people really love to demonize these things um but if you if you really just want to look at the facts let's talk about facts right so aspartame which is the original kind of the OG sweetener uh everybody loves to demonize aspartame or NutraSweet but the reality of it is if there is toxicity to it probably impossible to measure at regular doses this is a substance that at least the last time I checked had more data on it from a safety perspective than any other molecule tested by the FDA you're kidding no it's it's just because again it's been around since the 1960s right so does that mean that if you consume the equivalent of 12 cans of diet soda a day it's safe probably not but we don't know right so um where do I think these sweeteners potentially reek the most Havoc you know one is I I think that they probably increase your appetite for sugar anyway so if you're if you're consuming them in an effort to avoid sugar um you have to be just mindful of the fact that am I robbing Peter to pay Paul um if you really want to eliminate sugar as one of your dietary strategies uh you might just be better off reducing sweet things altogether and what you'll discover because I've gone I've done this myself I've had periods in my life where I've been you know very dogmatic about restricting sugar I'm not that dogmatic about it these days right but when I have been you know one of the things I noticed was how unbelievably sweet things are that I used to not think were that sweet like berries you know like you know raspberries aren't generally thought of as the sweetest thing in the world but when you completely eliminate artificial sweeteners and regular sweeteners you know after a few months berries become insanely sweet you know 85 chocolate becomes mind-bogglingly sweet as opposed to what most people would think but it's kind of bitter um you know there was a recent study published that looked at uh one particular sweetener erythritol and um it was a pretty poorly done study um but look it asked some interesting questions right which is you know is a metabolite of this potentially atherogenic I was androgenic uh would it lead to or cause atherosclerosis what's that cardiovascular disease sort of the the the inflammatory disease of the coronary arteries and other arteries um again I I think the data are are pretty underwhelming that artificial sweeteners are harmful but I also think there's probably a class of differences between them so my personal favorite of all of them is something called allulose um allulose is it's basically natural it is an enantomer of fructose meaning it's a molecule that's almost identical to fructose with one very minor structural change what's unique about it is it has in my opinion the best taste because the thing I don't like about artificial sweeteners is I just don't like the taste I actually like the taste of sugar I don't like the taste of you know saccharin I don't really like the taste of aspartame I certainly don't like the taste of stevia I mean that to me makes me want to vomit but alulose has the same taste the same mouth feel as sugar and the only drawback is it's only 70 is sweet which is not a real drawback because you could always dose it up if you want it also has the added benefit of it appears to actually reduce blood glucose a little bit it appears to have an effect where it pulls glucose um into the kidney and like basically increases the filtration glomerular filtration of glucose so it slightly lowers glucose not as potently as something called a an sglt2 inhibitor which is a class of drug that does that but it's it's very interesting nonetheless so um you know I guess if I were thinking about how I would consume it I would probably consume more allulose than other things but unfortunately it's still not that prevalent in Foods you have to you have to just buy the allulose itself so if I'm making something I'll use allulose in it what I like about this framing is it gets to one of the reasons why doing a randomized control trial for diet stuff is so hard because how are you going to be able to control for the psychological training that having a sweet thing even if it is a zero calorie sweetening even if it's a zero calorie sweet thing with no Downstream risks to your body unless you take it at insane dosages how are you going to be able to control for what that does psychologically to people's expectations of the sweetness of their foods of the frequency of having sweet things throughout their diet um yeah I think that's a really nice little microcosm there one of the thing I'm wearing a wood band at the moment um some people are drowning in data now right we've gone from a world where we knew nothing to where some people know a lot but I would guess on average that even people who care about the health and fitness are still mostly not wearing a Tracker they're still mostly not getting blood panels done they're still mostly not going and getting a full body MRI scan etc etc what are the most important metrics for someone who is completely uh unindoctrinated into the world of looking at Vital Signs within their body what are the most important metrics for people to be looking at well I mean again I I have a pretty long list on that because we're we're holding ourselves to a pretty high bar so the way I think about this is what are the inputs to what what I call the longevity risk assessment so um there were basically about seven or eight things that are a threat to your length of life and quality of life we've talked about them already right so cardiovascular disease cerebrovascular disease cancer neurodegenerative disease Orthopedic injury emotional distress misery like all those things right so how do we know how you're stacking up on all of those things what are the inputs to do them so yeah blood tests family history selective genetic testing colonoscopy MRI liquid biopsy VO2 max Test Zone 2 test dexa scan I mean the list is long and I I think in our Matrix we have over 40 things that go into that or over 40 inputs that go into our risk assessment and then that risk assessment leads to outputs so what do you do in response to the the ranking of risk based on those things okay run the Matrix go and do those things and then let's come back and measure and do again so it's hard for me to say what the most important is because it really comes down to an individual so if an individual shows up and they have a significant family history of cardiovascular disease well look a CT angiogram is going to be very important and a blood test that's measuring LP little a lipids and APO B is essential because you have to know which you know which of these things is responsible for that you know certainly you know a continuous blood pressure monitor or at the at a minimum you know we would have patients checking their blood pressure at home two to three times a day for a month again super low Tech right you might think how is that interesting well it's enormously interesting because blood pressure is one of the biggest risk factors for Alzheimer's disease and cardiovascular disease so again people are obsessed with things like you know their sleep data but don't forget the really you know you know less sexy stuff that we could have measured forever such as blood pressure but knowing how to measure blood pressure accurately is important and I I think you know undiagnosed hypertension is an epidemic in this country what do people get wrong when measuring blood pressure the first thing they get wrong is they don't measure it but assuming they do measure it um they're not stationary for five minutes before they measure it they don't have the cuff on correctly they don't have their arm in the right position you know if your arm is too low or too high you're going to get an inaccurate reading your arm really needs to be the cuff needs to be right at the level of your heart um you you have to pay very close attention to where the cuff tells you to put it you know you want to be about an inch above the break in your arm and there's a a good cuff will tell you where the how to line it up with the brachial artery in your arm you don't want to have just had coffee right before you do it you don't want to be sitting like I am with your legs crossed your legs need to be uncrossed so there's a whole protocol for how to do this and there's a very good study called the Sprint study that that really established the the measurement standard for how to establish um a proper measurement for blood reading which was you know five minutes sitting stationary without doing anything stimulating measurement five minutes of you know doing nothing again repeat measurement five minutes repeat measurement so 15 minutes to get three measurements taking the average that's a blood pressure now we don't ask our patients to do that we ask them to do it once but two to three times a day so you should even out any inconsistencies yeah and you'll also notice trends like are you normal in the mornings but elevated in the afternoons and uh you know the data are really clear that anything above 120 over 80 has long-term risk associated with it and so when we see people that have an elevated blood pressure we want to make sure we're addressing that and there's lots of ways to address it before you have to go down the pharmacologic pack but if you have to go down that path you're much better off going down to protect your kidneys your brain and your heart what is good and what is bad about different types of cuffs or automatic cuffs okay yeah so the gold standard is of course a manual cuff so having an actual person yeah who's who's got a stethoscope on the brachial artery and measuring your blood pressure the problem is unless you're you know you have like for me that's what I do typically because my wife can measure my blood pressure even I can measure my own blood pressure so marry someone who is trained for taking blood pressure that's what you're saying but the automated cuffs are pretty good um in me they run high so across the board automatic automated cuffs tend to run 10 to 15 millimeters per Mercury high systolically and they're accurate diastolically that's just a glitch I have never been able to come up with a compelling explanation for why but I'm not unique in this um I we do see this uh in a number of people where the the gold standard runs lower than the than the cuff um so the challenge of doing an a manual cuff when you're at your doctor's office is the challenge of having your blood pressure checked at the doctor's office for some people it produces this syndrome called white coat hypertension where my mom's got that yeah they just you you sort of get you know and by the way the other thing is most the time you walk into the doctor's office they don't even adhere to this principle right five minutes yeah yeah you sort of run in from the parking lot run up the flight of stairs sit down in the waiting room last time you had a coffee yeah yeah so so again I'm I think that blood pressure is a very difficult thing to to accurately glean in the doctor's office for all those reasons and that's why I just think everybody should you know buy one I I don't have any affiliation with any company that makes these things but there's a brand that I like called Omron Omron that's the one we tell our patients to get you can get these things on Amazon and um what are the most common uh lifestyle interventions let's say that someone does get to what that 120 over 80. where should they go first what do you think exercise is is a big one aerobic exercise is an enormous way to lower blood pressure as is weight loss so weight loss is going to be mostly driven by nutrition and then aerobic exercise and and sleep so because I track my blood pressure pretty regularly um two of the most obvious things that show up when I'm not well slept is you know higher blood glucose and higher blood pressure what's happening people if you enjoyed that at then press here for the full unedited episode and don't forget to subscribe peace