In case you hadn't got it, the first part of the title of this blog should be sung. You know the lyrics:
Sugar, sugar (da da da da da) Oh, honey, honey. (da da da da da) You are my candy girl...
Apologies, I digress.
I am going to let you in on a trade secret. Doctors eat crap. Well most doctors do. Especially younger doctors. It's a multi-factorial problem that is ably aided by long work hours, lack of time to develop decent culinary skills, every ward in a hospital having treats, hospital food tasting like a foot with very little nutritional value and being really bloody tired.
I had very busy couple of days of work recently where I think I only slept single digits over the course of 48 hours. So I was shattered. And when I'm tired, I eat awfully and usually in my car. On my return home, when I had finally left the hospital, I was forced to remove the bags of empty take-away from my car.
The funny thing is that I live in the health-nut headquarters of Australia, where kale juice and superfoods reign supreme. So in front of slim, anti-oxidised passers-by, I very shamefully took the evidence of my crime to the bin. If they knew that I was a doctor, I wonder if the shame would have resulted in an emergency admission to a health food retreat for immediate reprogramming?
Anyway, as a heart surgeon, I deal with the consequences of our lifestyle choices day in and day out. I look after patients who meet the criteria for morbid obesity, who have blocked coronary arteries or who have lost limbs due to peripheral vascular disease. Not only do I indulge in foods that I shouldn't more than is recommended, my own understanding of nutrition is frankly, dodgy.
Medical school did cover some nutrition but not a lot. I get that. When you have to cover an entire human body and all of its functions, some stuff has to go. Plus, we have our extraordinarily learned colleagues, dietitians, to steer us in the right direction and give sage nutrition advice.
But what about me? What about me and my nutrition? What about the fact that I should know how to advise people when they ask what to eat after bypass surgery to make sure they don't meet me again? (Most don't by the way) What about my own health?
This week, I saw that iTunes' weekly 99c rental was That Sugar Film made by Australian actor, Damian Gameau. So I decided to watch it, with the hope that it would start 2016 out for me with a good change in my own diet and more knowledge about what we should all eat.
I accept that as a society, we eat too much. We also probably eat too much sugar. Along with saturated fats and low levels of macronutrients and micronutrients (vitamins, minerals). That aside, I find the whole no-sugar, in fact a lot of 'diet' movements to be distasteful. I find their science to be quite shaky, they often advocate removal of foods or food groups that have good nutritional and medicinal value and their claims outside of maintaining a healthy weight lack evidence. So I went hunting for more information, specifically on sugar. While this a very simplistic view point, I hope it might be a starting off point for my own sugar and diet knowledge.
What is sugar?
Sugar is not just the stuff on the table you add to your coffee. The term sugar encompasses glucose (found in carbohydrates), lactose and galactose (found in milk), fructose (found in fruits) and in combination with glucose, sucrose, a disaccharide. When sugar consumption is being regulated, we are looking at that which is added in excess of naturally occurring. There is no good evidence to support that sugars occurring in foods such as fruit in a natural unprocessed state is the devil.
Glucose is a very important substrate. It is the cells' currency for energy production. The brain in particular, is highly dependent on glucose for normal function.
What is the problem with sugar?
Energy excess, whatever the source, is not great for our health and wellbeing. However it happens, whether it be from too much fat or too much sugar (of any form), if you have too much of it, the body will store it as fat. Consuming too much sugar is being increasingly recognised as an independent risk factor for cardiovascular disease, diabetes, hypertension and liver disease.
The argument is ongoing as to what forms of sugar are truly naughty. We also have not locked down whether all calories are created equal. That it is, is sugar truly toxic or is it just an energy excess that excess sugar consumption causes that hurts?
What about fat?
Fat has generally been blamed for all of our health woes in the past. It's likely that this was an over simplistic view of things. It's generally well accepted that saturated fat is linked with increasing levels of cholesterol and tryglycerides in the blood (not good). The recommendations now support using monounsaturated fats such as olive oil, seeds, avocado, fish to make a patient's blood lipids more in line with health. Fat can also help us feel fuller for longer as fat delays gastric emptying.
So how about fructose?
Poor old fructose. Fructose is the naturally occurring form of sugar that we eat in fruits. Fructose is getting a seriously bad rap at the moment, bearing the weight of all, well, our weight issues.
The movie That Sugar Film points out that naturally occurring fructose in fruit is accompanied by fibre. Say an apple or some berries. The fibre aids in making us feel sated, and fibre is important to regulate bowel health. (Ask someone who eats loads of protein and no fibre about their poos.)
Some evidence (from rat and short term human studies) have placed the blame for "toxic" sugar effects squarely at the feet of fructose. It has been linked with diabetes and insulin resistance, gout and obesity. The science behind this is thought to be due to the liver's handling of fructose. It may more readily convert it into fat.
The fact is with regards to fructose, the studies are not based on super strong science. The levels of fructose in some studies are much higher than the 'average' person consumes for example. I also have a real problem with the promotion of quitting fruit to reduce fructose consumption as fruit had many excellent benefits to health. I'm eating a punnet of blueberries right now! Not only are they tasty, they're stopping me attacking a block of Dairy Milk. Win, win.
How much sugar should we eat?
A few months ago, the WHO published guidelines to suggest that total energy intake should not have more than 10% of free sugars - that is added sugars. Not sugars found in fruits, vegetables, carbohydrates. However, for optimal health, we should be aiming even lower to 5% which equates to 25g of sugar or 6 teaspoons of sugar per day.
That is not much (bye bye Giant Freddos)
Nope. It's pretty small really. But bear with me. Here's some sugar contents of popular foods.
Can of coke (375mL): 39g (oh my goodness)
Light strawberry yoghurt: 14g
Clif Bar: 21g - damn. I loved these for emergency breakfast.
McDonalds Cheeseburger: 7g
Tomato sauce: 4g (for a 17g/tablespoon serving - I use more than that)
Strawberries (punnet): 7g
So all in all, what's the deal?
- Obesity sucks big time in terms of getting sick
- Our understanding of nutrition is constantly evolving, so this may change again in the future
- Sugar is not the only lifestyle problem - we eat too much in general
- Smoking and inactivity also are strongly linked to cardiovascular disease
- Too much sugar is not great for you
- Fructose - the jury is still out
- Fruit is good for you so don't give it up
- Evidence for mood swings or depression and sugar is not great
- Superfoods are non-essential food items, eat them if you like
- I am going to miss Giant Freddos
I am going to be much more conscious about cutting out excess sugar in my diet. And excess take away. However, I have a major problem with the terms good and bad when referring to food. I think the psychology behind it, for me at least, is harmful. And I like food, I like sugar. I want to have an actual birthday cake, not one made of kale. Yes, I really have it in for kale, I do not like the taste one bit!
I think it's important to get our information on diet and exercise from reputable sources. I mean no malice in this statement, however, a lawyer/actor/wellness blogger may not necessarily have the tools to correctly identify the plethora of information about this kind of thing. We have seen countless examples of how these people can miss the mark a little. Or more than a little.
For me, I am going to continue my research into food and sugar. I'm interested in it for my own well being, my patients and I think I can make a good go of the literature. That Sugar Film has prompted my reading and noted that excess sugar probably has a role to play in obesity and disease. But the science is lacking. If it helps people rethink their choice, great. But this just ain't gospel I'm afraid.
For further reading:
This great blog from Scientific American: http://blogs.scientificamerican.com/brainwaves/is-sugar-really-toxic-sifting-through-the-evidence/
Wendy Zuckerman's great podcast Science Vs. did an episode on sugar: https://soundcloud.com/science-vs-season-1/sugar
Q&A on Fructose: http://bmcbiol.biomedcentral.com/articles/10.1186/1741-7007-10-42