While far from fat at 5 foot 4 and 125 pounds, my waistline was surprisingly unflattering. Underneath rock-hard abs (I also did hundreds of sit ups a day) my intestines were coated in omental fat, a very unhealthy form of fat that develops in everyone eating low-nutrient, high-carb, high trans-fat, high vegetable oil diets. This gave me a classic "apple-shaped" figure even though I wasn't overweight.
At age 35, when I started eating better, I finally lost that omental fat and developed a more feminine waistline. (I also grew an inch taller!)
[...]As sugar seeps into your tissues, it coats the surface of cell membranes, with life-changing consequences. As a young girl, I would often sneak away to the corner candy store or munch on handfuls of the chocolate chips I would sometimes find hidden in the kitchen pantry, stressing my body's connective tissues already weakened by my low-fat, low-cholesterol, no-meat-on-the-bone diet. And the sugar en¬crusting my cells interfered with hormone receptor function, disrupting the complex series of physiologic developments scheduled to take place during puberty. As a result, I had no idea what all the fuss over boys was about until shortly after I went off to college.
Sugar Changes How Our Hormones Work
You may have heard that, on average, we gain ten pounds a decade after the age of 35; women, in particular, start reporting that they can't eat like they used to. This phenomenon may be directly related to the biochemical effects of sugar binding to hormone us insensitive to the hormone insulin. Once you are insulin resistant, blood sugar levels rise higher still, leading to diabetes and all its related disorders including weight gain, circulatory and sexual dysfunction.
For the same reasons sugar jams hormone signals, it also clogs nutrient channels, weakening bone and muscle and slowing neural communication, which can impair mood and memory and lead to dementia. While all this is going on, sugar stiffens the collagen in your tendons, joints, and skin, causing arthritis and premature wrinkling, while interfering with the production of new collagen throughout your entire body.
And because sugar changes the surface markers your white blood cells need to distinguish between indigenous cells from invaders, it opens the door to cancer and infection.
How does sugar do all this?
Glycation: The Reason Sugar is Bad for You
Ever notice how licked lollipops and half-chewed taffy have a tacky feeling? Sugar feels sticky because, once dissolved in water, it reacts with proteins on the surface of your skin to form easily breakable chemical bonds. When you pull your fingers apart and feel the sticky resistance, you're feel¬ing the tug of those bonds being broken. The process by which sugar sticks to stuff is called glycation.
Glycation reactions are reversible, but with enough heat or time, the temporary bonds becomes permanent due to oxidation reactions. The products of these later oxidation reactions are called advanced glycation end products, or AGEs. And that's a useful acronym, because AGEs make you age unnaturally fast.
When you toast bread, oxidation reactions generate AGEs in the proteins and sugars present in wheat. These AGEs change the bread from soft, pli¬able, and pale to hard, stiff, and brown because the proteins and sugars form cross-links that stiffen the bread. The same thing happens inside your body as AGEs cross-link normally mobile proteins. This hardens your cells and tissues, making them brittle and stiff. Fortunately, at normal blood sugar levels, the reactions occur so slowly that cleanup crews of white blood cells keep them under control by breaking them down. The
kidney cleans these AGEs from the blood and excretes them from the body. It is these waste chemicals that give urine its characteristic yellow color.
The clinical implications of having your tissues hardened by sugar-protein cross-links are vast and far-reaching. Cross-links turn the semi¬permeable surfaces of arteries into impervious walls, preventing nutrients from exiting the bloodstream. When trapped nutrients can't escape your bloodstream, where do you think they end up? Lining your arteries. As we saw in Chapter 7, when lipoproteins deposit on the arterial lining, they attract white blood cells, and can cause blood clots and / or atherosclerotic plaques. A few cross-links on your white blood cells slows them down, making infections more likely and more serious, enabling nascent cancer cells to grow under the radar unchallenged. Are your joints creaking and stiff? AGEs can form in them too. AGEs (primarily from high blood sugar) are one of two major biochemical phenomena that make us look and feel old (the other being free radicals, primarily from vegetable oils). [...]
{She recommends fasting glucose levels to be no more than 88, otherwise the risk of cardiovascular events increases exponentially.}
True Tales of Sugar-holics
Sugar-Induced "Spells"
Meet Mary, a nurse who worked in my office until a few years ago. Al¬ways on top of her game, she double-checked the charts to make sure we doctors didn't overlook any records. To stay alert, she would eat something sweet several times a day.
Not candy, mind you. Just the healthy stuff, fruit and energy bars. {The description of her story goes on showing the deterioration over the years with symptoms of hypoglycemia: feeling tired, hungry, shaky, nauseated before lunch or dinner. These feelings come from adrenaline, which helps the liver pump out more sugar but also makes us shaky, nauseous, even panicky.}
As her sugar levels dropped below 60, Mary's brain was deprived of glucose, triggering a stress response from the adrenal glands. They would in turn release adrenaline which, like glucagon, instructs the liver to release stored glucose. Adrenaline also affects the nervous system, causing anxiety, shakiness, and even nausea.
Rising and falling sugar, estrogen, and progesterone in combination with mixed signals from high levels of insulin, glucagon, and occasional bursts of adrenaline ultimately caused a short circuit in the brain that resulted in a seizure. Once a short circuit like this develops, it makes it easier to have another seizure. So taking her off the seizure medication, as she wanted me to do, could be risky.
I suggested a compromise. I recommended that she follow a strict low¬carb diet, which we reviewed. I also lowered her medication a bit, monitor-ing her blood to ensure we were still in the therapeutic range. I cautioned that if she were ever to lapse from the diet she would need to raise the dose of medication again. After some initial difficulty taming her ferocious sweet tooth, Mary has now been following the diet and been seizure free on a low dose of medication for five years. [...]
"I Don't Want Heart Surgery"
Gary is a scuba instructor. His job requires him to be ready to take action whenever one of the tourists on his boat gets into trouble. When he started feeling a fluttering in his chest, he needed to nail down exactly what was happening and do something to stop it. Though he could navigate the Ha¬waiian currents with his eyes closed, he had no idea how to navigate the medical system. So like many people, instead of starting with a visit to his primary care doctor, he went straight to the emergency room.
The ER doctor couldn't diagnose the source of Gary's problem because, When he went in, everything was fine. The ER doctor ordered a few tests, including blood tests and an EKG, all of which turned out normal. Just to be thorough, the ER doc sent Gary to his primary care doc to get a referral to a cardiologist, who did still more tests. All normal. Just to be sure, the cardi-ologist wanted an angiogram. If that test showed anything out of the ordi¬nary, like a slight narrowing of an artery, the patient would be nudged into position as a candidate for a major procedure—a stent, or even heart surgery.
This is when Gary came in to see me. His regular doctor was on vaca¬tion, and he was too anxious too wait.
"I don't want heart surgery," he said. I told him that, since I don't do heart surgery, he'd come to the right place. I looked over his records and only one element of his entire history caught my attention, his fasting sugar level. It was 92. Though generally considered "normal," I see this number as high because, as I mentioned earlier,
anything over 88 (89 or higher) seems to invite problems. I wasn't surprised to find his sugar was a bit high. I'd no¬ticed that
his heels were slightly calloused, and I've found that patients with high sugar levels often develop a dry callous on their heels
The chest fluttering Gary described is termed a palpitation.
Palpitations are disturbances in the heart rhythm which, in my experience, occur more often in people who eat lots of sugar. Just as with seizure disorders, sugar induced surges in hormone and energy levels irritate the nerves.
In his case the swings disturbed the nerves surrounding his heart. I asked Gary to tell me about his diet and discovered he was a classic sugar-holic. A sweet cereal for breakfast, a Snickers bar at 10 a.m. to buoy him through his morning then a sandwich for lunch, followed by another Snickers. Oh, and don't forget the fruit juice and soda. It was a routine he'd followed for years but now, at 39, it was catching up with him.
Whenever his sugar levels dropped the palpitations started.
I told him that if he wanted to avoid palpitations, he would need to cut his sugar in half, minimum. And to make clear the seriousness of his pre¬, dicament, I also told him that his high fasting glucose was a bellwether sign (that he was on the verge of losing his sensitivity to hormones—all hormones including testosterone. Testosterone helps men (and women, by the wav maintain libido. But when you gum up testosterone receptors on the surface of cells, they don't respond to signals as readily. When, at the same time you're gumming up the cells lining the blood vessels, the vessels can't dilate and fill up with blood. What we have here is a recipe for ED.
For Gary, this warning struck home, so to speak. I explained that if he wanted to avoid diabetic complications, including ED, it would be best for him to cut sugar out altogether. And that's what he did. Within a couple weeks, he was seeing all kinds of improvements, and so was his girlfriend. He traded in sugar for something even sweeter, and sugar-induced palpita¬tions for a better kind.
Gary didn't need heart surgery. He needed a sugar-ectomy. Had he gotten his angiogram, there's a fair chance that the cardiologist would have found something of interest. A tiny anomaly, a narrow spot on the dye-shadow, something—anything—to convert this healthy, fit, life-loving person into a cardiac case. And once that happens, as the side effects and complications from pills and procedures begin to pile up, once you are dependent on one or more medications for the rest of your life, once a healthy heart is refashioned into a living carrying case for the latest piece of medical gadgetry, you're in. And good luck finding the door.
The Sugar Headache
Susan's headaches were awful. As she described them, they felt like a hot blade had been plunged through her right eye. For 20 years, she'd been told that she had migraines and was given all kinds of migraine treatments, with little effect. Quite often, there was nothing she could do but wake up her husband in the middle of the night to drive her to the ER for intravenous painkillers. Without warning, another agonizing series of headaches would materialize, tear her life apart for days or even weeks, and then just as sud¬denly disappear.
When I saw her, I told her a couple things she was surprised to hear. One was that these weren't migraines. They were
cluster headaches, which would respond to an entirely different kind of therapy: breathing from an oxygen tank.
The second surprise was that she might be able to
mitigate or even cure her headaches permanently by—you guessed it—cutting out sugar. I told her about
sugar's effects on nerves and how adrenaline and other hormone fluc¬tuations are so irritating to the brain that they can cause pain or, in extreme cases, seizures.
Cluster headache sufferers are often addicted to sugar, eating sweets throughout the entire day. By the middle of the night, their blood sugar levels have bottomed out and hormones are swinging wildly to com-pensate. On some nights, this wakes them up with screaming pain. For any pain sufferer, cutting back on sugar is a great first move. Combined with a little exercise, cutting sugar could very well prevent Susan's headaches alto¬gether. [...]
In all these medical cases, you may have noticed a theme emergirg. Sugar wreaks havoc with the entire nervous system, so much so that one or the first things I ask about when someone comes in with a nervous disorder is their sugar intake. But it's not just nervous system disorders like anxiety, heart palpitations, and pain that make me think of sugar addiction.
It's also recurring infections, joint problems, and allergic disorders like eczema hives, and runny noses, and more.
Study Shows Sugar More Addicting Than Cocaine
Sugar has the edge over other addictive compounds thanks to the fact that it tastes better than most drugs. A study on rats entitled "Intense Sweetness Surpasses Cocaine Reward" found that between cocaine and sugar, sugar was more addicting. Their conclusion warns: "In most mammals, including rats and humans, sweet receptors evolved in ancestral environments poor in sugars and are thus not adapted to high concentrations of sweet [compounds]. The supranormal stimulation of these receptors by sugar-rich diets, such as those now widely available in modern societies, would generate a supranormal reward signal in the brain, with the potential to override self-control mechanisms and thus to lead to addiction." Intense Sweetness Surpasses Cocaine Reward. Lenoir M. PLoS ONE. 2007; 2(8): e698.
Sugar is the ultimate gateway drug. We now have research showing that exposure to
sugar early in life has lasting effects on the brain that can make us more prone to developing chemical dependencies. When researchers gave young rats a steady supply of chocolate Ensure, they found "daily consump¬tion alters striatal enkephalin gene expression." In other words, the study rats were programmed to consume substances that stimulate their opiate receptors.249
Sugar acts as a powerful epigenetic instructor, telling your child's genes to construct a brain with a built-in hankering for drugs.
As Michael Pollan points out in The Botany of Desire, by producing Chem¬istry desirable to humans, certain plants have domesticated us, turning peo¬ple into pawns in their Darwinian battle to rule the landscape. Like THC in marijuana, the sugar in fruit and sugarcane entices humans, and other ani-mals, to spread the plant's DNA. But this relationship is taken to dangerous extremes as refined sugar commands us to reorder the surface of the planet; millions of acres of tropical rainforest are burned every year to sustain the i ongoing habit of a growing population. We work for corn too. Each step in the production of high-fructose corn syrup is a giant leap forward in corm. domination of the planet. Sugar-producing plants like corn, cane, beets, ber¬ries, and mangoes give usa legal high every bit as addictive as a hit of crack cocaine, though less intoxicating. What I am arguing, however, is try sugar's hold on us is more dangerous than any illegal substance because effects are subtler and more pervasive.
If a child were given a dose of heroin, the chemical would trigger 41 flurry of neural activity in the pleasure centers of his brain.
Sugar, whether juice, pureed pears, or infant formula, results in the very same kinds of responses "via the release of endogenous opiates triggered by sweet taste[.]"' . And if you regularly give kids sugar-rich commercial juices, sweet cereal's, or daily cookies and candy, you're inadvertently playing the role of "enabler.'
Though sugar doesn't actually contain opiates like heroin, it affects us in very much the same way because it makes us release our own endogenous opiates.
The effect is powerful enough for solutions of sugar to work as a pain reliever. In a common practice, called "
sucrose analgesia," nurses give a sip of sugar water to infants to calm them during heel sticks, injections, and ' other painful procedures newborns routinely undergo. It works well and has the benefit of reducing fussiness for up to a week after the procedures.251 ) In 2002, a group of neonatal nurses at several intensive care unit throughout hospitals in Montreal, Canada wondered if there might be a downside to this common practice. Specifically they worried about the effect on the babies' developing brains. In spite of the convenient benefits, the nurses were granted permission to give half the babies in their study plain water, while the other half got sugar water.
They found that infants who got sugar in their first seven days of life suffered neurological effects that were still measurable when the study ended, eleven weeks later. "[H]igher number of doses of sucrose predicted lower scores on motor development and vigor. and alertness and orientation...and higher NBRS [NeuroBiological Risk Score, a reflection of processes deleterious to brain development]."
What does this study indicate? Little
nips of sugar water given to alleviate pain impair a baby's cognitive development.
How could sugar have such powerful effects? As I mentioned earlier, sugar induces endogenous opiate release. The study authors postulate that
repeated artificially induced stimulation of the immature brain with endoge¬nous opiates interferes with normal development of alertness and arousal systems, so much so that babies who got the most sugar became lethargic. Endogenous opiates normally play a role in making us feel okay after some¬thing bad happens to us. The authors suggest that
using sugar to induce the brain to release endogenous opiates during trauma prevents the brain from developing strategies to deal with pain normally. Why do they lose cognitive ability too? That question has yet to be answered.[...]
{Now she gives a very strong argument against all sugars}
Simple or Complex? Same Difference!
Everyone knows what a sugar high is. You eat a couple pieces of cake and the next thing you know you're bouncing off the walls. And what hap¬pens afterwards? Your energy level plummets and you feel lethargic. If it's really bad, you feel like you're getting the shakes. The temptation is to tea: these withdrawal symptoms with more sugar.
Sound familiar? Withdrawing from a sugar binge can feel a lot like withdrawing from a lot of other drugs, like alcohol. And we often treat other options. To avoid hangovers, you could drink less or none at all. Or, alternatively,
you could avoid the spikes and valleys by maintaining a more constant blood alcohol level. You could modulate your dose by drinking more often, starting first thing in the morning. It would really be convenient if you could find some kind of a "complex" form of alcohol, one that takes time for the intestine to break down so that four or five drinks, downed all at once, could provide a nice, steady buzz for the rest of the day. If there were such an alcohol, no doubt we'd call it the "good" alcohol, the one preferred by all health-conscious alcoholics to avoid ever waking up with a hangover again.
Sugar is a "simple" carb. String a bunch of sugars together and you've got starch, a "complex" carb. There's much ado about complex carbs being healthier than sugars but, nutritionally, there's no difference whatsoever. The only difference between simple and complex carbs is how quickly they get into your bloodstream. So if you have diabetes or are just trying to avoid sugar swings,
understand that when dietitians encourage choosing complex carbs for breakfast, it's very much as if they're telling a binge drinker to pace himself and get started first thing in the morning.
When you're eating pasta or a cracker, you don't feel as though you're doing anything naughty, because it doesn't taste sweet, like candy. But the molecules that make up starch are naughty; they're sugar. And once in your bloodstream, they'll be up to no good. Starch is like a chain gang which, when bound together in a long molecule (too long to fit into your taste buds) won't cause any harm. But if you let a cracker sit on your tongue long enough—or get broken down by digestion—the starch molecules turn into the very same sugar that you know is bad for your body.
If you've ever sat down and finished off a box of crackers, you've essentially just eaten a box of sugar. This stems from the fact that there's a big difference between ingesting and absorbing nutrients. You can swallow a small , marble and say you've eaten it, but you'll never absorb it. Technically, eating refers only to the act of swallowing, whereas absorption refers to the act of bringing chemicals into your body.
The point is, whether you eat sugar or starch, your body winds up absorbing sugar.
When we're talking carbs and sugar, we need to define our terms clearly. All carbs are composed of individual sugar molecules, called monosaccha¬rides. Table sugar is made from glucose and fructose monosaccharides bound together into a disaccharide called sucrose. Mono- and disaccharides are simple carbohydrates, a.k.a. sugars. If more monosaccharide units are added to the chain, the name changes to oligosaccharide, oligo meaning few. Starches have hundreds of monosaccharide units connected together and are called "complex."
Foods like bread, pasta, potatoes, and rice are little more than containers for sugar. A seven-ounce serving of cooked spaghetti is converted into the amount of sugar contained in four 12-ounce cans of Pepsi. Unlike Pepsi, the pasta has been fortified with iron and a few vitamins. The starchy parts of plants also carry small amounts of protein and minerals, but white flour and white rice have had most of that removed. Whether the rice and bread are white or brown, whether the starch is in the form of breakfast cereal or tor¬tilla chips, pasta or pancakes, complex or simple, you're mostly eating sugar. [...]
Fruit Sugar
Another big source of sugar that surprises many people is sweet, sugary fruit. We've heard time and again we should "eat fruits and vegetables," as though the two are equivalent. But they're not. Vegetables contain a higher nutrient-to-energy ratio than fruit.
Even fruits with decent nutrient content—like wild blueberries—are full of sugar. When you eat citrus, you're getting a wallop of sugar with very little nutrient thrown in. That's why, for most people, eating one apple-sized portion of fruit per day is plenty. With all that sugar, fruit just doesn't make the grade as a health food. As I tell my patients, fruit is a more natural alternative to a candy bar. And fruit juice, which lacks fiber and many of the antioxidants, is little better than soda.
People often protest the idea that fruit should be consumed in limited amounts. "At least it's natural sugar!" they say. Sure, but all sugar is natural. Sugar cane is natural. So is the corn from which high fructose corn syrup is made. The difference between sugar in fruit and sugar in high-fructose corn syrup (or confectioner's powder or granulated sugar) is that the former is still in its source material and the latter has been refined out of the source material and is devoid of other nutrients. And yes, that makes fruit a little better than sugar, but it's nothing to get worked up about. Though fruits do contain fiber, minerals, tannins and other flavinoids, which can function as antioxidants, sweet fruit is mostly sugar. What about honey? Same idea, mostly sugar and very little of anything else. [...]
