Asking questions often creates a great teaching moment. One of my favorite questions to patients who are eating the typical Western/U.S. diet is, “How healthy do you think you would be eating 15 chocolate cupcakes each day?” The answer is typically not very healthy at all.
Humans historically ate no added sugar for the vast majority of our 6-million-year existence. As humans learned to find or extract dense sugar from plants our consumption has exploded especially in the past 100 years. A whole food diet containing 40-50% carbohydrate provides about 30-35 grams of sugars. The current U.S. average is over 200 grams/day, or 6-8 times our historic norms. It is the primary mechanism driving both the obesity and diabetes epidemics which in turn drive several other problems such as vascular disease and Alzheimer’s disease.
The reality is that the major ill effect of the food we eat is not that it contains chocolate or that it is in the shape of a cupcake, rather it is the sugar content. Given that, it does not matter if the sugar is added to a cupcake, fruit in the bottom yogurt, in bread, cereal, soup or any other of the majority of foods it is added to.
The seriousness of this problem is the longer-term disease patterns that our sugar consumption is causing. It is thought to be the dominant contributor to the obesity and diabetes epidemics and to the development of cardiovascular disease. A review of all of the studies looking at the association between sugar intake and cardiovascular disease risk concluded the following: “Associations between added sugars and increased cardiovascular disease risk factors among US children are present at levels far below current consumption levels. Strong evidence supports the association of added sugars with increased cardiovascular disease risk in children through increased energy intake, increased adiposity, and dyslipidemia. Thus, there is consistent evidence that cardiovascular risk increases as added sugars consumption increases.” (1)
This data is typical of that used by a noted group of scientists to suggest that the youth of today will likely have a diminished life expectancy compared to prior generations.
Fixing the problem requires an informed consumer. A great exercise is to read every label of everything you eat for 2 weeks. First look at the grams of sugar a serving contains. Most whole food, natural carbs contain 1-5 grams of natural sugar per serving. Any amount greater than that should elicit an investigation as to where the sugar is in that food item. This is found in the ingredient list.
Watch out for the “sleight of hand trick” that is often done with serving size. Many labels now simply have changed the serving size downward to make the content of sugar look less than a functional serving size. For example, cola contained 52 grams of sugar in a 16 oz serving about 15 years ago. Now it contains 28 grams appearing to be healthier; that is until you notice that they simply redefined the serving size as 8 ozs so that the same 16 oz bottle or can actually is yielding 56 grams of sugar. Think honestly about how much your actual serving is when you consume it.
Look at what an item is made of, not how it appears on the packaging.
The following 2
labels demonstrate this idea well. They
are the ingredients from a chocolate cupcake and from a “heathy” cereal
bar. The words chocolate and cherry have
been hidden to not bias your selection.
Which is which? The first
ingredients are added sugars with the rest being the same just in different
order. These include artificial flavor,
refined white flour, propylene glycol (cousin to ethylene glycol or antifreeze)
and some artificial color. Both contain 18 grams of sugar per serving.
The answer to which is the cupcake is that from a content perspective they both are just with a different look (cherry vs chocolate and bar vs muffin shaped). A small cup of fruit in the bottom yogurt contains about 24 grams of added sugar, or “1 1/3 cupcakes worth”. A popular commercial tomato soup contains 13 grams of added sugar, or “two-thirds of a cupcake worth”.
Another sad part of our national 13-15 cupcake diet is that the added sugar is done only to increase consumption. Sugar activates a strong evolutionarily derived desire to eat more. It is thought that this was a signal when food was always in short supply to prefer those that impart high energy. However, in this time of constant food availability it drives excessive energy consumption.
Some very innovative studies by a group of French researchers has examined the strong drive to consumption that sugar imparts.(2) The study used lab rats who had access to cocaine for 3-4 days to habituate to it. Subsequently they had access to both the cocaine and to intensely sweet sugar water. After another 3-4 days most gave up the cocaine in favor of the sugar water. The researcher’s comments on the outcome of their study tells the story best; “Our findings clearly demonstrate that intense sweetness can surpass cocaine reward, even in drug-sensitized and -addicted individuals.”
There are many forces that create the environment that allows our food to be unhealthy in spite of the significant adverse health effects that result. At this point an informed consumer insures the best plan and outcome. Think about just how healthy someone could be consuming 15 cupcakes per day.
- Vos et al. Added Sugars and Cardiovascular Disease Risk in Children: A Scientific Statement From the American Heart Association. Circulation. 2016;134.
- Lenoir M, Serre F, Cantin L, Ahmed SH (2007) Intense Sweetness Surpasses Cocaine Reward. PLoS ONE, 2007;2(8): e698.