Clinical Question

Morgan GarlockMay 16, 2014

Sugar is toxic, I haven’t eaten it for 20 years. Why do dietitians let people eat

sugar?

What the Media Says

FED UP

Types of SugarAdded: sugars and syrups that are added to

foods or beverages when they are processed or prepared.

Naturally Occurring: sugars such as those in milk and fruits.Fructose, lactose

Added SugarsAnhydrous dextrose, brown sugar,

confectioner's powdered sugar, corn syrup, corn syrup solids, dextrose, fructose, high-fructose corn syrup (HFCS), honey, invert sugar, lactose, malt syrup, maltose, maple syrup, molasses. nectars (e.g., peach nectar, pear nectar), pancake syrup, raw sugar, sucrose, sugar, white granulated sugar

What is high fructose corn syrup?

Manufactured from corn syrup (glucose) processed to yield equal glucose and fructoseLead to liver toxicity some claim

Sucrose: equal parts glucose and fructose Naturally occurring

Do I Need To Eat Sugar?Brain uses about 120

grams of glucose/day Energy Production

Glucose converted to Adenosine triphosphate ATP

GuidelinesUSDASugar is included on the Generally Regarded

as Safe (GRAS) list Vitamin A, D, etc are also on this list

AHARecommends limiting added sugars to half

of daily discretionary calorie amount

Is Naturally Occurring Sugar Toxic?

Foods with naturally occurring sugar provide:Vitamins and MineralsAntioxidantsFiber

Consume fruit “to help reduce risk of chronic diseases, as part of an overall healthy diet. A diet rich in potassium may help to maintain healthy blood pressure.” choosemyplate.gov

Benefits of sugarSugar used for wound healing

Mesopotamians washed wounds with water or milk and then dressed them with honey or resin

Latin America, Europe, and Asia still use some of these techniques

Research FindingsCancerDiabetes

7% of US adult population has Type II Diabetes

Weight30% more people are

obese than malnourished

Sugar Containing SodaRisk of lymphoma and leukemia in men and women?Nurses’ Health Study and Health Professionals

Follow-Up Study22 years: 1324 non-Hodgkin lymphomas, 285

multiple myelomas, 339 leukemiasContradictory results based on if separated or

combined men and womenConcluded that there could be a detrimental effect,

but that chance is the likely explanation

Sugar and Cancer435,674 aged 50–71 years from the NIH-

AARP Diet and Health Study were followed for 7.2 years

29,099 cancer cases in men13,355 cancer cases in women124 item FFQSugar in diet and risk of cancer

Sugar and Cancer continued

In gender-combined analyses, added sugars were positively associated with risk of esophageal adenocarcinoma (95% CI, HRQ5 vs. Q1: 1.62, 95% CI: 1.07–2.45; P = 0.01)

Added fructose was associated with risk of small intestine cancer (HRQ5 vs. Q1: 2.20, 95% CI: 1.16–4.16; P = 0.009)

All investigated sugars were associated with increased risk of pleural cancer

No association between dietary sugars and risk of colorectal or other major cancer

DiabetesRepeated cross-sectional data on diabetes

and nutritional components of food from 175 countries

150 kcal/person/day increase in sugar availability (about one can of soda/day) was associated with increased diabetes prevalence by 1.1% (p <0.001)

Tested for biases and controlled for factors

Meta-analysis11 studies with 310,819 participants and

15,043 cases of type 2 DMSugar sweetened beverages1-2 servings/day of SSB had 26% greater

risk of developing type 2 DM (RR 1.26 [95% CI 1.12-1.41]) compared to those in the lowest quantile (<1 serving/month)

The Toxic Truth About Sugar

Sugar consumption is linked to a rise in chronic diseases such as heart disease, cancer, and diabetes.

Sugar’s effects on the body can be similar to those of alcohol

Toxic?Leads to hypertension: Fructose increases

uric acid, which raises blood pressureHigh triglycerides and insulin resistance

through synthesis of fat in the liverDiabetes from increased liver glucose

production and insulin resistanceThe aging process—damage to lipids,

proteins, and DNA by non-enzymatic binding of fructose to these molecules

Other Effects of Sugar Dampens suppression of ghrelin

Ghrelin signals hunger

Interferes with the normal transport and signaling of leptin

Leptin: satiety hormone

Reduces dopamineDopamine: reward hormone

Recommendations Focus on following food group guidelinesAvoid excess of low nutrient-dense foodsEncourage clients to enjoy foods

ReferencesBasu S, Yoffe P, Lustig RH. The relationship of sugar to population-level diabetes prevalence: an econometric analysis of repeated cross-sectional data. Public Library of Science. 2013;8(2):e57873.Berg JM, Tymoczko JL, Stryer L. Biochemistry. 5th ed. New York: Freeman; 2002. Biswas A, Bharara M, Hurst C, Gruessner R, Armstrong D, Rilo H. Use of Sugar on the Healing of Diabetic Ulcers. J Diabetes Sci Technology. 2010; 4 (5): 1139-1145. Lustig RH, Schmidt LA., Brindis CD. The toxic truth about sugar. Nature. 2012; 482(7383):27-29.Malik VS, Popkin BM, Bray GA, Despres JP, Willett WC, Hu FB. Sugar Sweetened Beverages and Risk of Metabolic Syndrome and Type 2 Diabetes. Diabetes Care. 2010:33(11):2477-2483.Tasevska N, Jiao L, Potischman N. Sugars in diet and risk of cancer in the NIH-AARP Diet and Health Study. 2012;130(1):159-169. International journal of cancer. Schernhammer ES, Bertrand KA, Feskanich D. . Consumption of artificial sweetener– and sugar-containing soda and risk of lymphoma and leukemia in men and women. The American Journal of Clinical Nutrition American Society for Nutrition. 2012: 98(6):1419-1428.