Understanding the Health Disadvantages of Excessive Sugar Consumption

Let’s dive into understanding the health disadvantages of excessive sugar consumption. Some people live vegetarian or choose specific diets, yet they do not pay attention to their sugar consumption, which can have a significant impact on health. Excessive sugar consumption is a widespread health concern that affects various bodily functions and can lead to numerous health issues. From disrupting gut health to affecting liver function and hormone levels, the negative impacts of sugar are significant. This article delves into the various health disadvantages associated with high sugar intake, offering a comprehensive overview of its effects on the body.

What is Sugar?

Sugar, primarily in the form of sucrose (table sugar) and high-fructose corn syrup, is a carbohydrate that the body uses for energy. While it occurs naturally in fruits and some vegetables, most dietary sugar is added to foods and drinks during processing and preparation.

Health Risks Associated with Excessive Sugar Consumption

Leaky Gut Syndrome

Excessive sugar intake can disrupt the balance of the gut microbiome, leading to an increase in gut permeability, commonly referred to as leaky gut. This condition allows toxins and bacteria to enter the bloodstream, which can trigger inflammation and may contribute to various chronic diseases. (1) Leaky gut syndrome, also known as increased intestinal permeability, is a condition where the lining of the small intestine becomes damaged, allowing undigested food particles, toxic waste products, and bacteria to “leak” through the intestines into the bloodstream. This phenomenon can trigger an autoimmune response, leading to various negative health effects:

Chronic Inflammation

The primary consequence of a leaky gut is chronic inflammation throughout the body. This can contribute to a host of diseases and conditions, including inflammatory bowel disease, arthritis, and other inflammatory conditions. (2)

Autoimmune Diseases

When foreign particles enter the bloodstream, the immune system may begin to attack these along with the body’s own tissues, potentially leading to autoimmune diseases such as type 1 diabetes, lupus, and multiple sclerosis. (3)

Gastrointestinal Complications

Symptoms can include bloating, gas, cramps, food sensitivities, and aches and pains, which can exacerbate conditions like irritable bowel syndrome (IBS), Crohn’s disease, and celiac disease. (4)

Nutritional Deficiencies

A leaky gut can impair the absorption of essential nutrients, including vitamins, minerals, and nutrients, due to the damage to intestinal cells. This can lead to deficiencies that may cause symptoms such as fatigue, anemia, and more complex nutritional imbalances. (5)

Skin Conditions

There is evidence to suggest that a leaky gut may contribute to skin conditions such as acne, eczema, and psoriasis. The inflammation caused by toxins escaping from the gut can lead to various dermatological issues. (6)

Mood and Mental Health Issues

Emerging research links gut health to mood and mental health, suggesting that conditions like leaky gut could contribute to symptoms of depression, anxiety, and other mood disorders, possibly due to the inflammation and its effect on the brain. (7)

Food Allergies and Sensitivities

The immune response triggered by particles passing through the gut can increase susceptibility to allergens. Individuals may find they become more sensitive or intolerant to certain foods as their immune system begins to react more aggressively. (8)

Increased Risk of Infection

he compromised barrier of the gut may allow more bacteria and viruses to enter the body, potentially leading to increased infections and a weakened immune response. (9)

Impact on Hormones – SHBG and Testosterone

High sugar consumption can lead to elevated levels of insulin, which in turn can affect other hormones. It can decrease the production of Sex Hormone Binding Globulin (SHBG), a protein that helps regulate testosterone and estrogen levels. Lower SHBG levels can result in reduced testosterone, affecting everything from muscle mass to overall energy levels and libido. (10)

Hormonal Imbalance

SHBG binds to sex hormones, particularly testosterone and estrogen, which are then carried through the bloodstream in an inactive form. When SHBG levels are low, there is an increase in the bioavailability of these hormones. This can lead to an imbalance, where testosterone and estrogen are present in higher active forms than normal. (11)

Effects on Men’s Health

For men, lower levels of SHBG can lead to elevated free testosterone levels, which might sound beneficial but can actually contribute to several health issues. These include an increased risk of developing conditions linked to high testosterone, such as acne, male pattern baldness, and an enlarged prostate. More seriously, it can elevate the risk of prostate cancer over the long term. (12)

Effects on Women’s Health

In women, reduced SHBG can lead to higher levels of free estrogen and testosterone. This imbalance can exacerbate or lead to symptoms of polycystic ovary syndrome (PCOS), which includes irregular menstrual cycles, infertility, acne, and excessive hair growth. Additionally, high levels of free estrogen without balance can increase the risk of breast and endometrial cancer. (13)

Metabolic Effects

Beyond the direct effects on reproductive hormones, low SHBG levels are associated with metabolic syndrome, which includes a cluster of conditions such as increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels. Each of these factors raises the risk of heart disease, stroke, and diabetes. (14)

Mood and Energy Levels

Fluctuations in hormone levels due to low SHBG can also impact mood and energy. Men might experience fatigue, low libido, and mood swings, while women might face similar issues along with symptoms like premenstrual syndrome (PMS) exacerbation. (15)

1. Liver Health: Sugar, particularly fructose, is metabolized in the liver, where excessive amounts can overload the organ. This can lead to non-alcoholic fatty liver disease (NAFLD), characterized by fat buildup in liver cells, inflammation, and potentially liver damage. (16)
2. Weight Gain and Obesity: Sugar is a major contributor to caloric intake with little nutritional benefit, leading to weight gain. Its consumption also influences the release of insulin, a hormone that plays a key role in fat storage. The cycle of spikes in blood sugar and insulin can lead to weight gain, especially as visceral fat around the abdomen, and decreased muscle mass. (17)
3. Increased Risk of Type 2 Diabetes: Consistently high sugar intake can lead to insulin resistance, where cells stop responding to insulin effectively. This can increase blood sugar levels and eventually lead to type 2 diabetes. (18)
4. Dental Health: Sugar is a primary cause of dental decay and cavities. It fuels the bacteria in plaque, leading to acid production that erodes the enamel of teeth. (19)
5. Cardiovascular Disease: Studies have linked high sugar intake with increased risks of high blood pressure, inflammation, and higher triglyceride levels, all of which are risk factors for heart disease and stroke. (20)
6. Mental Health and Mood Disorders: There is growing evidence that high sugar consumption may be linked to an increased risk of depression and anxiety. Sugar promotes inflammation, which is one potential pathway through which it can affect mental health. (21)
7. Candida Overgrowth: Excessive sugar intake can also feed Candida albicans, a fungus that naturally resides in the body but can grow out of control when the gut microbiome is imbalanced. (39) This overgrowth can lead to Candidiasis, causing symptoms such as fatigue, yeast infections, and digestive issues. (40)

Managing Sugar Intake

Reducing sugar intake can have profound health benefits. Here are strategies to manage and reduce sugar consumption:

1. Read Labels Carefully: Look for sugar content in the ingredients list, keeping an eye out for all forms of added sugars including sucrose, high-fructose corn syrup, and others like cane juice and maltose.
2. Limit Processed Foods: Processed and prepared foods often contain a high amount of added sugars, even in products that do not taste particularly sweet, such as bread and condiments.
3. Beware of Sugary Drinks: Beverages like soda, energy drinks, and even fruit juices can contain high levels of sugar. Opt for water, herbal teas, or infusions.
4. Understand Your Cravings: Sometimes, sugar cravings are a sign of other deficiencies or the body’s need for energy. Address these cravings with nutrient-rich foods or a balanced meal.
5. Use Alternatives: Instead of sugar, consider using natural sweeteners that have lower impacts on blood sugar levels. Options like xylitol, allulose, and stevia can provide the sweetness you desire without the negative effects of sugar.

Hidden Sugars and Their Impact on Health

Research has shown that understanding the health disadvantages of excessive sugar consumption can help reduce the risk of chronic diseases. Hidden sugars, such as high-fructose corn syrup, dextrose, and maltose, are often added to processed foods and beverages to enhance flavor, texture, and shelf life. These sugars are not always apparent on ingredient labels, making it challenging for consumers to recognize and limit their intake. By understanding the health disadvantages of excessive sugar consumption, individuals can make better decisions to maintain their overall well-being.

1. Prevalence in Processed Foods

1. • Hidden sugars are commonly found in a wide range of processed foods, including sauces, dressings, bread, and breakfast cereals. This makes it easy to consume high amounts of sugar unknowingly.

2. Impact on Blood Sugar Levels

1. • Consuming foods with hidden sugars can lead to rapid spikes in blood glucose levels, increasing the risk of insulin resistance and type 2 diabetes over time (22)

3. Contribution to Obesity

1. • High-fructose corn syrup, commonly found in sweetened beverages, has been linked to increased calorie intake and weight gain. These hidden sugars contribute significantly to the obesity epidemic by providing empty calories with little nutritional benefit. (23)

4. Dental Health Concerns

1. • Hidden sugars feed harmful bacteria in the mouth, leading to acid production that erodes tooth enamel and increases the risk of cavities and dental decay. (24)

5. Misleading Labels

1. • Food manufacturers often use various names for added sugars, such as sucrose, glucose, and fructose, which can mislead consumers about the true sugar content of a product. This makes it difficult for individuals to make informed dietary choices and manage their sugar intake effectively.

Sugar Alternatives: Benefits and Considerations

Reducing sugar intake doesn’t mean sacrificing sweetness. Various sugar substitutes offer the taste of sugar without its negative health impacts. Here’s a detailed look at some popular sugar alternatives and their unique benefits and potential drawbacks:

1. Xylitol

1. • Benefits: Xylitol is a sugar alcohol derived from plants that can replicate the sweetness of sugar with nearly 40% fewer calories. It does not raise blood sugar levels significantly, making it a diabetes-friendly option. Additionally, xylitol is known for its dental benefits; it can reduce decay-causing bacteria in the mouth and has been shown to prevent cavities. (25)
   • Considerations: While beneficial for dental health, xylitol can cause digestive discomfort if consumed in large amounts due to its laxative effect. It is also highly toxic to dogs, so pet owners must be cautious. (26)

1. Allulose

1. • Benefits: Allulose is a rare sugar found naturally in small quantities in fruits like figs and raisins. It tastes like sugar but contains only about 10% of the calories. Allulose has minimal impact on blood glucose and insulin levels. Interestingly, recent studies suggest that allulose may help regulate fat metabolism and increase the secretion of hormones in the gut that signal fullness, potentially aiding in weight loss. (27)
   • Considerations: Allulose is generally well-tolerated, but since it is not fully metabolized by the body, excessive consumption might lead to digestive issues.  (28)

3. Stevia

1. • Benefits: Stevia is a natural sweetener derived from the leaves of the Stevia rebaudiana plant. It is unique in that it provides no calories and does not raise blood sugar levels, making it an excellent choice for diabetics or those looking to reduce caloric intake. Stevia is much sweeter than sugar, so only small amounts are needed to achieve the desired sweetness. Additionally, some studies suggest that stevia can have beneficial effects on insulin sensitivity and might even lower blood pressure levels. (29)
   • Considerations: It’s important to choose high-quality, pure stevia products as some commercially available stevia products are highly processed and may contain other additives or sweeteners.

Disadvantages of Fructose

1. • Concerns with High-Fructose Fruits: While fructose is naturally found in fruits and is healthier than refined sugar, high intakes, especially from concentrated sources like high-fructose corn syrup or excessive fruit consumption, can have adverse effects. High fructose intake has been linked to insulin resistance, obesity, (30) and increased risk for fatty liver (31) disease because fructose is primarily metabolized in the liver, where it can convert to fat more readily than glucose.
   • Fruit Consideration: Fruits high in fructose include apples, mangoes, and grapes. While these fruits provide vitamins, minerals, and fiber, moderation is advised, especially for individuals managing diabetes or those susceptible to fructose malabsorption. (32)

Disadvantages of Artificial Sweeteners

Artificial sweeteners, such as aspartame, sucralose, and saccharin, are widely used as zero-calorie alternatives to sugar. While they offer the benefit of sweetness without the calories, there are potential disadvantages and side effects associated with their consumption:

1. Impact on Gut Microbiome:

1. • Microbiome Disruption: Research suggests that some artificial sweeteners may negatively impact the gut microbiome, the community of bacteria and other microbes living in the digestive tract. These sweeteners can inhibit the growth of beneficial gut bacteria, potentially leading to an imbalance known as dysbiosis. This disruption can affect digestive health and may have broader implications for immune function and metabolic regulation. (33)

1. Increased Sugar Cravings and Appetite:

1. • Appetite Regulation: Contrary to helping with weight loss, some studies indicate that consuming artificial sweeteners may lead to increased appetite and cravings for sweet foods. This is possibly due to the body’s response to the sweet taste without the expected calories, leading to an increase in appetite-regulating hormones. (34)

1. Potential Risk of Metabolic Disorders:

1. • Insulin Sensitivity: Some research has found that regular consumption of artificial sweeteners may be linked to an increased risk of metabolic disorders, including type 2 diabetes and metabolic syndrome. These effects are thought to be related to changes in the gut microbiota and alterations in glucose metabolism. (35)

1. Behavioral Responses:

1. • Sweet Preference: Regular use of artificial sweeteners might condition the palate to prefer intensely sweet foods, potentially making less sweet, healthier options less appealing. This altered taste preference can make it harder to enjoy fruits and other naturally sweet foods. (36)

1. Possible Neurological Effects:

1. • Headaches and Migraines: Certain individuals report headaches or migraines after consuming artificial sweeteners, particularly aspartame. While these effects are not universal, they can be significant for those who are sensitive. (37)

1. Regulatory and Health Controversies:

1. • Cancer Risk: Although most artificial sweeteners are considered safe by many health authorities, including the FDA, controversies and debates persist over their long-term safety and potential cancer risk. Studies have been inconclusive, with most showing no direct link, but consumer concerns remain. (38)

Conclusion

Understanding the health disadvantages of excessive sugar consumption is crucial for making informed dietary choices. The detrimental effects of excessive sugar consumption are extensive and multifaceted, impacting various aspects of health from metabolic functions to mental well-being. As our understanding of sugar’s impact deepens, it becomes increasingly clear that moderating sugar intake is crucial for maintaining long-term health. Reducing sugar not only helps prevent a host of chronic conditions but also supports overall vitality and well-being.

It is important for individuals, especially those following specific dietary choices like vegetarianism, to be mindful of hidden sugars in their diet. By adopting healthier alternatives and making informed dietary choices, one can significantly mitigate the risks associated with high sugar consumption, promoting a healthier lifestyle overall

FAQ – Health Disadvantages of Excessive Sugar Consumption

1. What are the immediate effects of consuming too much sugar?

A: Immediate effects can include spikes in blood glucose levels, which may lead to energy crashes, mood swings, and cravings. Over time, these can evolve into more serious health issues such as insulin resistance. Disadvantages of excessive sugar consumption also include increased risk of obesity and type 2 diabetes.

 2. How does sugar affect mental health?

A: The disadvantages of excessive sugar consumption are often overlooked despite their serious impact on mental health. High sugar intake has been linked to an increased risk of mood disorders, including depression and anxiety. This is thought to be due to sugar’s inflammatory effects and its impact on the body’s stress response and neurotransmitter regulation.

3. Can cutting out sugar improve my health even if I don’t have a sugar-related health condition?

A: Yes, reducing sugar intake can benefit almost everyone. Benefits include improved energy levels, better weight management, reduced inflammation, and a lower risk of chronic diseases. Educating people about the disadvantages of excessive sugar consumption can also lead to healthier dietary habits.

4. Are natural sugars in fruits and vegetables as harmful as added sugars?

A: No, the sugars in fruits and vegetables are part of a complex matrix that includes fiber, vitamins, and minerals, which helps regulate the absorption of sugar and mitigate its effects on blood sugar levels.

5. What are some hidden sources of sugar that I might not be aware of?

A: Hidden sugars can be found in many processed foods, including sauces, dressings, bread, yogurt, and even some canned vegetables and meats. It’s important to read labels carefully to identify added sugars. Awareness of the disadvantages of excessive sugar consumption is essential for preventing long-term health issues.

References

(1) Satokari, R. (2020). High Intake of Sugar and the Balance between Pro- and Anti-Inflammatory Gut Bacteria. Nutrients, 12. https://doi.org/10.3390/nu12051348.

(2) Garcia, K., Ferreira, G., Reis, F., & Viana, S. (2022). Impact of Dietary Sugars on Gut Microbiota and Metabolic Health. Diabetology. https://doi.org/10.3390/diabetology3040042.

(3) Zhang, X., Monnoye, M., Mariadassou, M., Béguet-Crespel, F., Lapaque, N., Heberden, C., & Douard, V. (2021). Glucose but Not Fructose Alters the Intestinal Paracellular Permeability in Association With Gut Inflammation and Dysbiosis in Mice. Frontiers in Immunology, 12. https://doi.org/10.3389/fimmu.2021.742584.

(4) Volynets, V., Louis, S., Pretz, D., Lang, L., Ostaff, M., Wehkamp, J., & Bischoff, S. (2017). Intestinal Barrier Function and the Gut Microbiome Are Differentially Affected in Mice Fed a Western-Style Diet or Drinking Water Supplemented with Fructose.. The Journal of nutrition, 147 5, 770-780 . https://doi.org/10.3945/jn.116.242859.

(5) Rohr, M., Narasimhulu, C., Rudeski-Rohr, T., & Parthasarathy, S. (2019). Negative Effects of a High-Fat Diet on Intestinal Permeability: A Review.. Advances in nutrition. https://doi.org/10.1093/advances/nmz061.

(6) Cheng, W., Li, S., Lee, T., Lee, T., Chung, C., Kao, Y., & Chen, Y. (2021). Sugar Fructose Triggers Gut Dysbiosis and Metabolic Inflammation with Cardiac Arrhythmogenesis. Biomedicines, 9. https://doi.org/10.3390/biomedicines9070728.

(7) Karl, J., Margolis, L., Murphy, N., Martini, S., Gundersen, Y., Castellani, J., Carrigan, C., Teien, H., Madsilen, E., Chakraborty, N., Kumar, R., Hoke, A., Gautam, A., Hammamieh, R., Montain, S., & Pasiakos, S. (2017). High Energy Expenditure and Negative Energy Balance Modulate Composition and Metabolism of the Gut Microbiota. The FASEB Journal, 31. https://doi.org/10.1096/fasebj.31.1_supplement.444.5.

(8) Geurts, L., Neyrinck, A., Delzenne, N., Knauf, C., & Cani, P. (2014). Gut microbiota controls adipose tissue expansion, gut barrier and glucose metabolism: novel insights into molecular targets and interventions using prebiotics.. Beneficial microbes, 5 1, 3-17 . https://doi.org/10.3920/BM2012.0065.

(9)  Calleja-Conde, J., Echeverry-Alzate, V., Bühler, K., Durán-González, P., Morales-García, J., Segovia-Rodríguez, L., Fonseca, F., Giné, E., & López-Moreno, J. (2021). The Immune System through the Lens of Alcohol Intake and Gut Microbiota. International Journal of Molecular Sciences, 22. https://doi.org/10.3390/ijms22147485.

(10) Chen, L., Xie, Y., Pei, J., Kuang, J., Chen, H., Chen, Z., Li, Z., Fu, X., Wang, L., Lai, S., Zhang, S., Chen, Z., & Lin, J. (2018). Sugar-sweetened beverage intake and serum testosterone levels in adult males 20–39 years old in the United States. Reproductive Biology and Endocrinology : RB&E, 16. https://doi.org/10.1186/s12958-018-0378-2.

(11) Nayeem, F., Nagamani, M., Anderson, K., Huang, Y., Grady, J., & Lu, L. (2009). Dietary beta-tocopherol and linoleic acid, serum insulin, and waist circumference predict circulating sex hormone-binding globulin in premenopausal women.. The Journal of nutrition, 139 6, 1135-42 . https://doi.org/10.3945/jn.108.103291.

(12) Ohlsson, C., Barrett-Connor, E., Bhasin, S., Orwoll, E., Labrie, F., Karlsson, M., Ljunggren, O., Vandenput, L., Mellström, D., & Tivesten, Å. (2011). High serum testosterone is associated with reduced risk of cardiovascular events in elderly men. The MrOS (Osteoporotic Fractures in Men) study in Sweden.. Journal of the American College of Cardiology, 58 16, 1674-81 . https://doi.org/10.1016/j.jacc.2011.07.019.

(13) Shin, J., Kim, S., Lee, M., Kim, H., Ye, B., Shin, Y., Baik, S., & Chung, C. (2011). Serum sex hormone-binding globulin levels are independently associated with nonalcoholic fatty liver disease in people with type 2 diabetes.. Diabetes research and clinical practice, 94 1, 156-62 . https://doi.org/10.1016/j.diabres.2011.07.029.

(14) Goto, A., Morita, A., Goto, M., Sasaki, S., Miyachi, M., Aiba, N., Terauchi, Y., Noda, M., & Watanabe, S. (2012). Associations of sex hormone-binding globulin and testosterone with diabetes among men and women (the Saku Diabetes study): a case control study. Cardiovascular Diabetology, 11, 130 – 130. https://doi.org/10.1186/1475-2840-11-130.

(15) Christensen, L., Hagen, C., Henriksen, J., & Haug, E. (1997). Elevated levels of sex hormones and sex hormone binding globulin in male patients with insulin dependent diabetes mellitus. Effect of improved blood glucose regulation.. Danish medical bulletin, 44 5, 547-50 .

(16) Jensen, T., Abdelmalek, M., Sullivan, S., Nadeau, K., Green, M., Roncal, C., Nakagawa, T., Kuwabara, M., Sato, Y., Kang, D., Tolan, D., Sánchez-Lozada, L., Rosen, H., Lanaspa, M., Diehl, A., & Johnson, R. (2018). Fructose and sugar: A major mediator of non-alcoholic fatty liver disease.. Journal of hepatology, 68 5, 1063-1075 . https://doi.org/10.1016/j.jhep.2018.01.019.

(17) Yamakawa, M., Wada, K., Koda, S., Mizuta, F., Uji, T., Oba, S., & Nagata, C. (2019). High Intake of Free Sugars, Fructose, and Sucrose Is Associated with Weight Gain in Japanese Men.. The Journal of nutrition. https://doi.org/10.1093/jn/nxz227.

(18) Malik, V., Popkin, B., Bray, G., Despres, J., Willett, W., & Hu, F. (2010). Sugar-Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes. Diabetes Care, 33, 2477 – 2483. https://doi.org/10.2337/dc10-1079.

(19) Touger-Decker, R., & Loveren, C. (2003). Sugars and dental caries.. The American journal of clinical nutrition, 78 4, 881S-892S . https://doi.org/10.1093/AJCN/78.4.881S.

(20) Stanhope, K. (2016). Sugar consumption, metabolic disease and obesity: The state of the controversy. Critical Reviews in Clinical Laboratory Sciences, 53, 52 – 67. https://doi.org/10.3109/10408363.2015.1084990.

(21) Christensen, L., Hagen, C., Henriksen, J., & Haug, E. (1997). Elevated levels of sex hormones and sex hormone binding globulin in male patients with insulin dependent diabetes mellitus. Effect of improved blood glucose regulation.. Danish medical bulletin, 44 5, 547-50 .

(22) Laville, M., & Nazare, J. (2009). Diabetes, insulin resistance and sugars. Obesity Reviews, 10. https://doi.org/10.1111/j.1467-789X.2008.00562.x.

(23) Bray, G., & Popkin, B. (2014). Dietary Sugar and Body Weight: Have We Reached a Crisis in the Epidemic of Obesity and Diabetes?. Diabetes Care, 37, 950 – 956. https://doi.org/10.2337/dc13-2085.

(24) Touger-Decker, R., & Loveren, C. (2003). Sugars and dental caries.. The American journal of clinical nutrition, 78 4, 881S-892S . https://doi.org/10.1093/AJCN/78.4.881S.

(25) Benahmed, A., Gasmi, A., Arshad, M., Shanaida, M., Lysiuk, R., Peana, M., Pshyk‐Titko, I., Adamiv, S., Shanaida, Y., & Bjorklund, G. (2020). Health benefits of xylitol. Applied Microbiology and Biotechnology, 104, 7225 – 7237. https://doi.org/10.1007/s00253-020-10708-7.

(26) Bates, N. (2018). Xylitol toxicosis in dogs. The Veterinary Nurse. https://doi.org/10.12968/VETN.2018.9.5.256.

(27) Hossain, A., Yamaguchi, F., Matsuo, T., Tsukamoto, I., Toyoda, Y., Ogawa, M., Nagata, Y., & Tokuda, M. (2015). Rare sugar D-allulose: Potential role and therapeutic monitoring in maintaining obesity and type 2 diabetes mellitus.. Pharmacology & therapeutics, 155, 49-59 . https://doi.org/10.1016/j.pharmthera.2015.08.004.

(28) Natsume, Y., Yamada, T., Iida, T., Ozaki, N., Gou, Y., Oshida, Y., & Koike, T. (2021). Investigation of d-allulose effects on high-sucrose diet-induced insulin resistance via hyperinsulinemic-euglycemic clamps in rats. Heliyon, 7. https://doi.org/10.1016/j.heliyon.2021.e08013.

(29) Ahmad, J., Khan, I., Blundell, R., Azzopardi, J., & Mahomoodally, M. (2020). Stevia rebaudiana Bertoni.: an updated review of its health benefits, industrial applications and safety. Trends in Food Science and Technology, 100, 177-189. https://doi.org/10.1016/j.tifs.2020.04.030.

(30) Rizkalla, S. (2010). Health implications of fructose consumption: A review of recent data. Nutrition & Metabolism, 7, 82 – 82. https://doi.org/10.1186/1743-7075-7-82.

(31) Kolderup, A., & Svihus, B. (2015). Fructose Metabolism and Relation to Atherosclerosis, Type 2 Diabetes, and Obesity. Journal of Nutrition and Metabolism, 2015. https://doi.org/10.1155/2015/823081.

(32) Livesey, G. (2009). Fructose ingestion: dose-dependent responses in health research.. The Journal of nutrition, 139 6, 1246S-1252S . https://doi.org/10.3945/jn.108.097949.

(33) Shil, A., Olusanya, O., Ghufoor, Z., Forson, B., Marks, J., & Chichger, H. (2020). Artificial Sweeteners Disrupt Tight Junctions and Barrier Function in the Intestinal Epithelium through Activation of the Sweet Taste Receptor, T1R3. Nutrients, 12. https://doi.org/10.3390/nu12061862.

(34) Swithers, S. (2013). Artificial sweeteners produce the counterintuitive effect of inducing metabolic derangements. Trends in Endocrinology & Metabolism, 24, 431-441. https://doi.org/10.1016/j.tem.2013.05.005.

(35) Iizuka, K. (2022). Is the Use of Artificial Sweeteners Beneficial for Patients with Diabetes Mellitus? The Advantages and Disadvantages of Artificial Sweeteners. Nutrients, 14. https://doi.org/10.3390/nu14214446.

(36) Garden, L., & Paterson, K. (2015). Artificial sweeteners and glucose intolerance: a dietitians’ perspective. Practical Diabetes, 32. https://doi.org/10.1002/pdi.1928.

(37) Newman, L., & Lipton, R. (2001). Migraine MLT‐Down: An Unusual Presentation of Migraine in Patients With Aspartame‐Triggered Headaches. Headache: The Journal of Head and Face Pain, 41. https://doi.org/10.1111/j.1526-4610.2001.01164.x.

(38) Weihrauch, M., & Diehl, V. (2004). Artificial sweeteners–do they bear a carcinogenic risk?. Annals of oncology : official journal of the European Society for Medical Oncology, 15 10, 1460-5 . https://doi.org/10.1093/ANNONC/MDH256.

(39) Leepel, L., Hidayat, R., Puspitawati, R., & Bahtiar, B. (2009). Efek Penambahan Glukosa pada Saburoud Dextrose Broth terhadap Pertumbuhan Candida albicans (Uji In Vitro). Journal of Dentistry Indonesia, 16, 58-63. https://doi.org/10.14693/JDI.V16I1.14.

(40) Nobile, C., & Johnson, A. (2015). Candida albicans Biofilms and Human Disease.. Annual review of microbiology, 69, 71-92 . https://doi.org/10.1146/annurev-micro-091014-104330.