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One of my jobs being a primary care doctor is to inform the patient about abnormal test results (it is not easy). Conditions can vary from a simple bronchitis to cancer. If explained appropriately patients accept those very nicely in general…until it comes to sugar levels. I almost always face a reaction of disbelief. That is because the majority of us think that only after the diagnosis of diabetes one should avoid sugar and this misconception is the topic of this writing.

Sugar consumption leads to certain biochemical changes in the body for everyone. Let’s examine these changes in the following paragraphs.

Sugar Addiction Studies

Studies have shown that sugar is addicting. There are behavioral and neurochemical effects of intermittent excessive intake of sugar. (N Avena 2008, Neuroscience review). Sugar is sweeter than cocaine. ‘Intense sweetness surpasses cocaine, study published in PLOS one 2007, Lenori, M.Intermittent excessive sugar intake cause endogenous opioid dependence.

Sugar Addiction Questionnaire

• Do you have allergies?
• Can you go more than four hours without eating?
• Do you have colds or bacterial infections more than once a year?
• Do you have difficulty concentrating?
• Do you have difficulty falling asleep or staying asleep?
• Do you have frequent headaches?
• Are you hyperactive or listless?
• Are you overweight?
• Do you have lot of dental filling?

Sugar Intake

The average American eats over 10 pounds of sugar each month. Four and half cup every week, 30-33 spoons every day. The US government first started keeping first records on sugar consumption in 1966, in which the average American ate 116 pounds a year. The highest recorded consumption was in 1999 at 151 pounds on average per person. Currently average person eats 141 pounds per year, that is 24 teaspoons per day. (Avena, N , Evidence for addiction’, Neurosci BIobehav , 2008)

Sugar Stats

Refined sugar is 99.4 – 99.7% pure calories. No vitamins, minerals or proteins — just carbohydrates. Therefore 20 percent of daily caloric intake of average American is spent on refined food that has no nutritional value and that upsets the basic biochemistry.

Different Forms of Sugar

• Agave syrup and nectar
• Barely malt
• Beet sugar
• Brown sugar
• Cane sugar
• Cane syrup
• Confections sugar
• Crystalline fructose
• Date sugar
• Evaporated sugar cane
• Fructose
• Fruit juice concentrate
• Galactose
• Glucose
• Granulated sugar
• High fructose corn syrup
• Honey
• Invert sugar
• Lactose
• Liquid cane sugar or syrup
• Maltose
• Maple syrup
• Molasses
• Powdered sugar
• Raw sugar
• Rice syrup
• Turbinado sugar
• Unrefined sugar
• White sugar

Conditions Associated With Sugar Intake

• A weakened defense against bacterial infection. (Sanchez, A ‘ role of sugars in human neutrophilic phagocytosis’. Amer jour of clinical nutrition, 1973)
• Sugar can upset the mineral balance of the body, it depletes minerals. Most enzymes are mineral dependent, therefore increased sugar intake alters the biochemical balance of the body. For example sugar reduces zinc function which is needed by enzyme chymotrypsin for carbohydrate metabolism and to decrease inflammation. The body needs chromium, copper, cobalt, manganese, zinc and magnesium to digest sugar, sugar refining strips these minerals, consequently making the body deplete its own minerals to process sugar. Sugar causes increased urinary excretion of chromium. Many diabetics are deficient in chromium, which is needed for insulin sensitivity.
• Sugar decreases rate of absorption and increases rate of elimination of calcium and magnesium.
• Sugar is associated with osteoporosis, it leaches calcium out of bones. (Kanis, J, ‘osteoporosis : diagnosis and management’ Lancet 1998)
• Sugar cause elevated triglycerides. Sugar reduces HDL, it elevates LDL. (Pamplona R, ‘mechanism of glycation and atherogenesis’ med hypothesis 1993.
• Sugar feeds cancer cells. (Quillin P, Beating cancer with nutrition. Nutrition time press. 2001.)
• Sugar elevates the concentration of bile in the stools and elevation of bacterial enzymes in the colon which can modify bile to produce cancer causing compounds and colon cancer. It can be a risk factor for lung cancer, (De Stefani E, dietary sugar and lung cancer, a case control study in Uruguay, Nutri cancer 1998). It also increases risk for prostate cancer.
• Sugar increases risk of GI tract cancer such as gallbladder, stomach, intestine and pancreatic cancer.
• Other cancers like breast and laryngeal are also associated with high sugar intake. (Potischman, N , the early stage of breast cancer related to consumption of sweat foods among women less than 45 years of age in United States, Cancer , causes and control 2002.)
• Sugar can cause skin wrinkles by changing the structure of collagen. Sugar causes weight gain. It can increase the risk of allergies and can cause asthma exacerbation.
• Sugar can increase the risk of crohns, ulcerative colitis and irritable bowel syndrome. It has association with rheumatoid arthritis. It can cause increase chances of yeast infection.
• Sugar can cause increase in ischemic heart disease, acute MI, metabolic syndrome, varicose veins, gastric and duodenal ulcer, acne, inflammation, multiple sclerosis, increases systolic blood pressure, lower growth hormones level.
• Sugar can change the structure of protein, impair protein absorption, impair the structure of DNA, increases the risk of macular degeneration, cataracts, fatty liver, fluid retention, constipation, its reduces the function of tendons and decreases its ability to repair, headaches, migraines, alter cognition, Alzheimer’s, exacerbate emphysema, Parkinson’s disease, increases estradiol in males, worsens symptoms of ADD in kids, decreases adrenal function, increases incidence of depression, fatigue, moodiness, nervousness, lower emotional stability, makes blood thick by increasing adhesiveness and increases in insulin resistance.

Insulin Resistance

Diseases associated with insulin resistance:

Autoimmune disorders, arthritis, MS, candidiasis, celiac disease, compulsive overeating, depression, diabetes, GERD, IBS, inflammatory bowel disease, gallstones, gestational diabetes, CAD, HTN, hyperlipidemia, infertility, obesity, panic anxiety attacks, reactive hypoglycemia, PCOS, thrombosis and some forms of cancer such as colon, liver, pancreatic, breast and endometrial cancer.

Testing Methods

• FBS
• HbA1C
• Fasting insulin
• Postprandial insulin.

Sugar Substitutes

ASPARTAME: phenylalanine and aspartic acid, can breakdown into methanol which can spontaneously break into formaldehyde. When phenylalanine is stored in warm temperatures, it can turn into Diketopiperazine, which is carcinogenic. Aspartame is 200 times sweeter than sugar.

Side effects of aspartame: dizziness, disorientation, disequilibrium, visual impairment, tunnel vision, severe muscle aches and numbness, inflammation of pancreas, HTN, eye hemorrhage, memory loss, seizures, fibromyalgia.

SUCRALOSE: It is a modified sugar molecule, its three components removed and replaced with chloride. It does not raise blood sugar, it can cause hypothyroidism. It is 2000 times sweeter than sugar. Sucralose is commonly mixed with dextrose or maltodextrin which makes it appear and taste like table sugar.

ASULFAME POTASSIUM: also known as asulfame K and Ace K. it is made from acetoacetic acid and potassium. Commonly used in combination with aspartame and sucralose to help decrease the bitter after taste. More research is being done.

NEOTAME: chemically similar to aspartame but it is not a source of phenylalanine. It is metabolized quickly and leaves the body quickly. More research is being done.

SACHARRIN: has been used for over 100 years, studies are mixed on whether it is a carcinogen.

STEVIA: Naturally occurring sugar substance, extracted from a leaf. No known side effects. Does not raise sugar or insulin level, but it is 300 times sweeter than sugar so sugar craving never goes away.

SUGAR ALCOHOLS: are naturally occurring sweet compounds found in fruits and vegetables. However due to cost, it is now created by adding hydrogen to simple sugars like glucose, maltose and fructose. They are sorbitol, xylitol, malitol, erythritol and mannitol. Sugar alcohols have about half the calories of table sugar. Caloric value of 2.4 cal per gram. Xylitol is 7 on the glycemic index, has a minimal effects on blood sugar and insulin level. Side effects includes, due to fermentation in the intestine, can cause diarrhea, IBS, bloating and flatulence.

Sugar and Related Compounds

SUCROSE: Sucrose (table sugar) is made from sugar beets and sugar cane. Sucrose is made from glucose and fructose, 50% each. Chemically bound together which slows the absorption in the body. Glucose is metabolized throughout the body but fructose metabolized only in liver.

HONEY: Contains small amount of vitamins and minerals. Glycemic index is about 73. 40% fructose. 20-60% sweeter than sugar.

HIGH FRUCTOSE CORN SYRUP: It can contain 80% fructose and 20% glucose. 4 cals per gram, same as table sugar. Out of 120 calories of fructose 40 are stores as fat. Fructose is directly absorbed into the cells without a carrier. This leads to fatty liver and increase triglyceride level. Fructose does not increase leptin to aid in appetite suppression, this may cause weight gain. Between 1970 -1990 the consumption of HFCS increased by 1000%. It is 40% of the caloric sweetener added to the food and beverages. Traditionally humans have consumed 15 grams of fructose a day from fruits and vegetables (about ½ ounce). In 1997 consumption was increased to 81 gram per day, about 3 ounces. This is the main cause of metabolic syndrome, obesity, insulin resistance and type II Diabetes.

Studies suggest high fructose diets leads to insulin resistance and decrease insulin sensitivity. HFCS can raise triglycerides and can cause heart disease. It elevates apoB100, main lipoprotein which carry cholesterol, causing fat deposition, it reduces HDL, lipoproteins are deposited in the vessel walls, can cause HTN, it inhibit endothelial nitrous oxide which can lead to vasoconstriction, it can produce gout, nonalcoholic fatty liver. Major increase in fatty liver with consumption of HFCS.

MAPLE SYRUP: It contains 33% water and 60% sucrose, rest is small amounts of fructose, glucose and minerals. From sugar maple, red maple, and black maple.

MALTODEXTRIN: Is a polysaccharides that has glycemic index of 130, less sweet than sugar, has fewer calories and used a lot in sports drinks, usually made from corn, increases sugar and insulin level than sucrose.

CRYSTALLINE FRUCTOSE: It’s derived from corn, it is almost all fructose. The down side of HFCS is amplified in this substance.

SUGARS: Glucose suppresses ghrelin the hunger hormone and stimulate leptin to suppress the appetite. Fructose has no effects of ghrelin and interfere with leptin, causing the person to overeat. Therefore, the higher the fructose level the greater the issue. All kinds of sugar promote sugar addiction.

HIDDEN SUGARS: Sugar is found in alcoholic beverages, ketchup ( almost ½ of the calories come from sugars), luncheon meats, breading on many products, salad dressings, hamburgers and most ‘low-fat’ items have fat taken out and sugar added.

Hidden Causes of Insulin Resistance

TOBACCO: Faccini, F ‘smoking and insulin resistance’ Lancets 1992. Nicotine replacement is also associated with IR. It interfere with insulin function, leads to more production of insulin.

CAFFEINE: Increase insulin production, increase stress hormones. (almost to the degree of DM II, Cherniske S, ‘Caffeine blues’ warner book, NY 1998).

SOFT DRINKS: Average American in 2005 drank almost 36 gallons of soft drinks with sugar. Ibid., Appleton 2001.

The average American drinks 171 cans of diet soda per year. (Economic research service, www.ers.usda.gov)

There are more than 3000 sugary drinks made in the United States. Sugary drinks may also contains phosphoric acid, caffeine, carbon dioxide, caramel coloring, citric acid, sodium citrate, ascorbic acid, sodium benzoate etc.

Other sugar drinks besides soda are fruit juice, sports drinks, energy drinks, enhanced water (vitamin water has 33 gm of sugar per bottle), Cocktail mixers, meal supplements (ensure has 41 gm of sugar which is more than coke of same size).

The Effects of Sugary Drinks

Weight gain, long term liver damage, mood swings, inflammation, insulin resistance, diabetes, high blood pressure, cardiovascular disease.

The upper limit of daily added sugar, as per American heart association, is no more than 100 calories for women and 150 calories for men, this is 6 teaspoons for women and 9 teaspoons for men. This would be 70% reduction in current consumption level.

People who drinks one diet soda per day increases their chance of heart attack or stroke by 61% over individuals that did not drink soft drinks. Data from Nurses health study showed that consumption of at least two sugary beverages a day increases 35% risk of CAD over 24 years.

Low HDL, tooth decay, osteoporosis, gout, metabolic syndrome, GI symptoms, cancers such as pancreatic, colon, breast, obesity, hypokalemia, cognitive decline, renal stones, decreases sperm count, depression, mood changes, fatty liver, seizures , asthma and Diabetes are some illnesses associated with soft drinks consumption.

Type II Diabetes, both sugar and caffeine in soft drinks may increase the risk of DM II. Nurses health study suggest 83% increase risk of developing diabetes with one sugary drink a day. Caffeine, sugar, and artificial sweeteners in soft drinks can lead to addiction. It creates both psychological and physiological dependence.

Sugar increases dopamine, serotonin and norepinephrine release. Beta endorphins increases in brains. 

How to Treat Sugar Addiction

• Start with reducing the intake into half.
• Treatment of yeast infections of the gut.
• Healthy diet for GI tract and gut detoxification.
• Balance amino acid
• Balance neurotransmitters. Serotonin, acetylcholine , dopamine
• Healthy exercise program
• Balance hormones, insulin, thyroid, adrenals, leptin.
• Nutrients that may help sugar cravings:

Glutamine 1 gm three times a day, B complex 100 mg daily, Resveratrol 100 mg , Coenzyme Q 10, EPA/ DHEA, Chromium 1200-1600 IU, alpha lipoic acid 300 mg, zinc , magnesium and carnitine.