Sugar: The Imperfect Chemical

Ahhhh, the joys of sugar. The perfect complement to chocolate. The key ingredient for pancake's syrupy topping. The mainstay of Halloween. The energy booster? What is it about the human condition that makes us want to have a constant intake of some chemical? (Also see The Perfect Mood Altering Chemical. More importantly, is sugar actually good for us? Please don't take that away.

Debates on the issue of whether sugar is good or bad for us go back and forth, with the sugar producing industry usually either funding research to say that sugar is good and not harmful. Who produces this Web site: Sweetscam, which is a little more balanced, but glosses over a lot. The people funding it are not telling.

I have my doubts about the efficacy of some US medical research. For example, sugar usage clearly corresponds to an increase in acne in some people, but past research only claimed that sugar may change metabolism, not cause acne. It was vindicated and approved for much eating. However, changing metabolism is medically noted as a cause of acne. I can still get acne from eating a large candy bar. But some people can eat a high sugar diet and never get acne. Recent research looks at glycemic index (foods that rapidly raise blood sugar [glucose] levels) and the effect of these foods on acne. (These same foods are also responsible for weight gain.) Studies are beginning to see a correlation, with some studies presenting dramatic decreases in acne over 3 months, by reducing sugar.

How do researchers, or people who interpret research, give misleading results? There are more ways than I can count, but I will give a few of them here. First, let me say that most university research, and especially research subject to FDA jurisdiction, must submit to exacting standards. It is more often the interpretation of the research that is the problem. Misinterpretation is often done by people from outside the research community who either have their own agenda to support or they are not qualified to interpret the research.

There is also a lot of so called "clinical" research that is done outside of the university setting, and not subject to FDA standards. While some is good, other studies are simply designed to get the desired result.

So how do researchers, or those who interpret research, give misleading results?

1. Misinterpret results from a correlational or latitudinal study. These are studies that indicate common characteristics of a population. In such a study, you might see that people who eat a lot of beans tend to pass gass more often. That is called an association or a correlation. As the amount of beans consumed increases, so does the amount of gas that is passed.

Correlational studies do not establish a cause and effect relationship. There may be more variables involved that are responsible for the correlation. It could be that people who eat beans also drink more beer, and this causes the increase in flatus. It could be that many people in the population studied (such as a college group), don't know how to cook and so don't cook the beans long enough, and this causes the increase in flatus.

Correlational and latitudinal studies are simply a place to start asking questions, such as, "Why is there a correlation between people who eat beans and flatus?" Drawing conclusions from these studies is almost always incorrect.

2. Generalize specific studies to a wider population. A tremendous amount of research in psychology has traditionally been done with college students. The results are often applied to people of all educational and age groups. But are college students the same as the rest of the population? Does their physical condition, interests, expectations in life, maturity (including moral and ethical code development), life experience, career experience, and in depth understanding of consequences, match that of someone in their 50s? No, not even close. So results obtained from college students probably will have limited application in the entire population.

By the year 2050, the US population most likely will have stabilized, and each age group will be equally represented in the overall population. Most likely it would be ill-advised to try to generalize research with college students to freshmen in high school and octo-generians.

3. Claim a causal relationship where none exists. For example, some may have the bias that seeing violence in the movies and TV leads to violence in the population. It's a very thought-provoking claim, and many have made this claim. But in reality, no survey has ever even shown a correlation. The media is more a reflection of society than an instigator of behavior. But we also have to be careful saying even this. The Alfred Hitchcock movie Psycho scared a lot of women and men into not taking showers in hotel rooms. We may find that what we see in the media has some overall impact on us.

4. Do the study for too short a period of time. Affects of medications, lifestyle, and behaviors often don't show up for months or many years. For example, does spanking hurt kids? There is a new study out every year, despite meta-studies of hundreds of studies that indicate that there is no difference. Instead, these studies should be of kids who were spanked, or not, by studying them in their 30s. What other variables might have affected their need for spanking when they were children. Children are not all the same - not at all. Some do almost exactly as they are instructed and don't do anything to hurt anyone. Some are terrors and their behavior can hardly be controlled in the safe range by any mechanism. These different children are often raised by the same people - brother and brother are just different. Most studies on children seem very poorly designed by people who want to make a point favoring their bias rather than show real results.

Realistically, no parent wants to spank their children, and there are very effective ways of modifying children's behavior. Day care workers learn these methods and use them. Parenting classes teach them. But there are some kids for whom these methods simply don't work - even though they may work when used by strangers they don't work by parents.

Doctors typically are very slow to change the medications they prescribe. They know that the drug companies, even though they are governed by the FDA, are likely to show results to them that don't include important data. One way to do this is to do the study for too short a period of time so that bad effects don't show up. Bad effects may not show up for years, and may be very difficult to find. Effects may require a much more diverse patient group in order to show up. The overall population is very diverse. Doctors usually like to see years of results - good and bad - before prescribing a new medication.

Many medications on the market are based on science, not results. For example, high HDL cholestorel in the blood stream is correlated with coronary artery disease. It makes sense then that drugs that lower HDL cholesterol, or raise LDL (good) cholesterol, would lower the risk of coronary artery disease. But that suppisition is based on background science, not results. Results take years to obtain. Few cholesterol lowering drugs have been proven to reduce the risk of coronary artery disease. Some have been shown not to help, and some have. Most have potential side effects. But the evidence is strong enough that the FDA and physicians approve their use.

6. The most important consideration. Look and see who sponsored the research. If they have an incentive such as financial gain or bias, then the research they do should be suspect and subjected to further scrutiny. Look to see if they are qualified to do research. Most university level research and medical research is supervised by competent authorities who make sure it meets exacting standards. But research done by independent people and clinics may not be supervised by competent authorities, especially if done in a foreign country where standards may be more lax. Most of the advertising on the Internet for over the counter drugs is based on correlations and flimsy research.

Doubtful research

Studies on the sweetener saccharin got it removed from the market because giving it to mice in amounts equivalent to hundreds of times normal human consumption caused cancer in lab animals. Later studies indicated saccharin was probably safe. I'm not really sorry about this one - casting doubt on saccharin prompted the creation of much better sweeteners than the foul tasting saccharin.

Another chuckle, studies have found that sugar does not cause hyperactivity in kids. The sugar industry would like you to believe that. $. Well, ask any teacher how children behave the day after collecting Halloween candy. Ask any mother how children behave after ingesting too many sweets. Thankfully the effect is short-lived. The more likely explanation is that for kids who are not used to eating a lot of sugar, it causes a change in metabolism. Hmm, where have we heard that before?

The "natural food" groups love sugar, as opposed to "artificial sweeteners." People won't use "diet" soft drinks, but instead drink lots of those sweetened with sugar. People consume around 20 teaspoons of sugar a day, or the equivalent in artificial sweeteners. But sugar, like flour, is not exactly a "natural" substance. Sugar (sucrose) is refined from the plants in which it occurs. Corn sucrose is being libeled by some food manufacturers as "un-natural" to get you to eat their products. Well, if you wanted to eat "natural" sugar, you would have to eat a sugar cane plant, or sugar beet, in which sugar accounts for only 12 to 20% of the plant's weight. Most of us don't graze on sugar cane. Sucrose would be a bit more difficult to eat to excess in this form. To refine it, it is actually treated with calcium oxide to remove the unwanted stuff. It may be "refined" with phosphoric acid, calcium hydroxide, and carbon dioxide. These chemicals don't really hurt it, although the natural food groups might object, but sugar is not a natural food. Eating sugar is not like eating a tomato or a potato. Sugar is an extract - very concentrated and very refined.

Not all natural things are good for you. We don't drink the sap from pine trees (turpentine), drink hemlock (a deadly poison), or eat rubber from the rubber tree plant. I break out in hives if I eat too many strawberries.

What this all natural substance, sugar, does for you, whether from cane or other plants, particularly if not eaten in moderation, or eaten in snacks between meals, is called tooth decay, acne, obesity, and diabetes.* This is "natural," of course, and highly preferable to the possible horrible problems caused by artificial sweeteners, which are, uh, hmm, ahem, actually major studies of thousands of people haven't really shown any major problems (except for phenylketonurics), even though artificial sweeteners are often named as a scape-goat when a real cause for disease is not identified.

There could be a kernel of truth here - margarine, a low fat and "safer" alternative to butter, has recently been found to contribute to heart disease because of its hydrogen content that is used for softening. Hydrogen has now been removed in most margarines. Margarines also contain triglycerides - don't know yet if it raises triglyceride levels, which is another path to heart disease. The more we know, the more we know we don't know.

The lowdown on sugar

Recently sugar has been the main ingredient in so called "energy drinks" or "sports drinks" that are either supposed to keep your eyes wide open and your brain totally productive, or give you a boost during sports. Is there any truth in this? What does your body actually do with sugar?

Sugar is a "dissacharide." The "disaccharide" sucrose molecule is made up of two bonded sugars: glucose and fructose. Sucrose is normally digested in the small intestine after leaving the stomach. The small intestine epithelium produces the enzyme sucrase, which splits sucrose into the monosaccharides glucose and fructose. These monosaccharide molecules are small enough to be transported through the intestinal cell wall and into the blood stream. (This is not related to lactose intolerance, which is caused by a deficiency of the lactase enzyme in the small intestine.)

Sucrase is mostly produced in the intestine, but is also found in saliva and the gastric juices. The salivary glands do not produce the sucrase enzyme. Instead, the enzyme is produced by bacteria in the saliva. In research, increasing the amount of sucrose ingested increases the amount of sucrase found in saliva, up to a limit. Some ingested sucrose does reach the blood stream.

What happens to sucrose in the blood stream? It isn't available for energy, and is a controlled process. Sucrose is converted by the liver into glucose to meet the body's energy needs, however the liver maintains glucose at healthy levels and converts excess glucose into glycogen (a storage form for rapid conversion) or into fats (long term storage).

We know that untreated diabetics commonly have sugar (as glucose) present in their urine. Too much glucose in food is not good for diabetics - it can cause a coma or death. In healthy people, if you inject sugar (as sucrose) under the skin, it is also excreted in the urine. But this is not so with sucrose in the blood. Sucrose in the blood is converted into glucose, glycogen, or fat.

Excess chemicals are generally broken down by the liver and sent for removal to the intestines as bile (in the feces), or to the kidneys (goes out in the urine). But continuously flooding your body with things it doesn't need can overload and progressively damage your system (example: obesity from overeating or poor diets). The balance is important: caloric intake from food must be burned through exercise or it sticks around as fat. Having more fat than your body can handle circulating in your blood stream, or stored, can contribute to various unhealthy conditions, including arterial sclerosis (plaque build-up in arteries, AKA "athro," AKA coronary artery disease) and diabetes.

In just the last few years modern medical science has decided that heart disease, diabetes, and obesity, the devil's mutual instigators of more and more disease, should be prevented with diet. Prevented! Prevented from ever happening. Simple carbohydrates, those high glycemic index foods (sugars head the list) are some of the main items to cut back on. Naturally.

Note that the formation of plaque (fat and calcium) in arteries is usually preceded by inflammatory conditions in the artery, often from irritation caused by oxidized LDL cholesterol, and by flexing. However, blood fat often builds up around these plaque areas, blocking the artery and causing severely restricted blood flow, resulting in angina pain, or if it breaks loose and blocks a smaller artery, a heart attack.

The intestines use enzymes to break food down into simple molecules that your body can use. Only food molecules that have been chemically converted to a small molecule can be transported into your blood stream.

The intestines exclude molecules from entering the blood stream by molecular size restrictions (they won't fit through the cellular channels), and the intestines transport small simple molecules to the blood stream by using proteins that bind to these molecules. This intestinal system transports water, ions, drugs, and proteins of various sizes (20 - 900 kDa) into the blood stream. (Sucrose molecular mass is 342.30 g/mol; kDa is generally equivalent to g/mol.)

Molecules such as sucrose don't have a transporter, while glucose does, so sucrose has to get broken down by enzymes into glucose and fructose. The molecular size limitation prevents things like bacteria, and larger and unusable food molecules, from crossing into your blood stream. But there is another mechanism by which sucrose can reach the blood stream.

"Sodium pumps" allow water to pass into the blood stream. Water soluble chemicals, such as vitamins and drugs... and sucrose, can pass through with the water. It is known that some sucrose does make it into the blood stream, thus the problem with drinking soft drinks, which contain large quantities of sugar (sucrose and fructose). Since sucrose requires conversion to glucose either by intestinal enzymes or possibly by the liver, it is not a more rapid means of acquiring immediate energy. It may be a rapid means of acquiring fat.

One soft drink provides the calories for about an hour of daily activity for someone weighing 150 pounds. To put it another way, when you drink a soft drink you need to do an hour of household cleaning to get rid of the calories, otherwise they are stored as fat. Unfortunately soft drinks account for around 10% of the calories in US daily eating. Energy drinks are slightly higher in calories.

The best way to get the energy needed for exercise is to eat food and water prior to exercising. Keep in mind that food is in the stomach for two to four hours before it has completely emptied into the small intestine in small amounts for digestion. So eating provides a two to four hour constant source of energy. Keep in mind that when you eat, a third of the blood that was going to your brain is diverted to your stomach to digest your food, so you get sleepy and feel like you have less energy. Exercise will usually fix that.

* Statements, misleading statements, and research on sugar.

FDA on sugar substitutes.

Does sugar lead to diabetes? It's a complex issue, and I can only summarize medical research: Type 2 diabetes (formerly called "adult onset diabetes") is alarmingly on the rise, and is associated with the rise of unhealthy lifestyles, including unhealthy eating habits. Weight, physical activity, and genetics all affect the way your body responds to insulin. Stress hormones also trigger the release of extra blood sugar. (Insulin enables sugar [glucose] to enter body cells for energy, or enter fat cells for storage.) Sugar is not a direct cause of diabetes (just like sugar is not a "cause" of ADHD - that is, it doesn't cause the chronic condition ADHD, just short term hyperactivity in some kids). Sugar does not directly cause insulin resistance. But sugar leads to overweight, which can lead to insulin resistance, and sugar raises blood sugar levels. Long term, insulin resistance can result in consistently high blood sugar levels, which increases a person's risk for developing type 2 diabetes. And then short term, eating excessive amounts of sugar when your body has difficulty regulating sugar (glucose) worsens the immediate condition (can lead to a medical crisis). Type 2 diabetes responds well to diet, and often diet alone controls type 2 diabetes. No blanket statement can be made that sugar is going to make everyone diabetic, but people with risk factors are much more likely to do so. Everyone is different. See your doctor for advice on your use of sugar.

Sugar gives you more strength.

When people chew sugar, (young and old alike) some will demonstrate increased muscle strength and some will demonstrate decreased muscle strength. Gain or loss seems to depend on the ability to metabolize sugar. But chewing sugar subjects it to digestive enzymes - it doesn't go directly into the blood stream.

Energy drinks give you energy.

This is another complex topic. They do provide simple carbohydrates, which are more quickly converted in the body than complex carbohydrates and protein. But are they really?

Soft drinks contain sugars that have to be digested. If you really need an energy boost, go for foods that contain glucose that can be transported directly into the blood stream. These include: almost any fruit or fruit juice (contains more than any other foods), tomato and tomato products (catsup), pickles, onions, Kellogs and Post Raisin Brand, Golden Puffs, and toaster pastries. All of these have more glucose than even an energy bar. One medium apple contains less calories than a soft drink, and has more immediately usable glucose - less fattening.

Even glucose is not pure energy, or even the fuel that the muscles use. The body has to use some energy to change glucose first to fructose diphosphate, and then to glyceraldehyde phosphates, using the enzyme glyceraldehyde phosphate dehydrogenase (GPDH). Energy for muscles comes from the reaction of glyceraldehyde phosphates and oxygen. The glyceraldehyde phosphate is oxidized (burned), releasing energy. The muscle cell also stores adenosine triphosyphate (ATP), for later access to energy.

The really bad thing about some energy drinks is that they are often full of caffeine, and taking caffeine during or after exercise has been shown to produce spikes in blood pressure in the stroke range. This is especially bad for hypertensives. Caffeine dehydrates the body, and that's not good for people who are exercising and losing a lot of fluid. Caffeine also affects the hormones adrenaline and glucagon, which releases stored sugar from the liver, and this results in high blood sugar, which causes a regulatory problem for diabetics and hypoglycemics. This increased blood "sugar" level may account for the "energy boost" seen by those using energy drinks (or morning coffee), which is caused by caffeine and not the sugar in the drink.

Another factor that may be involved is the placebo affect. Placebos are substitutes that don't actually work, but trick the mind into thinking they do. For example, people want to relax and feel more sociable so they drink an alcoholic beverage or maybe smoke marijuana. For both alcohol and marijuana, their main mechanism for relaxing nad being sociable is simply the desire in the mind of the person. The person wants that affect, so that is what they get - alcohol and marijuana are simply excuses for going where you want to go. In fact, even some medications only work slightly better than a placebo, and get success rates over 50%. Placebos work. How does this relate to energy drinks? You want more energy, and the drink is the excuse. When you stop exercising to drink, your body naturally relaxes and refreshes. Rest is more important than the drink, but the drink appears to be doing the trick. A glass of water would probably work just as well unless you have really run out of calorie laden food in your intestine.

Eating sugar substitutes leads to weight gain.

Misleading research is probably a misnomer - it's the interpretation that is bad. Once a regular visitor to Purdue University agricultural and horticultural research labs where this research took place, I know that most researchers work hard to make their research experiments uncorrupted. So I won't knock the research.

Basically the widely reported research was a study to see if animals use sweet taste to predict the caloric contents of food, or more to the point, whether the lack of nutrients affects physiological responses.

"These experiments were designed to test the hypothesis that experiences that reduce the validity of sweet taste as a predictor of the caloric or nutritive consequences of eating may contribute to deficits in the regulation of energy by reducing the ability of sweet-tasting foods that contain calories to evoke physiological responses that underlie tight regulation." - from the study abstract.

The idea is that cues that arise during eating can affect the "postingestive consequences of eating," which is a proven association. Sweet tastes prepare the body through physiological responses, to digest the nutrients. In this study, the p values were very low, meaning that the association with weight gain was very high.

I'm not at all certain how rats respond to saccharine. Studies have shown that cats do not taste sweets, so have no special interest in them. I know my experience with saccharine is to spit it out and say "yuck." Perhaps the rat response is the same as mine, or perhaps somewhat like the cat's. But within the study lies a hypothesis that possibly can be tested in humans if further research continues to support some of the claims that have been very broadly interpreted (extrapolated, generalized), by others from this study, correctly or incorrectly. See the "See also" paragraph below for other relevant studies.

Sugar is a simple carbohydrate. What we know about the physical response to sugar is that 1) It raises serotonin levels, so makes you feel good. 2) Many people who regularly consume large amounts of high carbohydrate, high fat, and high calorie food generally have cravings for more of it, either by design, or by habit and learned physiological responses. For some, these cravings go away within a week or two after switching to a high-protein diet. For others who switch, the same cravings are still present months later. It is very difficult to generalize a study to a larger population.

We know that people "physiologically" learn to get their nutrition from food that they customarily eat or possibly are genetically programmed to eat. So when people are hungry, they turn to the foods that they customarily eat, and eat these until they are "satisfied." We also know that the more calories you consume, the more weight you gain, and the fewer calories you consume the more weight you lose, except when metabolic response to restricted caloric intake prevents weight loss.

So we know that people who are accustomed to eating certain foods until they are satisfied will eat and eat and eat until they are satisfied, as did the rats.

Eating food has a great deal to do with physiological satisfaction. People eat until the right "switches" are turned off in their body. It might be serotonin. It might be "hunger." It might be a rise in blood glucose level. It might be a full tummy. In fact, studies in the 1980s showed that people varied in what told them to quit eating.

So does it surprise me that rats, when deprived of their regular diet and fed saccharine, will eat more and become obese? No. Can this study be extrapolated to humans? Possibly it raises questions about things to look at. Does this study mean that people who switch to artificial sweeteners may gain weight? It is a possibility that people who lack dietary restraint will eat or drink until they find the same level of satisfaction that they formerly got. Does it mean that sugar is better for you than artificial sweeteners? It's a long way from there, but I'm sure many people will point to the study to justify staying on sugar.

Not to critique the study, which was appropriately valid, but the interpretation by others: An association was established for the factors controlled or observed in the series of three studies, but an actual study on artificial sweeteners and obesity would have to be done with people, with a variety of artificial sweeteners, measuring actual preparatory digestive secretions, and would have to control for the effect of removing sugar and other carbohydrates from the diet. For example, does eating food from which the sugar has been removed elicit the same response of eating more. If so, it isn't the saccharine. See the "See also" paragraph below.

More science, more speculation

Tune in Dr. Oz on your TV and you will likely get the strong message that the one food you should remove from your kitchen is none other than sugar. Sugar reportedly "scars" your blood vessels.

The debate over sugar and artifical sweeteners is like the old battle over cigarettes. Smoking companies and smokers all wanted to deny that there was a "causal" link between smoking and health, despite the "correlation" that almost only smokers died of lung cancer, and there appeared to be strong links to other diseases, like heart disease, as well. Medical science takes time to get proof, but we know the facts about smoking now... it's worse than we thought. While medicine is proving links, in the mean time anyone can find evidence to support whatever answer they want. Delusion is rampant in both advertising and in self-destructive behavior.

One recent correlation study indicated that across populations, those who consume artificial sweeteners commonly weigh 10 pounds more than those who don't. It's not a strong link like in smoking. For some this is just another weapon in their arsenal against artificial sweeteners... as if there is any correlation or scientific evidence of any kind that strongly supports the idea that artificial sweeteners are bad for you.

Correlation studies are a great indication of what kinds of questions to ask. One of the first questions about the 10 pound weight difference should be whether behavioral issues are at work, as some scientists question. If those same people consumed sugar or fructose sweetened beverages, would they be even heavier? Are artificial sweeteners sometimes just a crutch that makes people think they are changing their behavior regarding simple carbohydrates, and overall calorie consumption, when they really aren't.

Some scientists who firmly thought that artificial sweeteners are bad for you, now often have swung to the other side of the debate. What recent scientific studies do show is that consuming many sugar or fructose sweetened beverages a day does cause significant long-term elevations (not just spikes) of blood fats... and the short answer is that elevated blood fats are linked to horribly destructive diseases. The overall evidence is strong enough about the detrimental effects of consuming sugar that many schools have taken sugary soft drinks completely out of their facilities.

I'm not on a campaign against sugar - I like sugar, especially in deserts. There is subtle evidence that artificial sweeteners may cause necessary glucose levels to decline. It is the overconsumption of sugar that is very likely to promote heart disease and lead to Type II diabetes, which also significantly accelerates heart disease. When you can cut down on sugar by either eating other foods or by substituting artificial sweeteners, you most likely significantly improve the quality of your life long-term. But you should also use a balanced approach to all food selection, limit calories, and exercise.

Sampling of the debate:

Mescape article: US Guidelines for Consumption of Sugar May Be Too High.

Minnesota Medicine article: Sweet Debate - Do artificial sweeteners contribute to rather than combat obesity?

- Scott

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