The Bittersweet Truth About Sugar

By Dr. Emilia A. Ripoll, M.D.

Sugar 2If you’ve ever visited Dr. Joseph Mercola’s Web site and viewed any of his articles on sugar, or seen Dr. Robert Lustig’s The Skinny on Obesity series on You Tube, then you already have a good understanding about how toxic sugar is and how America’s addiction to it has hijacked our national health.

Both Mercola and Lustig focus on fructose being one of the main culprits behind the decline in the health of Americans and the rampant rise in diseases linked to obesity (heart disease, diabetes, hypertension, and cancer). I agree, and I would like to broaden the discussion to include simple carbohydrates such as sugar and other sweeteners.

As I mentioned in a previous article, “What’s the Best Diet?”, it’s not that carbohydrates are inherently bad. They’re not. The real villains in the consumption of simple carbohydrates are the rise in blood sugar, which is followed by increased levels of the hormones insulin and leptin.

The aging and inflammatory effect on our bodies caused by elevated levels of insulin and leptin are both sad and preventable. As a physician, I feel compelled to inform my patients and friends how to avoid these pitfalls and enjoy fuller and healthier lives.

Let’s take a look at five prevailing myths about sugar and see how debunking these myths liberates you from old unhealthy habits.

Myth #1: A Calorie Is a Calorie

A calorie is NOT a calorie.

The antiquated “calories-in versus calories-out” model that treats all calories as equal is thoroughly dismantled and discredited by Gary Taubes in his best-selling book, Why We Get Fat: And What to Do About It. I highly recommend this book to anyone who is interested in health or has ever struggled with their weight.

As Taubes points out, different amounts of the fats, proteins, and carbohydrates may all contain the same number of calories, but these calories are not metabolized the same way in the body. This often misunderstood, yet extremely important, concept is the key to understanding why diet is so important to your health. As Lustig puts it, different foods may be “equi-caloric, but not equi-metabolic.”

Most carbohydrates are metabolized with the help of insulin. (Fructose is metabolized though a different pathway — more on that in a minute — and green leafy vegetables generally have such a low glycemic index that they require only minute amounts of insulin). I should also add that insulin is not normally involved with protein or fat metabolism.

For example, let’s use the simplest carbohydrate your likely to eat: refined sugar (sucrose). Sucrose is that wonderful white stuff that turns normally bitter coffee into sweet seduction. Sucrose is made up of two smaller sugar molecules: glucose and fructose. It is 50 percent glucose and 50 percent fructose.

With the help of insulin, glucose is metabolized by every cell in your body (bones, brain, and everything in between). This process happens even before the first molecule of glucose in your coffee hits your bloodstream.

Like Pavlov’s dogs that drooled when they heard a bell, the mere anticipation of receiving sugar is enough to cause your pancreas to start producing insulin. Once the sweet receptors on your tongue signal that something yummy is on the way, insulin production shifts into gear.

This adaptation is essential to your health, as it is insulin’s job is to move glucose out of your blood stream, where it can cause all sorts of problems (diabetes being the most dramatic), and into your cells where it is used right away or stored for later use.

Fructose follows a different pathway where it is metabolized only in the liver and stored directly as fat.

So eating sugar (glucose plus fructose) is a double whammy in the fat production and storage department. If you take home only one thing from this article, let it be this: The more simple carbohydrates you consume, the more fat your body stores.

For people trying to lose weight or maintain a healthy weight, cutting back on foods and beverages that contain sugar and other insulin-producing sweeteners is much smarter than restricting their consumption of proteins and fats (even though fats contain twice as many calories per volume as carbohydrates).

If you just said to yourself, Wow, that’s so simple. You’re right. It is simple… but it’s not easy.

Why? Because sugar tastes really, really good. So do all of sugar’s metabolic equivalents: evaporated cane juice, brown sugar, honey, high fructose corn syrup, agave syrup, maple syrup, brown rice syrup, molasses, and fruit juice concentrate. Food manufacturers have been taking advantage of this simple biological fact for decades, which is why sweeteners are so prevalent in processed foods.

I invite you to walk down any isle in any supermarket and start looking at the labels. Pay attention to the ingredients and “sugars,” listed in grams. Both Mercola and Lustig recommend no more than 15 grams of fructose per day. Depending on the sweetener, fifteen grams of fructose means approximately 30 grams of total sugar, which is enough to shift some people out of fat burning mode and into fat storage mode.

For a real shocker, begin your exploration of product labels in the breakfast cereal aisle.

Myth #2: “Natural Sweeteners” are Better for You than Sugar

Life would be so much sweeter if this were true.

Sugar, evaporated cane juice, brown sugar, honey, maple syrup, molasses, and high fructose corn syrup all contain roughly equal amounts of glucose and fructose.

This may be a particularly difficult concept to get your mind around because we’ve been taught that honey and maple syrup are “natural” products, so they have to be better for you than high fructose corn syrup. Sadly, that’s not the case. Evaporated cane juice is a natural product too — before it is further dehydrated and refined into table sugar.

Agave syrup has a low glycemic index (GI = 30, which is lower than apples), and its high fructose content makes it “sweeter” than sugar. In fact, agave can be upwards of 90 percent fructose (table sugar is 50 percent fructose). Because fructose is metabolized into fat in the liver, even with agave’s low glycemic index, it still promotes fat storing instead of fat burning.

There are three natural sweeteners that don’t contain fructose at all: brown rice syrup, stevia, and luo han guo. One of them is laden with arsenic, one is available in health food stores, and the other I’ve only seen on the Internet.

Brown rice syrup is a nutty, buttery tasting syrup created by cooking rice (usually white rice) with enzymes derived from barley sprouts and then decanting the excess water. Brown rice syrup’s glycemic index is relatively low (25), but its composition is weighted heavily towards glucose; hence, it triggers an even larger insulin pulse than regular sugar.

Brown rice syrup’s biggest health problem is not the insulin production it triggers but the arsenic it contains. Beginning in early 2012, the FDA reported large amounts of arsenic showing up two infant formulas whose main ingredient was brown rice syrup. These formulas had six times the recommended arsenic levels for drinking water (10 parts per billion). Subsequent reports have shown that some organic brown rice samples also contain alarmingly high levels of arsenic.

The high levels of arsenic in rice and rice products (brown rice syrup, rice cereals, rice cakes) are thought to come from rice fields that once grew cotton. According to the federal Agency for Toxic Substances and Disease Registry, lead-arsenate pesticide residue continues to linger in soils were cotton was once grown, even though these chemicals were banned in the 1980s.

The smart thinking on brown rice syrup is to avoid it until this arsenic issue is resolved. For more information, I highly recommend this Consumer Reports article on rice, brown rice syrup, and arsenic.

Stevia is derived from the leaves of plants in the sunflower family that are native to semitropical and tropical areas of South and Central America. Stevia contains no sugars, no calories, has a glycemic index of zero, and is up to 300 times sweeter than sugar.

Some people don’t like the taste of stevia; they find that stevia doesn’t satisfy their sweet tooth. Fair enough. But it won’t make you fat or increase your chances of developing a host of inflammatory diseases related to elevated insulin and leptin exposure (obesity, diabetes, heart disease, cancer, and others).

From a health perspective, Stevia is one of the better sweeteners. Nevertheless, the pancreas’ reaction to the stimulation of the sweet receptors on the tongue still causes an increase in insulin production — even if the anticipated glucose never arrives.

There were some studies in the 1980s that showed that daily Stevia use was linked to cancer of the penis in rats; however, the vast majority of subsequent studies has contradicted these early findings.

Since 2000, the World Health Organization, the European Food Safety Authority, and the FDA have all consider stevia as “generally recognized as safe” or GRAS.

Like stevia, sweeteners made from the luo han guo fruit (sometimes called Buddha fruit or monk fruit) are 300 times sweeter than sugar, contain zero calories, and have a glycemic index of zero. Luo han guo is a member of the gourd family and has been cultivated by Buddhist monks in southern China and northern Thailand since the 13th century; however, it did not appear in North America until the late 20th century.

Traditionally, luo han guo has been used in beverages designed to cool the body (hot weather, fever, hot flashes, and inflammation). In 2009, the FDA granted luo han guo GRAS status. No restrictions were placed on consuming the fruit or using its extracts as sweeteners.

As of the writing of this article, the only place I’ve been able to find Luo han guo is online.

Myth #3: Drinking Sugar Is OK

If you’re feeling particularly adventurous, take a trip down the beverage isle of your local market and look at how many grams of “sugars” are in Coke, Pepsi, AriZona Tea, Monster Energy Drinks, Red Bull, and the like.

According to Lustig and other experts, drinking one 12 oz. can of Coke per day for a year (that’s 10 extra teaspoons of sugar a day or roughly 30 pounds of sugar per year) will result in 15 additional pounds of fat — just from drinking one sugary soft drink every day.

Maybe New York City mayor, Michael Bloomberg, was right after all.

The simple truth is that drinking sugar is drinking sugar — no matter where the sugar comes from — Pepsi or organic apple juice. Both beverages contain the same amount of sugar per volume.

The only advantage of drinking juice is the moderate amount of vitamins and minerals. Also, if you drink apple or orange juice that contains a lot of fiber (pulp), the fiber will slow the rate of carbohydrate absorption in the small intestine, which will minimally suppresses insulin production, and induce some measure of satiety. None of which happens when drinking a Pepsi.

Perhaps the biggest problem with drinking sugar is that the fructose in high fructose corn syrup (the sweetener in most sodas and energy drinks) does not suppress the hunger hormone, ghrelin, which tells your brain that your stomach is full. This is how you can drink a 64-ounce Big Gulp of soda sweetened with high fructose corn syrup and still feel hungry 20 minutes later.

The other major hunger-suppression hormone, leptin, is produced by your fat cells, and works to signal your brain when your fat cells are either hungry or not. Insufficient leptin levels signal your brain that your fat cells are hungry; an abundance of leptin tells your brain that your fat cells feel satisfied.

As with insulin, if your body is exposed to too much leptin for too long, it becomes resistant to this hormone, and the once functional feedback system breaks down — and inflammation and early aging ensue.

When your body is awash in insulin from eating a high-sugar/high-carbohydrate diet, sugar is metabolized in your fat cells. When this happens, your fat cells release leptin, which should tell your brain that your fat cells don’t need any more food. However, that doesn’t happen if your brain has adjusted to this “new normal” of high leptin levels.

According to Taubes, even though your leptin levels are high (which should trigger your brain to control hunger), your fat cells actually begin acting like a tumor, requesting more and more energy (sugar), until you are essentially eating to keep your fat cells satisfied to the detriment of the rest of your body.

Experts including Mercola, Lustig, and Taubes believe that the only way to break this cycle of insulin and leptin overload is through a low-sugar/low-carbohydrate diet that includes healthy fats (coconut oil, olive oil avocados, nuts, butter, and animal fats) and moderate amounts of protein.

Myth #4: Exercise is the Answer

Exercise is an important part of a healthy lifestyle; however, you cannot exercise your way to health if you are eating a high-sugar/high carbohydrate diet — even if you are exercising multiple hours a day to burn more calories than you take in.

The problem isn’t a lack of calories burned (or being weak willed or lazy). The problem is that a diet high in simple carbohydrates (glucose and fructose) stores abundant amounts of fat. Once this fat-storing condition (with its high levels of insulin and leptin), becomes your “set point,” your body will actually shift energy away from your muscles and your reproductive system in order to keep your fat cells well fed.

Myth #5: What I Eat and Drink Doesn’t Affect Anyone but Me

I understand the sentiment. The reality, however, is a different story.

The ripple effect of our dietary choices quickly goes far beyond the boundaries of our skin to include our families, our communities, our work force, our country, and even our planet.

According to the CDC, the global cost of treating metabolic syndrome (the symptoms of which include obesity, heart disease, type 2 diabetes, several types of cancer, hypertension, excessive fat in the blood, non-alcoholic fatty liver disease, polycystic ovarian syndrome, and dementia) accounts for 75 percent of all global health care expenses.

The CDC also estimates that the global cost of just treating type 2 diabetes is $150 billion per year.

Here’s a little graphic from the CDC that I think brings the message home.

Year            Global Sugar Consumption                Global Diabetes Rate

1985                   98 million tons                                        30 million people
2010                 160 million tons                                      346 million people

Within one generation, the global sugar consumption almost doubled. In that same time period, however, the diabetes rate increased more than 11 times. You don’t have to be an epidemiologist to see that we have reached the tipping point.

What Can You Do?

Here are five simple suggestions you can do to shift you diet away from sugar and other simple carbohydrates.

  1. Drink water instead of sodas, energy drinks, and fruit juice. This switch might feel like a punishment for the first couple of weeks, but soon you’ll start to crave the clean, clear quenching quality of water. I recommend you drink purified water that comes in glass bottles, because plastic bottles leach phytoestrogens into the water.
  2. Read the label on any food that comes in a box, bag, bottle, or can. Select products for yourself and your family that contain the least amount of sweeteners and sugars. All this reading of labels may sound like it will dramatically extend the time you spend at the market, but you will quickly learn to spot products that are “unsweetened.” Actually, Spot the Sugar is a healthy game to play with your kids.
  3. Visit your local health food store and pick up some stevia. You may find it satisfies your sweet tooth. And with zero calories and a glycemic index of zero, it is perhaps the best sweetener.
  4. Introduce salads and other green leafy vegetables into your diet plan. Eating five to seven servings of vegetables a day will have a dramatic effect on your health.
  5. Replace traditional snack foods with seeds and nuts. Raw or dry roasted pumpkin seeds, almonds, walnuts, cashews, and pistachios make great between-meal snacks. They contain healthy oils that satisfy your appetite without raising your insulin level. Avoid “roasted” nuts because they are cooked in unhealthy omega-6 oils, which denature the proteins in the nuts.