This week, we will turn from the topic of fiber and the many health benefits it provides to explore sugar in the form of added sugar.  “Added sugars are defined as sugars and syrups that are added to foods during processing or preparation.” (4)  

Added sugars do not include whole food sources of sugars such as fruit or the starches in a potato.  The table sugar many of us use in our kitchens is an added sugar - if we were chewing on sugar cane or eating sugar beets in their whole form, this would not be considered an added sugar.  Maple syrup is also an added sugar as the maple sap it comes from is processed by boiling away the water, leaving behind a much more concentrated source of sugars. 

“Nature made sugar hard to get; man made it easy.” (6)  When we think about it, naturally occurring sweet sugars are found in fruit and honey.  Honey is guarded by bees and was once much less available than it is now, and fruit has its natural growing seasons and spoils quickly without preservation technologies such as canning, drying, freezing, or fermentation. 

As we will see, the ease with which we are able to access sugars poses many different problems in our individual and societal health.  Convenient access to sugar depends on an economy built around the exploitation of people, land, and resources.  

Sugar and Physical Health

Before we start down this road of exposing the dangers of sugar, let’s admit one thing first: sugar tastes good!  We are biologically designed to seek out sugar.  This isn’t a bad thing in itself, and for the majority of the history of the human species, this preference for sweets was protective, helping our ancestors survive.  

The problem arises when sugar is found everywhere rather than as a rare treat.  “A little is not a problem, but a lot kills - slowly.” (6)

In this section, we will cover the addictive nature of sugar and its contributions to the top three killers of U.S. residents: heart disease, diabetes/metabolic disease, and cancer.

Sugar Addiction

Sugar changes our brains and neurotransmitters.  Eating sugar lights up the same portions of our brain as cocaine and heroin.  We are lucky that this effect is not as strong as other addictive drugs, but sugar shares another common feature with these drugs: we develop a tolerance to sugar.  This means, over time,  it takes more and more sugar to get the same amount of pleasure. (1)  The pleasure we once got from a strawberry can require a spoonful of strawberry jam one week, a plate of strawberry shortcake the next, and a liter of strawberry flavored soda later on.  No wonder the sugar habit is so hard to kick!  

If you have ever tried to “detox” from sugar, you are probably familiar with the mood swings, headaches, and fatigue that can last for days to a couple of weeks.  So, if you have a hard time breaking away from added sugar, know it isn’t a personal failing on your part; you are battling biology and addiction.  Going it alone is rough; making this change in a supportive group setting is a good idea!

Sugar and Metabolic Diseases

It’s easy to make the connection between sugar and diabetes, which is, after all, a disease of sugar metabolism.  It might surprise you to learn that sugar is also closely linked to high blood pressure, cardiovascular diseases like stroke and heart attacks, cancer, fatty liver disease, and chronic low-level inflammation, which contributes to many different conditions, such as chronic pain, cognitive disorders, and psychiatric conditions.  This connection isn’t limited to those with diabetes or a genetic predisposition for diabetes, nor is it limited to adults.  We see measureable sugar/diet-related low-grade inflammation in children as young as two years of age! (2)

In a systematic review of 53 articles on diet and inflammation in 2-19 year old children, very clear evidence points to lower measures of inflammation in those eating healthy diets naturally low in refined sugars, and higher inflammatory markers in those eating a Standard American Diet. (2)  One could argue that it wasn’t the sugar that made the difference in these diets, but we see a very real trend where diets containing more refined sugars contain fewer healthy nutrients. (4)  Additionally, the fructose component of added sugars has been directly linked to liver damage; increased blood pressure; increased uric acid levels; increased triglyceride levels; increased insulin resistance; and more rapid aging of tissues due to direct damage of fats, proteins, and even DNA! (6)

When we bring up the topic of obesity, let’s also take a moment to clear the air.  Obesity itself is not a cause of metabolic disease.  At least 20% of people who are labeled as obese have very healthy metabolisms.  Obesity is, however, a sign of possible metabolic dysfunction that should be investigated.  Don’t think you’re off the hook if you have a “healthy” BMI: up to 40% of people with a weight that would make their doctor smile do in fact have metabolic disease. (6)

Sugar and Cardiovascular Disease

More sugar - more problems!  

To put this in perspective, the Institute of Medicine recommends no more than 25% of calories from added sugar - following this inflated recommendation would lead to more disease! (4)  The World Health Association and the 2020 USDA Dietary Recommendations for Americans recommend eating fewer than 10% of one’s calories in the form of added sugars. (9)  For a 2000 Calorie diet, this would be fewer than 50 grams.  However, no safe level of added sugar consumption has been determined and the recommendation level seems to be lowered with each new report.  The next USDA update is scheduled for 2026, so we will see if there are new updates in about 5 years. 

The current average added sugar consumption in the US is 13% (65 grams for that 2000 Calorie diet), well above the recommended level. (9)

In a 2014 study published in the Journal of the American Medical Association, subjects who ate 17-21% of their calories, 85 - 105 grams for a 2000 Calorie diet, in the form of added sugar had a 38% increased risk of death from cardiovascular disease over those who ate a lower sugar diet.  Those who ate more than 21% of their calories from added sugar had more than double this increased risk (more than 76%). (10) This wasn’t risk of developing disease and living with it: this was risk of death from cardiovascular disease.  

Sugar and Cancer

The relationship between sugar and cancer is a tricky one!  A 2018 systematic review showed results varying between sugar having no impact on cancer risk up to a 200% increased risk of cancer with the consumption of added sugars. (7)  Shall we see sugar as innocent until proven guilty?  With all the other proven negative effects of added sugar, I’m not personally willing to take that risk. 

Sugar and the Economy/Public Safety 

Turn on the news anytime in the past 30 years and healthcare spending is bound to come up.  In the United States, we spend more on healthcare than any other country, even when adjusted for population size.  It’s estimated that up to 75% of our healthcare dollars are spent treating metabolic diseases - diseases that result from the Standard American Diet, which is high is added sugar and saturated fat and low in fiber and other essential nutrients. (6)  How much of our public debate on healthcare spending would change if healthier foods and eating strategies were more available and became the norm instead of a fringe movement? 

What if we merely rerouted taxpayer-supported sugar subsidies to organic produce? 

We can then turn to the realm of public safety.  In 2019, the CDC released a document titled “Unfit to Serve: Obesity is Impacting National Security”.  First, let’s put obesity in perspective: around 1 in 5  people are healthy at a heavier weight.  Obesity is such an easy scapegoat that it’s hard to let it go!  A better title would be “Unfit to Serve: Metabolic Disease is Impacting National Security”, but that wouldn’t get as much attention.  The summary is, 71% of American youth would be ineligible to serve in our nation’s military and the biggest reason is metabolic disease.  Active duty military members are also experiencing more metabolic disease, and with it, much more frequent illness and injury. (3)

Sugar and Social Injustices

The history of sugar is the history of slavery and exploitation.  Before sugar cane was brought to the Americas, sugar was a luxury that wasn’t consumed by most people.  Sugar production is brutal, back-breaking work, meaning it wouldn’t become widely available until cheap, forced labor was freely available - slavery.  Sugar from Brazil and the West Indies was traded for money in Europe, which was used to purchase kidnapped people in Africa, who were exploited to produce more sugar.  As the technology to process sugar locally was developed, sugar plantations were also developed along the Mississippi river in the late 1700s. “During her antebellum reign, Queen Sugar bested King Cotton locally, making Louisiana the second-richest state in per capita wealth.” (8)

All this success led to ever-growing use of slavery.  “The enslaved population soared, quadrupling over a 20-year period to 125,000 souls in the mid-19th century. New Orleans became the Walmart of people-selling.” (8)  These were highly skilled laborers performing dangerous work, and it wasn’t only adults; children were working right alongside.  In addition to the dangers inherent in the production of sugar itself, fatigue, injury, and terrorization by overseers was a part of daily life.  The book Twelve Years a Slave documents the experience of Soloman Northup a free black man who was kidnapped and sold into slavery on a sugar plantation.  His first-hand account offers much more than I can on this topic. 

Even today, sugar production like many of the other luxuries we consider staples of daily life relies on overworking and underpaying populations of people in situations that force them to endure hardships that most of us never even have to consider. (5) 

Applications

As you can see, other than the fact that it tastes good and any current physical addiction to sugar, there really aren’t any good reasons to consume added sugar.  There are however, many reasons to avoid sugar!

Our personal health, the health of our children, the health of our nations, and seeking justice for vulnerable people are all meaningful and good reasons to reduce our sugar intake.  

So, moving forward, what are some good ways to cut sugar out?

1. Avoid sugar sweetened drinks, especially sodas.  One can of soda contains around 35 grams of sugar or 140 Calories, that’s 7% of 2000 Calories!

2. Avoid candy

3. Look at the packaging on your processed foods, you will be surprised by how much sugar you find there.  Last week, my daughter requested canned peas with dinner and sure enough, this already sweet legume had sugar added to the canning liquid!

4. Avoid pastries and baked goods or make your own using raw, organic, local honey, apple sauce, bananas, or other sweetening methods. 

5. Slowly reduce the amount of sugar you add to your coffee, tea, and other beverages - personally, I add a pinch of stevia leaves to my brews for a sweet treat.  You can purchase bulk stevia leaves from many herbal companies including Mountain Rose Herbs.  Using the leaf tastes much better than the processed stuff you find in your grocery store.  You can even grind it into a powder to add to foods if you like. 

6. Try a 30 day sugar fast.  You will be surprised just how much your taste buds change.  The sugary treats you once craved will now most likely taste way too sweet!

7. Enjoy ample fruits.  Frozen fruits are a fantastic treat to keep around.  We started to purchase them regularly just this year, and I’ve never seen my family eat so much fruit. 

8. Aim to keep your added sugar intake down to less than 25 grams per day.

9. Avoid introducing sugar to your children as long as possible, and learn ways to politely decline offerings of sugar laden foods that work for you and your family. 

10. Opt for fair-trade, organically, and sustainably grown raw forms of sugar such as sucanat for special treats. 

I’m sure you have other tips and tricks to share with the rest of us!  What are some of your favorite ways to avoid sugar? 

There is hope, and a healthy whole foods diet can be amazingly tasty and satisfying.  Any current addiction to high-calorie, high-salt, high-reward foods does need to be kicked, and taste buds do need a chance to reset.  Trying new foods, recipes, restaurants, and picking your friends’ brains for their favorite healthy dishes can be quite eye opening!  It’s similar to, but not quite as difficult as, quitting smoking or another harmful and addictive habit.  On the other hand, it can be just as rewarding.

There are many reasons why your friend who has made the effort to change their diet and exercise habits won’t stop talking about how great life is on the other side.  It really is!

Next Week

Next week, we will wrap up our four week focus on carbohydrates by talking about alcohol. 

References

1. Avena, N. M., Rada, P., & Hoebel, B. G. (2008). Evidence for sugar addiction: behavioral and neurochemical effects of intermittent, excessive sugar intake. Neuroscience and biobehavioral reviews, 32(1), 20–39. https://doi.org/10.1016/j.neubiorev.2007.04.019

2. Bujtor M, Turner AI, Torres SJ, Esteban-Gonzalo L, Pariante CM, Borsini A. Associations of Dietary Intake on Biological Markers of Inflammation in Children and Adolescents: A Systematic Review. Nutrients. 2021 Jan 25;13(2):356. doi: 10.3390/nu13020356. PMID: 33503979; PMCID: PMC7911843.

3. CDC 2019, Unfit to Serve: Obesity is Impacting National Security, https://www.cdc.gov/physicalactivity/downloads/unfit-to-serve.pdf

4. Institute of Medicine 2005. Dietary Reference Intakes for Energy, Carbohydrate, Fiber, Fat, Fatty Acids, Cholesterol, Protein, and Amino Acids. Washington, DC: The National Academies Press. https://doi.org/10.17226/10490. 

5. International Labor Rights Forum, “New Reports on Labor Conditions in Sugar Industry in Central America”, 06/29/2005, https://laborrights.org/releases/new-reports-labor-conditions-sugar-industry-central-america Accessed 3/23/2021

6. Lustig, R., Schmidt, L. & Brindis, C. The toxic truth about sugar. Nature 482, 27–29 (2012). https://doi.org/10.1038/482027a

7. Makarem N, Bandera EV, Nicholson JM, Parekh N. Consumption of Sugars, Sugary Foods, and Sugary Beverages in Relation to Cancer Risk: A Systematic Review of Longitudinal Studies. Annu Rev Nutr. 2018 Aug 21;38:17-39. doi: 10.1146/annurev-nutr-082117-051805. Epub 2018 May 25. PMID: 29801420.

8. Muhammad, G “The sugar that saturates the American diet has a barbaric history as the ‘white gold’ that fuleled slavery” The New York Times, 8-14-2019, https://www.nytimes.com/interactive/2019/08/14/magazine/sugar-slave-trade-slavery.html Accessed 3-23-2021

9. U.S. Department of Agriculture and U.S. Department of Health and Human Services. Dietary Guidelines for Americans, 2020-2025. 9th Edition. December 2020. Available at DietaryGuidelines.gov. 

10. Yang Q, Zhang Z, Gregg EW, Flanders WD, Merritt R, Hu FB. Added Sugar Intake and Cardiovascular Diseases Mortality Among US Adults. JAMA Intern Med. 2014;174(4):516–524. doi:10.1001/jamainternmed.2013.13563