Culture

Who’s afraid of sugar?

Apparently, sugar is killing us. Or is it?
Culture

Who’s afraid of sugar?

Apparently, sugar is killing us. Or is it?

For much of modern human history, the most ominous calories in our food were said to come from fat. It seemed obvious. Fat makes you fat, right? Cut the fat out of your diet and in no time you’re a beautiful waif. Then, somewhere around the time that French fries became Freedom fries, the focus shifted to the dreaded carbohydrate. Carbs, we were led to believe, skipped the digestive tract and went straight to your ass, and not in a good way. A diet rich in egg yolks and bacon grease was not only good for the heart, but for the scale.

Ah, how times change. A reality star is the president. Britain is leaving the European Union. Nearly every man is a sex harasser. And now it’s sugar that's fucking up everything about your life.

Whether it’s cancer, obesity, acne, or whatever is happening on Steve Bannon’s face, there's someone out there saying it’s sugar’s fault. The New York Times declared earlier this year: “If Sugar Is Harmless, Prove It.” The Guardian asked, “Is Sugar the World’s Most Popular Drug?” (no, that would be caffeine, but thanks.) Last year, The Wall Street Journal said that our sugar consumption was “a matter of life or death.”   Dio mio! The New York Post last year went topical, publishing a piece the day after Halloween that said a “lethal dose” of candy corn was “1,627 pieces.”

Macallan Rare Cask

Well, that sucks, because sugar is goddamn delicious, and I want to stuff my face with most of what I’m supposed to be giving to trick-or-treaters tonight.

There's a lot of misinformation swirling around out there about sugar. Despite what certain science writers and doctors say, it’s not the sole cause of obesity. It’s not addictive, and eating a marshmallow Peep will not bring on sudden death. So what's true about sugar, what's kinda true, and what's a hot steaming pile of bullshit that made you swear off your favorite ice cream forever when really, you should just learn portion control? Let's look at the science behind all of it to get a little smarter about the sweeter parts of life.

Yvette d'Entremont joined us to talk about sugar on our daily podcast, The Outline World Dispatch. Subscribe on Apple Podcasts or wherever you listen.

Myth 1: Sugar is habit-forming, like a drug

If your Facebook feed looks anything like mine, it’s clogged with stories from dubious sources on how you can break your addiction to sugar. I’ll never forget when, a few years ago, I saw on my feed a story in the Times that compared the sweet white powder to drugs. “Sugar stimulates brain pathways just as an opioid would, and sugar has been found to be habit-forming in people,” the article went. Um, what? I’ve never snorted sugar, but I don’t think that’s how that works.

Sugar is not a drug, nor does it act like one in your system.

First, let’s clarify some things. There are many different types of sugar. There’s fructose, which is the simple sugar in honey and fruit. Sucrose is your typical table sugar and is also present in many fruits. Lactose is the sugar that naturally occurs in milk. Sugars are simple carbohydrates, and every complex carbohydrate in existence is broken down into sugars in your body. It’s what the calories in everything from kale to quinoa are broken down into. Sugar tends to be processed by the body very quickly.

But let’s get this straight. Sugar is not a drug, nor does it act like one in your system. Studies based on models in rats may support this simple conclusion, but studies in humans are more conclusive and suggest otherwise. A review study published in Neuroscience & Biobehavioral Reviews in 2014 aimed to find out if eating patterns were similar to those of addictive behaviors. The study found that though eating in general could mimic addictive behaviors, it was inappropriate to deem sugar in all its incarnations an addictive substance.

As we pointed out in this review, there is very little evidence to indicate that humans can develop a “Glucose/Sucrose/Fructose Use Disorder” as a diagnosis within the DSM-5 category Substance Use Disorders. We do, however, view both rodent and human data as consistent with the existence of addictive eating behavior.

Translation: our addictive behaviors aren’t linked to any one component of food like sugar or fat, but we can can develop addictive eating patterns to food in general, and food has multiple components. Think about everything that you enjoy that tastes sugary. With few exceptions, most of those things contained other types of calories. Cookies. Cupcakes. Ice cream. But they also have a good deal of fat (and even some protein, and maybe even vitamins!). So yes, you can develop an unhealthy relationship with food that involves overeating and binge eating. Some of that food contains sugar. Some of it has fat. If that happens, your doctor, a registered dietitian, and possibly a psychiatrist are legitimate places to turn to for help in with your eating habits. However, sugar itself is not the culprit of these conditions, even if you have a little bit of it under your nose after snorting down a donut.

Myth 2: Excess sugar is way worse for your health than fat
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Myth 3: Sugar causes Alzheimer’s disease

Like I said, being anti-sugar is very fashionable these days. The anti-sugar crusade is a charge that many in the health and fitness community have taken up. In doing so, they’ve missed the bigger picture: excess calories, no matter if the source is fat or sugar, can cause obesity.

Take Mark Hyman, the director of the Cleveland Clinic Center for Functional Medicine (whatever that is), and prominent anti-sugar advocate. As of late, Hyman’s work seems to be dedicated to demonizing sugar; his position at the venerated Cleveland Clinic and frequent media appearances make him one of the most reputable anti-sugar physicians out there.

In a 2016 article on the Cleveland Clinic’s website titled “Sugar or Fat: What’s Worse for Your Waistline?” Hyman writes: “Surprisingly, new research shows that eating healthy fats can help you burn more calories than eating the same amount of carbs.” But the link in the article leads to a press release from the National Institute of Health that says: “NIH study finds cutting dietary fat reduces body fat more than cutting carbs.” Hm. This seems to indicate the exact opposite thing that Hyman is claiming.

Let’s deconstruct what’s going on. The study Hyman is referencing, which was published in the September 2015 edition of the journal Cell, was titled “Calorie for Calorie, Dietary Fat Restriction Results in More Body Fat Loss than Carbohydrate Restriction in People with Obesity.” I can sometimes understand if a non-scientist gets lost in the confusion of scientific language, but Hyman is a doctor who seems to glean contradictory findings from the studies he’s writing about.

Excess calories, no matter if the source is fat or sugar, can cause obesity.

This is par for the course for Hyman, whose livelihood depends upon demonizing sugar and promoting the “eat fat, get thin” model (in fact, Eat Fat, Get Thin is the title of one of his books). Why would the author of The Blood Sugar Solution (available on his website for $19.99, along with vitamins, all-natural supplements, “detoxification kits,” kits that regulate male hormones, kits that regulate female hormones, and DVDs) admit that excess sugar and excess fat have an equal impact on weight loss? Well, if I have to spell out the answer for you then… you’re probably not getting it.

Hyman does his most prolific and idiotic writing on his own website. In one blog post, he argues that consuming an excess of sugar can lead to Alzheimer’s disease. “Scientists now call Alzheimer’s disease ‘Type 3 diabetes,’” he writes, not naming any of the scientists who allegedly do this (he also says diabetes is can be "reversed" by eliminating sugar from your diet, but I'll address that later). He goes on to claim that “recent studies show people with diabetes have a four-fold risk for developing Alzheimer’s,” citing a study published eight years ago in Endocrine Reviews. Interestingly the review study, titled Cognitive Dysfunction and Diabetes Mellitus, did not show a four-fold increase in risk for Alzheimer’s for diabetic patients. Some studies included in the review showed a four-fold increase for mild cognitive impairment, but Hyman, a medical doctor, would know the difference between this and Alzheimer’s. The review study found that some studies showed no increase in Alzheimer’s and some studies demonstrated, at most, up to a 1.7-fold increase in incidence of Alzheimer’s in people with diabetes compared to people without the condition.

But Hyman isn’t content to stop there: “Here’s the bad news/good news. Eating sugar and refined carbs can cause pre-dementia and dementia," he writes. "But cutting out the sugar and refined carbs and adding lots of fat can prevent, and even reverse, pre-dementia and early dementia.”

Hyman espouses this information without qualifiers or data, putting his own biases and conclusions about the Endocrine Reviews study before the actual data in it. The robust study, which pulled for review a few hundred articles on the relationships between diabetes, hyperglycemia, and hypoglycemia, suggests a number of possible reasons for the slight rise in Alzheimer’s disease cases, and says that the potential link between Alzheimer’s and diabetes is from the abnormal processing of insulin that comes as a part of diabetes, regardless of sugar intake.

Furthermore, studies have shown time and time again that for losing weight, the only number that counts is total calories. But Hyman does not sell his books, supplements, kits, and DVDs by telling you to count calories. He sells books by telling you that sugar is killing you in ways that the data says it isn’t, medical ethics be damned.

So why then do we keep hearing that we have a sugar problem? According to a 2016 Pew Research analysis of USDA sales data, we’re consuming more of almost everything than we were in the 1970s, to the tune of about 450 calories more per day. However, our sugar consumption peaked around 2000 and has dropped since then, and it’s only marginally higher than it was 50 years ago. Our fat and oil consumption increased by about 200 calories per day and, over time, those calories add up.

But hey, there’s not a lot of money to be made in writing a diet book that says “maybe just eat fewer calories.”

Myth 4: Sugar can make kids hyper and give them ADHD-like symptoms

It’s easy to blame sugar for your child’s hellish behavior. Unfortunately, science says that sugar is not making your child crazy. It’s probably just you.

Kidding! But in a 1994 Journal of Abnormal Child Psychology study, parents were told that their children were given a placebo or actual sugar asked to report on their children’s behavior. The parents who were told that their children were given sugar reported that their allegedly sugar-sensitive children were bouncing off the walls. However, all of the children in the study were actually given a placebo. Sugar sensitivity, in terms of it causing a slew of psychiatric ailments, is not a thing, and there certainly does not seem to be a causal link with ADHD. If that was the case, doctors would have long called for a ketogenic diet for the treatment of severe ADHD symptoms as they do for some other medical conditions, but this isn’t the case.

Furthermore, the amount of overall sugar in a child’s diet hasn’t been found to have an effect on ADHD, according to a double blind placebo controlled study published in the New England Journal of Medicine. Overall, there was no change to behavior or cognitive skills dependent on sugar dose:

The absence of effects in our study could have resulted from the use of insensitive measures or an inadequate statistical power to detect small differences, but neither explanation seems likely. The measures we used have proved to be sensitive to hyperactivity, attention deficits, and the effects of medications and foods in earlier research.

If your kid’s acting hyper after you gave them sugar, maybe your kid’s just an asshole.

Myth 5: Some types of sugars are healthier than others

In a Refinery 29 video from last year, a producer named Lucie Fink documented her experience of giving up sugar for five days. Oh, the suffering people will go through for journalism! The video, which has garnered more than 800,000 views, begins with Fink explaining that the documentary Fed Up taught her that “sugar is the new cigarettes.” So she went cold turkey on her sweet tooth and “cut out” “sugar” entirely (the reason why I used scare quotes here will become clear in a second).

It’s important to note here: Fink is not presenting herself as an expert, but as someone who’s trying to learn. But that doesn’t excuse the fact that she’s wrong — a lot.

Fink arbitrarily decided that fruit sugars were okay to eat but added sugars were off-limits. It’s a commonly held misconception that sugars from fruit are “better for you” than sugars from, say, jelly beans, but that’s only because an apple has much less sugar than jelly beans (to wit: an apple has, on average, 19 grams of sugar, while 100 grams of jelly beans has 70. Also, the apple also comes with fiber, vitamins, and minerals, while jelly beans do not). The simple sugars in each are metabolized in the exact same way. Your pancreas really doesn’t care where you get those sugars from, just if you’re getting them or not (there are some rare cases in which the type of sugar makes a difference, but for most of the population, sugar is sugar. I implore you to ask a diabetic: fruit sugars do indeed raise blood sugar.

Fink even says that fructose is the sugar in whole foods like fruits, vegetables, and honey, so it’s the “healthy” sugar, and that sucrose is “the devil of sugars, white sugar, candy bars, chemicals added.” Lucie, please! Sucrose is present in fruit, and it breaks down into glucose and fructose. And everything you eat breaks down into glucose at some point.

It’s a commonly held misconception that sugars from fruit are “better for you” than sugars from, say, jelly beans, but that’s only because an apple has much less sugar than jelly beans.

Fink also says she’s cutting out high-glycemic fruits and vegetables in an effort to reduce her blood sugar. She does this based on the glycemic index, a scale that measures not just carbohydrates and calories, but the rate at which they impact your blood sugar. The glycemic index, while trendy and useful for some health issues like diabetes, is a debated concept in terms of its usefulness for people with healthy, functioning pancreases. As pointed out in an article from Brigham and Women’s Hospital website:

Researchers calculate and compare the GI value of foods based on identical portions delivering 50 grams of carbohydrate. Glycemic load, a rating based on GI and amount of carbohydrate eaten, is a better indicator. It reflects both the type and amount of dietary carbohydrate and is more practical for everyday use. A few examples illustrate the point. Carrots are often mistakenly maligned because of their higher GI but under appreciated for their lower glycemic load. One would have to eat about 1 1/2 pounds (or 10 medium) carrots at one sitting to get an undesirable effect on blood sugar.

The question Fink keeps coming back to is: Are some sugars healthier than others? Nobody can agree on which sugars are actually killing us. What about high-fructose corn syrup? Isn’t that really bad stuff that is causing our livers to fail? Is “Mexican Coke” — made with cane sugar — a healthier option than regular Coke, which is made with the high-fructose junk?

The truth about HFCS is that study after study after study has shown that it affects your body no differently than sugar, honey, or most other sweeteners. So why does it get a bad rap? It’s used in high volumes in many of calorically dense foods, so we associate it with the effects of our decisions to overindulge. If we’d tapped into a vast reserve of honey to sweeten our candy bars, we’d be yelling about the demon bee vomit calories instead of HFCS. You can easily eat an excess of calories from anything that seems healthy (avocadoes, hellooooo), and candy sweetened with honey or maple syrup is still candy.

As for some of the other random sugars in the food supply, let’s go through them lightning-round style:

Sugar Alcohol: This class of sugar substitutes includes erythritol and xylitol and tastes a whole lot like sugar. The problem with sugar alcohols is that, in many cases, they’re consumed in a large enough quantity to produce a well-documented laxative effect. This is mainly because your body does not fully digest it, and when that happens, your decision to eat an entire bag of sugar free regret comes back to bite you in the ass. Literally.

Coconut sugar: Have you seen those large brown granular crystals in the sugar aisle? They cost way more than regular sugar, but the only thing different about them are their labels, which proudly declare that they are things like natural, organic, and non-GMO. Bullshit artists like to use coconut sugar in their products, claiming that it’s “low glycemic,” but spoonful for spoonful? Both in terms of GI and calories, it’s about the same goddamn stuff as the white crystals — you’re just paying a lot more for it.

Non-GMO sugar: Sugar can be derived from one genetically modified source, the sugar beet. However, by the time the sugar reaches the bag, there’s no DNA in it. You cannot tell any chemical difference whatsoever between a bag of sugar derived from conventional sugar beets, genetically modified sugar beets, and sugarcane.

Unrefined Sugar: Let’s be clear — “refined” isn’t a very well-regulated term, and even unrefined sugar is clearly refined and altered from cane to crystal. Still with me? Sugars labeled “unrefined” are just not refined all the way, giving a product an illusion of being all-natural. Is unrefined sugar any healthier? There’s no evidence to suggest that, but if you like the taste (it has a hint of molasses), it has the same number of calories per teaspoon as “refined” sugar.

Myth 6: Sugar causes diabetes

There are several types of diabetes, each with different root causes. But the bottom-line cause for all of them is generally that a person doesn’t produce enough insulin to manage their blood sugar. Type 1 diabetes, also known as juvenile diabetes, is an autoimmune disease in which your pancreas is attacked by your immune system. In type 2, or adult-onset, diabetes, your body stops producing enough insulin to regulate blood sugar (this develops in stages, which are known as pre-diabetes and insulin resistance). A combination of factors contribute to developing type 2 diabetes, and according to the Mayo Clinic a primary contributing factor is one’s weight. Clearly, all overweight people do not develop diabetes. There are many compounding factors that influence the development of the disease, including genetics and lifestyle.

But is diabetes caused by sugar? No, and let’s look at two reasons why this isn’t true. First, we already know the causes, we don’t have to look for another culprit. But if weight is a factor, is it any more of a cause if that weight was gained via sugar? This doesn’t seem to be the case. The American Diabetic Association takes a nuanced stance on this, saying that “a diet high in calories from any source contributes to weight gain,” and the closest they come to outright condemning sugar is recommending avoiding sugar-sweetened beverages as a way of reducing your overall calories. Remember that everything you eat can be broken down into some form of sugar, so even if you eat a sugar-free diet, there will be glucose in your system because of how your body naturally processes macronutrients.

Myth 7: Sugar causes cancer

Yes, like many other cells in your body, tumors live off of glucose. But this does not mean that cutting out processed sugar or only eating natural sugar or doing lines of Splenda will prevent cancer or starve a tumor of fuel because, as has been mentioned, your body is a magical machine for turning all food into glucose (and poop).

So why do many health organizations recommend cutting down on your sugar intake to keep at bay the scary c-word? Because duuuuuh. Let’s let Cancer Research UK tackle this one:

Cutting out sugar doesn’t help treat cancer, and sugar doesn’t directly cause cancer. Why then do we encourage people to cut down on sugary foods in our diet advice? That’s because there is an indirect link between cancer risk and sugar. Eating lots of sugar over time can cause you to gain weight, and robust scientific evidence shows that being overweight or obese increases the risk of 13 different types of cancer. In fact, obesity is the single biggest preventable cause of cancer after smoking, which we’ve written about many times before.
So… Can I have my cake?

Yeah, you can eat it too. If you’re concerned about your dietary intake or any possible medical issues with food, talk to two people: your doctor and a registered dietitian. Get allergy testing done if there are any foods that are giving you an upset stomach. Try to manage your diet by mostly consuming fruits, vegetables, produce, and whole grains as appropriate for your energy needs and any medical conditions.

And when you want something sweet, you can work it into your caloric allowance without fear that it’s going to make you grow a third nipple because you’re an adult who’s capable of counting things like calories.

Seriously, though: Have a fucking piece of candy. You deserve it.

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Yvette d’Entremont is a contributing writer at The Outline.