Sugar - Health and Behavioral Questions.

[Lemur]

https://www.heart.org/en/healthy-living ... ded-sugars

The American Heart Association recommends limiting added sugars to no more than 6 percent of calories each day. For most American women, that’s no more than 100 calories per day, or about 6 teaspoons of sugar. For men, it’s 150 calories per day, or about 9 teaspoons. The AHA recommendations focus on all added sugars, without singling out any particular types such as high-fructose corn syrup.

So for men, that is 37.5 grams (150 calories and sugar is 4 calories per gram so 150/4) and for women, that is 25 grams. Note that this is for added sugars specifically so milk/fruit is not counted in this context.

I've made it a point lately to watch my intake. I would not describe myself as a sugar fiend. I don't drink soda, fruit juices, eat candy, cookies, donuts or anything like that at all (my exception being that I love ice cream) but I started looking at a lot of the food items in my household, and I had no idea how pervasive this stuff is in our food supply. Take a simple peanut butter sandwich. 2 tablespoons of peanut butter has 3 grams of sugar and 2 slices of generic white bread has 5 grams. That is 8 grams total. I also didn't realize that tomato sauce (guess it depends on brand) has a lot of added sugar - mine had 7 grams from a 1/2 cup serving. I'm generally a healthy eater, and health conscious individual, and I'm probably hitting the limit (or likely surpassing it) each day. I know because once I deliberately started tracking this a few days ago, I had to make some changes. On a normal day, I'm testing the limits but one "cheat" and I'm easily over.

I read a little bit about artificial sweeteners as well...definitely don't take my word for a it but I'd wager they're either neutral on overall health (especially if they help you stay away from sugar) or negative. Likely inconclusive. But probably has negative effects on the microbiome (some people get GI issues).

I became interested in this topic when I randomly came across some lectures by Robert Lustig. While I can probably nitpick some things (fructose being labeled as toxic seems a bit hyperbolic), I felt he has made some strong points on avoiding this stuff most of the time and it seems to coincide with some other things I've read over the years about lipids, insulin resistance, diabetes, and the like. There is plenty of good papers on the topic such as this one: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC552336/ but what I found most interesting was how Lustig pointed out that since fructose doesn't cause much of an insulin response (fructose is metabolized in the liver), then it is easy to end up overeating this stuff without knowing it. This comes from the lack of insulin response itself since insulin stimulates leptin synthesis and that hormone in turn regulates appetite. Thus, one ends up with an increased energy intake beyond normal regulation. This could explain why some people who take only a CICO approach to dieting (with only some regard to macronutrient profile) might find themselves excessively hungry on these diets compared to others who might deliberately do things to increase satiety (feeling of fullness) by eating more protein, fiber, and less sugar through various dietary approaches.

I've had no issue deliberately reducing my intake so far. From a behavioral perspective, I generally wouldn't recommend taking an extreme neurotic approach and treating sugar like a substance to be avoided at all costs (restrictive behaviors lead to wanting it more...bingeing,...eating disorders and the like) but definitely recommend limiting/moderation. In other words, only a small scoop of ice cream and don't go back for seconds...or thirds...but also you have to know your own psychological makeup. I'm a moderator and can do this but not everyone is the same in this regard - some people absolutely can't moderate and anything less then full on restriction leads to relapses and bingeing.

I want to know your thoughts. Do you limit sugar deliberately? Only use small amounts for cooking some recipes? Have you ever tracked this? What more can you add to this topic? Any experiences with embarking on severely cutting sugar (avoiding completely and checking every label) or moderation efforts?

[ertyu]

The murikan food supply is ridiculous. When i was in the us for school, canned tomatoes tasted unpleasantly sweet to me right after i'd arrive bc after spending summer break back home, my sugar palate (is that even a word) had downregulated. Cook all from absolute scratch for a month, then buy something commercially sourced, and you'll notice how sweet most common packaged and processed foods are. The only food without added sugar at mcd is the hamburger patty.

Thus, my advice to anyone who wants to cut sugar is to cook from scratch. That would do it without counting or checking labels etc. I was recently given a bread machine and I've made a tentative few loaves of white bread: flour, water, salt, a tbsp of sugar to feed the yeast, 2 tbsp of oil. Even though it's white bread, it tastes normal and way less sweet than what's in the store.

Sugar increases ad libitum food consumption both by reducing satiety/intensifying blood sugar spikes and by making food itself more palatable and making us eat more (sugar signals calorie density in nature thus we're wired to prefer sweet foods, both in type and in amount).

[fingeek]

Thanks for the info about fructose, that's interesting - TIL about liver metabolism.

I have a suspicion that sugar is possibly one of the worst hidden killers in the modern world, and I wouldn't be surprised if it surpasses tobacco and alcohol. No evidence sought, however.

I tried keto diet many years back, and I went through that similar process of being appalled at how ubiquitous sugar has become.

I, too, now make a lot of things with raw ingredients and my taste for sugar these days is pretty low. Equally, I find tons of things too sweet now. On the very odd occasion I go on a chocolate binge, I feel dreadful the day after - worse than an alcohol hangover.

FWIW, I've had good success with banana and almonds as a replacement, to also increase protein (for muscle and hunger satiation), and for magnesium and tryptophan level boosting (for sleep)

[chenda]

Honey can be a natural substitute.

[Scott 2]

I've been down this rabbit hole.

Limiting sugar is a proxy for managing your blood sugar curve. 10 days with a continuous glucose monitor will save you a lot of energy. Ask your doctor for an RX, get a 3 pack with GoodRx coupon for under $200. Share with family. It's far from remove the added sugar = you are good. The author Jessie Inchauspé has a couple books out that discuss what you might learn.

As an example - sourdough bread is very low sugar. But it's all refined white flour. That immediately metabolizes into glucose. I've opted to eat a whole grain seeded bread that has a couple grams of sugar per slice. I eat the sandwiches open face. You can get a German rye bread that is low sugar and something like 9 grams of fiber per slice. But it's almost a cross between a cracker and a bread.

Oatmeal spikes my blood sugar more than donuts.

Tropical fruits (banana, mango) have pretty much the same response as eating sugar, for me. As does honey.

I'm on board with the idea that fructose = bad. I'm not skipping fruit, but I habitually keep it to 2 servings a day, primarily berries. Keep in mind - modern fruit has been bred to be super sweet. I only have fruit juice if I very specifically want it. There are zero high fructose sweeteners in my diet.

There are times, during and following exercise, that I'll intentionally consume 25-50g of pure sugar. I believe it is immediately metabolized. That's one I haven't gotten to test on the glucose monitor yet, but really want to.

I'm also still willing to eat a pint of ice cream, have a dozen cookies, etc. But in those cases - I am choosing my sugar. I know it's not a healthy choice.

[ertyu]

One I'm trying to sort out right now is, it's legumes and bread for a complete protein, and legumes and bread is so much tastier and satiating than just legumes, but im much hungrier in 2-3 hours. Trade-off: complete protein vs. sugar curve.

[Lemur]

@Chenda

The Hadza eat a lot of honey and it comprises a large percentage of their diet. In fact, 15-20% of their calories come from it. 40% of honey is fructose which is lower then sucrose and HFSC. https://globalhealth.duke.edu/news/what ... ng-healthy . It definitely helps to have a lifestyle of sun exposure, whole foods otherwise, and 15000+ steps a day and probably why this group rarely sees western metabolic diseases.

@fingeek

Nuts are great for satiety. Walnuts in particular might have special properties to induce this. https://www.bostonmagazine.com/health/2 ... ack-ideas/

Also some other benefits like lowering LDL cholesterol...with apoB in particular being causal for heart disease.

In many feeding studies, walnuts have been shown to lower low-density lipoprotein cholesterol and triglyceride levels (Kris-Etherton, 2014).

@ertyu

Instead of legumes and bread you could try legumes with curry (coconut milk + curry spice) and use brown rice for a cheaper option. That would make a complete protein and would be rather satiating.

@Scott 2

That is an interesting variability about the oatmeal. My guess is because the donuts include fat which slows the absorption of the sugar in it. So the glycemic load is lower. Have you tried seeing if you had a difference in blood sugar from oatmeal compared to just whole grain rolled oats? I would guess the latter wouldn't cause as much as a spike since the grain is fuller and not as milled but I do think there is probably some individual variability between foods that cause blood sugar spikes for some people and not for others.

The connection to refined carbohydrates makes sense too...also a part of the American food supply is to take fiber out of foods to increase shelf life. But its fiber that slows the rate of glucose absorption. So it would make sense that things like white bread for all intents and purposes might be equivalent to a mild sugar bomb. Thus the glucose spikes. Thanks for pointing that out.

[Dave]

Limiting sugar is a proxy for managing your blood sugar curve. 10 days with a continuous glucose monitor will save you a lot of energy...

As an example - sourdough bread is very low sugar. But it's all refined white flour. That immediately metabolizes into glucose. I've opted to eat a whole grain seeded bread that has a couple grams of sugar per slice. I eat the sandwiches open face. You can get a German rye bread that is low sugar and something like 9 grams of fiber per slice. But it's almost a cross between a cracker and a bread.

Oatmeal spikes my blood sugar more than donuts.

Tropical fruits (banana, mango) have pretty much the same response as eating sugar, for me. As does honey....

Keep in mind - modern fruit has been bred to be super sweet. I only have fruit juice if I very specifically want it. There are zero high fructose sweeteners in my diet....

Very interesting, thanks for sharing!

Regarding the oatmeal, are you eating instant oatmeal with added sugars, or more traditional "unprocessed" oatmeal like Quaker Old Fashioned / steel cut? Like @lemur, I also expect the fat in donuts is blunting some of the blood sugar movement.

I haven't tested it with a CGM, but I notice that eating those sorts of fruits makes me feel the same (energetically) as eating a candy bar. Like you said, modern fruit has been bred to be much higher in sugar/lower in fiber, in same the way our root vegetables have been bred to be higher in starch/lower in fiber. Much of the food we eat has been heavily modified from what we evolved eating, which can cast doubt (in my mind) on recommendations to eat 4-5 or even more servings of (any kind of) fruit per day.

[Western Red Cedar]

I want to know your thoughts. Do you limit sugar deliberately? Only use small amounts for cooking some recipes? Have you ever tracked this? What more can you add to this topic? Any experiences with embarking on severely cutting sugar (avoiding completely and checking every label) or moderation efforts?

I go through phases. Salty snacks are typically harder for me to moderate. Right now I'm tracking all of my macros but I'm not necessarily avoiding sugar. Just trying to stay within a certain calorie range and trying to hit a daily protein target.

Minimizing heavily processed foods is the lowest hanging fruit and the win-win from an ERE perspective. I actively avoid added sugars as much as possible in things like nut butters, ketchup, barbecue sauce, dressings, bread, etc... I ended up giving up a bunch of things like store-bought bread and Kombucha, or paying more for certain products like organic soy milk because most of the alternatives have too much added sugar. I don't worry about natural sugar in fruit though.

From a dietary perspective, this led me to experimenting with different types of mustards or hot sauces to add flavor without the calories or sugars. Once you start going down this path, it is almost easier to start making things like your own salad dressings or bread from scratch so you have more control over your ingredients. I still buy some condiments with sugar, but it is usually something like cane sugar and has less than other options. I'll use those sparingly.

Ultimately, I think if someone is making relatively healthy choices they probably don't need to worry too much about heart disease, but the example of added sugars demonstrates how hard it is to actually make those choices. If you aren't paying attention, you may be sucking up huge portions of sugar with a "healthy" breakfast that includes some ketchup on your potatoes and a glass of orange juice before you leave the house.

[Scott 2]

My experience with oats and blood sugar spikes was using whole steel cut oats. I had a teaspoon of sugar (4g) in a half cup dry oats (300 cals).

Oats are a quick digesting starch. I think it's one of the most common surprises people find from a glucose monitor.

I'm sure an instant oats packet would be a worse offender. I haven't tried it.

I still have oats with breakfast. But I start with a vegetable, then I have my whey protein, maybe an ounce of cheese, and then the oats with a half cup of blueberries and an ounce of pecans. I also have 200 cals of oats instead of 300. Pretty much all my default portions, I've moved from 2 servings of grain to 1 and 1/3.


Another one that was interesting - I got a more substantial spike from a protein smoothie, than a bowl of Greek yogurt with fruit and nuts. Despite macros being very similar.

Turns out blending the smoothie makes it digest fast, so the glucose spike is bigger. I think less glucose variance is preferable, so I rarely make the smoothie anymore.


What you eat, how it was processed, and what you do around eating, determines how the body responds. It becomes very obvious macros aren't the full story, when you watch the glucose curve change in real time.


Not that I'm militant about it. Dinner last night was half a large frozen pizza. I enjoyed it and have no regrets. I did opt against adding a beer, because I knew rebound from the resulting glucose spike was already likely to cause a night time crash. No need to disrupt my sleep further, by adding alcohol into that mix.

[Scott 2]

From a behavioral perspective - what really sucks about thinking this way, is about 90% of the grocery store looks like a glucose delivery mechanism. Of the 3 dozen fun looking breads, there's maybe two that aren't cake. I'm not totally convinced missing out is worth it.

[Lemur]

Interesting stuff Scott 2.

what really sucks about thinking this way, is about 90% of the grocery store looks like a glucose delivery mechanism.

And salt delivery. That is a feature and not a bug...ask PepsiCo about where their continued revenue growth comes from lol. I've also been reading about how food companies test with many samples and iterations to get just the right combination of salt/sugar/fat (hyper-palatability) and texture to keep the brain hooked...its so manipulative. Similar to what WRC said about chips - that one is a hard one for me to put down as well if I manage to have a bag of chips. Certainly by design as the manufacturer intended.

I concur though from a philosophical standpoint - one shall not go through life without experiencing occasional Pumpkin Pie

But the distinction between Pleasure and Happiness makes me err toward the more deliberate (and possibly neurotic depending on who you ask) side of avoiding the short-term gratification of junk foods. Key I think is to not feel guilty about it when you do give in. That leads to psychological problems. I've learned that for myself at least. So IRL when these opportunities present themselves (say Mom brings over some Cake to share or Brother buys a bag of chips to watch Netflix later with everyone), I almost deliberately allow myself to partake but I do so with portions & limits.

[Slevin]

From a behavioral perspective - what really sucks about thinking this way, is about 90% of the grocery store looks like a glucose delivery mechanism. Of the 3 dozen fun looking breads, there's maybe two that aren't cake. I'm not totally convinced missing out is worth it.

This is crazy to me. My local grocer in CA has about 3 different local bakeries (read 15-20 options) that offer bread with 1g or less added sugar per slice. Aldi, Walmart, Kroger, and Safeway (and their local variations) are a different story. May be association with non-chain "healthy" grocery stores.

[ertyu]

The occasional cake is fine. But must it contain trans fats and preservatives to make it shelf-stable? Make your own cake and pumpkin pie.

[Scott 2]

bread with 1g or less added sugar per slice

Sugar is a preservative. It keeps the bread moist and extends shelf life. In terms of affordably feeding the masses, using it makes sense.

Whenever I buy bread with the ingredients I want, it either has to be frozen or it molds in a few days. It's also a couple dollars more a loaf.

[delay]

Whenever I buy bread with the ingredients I want, it either has to be frozen or it molds in a few days. It's also a couple dollars more a loaf.

As an idea, you could try unsliced bread. That seems to last much longer.

[Western Red Cedar]

And salt delivery.

When I combine a focus on sodium and added sugars, it makes it even more challenging to to stay at or under recommended daily levels. Yet another reason to limit heavily processed foods.

I'm in the middle of a cut and have been tracking food intake pretty diligently the last couple weeks. I looked at my sodium intake yesterday and it was at 2,415 mg (sugar was 16 grams). Yesterday was about as clean as i get, and I know I undercounted my sodium intake based on what I seasoned my chicken and beef with. My meals included:

Breakfast - 3 eggs scrambled in olive oil with a bunch of mushrooms, cabbage, green onions, radish greens, spinach, fresh garlic, turmeric, pepper, and fresh parsley. I topped it with a little salsa and hot sauce. 3 cups of black coffee throughout the morning.

Lunch - Post workout vegan protein shake. (Really) Large salad with spinach and organic mixed greens, radish, green onion, tomato, baked chicken breast. Topped with Franks red hot sauce and homemade ranch (avocado mayo, white vinegar, onion powder, garlic powder, fresh dill).

Dinner - (Really) Large salad with spinach and mixed greens, radish, green onions, tomato, homemade guacamole, topped with beef birria, high-protein tofu, hot sauce, and salsa.

So....even when I'm trying really hard, I'm still taking in too much sodium. In this case, the salsa and hot sauce would be the low-hanging fruit. Fortunately I'm pretty active and a little extra sodium isn't going to do too much harm.

-----

One area I've deviated from the norms on the forum is money spent on groceries. Our household grocery expenses for two is around $400 per month, sometimes more; and I know we would be fine on half of that. But, I found when I optimized for price I was sacrificing quality - particularly for meat and vegetables. DW and I enjoy cooking and consider food as more than just a fuel, so it seemed silly to limit ourselves when we have so much excess cash.

[Dave]

My experience with oats and blood sugar spikes was using whole steel cut oats. I had a teaspoon of sugar (4g) in a half cup dry oats (300 cals).

Oats are a quick digesting starch. I think it's one of the most common surprises people find from a glucose monitor.

...

Another one that was interesting - I got a more substantial spike from a protein smoothie, than a bowl of Greek yogurt with fruit and nuts. Despite macros being very similar.

Turns out blending the smoothie makes it digest fast, so the glucose spike is bigger. I think less glucose variance is preferable, so I rarely make the smoothie anymore.

...

What you eat, how it was processed, and what you do around eating, determines how the body responds. It becomes very obvious macros aren't the full story, when you watch the glucose curve change in real time.

Very interesting, appreciate you sharing this Scott!

The occasional cake is fine. But must it contain trans fats and preservatives to make it shelf-stable? Make your own cake and pumpkin pie.

I know, frustrating right? My takeaway has basically been what you say here (make your own) or to only buy desserts from high-end bakeries that don't use such ingredients. The effort of DIYing and cost of expensive desserts keeps me from having them too often, too!

[Scott 2]

I looked at my sodium intake yesterday and it was at 2,415 mg (sugar was 16 grams). Yesterday was about as clean as i get
...
One area I've deviated from the norms on the forum is money spent on groceries.

What motivates you to monitor salt intake? I've found adding electrolytes valuable in hydrating after exercise. I haven't seen much downside to ignoring my salt intake otherwise.

Agreed on the grocery spending. We budget $350/month, per person. When you look at ways to buy time or pleasure, food offers high returns.


@delay - unsliced bread might be better. I'm mostly using bread as an example. My primary solution is dry grains. They don't spoil and can be as simple as I want. Rice, quinoa, oats, whole wheat pasta, dry cereal. That's what I can easily buy at Aldi. I used to collect my best food from various stores, but I don't like doing the shopping.

[Western Red Cedar]

@Scott 2 - I'm not actively tracking salt intake. I'm currently using My Fitness Pal to monitor calories and macros, and it happens to track other things like sugar, sodium, vitamins, etc... In the past I've had elevated blood pressure though, so I try to remain somewhat aware of my sodium intake.

I just decided to look yesterday based on this thread and the notion that added salt is the other hidden ingredient that causes a lot of long-term health problems in the US.

After geeking out on diet and exercise for a while, I just try to make an effort to move multiple times per day and eat real food. Lately I've also optimized for protein intake.