Why I Don’t Worry About Sugar

Most of the peo­ple I talk to about nutri­tion are con­vinced that car­bo­hy­drates are their ene­my. They think that “sug­ar spikes” cause dia­betes. (They have it back­wards. Sug­ar spikes are the result, not the cause of dia­betes!) Peo­ple seem to be par­tic­u­lar­ly wor­ried about the effects of a sug­ar called fruc­tose. Per­son­al­ly, I’m not wor­ried about car­bo­hy­drates, even fruc­tose, as long as it’s found in an unre­fined plant source. I even think that adding a spoon­ful of sug­ar or per­haps some maple syrup every now and then could help a lot of peo­ple stick to a healthy low-fat, plant-based diet.

Genet­i­cal­ly, human beings are almost iden­ti­cal to chim­panzees. Our DNA is almost exact­ly the same as theirs, which means that our body chem­istry is also almost exact­ly the same as theirs. Since chim­panzees, like many oth­er apes, are main­ly fruit-eaters (fru­gi­vores), it stands to rea­son that they prob­a­bly thrive on a diet that con­tains a lot of fruc­tose, which is a sug­ar that is com­mon in fruit. How­ev­er, the fruc­tose that wild chim­panzees eat is dilut­ed with water and fiber and pack­aged along with plen­ty of oth­er nutri­ents, along with antiox­i­dants and oth­er good things.

Yes, you can make your­self sick by eat­ing too much sug­ar. How­ev­er, it would be dif­fi­cult for most peo­ple to get that much sug­ar from eat­ing fruit! One study found that eat­ing way too much added sug­ar (at least 25% of total calo­ries!) is asso­ci­at­ed with only a rel­a­tive­ly small increase in the amount of fat (triglyc­erides) in the blood and a small decrease in the lev­el of HDL (“good”) cho­les­terol. Of course, if you are hav­ing a prob­lem with triglyc­erides, you should prob­a­bly cut way back on your con­sump­tion of table sug­ar and high-fruc­tose corn syrup.

Sug­ar does rot your teeth, at least if you don’t brush care­ful­ly after meals. As a result, chim­panzees are prone to den­tal caries (cav­i­ties), just as humans are. How­ev­er, wild chim­panzees don’t seem to be fat and dia­bet­ic and they don’t get heart dis­ease. So why should I imag­ine that I would get fat and dia­bet­ic and suf­fer from heart dis­ease if I ate a lot of fruit?

Eat­ing lots of sug­ar does not cause dia­betes. Instead, cow’s milk seems to be the cul­prit in caus­ing type 1 dia­betes. A diet that is high in fats and ani­mal pro­tein seems to be the under­ly­ing cause in type 2 dia­betes.

Eat­ing too many calo­ries from any kind of diet tends to make peo­ple gain weight. How­ev­er, you gain a lot more weight from extra calo­ries from a fat­ty diet than from extra calo­ries from a high-car­bo­hy­drate, low-fat diet. Con­vert­ing sug­ar to fat wastes calo­ries. That’s why it’s hard to fat­ten on carbs but easy to fat­ten on fats.

Of course, there are a few peo­ple with genet­ic dis­or­ders that make it hard for them to tol­er­ate fruc­tose. One of them is hered­i­tary fruc­tose intol­er­ance. Anoth­er is fruc­tose mal­ab­sorp­tion.

Hered­i­tary fruc­tose intol­er­ance is a poten­tial­ly fatal genet­ic dis­or­der that occurs in about 1 out of 20,000 peo­ple in Euro­pean coun­tries. The dis­or­der results from the lack of an enzyme called aldolase B. In peo­ple with this dis­or­der, eat­ing any­thing con­tain­ing fruc­tose, includ­ing sucrose (table sug­ar), sets off a series of com­pli­cat­ed meta­bol­ic prob­lems that can ulti­mate­ly cause liv­er dam­age. The only solu­tion is for these peo­ple to avoid any foods that con­tain sucrose or fruc­tose.

Fruc­tose mal­ab­sorp­tion is an unre­lat­ed prob­lem that is far more com­mon but much less seri­ous than hered­i­tary fruc­tose intol­er­ance. Fruc­tose mal­ab­sorp­tion results from the absence of fruc­tose trans­porters in the cells that line the small intes­tine. With­out fruc­tose trans­porters, the per­son can­not absorb fruc­tose from his or her food. Even peo­ple who have some fruc­tose trans­porters might be able to absorb only a lim­it­ed amount of fruc­tose. The remain­ing fruc­tose will then remain inside the intestines, where it will be fer­ment­ed by bac­te­ria. The result is syn­drome that looks a lot like lac­tose intol­er­ance: gas and diar­rhea. Fruc­tose mal­ab­sorp­tion is a com­mon but often unde­tect­ed cause of recur­rent abdom­i­nal pain in chil­dren.

For­tu­nate­ly, I don’t have hered­i­tary fruc­tose intol­er­ance or fruc­tose mal­ab­sorp­tion. This means that I can eat as much fruit as I like!

Note: For a clear expla­na­tion of how the body han­dles sug­ar, see my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2.

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