This sweet, sweet poison
In their attitude to sugar, people rush to two extremes. And they miss
Some people wash down sweets with sweet soda, others join sugar-free marathons, fearing sugar addiction, obesity and diabetes. The current fashion for giving up carbohydrates, advertising commercial "sugar-free" diets, fragmentary awareness have led to the fact that sugar scares. Can simple carbohydrates be part of a healthy diet? Evidence-based nutritionist Elena Motova Elena Motova answers the questions of readers of the Attic about sugar.
[Q]: I replaced the sugar with honey and agave syrup. Am I good? Is it more useful this way?
[A]: For some reason, products with complex and exotic names seem to be better than the usual ones. "Sugar is terrible, cane sugar is not bad, agave syrup is wonderfully healthy. In fact, in terms of composition and properties, it's about the same thing: simple carbohydrates, which are built from one or two sugar molecules. One molecule is monosaccharides (glucose, fructose, galactose). When these molecules combine with each other, disaccharides are obtained – sucrose, maltose, lactose. Glucose together with fructose form sucrose – a table sugar familiar to us all, which is obtained from sugar beet or sugar cane. It (and other simple sugars) are added to industrial products and beverages (sweet sodas, chocolate, sweets, yoghurts, pastries, breakfast cereals, sauces and other unsweetened dishes). We also use sugar in the kitchen at home. When it comes to its total consumption, products containing free sugars should also be taken into account – honey, all kinds of syrups, fructose in natural juices and smoothies. In dairy products, vegetables and fruits, simple sugars are contained in small amounts and, for a number of reasons, are digested and absorbed more slowly. Their consumption (unlike added and free sugars) in healthy people is not regulated – be guided by your desire and appetite.
[Q]: I am very afraid of diabetes. If I give up sugar, will there be no sugar?
[A]: Unfortunately, it's not that simple. Type I diabetes mellitus is associated with an autoimmune lesion of pancreatic cells that produce the hormone insulin. We do not know what triggers cell death, and therefore there is no effective prevention. Insulin is just an intermediary that helps glucose molecules get into the cell. There it is used as the main source of energy. We get glucose not only with simple carbohydrates, but also when digesting starches of any plant food. The lack of insulin is a humanitarian disaster for the body. In type II diabetes, insulin is produced, but cells are less sensitive to its signals. Visceral adipose tissue, which is located in the abdominal cavity and surrounds the internal organs, produces substances that prevent insulin from binding to cell receptors. Abdominal obesity (waist circumference of more than 80 cm in women and more than 94 cm in men) is a risk factor for insulin resistance. The pancreas in conditions of resistance is not capable of indefinitely increasing the production of insulin. Its capabilities are depleted over time and diabetes develops. The lack of movement also matters: during physical activity, muscles need less insulin to get glucose. You can evaluate other risk factors (including age and blood relatives with diabetes) on the website of the American Diabetes Association.
As for nutrition, it's better to just take and give up sweet sodas. They contain a lot of sugar, but do not give an adequate sense of satiety. Two meta-analyses have shown that their excessive consumption increases the risk of developing diabetes regardless of weight. Nutrition, which is based mainly on deep-processed products containing a lot of not only sugar, but also added fats, is also associated with an increased risk of type II diabetes.
[Q]: We eat different foods, but in the end we still get glucose. Wouldn't it be easier then to eat jam right away?
[A]: It's only in the cartoon that a moderately well-fed hero can eat a jar of jam for lunch. In reality, we should get most of our energy from foods containing complex carbohydrates. We need soluble and insoluble fiber, vitamins, minerals and phytochemicals that are found in vegetables, fruits, cereals, legumes. In addition, the breakdown of starch into glucose molecules takes longer. An increase in blood glucose levels after the same product containing carbohydrates is a more individual thing than it was thought before. However, a sufficient amount of dietary fiber in food will make your glycemic profile smoother.
[Q]: I try to eat all sweet foods (including fruits) in the morning. After all, otherwise sugar will turn into fat, and I will gain weight?
[A]: No, you needn't worry. Energy value (caloric content) are products containing proteins, fats or carbohydrates. If for any reason we get more calories from food than we spend, excess energy is stored in the form of fat. The time of eating during the day does not matter, it is important that the energy balance is maintained. It is regulated by the hormones of the gastrointestinal tract and adipose tissue, as well as the centers of hunger and satiety in the hypothalamus of the brain.
[Q]: In the second half of the working day, I always eat something sweet, otherwise it is difficult to concentrate. Is it true that our brain needs sugar? Or is it a dependency being formed?
[A]: The brain is powered by glucose, and directly, without the mediation of insulin. Our brain is only 2% of the body weight, but it spends 20% of all incoming energy (and consumes 50-60% of all carbohydrates). Thinking, memory, and learning are closely related to glucose levels and how effectively the brain uses it. Studies have shown that a moderate increase in blood glucose levels (after simple carbohydrates) can improve cognitive function. This does not mean that you need to pour a couple of tablespoons of sugar into your tea before brainstorming. But it is absolutely necessary to eat on time if you want to work productively.
We are not robots, and after intensive mental work, fatigue accumulates. A socially acceptable way to relax and collect your thoughts for smoking employees is a smoke break, and for non–smokers – tea with a traditional box of chocolates. And with cookies. And buns. Sweet. No, there is nothing wrong with moderate consumption of sweets, but the need to switch, relax, relax should not be replaced by food simply because it is accepted. In my practice, there were two cases when patients ate frightening amounts of sugar in order to work productively. In both cases, it turned out to be associated with a violation of the sleep-wake cycle and sleep deprivation. A pilot study published in The American Journal of Clinical Nutrition shows that increasing the duration and quality of sleep may reduce the intake of simple carbohydrates. There may be many different reasons for excessive sugar consumption, but it is incorrect to talk about "sugar addiction" in this regard.
[Q]: I signed up for a sugar-free group, but six months later I broke down and again I eat sweets. How to overcome sugar addiction?
[A]: I am deeply saddened that people who have no idea about evidence-based medicine, eating disorders, who do not know anything about the physiology of the brain, make non-existent diagnoses and "treat" other people under the slogan of fighting "food addiction". Psychiatrist and psychotherapist Maxim Sologub, who treats eating disorders, sees a connection between following rigid food stereotypes and self-esteem. These numerous "as is" prescriptions do not only prohibit sugar. "The implementation of such rules increases self-esteem and as a result they become tools of emotional regulation, unfortunately, ineffective, because they lead in turn to even greater emotional dysregulation."
What does science think about sugar addiction? The largest study of the relationship between food consumption, addiction and stress, NeuroFAST is an interdisciplinary project of a number of European research centers (from the University of Gothenburg to the University of Bologna). "There is no evidence that any food, food ingredient or dietary supplement causes dependence on a particular substance (the only currently known exception is caffeine, which through certain mechanisms can potentially cause dependence). In this context, we specifically point out that alcoholic beverages are not considered as food. Overeating is clearly different from disorders associated with the use of psychoactive substances that cause addiction through specific neurobiological mechanisms (like nicotine, cocaine, cannabinoids, opioids)."
A review by experts from Cambridge does not find sufficient evidence of the existence of "sugar addiction" in humans. The biggest support for this idea is due to the fact that the brain's reward system reacts to the consumption of sweets. However, even in animal studies, bouts of gluttony were associated with intermittent consumption of sugar (first fed, and then taken away forever), and not with its neurobiological effects.
There are eating disorders, such as compulsive overeating, where the diagnostic criteria are the absorption of a large amount of food and loss of self–control during "zazhorov". This is not an addiction to food, but a disease associated with using the very process of eating food to cope with emotional problems. People with eating disorders need specialized help to cope with psychological situations and physiological factors that push them to overeat.
[Q]: Are there any sugar consumption standards for healthy adults and children?
[A]: The World Health Organization recommends that added and free sugars account for less than 10% of the daily caloric intake. For a healthy person consuming about 2000 kcal is 50 g of sugar or 12 teaspoons without a top. It counts not only the sugar that you put in tea, but also honey, syrups, added sugars in cereals and yogurt, sweets, sweet soda, fruit juice and so on. The problem is that added sugars can appear under several dozen names, and manufacturers are not required to specify their content separately (only the total amount of carbohydrates can be on the package). WHO calls for reducing sugar intake to 5% of the daily caloric intake, but not one of the nutrition guidelines does not recommend giving up sugar completely.
The American Academy of Pediatrics generally does not recommend added sugars to children under two years of age. (At the same time, cottage cheese and yogurt for children under one year old, where there are almost two teaspoons of sugar per 100 grams of the product, are on the shelves of any store.) For children over two years of age, the recommended intake is up to 25 g of sugar per day. Sweet sodas – no more than 240 ml per week, fruit juices and smoothies – no more than 150 ml daily.
[Q]: So after all, is there or is there not sugar? Tell me properly!
[A]:The clinical nutrition guidelines for diabetes write that it is important to enjoy eating, and any restrictions should be justified. One of the harshest organizations in terms of recommendations to the population – the American Heart Association – believes that added sugars with an adequately low intake can be part of a healthy diet.
Nutrition is an absolute, basic need, and we like the sweet taste because the food that carries it contains enough energy for life. Sweets should not be used for emotional regulation, should not be an encouragement and reward. But if you keep sugar under lock and key (and forbid yourself or children), it can fuel an unhealthy craving for sweets. Feeling guilty if you ate one cookie will most likely lead to you eating the whole pack. Therefore, find a balance – try different foods, enjoy it, make desserts (which may be fruits) part of an adequate and balanced diet.
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