Should You Avoid Sugar Completely?

Written by Dr. Steve Chaney on . Posted in Sugar in Diet

Is It The Sugar, Or Is It The Food?

Author: Dr. Stephen Chaney

 

Should we avoid sugar completely?  Almost every expert agrees that Americans should cut down on the amount of sugar we are consuming. However, for some people this has become a “sugar phobia”. They have sworn that “sugar shall never touch their lips”. Not only do they avoid sugar sweetened sodas and junk food, but they also have become avid label readers. They scour the label of every food they see and reject foods they find any form of sugar listed as an ingredient. Is this degree of sugar avoidance justified?

 

Should We Avoid Sugar to Keep it From Killing Us?

 

Let me add some perspective:

  • If you just take studies about the dangers of sugar at face value, sugar does, indeed, look dangerous. Excess sugar consumption is associated with increased risk of obesity, diabetes, and heart disease. However, when you look a little closer, you find that most of these studies have been done by looking at the correlation of each of these conditions with sugar sweetened beverage consumption (sodas and fruit juices).

A few studies have looked at the correlation of obesity and disease with total “added sugar” consumption. However, 71.6% of added sugar in the American diet comes from sugar sweetened beverages and junk food. None of the studies have looked at the sugar from healthy foods like fruits, vegetables, and whole grains. That’s because there is ample evidence that these foods decrease the risk of obesity, diabetes, and heart disease.

  • For example, if apples had a nutrition label, it would list 16 grams of sugar in a medium 80 calorie apple, which corresponds to about 80% of the calories in that apple. The sugar in an apple is about the same proportion of fructose and glucose found in high fructose corn syrup. Apples are not unique. The nutrition label would read about the same on most other fruits. Does that mean you should avoid sugar from all fruits? I think not.

Avoid Sugar or Avoid Certain Foods

 

avoid sugar from junk foodsThe obvious question is: “Why are the same sugars, in about the same amounts, unhealthy in sodas and healthy in fruits?” Let’s go back to those studies I just mentioned—the ones that are often used to vilify sugars. They are all association studies, the association of sugar intake with obesity and various diseases.

The weakness of association studies is the association could be with something else that is tightly correlated with the variable (sugar intake) that you are measuring. Could it be the food that is the problem, not the sugar?

If we look at healthy foods (fruits, vegetables, whole grains) they are chock full of vitamins, minerals, phytonutrients, fiber, and (sometimes) protein. Fiber and protein slow the absorption of sugar into the bloodstream. As a result, blood sugar levels rise slowly and are sustained at relatively low levels for a substantial period of time.

In sodas there is nothing to slow the absorption of blood sugar. You get rapid rise in blood sugar followed by an equally rapid fall. The same is true of junk foods consisting primarily of sugar, refined flour and/or fat.  Avoid sugar from those types of foods.

Another consideration is something called caloric density. Here is a simple analogy. I used to explain the concept of caloric density to medical students in my teaching days. There are about the same number of calories in a 2-ounce candy bar and a pound of apples (around 278 in the 2-ounce candy bar and 237 in a pound of apples). You can eat a 2-ounce candy bar and still be hungry. If you eat a pound of apples you are done for a while. In this example, the 2-ounce candy bar had a high caloric density (a lot of calories in a small package). Perhaps a more familiar terminology would be the candy bar was just empty calories.

Are Sodas and Junk Foods Killing Us?

avoid sugar from candyPutting all that together, you can start to understand why the foods the sugars are in are more important than the sugars themselves. When you consume sugars in the form of sugar sweetened beverages or sugary junk foods, your appetite increases. We don’t know for sure whether it is the intense sweetness of those foods, the rapid increase and fall in blood sugar, or the high caloric density (lots of calories ina small package) that makes us hungrier. It doesn’t matter. We crave more food, and it isn’t usually fruits, vegetables, and complex carbohydrates we crave. It’s more junk. That sets in motion a predictable sequence of events.

  • We overeat. Those excess calories are stored as fat and we become obese. [Note: The low carb enthusiasts will tell you our fat stores come from carbohydrates alone. That is incorrect. All excess calories, whether from protein, fat, or carbohydrate, are stored as fat.]
  • It’s not just the fat you can see (belly fat) that is the problem. Some of that fat builds up in our liver and muscles. This sets up an unfortunate sequence of metabolic events.
  • The fat stores release inflammatory cytokines into our bloodstream. That causes inflammation. Inflammation increases the risk of many diseases including heart disease and cancer.
  • The fat stores also cause our cells to become resistant to insulin. That reduces the ability of our cells to take up glucose, which leads to hyperglycemia and type 2 diabetes. [Note: The low carb enthusiasts will tell you carbohydrates cause type 2 diabetes. That is also incorrect. It is our fat stores that cause insulin resistance and type 2 diabetes. Our fat stores come from all excess calories, not just excess calories from carbohydrates.]
  • Insulin resistance also causes the liver to overproduce cholesterol and triglycerides and pump them into the bloodstream. That increases the risk of heart disease.
  • Sugar sweetened beverages and sugary junk foods also displace healthier foods from our diet. That leads to potential nutrient shortfalls that can increase our risk of many diseases.

However, none of this has to happen. The one thing that every successful diet has in common is the elimination of sodas, junk foods, fast foods and convenience foods. You should avoid sugar from those foods as much as possible. Once you eliminate those from your diet,you significantly enhance your chances of being at a healthy weight and being healthy long term.

 

What About Protein Supplements And Similar Foods?

Of course, the dilemma is what you, as an intrepid label reader, should do about protein supplements, meal replacement bars, or snack bars. They are supposed to be healthy, but the label lists one or more sugars. Even worse, the sugar content is higher than your favorite health guru recommends.  So, should you avoid sugar from supplements and the like?

In this case, a more useful concept is glycemic index, which is a measure of the effect of the food on your blood sugar levels. Healthy foods like apples may have a high sugar content, but they havea low glycemic index.

avoid sugar and consume protein to slow absorbptionThe same is true for the protein supplements and bars you are considering. Rather than looking at the sugar content, you should be looking for the term “low glycemic” on the label. That means there is enough fiber and protein in the food to slow the absorption of sugar into the bloodstream and stabilize your blood sugar levels.

What Does This Mean For You?

Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should work on ways to avoid sugar or reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners. I have warned about the dangers of artificial sweeteners previously.

We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. For example, some Starbucks drinks are mostly sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

So we don’t have to avoid sugar completely, but we should reduce sugar from sugar sweetened beverages and junk food.

 

The Bottom Line

 

We need to keep warnings about the dangers of sugar in perspective:

  • The studies showing that sugar consumption leads to obesity, diabetes, and heart disease have all been done with sodas and junk foods.
  • Many fruits have just as much sugar as a soda. They also contain about the same proportion of fructose and glucose as high fructose corn syrup. Yet we know fruits are good for us.
  • Diets rich in fruits, vegetables and whole grains decrease our risk of obesity, diabetes, and heart disease.
  • That is because the sugar in whole foods is generally present along with fiber and protein, which slows the absorption of sugar and prevents the blood sugar spikes we get with sodas and junk foods.
  • In the case of prepared foods like protein supplements, you should look for “low glycemic” on the label rather than sugar content. Low glycemic means that there is enough fiber and protein in the product to slow the absorption of sugar and prevent blood sugar spikes.
  • Don’t misunderstand me. I am not advocating for unlimited consumption of sugar. We should all work on ways to avoid sugar from junk foods or to reduce the amount of sugar in our diet. On the other hand, we don’t need to become so strict that we and our family need to eat foods that taste like cardboard. We also don’t want to replace natural sugars with artificial sweeteners.
  • We can go a long way towards reducing sugar by just eliminating sodas, other sugar sweetened beverages, junk foods, fast foods, convenience foods, and pastries from our diet. When considering fast foods and convenience foods, we should check the label for hidden sugar. When considering foods that are supposed to be healthy, we should look for the term “low glycemic” on the label.

For more details, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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Comments (2)

  • Sherry Billehus

    |

    Do you have an article on gluten intolerance? How do you decide if you are? Also do you have any nformation on pre diabetes? I enjoy your articles very much!! Thank you! Sherry

    Reply

    • Dr. Steve Chaney

      |

      Dear Sherry,
      I do not have an article on gluten intolerance. The best way to see if you are gluten intolerant is to eliminate it from your diet for a period of time. If you are gluten intolerant, you will often notice a difference in a day or two, However, it can take a couple of weeks to a couple of months for some people to notice a significant difference.
      Dr. Chaney

      Reply

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Latest Article

Are Pregnant Women and Children Dangerously Deficient in Omega-3s?

Posted August 13, 2019 by Dr. Steve Chaney

What Is The Omega-3 Status Of The American Population?

Author: Dr. Stephen Chaney

 

pregnant women omega 3 deficient fishIt is no secret that the American population is deficient in omega-3s. Numerous studies have documented that fact. There are many reasons for Americans’ low intake of omega-3s:

  • The high price of omega-3-rich fish.
  • Concerns about sustainability, heavy metal contamination, and/or PCB contamination of omega-3 rich fish.
  • Misleading headlines claiming that omega-3 supplements are worthless and may even do you harm.

Of course, the questions you are asking are probably?

  • How deficient are we?
  • Does it matter?

The latest study (M Thompson et al, Nutrients, 2019, 11: 177, doi: 10.3390/nu11010177) goes a long way towards answering those important questions.

How Was The Study Done?

scientific studyThis study used data on 45,347 Americans who participated in NHANES surveys between 2003 and 2014. (NHANES or National Health and Nutrition Examination Surveys is a program run by the CDC that is designed to assess the health and nutritional status of adults and children living in the United States).

EPA and DHA intake from foods was based on the average of two 24-hour dietary recall interviews. Trained dietary interviewers collected detailed information on all foods and beverages consumed during the past 24 hours.

To assess EPA and DHA intake from supplements study participants were asked what supplements they had taken in the past 30 days, how many days out of 30 they had taken it, and the amount that was taken on those days.

 

What Is The Omega-3 Status Of The American Population?

 

omega 3 statusThe results of the NHANES surveys were shocking.

In terms of total EPA+DHA intake:

  • EPA+DHA intake across all age groups was lower than recommended.
  • Toddlers (ages 1-5), children (ages 6-11), and adolescents (ages 12-19) had lower EPA+DHA intakes than adults (ages 20-55) and seniors (ages > 55).
  • Women had lower EPA+DHA intakes than men.
  • Pregnant women and women of childbearing age did not differ in their EPA+DHA.
  • Pregnant women consumed less fish than women of childbearing age (perhaps because of concerns about heavy metal contamination).
  • Pregnant women consumed more omega-3 supplements.

In terms of EPA+DHA from supplements:

  • Less than 1% of the American population reported using omega-3 supplements.
  • The one exception was pregnant women. 7.3% of pregnant women reported taking an omega-3 supplement.
  • People taking omega-3 supplements had significantly higher EPA+DHA intake than people not taking omega-3 supplements.
  • This was also true for pregnant women. Those taking omega-3 supplements had higher EPA+DHA intake.

Of course, like any clinical study, it has strengths and weaknesses.

The biggest weakness of this study is that omega-3 intake is based on the participants recall of what they ate. The strengths of the study are its size (45,347 participants) and the fact that its estimate of omega-3 intake is consistent with several smaller studies.

 

Are Americans Deficient In Omega-3s?

 

pregnant women omega 3 deficient questionsNow we are ready to answer the questions I posed at the beginning of this article. Let’s start with the first one: “How deficient are we?”

You would think the answer to that question would be easy. It is not. This study provides a precise estimate of American’s omega-3 intake. The problem is there is no consensus as to how much omega-3s we need. There is no RDA for omega-3s.

There are, in fact, three sets of guidelines for how much omega-3s we need, and they disagree.

  • The World Health Organization (WHO) recommendations for EPA+DHA intake range from 100-150 mg/day at ages 2-4 years to 200-500 mg/day for adults.
  • The US National Institute of Medicine (IOM) recommendations for EPA+DHA intake range from 70 mg/day for ages 1-3 to 110 mg/day for adult females and 160 mg/day for adult males.
  • As if that weren’t confusing enough, an international group of experts recently convened for a “Workshop on the Essentiality of and Recommended Dietary Intakes for Omega-6 and Omega-3 Fatty Acids” (Workshop). This group recommended an EPA+DHA intake of 440 mg/day for adults and 520 mg/day for pregnant and lactating women.

Using these recommendations as guidelines, this study reported that:

  • EPA+DHA intake for children 1-5 years old was ~25% of the WHO recommendations and ~40% of IOM recommendations.
  • EPA+DHA intake for children 6-11 years old was ~27% of WHO recommendations and ~40% of IOM recommendations.
  • EPA+DHA intake for adolescents 12-19 years old was ~50% of IOM recommendations (The WHO did not have a separate category for adolescents.
  • EPA+DHA intake for adults 20-55 years old was ~30% of WHO recommendations, and ~65% of IOM recommendations.
  • EPA+DHA intake for seniors >55 years old was 38% of WHO recommendations and 82% of IOM recommendations.
  • EPA+DHA intake for pregnant women was ~20% of Workshop recommendations (The WHO and IOM did not have a separate category for pregnant women).

While the percentage deficiency varied according to the EPA+DHA guidelines used, it is clear from these results that Americans of all age groups are not getting enough omega-3s from their diet.

The authors concluded: “We found omega-3 intakes across all age groups was lower than recommended amounts.”

 

Are Pregnant Women and Young Children Dangerously Deficient In Omega-3s?

 

danger symbolWhile the authors concluded that all age groups were deficient in omega-3s, they were particularly concerned about the omega-3 deficiencies in pregnant women and young children.

The authors said: “Taken together, these findings demonstrate that low omega-3 fatty acid intake is consistent among the US population and could increase the risk for adverse health outcomes, particularly in vulnerable populations (e.g., young children and pregnant women).”

In part, the focus on young children and pregnant women was based on their very low omega-3 intake. With intakes at 20-27% of recommended levels, I would consider these groups to be dangerously deficient in omega-3s.

pregnant women omega 3 deficient pregnancyHowever, the focus on young children and pregnant women was also based on the seriousness of the adverse health outcomes associated with low omega-3 intake in these population groups. This answers the second question I posed at the beginning of this article: “Does it matter?”

According to the authors low intake of EPA and DHA during pregnancy and early childhood is associated with maternal depression, pre-term births, low birth-weight babies, increased risk of allergies and asthma, problems with learning and cognition, and other neurocognitive outcomes.

None of these associations between low omega-3 intake and adverse health outcomes have been proven beyond a shadow of a doubt, but the evidence is strong enough that we should be alarmed by the very low omega-3 intake in pregnant women and young children.

There is, however, a simple solution. The authors of this study concluded: “Individuals taking EPA/DHA containing supplements had significantly elevated intake compared to individuals not taking omega-3 fatty acid-containing supplements or not reporting any supplement use.”

omega 3 supplementsThey went on to say: “As supplement use is associated with increased omega-3 intake, supplementation could be an important source of EPA/DHA, particularly for pregnant women given their lower fish consumption compared to non-pregnant women of childbearing age.”

I agree. Given the low omega-3 intake in these population group and current guidelines for omega-3 intake. I recommend:

  • Pregnant & lactating women (and women of childbearing age who might become pregnant) take an omega-3 supplement providing around 520 mg of EPA+DHA/day.
  • Young children (ages 1-5) take an omega-3 supplement providing around 100 mg of DHA/day.

Of course, this study also confirmed that Americans of all age groups are not getting enough omega-3s from their diet, and low omega-3 intake may increase the risk of heart disease. Furthermore, recent studies have shown that high purity omega-3 supplements may reduce heart disease risk.

You will find my recommendations for omega-3 supplementation for adults in a previous issue of “Health Tips From the Professor.”

 

The Bottom Line

 

The largest study to date (45,347 participants) measured omega-3 intake for Americans of all ages and compared that to current recommendations for omega-3 intake.

The authors of the study concluded:

  • “We found omega-3 intakes across all age groups was lower than recommended amounts.”
  • “Low omega-3 fatty acid intake … could increase the risk for adverse health outcomes, particularly in vulnerable populations (e.g., young children and pregnant women.”

In part, the focus on young children and pregnant women was based on their very low omega-3 intake. With intakes at 20-27% of recommended levels, I would consider these groups to be dangerously deficient in omega-3s.

However, the focus on young children and pregnant women was also based on the seriousness of the adverse health outcomes associated with low omega-3 intake in these population groups.

  • According to the authors low intake of EPA and DHA during pregnancy and early childhood is associated with maternal depression, pre-term births, low birth-weight babies, increased risk of allergies and asthma, problems with learning and cognition, and other neurocognitive outcomes.

There is, however, a simple solution. The authors of this study also concluded:

  • “Individuals taking EPA/DHA containing supplements had significantly elevated intake compared to individuals not taking omega-3 fatty acid-containing supplements or not reporting any supplement use.”
  • “As supplement use is associated with increased omega-3 intake, supplementation could be an important source of EPA/DHA, particularly for pregnant women given their lower fish consumption compared to non-pregnant women of childbearing age.”

For more details on the study and my recommendations for omega-3 supplementation, read the article above.

 

These statements have not been evaluated by the Food and Drug Administration. This information is not intended to diagnose, treat, cure or prevent any disease.

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