As a society, recent times have not been kind to our collective waistlines. In terms of overall health, we have reached an all-time high in the number of those affected by obesity and diet-related diseases. Currently in the US, 2 out of 3 adults and 1 out of 3 children are overweight or obese (Flegal et al., 2012). From an economic standpoint, we spend annually in upwards of $190 billion treating obesity-related health conditions (Cawley & Meyerhoefer, 2012). Research has shown that obesity rates have more than doubled in adults and children since the 1970s (Ogden et al., 2014). And the problem is expected to only get worse. According to the American Heart Association (2013), if current trends continue, total healthcare costs attributable to obesity could reach $861 to $957 billion by 2030, which would account for 16% to 18% of US health expenditures.
For health experts and policy makers, the million dollar question asks how do we quell this madness? While a number of factors have been addressed as potential causes, there is one main culprit that has single-handedly contributed to the ever-present bulge in our waistlines: SUGAR. As it relates to nutrition, sugar is one of the leading causes of our current obesity epidemic in the US and its namesake has become ubiquitous with poor health. According to the USDA, the average American consumes between 150 to 175 pounds of refined sugar in a year, and those numbers continue to grow annually (Haley & Suarez, 2012).
Along with increased consumption, research has found that sugar is responsible for a litany of health problems. For example, Kotronen & Yki-Järvinen (2008) found that excess sugar consumption can lead to a condition called non-alcoholic fatty liver disease, which is directly linked to incidences of obesity and diabetes. Another study by Yang et al. (2014) found that diets high in sugar can increase risk of cardiovascular disease even if you are not overweight. Sugar has even been linked to certain cancers (Boyd, 2003; Slattery et al, 1997). Bottom line: the stuff is TOXIC!
Fair enough. Then if sugar is so bad for us, we can just make a concerted effort to eliminate it from our diet, right? Well, it is not that simple. To begin, the stuff is in EVERYTHING! Essentially everything that you buy at the store that is not in its natural form will contain some semblance of processed sugar. Even foods which contain naturally occurring sugar in them, such as fruits, can be bad for us if eaten in abundance. More confusing is the fact that food marketing companies are damn good at hiding sugar in nutrition labeling. It has gotten to the point where you almost need a nutrition degree to go shopping, as even the savviest of health consumers can have a hard time identifying sugar content in products. Thus, in an attempt to bring light into the situation, this blog post will look at everything sugar-related; first identifying what it is, how it functions in our body and how food manufacturers sneak it into products through clever marketing.
What is Sugar?
When we think of sugar, the first thing that usually comes to mind is basic table sugar (sucrose); however there exist many different types of sugars, all of which have different effects on our body. Simply speaking, if the suffix ends with ‘ose,’ it is some form of sugar. From a chemical standpoint, there are two main types of sugars: monosaccharides and disaccharides. Monosaccharides (mono=1), which are also known as “simple” sugars, are the basic unit of carbohydrates. By “simple,” this refers to the fact that they do not require digestion by the body, in turn going directly into the bloodstream to increase blood sugar and provide immediate energy (WH Foods, n.d.). Disaccharides (di=2), which are also known as “complex” sugars, consist of two monosaccharide molecules joined together. By “complex,” this refers to the fact that they require some digestion by the body to be broken down into single sugar units (WH Foods, n.d.). The 3 most common monosaccharides are: glucose (i.e. glycogen), fructose (i.e. fruit sugars) and galactose (i.e. mammal’s milk). Essentially all carbohydrates are created by linking together some form of these 3 “simple” sugar molecules. The 3 most common disaccharides are: sucrose (glucose + fructose; i.e. beet sugar), lactose (glucose+ galactose; i.e. dairy products) and maltose (glucose + glucose; i.e. malt sugar).
In addition to these 2 main types, larger carbohydrate molecules formed from sugars (which include fiber and starches) are known as oligosaccharides and polysaccharides. An oligosaccharide is comprised of 3 to 10 monosaccharide molecules joined together, while a polysaccharide is comprised of many monosaccharide molecules joined together, ranging anywhere from the 100s to 1000s (Walstra et al, 2008). These 2 categories represent some of the more complex carbohydrates such as yams, potatoes and carrots. In terms of overall health, they typically require more digestion to be broken down by the body and elicit a more favorable blood sugar response in comparison to simple sugars.
What are “Good vs. “Bad” Sugars?
When it comes to sugar consumption, it is important to remember that not all sugars are created equal. Our body processes certain sugars differently than others, deeming some essential to our health, and others deleterious (trying to delineate which are which can be confusing). One place where we see this confusion is in determining good vs. bad “simple” sugars. As noted by Busch (n.d.), “all bad sugar is simple sugar, but not all simple sugar is bad. It depends on the source.” For instance, glucose, which is a considered a “simple” sugar, is an important nutrient in our bodies and is healthy as long as it is consumed in moderation (Kresser, 2010). Our blood sugar is made up of glucose, and glycogen (the molecule that stores energy in your muscles and liver) is composed of long chains of glucose (Daniels, n.d.). On the other hand, fructose, another “simple” sugar, which is found predominately in fruits, is another story.
Unlike glucose, which is rapidly absorbed into the bloodstream and taken up by the cells, fructose is sent directly to the liver where it is converted to fat (Kresser, 2010). In addition to being linked directly to diabetes and obesity, excess fructose consumption has been shown to elicit a bevy of negative health outcomes, which include: kidney disease, high blood pressure and the damaging of DNA (Gaby, 2005). Moreover, fructose is also the main ingredient in high fructose corn syrup (HFCS), a toxic additive which has shown to be one of the leading causes of metabolic disease in this country (Flavin, 2008). According to Hyman (2014), the average American increased their consumption of HFCS (mostly from sugar sweetened drinks and processed food) from zero to over 60 pounds per person per year; at a time in which obesity rates have more than tripled and diabetes incidence has increased more than seven fold. Perhaps not the sole cause, but experts have made correlations between the two.
In general, the more complex oligosaccharides and polysaccharides are viewed as superior sugars. For example, starch, which consists of long chains of glucose, requires heavy digestion by the body, providing a longer, more sustained source of energy (Worden, 2011). Also, because it does not go directly to the bloodstream, there is not the subsequent blood sugar spike which can lead to systemic inflammation and other health issues. Furthermore, there are some sugars that are not digested by the body at all. In point of fact, certain polysaccharides, such as dietary fiber and resistant starch (i.e. green bananas) are bonded in a way that the body cannot break them down. Instead, they are able to filter through the small intestine into the large intestine completely intact. This ability to move through the system to the large intestine helps speed the transit times of wastes excreted from your body, and because of this, fiber helps to support health by reducing constipation and promoting the excretion of toxins and wastes (WH Foods, n.d.).
While we can wax poetic about the biochemistry of sugar all day, the bottom line when it comes to sugar and our health revolves around two main concepts: insulin sensitivity and blood sugar regulation.
Generally speaking, when we consume sugar, our body has two ways of dealing with it: a) burn it as energy, and b) convert it and store it as fat. Depending on individual genetics, some of us are more adept at converting sugar into energy, while others will more likely store it as fat. Essentially, this equates to those with fast metabolisms versus slow ones.
Once sugar enters the bloodstream, the pancreas will detect it and release a hormone called insulin (Kamb, 2014). Insulin allows the body to regulate the level of sugar in the blood. Through a causal relationship, the more sugar that enters the bloodstream, the more insulin will be released. The main goal of insulin is to help take sugar out of the blood and drive it into the liver and muscles where it can be used for energy. Depending on a number of factors, including: type of carbohydrate (simple v. complex), metabolism rate, body fat percentage and glycogen levels in the body, the sugar can either be used as energy or stored as fat. This is where “insulin sensitivity” comes into play.
According to Diabetes.co.uk (2014), insulin sensitivity describes “how sensitive the body is to insulin.” In much the same way that we are able to build up a tolerance to alcohol or caffeine and become less sensitive to their effects, that same principle applies to carb and sugar intake. The more we eat sugar (particularly simple sugars), we become less sensitive to insulin and require more amounts to keep our blood sugar stable. In terms of glucose intake, our body has a limited capacity to store it as glycogen, with the remainder of it being stored as fat. For those with high insulin sensitivity, they are able to eat carbs without a large rise in insulin. Conversely, for those with low insulin sensitivity, they are forced to release more and more insulin in order to keep the blood sugar stable. If this persists for long periods of time, the pancreas will eventually stop producing insulin altogether, resulting in type 2 diabetes. Although there is more than just the risk of diabetes, as insulin resistance carries a multitude of other health concerns, including: thyroid issues, increase in risk of certain cancers as well as increased difficulty in shedding body fat.
However, with all of this being said, there are a number of ways to improve insulin resistance and increase sensitivity. Arguably the biggest way (and it is no secret) is through exercise. According to Sisson (2007), exercise has a major impact on improving insulin sensitivity because muscles burn your stored glycogen as fuel during and after your workout. “Muscles that have been exercised desperately want that glucose inside and will “up regulate” insulin receptors to speed the process.” In terms of a ‘bang for your buck’ protocol, research has shown that a combination of resistance training mixed with high intensity interval training (or HIIT) has been shown to offer the best benefits as it relates to insulin sensitivity (Little & Francois, 2014). This is mainly due to the metabolic benefits from the weight training and the glycogen depletion from the HIIT. Other ways to improve sensitivity include: get more sleep, drink green tea, fast regularly and keep a low body fat percentage (English, 2013).
Blood Sugar Regulation
As we become more familiar with the complexities associated with sugar, it is easy to see how it can cause so much confusion and demoralization when it comes to eating healthy. In general, I think that most people are indeed cognizant of their food choices and make conscious efforts to reduce sugar intake in their diets. We have all heard the sermons: “They check food labels, don’t eat “sweets,” never eat out, but still gain weight!” And for the majority of these people, they are doing almost everything right, but it is the devil in the details that gets them in trouble. I say this because I feel that overarching, when it comes to regulating sugar intake, the most common response from people is to simply eat less of it or remove it from the diet altogether. While this is a good start, it is only ½ of the battle. Taking insulin sensitivity into account, it is not enough to simply remove sugar from our diet; we have to control blood sugar regulation through the manipulation of our food choices and nutrient timing. This is why when we shop, it is not helpful to search for foods with labels that “look” sugar-friendly; such as “made with whole grains,” 100% juice” and “made with real sugar,” as they can be extremely confusing and actually can work to hinder our progress. Here’s why…
To begin, when carbohydrates (particularly simple sugars) are found in whole food, they are also infused with a number of vitamins, minerals and fiber. In these foods, the presence of fiber helps with digestion because it slows down the absorption of sugar, which mitigates the impact of our blood sugar response. Essentially, any natural sugar found in whole food is considered good sugar. However, anytime you add sugar to food during processing or remove the fiber content (i.e. fruit juice), this is considered bad sugar and increases risk of weight gain and obesity-related diseases. This includes the fancy sugars too, such as “organic cane juice,” “agave” or whatever other bullshit that food marketing companies like to slap on labels.
Also, it is important to understand that not all carbohydrates are created equal. For example, a 50g carb serving from a sweet potato will have dramatically different effects on the body than a 50g carb serving of Oreo cookies. With the sweet potato, you will get sustained energy levels and a better hormone response. Conversely, with the Oreo cookies, you will get that sudden spike of insulin followed by the crash, along with other long term effects such as systemic inflammation. Along these same lines, a 50g serving of vegetables will respond different to our body than 50g of “whole wheat.” For example, the glycemic index of carrots has a net load of 35, while whole wheat bread is 71 (Harvard Health, 2015). This is why I am personally not a fan of macronutrient and calorie counting when it comes to longevity and sustainable health choices. For me, the bottom line comes down to food choices. Put simply, if we are able to maintain a sustained blood sugar response throughout the day, our bodies will be better optimized not only physically, but mentally as well.
Additionally, in terms of blood sugar regulation, it is important to consider the timing of sugar uptake. For example, post-workout is the best time ingest simple sugars because they will be shuttled directly into the bloodstream as opposed to being stored as fat. Also, numerous research has shown that back-loading carbohydrates by slowly introducing them throughout will deem a more favorable blood sugar response. In addition to improved mental clarity, increased energy and better appetite control throughout the day, this method has also been shown to positively affect the neurotransmitters dopamine and acetylcholine (Poliquin, 2013).
Food Marketing of Sugar Products: Understanding Ambiguity in Labeling
As our modern food systems become more and more corporatized, food manufacturers are doing what they can to maximize profits. Stemming from this, the business of food marketing has flourished into a billion dollar industry all its own. The influence of food marketing on our purchasing habits is remarkable, as proof by a 2008 study by the Food Marketing Institute, which found that US companies spent a total $715.5 billion in marketing costs. Nowadays, because there is so much at stake in terms of revenue, food marketing has turned into the Wild West as it is impossible to know who to trust. Labeling continues to get more nuanced than ever, as companies try to bait us into purchasing their products. One area where this ambiguity persists is in the labeling of sugar.
When it comes to sugar, food companies love to add it to products; a) because it is extremely cheap to manufacture; and b) it improves the overall taste and marketability of the product. Therefore, for these companies, it is beneficial for them to add as much sugar as possible in their products to maximize revenue. Consequently, companies have started to disguise the sugar in their foods, so you can’t tell how much you are actually consuming.
According to the FDA (2013), food companies are required by law to list their most prominent ingredients first. However, through strategic food marketing, companies often add numerous different types of sugar into their products; and through ambiguous labeling companies can change their names so that sugar is spread across the ingredient list, showing up further down on the label. In fact, this has become so commonplace that companies have come up with 100s of different names for sugar. Here are a handful of them…
For a more complete list, Prevention magazine has a good piece on the different names that are associated with sugar (you can check it out here). Definitely worth checking out…
What do you think? All of this sugar talk is making me hungry. But in all seriousness, sugar is really no joke! It has taken over our modern food system and is showing no signs of letting up. Making things worse is the fact that there is so much strategic confusion out there on the part of these food companies that even someone with the best intentions can still be doomed to fail. And for those that could really care less, it is just a matter of time before they are struck with serious health complications.
And what I find most troubling is the fact that as a society we are not willing to deal with the problem head on. Instead on looking to troubleshoot our obesity problem and living in a preventative state, we always seem to be in a reactive state. For example, as opposed to keeping it real when it comes to our health (i.e. exercising more, researching how to eat better, pushing for legislative measures, etc.) we are ok with going to the doctor, taking a number of meds (blood pressure, insulin, etc.) and going on living our unsustainable lifestyles. Collectively, we have to be more serious and aggressive when it comes to our health. Because at the end of the day, everything will come down to us. If we are unwilling to step up to the plate and demand infrastructural change in terms of more stringent processing guidelines, clearer labeling methods, improved access to healthy options, etc., I guarantee you that these big-business food giants will not do it on our behalf!
So how do we go about shifting this paradigm? For me, the bottom line will always come down to awareness. You really have to think for yourself when it comes to your health and nutrition. We cannot take what food companies tell us (or even the government, for that matter) when it comes to our food at face value, because their vested interest is revenue, not our individual health.
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