Let's Debunk What We Know About Sugar

In an earlier blog post, I reviewed simple carbohydrates and why sugar is ideal for our health. There are several reasons why it is easy to forget that carbohydrates are the preferred source of fuel for our body: a lot of research claims that excess carbohydrate intake, mainly sugar, causes adverse health outcomes and that this one nutrient will magically cause weight gain, that simple carbohydrates/sugar have been demonized as bad as if they are morally wrong to consume, there’s the concept of sugar being addictive because it triggers similar neural pathways to that of drugs and alcohol, and that added sugars are worse for our health than naturally occurring sugars. These are just a few of the claims made about this macronutrient. 

So what’s the truth behind all this gossip and claims? In this blog, I’ll help tease through some of the facts, opinions, and associations (not necessarily causations) about sugar.

Does sugar cause weight gain?

Just sugar itself, no. If someone consumes various foods without compensatory or restrictive behaviors, the body gradually will be the best guide for what and how much to eat. Weight gain occurs with a positive energy balance overall, not from a specific kind of food, and everyone’s nutritional needs vary. Weight gain is also sometimes necessary, and part of the natural process, for recovering from an eating disorder or disordered eating (and yes, sometimes weight loss happens, but the idea of recovery is taking the focus off of weight being a behavior change). 

Is sugar addictive?

Addiction and substance use disorder (SUD) are in the Diagnostic Statistical Manual, 5th edition (DSM-5), and sugar is not a part of these diagnoses. Food cravings and feeling out of control around food are in the eating disorder section of the DSM-5, such as with the new diagnosis of Binge Eating Disorder (BED). The term food addiction was in the DSM-4, and discrepancies existed between food and drugs/alcohol causing the same addictive effect, so now found in the eating disorder section of the DSM-5. 

Some discussion points for and against food addiction being a diagnosis include: 

• Studies do not consistently define sugar as holding an addictive property.
• Studies closely link sugar to triggering the same neurological pathways as alcohol or drugs but are done on rats.
• Cravings can apply to both food and substances/alcohol.
• Research does not support that food creates intoxication or physically hazardous situations.
• Interpersonal problems can exist with BED and substance use, but studies are needed to show if addictive-like eating causes this in BED.
• BED is presumed to have a couple of subtype behaviors: the first being it "exhibits greater negative affect, impulsivity, and overall pathology" associated with the addictive process, and the second being practicing dietary restraint, not associated with addiction.

There is truth to the concept that sugar triggers similar neurological pathways in our brains as highly addictive drugs. Sugar, however, does not create a life-threatening situation or withdrawal symptoms like those in the DSM-5 criteria. Avoiding specific foods could create a worse effect on mental and physical health compared to an all-foods-fit balance, such as the forbidden foods phenomenon that could lead to binge eating or orthorexic tendencies. (I have witnessed this firsthand as an intuitive eating counselor and eating disorder specialist.) Also, sugar is not the only other item that triggers these neurological pathways. Other common phenomena are hugs, listening to music, pets, sex, shopping, exercise, meditation, yoga, being in nature, massages, and more. So should we remove these experiences too? (Imagine if you were not allowed to play with puppies, kittens, or your favorite pet anymore. I know I would be devastated!)

So to answer the question, is sugar addictive?, I will explain it in the context of treatment for an eating disorder/disordered eating. Therapy for BED and other eating disorders encourages practicing including all the foods, with a slow integration, and developing tools to manage triggers versus turning to or away from food to cope with emotions. Another skill to enhance is proper nutrition throughout the day and eliminating restrictions even if emotional eating and binging occurs. Giving our mind the understanding that food is available instead of forbidden prevents the all-or-nothing thinking and helps heal this desire to eat all the food all at once. This practice differs from the abstinence method from alcohol or substances in recovery. 

Can you eat sugar and still be healthy?

Yes. As I explained in an earlier blog post, avoiding carbohydrates, or simple carbohydrates (aka sugar), could increase the risk for adverse health consequences. Yet there is the caveat of how much sugar is ideal and is an overabundance harmful. Several studies state that a greater intake of sugar, especially added sugar, is associated (note association means different than causation) with the elevated risk for heart disease, and a diabetes diagnosis also puts someone at risk for cardiovascular conditions. Some studies do not show this or present this association in place of something else that might be the cause of why health has diminished. One recent study on the Sweden population and added sugar intake showed that participants with the lowest and highest consumption had the highest rate of cardiovascular events. With this study and the mixed evidence that sugar is associated with poor health, could it be possible that other issues are present and sugar is not the true culprit? For example, eating disorders/disordered eating, both restrictive and binging-types, put someone at risk for heart conditions and poor respiratory health. Weight stigma has been connected to poor health, also in the context of an increased intake of sugary foods. Chronic dieting has also shown associations in recent studies. The current research supports recovering from disordered eating/eating disorders, chronic dieting, or weight stigma again includes eating all foods in a balance and increasing nutrition knowledge to ensure sugar is not taking the place of other micro and macronutrients, but meets some part of a daily nutrition intake to provide positive benefits.

Can diabetics eat sugar?

The short answer is absolutely. A diabetic avoiding carbohydrates will likely experience poor effects, similar to high blood sugar. Someone with diabetes will also likely not feel well consuming pure sugar, liquid sugar like soda or juice, fruit, or a handful of candy alone. Individuals can consume high-sugar foods by pairing them appropriately with other food groups. Nutrition education for diabetes should involve pairing carbohydrates with protein, fiber, and fats to slow the digestion and release of blood sugar. It also should include eating every 3-5 hours to eliminate the possibility of hypoglycemia (low blood sugar) and eating consistent carbohydrates throughout the day compared to all at one meal. A couple of good take-home points: a nutritionally balanced intake with a carb counting plan (or basic understanding of the amount of carbohydrates in food) should be individualized. 

A blurb on high fructose corn syrup: what it is and its efficacy.

High fructose corn syrup (HFCS) is a chemically modified form of sucrose. Sucrose is a 50/50 ratio of glucose to fructose, whereas HFCS contains varying ratios, such as HFCS 42% and 55% fructose:glucose. HFCS starts from corn vs sugar cane as it’s more available and cheaper within our nation’s food system. Just like the body can convert fructose to glucose, and vise versa, food scientists found a process to do the same. Why? Because fructose is slightly sweeter than glucose, and to mimic sucrose, aka table (cane) sugar, some of corn’s glucose was converted to fructose, and HFCS was born.

A couple of differences between HFCS and sucrose include:

• Some or all of the fructose is chemically derived, converted from glucose
• Is derived from corn vs sugar cane
• The glucose and fructose are not joined by a glycosidic bond like in sucrose
• Water molecules are present in HFCS

Is HFCS safe to consume?

No studies to date identify HFCS as unsafe to consume compared to sucrose or other disaccharides. Studies have shown associations between a diet high in fructose and fatty liver disease or cardiovascular conditions– yet this is high being fructose, not HFCS. In reviewing a study completed in 2013 comparing sucrose versus HFCS consumption and intrahepatic fat accumulation (a risk factor for cardiovascular events or fatty liver disease) showed no differences between the sucrose and HFCS-consuming participants. This study was small and only ten weeks in duration; however, in the discussion, it explained some flaws of several studies up to that time that have reviewed HFCS and its relationship to fatty liver disease, cardiovascular events, and intrahepatic fat accumulation. First, studies used rats as test subjects, where humans and rats are not 100% biologically equivalent. Second, test subjects were given pure fructose in much higher doses than HFCS (greater than 55%) and without its glucose constituent. No studies compared changes that occur with sucrose-sweetened products versus HFCS containing as this 2013 study did.

 A common flaw in nutrition, obesity, and cardiovascular disease research is that social determinants of health, such as oppression, racism, wealth, stress, and recent life events, are poorly screened for. 

To sum it up: yes, the HFCS molecule differs in its ratio of glucose-fructose, is not a natural disaccharide found in food (but neither are sugar alcohols or folic acid, and these are safe to consume with upper limits in place), and the body may have to adjust to metabolize it. Yet our body knows what to do with this molecule. The body will convert it to glucose in the liver or store it as glycogen or fat for long-term, later use. Finally, the research on HFCS causing cardiovascular events and fatty liver disease is flawed, so it’s inaccurate to say that HFCS is harmful when consumed as a balance in the human diet.

In this post, I touched on some common arguments for why sugar gets identified as harmful and recommended to avoid. Considering the research, simple carbohydrates require more analysis to determine if they are specifically addictive, like drugs, medication, alcohol, or gambling. The treatment for eating disorders, disorder eating, chronic dieting, and weight stigma involve an all foods fit philosophy versus avoiding trigger foods. Carbohydrates should be consumed in balance with other food groups, and understanding why nutritional intake incorporates too little or the highest amount of simple carbohydrates needs to include the conversation of other variables as to why health conditions are present and why sugar gets consumed in the amount it is. The ingredient HFCS gets added for sweetness and palatability in foods, and no studies on humans specifically identify these ingredients as harmful and causing cardiovascular events. Nutrition research continuously shifts. Everyone has a different response to food. That's why it's essential to increase nutrition knowledge of the macronutrients and why each is good for our health in a balance, with an individualized twist, will build food autonomy and an easy, sustainable nutrition plan to follow.

Resources:

https://www.fda.gov/food/food-additives-petitions/high-fructose-corn-syrup-questions-and-answers 

https://www.courier-journal.com/story/life/wellness/health/2022/07/14/what-to-know-about-high-fructose-corn-syrup/7680954001/ https://cdnsciencepub.com/doi/full/10.1139/apnm-2012-0322 

https://my.clevelandclinic.org/health/articles/22588-dopamine-deficiency#:~:text=Engage%20in%20activities%20that%20make,nature%20or%20reading%20a%20book 

https://christyharrison.com/foodpsych/9/sugar-and-your-health -also reviewed in Christy Harrison’s weekly newsletter, visit her website to subscribe 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7786303/utm_source=convertkit&utm_medium=email&utm_campaign=Sugar+and+Your+Health%20-%206290604

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866877/utm_source=convertkit&utm_medium=email&utm_campaign=Sugar+and+Your+Health%20-%206290604

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5253095/utm_source=convertkit&utm_medium=email&utm_campaign=Sugar+and+Your+Health%20-%206290604

https://pubmed.ncbi.nlm.nih.gov/15847242/https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4179181/