Sugar: What You Should Know

Sugar is always making it into the news—and into products on grocery store shelves.  It, apparently like sex, sells. As a result, we are bombarded with conflicting and even controversial information about sugar every day. We love it, and at the same time, we hate it. One minute dietitians (RDs) are telling us “everything in moderation.”  How can we not love that–permission to eat what tastes good? The next minute, we hear how Americans should banish sugar from our lives forever.  And oh, how we hate that! Sugar is the ultimate love-hate relationship! What gives? Sugar tastes so good. How could it be so bad?

Well, let’s discuss all things sugar. In this post, I will do the following:

We Are Simply Eating Too Much Sugar
American women eat an average of 15 teaspoons of sugar each day, while men eat 21 teaspoons (it likely differs because men eat more, in general).1 Children eat an even higher percentage of added sugar than adults each day, and surprisingly, the majority of sugar is coming from store-bought foods eaten at home.2 These numbers are likely significantly lower than actual intakes, because they are estimates from 24 hr recalls, which are notoriously unreliable. Yet, even these numbers far surpass any current recommended limits (see chart), which I believe could even be falsely high due to sugar industry lobbyists influencing them. After all, a 20-ounce soda alone provides a day’s worth of sugar (about 15 teaspoons of sugar) according to all these current guidelines. I’d say soda companies have a vested interest in the science and policies of sugar, wouldn’t you?

Most concerning is the fact that people haven’t always eaten sugar in these proportions. In fact, for the great majority of human history, before sugar and flour became easily refined and cheap during the industrial revolution, we ate far less sugar and carbohydrate.  Americans have increased our sugar intake more than 40-fold since the American Revolution!6

Not everyone agrees on the cause, but all researchers agree that people grow fatter and sicker after adopting the “Western” diet and/or lifestyle. This has occurred in many populations around the globe, and it seems to happen within only two generations. Many argue that we grow fatter and sicker because of increased total calories, which have no doubt increased over time. But even if refined sugar and flour aren’t specifically to blame  (although many experts, including me, would argue that they are), it’s hard to argue that these excess calories are coming from anything other than refined sugar and flour. Yes, some increased calories are coming from the fat in our ice cream and other processed foods, but we probably wouldn’t be eating these foods if they didn’t have the added sugar.

Since the beginning of the low-fat diet craze that started in the early 1980’s, added sugar, and carbohydrate intake in general, has dramatically increased (food companies had to replace the fat with something) and so have many diseases.32  It appears that many chronic diseases such as obesity, diabetes, metabolic syndrome, heart disease, Alzheimer’s, and cancer are negatively associated with sugar intake.6-31

Soda often takes the brunt of the blame for added sugar intake because 1) Americans drink a lot of it, and 2) there are very few foods that are pure sugar like soda is, which makes it easier to identify and study than the various types of sugar in other mixed-nutrient foods. 6-31   I’m not a soda fan, but soda does not appear to be any worse than any other source of added sugar. The problem is it all adds up. Sometimes certain sugars are described as “better” than others. Particularly, there has been a lot of misguided focus on high fructose corn syrup (HFCS) as the “worst” added sugar, and honey, agave or maple syrup are often described as “better.” The bottom line is this: existing research shows (and in my opinion future research will continue to show) excess sugar of any kind appears to be harmful to your health—which is the first compelling reason we should limit all types of sugar–and FYI, sugar has 50+ names.

  1.  Sugar is Linked to Many Diseases

This is my first point deliberately—it’s actually many related points. Just look at this long list of diseases associated with sugar. It’s shocking, and I promise I don’t mean to scare you as much as educate you. But frankly, I find it a little scary. The good news: eating less sugar may improve your health!

  • Sugar provides excess calories and increases levels of the hormone insulin, which promotes fat storage and leads to obesity.
  • Chronically elevated levels of insulin are linked to insulin resistance, type 2 diabetes, and metabolic syndrome, all of which increase your risk for heart disease.
  • Sugar contributes to increases in blood levels of circulating fatty acids (dyslipidemia), which increases your risk for fatty liver disease and heart disease.
  • Sugar also contributes to hypertension, which may increase your risk of heart disease, stroke, and renal failure.
  • Chronically elevated levels of blood glucose and insulin levels are linked to cancer, including endometrial, esophageal, pancreatic, kidney, gallbladder, breast and colon cancer.
  • Chronically elevated levels of blood glucose and insulin levels are also linked to Alzheimer’s disease.

Further, there is research linking nearly all of these “Western” diseases with each other. Obese people are more likely to develop diabetes. People with diabetes are at higher risk for heart disease. Cancer occurs more frequently in people who have diabetes and obesity.  Alzheimer’s has been dubbed “type 3 diabetes” by many researchers.30  Is sugar part of the connection? It is not completely clear. It is very complicated and difficult to study to be sure what is causing the associations. And your genetics most certainly play a part. But let’s discuss what happens in your body when you eat sugar.

Of course, as you know, there are different types of sugar. But when they are metabolized, many break down into varying amounts of glucose and fructose in the body. The body handles both of of these differently.

Glucose enters the blood stream, increases your blood sugar, and your pancreas pumps out the hormone insulin to escort the glucose into the cells, where it can be used for energy. To be clear, insulin itself is not the problem. In fact, you can’t live without insulin; it is just the catalyst for increased fat storage in response to excess sugar intake.  Some glucose is used directly for energy, some  is stored as glycogen in the muscles and liver, and some is converted and stored as fat. So, a high sugar diet may lead to obesity, which then puts you at increased risk for metabolic syndrome, diabetes, heart disease and some cancers.

Many types of added sugar, including HFCS, white table sugar (sucrose), honey, maple syrup and agave also break down into about half fructose and half glucose. Fructose is the natural sugar found in fruits, and it should be noted it would be difficult to get too much by eating fruit alone.  But when you eat unnatural amounts of fructose from various sources of added sugar, fructose can be converted into fat directly in the liver, and this process also produces uric acid, which can lead to gout and possibly hypertension. So, a high sugar diet may also increase your risk of gout,  hypertension, and dyslipidemia, which further contributes to metabolic syndrome, obesity, diabetes, and fatty liver disease.

The metabolic pathways that occur when we eat various types of sugar are also thought to cause inflammation, especially when you have abdominal fat, which may be part of the process by which sugar is linked to certain diseases, especially cardiovascular disease.31 More research is needed, but the arrow is pointing in the right direction: cutting out all forms of added sugar and refined grains (which break down and are metabolized much like sugar) and eating mostly easy, real food can only help.

  1. Sugar Provides No Essential Nutrients

Excuse me for restating the obvious—but you do not need sugar, and it takes the place of more nutritious real foods.  This is the second reason I urge you to limit your sugar intake. It provides energy (that is, calories, usually in excess of what you need), but no other nutrients. That’s what we RDs mean by “empty calories.” Yes, we have been saying this for yeeeeears. But please don’t gloss over it—it’s what I like to call a “common sense verification of science.”  In other words, does the science make sense?  Well, yes, indeed, it does. There’s never been a research study or a dietary guideline that has suggested we need to eat any amount of refined sugar regularly. (I know, right? Duh. And it’s crazy to say “never” and “research” in the same sentence.)

If you want to get even more technical, carbohydrates from foods are not exactly necessary either. There are “essential amino acids” (protein) and “essential fatty acids” (fats) that our bodies cannot make, so we need to eat them from foods. But your body is technically able to make the carbohydrate it needs, specifically glucose from protein or even from glycerol, which is released in fatty acid metabolism.33 And your brain is able to function quite well on mostly ketones, which are produced when you burn fat for energy (hence, the popular “keto” diet.)  Of course, that’s another post…or several!  But I digress. For most people, this discussion is moot because our food supply provides more than enough carbohydrates for our bodies…even if you’re eating mostly real foods, which is the best way to get your carbohydrates because then you also get beneficial nutrients and phytochemicals that only whole foods provide.

Are you with me so far? We are eating too much sugar, it negatively affects your health, and it provides nothing your body needs. Still need another reason to lower your sugar intake?

  1. Sugar May Be Addictive

It is not my intent to minimize how hard it is to cut out sugar—it does take some getting used to. It even requires some will power.  But that might be putting it mildly, for some people. Although it’s controversial, some scientists suggest sugar may be addictive.34-36 Addiction or not, the jury is out, but sugar tends to lead to continued cravings for some people. If you’re one of them and you’ve ever tried cutting it out, you know the feeling. Sugar hovers in your forethought, almost haunting you, even after you’ve eaten a meal and should feel satiated. Maybe you need that piece of chocolate after your meal? You’re used to that feeling of satisfaction that serotonin triggers in your brain after you eat sugar.  We are learning more and more that our gut hormones are also intricately involved in appetite, satiety and sugar metabolism. Some people can have a little sugar and be fine. Some people can even have a lot. Some people find it easier to try to avoid sugar because even having a little leaves them wanting more and more. I suspect there’s something in that, beyond just will power.

However, as hard as it is to avoid sugar—both due to its prevalence in our food supply and the possibility it may be addictive—the cravings can be overcome with time, the right mindset—and by sticking with real foods. The body is able to adjust to lower sugar intake in a few weeks, and it gets easier, so don’t give up and give it enough time!

Sugar: Putting the Science into Real-Life Perspective

To summarize this evidence-based perspective and put it into practical terms, I will ask you the very questions I consider when deciding what to eat and feed my family:

  1. What if you have genes that are prone to obesity? Or diabetes? Or heart disease? Or cancer? Or Alzheimer’s? In other words, you may not know you have these genes, but what if these health problems run in your family, and therefore, you might also be more susceptible to them?

and

  1. What if our food supply is providing too much refined carbohydrate and sugar, often in hidden places, so that it’s nearly impossible to eat within the recommended guidelines (if you’re not purposely trying to avoid sugar and refined carbohydrates)? (Or worse still, what if the guidelines aren’t low enough for optimal health, even if you are eating within the recommendations?)

and

  1. What if sugar and/or refined carbohydrates may be addictive?

Add together these very real (evidence-based, although not all conclusive as of yet) possibilities and ask yourself this final question:

Do you want to be a slave to the high-sugar, highly-refined processed foods you eat, so that eating them makes you crave more and sabotages your health?

I, for one, don’t. So, I choose easy, real food. Every. Single. Day. And I personally find that once you limit sugar, it’s easier to eat for your health and most surprisingly, it’s equally satisfying. Do I deviate sometimes? Yes. I just got back from a week at Walt Disney World. I still tried to limit my carbohydrates to mostly real foods, but I had some dessert foods. You know how moderation makes me cringe, but that’s my kind of moderation–a very small portion of one or two of my favorites when I’m on vacation once or twice a year!

Real Food: a Work Around?

You know how I love simplicity. And real food. And most importantly–life itself (hence the extreme value I place on health.) So, while we are continually waiting for more conclusive research, I do not believe you need to count grams of sugar or carbohydrates. The simplest way to limit sugar is to choose real, unprocessed, whole foods.  Added sugars are not going away from our food supply. And public health policies or guidelines are not going to dramatically change anytime soon either. (Well, the Nutrition Facts Label is, but you can read what I think about that here.)  Rather, I see it as a “work around” to these fundamental problems if you choose to be mindful of your body and intentional with real-food fuel.  The quantity and the quality of the carbohydrates you eat will be vastly improved when you choose real, whole foods and you will drastically cut added sugars.

You might worry it will take lot of time looking for sugar in products, researching healthier options, and cooking from scratch. But I would argue lowering my sugar intake has even simplified my life. I share here How Slashing Sugar Can Simplify Life.

Final Thoughts

Slashing sugar (and refined carbohydrates) in your diet can be a big adjustment, I realize. We are surrounded by foods not fit for healthy lifestyles. But choosing better food doesn’t have to be complicated or a negative experience of deprivation. You are changing your health for the better, going back to the basics and simplifying your life, and enjoying foods as nature intended them. With the right mindset about food (which science shows you have control over, so think positively…more on that later), I believe it can be a very rewarding experience. Don’t aim for perfection, but aim for improvement with consistent healthy habits. You can retrain your brain and your body. You have nothing to lose–except possibly some excess weight and/or some health risk–giving it a try.

Start with these Tips for Slashing Sugar. I’d love to hear how it goes for you…please share your comments and tips if you’ve been trying to cut out sugar!

References

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