By Alan Safdi, M.D., FACG
Dr. Alan Safdi is past chairman of the Section of Gastroenterology at Deaconess Hospital and served as co-founder and president of the Ohio Gastroenterology and Liver Institute. Dr. Safdi is board certified in internal medicine and gastroenterology, and is a Fellow of the American College of Gastroenterology. He is former chairman of the Crohn’s and Colitis Medical Advisory Board in Cincinnati and still serves as president of Consultants for Clinical Research. He was also co-founder of eMerge Health Solutions, Consultants for Clinical Research, and outpatient GI and anesthesia programs.
Just as sugars are the primary ingredient in many beverages (see the The Risk of Simple Sugars: Part 1 here), they are also added to our diet via everyday foods. High-sugar diets lead to diabetes, obesity, and even hypertension (high blood pressure). Simple sugars are very quickly absorbed into the bloodstream and stimulate insulin secretion. Insulin blocks other hormones that that normally would make us feel full, so the appetite remains strong. Insulin often makes us even hungrier by depressing blood sugar below the baseline. This contrasts with fats, which slow gastric emptying and make us feel full quicker.
Back in the late 1970s, the powers that be declared war on the fats in our diet, and chose to ignore sugars. Food producers replaced fats with simple sugars. We got “low-fat” and “nonfat” foods loaded with sugar. As an example, some non-fat salad dressings contain enough sugar that we could and should consider them desserts.
First, what is hypertension and why should you care? Hypertension is another name for high blood pressure. Hypertension increases the risk of heart disease, stroke and death. You’ve doubtless been told that salt is terrible for hypertension. The truth is that simple sugars play a big role.
Dietary efforts to control high blood pressure have historically focused on limiting sodium, but the added sugar in processed foods may be a far worse actor. Fructose may uniquely increase cardiovascular risk by inciting metabolic dysfunction (abnormal chemical reactions in the body alter the normal metabolic process), increasing blood pressure variability, myocardial oxygen demand (the oxygen consumption of an organ), heart rate, and inflammation.
As active individuals, we need to focus on diets that call for plenty of vegetables, fruits, and whole grains, along with good dairy products, poultry, fish, legumes, nuts, and certain vegetable oils (like olive oil), while limiting our intake of sweets, sugar-sweetened beverages, and red meat. Compelling evidence from basic science, population studies, and clinical trials have linked sugars, and particularly monosaccharide fructose, to the development of hypertension. Sugars in general, especially fructose, may contribute to overall cardiovascular risk through a variety of mechanisms.
Simple sugars are not a natural part of the human diet. Several hundred years ago, hypertension basically did not exist. Europeans had only honey to sweeten their food. Then, in the 1700s, sugar was produced in large quantities for the first time, grown and refined in the Caribbean. Sugar consumption in Europe boomed, and so did hypertension, gout, obesity, and diabetes.
The only place in your body that can metabolize and use fructose is the liver. If you take in too much fructose, the excess is converted into fats in the liver. One out of three U.S. adults has prediabetes – that is, their blood sugar is higher than normal, but not high enough to be diagnosed with type 2 diabetes. Prediabetes puts you on the road to developing type 2 diabetes as well as heart disease and other health problems. A healthy diet and exercise can cut your diabetes risk in half. I recommend a Mediterranean diet that limits simple sugars.
New research has found that high-sugar, high-fat “Western Diets” are more damaging than a diet high in saturated fats alone. The typical skier’s lunch — cheeseburger-and-fries-with-soda is the perfect storm of high sugar with high fat content. A study published by Experimental Physiology shows that mice fed a high-sugar, high-fat Western diet, even briefly, suffer more liver damage than when they are fed a solely high-fat diet. Studies have long shown a link between fructose consumption and obesity rates. The mouse study now shows that combining sugars with fatty foods can damage the liver. While natural fructose found in fruits like berries, raw apples, and sugarcane can increase nutritional value, the artificial fructose found in most sodas, artificial juices and packaged foods are associated with health risks.
Remember, we need to differentiate between good and bad carbs and good and bad fats. Mono-saturated fats like olive oil are a very healthy option. Low-fat options are not necessarily bad. Just read food and drink labels. Make sure the labels don’t list hydrogenated fats, which are unnatural and detrimental to your health. Ingredients to avoid are hydrogenated or partially hydrogenated cottonseed, palm, soy, and corn oils, but theoretically almost any polyunsaturated oil can be hydrogenated.
Always read labels and think about what you are eating. With some practice, you will recognize the added sugars in packaged products, versus naturally occurring sugars. With yogurt, for example, don’t worry about the naturally occurring sugar in the fruit, but avoid significant amounts of added sugars (for instance, “natural” sugars may include healthy fruit and lactose sugars, but may also include pure cane sugar, one of the simple sugars to avoid). Recent claims against Dunkin’ Donuts state their blueberry donuts do not feature actual blueberries while the chain’s blueberry muffins do contain their namesake fruit. Dunkin’s blueberry donuts contain “flavor crystals” or “blueberry flavored bits” that allegedly mislead the customer and are most likely colored simple sugars. Remember that labels are there for a reason and often times the truth is buried in that small print. A lot of packaged foods might appear super healthy when in reality they are not. Take for example granola-based cereals that can have up to 15 grams of refined sugar in less than a cup. That is like eating three teaspoons of sugar. Granola bars can be even worse with up to 25 grams in a small bar, which is equal to the amount of sugar in a chocolate bar. A full cup of fresh cranberries has a just 4 grams of natural sugar, but the sweetened cranberries we often buy can have as much as a Snickers bar in a large handful.
Are there safe foods containing sugars? Yes! If you take some of the fruits mentioned in this article and make a smoothie, or eat them whole, they have significant health benefits. Whole grains contain complex sugars without the dangers of simple sugars.
So, what should you eat? It is in your best interest to eat foods as they come out of the ground or are otherwise natural. Is it natural for fish to eat corn (which is the case with farm-raised fish)? Is it natural for cows to eat corn? The answer to both questions is no. Should we consume white bread, white pastas or white rice? When we harvest wheat it is brown but we often remove the beneficial parts including the fiber and wheat germ. Eat whole oranges and fruits, but be careful when you make it into juice. When we juice, we remove beneficial fiber that lowers the negative impact on our blood sugar (read more on safe beverages for active individuals here). Yes, you can have desserts, but consider them a rare treat and know that whole fruit is a much better option.
Here’s the bottom line: be familiar with the foods you eat and the ingredients you are digesting.
The information included in my posts are for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan. Reading the information in my posts does not create a physician-patient relationship.
Alan V. Safdi MD, FACG
Co-founder Emerge Healthcare Solutions and Consultants for Clinical Research
Past President Ohio Gastroenterology and Liver Institute
President Nominations Committee Ohio GI Society
Served as Chairman Section of Gastroenterology at.Deaconess Hospital
President Consultants for Clinical Research
Past Chairman Cincinnati Crohn’s & Colitis Medical Advisory Committee
Former Medical Director Tri-State Endoscopy Center
Served as President of the Ohio Gastroenterology Society
Lectures Nationally and Internationally on Health and Wellness