Sunday, January 15, 2012

La Vita e Dolce, Part Three: How to Eat Your Sugar

III. Does HOW You Eat Sugar Make a Difference to Your Body?

Orange juice or an orange? Soda or chocolate-covered raisins? Cream of wheat or oatmeal? To make smart sugar choices, it helps to understand what happens inside the body after that sweet, creamy or starchy bite passes over our taste buds. No interest in the science behind it? Scroll down to “Our Friend Fiber: Delivering Sugar in Moderation.”

Blood Sugar Becomes Stored Sugar Becomes Fat

The body’s goal is to break down all digestible carbohydrates into simple sugar (glucose) molecules, which are the only ones small enough to cross into the bloodstream. Glucose (aka “blood sugar”) is called the “energy of life” because it is the basic fuel for living organisms, from bacteria to humans. Glucose gives our cells energy to move, grow and repair, and is also the primary energy source for the brain.

When we eat carbohydrates (aka sugars and starches), whether:
  •  Simple (i.e., fructose, glucose, galactose) or
  •  Complex (i.e., starchy vegetables, grains, legumes - think “FIBER”),
enzymes in the saliva, pancreatic juice and lining of the small intestine break down food to derive glucose (fructose is an exception, read on). As glucose entering the bloodstream elevates blood sugar levels, the pancreas releases the hormone insulin into the blood, which tells cells to absorb blood sugar either for use or for storage.

In the liver, surplus glucose is converted into glycogen to store energy for use in between meals, while the rest is sent to muscles and peripheral tissues for an immediate energy boost. Glycogen is the body’s short-term energy storage package, easily converted back to glucose when we need it. If the body is already storing enough glycogen, surplus glucose is changed into fat.

Conversely, when we need energy, like while exercising, our body extracts glucose circulating in the bloodstream and breaks down stored muscle glycogen into glucose, burning it; next signals the liver to start breaking down its glycogen stores, releasing more glucose into the bloodstream to be burned; and finally, oxidizes its fat reserves as glycogen stores become depleted. So if we regularly overdose on sugar, the body never need burn its fat.

In addition to keeping the body fatty, a high sugar diet induces the pancreas to pump out high levels of insulin. This stresses the pancreas and bombards body cells with insulin to the point that they may become insulin resistant:  unresponsive to insulin and thereby unable to get glucose out of the bloodstream. As an example, whereas normally 1 unit of insulin might be needed to help 10 mg of glucose go into the cell, in a hyperinsulinemic person, 10 units of insulin might be needed to get the same 10 mg of glucose into the cell.  The result is glycation: glucose molecules, unable to enter the body’s cells, glom on to proteins in everything from red blood cells to blood vessel walls to nerves. If glycation becomes severe, "it can damage cell membranes and corrode virtually every major system in the body." Jim Thornton, "The House That Snacks Built" Best Life Magazine

Meanwhile, glucose is the only fuel normally used by brain cells, which cannot store it, relying on the bloodstream to deliver a constant supply of fuel (glucose) to the brain. As your body tries to compensate for a high sugar diet, insulin levels are higher when you eat and between meals (aka "fasting insulin level"). Until the liver filters the insulin out of the bloodstream, circulating insulin keeps pulling glucose out of the bloodstream and “locks” your fat cells, preventing your body to burn fat for fuel. Your brain may experience an energy crisis, feeling spaced-out, weak, confused, nervous, unable to focus. Called “hypoglycemia,” these dips in blood sugar bring on the sugar cravings, as the brain calls for more glucose, stat!

See a cycle forming? If this cycle is so destructive to our bodies, why do we keep putting more and more sugar into our mouths? To pinpoint one culprit would be oversimplifying the complex workings of the body, but here are some possibilities:

Leptin-Resistance, Fructose, and Food Rewards

“Are You Leptin’?” (Uncle Tommy’s coined phrase for eating that causes your leptin to surge)
We understand part of the story of insulin gone awry, but let’s back up a step to examine how a person becomes a chronic sugar overeater. Neurosurgeon Dr. Jack Kruse asserts,
“Chronic leptin elevation leads to eventual leptin resistance and usually occurs 5-7 years before someone becomes insulin resistant.”
Leptin is what a Whole9 article dubs the “kingpin hormone” because it controls all of the body’s energy metabolism.  Your stored fat cells (adipocytes) make leptin and secrete it into the bloodstream to inform your brain about your status of energy reserves (how much fat you have). When this system is working, your brain uses this information to decide that you need to gather more energy (you feel hungry), that your energy needs are met for now (you feel full) and that you do or do not have enough energy to undertake some activity (you feel drained, tired or energized). Accordingly, leptin controls your appetite, fat placement and usage.

Many Americans have however become leptin-resistant, which much like insulin resistance, occurs when high levels of leptin are repeatedly secreted into the bloodstream, until our cells become deaf to its message. Given that the more body fat you have, the more leptin is secreted, what causes chronic leptin elevation in the blood?
  • Overeating. From infancy, many Americans overconsume sugar, increasing inflammation and body fat. As sugar gets metabolized in fat cells, they release surges of leptin.
  • Chronic Inflammation. When SOCS (suppressors of cytokine signaling) go to work to calm inflammation in the body (an overfed or fat body is an inflamed body), they block the brain’s leptin receptors, so the message to stop eating doesn’t get through to the brain. What to do? Eat more!
  • Snacking and Drinking Sugar. Processed snacks and sugary drinks cause insulin levels to spike repeatedly throughout the day, causing frequent leptin secretion.
  • Exercising without Recovery Time. Similar to overeating, overtraining without proper recovery time keeps the body perpetually inflamed. (See Chronic Inflammation above).
  • Stress. When cortisol levels go up, fat cells release more leptin.
  • Breastfed? This process could kickoff on the day you’re born:  “You first get leptin from your mother when she first breastfeeds you. So if you were not breastfed you may have started life off on the wrong foot from an energy metabolism stand point. In fact the latest research is showing that not getting leptin from your mother’s colostrum has huge implications right away for your DNA...This is one way we know obesity can be transmitted across generations. There are others.” -- Dr. Jack Kruse, [For more about the wonders of breastfeeding, see this previous post.]
Have you become a “Sugar Burner”?
Are you craving sugar in some form (drink, dessert, carbs, dairy) all day every day? Can you work out many days a week and seem to hardly lose a pound? Are you tired or ravenous after a workout? Do you have an eternal “beer belly” or “paunch” (fat below where your six-pack would be -- called “visceral fat”)?

Many of my friends and family would answer yes (I did). These are signs that you are leptin-resistant, and as such, have become a “sugar burner.” Your broken energy controls think you are in a famine, overlooking your fat when you need energy, and instead burning what sugar you have circulating in your blood stream or have stored in your muscles. This is why when you workout, you experience extreme fatigue and hunger, and minimal fat loss. It’s also why your body tells you to eat more often, especially at night, even though you have plenty energy stored in your belly, or hips or thighs, etc. After all, the brain needs blood sugar to operate, and if the body isn’t tapping its sugar reserves (fat), the alternative is to keep putting sugar in your mouth.
“Also lost is the knowledge of where to put that fat, so a preponderance of it is stored in the viscera [lower belly]...Some of that fat permeates the liver, impeding the liver's ability to listen to insulin and further hastening diabetes.” -- Dr. Ron Rosedale
Meanwhile body-wide inflammation from overeating blocks your satiety signal from registering in your brain. The vicious cycle forms:

The Fructose Loophole
Fructose, unlike other simple carbs, is metabolized in the liver where the body stores it as more glycogen. Also, because fructose does not stimulate insulin production, insulin doesn’t go up and therefore leptin doesn’t surge to signal the brain that you ate. Because it doesn’t spike insulin, fructose is sometimes recommended by health professionals as a better source of sugar, but several doctors running obesity clinics disagree.

Overdosing on fructose taxes the liver, which forms toxins in the body, stores more visceral (belly) fat and tricks you into overeating. Consider: a can of Coke with 40g of sugar sourced from HFCS (55% fructose, 45% glucose), gives you 22g fructose -- 3 times as much as one apple (about 7.5g fructose). Drinking sugar (regardless of the source because white/brown sugar, HFCS, fruit juice and evaporated cane juice all contain high levels of fructose) is one of the pillars of what Dr. Robert H. Lustig, MD, Professor of Pediatrics in the Division of Endocrinology at UCSF, calls the “fructosification of America.”
“Before food processing we got fructose from fruits and vegetables, and consumed about 15g of fructose a day. In 1994, American adults were consuming 54g of fructose daily.” -- Dr. Lustig
“Fructose is a special carb that makes more sdLDL [Small, dense LDL - heavy, “bad” cholesterol] than any other sugar we have because of how the liver has to handle it biochemically. The large amounts of these particles causes the liver to make a ton of triglyceride particles to store all the sdLDL’s for storage in the bad places like are arteries, viscera, heart or liver.” -- Dr. Jack Kruse
Sugar is not evil, but concentrated liquified doses of fructose may be. Check out this parody of the HFCS ads.

Misled by Our Survival Instincts -- Food Reward
In its 2009 statement, the AHA described how the quick hit of glucose and the palatability of processed/sugary food and drinks alter the pleasure center (aka limbic system) of the brain such that: you eat more regardless of whether or not you need to, hard-wired pathways are established to crave the sugary food, and you feel pleasure even as you overeat. They called it “The Hedonic Pathway of Food Reward.”

The limbic system is meant to help us survive by influencing our emotions and motivations related to many things, including eating. When something pleasurable or rewarding happens (like getting a surge of glucose from a soda while watching a great movie in the theater), the reward system is engaged to make sure the brain remembers to repeat that action.
“The brain uses input from smell, taste, touch, social cues, and numerous signals from the digestive tract to assign a reward value to foods. Generally, we are born liking the following:  fat, starch, sugar, salt, meatiness (glutamate), the absence of bitterness, certain textures, certain aromas, calorie density (rich foods). Over time, aromas and flavors associated with these qualities also become rewarding. For example, beer tastes terrible the first time you drink it because it's bitter, but after you drink it a few times and your brain catches wind that there are calories and a drug in there, it often begins tasting good.”

“Your brain is pretty simple in some ways. It has these very basic hard-wired associations, like ‘sweet is good’ [remember the brain needs a stable level of blood sugar to operate]. If your brain likes a little bit of sweet, then it really likes a lot of sweet. ..Our brains are wired to respond to the stimuli with which they evolved. For example, our natural taste preferences tell us that fruit is good. But what happens when we concentrate that sugar tenfold [i.e., juice]? We get a superstimulus. Our brains are not designed to process that amount of stimulation constructively, and it often leads to a loss of control over the will, or addiction.

Our bodies are finely honed to seek out healthy food, but only in the context of what we knew when our tastes developed during evolution. If all that's available is grass-fed meat, pastured eggs, vegetables, fruit, and nuts, your appetite will naturally guide you to a healthy diet. If you surround yourself with superstimuli such as sugars, refined grains and MSG, your body will not guide you to a healthy diet. It will take you straight into a nutritional rut because it's not adapted to dealing with unnatural foods.

It's a very similar process to drug addiction. Addictive drugs are able to plug directly into the brain's pleasure centers, stimulating them beyond their usual bounds. Food superstimuli do this less directly, by working through the body's taste reward pathways.

Why would your body deliberately encourage you to damage your health? In our hunter-gatherer state, it didn't. In this age of processed food, our technology has outstripped our ability to adapt. Any taste that's extraordinarily concentrated by some industrial process, relative to what we could have foraged, should be seen with suspicion in my opinion.”- Biochemist and Neurobiologist Stephan Guyenet (
Thank you, Mr. Guyenet, for explaining food rewards so well. I discovered his blog serendipitously just as I was in week 3 of a candida diet (no dairy, refined grains, alcohol or sweets), and it made me understand why I felt SO ANGRY! At the heart of my anger was a feeling of deprivation. I tried to cut deals with myself (“Maybe just a taste of the mac-n-cheese at Thanksgiving?” “If I could only have ONE of these foods, it wouldn’t be so hard to stick to the diet”). I complained to my husband about how I never get to do anything for myself. I ranted to my friends about how I was starving, until finally one of them commented, “you sound like an addict.” And so I was.

Now, just what is a hypoglycemic, leptin-resistant, pre-diabetic sugar addict to do?

Our Friend Fiber: Delivering Sugar in Moderation 
“The best carbs are those that not only provide a steady supply of energy, but also bring other nutrients the body needs.” - Dr. Sears

“Complex carbohydrates are like time-release capsules of sugar because their fiber resists digestion, slowing the breakdown and subsequent release of sugars into the bloodstream. Simple carbohydrates contain glucose that is absorbed directly through the stomach wall and rapidly released into the bloodstream, almost as quickly as if delivered by syringe.” -- The Franklin Institute Online, The Human Brain

“When God made the poison, he packaged it with the antidote.” - Dr. Lustig
Nature limits our sugar intake by encapsulating glucose and fructose in fibrous and nutritious grains, fruits and vegetables, aka Complex Carbs. Dr. Lustig asks you to imagine chewing a sugar cane. Without processing, you’d never be able to extract the amounts of sugar we consume everyday. Think about how many oranges you would eat for breakfast - three or four? That’s how many goes into an 8 fl.oz. glass of OJ.

Because our bodies cannot digest fiber, fiber-rich complex carbohydrates (legumes, unrefined grains, vegetables, etc.) move through the digestive tract slowly, regulating absorption of the food’s sugar content, reducing insulin response and giving your brain time to receive the signal that you are full. Equally valuable are the nutrients contained in the fiber (i.e., pulp, peel, seed coat, etc.) that enhance the absorption of the nutrients we want (i.e., Vitamin C).
“While it is true that the sucrose in an orange is chemically the same as the sucrose in the much-maligned table sugar, the fact that the sucrose in the orange is packaged along with other nutrients [like flavonoids found in pulp] makes it behave biochemically more friendly in the body. When you eat sucrose as naturally part of fruits or vegetables, you get not only vitamins and minerals in the package, but you get fiber and other complex carbohydrates that steady the absorption of the sugar. Yet, take the sugar away from the rest of the fruit and vegetable and refine it into a powder [or a juice or fruit juice concentrate], and it's this processing that downgrades sucrose from the healthy to the junk food category. So, it's the company the sugar keeps with other foods that affects its absorption from the intestines and its consequent behavior in the body.” - Dr. Sears
In 2008, The Nurses’ Health Study which followed a group of more than 70,000 women over 18 years concluded that fruit juice consumption increases the risk for diabetes:
“The positive association between fruit juice consumption and diabetes risk may relate to the relative lack of fiber and other phytochemicals, the liquid state, and the high sugar load. The rapid delivery of a large sugar load, without many other components that are a part of whole fruits, may be an important mechanism by which fruit juices could contribute to the development of diabetes. Fructose consumption has also been implicated in the development of many manifestations of the insulin resistance syndrome.”
Revisiting this section’s opener (“Orange juice or an orange? Soda or chocolate-covered raisins? Cream of wheat or oatmeal?”), it’s the latter!

Read IV. How Does the Body React to a High Sugar Diet? to see which ailments could be prevented or cured with diet change

Revisit II. Is Sugar by Any Other Name (like “HFCS”) The Same Thing? to identify sugar in all its forms
Revisit I. How Much Sugar is Too Much? to quantify a moderate amount of added sugar

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