One school-day morning, I was packing lunch for my 9-year-old daughter, Riya. I included an organic Zbar for a midday snack, a peanut butter and jelly sandwich, Greek yogurt with fruit and a carton of chocolate milk. For dessert, I gave her a cookie, which was pre-negotiated. (She gets one “unhealthy” item as long as she eats everything in her lunch bag.) But after I pulled it all together, I did a double take when I realized everything I gave her was unhealthy. I was happy that my daughter was eating organic ingredients, but I admit, I never paid close attention to sugar content. That morning, I realized each item contained more sugar than the recommended daily amount.
Several times during the day when I meet with patients, I find myself teaching them how to read labels. According to the Center for Disease Control and Prevention (CDC), Americans age 6 and older consume about 14 percent of their total daily calories from added sugars. So many packaged foods contain hidden sugars, such as energy drinks, fruit juice, sweetened coffee and teas, granola bars, salad dressing, bread and yes, even fat-free yogurt.
In 2015, the World Health Organization recommended reducing sugar intake to less than 5 percent of calories. How does that work? According to the American Heart Association, the maximum amount of added sugar a male should consume is about 150 calories per day, which is 37.5gm or 9 teaspoons. For a female, it’s 100 calories or 25 grams, which adds up to 6 teaspoons a day. If you’re a woman who enjoyed a prepackaged Greek yogurt with fruit on the bottom, along with a 6-ounce glass of orange juice for breakfast this morning, you already exceeded your daily-recommended amount of sugar. And if you were planning to have a midmorning protein bar, that contains even more added sweetener.
Natural sweeteners and sugar-free
When I talk with patients about reducing sugar in their diet, I’m usually asked about other natural sweeteners such as honey, Stevia, agave, molasses and maple syrup. While there is no concrete health benefit to consuming these types of sweeteners, the maximum daily limit of sugar should be observed. They are still considered added sugar. They are considered added sugar. Foods such has fruit and milk have naturally occurring sugar and are not considered as added sugar.
I told one of my patients, who was diagnosed as prediabetic, to reduce his sugar intake and gave him a daily limit. He returned three months later, proud that he followed my instructions, but he was surprised that he hadn’t lost weight. On closer examination, I noticed his triglycerides were higher and his sugar unchanged. As we started talking, he divulged he’d been eating prepackaged foods labeled as “sugar-free,” as well as no-added-sugar juice and other low-fat and low-cholesterol products. I had to explain that it’s better to eat an orange than drink a glass of orange juice and point out that prepackaged products are engineered foods and don’t hold nutritional value. He had to reduce the sugar content in his diet to see the results.
The dopamine connection
Why does a person look for alternatives to sugar when told to limit them? There is an increasing body of research from Australia, Europe and the U.S. about the addictive nature of sugar. Research studies with animals show that sugar is more addictive than cocaine. Sugar releases dopamine, which affects our reward center and is ultimately responsible for creating feelings of pleasure and content. Repeated behavior or consumption of sugar will repeat that feeling of pleasure, but less dopamine is released each subsequent time. As a result, those who crave sugar will consume greater amounts and in increased frequency to get the same effect, and they continue to do so, even though they’re aware it could be harmful. Sugar also stimulates the opiate receptors, which affects our reward centers and can lead to compulsive behaviors in people who are predisposed. It can cause cravings and an increase in tolerance.
When a disproportionate amount of calories come from sugar, your diet is imbalanced, leaving you in a nutrition deficient state. When you’re nutritionally deficient, you experience cravings for certain types of food, causing you to consume in excess and gain unhealthy weight. There’s even a school of thought that believes dehydration can lead to sugar cravings. An imbalanced diet lends itself to cravings that make the imbalance more severe.
A healthy diet
Over the years, I’ve come to realize that a healthy diet includes a variety and variation of foods, and that it’s best not to consume any one particular food to excess. And I advise patients to make sure at least 80 percent of the ingredients in their meals should come from foods that will spoil within a week of its purchase. Bottom line: load up your grocery carts with fresh fruits and vegetables and skip the middle aisles at the grocery store with prepackaged food items.
Rajina Ranadiva, M.D., is a board certified internal medicine physician with the St. Joseph’s Medical Group. She is also the medical director of the Petaluma Post-Acute Rehab. She can be reached at (707) 763-0802.
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