TRUTHITION

The Sweet Truth About Sugar

Unwrap the the truth about sugar.

January 23, 2025 Truthition Team

Unwrapping the Truth - Introduction

For the past several decades, sugar has been at the center of a storm of negative claims regarding its impact on human health. Sugar, and high-carbohydrate diets in general, are popularly considered to be linked to obesity, diabetes, and other health problems. Low-carb keto diets (diets attempting to induce ketosis in the body by reducing carbs) and paleo diets have become immensely popular in the past decade or so, with one survey finding that 5% of respondents follow the keto diet, and 4% follow paleo.^[1] While these diets can be beneficial for some, the science behind sugar’s role in health is far more nuanced than the widespread belief that excessive sugar intake directly causes obesity.

Despite this tremendous villainization of sugar and the proposed health risks, sugar in its simplest form is a requirement for the sustainability of human life. The true answer lies on the other side of the fence, with natural high-carbohydrate diets being shown to support metabolic health, enhance cognitive function, and even promote weight loss. Rather than being the villain it is often portrayed as sugar deserves a reassessment in light of new and old evidence unveiling its benefits when consumed appropriately. This article will explore the history of sugar’s misconceptions, the science behind its role in health, and why it’s time to view sugar through a more balanced lens.

A Sweet Beginning – Sugar’s Place in History

Sugar, in ancient times, was commonly consumed and used in various ways. One notable example of this is in China, where, for hundreds, if not thousands, of years before 1840 AD, sugar was a market it dominated. In modern times, China has kept up this ancient trend, reigning as the third largest producer of sugar in 2003/2004.^[2] Sugar, in ancient China, was used both as a luxurious treat and in various medicines the Chinese people concocted. Reportedly, sugar was “a potent ingredient to harmonize herbal remedies and soothe digestive ailments”.^[3] It was therefore considered a symbol of health and luxury. Many other societies have used sugar cane in many ways since and was notably traded among the middle eastern Nabataeans along with other valuable resources like olive oil, grain, and wine.^[4] For all of this, and for far more uses that sugar provided civilizations for thousands of years, modern society has taken a turn in the opposite direction, with sugar consumption significantly decreasing in western countries like the United States.

The Blame Game: Sugar and the Diabetes Debate

The 17^th century marks the beginning of sugar’s demonization. Thomas Willis, a renowned physician known for his contributions to medicine, was among the first to realize that diabetes patients had urine that tasted sweet, like “sugar or honey”.^[5] Willis was the first to coin the term diabetes mellitus, also known today as type II diabetes. This, and other observations would associate diabetes mellitus directly with sugar intake. The disease was known for slowly wasting away the patient’s body, with scientists later down the line stating that excess sugar is the direct result of this disease.

Before continuing, it’s important to know the difference between modern categories of type I and II diabetes.

Type I diabetes: This condition is distinguished by the body’s inability to secrete insulin from the pancreas almost entirely or completely.^[6] This can happen when the body attacks the cells that the pancreas uses to secrete insulin. Insulin is crucial in metabolizing glucose, which is among the simplest sugars and is the body’s primary energy source.

Type II diabetes: This is categorized by a reduced ability to secrete insulin, or a resistance to insulin in the body.^[6] Resistance means that the body is not responding the way it should to insulin, making metabolizing sugars more difficult. This type of diabetes can often be managed through diet, and thus has led people to believe that excess sugar intake directly causes or contributes to type II diabetes.

This modern misconception started with John Yudkin, an English physiologist, who believed that sugar was the primary underlying cause of cardiovascular illnesses, diabetes, and heart disease.^[7] On the other side, modern science has generally come to the consensus that many of these cardiovascular diseases are pinned on increased LDL cholesterol and saturated fat.^[8] However, looking deeper into these arguments disproves the surface-level beliefs that generate these claims.^[9] Now, due to Yudkin’s research and overstated claims, sugar has continued to be villainized in the same way.

The Sticky Myths

Generally, western society has carved a special place for sugar in the “do not eat” list, with various advertisements and government organizations attributing numerous health issues to sugar consumption. Many of these claims are simply not true or are significantly overstated. Common accusations include the “addictive” properties of sugar, the correlation sugary foods have with obesity, and even deeper, its purported role in causing metabolic and cardiovascular issues like type II diabetes, obesity, or hypertension.^[10,11]

Most of the claims about obesity and sugar are very surface level. Typically, they claim that increased sugar intake makes individuals feel “less full” and that sugar is correlated with weight gain and obesity in general. Obesity rates have been skyrocketing, a staggering 16.7% more individuals reported as obese from 1988/94 and 2015/16.^[12] One might expect this to correlate with an increase in sugar consumption, but quite the opposite is true: glucose consumption has been declining since 1997, and refined cane and beet sugar consumption declining 31.5% from 1970 to 2021.^[12]

^{Truthition PUFA 1 [12]}

More complex arguments have been making their way into the limelight. One being that type II diabetes is a direct result of sugar intake. This, at the very least, cannot be attributed to two of the simplest and most common sugars: fructose and glucose, and certainly does not have a correlation with refined sugar (which contains both sugars). Simply put, given the efficient way that glucose is metabolized in a healthy human, it cannot cause type II diabetes. Type II diabetes, as previously described, is the reduced ability to secrete insulin or insulin resistance, which can be caused by a variety of factors, including dietary ones.

To observe glucose and its potential interactions, there must be a deeper biochemical look.

Generally, glucose is metabolized in the body by cells quite naturally and is caught in a process called the glucose-fatty acid cycle, or “Randle cycle”. This cycle, simply put, is the competition between long-chain fatty acids (LCFAs)—the most common form of fat in the diet—and glucose being utilized in various tissues of the body.^[13] Essentially, the more glucose being utilized in tissues, the less that LCFAs will be utilized, and vice versa. This means that the more LCFAs are consumed, the ability of the body to use insulin to effectively use glucose for energy is reduced. In this context, while glucose alone cannot cause problems in metabolizing itself, other factors, including dietary, can. This mechanism lends credence to the idea that a high-sugar, low-fat diet may be superior for metabolic health, given the benefits of sugar that will be explained in later sections.

Fructose: The Misunderstood Sweetheart

Fructose, another common monosaccharide—the simplest sugars that make up larger sugar chains—in the human diet, has had more recent concerns regarding excessive fructose consumption and health. This is notably with the large increase of high-fructose corn syrup (HFCS) consumption. A notable concern is that when the body metabolizes fructose, a byproduct substance is generated called uric acid.^[11] Uric acid can be metabolized by itself and can cause inflammation and oxidation. This is the primary pathway by which fructose is said to cause type II diabetes and metabolic syndrome. There are a few animal studies showing the negative effects of a high nearly pure-fructose diet. However, various factors have been overlooked in these studies.

One byproduct of uric acid metabolism is the fact that it reduces nitric oxide (NO) availability for the body to use.^[14] NO is a substance that has been deemed to play a generally positive role in the body for cardiovascular health. This is one reason why excess uric acid (hyperuricemia) is considered a negative effect of excess fructose consumption, thereby villainizing the simple sugar. However, as beneficial as NO may seem, excess can also cause harm throughout the body.

NO plays vital roles in the cardiovascular system, as it helps dilate (widen) blood vessels and is generally protective against atherosclerosis.^[15] While reduced NO bioavailability does cause issues in general, the majority of the issues such as hypertension and atherosclerosis are more so associated with the body’s inability to synthesize it.^[15] This means that while reducing NO bioavailability in general is not conducive to cardiovascular health, most of the implications are from other factors of the body not being able to produce it properly. Furthermore, excess NO may cause issues with the mitochondria of the cell, which is what generates energy for every cell in the human body. Nitric oxide can inhibit ATP production in the mitochondria, causing an increase in oxidant production and can thus lead to cell death.^[16] The mitochondrion of a cell produces a substance called superoxide, which can react with NO to produce a powerful oxidant called peroxynitrite, which leads to oxidative stress in the body and significant cell damage.^[15]

Fructose consumption increases uric acid, which can reduce the availability of nitric oxide (NO) that can lead to problems. However, NO itself can not only cause problems, but most of the problems are associated with the body’s inability to synthesize it and have nothing to do with fructose itself. All of this means that excess uric acid from fructose consumption may not be as harmful as many studies make it out to be.

On top of this, there are other pathways that uric acid may take that increases inflammation. These pathways require that it must be taken up by a transporter called URAT-1, which brings uric acid to parts of the body like the renal tubular cells (tiny tubes in the kidneys), vascular muscle cells (blood vessel walls), and adipocytes (fat cells), which is where it causes these problems.^[11] However, uric acid is not the only substance that competes for transportation via URAT-1. Other substances like salicylate and nicotinate can also compete for, and in fact, drastically reduce this pathway by which uric acid is taken up into the body.^[17] It is important to note that some people are different in the sense that there are certain kidney problems, medications, and even genetic mutations that may also affect the volume of uric acid that is taken up into the body’s cells. However, the fact above generally remains true.

Salicylate is a substance that is similar to but is not exactly a vitamin. It is found in some medications, like aspirin. Salicylate is one of the substances discussed here that reduces uric acid uptake by URAT-1. Salicylate can come from many food sources. Interestingly, natural food sources that contain salicylate happen to contain a high amount of fructose. These foods include blueberries, grapes, apples, raisins, tomatoes, and bell peppers.^[19,20] This implies that as long as fructose is being consumed from natural sources, this inflammation problem is likely a non-issue. Nicotinate is the other substance discussed and is the vitamin niacin (B3). It is found in foods like liver, chicken breast, tuna, turkey, salmon, ground beef, brown rice, mushrooms, and potatoes.^[18]

So far, it seems a few of the problems regarding fructose have been overstated. Looking at one 2009 study, there are important results, but also important nuances to consider. To elaborate, this study compared two groups of people with nearly identical average age, weight, BMI, body fat, HDL, LDL, total cholesterol, insulin levels, etc. The fructose group, after 10 weeks, started showing markers of issues within the human body, like excess fat, higher LDL cholesterol, and higher total cholesterol.^[21] Although, higher LDL cholesterol itself is not necessarily a problem, as explained here. Blood pressure did not change significantly between either of the two groups, indicating that if there was going to be a problem related to hypertension and atherosclerosis with ingesting this amount of fructose, it would occur beyond the 10-week period of this study. However, one major consideration and nuance is that this study had each participant drink a fructose or glucose drink that made up 25% of their daily calories. This means that the fructose group was drinking an absurd amount of fructose. Assuming a fairly standard 2500 calorie diet, that’s 625 calories of fructose. One 2003 paper published in AJCN about high-fructose corn syrup found that the top 20% consumers ingest only 316 calories from high-fructose corn syrup.^[22] High-fructose corn syrup (HFCS), aptly named, is 42% or 55% fructose. This means that even the top consumers of the most widely consumed sweetener in the western world are consuming only a fourth of what this study proposed. Even HFCS-rich foods often contain nutrients found in natural foods and are certainly more nutrient-dense than a simple drink that made up the calorie requirements of each individual. Not to mention, HFCS consumption has been steadily decreasing since this 2003 publication.^[12] It is a valid hypothesis to suggest that there are other mechanisms by which fructose’s negative effects are balanced by the body via nutritional sources, and that consuming natural sources (and in certainly more moderate amounts) would lead to a more desirable outcome in these patients.

In fact, there are studies showcasing the fact that while fructose does change certain compositions of the blood, notably VLDL-triglycerol, it did not affect insulin sensitivity and slightly affected serum insulin.^[23,24] It is known that increasing VLDL-triglycerol can be an issue, however, the primary issues are associated with the process of oxidation of the LDL lipoprotein, which can be reduced by dietary patterns such as limiting polyunsaturated fat intake.^[25] Again, more support for a low-fat--specifically limiting PUFA--diet.

In fact, before the concerns listed above arose, there were several studies in the later 80s and 90s that found that far more moderate fructose doses were well-tolerated among type II diabetic patients, and that there were benefits in improving glycemic control anywhere from a longer 3 to 6 month period (the extent of the studies provided).^[26,27,28] Improving glycemic control essentially means that these type II diabetic patients’ bodies exhibited a greater ability to control their blood sugar levels. Now, studies are mostly concerned with the issues described above. However, there is a 2019 meta-analysis that found that fructose provides a more beneficial effect in glycemic control, although some issues arose in specific foods that were processed and had fructose added, like sweetened beverages. Interestingly, however, fructose sweeteners themselves appeared to have a slightly beneficial effect in glycemic control and fasting blood glucose in substitution and addition studies.^[29] This meta-analysis explains that the source of fructose matters, and high fructose may only be particularly beneficial when a part of the overall diet, not in addition to it.

In the matter of glucose and fructose (the two simple sugars that make up most of the more complex sugars people eat), it seems that a diet high in these sugars and generally low in fat with an emphasis on increased saturated and/or monounsaturated fat may be a suitable diet for healthy humans. The reason for this is because humans—and all known organisms on Earth—share a simple sugar being the primary energy source, glucose. Glucose is oxidized (“burned” or broken down) by human cells and transformed into various molecules like ATP. ATP is the main energy source that each cell uses in the body and is required for the proper regulation of every single cell. Therefore, simple sugars that the body can burn are required for the sustainability of human life. It is possible, on a very low-carb diet (keto), that the body will burn almost entirely fat by producing its own burnable molecules called ketones, but they are not nearly as efficient of an energy source as glucose for the human body and the diet as a whole is highly unsustainable in the long-term.^[30,1]

Given that sugars in their simplest form are a requirement for all biological life, it only makes sense that a diet with an emphasis on sugar and contrary to the all-too-generalized advice to reduce sugar may be more beneficial for health.

In this next section, the benefits of sugar consumption will be outlined.

The Sweet Side of Health – The Benefits of Sugar

Excess cortisol, also known as the “stress hormone,” is potentially a major factor contributing to type 2 diabetes. This is because hormones like cortisol and adrenaline are antagonistic to insulin in the body in various ways, including reducing insulin secretion in the body and promoting insulin resistance.^[31] High cortisol levels, whether due to increased stress or other factors, reduce the body's ability to oxidize glucose, leading to less efficient energy usage. Additional factors that increase cortisol production include elevated serotonin levels, which can cause increased cortisol production. When tryptophan—an amino acid that is a part of some proteins—is consumed, it can be converted into serotonin, spiking serotonin and cortisol levels. Both serotonin and cortisol are a part of a system called the hypothalamus-pituitary-adrenal (HPA) axis, which regulates physiological stress responses. Dysregulation of this system can impact overall health, which these factors can cause.

Sugars and Stress Regulation

Sucrose (also refined sugar), being 50% glucose and fructose, interacts with this hormone system in complex ways. Sucrose has been found, in animal studies, to normalize feeding, energy balance, and stress hormone levels.^[32,33] This suggests that sugars in general may play a greater role in regulating stress than previously thought.

It’s a fact that when people are stressed, they typically tend to indulge in high-sugar foods. In fact, various human trials have found that high-carbohydrate and high-sugar foods in general reduce cortisol response to stressors, both decreasing the cortisol levels in the body and reducing the time it takes for stress to go back to baseline.^[34,35] This suggests that sugars play a role in hormone regulation in humans as well. It certainly explains this response when people are stressed. Since reducing cortisol levels can reduce the risk of insulin resistance by this pathway, then this is one way that intake of certain sugars or high carbohydrates in general may actually reduce chances of getting type II diabetes.

Glucose, as described before, is the primary molecule that the human body (and every organism originating from Earth) utilizes for energy. The brain is one of, if not the largest consumer of glucose in the body, requiring about 2/3 of the glucose circulating within the body.^[36] On average, that’s about 200g of glucose, or 800 calories of glucose daily. The brain requires this amount of glucose for optimal cognitive function, as evidenced by one 2001 trial finding that a glucose drink increased cognitive function in healthy young adults.^[37] Although previous trials had shown a glucose-induced cognitive performance boost after a fasting period,^[38] this trial separated the conditions between a fasted and non-fasted state, and still found significant results.

Honey and Its Cardioprotective Properties

Commonly, dietary advice states that one should avoid “added sugars”, which can range anywhere from high-fructose corn syrup, to cane sugar, to honey. Honey’s composition being high in fructose and glucose, has been shown to exhibit many cardioprotective properties.

Natural honey, in one 2005 study published in Journal of Medicinal Food with several experiments, found an 8% reduction in homocysteine levels and 7% reduction of CRP in the blood.^[39] For reference, homocysteine is an amino acid that breaks down proteins in the body. Elevated homocysteine levels is a risk factor for cardiovascular diseases and inflammatory conditions. CRP is a protein produced by the liver in response to inflammation in the body and is therefore a marker of how severe inflammation is within the body. The fact that honey lowers both is significant, as it may have various other health benefits not measured in this study.

A 2014 review on honey found that honey administration in various studies generated an anti-carcinogenic effect, with tumor sizes decreasing and inducing apoptosis (cell death) in cancer cells.^[40]

Honey has a host of other benefits along with displaying an anti-estrogenic effect (high estrogen levels can cause issues in every human) such as being an antioxidant. All of this suggests that honey ingestion itself is extremely beneficial for healthy individuals and may be suitable for therapeutic use in for type 1 (in part) and type 2 diabetics.

It is anti-inflammatory, anti-carcinogenic, anti-estrogenic, and, as described in the 2005 study, can promote a much more moderate insulin response compared to other sugars.^[39,40]

Fructose and Glycemic Control

As described before, moderate doses of fructose have been found to increase glycemic control in diabetic patients. This is one of the potential benefits of fructose supplementation.

One 6-week study published in 2010 found that a diet containing moderately high amounts of natural fructose sources (50-70g per day) experienced significant weight loss, whereas the low-fructose group at <20g per day experienced weight loss, but less significant. These fructose diets also appeared to have a beneficial effect on insulin resistance, uric acid, and fat percentage compared to baseline.^[41] This study, combined with other evidence discussed before, suggests that high amounts of fructose from natural sources pose little health risks, and in fact may have beneficial effects in a well-balanced diet. In fact, considering how these simple sugars are metabolized, it would make sense that they could potentially contribute to an increase in metabolic rate, which would result in greater weight loss as seen here.

Finding the Right Balance - Conclusion

Many studies referenced in this article involved either supplementing diets with specific types of sugar or replacing parts of the diet with them. While negative effects of sugar are often highlighted, much of the research relies on overly simplistic methods or unrealistic doses of isolated sugars (aside from glucose). In the context of a balanced diet, simple sugars (including certain added sugars) have demonstrated numerous benefits. These include supporting HPA hormone regulation (sucrose), reducing cortisol levels (high carbohydrates/sucrose), enhancing cognitive and memory function (glucose), decreasing inflammation (honey), exhibiting anti-cancer properties (honey), and even aiding healthy weight loss (fructose). These findings align with the fact that the body metabolizes carbohydrates and sugars into glucose, its primary energy source.

There’s a need to reevaluate our understanding of sugar, either to validate current dietary guidelines or to create more nuanced recommendations. Sugar is not the villain it's often portrayed to be; in its natural forms, it can be safely enjoyed by healthy individuals. In fact, certain sugars may hold therapeutic potential for managing conditions like diabetes and other health issues. While some processed sugars like high-fructose corn syrup should be consumed with caution, sugar as a whole is far less harmful than commonly believed and deserves a fairer perspective.

Citations

[1] Rasch, Cara. "Consumer Demand for Keto, Paleo, and Low-Carb Lifestyles." Freedonia Group, 31 Oct. 2023, www.freedoniagroup.com/blog/consumer-demand-for-keto%2C-paleo%2C-and-low-carb-lifestyles.

[2] Li, Y. (2004). China: An emerging sugar super power. Sugar Tech, 6(4), 213–227. doi:10.1007/bf02942501.

[3] "Sugar in TCM: A Spoonful of Sugar Makes The Chinese Medicine Go Down." ActiveHerb, 20 Sept. 2024, www.activeherb.com/blog/sugar-in-tcm-a-spoonful-of-sugar-makes-the-chinese-medicine-go-down.html.

[4] "Ancient Trade Items." Nabataea, www.nabataea.net/explore/travel_and_trade/ancient-trade-items/. Accessed Jan. 2025.

[5] Karamanou, Marianna et al. “Milestones in the history of diabetes mellitus: The main contributors.” World journal of diabetes vol. 7,1 (2016): 1-7. doi:10.4239/wjd.v7.i1.1.

[6] "Diabetes Mellitus." American Psychological Association, 19 Apr. 2018, dictionary.apa.org/diabetes-mellitus.

[7] Yudkin, John. Pure, White and Deadly. Problem of Sugar. Penguin, 1988.

[8] "Saturated Fat." American Heart Association, 23 Aug. 2024, www.heart.org/en/healthy-living/healthy-eating/eat-smart/fats/saturated-fats.

[9] Truthition Team. "Saturated Fats: The Nutrient They Were Wrong About." Truthition, Jan. 2025.

[10] Detrano, Joseph. "Sugar Addiction: More Serious Than You Think." Rutgers, www.alcoholstudies.rutgers.edu/sugar-addiction-more-serious-than-you-think/. Accessed Jan. 2025.

[11] Russo, Elisa et al. “Fructose and Uric Acid: Major Mediators of Cardiovascular Disease Risk Starting at Pediatric Age.” International journal of molecular sciences vol. 21,12 4479. 24 Jun. 2020, doi:10.3390/ijms21124479

[12] Truthition Team. " Polyunsaturated Fatty Acids: The Real Killer I" Truthition, Jan. 2025.

[13] Hue, Louis, and Heinrich Taegtmeyer. “The Randle cycle revisited: a new head for an old hat.” American journal of physiology. Endocrinology and metabolism vol. 297,3 (2009): E578-91. doi:10.1152/ajpendo.00093.2009.

[14] Khosla, Uday M et al. “Hyperuricemia induces endothelial dysfunction.” Kidney international vol. 67,5 (2005): 1739-42. doi:10.1111/j.1523-1755.2005.00273.x.

[15] Roy, Roman, et al. "Dysfunctional and Dysregulated Nitric Oxide Synthases in Cardiovascular Disease: Mechanisms and Therapeutic Potential." International Journal of Molecular Sciences, vol. 24, no. 20, 2023, doi:10.3390/14220067.

[16] Guy C. Brown, Vilmante Borutaite, Nitric oxide and mitochondrial respiration in the heart, Cardiovascular Research, Volume 75, Issue 2, July 2007, Pages 283–290, https://doi.org/10.1016/j.cardiores.2007.03.022.

[17] Tan, Philip K., Sha Liu, and Jeffrey N. Miner. "The URAT1 Uric Acid Transporter Is Important in Uric Acid Homeostasis and Its Activity May Be Altered in Gout Patients and in Drug-Induced Hyperuricemia." American College of Rheumatology, 2014, acrabstracts.org/abstract/the-urat1-uric-acid-transporter-is-important-in-uric-acid-homeostasis-and-its-activity-may-be-altered-in-gout-patients-and-in-drug-induced-hyperuricemia/.

[18] Julson, Erica. "16 Foods That Are High in Niacin (Vitamin B3)." Healthline, 23 Mar. 2023, www.healthline.com/nutrition/foods-high-in-niacin.

[19] Kunik, Kelsey. "20 Foods High in Fructose (That Aren't Only Fruits and Vegetables)." Livestrong, 2 Mar. 2023, www.livestrong.com/article/30454-list-foods-high-fructose/.

[20] Regner, Leah. "Understanding Salicylates: Foods, Medicines, and Who Should Avoid Them." Naturally with Leah, 4 Apr. 2024, www.naturallywith.com/salicylates-food-medicine-supplements/.

[21] Stanhope, Kimber L et al. “Consuming fructose-sweetened, not glucose-sweetened, beverages increases visceral adiposity and lipids and decreases insulin sensitivity in overweight/obese humans.” The Journal of clinical investigation vol. 119,5 (2009): 1322-34. doi:10.1172/JCI37385.

[22] Bray, G. A., Nielsen, S. J., & Popkin, B. M. (2004). Consumption of high-fructose corn syrup in beverages may play a role in the epidemic of obesity. The American Journal of Clinical Nutrition, 79(4), 537–543. doi:10.1093/ajcn/79.4.537.

[23] Bantle, J. P., Raatz, S. K., Thomas, W., & Georgopoulos, A. (2000). Effects of dietary fructose on plasma lipids in healthy subjects. The American Journal of Clinical Nutrition, 72(5), 1128–1134. doi:10.1093/ajcn/72.5.1128.

[24] Lê, K.-A., Faeh, D., Stettler, R., Ith, M., Kreis, R., Vermathen, P., … Tappy, L. (2006). A 4-wk high-fructose diet alters lipid metabolism without affecting insulin sensitivity or ectopic lipids in healthy humans. The American Journal of Clinical Nutrition, 84(6), 1374–1379. doi:10.1093/ajcn/84.6.1374.

[25] Truthition Team. " Polyunsaturated Fatty Acids: The Real Killer I" Truthition, Jan. 2025.

[26] Osei, K et al. “Metabolic effects of fructose as a natural sweetener in the physiologic meals of ambulatory obese patients with type II diabetes.” The American journal of medicine vol. 83,2 (1987): 249-55. doi:10.1016/0002-9343(87)90693-0.

[27] Osei, K, and B Bossetti. “Dietary fructose as a natural sweetener in poorly controlled type 2 diabetes: a 12-month crossover study of effects on glucose, lipoprotein and apolipoprotein metabolism.” Diabetic medicine : a journal of the British Diabetic Association vol. 6,6 (1989): 506-11. doi:10.1111/j.1464-5491.1989.tb01218.x.

[28] Bantle, J P et al. “Metabolic effects of dietary fructose in diabetic subjects.” Diabetes care vol. 15,11 (1992): 1468-76. doi:10.2337/diacare.15.11.1468.

[29] Choo, V. L., Viguiliouk, E., Blanco Mejia, S., Cozma, A. I., Khan, T. A., Ha, V., … Sievenpiper, J. L. (2018). Food sources of fructose-containing sugars and glycaemic control: systematic review and meta-analysis of controlled intervention studies. BMJ, k4644. doi:10.1136/bmj.k4644

[30] Zilberter, Yuri, and Tanya Zilberter. "Glucose-Sparing Action of Ketones Boosts Functions Exclusive to Glucose in the Brain." eNeuro, 9 Nov. 2020, doi:10.1523/ENEURO.0303-20.2020.

[31] Schernthaner-Reiter, Marie Helene, et al. "The Interaction of Insulin and Pituitary Hormone Syndromes." Frontiers in Endocrinology, vol. 12, 2021, doi:10.3389/fendo.2021.626427.

[32] K. D. Laugero, M. E. Bell, S. Bhatnagar, L. Soriano, M. F. Dallman, Sucrose Ingestion Normalizes Central Expression of Corticotropin-Releasing-Factor Messenger Ribonucleic Acid and Energy Balance in Adrenalectomized Rats: A Glucocorticoid-Metabolic-Brain Axis?, Endocrinology, Volume 142, Issue 7, 1 July 2001, Pages 2796–2804, https://doi.org/10.1210/endo.142.7.8250.

[33] Laugero, K. D. (2008). A New Perspective on Glucocorticoid Feedback: Relation to Stress, Carbohydrate Feeding and Feeling Better. Journal of Neuroendocrinology, 13(9), 827–835. doi:10.1046/j.1365-2826.2001.00706.x.

[34] Tryon, M. S., Stanhope, K. L., Epel, E. S., Mason, A. E., Brown, R., Medici, V., … Laugero, K. D. (2015). Excessive Sugar Consumption May Be a Difficult Habit to Break: A View From the Brain and Body. The Journal of Clinical Endocrinology & Metabolism, 100(6), 2239–2247. doi:10.1210/jc.2014-4353.

[35] Markus, R et al. “Effects of food on cortisol and mood in vulnerable subjects under controllable and uncontrollable stress.” Physiology & behavior vol. 70,3-4 (2000): 333-42. doi:10.1016/s0031-9384(00)00265-1.

[36] Peters, A. (2010). The selfish brain: Competition for energy resources. American Journal of Human Biology, 23(1), 29–34. doi:10.1002/ajhb.21106.

[37] Sünram-Lea, S I et al. “Glucose facilitation of cognitive performance in healthy young adults: examination of the influence of fast-duration, time of day and pre-consumption plasma glucose levels.” Psychopharmacology vol. 157,1 (2001): 46-54. doi:10.1007/s002130100771.

[38] Foster, J K et al. “Glucose and memory: fractionation of enhancement effects?.” Psychopharmacology vol. 137,3 (1998): 259-70. doi:10.1007/s002130050619.

[39] Al-Waili, N. S. (2004). Natural Honey Lowers Plasma Glucose, C-Reactive Protein, Homocysteine, and Blood Lipids in Healthy, Diabetic, and Hyperlipidemic Subjects: Comparison with Dextrose and Sucrose. Journal of Medicinal Food, 7(1), 100–107. doi:10.1089/109662004322984789.

[40] Erejuwa, Omotayo O et al. “Effects of honey and its mechanisms of action on the development and progression of cancer.” Molecules (Basel, Switzerland) vol. 19,2 2497-522. 21 Feb. 2014, doi:10.3390/molecules19022497.

[41] Madero, M., Arriaga, J. C., Jalal, D., Rivard, C., McFann, K., Pérez-Méndez, O., … Lozada, L.-G. S. (2011). The effect of two energy-restricted diets, a low-fructose diet versus a moderate natural fructose diet, on weight loss and metabolic syndrome parameters: a randomized controlled trial. Metabolism, 60(11), 1551–1559. doi:10.1016/j.metabol.2011.04.001.