AMA #74: Sugar and sugar substitutes: weight control, metabolic effects, and health trade-offs

Peter Attia

Aug 18, 2025

Episode description

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In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the pros and cons of popular sweeteners including saccharin, aspartame, sucralose, allulose, and sugar alcohols like erythritol and xylitol. With a focus on weight management, glycemic impact, gut health, and long-term safety, this episode offers a comprehensive guide to navigating the sweetener landscape with clarity and nuance.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #74 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

  • A quick tangent on chess and parenting [2:30];

  • Overview of key scenarios for evaluating sugar and sweeteners [6:15];

  • Why humans are hardwired to crave sweetness [13:30];

  • Evaluating whether sugar is uniquely fattening or more harmful than other macronutrients under isocaloric conditions [15:15];

  • Why sugar drives appetite: low satiety, insulin response, and reward system activation [18:45];

  • How sugar type, liquid vs. solid form, and processing level influence appetite and metabolic impact [20:15];

  • Add

Episode description

View the Show Notes Page for This Episode

Become a Member to Receive Exclusive Content

Sign Up to Receive Peter’s Weekly Newsletter

In this “Ask Me Anything” (AMA) episode, Peter explains how to evaluate sugar and its substitutes in the context of health. Peter explores the role of sweeteners in three common use-cases – beverages, protein supplements, and sweet treats – and breaks down how our evolutionary craving for sweetness now clashes with today’s food environment. He examines whether sugar is uniquely fattening, the hormonal effects of sugar consumption, and the significance of timing in sugar intake. The episode compares natural versus refined sugars, sugar in beverages versus in solid foods, and the pros and cons of popular sweeteners including saccharin, aspartame, sucralose, allulose, and sugar alcohols like erythritol and xylitol. With a focus on weight management, glycemic impact, gut health, and long-term safety, this episode offers a comprehensive guide to navigating the sweetener landscape with clarity and nuance.

If you’re not a subscriber and are listening on a podcast player, you’ll only be able to hear a preview of the AMA. If you’re a subscriber, you can now listen to this full episode on your private RSS feed or our website at the AMA #74 show notes page. If you are not a subscriber, you can learn more about the subscriber benefits here.

We discuss:

  • A quick tangent on chess and parenting [2:30];

  • Overview of key scenarios for evaluating sugar and sweeteners [6:15];

  • Why humans are hardwired to crave sweetness [13:30];

  • Evaluating whether sugar is uniquely fattening or more harmful than other macronutrients under isocaloric conditions [15:15];

  • Why sugar drives appetite: low satiety, insulin response, and reward system activation [18:45];

  • How sugar type, liquid vs. solid form, and processing level influence appetite and metabolic impact [20:15];

  • Add

Mindsip insights from this episode:

Overcome protein formulation challenges for better taste

Protein is an inherently difficult macronutrient to formulate with because it tastes horrible, which is why most protein powders and bars require sweeteners to be palatable.

Incorporate allulose as a standout sweetener in your diet

Allulose is considered a standout sweetener, though it is challenging to incorporate into all types of food products.

Leverage xylitol for unique dental health benefits

Beyond being a low-calorie sugar alcohol, xylitol offers unique dental health benefits.

Reevaluate non-nutritive sweeteners based on recent research

Significant new research on non-nutritive sweeteners has emerged in the last two to three years, warranting a new look at the topic.

Evaluate health impact of switching from regular to diet soda

A key practical question is whether you are healthier switching from consuming large quantities of regular soda to the same amount of diet soda.

Evaluate sweeteners based on usage scenarios

A practical framework for thinking about sugar substitutes involves evaluating them in three distinct scenarios: beverages, protein supplements, and sweet treats.

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