When you learn what sugar actually does to your body, it may sour you on the idea of eating so much of it. This is the third part of our series by Jette R. Hogenmiller, PhD, MN, APRN.
The information contained in this article should not be construed as medical advice. Consult your health care provider for appropriate diet changes for you.
Rising Obesity & Type 2 Diabetes
An epidemic continues to sneak up on us, as it has for a few decades: obesity and Type 2 diabetes. More than 60 percent of people in the U.S. were considered overweight or obese in 2009 to 2010, with growing diabetes (CDC). Twenty years ago, no state in the U.S. had an obesity rate above 15 percent. Today, 38 states have obesity rates of more than 25 percent, according to Trust for America's Health. Experts used to believe this increase was solely a reflection of our more sedentary lifestyle and imbalance in food intake to exercise. However, more recent literature points to an insidious culprit: sugar.
Dr. Campbell-McBride (M.D.) (2007), a neurologist and neurosurgeon states, “Sugar was once called a ‘white death.’ It deserves 100 percent of this title.” Nancy Appleton, PhD., in her book Lick the Sugar Habit (1996), labels sugar as an addiction that negatively impacts our entire body chemistry.
Our goal is to describe more about the health risks associated with sugar and how simply decreasing the amount of sugar in your diet can help you achieve a better body weight, avoid obesity, and lower your risk for diabetes.
Statistics & Data
In 1958, only 1.6 million individuals 20 or older had diabetes in the U.S. By 2010, that number rose to 18.8 million, while our population size did not increase by the same proportion (CDC, 2011). Experts expect that 1 in 3 U.S. children born in 2000 will be diagnosed with diabetes during their lifetime (JADA, 2003).
In 2012, for just diabetes alone, the annual health care cost was $245 billion (Diabetes.org, 2013). Sadly, diabetes is a major cause of loss of eyesight and limb amputation. The financial and human suffering impact of the condition demands we make inroads on this devastating chronic disease.
Why the Increase?
The cases of obesity and Type 2 diabetes continue to rise, even though many people try to consume less fat. If you read Parts 1 and 2 of this “Struggling with Weight” series, you know we are eating processed foods with components that are more difficult to break down than eating fresh foods. Also, we aren’t eating the type of fats we should, and healthy fats are necessary for good health. Even if we ate fresh vegetables and the appropriate fats and avoided processed foods and bad fats, it doesn’t tell the whole story on why Americans suffer from an epidemic of obesity and diabetes. Sugar plays a big role. Before you panic, this does not mean we cannot enjoy any sweets, it means we need to take a healthier approach. Our ancestors did not eat Twinkies for breakfast and they didn’t indulge in a dessert after every meal. In our advancement of what we can create in the kitchen (or factory), it moved us away from eating more natural foods.
We have to get into some science now. It may be difficult to get through, but it helps us understand why sugar is problematic for our bodies. If you’re uneasy with the biology lesson, you can skip down to our recommendations. But if you want to understand why we make these recommendations, keep reading.
Our cells require energy to perform the massive amount of work it does to maintain our bodily functions – also known as keeping us alive. Carbohydrates, fats and protein all supply our bodies with energy. Sugar is a form of simple carbohydrates (CHOs). Sugar is called a simple CHO because it easily and rapidly enters the blood stream. Simple (e.g. orange juice or a candy bar) CHOs enter the bloodstream faster than a more complex carbohydrate (e.g. brown rice). The body converts carbohydrates to the sugar, glucose. The Nutritional Therapy Association (2004) likened carbohydrates to “kindling” and fats as “logs” for the fire needed to run our bodies.
Our body continually tries to keep an appropriate level of blood glucose (sugar) in our system to keep us functioning at our best. The body wants us to run like a Ferrari, not like an old car with faulty cylinders and too much exhaust smoke. The old car runs and is alive, but the Ferrari is a lot more fun to drive. When we eat a meal:
- The body draws from carbohydrates for quick energy.
- The body stores excess energy (calories) first in the liver.
- When the liver is full, the body stores the calories in fatty tissues.
- The pancreas produces insulin and the insulin helps transport the glucose into all cells in the body.
- The glucose, in its stored form, comes from the liver and is released when the body needs energy, as well as from fat storage when needed.
If we eat a high load of carbohydrates, especially ones that the body absorbs quickly, the pancreas puts out larger amounts of insulin than a more balanced dietary intake requires. One can actually experience low blood glucose, hypoglycemia, because the pancreas overshoots the amount of insulin and blood glucose rapidly drops. When this happens, we tend to grab something sweet to make us feel better, but that does not actually address the problem. If we overload our body with simple sugars and carbohydrates, we overwhelm our pancreas daily, weekly – and the years pass by. The pancreas eventually gets exhausted and quits producing insulin altogether. Our body cells also go on strike, saying, “You are throwing too much sugar at me and I can’t handle it.” That slows the ability of the glucose to gain entry by becoming resistant to insulin actions. Our cells then become insulin resistant and our journey along the path to metabolic syndrome and pre-diabetes to diabetes begins (ADA, 2013).
Individuals with diabetes base the amount of insulin they need by examining their carbohydrate intake. They do not base it on the amount of fat or protein they consume. Knowing this, for people who want to avoid diabetes or maximize their health while living with diabetes, we need to eat healthy carbohydrates in appropriate amounts. This leads to a healthy weight that doesn’t overwhelm the pancreas and it supports normalization of blood glucose in diabetes.
Furthermore, eating healthy carbohydrates in moderation does not present many downsides, though if you have gluten intolerance, the carbohydrates must not contain gluten.
Now, let’s talk about healthy carbohydrates.
A Look at Carbohydrates
Carbohydrates are categorized as simple or complex and, within those categories, as refined or unrefined. Unrefined CHOs have the whole grain intact, while refined CHOs are processed in a way that removes the germ and bran part of the grain. The removal of these parts also takes out important vitamins, iron and fiber.
An article in the medical journal Circulation (2010) found that whole grains intake is associated with a lower incidence of diabetes. The article says part of the reason for this is because: “Whole-grain foods contain fiber, vitamins, minerals, phenolic compounds, phytoestrogens, and other unmeasured constituents, which may have favorable effects on health by lowering serum lipids and blood pressure, improving glucose and insulin metabolism and endothelial function, and alleviating oxidative stress and inflammation.” Following that quote, we thought some definitions might help: Phenolic compounds are aromatic compounds found in some essential oils; phytoestrogens are estrogen-like chemicals found in plant foods such as beans, seeds and grains; serum lipids are any major lipid in the circulation, such as total cholesterol, HDL, or LDL; the endothelium is the thin layer of cells that line the inside of blood vessels, endothelial function is blood circulation; and oxidative stress is a condition that results in cellular degeneration.
Simple refined carbohydrates include such things as white sugar, fruit juice, and corn syrup. Unrefined carbohydrate examples include fruit, raw honey, raw maple syrup, and freshly-squeezed juices. Complex refined carbohydrates include such things as white bread, white rice, pasta, and potato chips. Examples of unrefined complex carbohydrates include vegetables, legumes (beans), and brown rice.
It’s preferable that we get unrefined complex carbohydrates as our source of carbohydrates for a number of reasons. First, the body absorbs them more slowly, so blood glucose rises more steadily, putting less stress on the pancreas. Additionally, the carbohydrates retain more of the vitamins, fiber and iron when they are not processed. That means they also get absorbed into your body when you consume them.
Over the last few decades, the number of people with a chronic illness has skyrocketed. The other thing skyrocketing is sugar consumption. In 1821, a person in the U.S. consumed 10 pounds of sugar a year. That number increased to 150 pounds in 1995, with an average of a half a pound a day (USDA, 1999). Since some people are clearly not consuming that much, many of us are consuming much more. This high-sugar intake overwhelms our bodies with high glucose and the pancreas has a progressively difficult time handling it all. Additionally, the source of our sugar intake is different. Up until the 1970s, it was primarily through beets and sugar cane (sucrose). Then it transitioned to corn (e.g. “corn syrup, fructose, dextrose, dextrin, and/or high fructose corn syrup – HFCS”) (Appleton).
Dr. Campbell-McBride states in her book Put Your Heart in Your Mouth (2007) that, “Free molecules of glucose are very reactive; they attach themselves to proteins in the blood, making those proteins very sticky (the scientific name for these proteins is AGEs – Advanced Glycosylated End products). These proteins stick to the walls of the blood vessels, damaging them and starting the atherosclerotic process. Apart from that, they get into small arteries and capillaries, block them and accumulate as a nasty substance called amyloid. It commonly blocks capillaries in the retina of the eyes causing blindness. Accumulating in the capillary bed of the capillary bed of the kidneys, it causes kidney failure. Accumulating in the capillaries of the brain, it causes Alzheimer’s disease” (pp. 52-53).
These types of observations bring into question whether cholesterol should be the primary target of heart disease prevention. The question asked is: If we consumed more healthy fats and fewer simple refined sugars, would we be healthier? Experts say when there were 60 deaths per 100,000 people when Americans ate 20 pounds of sugar per year. This increased to 300 deaths per 100,000 when people consumed 150 pounds of sugar a year (Nutrition Therapy Association, 2013). During this same period, experts encouraged us to change consumption from natural fats (butter, cream) to non-natural fats such as margarine. Experts also admonished us not to eat egg yolks, and gave us other advice that moved us toward a greater consumption of refined and processed foods. That advice did not seem to help our health. In answer to the question posed above, our poor state of health is associated with more than just a sedentary lifestyle, though that is certainly a concern.
Now that we’ve reviewed some of the science; it’s time to talk about what changes you may want to make to your dietary habits. If you skipped the entire science section, this is where you want to begin following along once again. As you read over these recommendations, keep in mind that the goal of our entire “Struggling with Weight” series is to help you achieve a good overall nutrition regimen.
As a reminder, any change in diet you take should be done after you consult a health care provider because everyone has unique needs. Below are general recommendations.
You should eat a balanced diet, with one commonly supported division of the three components being 40 percent CHOs; 30 percent proteins; and 30 percent fats.
Guidelines for healthy eating (Nutrition Therapy Association, 2013):
- Drink an eight ounce glass of water 6 to 7 times a day
- Eat plenty of vegetables
- Avoid deep fat fried food, partially hydrogenated oil and hydrogenated oil
- Avoid refined sugar
- Avoid refined carbohydrates
- Avoid chemical additives, which are found in increased amounts in processed foods and non-organic foods
- Eat slowly, chew your food thoroughly.
- Regular exercise is an important part of any focus on improving health.
- CDC (2013). FastStats. Obesity and Overweight.
- JADA (2003). Diabetes: A growing epidemic of all ages.
- American Diabetic Association (2013). Standards of medical care in diabetes – 2013. Diabetes Care. 36(Supplement 1) S11-S66.
- Appleton, N. (1996). Lick the Sugar Habit. Avery, Santa Monica.
- Bennett, P & Barrie, S. (2001). 7-Day Detox Miracle. Second edition. Three River Press. New York.
- Campbell-McBride, N. (2007). Put Your Heart in Your Mouth. Medinform Publishing. Cambridge.
- Clean Eating (2012): Meal Plans Made Easy – 16 Weeks of Slimming Menus. Robert Kennedy publishing.
- Davis, William (2011) Wheat Belly. Rodale. New York.
- Forte, S. (2012). The Sprouted Kitchen. Ten Speed Press. Berkeley.
- Melan, et. al. (2010) Whole-Grain, Cereal Fiber, Bran, and Germ Intake and the Risks of All-Cause and Cardiovascular Disease–Specific Mortality Among Women With Type 2 Diabetes Mellitus. Circulation. 121: 2162-2168.
- Nutrition Therapy Association. Nutrition Therapist Practitioner training materials (2013). http://nutritionaltherapy.com
- Sabbagh, M & MacMillian, B. (2012). The Alzheimer’s Prevention Cookbook: 100 Recipes to Boost Brain Health. Ten Speed Press. Berkeley