I am going to make a bold statement: excessive sugar consumption is the cause of type 2 diabetes. Wait, I know. You’re probably saying, “But Sean, I know sugar isn’t good for me, but if it was that simple wouldn’t doctors know about this and everyone would be cured of diabetes?” Well, many health care professionals do know this intuitively, and that’s why they routinely recommend cutting out sugar or soda from your diet. There’s just one problem:
No one can follow the advice. Not even the health professionals!
Why? Because we’re all assuming we’re talking about the same thing when we’re not. Sugar isn’t just one thing. There are many types of “sugar,” and they’re not all created equal. Moreover, they are hidden in nearly every food in the grocery store which makes it WAY too easy to over-consume. Knowing the differences between these sugars is the first step in dominating your nutrition and reversing metabolic syndrome, pre-diabetes, and full blown diabetes.
I want to start out with some basic examples to lay the groundwork on how we usually think about sugar on a day-to-day basis.
Added Sugar and Other Carbohydrates
Let’s specify what health professionals may be referring to when they recommend cutting out sugar from your diet. What they are likely referring to is added sugar. The World Health Organization (WHO) calls it “free” sugar. You can think of this as sugar added to a food or drink that would not have it otherwise. As an example you may literally be adding a spoonful of sugar in every cup of coffee you drink. Or perhaps you’re adding a creamer. You may be surprised to know that many popular coffee creamers have sugar as the first ingredient.
Soda is another common example of added sugar. While you didn’t add sugar to it yourself, sugar was added to the product for taste. Let’s go to less obvious examples like juices and sports drinks. A juice like “Hawaiian Punch” is loaded with added sugar. Sports drinks like Gatorade and Powerade also have a ton of added sugar. Although we’ve all grown up thinking it’s beneficial to drink when playing sports or working out, I will certainly argue it is completely unnecessary. Props to those brands for brilliant advertising and marketing. I digress! You may be surprised to know that fruit juices, iced coffees, and teas that come in pre-packaged bottles usually always have added sugar. Don’t be fooled by fruit juices that claim to be 100% juice. These juices technically don’t count as added sugars because fruit juice naturally comes with sugars that were inside the fruit; however, you still want to avoid it. Even though it’s “natural,” the sheer volume of sugar present is definitely NOT natural for your body to digest.
That’s a lot of added sugar to watch out for, and that was definitely not an exhaustive list. I didn’t even mention the cookies, cupcakes, cakes, and other desserts!
Let’s now look at sugar that isn’t added but comes naturally in foods like starches and dairy. Some common examples are breads and pastas or milk and yogurt, to name a few. The starches are essentially chains of sugar molecules linked together and the dairy products contain the natural sugar lactose. The starch and lactose are both considered a carbohydrate. Generally, you can think of carbohydrates as a nutrient that when digested will be broken down into single units of sugar molecules in your stomach. These sugar molecules are not “added” like in soda; however, they contribute to your body’s system and overdoing it can lead to unexpected consequences for your waistline, blood pressure, and blood sugar.
It is VERY important to note that carbohydrates are a complex creature. For example, when you look at a nutrition label and see the amount of total carbohydrates listed in grams, that doesn’t mean that all of those grams will be digested into sugar. There are so-called indigestible or complex carbohydrates (e.g. fiber, resistant starch) that will not be broken down into sugar. In this way we can say that not all carbohydrates are sugars, and you shouldn’t throw all carbohydrates out with the sugary bathwater. It is well-established that the consumption of carbohydrates like fiber is STRONGLY associated with being healthier and living longer. The point I am making for now is that since many carbohydrates are broken down into sugar in your stomach, it is critical to account for how much you’re consuming in a day.
At this point I hope you’re asking why. Why do we need to be cutting out these sugars and why should I worry about carbohydrate volume and quality?
I’m glad you asked 🙂
Not All Sugar is Created Equal
In the examples above regarding added sugar and the sugar resulting from the digestion of carbohydrates, it’s critical to understand that the resultant sugars are actually different molecules and therefore have different effects on your body. There are three primary molecules of sugar to remember and they are all related: sucrose, glucose, and fructose. Of course there are many other sugars that are important, but understanding these three will have the most impact on reversing diabetes. Let’s dive in!
A good place to start is with sucrose. That classic, granulated white stuff. Sucrose occurs naturally in sugar cane and beets and is then processed and refined into powdery table sugar. It comes naturally in other foods like corn, honey and fruit, too. Sucrose is classified as a disaccharide because it consists of one molecule of glucose linked with one molecule of fructose. Thus, we can say that one sucrose molecule is 50% fructose and 50% glucose. That sucrose is two molecules in one is important to keep in mind when thinking about the health consequences of its consumption. When you consume sucrose, you are really consuming glucose AND fructose.
Glucose is arguably the most important sugar for the body’s proper functioning. All the cells in your body depend on glucose as a fuel source. Your cells convert glucose into adenosine triphosphate (ATP) which is used throughout the body as energy to power critical cellular functions. In fact, it is so important that your liver will convert amino acids to glucose if you don’t consume it in your diet. Remember the carbohydrates that are digested into sugar? That sugar is usually glucose. The fact that your liver can make glucose by itself without any input from your diet should alert you to take serious inventory on how much carbohydrate you eat in a day. The point being that you could be seriously overdoing it (and likely are as we’ll discuss). If you consume more glucose than your body can use for energy, it will be stored in your liver and muscle as glycogen. Think of glycogen stores as keeping wood stored away to be burned when you need to warm up your house. Excess glucose that cannot be stored as glycogen can be stored as fat! Glucose is necessary for your body but unnecessary to consume directly in your diet.
The third sugar molecule to address is fructose. Unlike glucose, fructose may be the least necessary sugar for your body. This sugar has gained notoriety in the past couple of decades thanks to the highly demonized high fructose corn syrup (HFCS) as well as recent research shedding light on its deleterious effects. Researchers used to think that because fructose did not contribute meaningfully to blood sugar measurements, it was benign. We now know that is far from reality.
Every cell in the body can use and convert glucose into energy; however, only your liver can reliably metabolize fructose. This is absolutely key. Your liver converts fructose directly into undesirable things like fatty acids and uric acid. The former can build up and cause fatty liver, and it can be stored as fat in other organs, too. The latter is often associated with gout but is now known to cause other issues like high blood pressure. Instead of looking at salt and caffeine intake, it may be more prudent to be mindful of fructose consumption! It is VERY important to note that the package or formulation that fructose comes in matters. For instance, fructose in the form of a liquid is damaging while fructose that is in a fruit (not fruit juice) is not.
Fructose has many other unique characteristics that make it harmful to your body. It desensitizes your taste receptors which is likely why people addicted to junk food find “healthy” foods like fruit and vegetables less palatable. Fructose increases ghrelin, a hormone that makes you hungry, and makes it stick around longer after consuming meals when it normally should subside. This may explain why you always feel hungry. Also, fructose activates the same areas of the brain as addictive drugs which may explain why it’s nearly impossible to resist eating just one Oreo. Fructose speeds up the so-called Maillard reaction. This is a non-enzymatic reaction that occurs between sugar molecules and amino acids and leads to aging and browning of cells. This may explain the browning/darkening of skin seen in many patients with diabetes.
These unique characteristics of fructose may explain why it’s so hard for people to stop consuming junk food. So, where does fructose show up in our diets? I already mentioned HFCS. This syrup is an added sugar that is put into many products to improve taste or shelf-life of food. While HFCS has been demonized in our society, we can’t lose sight of the fact that sucrose (i.e. table sugar) may have more fructose depending on the type of HFCS used. There is HFCS 42 and 55 which correspond to the percent of fructose in the corn syrup. I raise this point to highlight that HFCS should still be demonized; however, sucrose is just as culpable. Remember, when you consume sucrose you are getting 50% glucose AND 50% fructose.
I’ve brought up a lot to consider, so let’s summarize some key point thus far:
- Added sugars are in soda, sports drinks, iced teas, creamers, cookies, and cakes
- Carbohydrates break down into sugar molecules in your stomach and contribute to your overall system
- Glucose is an important sugar used for energy by all cells
- Fructose is a sugar solely metabolized by the liver and is converted into fat and uric acid
- Fructose makes you hungry, crave more sugary food, and desensitizes your taste receptors and the form it comes in matters (i.e. liquid vs solid food)
- Sucrose is table sugar and is 50% fructose
Sleepwalking Through a Sugary Maze
Let’s take all this information we’ve learned together so far and describe how it plays out in day-to-day life for millions of Americans, if not billions of people around the world.
It’s been estimated that the average American consumes about 77 grams of added sugar daily. That’s about 2 cans of Coke a day (1 can = 39 grams). The recommendation for maximum daily added sugar consumption is 25 grams for women and 38 grams for men according to the American Heart Association (AHA). Just 1 can of Coke reaches the daily maximum for men and far exceeds the limit for women!
An alternative recommendation comes from the WHO and the U.S. Dietary Guidelines which recommend no more than 10% of calories in a day come from added sugar. There are two problems with this recommendation. First, the 10% is based on data from WHO that suggest that level of restriction prevents dental caries. Second, under this recommendation the more calories you consume, then more added sugar is tacitly deemed “okay” to consume. The AHA recommendation is based on data regarding metabolic and cardiovascular disease, so I HIGHLY recommend following AHA instead.
When looking at the U.S. dietary guidelines, they recommend some foods that at first seem like reasonable recommendations, but upon closer inspection you can see that you may be led astray.
As an example on their website they state that the following foods are acceptable forms of fruit and dairy:
All fresh, frozen, canned, and dried fruits and fruit juices: for example, oranges and orange juice, apples and apple juice, bananas, grapes, melons, berries, and raisins.
All milk, including lactose-free and lactose-reduced products and fortified soy beverages (soymilk), yogurt, frozen yogurt, dairy desserts, and cheeses. Most choices should be fat-free or low-fat. “
In another section they state:
“One cup of 100% fruit juice counts as 1 cup of fruit.”
I don’t believe these guidelines are maleficent; however, they are irresponsible for a couple of reasons. Fruit juice is very vague and should be specified for the general public. Furthermore, canned fruit and fruit cups commonly come soaked in liquid syrup. These guidelines do specify that juice should be 100%; however, the WHO and AHA don’t necessarily state this. In this way the U.S. dietary guidelines move the goal post for added sugar goals. 100% juice is still a liquid bolus of fructose to your liver and, for the reasons stated above, is HIGHLY likely to be detrimental. The absence of any fruit fiber totally changes the effect of the sugar on your body.
Here is further clarification as to why the guidelines are misleading. On its face the below recommendation for breakfast isn’t too horrific, but the hidden sugars put you on the fast track to metabolic syndrome. Remember, the maximum recommended daily added sugar content is 25 grams for women and 38 grams for men.
We can quickly calculate the added sugar in grams going off of the nutrition labels of some popular American brands:
- 2 T Jiff peanut butter = 2 grams added sugar
- 2 tsp table sugar (i.e. sucrose) = 8 grams added sugar
- 6 oz Yoplait strawberry fat-free yogurt = 13 grams added sugar
This breakfast would already put you at 23 grams of added sugar. That means a woman would already be at her maximum daily allotment of added sugar from the first meal of the day! By the way, I didn’t even count the natural sugars present in the milk, bagel, banana, and yogurt.
Is it any wonder that when a health professional recommends making changes to your diet, you may make an earnest effort but can’t seem to make any progress? You could be following well-intentioned dietary guidelines, but the food in the grocery store is giving you more than you bargained for. It’s no wonder eating “right” is hard and confusing.
That’s why I’ve been doing the work for you!
Escaping the Maze
It is 100% possible to reverse your metabolic syndrome, pre-diabetes, and type 2 diabetes. Choosing the right food and navigating food in public are critical to do so. This is easier said than done given the contamination of our food supply with hidden sugar and misleading labeling of food.
Here are the things you must do:
- Quick win: cut out all sodas, fruit juices, and sports drinks
- Learn how to understand nutrition labels
- Read EVERY nutrition label before buying any food or drink
- Learn how to limit refined carbohydrate foods
- Cook and prepare your own food
A lot of this is overwhelming and confusing which is why I’ve created the The One Pill to guide you through the process. Until next time!
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