Our (Cultural) Sugar High

Blog post by Bernadette Keefe MD

We need to start talking about how our food supply is making many of us sick.

“Sugar high” is the term used to describe the cascade of responses after eating high sugar foods. High sugar loads, especially of pure sugar, trigger a rapid release of insulin to counteract the increased blood sugar by promoting sugar (glucose) uptake into cells. The larger the insulin response, the faster we return to a lowered blood sugar which triggers hunger. If we then again consume a sugary snack or meal, the cycle restarts.  The taste of sugar is ‘addictive’ over time.  Our nation (and world really) has a cultural sugar high, a palate tuned to the taste of sugar, which has led to unprecedented levels of Type 2 diabetes and obesity and associated increases in chronic disease.

The Sugar – Obesity – Diabetes Connection

Our body uses glucose (a sugar) as the main source of energy, therefore we need glucose to live. Ingested sugar/glucose enters cells (including liver cells) through a process mediated by the hormone insulin. Diabetes occurs when there is a deficiency of insulin leading to decreased uptake of glucose by cells and thus increased blood sugar.

Type 1 Diabetes usually occurs at younger ages (although it can occur in adults). In Type 1 Diabetes the pancreas produces little or no insulin due to destruction of the insulin producing pancreatic ‘islet’ cells. Without insulin, the body cannot metabolize (‘handle”) sugar. There is both an immune and genetic component (both still not fully characterized) to Type 1 Diabetes. The individual with Type I Diabetes must receive exogenous insulin for life and monitor blood sugar levels carefully.

Type 2 Diabetes, on the other hand is adult onset (or now with childhood obesity at younger ages is occasionally seen in teenage years). It is characterized by decreased effectiveness of the insulin present (termed ‘insulin resistance”). The exact cause of Type 2 Diabetes is not known although genetics and environmental factors such as obesity and sedentary lifestyle are contributing factors. Depending on the severity of the disease (blood sugar levels), Type 2 Diabetes may be able to be treated by lifestyle interventions without medication, although even if meds are used, lifestyle modification is an essential part of treatment. Of persons diagnosed with diabetes, 10% have Type 1, and 90% have Type 2.

Today, 70% of the U.S. population is overweight or obese. Given that obesity is associated with insulin resistance, we are seeing the highest numbers of people with Type 2 diabetes this nation (and the world, for that matter) has ever seen. The Sugar – Obesity connection occurs when excess blood sugar in the form of fructose is turned into triglycerides (fat).  Most fructose comes in sucrose (table sugar, cane sugar, beet sugar or from high fructose corn syrup).  It is really the connection with obesity that makes diabetes the risk that it is. Obesity and lack of physical activity are the real culprits when it comes to cardiovascular risk.

Sugar Consumption

There is no denying that many of are lapping up sugar with abandon. We consume, on average (worldwide) 70 gms (17 teaspoons) of added sugar /other sweeteners each day. The American Heart Association recommendation is 3 tsps for teens, 6 for women and 9 tsp for men. At the core of this consumption is the western diet (which we export) which is one of predominantly packaged foods and “fast foods”. Shockingly, 80% of these foods have added sweeteners such as sugar, high fructose corn syrup or other. Take a look at this graphic of the variety of dietary sugars available. (Note: the body doesn’t care what the label says, it’s all just sugar!)

 

The problem with eating so much sugar is: increased sugar ingestion causes increased daily calories and eventually weight gain, which in turn, causes insulin resistance and eventually Type 2 diabetes. Chronic Type 2 diabetes leads to cardiovascular complications (throughout the body) A parallel cascade is increased sugar ingestion (increased empty calories) implies decreased calories from nutritious foods, leading to malnutrition, dietary gaps, decreased energy, decrease exercise and weight gain.

From the director of “That Sugar Film”, Damon Gameau in his NY Times interview:

I don’t think we should demonize one ingredient. But when that one single ingredient is now in 80% of all foods, we do need to look at it. This is not just about putting sugar in your tea or coffee. Its pervaded our entire food supply, and people are having far too much of it. And I think most of these people don’t realize how much they’re having.

The Diabetes Industry

We have an entire industry – a diabetes economy – that revolves around glycemic control

– Dr. David Newman (Mount Sinai School of Medicine, NYC)

We may be using drugs that are great for lowering glucose but don’t do anything for cardiovascular risk

– Dr Clifford Rosen (Tufts University School of Medicine)

The blood sugar lowering drugs administered to people with Type 2 diabetes not only have not been proven to help the diseases that Type 2 diabetes is associated with but also have side effects of their own and come with considerable cost to the patient. Unfortunately, the FDA has taken to using ‘surrogate’ measures when approving drugs thus for Type 2 diabetes they have allowed passage for drugs which only lower A1C levels but do not reduce of cardiovascular (heart, eye, kidney, leg vessel) complications.

The picture is further complicated by pharmaceutical firms paying millions to disease experts to both help bring new expensive drugs to market and to increase the numbers of people qualifying as ‘needing’ medication (lowering thresholds).

 

Aggressive management of blood sugars in Type 2 diabetes is an expensive process entailing high medical costs outlay, considerable time and psychological energy on the part of the patient, and large time commitments on provider side. On average a person with Type 2 diabetes pays $10,000 more per year on out of pocket medical expenses than an individual without Type 2 diabetes. (Shockingly, although insulin was discovered in 1921, there is still no generic insulin available.)

In an excellent article for Forbes (2013) Dan Munro described the financial toll that our nation’s high sugar consumption was causing. He cited a Credit Suisse report which had determined that approximately 30-40% of healthcare expenditures in the USA went directly to address issues closely tied to excess consumption of sugar. That % would represent over 1 Trillion dollars. I recommend the article and the graphs within it, as a wake up call on this issue.

In early August an article in HealthLeaders Media presented the opinions of several obesity experts on the topic of USA’s obesity epidemic. They did not mince words:

…the societal costs of obesity are becoming too great to bear. Our public health is a stake. We will not make meaningful headway on the prevention and treatment of chronic disease until we change the infrastructure that supports unhealthy habits. We have a sedentary lifestyle with an abundance of high caloric foods at our disposal. Obesity is a crisis for two reasons, we are seeing lower life expectancy rates among our children and we already know we can’t handle the economic impact of diabetes. It will wipe out healthcare.

– Jay H. Shubrook, Jr. D.O. (Touro University, College of OM, Calif)

The combination of high caloric intake, obesity and lack of physical activity will surpass tobacco as the leading cause of cancer death within the next two decades. It is already a leading cause of heart disease, diabetes and orthopedic injury.

– Otis Brawley, MD  CMO, American Cancer Society

IFMSA Policy Statement – Prioritizing Sugar in the Obesity

The International Federation of Medical Students’ Association, at their meeting in Antalya, Turkey in March 2015 issued a policy statement in support of prioritizing sugar in targeting the obesity epidemic worldwide.  From the ‘Summary’ in the report this statement:

We, the IMFSA, aim to prioritize sugar in the obesity epidemic by urging the food and drinks industry to commit to reducing the amount of non-milk extrinsic sugars (NMES) in manufactured food and drinks. We aim to lobby governments to introduce effective means of limiting consumption of high sugar food and drinks, and to raise awareness of the impact that these foods have on health. We call for members of the IFMSA to raiseawareness of the health effects of main dietary sugars in their local communities, medical schools and demand for medical curricula to teach and reflect the consequences of high sugar intake.

The IMFSA policy statement goes on to outline the specific steps that Industry, Government, and its’ national member organization must take. I recommend the entire four page policy statement to all readers. Perhaps it will be the interest and passion of millennials that will begin to turn the global obesity and diabetes epidemics around.

From the director of “That Sugar Film”, Damon Gameau in his NY Times interview:

I don’t think we should demonize one ingredient. But when that one single ingredient is now in 80% of all foods, we do need to look at it. This is not just about putting sugar in your tea or coffee. Its pervaded our entire food supply, and people are having far too much of it. And I think most of these people don’t realize how much they’re having.

Tips To Reduce Dietary Sugar

Avoid these foods, in order of importance:

1. Soft drinks:Sugar-sweetened beverages are awful, you should avoid these like the plague. (Note: A single 12 ounce can of regular soda has about 8 tsps sugar. )
2. Fruit juices:This may surprise you, but fruit juices actually contain the same amount of sugar as soft drinks!
3. Candies and sweets:You should drastically limit your consumption of sweets.
4. Baked goods:Cookies, cakes, etc. These tend to be very high in sugar and refined carbohydrates.
5. Fruits canned in syrup:Choose fresh fruits instead.
6. Low-Fat or Diet Foods:Foods that have had the fat removed from them are often very high in sugar.
7. Dried fruits:Avoid dried fruits as much as possible.

Conclusion

In summary, we’re on a cultural sugar high and we need to reverse course as fast as possible. But the lion’s share of that effort, in my opinion, needs to  be political :pressure on the food and drinks industry, educational campaigns re sugar intake, better food labeling, and NOT on medicalization, excessive drug taking.  We need to convert the business of diabetes into a national resolve to change our sugar culture , our destructive food supply and food choices and legislate policies that support and subsidize fresh produce, non packaged food items and penalize companies, industry that thwart healthy efforts. I would like to see the medical profession do the following: be a stalwart and enthusiastic companion for cultural change over drug taking, to be more cognizant of the evidence based medicine and to share those facts with patients. Enlightened, honest public policy on the obesity crisis and sugar consumption, in partnership with the skills of a courageous medical profession, is what is called for now.

The physician, to the extent he is a physician, considers only the good of the patient in what he prescribes, and his own not at all

– Plato

Please join us for the #HCLDR chat on Tuesday September 1st at 8:30 PM ET (for your local time click here) to discuss the following topic questions:

• T1 What responsibility does the food and drinks industry have in our obesity-diabetes epidemic?

• T2 What should government do about the obesity epidemic & sugar intake? Tax sugar products? Regulate food/drinks industry?

• T3 What should physicians, medical education, healthcare be doing to address the obesity/diabetes epidemic & sugar’s role?

• T4 How much is high sugar intake a problematic issue in your own life, and how do you address that?

References

“Sugar Linked To $1 Trillion In US Healthcare Spending”, Dan Munro, Forbes, October 27 2013, http://www.forbes.com/sites/danmunro/2013/10/27/sugar-linked-to-1-trillion-in-u-s-healthcare-spending/, accessed August 29 2015

“The Global Diabetes Epidemic”, Kasia Lipska, New York Times, April 25 2014, http://www.nytimes.com/2014/04/26/opinion/sunday/the-global-diabetesepidemic.html?_r=0, accessed August 29 2015

“Is Sugar Toxic?”, Gary Taubes, New York Times, April 13 2011, http://www.nytimes.com/2011/04/17/magazine/mag-17Sugar-t.html?_r=0, accessed August 29 2015

“Prioritizing Sugar in the Obesity Epidemic”, International Federation of Medical Student’s Associations, March 7 2015, http://ifmsa.org/wp-content/uploads/2015/05/PS_2015MM_Prioritising_Sugar_in_the_Obesity_Epidemic-1.pdf, accessed August 29 2015

“Sugar As Cholesterol Culprit”, Terry Graedon, The People’s Pharmacy, April 22 2010, http://www.peoplespharmacy.com/2010/04/22/sugar-as-cholesterol-culprit/, accessed August 29 2015

“Sugar Makes the Standard American Diet Dangerous”, Terry Graedon, The People’s Pharmacy, April 24 2014, http://www.peoplespharmacy.com/2014/04/24/added-sugar-makes-the-standard-american-diet-dangerous/, accessed August 29 2015

“How to teach your kids about sugar”, Casey Seidenberg, Washington Post, May 13 2015, https://www.washingtonpost.com/lifestyle/wellness/how-to-teach-your-kids-about-sugar/2015/05/12/6b8b7882-f401-11e4-b2f3-af5479e6bbdd_story.html, accessed August 29 2015

“Tom Hanks and Type 2 Diabetes – an evidenced based discussion I would like to have with Tom Hanks” (video), James McCormack, University of British Columbia https://www.youtube.com/watch?v=jOxxHbdyXcg, accessed August 29 2015

“CardioBrief: Does Obesity Research Go Better With Coke?”, Larry Husten, MedPage Today, August 10 2015, http://www.medpagetoday.com/PrimaryCare/Obesity/53008, accessed August 29 2015

“Cost of Obesity Will Wipe Out Healthcare”, Christopher Cheney, HealthLeaders Media, August 5 2015,  http://healthleadersmedia.com/page-1/HEP-319308/Cost-of-Obesity-Will-Wipe-Out-Healthcare, accessed August 29 2015

“Effects of diabetes drugs dubious”, John Fauber, Elbert Chu and Coulter Jones, Milwaukee-Wisconsin Journal Sentinel, December 21 2014, http://www.jsonline.com/watchdog/watchdogreports/effects-of-diabetes-drugs-dubious-b99398554z1-286482971.html, accessed August 29 2015

“People with diabetes are facing rising prices for lifesaving drugs”, Michelle Andrews, Washington Post, August 24 2015 http://www.washingtonpost.com/national/health-science/people-with-diabetes-are-facing-rising-prices-for-lifesaving-drugs/2015/08/24/dec2abd8-476f-11e5-8e7d-9c033e6745d8_story.html, accessed August 29 2015

“What Eating 40 teaspoons of Sugar A Day Can Do To You“, Anahad O’Connor, New York Times Blog, August 14 2015, http://well.blogs.nytimes.com/2015/08/14/what-eating-40-teaspoons-of-sugar-a-day-can-do-to-you/?_r=0, accessed August 29 2015

“Daily Intake of Sugar – How Much Sugar Should You Eat Per Day?”, Kris Gunnars, Authority Nutrition Blog,  http://authoritynutrition.com/how-much-sugar-per-day/, accessed August 29 2015

“9 Ways to Quit Sugar For Good (slideshow with info)”, Esther Crain, Health.com, http://www.health.com/health/gallery/0,,20923984,00.html?xid=socialflow_twitter_health, accessed August 29 2015

Image Credit

Sweet sugar, Potsdam – Coralle Ferreira https://flic.kr/p/3hYwBX

 

Tags: diabetes, epidemic, health, obesity, sugar