The Less-Sweet Side of Sugar

Many of us are aware that obesity has reached epidemic proportions in the U.S., which has sparked the creation of “diets” with “rules” that change faster than your clothing and hair styles. First, it was high-carb, low-fat diets to lose weight. Then it was low-carb, high-fat. Now, certain carbs are all right, but absolutely no sugar.

No sugar?

That sweet stuff we associate with the treats we had as a child (or maybe a little bit older), is not so sweet in the fight against obesity, according to many researchers. Sugar is toxic. Sugar is as addictive as heroin or cocaine (according to a lead pediatric endocrinologist specializing in childhood obesity). Even the World Health Organization (WHO) recently lowered the recommended added sugar intake to less than 5% of total calorie intake (which would be 100 calories of sugar for a person eating a 2000-calorie diet).¹ Currently, sugar makes up ~22.7% of the American diet, according to the National Health and Nutrition Examination Survey (NHANES).²

True, refined sugar is not the healthiest thing you can eat. It is calorie-dense and not satiating, which makes maintaining a calorie deficit difficult. Sugar also is present in unlikely places, including bread, yogurt, and pasta sauces, making it easy to surpass the WHO guidelines by lunchtime.

But is eliminating sugar the Holy Grail of losing weight? Probably not by itself. I recently contributed to a former colleague’s blog, which focuses on the importance of energy balance, (i.e. essentially the balance between food consumption and physical exercise), for losing weight. High-sugar foods and drinks have been around much longer than the recent rise in obesity rates. However, the portion size increase seems to parallel quite closely with the increase in portion sizes (two words: Big Gulp).³ Twenty years ago, a commercially sold blueberry muffin was 210 calories. Today, this store-bought muffin is 500 calories. Additional calories will result in weight gain if energy output (i.e. exercise) is not increased.

Overeating for a given level of activity is probably a major contributor to the obesity, and sugar is a common culprit. However, a 2012 study indicates this can happen with fruits and vegetables too. Participants who were instructed to eat the amount of fruits and vegetables recommended by the Dietary Guidelines for Americans actually gained weight, presumably because they failed to reduce calorie intake from other parts of their diet.⁴ Therefore, overeating—even if it consists of fruits and vegetables—will contribute to weight gain.

Nevertheless, sugar in the form of an Oreo cookie is much easier to overdo than an apple. A Double Stuf Oreo is 70 calories, about the same as a medium-sized apple. However, most of us probably find it much easier to eat two or three (or five or six) Oreos in one sitting, whereas we probably wouldn’t eat six apples at once.

Furthermore, eating sugar introduces a psychological element. The feel-good hormones serotonin and dopamine are released in the brain following sugar consumption, which increases the likelihood you’ll eat six cookies at once because they taste good, not because you’re hungry.⁵ You’re probably familiar with this if you can’t seem to limit yourself to just one or two cookies or cut yourself several slivers of cake until a quarter of the dessert is gone. Sugar also activates areas of the brain (including the orbitofrontal cotex, caudate nucleus, hippocampus, and insula) where drug cravings are activated, which may support the above pediatric endocrinologist’s opinion of the addictive nature of sugar.⁶

But will eliminating sugar lead to weight loss or stop the obesity epidemic? If you’re someone who cannot stop at one or two cookies and find that regularly eating sugar leads to cravings for more, cutting sugar out of your diet may make it easier to maintain a neutral or negative energy balance. However, if banning sugar makes you fall victim to sugar binges and you can moderate your portion sizes, then a small amount of sugar periodically may help you maintain a healthy diet most of the time.

References:

Draft Guideline: Sugars intake for adults and children http://www.who.int/nutrition/sugars_public_consultation/en/
Austin GL, Ogden LG, Hill JO. Trends in carbohydrate, fat, and protein intakes and association with energy intake in normal-weight, overweight, and obese individuals: 1971-2006. Am J Clin Nutr. Apr 2011;93(4):836-843.
Young LR, Nestle M. The contribution of expanding portion sizes to the US obesity epidemic. American journal of public health. Feb 2002;92(2):246-249.
Houchins JA, Burgess JR, Campbell WW, et al. Beverage vs. solid fruits and vegetables: effects on energy intake and body weight. Obesity. Sep 2012;20(9):1844-1850.
Fortuna JL. Sweet preference, sugar addiction and the familial history of alcohol dependence: shared neural pathways and genes. Journal of psychoactive drugs. Jun 2010;42(2):147-151.
Benton D. The plausibility of sugar addiction and its role in obesity and eating disorders. Clinical nutrition. Jun 2010;29(3):288-303.

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