Sweet Truth
If the national press is to be believed, sugar is the new tobacco. American lawyer Don Barrett, famed for suing the tobacco industry for more than $200bn (£1.2bn) has since turned his attentions to the food industry. His case against Big Food is that companies are misrepresenting their products, promoting them as “natural” or “healthy”, when in fact, he says, they are no such thing. Barrett points to hidden sugars in processed food as a big part of the problem. He cites examples of food labelling where sugar is disguised under other names, making the average consumer believe they are eating healthily when in fact their diet is full of sugar – sugar they are completely unaware of. In the 1980s, the developed world made a radical change to the way it ate. We stripped away fat and replaced it with sugar. For years we waged war on fat, believing that eating fat made us fat due to it’s higher calorie content per gram compared to protein or carbohydrates. Yet despite the thousands of low-fat products available to us we keep getting bigger. 63% of Britons are overweight, a third of those are clinically obese and it is widely believed that the increased amounts of sugar and refined carbohydrates in our diet is largely to blame for this. Once a rare treat, today we eat a staggering 1.25lbs of sugar on average a week, 65lbs of sugar a year. Not only is sugar making us fat, excess consumption is linked to an ever-increasing list of diseases. It also dramatically affects our skin health and the ageing process. Excess glucose intake affects how the body ages via a process called glycation (1) Sugars in the diet (or refined carbohydrates, which quickly breakdown into simple sugars) enter the blood stream and attach themselves to the amino groups of tissue proteins such as collagen, rearranging their structure into advanced glycation end products (AGEs). AGE molecules can undergo extensive cross-linking with proteins to form strong bonds, which cause healthy collagen fibres to lose their elasticity and become rigid, more brittle and prone to breakage (2). Glycation also induces fibroblast apoptosis, causing a state of cellular senescence that has been shown to switch fibroblasts from a matrix-producing to a matrix-degrading state (3). Glycation increases the release of MMP-1, which preferentially breaks down collagen (4). Today our diets are dominated by refined carbohydrates and sugar and, not surprisingly, this dietary pattern correlates with increased appearance of skin wrinkles (5). Diet fads come and go. Although not a completely sound nutritional strategy for optimal health, Dr Atkins made the world sit up and think about the effect that carbohydrates have on our health and our weight, and thus the backlash against sugar began. In recent months we have seen a rise in the popularity of the Paleo Diet and if we look at the diets of our Paleolithic ancestors, macronutrient intake differed significantly to what we eat today. Good-quality proteins and fats constituted a far greater proportion of our food intake, carbohydrates were rare and refined carbohydrates non-existent – a far cry from our modern diets. The glycemic index (GI) is a rating of how quickly blood sugar levels rise after eating a specific food. It measures how much each gram of available carbohydrates (total carbohydrate minus fibre) in a food raises the level of blood glucose following consumption, relative to consumption of pure glucose, which has a GI of 100. High glycemic foods quickly break down into simple sugars, leading to a sharp rise in blood sugar, whilst low glycemic foods break down slowly giving a sustained release. Research suggests that a high glycemic diet not only leads to accelerated ageing but may also contribute to inflammatory skin conditions such as acne, rosacea, psoriasis, and eczema (5).
COUNTERACTING GLYCATION
Maintaining a balanced blood sugar level by following a low glycemic diet reduces exposure to elevated levels of glucose and the threat of glycation. It is recommended to minimise intake of all sugars, refined carbohydrates and starchy foods. Carbohydrate intake should be moderated, the best sources being foods that provide additional nutrients including vegetables and low glycemic fruits. Consuming proteins and beneficial fats with carbohydrate food slows their release into the blood stream further minimising the increase in blood sugar level following a meal. It is all very well explaining to patients that sugar will make them gain weight and age faster, but the reality is that many individuals struggle to reduce sugar in their diet. Firstly, sugar is addictive. A 2008 study on rats found that sugar causes neural adaptions interfering with opioid and dopamine function in the brain. They concluded that “the evidence supports the hypothesis that under certain circumstances rats can become sugar dependent. This may translate to some human conditions as suggested by the literature on eating disorders and obesity.” (6) It is common for me to hear clients claiming to be “addicted to sugar” or “addicted to carbs” and managing these clients takes more than simply telling them quit sugar, just as it is not as simple as telling a smoker to give up cigarettes. It is important that a patient adapts their diet not only to include less sugar and refined carbohydrates, but also to increase good sources of proteins, essential fats and fibre, as well as specific micronutrients, in order to reduce their cravings. The second problem is that sugar is everywhere. Some clients will tell me that they don’t have much sugar in the diet, when the truth is they are consuming it via countless sources they weren’t even aware of. Breakfast cereals, cooking and table sauces, drinks – both alcoholic and non-alcoholic – high sugar fruits, not to mention the white bread, rice and pasta that quickly break down into simple sugars. The culprits are endless. As a practitioner, you may feel compelled to remind your patients how smoking is prematurely ageing their skin. Most people know this already but are they as aware of the ageing effects of sugar? Sugar is present in modern diets from countless sources and in higher quantities than ever before. It’s making us fat. It’s making us ill. And it’s dramatically speeding the rate at which we age.
REFERENCES
1. van Boekel MA (1991) The role of glycation in aging and diabetes mellitus. Molecular Biolology Reports 15(2): 57–64 2. Pageon H. M.P. Techer, and D. Asselineau (2008) reconstructed skin modified by glycation of the dermal equivalent as a model for skin aging and its potential use to evaluate anti-glycation molecules. Experimental Gerontology 43(6): 584–8 3. Alikhani M, Alikhani Z, Boyd C, Nagao K, Trackman PC, graves DT (2005) Advanced glycation end products enhance expression of pro-apoptotic genes and stimulate fibroblast apoptosis through cytoplasmic and mitochondrial pathways. J Biol Chem 280(13): 12087–95 4. Pageon H, Bakala H, Monnier VM et al (2007) Collagen glycation triggers the formation of aged skin in vitro. Eur J Dermatol 17(1): 12–20 5. Cosgrove MC, Franco OH, granger sP, Murray Pg, Mayes AE (2007) Dietry nutrient intakes and skin-aging appearance among middle-aged American women. Am J Clin Nutr 86(4): 1225–31 6. Nicole M. Avena, Pedro Rada, and Bartley G. Hoebel (2008) Evidence for sugar addiction: Behavioral and neurochemical effects of intermittent, excessive sugar intake. Neurosci Biobehav Rev 32(1): 20-39
[Author Biography]
Kim Pearson qualified as a nutritionist at London’s Institute for Optimum Nutrition in 2008 and has worked in the field of nutrition, diet and health for over eight years. Kim frequently features in the national media, writing articles and providing professional comment for a range of magazines, newspapers and medical journals and has also featured on national television and radio. She has also spoken at medical aesthetic and beauty conferences and trains healthcare professionals in nutrition and diet. She collaborates with corporate organisations on a variety of projects and has created dietary guidelines for medical research trials, developed nutrition policies and consulted on strategies for brand promotion. Kim is a full member of BANT (British Association of Applied Nutrition and Nutritional Therapy) and the Guild of Health Writers.
