Health Matters: New evidence for deadly role of dietary sugars

Conway McLean, DPM, Journal columnist

The incidence of obesity has risen remarkably over the last century. The obesity epidemic began in the US in the mid-70’s, eventually spreading across the industrialized nations, all having adopted the Western diet of fast foods, ultra-processed foods, and sweetened foods.

In lockstep with these changes to our nutrition has been heart disease and stroke. And it has become evident that our diet is the driving force behind this trend towards excess adiposity, the incidence of diabetes and the other major chronic diseases. The data indicates our food choices are leading to this epidemic of the deadly chronic diseases of lifestyle.

No longer is there controversy over an association between the two, diet and disease, with the only question being the mechanism for this association. What is it about our diets that leads to more heart attacks and kidney disease, diabetes and artery disease? The discussion has raged on this topic, but recent evidence may put an end to the discourse.

Thousands of research studies have been carried out over the years on the causes of obesity. Also investigated is the development of more effective forms of treatment. Likely, some new drug to help us better overcome the effects of the chemicals used in the manufacture of our foodstuffs. An alternative would be the alteration of one’s dietary regimen once you have learned the truth: your diet can kill you.

There has appeared in popular media the widespread belief that diet affects the development of these diseases of lifestyle only through the effects of excess body weight and fat. But the evidence has been accumulating for some time this is not the case. The primary culprit is sugar, in all its many incarnations. From good old, granulated sugar to high fructose corn syrup, we have come to consume the substance in ridiculous quantities, with current estimates claiming the average American ingests 150 pounds of sugar per year.

All these forms of sugar are broken down in the body into their most basic form, glucose, the one used by the human body. But in nature, too much of anything is a bad thing, and this certainly holds true for sugar. It has become clear that the increase in calories is not what is leading to these deadly conditions. Neither is the abundance of fats in our foods. The most recent studies demonstrate a direct causal role for the added sugar in our diets, in all the soft drinks, the frozen foods, the fast foods.

Some of the mechanisms for such a relationship revolve around the liver and its vital role in glucose metabolism. Most of the sugar added to our diets is predominantly fructose-containing sugars, which are processed by our livers differently than table sugar. Fructose, often referred to as “fruit sugar,” was once recommended for diabetics because of this mechanism.

Some years back, fructose became the sweetening agent of choice by the food manufacturing industry, at least in part since it could be made from corn, a ubiquitous crop. But the excessive quantities consumed by many Americans leads to the accumulation of lipids in the liver, decreased sensitivity to insulin, and even increased uric acid levels in the bloodstream, leading to a chronic inflammatory state. MRI studies of the brain have demonstrated the brain responds differently to fructose-type sugars compared to glucose.

The food industry has been increasing our consumption of sugar in all its iterations, adding some type of sweetener to every food possible. Items once considered naturally savory have become sweetened due to added sugar, with numerous examples seen at the grocery store, from salad dressings to main course entrees. The food giants are well aware the presence of sweeteners increases our cravings for these foods, an approach which has generated excellent profits.

The most significant source of dietary sugar is undoubtedly our beverages. Sugar-sweetened beverages, are consumed on a daily basis by about half of adults and two thirds of children in the US on any given day. These are soft drinks, fruit drinks, sweetened with various forms of added sugars like brown sugar, corn sweetener, corn syrup, dextrose, fructose, glucose, high-fructose corn syrup, honey, lactose, malt syrup, maltose, molasses, raw sugar, and sucrose. The companies making these products have quite a list of options to choose from but HFCS, high fructose corn syrup, is currently the most popular.

Both healthcare providers and the general public need to be informed of this new information on the role of added sugar in the development of the major chronic diseases of lifestyle. Meanwhile, the sugar-related industries have been campaigning vigorously to reinforce the concept that the only dietary culprit is excess calories.

Definitive data is needed to settle this critically important question. The impact of sugar consumption on health continues to be a controversial topic. We need to conduct well-controlled clinical trials, enabling us to generate the kind of experimental data to resolve these controversies. This is a topic demanding discovery: our very lives, and those of family and friends, hang in the balance.

EDITORS NOTE: Dr. Conway McLean is a podiatric physician now practicing foot and ankle medicine in the Upper Peninsula, having assumed the practice of Dr. Ken Tabor. McLean has lectured internationally on surgery and wound care, and is board certified in both, with a sub-specialty in foot orthotic therapy. Dr. McLean welcomes questions, comments and suggestions at drcmclean@penmed.com.


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