Sugar is sticky, and that’s why high blood and tissue levels can have toxic effects.
The body knows sugar is toxic and releases hormones to regulate it.
Eventually, too much sugar disrupts hormonal function.
Too much sugar also disrupts basic cellular functions in ways that accelerate the aging process.
Because grocery stores are full of foods that raise blood sugar, most people eat more sugar than they realize.
Now that I’ve made it abundantly clear that the vegetable oil present in so many foods is toxic to your health and your genetic legacy, brace yourself: you are about to be advised to throw out another ubiquitous product: sugar. Before you worry this will leave your kitchen cabinet bare, take heart. Processed foods made with vegetable oils are also the foods typically loaded with sugar, so cutting vegetable oil automatically helps you to cut sugar intake. And keep in mind that by cutting out these two deadly toxins, you’ll be allowing your genes to operate as they should and immunizing yourself against chronic disease. Once you get rid of vegetable oil and sugar, and start eating the Human Diet, everything you ingest will help keep you young, slim, smart, and beautiful. I promise, even if you really love sweet stuff, cutting your sugar intake way down will not be a big deal. Getting rid of sugar allows you to taste the natural sweetness in foods that your palate couldn’t previously detect. Not only do I get this feedback all the time from patients, I went through it myself. The only truly difficult part of getting sugar out of my life was the first step, accepting the fact that, because of my own chronic ailment, I had no choice.
On August 5, 2002, I finished a cup of coffee sweetened with homemade caramel sauce and set off on a mission to retrieve a species of Hawaiian fern. The hike into the hills on the south side of Kauai took me up a steep grade through mud and three-foot grass that wound itself around the wheel of my wheelbarrow. When my knee started hurting, I figured it would get better later, as it always had. I was wrong. Way wrong. The pain would continue to get worse over the ensuing months and then worse still after a desperate surgery. Soon, I could barely make the journey from the parking lot into the grocery store, and it was a struggle just making it through my workday. Eventually, I discovered that a virus had taken residence in the fluid inside my knee. When I learned of the possible connection between sugar and immune system dysfunction, I had to make a choice: either tame my cravings for sweets or give up any hope of recovery.
How could sugar cause such a serious and unusual problem? What I had learned in medical school was that sugar was energy that could be “burned off” by exercise. Besides, the single nutrition course I took made it clear that my body’s main enemy was cholesterol, not sugar and other carbs. Fortunately, my husband suspected otherwise. One day Luke handed me a newsletter he’d received from a friend and pointed to an article that said, “A half teaspoon of sugar puts white blood cells to sleep for four hours.” The article was missing a few experimental details; there was no description of whether the study was done in a lab culture dish or in living subjects. Though I tend to be wary of articles missing those kinds of facts, it did prompt me to do a little research of my own. I started looking into the effects of sugar on living cells, and what I found was horrifying.
EXERCISE AND SUGAR
If you are a competitive athlete or your job involves heavy labor, your hungry muscles act like sugar sponges, sopping the stuff from your bloodstream before the levels get dangerously high. But don’t think, like I did, that exercise enables you to get away with eating junk. For one thing, that junk destroys your collagen (see Chapter 11). It also forces you to store fat. Even as a college-level cross-country runner burning thousands of calories during two-hour daily training sessions, my dorm-food diet was so low in nutrients that, in spite of all the exercise, I actually developed one of the earliest signs of diabetes, called trunkal obesity.
While far from fat at five-foot-four 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 thirty-five, when I started eating better, I finally lost that omental fat and developed a more feminine waistline. (I also grew an inch taller!)
Of course, we need sugar in our bloodstream just to stay alive. Glucose is the only fuel that red blood cells—and a few other types—can use. But things go awry when you eat more than your body can deal with. Because sugar—in high concentration—is a rarity in nature, the human metabolism is simply not prepared for exposure to the 200-plus pounds the average American now consumes yearly.441 In a different century, only the wealthy could indulge in sweets made with refined sugar. Now, sugar is a mainstay of the modern diet.
After my (long overdue) review of the literature on sugar’s effects on body biochemistry, I found that the consequences of excess sugar consumption are disastrous, especially in childhood. 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 encrusting 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.
You may have heard that, on average, we gain ten pounds a decade after the age of thirty-five; 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 receptors, jamming them, and rendering 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 and 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 indigenous cells from invaders, it opens the door to cancer and infection.
How does sugar do all this?
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 that sticky resistance, you’re feeling 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 become 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, pliable, 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 principally 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 slow them down, making infections more likely and more serious. Debilitated white blood cells permit nascent cancer cells to grow under their noses, unchallenged. Are your joints creaky 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). To get a better idea of how AGEs impair normal body functions, let’s take a closeup look.
Far from being a hollow tube where blood components randomly bump about, blood vessels are busy places where coordinated events take place in parallel with each other thousands of times per second. Guided only by the thermodynamics of their own design, the biologic materials in your blood perform acrobatics as perfectly choreographed as a Las Vegas circus act. This concerted effort between teams of biological micromachines is what makes a muscle contract, a sweat gland produce sweat, and your brain translate optic nerve input into a recognizable face. But when too much sugar creates cross-links between moving parts, all cellular activity is impaired. Let’s take a look at just three cell types in your circulation—white blood cells, the blood vessel lining cells (called endothelial cells), and red blood cells—to see how sugar cross-links make it impossible for them to do their jobs.
Pushed by the currents of blood, circulating white blood cells travel over the lining of the blood vessels by rolling along like little tumbleweeds. When responding to the call of tissues in trouble, white blood cells must exit the bloodstream. How do they know where to go? Inflammatory chemical messages from the affected tissue seep through intercellular spaces to reach the endothelial cells lining the bloodstream. Those cells then put up little flags on their surface telling white blood cells to exit the blood vessel. The white blood cells magically transform from stiff, tumbling spheres into flowing, flat amoeba-like creatures, and wriggle through tiny spaces between endothelial cells into the troubled tissues below. All of this is basic physiology. But our knowledge of the biochemistry of sugar helps us understand how glycation reactions between sugar and protein can cross-link the endothelial cells, block those tiny spaces, and prevent white blood cells from getting to where they’re needed. And it follows that the more cross-links you have, the more your immune function is impaired.
AGEs are a primary reason diabetics develop circulatory problems. Over the life of a red blood cell (three months or so), the protein-rich red cell sops up sugar like a sponge, growing stiff and bloated. One of the jobs of the spleen is to test the quality of red blood cells in active circulation. It does this by making them pass through a maze of gradually narrowing corridors. Any cell too puffed up with sugar gets destroyed. But when sugar levels are high all the time, the spleen can’t remove all the bloated cells quickly enough, so they wind up clogging tiny capillaries. This is why diabetics go blind and develop numbness and infections in their feet. What’s true of white, red, and endothelial cells is true of every cell in your body. If sugar so drastically impairs the function of cells that are already fully formed, imagine what it might do to cells that are still developing.
Earlier in the book, we talked about the need to revise the way we think about food. Rather than “building blocks” made of carbs, fat, and protein, food is more akin to a language comprised of, and ultimately communicating with, complex dynamic living systems. That life-giving complexity is getting hard to come by.
As the remaining environment is polluted, used up, or replaced with human development, the unavoidable mathematics dictate a ratio of less complexity per capita. The more obvious outcome of this is the fact that it’s becoming increasingly difficult for individuals to surround themselves with nature in their daily lives. Though less obvious, the very same process is taking place on our dinner plates.
A whole wild salmon, liver from a free-range, grass-fed calf, and a pint of unpasteurized cream from pastured cows all share in common the fact that they are highly complex living systems. And each communicates to our cells the conditions of the complex microecology from which those animals fed. What they also share is that they each require a large section of healthy earth or sea for their production. At the opposite end of the spectrum is carbohydrate. This relatively simple food, lacking in complexity, has the advantage of needing very little space to produce, and that space need not be pristine. Needless to say, it’s cheap. As world resources shrink, economics increasingly necessitates that people consume more carbs, which is to say, sugar. The process represents a simple trade-off between human population size and individual health—quantity over quality. These days, much attention is devoted to access to healthcare. But the real health issue is access to nature, primarily by way of real, healthy food.
In Chapter 5, we discussed fetal alcohol syndrome, the term given for the constellation of congenital abnormalities attributable to maternal alcohol consumption. The more common version of this syndrome is called fetal alcohol effects. This describes the less profound effects of maternal consumption at (presumably) more moderate levels. Since most mothers would like to do all they can to avoid birth defects, they usually follow their doctors’ advice to avoid alcohol altogether. I think doctors should apply the same kind of reasoning when it comes to the consumption of sugar.
It is an accepted medical reality that if you have diabetes you run up to ten times the risk of having a child with a major birth defect, including major facial anomalies like cleft palate. Uncontrolled diabetes has been shown to have “a profound effect on embryogenesis, organogenesis, and fetal and neonatal growth.”442 The most conscientious doctors, therefore, tell their diabetic patients hoping to get pregnant to get their diabetes under control first. But what about those women who are borderline diabetic, insulin resistant, and hyperglycemic?
In my opinion, just as doctors now prohibit even moderate drinking in pregnancy, I think it’s time to take sugar consumption seriously as well. As we’ll see below, tens of millions of Americans, including many expectant mothers, suffer from diabetic complications and don’t know it. We know that major birth defects are more common in diabetics, but what about lesser growth anomalies like those of fetal alcohol effects or Sibling Symmetry Shifts? Could the cross-linking effects of a high-sugar, high-carb diet likewise impair the full development of facial features?
Given all we know about the disastrous effects of sugar on our cells, there’s every reason to believe the answer is yes. A few cells sticking together at key points in embryologic development is very likely to disrupt and distort the development of a growing baby. This is why I counsel all my pregnant patients to reduce their sugar intake as much as possible. If they want something sweet, they’ll have to wait for the perfect smile on their baby’s face.
Certain cells require a constant supply of glucose, so it must be readily available. The pancreas, a sock-shaped gland tucked behind the stomach, tries to keep sugar levels between about 70 and 85 mg/dl (in international units 4.2-4.4 mmol/ml) at all times by secreting multiple hormones including insulin—which helps to remove sugar from the bloodstream—and counterbalancing hormones like glucagon and somatostatin that all work together to keep glucose levels in that perfect Goldilocks zone. But a blast of sugar from a Big Gulp, a giant cookie, or a spongy soft piece of cake can overload the pancreatic control system and soak your tissues in sticky sugar long enough to form a mess of AGEs, which will need to be cleaned up. If the cleanup isn’t finished before your next treat, cell membranes are so full of cross-links that they are slow to respond to insulin, and sugar levels rise higher. This enables more cross-links to form than before, and so the cells respond even more poorly to insulin. This is the downward spiral into which so many of us fall. Eventually, when fasting sugar levels rise above 90 (or 100, depending on the doctor), a person is diagnosed with elevated blood sugar levels (or prediabetes), and finally, as levels continue to rise, with diabetes.
Since so many people with blood sugar problems have parents with the same condition, they naturally assume it’s hereditary, and therefore inevitable. But that’s not the case. If anything is being passed from parent to child here, it’s bad eating habits. If you can take control of your habits, you can escape the vicious cycle, normalize your blood sugar, and even cure diabetes.
You may know that diabetes increases your risk of having a heart attack. What you may not have heard is that more moderate versions of elevated blood sugar are dangerous as well. A study done in 2007 showed that people whose fasting sugar was even the slightest bit above normal (currently defined as 100mg/dl) when admitted to the hospital with a heart attack were up to five times more likely to die in the next year than heart attack victims whose levels were normal.443 These people with elevated blood sugar weren’t given a diagnosis of diabetes. Instead, they were told they had “impaired fasting glucose.” What that diagnosis too often translates to the patient’s mind is that—since they don’t have “diabetes”—they’re in the clear.
But here’s the truth: all the things that frighten us when we hear our doctor say the word diabetes—like kidney failure, blindness, stroke, amputation, heart attack, etc.—apply to impaired fasting glucose as well.444 People with “impaired fasting glucose” or “glucose intolerance” or “insulin resistance” or “prediabetes” or even the slightest elevation of fasting blood sugar levels, should be warned that they are at risk for all the complications associated with diabetes. If it were up to me, we’d put all of it under the umbrella of diabetes. But whatever you call it, if your blood sugar is elevated, take that as a big red flag telling you that it’s time to cut your sugar (and vegetable oil) intake dramatically.
So exactly how high is too high?
Many experts have suggested that the threshold at which we diagnose diabetes (a fasting blood sugar level of 125 mg/dl) should, in light of all this evidence, be revised down. I agree. When I first started practicing medicine, I used the cutoff that everyone else used: 125. But the longer I’ve been practicing medicine, the more I’ve noticed something remarkable: once people’s fasting levels reach 89, they tend to start gaining weight. And because high blood sugar disrupts the lipid cycle, some even develop atherosclerosis. If you have a fasting level of 89 or higher, you may be on the threshold of being sucked into the downward spiral that leads to overt diabetes. In my practice, I check fasting sugar levels on anyone who has any kind of symptom attributable to diabetes or who is simply overweight. If the level is 89 or higher, I recommend that they permanently cut their total intake of carbohydrates (including sugars) down to 100 grams a day or less.
Maybe it seems as though I’m being overly strict about sugar. To put the issue into perspective, realize that two hundred years ago, refined sugar was a costly commodity traded in tiny portions, like pepper. As you’d expect, sugar-related health problems were confined to the wealthy.445, 446 Today, thanks to cheap energy and labor—and sugar from beets and corn—diseases attributable to sugar have been made available to all.
Hypoglycemia is a commonly recognized problem of low blood sugar. But it may also be the earliest sign that a person is on their way to developing insulin resistance. The symptoms of hypoglycemia include feeling tired, hungry, shaky, or 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. Because sufferers often figure that their symptoms are due to low sugar levels, they often self-medicate by eating more sugar, which, as we’ll see next, only makes the problem worse.
Meet Mary, a nurse who worked in my office a few years ago. Always 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 “healthy” stuff, like fruit and energy bars. She was fit, exercised regularly, and kept her weight down. Over the years, however, she began to notice some shaking in her hands when she was hungry. She could make it stop by having another sweet snack, which she would keep stashed away in a special section of her purse. When she hit menopause, those hunger spells suddenly morphed into something more frightening. One day, when the surgeon she was assisting asked for a suture, Mary just stared into space, unresponsive and confused. She remained in a fog for about two minutes before snapping out of it. To make sure it would never happen again, she decided to eat something sweet a little more often. Later, when her blood was tested, the doctor told her everything was fine. If anything, he said, her fasting sugar levels were on the low side.
“It’s my hypoglycemia,” Mary told me. I told her that she was causing hypoglycemia by eating sweets and blunting her response to hormones so that the body produced more and more to get the same response. Neither of us was expecting what came next.
A few months later, Mary blacked out at the wheel and drove off the road into a ditch. Luckily, nobody was hurt. In the hospital, the neurologist said those spells she’d been having were seizures and put her on anti-seizure medication. But the medication made her drowsy and she didn’t want to take it, so she came to me looking for an alternative.
As any menopausal woman knows, fluctuating hormone levels can cause irritability. This was part of Mary’s problem. Rising and falling estrogen and progesterone were affecting her brain and causing anxiety. But that wasn’t the only issue. The big problem was the foil-wrapped snack hiding in her purse. Years of the habit had soaked her tissues in extra glucose often enough to generate cross-links too numerous to clean up. Since her cellular response to insulin was just a little delayed, her pancreas would keep releasing more. Of course, her response to glucagon—the hormone that tells the liver to release sugar—was sluggish as well. Imagine an airline pilot trying to fly a plane whose response to the controls is delayed by ten seconds or so. 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, monitoring 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 was able to follow the diet and has now been seizure-free on a low dose of medication for eight years.
Is this a happy ending? I suppose. She is, after all, less dependent on seizure medication than if she had continued her high-sugar diet. Had she continued, even the full dose of medication may not have been able to prevent the seizures completely. But here’s the other side of the coin: from what I’ve learned about sugar and its effects on human health, it’s not altogether unlikely that suffusing her bloodstream with toxic levels of glucose over a period of years may have been a sufficient cause of her seizure disorder. In other words, take the energy bar out of her purse ten years ago, and Mary might never have had any need for seizure medication, ever. Does this make me want to grab energy drinks, energy bars, and fruit juices out of people’s hands? You bet. Not just because sugar causes illness, but because sugar-induced problems pull otherwise healthy people into a medical system that loses revenue when people are healthy. It needs them—meaning you—to be sick. That’s why I’m giving you all the details. Hospitals, clinics, and much of the medical industry depend on keeping you in the dark. But your genes depend on you to learn the truth about what it takes to eat right.
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 Hawaiian 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 doctor to get a referral to a cardiologist, who did still more tests. All normal. Just to be sure, the cardiologist wanted an angiogram. If that test showed anything out of the ordinary, 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 vacation, and he was too anxious to 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 noticed that his heels were slightly calloused, and I’ve found that patients with high sugar levels often develop dry calluses 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 Gary’s 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 10:00 A.M. to buoy him through his morning lull, 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 thirty-nine, 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 predicament, 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 way) maintain libido. But when you gum up testosterone receptors on the surface of cells, they don’t respond to signals as readily. And when 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 erectile dysfunction (ED).
For Gary, this warning struck home. 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 palpitations 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’ve been absorbed into the system. And good luck finding the door. In Gary’s case, as with millions of Americans, the passage into the medical labyrinth from which so many people never return is encrusted in sugar.
Jane was a thin, suntanned, enthusiastic tennis player with a total cholesterol of 260 mg/dl and LDL of 170 mg/dl. A nurse, she was well indoctrinated with a fear of cholesterol. Because her father had had a heart attack, she kept her diet low in cholesterol, and she exercised fastidiously. Her cholesterol levels, she assumed, were “due to genetics.” She also knew that cholesterol medications might cause muscle aches that would affect her tennis game. Still, she was so terrified of high cholesterol that she was willing to take the chance and came to me for a prescription.
Naturally, she was surprised when I said that first she needed to get a fasting blood sugar test. Now that you’ve read about the lipoprotein cycle in Chapter 7, you shouldn’t be surprised that this is what I recommended. Blood sugar affects numerous physiologic functions, even those you might assume have nothing to do with sugar, like cholesterol.
Too much sugar makes LDL levels rise by several mechanisms. First, sugar elevates insulin. High insulin accelerates LDL production by turning on the enzyme HMGCoA-reductase—the very same enzyme statin drugs are engineered to turn off.447 Sugar also glycates circulating LDL apoproteins, locking the affected LDL molecules in circulation by making their docking proteins unrecognizable (see Chapter 7), thus raising LDL higher. Then, over several years, sugar cross-linked capillaries grow stiff. Capillaries must remain flexible to allow the passage of LDL and other lipoproteins to underlying tissues. But once caked stiff, capillary channels cannot open fast enough, if at all; the blocked-off LDL is forced to stay in circulation longer, and LDL serum levels rise further still. Most of the cholesterol in circulation is manufactured by your body, so if your diet is high in sugar, it is nearly impossible to bring your serum cholesterol down—unless you get on a cholesterol-lowering drug.
Jane agreed to cut her sugar, and her LDL soon plummeted to 120, which, given her HDL of 85, was just fine. Jane’s high LDL had nothing to do with family history and everything to do with her sugar intake. She didn’t need a medication, she just needed to identify the hidden sources of sugar in her diet and avoid them.
Susan’s headaches were awful. As she described them, they felt like a hot blade had been plunged through her right eye. For twenty 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 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 suddenly 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 fluctuations 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 day. By the middle of the night, their blood sugar levels have bottomed out and hormones are swinging wildly to compensate. 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 altogether.
Saying it is one thing. Doing it is another. “I don’t eat that much sugar,” Susan insisted. Very few people say otherwise. It could be true, or it could be the reflexive addict’s denial. I remember responding the same way to my husband back when I was downing more than a quarter cup of sugar a day, which I admitted to Susan. We talked about her diet and, as it turned out, we both came to realize that she was in fact eating lots and lots of sugar. That’s the good news. My advice to dump sugar, unfortunately, didn’t take, and the habit won out. When the headaches came, she treated them successfully by reaching under her bed and breathing in the oxygen. When the oxygen wasn’t enough, she headed to the ER for relief.
Whenever one of my patients goes to the ER, I receive a note. One day, it occurred to me that I hadn’t received a note about Susan for a while. I thought maybe she’d moved, until she came in to see me for a physical. I asked her how her headaches were doing. She said she read somewhere that cutting sugar out of her diet might help her headaches and she hadn’t had a single one since she’d changed her habits. She was very proud of the fact that she’d even resisted cake at her own birthday party.
Cutting sugar to treat headaches? Who would have thunk it? Sometimes people need to take ownership of information in their own way, and that’s just fine with me. What matters is that she finally came around and decided to notify the cookie monster on her back that its free meal ticket had been revoked.
In all these medical cases, you may have noticed a theme emerging. Sugar wreaks havoc with the entire nervous system, so much so that one of 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, runny noses, and more.
Susan’s story, like mine, shows us that people can be in denial about their sugar intake even while suffering horribly from its effects. The forces of denial overwhelm the forces of reason, preventing us from seeing what we are doing to ourselves. And who among us is sober enough to break sugar addicts from their spell? We are a nation of sugar addicts, surrounded by fellow sugar addicts raising sugar-addicted kids, with constant access to cheap and powerfully addicting sugar. The addict’s cravings go way beyond wanting the sweet taste. Long-term sugar abuse actually rewires the human brain, until we are all—in a very real sense—cuckoo for Cocoa Puffs.
Imagine you’re a space alien doing research on the most potent drugs in the solar system. You’ve already written reports on cocaine, opium, alcohol, and nicotine. But on planet Earth, there’s one more refined substance that seems to dwarf them all. There are few places where this substance isn’t imported and included with almost everything the residents eat and drink. It’s the first thing they ingest in the morning and the last they use at night. It’s the centerpiece of celebration. Overweight children and elite athletes carry plastic receptacles filled with colorful, drinkable versions of the stuff as though they need it like air. And although, at some level, they know it’s killing them, they just won’t stop.
Your report will show that the acreage and energy dedicated to the extraction, refinement, and export of this drug rivals that of criminalized compounds. It takes 1,000 pounds of water to produce one pound of crude drug from cane and days of heating and refining to produce fine granules of saleable product. A quick study of planetary history shows that this substance has been so highly prized that it has functioned as currency for trade, and its flavor—”sweet”—has earned it a greater presence in the lyrics of popular music than any other drug.
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 lead to addiction.”
The subject of your report is, of course, sugar.
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 that “daily consumption alters striatal enkephalin gene expression.” In other words, the study rats had been programmed to consume substances that stimulate their opiate receptors.448 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 chemistry desirable to humans, certain plants have domesticated us, turning people into pawns in their Darwinian battle to rule the landscape. Like THC in marijuana, the sugar in fruit and sugarcane entices humans and other animals 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 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 corn’s domination of the planet. Sugar-producing plants like corn, cane, beets, berries, and mangos give us a legal high every bit as addictive as a hit of crack cocaine, though less intoxicating. What I am arguing, however, is that sugar’s hold on us is more dangerous than any illegal substance because its effects are subtler and more pervasive.
If a child were given a dose of heroin, the chemical would trigger a flurry of neural activity in the pleasure centers of his brain. Sugar, whether in juice, pureed pears, or infant formula, results in the very same kinds of responses “via the release of endogenous opiates triggered by sweet taste.”449 And if you regularly give kids sugar-rich commercial juices, sweet cereals, 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.450
In 2002, a group of neonatal nurses at several intensive care units 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 neurologic effects that were still measurable when the study ended, eleven weeks later. Higher 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].”451 Essentially what this study indicates is that 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 endogenous 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 something 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 is cognitive ability affected as well? That question has yet to be answered.
Life is full of stresses and trials. Normally, we deal with them and move on. But studies like this suggest that when we offer kids sweet treats as an incentive to settle down, we’re rewiring their brains, potentially preventing them from learning normal, healthy, and more socially appropriate coping strategies than screaming for a box of juice. I have spoken with several child psychologists who feel that discipline among children is fast on the decline. For whatever reason, more and more adults seem unable to control their kids. My feeling is that if you start loading kids with sugar as a way of controlling behavior, you are not only training them to rely on external chemicals to feel good, you are training them to manipulate you to provide them with their fix. Sorry, Willy Wonka, but my patients who’ve taken their kids off sugar tell me they can’t believe what a better, more balanced, healthier family life they now have.
Those at the other end of life’s journey should know that most research into the origin of Alzheimer’s dementia implicates not genetic mutation, but sugar.
As we’ll see in the next chapter, your body is constantly growing and responding to signals. And every part of you is swimming with chemicals directing growth and cellular change, including your brain. When a brain is overloaded with sugar, you can see the effects on its cells.
Normally, a single brain cell looks a lot like a tree, with thousands of bifurcating branches, called dendrites. Dendrites on one brain cell reach out to dendrites on other brain cells to exchange the chemicals that enable us to remember, think, and experience emotions. Not surprisingly, intelligence roughly correlates with the number of branches in the brain’s neural trees.
HIGH-SUGAR DIETS MAY LEAD TO DEMENTIA
On the left is a normal brain cell, called a Purkinje cell. On the right, a Purkinje cell that exhibits the reduced branching seen in demented brains. Since insulin is necessary for normal brain cell health, insulin resistance (a result of high-sugar diets) may cause similar brain cell changes.
What makes the nerve cell grow more branches? It turns out that hormones do. The brain is constantly bathed in hormones that stimulate growth. Take away the hormones, and nerve cell branches die back.452 In a way, growth factors act like dendritic Miracle Grow; the more growth factors you get, the more vigorous your brain cells can grow and the better you can think. One of the earliest stages of Alzheimer’s dementia involves the loss of these branches, a process called dendritic pruning.453 It’s likely that sugar-induced cross-linking gumming up brain cell membranes is at least part of the problem. As with any cell membrane, cross-links reduce hormone sensitivity. Less receptivity means your brain cells can’t respond to growth factors. Less response means fewer branches, which means fewer connections. It seems that sugar can act as a brain cell defoliant, changing the physical structure of your brain over the years and ultimately, for some, resulting in dementia. So if you’ve ever wondered why the Kool-Aid guy in the commercial is always busting through walls, consider how much sugar he’s drinking. He probably forgot how to use a door.
A study done in Iraq on sweet taste habituation showed that the more sugar we eat, the less we taste it, and the less we taste it, the more we eat. In Iraq, sweetened tea accounts for the majority of sugar consumption in all age groups. Researchers offered people four cups of tea with increasing concentrations of sugar. In rural areas, where sugar was scarce, almost nobody wanted the sweetest tea, only 0.3 percent. But among those who had lived in the city for ten years or more, 100 percent preferred the sweetest tea on offer. The longer they’d lived in the city, the more sugar they wanted in their tea. The researchers asked everybody how much sugar they normally consumed, and then gave them another test to determine at what levels their taste buds could detect the presence of sugar. They found that the more sugar people tended to consume, the less they were able to taste it. Sugar had literally dulled their senses.454
I’ve done a similar experiment on my own. I researched the effects of sugar on an unwitting subject—myself. For nearly a decade, I poured homemade caramel sauce into my coffee, each dose containing a quarter cup of sugar. Luke (the experimental control) tried it once. After one taste, his eyes flew open wide, and he suggested I must be part insect. “You cannot possibly be drinking this every day,” he insisted. I knew it was a lot of sugar, but no more than other people used. Like other junkies, I was rationalizing, and I ignored the advice to cut down. And that’s what wore down my immune system so completely that a virus was able to take up residence in my knee. After a year or so of not being able to walk or get very much exercise, I decided maybe I should cut my sugar intake. Gradually, I cut back. First one-eighth cup, then half of that, and then just a teaspoon or two. As I did, over the course of months, I noticed my knee slowly getting better. But as an addict, I chalked it up to coincidence.
Finally, I went on a trip and couldn’t bring my caramel sauce, so I made do with just cream or milk in my coffee. To my surprise, it actually tasted fine. In fact, the cream tasted sweet. The next day, I noticed my knee was better than it had been in years. Recovering addicts often speak of moments of epiphany, or clarity, a moment when something finally clicks. Well, for me, the fact that I could enjoy the taste of coffee with milk and cream and no sugar meant that I really could do just fine without my little fix. And maybe, just maybe, my knee was improving because I was off the sugar. I’d had to step away from my habit, literally, to be removed enough from my daily routines and rituals in order to see the light. Now, as a recovered addict, I can better appreciate what my sugar-addicted patients are going through. I’m not just their doctor, I’m their sponsor.
From that day onward, I’ve never added sugar to my coffee. I’ve not had any soda or juice, and I don’t eat candy or cookies. I eat very little fruit. And I’ve cut out most starchy foods (for reasons described below). Not only has my knee recovered, the extra fifteen pounds I had on my waist since college melted away. Now I have absolutely no desire for anything sweet—except chocolate (I am human). But the chocolate I choose, Dagoba, is 89 percent cacao, with hardly any sugar and no cheap fats. I have one-tenth of a bar three days a week, chopped fine and sprinkled over whipped cream (no sugar) as a topping for my coffee. I never thought I’d be the kind of person who passed on dessert. But now, not only am I freed of sugar cravings, my taste buds are rejuvenated. I can taste the natural sweetness in milk and cream. Even vegetables, like a raw carrot, now taste as sweet as candy. I eat as much as I ever did but weigh fifteen pounds less and spend less time feeling hungry. I wish I knew ten years ago how easy getting trim could be.
Drug abusers say they don’t have to look far to find their drug; the drug finds them. That’s certainly true of sugar. The more people get wise about sugar and try to cut it out of their diets, the more manufacturers—the world’s most successful drug pushers—sneak it into their products.
The problem is made all the worse by the fact that we’ve been taught to equate low-fat with healthy. But low-fat foods don’t taste so great, so to make up for missing flavors from absent fat, manufacturers simply add sugar, and more sugar, and more. I’m looking at a can of Pediasure, which pediatricians frequently recommend over milk. The first ingredient is water. Guess what the second ingredient is. Sugar, accounting for 108 grams per liter.455 Whole milk, by comparison, has 8 grams of sugar per liter.
Denying kids healthy fat often drives them to sugar. When Luke was growing up, he spent a lot of time with his grandparents who were, like many people, on a low-fat kick. Everything in their fridge was low-fat—skim milk, low-fat yogurt, no-fat dressing. By four o’clock, Luke and his siblings were tearing the place apart looking for fatty foods, anything with fat in it. And they found it, hidden in the cupboard in the form of Ding Dongs. On top of the fridge, in the Twinkies box. Out in the breezeway, on the wooden swing, behind the pillow, in the half-eaten package of Oreo cookies that Grandpa forgot to put back. Luke’s grandparents were only trying to do the right thing, but they couldn’t have set things up better to drive their grandkids not just to toxic, artificial fats, but also to massive doses of sugar. For this reason, weaning kids off sugar should be done in concert with providing plenty of healthy fats.
SUGAR’S PSEUDONYMS
| Evaporated cane juice | Malt | Maple syrup |
| Corn syrup | Malt syrup | Brown rice syrup |
| Corn sweeteners | Barley malt syrup | Beet juice |
| High-fructose corn syrup | Barley malt extract | Muscovato |
| Crystalline fructose | Maltose | Succanat |
| Fructose | Maltodextrin | Turbinado sugar |
| Sucrose | Dextrose | Invert sugar |
All of these are molecules of glucose and/or fructose and/or maltose and/or dextrose monosaccharides either alone, or bonded to one of the other two monosaccharides. All are converted to glucose or glycerine when you eat them. Glycerine can force your liver into fat-making mode the same way fructose does (see text).
Luke’s experience happened a good thirty years ago. Since then, we’ve learned something about how too much sugar can be a real problem. Still, avoiding sugar can be harder than you think because of what I call the sugar shell game. You cut out Twinkies, but there’s sugar in the salad dressing. You pass on the office cupcake, but there’s sugar in the store-bought sushi. You decide to give up soda, but your “100 percent orange juice” is doped with corn syrup. (Some FDA officials suspect that many fruit juices claiming to be 100 percent natural juice are in fact sweetened with high-fructose corn syrup.456 Fruit naturally contains fructose, so if manufacturers added more, how could anyone prove it?)
Sweeteners are some of the cheapest ingredients around. So as the American palate is desensitized to sugar, supermarket foods undergo a kind of sweetness inflation, a race between manufacturers to hide more sugar in their products than the competition. What do you think kids want more, plain milk or chocolate? Plain shredded wheat or the frosted kind? Ice water with a twist of lime or a liter of Mountain Dew? The inevitable product of this arms race is the “energy drink,” a twelve-ounce atom bomb of sugar, carbohydrates, and caffeine—everything the addict needs but the syringe.
Another way of hiding sugar is by simply calling it something else. Let’s take a peek at the label of a popular brand of Raisin Bran Crunch to see just how much extra sugar they sneak in the ingredients: “whole wheat, rice, sugar, raisins [mostly sugar], wheat bran, high-fructose corn syrup [more sugar], whole oats, glycerin, brown sugar [obviously sugar], corn syrup [still more sugar], salt, barley malt syrup [yes, that’s sugar], partially hydrogenated soybean and/or cottonseed oil, almonds, modified corn starch, cinnamon, honey [full of sugar], nonfat dry milk, natural and artificial flavor, polyglycerol esters of mono- and diglycerides, niacinamide, zinc oxide, reduced iron, malt flavoring [also sugar], [and a few artificial vitamins].”457 (See here for alternative names for sugar.)
PACKING IN THE CALORIES: SUGAR VERSUS FAT
Dieters are typically encouraged to choose low-fat based on the idea that each spoonful of a low-fat product, say yogurt or a mocha cappuccino, will have fewer calories. This fails to consider the fact that manufacturers make low-fat taste more palatable by adding sugar. Far more sugar will dissolve into water than you might assume, and so the unsuspecting dieter often swallows a load of unexpected calories. Concentrated syrups like the kind used in low-fat foods contain more calories than cream or butter: while a dry teaspoon of granulated sugar has 16.8 calories, less than butter’s 33.3, when dissolved into water, freely moving sugar molecules pack together to occupy one-fifth the space, so concentrated syrups can contain up to 95 calories per teaspoon.
Calorie-wise, almost half of what’s in the box is sugar. What makes up the other half? Carbohydrates. Remember, I said manufacturers play the sugar shell game. If they can’t sell you sugar, they’ll happily sell you the next best thing, dirt-cheap carbs. Pasta lovers aren’t going to want to hear this but, as far as your body is concerned, carbohydrates are sugar. That’s right, one of the most abundant sources of sugar doesn’t even taste sweet.
We live in a world of sugar. The single most common organic molecule on earth is glucose, a kind of sugar. But unlike the candy garden in Willy Wonka’s factory, we can’t just eat anything we see. To humans, most of the world’s glucose is not edible. It’s trapped in a structural carbohydrate called cellulose, which makes wood hard and leaves resilient. But another kind of carbohydrate called starch is digestible. Plants use starch to store energy and they reconvert it back to sugar when needed. The human digestive system can also convert starch into sugar, which is exactly what it does every time we eat starch. This is why, as far as your body is concerned, starch and sugar are almost the same.
Everyone knows what a sugar high is. You eat a couple of pieces of cake, and the next thing you know you’re bouncing off the walls. And what happens afterward? 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 treat 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 it with the same homeopathic cure, a little hair of the dog. Of course, there are 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 with a high glycine index. String a bunch of sugars together and you’ve got starch, a “complex” carb with a lower glycine index. There’s much ado about complex carbs and low glycemic index foods being healthier than sugars, but nutritionally there’s no difference whatsoever. The only differences between simple and complex carbs are how quickly they get into your bloodstream and how fast your insulin must respond to control the surge of sugar. 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 that, 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. This means that if you’ve ever sat down and finished off a box of crackers you’ve essentially eaten a box of sugar. The take-home 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 monosaccharides. Table sugar is made from glucose and fructose monosaccharides bound together into a disaccharide called sucrose. Mono- and disaccharides are simple carbohydrates, aka 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 twelve-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 tortilla chips, pasta or pancakes, complex or simple, you’re mostly eating sugar.
As you’ll see in the next chapter, traditional foods—foods that comprise the Four Pillars of World Cuisine—tend to have fewer carbs than their modernized counterparts. For instance, a slice of sprouted-grain bread has 70 calories. A same-size slice of regular wheat bread has 110. This is because during the process of sprouting, the seed converts its storage starch into nutrients. Seeds can do this easily. Our bodies can’t.
WHY I’M NOT “ANTI-CARB”
I am not anti-carb. I’m pro-healthy carbohydrate proportioning.
What’s happening on our plates is the inevitable consequence of what’s happening on the planet: diverse ecosystems, both in the wild and in the form of small family farms, are being replaced by an ever expanding undifferentiated lawn of high carbohydrate monoculture crops like corn, rice, and wheat. And because high-carb foods are cheaper than more complex foods with higher nutrient content, these are the foods that are pushed in the grocery store and restaurants. Restaurants bring you free bread before a meal; I don’t know any that bring free lobster.
Re-proportioning carbohydrates not only makes a dish more nourishing and less fattening, most of us instinctively find it more appetizing. In one of my favorite episodes of Chef Gordon Ramsey’s Kitchen Nightmares, he instantly improves the presentation of a restaurant’s signature dishes by cutting out a third of the carbs. This simple move makes for a more colorful, more professional looking dish.
In Chef Thomas Keller’s beautiful The French Laundry Cookbook, you can find gorgeous photo after gorgeous photo of the kinds of dishes patrons pay upward of three hundred dollars per person (not counting wine) to enjoy. Almost every dish includes some starch—but in the proper proportion! Think of it this way: rather than a massive pile of mashed potatoes with a medallion of beef and sprig of green garnish, you would have that same beef medallion set atop an equal-size foundation of pureed potato, loaded with butter and cream, encircled with a moat of demi-glace reduction sauce all topped with a carefully arranged collection of colorful braised vegetables.
But you don’t have to be a Michelin star chef to present your family with dishes that align with the same proportions we instinctively find appetizing. Whether it’s Italian, Mexican, Southern, Chinese, or whatever, we’re simply talking about holding back some of the beige and white so that the colorful flavor and nutrient-rich ingredients can dominate the composition.
I am not a big fan of breaking foods into carbs, protein, and all that. But because starchy, empty-calorie foods fill so many shelves in the store, it’s one category we have to be aware of. I advise my patients with diabetes, or those who want to lose weight, to keep their total average carbohydrate intake under 100 grams per day. That allows for one small bowl of pasta, or four pieces of bread, or two apples, and that’s it.
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. Vitamin C happens to be a type of sugar we can’t make and need to eat, and one orange a day gives us most of what we need. But then again, so does a green pepper (technically, a fruit), but without all the unneeded, damaging sugar.
To make matters worse for fruit lovers, fructose kicks your liver into fat-storage mode. Some believe the explosive growth of fructose consumption in the form of high-fructose corn syrup may be responsible for the increased incidence of a condition called fatty liver. So although nutritionists and doctors will still insist that fruit sugar is better than sucrose, others aren’t so sure. But everyone agrees we’re all eating a lot more sugar than we should.
IS HIGH-FRUCTOSE CORN SYRUP WORSE THAN TABLE SUGAR?
What is high-fructose corn syrup? Is it really more likely to make you fat or give you diabetes than table sugar, honey, or any other sweetener?
Corn actually contains almost no fructose. It contains starch (a “complex” carb). Corn syrup manufacture begins with enzymatic breakdown of corn starch into its unit sugar molecule, glucose (this breakdown occurs in your GI tract during the digestion of any starch). Then, another enzyme converts glucose into fructose, to create high-fructose corn syrup (HFCS). The fructose in HFCS is identical to the fructose that occurs naturally. What’s different is that the rest of the fruit (or grain) nutrients are missing.
Before the explosion of the HFCS industry in 1978, fruit and grain (wheat, rice, oat, barley, etc.) products were the primary source of fructose. Now, grain and fruit consumption is down, and though we consume far more HFCS, our total fructose consumption has only increased by one percent (from 8 percent to 9 percent of total intake458, 459). Fructose, therefore, cannot logically be blamed for today’s obesity and diabetes epidemic. The root of today’s obesity has more to do with the fact that total caloric intake has increased by 18 percent, and total carbohydrate intake has increased a whopping 41 percent over 1978 levels.
Fruitarians, sometimes called fructarians, are a subset of vegetarians. Some people consider themselves fruitarians if at least half of their diet is fruit, while others go whole hog—if they’ll forgive the expression—eating nothing but fruit. There are many explanations for choosing this lifestyle, from biblical references to anecdotal evidence of health benefits. The most popular seems to be that since we are related to monkeys and other fruit-eating primates, living on fruit is only natural.
It’s important to remember that many primates, including monkeys, supplement their diet with other foods, like leaves, bark, bugs, nuts, and sometimes meat—even, on occasion, flesh of smaller primates. Some animals can get away with eating lots of sweet fruit because their big, rounded bellies contain digestive systems specifically designed for that purpose. The digestive tracts of orangutans, birds, and other fruit eaters are specialized to ferment the simple nutrients into more complex ones, enabling them to get far more nutrition from fruit than you could.
Animals that live on fruit or other sugary foods don’t absorb very much sugar into their bloodstreams. The way their digestive tracts are organized enables these specialists to first ferment carbohydrates inside special chambers where bacteria, yeast, and other microbes grow, multiply, and manufacture vitamins, amino acids, and other nutrients (for their own use). These probiotic microbes ferment the sugar-rich fruits into a slurry teeming with life-supporting nutrients. By the time the slurry reaches a point along the digestive tract where absorption can take place, it has been transformed into something far more complex. The process is very similar to that employed by grass-eating animals to ferment high-cellulose foods into a more nutritious product. If our digestive tracts were designed like a gorilla’s, we could eat a lot more fruit. But since we’d need a longer intestine to do it, we’d be carrying around gorilla-sized tummies as well.
When I was four or five, I thought of “kid foods” as things like cupcakes, peanut butter and jelly sandwiches on Wonder Bread, cereal—especially Cap’n Crunch!—and lots and lots of noodles. When the grownups went out to eat by themselves, I imagined they were eating things like liver, fish eggs, smelly cheese, and thick, meaty stews. In my imagination, they probably didn’t even have dessert.
What I didn’t know was that, since the 1980s, the U.S. Department of Agriculture has promoted practically nonstop consumption of sugar for everyone, recommending that 60 percent of our daily calories come from carbohydrate-rich foods. So, it turns out, most of the adults in my life were eating kid foods, too. Today, with all the finger foods, cookies, snacks, treats, and sugar everywhere, we might as well be having a non-stop birthday party. Little wonder, then, so many people are struggling with their weight.
So what does it mean to eat like a grownup? The first step is to reconsider the relationships between nature, your diet and your body. Rather than envisioning food in disconnected categories of often flavorless chemical compounds, I want you to understand it as your ancestors did, and to appreciate that nourishment captures the power of nature and carries it into your being. Once you learn about the Four Pillars of World Cuisine, and how to reproduce them, you will be well on your way to making your genes perform the way you want, releasing the power of your full genetic potential.