Our War on Sugar

Midterm Test

We’re at the midpoint of the year:  26 Healthy Changes delivered, 26 to go.  It’s a good time for reflection  I think we’re making progress in our modest goal of changing the world.  Last night I Googled the search term “Word of Wisdom.”  Thanks to you readers, of the 11 million results we were #2, a new high.  Only Wikipedia beat us.  To me it’s a big deal; in the Olympics that’s a silver medal. Now we just have to pass Wikipedia. 

Our stated goal is to change the world and according to Google, we’re doing just that.  But change is an action verb.  We write these charming posts not to entertain but to create change.  Talking is easy—doing is hard.  So we press on—in the next post we’ll ask you to score yourself on how many Healthy Changes you’re actually living.  Get ready.

A Public Dialog

Have you followed the recent discussion about calories and diet?  It involves three people—a physician/scientist, a chef turned food writer, and a serious journalist:

David Ludwig, MD, PhD:  Ludwig studies and treats child obesity.  A while back he made a controversial statement:  Severely obese children should be removed from the care of their parents.  One Ludwig study showed the risk of obesity jumped 60% with each daily soft drink.  

Ludwig’s most recent study evaluated three diets for their ability to keep weight off, once it has been lost.  This is important because in nearly all cases, when dieting loses weight, it is later regained.  The three diets were:

1. The standard low-fat diet you often hear recommended,
2. An ultra-low carb (Atkins) diet, and
3. A low-glycemic diet of vegetables, fruit, legumes, and whole grains (basically, the WOWL diet).

The low-fat diet did the worst, so it’s time to move away from the bad advice of the last generation.  The Atkins diet did best but with the complication of higher inflammation (measured by c-reactive protein) and cortisol (the stress hormone).  The low-glycemic diet (basically, the WOWL dietary) offered the best combination of weight loss and freedom from side effects. 

Mark Bittman:  Is a chef turned author who writes for the N.Y. Times.  He gave his take on Ludwig’s study in an article titled, “Which Diet Works.”  Bittman said, “Over the long term, the low-glycemic (WOWL, or whole foods) diet appears to work best . . . . The message is pretty simple: unprocessed foods give you a better chance of idealizing your weight—and your health.”  I like the simplicity of this; if you eat healthy you’ll have a healthy weight.  We won’t all look the same, that would be boring and unnatural, but we’ll be our healthiest.

Gary Taubes:  A serious researcher and journalist, author of Good Calories, Bad Calories, the definitive work linking sugar and highly processed foods to obesity, diabetes (type 2, not type 1 which afflicts some children for unknown reasons), and chronic disease, weighed in next.  His N.Y Times article, titled “What Really Makes Us Fat” attacked our fascination with calories and calorie counting. 

Taubes doesn’t believe in the equality of calories—some are good and some, in his view, are bad for you.  He spent six years researching his book, an attack on America’s sugar addiction, and he’s pretty convinced the first step to improving our nation’s health is to eat less sugar.  So am I—counting calories won't take the place of eating real whole foods.  

The Inequality of Calories

When America’s overweight problem is discussed the calorie truism, based on the 1^st Law of Thermodynamics—which speaks to the conservation of energy—is usually mentioned.  "A calorie is a calorie," you hear that a lot.  Sometimes so-called experts simply say, “Calories in, calories out.”  They mean overweight is the simple result of eating more calories than you burn.  Or you hear this guidance: “Eat less, move more.”  But is it that simple?  If you’re a regular reader of this blog you know better. 

I took thermodynamics in college—taught by Dr. Milton Willie, a brilliant and caring teacher—and I believe in the first law.  But, because of the complexity of nutrition, I’ve never believed in the equality of calories.  Think about it:  Will a calorie from a carrot have the same effect in your body as a calorie from a soft drink?  Of course not—so stop counting calories and focus on your daily servings of vegetables, fruits, legumes, nuts, whole grains, and a little meat. 

Our War on Sugar

As a young man I remember standing by the railroad track of a small town in rural Guatemala.  Lumbering past were car after car overflowing with sugar cane.  It was the time of the sugar cane harvest.  The harvest seemed a good thing, a blessing for the local economy.  Before that I remember watching long trains loaded with sugar beets in Davis, California.  And years later watching trucks load an Illinois corn harvest into massive tanks labeled, "high fructose."  These were all about the same thing: supplying our growing sugar gluttony.  Now we know that more and more sugar isn’t a good thing.  Our annual intake of about 100 lbs of sugar should be slashed to at least 20-30 lbs, per the AHA, to reduce our risk of overweight, diabetes, heart problems, and other chronic diseases. 

Of the 52 Healthy Changes, four have the goal of reducing our intake of sugar.  Here are the four strategies for reducing sugar intake:

• Our first Healthy Change went after soft drinks, the leading source of refined and artificial sugar: If you consume sugary drinks, real or diet, limit yourself to one (12 oz.) serving per week. 
• Healthy Change #10 was about grains and attacked the practice of removing natural fiber and adding sugar to grain products, beginning with bread but including breakfast cereal also:  Your daily bread must be whole grain with more natural fiber (see the nutrition panel) than added sugar. The mantra "more fiber than added sugar," drives us to eat whole foods.
• This week’s Healthy Change goes after the American love for candy: Enjoy your candy a piece at a time; never bring a bag or box into the home.  I like candy as a treat, but it should be a treat, not a habit.
• The final sugar strategy suggests a way to enjoy chocolate without gorging on sugar: Enjoy dark (70%) chocolate, with fruit and nuts. 

 
Please comment:  How do you manage sugar in your life?  How have you gotten past the false belief that artificial sweeteners like those in “diet” drinks—such a sad, pathetic name—are somehow healthier than real food?  Oh yes, happy 4th of July.  It's a great country but eating right would make it way better.

Sugar and Addiction

The quick answer:  The objective in eating less sugar is not to replace sugar with sugar-like substitutes, but simply to eat less sugar.  The split pea soup recipe attached delivers wonderful sugar-free flavor.

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Addiction

What’s addiction but the inability to resist harmful behavior.  Though known through out history, the rapid spread of addictive behavior is a phenomenon of our time.  The growing variety of addictions suggests a fundamental human vulnerability triggered by the modern diet and way of living.  Though some people are more vulnerable than others, with repeated exposure anyone is susceptible. 

Food addictions, as we have seen, make a good business for the suppliers.  The success of Coca-Cola, which originally contained cocaine, and of other caffeinated and sugary drinks is testimony to this.  These and other sugary foods are mildly addictive to most, but some find them highly addictive.  A central challenge of healthy eating and living is to live free of addictions. 

Occasionally we hear the refrain, “moderation in all things.”  This is actually a way of saying everything is okay, and we know that isn’t so.  Some things, like tobacco, or trans fats, should be avoided completely.  Other things—like sugar or sugar substitutes—should be minimized.  It would be wiser to say, “moderation in all good things.”

The reader comments to the last post suggest that even diet sodas are addictive and one reader asked for ideas on how to quit.  Serious addiction requires professional help and programs exist to provide such assistance, but here are a few suggestions for the mildly addicted:

1. Make your home a safe place:  If something desirable is in your home, it will be eaten.  So keep your addictions out of the home.  Healthy Change #8, for example, said to “buy candy a piece at a time; never bring a box or bag of candy into the home.”  So if you’re unable to resist soda drinks, just buy one when you do your weekly shopping.  And get a hacksaw and cut the drink holders out of your car.  Ha ha.  
2. Seek friends who don’t share your addiction.  A recent book, Connected: The Surprising Power of Our Social Networks, followed the behavior of people who stopped smoking, a difficult addiction.  Those who were successful gravitated to social groups who didn’t smoke.  Try inviting your friends to quit unhealthy practices with you; the best outcome is when friends improve together.
3. Eat a healthy diet.  Poor nutrition is addictive nutrition—some researchers, for example, describe sugar as “the mother of all addictions.”  The science is not complete but there is evidence of the depressive effect of sugar on neuro-transmitters like serotonin, which leads to addictive behavior to compensate.  The sugar substitutes may also have this effect.
4. Remember you’re being watched.  There is scripture about the sins of the fathers passing to the sons, and their sons.   If you want to protect your children, work very hard at eating well and avoiding addictive behavior.  The generation X’ers who embraced street drugs grew up in a culture where adults abused prescription drugs.
5. Replace your addiction with something better.  Take a walk when you’re tempted to reach for a diet drink.  Water always tastes better after a walk.

Stevia

Readers have asked about stevia as a replacement for artificial sweeteners.  I think the question misses the point—to improve our diet the safest approach is to reduce all sweeteners, not just our sugar intake.  There is no research, to my knowledge, that shows a total health benefit from replacing sugar with any chemical that has the same sweetening effect.  To improve health and longevity, we need to de-sweeten the modern diet and return to traditional flavors.

Look at the history:  A new chemical or product is regularly discovered and marketed to replace one found addictive or unhealthy.  Since sugar was shown to be unhealthy in the amount being consumed, we have seen a series of potently sweet new chemicals being introduced, from saccharine to cyclamate, to sucralose, to aspartame to the most potent yet, neotame (acesulfame potassium).  Short-term, these products are probably safe to use.  The long-term safety remains unknown and may never be known due to the needle-in-the-haystack difficulty of proving what makes us ill among the thousands of foods we eat. 

Stevia is a traditional sweetener in Latin America and is now used around the world, especially in Asia.  China—not generally considered a safe source for processed foods—is a significant exporter of stevia sweeteners.  The leaves, once used intact, are now chemically processed to isolate several of the sweetening molecules.  Two, stevioside and rebaudioside A are marketed in different forms.  Rebaudioside A was approved for the FDA’s GRAS (generally regarded as safe) list in 2009, which simplifies its addition to food products.  Coca-Cola and Cargill developed a stevia product called Truvia, and Pepsi-Co developed PureVia.  The use of these products will grow and we eat at our risk.

We have used stevia products in our home but have stopped.  My beautiful wife didn’t care for the after taste and I decided I just didn’t know enough about how they are manufactured. 

Please comment:  Reducing sugar intake to the AHA guidelines of 6 tsp daily for women and 9 tsp for men is about a 75% reduction for the average American.  The goal is to de-sweeten our diet, not just to replace sugar with non-sugar sweeteners.  Please share your experience with eating less sugar (whatever the form). 

Recipe:  Split Pea with Ham Bone

In the post on legumes I promised to share our recipe for split pea soup.  It’s a traditional dish good for several meals, full of flavor without resorting to sugar.  We started with the Cooks Illustrated recipe, which follows the traditional ingredients for legume soups but took too long.  Split pea soups are a thrifty dish for using ham bones left over from a Sunday dinner.  We cooked this twice, once with a ham bone from the freezer, the second time using cooked ham hock/shoulder from the store.  Because the amount of bone will vary, we wrote the recipe per pound of bone:

Ingredients

1# ham bone with a little meat attached, or a ham hock/shoulder

4-6 cups water, or enough to cover ham bone

1-2 bay leaves

1 cup split peas, rinsed

½ tsp thyme, dried

1 T EVOO

1 medium onion, chopped

1 carrot, chopped

1 celery stalk, chopped

1 T butter

1 garlic clove, minced (optional)

1 new potato, cubed (optional)

Tabasco sauce (optional)

Directions

1. Place the bones with meat in a suitable pot with bay leaves.  Bring to boil and simmer 2-1/2 hours.
2. Remove the bone from the pot and set aside to cool.  Add split peas and thyme to the pot.  Return to boil and simmer 45 minutes until peas are soft.  (Steps #3 and 4 can be done during the 45 minutes.)
3. While the peas are simmering, add olive oil to a frying pan and sauté carrots, celery, and onion about ten minutes, until soft and moisture is evaporated.  Clear a little space in the pan and add butter and optional garlic, then stir into the vegetable mixture. 
4. Remove the meat from the cooled bone(s) and chop into small pieces.
5. Place the vegetable mixture, cubed potato, and meat in the pot of split peas.  Add salt and pepper to taste.  Simmer for 20 minutes.  Add optional Tabasco sauce to taste and serve after cooling.  (During step #5 a green salad can be prepared and served with bread.) 

Note:  Not counting the 2-1/2 hours of step #1, this meal can be prepared in a little over an hour.  Cook it on a day when you have extra time and you’ll have enough leftovers for several more meals.  A 3# ham bone made enough to freeze a quart and provide two dinners and a lunch for two people. 

Dodging Diabetes

The Quick Answer:  The shopping list is the perfect place to manage snacking—if a snack is in the house you'll likely eat it; if it isn’t you won’t. ____________________________________________________________________

Have a great 4^th of July?  (Clearly I did: I’m a bit late with this post.)  Independence Day is a good time to reflect on the American spirit, the unique virtues as well as the defects that influence how we live, eat, and die.  We are the world’s true pioneers.  No other country is so innovative.  We invented democracy (with a little help from the ancient Greeks), for goodness sake.  And we invented processed foods, soda pop, fast foods, and diet drinks.  We love change.  What other nation would so recklessly experiment with food innovations—like getting half our calories from sugar and other refined carbs—of unknown consequence?   

Books on Diabetes

I like to collect old books on nutrition, not because they’re old, but because they offer lost dietary wisdom.  Here, for example, is the English biochemist R. H. A. Plimmer in his 1925 book, Food, Health, and Vitamins:

“The Americans, with their love of candy, are the largest sugar eaters in the world.  Incidentally, cancer and diabetes, two scourges of civilization, have increased proportionately to the sugar consumption.”   (Bold face added.)

We should have listened to Dr. Plimmer.  I have another book, not as old but just as revolutionary, by John Yudkin, with this long but descriptive title:  Sweet and Dangerous, The new facts about the sugar you eat as a cause of heart disease, diabetes, and other killers.  (First published in England as Pure, White and Deadly.)  Yudkin was the first to speak clearly about the dangers of our growing love for sugar.  People value these books: A used copy of Sweet and Dangerous is offered today at $100 while a copy of Pure, White and Deadly requires $199. 

Of course you can get the information updated at a lower cost with Nancy Appleton’s book, Suicide by Sugar: A Startling Look at Our #1 National Addiction.  Scary titles.

What Causes Diabetes?

Diabetes comprises a disease family that includes type 1, type 2 and gestational diabetes.  Type 1 diabetes, perhaps 5% of all cases, is an autoimmune disease of children that destroys insulin-producing cells in the pancreas.  The cause is unknown but a near-normal lifespan is now possible through improved medical technology.  

Type 2—the subject of this post—is an increasingly common consequence of the modern lifestyle.  How common?  Twenty-six million Americans have Type 2 diabetes, a chronic disease that leads to other diseases, such as heart disease, stroke, and cancer.  Seventy-nine million of us are prediabetic and at risk for full-blown diabetes.  These days, diabetes is a growth industry. 

So what causes type-2 diabetes?  This will drive you crazy but despite all the research, scientists don’t know for sure.  We think of diabetes as the sugar disease but it’s more complicated.  Not everyone who eats a lot of sugar gets diabetes.  There are other factors, including diet, family history, overweight, and lack of exercise.

The best book I’ve read on sugar and disease is Gary Taubes’ Good Calories, Bad Calories; Challenging the Conventional Wisdom on Diet, Weight Control, and Disease.  My conclusion after reading Taubes:  The best way to avoid the risk of overweight and diabetes is to bring sugar intake below the American Heart Association recommendation (6 tsp daily for women, 9 tsp for men), eat a whole foods diet, and exercise at least three hours weekly.  The Healthy Changes of the last six months build a foundation for doing this.

Where do we get most of our dietary sugar?  Sugary drinks (addressed here) and snacks!

Healthy Snacking

We talked about snacking in a prior post and implemented the Healthy Change of using a snack plate.  (Confession:  I sometimes forget and need to remind myself to do this.) 

Four principles for healthy snacking:

1. Commercial snacks are usually the unhealthiest food in the store and the worst value for your money.  Remember: money spent on unhealthy snacks is a vote for that company to succeed.

2. Watch for “boredom” snacking and substitute other forms of variety, like a walk, a chapter from a favorite book, calling a friend, or, ahem, checking your favorite nutrition blog. 

3. The key to healthy snacking is to eat a good (low G.I., whole food) breakfast.  Our worst snacking habits arise from stimulant-craving due to skipped breakfasts. (The danger of coffee, I suspect, is less about the coffee and more about habitually skipping a nutritious breakfast.) 

4. If your waist size is greater than your goal, eat a healthy breakfast and don’t snack after 8:00 pm. 

We’ll talk more about healthy snacks and proven waist-reducing habits in the next post, but just to remind, snacks can be organized in these groups:

•  Veggies

•  Fruits

•  Nuts and seeds (including popcorn)

•  Cheeses and yogurt

•  Leftovers

•  Home-made snacks (like crackers or cookies from healthy recipes).

Which brings us to the healthy change of the week:

If we don’t have unhealthy snacks in the home (or office), we won’t eat them.  If we have healthy snacks available, it’s likely we will eat them.  Pretty simple.  Got a nasty snack you can’t resist?  Buy just one serving, once a week.  The experience of many is that as you eat better, you’ll also snack better. 

Budget Wisdom:  As an experiment, wander the grocery store snack aisles and look at the cost per ounce.  Then compare to the cost of fruits and vegetables or other healthy snack ingredients.  With the exception of certain nuts and seeds, which I love, you save by buying healthy snacks.

Please comment:  Share your favorite healthy snacks.  We’ll collect your favorites into the next post.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Dental cavities: Preventable and curable?

The Quick Answer:  If you or a family member gets one cavity in three years, it’s not just an unnecessary expense that will lead to future pain and expense; it’s also a wake-up call to take preventative action.  Buy more fluoride?  No!  Eat less sugar (and more whole foods, including green salads).

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Here’s a fresh look at a common childhood disease: dental cavities (or caries).  The chronic diseases—type 2 diabetes, heart disease, cancer, autoimmune diseases, etc.—may take decades to develop, but cavities, which have a shared cause, can develop in baby teeth.  There’s a saving grace in the baby tooth cavity—if taken seriously, it’s an early warning that preventive change is needed to save the permanent teeth that follow.  Dental caries are highly preventable and curable, if caught early, by diet reform.

Dental cavity questions:

•  How big a problem is dental decay?   Cavities is the single most common chronic childhood disease (over 50% of children 5-9 years have at least one cavity; 78% of 17-year-olds do.  (How do 22% reach 17 with none?)

•  What causes cavities?  Sugar, mainly.  Bacteria that live in the plaque on your teeth use sugar to produce acid that can demineralize tooth enamel.  The body can repair this through remineralization but only if the plaque isn’t too acidic.

•  Can cavities be prevented?  Technically, yes, but you must move beyond the advice of the old dental establishment and the government.  If you Google “dental cavities, prevention” you will get official guidance on brushing & flossing, fluoridation, dental sealants, and regular visits to your dentists.  This is all good, it’s certainly a good business and does reduce decay, but history shows it won’t prevent or cure cavities.  Surprisingly, diet—the major factor—gets little mention.

•  So, can people actually prevent and even cure cavities?  Pretty much, but there are issues of family history, including genetics, and the fact that you’re starting well after your teeth were formed.

•  Is preventing and curing cavities a recent discovery?   No.  Important discoveries were made way back in the 1920s and 1930s and then forgotten.  So we should remember two pioneering women:  Dr. May Mellanby, and Mrs. Weston Price.

Dr. May Wellanby was the wife of Dr. Edward Wellanby who solved the problem of rickets (like caries, a bone disease) and contributed to the discovery of vitamin D.  His wife, a brilliant scientist in her own right, studied the epidemic of dental caries using dogs and then humans.  She found diet combinations that drastically reduced cavity formation and actually healed smaller cavities.  May Wellanby published her discoveries in 1924 (credit to Stephan Guyenet for this summary):

•  A diet with adequate minerals, particularly calcium and phosphorous (the ratio is important), is critical;

•  The diet must also include the fat-soluble vitamins, especially vitamin D which is also obtained from sunlight;

•  Dr. May Wellanby recommended a varied diet of whole foods, including dairy, and cautioned against excessive sugar and [refined] grain intake.

Mrs. Weston Price didn’t leave a record of her work; her contribution was to assist her husband during the ‘30s on expeditions around the world to the most primitive indigenous people they could find.  Their mission was to study the dental health of indigenous people who had not yet adopted the Western diet of refined foods, and compare them to their cousins who had moved to the city and converted to the modern diet.  Weston published his findings in the 1939 book Nutrition and Physical Degeneration:

•  Price found that for the same indigenous population, dental cavities were 35 times higher (that’s 3400% more) on the modern refined, sugary, diet, than on the traditional diet. 

•  Traditional diets were not only protective against cavities; they also resulted in well-formed dental arches in newborns.   Their cousins born in the city had the crowded malformed dental arches that delight the orthodontist.

•  Price visited tribal people all over the world who lived in varied climates and ate different diets.  What they had in common was an evolved food tradition based on natural foods and game at hand that sustained health. 

Preventive Dentistry:

Here we have a familiar story:  science has discovered a great deal about how caries develop, but we must turn to food traditions to learn how we can prevent them.  When scientists studied dental plaque—the coating on your teeth—they found a surprisingly complex community of bacteria that they gave a new name: biofilm.  Many of the bacteria in biofilm produce acid and when there is too much acid (the pH has to drop below 5.5) tooth enamel is demineralized, or eaten away.  When the pH is above 5.5 (less acidic) enamel can be remineralized, or repaired if given a healthy diet.  Your saliva is key to a healthy acid level.

The biofilm is constantly bathed in saliva.  Saliva, 98% water and sometimes called the blood supply for the mouth, is a rich broth that can buffer excess acid; it contains minerals, proteins, antibacterial agents, and enzymes needed for digestion of food.  The mouth produces about a liter of saliva each day, so drinking adequate water is as important as a healthy diet.  Prescription drugs present a special problem; there are around 3000 medications that have the side effect of “dry mouth,” which accelerates the formation of caries and gum disease.  If this warning is on the package insert of a drug you take, consult your dentist.

I had a phone interview with Dr. Cliff Sorensen, who practices preventive dentistry in Ogden, Utah.  I had read about Dr. Sorensen’s work so gave him a call, thinking that because he had once dated both my future Beautiful Wife and one of my charming sisters, he would talk with me.  We had a great conversation about saliva, biofilm, acid-producing bacteria, caries, and the difficulty of getting people to change self-destructive habits.  Dr. Sorensen gave up drill-and-fill dentistry, at considerable personal expense, when he became convinced that, for most, dental caries was preventable and curable.  As explained, he provides a cariogenic assessment and based on the outcome, provides guidance and support as appropriate.  (I like that word, cariogenic, meaning cavity or carie-producing.)

Dr. Sorensen doesn’t give nutrition advice, except to eat a healthy low-sugar diet.  I am not aware of any dentist who does; as you know, the subject is complex and the science incomplete.  But the guidance of science, tradition, and scripture combined can give us the best possible answer and that is the goal of this blog.  For example:

•  Cariogenic foods begin with sugar, but include refined and processed foods too.  Growth of the caries epidemic has paralleled our growing sugar appetite.  So sugary drinks and snack foods are a problem.  Research suggests eating less than 33-44 pounds of sugar a year will protect against dental caries.  This can be accomplished with the three sugar Healthy Changes (found here, here, and here), based on meeting the AHA’s maximum intake of six (women) to nine (larger men) daily teaspoons, which is about the proposed 33-44 pound maximum. 

•  Protective (non-cariogenic) dietary includes a variety of whole foods including dairy, plus adequate vitamin D (discussed here) as suggested by Dr. May Wellanby nearly 80 years ago.  Calcium and phosphorous are important minerals for bone health.  It's well-advertised that milk and dairy supply calcium; it's less well-known that plants are an essential source.  An important plant source is the leafy green vegetables used in salads.

Comment:  Share your favorite salad recipes, or your experience preventing cavities. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

is sugar toxic?

In his 1925 book, Food, Health, Vitamins, the pioneer English biochemist, R. H. A. Plimmer made a foreboding but prophetic comment about sugar in America: 

“The Americans, with their love of candy, are the largest sugar eaters in the world.  Incidentally, cancer and diabetes, two scourges of civilization, have increased proportionately to the sugar consumption.” 

We did not heed Plimmer’s warning—our sugar intake continued to increase, as did the incidence of diabetes and cancer.  Add to that list the illness that has since grown to be the #1 cause of death: heart disease.  Everyone knows excessive sugar is unhealthy, but we accept it, we’re much like the air traffic controllers who fall asleep at their station. 

Now a true crusader has taken on the task of awakening slumbering Americans.  Gary Taubes, author of the definitive exposition of the sugar-related diseases, Good Calories, Bad Calories, has fired another blast in the New York Times Magazine, under the title “Is Sugar Toxic?”

Taubes invokes the work of Robert Lustig whose YouTube video lecture, “Sugar: The Bitter Truth” has gone viral and is approaching one million viewings.  Lustig is a respected professor at a respected medical school (UCSF), and he addresses the common sugars—glucose and fructose—like a revival preacher, calling them “poison”, “toxic”, and “evil”.  Lustig gives a brief summary of the chemistry that supports his views about sugar, particularly fructose and its role in fat generation, and links them to the rise in obesity, diabetes, hypertension, heart disease, and the common cancers.  He closes with a benediction, however, on the natural sugars found in fruits: “When God makes a poison, He wraps it in the antidote.”

Taubes also reviews the work of Dr. John Yudkin who in the '70s warned of sugar's toxicity with his book, "Sweet and Dangerous" (the U.S. version of "Pure White and Deadly," published in England).  Yudkin made the link between sugar intake and heart disease when the loudest experts were (wrongly, it turns out) touting the “lipid theory” of heart disease that claimed dietary saturated fat and cholesterol were the cause.  A generation was wasted as thousands of “low-fat” foods and sugary drinks were added to our dietary.  This campaign not only failed to reduce the incidence of heart disease, it introduced two new epidemics: overweight and type 2 diabetes.  Yudkin was so effectively ridiculed by the lipid theory camp—yeah, scientists do that kind of stuff too—that it became politically incorrect to criticize sugar or mention Yudkin’s work.  Well, the times have changed—Yudkin, now deceased, is getting new respect and his books have become collector’s items.

Finally, Taubes returns to the subject of sugar and cancer, introduced by Plimmer in 1925.  Though the mechanism is not fully understood, there is no question that cancer increases with sugar intake and with diabetes.  Studies have shown cancer to be nonexistent in primitive societies who don’t consume refined sugars.  Taubes closes by quoting two cancer experts:

Dr. Craig Thompson (head of Memorial Sloan-Kettering Cancer Center in N.Y.):  I have eliminated refined sugar from my diet and eat as little as I possibly can.

Dr. Lewis Cantley (director of Harvard Medical Schools cancer center):  Sugar scares me.

Taubes’ closing paragraph:

“Sugar scares me too, obviously. I’d like to eat it in moderation . . . but I don’t actually know what that means, and I’ve been reporting on this subject and studying it for more than a decade. If sugar just makes us fatter, that’s one thing. We start gaining weight, we eat less of it. But we are also talking about things we can’t see — fatty liver, insulin resistance and all that follows. Officially I’m not supposed to worry because the evidence isn’t conclusive, but I do.”

Sugar: Love Gone Bad

Unless you live in a cave, you know about the diet-related surge in overweight and obesity in America.  What one thing has done the most damage to our diet?  After much pondering, my answer is “sugar”.  Better said, the problem is that sugar is the #1 additive in processed foods.  The experts don’t agree on how much sugar the average American is eating, but a good estimate is 30 teaspoons a day.  You don’t put that much sugar in your food?  You don’t have to; it’s already there.  A large bowl of ready-to-eat breakfast cereal, an 18 oz. soda and candy bar for snacks during the day, and a slice of cake after dinner adds up to 30 tsp of sugar.  And that’s just a fraction of what we eat in a day.  The foods in our diet are ever changing, but sugar is a constant.

My engineering career was in the medical device field.  During those years I gained an appreciation for the limits (and cost) of therapy for the chronic diseases.  I learned one big lesson:  Because these diseases generally aren’t curable, prevention is much better than treatment.  We were always looking for the next new application of technology for treatment.  I was fortunate to be part of a start-up company with a revolutionary treatment for brain aneurysms—for someone with a treatable aneurysm, this was a big deal.  If I were to invest in the next “big thing” today, I would put my money in companies working on diabetes.  

Although overweight and obesity are risk factors for diabertes, no one sets out to get diabetes—the diagnosis usually comes as a surprise.  Like high blood pressure, diabetes is a silent killer; a person is typically diabetic for seven years before the symptoms bring them to a doctor.  Some 24 million Americans are diabetic; six million don’t know they have the disease.  Most people have type 2 diabetes—mainly caused by too much sugar in the diet—which is usually preventable.  (Not so with Type 1, a tragic autoimmune disease typically diagnosed in childhood.) 

Our high sugar intake doesn’t just ruin our figure; it ruins our health.  Sugar is linked to a host of diseases besides diabetes, including atherosclerosis, high blood pressure, heart disease, stroke, some cancers (including breast and prostate cancer), autoimmune diseases like arthritis and Parkinson’s disease, kidney disease, and so on.  I forgot to mention dementia and Alzheimer’s disease.  And the meanest cut of all—accelerated aging. 

Later this week we’ll post a review of the best book about dietary sugar.  There’s also an upcoming post on Word of Wisdom Living as a protection against breast cancer.

Of the 52 Healthy Changes, five address the problem of too much sugar in our diet.   We previously addressed the problem of sugary drinks and candy-like breakfast cereals.  The next biggest source of sugar is candy.  Walk through your grocery store and observe the space dedicated to candy, including the treats conveniently located by the cash register.  Though this candy is sweet, have you noticed that much of it doesn’t even taste good?  We all enjoy an occasional treat; the goal of this change is focused on the word occasional:

This is a change you can live with.  Remember there isn’t a limit on the sugars in fruits and other natural foods, which come with a host of protective nutrients.  And if you’re baking a homemade chocolate cake, feel free to bring a piece by my house. 

There will be two more Healthy Changes about sugar; one will address diet drinks and how they actually cause us to eat more sugar.  The goal of these changes is to bring our intake below the American Heart Association recommendation of 6 teaspoons (25 grams) daily for women, and 9 tsp. (37 grams) for men.  Yes, the guys are allowed a little more; the rule is based on average body weight. 

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

To Your Health!

We passed the 10% milestone last week, by introducing the fifth of the fifty-two Healthy Changes for 2011.   If you’ve done all five, you should be feeling the benefits.  Each change addressed a serious lifestyle problem for Americans:

1. Sugar reduction: To beat the AHA ceiling for added sugars (25 grams or 6 tsp. daily for women, 37 grams or 9 tsp. for men), reduce sugary drinks to one (12 oz.) per week.  A future post will tell why this rule should also apply to diet drinks.

2. Trans fat elimination: To remove trans fats from the diet, stop buying all deep fat fried foods.

3. Whole grains:  To gain the health benefits of whole grains, only eat cereals a) made from whole grains and b) with more natural fiber than added sugar.

4. Vitamin D:  Reach optimum blood levels of vitamin D by including a little midday sunshine most days, weather permitting.  (People in the northern latitudes, intolerant of sunlight, or just worried about vitamin D should consult a doctor.)

5. Exercise:  For full health and fitness, get at least 30 minutes of exercise most days.  More is better, especially if you sweat.  Do it midday to top off your vitamin D.

Drinks are important—what you drink, because of the daily volume, can greatly affect your health.  Healthy Change #1 took away nearly all your sugary drinks (and it was suggested to apply the 1/week limit to diet sodas also).  So what can you drink? 

The short answer is “water”.  The experts say about eight cups a day, depending on size and activity.  I doubted I was drinking that much so I measured water into a pitcher and used it for 24 hours.  I was drinking less than I thought—I keep a glass of water handy now.  I drink it cold as tests show this improves metabolism and weight loss.  Drink two glasses before meals and you’ll improve weight loss by another 30%, according to one study.

Are you often tired?  Do you regularly need an energy boost?  One theory of why we’re all consuming so many sugary drinks and other addicting stimulants is that poor lifestyle habits leave us perpetually tired.  We eat foods high in sugar and that puts us on the sugar roller coaster—needing a sugar fix every couple hours.  Maybe we don’t get enough sleep so start the day tired.  Or perhaps we’re living with an overload of stress and never really relax.  There are other causes of tiredness, including chronic dehydration from insufficient water.  Fatigue is a common problem judging by the popularity of unhealthy energy drinks, or the more recent use of power shots.  If you frequently need a drink to pick you up, talk it over with your doctor.

Do you sometimes tire of water and just crave variety?  I do, about once a day. Here are some ideas that will help meet your fruit and vegetable goal:

• Homemade smoothies are great because you can put the whole fruit in along with the healthy ingredients you enjoy.  (I’ll share my recipe in a later post.)  You can even slip in some vegetables.  The green drinks are great for getting your veggies.

• Herbal teas are my wife’s preferred evening drink, especially when it’s cold out.

• Homemade fruit juices are best though easier if you have a juice extractor.  The store-bought juices are invariably processed from concentrates and often shipped 1000s of miles, so vitamin content suffers.

• Orange juice is refreshing, especially if you squeeze the oranges yourself.  Using oranges from Costco I can make a 6 oz. drink for $.58 (two oranges).  Store-bought O.J. costs about 50% more.  Grapefruit juice is good too; I dilute it with lots of ice.

• Lacking both an apple tree and a press, I buy my apple juice.  Everyone likes apple juice; it’s the cheapest fruit juice though the high level of natural sugars can be a problem for the diabetic.

• If you purchase drinks, look for the 100% berry juices rich in antioxidants, like blueberry, pomegranate, or cranberry.  A disadvantage is these drinks must be pasteurized for safety.  

• The 100% fruit juices can be extended by following the European custom of mixing them 50/50 with sparkling water, or use tap water with ice.

Oh, I forgot milk.  I like milk, though I don’t care for the way it’s produced or processed.  We’ll come back to milk in a future post.

Please comment with your own favorite drinks and we’ll share them in a follow-up post.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.

Trouble in the Cereal Aisle

In “The Whole Darn Grain” I promised to visit the local grocery store and list the package cereals that met our Healthy Change #3: 

This rule is a simple device for selecting healthy breakfast cereals.  It works for processed foods as well.  Some, for example, have noticed that their “whole wheat” bread has more added sugar than fiber.  (Stay tuned; in a later post we’ll look at healthy breads.)

If you're wondering where to find the sugar and fiber amounts on your cereal at home, see the nutrition facts on the side of the cereal box. Under "Total Carbohydrates" it lists the fiber and the sugar (see the area circled in green below).

The logic behind this Healthy Change follows the daily dictums of three whole-grain servings and limited sugar consumption (6 tsp. max for women, 9 tsp. max for men, per the AHA).  Plus you get all the other benefits of whole grains, including fiber.  When little sugar is pre-added, the cereal can be sweetened and upgraded by adding fresh fruit in the home.

Here are the 8 cereals that met our rule and 5 that were close, out of the 128 package cereals inspected in a local store (Ralph’s, the cereal section was 60 feet long!).  The first number is the grams of fiber, the second is the grams of sugar:

     Nature’s Path Flax plus Multibran,  5/4

     Weetabix Whole Grain Biscuit, 4/2

     Kashi Go Lean Original, 10/6  (Soy is 1^st ingredient listed.)

     Kashi Heart to Heart, 5/5

     Post Grape Nuts, 7/5

     General Mills Kix, 3/3

     Post Shredded Wheat (spoon size), 6/0

     Ralph’s Shredded Wheat (spoon size), 7/<1

     Kellogg’s All Bran, 10/6

     Ralph’s Bran Flakes, 5/5

     General Mills Cheerios, 3/1

     Ralph’s Toasted Oats, 3/1

     General Mills Wheat Chex, 5/5

For the typical family concerned about health and value, hot cereals cooked at home from bulk whole grains are the best choice.  You can buy grains for a dollar or less per pound versus paying three to five dollars a pound for the less-healthy packaged cereals.  Keep a package or two of the store-bought cereals for occasional variety or when you’re unusually rushed. 

If you have a favorite healthy package cereal not on this list, please comment. It may not have been in the store we checked.

The Short and Sweet of it?

Nice guy that I am, I’ll give you the answer right at the start of this post.  If you want to look better and live longer . . . eat less sugar.  Sugar, whether sucrose (table sugar), high fructose corn syrup, or in some other form, is ubiquitous in our food environment.  So where to start?  Healthy Change #1—the first of 52 small steps that could make a big change in your health—takes a bead on our biggest source of dietary sugar: soda drinks.   

To tell you how I got to this conclusion, here is a brief history.  Sugar, beginning in the Middle Ages, was precious—the food of kings.  The Industrial Revolution changed this, making sugar cheap and plentiful.  Our modern diet contains an amazing amount of sugar.  The 2000 USDA Factbook puts our total sugar supply at a shocking 152 pounds per person per year.  After subtracting for waste, this translates to 30 teaspoons each day, over 20% of our calories.  We actually don’t add this much, most of the sugar we consume is added at a factory, which makes sugar our #1 food additive.  From a clinical standpoint, such a high intake of sugar is an uncontrolled food experiment on us guinea pigs—what happens when a nation get 20% of it’s calories from sugar? 

Our sugar intake is not a new problem.  In 1925 the noted English scientist R. H. A. Plimmer warned: “The Americans, with their love of candy, are the largest sugar eaters in the world.  Incidentally, cancer and diabetes, two scourges of civilization, have increased proportionally to the sugar consumption.”  Plimmer’s genius was to make the connection between sugar and chronic diseases.  His failing was an excess of optimism about our ability to change: “ . . . as we now realize our predicament it should not be a difficult matter to rectify our mistakes.”  Nothing was rectified; our sugar intake grew and grew all through the 20^th century.

In 1972 another English scientist, John Yudkin, made shockwaves with his book, Pure, White and Deadly, which linked sugar consumption with heart disease.  In America we (incorrectly, it now appears) had linked coronary heart disease to cholesterol and saturated fat.  So Yudkin’s work was seen as politically incorrect and ignored. 

Fortunately, a possible cause of a disaster like coronary heart disease cannot be ignored forever.  In 2007 Gary Taubes published a fascinating critique of our sugar intake, based on seven years of research, titled Good Calories, Bad Calories.  Taubes’ carefully documented conclusion links our high consumption of sugar to the rise of obesity, diabetes, heart disease, and many cancers.  You can throw in dementia and accelerated aging also.  I highly recommend Taubes’ book, though it’s strong emphasis on science makes for heavy reading.  For an easier-to-read but no less macabre book, try Suicide by Sugar.  The shared message of these books: If you depend on sugar to make life sweet, your life will be shorter, perhaps much shorter.

So how much sugar should we eat?  There is no recommended daily amount—the body has no need for the simple sugars.  (The complex sugars contained in natural foods as carbohydrates, however, do provide needed energy and nutrients.)  The USDA, not known for going against the interests of the food industry, calls for reducing our sugar consumption by about two-thirds, to 10 teaspoons daily on a 2000 calorie diet.  This approximates the sugar in a can of soda, or a large bowl of breakfast cereal.  There does not appear to be any hard science behind the USDA recommendation.  The American Heart Association has recommended no more than 25 grams (about 6 teaspoons) daily for women, and 37 grams (about nine teaspoons) for men. 

The AHA sugar limits are a good place to start: 25 grams or 6 tsp. daily for women, 37 grams or 9 tsp. for men.  This is a limit we can live with.  Beverages like sodas and energy or fruit drinks are a major source of sugar.  (Fruit juices may be OK, check the ingredients for added sugars.)  Breakfast cereals are also highly sweetened.  Candy, bakery goods, and snack foods—heck, nearly all processed foods—are typically loaded with added sugars.   Today, let’s start with drinks.

One confession:  I enjoy Pepsi Cola and, no surprise, so do my kids.  Seeking a workable balance between healthy diet and guilty pleasure, I decided to limit sugared drinks like Pepsi to one per week.  After one year, this seems a workable solution.  Funny thing—my desire to drink sodas has diminished.  Side note:  my wife prefers diet drinks, also unhealthy but for different reasons.  We’ll get to those in a later blog.

Need a reminder? Download our Healthy Change reminder card. Print and fold, then place in your kitchen or on your bathroom mirror to help you remember the Healthy Change of the week.