Sugar & Glycemic Dysregulation

Natalie Ledesma is a board-certified specialist in oncology nutrition, Natalie is the founder of Natalie Ledesma Integrative & Functional Nutrition Consulting, the clinical nutrition specialist at Smith Integrative Oncology in San Francisco, an integrative and functional dietitian for Radiant Women’s Health, and the founding dietitian for the nutrition program at the University of California, San Francisco Helen Diller Family Comprehensive Cancer Center. This article is an excerpt from Natalie Ledesma’s monthly newsletter, reprinted with her permission. 

Americans LOVE sugar – the average sugar consumption in adults in the United States in 2017-2018 was 17 teaspoons daily! Sadly, it’s the same for children too. Sugar is linked to an increased risk of various health conditions, including heart disease, type 2 diabetes, cancer, fatty liver, cellular aging, and more. Sugar increases inflammation, and that may impact your brain, heart, skin, kidneys, liver, and joints. Want to age quickly? Drinking 20 ounces of a sugar-containing soft drink daily equated to 4.6 additional years of aging. Yikes! This premature cellular aging is related to shorter telomere length. What drives a fatty liver? Surprisingly, not fat, but sugar – processed and refined carbohydrates (& alcohol), particularly those rich in fructose. In this study, eighty grams of sugar daily, which is equivalent to about 27 ounces of a normal soft drink, boosts fat production in the liver. And even if no more sugar is consumed, the overactive fat production in the liver continues for a long period of time. If you eat too many refined or simple carbohydrates, you overwhelm the body with sugar. Sugar & Associated Health Challenges

• Increases blood sugar/insulin resistance
• Leads to weight gain
• Affects brain health
• Contributes to poor oral health
• Weakens immune function
• Associated with higher risk of cancer
• Leads to chronic inflammation
• Challenges liver function & can lead to fatty liver
• Harmful for the heart - increases triglyceride levels
• May lead to anxiety & depression
• Negatively affects sleep

I don’t think anyone would argue that added sugars are healthful and protective for one’s health. But, how do we know if our bodies are not metabolizing sugar and carbohydrates appropriately?

Symptoms of Glycemic Dysregulation

• Anxiety & depression
• Brain fog
• Emotional instability
• Fatigue
• Food cravings
• Food & chemical sensitivities
• Increased gastrointestinal upset
• Insomnia
• Joint aches & pains
• Phlegm or stuffy nose
• Skin rashes & breakouts
• Teeth grinding
• Weight loss or weight gain

Does the type of added sugar matter?

Is maple syrup or honey better than white sugar, I’m frequently asked? They both are still added sugars, but there are some advantages. Maple syrup and local honey have a lower glycemic index than table sugar, hence, they affect your blood glucose levels to a lesser extent. Note that most commercial honey, however, has a high glycemic index, so quality and source is critical. Honey does contain vitamins and minerals, notably various B vitamins and small amounts of calcium, iron, zinc, and others. Darker honeys, such as buckwheat, generally speaking, have a higher antioxidant level – you may recall color is an excellent indicator of phytochemical content (even in honey). Maple sugar also adds minerals and antioxidants and is naturally sweeter, so you can use a lesser amount. And what about blackstrap molasses? We don’t tend to use it as regularly, but it’s quite rich in iron, calcium, magnesium, and potassium. Blackstrap molasses, like maple syrup and honey, has a moderate glycemic index. Brown rice syrup has a smooth flavor, but does have a high glycemic effect.

Seeking a lower glycemic effect – think coconut and dates. Coconut sugar can serve as a good alternative to sugar and adds some micronutrient value and offers a lower glycemic response. Date sugar can be a good option from the nutritional front; low glycemic effect and lower in calories, but can be tricky to use as it does not dissolve easily into mixtures. Note that date syrup is also now available. Why did I not mention agave nectar? Agave does have a lower glycemic effect because it’s primarily composed of fructose and fructose does not increase blood sugar like the glucose in table sugar. Honey, for example, is closer to a 50/50 mix of fructose and glucose. The concern, however, is that when fructose is consumed in high quantities and/or over a long time, it leads to insulin resistance, metabolic syndrome, fatty liver, and weight gain.

What about artificial sweeteners?

Examples include aspartame (Equal, NutraSweet), saccharin (Sweet 'N Low), sucralose (Splenda), and acesulfame potassium.

Although artificial sweeteners were developed as a sugar substitute to help reduce insulin resistance and obesity, data in both animal models and humans suggest that the effects of artificial sweeteners may contribute to many health challenges. The use of artificial sweeteners perpetuate the desire for more sweets. Research has suggested that artificial sweeteners may lead to a lower satiety level, leading to an increase in overall calories. Women who consumed an average of ≥2 artificially sweetened beverages daily (≥24 ounces/day) had a significantly increased risk of all stroke, ischemic stroke, coronary heart disease, and all-cause mortality compared with those who consumed <1 artificially sweetened beverages per week. Additionally, artificial sweeteners may alter glucose homeostasis. Sucralose, or Splenda, appear to have a negative effect on glucose metabolism and decrease insulin sensitivity. Artificial sweeteners have been shown to induce glucose intolerance by altering the gut microbiota. While more research is needed, artificial sweeteners have been found to disturb the gut microbiome.

What about sugar alcohols?

How about sugar alcohols – those ingredients ending in -ols, like sorbitol, maltitol, xylitol, and erythritol? We don’t entirely digest sugar alcohols, hence, the lower calories. Downside? If they’re not fully digestible, they’re more likely to lead to diarrhea. Additionally, if you have food sensitivities, note that most sugar alcohols as well as dextrose, high fructose corn syrup, and allulose are corn-derived. What kind of corn? GMO cornstarch or cornstarch that has been genetically modified. What about health implications? Both erythritol and xylitol have been found to increase the incidence of major adverse cardiovascular events.

What could you possibly use instead as a sweetener?

And last, but not least, what’s the scoop on stevia and monk fruit? Stevia is derived from the leaves of the plant, Stevia rebaudiana. Pure stevia leaf extract is 100-300 times sweeter than table sugar yet it has no calories or artificial ingredients. Some find stevia bitter or do not like the aftertaste. It’s very sweet; I find the trick is to use a very small amount. Stevia and monk fruit both have no effect on blood sugar; they have a glycemic load of zero. Monk fruit, also known as luo han guo, is a small sub-tropical melon with naturally occurring antioxidants. It too has zero calories and is approximately 250 times sweeter than sugar. I find the taste more neutral than stevia.

While more research is needed, to date, research studies have not shown any adverse effects with monk fruit. A study published this year demonstrated that monk fruit extract reduces glucose levels following a meal by 10–18% and insulin responses by 12–22%. While a few earlier studies on stevia done in vitro or in vivo (not in humans) suggested some possible gut alterations. More recently, however, regular consumption of stevia for 12 weeks did not significantly impact the gut microbiota.

You will frequently find added ingredients in some stevia and monk fruit products, most frequently sucralose and erythritol. Truvia is an example of a mixed product. Be sure to opt for 100% pure stevia and/or 100% pure monk fruit.

For most, it’s not a matter of knowing that added sugars aren’t the best for us, but rather, how can we decrease our desire for sugar? Sugar cravings may be due to various reasons.Potential Culprits for Sugar Cravings

• Inadequate protein intake
• Insulin resistance
• Hypoglycemia
• Poor diet that includes regular added sugar consumption
• Dehydration
• Insufficient intake of healthful complex carbohydrates
• HPA axis dysfunction/stress
• Poor sleep
• Candida/yeast overgrowth
• Hypothyroidism
• Nutrient deficiencies – chromium, magnesium, B vitamins

Strategies to Improve Glycemic Control

• Be sure to adequately hydrate
• Limit or avoid foods made with refined flours/grains/sweets (‘white’ foods)
• Increase fiber (30-45 grams/day)
  • 3 cups vegetables daily
  • ½ cup fruit up to twice daily
  • 2 tbsp sacha inchi seeds, ground flax seed, Zen basil seeds, and/or chia seeds
• Let the 10:1 carb:fiber rule guide you
  • for every 10 gm of total carbohydrate listed on the label, you want 1 gm or more of dietary fiber
• Opt for healthy fats – avocado, olive oil, nuts/seeds, cold-water fish
• Avoid eating carbs alone – combine with protein and/or healthy fats
• Limit starchy carbs to 1-3 servings/day
• Limit caloric beverages
• Include Mg-rich foods – spinach, chard, pumpkin seeds, hemp hearts, chia seeds
• Optimize vitamin D levels – aim for 50-60 ng/mL
• Eat cinnamon daily (1/2 tsp)
• Avoid evening snacking; ↓evening meal size
• Be physically active daily
• Aim to achieve and/or maintain a healthy body weight
• Engage in stress-reducing activities

This is a chart on sweeteners that you may find helpful as a summary. Blood sugar imbalances result in an increased production of inflammatory cytokines, which lead to insulin resistance, chronic inflammation, and more. Do your best to identify why you may be desiring sugar. Nourish yourself with a healthful diet. Be active. Support the mind/body connection as well. What you include in your diet and lifestyle is as important as what you exclude.

If you’re interested in working directly with Natalie, you can reach out to her on her website, https://natalieledesma.com/, or consider joining her Nat Pak.

Nat Pack offers accountability, community building, personal connection, and loads of cutting edge nutrition discussion. This membership includes virtual 30-minute discussions twice monthly; meetings will be on Wednesdays at 12pm pacific time. These sessions will be recorded and available to members.