Fruit Juice, Soda Pop, Sugar, Honey, Maple Syrup, Agave--Avoid Them All
If Mary Poppins hadn't supplied the spoonful of sugar, maybe her charges wouldn't have needed the medicine in the first place!
Dr. Robert H. Lustig, "Just a spoonful of sugar helps the blood pressure go up," Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1497-9.
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Two years ago I decided to "mostly" ditch the sugar from my life. After "winning" a raffle of three giant boxes of truffles at a work Christmas party, and then downing more of them than I'm embarrassed to admit, I decided to just swear off sugar. But, mostly it was about ditching all the saturated fat that's always wrapped up in the kind sugar I craved--like chocolate chip cookies, "heart healthy" 85% cacao bars, and chocolate desserts.
Beyond all the empty calories & fat wrapped up in my kind of sugary faves--two years ago I had no idea how bad sugar really was--but I do now.
Right now I'm on a "Bitter Truth of Sugar" High. And I'm hoping to convince you all to find the 90 minutes it will take to watch Dr. Robert H. Lustig's eye-opening University of California at San Francisco's "Mini-Medical School" lecture, "Sugar: The Bitter Truth". Sure, it's a huge amount of time to stare at a computer screen, but it just may change your life--or at least what you put into your mouth. And I guarantee it will change what you feed your children or grandchildren. Take a measly 15 minutes each day to watch it, bit by bit. You won't regret it.
Honestly, I don't even know where to start when it comes to sharing Dr. Robert H. Lustig's story about how bad sugar is for us. I first listened to him on my recent flight to Florida via a podcast of his interview with Joe & Terry Graedon on the People's Pharmacy. I quickly followed that up on Sunday by watching his UC-SF mini-med school lecture, thanks to a recommendation from a physician blog reader in Michigan. Thank you, Dr. H!
It's not a simple story to tell. It's like trying to condense a 1000 page "who-done-it", that's a story of political intrigue, corporate greed, addiction, dietary indiscretion, consumer ignorance, complicated physiological biochemistry, and medical research all rolled into one. The story includes Richard Nixon, the 1973 Agricultural Secy'. Earl Butz, the sugar & farm lobby, presidential elections, the food industry, brain chemistry, liver metabolism, our taste buds and more--all conspiring to make us fat and sick. Oh my! Two years ago I wrote about a part of this story in: King Corn - and the Real Story Behind the Demise of the Family Farm, the Rise in Obesity, Type II Diabetes & Fast Food.
Bottom Line: Sugar has proved to be a major villain in our escalating rates of obesity, type 2 diabetes, hypertension, dental caries, inflammation, non-alcoholic fatty liver disease, insulin resistance, and metabolic syndrome--to name a few. And it's not just because sugar is empty calories--it goes way beyond that! It's a downright toxic substance--with adverse affects pretty similar to those of alcohol! No matter what kind of sugar you can think of, it's all fructose--and fructose is a poison. And I thought fructose was harmless substance! Here's the deal: once fructose is extracted from a plant's fiber--it becomes bad news.
Lustig's Mantra: When G-d made the poison, it was packaged with the antidote--like fruit--which is fiber and juice.
Wherever there's fructose in nature, there's way more fiber. The only exception is honey, and that's guarded by bees! G-d made it hard to get "fructose sugar" without eating the fiber.
The problem is: Man figured out a way to extract it! Not only has man made it easy to get--but the food industry has made it impossible to avoid!
Pre-1975, before the invention of high-fructose corn syrup, Americans ate 63 pounds of sugar a year--today we're up to 156 pounds. That's 22 teaspoons a day. The American Heart Association's 2009 Scientific Statement recommends the maximum to be 6 teaspoons for women--9 teaspooons for men.
Who Is Dr. Robert H. Lustig and Why Should We Believe What He Says?
Lustig has the credentials, the clinical and research experience to be an expert on how sugar damages our bodies. He's a professor of clinical pediatrics in the Division of Endocrinology at the University of California, San Francisco, where he directs the Weight Assessment for Teen and Child Health (WATCH) Program. His specialty is neuroendocrinology, with a specific emphasis on the regulation of energy balance by the central nervous system. He's working with overweight and obese kids who either have type-2 diabetes--or are on their way to getting it. As a neuroendocrinologist he's an expert in the appetite and satiety hormones of ghrelin and leptin.
He's also a major player in the field of pediatric obesity & has published numerous articles in top medical journals. Click here for his bibliography. Not to mention that a large UK study, just published online yesterday in the American Heart Association's journal, Hypertension, "Sugar-Sweetened Beverage, Sugar Intake of Individuals, and Their Blood Pressure. International Study of Macro/Micronutrients and Blood Pressure", backs him up on the association of sugar to hypertension. Lustig knows what he's talking about.
If you aren't seeing the video click here.
What's So Bad About Sugar?
What Do I Mean By Sugar?
- Table sugar made from beets or sugar cane.
- High-fructose corn syrup made from corn--the kind that's in soda pop & most processed foods.
- Honey made from bees.
- Agave made from succulents.
- Maple syrup made from the sap of maple trees.
- Fruit juice of any kind--even the 100% real stuff. Yes, that includes o.j. All fruit juices.
They're all the same. They are sucrose--which is 1/2 fructose, and 1/2 glucose.
Glucose is good. It's the energy of life. All carbohydrates are glucose--the starches, the pastas, the beans & legumes. It gives us energy--it can be used by every cell and every organ in our body.
Fructose, on the other hand, is bad news once it's separated from the fiber of whole fruit or plants. It's completely different from glucose.
Listen closely: fructose is metabolized ONLY in the liver and it's metabolized just like fat. No other organ in the body can metabolize it--and instead of generating energy--it ends up generating FAT. That's right, the liver turns fructose straight into fat cells--and when your liver generates fat, it becomes insulin-resistant (hepatic insulin-resistance). So, if you're eating a high-sugar diet--you might as well say you're on a high-fat diet.
What's so bad about insulin-resistance? When the liver becomes insulin-resistant--it drives up your insulin levels, so instead of burning the energy from the food you are eating, you store even more of it as fat in your cells, driving you to eat even more. Here's why. As Lustig explains it, sugar/soda pop/juice/dessert-eating Americans are releasing about twice the insulin than they were 25 years ago--and all that extra insulin is driving the food we eat to get stored as more fat, which makes us even more insulin-resistant.
"The higher the insulin goes, the more food you want to eat & the less well your brain is able to get the signal from your gut that you're full. Leptin, the satiety hormone, is effectively disabled in the presence of insulin-resistance, and you can blame that on all the sugar/fructose that the liver turned into fat.
The calories-in calories-out theory doesn't work in insulin-resistance or when you're eating too much "sugar/aka fructose"--because once the liver turns the fructose into fat cells you just aren't going to be able to burn all your calories, because they're trapped in your fat cells--unless you want to starve yourself. And no one's about to do that.
When leptin isn't being released the way it's supposed to--as happens in insulin-resistance--your brain doesn't know you've already had enough to eat. It thinks you're starving--so you just eat more. You end up in a vicious cycle of consumption and then disease." (Lustig, People's Pharmacy interview)
The Fructose-Cholesterol Connection: When it comes to LDL, the low-density lipoproteins, there are two types: a "neutral" one & a bad one. The harmless one is large, fluffy, buoyant, and kind of bounces around. It's just too big to get into the endothelial lining of your blood vessels and start the whole atherosclerosis & inflammation process. But, the small-dense ones are the ones to worry about, because they can burrow right under the endothelium--and according to Lustig: Fructose is the biggest generator of small-dense LDL's! Just ditch the sugar if you care about your arteries & blood vessels!
Note: In typical cholesterol tests the LDLs are measured with one number, with no differentiation between the fluffy (neutral) & the small dense (bad) kind. To get a reading on what kind of lipid particles you have, you need an NMR-lipoProfile test. And don't forget about the triglycerides--they're also driven up by sugar.
Last year research out of Emory University confirmed a statistically significant connection between sweetener consumption & lipid levels, Welsh, JA et al. JAMA, April 21, 2010 33:1490-96, "Caloric Sweetner Consumption and Dyslipidemia Among US Adults" Click here for the article.
Think the Less Processed Sugars, like Agave, Maple Syrup, Brown Rice Syrup, or Fruit Juice Are a Better Choice? Think again. Part of the Esselstyn diet includes specific instructions to avoid sugar & fruit juice--because of their connection to cholesterol--insulin-resistance-- and type-2 diabetes. Esselstyn even advises his patients to limit whole fruit to 2 pieces a day--or 3 if that includes berries or grapes. Too bad, so many plant-based no-oil advocates (myself included) don't think twice about using what we think are better sugar choices--like agave or maple syrup. Sorry to say, they're just as bad as high-fructose corn syrup, as far as the liver is concerned!
The Fructose-Disease Connection--Just a Few for Starters
- Ever hear of Advanced Glycation End Products (AGE's)? I hadn't. You know how sugar or maple syrup are terrific browning agents for food? Well, that's an example of AGE's-and the sugar we eat does something similar once it's inside of our bodies. Fructose is 7 times more likely to form AGE's--the nasty byproducts that are implicated in aging, cardiovascular disease, Alzheimer's, stroke, inflammation, wrinkles (damaged collagen), and the cross-linking of proteins that can cause cancer. Think of AGE's as browning agents for your arteries' walls.
- Ghrelin dysfunction. Fructose cannot suppress ghrelin--the hunger hormone--you keep on feeling hungry when you eat sugar. Ever notice how you can't stop with just one cookie--you always want more?
- Leptin dysfunction. Fructose can't stimulate leptin, either--the satiety hormone that says, "You've eaten enough. Stop!"
- Metabolic syndrome. Chronic fructose exposure promotes the metabolic sydrome. No surprise here.
- Hypertension. Fructose makes a waste product that increases uric acid, that blocks the enzyme our bodies need to make nitric oxide (NO), that "magic gas" that lowers blood pressure, and relaxes blood vessels. Not a good thing, at all. Check out the recent large study in Hypertension associating high blood pressure with sugar (the link's above)--or Lustig's Nov. 2010 editorial: "Just a spoonful of sugar helps the blood pressure go up" Expert Rev Cardiovasc Ther. 2010 Nov;8(11):1497-9. Sugar & hypertension--no physician had ever told me about that connection before.
- Calories turned into fat. Fructose increases a process called "Novo Lipogenesis" in normal adults--making 30% of calories from fructose turn into fat--making a high sugar diet, a high fat diet.
- Elevated triglycerides. Sugar raises triglycerides--6 days of high fructose feeding will double triglycerides!
- Liver disease. Too much sugar can cause hepatic dysfunction, also known as, non-alcoholic fatty liver disease, NASH.
- Hepatic insulin resistance. Fructose can cause liver insulin resistance--making the pancreas work harder--and causing more "food energy" to go straight into fat cells.
- Leptin resistance/insulin resistance/increased appetite
- Chronic fatigue
- Fetal Insulin resistance
- Promotes continuous consumption/Habituation/Sugar cravings, similar to addiction. For more on "sugar addiction" click here and here.
The Sugar Cure--Exercise, Fiber, Whole Foods, No Sugar, No Juice
Why is Exercise Important to Improved Insulin Sensitivity & Weight Control?
- It's not the Calorie Burn. You'd have to work-out too many hours to burn off the calories from a candy bar, juice, or dessert.
- Toned Muscles. Exercise, particularly weight-training, improves skeletal muscle insulin sensitivity--because insulin works better in strong lean muscle.
- Exercise Guidelines for Type 2 Diabetes. The latest guidelines for exercise in type-2 diabetes call for weight/strength training for 2, or ideally 3 times a week! "Exericse and type 2 diabetes: American College of Sports Medicine and the American Diabetes Association: joint position statement" Med Sci Sports Exerc. 2010;42:2282-2303.
- Stress Reduction. Exercise reduces stress and the release of the stress hormone cortisol--appetite goes down when stress goes down.
- Detoxifies Fructose. Exercise makes the body's "Citric Acid Cycle" run faster, which detoxifies fructose, improving liver insulin sensitivity--and preventing fructose from turning into fat.
Why is Fiber So Important to Insulin Sensitivity and Weight Control?
- Reduces sugar absorption. It reduces the rate of sugar/carbohydrate absorption from the gut into the blood stream--which limits the amount of fructose you'll absorb, as well as keeping the insulin levels down. If you keep that insulin level down, then you shunt less sugar into fat. Less fructose=less fat in the cells. That's why refined white flour + sugar is the worst combination.
- Makes you feel full faster. Fiber makes the food move through the intestine faster. At the end of the small intestine is a bunch of cells called Peptide YY (PYY), which regulate appetite. When PYY is released into our bloodstream it goes straight to the brain & that's the satiety signal! Once you get that "all full" signal, you're not going to eat again until the next meal. The problem is--with 22 feet of intestine that the food has to pass through before you can get that signal--that takes time--about 20 minutes. Fiber will speed up the time it takes for the food to move from the stomach to the end of the small intestine. Lustig tells his patients that they have to wait 20 minutes for seconds.
- Helps Fat Suppress Insulin Secretion. Fiber not only interferes with carbohydrate absorption, by slowing its absorption from the gut into the bloodstream, but it does the same thing for fats. Instead of absorbing all the fats in the small intestine--some of the fats will make it to the large intestine & the colon, where there's a special set of colonic bacteria (called bacteroides) that will digest those fatty acids into short-chain fatty acids--and when they get absorbed they'll SUPPRESS insulin secretion--as opposed to the long-chain fatty acids that STIMULATE insulin secretion.
- Fiber Works Three Ways. By reducing sugar absorption, making you feel full faster, and suppressing insulin--that's how fiber helps prevent type-2 diabetes and obesity.
- How much fiber do we need? The USDA says we should eat 25 grams of fiber a day. Lustig says we need 50 grams of fiber a day. Our ancestors consumed 100 grams of fiber a day. The average American gets only 12 grams of fiber a day. Any wonder that we're overweight, constipated, and insulin resistant?
Lustig's Rules for His UCSF WATCH Pediatric/Teen Patients
- Get rid of all sugared liquids! Only drink water or milk.
- Eat your carbohydrates in their whole natural form with fiber: fruit, whole grains, etc.
- Wait 20 minutes for 2nd portions
- Buy your (TV or video) screen time minute for minute with physical activity
Does it work? Yes!
Disturbing Lustig Observations:
- 6 month old babies who are obese from drinking juice
- 3 teen liver transplants performed on sugar soda drinkers at UC-SF Medical Center
- Similac infant formula has 10.3% of its calories as sucrose & 43.2% as corn syrup solids--a "baby milk shake", no different than drinking a Coke, which has 10.5% sucrose!
Lustig's Advice for Adults
1. Eat only real food, that comes from the ground.
2. No processed food, because that usually has sugar added to it--and the fiber removed--the 2 things that are driving the obesity & chronic metabolic disease epidemic.
3. Shop the perimeter of the supermarket--not the aisles. If it's in a box--it's often processed for shelf life--sugar-added, fiber-removed.
4. Eat only whole-grain bread--that's not the same as whole wheat bread--the fiber is in the whole grain--and the starch stays in the husk in the kernel, which slows the sugar & glucose absorption, so your insulin stys low.
5. A calorie is not a calorie--and fructose is NOT glucose.
6. Fructose is a chronic hepatoxin--It's alcohol without the "buzz".
Lustigism: If you reduce the rate of carbohydrate absorption in your gut by eating a high fiber diet--the bacteria will get to it. Which means, in life you have just two choices: It's fart or be fat. The decision is yours!
Any changes all this means for me? Not much. I eat plenty of fiber and exercise already. Sugary desserts are rare treats for me. But, I always eat wedding cake! Haven't had sugared soda pop in years. I'll still use a little maple syrup, agave, or even brown sugar for occasional recipes. I sweeten my coffee with unadulterated stevia. I'll think twice about ordering a pina colada, a margarita, or a mojito! But I'm sure I'll still have one a few times a year. I am going to eliminate pure juice from my Green Smoothies. And I definitely will try hard to resist feeding my grandson cookies & ice cream.